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From YouTube: CQC board meeting - October 2021
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A
Right
good
morning,
everybody
welcome
to
the
october
public
board
meeting
for
cqc.
We
have
an
apology
from
mark
saxton
who
is
unavoidably
elsewhere.
A
Rosie
is
joining
us
remotely
so
self-isolating
and
a
very
precautionary
way,
and
I
think
that's
all.
We
need,
by
way
of
apology
particular
welcome
to
jasper
jackson,
who
comes
from
our
lgbt
plus
equality
network,
you're
very
welcome
jasper
and
do
feel
free
to
contribute,
as
as
we
go
through
this,
I
also
want
to
welcome
three
of
our.
A
Our
clinical
fellows,
who
are
observing
clinical
fellows,
are
a
really
important
part
of
the
cqc
community
and
I've
enjoyed
working
with
previous
clinical
fellows
and
look
forward
to
getting
to
know
even
better
the
the
current
clinical
fellow
so
you're
you're
extremely
welcome.
A
A
I
don't
know
what
that
looks
like
if
you're,
if
you're
viewing
this
online,
but
can
I
just
say
to
the
board,
you
do
have
to
wave
quite
vigorously
to
catch
my
eye,
some
particularly
those
at
the
other
end
of
the
room,
but
do
please
do
so.
I
think
that's
all!
Oh
no
sorry
I
just
just
before
we
move
on.
Are
there
any
declarations
of
interest
anybody
needs
to
make
other
than
those
that
are
recorded
elsewhere?
Okay,
that's
excellent!
A
So
let's
then
move
on.
We
have
the
minutes
of
the
board
from
september.
Are
they
through
an
accurate
record
of
everything
we
discussed?
Yep?
Thank
you
so
they
are
approved.
We
have
no
outstanding
actions
on
the
action
log
we're
doing
really
well
on
this.
Is
there?
A
Are
there
any
matters
arising
that
aren't
otherwise
covered
on
the
board
agenda
that
follows
good,
in
which
case
we
can
move
swiftly
on
into
the
executive
team
report.
Please
thanks.
B
Very
much
peter
and
good
morning,
everybody
so,
firstly,
I'd
like
to
just
kick
off
and
and
and
cover
off
the
appointments
of
chair.
The
department
of
health
and
social
care
are
continuing
to
progress.
The
appointment
of
a
new
chair
follow
the
end
following
the
end
of
peter's
tenure.
At
the
end
of
this
year,
peter's
very
kindly
agreed
to
extend
his
term
for
a
short
period
to
ensure
a
smooth
transition
which
we
hope
will
be
complete
by
march
of
2022.
B
I
want
to
move
on
and
talk
about
net
zero,
I'm
part
of
the
net
zero
health
and
care
committee,
a
group
from
local
governments,
the
nh
and
the
nhs
aiming
to
coordinate
joint
action
to
get
the
health
and
care
system
to
net
zero,
we'll
be
working
with
others
to
support
the
national
net
zero
ambitions
through
regulation.
B
I
expect
to
see
us
bringing
forward
proposals
on
how
we
might
do
this
in
practical
terms
to
the
to
the
board
in
due
course,
october's
been
quite
a
busy
month
for
awareness
raising
campaigns.
B
We
also
ran
sessions
for
world
mental
health
day,
which
includes
sessions
highlighting
different
mental
health
experiences
at
work
and
again,
we've
had
some
very
powerful
sessions
from
colleagues
sharing.
Their
particular
experiences
of
various
of
mental
health
and
mental
ill
health
october
is
also
speak
up
month.
With
this
year's
theme
being
speak
up,
listen
up
and
again,
we've
been
we've
been
contributing
to
the
to
the
the
awareness
raising
around
that.
B
A
C
Thank
you
peter
and
good
morning
all
so.
The
first
thing
I
want
to
talk
about
this
morning
is
the
social
care
workforce.
So
colleagues
will
be
aware:
there's
been
lots
of
conversation
in
the
media
and
if
you
talk
to
stakeholders
and
people
who
work
in
social
care,
there
is
growing
concern
around
the
exhaustion
levels
and
challenges
around
recruitment
and
retention
of
the
social
care
workforce,
and
those
concerns
we've
been
hearing
anecdotally
and
we've
been
hearing
from
providers
is
starting
to
be
reflected
in
the
information
that's
returned
to
us.
C
So
I
look
forward
to
talking
publicly
about
this
more
in
our
state
of
care
report
that
we
publish
this
friday
so
just
want
to
flag
significant
growing
concerns
around
the
workforce
and
welcome
a
conversation
about
that
towards
the
end
of
the
week.
C
Second
thing
I
just
want
to
update
on
is
our
work
around
close
cultures,
so
this
board
will
be
aware.
We've
had
an
extensive
programme
of
work
around
ensuring
us
as
a
regulator
that
we
can
be
as
effective
as
as
possible
at
identifying
places
at
risk
of
close
cultures
and
regulating
those
services
effectively.
C
We
have
a
new
dashboard
for
our
inspectors
that
goes
live
in
november,
bringing
together
all
the
flags
that
may
trigger
concerns
about
a
service
potentially
being
a
close
culture,
and
we've
also
rolled
out
extensive
guidance
for
our
inspectors
around
our
new
quality
of
life
tool.
So
this
is
our
new
way
of
regulating
that
enables
us
to
really
get
under
the
skin
of
services
at
risk
of
closed
cultures.
C
We've
had
that
guidance
live
for
a
while,
we're
refreshing
it
and
we're
continuing
to
evaluate
that
approach,
which
today
is
appearing
to
be
pretty
effective
at
enabling
us
to
hear
people's
experiences
of
what
it
feels
like
to
receive
care
in
those
settings,
and
we
are
continuing
to
survey
our
staff
about
their
understanding.
So
we've
developed
a
new
way
of
working
we've
rolled
out
training
and
guidance,
and
we
now
need
to
be
doing
the
assuring
stuff
that
inspectors
have
digested
it
and
are
feeling
confident
in
implementing
it
and
how
they
regulate.
Thank
you.
D
Thank
you,
and
I
just
want
to
ask
about
the
social
care
workforce,
and
I
appreciate
the
state
of
care
will
no
doubt
say
more
about
that,
but
I
just
wanted
to
two
questions.
Really
one
is
the
extent
to
which
the
current
problems,
which,
of
course,
were
long-standing,
do
do
we
have
a
take
on
how
much
that
has
been
changed
or
impacted
on
by
the
vaccination
requirements.
C
Thank
you
robert,
so,
as
you
say,
and
the
issues
around
recruitment
and
retention
in
social
care
workforce
has
been
around
for
for
a
long,
long,
long
time,
prior
to
the
pandemic
skills
for
care,
we're
reporting,
122,
000
vacancies
and
a
turnover
rate
that
varied
between
about
37
to
40,
depending
on
the
role.
So
we
know
for
a
long
time,
we've
needed
to
do
something
different
around
recruiting
and
retaining
people
in
this
sector.
C
There
are
a
number
of
things
that
are
going
on
at
the
moment,
so
we've
seen
big
impact
around
kind
of
tourism,
we've
seen
quite
a
disproportionate
impact
around
the
country,
in
particular
coastal
towns,
where
workforce
has
become
even
more
challenging
as
people
haven't
gone
aboard
and
tourism
in
this
country
has
really
boomed
on
the
11th
of
november.
As
you
say,
the
requirement
for
everyone
working
in
a
care
home
in
social
care
to
have
their
two
jobs
done
comes
into
force.
C
We've
been
really
clear
that
our
approach
and
how
we
regulate
the
government's
requirements
on
this
is
that
we'll
be
proportionate
in
our
approach.
When
we
go
into
services,
we
are
going
to
focus
increasingly
on
workforce
in
our
coming
months.
C
So
I'm
really
keen
that
we
can
talk
about
how
workforce
that
kind
of
national
level
is
impacting
on
quality,
and
we
are
thinking
about
how
we
may
introduce
some
kind
of
focused
questions
on
up
and
coming
inspections
to
ask
providers
to
talk
to
us
about
impact
on
workforce
on
their
ability
to
deliver
care.
With
regard
to
your
second
question,
so
our
expectations
around
standards
of
care
have
not
changed
because
we
are
here
on
behalf
of
the
public
and
the
public
should
expect
high
quality
standards
of
personalised
care.
C
So
we
we
expect
those
standards
to
still
be
delivered.
However,
we
are
also
happy
to
talk
about
a
kind
of
national
pit
national
picture
where
we
may
see
workforce
impacting
equality
of
care,
but
we
are
not
lowering
our
standards
about
what
we
expect
people
to
be
receiving
from
their
social
care
providers.
E
I
just
wondered
if
there's
been
a
reduction
in
nursing
and
residential
care
beds
as
a
result
of
the
workforce
challenges,
have
you
seen
a
bed
being
deregistered
or
an
increased
number
of
care
homes?
Closing.
C
Thank
you
for
that
belinda.
So
it's
going
to
look
like
a
lot
of
my
answers
are
trailing
the
state
of
care
report,
but
we
do
on
friday.
We
will
be
talking
about
the
intelligence
we
hold,
particularly
in
our
market
oversight,
so
our
function
that
looks
at
large
and
hard
to
replace
providers.
We
will
be
talking
about
our
insights
into
occupancy
levels,
but
also
the
total
number
of
residential
nursing
beds
that
are
available.
A
I
think
it's
kate,
it's
probably
worth
saying
that
the
the
end
of
the
day
this
is
a
bit
of
a
zero-sum
game.
There
is
a
a
a
massive
shortage
of
labor
in
in
in
the
country
yeah
across
pretty
well
every
sector.
So
if
you've
got
a
fixed
pool
of
people
who
can
take
jobs
and
and
a
another
fixed
pool
of
vacancies
and
the
vacancies
is,
is
bigger
than
the
number
of
people
available
to
fill
them,
it's
going
to
be
a
challenge
and
the
challenge
for
the
the
care
sector
I
mean.
A
Obviously
there
are
people
with
very
specialist
skills,
but
also
a
lot
of
people
that
have
very
transferable
skills
into
into
other
other
sectors,
and
everybody
is
fighting
for
the
the
same
small
pool
or
same
pool
of
people,
obviously
a
small
pool.
So
I
mean
I,
I
think
this
is
just
a
huge
challenge:
isn't
it
cade
yeah.
C
And
it's
it's
keeping
pace
with
the
current
workforce
demands
and
also
recognizing
that
this
workforce
needs
to
grow
as
well.
So
if
we
think
about
fabulously
more
people
living
oh
living
longer
into
older
age,
supporting
people
to
live
well
in
the
community,
this
is
a
workforce
that
we
not
only
need
to
recruit
to
and
retain,
but
also
we
need
to
grow.
And
in
order
to
do
that,
we
need
some
new
plans
about
how
we
can
make
that
happen.
A
Good,
are
we
happy
to
move
on
having
failed
to
solve
that
problem?
Let's,
let's,
let's
move
on
ted,
I
think
to
you.
F
F
The
members
of
the
board
will
no
doubt
have
seen
some
of
the
performance
data
that
came
out
last
week
from
nhs
england,
which
showed
that
increased
number
of
patients
are
waiting
more
than
four
hours
for
admission
to
hosp
for
a
treatment
or
admission
to
hospital
in
in
accidents
emergency,
but
also
increasing
number
of
patients
waiting
more
than
12
hours,
and
the
figures,
as
reported
on
12
hours,
are
the
figures
for
from
the
time
of
decision
to
admit
not
from
the
time
of
arrival
in
a
e.
F
So
the
number
of
people
waiting
more
than
12
hours
in
a
e
is
way
beyond
the
the
5
000
quoted
for
september,
and
I
think
it's
really
important
to
to
emphasize
that
the
pressures
in
a
e
are
causing
significant
problems
for
patients
accessing
care,
and
it's
really
important
that
there's
focus
on
this.
I
have
to
say,
we've
stayed
in
close
contact
with
accident
emergency
departments
throughout
the
country.
F
I've
spoken
previously
to
the
board
about
the
work
we've
been
doing
with
them,
we'll
be
issuing
some
new
guidance
next
week,
building
on
our
patient
first
initiative
from
a
workshop,
we
did
with
clinicians
and
executives
in
accident
emergency
and
ambulance
services
last
week,
but
they
they
report
back,
that
the
staff
who
are
working
in
the
emergency
emergency
departments
are
under
intense
pressure
and
just
as
kate
was
talking
about
the
exhaustion
of
the
social
care
workforce,
I
think
it's
important
to
emphasize
that
the
staff
are
feeling
exhausted
after
what
has
been
a
really
very
long
summer
on
the
back
of
the
pandemic
and
going
into
winter,
where,
where
respiratory
viruses
and
other
illnesses
are
likely
to
increase.
F
Clearly,
we
are
concerned
about
the
pressures
and
the
ability
of
the
system
to
cope
with
that.
Interestingly,
it
isn't
just
covid
patients
as
driving
the
increased
demand.
It
is
non-covered
patients
as
well,
and
it
does
appear
that
the
covid
pandemic
has
had
a
a
change
on
the
way
people
behave
and
how
the
system
works
with
the
result.
There's
a
a
lot
more
patients
there
as
they've
been
attending
throughout
the
summer
and
are
attending
as
we
go
into
autumn
and
winter
going
forward,
and
some
of
those
are
not
related
to
covet
at
all.
F
F
I'm
also
concerned
about
ambulance
trusts,
and
I
highlight
that
in
the
report
speaking
to
ambulance
trust
they've
all
been
at
the
highest
level
of
escalation
really
now
for
several
weeks
across
the
country.
They're
all
affected
by
this
and
they're
all
concerned
about
their
ability
to
manage
the
pressures
because
of
delays
admitting
patients
to
hospital.
Inevitably,
that
means
ambulances
are
being
held
at
hospitals
for
far
too
long,
which
means
they're
not
available
to
go
out
and
do
calls
for
other
people
who
need
care.
The
ambulances
again
are
working
very
hard.
F
Their
staff
are
under
enormous
pressure
and
they
themselves
are
exhausted
as
well.
So
it's
important
to
see
that
this
is
a
problem
throughout
the
system
they
have
remarkably
well
maintained
the
response
to
the
most
urgent
calls.
The
life
threatening
called
c1
calls,
but
you
can
see
in
the
response
times
for
less
urgent
calls.
F
The
urgent
emergence
calls
non-life
threatening
that
the
time
the
the
time
response
times
have
deteriorated
over
the
last
month
or
two,
and
that
is
a
real
reflection
of
the
pressure
ambitions
under
like
we
worked
with
them
on
the
workshop
a
couple
of
weeks
ago,
and
we
will
be
publishing
guidance
to
try
and
help
them.
But
this
is
a
whole
system
problem
throughout
the
urgent
emergency
care
system.
I
think
it's
important
to
emphasize.
This
is
a
system
problem.
It's
not
a
problem
with
individual
providers.
F
We
will
need
to
work
very
closely
going
forward
with
them
we're
working
closely
with
nhs,
england
and
other
parts
of
the
system
to
try
and
make
sure
services
get
the
best
possible
support.
Despite
all
these
concerns,
I
I've
also
highlighted
the
report
we
published
on
the
either
white
nhs
trust.
In
last
few
weeks.
I
highlighted
this
glass
board,
but
but
couldn't
name.
The
trust
I
think
now
is
an
opportunity
to
name
the
trust.
F
It
is
remarkable
how
that
trust
has
improved
despite
the
pandemic
over
the
last
year
or
two,
and
I'm
really
pleased
that
the
trust
has
been
rated
as
good
now
having
been
in
special
measures
now
for
a
couple
of
years,
so
real
tribute
to
the
staff
in
that
trust,
but
also
the
other
parts
of
the
system.
That's
supported
that
trust
in
driving
those
improvements.
It
is
really.
It
is
really
good
to
see
that,
despite
the
pressure
of
the
system,
there
still
is
a
really
dedicated
workforce.
G
Thanks
peter
and
ted,
it's
really
encouraging
to
see
the
isle
of
wight
example,
ted
and
I'm
sure
there
are
more
across
the
country,
and
I
wondered
whether
at
a
future
board,
you
might
be
able
to
give
us
a
flavor
of
trends.
I
suppose-
and
some
of
this
good
practice-
that's
you
know,
could
be
applied
elsewhere
in
the
areas
where
they
still
need
improvement.
G
F
Yes-
and
we
are
now
going
back
to
inspect
those
trusts
that
we're
in
special
measures
or
rated
inadequate
to
follow
up
on
them
that
haven't
raised
new
concerns
with
us.
So
to
some
extent,
we
are
now
beginning
to
discover
that
improvement
up
during
the
pandemic.
We've
predominantly
been
inspecting
services
where
new
concerns
are
identified,
so
nobody
that
does
weight
our
ratings
towards
poorer
ratings,
but
I
think
we're
we're
now.
F
The
program
for
inspection
of
during
the
moment
is
going
back
to
those
those
those
other
trusts
and
I
am
inspect
I'm
anticipating.
There
will
be
some
more
good
news
about
other
trusts
in
the
next
few
months,
but
we
need
to
do
the
inspection
first
sally.
H
Thank
you
very
much
peter
and,
firstly,
apologies.
I
can't
be
with
you.
I
have
symptomatic
teenagers
with
positive
lateral
flow
tests
and
we're
all
awaiting
pcrs,
so
we
felt
it
was
probably
not
not
appropriate
for
me
to
join
the
board
in
person.
So
thank
you
for
bearing
with
me
online
just
to
echo
some
of
the
comments
that
ted
has
made.
H
H
Just
in
response
to
sally's
point
as
well.
We
have
done
a
significant
amount
of
work
with
special
measures
practice
and
it's
been
really
great
to
see
the
improvement
in
many
practices
over
the
last
few
months
as
we've
gone
back
to
reinspect
them
and
I'd
be
very
happy
to
bring
more
information
back
to
the
board
around
that,
because
we've
seen
practices
improved
despite
the
challenges
of
the
pandemic
and
really
turn
their
services
around
to
deliver.
Much
better
quality
care
for
patients,
which
is
excellent
in
terms
of
the
report.
H
H
Looking
in
discussions
with
stakeholders
around
our
proposed
work
with
integrated
care
systems,
as
the
board
outlines-
and
I
just
wanted
to
reflect
the
fact
that
these
these
proposed
changes
are
getting
a
very
positive
response
from
the
stakeholders
that
I've
been
discussing
it
with
and
the
opportunities
to
make
sure
that
we
get
good
good
care
right
across
all
parts
of
the
health
and
care
system
and
the
system
works
together
has
been
very
well
received.
We've
also
set
up
an
external
advisory
group.
We
think
it's
incredibly
important
that
we
bring
in
external
voices.
H
C
Kate,
thank
you
peter,
so
I
was
really
pleased
to
chair
the
first
expert
advisory
group.
I
think
it
was
last
monday,
looking
at
local
authority
assurance
and
we
really
benefited
as
ever
from
having
people
who
receive
care
around
the
table,
families
and
then
a
multiple
of
stakeholders.
C
We
use
that
group
to
ask
about
their
ambitions
about
where
we
might
focus
our
efforts
when
it
comes
to
local
authority
assurance.
So
a
really
rich
discussion
that
started
off
with
a
local
authority
assurance
will
move
to
integrated
care
systems,
but
again
just
the
value
of
having
people
who
draw
and
care
sat
around
the
table
with
stakeholders
helping
to
shape
our
thinking
was
just
something
to
kind
of
know
and
celebrate.
A
It's
good:
it's
the
way
to
go
any
anything
else.
We
should
move
on.
Okay,
so
tyson,
sorry,
kirsty,
a
bigger
partner,
I'm
jumping
moving
on
far
too
fast,
so.
I
Thanks
kirsty
yeah,
and
so
this
is
the
first
update
on
performance
against
our
new
business
plan,
but
we'll
also
be
doing
a
quarter
two
review
next
month.
So
I'll
just
give
a
brief
update
and
then
there'll
be
a
fuller
pack
next
month
with
with
visuals.
So
the
the
business
plans
focused
around
three
areas,
which
is
delivering
our
regulatory
business,
transforming
to
deliver
our
strategy
and
managing
our
people
and
resources.
I
So
just
a
few
areas
to
pull
out
for
this
month
in
terms
of
delivering
our
regulatory
business.
We
we
we're
constantly
monitoring
the
regulatory
activity
we
do
as
we
adapt.
Our
approach
for
the
year-to-date.
Ten
percent
of
registered
services
have
had
some
form
of
regulatory
activity,
be
an
inspection
or
a
monitoring
call
alongside
this
we're
regularly
assessing
our
approach
and
have
undertaken
61
quality
assurance
inspections.
I
This
helps
understand
if
our
risk
assessments
are
delivering
the
right
outcome
and
then,
finally,
in
this
area,
in
terms
of
registration,
we're
aiming
to
reduce
the
average
number
of
days
across
our
our
registration
applications
by
15
percent,
so
in
simple
and
normal
applications,
we've
almost
met
this
target
with
a
13
1,
13.1
and
14.4
reduction
respectively,
in
the
transformation
to
to
deliver
on
our
strategy.
I
All
current
milestones
are
on
track
for
our
change
program
and
there'll,
be
a
fuller
update
on
the
change
program
next
month,
as
well
in
terms
of
managing
our
people
and
resources.
Quite
a
few
measures
in
this
space
don't
fluctuate
month
on
month.
We
continue
to
monitor
this,
but
again,
there'll
be
there'll,
be
more
update
on
that
in
in
quarter
two
report
and
finally,
in
terms
of
finances.
I
At
the
end
of
august
revenue,
budgets,
underspent
by
7.8
million
and
that's
forecast
to
increase
to
12.9
million,
and
the
capital
budget
is
underspent
by
2.7
million
and
that's
forecast
to
be
on
budget
by
the
end
of
the
year.
A
Thank
you
thanks,
chris
I'm
under
strict
instructions
from
chris
that
we
are
to
make
this
board
meeting
as
quick
as
possible,
so
he
can
get
back
to
newcastle
to
celebrate
his
wedding
anniversary,
so
nobody's
allowed
to
ask
any
questions
of
chris
seriously.
Are
there
any
points
people
want
to
raise
with
chris,
because
there's
a
lot
in
that
performance
report.
A
Well,
I've
done
your
job
for
you,
chris,
please
tell
your
wife.
I
tried
okay.
Now
it
really
is
your
turn
tyson.
Sorry
about
that.
Thank.
B
A
Peter
I've
got
nothing
to
add
to
my
written
report,
so
chris
has
obviously
instructed
you
as
well.
To
be
brief,
any
any
any
questions
for
tyson.
Okay
mark.
J
Thank
you.
So
there
are
no
significant
information
or
cyber
security
incidence
report
this
month.
I'd
just
like
to
add
that
we
have
ongoing
continuous
improvement
activity
in
in
the
cyber
security
space
to
seek
to
continuously
improve
our
security
position.
J
An
example
of
that
is
recently
in
tandem
with
cyber
security
month
we've
run
a
campaign
with
a
series
of
training
and
information
exercises
which
has
included
some
dummy,
phishing
emails
to
test
colleagues,
knowledge
and
that
will
help
inform
and
and
target
our
next
training
exercises.
So
it's
a
ongoing
ongoing
area
of
improvement.
A
So
mark
did,
did
you
have
sorry?
Do
you
have
sight
of
what
other
organizations
you
know
across
different
sectors
are
doing
in
the
the
cyber
security
space
and
and
are
we
you
know
doing
everything
that
we
should
be
doing
and
everything
that
everybody
else
is
doing
so
I'd
say.
J
J
We
use
external
partners
to
support
us
with
making
sure
that
we
comply
with
those
and
we
we
are
we're
it's
a
constantly
moving
landscape
so
that
we
are
ensuring
that
we
are
performing
all
the
activity
to
make
sure
that
we
get
best,
keep
ourselves
safe
and
we
do
work
with
other
agencies,
particularly
within
the
health
and
health
and
care
landscape,
to
ensure
that
we
are
joined
up
with
our
other
colleagues
and
learning
from
others
as
well.
A
Thanks,
I
mean
just:
it
seems
to
me
that,
obviously,
from
a
from
our
regulatory
point
of
view,
it's
really
important,
we
understand
what
what
is
going
on
in
health
and
social
care,
but
actually
cyber
is
is
a
thing
that
affects
absolutely
everybody,
and
there
are
probably
people
in
other
sectors
doing
some
quite
interesting
things
to
make
sure
they
are
as
cyber
safe
as
they
can
be.
G
Peter
just
to
provide
a
little
bit
more
reassurance.
Part
of
our
internal
audit
plan
is
quite
a
deep
look
at
cyber
security,
and
that
reported
back
to
the
last
meeting
so
mark
and
his
team
will
know
that
they're
in
quite
a
good
place,
and
there
are
some
further
recommendations.
They're
picking
up
over
the
next
few
months,.
A
Great,
thank
you
sally.
That's!
That's
that's
good
to
hear
anything
else,
in
which
case
thank
you
mark
for
what
you're
doing
chris.
K
Just
a
couple
things
to
add
to
the
report
where
we
talk
about
the
evidence
given
to
the
public
services
committee
in
the
health
and
social
care
committee.
Today
the
government
has
published
details
of
the
which
includes
ccc's
oversight
of
the
system.
It
it
imposes
a
new
clause,
a
new
duty
on
on
the
cqc
to
carry
out
reviews
and
assessments
in
into
the
overall
function
of
the
system,
so
the
provision
of
nhs
care
and
adult
social
care
within
each
area
of
the
integrated
care
system.
K
So
I
think
that's
it's
quite
a
positive
move.
The
clause
is
very
much
in
line
with
the
conversation
we've
been
having
with
dhse.
Obviously,
there
is
more
detail
work
to
do,
but
I
think
there
is
this
is
the
in
the
right
in
the
right
place
for
us
moving
forward
and
hopefully
should
complement
our
work
on
transformation
and
our
new
thoughts
around
how
we
intend
to
regulate
in
those
in
those
sectors.
It
should
give
khaleesa
a
note.
That's
happened
just
this
morning.
A
K
A
Really
good
news:
it
would
be
really
worrying
if
it
didn't
happen,
but
it's
really
good
to
know
that
it
has
happened.
So
thank
you
for
that
update
chris
and
chris.
Did
you
wonder
anything
else?
You
know.
A
Okay,
that
was
chris's
celebrations
are
obviously
infecting
the
whole
board
we're
running
ahead
of
time,
for
once,
that's
excellent.
So,
let's
move
on
sally.
I
think
it's
on
to
you
and
the
acgc
report.
G
Yep,
thank
you
peter.
The
minutes
from
the
last
meeting
are
in
the
pack,
but
just
to
say,
the
audit
corporate
governance
committee
called
acgc
met
on
the
6th
of
october.
It
comprises
cqc
board
members,
independent
members
from
outside
our
organization,
and
also
our
internal
audit
and
external
audit.
Colleagues
from
the
national
audit
office,
we
looked
at
the
internal
audit
plan
and
the
three
reports
that
have
been
completed
as
part
of
that
work
and
the
management
responses.
G
We
are
obviously
close
to
the
point
of
laying
our
annual
report
and
accounts
subject
to
some
feedback
through
the
national
audit
office
about
local
government
pension
schemes,
which
delays
many
people,
many
bodies
laying
in
their
accounts,
but
our
particular
audit
found
no
nothing
to
be
concerned
about
and
we're
hoping
to
lay
our
annual
reporting
accounts
as
soon
as
we
can
in
terms
of
risk.
We
also
look
at
the
risk
register,
as
we
do
at
other
committees.
No
significant
changes
there
and
just
to
follow
up
the
comment
I
made
about
cyber
security.
G
D
We
are
now
three-quarters
of
an
hour
ahead
of
when
he
melted
was
expected
to
have
to
be
here
and
she
is
on
her
way,
but
not
in
the
building.
At
the
moment.
D
A
Because
there's
there's
nothing
else,
the
the
really
we
can't
yeah
there's
nothing
else.
So
we
can.
I
we
can
either
pause
the
meeting
until
the
mulder
gets
here,
which
is
which
is
okay.
We
can
do
other
things,
but
if
she's.
D
Only
a
couple
of
minutes
away,
I
think,
on
this
occasion
I
would
propose
that
I
could
easily
put
the
report
before
you,
but
it's
I
think,
we'd
like
to
see
her
off
the
premises.
Okay,.
A
So
what
I'd
like
to
suggest
is
that
we
do
just
pause
the
meeting
and
we've
got
some
other
business
we
can.
We
can
use
the
time
to
to
fill
and
then
we
will
restart
the
public
board
meeting
when
the
milder
gets
here.
Okay,.
A
Well
done,
this
is
a
okay.
Let's
now
resume
our
our
meeting
and
apologies
imelda
that
we
we
threw
you
by
for
once
in
our
lives,
been
ahead
of
time
and
so
far
ahead
that
you
had
to
run
to
get
here.
So
thank
you
for
doing
that.
Robert
over
to
you.
Thank.
D
You
well
I'm
not
going
to
steal
email
to
standard
in
relation
to
her
report,
but
I
think
I
have
to
note
that
this
is
her
last
board
meeting.
D
So
if
I
may
just
be
committed
a
couple
of
remarks
about
imelda,
I
think
it's
fair
to
say
that
under
her
stewardship
health
watch,
england
has
been
transformed
as
an
organization
both
in
its
effectiveness,
its
reach
and
and
its
profile,
and
I
think
this
report
from
her
shows
in
his
very
strong
testament
to
how
now
the
voice
of
the
patient
and
the
service
user
really
has
never
been
heard
so
effectively.
D
The
organization
nationally
has
matured
and
is
increasingly
listened
to
and
influential
in
relation
to
policy
decisions
being
made.
The
support
given
to
the
local
network
is
increasingly
effective
and
appreciated,
and
I
ask
colleagues
to
remember
that
healthwatch
england
has
virtually
no
in
fact
really
no
levers
of
direction
in
relation
to
local
health
watch.
It
is
entirely
a
matter
of
building
relationships,
offering
support
to
fear
sometimes
fiercely
independent
local
organizations.
D
Internally,
I
can
testify
to
her
leading
a
fantastically
hard
working
and
if
I
say
it's,
a
very
cheerful
team,
who've
coped
with
the
pandemic
extremely
well,
so
in
all,
never
has
a
chairs
role
been
so
easy,
as
it
has
been
in
supporting
imelda
in
her
fabulous
work
over
the
last
few
years.
So
I'd
lost
like
on
our
behalf,
to
thank
her
for
that
and
I
hope
give
her
a
report.
D
G
Thank
you.
Thank
you
very
much
for
that
you're
making
me
blush
robert,
I'm
mostly
not
shy.
Apart
from
when
there's
compliments
coming,
then
I
get
really
shy
so
well.
Thank
you
for
your
time
today,
you've
got
the
written
report
in
front
of
you.
What
I'll
do
is
just
do
really
quick
chop
through
some
of
the
headlines
that
there
there
are
lots
of
this
work,
we're
sharing
with
cqc
as
we
develop
it
and
build
it
so
that
we're
often
doing
it
together
as
well.
G
So
the
first
thing
that
I
talk
about
in
my
report
is
the
work
that
we've
been
doing
on
hospital
discharge.
As
you
know,
during
the
pandemic
we
moved
to
discharge
to
assess
so
people
being
moved
rapidly
out
of
hospital,
but
we
wanted
to
make
sure
that
that
was
working
for
people,
because
the
theory
is
a
good
theory,
but
what's
actually
happening
on
the
ground.
G
So
we've
done
a
lot
of
work
with
partners
on
identifying
what
works
and
what
doesn't
work
and
we've
seen
some
change
in
the
guidance
to
ensure
that
people
aren't
just
pushed
away
from
hospital,
but
without
the
right
support
around
them.
There's
still
a
lot
of
work
to
do
on
that,
and
I
think
that
that's
not
an
issue.
That's
not
going
to
go
away
for
a
long
time
because
of
the
lack
of
support
that
there
can
often
be
in
local
communities.
G
We
have
done
quite
a
lot
of
work
over
the
last
few
months
on
digital
exclusion,
the
move
to
to
to
digital
services
and
where
that
works
for
people
and
where
that
doesn't
work
for
people,
and
just
this
morning
we
were
feeding
a
lot
of
that
into
nhs
england
about
what
you
know.
Who
are
the
people
that
it's
really
great
for
and
who
is
it
the
people
that
it
doesn't
work
for?
And
how
do
we
segment
that
and
remove
some
of
the
heat?
G
That's
in
the
conversations
at
the
moment,
which
is
digital,
bad
face-to-face
good,
because
that's
not
what
the
public
are
saying,
they're
saying
something
much
more
nuanced
than
that.
G
Of
course,
some
of
our
work,
like
some
of
your
work,
is
just
stopping
things
happening
rather
than
making
things
happen,
and
we
did
a
lot
of
work
around
patient
data
when
when,
if
you
remember
there
was
a
hard
deadline
where
the
people
had
to
were
being
encouraged
to
opt
in,
but
they
weren't
told
there
was
an
opt-out.
G
So
we
did
quite
a
lot
of
work
on
that,
knowing
that
we
had
quite
a
a
good
backlog,
a
good
catalogue
of
information
from
the
public
on
that
issue,
and
so
the
position
we're
in
now,
I
think,
is
a
better
position
as
a
result
of
that,
we've
done
a
lot
of
work
and
we'll
continue
to
do
a
lot
of
work
on
the
elective
care
waiting
list
which,
which
is
a
big
issue
for
the
nhs.
It's
a
big.
G
G
And
again,
that's
that
all
that
work
is
feeding
directly
into
nhs.
England
and
some
work
we
published
with
the
king's
fund
just
two
weeks
ago
showed
that
people
in
the
most
deprived
areas
were
waiting
the
longest
for
their
surgery.
So
there
is
a
real
inequalities
angle
to
the
to
to
these
waiting
lists,
and
I
think
one
of
the
things
the
task
for
us
all
is
to
ensure
that
we're
not
widening
inequalities.
G
I
think
we've
reported
to
you
before
about
the
the
the
terrible
state
that
dentistry
is
in
in
this
country
and
the
the
significant
numbers
of
people
who
cannot
get
access
to
good
dentist.
Good
dentistry,
that
was,
there
were
difficulties
in
parts
of
the
country
pre-pandemic
that
is
much
worse
through
the
pandemic
and
and
now
also
people
are
finding
it
incredibly
difficult
to
get
nhs
treatment
when
they
need
it
in
a
timely
way
and
that's
having
a
huge
amount
of
impact.
G
It's
the
thing
that
that
we
at
the
the
numbers
that
we're
hearing
from
has
just
shot
up
over
the
last
year
compared
with
we
always
heard
quite
a
lot
about
it,
because
it's
in
parts
of
the
country
access
is
very,
very
difficult,
but
that
has
completely
shut
up
so
that
that's
again
something
that
we're
working
with
to
see
with
nhs
england
to
see
how
what
what
can
be
done
to
ease
that
point.
Those
points
of
access.
G
G
We've
been
looking
at
doing
some
pilots
around
some
metrics
around
that
and
and
that
piece
of
work
is,
is
going
going
very
well
a
piece
of
work
that
came
out
of
work
that
we
did
some
time
ago
around
the
the
before
the
long
term
plan
was
published
about
what
what
are
the
things
that
the
public
talk
about
in
terms
of
being
able
to
participate
fully
in
their
medical
care,
and
one
of
the
big
things
that
came
up
was
transport
and
simon
stevens
at
our
conference,
announced
that
they
would
the
nhs
would
do
a
review
into
it
and
that's
been
published
now.
G
So
there
are
some
significant
changes
to
the
way
non-emergency
patient
transport
is
dealt
with
to
try
to
make
those
situations
better
for
people
there's
still
a
lot
to
do
in
that
area.
I
have
to
say
it's
moving
on
through.
We
have
done
quite
a
lot
of
work
around
admin.
You'll
all
know
this.
G
From
your
personal
experience,
one
of
the
big
frustrations
people
have
with
health
and
social
care
is
the
is
the
way
things
are
administered
the
letters
you
get
that
don't
allow
you
to
make
appointments
the
call
back
and
there's
no
answer
that
sort
of
work.
So
we've
done
quite
a
bit
of
work
on
that
to
help
services
understand
the
impact
that
that
has
on
people
they're.
G
Just
looking
a
bit
to
the
future,
we
we
will
continuing
our
work
on
making
sure
that
healthwatch
is
ready
for
the
ics
and
for
the
the
new
organizations
that
will
appear
before
next
april,
so
we're
trying
to
get
ics
ready,
which
is
complicated
for
healthwatch,
because
robert
and
I
yesterday
just
met
with
the
with
with
one
of
the
ics's.
They
have
nine
healthwatch
in
their
patch.
G
Others
have
ten
eleven.
You
know
this
is
complicated
piece
of
work
and
and
we're
looking
both
at
having
healthwatch
roles
properly
acknowledged
within
the
legislation
and
the
guidance,
but
also
as
a
proper
infrastructure
to
be
put
in,
so
that
we
can
support
healthwatch
to
engage
properly
and
that
their
insight
has
a
real
impact
within
the
ics
boards
and
the
partnership
boards
too.
G
We're
also
doing
quite
a
lot
of
work
around
equalities.
It
is
a
main
thread
of
our
of
our
strategy.
All
our
work
takes
that
angle
to
make
sure
that
we
are
not
leaving
people
behind
and
that
we're
amplifying
the
voices
of
people
who
are
less
often
heard
one.
We
are
building
towards
a
campaign
that
will
be
run
right
across
the
country
with
most
healthwatch
participating,
which
is
about
accessible
information,
and
how
do
we
make
sure
that
the
information
well
every
there
is
a
duty
to
have
accessible
information.
G
There
are
standards
around
it,
but
in
you
know,
but
over
time
people
move
away
from
that,
and-
and
so
what
we
want
to
do
is
highlight
again
the
impact
that
it
has
around
when
when
information
is
not
accessible,
so
I
think
that's
the
that's.
The
top
line
of,
what's
going
on
in
healthwatch
england,
it's
very
busy.
It's
very,
I
have
to
say
very
energetic.
G
It's
a
great
place
to
be
at
the
moment,
and
just
my
final
comment
is
I
just
wanted
to
at
my
final
meeting
to
to
just
say
a
thank
you
and
to
appreciate
the
work
that
colleagues
in
cqc
have
done
to
support
me.
Over
the
nearly
five
years
I've
been
in
the
organisation
to
really
help
develop
and
mature
the
organization.
So
a
huge
thanks
to
you,
both
infrastructure
policy,
carl
everything
everybody's
been
really
fantastic.
So
thank
you.
A
H
I
just
wanted
to
say
a
very
big
thank
you
imelda
for
all
the
work
we've
done
together
over
the
last
couple
of
years.
Our
teams
are
working
brilliantly
together,
a
lot
of
the
areas
that
you
raise
in
the
report.
H
I
know
our
teams
are
working
together
to
make
sure
that
we
look
at
it
from
a
regulatory
point
of
view
as
well
when
the
aries
are
raised
with
us,
and
it
has
been
fantastic,
your
leadership
of
healthwatch
and
your
passion
for
hearing
the
voices
of
people
has
been
really
wonderful
to
to
learn
from
and
watch.
So.
H
Thank
you
very
much
I
just
on
on
with
regards
to
the
integration
and
the
integrated
care
systems,
I
think
it's
going
to
be
incredibly
important
for
healthwatch
to
have
a
very
strong
role
in
integrated
care
systems,
and
that's
certainly
something
I've
been
talking
about.
When
I
been
doing
my
stakeholder
engagement
around
ics's.
H
No,
I
wonder
if,
outside
of
this
meeting,
we
could
maybe
pick
up
a
separate
conversation
with
the
most
pro
person
in
your
team
in
terms
of
how
we,
how
we
look
at
working
together
around
that
agenda,
but
thank
you
very
much
for
what
you've
done.
A
So
actually
that
wasn't
what
I
was
going
to
say,
although
I
agree
we
agree
with
it
or
what
I
was
just
going
to
say,
imelda
in
your
normal
understated
way.
You
you
talked
about
the
appalling
state
of
dentistry
in
this
country,
and
I
think
it
might
just
be
worth
just
being
really
clear.
What
you
were
talking
about
was
difficulty
of
access
to
nhs
dentists,
rather
than
a
commentary
on
other
aspects
of
dentistry.
G
A
K
K
K
We've
managed
to
make
some
real
real
differences
and
real
change,
both
highlighting
where
policy
needs
to
change,
but
also
practically
what
organizations
can
do,
and
I
think
the
role
getting
accessible
information
right
in
a
post-covered
era
being
clear
about
what
people's
expectations
should
be
and
also
access
to
services,
how
we,
how
we
still
can
hear
the
voice
of
people
as
ics's
emerge
and
develop,
I
think,
will
be
critical,
so
I,
I
think,
there's
a
very
important
role
for
for
for
healthwatch
moving
forward
working
with
us.
K
G
Thanks
imelda,
I
don't
know
you
well,
but
I'm
sure
everybody
else
is
very
honest
in
their
in
their
tributes.
There's
something
in
the
paper
that
you
didn't
mention
around
access
to
mps
and
parliament
and
also
media,
and
I
just
wanted
to
give
you
the
opportunity
to
say
a
bit
more
about
that,
because
that
leaps
out
at
me
as
something
that
healthwatch
does
better
now
and
probably
has
more
of
an
influence.
And
I
just
wondered
if
you
wanted
to
comment
a
little
bit.
G
Thank
you.
I
I
was
trying
to
sort
of
just
stick
to
policy,
but
I
I
think
it
is
it's
in
this
report
for
you
to
read.
We
we
are
having
a
concerted
effort
to
make
sure
that
the
voices
of
people
who
use
or
need
services
are
heard
by
everybody
who
has
an
influence
to
bring
about
improvement.
G
So
we've
really
stepped
up
our
work
with
parliamentarians
really
supporting
parliamentarians
in
their
debates,
particularly
so
that
they
have
the
information
to
make
sound
decisions
and
and
also
building
longer-term
relationships
with
parliamentarians,
like
likewise
with
the
media,
took
a
took
a
while
for
us
to
get
our
voice
into
in
the
media.
Getting
the
tone
right
is
really
important.
G
We
could
be
on
the
front
page
of
the
daily
mail
every
day
if
we
wanted,
but
getting
the
tone
right
so
that
you
so
that
you
build
strong
partnerships
and
and
make
sure
that
people
get
the
nuances
of
what's
going
on
is
quite
hard,
and
I
think
we
found
that
it
took
us
a
while
to
get
there,
but
I
think
now
that
we've
got
our
evidence,
is
so
much
stronger.
It's
easier
to
tell
that
nuanced
story,
we
say,
know
a
lot
to
media
and
and
will
do.
A
So
I
was,
I
was
sorry,
did
you
want
to
come
in
eddie?
No,
no!
So
I
was
I
was.
I
was
going
to
say
melda,
that
before
you
and
robert
arrived
at
healthwatch,
healthwatch
was
a
a
really
good
idea
that
hadn't
quite
worked
out
how
to
to
to
perform
its
role,
and
since
you
and
robert
have
been
there,
it's.
A
It's
transformed
robert
of
course,
takes
all
the
credit
for
that,
but
I
suspect
that
just
a
little
bit
goes
to
you
as
well
and
melder,
so
the
risk
of
sparing
or
not
sparing
your
blushes.
I
just
want,
on
behalf
of
the
whole
board,
to
say
thank
you
very
much
for
all
you've
done
and
to
to
wish
you
well
in
the
next
next
step
in
your
life.
It's
been
a
it's
been
great
working
with
you,
so
bored
that
that
I
think
brings
us
to
any
other
business.
A
If
there
is
any
haven't
been
notified
of
any.
But
does
anybody
want
to
raise
anything
in
which
case
that
is
the
end
of
the
meeting,
but
we
do
have
two
questions
from
one
member
of
the
public
robin
pike,
and
the
first
question
is:
how
does
cqc
regulate
large
gp
practices
form
from
the
amalgamation
of
smaller
practices,
taking
into
account
any
differences
in
demographics
rosie?
I
think
that's
one
for
you.
Please.
H
Yes,
thank
you
peter,
and
thank
you
robin
for
the
question.
We're
we're
doing
a
lot
of
work
in
this
area.
There's
there's
two
scenarios
really
we're
working
through.
H
One
is
what
we're
calling
primary
care
at
scale
providers,
which
are
practices
that
are
large
practices
working
under
one
corporate
umbrella
and
the
other
is
that
we're
increasingly
seeing
primary
care
that
practices
come
together
under
primary
care
networks,
which
have
a
whole
variety
of
legal
structures
and
the
way
that
both
with
the
primary
care
scale
and
the
primary
care
network
providers
are
regulated,
depends
a
little
bit
on
their
legal
structure
and
how
they're
registered
with
us.
H
However,
having
said
that,
the
work
that
we've
done
to
date
and
the
work
we've
done
with
the
public
shows
that
actually,
the
public
are
still
very
interested
in,
what's
happening
at
the
specific
location
that
they
actually
attend
for
their
care.
So
we're
still
regulating
at
the
moment,
mostly
in
the
looking
at
the
locations
that
people
attend
for
their
care,
but
trying
to
understand
what
can
we
do
at
that
corporate
level
across
all
providers?
H
And
we
do
have
relationship
owners
with
those
with
each
of
those
large
providers
to
make
sure
that
we
get
a
good
understanding
and
a
good
picture
of
what's
happening
in
each
of
the
different
practices
that
they
run
and
just
make
sure
that,
if
there's
a
problem
in
one
we
investigate
or
we
look
into
whether
that's
a
more
general
problem
across
all
of
the
across
all
of
the
different
providers
locations.
H
A
Thanks
rosie
and
robin's
second
question
is:
how
does
cqc
regulate
nhs
hospital
trusts
that
have
large
independent
hospitals
on
the
same
site
when
as
much
as
as
40
of
their
activity
may
be
in
the
independent
hospital?
I'm
not
sure
that
that's
quite
an
accurate
statement
of
what
happens
but
ted
you
might
be
able
to
answer
the
general
point
of
the
question.
F
I
mean
the
general
point
is
that
the
nhs
trust
and
the
independent
hospital
are
usually
completely
separate
separately
registered
organizations
and
so
are
regulated
individually
as
separately
regulated
organizations
registered
organizations.
We
would
inspect
them
separately
and
we
would
report
on
them
separately
and
we
would
take
any
enforcement
action
if
it
was
necessary
against
them
separately.