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From YouTube: CQC Board Meeting - Feb 2023
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A
Okay
well
good
afternoon,
everybody
for
those
watching
on
the
webcast.
Welcome
to
today's
public
board
meeting
of
the
Care
Quality
commissioner
for
those
watching
on
recording
it's
about
1
30
on
the
1st
of
February
I'm
delighted
to
say
that
despite
rail
strikes,
which
unfortunately
have
hit
us
for
the
second
consecutive
board
meeting,
we
do
actually
have
100
attendance
today
from
our
board.
Colleagues,
one
of
our
executive
directors
is
not
in
the
room
at
the
moment.
A
A
However,
it's
not
just
the
rail
strikes,
but
many
of
you
will
be
aware
of
the
teacher
strikes
which
will
cause
major
problems
for
some
of
our
people
who
have
child
care
and
responsible
letters.
So
we
have
agreed
that
the
vast
majority
of
presenters
will
actually
join
us
virtually
today,
either
because
they
can't
get
here
or
because
they
they
have
home
carrying
Arrangements,
but
we're
grateful
for
the
efforts
everybody
have
made
to
to
either
get
here
or
make
alternative
Arrangements
and
a
few
other
words
in
terms
of
who
is
here.
A
First
I
kind
of
Welcome
Julia
Corrigan
Davis
who's,
our
equality,
Network
representative
Julia.
You
were
there
earlier,
but
welcome.
Thank
you
very
much
for
joining
us
to
my
right
is
namali.
The
silver
namali
is,
is
the
head
of
governance,
legal
services
and
deputizing
following
Rebecca
Lloyd
Jones,
who
left
us
towards
the
end
of
last
year.
A
In
fact,
in
due
course
we're
going
to
be
joined
by
Kate
Staples,
who,
hopefully
the
camera
is
working,
as
is
at
the
far
left.
Kate
has
actually
joined
us
today,
as
as
the
new
head
of
legal,
but
she's
really
just
observing
today,
so
as
if
as
necessary,
will
be
supported
by
nimaldi.
So
just
here
today,
but
welcome
Kate,
we
could
have
you
on
board.
A
I
will
mention
it
later
on
as
well,
but
Mark
Saxton,
a
long-standing
board
member
and
our
senior
independent
director
steps
down
at
the
end
of
well.
It's
now
nine
months
at
the
end
of
this
month.
Rather
that's
the
end
of
February
so
well.
This
will
be
all
your
last
board
meeting.
So
welcome.
A
I!
Think
all
that's
covered
everything,
though
so
just
add
to
to
thanks
for
everyone
making
the
effort
to
come
along
today.
A
I,
don't
believe,
I'd
be
notified
of
any
additional
conflicts
of
interest,
but
I
will
just
check,
don't
see
anyone
putting
their
hand
up
and
I,
don't
believe.
There's
any
other
urgent
business
to
add
to
the
agenda
is:
is
that
correct?
Okay?
A
The
first
item
was
actually
down
for
me,
which
was
just
an
oral
update
on
board
appointments
for
the
public,
just
who
are
interested.
In
truth,
there
isn't
much
to
say
it's
reconfirming.
What
you
know
is
that
the
chair
of
hwe,
who
healthwatch
England,
who
is
also
becomes
a
non-executive
director
of
the
board
left
in
November,
and
we
also
have
Jorah
term,
ended
and
I've
already
mentioned-
that
Mark
Saxton's
term
ends
towards
the
end.
A
This
month,
her
father
increment
exercise,
we
completed
interviews
last
November,
so
we
are
hoping
for
approval
from
ministers
for
new
appointments
to
the
board,
but
but
that
is
still
the
weighted
and
on
similar
themes,
since
we
last
met
about
as
flagged
previously,
the
chair
of
our
audit
and
risk
Assurance
committee,
Sally
Cheshire,
has
left
us
so
there's
now
chair
of
NHS
resolution.
We
do
hope
to
be
able
to
advertise
the
post
to
replace
her
as
chair
of
the
Iraq.
Shortly
but
again
we
are
waiting
ministerial
approval
for
that.
A
Just
so,
people
are
aware,
as
an
interim
measure,
Jeremy
boss,
who's,
our
independent
member
on
the
Iraq
committee,
has
agreed
to
step
up
and
act
as
a
joint
chair
and
he's
been
supported
by
Fox
accident
for
the
last
few
months
to
make
sure
we
have
links
into
this
board.
Obviously,
since
Mark
goes
at
the
end
of
this
month,
we
are
going
to
have
to
make
other
arrangements,
since
it's
obvious
now
that
we
won't
have
a
new
era
chair
appointed
by
the
end
of
this
month.
A
A
I
know
that
the
hwe
Team,
who
aren't
here
today
are
very
grateful
to
have
that
link
and
Jorah
Last
by
novia's
least,
is
still
here,
because,
although
he
is
full
term
as
a
non-executive
ended
in
October
agree
to
accept
appointment
as
an
associate
non-executive
director
so
continues
to
be
at
this
table.
So
I
thank
adjour
for
doing
that.
A
So
a
bit
of
a
long
list,
I
hope
we'll
have
an
update.
Next
time
we
meet
at
the
end
of
March.
So
let's
move
on
to
the
other
more
formal
business.
The
first
thing
is
a
market
oversized.
Market
oversight
update
my
apologies.
A
This
is
to
note
what
is
going
on.
Ian
can
I
hand
over
to
you
to
introduce
Stuart
and
the
topic.
Thank
you.
Thanks.
B
Ian
and
and
good
afternoon,
everybody
and
Stuart
Dean
joins
us
I'll.
Just
give
you
a
couple
of
words
by
way
of
introduction.
So
this
is
one
of
our
regular
updates
to
the
board
on
Market
oversight.
The
market
oversight
team,
as,
as
you
know,
is
responsible
for
monitoring
the
large
so-called
hard
to
replace
providers
in
Social
care
and
then
warning
local
authorities
if
there
is
likely
to
be
service
cessation
as
a
result
of
business
failure
as
two
very
distinct
but
and
join
things
Services
station
as
a
result
of
business
failure.
B
What
we
don't
do
is
we
don't
look
at
the
health
of
the
entire
Health
and
Social
Care
Marketplace,
and
but
what
we
can
we
do.
What
we
do
know
is
that,
whether
we're
with
the
themes
that
we
see
in
these
large
providers
often
give
us
give
us
some
good
pointers
in
terms
of
the
overall
Financial
Health
of
the
social
Care
Marketplace,
particularly
in
areas
like
turnover,
profitability,
cash
flow
and
Staffing
challenges.
C
Thank
you
very
much
Gian,
so
just
to
emphasize
Ian's
Point
first
thing,
I
sort
of
always
mentioned
when
talking
about
mock
Dave
site
publicly,
is
that
the
name
is
misleading.
We
don't
have
a
market
oversight
role
and
equally,
we
have
no
panels
to
prevent
failure,
and
the
scheme
design
has
no
protections
to
ensure
a
minimum
notification
window
to
the
impacted
local
authorities
and
further
to
a
judicial
review.
C
Last
year,
the
legal
threshold
that
and
criteria
that
Ian
has
talked
to
has
actually
increased,
there's
currently
six
two
providers
in
the
scheme
that
equates
to
broadly
at
30
percent
of
the
market.
The
Unseen
influence
of
Market
oversight
should
not
be
underestimated.
Indeed,
our
best
work
will
frequently
be
invisible
to
the
general
public.
In
that
regard,
God
I
would
like
to
place
on
record
my
thanks
to
colleagues
for
their
continued
hard
work
and
dedication.
C
Turning
to
the
Financial
Insights
I
should
stress
at
the
outset
that
this
trending
only
relates
to
Mark's
oversight
names,
so
typically
the
larger
providers
in
England
and
ebitdom.
The
arm
is
the
proxy
that
we
use
for
profitability,
but
adding
to
data
constraints
is
calculated
before
interest.
Tax
depreciation,
amortization,
rent
and
Central
overheads.
That
therefore,
has
the
effect
of
inflating
the
profit
margins
presented
in
this
paper.
C
Notwithstanding
this,
unsurprisingly,
the
profit
margins
cross
three
sub
sectors
that
we
segment
the
market
into
have
been
declining.
This
is
a
result
of
Workforce
pressures,
limiting
the
amount
of
care
provided,
as
well
as
requiring
higher
pay
rates
to
be
paid
in
order
to
be
competitive.
It's
further
compounded
by
General
inflationary
pressures,
particularly
utility
costs
for
Care
Homes
and
petrol
and
Diesel
costs
for
Home
Care.
The
consequence
of
this
has
been
a
reduction
in
capacity
in
the
two
years
to
September.
C
22
providers
facing
off
to
local
Authority
provision
in
Market
oversight
reduce
their
bed
capacity
by
over
eight
percent.
Similarly,
in
home
care,
whilst
there
is
evidence
of
slight
recovery
in
care
hours
delivered
in
recent
months,
like
the
like
data
for
the
15-month
period,
ended
September
22
show
is
that
care
hours
delivered
reduced
by
14
percent
of
most
concern,
however,
is
the
reduction
in
profitability
for
specialist
providers
who
continue
to
struggle
most
with
the
ongoing
Workforce
challenges
in
terms
of
Outlook.
C
This
will
very
much
depend
on
the
extent
to
which
the
additional
funding
that's
been
made
available
flows
through
to
the
providers.
The
adequacy
of
the
April
fee
increases
in
terms
of
local
Authority
fee
rates,
the
severity
of
any
continued
Workforce
challenges,
as
well
as
wholesale
utility
costs.
Does
anyone
have
any
questions.
D
Thank
you,
chairman
and
good
afternoon
Stuart
and
thanks
again
for
bringing
a
very
thorough
report
to
us
here
at
the
board
today.
D
I
think
what
you've
outlined
is
how
how
fragmented
the
market
is
in
terms
of
adult
social
care
and
the
loss
of
turnover
due
to
reduce
lower
bed
occupancy.
So
I
wasn't
really
surprised
that
staff
costs
as
a
percentage
of
turnover,
had
increased.
D
In
fact,
I
suppose
I
might
even
say
that
I
was
surprised
that
it
was
not
more
because
of
these
sort
of
perfect
storm
that
you've
been
outlining
in
this
report
in
terms
of
competitive
market
for
Labor,
the
increase
in
agency,
the
increase
in
utility
costs
and
Safe
Care
Staffing,
you
mentioned
specialist
providers,
so
I
think
you
know
it's
good
that
that's
been
highlighted
because
they
are
so
critical
part
of
of
this
sector.
But
my
question
is
you've
referred
to
it.
D
C
Okay,
so,
and
in
terms
of
the
capacity
sort
of
exiting
the
sort
of
sector
or
contract,
handbags
I
think
there's
two
ways
of
looking
at
it.
Firstly,
there's
what's
happening
in
terms
of
beds
and
I've
touched
on
that
in
terms
of
the
eight
percentage
Point
reduction
in
beds
that
face
off
to
local
Authority
provision,
so
what's
happening
within
the
Elderly
Care
home
space
is
the
overall
reduction
to
beds
has
been
much
smaller.
C
But
if
you
look,
if
we
focus
on
beds
provided
by
those
operators
that
face
off
to
local
authorities,
then
the
reduction
has
been
much
larger
and
why
that
is
the
case
is
because
the
overall
figure
is
masked
by
new
capacity
going
into
the
subfundor
market,
to
your
point,
specifically
on,
what's
happening
with
contract
handbags,
so
that
sort
of
phraseology
is
generally
used
more
in
domicily
care
and
it
isn't
a
kpi
that
we
specifically
track,
because,
if
you
sort
of
think
about
these
businesses,
their
winning
and
losing
sort
of
contracts
on
a
week
by
week
basis,
the
data
that
I
referred
to
was
a
specific
piece
of
analysis
that
we
did
to
understand.
C
With
all
of
the
pressures
that
were
compounding
over
the
sort
of
last
year,
what
what
impact
was
that
having
on
care
hours
delivered
and
that
was
to
assist
in
the
broader
system
conversation
around
well,
what's
happening
with
hospitals
and
hospital
discharge
and
in
terms
of
the
Outlook
of
both
sort
of
further
beds
with
exiting
the
market
or
contract
handbags.
It
will
very
much
depend
on
the
additional
funding
flowing
through
and
the
local
Authority
April
fee
settlements.
C
Every
I
would
expect
every
business
to
have
undertaken
their
contract,
profitability
or
location
profitability
and
be
very
much
on
the
front
foot
in
terms
of
understanding
that,
if
an
inadequate
fee
uplift
occurs
what
their
business
response
to
that
will
be,
and
let's
be
clear,
handing
back
provision
or
handing
back
a
contract
is
a
last
resort.
But
at
the
end
of
the
day,
if
it's
not
washing
its
face,
it's
in
the
commercial
interest
of
these
Enterprises
to
frequently
take
that
action.
D
Well,
I
think
that's
you
know.
That's
very
well
explained
and
I
appreciate
that
you're
you're
really
referring
to
the
pressure
that
the
sector
is
under
and
your
data
is
from
quarter
three.
So
we're
hearing
a
lot
at
the
moment.
Aren't
we
about
delayed
transfers
of
care?
So
imagine
that
you
know
turnover
is
further
being
affected
in
this
respect,
so
you're
highlighting
a
real
challenge
for
the
sector.
C
There
is
possibly
the
sort
of
early
shoots
of
recovery
there
I
use
that
phrase
from
a
Workforce
perspective
in
the
Home
Care
market.
So
we
believe
from
the
latest
analysis
that
we've
undertaken
that
ours
delivered
may
have
at
least
bottomed
out,
rather
than
continuing
to
decline.
It's
absolutely
what
now,
what
now
sort
of
happened,
Beyond
Q3
into
Q4
and
then
q1
of
this
year.
B
Thanks
Joe,
obviously
the
utility
costs
draw
the
eye,
but
I
guess
it
would
be
fair
to
say
that
a
lot
of
these
businesses
have
got
long-term
utility
contracts,
so
haven't
necessarily
been
completely
knocked
off
their
feet
by
the
the
recent
risers
but
I.
Guess
that's
going
to
change
over
the
course
of
time.
Do
you
have
any
sense
of
of
what
that's
going
to
do
to
some
of
these
names
in
the
sort
of
in
the
18
to
24
month,
Horizon.
C
So
18
to
24
months
out
and
businesses
won't
have
utility
cost
protection,
unlike
interest
rates
management
or
other
hedging.
Solutions
utilities
are
only
typically
hedged
generally
12
months
in
advance.
Some
of
the
largest
providers
are
able
to
enter
into
more
sophisticated
and
longer
term
hedging
Arrangements,
but
that
is
absolutely
the
exception
rather
than
the
norm.
Normally,
it's
a
12-month
cost.
Arrangement
that's
in
place.
If
I
sort
of
broaden
my
response.
That
question
out
slightly
what's
been
interesting.
C
Is
that,
depending
on
when
providers
locked
in
their
costs,
a
lot
of
them
were
able
to
lock
them
in
tighter
than
where
the
government
support
that
has
extended
to
business
through
to
March
this
year
was
actually
happening,
was
actually
kicking
in
and
clearly
Beyond
March.
Whilst
there
is
a
further
mechanism
to
provide
some
insulation
from
further
utility
cost
increases,
and
that's
that
support
is
less
generous
than
what
has
been
provided
and
proposed
through
to
March.
C
The
other
point
to
bear
in
mind
is
that
where
wholesale
energy
costs
are
at
the
moment,
they're
actually
inside
both
the
support
that
extends
through
to
March,
so
so
this
is
the
point
that
I
make
around
it.
Very
much
depends
on
where
those
costs
move
over
the
next
12
months,
because,
firstly,
the
support
from
government
is
less
generous
and,
secondly,
where
wholesale
prices
are
are
at
the
moment
that
support
from
government
isn't
actually
providing
in
it
or
sorry.
Post-Match
won't
provide
any
protection
from
cost
at
the
current
level.
C
It's
very
much
a
scheme
designed
to
provide
some
form
of
protection
for
exceptional
cost
increases,
but
again
Beyond
a
certain
amount.
The
if
the
wholesale
price
moves
in
that
direction.
There
won't
be
a
full
capping
thanks.
B
F
Thank
you,
sir.
Two
points
of
echoed
to
taking
advantage
of
both
you
and
Ian
have
made
that
market
oversight
is
a
is
kind
of
a
bit
of
a
misnomer.
It's
not
a
full
analysis
of
long-term
trends
of
Market
entry
and
exit.
It's
looking
at
particular
providers,
but
yeah
is
there
an
opportunity
actually
to
to
to
develop
some
of
the
insight
and
the
information
that
you
have
got,
particularly
in
support
of
the
new
ics's
icbs.
F
You've
got
some
really
valuable
information
to
help
the
icbs.
Do
that
work
trying
to
work
out
you
know,
have
we
got
a
confident
long-term
Supply
that
we're
able
to
commission
from
so
I
suppose
the
question
is:
is
there
any
discussion
going
on
with
the
icbs
on
on
those
lines
about
how
we
might
be
able
to
help
them
just
get
a
better
understanding
of
the
trends
in
their
own
geographical
Supply?
F
Second,
question
is
about
Workforce
and
whether
your
information
set
also
includes
Workforce
costs,
because
there
has
been
concern.
I
think
that
one
reason
for
the
reduction
in
beds
and
and
indeed
marketex
it-
is
the
shared
difficulty
of
recruiting
enough
people
with
the
right
skills
to
fill
fill
the
jobs.
F
C
Okay,
so
let
me
deal
with
the
second
question.
First,
so
Workforce,
the
Financial
Insights
that
we've
discussed
today
absolutely
do
capture
the
workforce
cost
what
I
refer
to
in
terms
of
a
bottoming
out
of
as
delivered
specifically
related
to
non-specialist
domicilory
sector.
Let
me
be
clear:
Workforce
Remains,
the
biggest
operational
challenge
across
any
care
operator
in
the
in
the
sort
of
three
sectors
that
this
point
in
time
personally.
C
I
think
that
the
workforce
challenge
is
I,
see
no
reason
as
to
why
it
is
going
to
improve
in
the
near
term
and
the
reason
I
say
that
is
the
cost
of
living
pressures
on
households
are
continuing
to
increase.
Yes,
they
might
loosen
off
as
we
move
from
Winter
into
spring
and
the
proportion
of
household
income
that's
spent
on
utility
bills
might
reduce,
and
so
I
accept
at
that
point,
but
I
don't
think
it's
going
to
significantly
ease
the
pressure
for
the
sector.
C
The
other
point
that
I'm
acutely
aware
of
is
we've
seen
a
increasing
trend
for
people
within
the
sector
to
take
second
jobs
outside
of
sector
to
make
ends
meets
throughout
the
winter.
My
concern
is
that
that
is
then
taking
the
first
step
of
it's
really
tough.
It's
a
tough
job,
social
care.
It's
really
tough
to
make
ends
me
actually
I
hear
that
I
can
earn
more
outside.
Let
me
get
my
toes
see
how
bad
in
inverted
commas
it
is
and
then
possibly
we
might
see
a
increase
in
exits
as
people
think.
C
C
They
are
National
operators
generally
and
unless
we
are
concerned
about
the
overall
financial
performance
of
a
particular
operator,
we
will
not
delve
down
to
within
the
national
sort
of
picture
if
you
like,
so
we
will
focus
on
the
national
financial
performance
of
these
groups
because
at
the
end
of
the
day,
if,
if
we
focus
lower
down
and
get
drawn
into
that
analysis,
we
we
might
start
missing
a
particular
problems.
C
So
yes,
what
I'm
trying
to
say
is
the
majority
of
our
focus
is
at
the
national
level
to
the
extent
that
we
want
to
better
understand
something
we
might
dig
down.
So
we
might
push
providers
to
demonstrate
that
they've
undertaken
contract
profitability,
reviews
Etc.
So
why
I
say
that
is
because
we're
not
armed
with
info
with
financial
information
on
a
regional
basis
that
might
be
of
use
to
icbs
and
ics's.
C
What
the
role
that
we
could
play
is
ensuring
that
we
socialize
the
overall
trends
that
we
believe
and
see
are
happening
across
the
entirety
of
the
market,
so
that
particularly
the
icbs
can
have
that
in
their
focus
when
they're
thinking
about
their
sort
of
expectations
of
social
care
in
the
wider
system.
C
My
other
hope
is
that
you
know
this
forces
the
NHS
to
better
understand
the
social
care
Market
in
their
locality
and
sort
of
my
sort
of
final
Point
here
is
yes,
I
absolutely
do
have
discussions
predominantly
with
nhse
to
ensure
that
they
are
aware
of
the
headline
developments
in
the
market,
and
indeed,
I
know
that
I
have
one
later
in
the
week
here.
Incidentally,.
A
Thanks
Joe,
okay,
any
other
questions
for
Jewett
Stuart,
just
I
had
two
and
they
both
pretty
much
been
asked
and
therefore
answered
as
well,
but
just
to
follow
up
on
one
point:
I
hadn't
appreciated-
and
we
picked
up
your
point
that
if
you
look
at
exits
in
the
market,
it
masks
differing
Trends
from
local
Authority,
funded
exits
versus
private
funded
increases,
which
I
think
is
is
quite
an
important
point
to
to
note,
and
whilst
accepting
the
caveat,
this
is
only
part
of
the
market.
A
It's
a
big
important
part
of
the
market
that
we
are
looking
at.
I
just
wondered
if
you
had
any
further
knowledge,
just
roughly
that
even
the
percentage
on
or
scale
for
US
exits
and
and
entrances,
and
would
we
have
any
view
on
whether
there's
any
Regional
variation
I
know
most
of
these
are
National
operators,
so
that
and
immediately
wouldn't
give
us
a
view.
But
but
from
your
discussions,
do
you
know
if
there's
Regional
Trend
there.
C
So
there
is
so
let
me
try
and
dissect
that
down
the
investment
into
the
sector
by
far
and
away
is
predominantly
focused
at
the
South
Thunder
end
of
the
market.
C
Why
we're
seeing
more
sort
of
exits
in
local
Authority
focused
provision
is
because
investors
struggle
to
make
the
economics
work
regionally,
if
you,
if
you
continue
to
expand
on
the
cell
funder
theme
in
recent
years,
there's
been
more
investment
in
the
South
have,
however,
you
know
a
care
home
is
all
about
understanding
this
catchment
area
and
these
catchment
areas
typically
would
have
been
three
to
five
miles.
C
You
might
get
a
larger
catchment
area
for
a
self-funded
home
depending
on
how
rural
it
is
and
the
other
sort
of
provision
in
the
locality,
but
that's
the
sort
of
broad
rule
of
thumb.
The
reason
I
say
that
is
that
there's
pockets
in
the
country,
so
solihull,
for
instance,
has
had
a
reasonable
amount
of
inward
investment
in
sort
of
self-fundor
care
and
provision.
So
that's
a
area
too
pick
up
outside
of
the
general
sort
of
Southern
comment.
C
But
beyond
that,
it's
it
is
very.
You
know
that
that's
kind
of
the
overall
theme,
but
it
does.
You
know
there
will
be
investment
Beyond
so
further
north
in
the
country,
where
there's
a
less
sort
of
competition
for
South
under
and
a
strong
buoyant
local
market
because
of
the
lack
of
competition.
A
A
If
we
move
on
to
the
reporting
updates,
we've
moved
last
meeting
to
our
sort
of
regulatory
oversight
on
an
organizational
matters,
so
I
suggest
we
take
them
in
that
order.
Let's
deal
first
with
regulation,
so
Ian
and
colleagues
over
to
you.
B
Thanks
Ian,
so
I
think
take
take
the
report
in
terms
of
its
detail
as
read,
but
there
were
three
things:
I
wanted
just
to
pick
out,
in
particular,
I
think
just
to
make
the
point
around
urgent
and
emergency
care
and
the
national
maternity
program
that
we're
continuing
to
work
across
all
sectors
to
ensure
that
we're
we're
mindful
of
the
pressures
facing
services
at
the
moment
and
at
the
same
time
we
are
representing
the
interests
of
the
public
in
terms
of
the
delivery
of
safe
high
quality
care,
and
the
paper
outlines
some
of
the
Thematic
work
that
we're
doing
and
colleagues
can
can
talk
to
those.
B
In
a
moment.
We've
also
engaged
with
the
government's
rapid
review
on
Mental
Health
around
a
week
ago,
when
the
terms
of
reference
were
announced
and
we'll
continue
to
support
that
rapidly
review
on
mental
health
and
we're
continuing
to
talk
to
the
Department
of
Health
and
Social
care
ready
for
the
new
powers
in
relation
to
our
work
on
integrated
Care,
Systems
and
local
Authority
assurance
that
both
of
those
pieces
of
work
are
due
to
start
are
at
the
beginning
of
April,
I
mean
we're
waiting.
B
G
Just
on
the
just
wanted
to
throw
College
attention
to
the
work
we've
done
on
learning
from
safety
incidents,
so
this
is
the
12th
issue
and
if
you
think
back
to
the
strategy,
there's
a
strong
important
work
for
us
to
look
at,
not
just
when
things
go
wrong.
Why
do
they
go
wrong?
But
how
do
we
learn
from
them?
So
this
particular
issue
focused
on
capacity
and
consent,
and
it
focused
on
a
couple
of
issues
where
we
know
some
organizations
are
struggling,
particularly
around
staff
training
and
also
oversight,
audit
and
monitoring.
G
What
we
try
to
do
with
these
reports
is
to
talk
about.
How
can
other
organizations
avoid
this
happening
to
them?
So
we
reference
both
the
nice
Guidance,
the
mental
capacity
act
and
also
our
own
and
Excellence
information
on
the
accessible
information
standards
and
we've
recently
tried
to
link
it
back
as
well
to
the
our
report
and
who
I
am
matters.
G
We've
looked
at
people
with
lend
disability
and
people
with
Autism
to
again
just
try
to
link
the
good
practice
that
we
do
see
in
some
areas
to
what
we
expect
all
organizations
to
do
so
just
I
just
wanted
to
make
it
clear
to
colleagues.
This
is
one
of
a
number
of
of
these
Publications
designed,
as
we
say
in
our
strategy,
to
drive
some
learning
from
what
we
see
around
safety
incidents.
Texture.
Okay,
thanks.
E
Yes,
thank
you.
Chair
I'll,
just
mentioned
that
there's
still
evidence
that
the
demand
in
an
emergency
and
Urgent
Care
hasn't
debated.
Although
there
are
now
fewer
numbers
of
patients
in
acute
hospitals
with
covid
and
flu
following
the
peak
in
late
December,
and
there
have
been
some
moderate,
modest
improvements
in
ambulance
Andover
delays
during
early
January,
which
has
been
reported.
A
Like
you
should
I'll
turn
to
my
other
colleagues,
any
questions
for
hearing
or
team
on
her
paper.
A
I
mean
I
I
had
a
a
couple.
The
I
just
wonder
if
there's
any
more
to
be
said
on
the
Hewitt
review
and
our
import
of
that
there
seemed
to
be
a
number
of
parts
to
it
and
Chris
I
know
you're,
for
example,
attending
some
of
the
meetings.
It
might
be
helpful
to
elaborate
and
then
also
just
picking
up
on
a
point
that
was
discussed
elsewhere,
but
I
think
it
might
be
helpful.
A
Just
to
put
something
on
the
record
here
is:
is
the
impact
of
the
the
strikes
and
the
shortage
of
labor
on
how
we
will
go
about
reaching
organizations.
I
think
would
be
helpful
just
to
have
some
some
views
on
what
the
impact
of
that
will
be
so
I
think
Chris,
it's
probably
one
for
you
and
Eddie,
and
you
might
want
to
pick
up
the
other.
Perhaps
what
am
I.
G
Sure,
certainly
so
my
colleague,
Joyce
and
I
have
been
heavily
involved
in
the
in
their
hearing
review,
as
it
sets
out
to
its
work
streams
to
understand
how
we
can
drive
the
right
conversations
at
a
regional
level
to
drive
the
right
change
and
Improvement,
both
in
ics's
and
also
in
relationship
with
local
authorities.
I.
G
Think
it's
fair
to
say
that
we've
been
our
our
support
and
advice
has
been
positively
welcomed
by
the
group,
and
we
are
what
we're
trying
to
do
is
to
draw
as
we
move
into
the
regulation
of
ics's
and
local
authorities.
How
do
we
draw
from
what
we've
learned
from
our
early
work
and
system
reviews
to
help
guide
and
support
icses,
and
also
to
help
link
both
the
ice?
The
working
and
ICS
is
to
the
work
in
in
local
authorities.
G
The
the
key
challenge
at
the
moment,
I
I
guess,
is
to
make
sure,
as
we
for
each
area
that
we
have
a
good
understanding
of
where
each
ICS
and
local
Authority
starts
from
what
the
issues
that
are
affecting
their
particular
area
and
how
their
plans
are
seeking
to
mitigate
and
to
to
improve
on
their
base
position.
We've
been
engaging
with
a
number
of
test
and
learn
pilot
sites
for
around
around
ics's
and
they've
they've
been
very
successful.
G
We'll
continue
that
with
those
conversations
and
we'll
continue
to
input
not
just
into
the
regulatory
elements
of
the
review,
but
also
into
the
the
Insight
around
place
and
I,
say
I.
Think
we'll
we'll
see
just
as
report
as
an
important
step
into
how
they
both
manage
themselves
and
how
we
support
that
that
leadership
moving
forward.
B
Thanks
Ian
in
terms
of
in
terms
of
the
work
we're
doing
with
providers
on
around
strike
action.
One
of
these
we've
been
very
anxious
to
do,
of
course
is
is
to
make
sure
that
we
are
mindful
of
the
impact
the
strikes
will
have
in
terms
of
in
terms
of
Staffing
levels.
But
what
we
are
seeing
is
a
number
of
of
providers
who
are
who
are
taking
sensible
precautions
in
terms
of
of
of
of
canceling
elective
procedures,
making
sure
that
the
public
understand
exactly
what's
going
on.
B
So
in
many
cases
the
public
are
not
presenting
for
for
treatment
in
some
cases.
So
so,
thus
far,
that
has
worked
reasonably
well.
B
I,
think
and
Sean
can
talk
in
a
moment
in
terms
of
the
detailed
work
that
he's
been
doing
with
NHS
England
colleagues,
but
I
think
I
think
that
there
is
a
a
concern
in
the
medium
to
long
term
around
what
the
long-term
impacts
of
canceling
elective
treatment
on
a
repeated
basis
and
also
the
very
practical
point
that
what
will
be
the
impact
of
of
layer
strikes
were
more
than
one
group
of
of
people
go
on
strike
at
the
same
time.
B
But
our
underlying
principle
really
is
is
about
talking
to
providers
around
what
they
are
doing
to
make
to
make
to
make
their
service
as
safe
as
it
can
be
in
in
the
circumstances,
I'm
sure
Sean
can
talk
in
a
bit
more
detail
around
that.
E
Absolutely
I
mean
the
thing
that
we
would
be
most
interested
in
understanding
in
the
Q
providers
when
there
is
industrial
action
or
those
of
industrial
action.
Is
the
steps
they've
taken
to
plan
and
to
make
sure
that
the
mitigations
that
they
can
achieve
are
in
place
and
that
they've
spoken
with
their
staff
they've
spoken
with
Union
Representatives,
so
that
Services
can
continue
to
be
as
safe
as
possible
for
patients
at
all
times.
A
So,
presumably,
if
the
actions
taken
by
management
is
to
reduce
the
through
flow,
which
they
can
do
for
elective
procedures,
volumes
actually
could
be
down.
So,
if
you're,
looking
at
it
from
the
point
of
your
safety
of
people
and
hospitals,
which
is
broadly
our
remit,
it
could
well
be
no
additional
problem
might
be
an
outcome.
In
fact,
you'd
even
have
higher
Staffing
ratios
on
the
obligation.
The
bigger
risk
potentially
is
deferral
of
treatments,
but
I
guess
that
it
goes
beyond
what
we
can
assess
or
our
remit
is
that
right?
Well,.
E
As
long
as
as
long
as
the
the
the
management
of
those
organizations
have
taken
those
steps
and
have
looked
at
their
capacity
and
their
ability
to
meet
the
predicted
Demand
on
those
days,
then
yes,
you
would
expect
safety
to
be
not
compromised.
But
of
course
that
is
not
a
position
that
can
be
maintained
over
a
long
period
of
time,
because
you
know
to
maintain
capacity,
you
might
be
postponing
elective
care.
E
You
might
be
postponing
Outpatient
Care
sensible
things
to
do
in
the
short
term
to
secure
safety,
but
not
not
sensible
things
to
do
in
the
long
term.
Okay,
thanks.
B
Thanks
Ian
so
I'm
going
to
ask
Tyson
just
to
just
to
touch
briefly
on
on
operational
performance
in
a
moment,
but
I
did
want
to
just
just
publicly
pay
tribute
to
Tyson
and
and
his
leadership
team
for
their
ability
to
respond
very
quickly
to
the
circumstances
we
found
ourselves
in
over
the
last
month,
or
so.
B
We've
we've
been
in
a
position
where
we
have
done
one
of
two
things:
we
we
have
continued
to
inspect
organizations
based
on
on
risk,
but
we've
been
we've
been
very
rigorous
about
making
sure
that
we
can
justify
each
and
every
inspection
and
again
recognizing
that
important
balance
between
making
sure
that
we
take
into
account
what's
going
on
in
terms
of
the
overall
busyness
of
of
Individual
Services
and
balance
that
sensibly,
with
the
risks
to
to
the
public,
and
we've
continued
to
do
that.
Tyson
and
his
leadership
colleagues
have
have
done
a
great
job,
I.
B
Think
of
of
doing
that,
as
well
as
standing
up
a
very
significant
program
of
work
to
add
capacity
to
the
social
care
system
in
particular,
and
there's
many
of
you,
you
know
in
Social
care.
Many
local
authorities
will
only
buy
care
from
organizations
that
are
are
rated
good
or
outstanding,
and
that's
a
very
positive
choice
that
makes
sure
that
there's
good
quality
Care
available
to
people
who
use
Services.
However,
if
an
organization
is
requires
Improvement
or
inadequate
it
can,
there
can
be
a
data
that
kind
of
get
stuck
there.
B
So
what
we've
been
doing
is
created
a
program
whereby
we've
been
talking
to
the
local
Authority
we've
written
to
every
director
of
adult
social
care
in
the
country
and
invited
them
to
to
put
forward
the
names
of
the
locations
that
they'd
like
us
to
come
back
to,
and
we
have
a
program
which
I
Tyson
will
talk
to
in
a
moment
around
creating
more
capacity
into
the
social
care
system
that,
in
turn
on
blocks
the
the
flow
of
people
through
through
from
hospitals
and
addresses
some
of
the
13
000
people
who
are
currently
stuck
in
hospital.
B
H
Thank
you,
Ian,
and
just
just
to
reiterate
the
the
thanks
that
he
Ian
has
given
to
the
teams.
I
think
the
way
in
which
the
teams
managed
to
sort
of
mobilize
around
our
new
operating
posture
very
very
quickly
was
very
impressive
and
exactly
how
we
were
able
to
do
it.
Last
winter,
as
Ian
has
said,
we
have
reduced
the
on
on-site
inspections.
H
We
are
doing
with
NHS
providers
so
that
we
only
do
those
where
we
think
there
is
risk
of
loss
of
life,
but
we
are
paying
more
attention
and
mobilizing
more
of
our
people
around
trying
to
increase
capacity
in
the
adult
social
care
sector,
both
by
doing
what
we're
calling
Improvement
inspections,
which
is
not
only
requires
an
improvement
to
to
good,
but
also
by
visiting
unrated
providers
and
seeing
if
we,
by
giving
them
a
rating,
will
start
to
open
up
capacity
in
the
system.
H
We've
set
ourselves
a
target
of
300
such
inspections
by
the
end
of
March
and
we're
confident
that
we
should
be
able
to
exceed
that.
Another
thing
that
we've
been
doing
is
looking
at
our
prioritization
within
the
registration
function,
so
so
that
we
can
prioritize
adult
social
care
and
domiciliary
Care
applications
for
registration,
which
again
might
be
able
to
open
up
capacity
and
again,
the
team
would
be
making
good
progress
in
that
regard.
A
Thank
you
very
much,
Tyson
I,
suppose.
That's
a
benefit
of
the
new
approach
generally
that
we're
adopting
so
show
validates
the
decisions
were
made
a
year
or
so
ago.
Any
questions
for
Ian,
Tyson
or
other
colleagues
on
the
organizational
performance
we'll
come
to
a
reporting
in
more
detail
later
on,
of
course,
but
no
questions,
okay!
A
Well,
let's
move
on
we've
forwarded.
We
asked
if
we
could
have
an
update
on
what
we
introduced.
I
think
pre
previously
briefly
called
The,
Listening
learning
and
responding
to
concerns,
review
and
title.
There
are
no
papers
for
this.
A
It's
a
very
much
a
work
in
progress
and
we'll
have
a
much
Fuller
Report
with
supporting
papers
for
the
March
board
meeting,
but
we've
held
on
the
circumstance
it'd
be
very
interesting
to
have
a
an
oral
update
as
to
how
things
are
going
for
those
listening.
Ali
Hassan
was
an
associate
executive,
non-executive
or
other.
A
We
asked
to
provide
some
oversight
of
what
is
going
on
as
an
independent
to
the
program,
but
also
as
a
link
to
the
board,
and
we
said
at
the
last
meeting
that
we
would
find
like
terms
of
reference
and
publish
them
which
we
have
done
so
the
terms
of
reference
are
now
on
the
website,
totally
consistent
with
what
we
discussed
previously
so
ali.
A
You
chair
the
review
board,
perhaps
you'd
like
to
make
some
initial
comments
about
how
that's
going
from
your
perspective
and
then
Scott
duraraj
who's
leading
much
of
this
work.
Perhaps
we
could
ask
you
to
give
us
a
an
update
ahead
of
the
March
meeting
but
Ali
over
to
you.
I
Thanks
very
much
and
I'll
keep
it
brief.
We
introduced
the
review
and
discussed
it
briefly
at
our
last
board
and
the
main
messages
I'd
like
to
give
is
an
introduction
to
what
Scott
will
talk
about.
Firstly,
we're
making
good
progress
on
both
the
first
phase
and
the
second
phase
of
the
review.
You'll.
Remember
that
the
first
phrase
is
a
fully
external
review
undertaken,
By
Zoe
11th
on
QC.
I
The
second
point
to
raise
I
think
is
that
there
are
a
wide
range
of
areas
that
are
being
covered
and,
while
we're
making
good
progress
in
all
of
them-
and
the
review
will
conclude
in
April
by
April,
there
is
going
to
be
continued
areas
that
we
need
to
focus
on
as
an
organization
as
you'd
expect,
with
a
review
like
this,
for
us
to
embed
as
an
organization
and
to
continue
getting
better
at
the
substance
of
what
we
do.
I
The
third
point
to
raise
to
is
that
there
will
be
areas
that
are
to
some
degree
challenging
some
of
which
we've
identified,
some
of
which
will
be
some
news
to
us
and
we're
all
committed,
I
think,
there's
an
organization
to
really
coming
out
of
this
review
as
strongly
as
we
can
and
being
a
more
effective
organization.
I'd
also
like
to
thank
everyone
involved
in
undertaking
the
work,
because
people
have
been
working
extremely
hard
on
this
program
and
have
worked
with
real
professionalism
and
commitment
to
deliver
what
we
need
to
Scott
over
to
you.
Thanks.
J
Thank
you
chair
and
thank
you
Ali.
You
know
so
I
think
it
may
be
just
helpful
as
a
reminder
that
one
of
the
core
underpinning
pieces
of
this
work
was
to
ensure
that
we're
building
confidence
and
credibility
in
in
the
public
and
our
within
our
stakeholders
and
our
own
staff
and
we've
continued
to
do
that.
J
We
have
extended
our
our
governance
structure
with
a
third
member
Aaron
Robson,
again
the
details
of
all
online
as
normal
process,
but
that's
an
important
part
of
the
review
to
have
that
level
of
Independence
scrutiny
into
both
the
work
we
do,
and
also,
of
course,
the
recommendations
and
findings.
J
So
again,
yeah.
Just
following
what
Ali
was
saying.
J
The
Zoe
Leventhal
piece
is
completely
independent
in
these
King's
Council
LED
about
Jerry,
and
we
have
been
engaging
to
make
sure
that
for
a
number
of
key
pieces
to
make
sure
that
we're
obviously
examining
different
sets
of
data
and
also
to
make
sure
that
our
our
kind
of
emerging
things
are
online
and
we're
not
missing
anything
which
is
I,
think
is
working
really
really
well
and
of
course,
Zoe's
part
because
I
have
received
some
some
questions
that
have
come
in
about
an
inauthentic
way,
but
I
think
I
just
need
to
answer
was
what
is
this
review
unpicking
the
tribunal,
which,
of
course
it's
not
in
the
terms
of
references?
J
The
chair
has
said:
are
there
this?
The
the
judgments
for
the
tribunal
were
accepted
in
full,
and
this
was
actually
to
to
look
at
the
protected
disclosures
from
the
MR
Kumar
made
and
the
handling
of
those
and
if
race
had
an
impact.
I
just
thought.
J
It
was
useful
just
to
restate
that
if
there
is
any
confusion,
especially
with
people,
maybe
watching
online,
we're
making
really
good
progress
as
I
say,
phase
two,
we
have
five
work
strength,
five
work
streams,
all
of
which
are
reporting
Korean
on
progress
and
we'll
all
be
reporting.
As
of
the
29th
board,
the
report
will
be
in
two
halves,
as
you
may
expect,
because
the
king's
Council
review
that
Zoe
is
leading,
of
course,
has
to
stand
alone
as
fully
independent
and
then
they'll
be
phase
two.
J
It
is
likely
that
it'll
appear
obviously
on
the
website
as
a
a
continuation,
because
it
is
a
holistic
view.
It's
a
number
of
issues
to
hit
last
year
that
we
needed
to
respond
to.
J
J
We've
made
sure
that
the
data
samples
as
I
say,
are
separate
and
just
to
make
sure
we're.
Not
leaving
anything
behind,
there's
been
a
high
level
of
internal
engagements
for
staff
networks
and
I'd
like
to
thank
the
staff
networks
and
trade
unions
and
those
who
have
been
undergoing
organizational
change
about
200
150
to
200
colleagues,
who
have
engaged
in
supporting
this
work.
I
would
like
to
obviously
thank
them
for
helping
us
get
to
this
stage
and
making
the
improvements
and
the
findings
Etc
face.
J
The
the
the
key
other
elements
that
we've
kind
of
looked
at,
as
you
may
expect,
are
obviously
policies,
processes,
systems
and
culture
and
they've
been
examined
across
most
work
streams.
We
are
looking
at.
The
review
will
have
approximately
one
third
of
findings,
one-third
of
recommendations
and
to
show
that
we
have
heard
we.
We
have
heard
at
University
that
people
are
concerned
of
will
the
secretion
deliver
the
improvements
or
the
recommendations
and
I'm
confident
by
obviously
working
here
and
having
those
discussions
at
the
board
are
committed
to
do
that.
J
So
there
will
be
one
third
of
the
review
also
focused
on
the
evaluation
and
how
that
adobe
recommendations
for
how
it
should
be
evaluated
going
forwards.
It
give
that
Assurance
of
progress
and
delivery
and
that
just
lastly,
obviously
to
thank
Mr
Kumar,
who
was
engaged
both
with
Zoe
and
myself,
on
trying
to
conclude
this
review
in
the
most
timely
manner
and
detailed
manner.
In
fact,
you're
accurate,
I
know
as
possible.
A
Thanks
very
much
Scott,
so
questions
from
all
comments
from
colleagues.
D
Book
well,
I,
don't
have
a
question
chairman,
but
I
would
really
like
to
thank
Scott
for
everything
that
he's
taken
on
here
and
just
his
diligence.
I've
had
several
conversations
with
him
and
I'm
very
confident
that,
as
he
says,
we
will
have
a
report
that
we
can
respond
to
effectively
and
it
will
have
been
very
diligently
reproduced.
So
thank
you,
Scott
and
thanks
Sally,
also
as
a
colleague
for
chairing
this
process.
A
A
Obviously
the
board
can
see
and
note
the
findings.
We
don't
have
any
input
to
them.
I
mean
they
will
be
what
they
will
be,
but
it'd
be
helpful
to
have
some
management
views
or
responses
to
how
issue
is
going
to
be
addressed.
I,
don't
think
we'd
expect
them
to
be
complete
at
that
stage
you
won't
have
had
a
chance
to
do
it,
but
but
obviously
we'd
like
to
know
how
things
are
going
to
be
addressed.
Some
will
be
detailed.
A
Some
of
the
slightly
vigorous
to
the
sort
of
the
process,
so
I
presume
we'll
be
able
to
do
that,
and
then
we
clearly
can't
agree
it
now,
but
I'm
picking
up
on
your
point
about
whether
people
think
anything
will
change
as
a
result.
We
will
need
a
mechanism
to
look
back
in
six
to
12
months
time
and
say
so.
You
know
this
is
what
we
said
there
that
has
anything
changed
so
I,
suppose
I
posit
that
for
confirmation,
you're
nodding
beverage
to
change
it
and
I'll
pick
up
with
you
as
well.
A
The
the
question
was
that
a
big
chunk
of
this
is
looking
at
people
who
are
not
employed
by
us
and
who
live
within
cultures
that
we
don't
control
reporting
to
us.
So
we
can
look
at
what
we've
done
with
something,
but
presumably
there
will
also
be
findings
or
potential
learnings
for
bodies
other
than
CQC.
A
Maybe
it's
too
early
for
you
to
comment.
If
you
don't
know
what
those
will
be,
but
I
just
wondered
whether
we've
given
any
thought
to.
If
we
have
those
learnings,
we
can
make
those
visible
too
and
useful
to
people
we
regulate,
and
indeed
others
in
the
wider
system,
rather
than
just
CQC,
because
I'm
making
an
assumption
here
that,
while
some
of
what
you
come
up
with
is
very
specific
to
us,
you
know
we
either
don't
have
a
policy
or
we
don't
have.
A
The
right
policy,
for
example,
is
us,
but
I'm
rather
suspecting
that
we
are
in
part
reflection
with
the
system
which
we
operate
and
therefore,
what
comes
out
of
this
will
not
be
just
just
for
us.
So
the
interest,
confirmation,
I
guess
of
the
first
point
and
Ian
may
wish
to
add,
but
then
I'd
be
interested
in
your
views
on
the
second
or
Chris
may
have
a
view
as
well.
A
B
I
think
I
think
I
I'm
I
would
say
that
this
review
is
is
very
well
timed
at
the
moment
because,
as
you,
we're
obviously
going
through
our
transformation
process
that
there'll
be
recommendations,
I'm
sure
around
process
there'll
be
recommendations.
Around
technology
there'll
be
recommendations
around
culture,
all
of
which
are.
We
are
currently
working
on
so
I'm
I'm
hopeful
that
we
will
be
able
to
dock
each
of
these
recommendations
into
it
into
an
active
and
program
managed
work
stream.
B
G
Think
and
I
probably
speak
before
Scott
Scott
says
this
and
I
think.
The
first
thing
is
to
make
sure
that
we
understand
and
learn
lessons
for
ourselves,
but
I
think
you
know
going
back
to
what
I
said
about
safety
through
learning
earlier.
There
is
also
an
opportunity
to
I
think
to
to
to
to
Showcase
what
we
are
learning
and
what
we
are
encouraging.
Others
to
learn,
but
I
think
this
starts
I.
Think
the
March
conversation
is
very
much
about
what
are
we?
What
do
we
take
away
from
this
ourselves?
How
do
we?
G
How
do
we
want
to
position
what
we
would
might
learn
from
ourselves
and
absolutely
then
getting
into?
Therefore,
what
would
you
expect
us
to
do,
but
I
think
the
the
first
part
of
that
the
learning
for
ourselves
is
is
critical
in
March.
J
I'd,
like
I'd
like
to
come
back
if
I,
if
I
can
so.
First
of
all,
thank
you
Mark
for
your
kind
comments
and
I'd
just
like
to
it's.
It's
a
it's
been
a
a
huge
team
effort,
actually
where
people
at
all
grades,
all
really
working
hard
to
make.
This
review
be
meaningful
and
tangible
to
those
people
who
may
not
have
experienced
what
we
would
have
liked
them
to
experience.
I
just
wanted
to
to
just
widen
that
that.
J
Thank
you
if
I
may,
with
regards
to
the
the
evaluation
piece,
I
think
it
is
important
that
again
the
independent
review
panel
or
board
should
I
say
they
will
give
some
ideas
on
how
an
evaluation,
independent
evaluation
can
be
done
again.
So
just
help
keep
a
confidence
and
credibility
there,
as
well
as
each
of
the
workstream
leads,
have
worked
on
an
evaluation
technique
that
is,
is
Meaningful
as
well
and,
as
Chris
did
say,
I
think
it
is
important
when
we
receive
it
just
to
hold
on
ourselves.
J
For
that
moment,
because
I
think
people
will
look
for
us
to
do
that
and
then
I
think
there
will
be
because
obviously
I've
got
a
little
bit
more
insight
onto
some
of
the
the
emerging
tracks.
There
will
be
opportunities
for
us
to
learn
from
others
who
may
do
some
elements
better,
but
then,
as
as
we
say,
really
sharing
that
transformation
and
improvements
and,
of
course,
the
tangible
benefits
it
delivers
to
our
people.
A
Okay,
thanks
I
mean
Chris,
just
part
of
responding
to
you,
I
mean
I
totally
get
that,
and
first
and
foremost,
we
need
to
look
at
this
ourselves
and
if
we
didn't
do
that,
the
right
way
the
risk,
as
it
might
look
without
deflecting
on
that.
That's
not
what
it's
about.
On
the
other
hand,
part
of
an
important
input
to
our
work
is
information
provided
by
others
and
with
an
eye
to
our
role
on
safety
of
others.
A
If
we
only
if
we
were
to
stop
I'd
only
breaking
changing
things
internally,
without
thinking
how
we
might
persuade
others
to
change
which
would
improve
the
frequency
and
quality
or
whatever
of
reporting,
where
things
are
going
wrong,
then
we
will
have
missed
a
trick
and
won't
be
serving
the
populist
right.
So
I
I
absolutely
agree.
Let's
take
it
in
steps,
but
I
I
wouldn't
want
to
on
the
30th
of
March
found
that
everything
was
only
about
us
and
we
weren't
giving
thought
to
what
learnings
for
the
wider
system
no.
G
We
are
signaling
to
the
wider
system
that
we
are
making
Necessary
changes
and
therefore
encouraging
others
to
do
so
and
I
think
it's
an
important
that
for
us
that
we
can
go
back
to
the
reviews
we've
done
in
the
past.
Around
learn
disabilities
and
autism.
We've
taken
some
steps
ourselves
to
improve
what
we're
doing,
and
we
call
upon
others
to
improve
what
they're
doing,
but
I
think
that
it's
an
important
step
that
we
are
demonstrating
our
leadership
and
looking
for
others
to
support
us
in
that.
In
that
space.
F
It's
kind
of
more
a
reflection,
but
it's
it's
became
something
that
that
Chris
just
said:
I
mean
the
language
we're
using
about
making
plans
and
taking
action.
Yes,
absolutely
we've
got
to
to
respond
rapidly
and
robustly
to
whatever
the
conclusions
are,
but
where
those
conclusions
are
about
culture
and
confidence.
F
We
possibly
can't
go
straight
to
this
is
the
right
to
response
and
action,
because
those
are
things
that
we'll
probably
need
some
level
of
Engagement
across
the
organization
to
understand
what
what
how
has
this
culture
developed?
What
would
create
a
stronger
sense
of
confidence,
so
it
made
the
action
in
some
areas
is
sensibly.
We
need
to
carry
on
this
discussion
across
our
community
or
your
organizations
out
there
need
to
carry
on
this
discussion
across
your
community
do
to
get
to
the
right
answer
in
terms
of
culture,
change
and
confidence
building.
G
G
Let's
understand
that
for
ourselves
and
what
we
need
to
do
and
another
question
I
just
want
to
initially
from
the
chair
was
that
we
need
to
understand
it
for
ourselves
what
we
need
to
do
before
we
start
to
talk
to
other
people
about
what
they
need
to
do
and
I
think
that's
just
a
there's,
a
logical
step
for
me
about
understanding
what
it
is
that
we
need
to
do.
I
think
chess
points
is
a
senseful
one
is
that
there
will
be
learning
for
other
organizations
in
this
as
well.
J
Just
just
following
Stephen
there
so
and
again
it's
really
hard
because
you
haven't
had
the
detail
or
or
the
inside,
but
the
way
we
obstructed
the
review
and
the
reason
why
we
have
the
independent
expert
is
when
we
have
a
finding.
What
we
are
looking
to
do
is
use
evidence-based
research
and
the
best
skills
that
are
available
to
make
the
recommendations
either
just
to
make
an
improvement.
J
All
that
more
work
will
need
to
be
done
and
I
think
the
cultural
element
is
going
to
be
one
of
the
harder
ones
which
is
a
a
global
factor
when
there
are
control
challenges
to
be
improved
on,
but
we
we
have
got
the
expertise
who
are
helping
to
shape
some
of
that,
so
it
it
should
be
well
formed
with
regards
to
making
Clarity
what
is
an
action
and
what
is
further
work
that
needs
to
be
considered.
A
Okay,
thanks
very
much
Scott
any
other
Reflections
or
observations
doesn't
look
like
it:
okay,
well,
Scott!
Thank
you
very
much
indeed,
for
joining
us.
Sorry,
you
weren't
able
to
make
it
down
to
London,
but
thank
you
for
joining
us
Ali.
Thank
you
for
the
time
you
put
into
this.
So
we'll
await
the
the
findings
and
Reflections
on
them
in
March.
So
thanks
very
much
Scott.
A
We
move
on
to
the
corporate
performance
report.
There
is
quite
a
long
paper
here,
so
we
normally
try
to
work
on
the
bases.
Take
the
paper
as
read
I,
think
on
this
case,
it'll
probably
require
a
little
bit
longer
or
a
little
adjustified
a
little
bit
more
common
something
I
I
have
asked.
If
we
could
do.
There
are
some
areas
in
here
where
we
are
flagging
in
the
the
later
sections
of
performance
report
that
we
are
showing
as
red
or
out
of
appetite
and
I.
A
Think
it'd
be
helpful
for
the
board
to
understand
why
that
evaluation
has
been
reached.
Perhaps
more
importantly,
what
steps
we
are
proposing
to
take
to
bring
us
back
inside
appetite
so
I
I
pose
that
as
an
advanced
question,
I
corporate
rule,
like
I,
said
earlier:
Chris
Usher,
our
finance
director
has
an
immovable
commitment
this
afternoon,
so
he
can't
be
with
us.
A
So
I've
turned
to
Ian,
perhaps
just
to
introduce
the
report
overall
and
then
Tyson
and
then
we're
joined
on
the
team
by
Steph
Tarrant,
who
has
had
the
envirable
task
of
putting
most
of
this
information
together
for
us
anyway.
So
welcome
Steph,
Steph
works
and
and
Chris's
team
so
contribute
to
the
answers
to
the
questions.
I
already
opposed
and
those
that
I'm
sure
that
will
come
up
during
the
discussion.
But
Ian
do
you
want
to
pick
this
up.
B
Yeah
thanks
Ian
Tyson
is
going
to
cover
off
the
Lion
Share
of
the
operational
performance,
but
I
I
wanted
just
to
pick
up
a
couple
of
things
which
I
thought
were
what
I
wanted
that
were
worth
highlighting
as
we've
as
we've
talked
a
couple
of
times
during
this
meeting.
We
continue
to
take
a
risk-based
approach,
and
it
does
mean,
though,
that
the
average
ratings
are
appearing
to
fall
as
we
are,
as
we
are
mainly
going
to
higher
risk
services.
B
B
I
think
at
this
stage
to
to
make
some
solid,
long-term
assumptions
around
that
I
think
it
is
worth
just
just
noting
that
that
the
work
that
we're
doing
at
the
moment
is
flagging,
a
significant
amount
of
amount
of
risk
and,
to
some
extent
it
does
validate
the
the
overall
approach.
We're
taking
is
that,
if
we're
finding
that
nearly
40
of
services
are
are
requires
improvements
or
inadequate,
it
does
suggest
that
that
our
basic
hypothesis
around
going
to
high-risk
Services
is
is
broadly
correct.
B
I
think
I
would
like
to
just
pay
tribute
to
the
the
teams.
Who've
been
doing
some
good
work
on
on
whistleblowing
and
safeguarding.
They
were
areas
that
that
we
felt
were
really
important
and
I
think
in
terms
of
in
term,
in
terms
of
chasing
those
down
sure
that
the
information
that's
coming
in
is
being
is
being,
is
being
captured
and
processed
in
a
timely
way.
I
think
what
we've
seen
is
some
sustained
good
performance
over
the
last
over
the
last
few
months
in
that
area
as
well.
B
If
we
move
on
to
people
and
resources
by
the
end
of
December,
we
were
overspent
by
1.7
million
pounds
and
we're
forecasting
a
3.7
million
pound
Surplus
at
year.
End,
which,
which
is
I
think
is,
is
a
surplus
that
that
has
come
down
a
little
bit,
but
it's
about
where
we
thought
we
would
be
in
terms
of
capital
portfolio.
The
portfolio
will
overspend
by
2.9
million
pounds
at
year
end
and
we've
been
discussing
with
the
Department
of
Health
and
Social
care.
How
we,
how
we
resolve
that?
B
The
other
thing
I
just
wanted
to
flag
up
before
handing
over
to
colleagues
is
the
high
digital
satisfaction
rates.
On
page
four
of
the
of
the
report
again
I
think
that's
just
again
a
testament
to
some
of
the
work
we've
been
doing
on
new
website
new
web
services
and
the
fact
that
people
are
seeing
those
as
a
as
a
really
a
really
positive
development
of
the
of
the
overall
service
that
we
make
but
chair
if
I
could
hand
over
to
Tyson
to
talk
in
a
little
bit
more
detail
about
his
area.
H
Thank
you,
Ian
I
mean
the
the
paper
in
the
slide
speak
for
themselves
as
you
as
you're
saying
so.
I
won't
go
through
them.
I'll
just
highlight
a
few
more
slides
and
than
the
ones
that
he
and
Ian
has
already
highlighted.
H
I
think
the
first
one
is
is
number
25
that
talks
about
regulatory
activity,
so
this
is
regulator,
activity
which
is
an
inspection
or
a
direct
monitoring
approach
to
which
we've
added
a
public
statement
and
the
figure
the
figure
currently
is
the
latest
fig
with
56.5,
which
is
actually
an
increase
on
the
last
quarter,
which
was
55.2
percent
I.
Think
the
other
point
I
would
make
here
is
that,
because
of
our
risk-based
approach,
we
do
sometimes
keep
going
back
to
the
same
providers.
H
Ian's
already
talked
about
the
Fly
26,
so
I
won't
I
won't
cover
that
other
than
to
say
that
now
that
we've
committed
to
do
a
several
hundred
Improvement
inspections
in
adult
social
care,
where
we're
hoping
to
raise
with
good
evidence
ratings
from
required
Improvement
to
good,
for
example,
that
should
start
to
see
the
number
of
good
and
outstanding
made-
maybe
tick
upwards
again,
but
that's
the
largely
as
a
result
of
our
our
change
in
posture
and
I.
H
Think
it's
still
worth
looking
at
the
the
data
over
the
course
of
a
year.
The
next
slide
I
want
to
talk
to
is
28
about
registration,
where
I
think
it's
probably
fair
to
say
that
we're
we're
not
we're
not
on
target
to
meet
the
business
plan
measure,
which
is
around
timeliness
of
different
types
of
applications.
What
I
would
say
about
that,
though,
is
that
what
we
have?
What
we
I
think
have
chosen
to
do
instead
almost
is
to
focus
on
the
good
health
of
the
case
working
system.
H
And
if
you
look
at
the
figures
underlying
some
of
these,
you
will
see
that
the
current
volume
of
work
in
the
system,
the
current
number
of
applications
rate
waiting
to
be
approved,
is,
is
now
lower
than
it
has
been
for
some
time
at
just
over.
Seven
thousand
I
think
it
peaked
at
8.
000
steps
we'll
probably
have
the
have
the
correct
figure,
but
I
think
it
peaked
at
eight
thousand.
So
the
team
had
done
a
really
good
job
on
getting
that
down.
H
The
the
productivity,
the
amount
of
applications
being
Pro
50
each
month
is
still
very
high
and
is
over
three
thousand
a
month
and
was
over
three
thousand
a
month
again
for
January,
and
one
figure
that
we
have
focused
on
in
this
board
before
number
of
applications
that
are
over
28
days,
old
they're
ready
to
be
dealt
with,
but
they
haven't
been
dealt
with
yet
that
reached
a
peak
of
nearly
1800
in
September
and
is
currently
down
to
around
1200
and
that's
the
lowest
since
May
22,
so
clearly
more
work
to
do,
but
very
much
a
good
direction
to
travel,
and
actually
we
have
been
bringing
in
some
of
the
older
work
in
the
system.
H
H
The
flight
or
number
number
30
I
think
it
is,
is
to
do
with
triggers
of
concern
and
I.
Think
what
that
shows
is
really
just
highlighting
our
our
approach
over
the
last
few
months
has
been
to
focus
on
risk,
and
we
now
have
83
percent
of
our
inspections
are
risk-based,
although,
as
I
said,
that
will
probably
change
with
the
with
the
change
of
focus
on
adult
social
care
inspections,
and
that's
probably,
that's
probably
it
in
terms
of
operational
performance
other
than
slide
36,
which
is
to
do
with
timeliness
of
publishing
reports.
H
And
this
is
something
that
we
we
continue
to.
Focus
focus
on.
You'll
see
an
improving
picture
on
that
slide,
but
also
there
are
still
a
number
of
reports
that
are
still
to
be
published
from
November
and
December.
In
particular,
a
number
of
those
will
take
longer
than
maybe
we
had
planned
because
there
may
well
be
enforcement
work,
that
we
are
we're
undertaking
with
the
provider
and
so
I
think
we'll
get
a
more
accurate,
more
accurate
picture
going
forward.
H
But
I
just
wanted
to
give
the
board
some
reassurance
that
this
continues
to
be
a
focus
for
us.
From
an
operational
point
of
view,
the
rest
of
the
slides
talk
about
transformation
which
we've
covered
as
some
of
the
HR
and
finance
issues
that
Ian
has
covered
and
then
I
think
we
move
on
to
risk
so
should
I
pull.
Certainly
in
for
you
to
to
start
the
discussion,
then
we
can
pick
the
risk
points
up
again.
Okay,.
A
Thanks
so
much
Tyson,
so
questions
for
comments
from
colleagues
Linda.
K
And
this
relates
to
the
staff
sicknesses
deliver
our
people
plan,
monitor
percentage
of
sickness,
triggered
by
stress
and
I
just
wanted
to
have
any
sense
of
the
levels
of
sickness
for
stress
and
mental
health.
It
was
related
to
work
or
not,
and
also
doing
Benchmark
sickness
against
other
organizations.
H
Okay,
I
think
when
I
we
had
a
discussion
about
this
at
my
my
board,
which
clearly
looks
at
just
just
the
just.
The
operational
teams
and
I
I'll
get
I'll,
get
the
figures
for
you,
but
but
it
is
complicated.
I
think
the
highest
proportion
of
stress
related
and
fitness
is
to
do
with
things
going
on
in
someone's
private
life,
then
I
think
we've
got,
we've
got
work
based
stress
and
then
we've
got
a
mixture
of
the
two.
H
D
Thanks
chairman
and
Tyson
thanks
for
a
very
thorough
deck
of
papers
and
also
to
you,
Steph
thanks
very
much
very
pleased
Echo.
What
the
chief
exec
said
about
our
performance
with
whistleblowing
could
I
ask
you
to
look
at
chart.
33
I'm,
not
sure
this
is
a
question
for
you
Tyson.
It
might
be
a
question
for
Mark,
but
this
is
the
chart.
D
That's
looking
at
services
that
require
enforcement
action
following
regulatory
activity
and
the
footnote
states
that
it
should
be
noted
that
the
there
is
a
lag
in
enforcement
actions
being
published
and
therefore
November's
and
December's
data
is
likely
to
have
a
greater
proportion
of
breaches
and
the
way
I've
read
that
that
looks
like
we.
We've
got
the
data,
but
we've
not
been
able
to
manage
it
to
get
it
into
this
report,
and
you
know
seeing
as
data
is
a
very
important
part
of
our
strategy
and
being
a
smart
regulator.
L
Yes,
I'm
is
that
okay,
Ian
I'm
yeah
I'm
delighted
to
to
to
to
answer
that
and
say:
yes,
you
are
interpreting
correctly,
but
we'll
we'll
update
the
the
the
narrative
in
here
to
make
it
Crystal
Clear.
L
What
that's
saying
so
it's
it's
not
that
we
don't
have
an
issue.
It's
not
that
we
have
an
issue
with
the
data.
L
L
It
is
simply,
we
don't
have
that
information
yet
so
when
we
get
to
the
the
the
the
February
and
March
versions
of
this
report,
you'll
see
those
numbers
increase
and
we
would
expect
you
know,
there's
a
run
rate
there
of
about
30
percent
we'd
expect
that
to
to
hit
those
levels
once
we
have
that
information,
but
not
not
a
data
issue
but
but
you're
quite
right,
it's
slightly
misleading.
D
Okay,
well,
thank
thanks
for
clarifying
that.
It's
just
you
know,
I
wanted
to
to
be
sure
that
we
are
not
managing
data
poorly
and
so
you've
reassured
me
on
that.
So
thank
you.
M
Thanks
Chad,
two
quick
things
from
me:
page
27
in
the
pack,
just
on
the
the
chart
on
the
right
hand,
side
unable
to
determine
was
about
a
third
of
the
of
the
sample
and
I
was
just
surprised
that
trying
to
understand
that
seemed
a
bit
that
seemed
quite
High
to
me
and
I
was
wondering
why
that
was
high
and
then
my
second
question,
which
I
know
we've
talked
about
before,
but
I
think
we
just
and
it's
you
know
on
page,
35
and
elsewhere.
M
I
think
we
just
need
absolute
Precision
about
out
of
hours
and
when
we
we
talk
about
out
of
ours
and
and
inspections
with
an
absence
of
ours
element,
and
we
just
need
to
be
Belinda.
Our
nose
raised
this
before.
We
need
to
be
very
clear
when
we're
talking
about
an
inspection
which
runs
past
the
end
of
the
day,
compared
to
an
inspection
at
a
weekend
or
in
the
middle
of
the
night.
H
I
can
certainly
pick
up
on
those.
Thank
you
on
the
first
one
Steph
may
may
want
to
come
in
as
well,
but
I
think
a
factor
may
be
that
if,
if
it's
the
provider
that
we've
not
rated
in
the
past
or
we've
done
an
inspection
that
have
not
been
rated
on
the
out
of
hours,
you're
right
Mark
this.
H
We
are
doing
a
project
now
from
within
the
Hub
in
my
area
to
look
at
how
we
can
do
how
we
can
set
our
teams
up
with
support
and
and
incentives
to
do
proper
out
of
hours,
work
we're
starting
to
gauge
the
trade
unions
on
that
so
I'm,
hoping
that
fairly
soon
we'll
be
able
to
come
to
the
board
and
give
you
the
outcomes
about
studying,
but
they're.
Definitely
something
we
want
to
do
and
as
we
as
we
look
move
forward
with
our
wanting
to
implement
the
Ripper
Powers.
H
The
that
you
have
gave
us
permission
to
use
last
year,
clearly
out
of
hours
activity
will
be,
will
be
important.
N
I
wanted
to
add
is
there
is
a
piece
of
work
to
be
done
in
regulatory
leadership
about
what
does
best
practice
look
like
so
we
know
we've
placed
a
real
emphasis
on
increasing
out
of
hours,
visits
for
services
for
people
with
learning
disabilities
and
autistic
people.
What
does
that
look
like
for
people
in
mental
health,
inpatient
units
in
dementia
settings
Etc?
So
as
well
as
doing?
N
How
do
we
support
our
staff
to
do
this
well
and
make
sure
all
of
our
proper
process
are
in
place
to
keep
our
staff
safe
for
out
of
hours
work?
There's
a
piece
of
work
around.
What's
regulatory
leadership's
ambition
about
what
percentage
of
inspections
should
have
an
out
of
hours
component
and
we're
on
the
case
with
that.
A
Thanks
Belinda
any
other
questions
before
we
move
to
a
risk,
I
mean
I.
I
just
had
a
a
couple.
If
I
could
I
was
gonna
pick
up
on
this
time
to
to
issue
reports,
which
we've
already
commented
on
and
said
that
the
the
right
hand
draws
the
right
hand
out
of
the
child.
It
will
change,
as
other
things
are
issued,
I
mean,
presumably
the
easier
ones
get
issued
first.
A
So
it's
the
more
complex
ones
later,
but
I
wondered
if,
if
you
could
say
any
more
or
two
things
really
one
is,
could
you
say
any
more
about
the
overall
trend
of
how
it
has
been
achieved?
I
mean
delighted
it
has
been
achieved,
but
what
measures
have
we
taken
to
get
things
out
more
quickly?
A
It
would
be
useful
to
understand
both
in
terms
of
Maintenance
of
quality,
on
the
one
hand,
but
also
how
can
we
can
continue
that
trajectory
and
get
that
figure
very
much
lower,
because
it
is
still
quite
a
long
period
of
time
before
the
public
knows
what
we
think
and
it
would
be
nice
to
to
get
that
down
and
as
a
related
Point.
A
Maybe
this
is
more
for
Ian,
but
given
what
he
introduced
earlier
at
his
remarks
or
the
last
paper
about
the
the
shift
and
the
way
that
we're
inspecting
in
hospitals
what
that
might
have,
in
fact
that
might
have
on
on
Timeless
of
issue
of
reports.
So
that's
a
a
2.1
question
and
then
just
to
the
point
of
detail
on
slide,
34
The
Heading
is
monitoring
the
percentage
of
civil
enforcements
which
receive
representations
and
the
outcome
of
those
representations.
A
H
If
I,
if
I
can
I'll
take
the
first
one,
then
maybe
I
can
hand
over
to
Steph
for
the
second
one,
because
you're
you're
right
I,
don't
think
it
is
covered
in
in
the
chart
in
terms
of
reports.
I
think
that
I
think
the
trend
has
been
fairly
stable
over
over
the
recent
period
with
adult
social
care
reports
taking
less
time
to
complete
than
hospitals
reports,
quite
often
for
for
very
good
reasons.
H
I
think
some
of
the
reports
are
taking
longer
to
complete
because
we
can
be
involved
in
in
sort
of
significant
factual
accuracy
challenges
and
also,
if
there's
enforcement,
it
it'll,
take
longer
I
think
I
think.
The
reason
our
performance
is
good
is
that
we
have
a
very
clear
kpi
about
this
and
our
and
our
managers
and
our
and
our
teams
are
very
much
focused
on
the
kpi
and
we'll
do
what
they
can
to
meet
the
kpi.
H
Clearly,
what
we
don't
want
to
do
is
publish
something
that
isn't
right
or
something
that
we're
still
discussing
with
a
provider,
but
where
we
can,
our
teams
are
very
focused
on
getting
the
reports
published
because,
obviously,
although
we
will
alert
a
provider
to
to
anything,
that
is
an
emerging
that
we
find
while
we're
visiting
clearly
the
the
sooner
the
reports
are
better.
O
Shannon,
it
comes
back
to
what
man
said
earlier.
We
are
finding
that
there's
quite
a
time
period
between
the
different
ratings
in
their
publication,
and
that's
why
we
caveat
the
last
two
months
because
on
average
our
publication
is
around
34
days,
but
the
good
reports
take
substantially
less
time,
whereas
an
inadequate
reports
can
take
up
to
55
days.
O
So
that's
why
we
need
to,
for
both
enforcement
and
publication,
be
aware
that
actually
there
may
be
a
change
in
the
inspection
activity
from
November
December
are
some
of
those
reports
are
still
finalized
and
published
in
terms
of
the
representations,
and
we
are
working
on
kind
of
processes
to
better
capture
the
outcome
of
those
representations.
So
we
do
have
some
data
on
this,
which
we
can
absolutely
include
in
the
next
board
report.
O
We
capture
as
an
organization
whether
the
representations
have
been
upheld,
whether
they've,
whether
we've
continued
with
the
enforcement
action,
but
also
we're
making
sure
that
we're
able
to
capture
specific
scenarios
whereby
actually
we've
been
able
to
inspect
the
service
and
identify
it's
improved
or
where
the
representations
may
have
been
withdrawn.
So
we're
just
trying
to
enhance
our
reporting
in
this
area
rather
than
just
kind
of
upheld
or
not
upheld
and
really
get
into
the
individual
areas
of
that.
But
we
can
certainly
include
that
in
future
reporting.
A
Okay,
I
I
think
that
latter
point
would
be
really
quite
insightful
because
it
tells
us
something
about
the
the
way
in
which
we're
doing
this.
On
the
the
timing
of
the
reports,
I
mean
the
I
appreciate
that
more
complex
reports
take
longer,
but
the
problem
is
that
the
more
complex
reports
which
are
possibly
can
have
more
adverse
findings
are
the
more
important
ones
on
the
users
of
the
the
system.
A
So
there's
a
there's
a
mismatch
there
between
the
importance
of
what's
going
out
on
how
long
it
takes
us,
I
I
would
encourage,
particularly
as
this
simplify
some
other
things
to
see.
If
that
can
be
shortened,
I
don't
know,
for
example,
whether
there's
any
flexibility
to
look
again
at
how
long
the
people
we
inspect
have
to
to
respond.
I
mean
if
you
contrast
with
ostler,
for
example,
they
tend
to
give
two
or
three
days
and
that's
it,
which
can
be.
You
know
in
the
dance
you're
getting
a
report.
A
B
Can
I
just
pick
up
on
that?
I
I
mean
at
the
moment
we
are
being
very
pragmatic
about
the
factual
accuracy
process,
particularly
with
larger
organizations
like
NHS
trusts,
given
how
busy
they
are
so
we're
taking
a
a
as
a
pragmatic
view
where
people
are
asking
for
for
more
time,
so
that
was
slain
so
much
about
slightly
moving
in
the
opposite
direction
to
the
one
you
were
just
describing.
But
but
it
is
something
I
know
that
we've
been
we've
been
talking
about
more
broadly
as
part
of
transformation.
B
As
we
start
to
change
our
our
methodology,
I
think
we
will
start
to
find
this
factual
accuracy
issue
starts
to
go
away.
B
B
M
Thanks
Mark
sorry
I
can
ask
another
question:
if
I
mate,
you
know
we
know
we
know
you
know.
We've
talked
previously
about
the
pulse,
server
results
and
I.
Think
we,
you
know,
we
know
the
we're
familiar
with
the
data
that
is,
that
is,
that
has
underpinned
the
the
the
ratings
on
on
page
39,
but
it
would
be
I
think
interesting
to
hear
an
update
on
the
progress
that
we've
made
with
the
the
colleagues
who
volunteered
to
help
us
work
through
those
issues
and
help
us
develop
a
plan.
N
Thank
you
so
you're
talking
about
us,
our
Advisory
Group
thanks.
So
much
so
we'll
cover
that
a
little
bit
in
the
people
update
in
the
next
agenda
item.
But
if
I
just
Trail
it
and
then
our
people
director,
Jackie
Jackson,
will
talk
to
it.
So
so,
as
you
know,
in
response
to
our
pulse
survey
results,
we
wanted
to
bring
together
a
group
of
colleagues
to
help
steer
us
about
where
we
should
focus
our
efforts.
N
There
was
fabulous
take-up
from
people
putting
themselves
forward
to
the
point
that
there
needed
to
be
a
little
process
run
in
each
of
the
directorates
for
nominated
people
to
go
and
they
had
their
first
meeting
I.
Think
he
and
you
you
attended.
So
it's
it's
up
and
running
Jackie
can
give
you
an
update
in
the
next
agenda
item,
but
it's
really
key
that
they
are
involved,
steering
us,
but
also
that
we
quite
quickly
turn
that
into
some
concrete
things
that
we
can
commit
to
doing
differently
as
a
result
of
it.
A
Okay
thanks,
if
there's
no
other
questions
on
the
detail,
I
don't
know
who's
going
to
pick
this
up,
but
perhaps
the
question
I
posed
right
at
the
outset.
If
someone
could
comment
on
the
the
the
things
that
are
evaluated
read
on
the
risk
profile,
some
I
think
are
very
obvious.
A
Why
they're
red,
because
we
picked
it
up
in
other
areas,
but
but
I
suppose
my
interest
is
not
so
much
why
it's
red,
although
you
need
to
understand
that,
but
some
actions
on
an
understanding
of
what
we're
doing
to
bring
it
back
with
intolerance
and
I.
Think
we've
also
discussed
that
for
future
reports.
Maybe
that
will
be
incorporated
as
part
of
the
commentary,
but
so
that's
for
the
future.
A
Just
for
today
can
you
expand
a
little
bit
on
what's
in
there
it's
there
for
you
again
to
do
that,
or
is
that
Tyson
I.
H
Mean
shall
I
kick
off.
Maybe
Steph
can
talk
about
how
the
judgments
were
made,
as,
as
you
were
very
closely
involved
in
putting
the
the
new
approach
together,
but
in
terms
of
the
actions
Ian
each
of
the
ACT,
each
of
the
each
of
the
risk
owners
will
will
have
put
together
a
list
of
actions
that
need
to
be
taken
in
order
to
bring
the
to
bring
the
risk
into
into
a
tolerable
sense
of
sense
of
appetite
if
I
use
for
an
example
the
one
to
do
with
productivity.
H
H
We
were
also
are,
as
as
we've
discussed
previously
looking
again
at
our
productivity
tool,
so
that
we
can
measure
our
productivity
more
accurately
and
as
we
move
into
our
new
integrated
teams,
we
are
helping
our
our
managers,
our
new
operations
managers,
to
to
have
all
the
tools
they
need
in
order
to
manage
operational
performance.
H
O
O
The
process
that
we
go
through
is
look
at
as
Tyson
says,
the
the
risk
owners,
but
we
also
have
a
senior
leadership
group
and
which
focus
on
risk
and
have
a
cross-directorate
challenge
on
the
mitigations
and
I
think
in
terms
of
the
the
ones
that
are
are
read.
To
be
honest.
There
was
a
sense
of
caution
in
that
and-
and
the
group
were
very
clear
in
terms
of
only
mitigating
the
risk
whereby
we
can
see
that
the
action
has
truly
come
to
fruition.
O
So
in
quite
a
number
of
the
risks,
there
is
actions
that
have
been
put
in
place
so
things
around
the
transformation,
there's
clear
plans
in
place
now,
but
because
they're
in
its
infancy-
and
there
is
confidence
there,
but
we
haven't
seen
in
that
mitigation
come
to
fruition.
Yet.
So
there
is
confidence
that
there's
plans
in
place,
but
we
just
wanted
to
be
sure
that
we
were
able
to
truly
mitigate
those
risks
and
the
agreement
was
to
kind
of
keep
them
as
they
were
and
review
them
in
the
future
months.
O
A
Okay,
thanks
I
mean
I
focused
on
the
the
red,
because
there's
only
six
of
them
and
that's
the
things
that
ought
to
be
of
most
concern
to
the
board,
but
whilst
I,
don't
any
organizations
ever
been
totally
within
rascotype
for
everything
it
does
for
all
time.
The
fact
is:
there's
an
awful
lot
in
here:
the
majority
where
we
exceed
the
appetite
and
it
would
be
helpful
to
I,
don't
want
to
make
this
too
come
some
reporting,
but
the
expectation
would
be
that
every
time
we're
not
with
an
appetite
we're
doing
something
about
it.
A
It's
just
the
priority
is
those
that
were
completely
up.
You
know
out
any
sort
of
reasonable
tolerance,
so
I
think
if
you
know
we
need
to
be
pragmatic
about
this.
We
don't
want
the
75-page
report,
but
I
think
if
we
could
have
an
understanding
of
the
actions
and
it
helps
the
Board
understand
if
there
are
any
gaps
and
narrow
things
that
need
to
be
done
might
also
help
prioritize
views
on
on
investments,
because
inevitably
there
are
some
things
where
the
response
will
be.
A
We
can't
do
it
without
spending
some
money
and
then
the
question
is:
is
that
spend
justified
in
priorities
to
others?
So
you
know
this
is
a
journey,
but
I
think
it
would
be
helpful.
A
The
other
thing
that
I
think,
if
in
terms
of
board
reporting
staff,
if
we
could
find
a
way
of
commenting
on
the
direction
of
travel,
so
that's
probably
particularly
true
with
some
of
the
the
ambers
here,
but
but
an
Amber
with
a
set
of
actions
or
even
a
red
with
a
set
of
actions
where
we
can
see
the
risk
is
being
addressed
and
coming
down
is
rather
different
from
something
where
it's
just
getting
worse.
That
used
to
be
green
and
is
now
Amber
and
it's
Amber
heading
red.
A
So
again,
don't
want
a
75
page
document,
but
even
using
arrows
to
indicate
directional
travel
I
think
would
help
us
focus,
and
indeed
the
executive
focus
on
the
the
key
things,
but
thank
you
very
much,
Tyson
and
stuff
for
that.
So
that
was
kind
of
my
request,
but
anything
else
people
want
to
ask
will
be
done.
On
corporate
performance
report
looks
like
we're
done,
okay!
Well,
thank
you
very
much
indeed
stuff
for
joining
us
appreciate
it.
A
One
more
item,
and
then
we
have
a
comfort
break
so
Kate
glad
to
see
you
have
been
able
to
join
us.
I
explained
at
the
beginning.
You
were
with
a
minister
but
hope
you're
with
us
in
due
course,
so
quarterly
transformation
and
people
update
so
I'll
hand
this
to
you
a
norc,
I
think
Amy
and
Jackie
are
joining
us
but
I'll
hand
it
to
you
to
introduce
the
social
thank.
N
You
lovely
thank
you,
so
this
is
an
opportunity
for
myself,
Amy
and
Jackie
to
update
you
as
the
board
about
where
the
progress
we're
making
around
transformation,
but
also
an
update
on
our
people
and
the
work
we're
doing
to
support
them
around
change.
So
very
short,
intro
for
me
and
I'll
hand
over
to
Amy
and
then
she'll
hand
over
to
Jackie
for
the
highlights
in
the
paper
and
then
we'll
take
questions
so
Amy
over
to
you.
P
Great,
thank
you
very
much
Kate,
so
I
think.
The
main
thing
to
focus
on
in
in
this
update
for
transformation
is
the
work
that
we've
done
to
agree
how
we
will
roll
out
our
new
regulatory
approach
over
the
next
year.
So
we
have
split
this
into
four
key
phases
and
by
doing
that,
we
believe
will
deliver
a
better
experience
for
colleagues
providers
and
stakeholders,
but
also
make
it
easier
to
adopt
those
new
ways
of
working
that
are
coming
so
just
in
a
nutshell,
phase
one
is
around
transitioning
colleagues
to
integrated
teams.
P
Two
is
all
about
introducing
these
support
services
that
are
required
to
operationalize
that
regulatory
approach,
those
things
like
regulatory
governance
and
how
we
make
decisions
around
what
we
inspect
and
things
like
that
and
phase
three-
is
about
introducing
a
new
contact
service
and
that's
primarily,
primarily
story
around
making
sure
we
collect
the
right
data
in
order
to
really
start
to
drive
our
insight-based
approach
to
inspection
and
assessment,
and,
as
part
of
that,
we'll
also
introduce
an
enforcement
service
where
we're
looking
to
improve
the
current
process.
P
Finally
and
phase
four
is
really
about
introducing
our
new
assessment
Approach
at
a
provider
level,
but
also
really
scaling
our
approach
to
local
Authority
assurance
and
integrated
Care
Systems.
The
final
bit
that
I'll
just
mention
before
handing
over
to
Jackie
is
we've
spent
an
awful
lot
of
time,
reflecting
on.
What's
worked
well
so
far
in
transformation
and
was
what
hasn't
worked
quite
so
well,
and
we've
put
in
place
a
number
of
changes
moving
forwards
to
improve
things.
P
One
of
the
most
notable
things
that
we
are
going
to
be
doing
differently
is
the
way
in
which
we
involve
colleagues
across
the
organization
in
in
the
way
that
we
design
and
deliver
change.
Moving
forward
so
I'll
hand
over
to
Jackie,
now
who's
going
to
give
a
bit
more
detail
on
the
people's
side
of
things.
P
Q
In
addition
regarding
post
survey,
then
I'll
come
on
to
the
culture
which
will
build
on
Amy's
summary,
so
Paul
survey,
Advisory
Group
has
had
the
first
meeting
really
positive
feedback
from
that
and
the
next
date
as
far
as
action
is
the
24th
of
February,
and
this
is
where
our
directory,
working
with
the
advisory
colleagues,
will
pull
out
their
three
priorities
and
look
to
how
they
feed
into
a
directorate
action
plan,
which
then
can
be
monitored
and
reviewed.
Q
The
director
of
plan
would
be
owned
by
leadership
and
regularly
monitored,
and
the
advisory
survey
group
so
I
think
that's
the
the
localized
element
then
we're
looking
at
the
corporate
priorities.
Q
An
ET
ought
to
agree
those,
so
just
a
couple
of
points
on
pulse
survey,
but
moving
in
the
right
direction
in
terms
of
culture
coming
into
this
role,
I've
spent
some
time
looking
at
the
activity
that
has
already
been
started.
So
I
wanted
to
split
this
into
two
first
would
be
the
work
that
is
being
carried
out
by
our
Ops
colleagues
and,
in
particular,
the
transition
work
and
it's
really
making
positive
progress.
Q
So
looking
at
a
United
and
cohesive
leadership
team,
so
we've
had
two
days
of
deputy
director
induction,
which
had
really
positive
feedback
and
looking
to
build
on
that
with
managerial
colleagues,
as
we
go
forward
for
all
induction
and
support
between
February
and
may
there's
a
program
of
work
planned,
creating
the
environment
for
success,
so
that
will
consist
of
looking
at
good
endings
transition,
it's
positive
and
good
beginnings
and
then
how
we
look
at
Team
development
going
forward
with
regular
reviews
and
checkpoints
in
terms
of
the
success
and
priorities
within
that.
Q
So
in
the
operational
area,
we've
got
really
good
foundation
where
we
can
pull
work
forward
into
the
organizational
wild
culture
work.
So
there
would
be
a
significant
amount
of
that
activity
aligned
from
an
operational
perspective,
but
we'll
need
to
look
at
what
else
we
need
from
an
organizational
perspective
so
running
a
series
of
workshops.
Q
Executive
team
have
already
had
theirs
working
with
people
leads
next
week
to
really
start
to
explore
how
we
embed
the
culture,
what
we
need
the
culture
to
look
like
what
we've
learned
from
Ops,
what
we've
learned
from
change
and
consider
how
we
make
this
not
a
separate
project,
which
is
often
the
case
with
culture.
We
need
to
embed
this
and
really
look
at
how
we
pick
up
the
pace,
how
we
measure,
monitor
and
hold
each
other
to
account
with
that.
Q
Q
A
Okay
thanks
very
much
Jackie
thanks
for
for
joining
us
questions
from
colleagues
for
Kate,
Amy
or
Jackie
Tyson.
H
Sorry
to
come
in
again,
but
just
to
add
to
what
Jackie
said
about
the
interventions
in
operations
with
the
deputy
directors
and
also
with
the
operations
managers.
The
feedback
I've
had
from
those
who've
been
on
those
induction
events
has
been
really
strong,
so
I
think
that's
a
great
start
to
us
coming
together
in
our
new
team.
So
thank
you
to
Jackie
and
the
team
for
that.
H
A
M
Good
good
to
hear
progress
on
the
the
the
pulsive
advisory
group
that
is
different
and
I
think
we
knew
that
something
different
needed
to
be
done
this
year
in
terms
of
the
the
in
terms
of
ensuring
that
there
was
the
right
response
and
ensuring
that
that
response
was
seen
as
as
authentic
as
and
coming
from
the
organization
as
well.
I
I
think
the
you
know
I'm
glad
to
hear
that
you're
aiming
for
three
priorities.
M
M
It
needs
to.
There
need
to
be
things
that
cut
across
all
the
directorates
and
they
need
to
be
things
that
are,
you
know,
simple,
to
understand
and
are
you
know
very
measurable
at
the
end
of
the
day,
so
that
you
can
show
real-time
progress
in
relation
to
to
this
so
I
think
that's
great
and
and
yeah
look
forward
to
I'm
curious
to
see
what
what
emerges
I
think
it'll
be.
That
will
be
very
interesting.
Thank
you.
Yeah.
D
Thank
you
chairman
and
Amy
Jackie,
thanks
very
much
indeed
for
joining
us.
Thanks
for
the
paper,
I
think
I've
got
a
question
for
both
of
you.
We've
just
been
talking
about
people
risks
and
on
the
risks
we've
identified.
Haven't
we,
as
colleagues
don't
have
the
appropriate
skills
you
know
to
to
make
it
through
the
transformation
and
I
guess,
I've
I
think
I've
heard
Amy.
You
say
in
the
past
that
there
was
a
skills,
Gap
analysis
going
on
in
terms
of
transformation.
P
Oh,
if
you
want
me
to
go
first,
I
will
so
from
a
transformation
perspective.
Mark,
we
absolutely
have
aligned
all
of
our
professions
to
kind
of
the
whatever
the
standard
framework
is
for
that
professional
area.
So
for
delivery,
people,
it's
PPM
an
APM
in
certain
instances,
but
for
other
delivery
professions,
there's
different
Frameworks.
So
we
have
gone
through
that
with
all
of
our
team.
P
We
have
aligned
them
in
terms
of
where
they
believe
they're
at
in
relation
to
certain
competencies
and
their
development
and
pathways
are
structured
around
those
things,
just
a
slightly
different
angle
for
the
transformation
program
in
general
and
supporting
the
organization
to
navigate
the
set
of
changes
that
are
coming
down
down
the
line.
P
Indeed,
one
of
the
things
that
we
did
as
part
of
re-planning
was
very
much
thinking
about
the
type
of
training
we
give
people
to
make
sure
it's
truly
holistic
and
not
very
one-dimensional,
but
also
that
we
are
absolutely
giving
a
sufficient
lead
time
and
enough
time
to
people
to
to
properly
absorb
that
training
and
have
chance
to
practice
it
before
they
have
to
use
it
in
life.
So
that's
that's
part
reflected
in
in
the
plan
that
you've
seen
come
before
you
I'll
just
hand
over
to
Jackie.
Now,
okay,.
Q
Yeah
in
terms
of
the
training
and
development
Academy
colleagues
are
working
with
Tyson
and
his
team
in
terms
of
the
support
and
training
required
going
forward.
Q
These
are
under
five
main
headings
of
policy
process
systems,
behavior
and
Technical
ability
and
then
threshing
out
the
content
under
each
of
the
headings,
and
we
have
also
got
our
dni
manager
and
we'll
be
linking
in
with
our
staff
groups
as
well
in
terms
of
the
content
and
the
academy
does
have
an
external
advisor
in
terms
of
the
technical
setup
of
training
to
make
sure
it
is
accessible
for
all
so
I'm.
Quite
reassured
that
I
think
we
got
everything
ticked
off
in
terms
of
how
we
make
sure
it's
inclusive.
D
A
Firstly,
I'll
need
the
people's
side,
I,
suppose
I'm
confirmation,
taper
granted
some
people
talked
on
earlier,
but
we
we
have
this
listing
learnings
review,
that
the
board
considered
20
minute
half
an
hour
ago,
I
Again
difficult
to
comment
without
a
machine
yet
but
I'm
assuming
there's
stuff
coming
out
of
there
about
ways
of
working,
a
culture
and
everything
else
that
we'll
need
to
feed
in.
A
A
And
then
you
mentioned
in
here
that
the
executive,
probably
more
one
for
UK
mentioned
the
executive,
has
looked
at
the
corporate
services.
Sorry
I
can't
find
the
page,
but
it
talks
about
a
couple
of
priorities
being
to
commence
the
corporate
services
design
work,
but
also,
of
course,
we've
got
mobilize.
The
teams
for
the
regulatory
transformation
I'll
just
be
interested.
If
there's
anything
to
say
at
this
stage
about
the
corporate
redesign
and
or
what
is
the
relative
priority
of
work
or
is
there
any
pressures
in
doing
both.
N
Thank
you
so
there's
a
couple
of
key
commitments
to
put
up
first,
which
is,
we
will
have
learned
from
the
management
of
change-
that's
gone
on
today,
predominantly
in
Tyson's
area,
and
that
will
shape
how
we
do
our
approach
to
Corporate
Services
review.
So
that's
a
commitment
we've
made
as
an
exec
team
and
I'm.
Confident
that's
feedback
will
get
through
the
learning
listening
and
responding
to
concerns
review
that
will
highlight
to
us
where
we
could
have
done
better,
as
well
as
things
that
we've
done
well.
Around
management
have
changed.
N
And
the
second
thing
is
we,
so
it's
a
bit
of
an
Advisory
Group
group
theme,
but
I'm
I've
been
a
fan
of
advisory
groups
over
over
the
years
and
when
I
first
took
on
the
interim
Chief
Operating
Officer
role,
I
established
an
Advisory
Group
in
the
corporate
services,
where
I
invited
colleagues
to
come
together
and
meet
with
me
to
inform
me
and
advise
me
and
steer
me,
and
then
we've
decided
we're
going
to
use
that
group
and
we're
going
to
expand
it
slightly
to
incorporate
Chris's
area
here
and
Joyce's
area,
and
so
engagement
and
policy
and
strategy
as
well,
and
that
Advisory
Group
is
going
to
help
again
us
think
about
our
work
around
the
Corporate
Services
review
and
already
in
my
very
first
discussion
with
them.
N
They
kind
of
came
up
with
eight
principles
around
ensuring
we're
not
marking
our
own
homework,
making
sure
we
really
challenge
what
sits
where
Etc.
So
we
want
to
have
a
group
of
people
really
going
with
us
on
the
journey
in
a
really
meaningful
way,
shaping
what
we
propose.
N
So
so
the
conversations
we've
had
so
far
as
an
exec
team
is
a
real
ambition
to
work
with
the
expertise
of
the
current
directors
in
Corporate
Services
to
shape
what
that
will
look
like
it's
an
active
piece
of
work
that
will
get
clearer
in
the
next
few
weeks
and
and
no
doubt
we'll
want
to
have
a
further
conversation
with
Ford.
As
with
the
organization
when
we
can
talk
a
bit
more
about
what
the
next
stages
will
look
like,
but
that's
the
main
sequential
thing
is
locking
in
the
learning
from
management
change.
N
That's
gone
on
to
date
to
inform
how
we
do
the
next.
The
next
kind
of
chapter
around
our
Corporate
Services
review,.
B
O
B
Just
just
to
add
to
that,
in
terms
of
the
the
bigger
picture,
one
of
the
things
we've
run
as
an
exec
team
is
a
design
Authority
an
organizational
design
Authority,
and
we
do
that
quite
deliberately
so
that
we
can
keep
an
eye
on
the
on
the
load.
If
you
will
on
the
organization
in
the
different
parts
of
it,
to
make
sure
that
we
can,
we
can
load
balance
and
then
we
can
make
sure
that
the
the
work
that's
going
on
in
the
transformation
program
is
cat.
B
It
does
doesn't
start
trading
one
bit
of
the
organization
off
against
another
and
that
it
is
it
is.
We
can
cope
with
it
because,
on
the
one
hand,
we're
kind
of
redesigning
one
piece
of
an
organization
whilst
that
piece
of
the
organization
is
supporting
another
part
of
the
transformation.
So
it's
important
to
make
sure
all
of
that
is
is
seen
in
the
in
the
round,
and
we
do
that
as
an
exec
team,
as
on
top
of
the
governance
that
that
Amy
and
colleagues
Run
for
the
for
the
program
itself,
thanks.
A
R
A
Later
it
was
a
pleasure
to
see
you
again
bye-bye
for
those
in
the
room.
Let's
treat
ourselves
to
a
10
minute.
Break
hit
was
scheduled,
so
why
don't
we
reconvene
we'll
say
just
after
3
30?
If
that's
okay,
thanks.
A
Okay,
thanks
so
much
everyone
welcome
back
I
we're
not
going
to
have
a
an
update
on.
There
was
a
sustainability
green
plan
agreed
long
before
I
joined
the
board,
but
we've
probably
my
colleagues,
will
explain
this
more
detail,
but
we've
broken
that
into
two
bits.
So
what
we're
considering
today
is
a
report
back
against
the
internal
element
of
those
plans
and
what
we're
being
asked
to
do?
A
I
think
is
note
the
report,
but
also
there's
some
suggestions
as
to
what
we'd
like
to
do
in
the
future
or
they
executive
like
to
in
the
future.
So
there's
an
element
of
approval
or
signing
off
on
that
as
well
Kate.
Do
you
want
to
pick
it
up
now
and
also
introduce
our
two
guests.
N
N
So,
as
you
said
chair,
this
is
a
opportunity
to
check
in
on
progress
against
our
current
green
plan,
but
also
to
kind
of
set
out
ambition
around
our
plan,
around
Net
Zero,
so
without
further
Ado
I'll
hand
over
to
Max
and
then
we'll
get
into
questions
over
to
Max.
S
Thanks
Kate,
hopefully
the
report's
Fairly
self-explanatory,
certainly
looking
at
the
green
plan,
we've
got
updates
there
and
what
we've
been
doing
about
producing
travel,
reducing
the
size
of
the
estate
recycling
made
big
strides
forward
in
with
the
technology
team,
in
terms
of
the
disposals
or
and
sort
of
changing
out
equipment,
both
in
offices
and
and
for
for
colleagues
who
are
home
based.
S
We
are
in
a
bit
of
a
strange
period
where
we've
had
a
benchmark
government
set
a
benchmark
here
which
is
pre
pandemic
and
we're
now,
obviously
coming
thankfully,
coming
out
of
that
so
trying
to
establish
what
the
new
normal
looks
like
in
terms
of
things
like
travel
and
and
how
we
work
as
an
organization
plus
all
the
change
is
we'll
we'll
provide
us
with
some
challenges,
I
think,
but
at
the
same
time
I
think
you
could
look
at
what's
happening
around
the
NHS
and
other
organizations.
S
T
Yeah,
so
a
lot
of
the
discussions
so
far,
I've
been
with
the
Department
of
Health
and
Social
care
to
make
sure
that
we're
aligning,
which,
what's
expected
of
us
from
them,
expected
us
from
the
NHS
the
main
focus
when
it
comes
to
the
Net
Zero
initial
steps
is
essentially
ensuring
governance
is
set
in
place,
and
that
is
a
mix
of
reporting
governance
as
well
as
internal
who's
responsible
for
wash.
Where
are
we
going
with
this
next?
T
Steps,
then,
is,
as
Max
was
pointing
out
the
2017
Baseline
year
that
we're
currently
using
is
obviously
pre-covered
I'm
currently
in
talks
now
with
the
Department
of
Health
and
Social
care
too,
and
decide
what
might
be
done
about
that.
T
There's,
obviously,
an
importance
to
include
the
impact
of
covid
on
you
know
on
the
the
missions
on
travel
on
energy,
whatever
it
is,
and
the
impact
that'll
have
on
not
just
the
Baseline
year,
but
on
future
projections,
making
sure
that
we
are
an
Exemplar
organization,
we're
one
that
other
organizations
are
looking
to,
and
you
know
wanting
to
emulate.
T
Next
steps,
then,
would
be
calculating
emissions
based
off
of
that
based
on
you
moving
on
then
to
basically
setting
a
mixable
short
on
long
term
reduction
targets
then
determining
what
steps
are
to
to
hit
those
reduction
targets
and
then,
importantly,
having
set
review
review
processes
in
place.
Be
that
with
the
executive
team,
be
that
with
the
board
and
then
be
that
with
smaller
sustainability.
T
Champion
groups
within
different
sites
within
different
directories,
main
focus,
obviously
as
I
said
initially,
is
on
governance
and
making
sure
that
that's
clear
and
then
also
incorporating
the
impact
of
working
from
home
is
having
so
we're,
not
in
a
sense
ignoring
the
emissions
that
are
generated
from
staff
working
from
home.
We're
making
sure
we're
keeping
that
in
mind
whenever
we're
looking
towards
any
developments,
any
projections
and
we're
incorporating
that
and
any
funds
we're
looking
to
work
on.
Basically.
A
Thank
you
any
questions
or
comments
from
colleagues.
F
Steve
to
if
I
could
looking
at
page
58
of
the
pack
you're
you're
reporting
the
CQC
performance
data
for
2122,
but
of
course
that
was
maximum
covered
lockdown.
So
all
those
hugely
impressive
reductions
against
the
2017
Baseline
kind
of
a
fairly
meaningless.
Do
you
have
any
sense
of
the
bounce
mark
when
we
get
closer
into
a
sort
of
post-covered,
New
Normal.
F
S
So
I
think
in
answering
the
first
point:
there
will
be
a
bounce
back
without
without
doubt
you
know
we'll
be
we'll
we're
seeing
that
already,
but
we
are
changing
the
way
we're
working
as
well,
so
obviously
the
sort
of
methodology.
That's
that
we're
undertaking,
will
look
different
from
how
we
used
to
go
out
and
inspect
and
regulate
so
I
think
it's
quite
hard
to
ask
to
sort
of
nail.
S
What
that
will
look
like,
but
I
would
imagine
there
will
be
a
significant
bounce
back,
but
we
just
need
to
make
sure
that
a
that
we're
tracking
that
properly
were
only
sort
of
particularly
with
round
travel
traveling
when
we
need
to
and
then
we're
trying
to
move
people
onto
Greener
modes
of
transports
out
of
cars
onto
trains
were
possible.
But
again
you
know
we
inspect
and
regulate
across
the
whole
of
England,
some
very
remote
areas.
So
we
know
inspectors
will
you
know
we'll
have
to
use
use
used
cars?
S
So
can
we
incentivize
electric
vehicles
or
encourage
people
through
this
with
various
car
schemes?
So,
but
it
it's
hard
to
ascertain
at
the
moment,
but
the
other
thing
we'll
be
doing
is
benchmarking.
With
other
organizations
in
terms
of
what
sort
of
patterns-
but
you
know
where,
where
unique
in
as
as
much
as,
were
the
only
Health
and
Social
care
regulator
in
England,
so
what
we
do
and
how
we
set
ourselves
up
for
the
future
I
expect
there'll
be
a
reduction
from
what
we
used
to
do.
But
how
big?
T
I
think
I
just
just
added
out
as
well,
and
we
were
actually
speaking
about
this
earlier.
Obviously,
as
you
pointed
out,
massive
reductions,
for
example,
from
2017.
This
is
one
of
the
big
reasons
why
I'm,
currently
speaking
with
the
Department
of
Health
and
Social
care,
about
incorporating
covert's
impact
a
bit
more
as
well
as
working
from
home,
but
an
important
thing
to
look
at
as
well
is
and
that
we're
going
to
look
to
examine
with
this
Net
Zero
plan.
T
The
transition
from
the
green
plant
to
the
netsurer
plan
is
that
different
ways
of
visualizing
it
so
not
just
looking
at
the
overall
number
of
here
was
our
2017.
You
know
maximum
energy
output
here
was
our
2021
energy
output,
but
looking
at
it,
for
example,
per
square
feet
of
an
office
space
that
we
use
per
individual
work
in
the
office,
so
we
can
actually
see
in
reality,
what
impacted
staff
working
from
home
have
on
this?
T
B
B
Inspectors
were
often
living
far
away
from
the
place
where
they
were
working
as
part
of
the
work
that
we've
done
with
with
Tyson's
team
people
are
now
you
know
predominantly
living
and
working
in
the
same
geographic
area
that
reduces
a
degree
of
travel,
introducing
roles
like
Assessors
for
and
inspectors
and
so
forth
again,
that
that
reduces
the
number
of
people
that
are
traveling
about
so
and
using
technology
and
remote,
working
and
so
forth.
So
so
I
think.
B
F
F
S
We
so
we
will
be
aiming
to
Go
Achieve
Net
Zero
and
the
Department's
already
published
its
strategy
for
Net
Zero
set
hopes
to
go,
I,
think
it's
Net,
Zero
and
travel
by
2025
and
Net
Zero
is
an
organization
by
2030,
so
we
feel
we
should
be
setting
out.
You
know,
sort
of
a
similar
course
part
of
that
might
be
offsetting
and
it's
interesting.
It's
a
question.
I
asked
our
Director
of
Finance,
who
can't
be
with
us
today.
Is
you
know
what
are
the
sort
of?
S
What
are
the
issues
around
using
public
money
to
pay?
Somebody
else
to
offset
your
carbon
footprint
question
so
we're
exploring
that,
but
there's
also
carbon
in
setting
which
I
wasn't
particularly
familiar
with
until
fairly
recently,
in
fact
until
when
Thomas
joined
where
so
it's
looking
at
it's
all
it's
this
sort
of
circular
economy.
What
do
we
do
with
some
of
our
technology?
What
about
furniture,
and
things
like
that?
S
So
you
can
use
some
of
that
to
offset
other
things,
but
I
see
no
reason
if
NHS
has
set
itself
a
Target
Department
of
Health
and
Social
care
set
itself
a
Target
to
reach
Net
Zero
that
we
shouldn't
as
an
organization
as
well.
We
should,
as
you
know,
aspire
to
that
and
do
everything
we
can
to
achieve
it
and.
T
On
on
sorry
on
off
settings,
well
so
the
department,
for
example,
they
are
looking
into
initiatives
for
offsetting.
They
haven't
identified
any
specific,
Flagship
ones
that
they
they
might
want
to
specifically
undertake,
but
as
part
of
their
Net
Zero
plan
report
for
2030,
they
have
noted
in
each,
for
example,
in
energy
and
travel
and
biodiversity,
and
so
on
that
they
are
at
the
moment
lucky
into
offsetting
measures.
T
For
very
obvious
reasons.
It's
usually
somewhere
between
85
to
95,
depending
on
what
the
the
organization
does,
so
that
order,
15
to
5,
let's
say,
has
to
either
be
offset
inset
or
mix
of
the
two
which
which,
as
Max
known
as
what
the
Department
of
Health,
is
currently
looking.
S
At
so
coming
back
to
the
point
about
sort
of
US
changing
as
an
organization
how
we
work
and
things
I
guess,
one
of
the
things
we
will
be
seeking
to
try
and
influence
and
make
sure
and
Annie
is
part
of
the
agenda-
is
sort
of
hard-wiring
sustainability
into
how
we
work
as
an
organization
into
how
we
operate,
how
we
inspect
how
we
regulate,
how
we
use
our
technology
and
to
sort
of
because
we
we
will
struggle
compared.
We
haven't,
got
a
huge
Fleet.
S
A
M
Thank
you
I'm,
really
pleased
to
see
this
I'm
really
pleased
to
see
continue
progress
on
this.
This
is
important
for
people
who
work
here.
It's
a
you
know
called
differentiator
Always
for
alignment
with
a
sense
of
alignment
with
an
organization,
and
you
know
any
aspiration
to
be
an
employer
of
choice.
So
this
is
this.
Is
this
is
important
just
a
couple,
you
know
a
couple,
but
you
know
we've
got
a
way
to
go.
M
We've
got
a
way
to
go
in
relation
to
this
and
I
think
for
the
reason
I
mentioned
in
a
moment.
I
think
it's
going
to
be
harder
for
us
than
than
some
some
others
just
one.
You
know
one
small
but
important
point.
The
numbers
on
electricity
performance
that
you've
got
here
in
the
in
the
appendix
are
quite
significantly
different
from
the
number
that
was
in
the
last
the
late.
The
last
time
we
looked
at
the
this
page
in
the
reporting
accounts.
So
can
we
just
double
check
and
make
sure
that?
M
That's
that
that
that's
right,
the
substantive
point
I
wanted
to
raise
is
we've
got
to
be
very
careful
about
spurious
accuracy
here.
If
we
have
a
huge
number
of
huge
percentage
of
our
Workforce
are
working
from
home
and
we've
got
a
a
growing
number
of
of
the
offices
that
we
occupy,
like
this
one
multi-use
offices,
making
assumptions
about
that.
M
So
you
you
can
fairly
quickly
imagine
getting
to
a
point
where
actually
there
are
assumptions
underpinning
to
a
material
extent,
what
what
we
have
in
there
so
I
think
we'll
have
to
try
and
over
time
do
things
that
are
that
are
that
are
different,
doing
some
sampling.
M
If
we
can
get
people
to
to
cooperate,
showing
the
homeworking
experience
as
a
as
an
example,
our
best
practice,
you
know
different
ways
of
doing
it
because
I
think
actually
the
numbers
are
not
necessarily
going
to
tell
us
a
really
it
give
us
an
accurate
picture
of
of
what's
going
on
with
a
Workforce,
that's
largely
remote.
O
S
Of
the
annual
report
I
think
it.
It
has
changed
since
the
last
time
since,
since
it
went
to
National
Audit
office
so-
and
it
was,
it
was
changed
as
a
result
of
the
comment,
but
I
don't
think
you've
seen
the
change
in
it
since
but
I'll
double
check
with
with
Chris
and
make
sure
that
everything
lines
up.
T
And
then
just
just
add
to
the
point
as
well,
about
working
from
home
and
engagement
and
the
importance
of
that
that's
yeah,
absolutely
crucial,
and
especially
when
it
comes
to
so
many
staff
members
working
from
home,
it
becomes
very
difficult
to
track
and
monitor,
for
example,
waste
energy.
Are
they
doing
what
they
should
be
doing?
So
the
big
focus
is
on.
You
know,
as
was
pointed
out,
engagement
information
is
a
huge
one
and
I've
been
speaking.
T
The
department
about
this
about
creating
information,
packs
and
I've
actually
been
working
with
them
to
create
information,
packs
for
staff
members
for
albs,
as
well
as
other
government
departments,
as
well
as
looking
at
estimates
for
how
much
you
know.
One
worker
from
home,
for
example,
generates
in
terms
of
energy
in
ways,
and
there
are
ways
to
estimate
that,
based
on
you
know
the
energy
you
save,
of
a
monitor
on
a
laptop
and
the
challenge
then
comes
from.
T
A
If
I
may
ask
you
if
I
call
a
number
of
comments
given
time,
if
you
want
to
take
these
away
for
a
future
time,
do
but
the
firstly
I
think
as
an
organization-
and
it's
probably
a
wider
issue
for
the
management
is
to
understand
the
Interlink
between
the
energy
usage
and
the
viable
business
model.
I
mean
if
we
can't
have
a
position
where
the
animatric
is
reduction.
Energy.
If
we
did
that
we
get
rid
of
all
the
officers,
everyone
would
sit
at
home.
We'd
never
go
visit.
A
Anybody
at
next
three
level,
that's
clearly
not
viable
I,
think
it's
an
easy
win
to
say.
Well,
we've
actually
physically
got
to
go
inside
the
hospital,
but
we're
going
to
go
inspect
it.
I
would
argue
strongly
that
some
meetings
had
to
take
pay
physically,
like
this
board
meeting.
A
I
personally
have
this
view
that
businesses
are
going
to
find
over
the
next
few
years
that
the
more
people
will
be
coming
back
into
the
office,
for
example,
as
they
realize
the
consequences
of
of
people
not
being
coached
or
trained
properly
online.
So
that's,
probably
the
most
substantive
one.
Secondly,
the
metrics
I
mean
it's
interesting.
A
You
you
highlight
things
like
energy
here,
sorry
electricity
here,
but
what
a
lot
of
people
would
do
is
look
at
the
source
of
the
energy
and
say
well,
you
know,
we've
had
a
contract,
that's
100,
renewable
and
therefore
there's
no
impact
on
the
environment.
If
you
believe
it's
100
renewable.
So
we
know
for
in
terms
of
reporting
we're
not
really
so
much
interested
in
the
energy
we're
using,
but
the
exemplative
track
it
where
it's
from,
which
might
lead
us
for
looking
to
the
executive
and
to
understanding
whether
we
have
a
choice
on
that.
A
So
if
we
have
a
choice
of
where
we
buy
our
electricity
from
then
a
way
of
achieving
that
zero
is
we
only
buy
from
certain
companies
or
you
know,
on
certain
tariffs.
If,
on
the
other
hand,
it's
a
shared
building,
we
have
no
input.
I
think
it'd
be
helpful
to
call
that
out,
because
we
could
be
in
a
position
where
some
of
the
major
costs
and
some
of
the
major
emissions
are
are
just
not
within
our
control.
I
think
it'll
be
be
helpful
in
the
plan.
A
If
by
plan
we
mean
the
actions
we're
taking
to
be
clear
on
what
we
we
can
or
can't
influence
and
I
suppose
just
wrapping
a
couple
up.
The
third
thing
is
around
this:
working
from
home
I
mean
clearly
it's
hugely
complex.
You
know
we
can't
go
assessing
the
Energy
Efficiency
of
either
the
homes
that
3
000
colleagues
work
from,
but
so
others
well
better
brains
than
mine
will
work
out
how
you're
going
to
make
those
estimates,
but
they
do
have
to
be
holistic,
so
someone's
working
from
home.
A
Yes,
they
may
have
the
heating
up,
but
they're
not
traveling
to
work.
So
you
know
there's
offsets
there
that
one
needs
to
take
into
account
that
I
know
others
are,
but
but
final
point
from
people
working
from
home
I
mean
as
an
organization
we're
only
responsible
for
the
emissions
generated
by
people
working
here.
But
but
in
truth,
the
carbon
footprint
of
3
000
plus
employees,
is
probably
more
what
they're
doing
when
they're,
not
here
working
for
us
when
they
are
and
I
just
wondered.
A
If
we
thought
of
or
we're
planning
to
do
more
to
help
individuals
and
their
personal
environment
save
energy,
it
may
not
be
something
that
we
can
be
held
accountable
for,
but
it
is
something
that
would
arguably
make
a
bigger
difference
now
than
further
reductions
on
our
own
footprint.
So
sorry
there's
a
number
of
points
there
respond
to
what
you
can
now,
but
the
first
one
probably
needs
to
be
thought
about
for
later.
S
I
think
they're
all
extremely
good
points
on
on
the
last
one,
I
think,
as
Thomas
said,
I
think
engagement,
communication
provision
of
information
is
critical
to
this,
both
in
our
roles
as
employees,
but
also,
if
you
know,
we
should
and
we'll
widen
that
to
just
provide
you
know
with
providing
information
about
good
practice
things
they
can
do
in
their
own
time
as
well,
or
you
know
Hobbies
Past
Times
what
they
buy,
how
they
recycle
and
those
sorts
of
things,
so
that
we
can
signpost
lots
of
things
and
encourage
people
to
you
know
to
adopt
good
practices
and
in
fact
we
get
a
lot
of
feedback
from
some
of
our
colleagues
already
about
things
they're
doing
to
to
be
greener
at
home.
T
No
and
on
that
topic,
as
well
I've
meeting
with
the
Department
of
Health
and
Social
care,
as
I
said,
one
of
the
things
we
were
working
on
is
packs
that
can
be
provided
to
the
lbs
about
this
and
actually
I've
been
working
on
a
sustainability
at
home
document
as
well
around
that
same
idea
to
basically
provide
beard
waste,
be
it
biodiversity,
be
it
actions,
you
know
volunteering
or
whatever,
what
have
you
and
as
well
as
energy.
T
Obviously,
energy
is
such
a
a
massively
important
thing
for
people
at
the
moment
in
relation
sustainability,
so
ways
to
cut
down
ways
to
save
ways
to
reduce
and
what
to
do,
I.
Think
for
the
the
other
points
you
brought
up,
for
example,
I
think
with
the
energy
Supply
I
think
that's
crucial,
and
and
that's
why,
for
example,
one
of
the
things
I
really
want
to
look
at
and
intend
to
investigate
more
are
alternative
ways
to
measure.
T
So,
instead
of
you
know,
as
I
mentioned
looking
at,
for
example,
per
square
feet
in
an
office
per
employee,
but
as
well
as
that,
you
know
for
looking
at
say:
we've
had
x
amount
of
rail
miles
per
year,
but
it's
great
to
know
that,
but
will
be
better
as
well.
How
much
CO2
equivalent,
for
example,
is
that
generate.
We
have
a
huge
amount
of
energy
usage,
but
in
reality,
how
much
of
that
is
owned
by
us?
T
How
much
of
it
is
owned
by
maybe
other
people
who
shared
a
space
and
importantly,
how
much
of
it
is
maybe
coming
from
renewable
sources
on
how
much
of
it
is
coming
from
fossil
fuel,
so
I
think
a
big
aspect
of
and
a
big
thing
that
I
hope
to
tackle.
While
here
is
new
ways
of
looking
at
things
and
making
sure
that
we're
examining
it
from
as
many
angles
as
we
can,
so
we
can
point
to.
Are
we
doing
enough?
T
So
let
me
just
for
example,
so
the
next
step
is
establishing
governance,
so
over
the
next
month
month
and
a
half
it's
going
to
be
establishing
reporting
procedures,
for
example,
speaking
the
department
about
things
like
the
green
and
government
commitments
and
Audits
and
reports
that
we
might
need
to
adhere
to
as
well
as
internal
governance,
so
which
teams
are
in
certain
directors
or
individuals
at
certain
sites
might
need
to
have
specific
oversight
over
certain
actions.
T
And
then,
from
that
point
we
go
on
to
data
Gathering
and
again
looking
at
things
in
a
new
way.
During
that
daily
Gathering
stage,
then
calculating
the
emissions
based
off
of
that
data
and
then
using
that
to
generate
actions
with
the
hope
of
by
the
end
of
this
summer.
Having
a
defined
you
know,
here's
our
governance
structure,
formalized
and
as
well
as
it's
actually
something
important
to
point
out.
T
Alongside
this
Net
Zero
plan,
one
of
the
things
I'm
looking
at
building
is
an
EMS
or
an
environmental
management
system,
which
is
the
hope
is
to
essentially
use
that
debutterous,
the
Net
Zero
plan
and
the
Environmental
Management
System.
Essentially,
it's
a
collection
of
all
of
our
policies,
people
and
procedures
and
relations
sustainability
in
one
centralized
location.
So
anybody
could
find
that
anybody
can
see
it
and,
most
importantly,
those
who
need
to
seed
and
who
are
responsible
for
sustainability,
in
whatever
aspect
they
are,
can
find
everything
they
need
to
in
that
one
central
location.
A
A
We
don't
have
to
agree
a
time
now,
but
I
think
be
helpful
if
you
come
back
in
six
months
or
something
with
this
fleshed
out
as
to
actually
how
are
you
going
to
do
some
things
differently
and
give
us
a
better
feel
for
what's
in
our
control
and
what
isn't
okay?
Well.
Thank
you
very
much
indeed.
Thank
you
appreciate
it
glad
to
see
the
progress.
Good
luck,
welcome
to
a
CQC
thank.
T
A
So
I
think
the
onto
a
couple
of
things
that
require
approval.
One
is
our
equality
objectives.
Ian
I
think
this
is
over
to
you
and
Jackie
Jackson.
Coming
back
to
us,
I,
think
and
also
Lucy
welcome,
Lucy
and
Jackie.
We
can
see
you
now.
B
Thanks
Ian
and
welcome
to
Lucy
and
Jackie
just
a
couple
of
quick
remarks
by
way
of
opening
before
handing
over
to
to
Lucy
and
Jackie.
So
in
July
2021
we
published
our
new
equality
objectives
and
they
they
are
the
quality
objectives
up
to
June
2025
they're
listed
on
page
one
of
the
paper
page
60
of
the
diligent
pack,
we've
moved
our
annual
reporting
to
better
align
with
our
business
planning
year,
which
is
why
we
reported
in
July
and
we're
reporting
again
now.
B
I.
Think
an
important
headline
within
all
of
this,
for
me,
is
that
we
are
really
integrating
the
the
work
that
we're
doing
in
this
area
across
our
Core
Business
processes,
and
also
embedding
equality
work
into
into
the
single
single
assessment
framework,
both
at
the
work,
we're
considering
doing
in
ICS
is
as
long
as
well
as
the
work
we're
doing
with
providers,
and
it
really
that
sort
of
embedding.
It
is
a
core
part
of
what
we
do
and
the
core
paths.
The
way
we
speak,
I
think
is
really
important.
B
The
aim
here
for
today's
paper
is
to
agree
that
delivery
priorities
and
the
detail
of
which
is
on
page
five
and
onwards
in
the
paper.
So
that's
all
I
wanted
to
say
really
by
way
of
introduction
and
then
hand
over
to
Lucy,
just
to
say
a
few
more
words
thanks.
U
Thank
you,
Ian
I'm
Ian's,
just
on
just
about
what
I
was
going
to
say.
U
So
so,
yes,
just
to
say,
we've
made
good
progress
since
we
last
reported,
but
though
it
was
only
seven
months
ago
and
the
the
key
things
are
Pages
five
to
eight
of
the
of
the
papers,
which
outlines
what
we'll
do
for
next
year,
there's
also
a
very
long
appendix
which
gives
a
lot
of
detail
around
both
our
deliverables
and
our
measures
of
success
and
I
know
the
board
were
Keen
to
see
that
following
the
July
paper.
U
So
so
yes
I'm
happy
to
answer
questions
on
any
of
it
just
pass
over
to
to
Jackie
to
to
speak,
particularly
to
some
of
the
internal
facing
Workforce
quality
issues
within
CQC
which
sit
in
equality
objective.
Five,
okay,.
Q
Thank
you,
Lucy
yeah
I.
Don't
intend
to
go
over
the
four
points
that
are
in
the
paper
in
any
great
detail,
because
they
do
form
part
of
our
biggest
strategy.
However,
I
will
just
pull
out
some
activity
by
way
of
updates,
so
reasonable
adjustments.
Q
I
think
we've
made
some
really
good
progress
over
the
last
few
months
on
reasonable
adjustments,
and
so
we've
got
our
den
Network
sponsored
by
Mark,
who
again
have
been
having
really
good
conversations,
which
was
resulted
in
contribution
to
to
thinking
in
terms
of
in
specif,
specifically,
our
approach
to
recruitment,
the
support
to
candidates,
the
panel
and
shortlisting,
so
I
think
we've
made
good
progress
there
not
withstand
any
recommendations
that
come
out
of
the
llr
review
as
well
and
also
I
think
we're
having
really
good
dialogue
with
colleagues
and
listening
to
and
listening
to
feedback,
so
I
think
in
terms
of
reasonable
adjustment.
Q
It
feels
as
though
we're
moving
to
a
much
more
positive
place
and
a
one
where
there's
really
good,
dialogue
and
and
and
listening
so
certainly
reasonable
adjustments
and
the
other
point
was
just
really
the
the
progress
we're
making
on
the
independent
panel
members.
Q
So
that's
due
to
relaunch
in
April
and
again
following
feedback
making
sure
that
we
include
independent
panel
members
in
shortlisting
activity
and
encouraging
more
people
to
be
independent
panel
members
with
relevant
training
and
support,
but,
like
I,
say,
the
four
points
that
are
on
the
the
bigger
part
of
the
paper
will
also
form
part
of
a
bigger
update
on
the
whole
strategy
in
the
months
to
come.
Thank
you.
I
I
This
I
wanted
to
Deep
dive
on
using
our
independent
voice
to
reduce
inequality,
so
the
work
we
do
with
the
organizations
we
regulate
to
help
them
reduce
equalities,
recognizing
the
fact
that
the
last
time
that
we
assessed
their
perceptions
was
July
and
since
then
there
have
been
increasing
economic
challenges
which
typically
tend
to
worsen,
rather
than
improve
inequalities
it'd
be
helpful
to
align
on
when
we
would
next
get
feedback
on
what
we're
doing
in
this
space
with
providers,
but
also
really
think
about
how
we're
working
with
providers
to
obtain
their
stories
and
help
them
share
best
practices
about
how
they've
reduced
outcomes
in
different
groups
who
encounter
inequalities.
U
U
We
do
where
it's
relevant
and
and
also
to
do
some
specific
pieces
on
on
that's
focus
on
inequalities,
for
example,
about
15
months
ago
now
we
published
our
maternity
reports
that
covered
maternity
Equity,
particularly
for
black
women,
and
we're
now
doing
further
work
on
maternity,
where
we're
picking
up
the
the
the
the
recommendations
we
made
to
ourselves.
U
We
are
doing
some
work
on
that
led
by
our
datron
insight
team
to
look
at
evidence
across
what
we've
we've
got
on
on
on
cost
of
living,
and
it's
an
area
that
obviously
is
really
important
as
we
expand
our
equality
work
into
Health
inequalities
into
socioeconomic
issues,
but
as
well
recognizing
that
many
groups
covered
by
the
equality
act,
such
as
disabled
people
and
people
from
certain
minority.
Ethnic
groups
are
also
more
likely
to
be
in
poverty.
G
So
Lucy's,
absolutely
right
in
that
assessment.
There's
just
a
couple
things
additional
to
say
so,
alongside
the
Thematic
work,
we'll
do
in
things
like
maternity,
we're
also
having
conversations
with
the
ons
who
produce
a
health
index
score
which
is
due
to
be
updated.
And
now
we
want
to
link
that
to
our
thinking
around
ICS
and
local
Authority
Assurance.
So
we
can
see
in
a
sense
the
starting
position
that
that
that
local
areas
have
as
a
way
of
judging
how
well
they're
moving
supporting
people
in
their
area.
G
So
we'll
continue,
as
Lucy's
absolutely
said
correctly,
we'll
continue
doing
to
bring
it
into
our
thinking
around
thematic
pieces
of
work
and
we'll
also
continue
to
have
that
overview
perspective.
As
we
begin,
our
assessments
of
systems
and
places.
A
L
Thank
you
I
mean
perhaps
if
it's
okay,
an
opportunity
for
me
to
talk
and
expand
a
little
bit
about
what
Jackie
said
about
our
disability,
equality
Network,
because
there's
been
a
huge
amount
of
activity
that
we
have
undertaken
over
the
last
year
and
I
think
perhaps
a
little
bit
more
detail
on
that.
If
that's,
if
that's
okay,
Jackie
talked
about
reasonable
adjustments,
which
I
think
is
something
we've
made
some
some
really
terrific
short-term
improvements
around
and
that's
focused
around,
as
Jackie
said
around
around
interviewing
around
recruitment
processes.
L
It
also
covers
you
know
specific
needs
of
colleagues,
particularly
with
with
protected
characteristics
like
neurodiversity,
who
have
in
order
to
get
the
very
best
out
of
colleagues
at
interview
you
can.
There
are
things
that
we
can
do
and
we
have
to
be
able
to
make
it
a
better
experience,
but
lots
of
other
areas
that
we've
we
focus
on
as
well.
L
So,
for
example,
accessibility,
two
perspectives,
one
is,
and
a
lot
of
work
done
in
in
my
technology
area
to
improve
the
accessibility
for
for
our
colleagues
to
particularly
with
hearing
or
visual
impairments,
particularly
through
the
Microsoft
365
work,
but
also
how
do
we
make
sure
that
we
we're
using
the
best
of
those
accessibility
tools
in
the
work
that
we
do
in
the
and
the
material
that
we
that
we
publish
externally
I?
Don't
know
you
know?
L
Chris
we've
talked
before
about
the
making
sure
that
we've
got
accessible
reading
materials
or
the
appropriate
reading
with
reading
age
for
for
for
public
material.
We've.
We've
also
done
a
lot
of
work
to
help
support
colleagues
with
with
their
queer
Ambitions,
and
we've
got
a
a
recent
program
that
we've
just
launched
the
inclusive
leadership
pathway
which
we're
which
we're
really
excited
to
buy
and
we've.
We've.
L
We've
started
that
very
recently,
and
that's
specifically
about
helping
colleagues
from
both
disabled
and
from
ethnic
minority
colleagues
to
help
further
their
career
prospects.
I
think
also
recognizing
that
the
role
of
the
line
manager
is
really
critical
in
supporting
supporting
colleagues
so
doing
some
work.
Around
training
and
supporting
our
line
managers
understand
more
about
how
to
be
empathetic
and
an
understanding
of
to
eradicate
discrimination.
L
Improvement
work
in
our
policies
and
ensuring
our
recruitment
process
is
fair,
open
and
transparent,
as
it
possibly
can
be
as
well,
and
lots
of
work
done
around
attempting
to
attract
colleagues
externally
with
protected
characteristics
and
I'll
probably
leave
it
there
if
that's
okay.
So
so
a
lot
of
work,
lots
of
work
going
on-
and
this
is
all
under
the
the
the
guys
are
attempting
to
or
obviously
improve
our
our
Workforce
disability
quality
standards
as
well.
According
to
that
standard,.
I
M
I've
had
the
opportunity
to
discuss
quite
a
bit
of
this
offline
and
and
one
of
the
things
that
you
know
glad
he
hadn't
mentioned
it
up
front
because
it's
you
know,
it's
really
important,
that
this
is
not
a
bolt-on
and
that
this
is
integrated
into
everything
that
we
do,
and
you
know
we
can
see
from
this
paper
the
you
know
the
the
reach
of
equality
considerations
through
the
organization
it
does,
you
know,
do
it
well
and
it
permeates
just
about
everything
that
you
do
I
think
that's
that's
really
important
for
maintaining
you
know
you
we.
R
Sorry
also
developing
in
launch
a
well
at
work
plan,
so
it
encompasses
more
than
the
disability
Network.
So
in
an
ideal
world
everybody
would
have
one
as
a
supportive
measure
whether
they
had
any
additional
or
specific
needs.
But
if
they
didn't
at
a
point
in
time
they
could
always
revisit
it
so
again
to
cover
all
the
networks
and
all
employees
at
CQC.
A
Thank
you
any
other
questions.
Lucy
you
had
your
hand
up
is
that
from
earlier
on.
U
Thing
between
the
regulatory
work
and
the
and
the
workforce
work
is
that
one
really
good
example
is
on
the
inclusive
leadership
pathway,
we're
running
some
stretch,
projects
for
for
cohorts
in
our
pathway
and
a
lot
of
those
stretch.
U
Projects
are
actually
to
further
things
within
our
regulatory
equality
objectives,
so
we're
trying
we
work
very
closely
together
the
the
kind
of
internal
facing
and
external
facing
aspects
around
equality,
so
that
we
we
give
a
lot
of
Learning
and
Development
for
colleagues,
but
also
take
those
opportunities
to
use
the
experiences
of
our
colleagues,
whether
that's
around
disability
or
or
ethnicity
or
or
other
protective
characteristics,
to
build
that
into
how
we
develop
our
regulatory
work
as
well,
and
that's
really
exciting.
Work
joint
work
that
we're
doing.
A
Foreign
thanks
Lucy,
any
other
questions
have
gone.
I
just
had
one
out
of
Interest
detail
question
really,
but
you
talk
about
work,
developing
a
shared
statement
of
commitment
with
two
other
albs
NHS
England
and
nice.
I
just
wondered
how
you
selected
those
two
or
why
only
those
two,
because
I
couldn't
see
that
blood
and
transport
or
resolution
or
one
or
two
others
would
be
equally
relevant.
U
Well,
the
the
two,
the
the
two
other
arbs,
are
leading
that
with
us,
but
we're
but
we're
the
core
Hub
and
we're
going
to
reach
out
to
all
the
other
albs
that
that
that
attend
the
chief
executive
of
Health
and
Care
alb's
group
and
to
see
who
else
wants
to
be.
And
this
came
from
an
original
meeting
that
Ian
Chad
back
nearly
a
year
ago.
Now,
when
we
looked
at
equality
in
some
depth
at
the
CEO's
meeting.
U
But
it
was
nice
nhse
and
we're
kind
of
driving
it
forward
and
to
try
and
get
something
to
give
more
clarity
to
people
in
the
city
to
other
albs
and
to
and
to
people
working
in
Health
and
Social
care
into
local
systems
about
about
tackling
Health
inequalities
in
particular,
and
the
different
roles
and
responsibilities
of
different
ALB.
So
it's
been
driven
by
nhse
and
Bola,
or
lobbyist
human
nhse,
and
by
by
nice
and
by
and
by
us
that
it
will
extend
out
to
other
albs.
M
Just
one
thing
very
quickly:
the
local
inequalities
Outreach
plans.
Do
you
want
to
sort
of
just
a
explain
what
that
is,
but
but
I
think
more
importantly,
you
know:
when
are
we
going
to
hear
about
the
outcomes
of
the
of
that
pilot
work
and
whether
that's
been
successful.
U
Thank
you
Mark,
because
that
is
one
of
our
big
ticket
items
for
next
year.
Really
so
we're
we're
kind
of
trying
to
get
the
piloting
work
done
between
in
in
quarter
one
and
Quarter
Two,
possibly
into
quarter
three
of
next
year,
I've
just
signed
managed
to
sign
up
three
three
Deputy
directors
in
operations
to
Pilot
in
their
in
their
areas,
so
we're
getting
ready
to
go
doing
the
prep
work
for
that
ready
for
when
the
new
local
teams
are
formed.
U
So
that's
very
exciting
because
that's
using
using
the
advantage
of
having
multi-disciplinary
local
teams
to
actually
go
out
and
talk
directly
to
people
that
we
might
not
hear
of
from
other
routes.
So
we
will
continue
to
develop
things
like
give
feedback
on
care
to
try
and
make
them
as
accessible
as
possible.
But
we
know
that
there
are
certain
communities
where
we
will
need
to
supplement
what
we're
doing,
not
repeating
what
providers
are
doing
but
to
triangulate
what
we
know
in
local
areas
to
use
a
bit
of
the
resource
in
the
local
teams.
A
Thanks
Lucy
we're
being
asked
to
approve
agree
with
our
phrase.
You
want
to
use
proof
the
the
general
director
traveled
on
the
priorities
for
the
next
year,
so
been
a
good
discussion
of
a
number
of
points.
I
haven't
heard
any
qualifications
or
additions,
so
we
agreed
on
that.
Okay!
Well
done,
it
is
so.
Thank
you
very
much
indeed
for
coming
along
and
talking
us
through
that.
A
Well
done
the
just
a
couple
of
final
things:
minutes
of
the
previous
meeting
they
were
circulated
a
while
ago,
I
haven't
been
notified
of
any
comments
in
ferrarity.
All
creators
approved
okay.
Thank
you
very
much.
We
had
a
couple
of
actions
carried
forward
from
previous
meetings.
It's
online
the
machine
closed
down
here,
but
I
think
they're.
Both
done
so
I
propose
to
close
those
if
that's
okay,
they're
both
picked
up
on
the
performance
report
we
discussed
earlier
so
that
deals
with
the
the
log.
A
Just
a
couple
of
final
points
from
me:
probably
go
around
the
table
for
any
other
business.
I
realized
the
other
day
that
nothing
about
the
other
reporting
accounts
on
the
agenda.
It's
10
months
after
the
year
ends
so
Ian.
Do
you
want
to
tell
us
where
we
are
we.
B
A
I
mean
it's
obviously
expressed
before
where
we
we
did
all
we
could
have
done
many
months
ago.
I
mean
at
one
level
it
doesn't
matter
except
there's,
some
really
quite
good
material
and
the
ARA
about
what
we've
done,
and
it's
not
public
and
by
the
time
it
is
it'll,
be
outdated.
So
I
I
think
it's
something.
Maybe
we
could
ask.
A
We
can't
speed
up
the
audit
process,
that's
beyond
our
control,
but
almost
like
questioning
whether
we
can't
bifurcate
the
accounts
and
publish
what
we
ought
to
publish
that
would
be
of
interest
to
people
and
the
numbers
could
follow,
which
perhaps
something
we
can
sort
out
next
year,
because
this
is
a
little
frustrating
or
put
another
way
around.
There's
not
other
point
in
putting
all
this
effort
in
the
reporting
accounts.
If
we
can't
publish
it
so
the
only
other
thing
I
just
want
to
mention
I
did
flag
it
right
at
The
Outsiders.
A
This
is
Mark
Saxton's
last
board
meeting
Mark.
You
are
currently
for
another
four
weeks,
the
longest
standing
member
of
the
board.
I
know
the
non-execs
have
valued
your
contribution
over
many
years.
That's
the
knowledge!
That's
past
and
present
the
executives
have
done
likewise,
with
your
helpful
support
and
advice,
particularly
around
people
matters,
but
other
areas
as
well
and
speaking
personally
I
inherited
you
as
the
senior
independent
director,
but
it's
been
huge
benefit
to
me
to
have
your
corporate
knowledge
and
be
available
to
chat
to
periodically
just
to
find
out.
A
What's
going
on
and
bounce
things
off
you
if,
if
it
were
bother
to
change,
would
you
think
people
would
think
so?
That's
been
hugely
beneficial
to
me
so
really
on
behalf
of
we're
not
saying
goodbye
to
you
yet
you
hear
for
another
month,
but
it's
your
last
board
meeting
so
on
behalf
of
all
my
colleagues
can
I
just
say.
Thank
you
very
much,
a
need
for
the
board.
Thank
you
personally,
Ian
and.
B
Can
I
just
echo
in
his
point
on
behalf
of
all
of
executing
colleagues
just
to
thank
you
Mark
for
your
your
Relentless
support
for
us
throughout
your
tenure
and
and
really
constructive,
thoughtful
Challenge
and
you're
always
available
on
the
end
of
a
phone
for
anyone
wants
to
chat
to
you
so
really
appreciate,
and
thank
you
and
the
very
best
of
luck
for
the
future.
D
D
What
I've
really
enjoyed
about
the
CQC
is
that
we
always
seem
to
be
learning.
We
value
our
employees.
We
talk
a
lot
about
our
our
people.
We
put
the
service
users
first
I.
D
Just
think
that
that
we
continuously
go
back
to
that
and
that's
a
great
place
to
be
and
I've
thoroughly
enjoyed,
that
we
listen,
we
act
and
we
respond
I
think
we
add
value
to
a
critical
Health
and
Care
System
affecting
everyone
in
England
and
I
just
want
to
say
it's
been
an
absolute
privilege
and
I've
been
really
proud
to
be
a
part
and,
as
Ian
said,
to
be
a
part
for
at
least
another
month.
So
thank.
R
A
Is
there
any
other
business
from
anybody
else?
If
not
well,
look
that
brings
up
10
minutes
over
apologize
for
that,
but
we
finished
the
main
formal
business.
As
you
know,
we
we
all
would
need
to
take
questions
to
the
public
here.
We
do
have
three
questions
submitted
in
advance
from
Robin
Pike,
so
I'll
take
them
individually.
A
I
think
people
know
they're
being
asked
to
respond
to
them.
I
hope
that's
right.
The
first
is
how
is
CQC
currently
regulating
Hospital
Emergency
Care
department,
so
Sean?
Do
you
wish
to
pick
that
up.
E
Thank
you
yes,
I
can
I
can
summarize
how
that
is
happening
at
the
moment
by
saying
our
our
inspectors
are
continuously
assessing
the
level
of
risk
in
the
provider,
organizations
that
they
work
with,
and
they
do
this
by
looking
at
information
a
number
of
sources
of
information
that
includes
performance
data
on
on
the
the
performance
of
the
provider
by
our
data
Insight
function
by
looking
at
feedback
from
patients,
feedback
feedback
can
complaints
from
patients
feedback
from
the
public
and
from
staff
members,
and
when
that
indicates
to
our
inspectors
that
the
level
of
risk
is
is
high.
E
We
respond
in
a
number
of
ways.
First
of
all,
we
would
probably
undertake
enhanced
engagement
with
the
organization
first
of
all,
to
clarify
and
and
understand
the
issues,
but
we
would
also
put
convene
management
review
meeting
where
we
would
plan
an
inspection
and
the
excuse
me,
the
the
the
inspection
would
take
place
and,
depending
on
what
the
inspection
found,
would
the
appropriate
follow-up
action
would
be
undertaken
which
could
range
from
enhanced
integration
to
to
formal
enforcement,
so
that
sort
of
summarizes.
E
The
approach
that
we
take
at
the
moment
should
say
also
that
decisions
at
the
moment
to
to
undertake
an
inspection
do
have
senior
oversight
from
colleagues
in
the
in
in
in
the
CQC.
A
Like
so
out
sure
Kate
Ashley,
two
for
you
here
first,
is
how
are
providers
of
domiciliary
care
performing
during
the
winter
months.
N
Thank
you.
So
the
short
answer
is
it's
a
little
bit
too
early
to
say.
Let
me
expand
on
that.
A
little
bit
we
looked
at
data
of
inspection
reports
published
between
November
and
January,
compared
to
March
and
May
of
last
year.
It
appears
that
there
is
a
slight
reduction
in
the
number
of
requires
an
improvement
and
inadequate
ratings
that
have
been
issued.
N
A
N
You
so
we
have
a
number
of
forums
where
we
can
have
local
and
national
conversations
with
our
our
trade
unions.
N
I
think
we
will
there'll
be
lessons
coming
out
of
the
listening
learning
and
responding
to
concerns
review,
which
will
look
at
how
we
worked
with
key
people
such
as
our
trade
unions,
around
management,
a
change
I
think
our
Unions
would
join
me
in
saying
that
we
have
worked
incredibly
hard,
particularly
over
the
last
six
months,
about
early
engagement
with
them
and
I.
N
A
Hey
Andrew
steward,
okay.
Well,
thank
you
very
much.
Kate
also
I,
think
that
brings
us
to
the
end
of
the
questions
as
well
so
form
business.
So
thank
you
very
much
indeed.
Colleagues.
Thanks
once
again,
I
know
some
people
had
to
make
a
real
effort
to
get
here
today,
whether
it's
staying
overnight,
because
you
can't
get
home
on
the
train
or
whether
it's
special
childcare
Arrangement.
So
it
is
very
much
appreciated.
Thank
you.