►
From YouTube: CQC Board Meeting 15 October 2014
Description
Agenda of the Care Quality Commission Board Meeting, London, 15 October 2014:
1. Apologies and Declarations of Interest 0:01
2. Minutes of the meeting held on 17 September 2014 0:13
3. Matters Arising and action log 0:17
4. Chief Executive’s Report 0:19
5. Covert and Overt Surveillance update 1:12:10
6. AOB 1:47:33
7. Questions from the Floor 1:47:37
Read more about CQC's Board Meetings at
http://www.cqc.org.uk/public/about-us/our-people/board-members/board-meetings
A
C
Good
morning,
everybody
thank
you
david.
So
this
is
a
longish
report
and
I've
got
a
couple
of
items
that
I'd
like
to
add,
which
are
not
actually
recorded
at
the
in
the
paper
itself,
david.
So
I'll
pause
at
some
given
points
during
this.
So
members
of
the
board
can
raise
questions
and
raise
points
of
for
discussion.
C
C
There
are
two
or
three
further
handbooks
yet
to
be
worked
on
and
yet
to
be
published,
but
the
progress
continues.
The
importance
of
these
handbooks.
It
declares
in
a
clear
and
transparent
way
how
we're
going
to
go
about
inspecting,
and
it's
therefore
providers
as
an
explanation
of
how
we'll
approach
this.
A
A
E
A
Just
on
the
leadership
conference
that
that
we
had
what
two
weeks
ago,
I
think
there
were
400
people
that
came
to
it
when
the
values
were
launched.
I
mean
kk,
you
were
there
robert,
you
were
there,
I
mean
it
was
a
really.
I
mean
it
was
a
good
buzz
in
the
room
and
I
think
people
felt
that
they
were
their
values,
not
our
values
but
everyone's
values.
I
thought
it
was
a
really
good
session,
so
it
went
really
well,
I
think,
did
you
feel
that
robert
as
well.
F
G
Not
commenting
on
the
comparing,
why
not?
I
just
want
to
draw
the
the
link
between
the
values
and
the
handbooks.
So
even
though
the
handbooks
were
largely
or
developed
before
we
launched
the
the
values.
It's
great
that
yours,
you
know,
you're
saying
they're
they're
a
great
set,
that's
what
we're
hearing,
but
the
the
the
sense,
the
values
around
teamwork,
integrity
and
excellence.
That's
why
I
think
what
actually
has
what
made
them
good
documents,
so
it
wasn't
something
that
was
born
out
of
policy
or
born
out
of
an
individual
inspecting
director.
G
C
C
So
what
that
then
raises
is
what
is
our
role
where
that
responsibility
is
on
the
trust
to
make
sure
that
they've
got
those
arrangements
in
place
and
where
incidents
occur,
they're
behaving
in
a
way
which
is
consistent
with
this
requirement
expectations.
Some
would
argue
it's
good
practice,
but
this
requirement's
in
regulations.
C
So
I
think
the
report
sets
this
out
an
assessment
of
providers
on
application
for
registration,
it's
embedded
within
the
assessment
framework
that
mike
and
his
teams
are
taking
forward.
The
prompt
question
is
in
there
are
people
who
use
services
told
when
something
goes
wrong,
given
an
apology
and
informed
what
actions
are
taken.
C
The
work
is
still
going
on
in
relation
to
landing
this.
It's
not
yet
finalized
so
that
the
hospital
inspector
colleagues
can
inspect
against
the
duty
candidate
from
mid-november
and
again,
there
are
some
bullets
down
there
about
the
work
that
he's
been
undertaking
over
the
next
couple
of
weeks,
so
that
we're
in
a
position
in
the
inspections
that
will
take
place
during
november
and
december
to
actually
apply
this
new
regulation
that
will
include
training
those
staff
who
will
be
on
those
inspections
carrying
out
the
inspections
during
that
period
of
time
and
then
for
other
staff.
C
We've
had
discussions
with
the
action
against
medical
accidents
that,
as
the
organization
has
campaigned
around
the
duty
candidate
for
a
long
time,
based
on
some
individual
cases
and
we're
working
with
them
about
supporting
some
regional
provider,
focused
events
in
relation
to
this
as
well.
So
it
picks
up
on
andrea's
point
about
co-production
earlier.
C
The
approach
we're
going
to
take
is
to
use
this
first
few
months
to
embed
the
duty
of
candor
in
our
inspection
process.
This
is
new
right
across
the
nhs
in
terms
of
its
regulation
and-
and
we
need
to
be
clear
about
how
we
will
approach
this,
but
also
acknowledge
that
this
is
a
new
duty.
That's
coming
in.
Is
it
worth
me,
pausing
there
david
on
the
duty,
candy
rubble
than
rushing
into
the
fit
and
proper
person.
F
F
You
know
forms
of
words,
so
if
there
was
a
way
of
building
that
into
our
inspection,
where
we
could
actually
speak
to
people
who'd,
you
know
experience
the
duty
of
canada
and
the
other
thing
is
the
you
know.
There's
been
a
lot
of
talk
around
sort
of
culture
and
honesty
and
openness,
and
and
also
this
thing
about
sort
of
just
culture.
I
mean
the
people,
the
reason
that
people
don't
tell
patients.
F
F
I
think
we
can
lead
by
example
on
that
which
I
think
we
are
doing
actually,
but
it's
just
to
sort
of
just
taking
with
I
mean
I
know,
there's
a
specific
duty
and
it's
coming
in
and
we
need
to
prepare,
but
I
think
we
also
need
to
be
mindful
of
the
sort
of
wider
culture,
particularly
when
we're
inspecting
you
know
not
just
have
they
implemented
the
duty
of
candor,
but
but
I
guess
it's
also
talking
to
staff
actually
about
it
as
well.
Did
they
feel
blamed?
F
D
Completely,
I
mean,
I
think,
we're
going
to
have
to
learn
over
the
next
few
months
exactly
how
best
to
do
to
do
this,
and
we've
already
had
a
training
session
on
duty
of
canada
for
senior
staff
in
the
hospitals
directorate
and,
as
the
paper
says,
we're
also
developing
e-learning.
But
I
think
that
suggestion
is
a
good
one.
Andrew
has
just
reminded
me
that
we
have
actually
done
just
exactly
as
you
suggested,
in
a
recent
inspection
and,
and
so
yet
we
have
an
example
there
and
I
think
we
need
to
build
on
that.
H
Just
a
wider
point
I
mean
there's
candor
about
when
harms
actually
happened,
but
there's
also
something
about
candor
about
the
risks
of
harm.
That
could
happen
and,
although
you
know
we've
got
enough
to
do
on
the
former,
I
don't
know
whether
at
some
point
our
thinking
could
extend
to
the
latter,
where
it's
a
risky
environment
and
somehow
or
others.
The
system
isn't
candid
enough
with
itself
about
that.
I
know
it's
a
wider
point,
but
it's
just
a
thought.
B
Well,
it
won't
surprise
you
to
know
that
I
consider
this
to
be
a
seminal
part
of
the
of
getting
the
right
culture
going
and
the
sorts
of
things
that
kay
has
said
are
absolutely
important.
Firstly,
it
is
vital
that
the
due
to
cando,
which
is
not
easy
to
do
at
least
leave
aside
the
difficulties
about
actually
testing
out
something
wrong.
B
But
they're,
not
the
only
people
in
the
equation.
As
k
has
mentioned,
the
staff
need
support,
because,
unless
the
organization
is
told
by
the
staff,
what
has
gone
wrong?
The
organization
will
not
know,
and
I
would
suggest
that
the
rig
as
we
as
regulators
need
to
find
a
means
of
looking
to
see
whether
that
has
happened
and
kay
is
also
right
and
saying
that
a
lot
of
the
reasons
it
doesn't
happen
is
because
people
are
afraid
of
consequences.
B
And
it
seems
to
me
that
the
principal
consequence
of
discussing
with
your
employer
that
something
has
gone
wrong
is
that
the
employer
and
you
and
your
colleagues
learn
from
that
experience
and
that's
what
the
patients
actually
want
to
happen.
And
I
think,
therefore
I
would
suggest
the
regulator.
We
as
regulators
need
to
play
our
part
in
that.
B
G
So
this
is
a
good
example
of
where
we've
got
on
two
two
roles
here,
so
it
as
it
becomes
a
fundamental
standard.
It
becomes
something
that
we
do
have
to
specifically
check
and
we
have
to,
through
the
enforcement
policy,
in
the
guidance
against
registration,
be
clear
about
what
constitutes
a
breach
and
in
which
cases
we
would
prosecute
or
or
take
enforcement
action.
G
Separate
to
that
one
point:
you're
getting
it
robert
there's.
We
should
use
this
and
we
only
need
to
embed
it
as
part
of
our
comprehensive
assessment
that
really
gets
under
the
skin
of
the
culture
on
the
leadership
as
well
as
the
safety,
and
I
think
the
trick
for
us
is
to
do
both
of
those
that
we
don't.
G
I
Test
thanks
that
it
would
be
impossible
to
be
against
the
duty
of
canada.
So
that's
obviously
it's
a
good
thing,
but
I
do
think
it
has
the
law
of
unintended
consequences
written
into
it
and
and
that
is
to
say
that
patient,
alarm
and
and
staff
and
retribution
against
staff
deciding
under
what
circumstances
a
letter
needs
to
be
sent
deciding
what
actually
happened
in
an
instant
is
not
straightforward.
A
Interesting,
that's
a
good
point
to
make
lewis
I
mean
mike
when
just
give
us
a
flavor
of
put
the
dude
a
candid
just
slightly
on
one
side,
but
in
terms
of
getting
the
real
culture
of
the
organization.
You
know
the
just
culture,
openness,
the
no
blame,
but
clearly
there's
going
to
be
blame
when
things
go
beyond
a
certain
point.
But
do
you
feel
that
our
inspectors
are
getting
genuine
at
the
culture
of
the
organization.
D
Yes,
I
do
and
not
to
say
that
we
can't
do
it
better,
but
I
I
do
think
we
are
and
because
I
think
we're
doing
it
by
coming
at
it
from
a
whole
lot
of
different
angles,
so,
for
example,
in
each
of
the
core
services
we
go
into
we
we
look
at
incident
reporting
and
instance,
and
that's
where
we
will
be
dealing
with
this
specifically,
but
we
learn
a
lot
about
the
culture
before
we
go
on
inspection.
We
learn
about
it
from
the
staff
survey.
D
I've
often
said
that
it
is
the
staff
survey
that
is
the
single
most
informative
data
set
from
my
point
of
view
about
a
trust,
and
that
has
the
questions
about
bullying.
It
has
the
questions
about
whether
the
people
working
in
the
trust
would
recommend
the
trust
to
others.
So
all
of
those
questions,
so
we
get
a
feel
from
that.
You
get
a
feel
from
sickness
levels
if,
in
one
particular
department,
the
sickness
levels
are
very
high.
D
It's
always
a
prompt
for
me
to
say
what's
going
on
in
that
department,
and
there
may
be
a
reason,
but
it's
worth
worth
a
look.
We
get
a
lot
of
information
from
the
focus
groups,
and
so,
if
you're
sitting
down
with
consultants
with
junior
doctors
with
nurses
and
saying,
tell
us
about
the
place,
that's
where
we
get
a
lot
of
the
signals
about
about
culture,
and
I
think
that's
where
we
will
in
the
future
be
asking
questions.
D
So
what
about
the
duty
of
canada
and
getting
a
feel
from
people
who
are
there
about
all
the
the
issues
you're
raising,
which
I
think
are
absolutely
valid
ones,
but
we
will
get
an
impression
from
stuff
and
then
towards
the
end
of
the
inspection
we
we
talked
to
the
senior
management,
and
but
we
talked
to
senior
management.
Having
already
been
informed
by
what
we've
heard
and
seen
on
the
rest
of
our
inspection,
and
we
can
then
probe,
you
know
how
well
they
think
they
are
doing
in
terms
of
openness
and
culture
generally.
F
Just
wondered
after
say
after
it's
be
it's
you
know,
come
into
force,
maybe
say
after
six
months
or
something
we
could
have
a
a
report
on
how
it's
going
you
know.
So
we
can
kind
of
keep
an
eye
on
unintended
consequences,
because
I'm
sure
there
will
be
some,
it
will
be
a
kind
of
trade-off.
But
I
think
it'll
be
quite
helpful.
I
don't
know
if
six
months
is
too
soon,
but
but
you
know
just
to
keep
an
idea
of
what
the
issues
that
are
emerging
and
yeah.
C
C
So
the
challenges
that
that
presents
are
going
to
be
very
much
different.
Indeed,
some
small
primary
medical
services
won't
have
that
kind
of
infrastructure
as
well,
so
they'll
present
different
kind
of
issues.
I
think,
but
it's
a
good
point,
so
thank
you
on
the
other
requirement
that
comes
in
from
the
21st
is
the
fit
and
proper
person
test,
and
this
is
again
a
responsibility.
That's
placed
on
trusts
and
nh
foundation.
C
Trust
trust
governors,
the
trust
development
authority
to
ensure
that
execs
and
non-executive
directors
are
of
good
character
and
are
not
unfit
to
undertake.
The
role
for
which
they're
appointed
monitor
will
carry
out
this
function
when
foundation
trusts
are
subject
to
the
regulatory
regime
where
they
change
the
chief
executive
and
what
we've
done
in
the
remainder
of
this
paragraph
is
just
go
through
some
of
the
issues
that
we
know
will
be
considered
or
people
on
the
bar
in
this
have
they've
been
prohibited
from
holding
relevant
positions
under
the
companies,
law,
charities,
act,
etc.
C
Again,
this
is
entirely
new
and
our
approach
to
this
is
going
to
be
about
how
do
organizations
discharge
this
responsibility
and
very
much.
The
approach
that
we're
setting
out
in
this
note
david
is
that
we
will
assess
how
organizations
in
this
from
november
trusts,
are
approaching
this
and
considering
the
appointments
they're
making
to
these
senior
positions
again,
we
need
to
develop
our
systems
and
processes
and
then
ensure
staff
are
trained
in
the
application
of
these
new
systems
and
processes.
C
This
rolls
out
in
trusts
in
the
nhs
in
the
first
instance
and
then
from
april
15
rolled
out
across
our
other
areas
of
responsibility
to
other
sectors,
so
allows
us
to
try
it
in
nhs
trust,
if
that's
not
too
unkind
of
phrase
and
then
develop
the
way
we
work
across
the
other
sectors
as
well
I'll
leave
it
there
david.
I
don't
know
other
people.
D
Just
just
to
emphasize
the
point
about
co-producing
with
chairs
and
chief
executives
of
trusts,
we
had
a
very
useful
roundtable
meeting
with
them.
I
think
this
is
very
much
on
their
agenda
because
just
about
everybody
we
invited
came
to
that
meeting
and
but
remembering
that
the
duty
is
on
them
to
make
sure
that
they
are
appointing
directors
who
are
fit
and
pro
proper
persons,
and
so
they
are
very
mindful
of
this,
and
I
think,
as
a
result
of
that
meeting,
I
think
the
foundation.
B
D
D
B
G
So
it's
it's
not
the
first
consultation.
That's
happened
on
this
one,
so
there
was
one
at
the
early
part
of
the
year
that
the
government
ran
on
the
regulations
themselves.
I
think
what
we
pick
up
is.
It
is
one
that
they
are
have
been
live
to
for
some
time
are
very
concerned
about,
so
we'll
have
to
see
through
inspection,
how
many
of
them
have
put
the
appropriate
processes
in
place,
but
I
don't
think
it's
new
news,
something
you
know
on
the
base
of
our
consultation.
C
I
think
your
question
robert
was:
is
the
system
ready
for
it?
So
let's
take
that
in
two
parts
I
think
mike
answered
what
we're
doing
to
get
our
staff
ready
and
there's
a
lot
of
guidance
out
there.
Andrea
in
previous
incarnations,
was
responsible
for
some
of
it
in
terms
of
how
you
go
about
these
appointments,
but
in
the
debate
course
your
report,
but
also
from
other
sectors.
We
talked
last
night
about
the
financial
services
authority,
doing
shadow
interviews
of
people
who
were
going
on
to
other
boards.
C
The
hsbc
issue
was
raised
this
week
as
well
and
we're
not
doing
shadow
ratings.
I
think
the
issue
for
this
is
shadow
interviews
yeah.
The
the
responsibility
for
this
is
on
the
trusts
and
our
responsibility
is
to
ensure
that
they're
discharging
that
responsibility
in
an
appropriate
way,
which
is
very
different
than
I
think,
what's
happening
in
financial
regulation.
C
I
glossed
over
it
in
the
in
presenting
it,
but
there
is
in
the
bottom
third
on
page
five,
that
we
anticipate
getting
difficult
cases
and
mike
will
cheer
a
panel
where
we've
got
those
difficult
cases
referred.
So
I
think
we
are
anticipating
some
difficult
cases
which
won't
be
straightforward,
which
will
be
out
with
the
guidance,
and
I
think
that
again,
I
think
this
notion
of
learning.
C
C
A
J
J
You
know
I
mean
they
really
did
go
into
details
that
I
wasn't
expecting.
I
mean
you
know:
technicalities
about
the
amount
of
reserves.
I've
ever
had
against
particular
risks.
I
mean
how
it
monitored
risks
and
so
on.
So
and
of
course
you
know
there
have
been
a
number
of
cases
in
which
the
pra
and
the
fca
have
actually
turned
down
people
as
a
result.
J
J
I'm
not
100
sure
of
this
idea
that
everything
starts
or
the
tone
starts
from
the
top,
but
there
is
some
truth
in
that
and
the
chairman
is
the
top,
and
you
know
I'm
thinking
I
was
taken
by
struck
by
robert's
remarks
at
the
dinner
last
night
about
you
know.
Some
trust
boards
appear
to
be
there
too,
or
at
least
there's
an
attitude
that
they
are
there
to
ensure
that
their
seats
on
the
board
remain
unchallenged,
and
you
know,
which
is
obviously
a
totally
wrong
objective
for
a
non-executive
director.
J
But
what
I'm
confused?
Actually
the
question
I
was
going
to
ask:
is
I'm
not
entirely
sure
from
reading
this
or
from
general
understanding
about
the
role
of
monitor
the
role
of
the
tda
and
our
role
in
this,
because
are
we
actually
saying
that
monitor
could
have
could
have
approved
the
appointment
of
a
chairman
and
ceo
and
and
individual
board
members
and
the
cqc
could
say
that
we
don't
actually
think
that
some
of
these
are
fit
and
proper
people.
So
I
was
actually
going
to
ask
where
the
boundaries
lie
between
these
three.
J
C
They
need
to
ensure
that
the
people
that
they're
appointing
to
those
foundation
trusts
are
fit
and
proper
in
the
meaning
of
the
legislation.
Potentially.
Does
that
mean
we
can
disagree
with
somebody?
That's
appointed
probably
not
agree
with
some
disagree
with
somebody.
That's
been
appointed
because
our
job
is
to
say
what
is
the
system
and
process
that
you've
got
in
place
to
make
that
appointment,
we're
not
there
to
reinterview
you
to
use
the
aviva
example.
We
are
there
to
ensure
that
there
has
been
a
fit
and
proper
person.
Now.
C
I
think
we'll
get
lots
of
referrals
about
saying
person
xy.
Is
that
he's
not
a
fit
and
proper
person?
What
are
you
going
to
do
about
it,
security
and
and
again
the
the
this
is
the
nooks
and
crannies
are
twofold:
one
is
a
nooks
and
crannies
of
individuals
that
have
got
a
history
or
a
past,
and
at
what
point
is
that
spent?
C
I
think
they'll
be
referred
to
us,
but
I
think
there'll
also
be
concerns
about
whether
the
system
that's
in
place
is
fit
and
proper,
and
I
think
just
going
back
to
the
values
a
bit.
Some
of
this
will
not
be
about
whether
people
have
got
convictions
but
about
their
behaviors,
and
I
think
some
of
this
is
going
to
come
back
as
a
challenge
to
the
behaviors
and
that's
where
the
difficulties.
I
think
are
going
to
come
in
how
we
judge
the
fit
and
properness
of
individuals.
C
J
Yeah,
I
think,
that's
a
very
good
response,
david,
because
I
think
it
still
leaves
this
element
of
ambiguity,
which
is
that
how
can
we
tell
whether
a
let's
say
a
foundation?
Trust
has
actually
appointed
fit
and
proper
people,
or
it
has
a
process
to
point
for
them.
Proper
people,
without
looking
at
the
people,
who've
been
appointed
to
see
if
they're
fit
and
proper.
It's
you
know
it.
This
is
this
is
the
issue?
No
no
you've.
C
C
A
That
the
point
being
that
a
fit
and
proper
process
could
appoint
someone
who
wasn't
fit
and
proper,
I
mean
just
because
the
process
is
right.
It
doesn't
mean
to
say
that
the
the
outcome
is
right,
but
I
think
we'll
need
to
keep
doing
the
review
again
mike
it'll
be
determined
by
individual
cases.
I
suspect
how
this
evolves.
D
I
think
it
will,
I
think,
and
in
terms
of
our
inspection
process,
I
think
we
will
always
address
it
in
the
comprehensive
inspections
and
that
will
be
part
of
the
sort
of
the
the
interviews
with
the
chair
and
the
chief
executive.
But
that
will
also
on
top
of
that
be
responsive
occasions
when
things
are
brought
to
our
attention
and
we
won't
wait
until
the
next
comprehensive
inspection.
If
there
are
concerns,
we
will
then
have
to
go
and
ask
those
questions
of
the
chair
and
chief
executive
of
the
trust
straight
away.
C
C
A
D
The
answer
is
no,
I
can't
at
the
moment,
but
for
very,
very
good
reason.
I
was
part
of
the
original
process
in
that
I
chaired
the
national
quality
assurance
group,
the
first
time
that
dudley
came
round
and
as
they
asked
for
a
review
of
ratings,
I
stepped
aside
from
that.
I
have
now
just
received
all
the
paperwork
back.
It
has
been
through
a
completely
independent
process,
not
led
by
me,
and
so
I
now
have
to
take
on
board
what
what
exactly
what
has
happened.
D
But
you
know,
unless
there
is
good
reason
not
to
I
will
accept
the
recommendations
of
the
independent
review.
So
we
have
what
I
can
tell
you
is
that
it
has
been
independently
reviewed.
It
has
been
through
a
second
national
quality
assurance
group
and
recommendations
have
just
come
back
to
me,
which
I
am
now
considering.
A
C
There's
an
update
on
recruitment
and
you
can
see
what
we've
had
from
august.
The
first
156
new
starters
across
the
directorate
we've
previously
flagged.
The
issue
of
the
risk
of
recruitment
and
action
has
been
taken.
We've
now
got
a
plan
in
place
which
is
now
being
delivered
and
new
starters
are
beginning
to
be
appointed
and
take
up
their
posts.
C
In
paragraph
8
just
wanted
to
brief
the
board
on
some
work
that
paul
and
steve
have
been
doing
in
relation
to
intelligent
monitoring.
We
had
planned
to
launch
the
intelligent
monitoring
for
general
practice
earlier
this
month,
but
we
found,
as
we
approached
launched,
that
we
wanted
to
validate
the
data
that
we'd
got
and
as
we
began
to
do
the
validation
of
the
date,
it
then
became
clear
that
the
next
wave
of
information
based
on
the
previous
12
months
will
be
available
within
a
week
of
that
validation.
C
C
This
had
been
previously
agreed
with
the
secretary
of
state,
so
paul
and
steve
have
had
discussions
directly
in
relation
to
the
delay
of
that
publication.
But
as
I
say
with
that,
that
purpose
in
mind
going
back
to
last
month's
board
meeting
where
we
talked
about
an
individual
case
ph,
saw,
is
now
formally
written
to
cqc
and
to
a
number
of
other
organizations
saying
that
they
are
changing
the
way
that
they
operate
and
they'll
now
consider
cases
outside
of
the
12-month
period
I.e.
A
C
C
Are
two
different
things?
One
is
a
an
investigation
of
their
case
and
the
circumstances
in
their
case,
and
then
what
we
were
offering
in
section
48
is
to
look
at
issues
such
as
the
transfer
of
pediatric
cases
from
one
hospital
to
another.
So
we
weren't
looking
at
the
individual
circumstances,
but
the
general
issues
so
transition
issues
care
after
death
issues.
These
are
consistent
with
some
other
cases
that
mike
has
had
dealings
with,
and
indeed
mike
himself
have
met
some
families
where
there
were
similar
issues.
C
So
this
isn't
the
issues
around
transfer
around
complicated
pediatric
cases
isn't
just
an
issue
related
to
this
particular
case.
It's
a
more
general
issue
that
needs
to
be
addressed
and
that's
what
the
section
48
investigation
would
do.
So
one
would
look
at
the
case.
Phso
and
we'd
look
at
the
systemic
issues,
the
systems
issues
if
you
wish
that
are
provoked
by
the
case.
So
that's
how
I
think
this
could
be
taken
forward.
C
C
That
said,
we
should
communicate
with
each
other
about
what
we
are
respectively,
doing
if
it's
a
case
that
has
some
commonalities
between
what
they're
doing
what
we
do,
but
our
powers
are
not
the
same
as
those
their
powers
are
not
the
same
as
ours,
and
therefore
we
just
need
to
be
clear
about
who's.
Doing
what
and
why.
A
J
C
I'll
switch
it
off
always
better.
I
find
schema
delegation.
I
asked
you
to
note
that
the
state
care
report
was
published
on
friday.
I
just
wanted
to
make
sure
the
board
were
cited
on
the
fact
that
david
dalton
has
been
carrying
out
a
review
of
options
and
opportunities
for
providers
in
the
nhs
and
that
work
is
coming
to
a
conclusion,
and
work
has
been
undertaken
over
the
during
the
autumn
by
simon
stephens
on
the
forward
view,
which
is
looking
at
the
challenges
faced
by
the
nhs
over
the
next
five
years.
C
A
On
on
the
market
oversight,
I
think
it
would
be
useful
to
have
a
paper
probably
to
the
private
board
for
the
first
time
just
see
how
we're
going
to
approach
then,
because
I
don't
think
everyone
is
fully
up
to
speed
with
that.
If
we
could
have
that
in
maybe
next
month,
maybe
sally
warren
could
come
ander
as
well.
C
C
We
do
have
a
code
of
practice
in
relation
to
access
to
medical
records
and
the
responsibility
around
confidentiality
that
all
of
our
staff
have
in
relation
to
accessing
medical
records.
Indeed,
cqc
and
its
predecessors,
the
healthcare
commission
and
its
predecessor,
the
commission,
for
healthcare
improvement
and
csci
and
its
predecessor,
the
national
co-standards
commission,
all
had
access
to
records
and
all
had
confidentiality
agreements,
codes
of
practice
around
confidentiality
about
what
could
be
accessed.
C
The
bma,
the
health
select
committee,
nhs
england
and
say
what
our
approach
is
and
we'll
get
a
letter
off
to
people
explaining
what
we
do
and
why
we
do
it.
An
example
of
this
may
well
be
if
we're
carrying
out
an
inspection,
or
indeed
an
investigation,
to
go
back
to
one
of
the
some
of
the
earlier
discussions.
It
may
well
be
that,
in
order
to
discharge
that
investigation,
we
actually
need
access
to
medical
records.
C
C
C
K
K
It
probably
needs
updating
with
more
examples
of
why
we
would
want
to
look
at
the
records
just
to
be
absolutely
clear,
but
I
do
find
it
very,
very
sad
that
the
social
media
storm
that
has
happened
over
the
last
few
days
really
might
frighten
people
in
england
unnecessarily
without
thinking
about
the
consequences
of
that
regarding
ensuring
that
they
have
safe
and
high
quality
care,
and,
I
think
actually
in
the
social
media.
Sometimes
commentators
do
need
to
think
about
the
consequences
of
their
actions
as
well.
K
What
we
try
to
do
is
do
things
in
a
very
proportionate
way
and
only
look
at
records
where
they're
appropriate
and,
if
possible,
to
anonymize
them
and
in
in
one
of
the
big
gp
systems,
you
can
monetize
data
very
easily
and
for
most
cases
that's
fine,
but
in
some
you
want
to
actually
have
a
look
into
the
depth
of
the
record.
So,
for
example,
in
the
last
few
weeks,
we've
been
to
a
practice
that
had
many
months
of
investigations
and
hospital
letters
unread
according
to
the
records.
K
In
fact,
they
were
so
bad
that
within
hours
of
us
being
in
they
apparently
according
to
the
inspectors-
and
the
report
is
still
being
written,
spent
the
whole
weekend
going
through
those
investigations
and
records.
Unless
we
look
into
the
medical
record,
it
might
just
be
an
administrative
issue,
but
if
you
want
to
look
in
and
say
that
a
person
has
had
serious
diagnosis
in
a
hospital
which
hasn't
been
followed
up
or
investigations
that
have
not
been
followed
up,
there
is
no
way
of
doing
that,
apart
from
checking
the
medical
record.
K
Now
these
are
on
a
small
number
of
gp
practices,
but
if
you're,
one
of
the
many
thousands
of
patients
that
are
looked
after
by
that
gp,
your
life
could
be
at
risk.
This
is
very,
very
serious
and
I
think
one
of
the
problems
with
social
media
is
it
doesn't
give
you
the
chance
to
really
explain
that,
and
I
think
part
of
the
reason
this
might
have
started
as
a
social
media
issue
is
that
I've
tried
to
be
very
transparent
and
open.
K
So
one
of
the
first
meetings
I
had
with
all
of
our
inspectors,
many
of
whom
have
come,
come
from
social
care
and
also
had
access
to
records
for
very,
very
good
reasons,
and
hospital
care
was
to
say
look.
This
is
a
very
sensitive
issue
in
general
practice
and
I
do
not
want
people
going
in
looking
at
records
and
fishing
and
looking
for
stuff
without
very
good
reason,
and
we
had
a
very
good
discussion
about
that.
K
I've
also
been
very
keen
to
issue,
as
david
says,
through
the
mythbusters
idea,
additional
information
on
top
of
the
code
of
practice,
because
we've
now
got
many
hundreds
of
gps
working
with
us
as
specialist
advisors,
we've
been
so
successful
on
recruitment,
we've
overshot
the
target
that
we
gave.
They
need
to
understand
that
their
role
is
different
as
an
advisor
to
an
inspection
than
being
a
gp
in
a
surgery,
and
it
might
be
obvious
to
most,
but
we've
been
trying
to
train
those
and
give
them
information.
K
B
The
only
question
I
would
ask
is
whether,
in
relation
to
our
code
of
practice,
and
indeed
any
concerns
there
may
be
about
what
happens
do
do
we
have
any
regular
consultation
with
patient
groups
in
order
to
because,
after
all,
the
notes
are
owned
by
patients.
They
have,
of
course,
a
right
of
access
to
them
themselves,
and
I
just
wonder
whether
we
do
enough
in
relation
to
reassurance
in
that
way,
that
any
concerns
that
patient
groups
get
from
their
membership
or
who
they
represent
are
taken
into
account.
K
K
We've
done
from
the
start-
and
this
is
one
of
many
things
that
have
happened
on
social
media-
to
challenge
what
we're
doing
I'm
here
on
behalf
of
patients-
and
I
think
wanting
to
respond
robert
would
be
very
helpful-
is,
as
we
publish
the
reports
as
people
understand
the
bad
in
some
cases,
variation
in
quality
of
care,
that's
provided,
they
might
understand,
and
gps
who
are
now
being
inspected.
All
of
the
feedback,
apart
from
one
case
since
we
started,
has
been
hugely
positive
about
our
methods
when
we
go
into
practices.
C
C
So
we've
formally
responded
to
that
request
that
went
out
this
week,
so
it's
an
opportunity
david
just
to
share
that
with
the
full
board.
Since
august
of
last
year,
to
august
of
this
year,
we
spent
190
000
pounds
on
the
contract
with
the
company
that
records
these
video.
These
board
meetings-
I
think
the
important
thing
to
say
is
that
we
had
2
000
live
views
during
that
period
and
over
8
000
views
on
demand
pause
the
event:
that's
10
000
views
that
have
taken
place.
C
The
conversations
that
take
place
and
some
of
the
conclusions
that
we
arrive
at
and
the
decisions
that
are
made
so
the
other
questions
were:
do
we
televise
the
whole
of
the
board
meetings?
Well,
no,
we
don't
televise
private
board
meetings,
the
private
elements
of
the
board
and-
and
there
is
never
a
second
off
camera
meeting.
I
think
this
was
do
you
have
one
conversation
in
one
place
and
then
another
conversation
and
the
answer
to
that
was
no.
There
are
no
off
camera
board
meetings.
A
C
Missed
that
out,
we
are
re-tendering
the
complaint
at
the
back,
we'll
know
this,
but
we
are
re-tendering
with
a
view
to
doing
that.
We
did
retender
about
12
months
ago
and
that
took
between
two
and
three
thousand
off
the
cost
of
each
board
meeting.
So
we
did
take
the
cost
down
and
there'll
be
a
further
retender
for
the
offer,
and
we
are
optimistic
that
it
will
be
possible
to
take
that
cost
down.
H
Just
to
add,
I
mean
we
are
going
through
a
formal
procurement
process
that
will
culminate
in
march
jennifer.
We
have,
we
have
to
actually
buy
from
approved
list,
which
is
the
same
list
nhs
england
would
buy
from
anyway,
so
the
economy
scale
is
held
to
have
been
created
by
the
establishment
of
that
framework
already.
So
so
we
are
absolutely
adhering
to
that.
L
Reports
from
the
directorates
there's
several
mentions
in
them,
starting
with
adult
social
care,
about
a
report
on
special
measures
and
then
concerns
around
midway.
I
think
it'd
be
quite
useful
to
have
a
report
on
special
measures
across
them
all
because
I
think
we're
we're
developing
today
in
in
the
times
around
medical
primary
medical
services.
J
J
A
E
E
K
Just
to
comment
on
the
press
aspect,
I
met
with
most
of
the
health
correspondence
of
the
national
press
to
give
them
the
good
news
about
out
of
hours
care
the
paper
you
all
read
here
and
we
had
hardly
any
coverage,
even
though
this
was
a
very
important
statement
that,
since
the
disaster
of
the
urbani
case
in
cambridge
care
has
improved
dramatically
the
providers,
whether
they're,
private
or
gp,
run
groups
have
got
their
act
together
in
a
very
dramatic
way.
But
could
we
interest
the
press?
K
G
Thank
you
yes,
so
andrew
and
I
both
talk
a
bit
to
this.
The
paper
and
the
slides
are
accompanying.
It
are
aiming
to
do
a
couple
of
things.
At
least
one
is
just
in
light
of
the
board's
discussions
at
the
last
meeting
just
to
highlight
the
journey
that
we've
been
on
for
over
a
year
as
we've
developed
this
work
and
just
to
start
there
the
point,
this
isn't
something
that
we
are
considering,
because
it's
a
flight
of
fantasy
of
ours.
This
is
because
this
is
happening.
G
G
G
The
paper
lays
out.
There
is
no
consensus
from
all
the
engagement
that
we've
done.
It
is
one
time
that
polarizes
people's
views
completely,
understandably,
and
that's
also
been
reported
in
the
press,
just
how
different
people's
views
are
literally
at
the
level
of
whether
you're
a
resident,
for
example,
or
caring
for
somebody
in
a
care
home.
G
That's
not
guidance
about
how
you
set
up
a
camera
that
we
can
leave
that
to
others.
But
it's
important
that
providers
and
the
public
are
aware
of
our
our
position
and
aware
of
what
the
the
legal
framework
is,
but
most
important.
They
can
feel
confident
in
them
in
the
actions
that
they
choose
to
take
and
that's
what
the
both
the
provider
guidance
and
the
public
guidance
are
both
currently
in
draft
are
aiming
to
get
at.
G
So
the
slides
set
out
some
of
the
principles
for
what
would
be
in
that
guidance,
we're
taking
our
time
developing
that
we
want
again
to
to
understand
from
people
who
be
the
audience
for
those
two
sets
of
guidance,
whether
it's
the
right
sorts
of
things.
We
have
quite
an
important
principle
that
it
should
be
jargon,
free
that
it
should
be
easy
to
understand
and
that
we
will
test
it
carefully
before
we
we
publish
it.
E
E
But
I
guess
the
the
the
point
I
wanted
to
emphasize
is
that
it
is.
It
is
important
for
us
to
have
a
position.
I
think
it
will
be
helpful
for
us
to
set
that
out
in
clear
and
clear
information
for
people
to
use
and
for
our
inspectors
to
be
guided
and
by,
but
it's
not
the
only
way
that
we're
going
to
get
safe,
high
quality,
effective
and
compassionate
care.
E
You
actually
the
standards
that
we're
setting
our
expectations
of
what
providers
will
be
doing,
how
they
recruit
and
train
support
and
develop
their
staff
and
all
of
the
issues
about
culture
that
we
were
talking
about
earlier
as
a
board
around
the
duty
of
candor.
All
of
those
things
are
absolutely
fundamental
to
making
sure
that
sure
that
we
we
do
see
the
high
quality
care
that
we
want
to
see
for
all
of
our
all
of
our
loved
ones
and
anybody
else
who
is
using
a
service.
E
So
we've
said
it
out
in
in
the
principles
out
in
the
in
the
slides,
and
I
wasn't
intending
to
go
through
them
kind
of
page
by
page,
because
I'm
sure
you've
all
had
a
look,
but
really
what.
I
think
that
we're
asking
for
is
a
view
from
the
board
that
those
principles
set
out
the
right
issues
that
we
should
be
considering
and
agree
that
we
should
use
that
to
publish
information
for
the
public
and
providers
as
soon
as
we
reasonably
can.
I
So
there's
a
there's
a
slight
risk
here
that
this
is
just
about
cameras,
whereas
in
fact
what
it's
about
is
family
anxiety
once
somebody
they've
been
caring
for
is
under
the
care
of
somebody
else
and
the
the
tone
of
the
the
documents
the
the
the
reports
come
to
the
board,
but
the
accompanying
slides
and,
of
course
we
haven't
seen
the
actual
guidance
yet.
But
I've
got
to
assume
the
guidance
in
draft
form.
It's
just
a
little
bit
cautious.
I
I
Is
it
I
would
have
thought
it
was
a
reasonably
straightforward
issue.
It
refers
to
a
hugely
diverse
range
of
views.
I
suppose
I
think,
there's
a
small
number
of
views
which
will
be
different,
but
it's
not
it's
not
that
confident.
There
are
several
points
of
view
to
take
into
account,
but
it
isn't
that
complicated.
This
is
about
people
being
anxious
about
what
happens
when
they're
not
there,
and
that's
not
all
that
complicated
to
understand
the
and
and
why
that's
important
is
that
it
it.
I
It
comes
across
a
little
bit
in
some
of
the
rest
of
the
way
this
is
presented.
So,
for
example,
there
is
we're,
told,
there's
a
report,
a
literature
review
on
the
evidence,
which
concludes
that
there
is
no
definitive
evidence
now.
You
know
I've
been
around
the
academic
game
for
quite
a
long
time,
so
I
know
what
that
means.
I
That's
quite
a
cautious
position
that
isn't
a
neutral
position,
that's
a
cautious
conservative
position
and
I
would
have
been
astonished
if
they've
been,
if
they've
been
definitive
evidence
how,
how
would
that
have
been
obtained?
What
there
is
is
evidence
of
individual
cases,
where
it's
quite
clear
that
cameras
have
been
helpful
and
identifying
criminal
acts,
identifying
abusive
patients
and
and
and
that
needs
so
so
in
certain
circumstances,
the
evidence
is
quite
clearly
positive,
quite
clearly
helpful
and
that's
slightly
different
from
saying.
I
I
So,
to
give
an
example,
I'm
unhappy
about
the
language
of
we
will
neither
encourage
nor
discourage,
because
I
think
that
is
is
by
definition
a
discouraging
position.
It's
it's.
We,
I
think
we
have
to
be
prepared
to
say
that,
in
certain
circumstances,
cameras
can
be
helpful
and
these
are
what
the
circumstances
are.
I
So
it's
therefore
a
matter
of
judgment
as
to
whether
these
circumstances
are
fulfilled
in
this
particular
the
case
that
we
might
be
asked
about,
but
it's
not
and
then
some
information
about
how
that
might
be
carried
out.
I
take
your
point:
it's
not
just
about
how
we
might
how
someone
might
set
up
a
camera,
but
what,
if
somebody
says?
Well,
where
do
I
get
a
camera?
What
sort
of
camera
will
do?
I
I
I
Well,
we
don't
know
the
result
yet,
but
the
early
anecdotal
reports
are
that
the
police
themselves
are
seeing
it
as
positive.
So
it's
a
measure
to
protect
the
public,
but
it's
the
police
themselves
who
are
saying
that
this
has
been
helpful,
because
sometimes
complaints
are
not
true
and
are
mistaken
and
they're
saying
here
is
a
way
in
which
we
can
demonstrate
our
practice,
and
I
I
don't
know
whether
we're
capturing
that
benefit
of
overt
surveillance
on
prevention
and
the
general
standard
of
of
behavior.
I
So
I
hope
that
what
you
said
at
the
end
there
andre
is
probably
reflected
in
the
in
the
eventual
guidance.
I
think
we
need
to
be
able
to
say
what
will
we
do
exactly?
What
will
we
do
if
somebody
comes
to
us
and
says
I
want
to
use
a
camera.
What
how
do
I
go
about
it?
If
a
whistleblower
comes
to
us
and
says
the
same
thing,
we
need
to
be
able
to
say:
would
we
ever
do
it?
I
I
I
mean
I,
you
know,
there's
the
interesting
hc1
survey
and
which
you
refer
to
where
most
of
the
families
were
in
favor
of
cameras,
but
on
less
than
half
the
residents
who
were
so
now.
The
conclusion
for
that
is
that
the
slight
implication
that
there
for
the
families
are
slightly
out
of
step
with
what
residents
want,
but
actually
what
that
shows
is
the
tremendous
anxiety
that
families
feel
on
this
issue,
which
we've
got
to
reflect
and
may
be
there,
for.
I
We
should
be
prepared
to
be
more
positive
about
what
overt
surveillance
might
achieve
and
reflect
that
in
the
ratings
that
we
apply
to
to
providers
who
are
prepared
to
take
this
general
step
to
improve
their
standards
and
reassure
the
public
reassure
their
their
families.
So
there
are
some
very
specific
questions
which
are
not
about
neither
encouraging
or
discouraging
they
are
about
the
practicalities
and
the
impact
on
our
work,
which
I
feel
we
haven't
quite
got
to
yet.
A
G
I
think
we
both
might
yeah
there
is.
There
is
a
lot
in
this
and
I
think
andrew
will
want
to
comment,
but
and
pretty
particularly
about
them
the
level
of
advice
that
we
want
to
give
and
it's
appropriate
to
give
as
a
regulator
the
comp.
If
I
just
take
the
complexity
point
you
mentioned
the
beginning,
I
take
your
point.
There
are
a
limited
range
of
different
views,
but
sort
of
precisely
because
it's
so
polarized
I
get
that.
But
it's
not
just
the
it's
not
where
people
sit
on
the
spectrum.
G
It's
the
complexity
of
in
an
individual
situation
that
we're
highlighting
that
a
resident
may
or
may
of
our
care
home
to
take
an
example
for
a
moment
may
or
may
not
have
capacity.
Their
capacity
may
change
over
time.
Their
views,
of
course,
if
they
do
have
capacity,
are,
must
be
the
the
starting
point,
the
ending
point
they're
the
ones
who'll
be
on
camera,
whether
it's
overt
or
covert
they
they
complexity
comes
in
because
there
is
enormous
anxiety
from
families
and
friends
and
carers.
G
There's
complexity,
because
the
cameras
may
or
may
not
be
placed
in
public
areas.
There's
complexity
because
of
the
the
caring
environment
itself
and
the
hospital
environment
is
a
different
environment
too,
to
a
care
home
for
example.
So
it's
it's
more
that
complexity,
we're
trying
to
tease
out
not
and
certainly
not
say
because
it's
inherently
difficult,
we'd,
better,
just
sort
of
throw
up
our
hands
and
not
worry
about
it.
G
E
Okay,
thank
you,
but
I
think
there's
there's
a
variety
of
things
and
we
could
probably
kind
of
have
this
conversation
for
several
hours
and
I
do
with
lots
of
people
but
I'll
try
not
to
do
that.
If
you
ask
the
specific
question,
what
would
we
do
if
somebody
rang
up
and
said
I'm
concerned
about
care,
and
I
want
to
put
in
a
pr
and
a
camera,
and
what
do
I
do?
E
So
I
think,
as
making
sure
that
that
was
the
case
is
really
important,
and
the
final
thing
I
think
I'd
say
on
this-
is
that
and
the
reason
why
I
would
not
be
keen
for
us
to
link
the
introduction
of
overt
surveillance
to
ratings,
is
that
I
don't
want
people
I.
I
don't
want
us
to
think
that
this
is
the
way
that
we
get
good
quality
care.
E
E
So
what
I
don't
want
us
to
end
up
is
kind
of
getting
ourselves
into
a
situation
where
we
think
that
technology
is
the
answer
to
good
quality
care.
Well,
actually,
fundamentally,
the
answer
to
good
quality
care
is
enough
staff
who
are
properly
recruited
and
trained
and
supported
to
do
a
good
job
day
in
day
out,
and
if
I'm
expecting
people
to
pay
attention
to
how
they're
going
to
deliver
on
the
standards
that
we're
expecting.
E
That's
what
that's
where
I
want
them
to
focus
their
efforts.
This
might
be
something
that
they
can
use
to
supplement
that
and
to
and
to
help
in
some
specific
circumstances
and
you,
and
I
think
that
we
have
a
role
to
play
in
making
sure
that
that's
done
properly.
But
I
don't
want
them.
Thinking
that
the
first
thing
that
they've
got
to
do
to
get
a
decent
rating
from
cqc
is
put
a
camera
up.
I
So
what
you're
saying
earlier
about
trying
to
set
it
in
a
broader
context
is
right,
but
that
doesn't
mean
that
we
should
then
take
a
conservative
view
of
this
this
specific
issue.
So,
for
example,
maybe
I
was
wrong
to
pick
up
the
particular
issue
of
what
the
technical
equipment
should
be
and
where
you
could
buy
it.
I
didn't
particularly
mean
to
get
onto
that.
I
just
mean
that
if
people
ask
about
that,
I
think
we've
got
to
try
and
have
an
answer.
I
I
That
here
are
the
actions
that
we
will
now
take,
and
that
of
course,
is
is
vital
on
the
question
of
you
know,
of
course
I
understand
that
on
the
overt
surveillance
that
what
we
would
then
look
at
was,
has
the
camera
been
put
in
properly?
Have
all
the
issues
of
consent
being
addressed,
the
issue
of
public
versus
private
and
so
on,
people's
dignity
being
respected?
I
Of
course,
that's
all
very
important,
but
once
you've
done
that,
could
there
be
some
credit
for
taking
seriously
an
issue
of
public
and
family
concern,
and
I
think
we
have
to
directly
address
that.
Personally.
I
think
that
the
answer
is,
if
you
have
done
it
properly
and
if
you
think,
if
you
can
make
the
argument
for
the
potential
benefit,
then
that
is
a
reason
to
to
offer
credit
to
the
to
the
provider,
so
I
won't
keep
going
on,
but
I
I
do
think
there
are
some
these.
B
What
I
wasn't
clear
from
that
about
is
whether
actually
enough
research
has
been
done
on
the
use
of
particularly
overt
surveillance
and
whether
we
would,
if,
if
research
has
not
been
done,
then
whether
we
would
encourage
providers
to
do
some
sort
of
research
that
would
look
at
what
are
the
best
ways
of
using
overt
surveillance.
What
are
the
benefits?
B
B
So
if
people
come
to
us
worried
what
are
we
doing
about
that
anxiety
and
what
should
if
someone
goes
to
a
provider
and
asks
for
surveillance?
What
does
that
signify
that
there's
something
wrong
going
on
already?
The
the
third
point
was
this.
Understandably,
it
looks
to
me
as
though
this
guidance
is
principally
focused
on
the
adult
care
sects,
because
that's
where
this
happened,
but
but
it
seems
to
me
potentially
different
considerations
apply
in
the
hospital
settings.
B
The
other
point
is
there's
potential
over
that,
because
we
also
know
that
some
forms
of
treatment
in
surgery
are
routinely
film,
the
whole
time,
partly
for
educational
purposes,
but
also
partly
for
record
keeping,
and
I
don't
know
what
what,
if
any
routines
are
put
in
place
to
alert
patients
to
the
fact
that
that
is
actually
happening,
useful
as
it
undoubtedly
is.
Now.
I
appreciate
that.
That's
a
stretching.
B
It's
a
bit,
but
if
you
have
no
guidance
tool
specific
to
hospitals,
I
think
I
would
suggest
there's
a
little
bit
of
a
of
a
gap
there,
and
the
other
point
is
again.
This
is
just
a
question.
Really
is
the
guidance
going
to
sufficiently
apart
from
whether
we
sit
on
the
fence
or
not?
Is
it
sufficiently
helpful
in
terms
of
the
detail
it's
going
to
provide
either
to
a
provider
or
to
a
member
of
the
public
to
say
this
is
really
complicated.
B
You've
got
to
consider
it,
or
should
we,
I'm
afraid,
gave
the
extra
mile
and
actually
set
out
either
a
decision-making
process
in
more
detail,
maybe
a
reference
to
what
the
legislation
actually
is
because,
frankly
I
I
know
a
little
bit
about
this
field,
but
I
couldn't
tell
you
what
legislation
is
people
need
to
need
to
have
access
to
that,
rather
than
just
saying
to
them,
it's
very
difficult.
Think
about
it
carefully.
That
would
be
my.
Those
would
be
my
observations.
A
J
J
The
decision
is
a
decision
for
families
and
individuals
to
take.
There
are
other
types
of
technology.
I
don't
know
what
those
are
that
are
less
intrusive
and
then
finally,
we
will
actually
use
the
evidence
provided
by
surveillance.
So
you
know
half
the
page
sort
of
is
saying
that
you
know
we
don't
encourage
or
discourage,
but
our
last
point
is:
we
will
actually
use
the
evidence
that
surveillance
provides.
J
J
J
I
just
I
think
in
a
way
where
we
need
to
give
just
much
clearer
guidance
and,
as
I
say,
probably,
the
first
thing
is
that
we
will
inspect.
If
somebody
comes
to
us-
and
you
know,
that's
the
in
a
way
the
most
important
message
to
get
across.
But
of
course
I
don't
know
and
andrea
can
tell
us
whether
in
fact
we
do
have
the
capability
or
the
resources
to
inspect
within
a
week.
If
a
relative
comes
to
us,
I
don't
know.
E
A
Just
just
just
sorry
to
interrupt,
I'm
gonna
be
rude,
there's
quite
a
lot
to
come
back
to
I
I
I
suppose
my
feeling
is.
Is
that
we're
not
quite
there
yet
with
this,
and
what
I'd
like
to
suggest
is,
if
you
could
take
it
away,
you
know
with
the
comments
that
have
been
made,
maybe
come
back
at
the
next
meeting.
A
I
Okay,
david:
let's
make
one
point
just
to
try
to
be
helpful
about
it.
I
think
the
the
I
would
actually
move
away
from
having
a
sort
of
definitive
position
where
I
think
we've
we've
ended
up
sitting
on
a
fence
when
actually
there
doesn't
need
to
be
a
fence
here
and
it's
just
a
set
of
ways
of
responding
with
to
certain
circumstances
and
a
kind
of
process
to
be
gone
through,
which
is
measured
and
proportionate
and
so
on,
but
in
the
end
reflects
the
anxiety.
I
So
I
I
just
I
would
get
away
from
the
language
of
having
a
position
to
a
pr,
a
practical
document
of
what
we
would
do
in
under
certain
circumstances,
how
this
will
affect
our
work
and
so
on
and
get
away
from
the
encourage,
discourage.
I
don't
think,
that's
necessary.
Actually,
in
fact,
it's
distracting
from
the
overall
messages.
You
know
you've
in
what
you
said
earlier.
You
articulated
a
good
set
of
responses
and
I
think
that's
the
in
the
end,
the
heart
of
what
this
should
be
about.
L
On
the
question
of
sort
of
sitting
on
the
fence
and
being
neutral,
I
think
it
is
possible
to
be
neutral
about
encouraging
people,
but,
as
you
say
in
this,
it's
people's
own
decision.
If
they
come
to
you
with
having
made
a
decision,
then
I
think
you
could
be
encouraging
and
you
could
be
positive,
perhaps
about
helping
them
to
do
so,
because
I
think
people
certainly.
L
I
know
myself
are
quite
worried
about
putting
in
a
camera
it's
the
first
time,
probably
they've
actually
sort
of
done
it
in
their
lives
and
also,
I
think
you
could
be
a
lot
more
positive
than
you
seem
to
be
going
to
be
about
showing
an
interest
in
the
result.
You've
got
to
remember.
I
think
that
in
the
past
cqc
said
they
wouldn't
pay
the
slightest
attention
to
any
surveillance
evidence,
and
I
think
you
need
to
counteract
that
impression
and
going
back
to
what
andrew
was
saying
about
there'd,
be
lots
and
lots
of
other
methods.
L
I
would
just
like
to
sort
of
throw
a
contentious
issue
with
panoramas.
Great
success
with
cameras
was
because
they
put
great
success
in
their
recent
program
was
because
they
put
a
mole,
an
undercover
member
of
staff
into
the
odin
area,
and
I
think
the
cqc
should,
in
addition
to
cameras,
be
thinking
about
that
as
well.
E
Okay,
can
I
just
deal
with
quickly
with
the
point
that
says
if
somebody
came
along
with
evidence
from
a
camera
which
actually
was
evidence
that
demonstrated
that
either
poor
or
care
or
unacceptable
levels
of
care
or
abuse
that
occurred,
we
absolutely
would
take
notice
of
it
and
use
it
so,
and
that
would
be.
That
would
be
part
of
the
information
that
we
provide.
So
thank
you
for
giving
me
the
opportunity
to
say
that
david.
M
C
But
anyway,
let's
do
this
on
the
record:
what
action,
if
not
a
fit
and
proper
person,
then
our
normal
enforcement
action
can
come
in
to
play
and
it
will
inform
mike.
I
think
they
are
judgments
about
how
well
led
that
organisation
was,
if
they're
appointing
people
to
that
organization
that
are
not
fit
and
proper.
C
I
think
the
other
issue
about
this
is
the
reputational
impact
of
this
is
something
that
doesn't
get
talked
about
a
lot,
but
I
think
the
power
of
us
saying
actually
we're
not
convinced
this
has
been
done
in
the
right
way.
This
is
our
evidence
for
arriving
at
that
judgement.
This
is
our
judgment
over
all
about
the
organization.
G
G
M
M
G
No
it
it
does
exist,
it's
separate
to
the
duty
of
canada
I'll
get
its
name
wrong.
If
I
try
to
say
what
it
is,
but
it
is
the
new
legislation
that
does
allow
for
for
criminal
prosecution.
It
would
be
by
the
cps
not
ourselves
instances
where
instances
where
an
individual
has
caused
serious
arguments.
Clearly
there
is,
there
is
already
the
whole
criminal
law,
but
I
think
there
was
felt
to
be
a
a
gap
in
the
ability
to
particularly
prosecute
those
cases.
But,
as
mine
says,
that's
now,
legislation.
G
So
in
a
case
where
there's
a
disagreement,
we
would
reserve
the
right
to
to
look
at
that
and,
if
our
you
know,
if
we
had
chosen
to
investigate
that,
particularly
if
there
was
a
pattern
of
such
cases,
if
our
view
was
that
the
trust
was
getting
it
wrong,
then
that
would
be
grounds
for
us
enforcing
on
that
basis.
It's
also
we'd
also
be
looking
more
widely
in
terms
of
the
leadership
and
culture
of
the
organization
as
to
how
they
handle
those
types
of
complaints
and
what
they
did
with
sensitivity.
G
And
not,
it
could
include
to
cqc
and
and
part
of
our
public
engagement
work
that
takes
place
before
any
hospital
inspection
is
to
invite
people
to
to
talk
to
us
about
any
of
their
concerns,
as
well
as
about
the
good
care
that
they're
seeing.
But
of
course
they
will
also
entitle
entitled
to
and
we
encourage
them
to
raise
their
concerns
directly
with
the
provider.
And
then
we
look
at
the
concerns
that
are
raised
with
the
provider,
so
we
can
catch
it
that
way,
if
you
like
as
well,
but
ultimately
yes,
it.