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From YouTube: CQC Board Meeting - March 2020
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A
A
Today,
I
mean
obviously,
this
is
a
different
format
for
the
public
board
meeting,
but
I
think
it's
the
exactly
the
right
format
for
the
circumstances
and
mark
I
particularly
wanted
to
thank
you
and
your
team
for
putting
us
in
position
where
we
can
have
such
a
good
meeting
remotely
I.
Think
it's
a
it's
a
great
great
benefit
list.
A
There
are
two
really
big
topics
on
the
the
agenda
for
today.
Obviously,
Kevin
19
and
our
response
to
it
is
something
we
will
need
talk
about
at
some
length
and
then.
Secondly,
professor
Murphy's
report
will
be
very
important
as
well
and
we'll
devote
plenty
of
time
to
those
two
items.
There
is
obviously
also
some
normal
business
to
deal
with,
and
we
will
we
will
deal
with
that
as
we
go
through.
So
that's
sort
of
by
way
of
introduction.
A
The
only
apology
that
we
have
today
is
from
Paul
roux
and
we
are
joined
today
by
Holly
Sutherland
from
our
race,
equality,
Network
or
very
welcome
Holly
at
this
meeting.
Are
there
any
declarations
of
interest
that
anybody
needs
to
raise
very
good
and
then
minutes
of
our
last
meeting
26th
of
February?
Are
there
true
and
accurate
record
of
everything
we
discussed
I'll
take
that
as
agreement.
A
A
A
B
B
I'm,
a
clinical
psychologist
by
training
and
I've
worked
at
the
Institute
of
Psychiatry
and
various
universities
and
am
now
at
Design.
Center
University
of
Kent
and
all
my
working
life
has
been
spent
with
people
with
learning
disabilities.
And/Or,
autism
and
challenging
behavior
has
been
a
particular
interest
of
mine.
B
I've
worked
in
universities,
doing
research
and
teaching,
but
also
consultancy,
and
almost
all
of
my
posts
were
off
time
in
the
NHS.
I've
worked
in
a
whole
series
of
different
kinds
of
settings
both
for
children
and
adults
in
the
community
in
forensic
services
in
secure
services.
So
this
is
a
topic
very
close
to
my
heart
and
just
before
we
start
to
say
a
little
bit
about
the
terms
of
reference.
B
What
I
should
say
in
terms
of
limitations
is
that
I,
probably
haven't
read
everything
I
feel
like
I've
read
everything
but
I
probably
haven't
there
are
some
people
I
couldn't
interview?
There
was
a
police
investigation
ongoing
during
the
whole
of
the
time
of
my
report,
and
so
of
course,
I
haven't
been
able
to
interview
service
users
and
carers,
who
were
witnesses
in
that
investigation,
although
I
did
speak
briefly
to
the
police
and,
lastly,
I
wasn't
able
to
interview
people
who
worked
in
the
current
provider
Cygnet.
B
B
I
then
go
on
to
the
inspections
and
then
to
the
interviews
and
finally
to
analysis
and
recommendations
and
I
think
probably
be
most
helpful.
If
I
move
straight
to
the
analysis
and
then
the
recommendations,
the
things
that
were
striking
having
conducted
all
the
interviews
and
looked
at
the
paperwork
were
that
in
that
there
were
seven
inspections
in
all
of
Wharton
Hall,
the
last
one,
the
seventh
one
I
will
discount
because
it
happened
after
the
panorama
program
had
not
hadn't
been
aired,
but
was
CQC
was
aware
of
its
contents,
so
that
was
very
much
post
talk.
B
B
Think
one
of
the
things
that
is
is
clear
is
that
in
in
those
kinds
of
settings
it
is
possible
to
make
it
look
good,
especially
if
you
know
you're
going
to
be
inspected
and
you've
got
maybe
senior
staff
in
the
provider
who
can
come
and
help
make
sure
that
you've
got
all
your
care
plans
in
place
and
all
your
records
straight
and
so
on.
But
it's
clear
that
unannounced
visits
are
much
more
revealing.
B
Now.
Another
thing
that's
very
striking
in
the
inspection
reports
is
that
in
every
single
one,
service,
users
and
carers
are
said
to
be
happy
with
a
service,
so
service
users
say
that
staff
are
caring,
that
they're
kind
to
them,
that
they
respect
them
etc
and
from
what
we
saw
on
panorama.
Of
course,
that's
extraordinarily
surprising,
but
I
think
there
were
reasons
for
that
in
the
service
users
were
interviewed
in
the
presence
of
staff,
and
very
few
carers
were
interviewed
and
those
carers
were
selected
by
the
staff
staff
themselves.
B
The
more
junior
staff
in
Wharton
Hall
were
interviewed
by
inspectors,
but
again
not
on
their
own.
So
there's
clearly
an
issue
about
interviewing
in
private,
then.
The
third
thing
that's
striking
is
that
there
were
a
lot
of
abuse
allegations
and
they
were
escalating.
So
the
the
table
that
the
safeguarding
representative
gave
me
made
it
clear
that
there
were
a
large
number
of
escalations.
They
were
escalating
and
also
that
dental
that
provided
for
most
of
that
time
did
know
about
the
so-called
toxic
culture.
B
B
They
all
said
to
me
that
they
found
it
very
difficult
to
find
information
on
things
like
abuse
and
complaints
and
aspects
of
the
provider
before
they
went
on
inspections.
If
they're
going
on
in
a
comprehensive
inspection,
they
get
a
proper
provider
information
report
that
is
presented
to
them
by
the
analytics
department.
That's
fine,
but
the
rest
of
the
time
they
found
it
very
difficult
to
access
data.
So
I
think
there
is
a
need
for
more
accessible
data
of
the
dashboard
type
for
services,
so
that
inspectors
can
just
look.
B
Secondly,
I
think
they
need
to
be
more
unannounced
inspections,
including
evenings
and
weekends,
because
it's
clear
that
people
can
come
poor
practice
given
sufficient
notice,
I
think
the
provider
information
requests
need
to
be
six
monthly
and
I
also
think
that
borer
inspection
should
provide
ratings.
There
were
some
inspections,
they
were
focused
inspections,
but
they
provided
no
ratings
at
all,
like
inspection,
six
and
I
think
that's
just
not
helpful
and,
of
course
there
there
is
an
issue
about
the
speed
of
providing
reports
which
I
know
CQC
is
already
aware
of.
B
My
third
recommendation
is
about
abuse,
allegations,
safeguarding
whistleblowing
and
retracted
allegations.
I
think
they
need
to
be
seen
as
a
whole
for
the
service.
What
tends
to
happen,
especially
in
Durham,
safeguarding
and
in
other
safeguarding
bodies.
They
tend
to
be
seen
as
individual
issues
to
be
sorted
out
and
actually
people
hadn't
realized
how
they
were
escalating
for
that
service
as
a
whole.
Now,
obviously,
recommendation
one
in
relation
to
the
data
will
help
people
do
that,
but
I
think
it
needs
to
be
very
certainly
a
focus
for
services,
especially
high
risk
services
like
these.
B
B
Often
I
think
they're,
the
specialist
advisors
are
asked
to
cover
those
and
I
suspect
they're,
not
given
very
much
priority,
so
I
think
they
need
to
be
much
more
highly
prioritized
and
I.
Think
inspectors
need
some
extra
communication
skills
to
do
this
kind
of
work
with
people
with
learning
disabilities
and
autism
and,
of
course,
those
kinds
of
interviews
need
to
be
done
in
Pratt,
in
private,
without
being
overseen
by
the
services
staff.
B
My
fifth
recommendation
is
about
what
I've
called
level
2
inspections,
because
I
think
there
needs
to
be
a
way
of
engaging
in
much
more
in-depth
inspection.
If
there
are
whole
series
of
red
flags
about
a
service
which
they
certainly
were
with
Walton
Hall
at
various
times,
they
had
very
high
levels
of
restraint.
They
had
very
high
levels
of
staff,
turnover
of
use
of
agency
staff.
B
They
had
very
untrained
frontline
staff,
all
of
those
things
are
absolutely
red
flags
and-
and
there
needs
to
be
a
way
of
going
in
and
doing
a
more
in-depth
inspection
in
those
circumstances,
I
think
to
include
more
time
observing
like
a
fly
on
the
wall,
to
include
more
time,
more
in-depth
service
user
interviews,
ratings
of
culture
and
if
it's
possible,
to
interview
next
staff.
What
obviously
happens
in
Walton
Hall
is
staff
often
left
very
quickly
and
I
suspect?
B
That's
because
they
realized
it
was
an
abusive
culture
and
they
didn't
want
to
stay,
but
they
are
the
people
who
hold
very
valuable
information
about
a
service
and
I
think
that
CQC
should
consider
covert
surveillance
when
these
red
flags
are
showing
that
a
service
is
failing,
then
my
final
recommendation
is
about
registration,
because
clearly,
Walton
Hall
was
a
very
unsuitable
building.
That's
what
everybody
said.
It
was
operating
an
outdated
model
of
service
with
very
untrained
staff
and
really
the
wrong
model
of
care,
as
CQC
I'm
sure
is
aware.
A
Professor
Murphy,
thank
you
very
much.
I
mean
it's
it's
interesting.
There
are
amongst
your
recommendations,
some
things
which
we
have
been
working
on
anyway
for
some
time,
but
you
you've,
really
sort
of
highlighted
and
emphasized
them.
I
think
there's
some
other
things
there,
which,
whilst
we've
discussed
in
the
past
merits,
for
example,
of
announced
or
unannounced
inspections,
I
think
you've,
given
us
a
real
focus
for
a
lot
of
further
consideration
and
then
there's
some
other
things
in
there,
which
I
don't
think
we
probably
have
given
sufficient
thought
to
at
all.
A
So
I
are
just
really
good
Kate
before
we
open
it
up.
Is
this
the
moment
where
it
would
be
worth
just
you
saying
what
we
have
been
doing
since
Wharton
Hall
and
since
the
the
other
report
that
we
had
and
then
people
have
got
a
sort
of
complete
picture,
and
then
we
open
it
up
for
comments
and
questions
to
Professor,
Murphy
sure.
C
A
Sorry
I
should
have
introduced,
and
you
mentioned
earlier,
I
should
have
said
that
we've
been
joined
by
Ursula
Gallaher,
who
has
been
doing
a
lot
of
the
work
that
we've
been
doing
in
in
response
to
that
yeah
I
was
just
gonna,
say
and
I
see
that
dr.
Kevin
Cleary,
our
Deputy
Chief
Inspector
and
our
mental
health
lead
is
also
here
so
I
think
that
is
a
complete
list
of
the
people
that
are
with
the
staff.
Sorry
Kate
back
to
you
and.
C
Just
explain
why
I'm
kicking
off
our
response,
so
I
currently
chair
a
program
board
called
improving
regulation.
Today
that
looks
at
changes.
We
need
to
make
right
here
right
now
to
how
we
regulate
to
ensure
that
people
remain
safe,
so
we
originally
had
a
work
stream
within
improving
regulation.
Today
that
was
looking
at
response
to
the
David
Noble
recommendations,
and
actually
we
made
a
decision
that
we
wanted
to
bring
together
all
the
activity.
C
That's
going
on
around
closed
environments
with
David
nobles
recommendations,
and
we
will
also
fold
in
the
lessons
coming
out
of
Professor
Murphy's
report
as
well.
So
we
have
a
single
place,
providing
governance
and
assurance
that
we
are
making
the
changes
and
implementing
the
changes
that
we
are
and
will
commit
to,
and
so
that
explain
what
my
role
is
and
I'm
the
senior
responsible
officer
on
that
and
obviously
working
very
closely
with
Ted
and
other
colleagues
to
do
that,
and
so
I
think
for
me,
they're
kind
of
strategically.
C
C
So
we
developed
that
guidance
that
includes
things
such
as
an
increased
focus
and
emphasis
on
hearing
the
voice
of
people
with
lived
experience
and
their
families,
including
things
such
as
local
advocacy
organizations
when
we
are
trying
to
really
understand
what
that
quality
of
care
looks
like,
so
that
supporting
guidance
was
produced.
We
always
intended
to
take
the
learning
from
professor
Murphy's
feedback
to
refresh
that
guidance,
so
that
will
happen
now
and
that
guidance
wasn't
just
for
our
staff.
We
predominately
and
developed
it
for
our
inspectors,
but
we
also
shared
it
with
our
colleagues
in
HealthWatch.
C
You
do
enter
in
views
into
such
environments,
but
we
also
shared
it
with
organizations
such
as
the
association
of
directors
of
adult
services,
so
your
directors
of
Social
Care,
who
have
our
commissioners
and
social
workers
going
into
these
type
of
environments
as
well.
So
that's
a
little
bit
about
our
closed
environments
and
the
thinking
about
how
we
should
how
we
should
be
regulating
these
types
of
services.
C
How
we
have
an
easily
accessible,
much
more
dynamic
view
of
quality
is,
is
something
that
was
always
going
to
be
picked
up
in
our
longer-term
strategy,
but
actually
the
work
that
we'll
talk
about
a
bit
more
later
in
this
board
about
how
we
are
right
here
right
now.
Responding
to
the
challenge
that
kovat
19
is
presenting
to
us
will
also
help
accelerate
our
learning
about
having
that
view
of
quality
and
in
a
much
more
kind
of
dynamic,
dynamic
ways
and
then
the
way
we
kind
of
we
currently
do
that.
C
The
two
of
the
big
strategic
pieces
is
obviously
the
piece
of
work
we've
done
around
restraints,
seclusion
and
segregation.
So
this
piece
of
work
started
six
months
ahead
of
the
water
haul
panorama
program
and
initially
looked
at
how
restraints
seclusion
and
segregation
was
experienced
by
people
in
mental
health
services
and
then
in
Phase
two.
It
is
also
looked
at
what
that
means
for
people
in
adult
social
care
settings
in
the
community,
for
children
is
secured
units,
etc.
C
So
that
piece
of
work
is
reaching
its
conclusion
and
we
have
worked
absolutely
extensively
with
families
and
people
who
have
experienced
seclusion
to
really
hone
down
what
the
key
recommendations
are
in
this
report
that
are
actually
going
to
make
the
difference.
So
many
people
who
have
been
in
the
kind
of
learning,
disability,
autism
sector
for
a
long
time
will
know
that
there
have
been
numerous
reports
in
this
area.
Talking
about
what
change
needs
to
happen
and
I
think
there
is
a
feeling
that
none
of
this
has
made
the
progress
that
people
would
have
wanted
to.
C
So
it's
critical
when
our
restraints
seclusion
segregation
report
lands,
it
lands
with
a
hole
with
with
a
set
of
actions
that
we
across
the
whole
multitude
of
organizations,
are
ready
to
deliver
and
implement
and
really
make
make
the
difference
and
then
the
final
kind
of
strategic
piece.
So
professor
Murphy
talked
about
our
role
in
terms
of
regulating
the
regulating
models
of
care.
C
So,
as
you
all
know
about
four
years
ago,
we
implemented
some
guidance
called
registering
the
right
support,
which
looked
at
our
approach,
based
on
best
practice,
nice
guidance
and
best
practice
about
what
the
model
of
care
should
adults
with
learning
disabilities
and
autism,
and
it
talked
about
services
predominately
being
small,
being
community-based,
supporting
people
to
have
an
ordinary
life.
So
for
about
four
years,
we
have
been
registering
services
under
that
remit,
and
we,
we
started
thinking,
maybe
about
six
months
ago
about
whether
that
guidance
has
sufficient
attention
paid
to
how
on
an
ongoing
basis.
C
We
also
regulate
to
make
sure
that
the
right
model
of
care
is
being
delivered
for
this
group
of
people.
So
we
are
in
the
process
of
refreshing
that
guidance.
It's
going
to
be
called
right
care
right,
support,
right,
culture
and
throughout
it
we
give
examples
of
what
best
practice
looks
like
when
it
comes
to
and
this
type
of
care,
but
also
we
talk
about
how
we,
on
an
ongoing
basis,
need
to
be
regulating
these
types
of
services
through
the
lens
of
what
is
the
best
practice.
C
C
D
So
so,
first
of
all
kind
welcome
this
report.
Professor
Murphy,
has
done
a
very
careful
study
here
and
I
think
it
is
really
important
that
we
take
away
the
learning
from
it
to
improve
our
spectrum
of
regulation
of
these
closed
environments,
but
also
I
think
there
are
lessons
about
the
wider
pattern
of
our
regulation,
because
one
of
the
key
messages
for
me
from
this
report
is
that
we
have
to
target
our
inspection
methodology
in
a
way
that
takes
into
account
of
the
risks
of
different
service
sectors
and
I.
D
Don't
think
our
spectrum
methodology
was
really
focused
around
the
the
risks
in
closed
environments
and
that's
an
important
lesson
for
us.
We've
moved
forward.
We've
made
a
lot
of
progress
since
then.
The
press
of
Murphy's
report
I
really
come
out.
Some
really
important
areas
where
we
need
to
go
further
and
I.
Think,
as
Kage's
explained,
we
need
to
build
on
the
work
we've
done
so
far
to
make
sure
that
we
do
have
a
regulation
approach
and
inspection
methodology
that
really
identifies
risk
and
abuse
going
on.
In
these
closed
environments,
I
think
is
really
important.
D
Learning
for
there
and
pres
Murphy
has
identified
some
different
approaches
that
we
haven't
tried
yet
such
as
the
level
2
inspection,
such
as
the
covert
surveillance
and
such
as
the
the
better
way
of
interviewing
and
understanding
the
experience
of
service
users
themselves,
which
I
record
reading.
The
report
was
clear,
something
we
had
not
got
right
as
yet
so
I
think
there's
really
important
learning.
So
thank
you
very
much
present
for
the
report.
We
must
build
on
this.
Going
forward.
Can
I
can
I
hand
over
to
Kevin
at
this
stage.
Peter
just
say
he
can.
E
E
You
have
to
be
able
to
get
a
full
picture
of
what's
happening
in
the
service
at
any
one
particular
time
you
have
to
understand
the
flow
of
information
around
whistleblowing
abuse,
allegations,
restraint,
etc
and
be
able
to
easily
get
that
I
think
you
have
to
have
an
approach
to
whistleblowing
and
abuse
allegations
in
which
it's
sort
of
seen
at
a
senior
level.
You
know
to
make
sure
that
everyone
is
actually
looking
at
this
in
the
same
way
and
is
understanding
what's
happening.
I
think
there
is
a
real
one
of
the
message
come
through
too
quickly.
E
Is
you
cannot
do
this
remotely?
You
have
to
be
going
into
the
service,
unannounced
I,
agree
and
seeing
what
is
happening,
but
we
do
realize
and
talking
to
patients
talking
to
service
users
in
a
way
which
makes
sure
that
you're
likely
to
capture
the
most
important
information
and
also
that
you're
talking
to
staff
in
a
way
in
which
you're
sort
of
like
the
again
to
be
able
to
access
their
true
opinion
about
what's
happening
and
I.
Think
the
final.
My
final
comment
is
around
culture,
culture,
trumps,
everything
and
I
would
II
think
there's
a
lot.
E
We
could
to
probably
do
around
how
we
assess
the
culture.
There
are
cultural
assessment
tools,
I've
seen
them
used
effectively.
It's
not
just
some
abstract
concept.
It
is
that
what
shapes
the
whole
nature
of
the
care?
That's
being
provided,
and
so
I
really
think.
That's
something
that
we
would
like
to
take
forward.
But
you
know,
on
behalf
of
all
the
staff
and
my
director
I'd
like
to
thank
the
Murphy
done.
F
Is
he
a
pizza?
Could
I
come
in
yes,
business?
Yes,
so,
first
of
all,
I
thought
this
was
a
really
clearly
analyzed
report
and
I
particularly
welcome
the
focus
both
on
what
data
can
tell
us.
So
you
know
the
I
the
the
recommendation
for
simple
graphical
information
that
shows
you
trends
and
things
like
the
use
of
restraint
or
the
number
of
complaints
coupled
with
as
Kevin
was
just
saying.
You
know
you.
F
You
have
to
actually
hear
from
people
with
lived
experience
and
from
advocates
and
from
family
members
and
from
members
of
staff
and
former
members
of
staff.
It's
that
real
interaction
and
observation.
So
it's
both
it's
both
the
data
and
the
direct
interaction
and
and
I
think
there's
lots
of
sort
of
specifics
in
this
report.
F
F
That
goes,
you
know
not
just
registering
the
right
support,
but
actually
regulating
the
support
right
through
the
regulatory
process
to
ensure
that
we
are,
if
you
like,
incentivizing,
encouraging
the
types
of
models
of
supports
that
actually
support
people's
human
rights
and
people's
ability
to
live
a
decent
life
free
of
the
kind
of
abuse
that
we
unfortunately
saw.
It
welcome
home.
G
I
particularly
appreciated
the
way
in
which
you've
set
out,
in
effect,
all
the
information
that
each
of
these
inspections,
each
of
the
interactions
are
produced
and
how
that
looks
cumulatively-
and
it
of
course
has
huge
echoes
in
relation
to
other
other
previous
scandals,
winter
ball
view
and
even
mid
steps
and
a
common
feature
there,
it
seems
to
me,
is
that,
in
effect,
the
poor
standards
and
so
on
were
actually
hiding
in
plain
sight,
but
no
one
seemed
to
put
it
together
and
I.
Think
that's
a
huge
lesson
to
learn.
G
But
I
do
wonder
whether
there
is
in
effect
too
much
of
a
focus
on
whether
there
is
evidence
to
support
the
complaint
that
is
made,
which
inevitably
there
will
not
be
in
a
closed
community
where
things
such
as
the
shocking
scenes.
We
saw
a
panorama
developed
and
I
need
to
say
well
when
someone
makes
that
complaint.
What
does
the
fact
that
that
complaint
is
being
made?
Tell
us
about
the
in
station,
for
which
it's
coming,
and
particularly
when
there's
a
certain
level
of
these
things?
G
If
the
there
was
no
evidence,
for
instance,
which
positively
says
there
wasn't
a
Beauty's,
then
itself
may
be
evidence
that
the
risk
is
is
there.
I
may
not
have
put
that
wholly
clearly
but
I.
Just
wonder
what
your
comments
are.
Professor,
on
how
an
attitude
change
could
help
to
make
sure
these
things
don't
happen
again.
B
Well,
I
agree
with
you.
The
the
the
evidence
I
read
in
the
various
allegations
of
abuse
made
me
feel
that
they
weren't
being
taken
as
seriously
as
they
should
have
been
and
I.
Think
one
of
the
very
big
problems
was
that
many
of
them,
many
of
the
allegations
that
service
users
made
were
retracted,
and
you
can
see
that
in
the
big
table
of
allegations
that
came
from
the
durham
safeguarding
and
I
think
it's
very
easy
to
brush
those
off,
especially
for
people
with
learning
disabilities
as
false
allegations.
B
And
you
know
they
probably
weren't,
and
it's
quite
likely
that
having
made
an
allegation
and
maybe
an
excellent
staff
man.
But
because
there
were
some
good
staff
members,
I'm
pretty
certain
would
have
reported
it.
But
then
an
unscrupulous
star
then
becomes
and
leans
on
the
person
to
retract
it
and
I
I.
G
B
G
Now
it's
now,
of
course
the
provider
will
always
say
well,
you
can't
show
that
any
of
this
is
happening
to
which
I
would
suggest
that
the
response
might
be
well.
You
can't
show
it's
not,
and
we
have
people
in
your
care
who
are
therefore
at
risk.
One
needs
to
develop
that
sort
of
attitude,
rather
than
with
an
attitude
which
is.
Could
we
prove
this
at
a
criminal
court?
Absolutely.
B
Think
going
back
to
your
original
point
about
whether
this
is
a
population
where
those
kinds
of
things
can
be
dismissed,
I
think
it
does
often
get
dismissed
for
people
with
learning
disabilities
and
autism
on
the
grounds
that
well,
these
are
very
challenging
clients
and
that's
why
they're
here
and
that's
why
we
have
to
restrain
them,
but
all
of
those
things
seem
to
me
to
be
going
together
and
I
absolutely
agree.
Of
course,
abuse
allegations
should
be
part
of
the
red
flags
and
the
work
that's
being
done
by
your
analytics
Department
developing
the
insight
tool.
F
F
You
know.
Oh
these.
These
allegations
were
retracted
or
whatever,
because
I
think
you
know.
We
know
that
in
relation
to
people
with
learning
disabilities,
people
with
mental
health
conditions,
there
is
unfortunately,
a
tendency
for
all
sorts
of
people
to
keep
their
used
and
stated
experience
less
weight
than
the
weight
of
professional
and
our
job
is
to
give
those
views
real
weight
and
not
be
not
be
sort
of,
inappropriately
assured
and
I.
Suppose
I
just
like
to
know
that
our
staff
really
have
that
knowledge
base
to
think
in
those
sort
of
human
rights
terms.
A
Kate,
do
you
want
to
respond
on
that
and,
while
you're
after
that,
I'd
like
to
go
back
so
I
think
it's
linked
to
I?
Think
it
was
you
robbers.
But
somebody
said
earlier
what
what
I
found?
Professor
Murphy
really
compelling
in
your
report,
was
when
you
laid
out
a
narrative
of
everything
that
was
known
over
a
period
of
time.
A
It
gave
such
sort
of
a
clarity
of
what
was
probably
going
on
that
was
missed
when
you
looked
at
each
individual
inspection
and
then
aligned
with
that
the
comment
that
inspector
sounded
difficult
to
access
the
data
and
not
for
where
it's
Marco
or
Ian,
who
would
want
to
respond.
But
we
we
have
been
doing
quite
a
lot
of
thinking
about
about
that,
some
of
which
we'll
cover
later
in
the
the
agenda
but
I
but
I.
Think
to
your
point.
Liz.
A
C
So
I'm
again
happy
to
kick
off
Peter
and
then
whether
I'm,
Ted
or
Kevin
want
to
talk
a
bit
more
specifically
about
this,
this
type
of
environment.
So
so
in
our
supporting
guidance
about
how
we
should
be
regulating
and
closed
environment
environment
Sui
been
absolutely
explicit
that
they
should
involve
experts
by
experience
so
that
that
is
out
there,
and
that
is
happening.
C
What
was
interesting
about
professor
Murphy's
reflections
was
this
kind
of
challenge
or
this
opportunity
for
us
to
reflect
on
how
much
of
that
gathering
and
hearing
the
voice
of
people
with
lived
experience
is
left
to
our
experts
by
experience
and
actually
should
that
be
a
supplement
and
an
enhancement
of
those
direct
conversations.
Inspectors
are
having
privately
with
people
who
have
care
and
support
needs,
and
a
follow-up
question
is
also
about
us
being
assured
that
our
inspect
have
the
confidence
and
the
skills
about
managing
communication.
C
So,
for
example,
interacting
with
someone,
maybe
who
doesn't
have
verbal
communication?
How
how
do
you
take
the
time?
How
might
you
use
an
advocate
to
be
really
confident
that
you're
you're
finding
out
what
what
their
experiences
is?
So
we
captured
the
expert
by
experience
requirement
within
our
supporting
guidance
on
a
kind
of
a
kind
of
separate
issue.
We
re
looking
at
how
we
as
an
organization,
use
experts
by
experience
and
what
their
contributions
should
be
to
an
inspection,
which
is
the
point
I
just
made.
C
D
Which,
I
think
is
really
very
important
and
that
is
that
I
think
leading
the
whole
world.
We
were
too
focused
on
identifying
where
the
abuse
was
occurring
rather
than
identifying
whether
this
was
a
high-risk
environment
for
abuse
and
I.
Think
we
did
the
guidance
we've
developed
since
then
has
very
much
talked
about
the
environments
and
the
risk
and
and
us
taking
action
on
on
the
risk,
rather
than
focusing
on
whether
abuse
was
proven
or
not
and
I.
D
Think
reading
president
Murphy's
report,
it
was
very
clear
of
the
risks
that
they
were
warned
halt,
but
because
we
didn't
get
to
the
point
of
proving
abuse
was
taking
place
to
some
extent
we
stood
back
and
I
think
think
that
was
the
challenge
to
us.
We
need
to
be
more
proactive
in
identifying
and
acting
on
risk,
rather
than
waiting
for
things
to
be
proven.
So
I
think
that's
that's
an
important
learning
for
us.
If,
for
these
kind
of
environments
Kevin,
do
you
want
to
have
anything.
E
I
think
that
the
way
that
you
look
at
whistleblowing
and
staff
allegations
has
to
be
sort
of
with
the
aim
of
getting
a
whole
picture,
we're
not
there
to
make
sure
that
the
allegations
are
proved.
That's
not
our
role,
which
you
have
to
be
listening
to
that
information
and
acting
on
it
actually
on
the
quickly
and
I
think.
E
Actually,
in
the
last
since
I've
been
here,
we
we
have
been
acting
on
that
we
have
closed
a
number
of
hospitals
of
this
type
or
we
have
put
them
in
special
majors
and
have
undertaken
series
of
unannounced
inspections.
So
I
think
it
probably
has
shifted
I'm
already
the
thinking
of
the
teams
in
relation
to
how
we
respond
to
these
allegations,
but
I
do
think
this
further
work
to
be
done
and
it's
the
importance
of
it
beans
or
listen
to
at
a
senior
level
I'm.
Having
a
senior
review
of
this.
H
You
I
mean
first
mafia
again,
I
just
want
to
reiterate
the
thanks
of
other
people.
I
think
this
is
a.
This
has
been
a
really
important
police
work.
I
think
there's
a
number
of
things
that
that
you
pulled
out
here.
I
think
one
is
you've
taken
a
very
broad
view
of
what's
happened
and
I
I
was
particularly
struck
by
this
interplay
of
regulators
providers
CCGs
on
the
police
and
the
fact
that,
in
order
to
to
regulate
a
high-risk
environment
effectively,
it
needs
more
than
just
the
conventional
regulate
or
it
needs
a
group
of
people.
H
So
I
think
there's
important
lesson
for
us.
There's
also
important
lessons
I
think
for
other
agencies
that
were
involved
in
Walter
Hall
and
are
currently
involved
in
regulating
other
similar
high-risk
environments.
I
do
also
appreciate
your
recognizing
the
commitment
of
our
teams.
I
know
we
all
felt
absolutely
devastated
by
by
what
had
gone
on
at
Walton,
Hall
and
I.
Think
I
think,
as
our
teams
have
have
have
looked
at
this
again
and
again,
I
think
I
think
that
that
has
not
improved.
We
still
feel
that
that
we
could.
H
We
could
have
done
better
as
a
collective,
but
I
think
the
fact
that
you've
recognised
the
personal
commitment
of
individuals
and
those
teams
I
think
it's
been-
is
really
appreciated.
I
I
think
the
other
thing
that
has
struck
me
about
about
this
is
the
low.
The
report
is
focused
on
learning,
disability
and
autism
services,
in
particular,
I
think.
Actually
it
has
an
applicability
across
pretty
much
everything
we
do
that
there
are.
There
are
versions
of
closed
environment
in
most
of
the
services
that
we
regulate
and
I
think
there
are
some
lessons
for
us.
H
A
B
I've
been
impressed
by
how
open
CQC
has
been
to
considering
its
processes
and
its
ways
of
working,
because
I
think
you're
all
very
keen
to
try
to
avoid
this
happening
again.
I
have
to
say
that
I
think
it
will
be
very
difficult,
because
even
if
we
glue
all
the
things
in
my
recommendations,
it
may
be
very
difficult
to
detect
abuse
where
there
is
a
group
of
people
who
are
very,
very
clever
at
disguising
it
but
I.
You
know,
I
do
think
we
have
to
try
to
make
things
as
good
as
we
possibly
can.
B
A
Agree,
thank
you
and
and
Ian
just
mentioned
a
minute
ago,
that
there
is
a
second
part
to
your
work,
which
very
grateful
for
and
I
think
in
that
second
part
I,
think
you're
hoping
to
be
able
to
engage
with
service
users
and
their
and
their
families.
More
than
you
were
able
to
in
the
first
body.
Is
that
right?
Yes,.
B
That's
right,
and
what
we
also
hope
to
do
is
to
look
at
international
experts
who
have
examined
ways
of
rating
environments,
cultures,
as
well
as
maybe
developing
performance
indicators
that
relate
to
outcome,
so
that
that's
also
part
of
what
we
plan
to
do.
We
may
have
to
do
it
slightly
differently
than
we
did
intended,
given
the
kovat
19
crisis,
but
yeah.
That's
part
of
what
we're
doing
great.
A
So,
thank
you
again.
You
obviously
will
be
back
with
us
in
due
course.
If
we're
still
having
to
have
our
board
meetings
virtually
we
might
even
manage
to
get
you
a
camera
by
next
time.
You
come
so
he
could
see
you
as
well
as
as
here
you,
although
we
could
hear
you
very
clearly,
which
was
which
was
great
and
when
you
do
come
back
again.
Hopefully
you
will
see
that
we've
made
a
lot
more
progress
than
we've
already
made
in
implementing
the
changes
that
you
and
indeed
David
Noble
previously
have
recommended
so
can
I.
A
Thank
you
and
also
Kevin.
Thank
you
for
joining
us
and
and
Sylla
as
well,
and
let's,
let's
just
hope
that
the
the
attention
that
Wharton
Hall
has
brought
to
everybody
does
significantly
reduce
the
chances
of
another
situation
arising,
although,
as
you
rightly
say,
if
people
are
determined
enough
and
dishonest
enough,
it
can't
be
guaranteed.
It
doesn't
happen.
Thank
you
very
much,
professor
Murphy.
Thank.
A
You
right
so
lots
of
work
that
we
need
to
do
before.
Professor
Murphy
comes
back
to
us
Ian.
Can
we
move
on
to
the
the
executive
teams
report
and
I
think
the
that
the
main
item
that
we
want
to
talk
about
is
the
response
to
Kay
mid-nineteen,
but,
as
I
said
earlier,
there
are
other
things
going
on
that
we
need
to
bring
to
the
board
as
well.
So
do
you
want
to
kick
off
thanks.
H
The
three
chief
inspectors
around
our
regulatory
response
Chris
day
around
our
external
response
and
then
Kirsty
around
how
we
as
a
organization,
are
preparing
and
then
and
then
finish
up
with
mark
around
some
of
the
technology,
things
that
we're
doing
and
the
particular
piece
of
work
we're
doing
to
try
and
make
sure
that
we
can
operate
completely
remotely,
but
I
think
I
still
have
set
the
scene
a
little
bit
for
board
members.
Although
there
is
a
there
is
a
paper
in
the
in
the
board
papers,
which
sort
of
summarizes
a
lot
of
things
were
doing.
H
H
It
see
the
fact
that
we
will
change
very
significantly.
The
manner
in
which
we
we
do
our
job,
but
over
an
extended
period
of
time.
I
think
we
need
to
see
that
we
need
to
recognize
that
that
whilst
people
are
rightly
talking
about
preparing
for
the
next
week,
the
next
month
realistically
I
think
we
have
to
prepare
for
the
next
year.
That
will
be
disruption
to
what
we
do
over
the
next
year
and
we
certainly
still
be
talking
about
this
actively
during
during
the
rest
of
2020.
H
So-
and
we
know
that,
as
we
come
out
at
the
other
side,
we'll
have
to
be
very
flexible
about
our
thinking
and
unarguably
the
way
we
do.
Our
job
may
never
be
the
same
again
because
of
the
lessons
that
we
learned
during
Kovach
19
so
but
I
think
that
sense
of
of
profound
change.
It
is
an
important
one
for
us
to
ask
us
to
realize
and
understand
I
think
in
terms
of
some
very
practical
things
that
we've
done
in
the
short
term.
H
We
will
be
changing
that
registration
very,
very
quickly
and
a
matter
of,
in
some
cases,
a
matter
of
hours
and
we
we
don't
want
to
be
in
the
way
of
a
service
getting
on
and
doing
the
things
that
they
will
need
to
do.
We
on
Monday,
we
suspended
all
routine
inspections,
which
means
that
that
we
won't
be
doing
any
more
routine
inspections,
but
what
we
will
be
doing
is
responding
to
specific
risks.
So,
for
example,
we've
just
been
talking
to
professor
Murphy
around
around
the
allegations
of
abuse
that
were
found
at
Walton
Hall.
H
In
that
example,
I
think
the
public
would
rightly
expect
us
to
use
our
existing
powers
to
to
take
action
to
protect
people.
Yeah
I
would
expect
these
things
will
continue
to
happen.
They
will
tap
and
I
hope
in
incredibly
rare
circumstances,
but
but
we,
it
is
important
that
we
retain
that
right
to
act
in
the
event
that
it's
needed
in
those
extreme
circumstances.
If
we're
not
doing
inspections,
we're
also
not
not
rating
either
so
I,
don't
expect
us
to
be
to
be
rating
services,
and
the
same
applies
for
enforcement.
H
We'll
take
enforcement
action
when
there's
there's
extreme
risk
and
those
it's
extreme
extreme
extreme
danger
to
to
people,
but
I,
don't
see
us
taking
enforcement
action
or
if
you
like,
a
more
ordinary
sort,
because
we
simply
won't
be
gathering
the
evidence
to
do
that.
I
think
we
have
to
have
to
remember,
though,
that
that
we
have
a
duty
both
to
providers
but
also
to
kovat
19
patients
themselves
and
also
those
who
use
health
and
social
care.
Normally,
women
will
still
be
having
babies.
During
this
period.
H
People
will
still
need
surgery,
people
will
be
detained
in
mental
health
wards
and
people
will
still
need
social
in
all
its
forms,
and
we
need
to
be
make
sure
that
we
are
protecting
the
interest
of
all
of
those
people,
alongside
the
the
obvious
focus
on
ANCOVA,
19
and
I.
Think
that
independent
voice
that
we
offer
across
the
whole
of
our
health
and
social
care
system
is
really
important
and
a
voice
also
that
can
convene
social
care
providers
to
pass
messages
to
and
from
government
becomes
really
really
important
at
this
time
as
well.
H
So
I
think
my
my
final
message
to
providers
really
is
that
is
that
we're
going
to
do
everything
in
our
power
to
ensure
that
providers
can
act
to
deliver
the
best
possible
care
for
for
patients.
Given
the
circumstances-
and
we
recognize
it-
we
recognize
that
we
we
are
in
extraordinary
times
and
so
delivering
even
the
basics
of
care
are
going
to
be
really
difficult,
and
we
absolutely
understand
that,
but
nothing
the
CQC
is
aiming
to
do
should
should
stop
providers
from
from
delivering
the
sort
of
care
that
we
all
frankly
want
to
be
delivered.
D
Okay,
thank
you
in
I've,
worked
in
the
area
so
many
years
and
have
worked
in
it's
been
under
intense
pressure
before
and
I
have
every
confidence
that
the
staff
and
the
NHS
will
rise
to
the
challenges
being
given
to
them
in
this
in
this
situation.
But
this
is
this
summer,
centers
exceptional.
It's
probably
the
biggest
challenge.
D
Nhs
has
faced
for
many
years,
if
at
all
in
that,
not
only
is
this
a
severe
challenge,
but
it
is
like
to
last
for
quite
a
while,
and
even
the
most
benign
scenario
about
the
cobia
19
epidemic
is
going
to
severely
test
acute
hospital
services
and
the
rest
of
the
health
and
social
care
system.
So
it's
very
important
that
we
find
new
ways
of
of
supporting
and
regulating
the
system.
Under
these
circumstances
and
I'm
pleased,
we've
stopped
the
routine
inspections
and
the
routine
information
collection
from
the
Manchester
providers.
I
think
it's
important.
D
We
give
them
the
space
and
help
them
free
up
capacity
to
focus
on
the
care
of
people
who
need
their
care
and
that
really
tests
us
as
EMR,
saying
to
move
to
a
different
approach
using
data
in
a
much
more
effective
way
to
monitor.
What's
going
on
and
also
things
like,
staff
raising
concerns
with
us,
I'd
encourage
staff
to
feel
free
to
raise
concerns
with
us
about
what
is
going
on
and
keep
us
informed.
D
D
We
still
have
a
purpose.
Our
purpose,
our
primary
purpose
of
making
sure
people
receive
safe
care,
but
safe
care
means
something
different.
When
services
are
under
enormous
pressure
and
it's
very
important
that
we
are
proportionate
and
reflect
the
fact
that
we
are
asking
services
to
provide
the
safest
care
they
can
under
the
circumstances
that
they
face
with
the
pressures
they
face.
D
I
Yes,
certainly,
and
so,
if
I
could
just
go
through
my
different
sectors
and
explain
some
of
them
and
what
we're
seeing
in
the
different
sectors.
So
certainly
we
step
down
routine
inspections
a
couple
of
weeks
ago
in
our
one,
more
modernize
files
providers
because
of
the
demand
that
they're
seeing
and
there's
no
doubt
because
of
the
pressures
in
the
system.
There's
huge
demand
going
through
that
sector,
those
sectors,
we're
hearing
a
mixed
picture
from
GP
colleagues
who,
in
some
cases
they
are
seeing
a
significant
increase
in
demand.
I
In
some
cases,
the
patient
population
are
heeding
the
messages
that
are
going
out
about
calling
one
one
one
rather
than
turning
up
at
the
surgery,
which
is
absolutely
the
right
thing
to
do.
If
people
have
got
symptoms,
suggestive
of
coded
or
flu-like
symptoms,
so
we
are
working
to
understand
how
we
really
identify
the
kind
of
key
risks
in
the
sector
and
actually
look
at
how
we
can
support
the
sector
during
that
time.
I
In
in
dental
services,
we
are
hearing
increasing
concerns
about
the
availability
of
PPE
protective
equipment
and
feeding
that
back
and
we're
also
I'm
just
helping
support,
particularly
the
private
dentists.
In
how
we
can
get
messages
to
them,
some
of
the
ones
who
may
not
be
linked
into
through
the
NHS
channel,
so
we
are
working
with
that
sector
to
understand
how
we
can
support
specific
messages.
I
Independent
doctors,
they
are
they've,
got
a
significant
role
to
play
in
supporting
the
capacity
within
the
NHS
and
they're.
Very
keen
to
do
that.
However,
we
are
hearing
the
odd
case
now
of
people
trying
to
profit
here
through
this
situation
and
I
think
it's
very
important
for
us
to
send
out
a
message
that
we
don't
feel
that
profiteering
through
this
situation
is
at
all
appropriate
and
and
we
we
don't
tolerate
that
at
all
we
know
in
these
situations.
Sometimes
a
very
small
minority
of
people
can
use
a
crisis
to
exploit
people
and
I.
I
In
our
defense,
medical
services,
we've
suspended
the
program
and
we're
working
with
the
defense
medical
services
regulator
to
look
at
how
we
can
ensure
that
we
follow
up
on
any
kind
of
key
risks
that
we've
identified
with
services
there,
health
and
justice
services
we're
working
with
some
of
the
other
regulators,
such
as
Majesty's
inspector
of
prisons,
because
I
think
we
do
have
a
variety
of
vulnerable
groups
across
a
whole
variety
of
sectors
that
we
need
to
work
out,
how
we
pay
particular
attention
to
and
how
we
make
sure
that
they
get
the
right
support
and
we
know
with
health
and
justice
services.
I
I
Likewise,
we're
working
with
our
Children's
Services
we're
working
with
Ofsted,
because
I
think
we
need
to
understand,
particularly
the
vulnerable
groups
that
we
normally
support
with
our
special
educational
needs.
Work
for
example,
and
consider
how,
as
regulators,
we
continue
to
support
safe
care
into
those
environments
at
a
time
when
people
might
be
feeling
more
stress,
more
anxious
risks
may
go
up
as
a
result
of
that,
though,
I
think
that's
very
important.
I
Our
medicines
team
are
looking
at
how
we
can
understand
issues
with
medicines
that
might
emerge
from
this.
I
know
that
there
has
been
some
messaging
which
actually
we
we
very
much
support
that
people
should
not
over
order
any
medication
during
this
period
of
time
and
I
think
that's
a
very
important
message
and
our
medicines
team
will
be
looking
to
see
how
we
can
support
that
those
messages
and
finally,
I
think
there
is
an
opportunity
for
us
to
look
at
our
integrated
care
work
through
this.
I
So
I
think
we
need
more
than
ever,
for
our
teams
within
CQC
to
be
working
in
a
local
area
across
all
of
the
directorates.
So
they
can
really
understand
that
picture
in
the
local
region
across
our
dult
social
care,
hospital
teams
and
primary
medical
services.
We
already
know
that
we've
heard
some
stories
of
people
having
problematic
discharge
pathways
from
hospital
of
those
kind
of
real
key
issues
that
fall
between
the
gaps
of
all
of
the
different
providers
that
I
think
more
than
ever.
I
We
need
to
understand
and
work
out
how
we
can
support
and
I'm
we're
also
with
those
local
teams
looking
at
how
we
can
plug
into
the
regional
incident,
support
teams
and
use
the
intelligence
that
are
coming
out
of
that
local
teams
to
really
support
that
sharing
of
best
practice
and
identification
of
risks.
I
would
just
echo
Ted's
point
about
raising
concerns
more
than
ever
it's.
C
So
in
in
social
care-
and
we
CQC
have
quite
a
unique
overview
of
the
23
and
a
half
thousand
providers
across
the
country
providing
support
to
people
with
care
and
support
needs
and
because
of
that,
like
ian
said
at
the
front,
it's
more
important
than
ever
that
we
are
involved
and
having
a
really
good
understanding
about
what
the
kovat
19
impact
is
on
those
individuals.
So
what
does
it
mean
to
be
an
adult
of
working
age
with
physical
disabilities
in
the
coming
weeks
and
months
as
as
the
impact
of
this
is
truly
felt?
C
So
so
we
we
see
our
role
in
the
social
care
sector
in
the
coming
weeks
and
months
in
terms
of
having
a
really
good
view
of
the
impact
being
able
to
escalate
concerns.
So
there's
a
particular
conversation
going
on
at
the
moment
about
the
ability
to
access
the
right,
personal
protective
equipment
to
provide
support
to
people
during
this
time.
C
So
we
need
to
ensure
that
we've
got
a
good
grasp
of
what
the
impact
is,
so
that
we
can
escalate
and
carry
having
conversations
with
government
and
within
those
regional
areas
to
be
talking
with
health
partners
as
well
about
about
the
impact.
This,
for
me,
is
about
constantly
flagging
people
with
care
and
support
needs
as
a
really
important
factor
in
this.
So
conversations
are
happening
as
you'd
expect
around
hospitals
and
making
sure
that
there
are
sufficient
beds
to
be
able
to
respond
to
the
increased
in
demand.
C
What's
really
important
is
that
should
people
be
leaving
hospital
sooner
than
they
would
have
done
in
this
current
circumstance
that
they
are
supported
to
transfer
safely
and
that
their
Care
Services
and
the
community
health
services
are
ready
to
pick
up
that
care
and
support?
So
it's
as
seamless
as
ever,
social
care
providers
welcomed
the
decision
to
step
away
from
routine
inspection
and
move
to
our
risk-based
risk-based
approach,
and
we've
been
talking
very
publicly
about
the
increased
emphasis
on
providing
support
providers
so
saying
to
our
social
care
providers
if
you've
got
significant
concerns
about
work
force.
C
J
And
so
just
follow
for
my
sheer
expected
colleagues,
we've
been
working
and
nationally
with
partners
around
how
we
join
up
my
support,
whether
the
regulator's
as
consistent
messages
come
in
from
all
of
us
around
our
approach
to
conveyed.
We've
also
particularly
been
working
with
partners
in
health,
including
NHS
England
around
how
and
public
health
and
around
how
we
support
communications,
both
the
public
and
to
provider
groups
and
we've
actually
embedded
some
our
staff
in
the
NHS
England
cells,
particularly
supporting
communications.
J
Why
don't
social
care
in
terms
of
providers
we'd
be
showing
some
of
the
guidance
through
through
bulletins
of
special
briefings,
was
being
support
for
the
idea
of
webinars,
so
I'm
going
to
test
that
out
an
idea
out
with
different
groups,
so
they
can
have
real-time
information
from
us
and
from
other
partners.
We
are
maintaining
regular
contact
on
the
trade
associations
as
Kate
mentioned,
and
they
are
a
really
good
source
of
OHS,
both
of
information
and
and
of
feedback
on
how
our
messages
are
landing
with
the
sector.
I
think
it's
important.
J
At
this
time,
we've
been
using
experts
by
experience
in
a
new
way
to
gather
some
of
that
sand.
That
information
and
we've
been
handling
a
high
volume
of
both
social
media
calls
and
give
feedback
on
care
returns.
I
think,
as
Rosie
mentioned,
that
there's
been
a
step
up
increase
in
people's
risk
using
those
tools
as
a
means
of
giving
us
voice
back
and
it's
important.
J
We
can
play
that
back
in
to
both
the
regional
and
a
national
picture,
just
say
in
certainly
as
well
be
making
sure
staff
are
fully
briefed
in
terms
of
what's
going
on.
We
have
daily
daily
updates
for
colleagues
and
then
Monday,
Wednesday
and
Friday
briefings
for
senior
managers
and
managers,
so
they
feel
equipped
to
have
the
right
conversations
with
with
colleagues
on
the
ground.
J
We'll
continue
to
maintain
as
we
go
through
this
next
period
of
time,
and
we've
been
working
closely
with
the
media
to
make
sure
that
our
and
their
their
understanding
of
our
approach,
and
also
they
understand
your
partner's
approach,
is
maintained
and
also
we
can
have
a
good
conversation
about
areas
outside
COBIT
where
they
still
have
interest.
Thanks.
K
Thank
you.
So
we've
we've
been
doing
a
number
of
things.
We've
put
some
program
activity
around
this
we've
put
some
program
managers
in
so
we
take
a
program
approach
to
looking
at
all
the
various
activities
to
ensure
that
we
are.
We've
got
good
oversight
with
moving
things
forward
at
the
pace
that
they
need
to
do
and
we're
managing
in
the
interdependencies
between
their
work.
We've
been
doing
work
around
contingency
planning
and
looking
at
us
working
through.
The
sort
of
must
do
should
do.
K
Could
dues
and
identifying
the
resources
required
to
enable
us
to
do
that,
so
that
we
can
scenario
plan
for
if
we
get
to
some
critical
threshold
levels
and
what
we
do
in
the
event
of
that,
we've
also
been
doing
some
other
scenario.
Planning
were
looking
at
various
scenarios,
but
it's
for
internal
impacts,
but
also
wider
strategic
scenarios
and
putting
together
our
solo,
a
policy
position
on
all
of
these
and
as
a
must,
implement
a
ssin
plan
so
that
we
can
implement
quickly.
If
needs
must.
C
K
So
last
week
we
ran
over
the
last
week.
We
ran
a
series
of
activities
where
we
moved
chunks
of
people
out
from
ncsc
who
are
primarily
office
based.
We
did
that
in
rotation
to
check
the
connectivity
and
that
could
work,
and
then
yesterday
we
fortuitously
asked
everybody
to
work
at
home
across
the
whole
organization
to
test
that,
and
that
went
fine
in
terms
of
our
people
policies.
K
We
are
putting
in
place
policies
to
ensure
that
we
can
provide
support
and
guidance
to
our
people
who
are
also
working
at
home
and
who
are
having
self
isolate
and
who
are
ill.
We're
looking
at
how
we
might
do
that
if
schools
are
closed
and
the
impact
on
our
people
in
terms
of
how
they
work
and
also
collecting
data
through
sickness
recording.
So
we
can
keep
track
of
the
health
of
our
of
our
own
workforce.
K
Also,
now
looking
at,
if
we
do
have
spare
capacity
in
the
organization
where
people
have
not
been
as
we've
suspended
routine
inspections
for
the
moment,
what
we
can
do
with
our
people,
who
are
who
are
not
out
of
inspections
and
we're
looking
at
how
we
can
utilize
their
skills,
knowledge
and
experience
to
help
us
accelerate
some
of
our
work
around
change
program
so
that
we
we
can
do
some
of
our
user
led
design
at
an
earlier
stage
than
we
perhaps
had
envisaged
around
the
program
work.
Okay,
thanks.
L
We've
we've
had
some
superb
support
from
Microsoft
or
an
existing
provider
around
a
current
environment
in
helping
us
design,
some
quick
solutions
and
we're
live
in
to
establish
an
environment
that
will
enable
us
to
do
this
in
in
a
very
short
space
of
time.
This
will
enable
us
to
to
collect
data
and
to
support
providers,
even
if
we're
doing
that
remotely.
H
Mark
I
hope
that
gives
you
a
sense
of
work,
a
significant
amount
of
work
across
the
whole
organization.
That's
both
trying
to
get
us
as
an
organization
ready
for
what's
going
to
be
a
difficult
time
internally,
but
also,
more
importantly,
what
we're
doing
externally
to
two
men
to
ensure
that
the
public
are
reassured
by
the
health
and
social
care
systems
that
they
are
they
are
using,
and
that
where
we
can
that
we
continue
to
the
most
improvement
thanks.
Peter
thank.
A
You
and
thank
all
of
you
because
there's
a
huge
amount
of
work
going
on
led
by
by
you
guys,
obviously,
but
a
lot
of
our
staff
are
doing
some
fantastic
things
at
the
moment.
So,
thanks
to
everybody,
can
I
just
invite
my
non-executive
colleagues,
if
there's
anything,
they
want
to
ask
or
add
just
on
the
the
covert
19
response
and
then
there's
a
few
other
small
pieces
of
relatively
small
other
things
that
we
want
to
talk
about
in
your
executive
report,
but
just
on
the
cove
819
is
anything
anybody
wants
to
add.
M
Say
thank
you
to
everybody
for
what
you're
doing
but
I
guess
on
behalf
of
citizens
in
some
sense,
we're
here,
representing
that
the
public
discourse
on
Kovac
19
has
been
predominantly
around
the
NHS
and
its
response,
and
that's
clearly
very
important.
But
the
country
isn't
going
to
get
through
this
unless
there's
an
equivalent
focus
also
on
social
services
and
their
ability
to
respond,
and
we
already
highlighted
in
state
of
care
the
palace
nature
of
social
care
and
I.
Do
worry
about
that
lack
of
conversation.
M
Has
been
mystique
in
the
NHS
for
all
of
their
career
carers
are
going
to
need
protective
equipment
just
in
the
same
way
as
NHS
day
care
services
are
not
going
to
be
able
to
deliver,
quite
as
they
have
been
just
in
the
same
way
as
the
NHS.
The
NHS
has
been
promised
all
the
resources
that
it
needs.
In
my
view,
that
promise
should
be
extended
to
social
care
services.
M
C
G
I
mean
it's
not
the
only
issue,
but
it
happens
to
be
the
current
one
in
the
in
the
news
about
concerns
being
raised
by
staff
made
within
the
healthcare
sector
and
social
care
sectors
about
the
lack
of
protection
they
did
and
I
one
question
I
have
is
well
what,
if
we
as
an
organization
or
in
a
particular
place
or
area,
the
inspector
feels
that
things
are
not
safe.
What
is
actually
going
to?
What
are
we
actually
going
to
do
about
that?
I
To
join
shall
I
start
on
those
two
points,
so
I
think
the
the
work
we
need
to
do
going
forward
really
needs
to
link
into
those
regional
incident.
Centers
I
think
we're
one
of
the
few
organizations
or,
if
not
the
only
organisation,
that
has
that
overview
of
all
the
different
sectors,
including
sectors
that
aren't
necessarily
plugged
into
some
of
the
NHS
work
and
we've
talked
about
adult
social
care,
but
also
independent
health
settings
and
I.
I
Think
we
have
a
role
really
to
be
looking
at
how
we
can
firstly
flag
all
of
those
issues
and
collect
them
and
use
that
as
intelligence
to
feed
into
the
Nash
and
regional
response
and,
secondly,
support
as
new
models
of
Caribbean
initiated
to
look
at.
How
do
we
support
them
being
set
up
in
the
way
that
they've
got
fundamental
standards
built
in
Russia
at
the
beginning
of
that?
I
They've
got
the
thinking
about
governance
and
safety
built
in
right
at
the
beginning
and
to
support
our
local
and
regional
and
national
partners
to
be
able
to
to
give
them
advice
on
that
and
help
them
think
through
those
different
issues
in
terms
of
inadequate
providers
in
my
sector.
Certainly,
we
are
following
up
those
inadequate
providers
and
identifying
how
we
follow
up
those
and
adequate
providers.
I
There's
some
inadequate
providers
where
the
risk
is
so
great
or
we
are
that
very
concerned
or
we've
had
an
increase
in
concerns
from
whistleblowers
or
safeguarding
concerns
raised
with
us
that
we
will
go
back
in
and
look
at
those
providers
again
in
some
of
the
inadequate
providers.
We
will
be
looking
at.
I
Actually
how
do
we
can
we
get
assurance
from
a
desktop
way,
or
is
there
a
focus
kind
of
approach?
We
can
look
at
with
those
providers
that
will
give
us
the
assurance
that
they've
dealt
with
the
issues
that
we've
identified
and
I
think
this
is
where
our
partnership,
working
with
our
other
agencies,
is
so
important.
I
So
I
was
discussing
a
provider
where
we
would
have
normally
taken
cancellation
of
enforcement
action
yesterday
and
actually,
instead,
we
came
to
a
view
with
the
local
CCG
and
NHS
England
about
a
different
approach
that
a
we
felt
passed
the
Public
Interest
test
of
making
sure
that
people
weren't
without
services
during
this
very
difficult
time,
but
also
looked
and
managing
that
risk.
So
the
risk
was
mitigated
and
the
public
could
be
more
assured
of
getting
a
safe
service.
So
I
think
it
is
on
a
much
more
kind
of
individual
basis.
Working
with
our
partners.
D
Hospitals
there's
as
work,
you
say
yes,
so
as
said
that
right
starts
we're
not
interested
just
in
services
for
people.
Who've
got
Kovac
19,
we're
interested
in
people
who
have
other
conditions
who
who
also
need
care,
and
we
mustn't
lose
oversight
of
that
and
focus
just
on
on
the
particular
pressure
of
the
Kovac
19
service.
And
of
course
we
do
have
a
lot
of
knowledge
of
services
already
in
terms
of
we
have
inspected
them
and
rated
them.
D
So
we,
if
you
like,
know
the
starting
risk
situation-
and
you
know
one
of
the
good
things
about
this-
is
that
a
lot
of
services
have
improved
considerably
over
the
last
few
years
and
I
think
that
that
puts
them
in
a
good
position
to
deal
with
the
enormous
pressures
they'll
face,
but
you're
right.
There
are
some
service
system
and
special
measures.
There
are
some
services,
we're
still
concerned
about
and
we'll
need
to
want
those
services
very
carefully
and
we'll
be
using
predominantly
data
to
monitor
those
service.
D
But
we
are
very
keen
to
hear
of
the
experience
of
staff
and
of
patients
and
service
users,
so
we
have
a
real
sense
about
what
is
going
on
in
those
services
and
we
will,
if
necessarily
go
in
and
inspect
them,
but
this
is
something
we
reluctant
to
do
with
the
system
under
so
much
pressure.
But
you
know
we
will
not
not
stand.
We
will
not
stand
back
if
we
believe
we
need
to
find
out
about
real
risk
going
on
to
people
in
services.
D
C
They're
basing
their
picture
in
social
care,
as
with
many
things
about
cope
at
19,
I,
think
it's
bringing
into
sharp
focus
a
lot
of
work
that
was
in
train
anyway.
So
conversations
we've
been
having
for
a
couple
of
years
about
systems
and
about
not
just
being
responsible
for
running
your
hospital,
your
GP
practice,
your
care
home.
Well,
more
importantly
than
ever,
is
if
you
happen
to
have
a
care
home,
that's
not
providing
acceptable
quality
of
care.
On
your
part,
it's
not
good
enough
to
say
that.
C
That's
not
my
problem,
we
need
we
need
those
beds
to
be
available
and
we
need
people
to
be
getting
good
quality
care.
So
I
think
we
will
see
a
kind
of
ramping
up,
I'm
hopeful.
We
will
see
a
ramping
up
of
people
working
with
there
and
in
the
system
to
make
sure
there's
the
maximum
capacity
available
and
that
itself
and
accept
standard
as
we
kind
of
move
through
this.
This
unprecedented
time.
G
Apart
from
any
other
organizations,
we
have
a
facility
at
the
resource
to
be
able
to
tell
the
country
told
the
government
what
is
actually
going
on
without
the
filter
of
the
layers
that
existed.
The
system
I
think
we
must
hold
on
to
that
throughout.
What's
going
to
be
a
very
difficult
time
for
everybody,
but
I,
thank
you
for
what
you're
doing
thanks.
A
M
My
thanks
already
reference
to
by
my
other
colleagues,
so
to
everything
that
you're
doing
and
also
all
our
employees,
but
Krusty
just
was
really
good
to
you.
You're
talking
about
some
focus
on
our
people.
I
just
wondered
going
forward
just
to
for
understanding.
Could
we
get
an
idea
of
the
numbers
of
our
people
that
are
being
redeployed
back
into
frontline
service?
M
To
that
I
wondered
whether
there
is
a
well
I
hope
there
is
a
process
whereby
those
people
who
are
redeployed
their
managers
are
able
to
stay
in
touch
with
them,
both
from
a
communication
from
our
point
of
view,
but
also
to
check
on
their
well-being
with
us
as
their
their
main
employer
and
then
finally,
will
we
be
able
to
get
a
report
on
how
many
of
our
star
Thersites
self
isolating,
rather
than
registering
as
sick?
Having.
M
K
Pissed
off
actually
was
the
fact
that
we've
created
a
dashboard
with
all
this
information
in
so
the
dashboard
covers,
or
our
staff
metrics,
so
people
who
are
sick
people
in
South
Bates
isolating
people
who
are
out
on
scum
and
so
I'm
sure
we
be
able
to
share
that
dashboard
with
you.
If
you
wants
to
see
its
power
bi,
if
people
are
out
on
sick,
advanced
comma,
we
do
what
we
know
me
doing
asked
just
to
keep
in
touch.
K
I
H
Know
it's
also
worth
adding
into
that
as
well
plea
to
that,
despite
what
people
might
think,
we
have
a
relatively
small
number
of
clinicians
on
as
employees
there's
like
there's
a
kind
of
an
assumption,
I
think
in
some
courses
that
all
of
our
people
are
doctors
or
nurses
and
clearly
that's
not
the
case
so
so,
where
we
can
we're
encouraging
all
of
our
colleagues
to
to
volunteer
but
I
see
the
numbers
of
doctors
and
nurses
is
relatively
modest.
Yes,.
A
H
H
Just
just
an
enormous
thank
you
to
to
my
to
my
team,
who
have
been
working
incredibly
hard
to
get
us
to
where
we've
got
so
I
think
it's
felt
like
we've
been
sprinting
up
to
this
point,
to
try
and
get
to
a
position
where
we
understand
what
our
role
is
in
in
the
in
the
overall
National,
Response
and
I.
Think
that's
an
important
it's
an
important
place
for
us
to
be
confident
around
I.
H
Think
this
done
an
awful
lot
of
moving
parts
here
and
I'm
sure
there
will
be
some
rough
edges
to
to
our
response,
but
we're
trying
incredibly
hard
to
to
make
sure
that
we
can
be
a
responsible
regulator
rather
than
an
inspector.
But
a
responsible
regulator
that
that
is
is
protecting.
The
public
is
providing
that
independent
public
voice
that
a
number
of
board
members
have
spoken
to
that
also
acts
as
an
intermediary
bringing
together
groups
of
providers,
particularly
those
providers
that
people
like
Rosie
was
talking
about
independent
doctors.
Cate
was
talking
about
social
care.
H
Those
providers
that
haven't
necessarily
got
a
traditional
NHS
voice,
making
sure
that
that
voice
is
heard.
But
I
think
we
also
can
inter
mediate
back
as
well,
which
is
you
know
we
are
in
extraordinary
times,
and
we
need
to
to
make
sure
that
that,
whilst
our
focus
has
got
to
be
on
safety,
it
can't
be
safety
using
a
benchmark
of
where
we
were
two
or
three
months
ago.
It's
got
to
be
safety
in
in
a
proportional
and
sensible
way
and
having
an
independent
voice.
A
F
C
J
You're
absolutely
right
and
we
are
having
daily
conversations
with
an
interesting
and
and
other
partners
about
the
information
that
we
share
back
with
the
public
I.
Think
there's
really
two
important
points
here.
We
have
a
role
in
informing
the
system
about
what's
happening
at
a
local
level
so
that
they
understand
the
issues
that
are
in
a
local
area
and
that
should
inform
the
action
they
take
locally,
but
also
the
advice
we
offer
nationally
through
Phe
NHS,
England
and
ourselves.
J
Now
that
new
platform
is
in
place,
I
think
people
many
more
people
that
are
giving
us
their
feedback
alongside
information
we
get
from
from
expose
by
experience
and
other
other
public
groups,
so
we'll
absolutely
use
that
feedback
to
inform,
what's
happening
locally
and
use
that
with
the
regional
groups
and
also
make
sure
that
you
can
tie
in
to
the
measures
that
we
need
to
give
back
nationally,
I
think
as
the
inside
of
the
very
start.
This
is
a
daily
ongoing.
Changing
situation
and
we
need
to
make
sure
we
can
respond
collectively
and
appropriately
good.
A
I'll
be
happy
to
move
on
from
covert
19.
This
briefly,
so
I
see
that
we've
been
joined
by
by
Stewart,
Stewart,
Dean
and
I
wonder
whether,
rather
than
keep
still
hanging
on
colleagues,
are
happy
to
go
to
the
market
oversight
report
and
then
come
back
in
and
do
the
rest
of
the
executive
team
up
dataset
is
that
okay,
that
sounds
fine.
N
Afternoon,
everyone,
this
sort
of
paper,
is
to
update
on
what
we've
been
doing
from
a
marketing
site
perspective
over
the
past
six
or
so
months.
Appreciating
that
we
provide
the
similar
update,
I
believe
in
a
June
last
year,
so
I'll
sort
of
canter
through
the
presentation,
I'll
update,
specifically
on
k-league
19
at
the
end
and
I'd
sort
of
proposed
to
take
questions
sort
of
thereafter.
Just
given
the
forum
that
were
operating
in
today
so
slide,
3,
essentially
sort
of
aims
to
set
out
a
sort
of
overview
of
market
oversights
sort
of
responsibilities.
N
So
what
we're
essentially
saying
is
that
in
the
broadest
sense,
the
purpose
of
market
oversight
is
to
minimize
avoidable
uncertainty
for
vulnerable
people
owing
to
a
disruption
of
the
continuity
of
care
as
a
result
of
business
failure.
We
do
that
by
monitoring
the
finances
of
potentially
difficult
to
replace
providers
and,
in
the
event
that
we
satisfy
ourselves
of
likely
service
cessation
as
a
result
of
likely
business
failure.
We
would
then
issue
a
stage:
six
notification
to
local
authorities
to
assist
them
in
their
contingency
planning
arrangements.
N
The
scheme
design
assumes
that
the
market
can
typically
absorb
business
failure.
Hence
a
business
failure
in
itself
is
insufficient
to
trigger
the
local
authority
notification,
and
it's
also
important
to
appreciate
that
marks
oversight
doesn't
actually
have
any
powers
to
prevent
provider.
Failure.
More
information
in
terms
of
the
pride
is
captured
by
the
scheme,
as
well
as
our
guidance
is
published
on
CQC's
website,
so
just
them
sort
of
bringing
people
up
to
speed.
N
In
terms
of
the
current
picture,
we've
now
got
approximately
sixty-five
corporate
providers,
including
in
it
included
in
the
scheme,
and
we've
got
a
further
visibility
on
additional
five
providers
that
will
be
coming
in
over
the
next
couple
of
months.
The
additional
providers
and
the
increase
in
providers
more
generally
is
being
driven
by
two
factors.
N
Firstly,
a
broader
market
consolidation,
where
the
larger
groups
are
divesting
of
problem
locations
or
contracts,
and
those
are
frequently
being
picked
up
by
providers
that
are
just
outside
of
the
market
over
market
oversight.
Entry
criteria
there's,
therefore,
a
tendency
for
the
new
entrants
coming
into
the
scheme
to
enter
at
a
higher
level
of
risk,
given
that
frequently
they're
coming
into
the
scheme
as
a
result
of
picking
up
other
providers
challenges.
N
The
second
sort
of
aspect-
that's
driving
the
increase
in
names-
is
the
ongoing
Four
Seasons
restructure,
particularly
the
restructure
of
the
leasehold
estate,
which
again
has
brought
additional
operators
into
the
scheme.
So
this
point
in
time,
and
if
we
consider
care
homes,
we
believe
that
we
cover
approximately
30
percent
of
registered
bed
capacity
that
is
registered
with
CQC.
N
Well,
so
that's
a
seven
percentage
point
reduction
in
the
level
of
sort
of
risk
deterioration
on
the
same
basis
from
the
same
inception
date.
What
it
actually
masks
is,
there's
a
significant
increase
in
risk
in
our
highest
risk
classification
prior
to
us,
and
needing
to
issue
a
local
authority
notification,
and
this
analysis
has
been
prepared
prior
to
the
impact
of
David
19,
which
I'll
talk
to
latterly
in
terms
of
local
authority
notification
position.
That
remains
unchanged.
N
The
operation
of
market
oversight
has
a
number
of
sort
of
referred
to
here
on
slide
for
ISM.
Seen
influences
those
being
improved
financial
discipline
across
the
providers
captured
by
the
scheme
and
the
byproduct
being
enhanced
financial
stability.
We've
also
a
number
of
sort
of
specific
instances
whereby,
by
effectively
holding
providers
and
the
broader
stakeholders,
to
account
with
being
able
to
preserve
and
indeed
secure,
additional
cash
injections
to
maintain
future
liquidity,
slides
five
and
six
talk
to
the
consolidated
data
and
trending,
and
that
is.
N
That's
based
on
a
consistent
population
of
names
captured
by
the
market
oversight
scheme,
and
it
relates
predominantly
to
the
two-year
period,
ended
the
30th
of
September
2019.
So
again,
this
predates
any
impact
of
sort
of
the
ongoing
challenge
in
the
system.
So,
if
you
just
focus
on
this
analysis,
then
over
the
two
year
period
overall
turnover
has
increased
by
approximately
eight
percent
and
the
component
parts
of
that
increase.
N
N
N
That's
important
because,
notwithstanding
sort
of
that
that
change
in
the
sales
mix
within
turnover
was
still
seeing
an
overall
attrition
to
profit
margins
and
on
the
bottom
of
slide
five,
we
talked
to
EB
D,
a
R
M
margins,
which
are
a
very
high-level
proxy
for
profit
and
we're
seeing
over
the
two-year
period
a
further
half
a
percentage
point
duty
creation
in
that
profit
margin
to
22.4%,
and
that
is
being
driven
essentially
by
staff
costs
and
agency
costs.
Outpacing
any
increase
in
turnover.
N
And
then,
if
we
look
at
the
overall
picture
as
to
what's
happening
within
CQC
registered
beds,
we've
seen
a
3427
bed
reduction
over
the
two-year
period,
which,
when
you
consider
the
practic,
it
is
a
centage
of
the
practical
spare
capacity
in
the
system.
That
equates
to
broadly
attempts
and
reduction
in
bed
capacity
over
that
two-year
period.
N
We've
then
done
some
analysis
in
terms
of
the
outlook
for
the
sector,
and
essentially
what
this
is
suggesting
is
that,
on
average,
a
local
authority
Authority
fee
increase
circa
three
to
four
percent
would
be
required
to
maintain
current
EBIT
Dom
margins.
But
as
you'll
appreciate
from
my
prior
comments
that
level
of
profitability
is
already
insufficient
to
support
the
attributes
of
a
normally
performing
market
and
I
say
that,
because
of
despite
the
accepted
increase
in
demand,
but
capacity
continues
to
reduce
the
limited
inward
investment
that
is
occurring
is
biased
towards
private
pay.
N
K
N
N
So
if
we
then
turn
our
thoughts
to
cave
at
19,
then
the
adult
social
care
sector
is
a
significant
vulnerability.
I
say
that,
because
it's
driven
by
the
typical
person
using
these
services
being
more
susceptible
to
the
virus
virus
and
a
search
occupancy,
will
decline.
There's
limited
cross
phase
flexibility
generally
across
the
sector
and
a
potential
doubling
up
of
cost
to
cover
sickness
and
self
isolation,
alongside
methods
of
payment,
where
typically,
the
providers
would
be
paid
for
care
delivered
rather
than
and
the
cost
of
maintaining
a
level
of
care.
N
And
thirdly,
there's
the
well
reported
workforce
workforce
challenges
given
the
general
level
of
vacancies
in
the
sector.
The
fact
that
the
ASC
workforce
is
frequently
older
and
therefore
more
susceptible
and
the
proportion
of
the
workforce
that
are
low
income
and
therefore
particularly
susceptible
to
school
closures
and
increased
child
care
costs
and
final
point
would
be
sort
of
the
one
that
I've
made
around
the
low
margins
and
those
sort
of
being
struggling
to
support
the
attributes
of
a
normally
functioning
market.
N
So,
as
a
result
of
that
market,
oversights
undertaken
a
one-off
review
bit's
portfolio
to
suit
quickly
consider
those
providers
that
may
be
more
exposed
to
a
cave
in
nineteen
shock.
The
outcome
of
that
reviews
identified
circa
fifteen
percent
of
the
portfolio
where
we're
concerned
that
there's
a
immediate
challenge
with
regards
to
financial
viability
and
as
such,
the
teams
are
engaging
with
those
providers
to
understand
their
both
their
operational
as
well
as
their
financial
contingencies.
So
just
to
be
clear,
Servilia
in
the
absence
of
appropriate
sector
support.
A
Stuart,
thank
you
very
much.
I
think
what
your
presentation
is
demonstrated
is
the
phenomenally
deep
knowledge
that
you
and
your
colleagues
have
of
the
financial
well-being
or
otherwise
of
the
sector.
It
is,
of
course,
worth
remembering.
It
is
only
that
part
of
the
sector,
that's
in
the
market
oversight
scheme.
So
it's
not
what
everybody
but
I
think
we
are
occasionally
accused
of
not
having
that
detailed
knowledge.
I
think
you
demonstrated
very
clearly
that
you
do
have
that
knowledge,
which
is
which
is
really
good.
So,
colleagues,
any
any
questions
for
Stuart.
A
H
You've
made
the
point,
but
I
think
it's
just
worth
restating
that
the
the
amount
of
hard
levers
that
Stuart
and
his
team
have
got
to
affect
change
are
pretty
much
zero,
but
what
we,
what
they
can
do
is
do
this
behind-the-scenes
work
that
he
was
alluding
to
and
I.
Think
he's
in
the
team
do
a
great
job
of
having
those
behind-the-scenes
conversations
to
make
sure
that
that
the
right
decisions
are
made
by
banks
and
others
and
I
think
that
that
role
become
increasingly
important
in
the.
K
H
Months
as
the
sector
becomes
becomes
under
a
lot
of
pressure
and
I,
think
trying
to
maintain
visibility
is
going
to
be
challenging.
Undoubtedly,
but
I
think
it's
a
really
important
piece
of
work
that
the
CQC
we
don't
often
talk
about.
So
this
is
a
really
important
opportunity
to
publicly
talk
about
the
way
that
steering
is
team.
Do.
H
M
In
particular,
your
reference
to
the
ability
of
the
system
to
respond
to
the
Kovach
19
that
cause
something
I
said
a
few
minutes
ago.
Chris
there's
some
really
meaty
figures
here.
Have
we
any
plans
for
using
that
publicly
or
with
in
governmental
discussions,
to
get
people
to
really
sit
up
and
take
notice.
J
Stewart
said
I
think
he
and
his
team
are
well
engaged
with
with
colleagues
across
government,
and
it
is
a
it
is
a
very
important
part
of
how
we
talk
about
the
state
of
care
both
nationally
and
regionally,
and
will
continue
to
be
so.
I
think
it'll
be
interesting
to
see
how
the
situation
develops
as
we
go
through
the
next
few
months
and
kovaydin
I
think
it
should
form
part
of
our
conversation
back
both
regionally
and
nationally.
J
That
I
mentioned
about
how
we
take
the
right
action
to
make
sure
services
are
supported,
I
think
just
to
echo
Peter's
points,
I
think
it
is
important
that
we
recognize
that
we
do
have
this
insight
and
understanding,
and
that
information
is
shared
with
colleagues
across
the
sector
and
that's
something
I'll
be
keen
to
do.
John.
A
C
Already
be
described,
words
I
just
want
to
emphasize
this.
This
work,
this
oversight
it's
more
important
than
ever,
so
there
are
conversations
going
on
by
trade
associations
about
the
potential
impact
that
they
will
see.
You
know
some
are
already
seeing
about
covert
19
and
workforce
and
the
impact
on
their
finances.
So
it's
it's.
C
It's
absolutely
central
that
we
continue
to
use
that
intelligence
to
do
the
behind
the
scenes,
conversations
with
those
large
providers,
but
also
to
kind
of
really
shine
a
spotlight
on
the
risk
and
how
that
risk
will
change
in
in
coming
weeks
and
months
as
providers
respond
to,
and
so
these
completely
unprecedented
times
that
they
were
all
entering
into
together.
I
think.
G
I
may
well:
firstly,
these
are
very
compelling
figures
and
they
need
white
circulation.
It
might
be.
Thank
you
for
them
to
do
it,
but
my
question
is
whether
the
proposals
announced
by
the
transfer
relation
to
business,
support
and
so
on
have
any
little
shorter
and
favorable
impact
of
this
around
in
the
same
way
as
on
other
sectors
and
I
appreciate
that
it's
may
be
difficult
to
judge
in
the
absence
of
detail,
but
presumably
the
care
home
organizations
are
able
to
benefit
from
this
form
of
support
as
much
as
anybody
else
or
not.
I,
don't
know.
N
So
that's
sort
of
what
we've
focused
on
I
think
it's
also
important
to
for
the
sort
of
providers
to
be
getting
the
sort
of
granularity
so
that
the
workforce
understands
that
of
the
various
support
packages
that
have
been
mentioned.
What
that
actually
means
so
will
the
sort
of
workers
benefit
from
sort
of
additional
benefit
payment,
or
will
support
go
into
providers
by
way
of
additional
funding,
grants,
etc,
and
once
that
sort
of
granularity
is
provided,
then
between
the
providers
and
the
workforce,
they
can
work
out.
N
How
it's
going
to
land
key
point
that
I
cannot
emphasize
sort
of
enough
is
that
the
money
needs
to
keep
flowing
in
the
system,
because,
just
by
nature
of
the
high
percentage
of
turnover
that's
paid
out
every
month
and
for
some
providers
more
frequently
than
monthly
on
staff
costs
and
agency
payments.
If
there
is
a
bump
in
the
road
from
sort
of
the
non-payment
or
a
delay
in
the
payment
of
sort
of
standard
invoice,
then
it's
likely
to
have
a
disproportionate
impact
on
this
sector
and
that's
a
disproportionate
negative
impact
on
this
sector.
A
Stuart,
thank
you
very
much
like
you
and
the
team
are
doing
as
Ian
said,
this
has
never
never
been
more
important.
It's
always
been
important,
but
it's
never
been
more
important
than
it
is
at
the
moment.
So,
thanks
for
the
work,
you're
doing
I
think
that
the
sort
of
key
messages
back
from
the
board
are
just
to
share
this
this
as
widely
as
we
can
so
that
government
that's.
The
department
is
obviously
also
that
the
Treasury
is
they're
thinking
through
the
responses
to
the
crisis.
A
A
Time
flies
when
you're
enjoying
yourself
I'm
minded.
If
you
can
bear
with
it
to
try
and
finish
this
part
of
the
the
meeting
which
I
think
will
take
about
another
half
hour
and
then
break
for
a
quick
sandwich
is
that
is
that
okay,
also
conscious
we've
got
quite
a
long
afternoon
ahead
of
us
as
well
right.
So
let's
come
back
in.
If
we
could
please
to
the
the
other
parts
of
the
executive
team
report,
we've
done
the
coded
response,
but
we
haven't
done
the
rest.
Perhaps
we
can
counter
through
that.
Okay.
H
C
That
looks
at
our
findings
following
a
review
of
three
months
worth
of
notifications,
in
which
their
provider
check
the
box
to
say
that
a
sexually
inappropriate
incident
that
happened,
anything
that
ranged
from
inappropriate
sexual
touching
to
someone
you
know
nudity
through
to
sexual
assault.
So
the
report
has
a
couple
of
kind
of
key
messages
in
it:
one
it
talks
about
how
pretty
broadly
we
are
not
as
good
as
we
need
to
be
as
a
society
in
having
conversations
about
sex,
sexuality
and
relationships,
and
because
we
are
not
that
confident
in
talking
about
it
in
general.
C
Why
on
earth
would
we
expect
social
care
workers
to
feel
like
they
have
the
skills
and
the
permissions
to
have
those
types
of
conversations
with
people?
So
there's
a
real
issue
about
when
people
are
identified
as
having
social
care
needs.
As
a
general
rule,
we
we
don't
give
sufficient
attention
to
what
their
needs
are
around
sex,
sexuality
and
relationships.
So
the
report
landed
after
a
huge
amount
of
effort.
C
It
was
unanimously
well
received
by
charities
and
all
of
our
provider
organizations
which
are
really
pleased
about,
but
obviously,
there's
no
point
in
having
a
report
unless
it
leads
to
meaningful
change.
So
we
had
the
courageous
families
who
told
their
stories
about
when
things
go
wrong
with
a
plea.
D
Well,
we've
already
covered
closed
environments,
so
I
won't
cover
that
section.
The
report
again
I
think
think
all
those
issues
were
covered
and
just
highlighting
that
we
published
on
March
the
5th
a
report
on
quality
improvement
in
four
trusts
and
how
they
sustained
it
over
time
and
I
think
this
is
important
part
of
our
contribution
to
the
driving
improvement
in
trust
and
it's
been
well
received
and
I
think
will
be
an
important
report
going
forward.
H
Thanks
Ted:
if
then
moving
on
to
the
assessment
framework
consultation
as
board
members
will
know,
we've
been
working
with
NHS
he
and
I
on
our
assessment
framework.
I
think
we've
agreed
with
them
in
the
light
of
Cobie
19
to
delay
the
consultation
that
was
that
was
scheduled
and
we
will
update
the
board
when
that,
when
we
get
back
to
that
work
again,
a
couple
of
forthcoming
publications,
one
from
the
second
round
of
sandboxing
and
and
one
from
run,
around
innovation,
I
think
again.
H
The
sandboxing
reports
I
think
it
is
interesting
in
terms
of
demonstrating
how
we
can
work
with
providers
collaboratively
to
ensure
that
new
services
can
be
registered
and
I
think
that
that
may
have
some
some
some
applicability
during
the
Cobie
19
emergency
I.
Think
in
terms
of
principles
for
successful
innovation,
I
think,
whilst
we're
in
telling
to
publish
the
report
really,
we
need
to
come
back
to
this
at
a
later
date
to
provide
further
support.
That's
provided
us
as
necessary
and
then
finally
feature.
H
A
M
Point
about
developing
the
support
for
our
inspectors
to
gather
the
views
and
experiences
of
people
who
are
non-verbal
I
mean
that
came
out
very
strongly
in
professor
Murphy's
report
and
I.
Just
wonder
whether
are
you
thinking
of
making
Makaton
a
core
competence,
part
of
training
for
inspectors,
for
these
to
these
environments,
and
also
attached
to
that?
Are
you
also
putting
some
more
training
in
around
observations
that
she
mentioned
about
communication
and
observation?
M
D
The
recommendations
of
this
report
and
what
are
the
key
elements
of
that
is
how
it
can
better
communicate
with
service
users,
so
I
think
we'll
be
exploring
all
those
issues
that
you've
developed
are
dead,
that
we've
got
a
four.
We
have
got
a
determined
plan,
yet
so
I
think
work
is
being
done
and
is
under
review
on
those
areas
and
I
think
that
that
is
a
very
strong
message
coming
out
of
Professor
vs.
report
and
I.
Think
it's
something.
We've
got
a
focus.
D
A
G
F
Sorry
forgot
to
unmute.
Yes,
thank
you
very
much
sure
we
started
us.
You
might
expect
by
having
a
discussion
about
implications
of
Kovach
19
in
the
context
of
those
risks.
Regulatory
risks
that
the
regulatory
government
governance
committee
looked
at
and
we
agreed
that
at
our
next
meeting
we
would
look
particularly
at
the
regulatory
methodology
that's
being
developed
for
use
during
this
unusual
period,
so
we
will
be
coming
back
to
that.
Obviously
it'll
be
discussed
at
the
main
board
as
well,
but
we
will
be
doing
the
sort
of
deep
dive
on
it.
F
Next
time
we
had
two
major
items
for
discussion
yesterday.
The
first
was
about
medicine,
optimization
and
big
focus
on
how
to
reduce
medication
errors.
So
the
World
Health
Organization
has
set
up
a
real
target
of
reducing
medication
errors
by
50
percent
by
2023,
and
we
had
a
very
interesting
presentation
about
everything.
Cqc
is
doing
in
this
space.
F
Quite
a
lot
of
upstream
work
to
to
encourage
and
stimulate
improvement
through
collaboration
with
a
whole
range
of
other
agencies,
and
also
the
the
team
in
CQC
who
have
expertise
working
closely,
offering
training
etcetera
to
our
inspector
so
that
we
can
really
pick
up
on
those
medication
errors.
We
also
discussed
the
social
care
sector
where
there
isn't
an
independent
reporting
mechanism,
as
there
is
in
health
care
for
medication
errors,
and
we
explored
whether
there
might
be
a
role
for
us
with
others
to
you
know,
discuss
how
that
might
be
rectified.
F
F
We
noted
that
there
been
an
increase
in
appeals
to
us
about
decisions
being
allowed
with
conditions,
and
we
had
a
bit
of
so.
In
other
words,
the
the
service
might
be
able
to
continue
or
the
particular
part
ourselves
be
able
to
continue,
but
with
clear
conditions
that
we
monitor,
and
we
had
a
bit
of
debate
about
whether
we
could
do
that
kind
of
improvement.
F
Encouragement
to
be
earlier
before
you
get
to
a
tribunal,
we
were
interested
to
hear
about
future
plans
on
enforcement,
particularly
around
making
more
use
of
those
colleagues
who
have
particular
investigation
skills
just
to
strengthen
the
overall
approach
and
integrate
it.
And
we
had
a
bit
of
discussion
about
sort
of
where
we
focus
our
enforcement
energies,
and
we
thought
that
there
may
be
certain
areas
where
we
could
particularly
gather
information
to
enable
us
to
take
enforcement
activity
where
appropriate.
For
example,
we
we
discussed
the
closed
environments,
but
clearly
we
are
enforcing
across
the
piece.
A
A
A
1919
in
Leeds,
in
all
probability,
it'll
be
another
virtual
meeting,
but
in
the
unlikely
event,
and
we
can
have
a
physical
meeting
again,
it
will
be
in
London.
So
just
to
note
that
I
should
have
said
at
the
end
of
thanking
professor
Murphy
that
her
reports
Chris,
is
being
published
immediately
after
this
meeting.
I
think.
A
Perfect,
thank
you
Chris
and
then.
Lastly,
I
I
was
just
again
wanting
to
thank
mark
Sutton
and
the
team.
From
my
point
of
view,
this
has
worked
incredibly
well,
it's
in
format
what
it's
like
for
anybody
sitting
outside
viewing
it
I
have
no
idea.
The
only
are
additional
ask.
I
have
marquees
whether
the
check
and
having
a
button
that
mutes
colleagues
we
could
get
through
this
meeting,
much
quicker.
If
I
could
mute,
everybody.
A
Like
seriously
just
before,
we,
we
completely
finish
because
obviously
the
public
and
are
able
to
join
us
in
the
normal
way.
I
have
exceptionally
said
that
we
will
take
some
questions
from
the
public
and
there
are
two
questions
from
David
Hogarth
and
one
from
Robin,
Pike
and
I
get
a
slightly
truncate,
the
the
question,
but
just
a
David
quit
Hogarth
first
question
is
around
telephone
outpatient
appointments
and
his
rather
varied
experience
are
of
those
happening
and
I
think
this
is
probably
for
you.
D
D
The
use
of
telephone
and
virtual
appointments
is
becoming
much
more
common
and
frequent
and
I
think
we
need
to
develop
an
approach
to
assessing
those
services
in
perhaps
more
detail,
we've
seen
I
think
such
as
telephone
appointments
as
relatively
peripheral
to
the
main
work
of
outpatients,
and
so
while
we
were
living
cluded
it,
it
would
not
have
had
a
strong
focus
and
I
think
going
forward.
There
really
is
an
opportunity
to
look
at
virtual
appointments
in
much
more
detail.
A
You
David
second
question
and
I
will
read
out
the
relevant
sentence
for
18
months:
I've
been
urging
CQC
to
get
a
page
about
Singh,
simple
video
communications
into
the
technology
resource
and
in
November
Peter.
That's
me
told
me:
there
would
be
a
general
piece
about
it
and
thought
it
would
be
really
by
genuine
January.
Why
hasn't
this
happened?
C
You
think
on
that,
so
when
we
have
published
our
and
driving
improvement
through
technology
which
shines
a
spotlight
on
best
practice
when
it
comes
to
tech
across
Health
and
Social
Care,
so
we've
got
that
the
second
thing
kind
of
related
back
to
our
earlier
and
focused
topic.
We
are
we've,
got
a
specific
work
stream
looking
at
surveillance
and
how
survelliance
should
be
used
by
us
as
a
regulator
under
the
closed
environment
banner.
So
so
two
big
things
one
we
have
been
talking
about.
C
C
A
I
So
we
look
at
this
through
our
assessment
framework,
four
or
five
key
questions
actually
and
when
we're
on
a
section.
We
look
at
radicals
that
are
kept
and
referrals
that
are
made
and
attract
that
through
I
think.
This
is
something
that,
as
we
develop,
our
integrated
care
work,
I'm,
keen
that
we
expand
further
and
start
track
patients
through
the
old
system
and
start
to
think
about
how
do
we?
I
How
do
we
look
at
a
person's
journey
as
they're
being
referred
from
a
from
a
GP
right,
the
way
through
to
seeing
the
specialist
they
need
and
then
back
through
and
that
process
as
well
as
they
come
out
of
care
of
the
consultant
and
or
a
specialist
and
the
the
actions
that
are
taken
after
that?
So
I
think
we
already
do
a
lot
with
our
current
assessment
framework,
but
I
think
there's
a
lot
more.
We
can
expand
as
we
go
through
our
work
on
integrated
care.