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From YouTube: CQC board meeting – September 2018
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A
Goodness
me
I've,
never
known
the
board,
so
quietness
is
fantastic,
so
welcome
everybody
to
the
8
April
head
for
the
September
board
meeting
good
to
see
everybody
here
we
have
apologies
from
Paul,
Corrigan
and
Rebecca.
Lloyd
Jones
is
away
so
Naomi
Patterson,
our
head
of
governance
and
our
private
office
is
sitting
in
to
keep
me
in
order.
So
thank
you
for
that.
Naomi
I
know
everybody
will
realize
this,
but
this
is
ins
first
meeting
as
chief
executive.
So
welcome
to
you.
Thank
you.
A
A
There
are
two
items
on
the
action
log.
The
first
one
is
completed.
The
second
one
is
an
ongoing
action
which
will
be
here
for
some
time,
but
we
are
progressing
constantly
with
communication
anything
arising
that
is
neither
on
the
action
log
or
otherwise
on
the
agenda.
Anybody
wants
to
raise
perfect,
in
which
case
in
its
the
executive
team
report
over
to
you
thanks.
B
B
We
identified
a
technical
error
within
some
of
our
data
management
systems,
which
meant
that
we
may
not
have
at
var
made
timely,
safeguarding
referrals
to
56
local
authorities
relating
to
a
hundred
and
twenty-one
cases
we
refer
to
those
cases
as
safe
in
cases
and
they
varied
in
severity
from
being
relatively
modest
areas
of
concern
through
to
cystic
areas
of
greater
concern.
We
have.
We
continue
to
work
with
local
authorities
to
to
to
report
those
cases.
B
They
were
all
reported
immediately,
but
we're
following
up
with
local
authorities
and
we
will
be
holding
an
independent
review
of
what
happened
and
the
impact
of
what
happened
and
that
will
be
taking
place
shortly
and
that
will
be
independently
reviewed
and
will
report
back
to
the
public
section
of
this
board.
The
second
thing
I'd
like
to
draw
your
attention
to
is
in
in
Section
two
of
my
section
of
the
report
that
refers
to
the
responsible
officer
annual
report
board.
B
Members
will
be
familiar
with
the
requirement
for
us
to
ensure
and
provide
you
with
assurance
that
doctors
who
work
have
a
connection
with
CQC
have
an
annual
revalidation
process,
and
this
describes
how
that
process
took
place
and
gives
you
assurance
that
the
doctors
that
are
connected
with
CQC
in
a
professional
capacity
are
appropriately
competent
and
unfit
to
practice.
So
I'm
going
to
I'm
going
to
to
pause
at
that
point
and
and
hand
over
to
to
Andrea
for
the
adult
director
of
adult
social
care.
D
Sorry,
yes,
we've
published
two
very
important
reports
last
week,
one
armed
sexual
safety,
mental
health
wards,
and
this
short
summary
of
that
it
in
your
report.
There
I
think
this
is
important
really
for
two
aspects.
One
is
we
were
it's
a
new
process
of
looking
at
NRL
s,
reports
and
analyzing
them
to
identify
risk
factors
and
developing
patterns
from
them
and
I.
D
It's
not
an
easy
area
to
address,
and
the
report,
of
course
doesn't
come
up
with
answers.
It
challenges
the
system
to
find
the
right
answers
and
challenges
the
system
to
develop
guidance,
to
managers.
It's
difficult
and
challenging
area
well
and
I
think
this
is
very
important
part
of
what
we
do
as
a
regulator
is
not
just
to
go
out
and
point
to
individual
risk,
but
to
challenge
the
system
about
the
risks,
as
it
perhaps
is
not
addressing
adequately,
and
this
is
very
much
one
of
those.
D
So
we
will
be
following
through
to
make
sure
that
guidance
is
developed
and,
of
course,
when
the
guidance
is
there,
it
makes
our
job
easier
in
terms
of
individual
inspection
and
regulation
of
organizations
to
make
sure
they're,
following
the
guidance
and
I
think
that
that
is
going
to
be
important.
Going
forward.
Seeing
this
developed.
D
The
right
way
and
the
important
point
about
this
report
is,
it
doesn't
say
we
at
the
CQC
know
the
answers
it
says
we
at
the
CQC
have
been
talking
to
people
have
demonstrated,
they
can
do
it
and
we
want
others
to
learn
from
that
now.
I'm
very
pleased
to
say
that
mgs
providers
took
this
report
up
and
circulated
it
to
chief
executives
across
a
digest
Trust
on
our
behalf
when
it
came
out
and
the
initial
reaction
I've
got.
Both
managers
providers
generally,
but
also
from
individual
chief
execs,
is
very
positive.
E
Comment
on
the
sexual
safety
report:
this
is
an
incredibly
sensitive
subject
and
a
very
difficult
one
to
get
good
data
on
it's,
not
new,
it's
something
that
was
subject
to
reporting
at
least
ten
years
ago,
and
at
that
time
we
resolved.
The
challenge
to
the
system,
then
was
to
get
better
data
and
I
think
what
one
of
the
things
this
report
showed.
It
was
very,
very
I
mean
it's
a
good
report
in
lots
of
ways,
but
it's
good
in
ways
that
are
not
that
good.
E
Some
of
them
involve
staff
as
perpetrators,
at
least
that's
the
allegation
and-
and
some
of
them
involve
patients.
Saying
they
weren't
believed
when
they
reported
being
victims
of
a
sexual
assault
so
that
they
couldn't
be
more
serious
really.
On
the
other
hand,
the
seriousness
isn't
matched
by
the
quality
of
the
data
that
we
were
able
to
get
hold
of,
and
I
I
felt
that
in
the
end,
we
were
in
a
slightly
awkward
position
where
we
had
got
half
the
story:
data
wise
and
then
what
do
you
do
with
half
data?
Do
you
say?
E
D
E
D
Back
on
that,
I
share
your
concern.
I
think
it
is
true
what
you're
saying
there
Louis
that
actually,
this
has
been
known
about
in
the
system
for
a
long
time,
but
it
hasn't
been
given
the
the
if
you
like,
the
not
publishes
the
wrong
word
but
the,
but
the
air
turn
for
people
to
actually
take
it
seriously
to
take
it
forward
and
I
think
the
challenge
from
us
it
is.
D
It
is
a
Chancellor
system,
the
system
that
the
trust
managing
these
services
need
to
address
this
problem,
and
we
need
to
hold
it
to
account
for
that.
But
equally
they
need
to
define
what
good
good
practices
it's
very
difficult
for
us
to
tell
them
what
good
practices
they
need
to
take
the
risks
that
we've
identified
that
they
know
about,
and
they
already
knew
about,
but
perhaps
were
not
managing
effectively.
D
They
need
to
take
that
risk
and
and
learn
and
develop
really
good
practice
guidance
which
we
can
then
hold
this
system
to
account
for
so
I
suppose
your
challenge
to
us
is:
are
we
going
to
follow
through
absolutely
they're
going
to
follow
through
on
this,
but
we
need
to
do
it
in
partnership
with
people
providing
the
services?
It's
not
something
we
can
just
impose
as
a
regulator,
so
Robert
and
then
John.
F
Well,
I
think
this
is
a
very
valuable
report
in
a
much
still
neglected
area
and
it
shows,
in
my
view,
the
woeful
lack
of
priority.
That's
given
to
mental
health
and
the
people
who
suffer
suffer
in
that
area.
The
question
I
had
really
was
a
man
Ted.
You
saying
the
sector
needs
to
develop
guidance,
absolutely
understand.
F
It's
not
something
which
has
been
the
subject:
I
suspect
of
a
widespread
public
debate
or
all
with
service
users,
and
so
on
and
I
just
wondered
whether
there's
anything
in
that
area
without
us
producing
the
guidance
with
what
we
could
do
or
to
to
promote
the
discussion
that
is
needed
to
get
that
guidance.
Well,.
D
Together
to
actually
discuss
that
very
point
and
I
suppose,
because
it
is
a
sensitive
subject,
as
you
say
that
to
stop
people
addressing
it
as
a
very
critically
as
perhaps
they
should
have
done
and
I
think
it's
for
us
to
say
well,
actually
maybe
a
sensitive
subject,
but
actually
it's
an
important
issue
that
is
affecting
people's
lives,
affecting
someone
very
badly.
We
need
to
get.
We
need
to
get
on
top
of
it
in
terms
of
protecting
patients
as
best
we
can
and
I
think
in
lots
of
areas
of
clinical
practice.
D
The
evidence
isn't
always
as
clear
as
it
could
be.
That
doesn't
mean
that
that
the
people
who
are
managing
the
service
cannot
develop
gardens
around
good
practice
and
come
from
that
learn
how
to
do
it
better,
and
this
is
not
a
static
process
and
I'm
sure
there's
a
learning
process
involved,
but
that
doesn't
mean
there
shouldn't
be
a
basic
element
of
good
practice,
defined
I.
I
I
Work
was
first
done
on
this,
when
the
first
guidance
came
out
recommending
at
the
choice
of
single-sex
wards
in
mental
health,
which
was
in
the
1990s
which
came
out
of
anxieties
about
sexual
assaults
and-
and
it's
just
kind
of
an
interesting
question
as
to
why
there
are
these
sort
of
surges
of
kind
of
concern,
but
not
that
much
has
changed
over
really
quite
a
considerable
length
of
time.
So
what
what
are
the
levers
that
might
be,
that
might
actually
be
effective
and
and
I
mean?
I
It
would
be
quite
useful
if
we've
not
done
this
already
to
talk
with
people
within
the
CPS
and
the
police
and
sort
of
stimulate
that
dialogue.
But
you
know
what
what
is
the
threshold
at
which
you
would
expect.
You
know
crimes
to
be
reported
and
properly
investigated
and
dealt
with
in
that
way,
so
that
the
the
kind
of
awareness
off
crime
and
people's
rights
in
relation
to
crime
kind
of
should
should
go
up.
Just
a
couple
of
potential
leaves
categorization
and
criminal
justice.
I.
Think.
D
That's
entirely
right
and
that
that
good
guidance
has
to
remove
any
ambiguity
about
when,
when
you
need
to
involve
the
criminal
prosecution,
the
police
and
prosecution
services
and
I
think
that
needs
to
be
clear
to
the
staff.
So
there
is
no
ambiguity
there,
but
equally.
This
is
this
is
that
this
is
a
subtle
and
difficult
area,
so
it
leads
Gardens
across
the
board,
but
involving
CPS.
Indeed,
yeah
Chris.
J
Just
say
he
to
respond
to
a
couple
of
the
points
that
were
raised
earlier.
One
of
the
things
about
the
report
he
puts
in
the
report
together.
I
think
some
things
we
have
to
maintain
beyond
the
life
of
the
published
report
is
a
conversation.
We've
begun
with
both
the
the
charities
that
represent
people,
but
also
the
organization's
as
multiple
for
care
and
I
think
there
was.
J
There
was
a
very
interesting
dialogue
in
the
lead-up
to
the
final
report
about
how
the
guidance
should
be
framed
about
who
should
be
involved
in
the
guidance
about
the
importance
of
bringing
in
organizations
like
the
CPS
and
the
police
and
I
think
it's
important.
We
mean
I
think
that
to
go
back
to
those,
perhaps
original
challenge,
there's
an
importance
about
maintaining
the
light
in
this
area
that
it
be.
Then
it
becomes
part
of
how
we
describe
performance
every
day.
J
I
think
the
conversation
we've
begun
with
no
interest
improvements
and
also
the
conversation
we've
involved,
mind
I,
think
bringing
people
use,
services
and
providers
together
as
we
as
we
do
in
so
many
other
cases,
is
an
important
aspect
of
how
we
will
continue
to
shine.
The
light
in
this
area
and
make
sure
that
the
working
groups
that
have
been
set
up
to
put
the
guidance
together
do
actually
put
the
guidance
together
in
a
way
that
satisfies
all
those
groups
and
in
the
way
that
we
can
use
as
as
tennis
set.
J
A
D
Isn't
there
we
can
keep
pressure
up
for
it,
but
equally
we
can
use
our
regulatory
powers
to
hold
all
practice
to
account
for
taking
action
on
this,
and
so
I
think
this
is
an
important
part
of
what
we
do
and
I
think.
The
message
needs
to
go
out
that
when
we
publish
reports
about
this
and
there's
several
others
about
other
risks
in
the
system
that
you
know,
that
is
not
the
end
of
the
story.
That
means
we're
going
to
keep
coming
back
and
focusing
on
so
I.
A
A
H
I
just
want
to
commend
the
work
that
was
done
on
that
so,
not
least
by
I
own
the
thorn
one
of
the
clinical
fellows
and
but
also
to
just
emphasize
the
point
that
these
organizations
didn't
do
that
by
happenstance,
but
by
rigorous
discipline.
Systematic
implementation
of
quality
improvement
program,
including
the
people,
the
methods
in
the
data
and
as
we're
seeking
to
ramp
up
our
own
program
internally
on
quality
improvement.
That
there
are
probably
lessons
to
be
drawn
from
that
for
ourselves,
not
least
in
some
of
the
ways
that
the
training
and
so
on.
K
K
From
a
health
point
of
view
have
lessons
across
all
sectors
which
are
really
important.
In
my
section
there
are
two
things:
I
want
to
talk
about
online
consultations
and
prescribing,
and
also
the
renewal
of
the
contract
on
local
system
reviews
which
isn't
currently
on
the
papers,
but
a
short
update.
K
The
text
is
in
front
of
you
on
the
paper
about
the
online
work,
but
I
just
wanted
to
say
two
things.
One
is
I,
really
welcome
the
Secretary
of
State's
enthusiasm
for
the
use
of
technology
and
for
doing
things
differently,
and
we
would
support
that
because,
from
a
ctbc
point
of
view,
we
want
to
be
seen
and
act
not
to
stifle
innovation,
but
our
role
is
to
make
sure
that
people
in
England
are
kept
safe
through
our
regulatory
actions.
K
So
we
work
very
closely
with
providers
of
these
services
and,
secondly,
to
say
that
we're
working
very
closely
through
a
regulation
board,
which
we
lead
and
with
the
DHS
C,
to
look
at
many
of
the
concerns
that
were
raised,
not
just
in
the
panorama
program
which
proceeded
but
just
was
after
the
last
board
and
that
are
raised.
You
know
ongoing
work.
So
the
work
is
being
reviewed
with
the
DHS
C
through
an
oversight
group
and
through
our
regulation
book.
K
K
Reviews
has
been
recommissioned
with
great
thanks
to
everyone
here,
but
particularly
to
Moltres
team
for
working
with
us
on
getting
the
repro
kumin
we're
going
to
be
looking
before
Christmas
at
three
new
areas
and
reviewing
three
of
the
local
authority
areas
out
of
the
twenty
that
we've
been
to
over
the
past
year,
and
we
will
report
an
ongoing
way
to
the
board.
Has
that
work
progresses.
L
A
L
Peter,
thank
you
very
much
so
I
presidential
e,
the
performance
report
for
the
first
quarter
of
this
year,
April
to
June
of
the
year,
though,
in
the
slides
attached
to
the
report,
you'll
see
that
some
have
an
update
for
the
July
performance
as
well
as
always
there's
a
lot
of
detail.
So
I
just
wanted
to
pull
out
a
short
number
around
the
performance
before
handing
to
Kirsty
and
Chris
on
on
the
strategic
risk
and
finance
and
budget
summary
in
terms
of
the
performance
that
is
on
track.
L
I
wanted
to
particularly
commend
our
colleagues
and
the
National
customer
service
center,
where
our
performance
is
currently
on
track
and
a
hard
work
they're.
Putting
into
that
making
sure
that
people
who
approach
our
organization
are
being
responded
to
timely
and
well.
I
also
wanted
to
say
thank
you
to
our
inspection
colleagues,
particularly
a
hospital
in
primary
care,
where
a
lot
of
hard
work
is
going
into
being
on
track
in
terms
of
our
inspection
program.
L
Coming
coming
to
the
some
of
the
key
areas
where
we're
currently
not
on
planned
but
are
looking
to
improve.
I
similarly
want
to
really
thank
all
the
colleagues
for
putting
really
hard
to
work
into
our
inspections
and
adult
social
care
when
the
huge
pressure
in
that
area
at
the
moment-
and
we
now
know
that
we
will
not
be
able
to
meet
our
target
against
the
frequency
of
inspections
inspection
program
for
the
for
the
year.
However,
we
are
confident
that
we
are
responding
to
risks
in
the
secretary
when
they
occur.
L
Andrea
will
be
able
to
say
but
more
about
that.
Secondly,
in
registration,
we
continue
to
do
overall,
okay
performance,
but
we're
not
meeting
the
target
that
we
set
ourselves,
particularly
in
terms
of
the
80%
of
new
bridge
directions
being
target
to
do
that.
The
team
is
particularly
struggling
with
increasing
demands
of
registration
and
with
increasing
demand,
where
we're
being
approached
with
potentially
unregistered
providers.
That
need
to
be
that
need
to
be
followed
up
again.
L
Andrea
can
say
a
little
bit
more
about
that
and
then
finally,
I
wanted
to
mention
our
work
on
the
timeliness
of
the
publication
of
inspection
reports,
we're
making
good
progress,
particularly
in
primary
care
and
an
adult
social
care
we're
in
primary
care.
We're
now
at
89%
against
the
target
of
90%
in
an
adult
social
care,
81%
particular
to
notice
that
the
average
time
we're
taking
on
reports
as
increasing
as
sorry,
it's
decreasing,
decreasing,
very
important,
which
is
a
which
is
a
very
positive
sign.
On
the
overall
progress
that
we're
making
on
improving
our
processes.
L
A
performance
is
still
off
track
in
the
hospital
sector,
which
is
now
a
priority
area
for
us.
It
is
also
a
priority
area
for
us
where
we're
beginning
to
roll
out
a
quality
improvement
methodology,
and
we've
got
a
number
of
improvement
themes
that
are
now
being
worked
through
with
hospital
colleagues,
but
also
shared
across
across
all
sectors
and
Ted
can
say
more
to
more
to
that
later.
A
E
E
Is
that
it's
the
number
of
enforcement
actions
that
we're
now
taking,
and
so
almost
two
thousand
four
two
thousand
three
hundred
and
twenty-nine
and
forcement
actions
in
the
last
twelve
months,
which
is
a
huge
number?
It's
two
hundred
I
mean
this
is
a
lot
of
enforcement
and
it's
going
up
and
I
suppose.
On
the
one
hand,
there's
a
there's,
a
story
there
of
CQC
taking
action
when
necessary,
protecting
the
public
and
so
on.
E
On
the
other,
there's
a
question
about
why
it's
going
up,
because
we've
always
intended
to
protect
the
public
and
now
are
we
seeing
more
poor
practice?
Are
we
just
better
at
identifying
it?
Are
we
losing
patients?
What
what
actually
is
happening?
That's
causing
a
rise,
or
is
it
just
that
we
have
more
powers
now
that
we
were
prepared
to
use
okay.
C
C
As
Malta
has
already
said,
we
are
for
a
variety
of
different
reasons,
largely
because
of
vacancy,
so
we've
not
recruited
and
to
the
establishment
as
quickly
as
we
wanted
to
in
adult
social
care
and
also
because
of
increased
complexity
and
the
point
about
enforcement
that
you've
subsequently
made
Louis
pressure
on
the
teams
is,
is
quite
intense
and
the
reason
for
the
apparent
imbalance
explained
you.
We
look
like
we're
going
back
to
the
good
night
standing
services.
Well,
why
would
we
do
that
and
the
reason?
Why
is
because
we're
responding
to
risk?
C
So
we
are
having
information
come
through
to
us,
either
from
people
who
are
using
services
and
their
families,
often
staff,
or
that
we're
picking
that
up
from
other
partners.
Healthwatch
other
partners
like
local
authorities,
the
clinical
commissioning
groups
who
are
going
into
services,
or
indeed,
observing
that
through
the
notification
information
that
we
get,
that
there
appears
to
be
a
deterioration
and
the
quality
of
some
of
those
good
services.
And
so
we
are
going
back
out
to
those.
C
Because,
obviously,
if
services
are
deteriorating
a,
we
need
to
be
able
to
identify
that
respond
to
it
and
B.
Obviously,
we
need
to
make
sure
that
the
public
is
aware
that
the
service
is
not
necessarily
at
the
good
level
that
we'd
previously
identified
that
it
was
each
of
the
regions
is,
has
established
a
recovery
plan
to
look
at
how
we
can
get
back
on
track
with
with
our
inspection
in
terms
of
going
back
in
the
frequencies
that
we
we
would
want
to
do
so
and
really
focusing
particularly
on
the
inadequate
and
the
requires
improvement.
C
Takes
me
to
the
enforcement
actions.
It's
interesting
I
think
that
you
you're
picking
up
that
trend,
and
that
is
a
cont
trend
that
has
continued
on
open
ioan
that
nearly
five
years
I've
been
here,
and
you
know,
we've
kind
of
seen
that
trend
increase
over
time
and
I
think
there
were
a
number
of
factors
that
are
behind
it.
C
The
first
is
that
we
are,
we
did
get
more
powers
kind
of
halfway
through
that
period
of
time,
so
from
2015
onwards,
and
and
we
are
using
those
powers
at
some
of
those
powers,
particularly
the
criminal
enforcement
powers-
new.
It
takes
time
to
criminal
prosecution
through.
So
we
have
lots
of
lots
of
investigations
on
the
books,
and
now
they
are
coming
to
fruition,
so
they
are
being
seen
as
published
action,
which
is
which
is
coming
through,
which
wouldn't
have
been
in
the
first
couple
of
years
being
able
to
do
that.
C
We're
also
I
think
because
we're
now,
in
a
period
of
time
where
we
are
going
back
to
services
much
more
regularly,
and
we
have
said
that
if
the
service
is
inadequate
and
we're
putting
in
special
measures,
that
means
that
the
clock
is
ticking
in
terms
of
enforcement
action
that
we
would
be
taking.
So
actually,
the
kind
of
expectation
of
us
taking
that
enforcement
action
is
increasing
over
time.
C
As
we
discussed
last
night,
we
are
seeing
services
struggling
to
maintain
their
good
services
and
deteriorating,
but
also
particularly
requires
improvement
services
they're,
not
improving,
and
one
of
the
things
that
we
introduced
last
year
and
the
new
assessment
framework
was
then
a
greater
scrutiny
of
those
services
that
were
continually
at
requires
improvement
only
ever
putting
things
right
when
we
were
identifying
them
and,
frankly,
failing
in
their
regulation
around
good
management
and
good
governance,
and
so
we're
taking
more
enforcement
action.
A
relationship
to
that
and
we're
also
picking
up.
C
Some
of
the
thing
like
this
will
also
include
the
fixed
penalty,
notices
that
we're
issuing
for
failure
to
display
ratings
and
and
we're
doing
more
of
those
as
time
is
going
on.
So
there's
a
variety
of
different
reasons,
which
I
think
are
both
about
services
truly
struggling
and
not
being
able
to
respond
appropriately
and
the
progress
of
our
own
programs.
D
Microphone
can
I
just
come
back
on
the
inspection
frequency
issue,
because
I
think
it
is
a
concern
going
forward.
The
only
the
hospital
teams
are
very
busy
delivering
the
inspection
frequencies,
but
my
concern
is
that
if
there,
if
that
risk
is
being
about
chiefly
determined
by
inspection
frequency,
rather
them
by
other
assessments
of
risk,
and
so
they
are
very
busy
delivering
the
inspection
frequencies
on
time
which
they're
managing
to.
D
But
having
said
that,
then
there's
less
resource
available
to
be
responsive
to
risks
when
it
occurs
and
as
we've
discussed
before,
there
are
risks
in
the
system
that
we're
becoming
aware
of
so
I
think
there's
a
kind
of
sense
of.
Perhaps
we
need
to
think
again
about
inspection
frequencies
as
our
main
driver
and
determination,
a
determiner
of
risk
in
assessing
services
and
actually
look
beyond
back
to
intelligence,
we're
requiring
about
services,
because
I
think
that
will
give
us
a
more
responsive
effect
and
I.
Think
that
is
something
we
are
learning
in.
D
The
current
system
can
I
also
pay
tribute
to
the
the
quality
improvement
team
as
they
work
around
report
timeliness.
It
isn't
in
the
data
that
you've
been
sent,
but
August
was
the
best
month
ever
for
report,
timeliness
fit
for
hospitals
and
they
are
the
work
they're
doing
is
beginning
to
show
benefit.
D
So
the
figures
I
got
for
August
are
64%
for
three
or
more
core
services,
61%
for
two
core
services,
which
is
the
best
we've
ever
achieved,
and
so
there
is
enough
with
trajectory
there,
but
in
the
face
of
the
the
amount
of
work
going
on
in
keeping
the
wrist
the
reports,
the
inspection,
frequency
up
I
think
there's
a
big
pressure
on
our
frontline
staff
and
I.
Think
we
need
to
measure
the
the
the
KP
are
about
inspection
frequency
carefully
to
determine
how
we
can
create
a
sustainable
situation
of
delivering
on
this.
So.
M
C
So
the
the
next
stage
of
the
work
that
we're
doing
is
to
look
at
that
to
see
rather
than
as
kind
of
new
creating,
as
you
quite
rightly
suggest,
a
sort
of
unmanageable
backlog
in
some
parts
of
the
country,
whereas
other
parts
of
the
country
might
be
progressing
reasonably.
Is
there
some
way
that
we
can
balance
that
out?
We're
also
looking
at
new
issues
around?
C
How
do
we
use
our
bank
staff
to
support
inspections
where
we
need
a
second
inspector,
so
we're
not
going
to
be
using
span
thanks
stuff
to
lead
on
inspection
but
to
to
support
those
larger,
because
some
of
the
care
homes
that
we
are
looking
at
or
bigger
than
some
of
the
community
hospitals
that
ted's
ting
look
at
so
you
there's
that
there
aren't.
There
are
times
when
we
have
quite
significant
teams
going
out.
C
A
H
Tell
me
this:
isn't
the
appropriate
I
just
wanted
to
comment
on
what
Teddy
just
said
about
the
progress
in
timeliness,
which
is
good?
As
you
know,
I
asked
for
the
process
maple
s
board
meeting,
and
that
illustrates
both
the
challenge
you
have,
but
so
there's
tremendous
opportunities
for
improvement
and
I'm
cautious
about
the
numbers.
H
You've
just
quoted,
not
because
they're
not
in
the
right
direction,
but
because
there
isn't
yet
a
data
mechanism
in
stall
for
determining
whether
they
are
part
of
the
natural
inherent
variation
of
the
current
system,
as
opposed
to
a
shift
change
of
a
new
system
and
as
part
of
the
inquires
and
ongoing
dialogue,
I've
identified,
there
are
about
12
or
15
inspectors
who
consistently
deliver
the
KPI.
Have
we
seen
what
they
do
differently?
H
D
C
We
are
actually
kind
of
above
the
90
percent,
but
once
you
take
the
full
12
months
and
rolling
average
into
account,
what
where
we
were
twelve
months
ago
is
kind
of
keeping
the
the
average
down
a
bit.
So
one
of
the
things
that
talk
to
and
Gavin
Kennedy
and
the
performance
team
about
is,
is
how
can
we
demonstrate
that
progress,
not
just
on
average
of
days
which
are
reducing,
but
also
whether
we
can
kind
of
look
a
bit
looking
a
bit
more
of
a
sophisticated
way
at
the
the
way
that
there.
A
Okay,
I
think
it's
just
also
worth
saying
that
if
we
have
a
KPI,
it's
really
important
that
we
meet
the
KPI.
Having
said
that,
and
to
your
point
ed,
we
also
have
to
remind
ourselves
that
inspection
is
only
one
of
the
methods
that
we
have
we're,
not
an
Inspectorate.
It's
one
of
the
tools
that
we
have
in
our
armory.
We
have
lots
of
other
contact
with
providers,
so
I
think
we
need
to
and
as
we
move
to
to
be
more
intelligence,
driven,
I
think
you're
absolutely
right
at
some
point.
A
N
You
just
before
I
talk
on
risk.
I
just
come
back
to
Paul's
point,
which
was
in
terms
of
that
backlog.
One
of
the
other
bits
of
work
we
are
doing
is
actually
looking
at
the
role
of
the
inspector
I'm,
actually
looking
at
whether
some
of
those
tasks
that
they
do
on
a
day-to-day
basis
are
better
done
elsewhere
in
the
business,
so,
for
instance,
by
the
National
customer
service
team
up
in
Newcastle,
because
they
can
take
free
up
time,
which
all
then
can
be
reinvested
in
to
do
more
inspiration
time
so
trying
to
right
place.
N
My
skills,
my
play,
stagnancy
in
terms
of
risk
I
just
wanted
to
highlight
today
that
we've
got
three
areas
which
will
sit
under
the
transformation
banner
which
are
now
in
excess
of
us
of
maximum
tolerance,
and
those
ones
are
wrists
13.
But
we
did
not
have
the
capacity
or
capability
to
manage
change,
effectively
risk
for
where
we
do
not
effectively
collect
or
process
information
to
be
an
intelligence,
driven
regulator
and
risk
5,
which
is
where
we're
not
well
supported
by
our
IT
technology
and
systems
there.
The
CQC
strategy,
so
those
are
all
a
red
risk.
N
N
We
have
we're
building
capability
around
our
project
management
office,
putting
a
centralized
project
management
office
in
place
and
looking
at
the
reporting
and
the
control
mechanisms
that
go
around
that,
so
we
can
start
to
actually
get
a
handle
on
on
what
it
is,
we're
doing
and
really
good
progress
made
there
in
terms
of
the
intelligence
driven
piece.
There's
a
number
of
work,
a
number
of
pieces
of
work
on
this
front.
N
N
Think
just
to
say
here
is
there
is
a
huge
amount
of
work
going
on
in
this
in
this
space
to
really
understand
what
our
capability
is
and
match,
our
ambition
to
that
capability
and
looking
at
a
number
of
areas
in
terms
of
how
we
drive
up
user
experience
around
RIT,
but
also
looking
at
our
underpinning
architecture
and
making
sure
that
that
is
consistent
with
what
we
need
to
do
as
an
organization
moving
forwards.
But
I'll
come
back
to
that
a
bit
more.
When
I
talk
about
a
change.
A
Good
iëm
think
that
two
things
one
it's
it's,
it's
really
really
good
that
that
will
happen.
It's
very
thorough
review
of
where
we
are
on
all
these
things
and
thanks
to
you,
honey
and
also
for
for
that
and
as
you've
just
said,
you
know
there
are,
there
will
be
plans
in
place
to
get
off
red
custody
woody.
Would
it
be
the
right
time
to
come
back
to
the
board
with
a
with
a
clear
path
to
not
having
red?
Would
that
be
December
the
end
of
the
next
quarter?
Yes,.
N
A
A
O
N
A
A
Right
so
we
come
on
to
change
sorry
in
if.
B
P
And
so
update
beyond
caught
once
at
the
end
of
July,
were
over
spent
Vice
okay
on
a
budget
which
is
mainly
use
of
specialist
advisors
in
hospitals,
Directorate
and
non
pay
budget
in
hospitals
as
well,
that's
been
offset
by
own
spend
elsewhere
and
in
the
Commission
we're
currently
forecasting
a
1.3
million
overspend.
But
given
the
plans
we
have
in
place
to
recover
the
issue
with
especially
for
advisors
and
other
plans
put
in
place,
I,
don't
anticipate
that
that's
that's
going
to
materialize.
P
I
anticipate
we'll
be
on
budget
for
the
end
of
the
year
figures,
I've
seen
from
August
initial
figures
show
that
that
is
coming
coming.
True,
this
we've
got
30
million
capital
budget
for
the
year.
We've
spent
3.4
million
to
date,
which
brings
on
to
the
change
point
next,
so
we'll
monitor,
and
how
much
of
that
allocation
will
actually
use
this
year,
currently
were
planning
to
use
the
full
allocation,
but
it
does
bring
onto
the
work
around
the
change
and
what
exactly
will
spend
this
year.
Thank
you.
Thanks
Chris,
any.
A
N
So,
thank
you,
I'm,
going
to
talk
to
the
change
portfolio
report,
which
is
in
your
pack
of
data
I'm
not
going
to
go
through
everything
in
detail,
but
what
I
will
do
is
just
pick
out
a
couple
of
some
salient
points
that
I
want
to
talk
about.
So
the
first
thing
I
want
to
say
is:
we've
been
doing
quite
a
lot
of
work
to
look
at
our
portfolio
and
to
reprioritize
that
portfolio
so
that
we
can
match
our
ambition
to
our
resources
available.
So
we
are
in
return.
N
In
response
to
your
point
sure
we
have
taken
all
our
work
and
we're
looking
at
it
and
we
are
really
having
a
really
good
look
at
what
we
have
the
capability
to
deliver
and
reprioritizing
our
planning
in
a
corners
with
that
and
when
we've
been
doing
that
what
we've
looked
at
is
we've
looked,
we've
broken
it
into
three
areas,
so
we're
looking
at
one.
The
first
bit
is
what
I'm
calling
mending
the
road
but
improving
us
or
service
service
experience.
N
There's
a
lot
of
work
going
on
at
the
moment
in
terms
of
planning
that
and
looking
at
how
making
sure
that
that
is
the
right
move
for
us
to
do,
and
then
the
third
area
we're
looking
at
is
our
strategic
programs
which
are
delivering
our
strategy.
There
was
a
lot
of
work,
a
lot
of
ambition
in
that
area
and
with
what
we're
doing
now
is
really
focusing
down
on
a
number
of
areas.
One
is
our
regular
registration
program.
N
So
really
some
really
good
work
in
that,
and
actually
a
lot
of
progress
being
made
in
in
that
front
in
a
relatively
short
space
of
time.
In
that
strategic
program
piece
as
well,
we
also
have
some
work,
which
has
been
ongoing
for
some
time
now,
which
is
around
the
provider
information,
the
information
exchange
platform.
N
We
had
hoped
to
finish
adult
social
care
provider,
information
piece,
but
that's
now
come
out
of
first
stage.
First
stage
beta
and
we've
found
that
we
have
some
stability
problems
with
that,
so
we've
gone
back
in
to
do
a
bit
more
work
to
enable
us
to
really
make
sure
that
that
underpinning
architecture
on
that
program
of
work
will
enable
us
to
build
on
future
exchange
plan,
the
future
exchange
services
in
the
future.
N
So,
even
though
that
has
slightly
delayed
what
we're
doing
around
GP
information
exchange
overall
I
think
it's
a
much
it's
a
good,
a
good
piece
of
work
that
we've
done,
because
when
we
actually
start
to
roll
out
these
products
to
to
the
users,
they
will
be
really
good
a
fit
for
purpose.
We've
been
talking
to
our
stakeholders
around
this
and
there
they
are
they'd.
N
Rather
we
deliver
something
that
was
work
was
working
and
took
a
bit
longer
than
delivered
something
that
wasn't
up
to
speed
so
in
terms
of
our
overall
process
in
that
overall
or
overall
activity
in
this
area,
there
is
a
lot
of
work
going
on.
As
I
said
earlier,
we
are
building
our
capability
enough
capacity
around
our
ability
to
deliver
change
effectively
and
putting
some
really
rigorous
process
and
governance
around
that.
N
That
is
going
to
take
a
little
bit
of
time
to
really
come
to
fruition,
but
it's
really
important
that
we
build
those
foundations
in
a
really
strong
way
to
enable
us
to
move
forward
at
pace
when
we
start
to
really
start
to
get
into
delivery
and
I'm
very
confident
that
we'll
all
be
able
to
do
that
before
too
much
longer.
So
just
to
come
on
to
some
notable
successes,
which
is
always
good
to
focus
on
our
laptop
rollout
that
will
be
complete
by
September.
N
We
will
have
moved
everyone
on
to
newer
upgrades,
either
these
service
pros
or
more
and
powerful
lightweight
laptops
office
365.
As
part
of
that
is
being
rolled
out,
and
once
we
have
everyone
on
office,
6
365,
we
could
start
to
open
up
some
of
that
functionality.
That
goes
with
that.
We
are
improving
their
connectivity
for
people's
broadband
at
home.
That
was
approved
at
Resources
Committee
yesterday,
and
we
have
a
plan
in
place
to
upgrade
that
functionality
politically
and
we're
also
looking
to
roll
out
the
new
phone.
N
Some
some
of
those
are
out
in
the
business
already,
but
those
will
be
completed
by
the
new
year.
Moving
us
off
the
the
blackberry
and
BlackBerry
devices,
which
most
of
us
will
be
very
happy
with
we're,
also
doing
some
work
to
stabilize
our
current
infrastructure.
So
our
customer
relationship
management
software
is
has
been
quite
problematic.
There
is
some
work,
that's
going
on
at
the
moment
where
we're
taking
out
all
records.
N
To
date,
we've
taken
out
10
million
records,
which
is
freeing
up
server
space
and
enabling,
with
the
thing
to
move
quicker
and
be
more
stable
and
we've
also
taken
another
another
part
of
our
operating
system
off
that
server
to
free
up
more
space,
to
drive
that
improvement
in
productivity
and
I.
Think
that
is
starting
to
show
a
little
bit
now
in
the
field
and
we'll
get
the
good
guys
we
move
forwards.
We've
also
done
some
work.
We
also
currently
do
some
work
around
digital
publisher
to
support
the
report.
N
Writing
to
ensure
that
those
those
that
technology
can
enable
people
to
get
their
reports
out
on
time
and
it
doesn't
fall
down
at
the
last
minute
with
some
technical
issues.
So
that's
all
I
wanted
to
say
on
the
on
the
digital
space.
The
report
also
covers
people.
We
are,
we
are,
do
some
work
around
workforce
strategy
and
we'll
bring
that
back
to
the
board,
either
in
October
November,
not
sure
which,
depending
on
timing,
but
that
work,
we've
done
a
three-day
sprint
on
that.
The
last
couple
of
days
to
really
pin
that
down.
N
So
that
will
be
there's
a
good
piece
of
work
and
we've
also
got
work
ongoing
around
paying
attention.
We've
got
a
business
case
into
Treasury
at
the
moment
and
we
are
starting
to
build
up
some
draft
proposals
for
conversations
with
the
unions
around
our
pay
deal
moving
forwards.
So
that's
all
I
wanted
to
highlight
if
anyone's
got
any
questions
on
any
of
that,
please
do.
H
H
H
N
Just
in
response
to
that
John,
the
two
major
Qi
projects,
which
we
have
we're
going
to
run,
one
is
obviously
the
hospital's
piece.
The
other
one
is
around.
The
improvements
in
the
service
in
the
National
customer
service
center
are
being
reported
through
our
changed
program,
and
it
on
our
change
plan
say
when
we
come
back
with
a
more
detailed
update,
you'll,
be
able
to
see
those
and
the
progress
being
made
in.
I
Thanks
very
much
and
on
digital
and
look
forward
to
seeing
the
next
stages
of
development,
it's
really
helpful
to
have
that
summary.
I
just
want
to
ask
you
a
question
about
people
under
workload
and
well-being.
This
sounds
like
use
a
useful
piece
of
work.
I,
just
wonder:
we've
touched
once
or
twice
in
the
past
on
the
the
the
subject
of
kind
of
how
much
autonomy
people
have
in
their
work
and
the
sort
of
distributed
leadership
model.
I
N
Think
the
workload
piece
we
are
looking
at
being
with
more
resources
into
free,
UPS
and
people
to
free
up
people's
time.
I
think
in
terms
of
the
autonomy
piece
is
a
piece
of
work
that
we
need
to
do
around
our
management
capability
and
upskilling
our
management
in
terms
of
how
they
can
support
their
staff
to
be
a
bit
more
autonomous
and
take
decisions
a
bit
more.
So
that
is
some
work
that
will
come
into
play
over
in
the
next
few
months.
N
Q
Thank
you,
German
Kirsty,
thanks
for
the
people
update
and
particularly
the
workforce
strategy.
I
just
would
like
to
get
some
assurance
that
the
strategy
will
be
looking
at.
You
know
how
we
manage
a
field
workforce
or
dispersed
workforce
that
learnings
from
our
local
systems
reviews
and
how
we've
managed
people
element
of
that
will
be
taken
in.
But
finally,
I
would
hope
that
the
three-day
workshop
that
you're
going
to
conduct
would
an
outcome
would
be
some
clearer
and
more
focus.
People
KPIs
that
we
as
a
board
could
look
at
in
the
performance
section.
Q
N
I
know,
booth
I
need
her
conversations
as
roost
about
kpi's
and
then,
though,
she
is
looking
at
that
in
terms
of
our
workforce
strategy
and
how
we
manage
and
motivate
our
staff
at
until
that
is
certainly
something
than
we're
looking
at.
We
want
to
look
at
both
driving
up
productivity,
as
well
as
making
sure
that
our
staff
are
feel
supported
and
able
to
do
the
job
to
the
best
of
their
ability,
and
that's
part
of
our.
What
we're
looking
at
to.
O
Dora
yeah
thanks
Kirsty,
it's
also,
if
it
probably
is
in
here,
but
maybe
not
called
out
if
it's
worth
looking
at
the
wider
organizational
model,
we're
sort
of
siloed
correctly
based
on
you
know,
when
hospitals
fear,
you
know
PMS
and
Social
Care,
and
then
we
have
silos,
of
course,
finance
and
technology
and
intelligence
and
HR.
But
if,
but
this
change
program
is
really
gonna,
be
bringing
folks
from
those
silos
together,
setting
them
clear
objectives
and
holding
them
accountable
with
with
autonomy,
but
holding
them
accountable.
N
N
We
need
to
do
some
of
this,
a
real
basic
underpinning
stuff,
to
get
us
into
a
position
that
if
we
do
want
to
start
to
look
at
organizational
change,
we
have
both
the
capability
and
the
capacity
to
manage
that
properly
and
our
systems
are
properly
set
up
so
that
we
can
make
best
use
of
that.
So
I
think
all
that
in
answer
that
the
more
detail
question,
but
we
are
not
in
a
position
at
the
moment
to
be
able
to
really
do
that.
I-I.
B
Think
it
looking
at
operational
model
over
the
course
of
time
is
probably
something
I
will
get
into,
but
I
think
I'd
echo
Kerry's
remarks.
I
think
there
are
still
a
number
of
things
that
we
need
to
to
sort
out,
particularly
on
around
technology
and
processes,
and
we've
talked
about
a
number
of
those
things
over
the
course
of
time.
So
I,
I,
guess
in
simplistic
terms,
so
I
think
there's
some
hygiene
factors
we
need
to
fix
before
we
can
get
into
that
intensively.
B
F
Question
really
about
what
is
described
here
as
connectedness,
which
I
think
actually
means
getting:
people
together
and
I
sent
from
staff
surveys,
and
so
on.
The
one
of
them
it's
missing
human
connection
or
some
staff
they
feel
is
missing.
Connection
is
an
understanding
that
is
the
connection
with
what's
going
on
the
organization-
and
we
talk
here
grandly
about
and
quite
rightly
about
change,
which
is
a
word
that
often
concerns
people
who
are
trying
to
do
a
job
whether
so
connecting
this
probably
includes.
How
are
we
explaining
to
the
staff?
F
How
are
we
involving
them
in
these
processes,
but
on
a
more
human
on
a
human
level?
Are
we
getting
any
full
consistency
in
the
way
we
look
after
our
staff
in
relation
to
actually
getting
them
together?
That
did
diminishing
the
isolation?
Some
of
them
apparently
feel
and
again
I
have
a
sense
that
some
parts
the
organization
may
be
dealing
with
this
rather
more
effectively
than
others
and
I.
Just
wonder
whether
that's
something
that
need
wait
for
reviews,
research
and
so
on,
rather
than
actually
doing
something.
N
If
I
start
that
and
some
others,
my
colleagues
may
well
want
to
chip
in
in
terms
of
the
connectedness
I-
think
we're
a
largely
dispersed
organization.
6%
of
our
staff
work
at
home
and
I
think
we
do
have
an
issue.
Some
people
feeling
a
bit
isolated.
We
are
doing
some
work
on
that
some
of
the
work
around
upskilling
our
managers
is
really
crucial
on
that,
because
to
manage
a
dispersed
workforce
is
very
different
from
managing
a
workforce
sitting
in
an
office
that
you
see
every
day.
So
there
is.
N
There
is
quite
a
lot
of
work
doing
about
going
on
that,
but
we've
also
got
some
other
initiatives
going
so
trying
to
get
our
staff
more
engaged
with
things
like
Yammer
and
using
that
as
a
sort
of
a
social
network
for
them
to
enable
people
to
communicate
so
I
think
there
is
a
lot
of
going.
We
recognize
it's
a
problem.
We
recognize
it's
difficult.
It
is
the
best
workforce,
but
I
think
some
of
the
improvements
in
the
connectivity
that
we're
doing
will
also
help
as
well.
Just
in
terms
of
the
messaging.
N
There
is
some
work
that
Chris
Chris's
team
has
been
leading
on
looking
at
getting
that
overarching
narrative
around
why
we
are
why
we're
doing
what
we're
doing
and
then
what
this
means
to
people
on
a
day
to
day
basis,
so
that
we
then
have
a
consistent
story
that
we
can
constantly
tell
people
and
then
because,
quite
often
with
changes,
people
don't
feel
that
they
are
a
part
of
it
but
B.
They
don't
feel
confident
in
it
because
they
don't
get.
They
don't
get
a
consistent
message
all
the
time.
N
So
there's
a
lot
of
work
going
on
to
really
nail
down
that
message
and
really
make
it
very
clear.
So
that's
the
con.
We
constantly
talk
about
it
in
the
same
language
in
the
same
way,
but
also
looking
at
how
we
can
engage
people
in
in
in
if
we're
looking
at
how
how
to
improve
their
day
to
day
jobs
through
some
of
this
of
quality
improvement,
work
and
some
of
the
continuous
improvement
we
work
on
a
date
on
a
work,
we're
going
doing
is
actually
gave
them
to
own
some
of
the
changes.
N
J
Build
on
that,
we've
done.
I've
done
some
work
as
part
of
the
post
check
surveys
already
with
their
staff
across
the
organization.
What's
clear,
sort
of
looking
at
the
what
and
the
how
as
kursi
said,
is
that
there
needs
to
be
a
compelling
message
about
what
the
vision
looks
like
in
the
context
of
the
strategy,
but
we
also
heard
and
and
responding
to
the
idea
of
making
it
easy
now
and
fixing
the
basics.
J
J
C
Think,
just
to
kind
of
put
some
practicalities
on
that,
because
obviously
adult
social
care
about
90
percent
well
over
90
percent
of
my
team
work
at
home
and
in
the
main
adult
social
care
inspections
are
small
kind
of
new
inspections,
not
necessarily
kind
of
getting
together
in
the
team.
That
might
happen
for
a
comprehensive
inspection
of
a
hospital,
for
example.
So
two
three
things
that
we've
been
doing
with
the
support
of
Kirstie's
colleagues
and
the
people
and
Directorate
creating
hopes.
C
So
linking
teams
together
so
that
when
there
are
team
meetings,
they
know
they're
coming
together
and
having
those
meetings
together
and
using
that
as
an
opportunity
to
share
information,
share,
good
practice
and
understand
risk
and
all
of
those
sort
of
good
things.
So
so
that
there's
a
better
connection
and
between
colleagues.
At
that
level.
C
So
particularly
a
lot
Social
Care
we've
been
developing
areas
of
interest
for
for
colleagues,
and
you
know
bringing
them
together
and
sharing
good
practice
from
that
point
of
view
and
then
just
again
showing
some
good
practice
that
one
of
them,
one
of
my
inspection
managers,
who
is
now
working
with
Steve's
team
on
the
local
system,
reviews
instituted
virtual
coffee
mornings.
So
11
o'clock,
you
know,
people
dial
in
they've
got
the
cup
of
coffee.
C
They
might
do
what
you
and
I
might
do
when
we
sort
of
bump
into
each
other
when
we're
making
our
coffee
and
talk
about
the
weekend
or
whatever
it
may
be,
just
that
everybody
doesn't
have
to
do
it.
But
it's
there
as
an
opportunity
and
we've
been
rolling
those
sorts
so
just
very
practical
ideas
out
there.
None
of
this
has
to
be
rocket
science,
but
I
think
it
is
about
giving
people
they
permission.
If
you
like
that,
this
is
something
that
they
need
to
pay
attention
to
and
support
their
their
their
teams
and
doing.
A
Great
anything
else
on
the
change
program
anybody
wants
to
raise
so
Kirsty,
thanks
to
you
for
all
the
work
that's
going
on
here.
Can
you
pass
thanks
on
to
the
people
in
your
team,
because,
obviously,
those
are
teams,
there's
a
there's,
a
lot
of
work
going
on
I
think
it's
really
really
exciting
and
then
finally,
thank
you
for
my
service
pro
which
I
am
enjoying
using.
So
there
is
some
evidence
that
something
is
changing,
really
good,
excellent
right.
A
We
move
on
to
HealthWatch.
We
start
with
some
sad
news.
We
then
move
to
some
good
news
and
then
we'll
move
to
the
report.
So
the
sad
news
Jane
is
that
this
is
your
last
board
meeting,
because
your
term
as
chair
of
HealthWatch
England
comes
to
the
end
at
the
end
of
this
month.
So
very
sad,
but
thank
you
hugely.
A
Thank
you
hugely
for
the
contribution
you've
made
to
the
board,
as
well
as
to
HealthWatch
England.
The
good
news
is
the
Secretary
of
State
has
appointed
Sir
Robert
Francis
as
Jane's
successor
as
chair
of
HealthWatch,
jinglun
and
I.
Think
that's
a
it's
a
fabulous
appointment
and
Robert.
Many
congratulations.
I!
Think
from
all
of
us
on
that.
A
R
You
very
much
indeed
I
have
to
say
that
genuinely
have
always
thought
that
the
next
chair
of
HealthWatch
England
should
be
someone
a
name
and
to
get
the
name
is
absolutely
fantastic,
so
I
am
genuinely
very,
very
pleased
and
happy.
I
also
think
it
is
a.
It
is
a
sign.
I
think
the
government
is
generally
interested
genuinely
interested
in
hearing
what
people
have
to
say
about
health
and
social
care,
so
I
think
we
can
take
this
we'll
take
that
you
will
take
the
game
up
to
the
next
level
and
report
today.
R
Essentially,
it
tells
you
what
the
challenges
are
and
they
are
going
to
let
I
can
either
Melda
go
into
it
in
more
detail,
but
essentially
they
remain
as
ever.
It's
about
the
funding
for
local
HealthWatch
and
it's
also
I'm
I,
was
really
pleased
to
see
our
our
intelligence
reports.
You
know
there's
a
whole
raft
of
information
in
there
sort
of
sense
of
really
people
coming
to
us
with
lots
of
information
and
stopping
to
do
about
it.
So
good
luck!
I
Thank
you
very
much
and
could
I
also
extend
my
thanks
to
Jane
she's
been
a
great
support
to
me
for
the
18
months
or
so
I've
been
in
post.
But
we've
got
lots
of
time
for
that.
You
have
a
short
paper
in
front
of
you
from
us
on
the
work
that
we've
been
doing
over
the
last
quarter.
It's
real
headline
stuff
and
it's
very
much
a
sort
of
rear
view
gaze
at
what's
going
on.
I
We
have
our
annual
conference
on
the
second
and
third
and
a
number
of
you
I
know:
Andrea
will
be
there
and
we're
looking
forward
to
it's
a
really
great
program
of
activities
for
the
two
days
and
we've
got
a
really
high
signup
rate
and
the
nominations
for
awards
has
been
higher
than
ever
and
I
think
the
quality
is
really
good.
So
there's
quite
a
lot
of
exciting
stuff.
That's
going
on
there
if
I
just
take.
I
You
then,
to
some
information
around
HealthWatch
funding,
which
I've
brought
to
the
people's
attention
at
different
times,
but
I
think
we
need
to
be
aware
of
the
impact
of
the
reductions
in
local
government
funding
and
that
that
is
having
on
local
HealthWatch
and
their
ability
to
to
work.
At
this
point,
we
were
reporting
a
10
percent
decrease
in
funding
for
this
current
financial
year.
That
was
the
prediction
at
the
moment.
Actually,
we've
asked
for
data
returns
and
it
looks
like
it's
reducing
to
around
5
percent
and
we're
doing
our
announcement.
I
We
don't
know,
we've
done
a
lot
of
work
with
local
authorities
to
try
and
move
the
dial
in
a
more
positive
direction.
So
hopefully
we
are
having
some
impact
on
that.
The
the
other
thing
I
wanted
to
really
talk
to
you
about
was
really
looking
forward
in
the
work
that
we're
doing
we're
very
engaged
in
the
work
on
the
NHS
10
year
plan,
and
we
sit
on
two
of
the
work
streams,
the
one
on
clinical
priorities
and
one
on
engagement.
I
We
they're
the
ones
that
we're
doing
some
concentrated
work
through,
but
we're
also
contributing
to
a
number
of
other
work
streams
and
and
I'm
really
pleased
that
we've
been
able
to
share
the
views
and
experiences
of
34,000
people
who
either
use
or
have,
or
have
tried
to
use
mental
health
services
with
the
team
that
are
working
on
how
we
improve
mental
health
services
across
the
piece
we've.
Also
given
the
team
feedback
from
45,000
people
about
their
experiences
of
primary
care.
I
Most
of
that
is
about
GPS,
but
some
of
it
is
about
dentistry
and
some
of
it
is
about
pharmacy.
So
we're
feeding
that
work
in
on
a
daily
basis
into
the
the
work
of
the
the
intense
work
that's
going
on
at
this
period,
so
that
a
plan
will
be
produced
by
the
end
of
September,
which
is
just
the
next
couple
of
weeks.
We've
also.
I
Our
feeding
and
patel
thoughts
are
particularly
good
at
is
getting
into
communities
that
others
find
it
very
hard
to
to
to
get
to
know
and
understand,
and
so
we're
doing
significant,
a
piece
of
work
around
the
experience
of
homeless
people
and
they're
maxing,
how
health
care,
and
likewise
with,
where
we're
analyzing
some
work
around
gypsy
and
traveler
communities,
and
so
we'll
be
feeding
in
lots
of
information
across
the
next
couple
of
months.
We
continue
to
do
work
on
the
green
paper
on
social
care.
I
And
we
will
continue
to
do
our
work
on
the
green
paper
on
social
care.
We
carried
out
a
number
of
deliberative
events.
We've
carried
out
research,
we've
done
polling
with
it
with
the
with
the
public,
and
we
published
some
of
that
findings
on
Monday
on
on
the
social
care
which
got
some
pick
up
in
the
national
papers.
The
only
other
thing
to
say
is
that
we
are
currently
working
on
our
finalizing.
A
H
I
We're
doing
what
we
can
John.
It
is
a
very
it's,
a
very
big
question
that
question
and
and
we've
we've
been
to
meet
with
ministers,
and
we've
asked
ministers
at
Department
of
Health
and
Social
Care
to
liaise
with
their
colleagues
in
Department
for
Housing
and
local
government,
where
we're
in
an
ongoing
dialogue
about
that,
we
are
engaging
with
local
political
leaders.
I
Slurs
particularly
cabinet
members
that
have
a
responsibility
for
health
and
social
care
and
we're
engaging
with
the
chairs
of
health
and
well-being
boards.
So
we're
doing
we're
we're
doing
our
sort
of
messaging
to
those
and
I'm,
assuming
that
some
of
that
is
having
some
impact
and
why
things
have
not
been
quite
as
bad
as
we
thought
they
were
going
to
be
I.
H
Just
wondered
if
there's
mileage-
and
you
may
have
thought
this
already,
and
so
you
know
forgive
me
if
you
have
in
targeting
some
of
the
areas
that
are
championing
a
more
integrated
approach:
debo
manx,
some
these
are
places
where
you
may
get
more
traction
which
they
may
give
you
leverage
in
deliverability
that
you
could
argue
with
others.
I,
don't.
H
A
A
A
So
what
we
might
do,
while
we're
waiting,
we
might
just
take
the
agenda
out
of
order
Queenie
we're
running
a
bit
ahead
of
ourselves
and
we
could
do
with
Nik
Kurzweil
here.
Should
we
just
just
take
the
update
to
the
Standing
Orders?
This
is
a
routine
piece
of
business
that
needs
to
come
to
the
board
periodically,
just
to
make
sure
that
we
have
reviewed
where
we
are,
everything
is
up
to
date,
very
modest
changes
from
from
from
the
past,
but
it's
a
good
thing
to
review.
A
Having
said
that,
there
are
a
couple
of
changes
that
we
just
need
to
note
that
aren't
in
the
original
graph.
One
is
there's
an
update
strange
enough
for
the
definition
of
the
board
to
reflect
the
2014
act
and
the
are,
though,
which
Liz
your
Eagle
I
spotted,
which
none
of
the
rest
of
us
did.
So.
Thank
you.
There's
some
references
to
legislation
that
have
been
superseded
by
more
recent
legislation
to
do
with
the
Equality
Act,
so
we'll
make
those
adjustments,
so
they
don't
change
anything
beyond
just
actually
having
the
right
citations
in
place.
A
Lots
of
nods
so
I'll
take
nods
as
we
approve
the
updated
for
Standing,
Orders
and
code
of
conduct
with
those
couple
of
small
amendments.
Nick,
perfect
timing,
welcome
no
no
work
we're
early,
but
I
was
beginning
to
run
out
of
other
items.
I
could
have
taken
waiting
for
you,
so
yeah
you
need.
You
need
your
microphone
on
when
you're
speaking
Nick.
So
we've
seen
a
discussion
around
the
the
broad
content
of
this
we've
discussed.
A
S
You
Peter
I'm
sure
the
board
may
remember
seeing
the
draft
policy
as
part
of
the
freedom
to
speak
ups
Guardians
annual
reports
during
the
year
and
at
the
time
the
board
was
very
positive.
So
we
bring
you
this
paper
really
for
final
sign-off.
There
is
not
not
a
great
deal
that
has
changed
since
you've
seen
it
before
I
think
the
appendices
have
been
fleshed
out
and
since
we
came
to
you,
we
consulted
with
the
unions
and
with
the
staff
representative
groups
so
including
the
quality
networks
and
they've
all
been
very
positive.
S
They've
all
welcomed
it
and
they're
very
keen
that
we
get
on
with
the
business
of
publishing
this
and
go
about
the
business
of
the
freedom
to
speak
up.
Guardian,
you
may
know,
Mary
will
come
to
you
in
due
course
to
provide
you
with
a
report
on
progress,
but
you
may
know
that
we
have
a
team
now
of
95
ambassadors
in
place.
S
So
these
are
people
who
were
previously
Dignity
work,
advisers,
specifically
and
also
volunteers,
who
came
forward
in
response
to
a
request
for
for
volunteers
some
time
ago,
so
we've
been
training
them
and
and
that
their
function
is
to
support
and
guide
anyone
among
our
staff,
who
wants
to
raise
a
concern
that
the
policy
then
sub
sets
out
the
process
that
we'd
go
through
and
and
how
they
would
guide.
A
person
who
wants
to
it
wants
to
raise
an
issue.
F
Well
as
before,
this
is
an
excellent
document.
One
thing
I
spotted
was
I've
thought
about
Sint
and
actually
because
of
some
other
experiences,
I
can
share
with
you
out
offline
mediation
and
conciliation
at
one
source.
The
other
can,
of
course,
be
an
extremely
useful
tool
to
resolve
some
differences.
F
And
it's
not
the
intention
that
I
know
and
I'm
sure
can
I
just
ask
you
to
look
to
make
sure
that
the
impression
isn't
given
that
there's
some
sort
of
pressure
on
someone
who's,
raising
a
creditor
and
to
try
and
resolve
stuff
through
an
informed
process
when
actually
they've
read
things
others
might
not.
It
depends
is.
Is
that
just
too
serious
for
that
all
is
it
was
solvable
experiences?
Some
other
organizations
has
been
the
unwittingly.
F
Perhaps
there
is
perceived
to
be
a
pressure
to
go
down
an
informal
route
which
ends
up
with
a
concern
disappearing
off
the
agenda,
rather
than
actually
action
being
taken
when
action
is
required.
But
I
did
that's
not
the
intention,
but
if
you
could
just
not
necessarily
change
the
policy
now,
but
keep
that
under
review
I
think
it
would
be
a
good
idea.
F
L
Nick,
thank
you.
Thank
you
very
much
as
one
of
the
freedoms
to
become
ambassadors
in
the
organization,
I
I
highly
well
highly.
Welcome
back
the
the
point
I
wanted
to
make
is
that
it's
greater
the
policy
in
place.
We
also
know
from
our
staff
that
often
by
the
time
they
have
to
look
for
a
policy.
It's
you
know,
they're
they're,
in
a
space
where
they
move
into
formal
process,
and
it
can
be
difficult.
L
So
what
I'd
really
encourage
us
to
do
is,
on
the
one
hand,
to
make
sure
that
our
speaking
speaking
up
agreement,
a
culture,
is
something
we
include
into
our
into
our
corporate
inductions
for
all
staff
that
they're
aware
of
that,
and
secondly,
that
in
the
way
we
put
this
policy
on
our
intranet
make
it
available
to
staff
that
we
include
some
easy
guides.
How
to
look
at
this,
so
that
stuff
don't
have
to
trail
through
30
pages,
to
really
understand.
J
I
think
that
was
very
clear
from
from
the
work
we
did
in
the
training
very
clear
from
we've
had
since
then,
and
to
your
point
more
thing,
you're
right
then,
yet
the
the
appendix
be
flowchart
is
a
good
way
into.
What's
the
easier
way
to
do
this,
how
do
how
do
I
make
it
work
for
me?
I
think
that
and
the
conversations
that,
as
ambassadors
we
will
have
with
other
colleagues
in
the
organization
will
be
important,
but
an
easy
way
into
that
and
I
think
I
said
appendix
is
a
good
benefit.
D
General
members
of
public
raising
concerns
with
us
is
to
our
success
as
a
regulator.
To
some
extent,
it's
not
something
because
you
can't
give
publicity
to
the
individual.
We
can't
give
publicity
to
them
to
the
whole
process,
but
I
suppose
the
question
for
us
internally
is:
what
can
we
do
to
celebrate
the
success
of
this
in
making
us
a
better
organization
in
a
way
that
it
seems
to
be
valuable
or
not
not
a
difficult
area
to
deal
with,
but
actually
a
valuable
contribution
to
the
success
of
the
organisation
and
they're?
D
Not
sure
it
just
just
feels
the
bits
just
looking
as
policy.
It
feels
a
bit,
so
it's
kind
of
compartmentalizing
people
raising
concerns
into
our
into
a
pigeonhole
rather
than
saying.
Actually,
people
raised
a
good
scientist,
part
of
a
healthy
successful
organization.
So
it's
just
a
challenge
about
positioning
of
this
as
much
as
the
details
of
policy.
B
Thanks
Peter
I
think
it's
worth
noting
that
we
have
an
Employee,
Assistance
Program
and
sometimes
people
will
come
to
raising
a
concern
around
the
organisation
through
having
some
personal
concerns
and
seeking
support
through
the
Employee
Assistance
Program.
So
I'd
be
grateful
if
you
could
make
sure
that
the
this
work
is
positioned
with
the
Employee
Assistance
provider
and
to
some
extent
that
that
talks
to
the
point
the
robot
was
making
around
not
wanting
to
necessarily
start
the
conversation
internally,
even
though,
ultimately,
they
may
get
signposted
to
someone
internally
who
they
may
feel
comfortable.
Talking
about.
Q
S
It's
a
very
good
point:
it
of
course,
and
emission
from
the
flesh
I'm
sure
it's
right
that
everybody
who's
been
involved
he's
kept
informed
as
the
process
goes
through
so
I'm
sure
we
wouldn't
pick
that
one
thank
you
and
may
I
just
add
Peter
in
response
to
people's
comments,
I
think.
Well,
perhaps
perhaps
the
reason
why
I'm
involved
with
suppose
that's
anyway
is
because
I'm
keen
that
we
promote
this
having
got
to
this
stage
and
I
think
this.
A
Great,
thank
you
Nick
very
much
indeed,
and
obviously
thanks
to
Mary,
but
also
thanks
to
the
large
number
of
people
are
engaged
in
this
within
the
organization.
So
great,
really
good.
So
we
move
on
one
of
the
things
that
I
find
really
enjoyable
about
CQC
and
I.
After
nearly
three
years
here,
I
still
come
across
things
that
I
didn't
even
really
realize
that
we
did
done
by
really
great
people
that
I
hadn't
actually
met.
A
So
when
we
get
to
recognizing
the
outstanding
contribution
award
today
and
I
discover
both
something
I
didn't
know
about,
and
somebody
who's
clearly
by
by
definition
out
making
an
outstanding
contribution
doing
yet
I'm
really
exciting
sighted
and
the
the
award
is
going
to
Rachel
Ward,
who
is
the
inspection
manager
for
the
ionizing
radiation,
medical
exposure,
exposure
regulations,
2010
and
I
hadn't
really
focused
on
this
team.
I
have
to
admit
until
now.
A
Although
I
was
fairly
aware
of
some
of
the
work
that
it
was
that
somebody
obviously
was
doing
behind
this,
but
Rachel
you're
receiving
the
award
for
the
work
you've
done,
supporting
the
teams
through
a
period
of
great
change.
You've
stepped
up
into
the
role
of
inspection
manager
when
there
were
some
real
challenges
in
the
service,
and
you
solve
all
sorted
out
a
lot
of
the
issues
that
were
there.
A
So
you
now,
you
know,
but
there's
also
technical
support
officer
and
the
team
provides
the
expertise
you
see,
which
obviously
we
need
is
an
organization
around
radiology
services.
So
it's
a
really
important
part
of
the
organization
and
I
apologize
to
the
team
that
I
wasn't
fully
aware
of
them
until
now,
but
now
I
and
the
whole
world
are
which
is
fantastic,
so
Rachel.
Very
many
congratulations.
Do
we
have
we
have
a
certificate.
D
This
again
identified
a
risk
that
has
been
largely
neglected
and
just
to
celebrate
the
team's
work
on
that
they
did
a
great
job
on
that,
both
in
producing
a
report
in
the
difficult
complex
field
and
a
controversial
field,
but
also
working
very
well
with
the
outside
bodies,
including
providers
to
produce
a
really
good
way
forward.
It's
looking
at
Reggie,
ology,
backlogs
and
radiology
I
mean
this
is
the
ionizing
radiation
sounds
grand,
but
it's
x-rays.
D
Basically-
and
you
know,
this
is
something
that's
going
on
every
day
in
the
health
service
and
it's
important
that
it's
done
well
and
we
have
a
very,
very
important
role
in
that
in
making
sure
it's
done
well.
So
so
I
think
I'm
really
encouraged
by
the
progress
that
the
team
has
made
since
Rachel's
taken
over
and
I
think
they
will
lead
us
forward
in
terms
of
dealing
with
the
ongoing
risks
very
well
much.
A
More
eloquently
put
than
I
managed
Ted.
So
thank
you
very
much
indeed,
but
thank
you
again
Rachel
and
congratulations
n
to
the
team
as
well,
because
it's
so
the
whole
team
has
performed
brilliantly
any
other
business
I
have
two
one
Malta,
which
is
to
wish
you
well
you're,
taking
extended
parental
leave.
You
may
live
to
regret
this,
but
I
have
no
doubt
you'll
be
tuning
into
every
board
meeting.
I
A
Great
thanks
again
Jane
so
looking
around
them.
That
is
the
end
of
the
board
meeting.
Thank
you
very
much
deed.
However,
we
will
have
some
time
for
questions
from
the
public,
so
just
trying
to
take
them
in
the
order
which
they
came
to
me
and
thank
you
again,
people
for
giving
the
advance
notice,
because
it
makes
it
much
more
helpful.
It
is
Missy.
Be
here
know
so
that
case
that
some
we
won't
take
those
if
she's
not
here
to
ask
them
so
Robin,
you
I
think
you're
the
next
one.
G
G
Patient
access
was
changed,
I
think
around
June
this
year
and
the
new
version
of
patient
access
has
caused
a
good
deal
of
chaos.
In
my
own
GP
surgery,
they
were
inundated
with
phone
calls
from
patients
who
could
not
navigate
the
new
version
of
patient
access,
who
had
been
perfectly
confident
with
the
previous
version,
but
could
not
navigate
the
updated
version
in
other
GP
practices.
I
gather
there
were
queues
of
patients
who
had
to
re-register
for
patient
access.
That's
a
process.
It
requires
a
photo
ID,
a
utility
bill
and
a
form
who
regulates
patient
access.
A
So
let
me
let
me
go
first
and
tell
you
we
don't
so
you're
in
the
wrong
place.
However,
clearly
you
know
we
do
look
at
access
and
people's
ability
to
get
GP
appointments
if
we're
talking
about
primary
care.
So
indirectly,
if
you
like,
we
have
out,
we
have
a.
We
have
a
sort
of
view
on
this,
but
we
need
to
be
really
clear.
We
are
not.
We
are
not
the
regulator
for
patient
access
or
or
any
like
it.
I
don't
know
whether
anybody
wants
from
mine
looking
around
the
board
has
anything
more
substantive.
J
Obviously,
it's
England
I
think
are
and
in
part
the
commissioners
of
the
service.
So
we
can
take
that
what
you
said
today
to
colleagues
and
interesting
to
have
a
conversation
with
them.
The
past
put
you
in
touch
with
their
the
colleagues
in
the
digital
team.
Anything
they
were
taking,
taking
the
link,
the
link
for
this
service
forward.
A
Q
I'm
David
Hogarth
I'm,
the
coordinator
of
a
small
charity
in
North
London,
which
the
friends
older
people,
and
in
that,
because
of
that,
we
have
a
lot
to
do
with
Social
Care.
They
often
go
into
hospital
as
well.
They
tell
us
about
their
doctors
and
quite
a
lot
of
them.
Have
mental
health
problems
as
well.
Q
I
wanted
to
talk
about
what
we
were
talking
about
at
the
late
July
meeting,
which
is
the
new
technology
resource
and
I'm
grateful
particularly
of
Chris
day
for
letting
me
see
various
iterations
of
this
resource,
one
in
August
and
most
recent
one
as
well.
I
would
like
to
pay
tribute
to
the
amount
of
hard
work
that
various
people
have
been
putting
into
this
and
to
provide
that
as
a
context
for
the
points
I'm
going
to
bring
up,
which
are
three
suggestions.
Q
Q
But
this
is
supposed
to
be.
Surely
the
whole
purpose
of
having
this
resource
is
to
make
providers
more
interested
in
technology
and
get
have
more
of
it
and
I
think
this
tends
to
discourage
them,
and
the
third
is
the
thing
which
is
really
nearest
to
my
heart-
that
although
many
many
kinds
of
technological
innovations
are
mentioned,
one
thing
they
don't
mention
is
the
wonderful
opportunities
offered
by
technology
to
put
distant
relatives
in
touch
with
their
residents,
who
are
receiving
care
in
care
homes,
or
indeed
people
getting
Home
Care
in
their
own
homes.
Q
I
mean
this
is
the
great
sadness
of
this
way.
History
has
gone.
Is
that
noble
people
don't
no
longer
live
near
each
other,
but
technology
can
help
to
do
this
and
there
are
systems
and
I
think
that
ought
to
be
in
this
report
a
definite
section
which
would
talk
about
communication
between
bringing
families
and
relatives
and
and
friends
as
well
together.
A
J
J
So
one
of
the
things
we're
trying
to
do
with
with
the
work
here
is
to
is
to
break
it
into
a
series
of
what
would
be
interesting
and
targeted
content
at
both
the
public
and
providers
and
I'd
like
to
offer
David
the
opportunity
to
be
part
of
it
with
a
small
working
group
that
will
put
into
to
support
that
work.
The
idea
of
providing
content,
that's
both
tailored
to
public.
Alongside
the
information
which
comes
to
providers,
I,
think
your
point
about,
and
technology
is
an
important
enabler
and
we
should.
J
We
should
be
clear
that
that's,
that
is
our.
That
is
our
view
and
how
how
it
enables
people
to
to
live,
to
live
well
in
different
circumstances
and
to
have
access
to
two
friends
in
relation.
So
we
will
do
that
and
we
will
split
the
guidance
into
those
into
those
areas
and
make
it
both
more
easily
searchable
for
providers
that
are
looking
for
a
particular
area
and
also
more
digestible
to
members
of
the
public.
So
if
you
happy
David
happy
to
welcome
you
to
that
group
well,.