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From YouTube: CQC board meeting - April 2021
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A
So
good
morning,
everybody
welcome
to
the
april
meeting
of
the
cqc
board.
We
have
no
apologies
for
absence
we're
all
here.
I
particularly
want
to
welcome
this
morning.
Beth
matthews
from
our
lgbt
equality
network,
beth,
you're
you're,
very
welcome
and
please
put
your
hand
up
if
you,
if
you
wish
to
speak
at
any
time
during
the
meeting
declarations
of
interest,
is
there
anything
anybody
needs
to
declare?
A
No,
that's
good!
Thank
you
very
much
indeed,
that
takes
us.
I
think,
to
the
minutes
of
our
our
march
meeting.
Are
there
a
true
and
accurate
record
of
everything
we
discussed
lots
of
nods,
so
we
will
take
those
as
approved,
there's
nothing
outstanding
in
the
action
log.
Is
there
anything
else
arising
that
anybody
wanted
to
raise
that
doesn't
come
up
on
the
agenda
later
great
good?
So,
let's
move
straight
on
then
to
the
executive
team
report
in
to
you.
B
Thanks
peter
to
just
a
couple
of
quick
things
from
me
this
morning,
before
handing
on
to
to
colleagues,
just
I'm
pleased
to
say
that
the
consultation
that
we've
been
running
on
taking
a
more
flexible
approach
to
regulation
has
now
has
now
closed,
we're
just
analyzing
the
responses
to
that
consultation
board.
Members
will
recall
that
that
consultation
was
was
run
to
give
us
more
flexibility
around
this
link
between
inspection
and
ratings
and
one
or
two
other
things
that
we
knew
had
slightly
held
us
back
in
terms
of
thinking
innovatively
around
our
future
regulatory
approach.
B
So
we'll
obviously
analyze
the
the
the
the
constant
the
consultation
responses.
But
it's
an
important
for
me.
It's
an
important
building
block
towards
being
the
smarter
regulator
that
we
aspire
to
within
our
strategy.
So,
of
course,
as
you
know,
we're
bringing
the
the
strategy
to
board
for
for
consideration
in
the
next
month
or
so
so
with
a
view
that
the
strategy
will
launch
on
the
27th
of
may.
So
this
is
just
an
important
underpinning
component
part
of
it.
B
So
the
second
thing
I
wanted
to
touch
on
is
I
I
I
gave
evidence
to
a
public
accounts
committee
inquiry
yesterday.
Sorry,
on
monday,
I
should
say
on
the
adult
social
care
market.
In
england,
I
was
with
colleagues
from
the
department
of
health,
social
care,
the
ministry
of
of
housing
communities
and
local
governments,
and
we
I
gave
evidence
particularly
evidence
for
that.
That's
been
sourced
from
our
marx
oversight
team
that
had
contributed
to
a
national
audit
office
report,
particularly
around
the
financing
of
the
adult
social
care
market.
B
So
that
was
a,
I
think,
an
important
opportunity
for
us
to
to
give
our
point
of
view
on
on
the
role
that
we
play
and
indeed
don't
play
in
some
cases
in
relation
to
financial
regulation
of
of
the
the
the
adult
social
care
market.
Peter.
That's
all.
I
really
wanted
to
say
before
handing
off
to
to
kate
great
kate
over
to
you.
A
C
You
and
so
just
to
update
board
on
infection
prevention,
control
and
efforts
in
adult
social
care,
and
since
this
paper
was
published,
I'm
really
pleased
to
say
that
there
have
now
been
over
600
inspections
since
april
last
year
and
as
board
are
aware,
this
is
a
blend
of
responding
to
risk
so
risk-based
inspections
and
also
our
inspections.
Looking
at
infection
prevention
control
again,
the
eight
against
the
eight
ticks
of
assurance
on
the
risk-based
inspections.
So
those
are
inspections
where
we've
gone
out
with
to
see
services
where
we've
had
concerns.
C
54
of
those
inspections
are
being
triggered
by
information.
We
continue
to
receive
from
the
public
from
people
who
use
services
from
family
members
and
from
people
who
work
in
social
care,
so
just
to
plea
to
continue
to
ask
the
public
to.
Let
us
know
about
good,
bad
and
mixed
experiences
of
care,
because
it
absolutely
drives
our
regulatory
understanding
of
risk
and
quality,
but
also
our
efforts
as
to
where
we
should
go
out
and
cross
the
threshold.
C
So
54
of
our
space
inspections
are
driven
by
information
we
get
from
members
of
the
public.
So
a
big.
Thank
you
to
colleagues
who
people
in
the
public
who
take
the
time
to
give
us
that
information.
We
do
use
it
and
I'd
also
like
to
say
a
big
thank
you
to
our
all
of
our
inspectors,
who
are
involved
in
undertaking
these
huge
efforts
to
get
out
and
get
these
numbers
of
inspections
underway.
C
Just
wanna
focus
on
one
particular
issue
with
regard
to
our
inspections
and
that's
the
issue
about
visiting
in
care
homes.
So,
throughout
the
pandemic,
we've
been
really
clear
that
we
expect
care
home
providers
to
follow
government
guidelines
to
pay
attention
to
their
local
risk
levels,
so
advice
from
their
directors
of
public
health,
but
that
we've
always
expected
an
individualized
approach
to
making
visiting
happen
where
it's
safe.
To
do
so
so
we've
always
looked
at
it
as
part
of
our
ipc
is
visiting
happening
in
a
safe
way.
C
Following
changes
in
recent
guidance,
we've
now
got
a
new
mandatory
question
within
our
ripc
tool
to
provide
evidence
about
how
that
care
home
is
enabling
visiting
to
happen
according
to
current
guidance,
and
we
are
also
through
various
different
communication
channels,
really
asking
people
whose
loved
ones
are
in
care
homes
to.
Let
us
know
if
there
are
any
issues
with
having
visiting
happens.
C
So
we've
been
really
clear
that
there
should
be
no
blanket
bans
on
visiting
that
people
should
be
able
to
see
their
loved
ones,
noting
that
care
homes
still
have
the
really
tricky
balance
of
ensuring
that
happens
in
a
safe
way.
So
visiting
might
feel
very
different
at
the
moment
with
certain
time
slots
and
people
being
visited,
maybe
not
in
their
usual
in
the
usual
way.
But
we
absolutely
do
not
expect
to
see
any
blanket
visiting
bands
and
where
potential
visiting
bands
blanket
approaches
have
been
brought
to
our
attention.
C
We
have
followed
up
on
every
single
one
of
them
and
we
haven't
found
one
to
date.
So
that's
a
bit
about
ipc
and
then,
if
I
can
briefly
update
board
on
the
ongoing
work
around
closed
cultures.
So,
as
our
board
is
well
aware,
it's
a
real
priority
for
us
about
how
we
effectively
identify
services
at
risk
of
developing
closed
cultures
and
how
we
can
enhance
how
we
regulate
those
services.
C
So
we've
developed
guidance
we've
recently
done
a
survey
to
ensure
that
our
staff
have
a
good
understanding
of
the
issues
around
closed
cultures.
What
that's
teased
out
is
there's
still
some
work.
We
need
to
do
around
inspectors,
confidence
levels
about
having
the
variety
of
communication
skills
they
might
need
when
hearing
directly
from
people
who
access
such
services
and
also
we're
underway.
C
Now,
with
these
with
inspections
of
services
for
people
with
learning
disabilities
and
autistic
people,
where
our
inspections
are
placing
an
increasing
emphasis
on
observation
of
sitting
and
observing
and
just
immersing
themselves
in
in
in
the
service
in
the
care,
that's
being
delivered
to
help
inform
richer
reports
that
really
give
people
who
are
looking
at
the
quality
of
that
care
and
commissioners,
for
example,
a
good
flavor
of
what
it
feels
like
to
receive
care
in
that
place.
That's
it
for
me
thanks
peter.
A
D
Okay-
oh
yes,
yes,
robert!
Thank
you
thank
you
for
that,
sir
okay.
So
just
on
the
visiting
care,
homes
and
something's
come
to
my
attention
recently,
and
I
hope
I've
misread
it,
but
I'm
not
sure
I
have
is
it
about
the
ability
of
people
in
care
homes
to
leave
them
as
in
go
out
either
on
a
visit
or
whatever
that
there's.
D
C
So
so
a
really
important
issue,
robert,
so
new
guidance
published,
maybe
a
little
over
a
week
ago.
You
are
correct
in
your
interpretation
of
that
government
guidance.
C
Your
reflections
on
it
have
been
echoed
quite
strongly
by
many
of
the
stakeholders
who
talk
to
us,
so
we
have
been
very
much
a
conduit
of
that
those
concerns
and
that
reaction
back
to
the
department,
and
we
will
continue
to
share
that
information
with
the
department
and
you
know
flag
what
the
impact
of
this
may
be
in
terms
of
kind
of
quality
of
life
for
people
in
those
settings
with
claims.
D
Am
I
right
in
thinking
it
doesn't
matter
whether
or
not
the
resident
has
been
vaccinated,
because
most
of
them,
of
course,
have
not
happily
now
been
vaccinated?
I
appreciate
that's
not
completely
fair,
but
it
does
seem
to
be
an
area
where
people
elder
people's
rights
in
care
homes
have
been
treated
entirely
differently
to
the
rest
of
the
community.
C
As
I
say,
the
the
guidance
very
recently
published
there's
been
a
strong,
a
strong,
strong
reaction
to
a
whole
whole
wealth
of
people,
and
we
are
ensuring
that
the
that
that
the
government
is
aware
of
that
that
strengths
are
feeling
and
what
it
means
in
terms
of
practical
terms
of
the
sector.
C
Trying
to
implement
that-
and
you
know,
the
heart
of
this
visiting
has
always
been
this
balance
of
keeping
people
physically
safe,
while
enabling
them
to
have
a
quality
of
life,
and
you
know,
loneliness
issues
and
visiting
and
seeing
families
etc.
So
we
will,
we
will
continue
to
give
that
feedback
to
government
so
that
they
are
aware
of
of
the
impact
of
that.
Thank
you.
E
Right
ted,
I
think
we'll
move
on
to
you
all
right.
Thank
you.
Peter
board.
Members
may
remember
that.
Last
autumn
we
published
a
report
a
very
important
report
on
how
mental
health,
the
needs
of
patients
with
mental
health
needs
were
met
in
acute
hospitals.
E
Currently
we're
focusing
on
an
area
with
a
particular
concern
at
some
recent
inspections,
where
we've
seen
children
and
young
people
admitted
to
acute
awards
in
hospitals
and
not
receiving
the
care
they
require
either
the
environment
is
is
is
not
as
it
ought
to
be.
All
the
staff
do
not
have
the
training
and
competencies
to
look
after
these
children
and
young
people.
Well
now,
where
we
find
it,
we
are
taking
enforcement
action
to
make
sure
that
that
action
is
taken
to
protect
the
these
young
people's
well-being.
E
But
having
said
that,
I
think
it
is
really
important
that
acute
trust
have
clear
guidance
on
how
they
manage
children
who
are
admitted
with
mental
health
needs
and
I'm
glad
to
say
that
ages.
England
has
agreed
to
to
issue
some
new
guidance
on
this
to
acute
trusts
and
we're
looking
forward
to
that
coming
out
shortly.
E
E
The
the
original
the
original
issue
was
was
brought
to
light
in
the
morgan
bay
report
several
years
ago
and
was
reiterated
in
the
oculum
report
last
autumn.
So
remains
a
very
real
issue
and
we're
finding
cultural
issues
in
maternity
services
as
we
inspect
them,
and
we're
reporting
on
individual
maternity
services
and
taking
action,
of
course,
but
again,
I'm
glad
to
say
genesee
nhs
england
is
taking
the
issue
forward.
E
They
have
called
a
national
summit
of
national
stakeholders
next
month
to
review
what
can
be
done
together
across
the
board
to
address
this
underlying
cultural
issue
and
to
improve
the
safety
of
maternity
services
going
forward.
So
I
think
that's
really
a
very
important
initiative,
which
I'm
pleased
to
see
we're
continuing
to
monitor,
use
the
transitional
monitoring
approach
to
look
at
independent
healthcare.
We've
now
completed
the
program
of
looking
at
all
our
independent
healthcare
providers,
and
we
where
it
is
where
that
approach
is
identified,
risk
of
course,
before
we
get
with
inspection.
E
But
having
said
that,
we
are
now
reviewing
how
how
effective
the
transitional
monitoring
approach
has
been
to
establish,
giving
us
assurance
about
the
safety
and
quality
of
care
in
across
independent
healthcare.
E
I
think
that's
going
to
be
a
very
valuable
exercise,
both
for
us
assessing
independent
healthcare,
but
also
for
the
cqc
in
assessing
how
the
app
works
we're
using
a
similar
approach
on
vaccine
centers
and
we've
now
followed
up
with
using
a
transitional
monitoring
approach
in
vaccine
centers
across
the
country
over
the
last
few
weeks
and
we're
keeping
abreast
of
new
centres
as
they're
set
up
as
the
rate
of
nosocomial
infection
of
covid
have
diminished.
E
We
are
now
reviewing
our
approach
to
infection
prevention
and
control
going
forward.
I
think
the
covid
pandemic
has
demonstrated
how
important
this
is
in
in
terms
of
providing
safety
in
hospitals,
and
we
need
to
make
sure
that
we've
learned
the
lessons
from
that.
So
we
are
going
to
be
continuing
our
approach
on
infection
prevention
and
control,
but
focusing
on
non-covered
areas
going
forward
and
we're
present
we're
presently
reviewing
our
approach
to
that.
A
E
Peter
we
have
to
if
we
are
going
to
turn
the
corner
in
maternity
services,
but
it's
I
mean
the
this
culture
in
maternity
services
is
a
particular
concern,
but
it
is
to
some
extent
a
microcosm
because
of
the
wider
safety
culture
issues
that
we've
identified
in
our
strategy,
and
I
I
really
take
the
view
that,
if
we're
going
to
apply
our
strategy
of
safety
through
learning
maternity
is
the
right
place
to
start,
we
can
make
the
biggest
difference
most
quickly
there.
But
having
said
that,
I
think
what
we
learn
in
driving
us
forward
in
maternity.
E
We
can
then
apply
it
in
other
parts
of
the
system,
because
getting
the
safety
culture
right
across
the
whole
of
health
and
social
care,
I
should
say,
is
really
important
if
we're
going
to
drive
improvements
and
services.
So
I
think
I
think
this
is
an
opportunity
for
us
to
learn
how
to
do
this.
Well,
there
is
a
real
commitment,
I
think,
from
other
stakeholders
other
parts
of
the
system
to
work
together
on
this.
I
think
it
is
now
widely
recognized
that
the
issues
in
maternity
are
not
purely
process
issues.
E
They
are
cultural
issues,
leadership,
culture,
multi-disciplinary,
working,
driving,
real
safety
through
the
system
and
I
think,
there's
a
real
opportunity
to
move
this
forward.
So
in
answer
to
your
question,
I'm
determining
we
should
crack
this.
It's
too
important
not
to
do
so
great
because
I
I
so
agree
with
you.
A
Right
if
nobody
else
wants
to
come
in,
I
think
where
is
he
move
on
to
you?
Please.
F
Thank
you
very
much
peter
so
two
areas
to
cover
my
report
at
this
time.
The
first
is
about
our
regulatory
approach.
We
are
aware
again
of
huge
demand
in
primary
care
and
general
practice,
particularly
at
the
moment.
F
We
know
that
gps
are
working
very
hard
to
deliver
the
vaccination
program
as
well
as
significant
demands
on
gps
being
reported
in
terms
of
increased
increased
people,
attending
appointments,
and
also
some
of
the
we're
hearing
from
gps
about
some
of
the
impacts
of
long
waiting
lists
and
the
the
backlog
of
cases
that
are
happening
on
them.
So
so
we're
fully
aware
of
the
demands
in
primary
care.
F
So
we
are
balancing
delivering
on
our
function
with
those
supporting
providers
with
those
demands,
and
we
are
with
primary
with
general
practice.
F
We
are
looking
at
re-inspecting,
our
requires
improvement,
practices
or
practices
that
have
regulatory
breaches
or
looking
at
following
up
areas
that
where
there
is
significant
risk
with
independent
health,
our
focus
is
more
on
those
practices
that
haven't
been
or
those
providers
that
haven't
been
inspected
since
registration
and
also
those
ones
with
a
breach
of
regulations
and
our
dental
inspections
are
very
much
following
a
risk-based
approach
as
well,
but
looking
at
how
we
incorporate
the
learning
and
the
work
that
we've
done
on
the
tma
approach,
which
has
been
very
well
received
in
the
dental
sector.
F
So
that's
that's
our
regulatory
approach,
just
to
mention
as
well
provide
a
collaboration,
review
work.
We
have
completed
the
field
work
for
cancer
and
learning
disabilities
and
we
shall
be
publishing
the
results
from
those
we
are
just
soon
to
be
undergoing
the
mental
health
review
work.
As
the
report
says,
this
focuses
on
children
and
young
people's
mental
health
across
the
whole
pathway.
F
I
think
we
all
are
concerned
about
the
impact
that
the
pandemic
has
had
on
children
and
young
people's
mental
health,
and
we
feel
that
it's
really
important
that
we
look
to
make
sure
that
people
get
good
access
to
care
and
the
right
care
and
treatment
at
every
aspect
of
the
pathway
which
includes
areas
such
as
primary
care,
community
services
and
and
also
the
the
the
very
kind
of
high
level
mental
health
need
in
in
mental
health
settings.
F
So
that
work
is
undergo
is
due
to
start
in
may,
and
lots
of
preparation
is
going
ahead
with
that.
A
Great
rosie,
I
can
report
that
I
had
my
my
my
second
jab
yesterday
through
my
local
gp
practice.
It's
the
only
advantage
of
being
older
than
anybody
else
in
the
room
because
I
get
there
quicker
than
you
do.
They're
just
so
well
organized
as
just
it's
something
we
should
be
very
proud
of.
I
think,
as
a
country,
just
brilliant
good
right.
So
having
got
that
off
my
chest,
let's
move
on
kirsty
the
vaccination
program.
More
generally,
I
think.
G
Thank
you
peter,
as
you
say,
seamlessly
transitioning
into
the
vaccination
program.
So
we
continue
to
to
to
keep
a
monitoring
approach
to
to
to
vaccination.
We
are
making
good
progress
with
both
the
vaccines
monitoring
in
pms
and
in
hospitals.
G
We
are
using
our
transitioning
monitoring
approach
in
in
pms
to
to
to
do
that
as
part
of
our
risk-based
activity
and
within
hospitals.
We
have
adapted
our
our
our
activity
to
use
our
vaccine
monitoring
app
again
risk-based
approach.
So
far
we
have
found
no
issues.
G
Today
we
have
conducted
assurance
activity
on
around
78
of
those
mass
vaccination
sites
and
fans
say
nothing,
nothing
untoward,
particularly
what
we
have
done
is
we
have
adapted
our
methodology
slightly
to
make
sure
we
are
picking
up
issues
around
equality
and
diversity
and
human
rights,
around
access
to
vaccines,
for
migrants
and
also
around
language,
to
make
sure
that
we
are
just
covering
those
off
in
in
our
evaluations.
So
all
good.
G
Moving
on
to
the
people
plan
update
in
terms
of
our
people
plan
work,
we
continue
to
work
across
on
a
number
of
fronts
around
our
people
activity,
but
just
to
draw
highlights
to
a
couple
of
areas
this
month,
one
it's
stress
awareness
month
for
april
and
we've
been
running
a
healthy
working
campaign
as
part
of
that
for
our
well-being.
A
G
And
making
sure
that
people
have
a
good,
a
good
work-life
balance,
where
possible.
We've
also
provided
made
available
to
our
colleagues
the
headspace
app
to
help
people
with
mindfulness
tools,
and
things
like
that.
That's
gone
down
very
well
with
over
a
thousand
people
downloading
that
in
the
first
month
of
its
of
its
availability,
we
are
also
continuing
to
work
across
our
diversity
and
inclusion
agenda,
and
this
month
we
I
just
wanted
to
highlight
that
we
have
introduced
some
new
roles
at
directorate
level,
which
are
our
diversity
and
inclusion
advocates.
G
These
are
going
to
work
at
a
at
a
directorate
level
to
make
sure
that
we
are
driving
best
practice
at
a
delivery
level
at
a
local
level,
working
with
the
management
teams
and
with
colleagues
to
ensure
that
we
really
do
embed
best
practice
and
also
ensure
that
we
have
a
good
link
with
our
transformation
and
strategy
work
in
terms
of
making
sure
we
put
diversity
and
inclusion
front
and
center
of
what
we
do.
So
that's
all
from
me
on
on
those
areas
this
month.
Thank
you,
peter.
B
Ian
sorry,
hey:
can
I
just
just
picking
up
the
points
about
diversity
and
inclusion?
I
I
notice
I
note
that
the
the
commission
on
race
and
ethnic
disparities
report
reported
a
couple
of
weeks
ago,
and
I
think
I
would
I
would
broadly
welcome
the
report
in
terms
there
were
a
number
of
are
very
powerful
points.
B
I
think
the
only
thing
that
that
I
would
say
is
that
the
particular
the
particular
recommendation
that
related
to
cqc
was
something
that
we're
talking
to
the
department
of
health
and
social
care
about,
because
we
have
been
working
with
the
with
nhs
england's
reds
team
for
some
years
now
on.
Promoting
the
reds-
and
I
know
ted
will
want
to
come
in
and
just
talk
about
some
of
that
work
in
a
moment,
but
I
say
I
think
it's
a
it's
a
powerful
report.
B
I
know
it
had
a
somewhat
mixed
reception
in
some
quarters
of
the
media,
but
I
think
there
are
some
some
important
points
to
make
and
I
think
if
I
could
our
work
more
broadly,
it
absolutely
connects
in
with
our
intentions
around
our
new
strategy,
which
is
coming,
which
has
inequalities
as
at
the
heart
of
of
our
of
of
how
we
will
we
will
be
going
forward
and
of
course,
I
think
we've
got
a
strong
track
record
of
working
within
inequalities,
particularly
with
the
res
team
over
a
number
of
years.
E
Ted,
yes,
thank
you
peter.
Yes,
the
the
workforce,
race,
equality
standards
in
the
nhs
or
for
nhs
services
were
introduced
in
2016..
E
I
I'm
really
glad
to
say
that
right
at
the
start,
we
recognized
the
importance
of
this
agenda
and
built
the
adherence
with
those
with
those
standards
into
our
well-led
assessment
of
nhs
services,
and
I
think
the
fact
that
we
have
drawn
attention
to
it
in
our
reports
occasionally
taken
enforcement
action
not
directly
on
the
race
equality
standards,
because
we
don't
have
power
to
do
that,
but
using
the
health
and
social
care
act
where
we
believe
that
the
culture
in
organizations
identified
by
the
race
equality
data
indicates
that
it's
affecting
the
quality
of
care
for
patients.
E
We
have
been
able
to
take
enforcement
actions.
In
one
case,
it
was
a
very
important
part
of
a
reason,
putting
a
trust
into
special
measures
so
that
we
have
used
these
standards
going
forward,
and
I
have
to
say,
I
think
the
work
we've
done
has
been
really
very
important
to
bring
them
to
problem.
That's
in
the
nhs
and
has
made
a
difference.
But
I
think
the
the
this
report
was
coming
out
has
identified
that
more
work
needs
to
be
done,
and
that
is
entirely
correct
and
this
is
an
agenda.
E
We're
not
going
to
let
go
of
we're
building
the
the
race
equality
standards.
Learning
from
what
we've
done
over
the
last
few
years
into
our
well-led
framework,
going
forward
we're
determined
to
make
a
real
difference
to
race,
equality
in
nhs
services,
and
I
think
the
ball.
I
think
this
report
is
is
right
in
drawing
attention
to
the
inequalities
that
still
exist
in
in
amongst
staff
in
health,
in
nhs
services
across
the
board,
and
that
is
something
we're
very,
very
much
very
keen
to
take
forward
in
our
assessment
of
leadership
and
culture
in
nhs
trusts.
A
Thanks
ted,
it's
so
important,
and
I
I'm
really
pleased
to
hear
what
you've
just
said.
Thank
you.
Anybody
else
wants
to
come
in,
in
which
case
shall
we
move
on
to
the
performance
report.
Chris.
H
Thanks
peter
yeah,
so
just
a
quick
update.
We've
got
a
fuller
end
of
year,
recap
of
performance
and
delivery
at
next
month's
board
session,
which
hopefully
paints
a
story
of
the
year.
So
just
in
terms
of
the
year
to
february
and
beyond,
so
in
efficient,
fair
and
efficient,
effective
registration
service,
we
process
simple
applications,
an
average
of
20.5
days
and
complex
applications
of
114.3
days,
pull
out
more
on
that
next
month.
H
H
as
a
6th
of
april,
just
over
54
of
inspections
that
were
triggered
by
risk
result
of
information
of
concern.
We
received
so
really
demonstrating
how
safeguarding
and
wispon
information
is
used
as
a
key
piece
of
intelligence
and
also
at
the
same
0.6
of
april
7006
locations
have
been
inspected
during
the
year
and
24
000
active
locations
have
had
either
an
inspection,
an
esf
or
a
tma
call,
since
this
start
of
the
year.
So
that's
just
over
50
percent
of
active
locations
with
some
form
of
regulatory
action
during
the
year.
H
Finally,
just
in
terms
of
how
we
equip
our
organization
and
people,
staff
turnover
remains
stable
at
7.61
and
10,
just
over
10
for
those
with
under
two
years
service
and
on
our
budget.
We're
forecast
to
be
13.2
million
under
spent
on
our
revenue
budget
and
1.8
million
under
spent
on
the
capital
budget.
A
I
Thanks
chris
and
peter,
can
we
just
clarify
what
we
might
do
with
the
underspend?
Is
it
carryable
forward.
H
We'll
we'll
retain
the
underspend
within
our
reserves
as
as
part
of
the
end
of
year
and
accessing
that
will
be
through
discussion
with
the
department
for
future
years,
but
we'll
retain
those
those
in
our
reserves.
I
A
Yeah,
I
think
it's
really
important
that
the
with
the
sort
of
long-term
multi-year
programs
that
that
were
running
in
places
that
we
we
can't
just
look
at
each
year
in
complete
isolation,
but
obviously
also
in
the
you
know,
overall
we're
not
a
for-profit
organization.
A
So
eventually,
if,
if
there
are
surpluses
that
we
don't
need
to
use,
then
they
get
back
to
to
feed
payers
either
in
reduced
fees
or
or
you
know,
conceivably,
I
think,
unlikely
but
conceivably
in
a
refund,
but
but
but
not
just
taking
it
one
year
at
a
time
that
that
makes
no
sense.
In
my
view,
right
mark
you
you,
you
actually
and
did
you
want
to
come
in
on
that
point,.
B
I
think
what
we've,
what
we've
managed
to
do
over
the
last
couple
of
years
is
to
freeze
our
fees
so
and
what
we,
what
we're
trying
to
do
with
providers
is,
give
them
some
long-term
certainty,
so
we're
able
we're
making
the
investments
that
we
that
we've
talked
about
in
previous
meetings
around
new
mit
infrastructure
and
so
forth,
where
we're
trying
to
do
that,
whilst
at
the
same
time
keeping
keeping
fees
as
stable
as
possible
so
give
to
give
providers
that
long-term
stability
that
I
know
is
so
important.
B
J
Thank
you,
I'm.
You
know
reassured
by
the
information
that
that's
in
the
pack.
I
should.
I
should
emphasize
that
before
asking
this
question,
but
obviously
for
some
of
these
metrics
and
I'm
focusing
particularly
on
the
safeguarding
one,
you
know
the
tail
could
hide
some
quite
difficult
and
and
and
bad
situations
so
just
be
helpful
to
just
to
understand
the
process
a
bit
for
how
a
little
bit
more
about
the
process
for
those
those
metrics
where
the
devil
could
be
in
the
in
in
the
tail.
What
is
the
what's?
G
Thanks
peter
yeah
I
can.
I
can
certainly
look
at
that.
So
in
terms
of
the
the
metrics,
I
think,
there's
there's
there's
looking
at
this
of
the
outliers,
as
you
say,
so
we
want
to
make
sure
we've
got.
We
understand
what
the
average
also
our
average
is,
but
then
also
make
sure
that
we're
looking
at
those
those
ones
on
on
the
edge
of
the
of
the
bell
curve
to
make
sure
that
we're
not
picking
things
up
things
like
safeguarding
where
we've
got
discrepancies.
G
So
if
we
have
got
areas
where
we've
got
where
we're
consistently
picking
up
the
tail
is
not
getting
down,
or
it's
growing
and
really
trying
to
understand.
What's
driving
that
so
that
we
can
get
to
the
root
cause
and
address
some
of
those
issues
so
that
we
can
make
sure
that
we're
we're
tackling
them
in
the
right
way
and
not
just
constantly
putting
a
sticking
plaster
over
the
top
of
it.
G
C
Just
very
briefly
to
bring
it
to
life
in
terms
of
kind
of
operationally
and
the
the
functionality
we've
now
got
in
power.
Bi
means
that
there's
a
trigger
for
our
inspection
managers
if
the
deadline's
not
been
hit
to
inform
their
conversations
with
inspectors
to
seek
assurance
or
to
help
them
get
past
any
blocks
or
delays,
and
then
there's
also,
and
then
an
escalation
to
our
heads
of
inspection.
If
that
progress
hasn't
been
made,
so
there
are
a
number
of
checks.
That
means
that
this
is
getting
escalated.
C
If
action
isn't
happening,
often
it
comes
down
to
a
clicking
the
right
box,
or
it
comes
down
to
a.
I
can't
close
this
off
till
I've
been
assured
that
I've
passed
it
on
to
a
local
authority
and
they've
done
with
it
what
they've
needed
to,
but
in
terms
of
our
power
bi,
giving
us
the
tools
that
we
need
to
have
those
conversations
to
give
us
assurance.
I
think
I
can
speak
confidently
from
my
inspection
managers
and
heads
off
to
say
that
they've
absolutely
got
that
tool
now.
F
Just
just
to
build
on
that,
we
also
have
a
system
where
our
delivery
team
contact
the
relevant.
I
am
having
looked
at
the
the
data
on
a
weekly
basis
with
the
information
just
to
make
sure
that
nothing
does
slip
through
the
net.
So
so
we
have
got
robust
systems
in
place
around
that.
A
Great
thanks
rosie
thanks
mark,
so
I
think
that
that
enables
us
to
move
on
to
cyber
risk
security.
I'm
hoping
mark
was
another.
Another
nil
report
very
very
pleased
to
offer
a
new
report,
peter
that's
what
I
like
to
hear.
Thank
you
very
much
indeed,.
K
Chris,
they
right
to
give
them
colleagues
an
update
on
some
of
our
engagement
with
government
and
parliament.
Recently,
following
the
our
listening
publication,
we've
been
asked
by
the
health
and
social
care
committee
to
give
some
evidence
to
the
inquiry
into
children.
Young
people's
mental
health,
which
I
think
is
an
important
vehicle
for
us
to
sort
of
to
highlight
some
of
our
ongoing
concerns
about
the
treatment
of
young
people
in
mental
health
settings.
K
We've
also
submitted
some
evidence,
the
health
and
social
care
committee
on
the
government's
white
paper
and
we're
continuing
conversations
both
with
government
and
parliament
in
that
important
area,
and
today
we're
offering
some
evidence
to
the
joint
committee
on
human
rights
regarding
visiting
in
in
adult
social
care
settings
more
generally
wanted
to
make
the
point
that
we
continue
to
give
both
all
and
written
evidence.
K
Usually,
we've
got
two
committees
preparing
at
any
one
time
and
we
give
on
average,
all
written
evidence
every
every
two
weeks
to
a
committee
of
parliament.
In
addition
to
the
informal
conversations
that
highlighted
in
the
report,
I
think
this
is
helpful
because
it
ensures
that
our
voice
and
our
ability
to
drive
change
and
improvement
in
the
system
isn't
just
about
media
releases,
and
it
is
also
about
the
conversations
we
have
with
both
government
and
parliament
so
that
they
understand
what
we
know
to
help
drive
change
in
the
system.
A
Great,
thank
you
quite
a
lot
going
on.
Unsurprisingly,
quite
a
lot
going
on
in
in
parliament.
So
is
there
anything
else
anybody
wants
to
raise
in
relation
to
the
executive
team
report?
A
Well,
just
then,
my
thanks
to
executive
colleagues
because
there's
an
awful
lot
awful
lot
going
on
and
I
think
the
report
barely
touched
the
sides
of
what
of
the
activity.
So
so
thank
you
for
that.
Kirsty
we're
running
a
little
ahead
of
ourselves
now,
but
are
we
able
to
do
the
the
pulse
survey?
I
don't
know.
G
I
think
if
we
can
get
jill
in,
we
should
be
able
to
pick
that
up,
don't
want
to
steal
her
thunder
so
certainly
not
now.
Maybe
you
called
her
in.
I
I
Peter
I
was
just
going
to
follow
up
on
your
comment
on
vaccinations.
Yes,
but
I
think
everybody
who's
had
one
has
had
a
fantastic
experience.
Haven't
they,
but
even
if
you
haven't
had
both
of
them,
the
results
are
really
encouraging.
Aren't
they
in
terms
of
hospital
admissions
and
the
prevention
for
people?
Who've
only
had
one
of
the
vaccination
jobs.
A
So
so
some
younger
members
of
the
board
are
still
waiting
for
their
first.
But
that's
that's
the
price
you
pay
for
being
young,
I'm
afraid
by
the
way,
I'd
swap
I'd,
swap
to
be
much
younger
and
not
have
the
vaccination,
but
anyway.
M
A
A
It
gave
us
a
chance
to
have
a
quick
chat,
so
the
pulse
survey
please
jill.
Thank.
C
You
and
good
morning,
everyone
so
just
I'll,
give
a
kind
of
quick
summary
of
some
of
what
I
think
of
the
highlights
and
then
I'll
pause
so
that
we
can
have
a
conversation.
C
C
C
C
Again,
something
really
positive
to
sort
of
to
focus
on
the
questions
on
people
experiencing
bullying.
Harassment
abuse
are
slowly
coming
down,
but
I
think
there's
still
more
for
us
to
do
and
there's
something
interesting
in
the
reasons
that
people
are
giving
for
bullying,
harassment
and
abuse,
and
so
I
really
want
to
do
some
work
to
further
explore
what
we
can
do
to
address
those
responses
which
talk
about
email,
tone
and
style.
C
So
there's
a
an
opportunity,
I
think,
to
really
focus
on
kind
of
how
do
we?
How
do
we
engage
people
in
that
sort
of
that
narrative
around
our
strategic
direction
and
the
question
on
feeling
informed
about
changes
and
the
and
transformation
is
up
from
the
main
survey
by
21
percentage
points
at
63
positive.
C
This
overall
score
has
shifted
a
little
downward
since
we
pulsed
in
the
autumn
time
which,
if
you
remember,
we
were
in
the
depths
of
our
strategy-
consultation
in
the
organization,
and
so
I
think
this
tells
us
that
our
transformation
engagement
continues
to
be
a
key
priority
for
us.
C
The
dni
section,
I
think
again,
is
a
strong
platform
on
which
we
can
build
as
we
approach
our
first
year
of
the
anniversary
of
the
launch
of
our
dni
strategy.
It's
only
so
not
even
a
year
since
we
launched
the
document.
So
that's
a
a
really
sort
of
a
really
good
response.
I
think
for
us,
the
awareness
levels
on
our
dni
ambitions
are
really
high
at
84.
I
couldn't
have
predicted
that
that
was
the
score
that
we'd
get
and
the
response
that
we
get.
C
So
I
think
more
to
understand
about
that.
Once
we
get
that
more
detailed
data,
some
of
the
responses
on
career
progression,
opportunities
and
visibility
of
diverse
teams
across
the
the
organization
are,
if
I'm
honest,
not
where
I
and
we
would
want
them
to
be,
and
they
show
us
that.
I
think
that
we
really
need
to
press
on
with
our
commitment
in
the
dni
strategy
and
the
res
and
with
des
action
plans.
C
C
So
the
50
positive
score
that
we
see
in
this
pulse
survey
is
a
slight
increase
on
the
last
main
survey
and
the
last
time
we
asked
this
question,
but
it's
really
important
to
note
in
this
particular
question
that
it's
now
at
its
highest,
that
it's
been
and
in
the
sort
of
in
the
surveys
historically,
and
also
that
the
rate
of
increase
has
been
greater
in
recent
years.
C
C
So
I
will
kind
of
just
remind
us
what
I
think
are
probably
the
focus
priorities
or
I
perceive
to
be
the
focus
priorities
from
this
organizational
level
data
and
they
are
really
to
continue
with
our
focus
and
attention
on
our
dni
strategy
and
the
waders
and
res
action
plans
that
we
shared
with
the
board
in
february.
C
I
really
wanted
to
do
something
to
really
continue
to
focus
on
creating
an
environment
where
all
colleagues
feel
safe
to
challenge
so
there's
something
I
need
to
sort
of
unpack
a
bit
more
around
that
and
the
role
of
leaders
continues
to
be
important
and
how
we
lead
inclusively
through
change.
We
need
to
maintain
our
focus
on
our
narrative,
aligned
to
transformation
and
actually
the
changes
that
we
are
starting
to
sort
of
develop
and
I
think,
also
sort
of
linked
back
to
the
dni
approach
and
and
priorities.
C
I
think
there's
a
real
opportunity
for
us
to
create
more
opportunities
for
diverse
talent
to
flourish
in
the
organization.
So
I
will
pause
there
for
comments
and
reflections.
A
Robert
you
started
off
thanksgiving
by.
D
The
way
robert
well,
thank
you
very
much,
sir
peter,
and
thank
you
jill
for
that
comprehensive
report.
When
I
say
so,
I
think
it's
a
testament
to
the
commitment
we
have
to
change
things
for
the
better
that
we
deal
with
this
in
the
public
board
meeting
and
the
figure
with
the
pretty
granular
figures
that
we
have
here.
Clearly,
there's
a
lot
to
be
encouraged
about.
D
My
comments
would
be,
though,
on
the
the
group
of
figures
around
harassment
and
discrimination,
and
the
numbers,
as
I
think
you
apply,
are
still
of
concern,
and,
and
actually
it's
one
of
those
areas
where
percentages
really
don't
tell
the
story,
because
actually
I
believe
it's
the
always
believe
that
this
this
sort
of
issue
is
the
numbers
of
people
involved,
who
are
important
and
for
every
person
who
has
been
or
feels
they've,
been
bullied
or
discriminated
against
or
with,
and
have
witnessed
that
a
number
of
others
will
change
their
behavior
because
that's
what
they've
experienced,
and
so
it
is
a
creeping
form
of
cancer
that
it's
important,
that
we
don't
tolerate.
D
It's
an
area
where,
in
a
sense,
the
temptation
to
benchmark
and
think
oh
well
we're
about
the
same
as
other
organizations
I
think
can
produce,
and
I
don't
appreciate
you're
not
doing
that
here
can
produce
a
slight
sense
of
complacency,
but
a
particular
concern
and
I
would
have
thought
as
a
board.
We
need
to
ask
the
direct
question,
which
is
that,
where
of
those?
D
If
I
read
this
correctly,
those
who
reported
an
adverse
experience
of
bullying
or
humiliating
behavior
in
the
last
12
months,
38
are
saying
it
happened
with
a
senior
manager
or
an
executive
director,
and
I'm
not
sure
what
that
translates
into
in
numbers,
and
perhaps
we
don't
know
or
need
to
know.
But
I
just
wonder
with
what
reflections
is
it
where
the
senior
management
team
or
executive
team
can
have
about
that,
because
all
organizations
end
up
looking
like
their
leadership.
So
it's
a
hard
question
to
ask.
I
know.
C
Can
come
in
so
I
think
I
think
you're
right
robert
there's,
it's
the
individuals
and
their
experiences
of
work
and
whether
that
is
a
sort
of
true
to
the
acas
definition
of
bullying,
harassment
and
discrimination,
or
whether
that
is
a
perception
of
something
that
feels
not
appropriate
for
them.
I
think
we
need
to
take
this
seriously
and
we
do-
and
I
I
think,
you're
right
there,
the
sort
of
recognizing
that
you
are
about
the
same
or
better
than
an
organ.
Another
organization
is
not
the
approach
that
we
are
taking
in
cqc.
C
You
know
we
I'd
like
to
get
to
a
point
where
these
scores
is
zero
and
I
think
we'll
continue
our
commitment
until
they
are,
and
I
think
you
you're
really
you're
spot
on
about
kind
of
the
leadership
and
role
modelling
behaviors
and
I
think
we're
paying
a
lot
of
attention
through
some
interventions
that
we're
doing
with
our
leadership.
Cardra
we've
got
a
big
piece
of
work,
going
on
with
reverse
mentoring,
which
is
actually
helping
people
to
absolutely
understand
the
experiences
of
others
who
are
not
and
who,
where
they
don't
have
the
same,
lived
experience.
C
We're
also
doing
a
piece
of
work
around
inclusive
leadership,
which
is
across
the
whole
of
slt30.
It's
a
very
powerful
piece
of
work
which
we're
helping
people
to
understand
where
behaviors
are
make
an
impact.
This
is
not
an
easy,
quick
fix
at
all,
but
it
remains
a
real
priority
for
us,
so
I
hope
you
feel
assured
about
that.
D
Yes,
I
appreciate
how
difficult
this
area
is,
but
it
is
an
area
where
the
important
point
is
how
people
perceive
behavior
and
that's
what
has
to
be
learned
from,
and
we
all
do,
it's
not.
We
all
think
we're
great
and
we
all
think
we're
being
generous,
but
that's
sometimes,
unfortunately,
not
how
we're
received.
B
Sadly,
yes,
ian
yeah
peter.
Thank
you
I
mean,
I
think,
just
to
echo
jill's
point
we're
not
we're
not
deliberately
making
it
any
attempt
to
benchmark
here.
I
think
there's
a
there's
a
there's,
an
easy
temptation
to
try
and
see
these
the
the
this
survey
in
the
context
of
similar
questions,
they're
at
cast
of,
say,
nhs
trust,
but
we
are
a
completely
different
organization,
so
I
I
think
we're
not
making
any
attempt
to
benchmark.
I
think
I
think
we
have
to
hold
ourselves
to
a
a
to
a
count
on
the
on
the
absolutes.
B
In
terms
of
your
broader
point,
robert
though
I
think
one
of
the
things
that
is
quite
striking
is
the
the
impact
of
email,
tone
and
style
and
the
excessive
criticism
elements
of
of
of
perceptions
around
bullying
and
harassment,
and
I
know
we
have
had
to
do-
we've
had
to
be
quite
directive
during
during
parts
of
the
last
of
the
last
year.
We've
had
to
stop
people
from
doing
things
that
they
would
otherwise
have
liked
to
do.
B
We've
had
to
we've
had
to
ask
people
to
do
things
that
they
may
not
necessarily
have
wanted
to
do,
and
at
times
we've
had
to
do
that
relatively
quickly
and
in
quite
a
directive
way
just
because
because
of
government
guidelines
or
or
because
of
or
because
of
an
overarching
need
organization
to
keep
people
safe,
and
sometimes
people
disagree
with
that,
and
I
know
I've
seen
many
examples
on
my
weekly
calls
where
people
disagree
with
the
policy
position
that
we've
taken.
B
But
we've
had
to
be
very
very
clear
that
this
is
not
a
discussion
point,
so
we've
had
to
do
something,
so
I
I
think
that's
an
element
of
it,
but
I
think,
as
jill
said,
the
the
the
real
power
of
these
surveys
is
probably
not
in
these
aggregate
numbers.
It
is
about
breaking
it
down
by
types
of
by
by
people's
backgrounds,
the
the
characteristics
which
part
of
the
organization
they
sit
in
and
and
so
on.
B
So
I
I
think
all
of
that
needs
to
be
needs
to
be
the
answer
to
this,
and
then
we
need
to
sort
of,
I
think,
also
break
this
down
into.
So
what
can
we
tangibly?
Do
about
this,
and
so
one
of
the
you
know
the
early
conversations
we've
had.
Is
it's
just
looking
at
how
we
you
know
what
what
is
the
email
culture
around
here?
How
do
we
write?
How
do
we
write
to
each
other?
B
Are
there
some
very
practical
things
we
can
do
just
so
that
we
can
deliver
difficult
messages,
but
in
a
way
that
that
people
see
us
as
constructive
as
opposed
to
something
which
is
seen
as
as
potentially
bullying,
bullying
or
harassing
so
it
feels
like
a
you
know,
an
important
area
and
I
think,
as
jill
as
just
said
for
me,
the
the
the
that
feels
like
there's
a
disconnect
between
this
group
of
questions
and
some
of
the
the
questions
around
perceptions
of
fairness,
some
of
the
questions
around
recommendation
of
cqc
as
a
place
to
work
and
so
forth,
and
I
think
just
trying
to
connect
the
dots
between
those
two
things
is-
is
going
to
be
really
important
for
us
thanks
peter.
M
M
M
I
think
it's
really
important
that
in
our
emerging
teams
that
we
continue
to
demonstrate
the
visibility
of
our
dni
actions,
specifically
around
recruitment,
around
training
and
around
development.
So
those
are
two
observations.
I'd
make
a
question
I'd
like
to
ask:
is
that
the
pulse
surveys
and
your
our
responses
to
them,
you
know,
have
really
been
a
positive,
the
launching
of
of
the
pulse
surveys.
M
So
I'm
wondering
are
there
any
lessons
that
from
the
pulse
service
that
can
help
with
the
long
survey
which
you're
still
intending
to
run
at
the
end
of
the
year,
I.e
power
questions
asked
the
flow
of
the
survey,
the
way
the
surveys
are
promoted
and
advertised,
and
indeed
the
speed
of
the
survey
feedback,
whether
we
you
know
there
are
lessons
we
could
take
from
the
pulse
survey
and
apply
them
to
the
long
survey
to
make
it
perhaps
a
more
dynamic
tool.
That's
my
question.
Thank
you
chill.
Do
you.
C
Yeah,
I
can
respond
to
that,
so
I
think
I
think
you've
identified
things
that
that
marco
are
are
actually
important,
and
I,
I
guess
they're
kind
of
the
being
more
explicit
about
our
continued
focus
on
behaviors
at
work
is
part
and
parcel
of
our
dna
strategy
and
our
action
plan,
but
absolutely
appropriate
that
we
we
ensure
that
everyone
is
aware
that
this
is,
you
know,
a
continued
priority
for
us
as
an
organization.
C
I
think
I
think
it's
a
good.
It's
a
really
good
call.
An
observation
about.
Are
we,
as
are
we
playing
back
some
of
the
actions
and
improvements?
So
we
know
from
data
from
our
recruitment
activity
that
we
are.
You
know
we
are
recruiting.
C
Probably
about
20
of
our
new
of
our
recruitment
activity
is
for
is
to
those
from
a
black
asian
or
minority
ethnic
background.
We
probably
don't
make
as
much
of
a
thing
about
that
in
the
organization,
so
there's
probably
more
to
do
to
sort
of.
C
C
We
are
we're
in
the
position
where
we're
coming
to
the
end
of
our
of
our
contractual
arrangements
with
the
with
our
current
survey
provider,
and
that
includes
survey
pulse
survey
in
the
summer,
the
main
survey
in
the
autumn
and
then
a
further
pulse
survey
early
in
the
new
year
until
we
move
on
to
a
new
provider,
I
think
it's
important
for
our
trend
data
that
we
try
to
keep
as
many
of
the
questions
right
and
relevant
with
this
particular
provider,
so
that
we
can
track
our
progress.
C
What
I'm
wanting
to
do
is
really
look
at
those
dynamic
factors
that
we've
learned
from
both
in
terms
of
timing
for
the
pulse
surveys
and
how
we
can
actually
how
we
corral
a
set
of
questions
that
give
us
the
right
snapshot
as
we
progress
into
pulse
surveys
for
the
future.
So
I
think,
there's
a
lot
of
learning
for
how
we
continue
to
manage
and
develop
our
pulse
survey
approach
in
terms
of
our
main
survey.
I
think
it's.
C
I
think
there
are
some
really
important
questions
that
whilst
we've
asked
them
periodically
over
the
last
18
months,
we
haven't
asked
them
all
in
one.
Go
and
we've
had
quite
an
extraordinary
period
between
the
last
survey
in
at
the
end
of
2019
and
where
we
are
now
so
I
I
want.
I
want
to
try
and
keep
that
survey.
C
Question
set
stable
for
this
last
iteration
before
we
move
into
something
where
we
can
kind
of
look
again
with
a
fresh
eye
at
some
of
the
questions.
C
M
M
If
I
could
one
is
the
the
the
question
about
strategic
direction
and
I'd
be
interested
in
your
take
on
on
what
what
it's
really
telling
us
that
56
are
positive
about
strategic
direction
and
44
by
implication,
not
that
that
could
be
I'm
I'm
not
positive,
because
I
don't
understand
it
which
would
sort
of
trigger
one
response.
It's
a
sort
of
briefing
and
information
response,
or
I
do
understand
it,
but
I
don't
like
it,
which
would
kind
of
require
a
different
type
of
response.
M
I
know
you've
been
putting
massive
amounts
of
effort
into
sort
of
briefing
colleagues
on
what
is
the
strategy?
What
is
the
direction?
Where
are
we
going
what's
the
new
operating
model,
so
I
I'm
absolutely
clear
is
not
for
lack
of
trying.
What
what
do
you
think?
What?
What
more
might
it
be
possible
to
do
to
shift
that
indicator
about
being
positive
on
the
strategic
direction?
M
Second,
one,
if
I
could
very
briefly,
do
you
have
any
plans
to
ask
staff
about
sort
of
the
easing
of
lockdown
and
what
it
means
for
returning
to
or
moving
on,
to
sort
of
returning
to
the
office
returning
to
office-based
working
returning
to
sort
of
ways,
ways
of
working
pre-lockdown
for
many
organizations,
there's
quite
a
significant
issue.
I
think
about
rebuilding
confidence
about
coming
back
into
the
office
if
you've
got
used
to
working
from
home
is.
Is
that
an
issue
for
you
in
terms
of
sort
of
staff
surveying
and
opinion?
Thank
you.
A
A
lot
of
questions,
good
ones
jill.
I
wonder
whether
it
might
be
sensible
to
ask
ian
to
to
come
in
and
talk
about
the
the
strategy,
because
I
think
I
think
there
are
other
reasons
and
the
the
two
you
suggested,
stephen,
that
that
might
be
behind
what
we're
seeing
in.
B
Thank
thanks,
sir
peter
yeah,
stephen.
I
think
it's
it's
a
it's
a
good
point,
and
certainly
one
of
the
things
we've
been
picking
up
into
anecdotally,
as,
as
we've
been
as
we
do,
an
ongoing
assessment
of
of
our
communications
and
we
look
for
feedback
specifically
around
specific
pieces
of
communications.
B
What
what's
obvious
is
we
did
a
a
big
piece
of
work
early
part
of
this
calendar
year
around
talking
about
the
next
stages
of
our
transformation
activity?
We
talked
about
the
the
the
new
target
operating
model.
We
talked
about
long,
our
long-term
ambitions
for
the
next
couple
of
years,
so
we
we
set
our
stall
out
very
clearly
and
what
people
immediately
and
under
completely
understandably
said
was
so
what
does
it
mean
for
me
personally?
B
What
does
it
mean
for
my
team
and
they
were
questions
that
we
deliberately
weren't
able
to
answer,
because
we
started
from
the
premise
of
we
want
to
go
out
early
and
talk
about
the
direction
of
travel
and
then
try
and
build
a
new
organization
alongside
people.
So
we
can
be
completely
open
and
transparent
about
that.
We
recognized
that
that
there
was
a
risk
to
that.
To
that
strategic
communications
decision
that
which
was
people
would
immediately
be
looking
for
detail
and
that's
exactly
what's
happened
so
some
extent.
B
This
is
not
entirely
unexpected
and-
and
I
think,
as
we
get
into
this
as
we
get
into
the
detail
over
the
next
the
next
couple
of
quarters,
I
think
what
we'll
start
to
see
is
people
starting
to
see
that
detail
understand
where
they
fit
in
specifically
in
terms
of
their
team
where
they
fit
in
specifically
as
an
individual
and
then
they'll.
I
think
that
that
will
drive
drive
confidence.
B
So,
on
the
one
hand,
it's
always
nice
to
have
seen
better
numbers
here,
but
on
the
other
hand,
I
I
think
I
can
based
on
other
other
research
that
we've
got.
I
think
I'm
confident
as
to
as
to
why
that
is.
I
don't
know
whether
chris
wants
to
just
jump
in
and
add
to
anything.
I've
just
said
just
yeah,
just
just.
K
One
thing
to
answer
that
so
just
firstly
on
the
on
the
stats
in
the
in
the
pulse,
check,
survey,
50,
50
positives,
but
actually
it's
quite
a
lot
of
neutral,
so
the
rest
of
it
isn't
negative.
It's
neutral
and
it's
neutral
for
exactly
the
reason
that
ian
said
that
people
are
looking
for
the
detail
we
actually
had.
Obviously
I
don't
want
to
preempt
another
conversation
we'll
have
later.
K
We
actually
had
more
responses
to
this
consultation
from
staff
than
we've
ever
had
on
any
consultation,
and
there
was
absolutely
in
terms
of
the
broad
support
there
was
absolute
support
for
the
student
direction.
The
challenge
is
about
their
place
in
that
and
how
how
we
have
the
the
appropriate
support
for
people
to
take
on
a
slightly
different
role
as
the
organization
changes
as
a
result
of
the
strategy,
but
just
to
be
really
clear.
Stephen.
This
is
not
a.
This
is
not
half
and
half.
K
This
is
a
very
broad,
either
support
or
or
looking
for
more
detail
in
order
to
understand
where
they
fit
in.
I
think
those
are
the
two.
The
two
challenges
and
azir
says,
as
we
get
into
the
conversations
going
forward,
we'll
be
in
a
much
better
place
for
people
to
see
how
they,
how
their
skills
and
experience
will
be
used
in
the
organization
moving
forward.
A
And
chris,
it's
not
specifically
on
the
the
the
agenda
because
we're
still
doing
the
analysis,
but
it
is
probably
worth
just
just
also
making
the
the
comment
that
externally,
the
support
for
the
strategy
is
is
overwhelmingly
positive
from
what
we've
seen
so
far.
Indeed,.
K
From
a
variety
of
public
groups,
provider
organizations,
other
stakeholders,
there
is
uniform
support
for
the
direction
that
the
organization
is
taking
and,
in
from
other
organizations,
a
desire
to
be
involved
in
how
we
develop
the
detail
of
that
as
well.
So
really
it's
a
really
positive
conversation.
We
should
talk
more
about
this
at
the
end
of
may,
as
we
launch
the
report,
yeah.
A
C
Do
you
want
me
to
come
back
on
stephen's,
second
question
about
the
sentiment
for
people
and
the
worries
that
people
may
have
about
returning
to
offices?
So,
yes,
absolutely
we
are
planning
to
do
a
survey.
We
will
also
do
some
analysis
of
the
free
text.
Comments
from
this
pulse
survey
to
see
if
there
are
any
themes
that
are
emerging
about
that,
but
our
intention
is
to
do
some
work
to
understand
sort
of
how
people
are
feeling
and
we're
not
sort
of
pushing
at
all
for
people
to
return
to
offices
immediately.
So
we're
handling
this.
A
So
I
think
jill
it's
worth,
adding
that
the
bigger
issue
for
us
is
not
people
returning
to
offices
but
but
people
crossing
thresholds.
I
don't
know
it's
a
bigger
issue
because
they're
more
people
who
who
do
that
and
that
than
routinely
come
to
offices.
So
it's
a
it's
a
big
issue
and
I
know
some
people
are
itching
to
get
back
and
other
people
are
quite
nervous
about
it.
C
Yes,
so
it's
it's,
the
kind
of
it
will
be
testing
all
of
that
and
you're
absolutely
right,
81
of
our
workforce
on
our
home
base.
So
it's
it's
the
sentiment
of
everybody
leaving
their
homes
rather
than
just
returning
to
offices
but
yeah.
But
for
those
who
are
returning
to
offices,
there
is
probably
an
additional
issue
around
use
of
public
transport,
if
that
is
if
that
is
a
factor
in
them
getting
to
their
workplace.
I
Thank
you
peter,
and
thanks
jill.
I
agree
with
a
lot
of
what's
been
said,
particularly
around
the
the
positive
trends.
So
I
appreciate
you
doing
this
in
public
and
well
done
to
you
and
your
team
just
had
three
comments
actually,
which
are
which
are
different.
I
The
first
one
is
around
the
difference
between
our
results
on
discrimination
and
our
results
on
bullying
and
harassment.
So
there's
actually
an
overwhelming
percentage
of
people
who
say
they
haven't
experienced
discrimination,
and
if
they
have
it's
from
a
range
of
people
and
there's
a
specific
point
about
disability,
perhaps
we
ought
to
look
into
so
I
think
the
the
discrimination
is
quite
different
to
some
of
the
comments
that
people
have
already
made
around
bullying
and
harassment
which
inevitably
crosses
over
with
performance
management.
I
It's
always
quite
difficult,
isn't
it
particularly
with
the
really
difficult
year
that
we've
had
what
we
think
is
performance
people
might
be
perceiving
as
bullying
or
they
might
be
genuine
cases.
So
I
just
wanted
to
highlight
the
positive
things
around
discrimination,
even
though
we
might
have
more
work
to
do
on
bullying
and
harassment.
I
I
think
the
second
thing
is
that
on
page
36
of
our
board
pack,
there's
a
bar
chart
around
what
people
think
would
be
most
effective
in
improving
how
we
are
as
an
inclusive
organization,
and
I
just
think
it's
interesting-
that
some
of
the
very
practical
things
we
are
we've
talked
about
already
on
this
call
around
reverse
mentoring,
around
a
new
organization
structure,
around
policies
and
possibly
provision
of
support
right
down
the
bottom
and
all
of
the
things
at
the
top
are
actually
emotional
or
cultural
things.
I
Around
listening
and
acting
around
leadership
behaviors
around
manager,
training,
we've
talked
about
that
and
perhaps
there's
a
mismatch
at
the
moment
between
the
practical
and
the
the
cultural,
emotion,
cultural
or
emotional,
because
staff
clearly
don't
feel
that
they're
very
practical
and
the
new
organization
structure
and
operating
model.
We
have
aren't
going
to
solve
their
issues
and
the
third
thing
I
was
just
going
to
say.
I
am
now
responsible
in
this
role
as
acgc
chair,
for
liaising
with
the
national
guardians
around
freedom
to
speak
up
and
they're
going
to
talk
next
in
their
item.
I
But
I
just
wondered
whether
staff
feel
that
they
always
know
the
right
place
to
go
if
they
have
a
particular
issue,
and
I
think
some
of
the
other
points
we've
seen
in
different
items
are
around
some
confusion,
occasionally
about
where
issues
are
dealt
with
in
the
organization.
C
Thanks
thanks
sally,
I
think
it's
helpful
for
you
to
point
out
the
distinction
between
discrimination
and
bullying
and
harassment.
I
think
this
sort
of
I
think
there
is
there's
often,
as
you
say,
an
interface
between
performance
management
and
where
somebody
is
sort
of
having
a
a
conversation
which
perhaps
isn't
always
as
welcomed
as
it
might
be
around
improving
capability
and
in
the
in
their
role.
I
think
there's
I
think,
on
that
sort
of
bar
chart
of
this,
of
the
reasons
of
the
the
ideas
or
things
that
we
should
focus
on.
C
There
are
some,
as
you
say,
interesting
things
around
cultural
behavioral
aspects
that
we
can
continue
to
need
to
pay
attention
to.
I
think
the
really
important
thing
for
me
as
well
is
right
at
the
top,
which
is
about
recruitment
policies
and
processes.
So
you
know
there's
a
pers.
There
continues
to
be
a
perception
of
unfairness,
we're
doing
a
huge
amount
of
work
on
that.
C
So
I
think,
there's
that
there's
then
how
our
leaders
and
managers
behave
in
an
organization
which
I
think
we've
kind
of
touched
on
with
in
relation
to
some
of
the
stuff,
around
email
tone
and
and
potentially
some
etiquette
around
how
people
behave
and
interface
in
what
has
been
largely
a
digital
environment
for
most
people
for
the
vast
majority
of
the
last
13
months,
and
I
think
they
kind
of
I
think
your
points
about
freedom
to
speak
up
and
do
we
have
do
people
understand
where
to
go.
C
We've
been
working.
My
team
have
been
working
really
closely
with
the
freedom
to
speak
up
guardians
because
quite
often
some
of
their
work
is
about
signposting
and
we
and
and
that's
often
because
their
individuals
may
not
feel
comfortable
or
confident
speaking
to
their
line
manager.
So
a
point
we
need
to
address
going
forward,
but
I
think
sometimes
just
having
another
pair
of
ears
to
hear
and
listen
to
a
particular
concern
is
important
for
people.
So
I
think
it's
a
work
in
progress.
C
I
think
our
I
think
our
our
new
hr
policies
have
been
that
have
been
launched
as
they've
been
refreshed.
Give
us
a
sense
of
of
a
clear
signposting,
but
I'd
never
say
that.
Well,
our
work
is
done
in
this
area
and
I
think
the
the
way
in
which
the
teamwork,
my
team,
worked
really
closely
with
the
three
guardians
over
and
have
done
over.
A
Thanks
jill
mark
chambers,
I
think
you're
next.
J
This
paper-
and
it
is
more
evidence
and
assurance
to
us
that
that
we're
part
of
an
organization
that's
actively
listening
and
that
is
committed
to
to
taking
action
that
improves
the
position
for
everyone
and
makes
it
a
truly
inclusive,
inclusive
organization.
J
J
I
think
free
text
responses
are
enormously
helpful
and
they're
easily
overlooked
here,
but
actually
there's
some
there's
some
real
gems,
always
in
there.
I
I
think
the
you
know
the
emerging
priorities
list
is
is
interesting.
It's
right
on
and
very
appropriate
there
that
creating
an
environment
where
all
colleagues
feel
safe
to
challenge
is
on
the
list
and-
and
you
know
to
the
earlier
discussion
that
everyone
feels
comfortable
speaking
up
but
also
knows
the
right
place
to
go
to
to
raise
their
issues.
J
I
do
think
that
something
else
needs
to
be
on
that
list,
though,
because
to
you
know
to
resolve
some
of
these
speaking
up
is
any
part
of
it.
You
know
the
organization's
got
to
listen
up
and
and
and
resolve
the
issues,
and
most
of
those
most
of
these
issues
are
really
quite
difficult.
You
know,
excessive
criticism
doesn't
mean
that
we
have
an
environment
where
people
never
get
feedback,
never
get
difficult
from
developmental
feedback.
J
You
know,
tone
and
style
of
communication
doesn't
mean
that
you're,
not
candid
and
straightforward,
and
occasionally
directive
with
people.
It
is
about
how
it's
done
and
those
will
all
resolving.
It
is
all
going
to
require
really
quite
difficult
conversations
because
they're
fundamental
to
people's
behaviors,
their
fundamental
people's
style
and
and
way
of
of
of
working,
and
so
I
think
we
you
know
we
do
need
to
aspire
to
be
an
organization
where
difficult
conversations
are
are
easy.
J
C
Thanks,
I
think
I
just
on
that
or
that
last
point
around
difficult
conversations,
I'd
kind
of
like
to
change
the
focus
to
having
constructive
conversations,
because
I
think
ultimately,
people
shy
away
from
even
those
who
are
most
experienced
line.
Leaders
shy
away
from
something
that's
perceived
to
be
difficult
or
can
do
on
occasions
and
for
fear
of
not
wanting
to
offend
and
upset
people
and
and
actually
I'd
like.
C
I
really
rather
shift
the
focus
into
constructive
conversations
where
actually,
both
both
parties
in
a
in
a
dialogue
come
with
a
a
sort
of
an
endeavor
to
sort
of
create
a
a
constructive
outcome,
rather
than
a
different
com.
Come
at
it
because
it's
difficult
so
and
that
requires
sort
of
a
shift
of
culture
and
a
shift
of
behaviors
and
and
but
that
that
would
be
my
stuff.
My
ambition
in
terms
of
that
space.
J
I
agree
with
that
and
and
a
conversation
that
does
not
doubt
the
issue.
It's
it's,
unfortunately,
just
avoiding
the
issue
really
doesn't
bring
resolution
for
anyone.
A
So
jill,
thank
you
very
much
for
for
the
survey
and
and
for
coming
to
term,
and
I
take
two
massive
positives
out
of
the
survey
and
the
discussion
that
we've
just
had.
The
first
first
is,
as
you
said,
you
know
inch
by
inch.
The
the
the
results
are
moving
in
the
right
direction
and
that's
always
positive.
Obviously,
but
the
other
big
positive
is
that
that
none
of
us
are
resting
on
our
laurels.
A
We
really
want
this
to
be
as
good
a
place
to
work
as
is
possible
and
that
continued
drive
to
address
people's
issues.
I
I
think,
is
really
really
good.
So
thank
you
and
your
team
very
much
for
for
the
work
that
you're
doing
and
and
of
course,
executive
comments
generally
so
everybody,
but
I
think
we
we
we've
had
a
good
discussion
around
that
and-
and
it
does
segue
quite
neatly,
into
the
freedom
to
speak
up
report
as
as
was
suggested
so.
N
Yes,
so
thank
you.
Everybody
thanks
for
asking
us
to
come
along
again
and
talk
to
about
and
speak
up,
and
you
know-
and
I
think
it's
probably
good
for
us
to
introduce
ourselves,
because
there
are
some
new
board
members
that
we've
not
met.
So
I'm
carolyn
jenkins
and
I'm
my
day.
Job
is
one
of
the
heads
of
inspection,
I'm
currently
working
on
the
provider,
collaboration
reviews
and
the
dna
cpr
and
thematic,
and
then
I've
got
a
couple
of
colleagues
with
me.
Julie.
Are
you
there
julie?
Yes,.
N
So
we
are
the
the
three
speak
up
guardians
and
we've
been
in
post
a
year
now.
You
know
obviously
a
challenging
year
that
everybody's
had,
and
so,
as
you
can
see
from
our
paper,
which
I'll
I'll
take
them.
N
You
know
that
you've
read
that
we
continue
to
to
hear
from
our
staff
across
the
organization,
with
varying
issues
come
to
us
through
the
speak-up
route,
and
we
have
really
taken
that
year
to
get
a
grip
of
what's
happening
and
and
to
assess
how
we
feel
that
the
culture
is
in
our
organization,
and
I
think
we've
got
a
much
clearer
understanding
now
of
where
we're
at
and
where
we
need
to
go,
and
we
are
quite
clear
actually
about
the
things
that
we
need
to
do
and
there's
a
lot
that
we
a
lot
more,
that
we
can.
N
We
can
do,
but
I
think
it's
important
to
to
try
and
get
over
a
couple
of
points
today.
So
I
think
it's
fair
to
say
that
as
the
guardians
and
and
we're
not
on
our
own,
we've
got
a
mass
of
around
a
hundred
speaker
ambassadors
as
well.
N
But
you
know
we
do
feel
that
we
work
in
an
an
organization
that
ultimately
does
want
to
listen
to
what
people
have
got
to
say
and
does
want
to
hear
from
people
that
want
to
speak
up
and,
and
the
organization
cares
about
what
people
have
to
say,
and
sometimes
what
we
find
is
our
biggest
challenge
is
it's
that
next
bit
it's
that
so
what
question
and
and
how
do
we
get
that
assurance
that
actually,
we
have
listened
and
we've
listened
well
and
and
that
we've
made
a
difference
to
people's
experiences
and,
and
that's
a
that's
our
challenge,
really,
I
think
our
paper,
as
you
will
hopefully
feel
it
resonates
with
the
latest
pulse
survey,
and
you
know
hearing
the
discussions
that
you've
had
of
that
on
that.
N
But
it's
also
important
for
us
to
get
across
to
you
today
that
you
know
in
an
organization
like
ours
as
an
arms
length
body
it.
It
could
be
easy
to
say
well,
you
know
we're
not
we're
not
providing
direct
services
so
and
everything
that
comes
to
us
isn't
related
to
patient
safety,
which
of
course,
is
what
the
speak
up
was.
N
You
know
first
started
up
around
with
them,
sir
robert
they're,
obviously
listening
in,
but
you
know
anything
that
our
staff
do
in
our
organization
can
have
an
indirect
link
to
patient
safety,
because
if
our
staff
are
feeling
you
know
not
in
the
right
place
around
how
they
do
their
job,
then
it
can
impact
ultimately
on
on
patient
safety.
N
So
it's
important
that
people
really
do
feel
able
to
to
speak
up
about
anything
and
they
can
come
to
us
about
anything
and,
as
jill
said,
one
of
our
biggest
roles
is
that
we
have
to
sign
post
people
and
we
can
often
sort
things
out.
We
can
often
be
another
ear
and
and
make
some
suggestions
and
and
quickly
try
and
nip
things
in
the
board.
N
If
I
wanted
a
better
phrase
and
but
then
we
also
find
that
we
have
another
stream
of
of
cases
where
they're
more
complex
and
they're-
often
quite
historical,
and
they
go
back
over
a
number
of
months
or
if
not
that
people
have
had
issues
for
quite
some
time
and
they
they
often
take
a
lot
more
on
picking
and
a
lot
more
sorting
out.
A
Thank
you,
carolyn
very
much
indeed
mark
saxton.
You
were
first.
M
Thank
you
chairman,
and
thank
you
carolyn,
julian
luma,
for
a
very,
very
good
paper.
I
last
month
we
had
the
presentation
by
henry
etter
who
informed
us
of
the
traction
of
the
speak
up
guardian
across
the
whole
health
sector.
So
to
get
your
report
directly
afterwards
and
to
follow
our
journey,
I
think
has
been
instructful,
instructive
and
helpful.
M
M
I
think
it's
important,
however,
that
you
know
as
we
move
forward.
You
know
we
really,
you
know,
have
a
a
group
of
guardians
that
that
are
reflecting
our
whole
organization
and
support.
You
talked
about
the
the
survey
that
the
guardian
is
working
to
support
the
issues
highlighted
in
the
survey
so
bringing
disrespect
discrimination,
abuse
and
well-being,
and
I
suppose
my
question
is
you
know?
How
are
we
going
to
collaborate
to
to
achieve
this?
M
I
mean
we've
already
got
examples
of
you
working
with
the
people
directorate
and
signposting,
but
it
seems
to
me
that
collaboration
and
the
support
of
you
will
only
enhance
the
ability
for
people
to
feel
confident
and
supported
to
speak
up.
N
N
But
I
think,
ultimately
you
know
often
our
staff,
they
don't
mind
where
things
go
because,
ultimately,
all
they
want
is
some
sort
of
you
know,
improvement
or
resolution,
or
they
want
things
to
get
better
and
for
their
experience
to
be
better.
N
So
we
you
know,
I
think
we
need
to
keep
hold
of
that,
and
perhaps
remember
as
well
that
not
sometimes
not
one
size
fits
all
and
we
we
have
lot
policies
and
procedures
and
for
very
good
reason.
You
know
we
we
have
to
have
policies
and
procedures,
obviously,
and
but
sometimes
we
might
need
to
look
at
things
a
bit
more
flexibly
in
order
to
meet
people's
different
needs
and
and
make
sure
that
we
we
do
work.
N
You
know
us
as
guardians.
We
need
to
have
a
close
relationship
with
hr,
but
we
also
need
to
maintain
our
independence
as
well
and
and
we
we
really
need
to
challenge,
I
think,
timeliness
and
and
that
feedback
loop.
You
know
that's
so
what
question
we
really
really
need
to
work
on
that.
That's
so
what
question.
M
Yeah,
I
I
think
you're
absolutely
right
on
that,
or
all
I
could
say
is
that
you
know
the
listening
element
that
you've
struck
so
forcefully
put
forward.
M
D
B
Thought
that
sort
of
slightly
more
general
point,
I
guess,
which
was
yeah.
I
I
think
one
of
the
comments
was
made
earlier
on-
was
the
sort
of
the
potential
for
a
plethora
of
different
ways
to
essentially
raise
the
same,
the
same
thing
and
there's
a
there's,
an
upside
and
a
downside.
To
that.
I
think
which
is
you
know.
I
know
with
some
of
these
cases
and
you
could
raise
them
directly
with
your
line
manager.
You
could
raise
them
with
your
trades
union.
You
could
raise
them
with
a
senior
manager.
B
You
could
raise
them
through
freedom
to
speak
up
and
in
some
respects
it
doesn't
matter.
I
suppose
there
are
you
know
my
preference
would
always
be
that
you
talk
to
your
line
manager
and
try
and
resolve
the
issue
quickly,
because
that's
always
the
quickest
way
of
resolving
it,
but
but
the
the,
I
think,
the
thing
that's
really
really
powerful
about
about
the
guardians
is
this
connection
with
with
the
people
team
and
the
openness
with
which
I
know
a
number
of
senior
managers
view
the
freedom
to
speak
up
process.
B
So,
as
a
consequence
of
that,
I
I
think
it
means
that
things
can
be
raised
and
issues
can
be
surfaced,
so
surface
relatively
quickly
and
and
then
listens
to.
But,
as
I
say,
we
given
given
the
number
of
policy-based
activities
that
we've
changed
over
the
last
year.
This
is
a
relatively
modest
number
of
speak
up
issues,
given
the
fact
we
have
had
to
be
quite
direct
about
about
changing
some
things.
We've
had
to
move
out
some
pace.
B
We
haven't
necessarily
been
able
to
talk
to
everyone
about
every
change
that
we've
made,
but
I
I
think
this
this
represents
a
you
know,
broadly
positive,
broadly
positive
story,
but
I
sort
of
make
the
point
that
this
sort
of
plethora
of
channels
is
is
potentially
a
good
thing,
because
it
means
that
people
can
choose
the
channel
that
that
perhaps
most
most
most
suits
them.
Peter.
C
Yeah,
I
just
think
kind
of
into
that
sort
of
strengthening
the
collaboration,
though
sort
of
just
thinking
as
we
were
as
mark
was
talking
and
nazim
was
talking.
C
I
think
there's
an
opportunity
perhaps
to
invite
the
and
forgive
me
for
saying
this
out
loud
without
actually
giving
you
the
heads
up,
but
it's
just
it's
just
come
to
me
that
actually,
I
think,
there's
an
opportunity,
perhaps
to
invite
the
guardians
to
come
and
report
to
the
people
committee
that
I
chair
on
as
a
subcommittee
of
the
of
the
executive
team,
just
to
sort
of
to
start
to
pick
up
some
of
the
thematic
issues
not
go
into
individual
cases,
but
I
think,
given
we
have.
C
A
You
robert
you
were
wanting
to
come
in.
I
think
thank.
D
You
thank
you
to
all
of
you
for
this
report
but,
more
importantly,
perhaps
thank
you
for
taking
on
this
really
important
role,
and
I
appreciate
from
the
work
I've
done
how
difficult
it
can
be.
So
thank
you
personally,
a
big
thank
you
to
all
of
you
taking
a
little
point
from
what
ian
has
just
said
about
that.
Is
it
where
the
number
of
cases
rather
like
complaints,
one
can
never
be
sure.
D
I
think
whether
a
number
is
good
or
bad,
whether
and
whether
it's,
if
it's
going
up
or
down
it's
good
or
bad.
All
I
would
suggest
is
that
it's
quite
likely
that
the
number
of
cases
you
have
could
be
a
tip
of
an
iceberg.
It
might
not
be,
but
it
could
be,
and
so
I
just
put
that
caution
there.
D
I
really
welcome
the
idea
of
the
ambassadors,
and
I
think
that
I
would
hope
that
that
would
lead
to
a
more
relaxed
atmosphere
in
which
general
conversations
can
happen
in
various
parts
of
the
organization
which,
in
themselves
can
increase
the
likelihood
that
raising
concerns
becomes
just
normal
business.
But
I
have
a
question
about
it.
You
it's
you
report
that
a
small
number
of
them
will
undertake
or
have
undertaken
mental
health
advocacy
training.
D
The
caution
I
would
have
is
to
ensure
that
it's
not
misunderstood,
and
I
say
that
because
of
the
particular
history
of
one
at
whistleblowing
in
the
cqc,
I
think,
probably
before
all
our
times
when
one
particular
high
profile
whistleblower
was
treated
as
if
they
were
a
mental
health
case
and
corporate
memory
being
what
it
is.
It
will
be
important
that
that
is
not
misunderstood
going
forward,
but
basically
thank
you
very
much
for
what
you're
doing,
and
I
look
forward
to
continual
reports,
because
there's
a
lot
of
learning
to
come
out.
A
Thank
you
robert
this.
I
I
do
remember
the
case
that
you're
talking
about
and
you're
right
it
was
before.
All
of
our
times.
Do
you
want
us
to
yeah
julie,.
L
A
Q
L
I
could
I
could
respond
to
that.
Yes,
I
mean
the
mental
health,
it's
a
mental
health
advocacy
role
rather
than
advisor
or
anything
other
than
that,
and
it's
very
clear
to
within
the
training
that
it's
about
recognizing
someone,
because
usually
when
people
are
contacting
us
they're
in
some
state
of
turmoil,
emotional
turmoil,
because
you
know
they've
been
perceived,
that
being
bullied,
harassed
or
they've
got
other
issues
going
on
that
can
be
infecting
them.
L
So
it
was
just
about
a
group
of
ambassadors
being
able
to
have
the
skills
to
recognize
if
someone
may
potentially
be
actually
suffering
from
some
kind
of
mental
health
concern
around
that
and
then
within
that
being
able
to
sign
post
to
the
correct
area,
certainly
not
diagnostic
or
you
know,
being
above
the
station,
they
absolutely
know
their
remit
and
what
to
do
within
that
role?
I
mean
it.
What
was
quite
positive
was
that
actually
we've
had
one
person
actually
request
somebody
an
ambassador
with
that
particular
training.
L
So
I
thought
I
saw
that
as
a
positive
that
they
were
actually
seeking
out
that
particular
support
so
yeah.
We
absolutely
know
the
remit
and
the
responsibility
that
comes
with
with
saying
that
you
know:
we've
got
mental
health
advocates,
it's
purely
about
signposting.
So
robert.
D
A
Thanks
robert
thanks
julie,
very
good,
so
ali,
then
sally,
then
mark
and
then
we'll
move
on
ally.
Q
Thank
you.
Thank
you
for
the
report.
Back
at
my
colleagues,
I
think
there's
a
tremendous
amount
of
information
here
that
is
positive
and
shows
the
service
has
been
been
wrong
progressing
over
the
previous
year.
I
was
particularly
pleased
to
see
also
at
the
end,
the
the
continued
acknowledgement
of
the
evolution
and
the
focus
on
outcomes
that
we'll
be
seeing
next
year.
Q
What
would
be
really
interesting
to
see
one
year
from
now
is
actually
more
narrative
to
support
the
numbers
as
well.
I'm
not
getting
specific
details
but,
as
I
think,
jill-
and
I
mentioned
earlier,
to
really
help
us
understand
how
this
is
making
an
impact
on
individuals
across
the
organization
in
terms
of
stories,
I
do
have
one
question
for
clarification.
If
that's
okay,
we
noted
in
the
report
that
more
than
two-thirds
of
concerns
recorded
were
for
female
colleagues.
C
Our
workforce
we've
got
sort
of
70
female
workforce,
so
I'd
expect
that
to
be
entirely
proportionate,
and
this
data,
of
course,
is
not
my
hr
data.
This
is
the
data
that
that
the
ambassadors
gather.
So
it's
sort
of
you
know
that
I
guess
I'll
leave
them
to
explain
so
the
validity
of
their
data
keeping
but
we've
got,
but
we
have
our
workforce
is
70
females,
so
yeah
you'd
expect
that
kind
of
proportion.
I
Yeah,
I
was,
I
had
only
had
the
pleasure
of
meeting
carolyn,
julie
and
uma
quite
recently,
but
I
just
think
it's
worth
pointing
out
that
these
roles
have
only
been
in
place
for
a
year.
They've,
obviously
incredibly
committed
it's
good.
That
cqc
is
taking
part
in
something
which
is
much
wider
across
health
and
we're
playing
our
part
as
an
arms
length
body,
and
I
know
that
the
three
of
them,
with
their
ambassadors
and
their
network,
are
trying
really
hard
to
improve
what
we
do
as
we
go
along.
I
So
they
talked
about
recording,
better
data
around
the
reasons
for
people's
concern
around
following
up
on
actions
and
making
sure
that
they
are
complete,
and
there
is
a
resolution
and
also
making
sure
that
our
revised
policies
reflect
any
concerns
that
come
out
so
as
the
person
on
the
non-exec
side
of
the
board
who's
going
to
pick
that
up
with
them.
I
just
wanted
to
echo
what
robert
said
to
say.
I
Thanks
for
the
commitment,
they
all
have
quite
senior
day
jobs
alongside
this,
and
I
suppose
it's
just
a
point
that
says
if
we
believe
you
know
if
we
do
see
an
increase.
If
this
becomes
more
widespread
across
the
organization,
just
plea
to
say,
we
might
want
to
think
about
additional
support
or
how
we
work
this,
given
that
they're
doing
this
as
a
topic
role
alongside
a
senior
management
position
in
cqc,
but
well
done.
Ladies,
thank
you
thank.
A
I
A
Echo,
the
the
thanks
and
appreciation
sally
and
just
for
clarification,
I'm
sure
you
didn't
mean
to
suggest
otherwise,
but
we've
had
a
speak
up
role
in
in
in
cqc
for
much
more
than
a
year.
It's
just
that
our
current
colleagues
have
been
in
in
post
for
for
a
year,
probably
seems
much
longer
to
them,
but
anyway
right,
mark
chambers
and
then
we'll
move
on.
J
Yeah,
just
to
you
know
to
to
to
echo
from
from
my
perspective,
how
you
know
enormously
valuable.
The
role
of
the
guardians
is
and
to
direct
the
thanks
that
we've
that
we've,
that
we've
heard
from
from
other
colleagues
and
you
know
to
see
this
as
part
of
a
broader
commitment
to
a
speaker,
culture
within
the
organization
where,
if
something
doesn't
feel
like
people
put
their
hand
up
and
take
advantage
of
the
multiple
channels
to
to
to
raise
their
concerns.
J
You
know
it
is
enormously
valued
by
the
board
and
it
ought
to
be
enormously
varied
by
the
board.
One
of
the
things
that
you
mentioned,
carolyn
was
the
you
know.
This
is
a
sort
of
a
vital
early
warning
and
the
opportunity
to
fix
something
while
it's
still
fixable
and
something
that
you
might
not
have
otherwise
seen.
And,
of
course
it's
a
you
know,
it's
an
incredibly
useful
tool
to
reach
throughout
the
organization
and
find
out
what's
really
going
on
in
the
organization.
J
So
I
would
say:
well
you
know,
from
from
the
business
world,
there
is
strong
empirical
evidence
that
actually
more
people
speaking
up
is
good
news
organizations
that
have
more
speak
up.
Reports
generally
have
better
outcomes
in
terms
of
regulatory
interventions,
levels
of
litigation
within
their
business.
There
is
empirical
evidence
to
support
this,
so
we
should
not
be
afraid
of
seeing
more
numbers.
Obviously,
we
should
understand
the
substance
behind
what
is
being
being
raised,
but
more
more
reports
in
their
own
in
their
own
regard
is
not
that
new.
A
Great,
thank
you,
everybody,
I'm
I'm
just
a
little
bit
conscious
of
time,
but
can
I
just
julie
carolyn,
thank
you,
first
of
all
for
coming
today,
but
much
more
substantially.
Thank
you
for
all
you
do
for
cqc
in
in
both
your
roles,
but
particularly
in
this
one,
so
really
good,
and
we
will
obviously
be
seeing
you
at
the
board
at
some
future
time.
So
thank
you.
A
That's
great
good,
so
sally
acgc,
your
sort
of
summary
of
your
your
meeting.
Please.
I
So
the
board
are
just
asked
to
note
our
report
no
need
for
action.
Our
march
meeting
was
very
comprehensive,
as
you
would
imagine.
It
always
includes
external
auditors,
national
audit
office,
internal
auditors,
our
own
exec
and
our
members
of
the
board,
who
are
there
to
challenge
and
provide
assurance,
so
I
feel
like
jill's,
really
under
the
cost.
At
the
moment,
we
had
a
presentation
on
people
metrics,
but
at
least
we
are.
I
We
are
consistent
with
the
way
that
we
are
asking
questions
as
non-execs
and
challenging
on
behalf
of
our
staff
and
the
results
and
trying
to
seek
assurance
to
come
back
to
the
board
and
you've
heard
many
of
the
themes
today
about
delivering
very
soundly
on
the
people
plan.
I
We
also
talked
about
our
internal
audit
program
to
provide
assurance
and
despite
the
pandemic
and
all
of
the
delays
that
there
might
have
been,
the
internal
audit
program
has
been
delivered.
I
There's
only
a
little
bit
of
field
work
left,
which
always
hangs
over
into
april
and
some
specific
work
around
cyber
security
on
our
digital
foundations,
projects
that
we
were
doing
so.
I
just
wanted
to
say
thanks
to
the
exec
who
manfully
delivered
all
of
those
reports
in
line
with
the
auditors,
despite
the
pressures
of
the
pandemic
and
that's
a
really
good
result.
I
We
talked
about
risk
and
you'll
know
that
we
are
having
ongoing
conversations
about
risk
between
our
committees
to
ensure
we're
handling
those
in
the
most
effective
way
and
then
on.
Our
external
audit.
National
audit
office
have
been
doing
their
interim
audit.
They
take
nine
months
results
just
towards
the
end
of
the
financial
year,
and
then
they
come
back
after
month,
12,
which
is
around
about
now,
with
their
plan
to
certify
our
accounts.
I
They
talked.
There
are
no
issues
there.
They
talked
also
about
the
timetable
for
next
year,
because
people
will
have
been
aware
there
is
a
delay
due
to
the
auditing
of
local
government
pension
schemes,
and
we
are
thinking
about
a
possible
way
to
try
and
bring
that
forward
and
make
it
a
little
earlier
for
next
year.
I
A
Thank
you
sally.
I
hope
jill
doesn't
feel
under
the
course.
I
hope
joel
feels
really
supportive,
because
we're
also
interested
in
in
our
people
and
and
jill's
role
in
that
so,
as
I
hope
she
feels
loved,
not
under
the
cosh.
Any
questions
for
sally
comments,
no
excellent,
so
thank
you
sally
any
other
business.
Does
anybody
want
to
raise
okay?
So
that's
the
end
of
the
meeting
as
such,
but
we've
got
a
couple
of
questions
from
from
the
public
two
questions,
in
fact,
from
robin
pike.
A
The
first
is:
how
well
did
primary
medical
services
perform
over
the
four
days
of
easter?
Robin
that's
a
question
you
need
to
direct
to
nhs
england
not
to
us,
I'm
afraid
you'll
have
to
go
to
their
board
meeting
rather
than
rather
than
ours.
Your
second
question
was:
how
does
how
has
cqc
regulated
the
work
of
independent
hospitals
during
the
pandemic?
A
Have
the
numbers
of
nhs
patients
being
treated
in
independent
hospitals
changed
during
this
period
ted?
I
don't
know
whether
you
can
answer
that
one
for
robin.
E
E
We
saw
a
lot
of
really
important
work
going
on,
particularly
in
the
first
phase
of
the
pandemic,
where
and
there
was
an
increased
referral
of
nhs
patients
to
independent
hospitals,
and
they
played
a
very
important
part
in
keeping
abreast
of
some
of
the
particularly
the
non-covered
work
and
as
we
go
into
the
recovery
period
from
the
pandemic,
the
capacity
within
independence,
acute
hospitals
is
going
to
be
important
in
recovering
and
making
sure
people
with,
not
with
other
conditions
other
than
cobit
gets.
The
treatment
that
has
been
delayed
by
the
pandemic.
E
So
they've
been
a
very
important
part
of
the
system.
In
answer
to
the
question
about
how
we
regulate
them,
the
same
standards
applied
to
independent
providers
as
to
nhs
providers,
and
our
approach
to
regulation
is
brought
to
the
same.
During
the
pandemic.
We've
we've
had
a
risk-based
approach
to
independent
providers
inspecting
them
where
risks
are
identified
and
taking
action
where
necessary.
E
As
I
discussed
earlier
on
in
this
meeting,
we've
used
a
transitional
monitoring
approach
to
to
we've,
had
a
program
of
contacting
all
independent
health
healthcare
providers
over
the
last
few
months
to
make
sure
that
we
have
assurance
about
the
standards
they're,
providing
whether
that's
identified
any
risks.
Of
course
we've
taken
action
on
them,
so
so
we've
kept
vigilant
on
independent
healthcare
during
the
pandemic,
as
we
have
on
the
nhs.
A
And
then
the
the
the
last
question
we
had
is
from
david
hogarth
and
it
is,
has
the
care
quality
commission
receive
requests
from
any
source,
for
example,
dhscadas
local
authorities
or
care
services,
to
ensure
that
a
majority
of
care
services
are
rated
good
or
outstanding
and
david?
I,
I
can
absolutely
say
that
I
have
never
personally
had
any
such
requests.
Nor
am
I
aware
of
cqc
as
an
organization
having
that
sort
of
request.
A
I
I
and
you
will
know
we
we
we
wouldn't
respond
anyway
in
in
that
way,
we
don't
operate
a
quota
or
anything
like
that.
What
I
have
quite
often
said
when
I'm
asked
you
know
what
what
what?
What?
What
would
success
look
like
for
cqc?
A
It
would
be
that
all
the
services
that
we
rate
are
outstanding
or
good,
but
achieved
because
there's
been
a
you
know
an
increase
in
in
quality
so
that
we
get
to
that
result
not
because
we've
altered
in
any
way
how
we,
how
we
measure
what
is
good,
and
so
a
lot
of
the
discussion
we
have
with
all
kinds
of
different
organizations
is,
is
what
more
can
be
done
to
improve
the
quality
of
care
being
provided
by
those
organizations
that
are
either
requiring
improvement
or
or
inadequate.
A
But
it's
not
a
pressure
point,
and
I
wouldn't
want
anybody
to
think
that
either
we've
been
put
under
pressure
or
if
we
were,
we
would
respond
in
that
way.
So
I
hope
that
answers
your
question
david,
and
I
think
that
concludes
the
business
for
this
morning.
So
thank
you
all
very
much
indeed
for
your
time
and
for
your
contributions.