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From YouTube: CQC board meeting – June 2019
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A
Okay
good
morning,
everybody
and
welcome
to
the
CGC
public
board
meeting
here
in
Bristol,
so
welcome
to
Bristol.
We
have
apologies
from
Jorah,
Gill
and
John
Oldham
and
Liz
seis,
otherwise,
I
think
we're
all
here.
I
want
to
particularly
welcome
this
morning.
Rena
abadeer,
who
is
the
co-chair
of
the
CQC's
race,
equality,
Network
you're,
very
welcome
and
please
feel
free
to
speak
as
if
you
were
a
member
of
the
board
throughout
this
session.
A
Does
anybody
have
any
declaration
of
interest
they
need
to
make
excellent?
That
takes
us
to
the
minutes
of
the
meeting
of
the
15th
of
May.
Are
they
are
true
and
accurate
record
of
everything
we
discussed?
Thank
you
very
much.
So
they
are
approved.
We
have
three
items
on
our
action
log.
The
first
one
is
completed.
So
thank
you
for
that.
The
written
response
has
been
sent.
A
The
second
one
again
is
due
for
today,
but
actually
not
quite
ready
to
provide
the
information,
so
that
will
come
back
to
the
next
meeting
and
then
the
third
item
again
was
a
written
answer
to
a
question
that
was
raised
at
a
the
last
public
session
and
that
has
been
sent.
So
was
anything
else
arising
from
the
minutes
that
anybody
wants
to
raise
okay.
So
we
then
move
on
to
the
first
substantive
item
of
the
agenda,
which
is,
is
wharton
hall
and
before
I
hand
over
to
Ian.
A
Can
I
can
I
just
say
that
I
think
that
anybody
and
everybody
that
watched
the
panorama
program
would
have
been
absolutely
horrified
by
what
we
saw
and
I
personally
and
I
know.
Colleagues
as
well
very
much
regret
the
fact
that
those
who
who
were
seen
to
be
abusing
very
vulnerable
patients
were
able
to
conceal
their
their
activities
from
our
inspectors
and
indeed
from
all
the
other
professionals,
the
visited
Walton
Hall
over
quite
an
extended
period
of
time.
A
It's
a
matter
of
huge
regret
and
my
thoughts
have
been
very
much
with
the
victims
and
their
families
might
have
also
been
with
with
with
our
staff,
who
were
involved,
because
I
know
that
they
are
deeply
upset
by
what
happened
so
really
really
regrettable
set
of
circumstances
to
put
it
at
its
mildest
needs
that
Ian
can
I
pass
over
to
you.
Please.
B
B
B
Although
this,
although
we've
been
we've,
been
quite
forthright
in
terms
of
what
we
think
needs
to
happen
and
and
what
we
can
do,
I
know
that
other
partners
are
starting
to
reflect
on
what
they
can
do
and
that's
been
less
clear
in
the
public
in
the
public,
mind,
I,
think
effective
regulation,
as
I've
said
on
a
couple
of
occasions
before
relies
on
an
alliance
of
partners,
commissioners,
patients
advocates
providers
and
ourselves
working
together.
If
all
of
those
people
work
together
and
work
effectively,
then
then
there
was
an
opportunity
for
really
effective
regulation.
B
B
We
have
asked
David
Noble
a
respected
retired
former
senior
lawyer
who
to
look
about
on
our
behalf
to
run
an
independent
review
into
exactly
what
happened
in
2015
going
into
2016
and
the
reason
we're
doing.
That
is
because
we
know
that
that
that's
enough
that's
an
issue
which
we
want
to
get
looked
at
fairly
quickly,
but
but
it
and
it's
something
that
we
think
can
can
be,
can
be
report
in
a
matter
of
weeks
rather
than
months.
B
B
It
is
also
worth
underlining,
though,
that
although
there
are
two
reviews
and
and
and
I'm
I'm
reluctant
to
rush
to
judgment
in
terms
of
what
those
those
reviews
may
take
place,
it
is
very
important
that
they
are
genuinely
independent.
None
of
that
stops
us
from
from
acting
in
the
short-term.
So
there's
a
number
of
operational
changes
that
we've
already
made
and
we
will
continue
to
make
over
weeks
or
months.
Some
of
that
will
be
around
the
the
methodology
they
use,
but
some
of
it
will
also
about
will
be
about
enforcement
activity
that
that's
going
on.
B
Please
be
assured:
there's
a
significant
amount
of
inspection
and
enforcement
activity
going
on
much
of
which
we
can't
currently
talk
about
publicly,
because
it's
still
it's
still
in
process.
But
as
soon
as
we're
able
to
talk
about
about
individual
cases,
then
we
will
do
so
publicly,
and
so
we
will
be
revisiting
our
practice
or
not
on
a
continuous
basis
and
as
as
things
emerge
from
these
reviews,
if
there's
an
obvious
change
to
make,
then
we
will
absolutely
make
it
so
I'm
going
to
pause
there.
C
Thank
you
in
thank
you.
Peter
can
I
just
reiterate
what
you've
just
said
about
how
pulled
we
were
by
what
we
saw
in
the
panorama
program
and
I
speak
for
myself
and
deep
regret
that
that
we
failed
to
pick
up
what
was
going
on
there,
but
also
on
behalf
of
all
my
colleagues,
and
it
is
important
to
stress
that
the
people
work
in
the
CQC.
C
My
colleagues
are
very
driven
by
their
purpose
to
prevent
harm
to
patients
and
service
users,
and
when
we
fail
to
do
so,
we
feel
it
deeply
and
we
determine
to
the
lessons
we
know
we
must
do
better
as
Ian
as
a
highlighted,
we've
already
made
some
changes
and
we
will
continue
to
do
so.
Learning
lessons
from
the
immediate
events,
but
also
we've
stepped
up
our
inspection
activity.
We've
reassessed
risk
in
similar
services.
We
have
taken
enforcement
action
and,
as
and
when
we
can
talk
about
that,
we
will
because
I
think
important.
C
Lessons
are
still
to
be
learnt
of
this.
We,
of
course,
will
learn
from
the
independent
reviews
and
they
are
very
important,
very
important
to
it
for
us
to
learn
from
the
best
expertise
out
there
about
how
we
can
improve
an
spectral
methodology.
So
we
can
be
much
more
likely
to
pick
up
this
kind
of
abuse.
Inspections
will
never
be
perfect,
but
we
know
they
can
be
better
and
we
must
do
everything
possible
to
make
them
as
good
as
possible.
C
I
just
come
back
to
the
thematic
review
on
restraint,
seclusion
segregation
I
was
deeply
shocked
when
I
read
it
as
I
know.
Other
members
of
the
board
were.
It
is
deeply
disappointing
that
the
whole
system,
including
us,
have
failed
to
move
forward.
The
model
of
care
for
these
very
vulnerable
patients
failed
to
learn
lessons
effectively
from
Winterbourne
view
and
move
things
forward.
We
must
redouble
our
efforts
to
lead
on
that.
We
can't
do
it
alone,
but
we
must
lead
on
it.
We
must
cease
in
this
process
forward
and
I.
D
Chris
just
to
build
on
what
Ted
was
saying
since
the
panorama
documentary
we've
been
in
contact
with
a
number
of
whistleblowers
and
one
of
the
things
that
is
interesting,
they
noticed
is
talking
to
them
about
the
support
that
they
we
can
receive
and
also
the
way
in
which
we
can
help
them
to
to
tell
their
story
more,
and
so
we
can.
We
can
learn
from
it.
I
think
this
work
that
we
can
do
and
should
do
in
that
regard,
and
the
other
thing
too
is
we've.
We
set
up
as
part
of
Paul
Elias,
dr.
D
Wallops
review.
We
set
up
an
advisory
group
of
a
group
of
people.
Who've
got
a
lived
experience
of
these
services
and
they
were
led
to
be
talking
about
the
important
role
that
advocates
plain
understanding
how
these
services
operate.
If
you
like,
between
these
patient's
all
the
time
and
I,
think
there's
something
about
the
nature
of
advocacy,
making
sure
that
they
are
genuine
out,
because
people
who
have
build
relationships
with
people
use
services
and
that
we
can
have
ongoing
conversations
with
them,
I
think
there's
more.
We
can
do
with
the
cost
of
that.
D
So,
alongside
the
work
of
the
independent
reviews,
I
think
there's
work
that
will
begin
to
do
ourselves
in
trying
to
understand
some
of
the
how
we
can
take
forward
some
of
those
actions
early
but
but
I
think
there's
a
desire
from
the
the
groups
that
represents
the
the
Advisory
Group
and
from
other
public
organizations
that
we
to
Ted's
point
me
to
move
in
to
how
do
we
how
to
move
away
from
this
model
of
care?
Because
it
doesn't
it's
it's
toxic
for
the
individuals,
it's
it's.
D
E
Independent
review
is
very
important.
There
is
always
a
sense
outside
I
think
that
when,
when
we
point
to
independent
reviews
and
they're
good
to
pick
up
a
lot
of
the
issues,
there's
a
sort
of
suspicion.
I
suppose
that
we
are
slightly
ducking
the
discussion
that
needs
to
take
place
and
I
think
it
I
just
want
to
be
certain
from
today
that
that
will
be
taking
straight
away.
E
And
for
that
reason
sometimes
don't
meet
the
standards
of
evidence
that
we
might
in
the
rest
of
our
work
require.
And
it's
worth
while
people
understanding
that
I'm
CQC
gets
a
lot
of
challenges
to
the
evidence
that
it
puts
forward
about
inspections
quite
and
they
come
from
the
providers.
And
so
we
have
to
be
quite
robust
about
the
evidence
that
we
put
forward.
E
But
you
just
wonder
looking
at
what
happened,
whether
and
the
robustness
that
we
require
has
to
be
tempered
with
an
understanding
of
who
is
providing
this
evidence
at
times
and
when
it's
somebody
with
learning
disability,
we
we
should
be
now
reviewing
how
we
respond
to
people
with
learning
disability,
the
kind
of
credibility
that
we
lend
to
their
account,
even
if
it
doesn't,
even
if
it
changes
from
time
to
time
or
isn't
endorsed
by
what
other
people
tell
us.
So
one
person
telling
us
that
they've
been
a
view
should
be
enough
for
us
to
be
concerned.
E
I,
don't
know
in
what
circumstances
somebody
with
learning
disability
might
say
they
had
been
abused
if
they
hadn't
I
daresay
it
could
happen.
But
I
don't
know
in
what
circumstances
it
would
happen
and
I
think
that's
the
starting
point
that
we
should
have
when
we,
when
we
inspect
so
listening
to
what
people
have
got
to
say
and
looking
for
the
signs,
the
institutional
signs
that
all
is
not
right.
E
We
can
move
away
from
the
sense
that
we're
dealing
with
deception
by
staff,
which
we
will
always
find
it
difficult
to
to
get
around,
but
actually
dealing
with
something
which
we
can
understand
in
a
better
way,
both
the
testimony
of
the
residents
themselves
and
the
institutional
factors
which
might
signal
something
to
us
that
we
should
take
more
seriously.
So
there's
one
area
that
we
could
say
now
that
we
will
do
something
about
I.
E
Think
a
second
one
for
me
is
on
the
issue
of
how
we
use
CCTV
and
technology
to
monitor
what
happens
and
I
accept
the
limitations
of
that
I.
Do
Northmoor
chillin
parts
of
the
program
as
when
staff
are
talking
about
how
they
might
get
around
the
use
of
CCTV
and
but
it's
possible
that
we've
been
rather
cautious
in
in
our
previous
considerations
of
this
issue
and
the
balance
that
we've
tried
to
strike
between
safety
and
the
use
of
CCTV
and
related
technologies
and
some
of
the
human
rights
issues
that
we've
been
concerned
about.
E
The
the
capacity
and
confidentiality
concerns
that
we
might
need
to
rethink.
Whether
we've
got
that
and
that
balance
in
the
right
place.
Now
and
then
the
third
thing
is
the
one
that
that
Ted
and
Krys
was
referred
to,
which
is
the
the
the
model
of
care
actually
notices.
My
last
CQC
board
meeting
I
came
into
CQC
in
the
aftermath
of
Winterbourne
view
and
I'm,
leaving
in
the
starting
point
of
responding
to
Walton,
Hall
and
I
think
that
CQC
has
tried
to
do
what
it
can
to
raise
standards
in
what
are
sometimes
quite
closed.
E
Institutions
for
people
with
learning,
disability
and
the
CQC
is
not
the
only
part
of
that
system
and
if
we're
finding
that
the
system
as
a
whole
in
the
care
of
learning
disability
pay
residents
who
have
what
is
often
called
complex
needs.
If
we
find
the
system
as
a
whole
is
not
responding
in
the
right
way,
then
we
probably
have
to
step
up
our
response,
and
that
might
mean
that
we
no
longer
register
this
model
of
care
and
that
we
look
retrospectively
at
places
that
we
have
registered.
E
My
personal
view
is
that
this
model
of
care
is
no
longer
acceptable,
no
longer
supportable.
The
history
tells
us
that,
and
anything
we
do
other
than
ending
this
model
of
care
will
simply
lead
us
to
the
next
scandal.
At
a
future
point
so,
and
so
I
know
that
we've
started
to
consider
that
and
but
I
think
we
just
need
to
make
it
clear
to
people.
E
G
Like
everyone
else,
the
idea,
though,
that
program
I've
read
what
I've
read
with
profound
shock
and
recognized
in
it
in
what
we've
seen.
Sadly,
although
is
much
even
more
extreme,
this
water
hall
is
some
of
the
elements
that
are
found
at
Mid
Staffordshire,
multiple
visits
by
multiple
agencies
to
an
establishment,
none
of
them,
apparently
finding
anything
remotely
connect,
as
concerning,
as
we
now
know,
was
there
and-
and
it
welcomed
the
reviews
that
have
been
put
in
place
and
I
wanted
to
ask
two
questions
about
about
those
reviews.
G
G
Will
be
with
that
reviewing
compass,
a
consideration
or
CQC's
role
in
registering
places
where
or
services
where
the
model
of
care
is
said
by
us
in
a
report
not
to
be
satisfactory.
In
other
words,
there's
nothing
intrinsically
bad
about
the
people
running
a
particular
place
and
they're
doing
their
best
and
so
on.
But
we
are
saying,
as
we
have
sent
now
clear,
that
a
model
of
care
is
is
not
acceptable
and
is
therefore
what
are
we
meant
to
do
as
a
regulator
in
those
circumstances,
and
the
third
point
that
they
can
make.
G
Is
this
that,
bearing
in
mind
what
we've
heard
about
we
know
already
about
as
I
said,
that
lots
of
people
visiting
and
not
finding
anything,
we
do
need
to
consider
what
it
is
that
people
ought
to
be
looking
for
when
they
are
considering
these
matters,
and
you
would
probably
expect
me
to
raise
this.
But
this
chair
of
HealthWatch
England
and
therefore
your
representative
for
152
HealthWatch,
is
on
on
the
ground.
I
would
ask
the
consideration
is
given
to
what
assistance
we
could
ask
HealthWatch
to
give
in
these
circumstances.
G
I
hasten
to
add
that
I'm
as
I
understand
it
and
we
have
asked
local
HealthWatch
had
no
knowledge
of
anything
like
this
at
Walton
the
hall,
but
that's
partly
my
point,
which
is
what
is
it
that
we
can
do
to
equip
organizations
such
as
HealthWatch
and
indeed
mental
health
advocates
with
the
know-how
or
the
perception
perceptiveness
that
might
make
it
less
likely
that
things
like
this,
all
the
concerns
about
risk
and
so
on,
go
undetected
and
I
just
put
that
wider
point
into
the
picture
there.
Thank
you
thanks.
B
And
Robert
ed
up.
Thank
you.
A
number,
a
number
of
important
points,
I
think
I
can
I.
Think
I
can
give
the
assurances
that
both
of
you
are
asking
in
different
ways
in
terms
of
the
in
terms
of
the
independent
reports
they
will
be,
they
are
genuinely
independent
undetermined.
They
are
genuinely
independent,
so
the
the
chairs
of
those
of
those
reports
will
have
the
absolute
discretion
to
go
wherever
they
need
to
go.
I
think
it's
alright.
B
Oh
so
Robert
specifically,
we
will
flex
the
terms
of
reference
if
we,
if,
if
it
turns
out,
we
need
to,
are
there
specifically
not
announced
timescales
for
these
reviews,
because
we
want
to
give
the
the
chairs
of
the
reviews
the
opportunity
to
talk
to
whoever
they
need
to
talk
to
and
look
at
what
they
needed
to
look
at
in
order
to
get
to
the
bottom
of
the
issue.
Rather
than
said,
this
must
be
delivered
within
within
a
narrow
time
frame,
so
that
I
hope
it
gives
you
some
assurance.
I.
Think
blue,
is
you
it?
B
That
is
that,
where
we
see
particularly
extreme
risk
factors,
then
we
need
to
take
sort
of
almost
intermediate
action
to
look
for
more
and
more
evidence
and
not
leave
until
until
we
have
got
more
assurance
around
what's
going
on
and
that
might
be
assurance.
We
stopped
short
of
us
actually
taking
any
forcement
action
if
that
makes
sense.
So
III
think
III
was.
We've
already
asked
our
intelligence
team
to
review
the
walls
with
all
evidence,
because
in
many
respects
we
with
other
providers
where
we've
closed
them
down
or
we've
taken
legal
action.
B
We
put
something
like
seven
providers
into
special
measures
in
recent
times
and
we've
closed
down
three
of
them.
There
wasn't
necessarily
evidence
of
abuse,
so
we
knew
that
they
weren't
well-run
institutions,
but
we
couldn't
connect
the
the
risk
factors
to
abuse
in
Walter
Hall.
We
absolutely
can,
and
so
at
Walter
Hall
I
think
I
think
it
is
an
opportunity
to
look
for
what
are
the
real
risk
factors
and
try
and
look
for
patterns
in
the
data,
and
that's
exactly
that.
B
B
I
think
these
I
think
part
of
this
review
activity
must
be
to
bring
people
together
to
start
to
start
to
get
a
consensus
around
that
topic
and
and
I
think
there
is
a
sense
that
that
in
the
past,
perhaps
that
people's
privacy
has
outweighed
everything
else,
but
I
think
in
what
Walton
hall
shows
perhaps
is
is,
that
is
that
privacy
perhaps
might
need
to
be
traded
for
for
safety.
In
certain
circumstances,
it's
not
it's
not
the
place.
B
One
would
like
to
go,
but
I
think
it's
a
it's
a
realistic
X,
which
some
realistic
assessment
of
were
some
places
are
I.
Think
your
point
about.
There
are
other
closed
locations
that
carry
risk.
I
think
is
well-made,
and
a
number
of
colleagues
have
already
picked
up
on
that
I
know
in
in
Kate's
area,
in
adult
social
care.
Close
dementia
floors
are
a
concern
actually
domiciliary
care
in
people
with
particularly
people
with
with
dementia,
living
at
home
or
being
supported
on
a
daily
basis.
B
House
with
no
relatives
are
another
another
risk
risky
area
that
are
quite
difficult
for
us
to
get
in
and
inspect
so
again.
I
think
we
need
to.
We
need
to
do
that.
I.
Think.
The
balancing
factor,
though,
is
that
is
that
an
awful
lot
of
great
care
is
delivered
by
people
in
these
closed
environments,
and
we
need
to.
B
That's
going
on,
as
I
said
earlier
on,
there's
there's
a
range
of
enforcement
action
which
we
can't
talk
about
publicly
at
this
stage,
but
the
a
week
we
will
be
able
to
but
I
am
very
happy
to
commit
to
both
enforcement
action
and
reporting
on
a
forcement
action
as
well
as
reporting
on
other
operational
changes.
We've
made
just
to
give
the
board
the
assurance
that
we
are.
B
I
think
I
think
we
need
to
think
about
all
options.
Frankly,
I
am
instinctively
reluctant
to
start
to
commit
to
closing
places
down
before
this
new
provision
fairly.
Obviously,
I
think
everyone
share
that
view,
particularly
in
in
a
in
a
marketplace
that
were
there's,
there's
extreme
limits
on
beds,
and
so-
and
so
you
know
there
isn't
there
isn't
capacity
in
the
market,
but
I
do
think.
B
We
will
be
in
a
position
where
we
can
start
to
do
perhaps
a
bit
more
structured
interviewing
use
technology
in
a
range
of
different
ways,
which
I
hope
professor
Murphy
and
others
can
help
us
with
to
design
a
a
set
of
tools
and
techniques
and
approaches
which
enable
us
to
be
far
more
incisive
and
deal
more
effectively
with
individuals
who
are
seeking
to
thought
our
regulation,
because
I
think
I
mean
in
closing
I.
Think
I.
B
You
know
these
are
criminal
offences
committed
by
people
who
are
seeking
to
thwart
conventional
methodologies,
and
we
need
to
be
better
than
that
and
I
think.
That's
that's
what
I'm
hoping
these
reviews
will
help
us
with
and
that's
going
to
require
a
level
of
research
and
academic
input
which
which
we
haven't
had
today
thanks
Peter,
so.
A
H
So,
if
I
can
just
give
the
board
a
bit
more
detail
about
what
we're
doing
in
the
meantime,
to
continue
progressing
this
work.
So
as
part
of
the
original
plan
around
the
restraints
seclusion
and
segregation
piece
of
work,
there
was
always
going
to
be
two
phases
and
we
are
currently
moving
into
Phase
two,
which
is
looking
at
restraint,
seclusion
and
segregation
within
a
broader
range
of
settings,
with
a
large
focus
on
those
settings
within
adult
social
care.
H
So
at
the
moment
we
have
identified
those
homes
that
we
will
be
going
out
to
through
the
next
couple
of
months.
We've
got
a
team
assembled
that
are
very
experienced
inspectors,
along
with
experts
by
experience
of
pharmacists,
will
be
going
into
these
services
and
during
this
period
of
time,
when
we're
doing
these
kind
of
focused
inspections
on
these
homes
that
we've
identified,
we
will
also
be
asking
other
inspectors
who
are
going
into
similar
sorts
of
services
to
be
asking
addition.
H
Specific
questions
focused
on
a
restraint,
seclusion
and
segregation,
so
that
we've
got
a
window
to
really
get
a
good
picture
about.
What's
going
on
with
this
agenda
in
in
other
people's
in
other
homes
that
we
haven't
looked
at
yeah,
so
that
piece
of
work
is
progressing
as
planned
and
I
just
wanted
to
respond
in
terms
of
Louis's
challenge
about
it's
really
important
that
we're
not
sitting
here.
While
these
reviews
take
place,
there
was
concrete
work.
That's
still
going
ahead
as
planta
to
move
forward
on
this
thanks.
A
Kate
so
I
think
the
the
the
the
independent
reviews
which,
just
to
reinforce
what
Ian
said,
are,
are
completely
independent
and
will
be
as
critical
of
us
as
they
feel
is
appropriate
things
anyway
in
to
them
they
are
really
important,
and
then,
meanwhile,
we
get
on
with
whatever
else.
We
think
we
can
do
to
improve
the
situation
and
minimize
the
risk
of
a
repeat
so
good.
Let's
move
on
then
to
the
next
item
in
which
is
that
the
executive
team
report,
please.
A
B
And
so
I'd
be
the
the
executive
team
reporter
has
a
number
of
publications,
I'll
hand
on
to
the
chief
executive
chief
inspectors
and
others
too,
and
the
other
directors
to
talk
about
that
shortly.
This
is
the
first
time
we've
been
using.
Microsoft
power,
bi
to
review
performance
and
and
non-executive
directors
will
be
given
access
to
that
shortly,
to
enable
them
to
do
deep,
dives
into
performance
in
future
months.
B
They
I
think
it's
worth
worth
noting
that
our
core
timeline
commitments,
particular
anticipation
and
registration-
have
all
started
well.
This
year,
I
think
I
was
also
pleased
to
see
the
safeguarding
referral
performance,
which
has
been
an
area
of
concern
in
previous
months,
has
hit.
100%
enforcement
levels
are
are
similar
to
last
year,
which
I
think
is
an
important
point
of
things.
Sometimes
in
the
press
work
we
often
seem
to
be
taking
more
and
more
enforcement
than
perhaps
has
been
the
case
in
previous
years.
That's
not
currently
the
case.
B
I
was
also
pleased
that
sickness
levels
are
broadly
on
track
and
I
think
that's
good
in
one
sense,
but
we
what
we,
what
we're
doing,
what
we're
doing
this
year
is
looking
at
something
called
the
Bradford
factor,
which
is
a
composite
measure
that
looks
at
sickness,
both
in
terms
of
numbers
of
days
absent,
but
also
frequency
of
sickness.
So
therefore,
it
gives
us
a
much
more
intelligent
view
of
sickness
and,
and
it
gives
us
a
view
of
why
people
are
sick
and
they
in
turn,
talks
to
engagement
and
a
whole
range
of
other
things.
B
So
I
think
that's
this.
Give
me
that
that's
a
that's
a
useful
development
and
then
finally,
from
a
financial
position,
I
think
we
started
the
start
of
the
year
with
a
with
a
small
overspend
in
the
month
of
April.
No
Chris
and
colleagues
are
working
hard
to
to
get
behind
the
detail
of
that,
and
we
will
be
working
working
hard
to
make
sure
that
we
get
the
budget
back
on
track.
Thanks,
Peter
great.
C
You
very
much,
sir,
in
terms
of
the
the
publications
that
that
we've
got
coming
out
at
the
moment.
We've
already
mentioned
the
review
of
restraints
seclusion
segregation.
A
very
important
report
and,
as
colleagues
have
already
expressed,
is
very
important.
We
follow
up
on
that
report
and
complete
the
review,
so
that
is
going
to
be
a
major
part
of
our
work
going
forward
today.
C
We're
also
publishing
a
a
update
on
driving
improvement
in
independent
hospitals,
study
from
eight
independent
hospitals
who
improved
significantly
ratings,
and
the
themes
in
that
are
very
similar
to
the
previous
driving
improvement
reports.
We
produced
that
this
is
about
leadership,
culture,
engagement
and
building
all
the
CQC's
findings
and
and
I
think
it's
very
encouraging
that
the
case
reports
are
there
highlight
how
those
individual
hospitals
have
used
the
CQC's
findings
to
drive
improvement
and
we've
seen
real
improvement
over
the
last
few
years.
C
This
is
looking
at
the
Mental
Health
Act
code
of
practice
and
what
we've
learned
about
that
in
the
last
year,
in
the
light
of
Sun
witness
report
on
the
Mental
Health
Act
and
the
way
for
it,
so
an
important
reporting
context
in
terms
of
providing
evidence
how
effective
the
code
is
being
implemented.
At
the
moment,
colleagues
would
have
seen
previous
reports
on
that
where
we
expressed
some
dissatisfaction,
the
implementation
of
the
code-
and
this
is
the
if
you'd
like
the
latest,
our
latest
position
on
that
now
next
week,
we're
publishing
the
2018
inpatient
survey
results.
C
This
is
the
biggest
survey
of
inpatients
that
takes
place
every
year.
It
is
a
very
important
part
of
the
year
in
assessing
how
patients
experience
of
inpatient
care
has
changed
over
the
last
year,
so
that
will
be
important
next
week
and
we
will
be
publishing
shortly
some
guidance
on
effective
staffing
looking
at
how
services
have
improved
the
way
they're
using
their
staff
more
flexibly
to
be
more
productive
and
improve
the
quality
of
care.
C
This
is
really
important
part
of
what
we're
trying
to
do
with
providers
encouraging
them
to
innovate
around
staffing
practices
in
a
way
that
is
safe,
but
not
in
a
way
that
is
very
rigid,
I
think
a
lot
of
writers
sometimes
take
a
very
rigid
approach
to
our
guidance,
and
we
want
to
emphasize
that
we
are
flexible.
You
know
how
staffing
takes
place,
provided
this
is
done
in
a
considerate
and
safe
way,
and
so
there
are
opportunities
to
learn
from
those
people.
I
We've
got
an
upcoming
publication,
which
is
the
defense
medical
services
annual
report
we're
in
the
second
year
of
working
with
the
Surgeon
General,
to
look
at
the
defense
medical
services
and
the
reports
going
to
show
our
findings
over
the
last
year.
Just
to
mention
that
we're
getting
very
positive
feedback
from
the
defense
medical
services
by
our
joint
work
with
them.
And
that's
highlighted
in
the
report
as
well.
So
that's
being
published
in
early
July.
A
J
Of
all,
to
make
the
board
aware
of
our
work
following
the
passing
of
new
legislation,
the
Mental
Capacity
Amendment
Act
2019,
which
became
law
last
month.
This
is
a
very
important
legislation
because
it
describes
how
people
in
care
settings
can
be
deprived
of
their
Liberty
if
they're
seen
to
not
have
capacity
to
decide
for
them
for
themselves.
Cqc
over
the
last
few
years
has
raised
issues
with
the
previous
so-called
the
privation
of
Liberty
Safeguards
and
their
implementation
of
these
rules
and
the
challenges
around
them,
and
this
legislation
is
going
to
address
some
of
these.
J
Some
of
these
challenges.
The
legislation
is
going
to
expand
the
the
rules
on
what
is
now
going
to
be
called
Liberty
protection
safeguards,
including
to
younger
people
and
to
people
in
in
their
home
settings
or
shared
living
arrangements.
So
that
has
implications
for
CQC's
duty
to
oversee
the
implementation
of
previously
the
deprivation
of
Liberty
Safeguards
and
now
the
Liberty
protection
safeguards
they're
going
to
be
implemented
in
October
next
year,
2020
and
we're
currently
working
to
fully
scope
out
the
implication
for
CQC
and
make
the
morality
of
reality
in
our
operational
approach
by
and
by
October.
A
K
We've
done
some
work
around
finalizing
our
portfolio
to
make
sure
that
the
programs
we
have
in
our
change
portfolio
are
really
well
aligned
to
our
strategy
and
really
going
to
deliver
against
our
business
priorities
moving
forwards.
We
have
now
created
our
PMO.
That's
our
project
management
office
and
put
the
resources
in
there
and
start
to
build
the
processes
to
support
effective
delivery
of
change
through
regular
reporting
managing
of
the
portfolio.
We've
also
done
some
work
to
onboard
our
Qi
partner.
K
K
We
have
a
number
of
strategic
programs
in
place.
Our
registration
transformation
program
is
making
a
progress.
We
are
well
into
our
initial,
a
private
beta
stage
of
the
first
end-to-end
piece
around
delivering
adult
social
care
to
agencies
and
that's
looking
at
registration
from
the
start
of
the
process
right
through
to
the
end
and
we're
making
really
good
progress
in
that
space,
using
service
design
methodologies
to
ensure
that
we
ask
the
right
questions
and
deliver
against
the
right
right
area
of
work.
K
We're
also
making
some
really
good
progress
around
the
quality
improvement
elements
of
that
driving
improvements
in
the
work
that
we're
doing
to
lean
out
lean
out
our
systems
and
prices.
So
there
is
efficient
as
they
can
be,
and
we
can
really
start
to
see
some
really
good
progress,
though
in
terms
of
saving
time
off
the
time
it
takes
from
an
application
coming
in
to
us
making
a
decision
and
notifying
providers
future
HP
services.
K
Well
and
efficiently,
we
have
a
number
of
projects
working
within
that
program
to
look
at
both
how
we
can
improve
how
we
can
improve
our
data
gathering
and
how
we
can
use
our
data
to
really
look
at
helping
us
make
informed
regulatory
decisions
and
also
look
at
our
operating
model
in
the
future
and
what
that
might
mean
to
it
to
look
at
and
we're.
Dudes
are
working
in
discovery
stage
to
really
to
understand
and
scope
out
what
we
might
want
to
look
at
in
that
space.
K
Also
in
there
is
some
programs
and
work
to
look
at
how
we
can
share
so
how
the
public
can
share
their
experiences
of
care
with
us
one
of
our
programs
we
have
in
this
place.
It's
called
tell
us
about
your
care
and
that's
a
new
system
to
make
it
easier
for
people
to
tell
us
about
the
experiences
they've
had
with
care.
That's
now
in
private,
beta
and
I'm
hope
we'll
get
that
into
the
public
public
beta,
which
means
we'll
actually
have
a
live
service
up
and
running
at
some
point
in
the
autumn.
K
In
terms
of
our
people,
we
are
continuing
to
work
on
on
our
vision
and
our
culture
to
think
about
what
it
that
there
needs
to
be
for
the
future
in
terms
of
what
we
want
this
organization
to
look
and
feel
like
we
are,
we've
started
to
work
on
that.
We've
got
more
work
to
do
in
this
space
and
it's
very
much
the
focus
of
the
executive
team
and
our
leadership
team
moving
forwards.
K
We've
also
done
some
more
work
around
our
attraction
and
retention
and
looking
at
our
pay
structures
and
look
at
how
we
can
simplify
those.
We
are
hoping
that
we'll
have
our
file
and
our
business
case
finalized
for
our
pay,
which
will
enable
us
to
do
more
around
simplifying
those
structures
and
making
easier
to
understand
the
structures
that
we
currently
have.
K
We
also
have
done
some
work
around
our
well-being
and
workload
and
we're
looking
at
putting
in
some
processor
processes
to
or
have
put
in
some
prices
now
as
a
resource
oversight
to
help
manage
supply
and
demand
across
the
organization.
So
we
can
match
skills
with
the
right
place
in
the
organizer,
so
we
can
match
skills
with
the
demand
and
move
people
around
much
more
effectively
to
manage
both
our
vacancy
factors
and
also
ensure
that
we
can
get
people
in
to
post
quickly
and
effectively.
Our
diversity
and
inclusion
is
really
core
to
what
we're
doing.
K
L
Thanks
Kirsty,
so
we've
got
a
number
of
initiatives
in
progress
to
transform,
add
to
stall
capabilities,
to
give
our
colleagues
the
digital
tools
to
do
their
jobs,
to
support
our
vision,
to
become
intelligence-led
and
to
improve
digital
services
to
providers
and
to
the
public.
In
the
short
term,
there
are
a
number
of
projects
in
progress
which
will
complete
by
the
end
of
this
year.
This
includes
projects
intended
to
ensure
our
colleagues
have
got
access
to
the
appropriate
technology
and
includes
things
like
laptops,
smartphones,
improving
broadband
office,
Wi-Fi
metering
technology,
etc.
L
We
also
have
in
progress
initiatives
to
improve
the
performance
of
our
analytics
capabilities
and
introduce
new
analytics
and
reporting
tools,
which
will
also
be
completed
by
the
end
of
this
year
longer
term.
We're
making
really
great
progress
in
initiating
a
program
to
migrate,
all
of
our
foundational
IT
services
into
a
new
digital
service
delivery
model
and
finally,
we're
formulating
a
business
case
to
deliver
a
replacement
to
our
core
CRM
technologies
into
more
suitable
alternatives,
and
this
complex
multi
year
rolling
initiative
which
seeks
to
improve
those
core
applicate
that
application
services
to
support
our
regulatory
activity.
A
So
I
get
exhausted
just
listening
to
what
what
you're
holding
but
more
seriously
I
think
just
a
congratulations
to
you,
Kirsty
and
your
team
for
what's
going
on,
and
it's
also
a
huge
amount
still
to
do
but
I.
It's
feeling
really
good
now
and
I'd
like
to
congratulate
you
similarly
mark
I
think
Gamelab.
It
feels
good
that
we're
now
getting
our
arms
around
these
use
as
we
need
to
so.
Thank
you.
A
We
might
also
cursed-
you
didn't
mention
it,
but
it's
in
your
written
report,
when
the
board
might
like
to
congratulate
Debbie
Westhead
on
her
appointment
as
director
of
improvement.
Debbie,
of
course,
was
a
constant
feature
at
the
board
for
the
first
few
months
this
year
until
Kate
arrived
so
well
known
to
us
all.
It's
great
I'm,
really
good
news.
Any
questions
for
mark
or
omok.
D
A
D
I
just
wondered
on
people
where
there
are
survey,
actions
that
were
communicated
to
the
board
several
months
ago
following
the
survey
just
where
they've
got
to
and
if
we're
not,
you
know,
I'm
not
asking
for
a
response
now,
but
I.
Just
wonder
whether
that
could
be
part
of
an
ongoing
piece
of
work
from
you.
And
so,
if
you
could
just
comment
on
that.
D
K
K
We
probably
just
need
to
come
back
and
refresh
that
one
again,
just
to
make
sure
that
we've
got
the
right
people
leading
on
the
right
right
areas,
I
know,
and
then
so
we
have
those
key
priorities
and
then
a
sitting
underneath
that
we
challenge
each
of
the
individual
directorates
and
the
team
sitting
under
them
to
make
sure
that
they
also
have
that
change
that
their
response
is
tied
up
with
it
was
all
neatly
aligned.
I
know
something
from
my
Directorate,
that's
what's
happening
and
I
know
from
the
work
across
other
other
across
the
organization.
K
D
D
D
I
had
to
say
a
slightly
challenged
by
the
number
of
lines
and
colors,
but
perhaps
I
can
you
know
do
something
about
that
myself,
but
I
really
had
three
questions
so
Kirsty,
the
the
vacancy
factor,
which
is
which
is
now
a
feature
in
the
people
and
learning
piece
or
part
of
that
balanced,
scorecard
I'm.
Just
assuming
that
that
number
is
excluding
the
transformation
resources.
K
It
is
that's
the
vacancy
factor
that
the
individual
directorates
have
in
order
to
manage
their
budgets.
We
do
look
at
that
across
the
organization
and
that's
part
of
that
work.
I
talked
about
around
putting
the
input
the
resourcing
central
resourcing
oversight
group
together
to
help
us
that
vacancy
factor
to
enable
to
help
people
come
in
within
their
budgets
and.
D
Could
I
say
I
think
it's
great
that
we've
got
more
people
kpi's
and
especially
with
Rena
here
I
think
it's.
You
know.
We
have
a
commitment
to
the
networks
and
a
commitment
to
deliver
on
the
challenges
made
to
us
as
an
organisation
from
Klein
report.
So
it's
really
good
to
see
that
we've
got
a
KPI.
We
don't
have
a
measure
for
it
yet,
but
we've
got
the
KPI
there
around
underrepresented
groups,
around
recruitment,
career
and
development
opportunities
and
I.
Think
that
that's
a
really
positive
step
forward.
D
So
I
really
thank
the
executive
team
for
moving
that
part
of
the
agenda
forward
and
then,
if
I
could
just
finally
ask
Chris
a
question
about
the
finance
update
where
we
we
note
that
there's
a
negative
trend
at
the
beginning
of
the
year
and
then
there's
a
piece
of
work
that
I
know
you're,
leading
about
budget
and
capital
revenue.
Split
this
and
and
what
I'm
not
sure
about
is
whether
that's
good
news
or
bad
news.
So
could
you
could
you
perhaps
comment
on
that?
Yeah.
M
So
so
we're
early
into
the
year,
but
the
the
trend
is
showing
an
adverse
position
for
the
year,
so
we're
looking
at
that
across
Directorate.
So
that's
not
a
good
good
part.
At
the
same
time,
we're
still
assessing
the
change
program.
So
there's
a
piece
of
work
ongoing
in
the
minute
around
resources
for
our
change
program
and
and
that
as
we
as
we
get
in
the
business
cases
to
its
really
standard
to
find
this
split
between
capital
and
revenue
funding
and
we're
concluding
that
work
at
the
end
of
this
month.
M
So
from
that
that
will
give
us
more
clarity
on
what
is
our
revenue
position?
Look
like
for
the
earn?
What
is
our
capital
position
so
I'll
bring
that
I'll
keep
board
update
on
that,
but
we
just
need
to
conclude
that
bit
of
work
before
we
have
a
full
of
position,
but
at
the
same
time
as
discussions
at
80
around
the
director
of
performance,
which
we
can,
we
can
have
anywhere.
A
B
It's
not
a
question
just
picking
up
on
Mark's
point
actually
around
this
there's
a
wider
problem,
I
think
across
governments
around
this,
this
capital
revenue
split
because
I
think
increasingly,
organizations
like
ours
are
increasingly
buying
consuming
technology
services,
in
particular
that
work
conclude
we
as
soon
as
you
start
buying
services
from
the
cloud.
That's
all
that's
the
latest
thing.
It's
the
right
thing
to
be
doing
operationally,
but
that's
actually
a
revenue
activity,
not
a
capital
activity.
So
in
the
olden
days
you
would
just
buy
more
servers.
B
Now
you
buy
more
service
and
and
I
think
I.
Think
government
agencies
in
particular
are
the
revenue
capitis
Blair's,
just
not
kept
up
with
the
operational
reality
of
cloud
services,
so
I
think
it's
going
to
be
an
issue
in
the
next
sort
of
year.
18
months
across
across
the
whole
of-
and
you
know
where
the
Chris
is
doing
is-
is
simply
part
of
that.
E
Lois
I'm
first
asked
about
enforcement
again,
if
only
for
the
reasons
of
tradition,
the
the
as
you
know,
I've,
put
forward
the
idea
that
we
should
have
more
detailed
information
about
how
enforcement
proceeds
not
just
the
outcomes
so
that
we
can
understand
the
process,
but
because
we
have
we
used
to
have
in
our
the
previous
performance
report,
different
ways
of
reporting
on
or
providers
who
are
in
breach.
How
long
they'd
been
in
breach
those
that
are
in
special
measures
and
the
kind
of
enforcement
action
that
we'd
taken.
E
But
those
were
all
separate
strands
of
information
and
it
was
it
was.
It
was
useful,
there's
no
question
of
useful
it
and
it
reminded
us
every
time
we
met
that
there
were
four
or
five
hundred
organizations
and
special
measures,
which
was
a
very
important
thing
for
us
to
be
aware
of
and
I,
but
it
what
it
didn't
do
was
fit
together
and
tell
a
story
about
how
enforcement
was
taking
place.
E
It
looked
like
we
were
taking
less
enforcement
action
during
the
course
of
the
last
year,
step
by
step
and
I
can't
believe,
that's
true,
so
it
must
be.
There
must
be
some
other
explanation
for
why
we've
set
it
out
in
the
as
monthly
figures
and
I
don't
mind.
If
we
don't,
you
don't
explain
that
right
now,
but
it's
just
an
example
of
how
they
at
face
value.
The
information
can
look
quite
superficial
and
the
detail
that
lies
behind.
It
is
probably
the
thing
that
we
need
to
know.
B
B
We
perhaps
need
to
get
into
some
kind
of
regular,
deep
dive
cycle
cycle
of
reporting
every
four
to
six
months
or
something
which
may
enable
that
narrative
conversation
to
take
place,
albeit
sub
sub,
supported
with
numbers,
but
I
think
we
have
traditionally,
as
you've
said
many
times,
I
think
struggled
to
to
try
to
get
behind
the
detail
of
what
otherwise
just
look
like
aggregations
of
things,
and
you
miss
that
what's
actually
really
happening.
While
the
trends
which
I
think
is
what
we
all
really
want
to
see.
B
A
H
H
Thank
you,
and
so
this
agenda
item
is
an
opportunity
for
us
to
share
with
the
board
some
key
facts
about
the
work
of
the
market
oversight
team
and
what
they've
been
doing
over
the
last
financial
year,
but
also
some
reflections
of
the
kind
of
unique
position
they
have
about
the
work
they're
doing
with
providers
so
I'm
at
this
point
I'll
hand
over
and
to
shoot,
Stuart
Dean
who's,
director
of
the
market
oversight
team
to
walk
you
through
your
short
slide
deck.
Thank.
N
It's
a
two-pronged
notification,
and
the
reason
for
that
is
because
there's
a
general
acceptance
that
the
market
can
typically
accommodate
ongoing
small-scale
business
failure.
So
that's
why
it
links
service
cessation
as
a
result
of
likely
business
failure.
There's
no
remit
within
the
market
oversight
pass
to
prevent
failure
and
the
detail
of
the
guidance
and
the
providers
that
are
captured
by
the
scheme
is
published
on
the
CQC
internet
site.
So
a
couple
of
facts
on
page
four
there's
currently
around
60
providers
in
the
scheme
that
covers
approximately
25
percent
of
the
care
home
market
in
England.
N
If
we
look
at
the
higher
risk
classifications
and
the
published
operating
model
than
there
has
been
a
twenty
seven
percentage
point
deterioration
in
that
risk
profile
since
launched
in
April
2015,
and
we've
made
no
further
Stage
six
notifications,
since
I
must
presented
in
December.
So
since
the
scheme
was
launched,
one
very
much
a
technical
notification
and
as
far
as
I'm
concerned.
N
Yes,
it
met
the
criteria
for
making
gay
notification,
but
it
was
a
single
home,
a
single
local
authority
and
the
one
that
obviously
caught
more
attention
was
the
corporate
wide
notification
that
we
made
on
allied
health
care
later
on
last
year.
We
do
also
fall
back
on
to
wider
CQC
powers
as
and
when
the
need
arises
to
ensure
that
objectives
and
endeavors
to
discharge
the
motto,
site,
regulatory
responsibilities
and
and
mind
and
I
think
it's
also
important
to
sort
of
emphasize
the
unseen
influence
of
Marc's
oversight.
N
I
was
going
to
now
talk
a
bit
about
the
latest
consolidated
data
trending,
which
starts
on
slide
five,
so
this
captures
data
predominantly
to
December
2018.
It
is
predominantly
because,
unfortunately,
the
inflation
returns
that
we
have
from
the
providers
in
the
scheme
don't
nicely
land
on
the
same
period
end.
So
it's
broadly
two
December
2018
and
it
covers
the
like-for-like
data
analysis
for
54
of
the
60
days
currently
in
the
scheme,
so
a
meaningful
representation,
but
importantly
on
a
like-for-like
analysis.
N
N
N
The
reason
why
it
is
pegged
that
high
is
purely
a
result
of
the
information
that
we're
provided
with
by
way
of
the
financial
templates,
notwithstanding
that
it
provides
us
with
a
directional
proxy
for
not
only
profit
but
also
what's
happening
to
the
underlying
businesses
and
what
we're
seeing
there
is
continued
margin
attrition
to
the
tune
of
one
cent
over
the
two-year
period.
I
think
what's
important,
see
if
you
look
at
the
chart
on
the
top
right
corner
on
the
slide
on
page
five.
N
Is
that,
notwithstanding
the
increase
in
turnover
per
V,
two
green
columns,
which
in
part
is
driven
by
both
a
increased
proportion
of
private
pay,
was
also
increased
local
authority
fee
increases?
Those
increases
have
not
been
able
to
keep
pace,
with
the
increased
costs
that
these
businesses
are
facing
and
that's
predominantly
staff
ghos.
Both
permanent
labor
costs,
as
well
as
agency
costs,
the
negative
impacts
or
margins
is
more
significant
in
care
home
businesses
that
are
predominantly
funded
by
the
taxpayer.
N
So
for
the
public
purse,
and
in
this
latest
analysis
it's
three
times
higher
occupancy
continues
to
be
under
pressure
during
this
period,
which
again
can
is
still
pegged
back
to
the
harsh
winter
last
year,
where
there
was
an
unprecedented
level
of
deaths
in
the
sector,
and
it
does
take
time
and
these
businesses
can
only
recover
at
a
certain
rate,
assuming
that
there
is
the
admissions
pipeline
to
actually
back
fill
the
vacancies
that
that
creates.
The
other
important
points
about
that's
driving.
N
Six
is
really
to
try
and
develop
sort
of
outlook
in
terms
of
given
what
we
know
about
the
sector.
As
far
as
possible,
what
might
the
sort
of
outlook
be?
So
we
know
from
sort
of
the
market
that
there
are
sustained
staff
cost
pressures
and
that
those
are
exceeding
local
authority
fee
increases,
which
they
would
suggest
that
existing
market
fragility
is
unlikely
to
improve
in
the
short
term
based
on
realistic
cost
increases
in
the
next
12
months.
N
So
that
uses
the
nmw
percentage
increase
that
was
sort
of
in
play,
see
it's
not
living
wage
April
and
her
pension,
auto
enrolment,
as
well
as
a
probably
a
conservative
estimate
for
continued
agency
cost
increases,
as
well
as
the
published
retail
price
index
increase
for
the
next
12
months,
when
you
roll
all
of
that
together
if
the
providers
are
likely.
So
this
is
a
forecaster
there's,
no
certainty,
but
if
they're
likely
to
stand
a
chance
of
being
able
to
preserve
their
existing
margins,
then
that
would
require
a
fee
uplift
of
the
tune
of
5.7%.
N
The
feedback
from
the
sector
that
we're
receiving
when
we're
sort
of
having
our
engagement
meetings
is
that,
typically,
that
level
of
fee
increases
and
happening.
It's
far
nearer
the
three
and
a
half
percent
and
there's
a
result.
When
you,
you
make
the
same
assumptions
that
I've
just
countered
through
the
impact
on
profit
margins,
there
would
be
a
further
1.6
percentage
points
at
Rishon,
so
between
1
and
2%,
but
it
remains
to
be
seen
and
I
would
say.
The
key
vulnerability
to
this
analysis
is
what
happens
to
labour
costs
both
on
a
permanent
and
agency
basis.
N
D
K
N
The
because
the
scheme
is
the
vast
majority
of
companies
captured
by
the
scheme
are
captured
because
their
overall
size
and
the
way
in
which
we
capture
the
financial
performance
is
to
look
at
the
group
level.
So
what
I'm
saying
is
our
ability
to
actually
distill
the
information
down
onto
a
regional
basis
is
very
limited
when
we're
in
an
effort
to
discharge
the
primary
responsibility
of
the
scheme,
trying
to
be
proportional
and
reasonable,
with
the
information
requests
that
we're
making
of
the
providers.
So
that
is
something
that's
very
difficult
for
us
to
do.
N
What
we
do
do
is
by
working
with
partner
organizations
and
anecdotal
sort
of
conversations
that
we're
having
with
providers
and
also
where
a
situation
allows
perhaps
there's
been
quite
public
contract
hanboks
that
has
happened
in
certain
situations,
is
to
sort
of
capitalize
on
that
and
again
or
in
getting
insurance
brought
into
the
conversation
both
with
the
Department
LGA
aid,
us
etc.
But
we
are
limited
as
to
the
detail
of
the
regional
work
that
we
can
undertake,
because,
frankly,
I
don't
have
that
information
as
a
starting
platform,
but.
F
Given
the
analysis
contained
in
your
slide
deck,
which
is
those
providers
that
depend
upon
local
authority
paid
for
as
against
pay
paid
privately
I'm
going
to
have
a
harder
time,
then
those
providers
that
are
within
those
local
authorities
will
be
more
at
risk
than
those
that
are
having
likely
to
be
less
than
those
that
are
probably
faithful,
and
that
would
be
a
North
versus
South
problem.
That's.
G
N
So
as
a
starting
point,
these
businesses
are
operationally
levered.
So
what
that
means
is
that
they
have
high
fixed
cost
basis
and
therefore
any
change
if
there
is
a
disproportionate
impact
of
a
change
in
turnover
in
terms
of
what
then
flows
through
to
profit,
that's
whether
into
whether
turnover
increases
or
whether
turnover
reduces.
A
A
Why,
today,
those
what
I
was
gonna
say
Stewart
is
that
right
at
the
start,
you
you
had
a
slide
that
talked
about
the
the
unseen
influence
of
market
oversight
and
I'm
in
the
sort
of
privileged
position
have
been
over
to
see
that
unseen
influence
and
it's
really
huge
I.
It's
a
great
pity
you
that,
for
a
whole
pile
of
very
sensible
reasons,
it
has
to
be
unseen,
but
it's
worth
just
saying
to
you
and
your
team
that
the
work
you
do
is
really
important
and
that
unseen
influences
is
huge,
I'm
very
valuable.
A
A
C
What's
in
visitor
that
category
realistic
plans
in
place
and
getting
greater
insights
and
ability
to
report
progress
there,
both
of
the
board
and
and
generally
say,
congratulations
to
the
team
on
that
I
think
we've
made
a
made
a
lot
of
progress.
We
have
also
made
a
progress
on
the
that
the
change
program
itself.
C
C
C
The
management
of
its
management's
own
processes
of
assurance,
which
are
really
very
commendable
in
the
way
that
they
go
through
a
thorough
basis,
management
looking
at
his
own
basis,
for
big
assured
that
it
has
sound
controls
and
certain
financial
reporting
came
in
with
some
some
some
really
good
responses
on
that,
and
they
marked
on
a
basis
out
of
10,
and
there
are
some
areas
which
I'm
moving
into
10
out
of
10
on
that
which
is
really
really
quite
encouraging.
So
some
good
work
in
there.
C
We
need
to
keep
that
up
and
then
on
the
order
has
a
hole
in
the
financial
reporting
as
a
whole.
We
we
heard
a
bit
earlier
about
where
we
are
on
progress
there,
and
just
just
so.
We
can
summarize
that
there
are
world
two
areas
where
we're
just
finalizing
what
are
two
bits
of
their
financial
reporting
with
particularly
ourselves
and
then
also
get
in
there
neo
through
there,
their
final
crisis
that
looks
like
it's
all
on
track
for
a
clean
audit
report
in
due
course,
so
I
think
with
that
I'll
stop
and
bite
any
questions.
A
So
can
I
just
just
add
Paul
the
I
think
the
work
of
the
the
subcommittee,
the
changed
subcommittee,
which
and
I
came
in
towards
the
end
of
the
year.
You're
reporting
on
I
think
that's
been
a
really
useful
addition
to
the
work
of
your
committee.
So
thank
you
and
thanks
to
the
people
who
are
giving
up
a
lot
of
their
time
to
to
be
on
that
group,
any
any
questions
for
Paul,
so
Louis
we
move
to
what
is
your
swan
song?
We've
got
three
or
four
hours.
If
you
want.
E
Well,
just
briefly:
Vera
rgc
regulatory,
Governance,
Committee
and
two
things
too,
to
say:
first
of
all,
I'm
reporting.
This
is
the
annual
report
of
our
GC
and
also
there
is
the
slightly
postponed
report
on
the
most
recent
meeting,
so
just
putting
them
together.
Two
points
from
each
eye:
the
on
the
annual
report
we've
and
we
changed
the
way
our
GC
works
this
year.
E
The
second
was
on
dementia
and
the
third
was
on
inequalities
and
the
I
think
the
benefit
of
doing
that
has
been
that
it's
a
bit
more
aligned
with
some
of
our
future
work
on
inspecting
multiple
providers
within
a
within
a
sense
of
place
that
but
place-based
model
that
we
that
people
talk
about
I,
think
it
made
more
sense.
I
think
it
also
highlighted
that
within
CQC
we
weren't
always
certain
where
the
leadership
was
coming
from
in
some
of
these
cross-cutting
areas
and
and
because
many
of
the
inspectors
to
do
very,
very
good
work.
E
We
didn't
stop.
Looking
at
individual
areas
of
inspection
and
they're,
also
remarkable
in
their
own
way.
We
this
this
year
because
of
that
changed
towards
themes.
We've
also
we've
looked
at
what
have
ended
up
being
relatively
circumscribed
parts
of
the
CQC
remit
for
health
and
justice
and
children,
where
our
inspectors
work
alongside
other
inspectorate's
and
so
relatively
I,
suppose
unseen,
relatively
unsung
in
some
ways,
part
of
the
system,
but
incredibly
important
work
working
with
some
very
vulnerable
people
and
contributing
to
these.
E
These
broader
and
broader
multi-agency
inspections,
and
then
there
was
the
exposure
to
medical
radiation
inspection.
So
a
part
of
CQC
that
many
of
us
didn't
know
existed,
but
it
was.
It
was
fascinating,
partly
because
it
had
been
prompted
by
a
national
visit
by
the
International
Atomic
Energy
Agency,
and
so
you
know,
when
you
think
of
the
breadth
of
work,
sometimes
that
CQC
is
engaged
in
a
visit
from
the
International
Atomic
Energy
inspector
I.
Think
you
know
it's
not
something
that
most
people
think
we
do,
but
and
but,
but
they
are,
it
was.
E
It
is
fascinating
and
very
important
work,
because
radioactive
products
are
a
very
important
part
of
medical
provision,
and
yet
you
know
who
is
inspecting
them.
Who
is
ensuring
safety
that
comes
down
to
what
CQC
do
so
so
some
some
very
important
reporting
opportunities
and
some
very
important,
cross-cutting
themes
on
the
the
specifics
of
the
last
meeting,
which
was
a
couple
of
weeks
ago.
E
This
is
where
we
looked
at
inequalities
as
a
theme
I
just
want
to
mention
just
in
summary,
the
the
the
outcome
of
that
I
think
there
was
a
recognition
that
we
could
be
a
driver
of
a
greater
attention
to
issues
of
inequality
by
the
questions
that
we
ask
providers
and
those
questions
might
be
about
how
those
providers
are
meeting
their
obligation,
their
Equality
duties
under
legislation
and
all
for
that
matter,
under
existing
standards
and
I.
Suppose
the
race
equality
standard
is
the
most
obvious
example
of
that
now.
E
But
there
is
also
a
chance
for
us
to
say
as
an
inspector
that
we
want
to
know
how
has
a
provider
taken
into
account
the
demography
of
the
area
in
which
they're
providing
care?
What
are
they
they're,
if
they're
in
a
an
area
with
quite
mixed
ethnicity?
How
does
that
affect
the
provision
of
care
in
that
area?
And
so
so?
The
conclusion
was
that
that
is
a
role
for
us,
and
that
is
something
that
we
would
take
further
and
then.
E
Finally,
we
we
looked
at
something
which
is
in
the
terms
of
reference
of
rgc,
but
hasn't,
isn't
always
talked
about
needed
and
that's
how
whistleblowing
responsibilities
and
and
and
in
in
that
area.
We
we.
We
had
one
very
important
conclusion,
which
is
about
feeding
back
to
people
who
report
to
us
under
under
the
broad
heading
of
whistleblowing,
I,
think
it's
fair
to
say.
E
But
people
who
give
us
information
which
is
privately
presented
and
and
reflects
their
concerns
that
they
then
want
us
to
take
up
in
one
way
or
another
and
a
recognition
from
CQC
that
sometimes
we
don't
feed
back
to
them
enough.
What
we've
done
about
their
concerns
and
how
they've
influenced
our
inspection
plans
or
the
questions
that
we
might
ask.
A
Thank
you,
there's
any
questions
or
comments
for
fertilis,
it's
a
great
it's
a
great
committee,
Louis
and
I
go
to
most
of
your
meetings.
I
think
it's
every
single
one,
but
there
really
are
superb
nothing's
made
a
big
contribution
to
CQC,
takes
us
to
any
other
business.
A
matter
of
profound
regret
that
unusually
Bren
McInerney
is
not
actually
with
us.
Today
is
particularly
regretful
for
two
reasons:
one
actually
he
doesn't
live
very.
He
lives
closer
to
Bristol
and
he
does
to
London.
A
So
I
didn't
wear
brain
easy
tells
me
Mellie's
not
coming,
but
but
secondly,
I
wanted
to
be
able
to
say
publicly
to
him
in
person.
Our
congratulations
on
his
British
Empire
medal
that
he
was
awarded
in
the
in
the
Queen's
Birthday
Honours,
List
and
Ben's
been
a
superb
supporter
of
CQC
and
the
local
community,
particularly
in
Gloucester.
A
Although
he
sort
of
got
national
ambitions
because
Chris
you
and
I
spent
some
time
with
braining,
Coventry
and
I,
don't
know
where,
where
else
he's
gonna
go
next,
but
that
Birmingham
so
so
Brendan,
if
you
happen
to
watch
this
from
the
board
of
the
CQC.
Very
many
congratulations
on
your
your-your-your.
Your
honor
in
a
well-deserved
honor
in
though
in
the
Birthday
Honours,
secondly,
Louis
and
Paul
it's
your
last
meetings,
I
mean
as
a
a
matter
of
corporate
governance
as
a
matter
of
the
board
as
a
whole.
I
think
it
is
absolutely
right.
There
is
rotation.
A
That's
to
three-year
terms
is
probably
about
the
right,
the
right
time.
So
I
don't
know
corporate
level.
It's
it's
a
good
thing,
but
at
a
individual,
personal
level,
it's
a
tragedy.
I
mean
we're
going
to
miss
two
colleagues,
you
both
both
been
through
what
I've
referred
to
as
CQC
2.0.
So
you
you
you
both
came
in
at
the
time
when
CQC
was
at
its
lowest
level
and
been
a
huge
part
of
turning
it
around
and
building
it
into
the
organisation.
A
It
is
today,
and
you
made
a
huge
contribution
and
I
think
in
addition
to
that,
both
of
you
in
your
different
ways
have
been
a
huge
support
to
me.
I
mean
offline.
You
both
said
things
sometimes
and
always
agreed
with
everything
you
vice
you've.
Given
me,
but
it's
been
it
seriously.
It's
been
a
really
really
good
supportive
role
and
I've
valued.
A
Your
counsel
on
both
of
you
hugely
and
I
and
I
hope
that
will
continue
from
wherever
you're
you're
looking
at
things
that
are
going
on
here,
I'd
be
very
sad
not
occasionally
to
be
getting
in
from
both
of
you,
so
just
on
behalf
of
the
board
and
the
whole
of
CQC,
a
huge
thank
you
to
your
new
base.
By
the
way
you've
got
two
more
weeks
when
you're
still
on
the
hook
is
board
man,
but
it's
just
in
case.
Anything
else
happens,
but
this
will
be
your
last
board
meeting.
A
A
A
So
no
I'm,
sorry
I,
would
like
to
sit
down
with
you
and
professor
Baker
has
said.
He
would
would
like
to
sit
down
and
hear
what
you
have
to
say,
but
we're
not
doing
it
in
a
public
board
meeting,
because
it's
just
not
appropriate
to
do
this
in
public
I'm.
Really
sorry,
but
I
would
like
it
I
hope
you
won't
rush
off
professor
Baker
and
I
have
agreed
before
the
meeting.
We
would
like
to
sit
down
and
talk
to
you
and
hear
hear
your
stories.
It's
not
that
it's
not
important.