►
From YouTube: CQC Board Meeting 19 June 2013
Description
Agenda for the meeting of the Care Quality Commission on 19 June 2013:
1. Apologies and Declarations of Interest 00:00:01
2. Minutes of the meeting held on 22 May 00:00:14
3. Matters Arising and action log 00:00:49
4. Morecambe Bay Review - Grant Thornton 00:00:58
5. Chief Executive's Report 00:59:31
6. Finance Report 01:06:31
7. Transformation Project Update 01:16:15
8. Consultation on Regulatory Review 01:33:41
9. Winterbourne View update 02:07:28
10. Themed Inspections 2012/13 -- Follow up Activity 02:38:48
11. State of Care report 02:49:43
12. Statement of User Involvement 02:59:38
13. Board sign off -- T5 Business Case rework 03:09:03
14. Healthwatch England 03:15:48
15. 5 ARAC Annual Performance Report 03:16:20
16. Report back from Remuneration Committees held on 20 and 28 May
17. Report back from the National Information Governance Committee's first meeting
18. Board Forward Plan
19. AOB
Read more about CQC's Board Meetings at
http://www.cqc.org.uk/public/about-us/our-people/board-members/board-meetings
A
B
A
Okay,
all
right
claire
thanks
thanks
anna
anyone
else,
any
minutes
all
right
right.
Thank
you.
Can
we
take
the
matters
of
rising
as
we
go
through
the
agenda?
I
think
they're
all
covered
actually
in
the
agenda
and
if,
for
some
reason,
one
isn't
at
the
end,
we'll
pick
it
up
at
the
end,
and
so
it
goes
straight
into
the
and
the
grant
thornton
report
which
everyone
has
had
a
copy
of,
and
before
we
have
the
discussion.
A
C
C
C
If
members
of
the
board
were
to
refer
to
people
by
name
of
course,
that
might
fill
in
the
blanks
allowing
a
claim
or
some
challenge
to
the
report,
and
my
advice
would
be,
therefore
that
the
board
should
adopt
the
same
anonymization
scheme
as
has
been
set
out
in
the
report
in
discussing
it.
I
hope
that
makes
sense.
Of
course,
if
there's
anything
else,
I
can
help
with.
Please
do
say.
A
B
Sorry
this,
I
think,
there's
a
precursor
which
I'd
quite
like
to
understand,
which
is
I
understand
that
a
report
has
been
anonymized
and
and
and
that
it
would,
I
mean
actually
being
relatively
new
to
the
board,
I'm
not
in
a
position
to
name
any
of
the
individuals,
so
it
doesn't
apply.
But
I
mean
I
but
by.
B
And
I
think
that
I
suspect
that
probably
rests
on
the
difference
between
a
report
of
this
sort
and
something
like
the
francis
report,
which
was
has
a
different
status
in
law
and
therefore
a
different
position
in
terms
of
its
ability
to
name
names
rather
than
keep
names
anonymous.
And
I
just
I
would
find
it
helpful
if
you
could
explain
that
for
us
and
I'm
sure
other
people
would
like
to
know
the
answer
to.
C
Well,
exactly
that
there
is
in
a
report
of
this
nature's
still
the
possibility
that
individuals
named
might
make
claims
for
defamation
or
that
their
data
protection
rights
have
been
breached
and
in
order
to
prevent
that
possibility.
As
far
as
it's
possible,
the
decision
was
taken
by
the
authors
of
the
report
to
anonymize
names.
A
D
C
D
I
I
mean
I
I'm
not
a
lawyer,
so
I'm
not
in
position
to
be
able
to
debate
the
legalities
of
this,
but
I
found
the
report
very
frustrating
because
it
wasn't
clear,
even
though
I'd
been
on
the
board
for
a
few
years,
it
wasn't
clear
to
me
who
some
of
these
people
were,
and
at
some
point
I
think
we
do
clearly
as
a
board
need
to
discuss
who
they
are
and
what
actually
happened.
We'll
come
on
to
that
in
a
minute,
so
be
helpful
to
understand
how
we're
going
to
do
that.
E
So
when
I
arrived
in
my
role
as
chief
executive
of
cqc
at
the
end
of
january
last
year,
there
was
an
outstanding
complaint
raised
by
board
member
case
sheldon
about
the
decision-making
in
relation
to
uhmb
and
that
contained
the
allegation
that
there
was
a
cover-up
as
the
incoming
chief
executive
and
accounting
officer.
I
wasn't
prepared
to
let
that
stand
at
the
beginning
of
my
role
with
cqc
and
therefore
discussed
with
the
denture
commissioning
an
independent
investigation
of
our
decision
making
in
relation
to
uhmb.
E
E
What
I'm
going
to
do
now,
chair,
if
I
may,
is
just
present
the
report
in
what
I
think
are
three
chunks.
The
first
chunk
is
to
deal
with
the
three
issues
from
what
the
report
refers
to
as
a
complainant.
The
father
of
the
child
that
died
I'll
then
proceed
to
the
11
questions
that
was
raised
by
our
board
member
and
is
referred
to
in
the
report
as
the
whistleblower
and
then
I'll
deal
with
the
internal
investigation
into
cqc
and
go
through
that.
F
E
So,
if
I
can
turn
to
the
three
issues
raised
by
the
complainant,
the
first
one
was
did
cqc
make
its
own
independent
decision
about
the
action
to
take
following
an
investigation
case,
referral
from
cqc's
north
west
regional
team
in
2009,
which
concerned
five
serious
untoward
incidents
that
occurred
at
university
hospitals
of
more
convey
maternity
services
in
2008,
one
of
which
involved
the
death
of
a
named
baby,
and
to
summarise
the
conclusion
in
the
report.
This
is
content.
E
The
relevant
pages
in
the
report
that
colleagues
have
got
in
front
of
them
is
34
to
69
and
then
286
to
287,
and
I
summarised
the
conclusions,
but
it
in
this
way.
The
decision
not
to
investigate
at
the
time
was
a
missed
opportunity
by
cqc,
but
cqc's
decision
was
independent
and
there
was
no
evidence
of
any
attempt
to
interfere
with
the
decision-making
process
in
terms
of
the
second
issue
that
was
raised,
which
was
concerning
the
nature
of
cqc's
involvement
with
the
parliamentary
and
health
ombudsman
service
and
what
evidence
is
there?
Regarding
that?
E
Information
was
available
at
the
time
that
should
have
caused
cqc
to
reflect
on
whether
there
was
a
need
to
register
uhmb
with
conditions.
However,
neither
the
trust
through
the
fielding
report
nor
the
pct
inform
cqc
in
a
timely
way
about
these
specific
pieces
of
work
or
the
emerging
findings.
Cqc
said
that
the
concerns
they
were
aware
were
being
addressed,
and
I
think
they
conclude
that
cqc
was
insufficiently
skeptical
and
was
too
accepting
of
the
assurances
given
and
relied
too
heavily
on
unverified
data
and
information.
E
E
The
first
question
was:
why
did
cqc
not
identify
any
of
the
serious
issues
with
the
trust
maternity
services
that
were
clearly
around
in
july
2010
and
a
summary
of
the
conclusions
of
the
report
were
that
cqc
should
have
identified
the
concerns
that
were
identified
in
the
field
and
report.
This
report
was
finalized
in
august
2010
and
by
the
pct
in
both
february
2010
and
may
2010.
E
Uhmb
did
not
share
this
information
with
cqc
at
the
relevant
time
and
when
cqc
learnt
of
it,
there
was
a
significant
delay
before
obtaining
the
report.
Cqc
then
failed
to
follow
up
after
learning
that
north
lancashire
pct's
concerns
in
june
2010,
and
there
was
a
lack
of
involvement
by
specialists
in
cqc's
june
2010
inspection.
E
E
E
E
A
follow-up
review
was
planned
for
december
2011,
but
this
did
not
occur
at
the
time.
Gold
command
and
a
diagnostic
review
was
in
place.
There
was
a
decision
made
by
cqc
at
the
time
that
the
inspection
would
be
conducted
once
this
additional
support
was
withdrawn,
so
that
it
could
more
fully
assess
the
sustainability
of
any
changes
being
made.
E
Cqc's
policy
at
the
time
was
not
clear
as
to
whether
a
follow-up
inspection
was
required
following
the
deadline
for
compliance
set
out
in
a
warning
notice.
Cqc
apparently
carried
out
an
inspection
at
furnace
general
hospital
on
the
1st
of
october
saturday,
the
1st
of
october,
but
no
records
are
found
in
relation
to
this.
E
On
the
27th
of
october,
uhmb
was
discussed
at
the
risk
and
escalation
committee
and
on
the
21st
of
november,
the
trust
submitted
an
action
plan
following
the
warning
notice.
This
is
the
september
warning
notice
on
the
6th
of
december
cqc
and
monitor
held
a
risk
summit
and
on
the
21st
of
december,
a
visit
was
undertaken
to
a
e
at
the
royal
lancaster.
E
Cqc
did
follow
up,
other
activity
was
being
undertaken,
given
the
concerns
that
had
come
to
light.
Just
to
note
here
that
a
warning
notice
is
a
warning,
it
doesn't
impose
restrictions
to
be
lifted
or
restrictions
that
could
lapse.
However,
cqc
would
need
to
conduct
a
follow-up
for
further
reports
to
be
issued
for
the
website
to
be
updated
for
that
to
go
into
in
a
sense
into
the
public
domain.
E
E
My
view
chair
is
that
I
fully
understand
why
monitor
could
not
trust
the
judgments
that
we
were
expressing
at
the
time
question
seven.
Why
was
an
investigation
launched
into
this
case?
This
is
into
more
convey,
uhmb
and
and
at
this
time,
especially
as
there
seem
to
be
other
providers
with
similar
or
worse
situations,
where
an
investigation
had
not
been
launched.
E
The
warning
notice
on
staffing
related
to
a
e
in
december
2011,
and
not
to
the
february
inspection
grant
thornton
concluded
that
the
day
delay
in
publishing
the
warning
notice
does
not
assist
in
demonstrating
transparency
as
a
phrase
that
they're
used,
especially
as
the
deadline
for
complying
with
the
warning
notice
had
passed
long
before
that
report
was
published,
question
10.
Why
were
two
further
warning
notices
issued
on
outcomes,
one
and
four
which
were
found
compliant
just
a
couple
of
weeks
previously
in
march
2012?
E
The
eleventh
question
was:
can
we
demonstrate
consistency
and
transparency
and
fairness
in
our
regulatory
judgments
and
actions
throughout
this
period?
And
how
would
we
cqc
demonstrate
that
we
have
followed
our
enforcement
policy
208
and
298?
In
the
report
itself,
there
were
a
number
of
weaknesses
in
the
actions
and
decisions
taken
by
cqc
and
in
the
systems
and
processes.
E
E
So
that's
how
those
11
questions
have
been
addressed
in
the
grant
thornton
report,
what
they
then
go
on
to
address
in
part
three.
A
of
the
report.
This
is
page
210
onwards
is
the
allegations
of
a
cover-up
that
arose
from
those
11
questions
and
in
this
report
and
I
draw
attention-
I
think
this
is
226
onwards,
paragraphs
599
onwards,.
E
That
the
matches
to
conclude
the
report
are
point
to
organizational
failings,
but
they
conclude
the
facts
of
the
case.
Examined,
do
not
prove
in
our
view
that
some
form
of
cover-up
existed
and
that's
how
they
conclude
that
particular
section,
but
in
the
course
of
their
investigation
they
discovered
an
internal
review,
and
this
is
dealt
with
in
the
report
on
page
230
onwards.
This
is
part
3b
of
the
report.
E
In
the
latter
part
of
2000
2011,
an
internal
review
was
commissioned
within
cqc
to
identify
the
lessons
learned
that
report,
as
this
section
identifies,
identified,
failures
and
weaknesses
in
the
regulatory
systems
and
processes
and
decision
making
in
6.8
and
6.10.
It
draws
attention
to
the
fact
that
assurances
were
taken
from
others
from
the
sha.
E
Insufficient
validation
was
given
to
the
evidence
that
was
identified
by
others.
The
report
by
fielding
was
known
at
an
early
stage
in
january
2010
to
some
members
of
cqc.
I
think
it's
fair
to
conclude
that
they
did
not
identify
the
significance
of
that
report
and
we
didn't
formally
receive
the
report
until
august
of
2010..
E
Part
four
of
the
review,
which
is
pays
280
onwards,
deals
with
the
existence
of
the
field
in
review
and
the
precise
chronology
of
who
knew
what
about
that
review
and
at
what
time
and
what
weight
was
given.
I
don't
intend
to
summarize
any
more
about
that
chair.
I
think
that's
set
out
in
the
report
and
I've
already
covered
the
significance
of
the
field
in
review,
both
from
uhmb's
perspective
and
also
the
implication
for
the
judgments
that
we
were
able
to
make.
E
So
by
way
of
conclusion
chair,
I
think
this
report
does
demonstrate
that
cqc
then
did
not
get
this
right,
that
we
did
let
down
people
who
should
have
had
the
confidence
and
trust
in
our
judgment
we
have
apologized
for
that.
We
let
down
individuals
and
both
the
complainant
and
the
whistleblower
have
identified
these
concerns.
E
G
G
E
Thank
you
chair,
I'm,
I
think
what
I
do
apologize.
Thank
you.
I
think
what
we
are
doing
in
this
report
is
responding
to
the
11
questions
that
I
thought
you
were
raising
in
the
report,
though
the
questions
that
I
inherited
when
I
came
into
the
organization
in
july
2012.,
my
recollection
is,
I
have
updated
the
board
in
both
private
and
public
session,
that
this
review
was
taking
place
and
that
it
will
be
investigating
those
questions.
D
D
D
The
first
is:
what
is
what
this
report
tells
us
about
how
the
cqc
went
about
the
process
of
regulating
particularly
hospitals
and
there?
It
covers
some
of
the
ground
much
of
the
ground,
which
has
been
covered
by
other
reports
and
other
examinations
into
what
the
cqc
did
and
confirms
points
that
the
board
has
made
in
the
past
and
which
has
concerned
us,
for
example.
The
this
is
these
are
examples
meant
rather
than
a
conclusive
list,
but
the
the
closure
of
the
investigations
unit
is
covered
in
the
in
the
grant.
D
Thornton
report,
the
viability
and
value
of
the
generic
inspection
model
is
is
questioned.
The
lack
of
consistency
in
our
regulatory
judgments,
uncertainty
as
to
the
procedures
that
should
be
followed
and
the
purpose
that
we
are
pursuing
the
inadequate
training
and
the
skill
sets
which
have
been,
which
the
organization
began.
D
At
the
outset-
and
I
want
to
pay
tribute
to
david
bean
for
tackling
a
lot
of
those
issues
when
he
arrived
and
putting
us
on
the
course
which
I
think
we're
now
on-
where
we
can
overcome
many
or
in
the
process
of
overcoming
many
of
these
difficulties
and
errors
which
were
made
in
the
past,
and
we
can
pursue
some
of
those
issues
if
you
want
now,
but
I
do
think
that
we
we
do
need
to
come
back.
This
can't
be
just
the
whole
discussion
on
this
report.
D
Frankly,
I
regard
the
suppression
of
the
of
the
internal
review
as
disgraceful.
I
think
that
is
absolutely
appalling.
I
would
like
to
see
a
copy
of
that
report.
It
apparently
still
exists
and
I
think
the
board
that
report
should
be
shared
with
the
with
the
board,
and
there
are,
I
think,
big
issues
about
how
we
pursue
that.
We
may
not
be
able
to
pursue
it
today.
I
certainly
found
it
difficult
to
understand
what
was
actually
happening,
because
I
didn't
understand
who
the
people
were.
I
think
it's
a.
D
I
understand
the
legal
advice,
but
I
think
it's
the
most
unsatisfactory
way
of
reporting
a
series
of
events,
and
I
think
we
need
to
look
more
closely
into
who
did
what
and
whether
all
or
any
of
the
people
who
were
involved
are
still
working
for
the
the
commission
and
then
I'm
not
sure
how
you
want
to
pursue
that
in
the
future.
I
just
flag
up
that.
D
There's
much
more.
I
could
say,
and
I'm
grateful
chairman
for
you
and
to
you
and
the
chief
executive
for
the
apologies
which
have
been
given,
which
I
think
are
entirely
in
order
and
appropriate
and
overdue,
and
I
think
we
need
to
both
discuss
it
now,
but
also
discuss
this
report
in
the
future.
Thank
you.
G
G
B
B
So
so
I
I
also,
as
as
john
has
said,
we
wish
to
say
thanks
david
for
commissioning
this
work
and
and
and
for
kind
of
grasping
the
nettle
if
you
like,
because
it
was,
it
clearly
absolutely
had
to
be
done,
and
I
recognize
entirely
that
the
new
strategy
and
the
consultation
document
that
we've
published
addresses
many
of
the
the
themes
in
this
report,
but
I'm
not
sure
that
it
does
address
all
of
them.
Or
perhaps
I
want
some
further
assurance
about
some
of
them.
B
B
B
And
I
I
find
that
very
disconcerting
and
clearly
there
are
many
issues
in
both
the
strategy
and
the
consultation
document
which
addressed
that
that
that
that
approach
to
risk.
But
actually
I'm
not
sure
we
can
wait
for
all
of
that.
You
know
that
for
the
perfect
solution
for
to
to
to
come
through,
I
think
we
need
some
assurance
in
this
next
period.
B
You
know
it's
going
to
take
us
a
while
to
change
the
the
the
organization
in
the
way
the
strategy
describes,
and
I
think
we
need
some
assurance
in
the
organization
at
the
board
level
about
the
way
in
which
these
risks
are
being
managed.
Now
you
know
which
trusts
we're
talking
again
here
about
hospitals
and
that's
not
the
full
sum
of
our
risk
exposure,
but
let's
just
talk
about
hospitals
for
the
moment
which
trusts
are
actually
on
our
kind
of
red
list
right
now
and
what
are
we
doing
about
them?
B
I
want
to
be
confident
about
that
as
a
board
member,
and
this
just
kind
of
reinforces
the
need
for
for
that.
So
there's
an
interim
measure.
I
feel
we
need
to
really
grapple
with
to
make
sure
that
we're
comfortable
with
those
issues
around
risk
and
similarly
and
relatedly
this
question
of
escalation
to
through
the
management.
B
So
those
are
the
five
things
relating
specifically
to
the
report.
I
think
that
the
last
thing
that
I
would
like
us
to
make
sure
that
we
have
right
relates
actually
to
kay's
position
and
this
whole
question
of
the
fact
that
she
felt
it
necessary
to
whistleblow
because
she
felt
she
wasn't
being
properly
listened
to
within
the
organization
or
at
the
board,
and
I
know
we've
had
some
conversation
in
the
past
about
this,
particularly
around
the
kind
of
process
that
we
think
it
appropriate
to
follow.
B
If
we
have
concerns
who
we
should
talk
to,
in
particular
the
list
that
that
kay
has
already
rehearsed.
But
I
think
there's
there's
there's
something
which
I
I
I
would
like
to
be
confident.
We
all
understand,
which
is
what
the
if
you
like
the
formal
process
is
for
ensuring
that,
if
we
have
concerns
of
this
nature,
that
we
register
them
and
that
there
is
a
requirement
that
they
be
properly
responded
to
such
that
we
shouldn't
find
ourselves
in
this
position
in
the
future.
B
Now
maybe
that
exists,
but
I'm
not
sure
it
does,
and
I
think
there's
something
very
valuable
about
having
a
very
explicit
kind
of
registration
and
response,
which
is
on
the
record,
even
if
it's
not
in
the
pa
in
in
in
the
public
domain
in
the
first
instance.
So
those
are
the
things
that
fall
out
of
this
for
me
and,
as
you
can
see,
many
of
them,
I
think,
will
be
addressed
by
the
strategy,
but
I
think
a
couple
of
them.
B
F
F
I
agree
so
I
just
want
to
emphasize
how
much
I
support
anna's
talk
about
making
sure
that
we
learn
the
lessons,
because
there
are
always
lessons
to
be
learned,
and
you
know
this
is
full
of
some
very,
very
important
things
that
we
have
got
to
look
at.
So
the
francis
report
concentrated
or
focused
on
the
absence
of
leadership
and
culture
and
how
important
they
were
in
in
that
particular
acute
trust.
F
They
are
being
damned
understandably
and-
and
probably
you
know
not
without
some
cause
for
the
past,
but
that
can't
go
on
if
we're
going
to
succeed
as
an
organization
and
deliver
what
both
the
public
and
the
government
want
and
expect
from
a
regulator.
We've
got
to
look
forward
and
we've
got
to
actually,
I
think,
train,
develop,
encourage
and
show
the
leadership
and
direction
that
this
organization
so
desperately
wants.
Now,
I
think,
that's
happening
and
I
think
john's
word
about
the
change
of
climate
since
david
arrived.
F
I
also
share,
but
I
do
think
that
we've
got
this
important
thing
to
important
responsibility
to
our
staff
and
the
other
important
thing
is
that
we
must
make
as
sure
as
we
possibly
can,
and
I
don't
think
we
can
ever
be
eliminate
that
risk.
That
anna
was
talking
about
that.
This
never
ever
happens
again
or
if
it
does,
we
certainly
don't
hide
it
again
or
be
accused
of
hiding
it
again.
F
I
respect
completely
the
role
of
whistleblowers,
but
a
regulatory
authority
can't
depend
on
whistleblowing.
We
have
got
to
actually
be
able
to
regulate
the
services
that
we
are
meant
to
regulate
in
an
effective
way
and
through
an
inspection
regime
and
all
the
other
tools
available
to
us.
And
so
I
think
it's
an
important
report
and
I
I
share
others-
concerns.
A
H
I
think
we
now
have
the
obligation
to
get
right
and
put
right
the
wrongs
that
the
report
lays
out
so
clearly.
I
think
the
strategy
and
the
consultation
document
at
the
start
of
that,
as
anna
said
they
they're
the
start
of
the
journey
they're
not
enough
in
itself,
and
we
need
to
be
judged
by
what
we
do,
not
just
what
we
say.
But
fundamentally
we
need
to
be
a
regulator,
that's
strong,
that's
independent
and
that's
genuinely
on
the
side
of
the
public
and
the
people
who
use
our
services.
A
Well,
I
think
it's
it's
a
damning
report.
However,
you
look
at
it.
It's
a
huge
criticism
of
leadership
at
the
time.
I
do
believe
in
the
old
adage
that
the
fish
rots
from
the
head
and
I
think
that
the
the
board
of
the
organization
has
to
take
the
prime
responsibility
of
what's
happened.
I
think
we
have
some
extremely
good
inspectors
and
I
think
they
should
not
be
tarnished
by
this.
A
The
vast
majority
of
our
inspectors
become
inspectors
because
they
care
deeply
about
health
and
social
care
and
they
want
to
make
a
difference
and
we've
let
them
down
we've,
let
the
public
down
we've,
let
many
people
down
and
I
think
we've
left
we've
let
a
lot
of
our
staff
down.
So
it's
a
failure
of
leadership.
A
A
They
got
it
wrong
every
time
and
I
think
that
if
I
had
to
point
out
the
the
most
serious
failure
strategy,
it
was
this.
What
appears
to
be
now
to
be
an
extraordinary
belief
that
a
generalist
inspector
could
do
a
job
in
a
hospital
or
indeed
in
a
mental
health
trust
or
a
learning
difficulties
or
a
dementia
unit.
You
know
that
you
I
mean
you,
I
mean
one
of
the
light
bulb
moments
of
this
report
happened
at
the
end
of
june
2010
when
two
of
our
inspectors,
probably
good
people,
I'm
sure
they
were
good
people.
A
A
Actually,
the
bruce
keough
model
when
looking
at
outliers
now
is
absolutely
the
right
one,
and
the
second
thing
I
think
to
say
about
more
conveyors.
Is
you
know,
even
without
the
inspection
should
we
have
picked
it
up
from
our
intelligence,
and
the
answer
is
of
course
we
should.
You
know
six
babies
had
died,
I
mean
you
know.
Of
course,
we
should
have
picked
it
up
and
at
the
time
six
babies
had
died,
and
so
I'm
looking
at
paul
now
on
the
work
that
we're
doing
on
intelligence.
A
A
I
mean
when
anna
was
talking
about
the
identification
of
risk
and
the
escalation
of
risk.
It
is
critical.
This
I
mean.
I
remember
the
the
first
meeting
I
came
here.
You
know
what
hospital
should
we
be
worried
about?
We
didn't
know
that
we
must
have
a
list
of
hospitals
and
it
must
be
a.
It
must
be
a
list
that
is
evidence-based
and
evidence
backed
up
that
we
can
rely
upon
now.
I
just
want
to
end,
and
I've
said
there
was
a
failure
of
leadership,
a
failure
strategy
and
there
was
also
a
failure
of
operational
delivery.
A
You
know
there
was
a
lack
of
urgency,
it
wasn't
joined
up
and
the
the
cover-up
of
the
meeting.
The
attempted
deletion
of
that
report
is
just
symptomatic
of
an
organization
where
the
culture
has
gone
wrong
with
the
relationship
between
the
executive
and
the
board
had
gone
wrong.
It's
symptomatic
of
a
of
a
failing
organization-
and
I
just
like
to
end
because
and
and
to
just
publicly
acknowledge
the
courage
that
it
took
kay
to
pursue
this.
It
is
not
easy
being
a
whistleblower.
A
D
A
Over
the
last
six
months
has
said
that
we
don't
need
a
regulator,
you
know
we
need
an
effective
regulator.
We
must
be
able
to
give
assurance
to
the
public
that
care
is
safe,
it's
effective,
it's
caring,
it's
responsive
and
that
the
organizations
that
we
register
are
well
led,
so
judges
by
what
we
do
not
what
we
say.
A
I
think
we
should
probably
have
a
break
now
if
we
can
and
just
maybe
just
reflect
what
we've
all
said
a
bit,
we
will
not
let
this
rest.
We
will
come
back
to
the
board,
we'll
give
a
report
to
ministers,
as
well
as
to
what
we've
learned
from
this.
What
we're
doing
about
to
make
sure
it
never
happens
again.
E
E
Activities
where
we
inspect
the
surveillance
we'll
undertake
the
way
we
will
register
the
action
we
will
take
and
the
propositions
around
ratings.
That
document
has
been
published
on
monday
of
this
week
and
we're
following
that
up
by
a
pretty
extensive
process
of
internal
external
events
to
our
first
to
face
discussions
with
key
stakeholders.
E
The
asks
a
number
of
questions
on
which
we
are
inviting
feedback
to
help
us
settle
some
issues
and
we
look
forward
to
people
coming
back
to
us.
They'll
do
that
by
the
middle
of
august.
What
we'll
then
do
is
further
consider
the
feedback
and
that
will
then
inform
subsequent
consultations
that
we'll
make
as
we
build
up
the
change
model
of
inspection
and
surveillance
and
ratings.
E
We
will
share
and
I
think
it
will
be
helpful
if
commissioners
were
able
to
be
present.
I
know
steve.
You
were
present
at
some
of
the
strategy
development
sessions
and
I
I
thought
that
helped
immensely,
and
the
second
issue
is
the
curb
bill.
This
is
was
considered
on
the
12th
of
june
at
the
lord's
committee
stage,
and
this
covers
warning
notices
for
trusts
and
foundation
trusts.
This
is
a
change
from
the
current
way
of
operating,
and
I
set
that
out
in
the
report.
E
I
also
cover
the
single
failure
regime,
the
limits
on
providers
deregistering
the
fact
that
this
board
is
becoming
a
unitary
board
and
there
will
now
be
a
criminal
offence
of
providing
false
or
misleading
information,
which
is
not
unrelated
to
the
first
item
of
this
board.
This
afternoon
the
you'll
see
from
the
report
that
a
number
of
amendments
were
tabled
and
were
withdrawn.
E
E
E
Oh,
you
can
say
he's
joining
us
in
august
chad
yeah,
but
he
will
be
joining
us.
A
serious
point
in
this
is
there
are
a
number
of
things
that
are
coming
up.
The
consultation
document
which
went
out
mike
was
able
to
have
a
look
at
under
the
events
coming
up,
which
is
actively
assisting
with
that.
I
think
it
is
fair
to
say
he
is
beginning
to
focus
on
the
job
that
he's
got.
B
But
I'm
particularly
keen
to
see
is
some
some
sort
of
process
which
I
would
not
describe
as
consultation
in
quite
the
the
way
that
people
understand
consultation,
but
something
which
is
much
more
in
the
space
of
involvement,
which
would
allow
ordinary
users
and
consumers
of
service
to
engage
with
the
fundamental
standards
and
the
way
that
those
are
shaped
going
forward.
And
if
that's
not,
that
that
kind
of
activity
isn't
in
this
list.
Here
I've
been
assured
that
there
is
some
activity
of
that
sort,
but
it'd
be
really
good.
I
Absolutely
a
very
important
part
of
the
of
the
constellation
will
be
more
than
just
the
the
the
sort
of
the
stakeholder
engagement.
It
will
be
directly
with
users
of
service,
and
it
will
include
key
questions
about
how
they
want
to
receive
information
about
about
services
different
sectors.
So
I
will
include
that
in
the
note
that
we
pass
around,
which
includes
also
the
dates
for
the
formal.
I
J
The
board
have
gotten
you've
got
before
you
a
very
brief
finance
report
for
the
first
two
months
of
the
year.
I
think
I'd
just
like
to
remind
the
board
of
the
budget
for
the
year
and
how
we're
going
to
report
the
figures
going
forward.
We
have
a
recurring
budget
of
159
million
for
the
current
year.
We
also
on
top
of
that.
We
also
have
a
transformation
budget
of
20
million,
and
the
paper
sets
out
on
page
three
just
how
that
transformation
budget
is
made
up.
J
J
J
We
are
in
the
process
of
setting
up
the
reporting
for
the
transformation
budget.
There
was
a
spend
of
approximately
a
million
on
transformation
costs
noted
on
page
at
the
top
of
page
three
so
far
this
year,
really
the
the
costs
of
setting
salary
costs
for
setting
up
the
two
two
new
directorates,
director
of
directorate
of
change
and
the
directorate
for
strategy
and
intelligence.
J
So
the
recurring
costs
you
can
see
from
the
the
summary
very
much
in
line
with
budget
for
the
first
two
months
of
the
year.
The
transformation
costs
will
be
reported
separately,
we're
in
the
process
of
setting
that
up
on
allocating
budgets
across
the
directorates,
for
the
total
of
20
million
transformation,
the
20
million
transformation
budget
for
the
current
year.
J
One
of
the
things
I
think
that
the
board
should
be
aware
of
the
recurring
costs
that
we
have
agreed
here
with
the
department
of
health
assumes
a
fixed
number
of
in-depth
hospital
inspections
for
the
current
year
and
any
changes
that
the
secretary
of
state
may
want
to
make-
or
indeed
we
want
to
make
in
terms
of
the
number
of
in-depth
inspections.
Over
and
above
what
we've
budgeted
would
in
fact
require
additional
funding
which
will
be
subject
to
negotiation
with
the
secretary
of
state
and
the
department
of
health.
J
So
all
of
that
the
work
is
ongoing.
We're
currently
working
across
the
the
business
looking
at
how
we're
going
to
model
the
the
in-depth
inspections,
the
numbers
that
are
required,
the
costs,
etc.
We've
had
a
couple
of
workshops
already
and
that
will,
over
the
next
few
weeks,
we'll
finalize
what
the
recurring
cost
might
be
in
the
next
financial
year,
depending
on
some
of
the
strategic
decisions
that
we
and
indeed
the
board,
might
make.
So
the
the
transformation
budget
is
fixed
for
the
current
year.
J
D
But
what
it
doesn't
explain
is
the
relationship
between
the
table
at
the
bottom
of
page
three
and
the
table
at
the
top
of
page.
Two,
and
my
query
is
really:
wouldn't
it
be
simpler,
just
to
have
separate
lines
for
healthwatch
in
the
overall
summary,
so
that
we
could
see
how
the
two,
the
rather
smaller
sum
of
healthwatch
fitted
into
the
rather
larger
sum
of
the
cqc,
not
necessarily
for
now,
but
for
future
reports.
F
J
There
are
the
table
sets
out
the
additional
costs
that
cqc
are
going
to
incur
in
the
current
financial
year.
There's
a
total
of
20
million
allocated
to
the
transformation
budget
as
well
correct,
so
we've
already
agreed
tentatively
at
this
stage.
I
think,
with
the
department
of
health
that
that
12
million
will
rule
forward
into
14
15..
The
point
I
was
making
was
that
should
the
inspection
program
change
and
we
want
to
do
more,
inspect
in-depth
inspections
in
hospitals
in
1415,
we
would
need
to
go
back
to
the
department
of
health
and
discuss
that
further.
G
So
is
that
point
related
to
the
the
sort
of
challenge
that
you've
or
that's
alluded
to
in
the
last
paragraph,
which
is
around
sort
of
allocating
the
transformation
budget?
So
it
seems
I'm
just
thinking
what.
How
are
we
going
to
ensure
that
it
is
allocated
appropriately
and
does
fit
in
with
our
kind
of
strategic
direction?
If
you
like.
J
J
Of
course,
we
know
there's
a
lot
more
behind
this
table
than
what
actually
is
in
this
report,
a
lot
of
detail
behind
this
table
k,
which
sets
out
just
exactly
how
this
money
is
being
allocated
that
will
be
allocated
into
separate
cost,
centers
managed
by
the
either
the
director
of
change,
or,
indeed,
the
strategy
director
and
corporate
services
to
a
degree
going
forward.
So
we
have
got
quite
a
bit
of
information
here
already:
okay,
which
is
not
in
this
paper
as
to
how
that
money
is
going
to
be
spent.
G
J
G
E
So
I
think
hillary
is
going
to
present
on
the
transformation
program.
The
transformation
programme
board
will
oversee
this.
We've
had
meetings
this
week,
which
have
begun
the
process
of
finalizing
the
programme
plans
and
the
detailed
action
that
will
be
taken
will
then,
as
john
has
indicated,
allocate
that
money
alongside
those
and
will
be
subsequent
and
regular
reports
to
the
board
from
the
transformation
programme
board.
I'm
chairing
the
transformation
programme
board
and
hillary
will
report
on
a
regular
basis
to
the
board.
E
E
K
Good
morning,
good
morning,
chair
good
morning
board,
when
I
came
here
on
the
22nd
of
may,
I
introduced
myself
as
a
fairly
new
director
of
change,
and
I
talked
then
about
the
transformation
program
and
the
key
areas
of
change
we
were
looking
at.
I
also
spoke
briefly
about
the
timelines
for
what's
a
three-year
programme
of
change.
K
K
So
the
nuts
and
bolts
are
really
about
what
we've
been
doing
to
organize
ourselves
to
deliver
so
john's
just
talked
to
you
about
the
budget.
A
really
key
feature
is
to
take
a
tight
grip
on
having
decided
why
we're
doing
what
we're
doing
make
sure
we're
doing
the
right
things
and
then
have
who?
What?
How,
when
how
much
in
really
rigorous
order
and
to
have
governance,
to
support
that
and
to
demand
challenge
of
the
programs
that
we
keep
it
all
together.
K
K
A
communications
approach
to
co-development,
involving
and
informing,
which
we're
embedding
in
every
single
work
stream
and
a
program
of
ongoing
staff
engagement
resources,
absolutely
key,
not
just
the
money,
but
the
skills
and
the
capabilities.
So
we
have
a
resource
plan
where
we've
now
really
got
nailing
down
the
skills
and
capability
we
do
have
within
the
organization
and
the
skills
and
capacity
and
capability
that
we
need
to
bring
in
so,
for
instance,
we
are
bringing
in
additional
program
managers.
This
isn't
a
small
program.
K
We
need
people
who
understand
the
disciplines
and
rigor
of
programmatic
management,
a
resource
manager,
because
we
will
be
recruiting
inspectors
special
inspectors.
We
need
somebody
really
focused
on
making
sure
we
do
that.
Well,
we're
bringing
in
a
workforce
planner
before
we
can
recruit.
We
need
to
know
what
the
workforce
plan
will
look
like
bringing
in
some
real
project
support,
bringing
in
an
integration
manager
key
risk.
K
This
program
is
the
absence
of
integration
across
all
the
strands,
and
we've
brought
in
already
someone
to
lead
on
a
development
of
the
academy
offer,
for
instance,
so
we're
already
tackling
some
of
the
resource
gaps.
We
know,
but
that
will
continue
to
be
a
nuts
and
bolts
issue
for
us
over
the
next
couple
of
months.
A
Just
on
that,
just
before
you
move
on
the
academy
staff,
train
staff
is
so
critical
to
everything
that
we're
doing
yeah.
I
I
I
don't
know
how
other
members
of
the
board.
I
think
we
ought
to
have
a
spend
some
time
on
that.
Specifically
on
the
academy,
because
I
mean
you
know,
ofsted
have
a
different
model.
You
know
they
do
out.
They
outsource
a
lot
of
their
inspectors.
A
A
K
If
I
leap
to
a
first
early
deliverable,
we've
brought
someone
in
to
develop
an
offer
for
the
academy
at
the
moment.
We're
co-developing
that
with
staff.
So
this
week,
next
and
the
week
after
ian's
out
and
about
with
groups
of
our
people
focused
on
what
their
expectations
are.
What
we
believe
our
first
offer
is
and
to
help
us
develop
a
a
proposition
for
an
academy
which
is
actually
up
and
running,
but.
K
So
we've
been
doing
a
lot
of
that.
A
lot
of
mobilization,
a
lot
of
workshops
really
to
involve
people
across
the
business,
so
not
just
project
people,
but
our
people
who
are
currently
delivering
our
frontline
inspections
and
our
registration.
Our
intel
people,
our
enabling
functions,
have
all
got
to
be
part
and
parcel
of
setting
up
this
governance.
To
succeed.
K
We've
also
saw
input
from
a
number
of
expert
domains
as
we
go
about
setting
this
up.
So
department
of
health
have
been
very
helpful
in
giving
us
their
informal
assessment
of
what
we're
doing
in
terms
of
setting
up
our
programme.
We've
looked
at
the
common
causes
of
failure.
There's
some
screeds
of
research
on
why
programs
fail
common
causes
of
failure?
K
The
consultation
document
published
on
monday
and
paul's
going
to
take
you
through
the
conduct
a
bit
later
on
that
was
a
key
deliverable
and
delivered
through
a
project
disciplines.
The
recruitment
of
our
inspectors
is
an
early
deliverable
and
david's
already
mentioned
mike
richards
we've
developed
in
other
ways
a
change
narrative
which
we're
already
using
in
lifetime
with
our
with
our
people,
which
is
going
down
very
well.
That's
a
classic
piece
of
programme
material,
but
why
we're
changing?
K
How
we're
changing
what
difference
that
will
make
to
the
processes
and
what
we
ask
our
people
to
do
and,
as
I
said,
we're
co-developing
at
the
moment
the
early
thoughts
around
an
academy
from
our
staff's
point
of
view,
with
some
expectation
that
we'll
have
an
offer
ready
to
to
start
an
academy
live
in
the
autumn.
But
I
think
it'd
be
really
good
to
come
back
here.
To
talk
about
that
that
first
set
of
insight
from
our
people
and
to
get
the
insight
from
here
be
really
good.
K
So
I've
talked
about
nuts
and
belts
early
deliverables.
I
just
wanted
to
focus
down
cultural
engagement,
really
critical
strand
for
us
common
cause
of
failure.
One
we're
determined
not
to
go
to
we've
got
a
number
of
road
shows
at
the
moment
for
all
every
single
member
of
our
staff,
all
around
the
country
designed
to
engage
with
our
staff
focused
on
the
consultation
document.
K
What
the
regulatory
model
is
our
plans
for
changing
the
way
we
work,
how
we're
going
to
implement
the
strategy
through
a
change
program
and
giving
staff
plenty
of
opportunity
to
discuss
the
plans
and
ask
questions
both
about
that
and
actually
anything
else
they
want
to
talk
about.
We
started
that
last
week
with
a
a
roadshow
on
friday,
we've
got
around
40
throughout
june
and
july,
so
I'm
doing
four
next
week,
for
instance-
and
I
suspect
the
same
is
true
for
other
directors
around
this
table.
K
In
addition,
and
in
parallel
we're
doing
the
provider
session
specifically
on
the
top
conduct,
which
you've
already
talked
about
as
well.
So
a
lot
of
engagement
going
on,
there's
also
plenty
of
functional
conferences
and
get-togethers,
which
we're
using
every
opportunity
to
talk
about
the
approach
to
change
the
change,
narrative,
the
consultation
document,
etc.
K
K
One
signal,
perhaps
of
the
changed
culture,
is
that
we
we've
asked
our
staff
through
messages
today,
first
thing
to
talk
about
that
coverage
to
talk
about
how
they
feel
with
their
colleagues
to
actually
express
and
reflect
how
they're
feeling
about
it
and
to
reflect
on
what
we're
going
to
do
differently
going
forward.
So
we're
having
that
conversation
today
in
a
much
more
open
way.
K
A
B
I
just
want
to
I
mean
the
there's,
always
a
tension
between
the
pace
and
the
amount
of
room
for
engagement,
but
I
I
like
your
use
of
the
term
co-creation
by
development
with
reference
to
the
board,
and
I
mean
I
think
dave
is
absolutely
right-
that
that
that
that
we
need
to
have
the
opportunity
to
do
that.
I
don't
think
that's
probably
in
in
in
public
board
sessions.
I
think
there's
that
there
needs
to
be
an
opportunity
for
us
to
have
a
kind
of
we
need
to
reflect
on
the
program
in
our
governance
role.
B
But
we
do
have
the
opportunity
to
do
it
about
around
the
academy
and
whatever
the
next
deliverables
are.
So
I
just
really
encourage
that,
because
I
think
that
that
will
be
important
to
our
ownership
and
leadership
over
the
whole
of
the
program
going
forward
is
that
we
have
also
had
the
opportunity
to
make
a
contribution
to
the
thinking
before
we
then
clear
and
approve
the
proposals.
A
Yeah
I
mean
just
on
that,
and
I
I
mean
for
the
july
meeting,
I'm
hoping
to
convert
that
into
an
away
day
type.
I
mean
we'll
have
a
board
meeting
at
first
thing
on
the
on
the
morning
of
the
on
that
on
the
31st
of
july.
I
think
it
is,
and
then
I
thought
we
would
spend
the
rest
of
the
day
talking
about
the
transformation
project
and
then
on
on
the
intelligence
surveillance
metrics.
That
paul
is
developing
and
have
an
informal
chat
about
it.
The
evening
before
before
the
board
as
well.
G
Thanks
for
the
update
a
couple
of
things,
obviously,
it
was
a
very
sort
of
high
level
sort
of
overview,
and
one
of
the
things
that
I
know
is
is
comes
up.
A
lot
is
about
how
we
make
sure
that
we,
you
know
when
we're
developing
our
new
approach,
that
we
do
give
sufficient
emphasis
to
maybe
areas
that
sometimes
can
get
neglected
like
sort
of
mental
health,
because,
of
course,
mental
health.
Most
of
mental
health
services
are
provided
in
the
community.
They're
not
provided
in
a
hospital.
K
Okay,
thank
you
for
that
kay
on
the
mental
health
area.
One
of
the
things
we're
trying
to
be
really
clear
on
is
this
is
a
three-year
program,
we're
starting
with
our
focus
on
hospitals,
but
actually
there
are
huge
other
areas
as
well,
and
mental
health
we've
already
established
as
one
of
our
key
work
streams,
because
we
can
and
should
do
much
better
thinking
and
doing
about
it,
and
the
change
narrative
absolutely
really
happy
to
share
that.
It's
a
it's
a
good
story
to
use.
So
thank
you.
H
Yeah,
absolutely
hillary's
absolutely
right
that
we
will
have
a
a
separate
piece
of
work
on
mental
health.
But
I
think
there's
something
broader
to
say
as
well
is
that
we
want
to
make
sure
that
in
having
three
chief
inspectors,
the
result
isn't
that
we
see
people
as
fitting
in
naturally
into
any
of
those
three
boxes.
We
think
there
are
several
cohorts
of
of
people
who
use
services
who
quite
clearly
cut
across
those
and
and
mental
health.
H
Usa
are
clearly
one
of
those
such
groups,
and
so
we
are
putting
forward
our
thinking
on
what
the
the
way
to
go
through
the
patient
journey
of
the
service
you
the
journey
is
and
how
we
can
look
at
regulation
in
the
context
of
what
people
who
actually
use
services
actually
see,
as
opposed
to
only
the
providers
and
that's
an
important
part
of
our
work
going
forward
and
I'll
talk
a
bit
more
about
our
ongoing
plans
in
the
in
the
next
agenda.
Item.
H
On
the
point
you
raise
chair
about
the
academy
and
we've
also
started
conversations
not
just
about
the
what
we
could
call
the
harder
skills
that
we
absolutely
need
to
make
sure
our
special
inspectors
precious
inspectors
have,
but
also
what
are
the
set
of
behaviors-
that
we
would
expect
everybody
to
have,
and
one
recent
conversation,
for
example,
is
whether
we
can.
What
will
it
take
for
our
organization
to
be
the
most
consumer-focused
organization
across
health
and
care
as
an
aspiration?
H
But
if
we
are
serious
about
that
and
we've
said
that
we
are
firmly
on
the
side
of
people
who
use
services
and
we're
independent,
then
we
need
to
think
seriously
about
what
the
training
program
is.
Clearly,
a
lot
is
just
you
know,
is
up
here,
but
we
know
that
other
organizations
have
gone
through
structured
programs
in
order
to
develop
that
strong
consumer
focus
and
that's
something
we're
also
considering.
F
Just
briefly
to
to
follow
up
from
kay's
request
that
we
become
engaged
with
with
this
process.
I
just
wanted
to
report
the
k
that
hillary
and
I've
already
exchanged
emails
on
this
subject,
and
I
think
she
has
every
intention
of
volunteering
all
board
for
engagement
in
the
culture
and
leadership
program,
including
the
members
who
aren't
even
here
yet.
H
I
think
the
first
thing
to
say
is
this
is
the
first
of
many
consultations.
This
one
sets
out
the
overall
operating
model
and
gives
more
detail
on
the
acute
trust,
acute
hospitals,
regulatory
model.
There
will
be
a
subsequent
consultation
in
september
or
october
on
adult
social
care.
There'll
be
a
further
one.
H
Before
the
end
of
the
year
on
primary
care,
there
will
be
further
consultations,
statutory
consultations
around
the
regulations
due
to
be
introduced
in
secondary
legislation
by
april
2014,
and
that
pattern
will
just
carry
on
because
we're
changing
the
organization's
operating
model
from
top
to
bottom.
That's,
the
natural
implication
is
that
we
need
to
co-create
and
confront
on
all
the
changes
that
we're
making.
H
The
second
thing
to
say
is
that
we've
had
an
awful
lot
of
input
into
the
consultation
which
we're
extremely
grateful,
and
that
includes
from
board
members.
So
thank
you,
and
we've
also
had
input
from
large
numbers
of
other
people
within
the
system
on
a
in
confidence
draft
basis,
and
we're
also
thankful
for
the
to
those
people
for
commenting
as
well
and
taking
their
time
and
the
staff
has.
H
One
thing
I
take
some
comfort
in
is
that
this
is,
I
think,
an
example
of
the
way
we're
working
differently.
This
wasn't
a
piece
of
work
that
was
hatched
within
sort
of
the
minds
of
three
or
four
policy
people.
This
genuinely
did
take
into
account
the
views
from
people
outside
the
system
and
just
within
the
organization.
The
operations
directorate
were
heavily
involved,
as
was
communications
directorate
in
intelligence
as
examples
and
that's
the
way
we
need
to
do
this.
H
As
chris
says,
we
will
send
round
more
details
of
the
consultation
plan
and
specific
events,
but
I'll
try
and
cover
those
off
in
the
slides.
Let
me
talk
to
these
slides
and
the
first
page
page
two
tries
to
summarize
what
will
be
different
as
a
result
of
the
new
model.
It
doesn't
attempt
to
do
everything,
of
course,
but
fundamentally
we
want
to
completely
move
away
from
a
yes,
no
compliance
approach,
it's
something
that
our
inspectors
absolutely
want
to
move
away
from,
and
I've
been
on
inspection
and
people
say
well.
H
I
think
that's
important
to
be
clear
about
and
that's
what
I
meant
by
the
secondary
legislation
in
april.
2014
we
currently
use
the
2009
regulations,
28
of
them
and
16
outcomes.
There
will
be
a
reduced
number
of
regulations
that
will
include
the
fundamental
standards
was
called
in
the
fundamentals
of
care,
as
well
as
the
additional
requirements
that
we
need
to
make
effective
judgments
and
legally
binding
judgments
against
each
of
the
five
questions.
H
A
So
I'm
absolutely
clear
on
this
individuals
at
board
level
via
account
the
quality
of
care.
I
mean
just
just
apply
that
to
morgan
bay,
for
example,
because
it
covers
nhs
bodies
as
well
as
private
ones.
It
does
I
mean
if
it
was
found
that
there
had
been
a
you
know,
the
the
the
breakdown
in
care
in
maternity
services
at
morgan
bay
was
systemic
and
that
it
was
unsafe.
H
A
H
I
I
think
it
is
yeah,
fundamentally
it's
not
being
candid
about
quality
about
about
care
and
care
failings
yeah,
but
I
think
there
is
a
separate
question
about
whether
there
is
an
additional
need
for
a
specific
duty
of
disclosure
which
the
which
the
report
throws
up
and
which
we
need
to
then
just
now
discuss
as
the
cables
going
through.
Thank
you,
yeah
see.
F
You
surely
I
mean,
I
think,
they're
the
right
question
to
ask
chair,
but
surely
our
role
is
to
make
sure
that
it
doesn't
get
that
far,
and
this
is
one
of
the
this,
I
think,
is
one
of
the
the
new
ways
that
we
could
prevent.
That
I
mean
I
have
vivid
memories
of
the
comprehensive
performance
assessment
of
local
authorities
being
summoned
to
the
audit
commission
to
explain
what
was
going
on
and
that's
not
a
tactic.
F
E
So
there's
already
some
responsibility
on
them
and
I
think
that's
what
the
reference
in
the
grand
tournament
report
to
feel
the
fielding
report
was
about.
I
think,
paul's,
absolutely
right.
The
current
proposition
is
that
the
duty
of
canada-
and
this
was
covered
in
the
kirby
updates
in
my
report-
will
actually
put
organizations
under
a
duty
of
canada
to
describe
changes
in
their
circumstances
and
that
will
come
through
our
regulations
that
won't
be
in
primary
legislation
being
secondary
legislation,
and
we
will
need
to
both
identify
that
and
then
enforce
that
through
our
regulatory
action
moving
forward.
E
I
think
there's
also
some
discussion
and
again
this
isn't
certain
there's
a
policy
debate
to
take
place
about
whether
there
should
be
a
criminal
offence,
and
this
is
where
the
debate
is
taking
place
in
policy
terms
around
providing
misleading
information.
This
is
largely
about
statistical
information,
and
this
focuses
in
some
of
these
stories,
which
have
been
in
the
media
over
the
past
12
months
about
suppressing
standard
mortality
rates
or
emphasizing
septicemia
rates,
or
any
of
the
other
conversations
that
have
gone
on
and
the
proposition
is
that
becomes
a
criminal
offence.
E
I
think
on
this
one.
This
stems
from
winterbourne,
and
the
proposition
here
is
that
we
change
in
technical
terms
the
notice
of
proposal,
which
means
that
we
can
take
action
against
boards
and
individuals
where
they
are
named
as
being
responsible
for
quality,
so
on
the
winterbourne
cares
in
castle
back.
There
was
nobody
at
the
board
level
that
was
named
as
being
responsible
for
quality,
and
these
changes
would
allow
cqc
to
pursue
a
board
level.
E
The
person
that
was
responsible
for
quality
in
winterbourne
criminal
prosecutions
were
taken
against
staff
that
worked
at
winterbourne,
and
indeed,
some
have
been
convicted
and
imprisoned
as
a
consequence
of
that,
but
there
was
no
other
way
of
holding
the
board
and
the
more
senior
people
to
account.
So
the
proposition-
and
this
last
two
sets
of
bullet
points
of
moving
from
and
two
is
really
the
work
that
we're
undertaking
to
capture
that.
So
I
think
there's
three
things
going
on.
E
If
I'm
a
chair,
there's
the
changes
that
we're
making
to
the
way
that
we
register,
which
places
a
duty
on
boards
around
quality.
Secondly,
there's
a
duty
of
candor
which
is
arising
post
francis,
which
will
be
regulatory
that
we
will
please
and
then.
Thirdly,
there's
a
debate
about
false
and
misleading
information
which
is
really
about
people
presenting
in
an
open
and
honest
way,
the
data
relating
to
things
like
death
rates,
and
it's
that
last
one
which
has
got
the
most
debate
going
on
around
it
in
terms
of
the
contention.
F
Can
I
make
one
more
comment
on
this
slide,
I'm
very
much
in
favor
of
the
statement
on
the
side
of
the
people
who
use
the
services,
and
I
think
that
they're,
one
of
the
things
that
I'd
like
to
see
happen
is
that
we
change
our
relationship
with
members
of
the
public
patients
and
their
families,
in
particular,
from
the
position
where
they
feel
that
making
a
com.
I
think
making
a
complaint
is
a
very
sterile
process.
You,
you
feel
disempowered
by
making
a
complaint.
F
Something
must
be
done
and
that's
one
of
the
reasons
why
a
lot
of
the
complaints
end
up
here.
They
don't
know
who
to
go
to
so
I
think
we've
talked
in
the
past
about
better
sign
posting
and
we
made
that
submission
when
there
was
a
consultation
on
complaints.
But
I
think
one
of
the
things
that
we
ought
to
be
aiming
to
do
is
possibly
turn
the
general
public
and
patients
and
their
families
into
part
of
our
inspection
team
and
make
them
feel
not
only
on
their
side
but
they're.
B
Sorry,
risk
of
prolonging
but
just
just
to
say
that
well
as
as
police
know
that
the
cqc
published
something
talking
about
the
the
way
people
felt
about
raising
concerns
about
services
at
the
weekend.
But
healthwatch
england
has
got
its
first
national
conference
tomorrow
and
will
be
publishing
a
report
on
which
on
debate,
on
the
strength
of
which
actually
I'll
be
writing
to
you,
david
and
other
chairs
of
key
players
in
in
health
and
social
care.
B
Talking
about
the
findings
that
we've
made
and
the
need
for
complaints
and
concerns,
this
whole
kind
of
continuum,
from
feedback
through
to
complaints
to
be
sort
a
rather
radically
altered.
If,
if
we're
to
arrive
to
situation
where
people
do
feel
that
their
partners,
consumers
and
users
do
feel
that
they're
partners
in
this,
rather
than
potential
potentially
vulnerable
players
who
who
who
don't
have
trust
and
confidence
in
the
system
and
don't
come
forward.
So
I
think,
there's
a
there's
some
vehicles
here
for
taking
forward
that
conversation.
I
hope.
D
D
H
We've
been
offered
more
joint
research
work
with
the
department
of
health,
and
this
would
be
an
excellent
thing
to
to
to
use
that
sort
of
money
for
because
we
need
to
do
better,
but
I
also
think
the
reality
is.
We
need
to
accept
that
we
won't
not
everybody
will
who
wants
to
express
a
concern
will
express
it
to
the
cqc.
H
In
fact,
I'd
be
amazed
if
the
major,
if
that
was
where
the
majority
of
concerns
were
expressed,
so
we
have
a
whole
set
of
other
areas
that
we
need
to
use
the
friends
and
family
test
that
went
live
from
april
for
alien
inpatient
roles
out
from
maternity
from
october,
the
full
use
of
social
media.
So
we
have
work
underway
with
with
the
firm
to
look
at
what
was
sentiment.
Analysis
on
what
social
media
is
saying
about
the
whole
about
any
given
organization.
H
I
think
we're
at
the
starting
point
of
that
journey.
There's
an
awful
lot
more
to
do,
but
part
of
what
the
consultation
is
trying
to
do
is
to
say
there
cannot
be
a
division
that
somehow
intelligence
from
statistics
beats
intelligence
from
people
you
know
and
where
they're
hard
and
soft-
and
that's
just
not
right-
and
we
know
that's
true
from
winterbourne.
We
know
that's
true
from
mid
staff,
so
they
have
to
be
treated
absolutely
on
upon
both
the
integral
to
the
to
the
surveillance
model.
H
If
I
go
to
slide
four,
having
talked
about
their
questions
already
on
slide
three,
I
just
want
to
dwell
on
that
for
a
moment,
not
the
whole
slide
in
detail.
But
I
want
that's
the
overview
of
our
new
operating
model,
which
will
be
common
across
all
different
care
sectors,
but
then
applied
very
differently
through
for
a
forgiven
sector.
So
the
the
style
of
inspection
would
expect
to
be
very
different
between
an
acute
trust,
for
example,
and
a
care
home.
H
If
the
five
questions
drive
all
our
lines
of
inquiry
and
what
we
care
about
in
regulating
those
three
levels
are
the
levels
that
we
will
think
about
in
terms
of
the
action
that
we
take
the
fundamentals
of
care
map
directly
to
the
fundamental
standards
that
robert
francis
proposed
and
for
which
there
are
examples,
but
only
examples
in
the
consultation,
precisely
because
we
want
to
co-create
them
with
the
public,
but
they
are
the
absolute
basics
and
but
they
do
not
represent
what
we
think
is
acceptable
care.
They
are
significantly
below
what
would
be
acceptable
care.
H
They
are
the
basics
that
anyone
should
expect
in
this
country.
The
expected
standards,
which
we
give
an
example
on
for
maternity,
but
again
only
an
example
on
the
consultation
document
is
where
we
will
effectively
judge
the
bar
between
what
is
good
care
and
what
isn't
and
then
the
high
quality
bar.
We
work
with
partners
such
as
nice
to
determine
what
genuinely
high
quality
and
outstanding
care
really
looks
like.
So
we
want
to
differentiate
between
those
three.
H
If
I
move
on
into
slide
five
and
our
audiences,
we
see
six
key
audiences
if
you
like,
for
our
ongoing
communication,
particularly
the
consultation
providers
of
professional
stakeholder
security
staff,
the
public
and
people
who
use
services,
the
department
of
health
and
other
government
bodies
and
members
of
parliament
and
peers
all
are
important.
But
I
want
to
just
draw
attention
to
a
couple
of
the
pieces
on
the
following
slide
in
terms
of
the
work
that
we're
doing
over
the
next
two
months.
H
As
hillary
laid
out,
we
have
over
40
staff
road
shows
because
it's
vital
that
our
staff
understand
and
are
part
of
the
development
of
this
work.
We
have
more
than
20
focus
groups
and
workshops
and
one-to-one
interviews
with
the
public
eight
meetings
with
providers
in
the
public,
and
I
don't
think
we
we
should
underplay
how
much
activity
we
will
be
doing
with
the
trade
associations
and
the
royal
colleges,
and
this
isn't
because
we've
somehow
got
captured
by
providers.
H
It's
because
we
know
this
has
to
be
credible
with
the
professionals
and
so
you'll
see
in
the
following
slides
that
we're
doing
work.
For
example,
the
academy
of
medical
role,
colleges,
who
have
endorsed
the
consultation
document,
its
direction
of
travel,
precisely
because
we
want
the
doctors,
as
leaders
in
hospital
environments,
to
understand
what
we're
trying
to
do,
and
we
know
that
they
want
to
see
more
peer
review
and
that's
something
that
mike
richards
in
particular
brings,
and
we
will
do
that.
But
we
need
them
on
board
with
the
philosophy
of
what
we're
trying
to
achieve.
H
But
that
doesn't
mean
for
a
second
that
we
tend
to
be
captured
by
any
provider
group.
I
just
want
to
lay
out
that
we
are
heavily
involving
them
in
the
development
of
the
work
as
well.
So
if
I
look
pages
seven,
eight,
nine
and
ten
look
at
the
timeline.
What
we're
calling
phase
one,
which
is
over
the
summer
and
into
october
for
some
of
those
different
groups.
I
don't
propose
to
go
through
all
of
them
in
the
board
meeting.
H
But
if
I
can
just
touch
on
slide
eight
to
show
what
we're
doing
with
public
and
stakeholders
throughout
july.
There
are
a
whole
series
of
events,
regional
events,
public
focus,
events
and
people
who
use
services.
I
see
on
the
fourth
of
july,
I'm
going
to
ask
chris
in
a
moment
just
to
comment
briefly.
H
I
So
I
think,
there's
sort
of
two
things
to
note.
One
is
that,
beyond
the
normal
advisory
groups,
it's
the
the
involvement
in
of
of
wider
groups
of
the
public
and
people
who
use
services
and
particularly
people
who,
who,
for
various
reasons,
don't
normally
reply
to
a
consultation.
It's
it's.
Our
absolute
determination
is
to
make
sure
we
involve
those
those
people,
because
they
will
help
drive
a
better
understanding
of
what
we
should
do
and
what
the
outcomes
are
like.
I
We
do
want
to
have
local
groups
that
will
feed
information
back,
as
hillary
mentioned,
we
have
seven
work
streams
of
work
about
about
how
we're
going
to
change
what
we
do
as
an
organization.
Each
of
those
work
streams
of
work
will
have
outputs
that
we'll
ask
we'll
ask
advice
from
from
from
these
these
groups
and
they
will
be
initially
supporting
co-production
and
then
and
then
agreeing
with
the
outcomes
that
were
that
were
developed
as
part
of
that,
and
this
isn't
a
really
important
phase.
It
determines
the
for
me.
I
B
So
I
I
I
don't
think
this
is
a
place
to
have
a
conversation,
and
I
I
welcome
much
of
what
you've
you
you've
said
chris
in
this
slide,
but
I
mean
I
would
really
appreciate
a
a
a
more
detailed
conversation,
because
I
think
I
think
the
key
for
me
here
is
about
what
the
objective
of
this
activity
is
and
there's
a
very
big
difference
between
getting
people's
views.
And
I
applaud
your
efforts
to
get
people
who
to
get
to
people
who
wouldn't
normally
respond.
B
But
there's
a
there's,
still
a
lot
big
distance
between
getting
people's
views
about
propositions
which
have
been
developed
even
if
very
green
propositions
and
inviting
people
to
do
what
I
count
as
co-create,
which
is
start
from
the
beginning,
with
without
a
proposition
and
and
help
to
develop
a
proposition.
So
so
so.
So,
I'm
quite
keen
to
understand
where,
on
the
spectrum,
that
this
various
different
bits
of
this
work
are
and
to
contribute
and
be
helpful.
If
I
possibly
can
be
as
it's
something
that
obviously
I
it's
kind
of
part
of
my
my
lifeblood
say.
F
H
A
Can
I
just
so
I'm
clear
that
what
the
point
that
anna
was
making,
as
I
see
it
and
and
used
to
you-
I
I
think
the
the
co-creation
argument
is
particularly
powerful
around
the
fundamental
standards,
because
the
whole
point
that
robert
francis
was
making
is
to
have
real
traction
around
those
fundamental
terms.
People
got
to
feel
that
they
have
actually
to
use
your
work,
co-created
them
or
develop
them
together
jointly.
A
A
I
mean
steve
is,
at
the
other
end
of
the
spectrum,
in
a
sense
to
make
sure
that
we,
the
thought
the
consultation
program
sort
of
formally
complies
with
what
is
the
correct
sort
of
process
and,
of
course
the
ratings
is
a
part
of
the
fundamental
standards
ratings
and
the
inspection
process
are
the
three
sort
of
parts
of
the
of
the
consultation
on
the
on
the
ratings
and
well
and
on
the
surveillance
metrics.
We've
had
to
set
out,
I
think,
what
they
are
or
what
we
propose.
A
H
Right
there
is,
there
are
some
areas
where
we
are
under
statutory
obligation
to
consult
or
the
department
of
health
is,
and
that's
predominantly
where
things
will
be
laid
out
in
secondary
legislation,
and
there
will
be
further
consultations
specifically
on
those.
What
we've
absolutely
tried
is
go
well
beyond
any
sort
of
basic
legal
requirement
on
consultation,
as
my
understanding
there's
no
formal
requirement
if
we
choose
to
change
our
operating
model
to
lay
that
out,
but
we
want
to.
We
want
to
be
transparent
in
that
and
to
confirm
your
point.
H
E
And
on
steve's
point
the
committee,
which
is
considering
the
kerbel,
will
meet
on
the
third
of
july,
and
it's
planned
that
they'll
discuss
the
ratings.
Propositions
are
because
we
need
primary
legislation
to
give
us
the
power
to
rate
and
then
on
that
basis,
there'll
be
some
further
consultation
required
on
the
rating.
E
So
I
think
this
is
indicating
the
direction
of
travel
we're
moving
in
in
ratings,
how
the
inspections
will
relate
to
ratings,
rather
than
into
the
kind
of
slightly
more
technical
mechanical
analysis
of
how
the
rating
will
operate
and
we'll
take.
We
will.
We
will
do
some
further
work
on
that
to
provide
reassurance.
D
D
What
I'm
interested
in,
though,
is
whether
any
modeling
has
been
done
as
to
the
likely
ratings
that
would
be
accorded
to
particular
institutions
organizations
compared
with
what
we
get
at
the
moment
in
terms
of
the
the
compliance
stroke
non-compliance
status
is,
it
is,
are
we
going
to
get
more
reds
and
fewer
greens,
or
more
greens
and
fewer
reds?
I
mean
I'm
not
quite
sure
what
this
is
going
to
look
like
when
it's
finished.
D
A
No,
no,
I
think
that
I
think
it's
it's
a
it's
a
good
question.
I
want
to
answer
in
two
in
two
parts.
If
I
can
at
the
moment
we
have
a,
we
have
a
list,
a
worry
list,
don't
we
that
we
see
in
private
and
we
have
it
in
private,
because
we
are
not
confident
that
that
list
is
is
as
evidence-based
as
it
should
be
of
hospi
of
hospitals
that
we
worry
about.
A
We
will
have
by
before
the
end
of
the
year,
a
list
in
which
we
do
have
confidence
and
it
will
be
evidence-based
and
that
we
envision
that
list
will
be
published.
Now
we
don't
know
how
many
hospitals
be
on
that
list,
which
I
think
was
your
probably
behind
your
point,
whether
it's
10
20
or
so
we
don't.
We
don't
know
that
that's
one
part
of
it.
The
second
part
is
when
we
come
to
the
ratings.
A
I
mean.
Interestingly,
I
mean
when
we
met
with
ofsted,
I
mean
nine
percent
of
schools
are
rated
outstanding,
which
gives
you
an
idea
of
how
many,
how
many
it
may
not
be
nine
percent.
It
may
be
twelve
percent
or
or
five
percent,
but
it's
it's
quite
a
small
number
of
hospitals
will
be
sort
of
green
glowing.
Green.
The
vast
majority
will
be
in
that
good.
A
What's
the
third
category
that
we
have
good
requires
improvement
good
requires
improvement,
yeah
because
satisfactory
by
definition
is
not
satisfactory
and
so
therefore
requires
improvement,
but
we
until
but
we
won't,
although
we'll
have
done
the
surveillance
stuff
and
we'll
have
our
worry
list.
Definitely
by
the
end
of
the
year,
we
will
not
complete
the
entire
the
complete
ratings
of
all
hospitals
for
two
years,
two
and
a
half
years.
A
D
So
my
question
is:
is
my
question
about
modeling
was
whether
we
think
that
is
actually
what's
going
to
happen
or
not?
And
given
that
we
don't
know
the
answer
to
that,
because
the
modeling
hasn't
yet
been
done,
whether
we
will
have
the
resources
to
be
able
to
cope
with
the
processes
needed
to
deal
with
that
level
of
non
of
what
we
call
non-compliance
or
in
inadequate
or
requiring
improvement
status.
H
I'm
on
the
resources
point
because
I
agree:
I
think
that
we
will
have
large
numbers
of
of
organizations
who
are
inadequate
or
requires
improvement
on
the
resourcing
point.
We
are
carrying
out
the
modeling
on
and
today's
about
how
quickly
we
can
get
through
the
program
for
acute
hospitals,
but
doing
it
correctly.
That
modelling
includes
follow-ups
as
a
result
of
finding
inadequacies
of
care
to
give
us
assurance
on
that.
The
way
we've
laid
it
out
in
the
document
says
that
a
hospital
cannot
be
outstanding
if
there
are
any
fundamentals
of
care
breaches
that
that's
for
consultation.
F
L
L
The
purpose
of
the
paper
is
really
for
information
for
any
comments
that
that
you
have,
but
I
just
wanted
to
point
out
two
important
factors
in
as
much
as
failure
to
deliver
on
these
actions
does
have
a
risk
for
people
with
learning
disabilities
that
poor
care
could
be
perpetuated,
so
there's
a
significant
risk
if
we
fail
to
deliver
an
equally
a
reputational
risk
for
cqc.
I
just
wanted
to
point
out
those
two
things.
L
First,
I
mean,
as
you
were
aware,
the
issues
at
winterbourne
view
came
to
light
in
may
2011
and
at
that
time
the
normal
safeguarding
processes
were
put
into
place,
which
included
a
review
by
the
south
gloucestershire
adult
safeguarding
board,
who
commissioned
a
serious
case
review
that
wasn't
then
published
until
the
7th
of
august
2012,
mainly
because
of
the
prosecutions
that
were
in
place.
It
couldn't
be
published
until
all
those
had
gone
through
the
process
and
the
set
of
recommendations
from
serious
case
review
covers
the
the
full
spectrum
of
care
and
commissioning
providing,
etc.
L
L
We
have
made
good
progress
on
on
many
of
those,
but
the
paper
comes
with
the
caveat
that
there
is
still
some
more
work
to
be
done
as
you've
had
chance
to
review
the
paper
already.
I
wasn't
going
to
go
through
each
of
the
actions,
but
just
wanted
to
take
the
the
reds
and
the
ambers
and
I'm
happy
to
take
questions
on
any
of
the
others,
if
you
so
wish.
L
Having
listened
to
the
conversation,
you've
just
had
there's
two
two
areas
that
are
are
red:
one
red
and
one
amber
relating
to
the
care
of
people
with
mental
health
problems,
and
I
think
that
you're,
just
talking
about
the
strategy
and
the
consultation
and
new
ways
of
inspecting
etcetera,
will
cover
some
of
this
off.
So
that
should
proceed
as
we
go
through
with
new
ways
of
inspecting
and
regulating
services.
So
I
wasn't
going
to
say
too
much
on
that.
L
Now
the
absence
of
a
risk
of
a
registered
manager
does
increase
the
risk
of
poor
performance.
There's
there's
quite
a
bit
of
work
on
winterbourne
view
being
one
of
the
examples
of
where
not
having
a
registered
manager
can
lead
to
poor
performance.
So
they
are
on
our
on
the
inspector
sort
of
risk
alert
list.
L
What,
in
what
we
haven't
done
as
an
organization
is
really
use.
Those
enforcement
powers
historically
now,
wherever
a
location,
requires
a
registered
manager.
We
do
impose
a
condition.
There
are
some
circumstances,
for
example,
where
a
service
is
owned
by
an
individual
and
they
are
in
day-to-day
management.
They
don't
have
to
have
a
registered
manager,
although
we
can
impose
a
condition
so
where
we
have
imposed
a
condition
for
a
registered
manager,
it
is
actually
an
offence
to
carry
on
the
regulated
activity
without
a
registered
manager
in
place.
L
One
of
the
difficulties
of
that
is
evidencing
that
the
organisation
hasn't
taken
appropriate
action
to
fill
that
post,
so
in
as
much
as
you
know,
if
somebody
leaves
they've
got
to
have
time
to
recruit,
the
recruitment
might
be
unsuccessful
and
that's
led
to
some
obstacles
in
the
past.
However,
this
is
in
recognition.
This
is
not
something
that
can
continue.
There
is
a
specific
project
group
looking
at
this
at
the
moment
and
they're
looking
at
two
arms
of
it.
L
The
other
item
that's
amber
on
these
actions
is
about
it.
Taking
inspections
are
carried
out
by
sector
specialists
and
experts
by
experience.
An
increasing
number
of
our
inspections
do
now
include
experts
by
experience,
but
it
is
something
that
we
wish
to
see.
More
of
and
again
that's
covered
in
the
consultation
that's
out
now
and
the
new
new
way
of
inspecting.
We
would
expect
people
the
inspectors
to
be
specialized
and
more
involvement
of
experts.
L
Those
are
the
main
things
and,
overall,
with
the
strategy
and
the
plans
for
registration,
we
talked
earlier
about
the
holding
directors
to
account
for
quality
will
help
to
ensure
that
the
program
that
we've
signed
up
to
helps
us
deliver.
Our
commitments
to
winterbourne
views
serious
case
review,
I'm
happy
to
take
any
questions.
G
Okay,
thanks
for
the
update,
we
seem
to
have
fallen
into
the
usual
trap
in
that
we've
said
that
when
we've
referred
to
the
mental
health
arm,
we've
omitted
to
realize
that
it's
actually,
our
monitoring
of
the
mental
health
act.
That's
crucial
here
and,
of
course,
our
mental
health
act.
Commissioners
are
going
into
these
places
on
a
fairly
regular
basis
and
in
fact
one
of
the
issues
I
think,
with
the
winter
ball
case,
was
that
there
was
this
disconnect
between
our
mental
health
act,
commissioners
and
the
sort
of
general
inspection
regime.
G
L
Framework,
I
think
that's
a
very
fair
comment,
and
certainly
we
have
a
memorandum
of
understanding
between
operations,
compliance
inspectors
and
our
mental
health
act.
Commissioner,
colleagues
and
I
think
we
are
seeing
more
of
joint
inspection
work
going
on,
but
I
think
you've
got
a
very
valid
point
that
it's
not.
G
A
E
D
Certainly
to
my
satisfaction-
and
I
suspect
other
board
members-
and
I
do
think
we
need
some
to
use
the
word
that
was
being
used
earlier
on
pace
about
about
this.
Then
there
is
the
the
the
serious
case
review,
which
is
what
the
foundation
of
this
particular
document
and
I
have
to
say.
I
don't
understand
why
we
are
separating
these
two
documents.
It's
one.
It
was
one
serious
incident
which
went
wrong.
We've
got
a
number
of
actions
arising
from
two
reports.
D
I
don't
understand
why
we
can't
have
an
integrated
schedule
of
what
we
agreed
to
do
in
the
light
of
those
two
reports
and
whether
they
have
been
done
or
not.
So
that's
the
first
proposition
which
david
might
want
to
pick
up
in
a
minute
when
he
comes
in.
The
second
issue
is
that
I
do
have
concerns
about
what
is
here.
One
of
them
is
already
been
highlighted,
which
is
that
the
care
quality
commissions
is
on
page
four
care.
Quality
commission
should
take
appropriate
enforcement
action
where
registered
managers
are
not
in
place.
D
I
think
we've
been
over
sympathetic
and
over-generous
about
this.
I
don't
quite
understand
why
we
aren't
taking
enforcement
action.
Why?
I
don't
understand
why
this
is
red,
it
doesn't
seem
to
me
to
be
a
particularly
difficult
issue
to
do.
The
caa
would
not
tolerate,
for
one
moment
aeroplanes
taking
off
without
qualified
pilots
in
them.
I
don't
see
why
we
are
tolerating
institutions
which
are
being
run
without
people
who
are
registered
in
charge
of
them.
D
If,
if
officials
feel
that
there
should
be
a
more
tolerant
approach
to
this,
then
I
think
there
is
an
obligation
to
come
and
seek
strategic
guidance
on
that
and
let
the
board
take
responsibility
for
not
implementing
it.
I
don't
think
this
is
a
matter
for
officials
to
make
their
own
judgments
about
whether
we
should
be
more
tolerant
than
he's
recommended
in
the
in
the
serious
case
review.
D
The
third
sorry.
The
second
point
I
wanted
to
make
was
about
the
first
recommendation,
which
was
about
these
institutions
requiring
frequent,
more
thorough,
unannounced
inspections,
and
what
what
I'm
not
clear
about
is
whether
that
is
what
we
are
actually
doing.
Although
there's
a
green
rating
that
the
narrative
next
to
it
says
that,
where
we
identify
regulatory
concerns,
we
inspect
frequent
services
more
frequently.
That
was
not
what
was
recommended.
D
What
was
recommended
was
that
we
should
automatically
inspect
these
services
more
frequently
and
more
thoroughly,
and
I
don't
understand
whether
we
are
or
aren't
doing
that,
and
I
think
it
I'd
be
grateful
if
we
could
have
an
answer
on
that.
The
third
point
I
was
going
to
raise
has
already
been
discussed.
E
Questions
I'll
do
some,
my
apologies
kay
and
john.
If
I've
missed
the
report,
I
clearly
have.
I
was
going
on
the
winter-born
case
review,
so
what
I
will
personally
give
an
undertaking
to
do.
We
will
bring
back
to
the
next
meeting
a
clear
statement
in
relation
to
and
a
combined
action
plan
which
draws
together
what
happened
in
cqc
on
the
winterbourne
case,
review
report
and
we'll
deal
with
the
actions
that
follow
that
as
you've
indicated.
So
let
me
just
give
agreement
to
doing
that
john
and
care
on
registered
managers.
E
I
think
your
point
is
absolutely
right.
We
discussed
this
last
week
and
I
asked
for
further
work
to
be
done
on
this,
so
we
could
be
absolutely
clear.
I
think
one
of
the
issues
that
we
need
to
be
clear
about
that
we'll,
try
and
walk
through
in
the
advice
to
the
board,
so
you
can
actually
give
a
steer
is.
We
know
there
is
a
proportion
of
vacancies
at
registered
managers.
E
I
think
this
is
why
bernadette
is
saying
one
of
the
judgments
we
need
to
make
is
legitimate
and
appropriate
action
being
taken
to
use
one
of
the
phrases
at
pace
to
fill
these
vacancies,
or
are
people
genuinely
doing
it
for
whatever
reason
to
reduce
costs
to
manage
it,
etc,
etc?
And
we
need
to
take
a
judgment
on
that,
but
we'll
we'll
draw
that
through
and
I
think
on
your
challenges
about
more
thorough,
we'll
just
be
clear,
clearer
with
you
john
about
what
it
is
that
we
are
doing
on
inspections.
E
I
think
bernadette
will
be
able
to
describe
some
of
the
work
that
we're
doing
currently
on
that,
but
we'll
set
that
out
in
the
north
more
fully
than
here
and
on
your
point
about
not
how
many
whistleblowers
have
we
had.
But
how
are
we
encouraging
whistleblowers
we'll
come
back
to
you
on
that
as
well?.
B
Well,
I've
got
a
question
for
information
and
then
I'd
like
to
armed
with
that
say
say:
that's
inappropriate,
use
of
the
term,
isn't
it,
but
anyway,
with
that
information,
I
would
then
perhaps
like
to
say
something
else.
But
can
you
tell
me
how
how
many
institutions
are
we
talking
about
that?
That
we
are
that
that
we
are
applying
this?
This
approach,
to
how
many,
how
many
such
hospitals
are
there.
L
I'd
have
to
I'd
have
to
go
away
with
the
exact
figure,
but
there
lies
in
an
interesting
issue
and
when
we
did
the
inspections
of
the
150-
and
it
does
say
in
here
about
one
of
the
actions
is
about
assessment
and
treatment
centres,
and
one
of
the
problems
that
we
had
was
identifying,
which
which
locations
were
providing
assessment
and
treatment
services
which
links
into
conversation.
You
had
earlier
about
the
statement
of
purpose
and
our
services
actually
providing
what
they
set
out
to
provide.
L
B
Okay,
well,
I
I
understood,
although
it's
constantly
a
source
of
surprise,
to
me,
that
we,
we
can't
kind
of
lay
off
our
hands
around
these,
these
sort
of
numbers
and
know
what
the
scale
of
the
task
is.
But
so
I
I
feel
less
close
to
this
than
than
colleagues
who've
kind
of
lived
and
and
and
breathed
it
a
bit
more,
but
but
so
reading
this
quite
cold.
I
have
to
say
that
it.
B
It
left
me
concerned
in
the
ways
in
various
ways
that
other
people
have
talked
about
left
me
feeling
that
actually
we
hadn't
yet
done
what
we
needed
to
do.
In
short,
in
response
to
winterbourne
view-
and
I
am
very
clear
that
the
strategy
does
provide
us
with
a
a
means
for
addressing
some
of
these
issues.
B
But
it's
also
the
case
that
the
strategy
doesn't
plan
to
move
into
this
space
in
in
terms
of
our
approach
to
inspection
being
radically
different
until
2014-15,
and
that
will
be
the
beginning
of
that
process,
which
will
take
some
time
to
cut
to
to
come
through
the
system.
And
so
and
I
and
I
have
to
say
that.
B
I'm
not
sure
that,
therefore,
that
the
strategy
will
address
some
of
these
issues
is
is
an
explanation
that
I
feel
comfortable
with,
because
I
think
given
I
mean
I
was
hoping
to
hear
a
slightly
smaller
number.
But
it
seems
to
me
that
you
know
maybe
we
need
to
really
focus
our
effort
on
those
places
which
are
major
providers
of
service
in
this
space
and
just
make
sure
that
we
we've
done
everything
necessary.
B
These
are
particularly
vulnerable
group
of
consumers
and-
and
I
think
we
we
have
a
very
strong
responsibility
to
make
sure
that
we've
learned
and
implemented
the
lessons
in
in
those
biggest
providers
at
the
very
least
very
very
quickly
and
before
we
implement
the
full
change.
All
the
changes
in
the
strategy.
G
I've
recently
started
sitting
on
mental
health
review
tribunals,
and
I've
already
picked
up
a
couple
of
examples
that
I've
been
able
to
refer
to
cqc.
It
seems
to
me
that
these
you
know,
tribunal
members
are
going
in
and
you
know
the
doctor
goes
on
the
ward
and
interviews
clients.
You
know,
and
I
just
wonder
whether
there's
something
that
we
develop,
I
don't
know
a
memorandum
of
understanding
because
they're
actually
there
and
you
hear
some
concerning
things,
so
I
think
you
know
just
thinking
of
getting
intelligence.
E
Just
on
an
anna's
point,
I
think
the
strategy
deals
exclusively
with
the
issue
about
changing
the
registration
process,
not
the
other
issues
that
have
flagged
in
this
action
plan,
which
are
either
amber
red
or
green
rated.
So,
in
a
sense
I
don't
think
the
vehicle
for
taking
action
on
these
recommendations.
I
I
can't
speak
for
the
internal
cqc
one.
I
will
go
away
and
look
at
that,
but
take
the
action,
so
I
don't
think
we're
investing
everything
in
the
strategy
to
do
this.
E
What
we
have
done
is
we've
signed
a
concordat
where
the
recommendations
that
were
made
in
the
serious
case
review,
or
that
the
minister
and
other
colleagues
wanted
us
to
commit
to
we've
actually
laid
out
what
we've
committed
we've
laid
out
there
our
commitments-
and
that
is
what
I
think
we
need
to
account
to
you
as
board
members
on,
as
well
as
the
things
that
have
previously
been
committed.
That
john
and
kay
have
raised
and
that's
what
we'll
go
away
and
we'll
come
back
to
you.
A
Can
I
just
add
one
thing
before
that
you
want
to
come
back
in
bernadette,
but
I
mean
I
my
real.
My
real
concern
is
here:
is
we
still
don't
have
enough
specialist
inspectors
and
it
comes
back
to
the
point
k
making
the
beginning
about
using
mental
health
act
commissions
as
well.
We
don't
have
enough
specialist
inspectors
going
into
these
places.
L
So
I
think
that
I
probably
didn't
you
know,
explain
that
well
enough.
So
I'd
just
like
to
give
you
some
reassurance
that
those
inspections
have
haven't
have
increased.
They
are
all
unannounced.
We
are
going
back
to
follow
up
where
they're
finding
concerns,
so
the
frequency
now
to
three
years
ago
is
a
very
different
picture
in
in
the
positive
way.
So
I
just
wanted.
I
didn't
think
that
perhaps
I've
made
that
clear.
L
I
I
believe,
the
the
learning
disability,
the
150
inspections,
all
included
a
team
of
people,
because
the
inspectors
weren't
necessarily
experts
in
the
field
of
learning
disability,
but
what
they
had
with
them
was
a
professional
advisor.
So
they
had
somebody
that
was
an
expert
in
that
field
and
they
had
experts
by
experience,
usually
a
person
who'd
used
services
and
under
carer.
So
they
had
a
different
number
of
perspec
perspectives
and
that's
what
we're
taking
forward,
really
that
we
may
have
inspectors
going
in
that.
L
A
A
We
do
an
inspection
and
people
think.
Therefore
it's
fine,
then
you
dig
underneath
you
find
the
inspection
was
done
by
people
who
don't
anything
about
him.
I
mean
that
is
my
real
word.
It's
all
our
worries,
I
think,
particularly
after
what
just
happened
in
you
know
the
grant
autumn
report,
but
it's
been
our
worries
for
a
long
time
I
mean,
can
you
say
categorically
that
no
inspections
take
place
now
without
an
expert,
whether
that's
a
specialist
or
whether
that's
an
expert
patient
by
experience,
type
expert.
E
E
I
think
one
of
the
issues
from
this
conversation
that
we
need
to
reflect
on
is
how
can
I
report
to
you
as
part
of
the
regular
monitoring
that
gives
you
some
confidence
of
just
what
the
proportion
of
all
of
our
inspections
are.
That
include
experts
and
I've
said
all
of
that
without
the
microphone
as
the
man
at
the
back
has
just
so.
What
I'm
saying
chair
is,
let
me
take
that
away.
I
do
agree
with
you.
The
issue
is
about
person
trajectory,
I
think,
in
old
150.
E
We
did
have
experts
by
experience,
experts
on
these
groups,
and
let
us
see
if
we
can
find
a
way
of
reporting
to
you
the
proportion
of
all
of
our
inspections
as
we
make
this
transition
over
the
next
two
to
three
years.
That
actually
are
where
our
inspection
teams
are
constituted.
In
that
way,
as
we
make
the
transition
and
we'll
take
that
away
and
look
at
how
best
we
can
do
that.
H
I
I
think
in
the
acute
hospital
sector,
I
think
we've
crossed
the
route
kind
of
accepting
that
our
current
inspection
model
is
inadequate
and
broken,
and
we've
started
saying
that,
but
I
think
for
the
the
purpose
we're
saying
that
we
need
to
be
healthily
skeptical
in
all
our
inspections,
that's
a
better
way
to
be,
and
we're
also
saying
that
we
supply
the
same
discipline
to
our
own
organizations.
We
do
to
those
that
we
inspect
and
regulate.
H
So
it
seems
a
reasonable
proposition
that,
as
we
go
sector
through
by
sector
over
the
next
three
years,
taking
the
most
vulnerable
sectors
as
early
as
we
can,
we
we
apply
that
skeptic
and
assume
our
model
is
wrong
until
we
know
better,
rather
than
assuming
that
we
could
be
okay.
So
I
think
that's
that's
one
of
the
tests
that
we
need
to
apply
as
we're
going
through
the
further
consultations,
not
to
assume
things
are:
okay,.
F
I'm
not
really
very
happy
with
the
the
link
to
the
concord
and
the
absence,
because,
whatever
we
do
to
improve
the
number
of
registered
managers,
there
are
unless
they
change
the
recruitment
model.
So
there
are
whether
there's
locums
or
something
else
available.
There
will
always
be
gaps,
and
I
don't
think
that's
acceptable
and
I
think
what
we
should
be
saying
is
that
there
should
be
a
different
model.
F
Four
registered
managers,
staffing
arrangements,
so
that
if
one
goes
there
is
a
team
of
locums
or
temporary
or
I
don't
know
what
that
go
in
and
that
is
going
to
be
the
provider's
responsibility
and
we've
got
to
insist
on
it.
But
you
know
just
wait
six
months
or
we
recruit
someone
and
guess
what
that
might
go
wrong.
I
don't
think
it's
adequate.
A
L
A
H
A
A
I
mean,
presumably,
if,
as
part
of
our
consultation,
this
this
is
something
we
will
ask
the
industry
as
well.
Is
it
but
the
presump
the
presumption
has
to
has
to
be,
there
must
be
a
registered
manager
hasn't.
That
must
be
the
presumption.
I
suppose
it
is
rebuttable
in
certain
exceptional
circumstances,.
D
And
what
worries
me
is
that
there's
a
there's,
a
there's,
a
published
regulation
about
what
is
required,
which
is
the
written
expectation
and
then
there
is
the
unwritten
expectation
of
the
way
that
we
then
enforce
that
and
what
we're
actually
doing
is
saying:
oh,
don't
worry
if
you
can't
actually
get
a
registered
manager,
don't
worry
we,
we
won't
take
enforcement
action.
That's
what
we're
that's
the
message
we're
actually
giving
and
I'm
very
unhappy
about
that
message.
A
You've
got
the
gist
yeah
we're
all
coming
from
the
same
place.
There's
got
to
be
an
exception,
a
really
strong
reason
to
depart
from
a
absolute
blanket
rule.
A
really
strong
reason
will
you
take
that
that
away
we've
got?
We
must
keep
this
winter
bomb
view
on
the
on
the
right
up
on
the
radar
screen
david.
I
think
it's
there's
it's
such
a
vulnerable
area.
E
E
We
can
put
to
you
some
propositions
about
what
our
operating
practices
should
be
in
respect
to
registered
managers.
I
have
to
say
it's
not
just
here.
This
goes
across
all
homes
and
I
will
get
a
letter
out
to
you
this
evening,
which
tells
you
the
number
of
homes.
I
think
it's
in
the
small
thousands,
but
I'm
reluctant
this,
the
small
thousand,
but
I'm
reluctant
to
give
a
figure,
because
I'm
just
not
confident
I've
got
it
properly.
E
But
if
you
think,
there's
20
000,
adult
social
collocations
registered
around
12
000
of
those
are
older
people
services.
Then
you,
the
rest,
are
split
between
mental
health
that
are
registered
learning
disabilities
and
physical
disability,
and
what
I
can't
do
is
just
give
you
that
breakdown
of
the
others.
So
let
us
just
remove
that
from
the
meeting
and
I'll
call
the
letter
to
go
to
every
board
member
this
evening.
That
says
what
those
precise
proportions
are
just
to
get
the
manageability
of
this,
but
let
me
take
it
away
and
bring
it
back.
E
H
M
So
warning
notices
were
issued
straight
away
for
those
and
the
further
inspections
on
those
found
that
there
had
been
improvements
to
the
point
of
compliance
for
eight
of
them
and
at
two
locations.
Some
improvements
have
been
made,
but
the
level
of
concern
was
still
minor,
so
they
will
be
followed
up
further
and
one
service
canceled
their
registration.
M
H
The
only
point
I
made
is
that
the
level
of
assurance
we
can
take
from
this
is
that
the
proportion
of
follow-ups,
because
these
are
themed
inspections-
we
should
not
take
not
feel
confident
that,
therefore,
everybody
who
could
be
non-compliant
is
being
followed
up.
That's
the
fundamental
challenge
of
the
theme
perspective.
The
point
I'll
draw
out.
B
B
Given
the
number
of
things
that
we
we
have
to
do,
but
it
seems
to
me
that
there's
it's
imperative
that
we
follow
up
on
those
people
we
identify,
who
are
non-compliant.
That
has
to
be
a
kind
of
you
know,
must
must
have.
But
given
that
in
many
of
these
themed
inspections
we
find
actually
there
are
not
insignificant
issues
across
the
sector.
H
So
the
theme
inspection
split
into
two
type:
there's
the
from
12
13.
There
was
a
dignity,
nutrition
ones
that
are
an
example
of
a
particular
yeah.
A
manifestation
of
poor
care
versus
the
ones
are
on
domiciliary
care,
which
is
an
entire
sector
on
on
the
first
of
those
two,
I
think
it
is
it's
symptomatic
of
the
problem
that
we've
we've
had
and
got
until
we
changed
the
model
that
you
need
to
do
a
themed
inspect
for
something
as
basic
as
dignity,
nutrition
and
so
one
one
way.
H
I
think
we
move
it
off
the
wishes
and
make
it
mainstream.
Business
is
the
sorts
of
things
that
we
would
had
to
in
the
past.
Use
thematic
inspections
for
are
just
mainstream
business
for
us,
and
certainly
part
of
caring
and
being
responsive,
and,
if
we're
not
looking
at
dignity
and
nutrition,
both
of
which
are
examples
on
the
fundamentals
of
care,
then
something's
gone
wrong
with
our
new
model.
M
I
absolutely
take
that
point
and
I
think
that's
very
much
the
direction
that
we're
going
with
themed
inspection.
Certainly
with
these
reports
we
took
a
significant
step
forward
in
that
we
used
the
reports
to
publicize
what
we
saw
as
being
good
practice
and
so
working
encouraging
people
to
improve,
and
we
worked
with
trade
associations
etc.
To
actually
highlight
that
moving
forward.
Of
course,
priority
four
of
the
strategy
is
about
progressing
the
way
in
which
we
do
that
themed
inspection
work
and
using
it
as
a
tool
in
which
we
can
encourage
improvement.
M
We're
certainly
looking
at
reporting
that
much
more
up
front,
and
we
may
want
to
think
about
how
we
link
in
more
widely
to
the
sector,
and
the
other
element
of
that
is.
We've
also
talked
with
christina
cornwall
about
the
ability
we
have
maybe
to
evaluate
that
wider
impact
on
the
sector.
So
when
we
do
issue
a
national
report,
is
it
making
other
people
talk
about
what's
happening
in
their
organization,
even
if
they
weren't
a
part
of
the
you
know,
the
actual
review
itself.
A
So
is
it
also
true
that,
as
we
go
forwards,
I
mean
one
of
the
potential
weaknesses
of
our
new
structure.
Is
that
it's,
it
could
be
seen
as
a
silo
silos,
and
actually
we
want
to
look
at
the
journey
of
patients
through
the
health
and
social
care
system
or
through
mental
health,
into
acute
care
and
back
those
sorts
of
issues,
and
that
themed
inspections
will
give
us
a
way
of
following
the
patient
journey.
H
M
I
think
the
other
thing
is
then
it's
it's.
How
you
make
sure
that
you
that
topics
are
picked,
that
link
with
that,
and
I
think
board
has
already
picked
two
topics
as
the
initial
work
this
year
and
that
is
around
you
know
the
transition
of
children's
to
into
adult
services
and
dementia,
both
of
which
are
absolutely
right
as
topics
to
be
able
to
do
it.
That
sort
of
you
know
pathway
approach,
rather
than
being
it's
purely
focused
on
particular
parts
of
particular
sectors.
E
Did
and
it
will
go
on
the
program,
but
that
needs
work.
You
know
we
did
agree
to
look
at
that.
We
agreed
to
take
that
away
and
work
that
through.
I
think
what
sue's
referring
to
are
the
two
that
you've
already
agreed
as
a
board,
and
I
think
sue's
leading
that
work
and
I
think,
he's
well
on
with
the
design
so
that
they
can
be
given
action
in
the
next
in
the
next
period.
We
will
pick
that
up
david
you're
right.
We
have
agreed
here.
F
H
H
Can
I
come
back
on
that?
I
don't
think
it's
either
all
right
actually,
but
it's
john
I,
if
we're
not
putting
in
place
the
incentives,
there's
you
know
it
doesn't
matter
to
people,
then
I
think
legitimately.
We
do
need
to
look
at
what
we're
doing
differently,
but,
yes,
the
responsibilities
with
the
provider
board.
A
H
So
this
about
the
state
of
care
reports
which
chris
is
going
to
talk
about
in
a
bit
of
detail,
it'll
come
out
after
summer
recess,
so
either
in
september
or
very
early
october,
and
the
point
of
perhaps
bringing
it
here
is
so
that
we're
not
saying
this
is
what's
going
to
be
in
it
we're
asking
for
views.
We
have
some
thoughts
on
what
should
be
in
it.
This
is
not
the
first
time
I've
run,
I
think,
the
third
time
chris
we've
done
it
and
it
is
a
landmark
document
for
the
cqc.
H
I
I
I
One
of
the
building
blocks
of
that
is
that
stakeholder
information,
which
comes
from
from
other
sources
there
are
some.
There
are
some.
We
think
critically
important
pieces
of
information
that
just
aren't
available
until
I
put
a
as
one
of
the
appendices,
some
of
the
key
pieces
of
information,
so
the
complaints
information
for
the
last
12
months,
the
the
information
on
hcai
infections
cause
of
death
information
on
the
osa.
I
There
are
really
some
really
chunky
and
important
pieces
of
data
that
are
that
will
come
to
come
out
to
us
in
order
to
begin
some
analysis
during
this
month.
I
don't
think
you
can
do
it
without
that.
I
think
it's
really
important
that
you
have
that
information.
You
have
that
data
to
make
an
informed
picture
to
begin
the
conversations
with
with
yourselves
with
staff
with
other
stakeholders.
I
I
I've
described
with
the
tiers
are
some
early
themes
that
we
that
we
said
we
do
so
we
we
go
and
we
have
that
initial
analysis
come
back
with
some
early
themes
about
these
are
the
things
we
think
are
issues
for
each
of
the
sectors
we
already
have
got
some
some
from
the
the
work
we
did
on
some
intelligence.
Colleagues
and
colleagues
operations
did
on
the
the
links
between
a
e
attendance.
You
may
remember
in
the
care
update
that
we
did
earlier.
I
We
talked
a
bit
about
the
linkage
between
problems
of
people
getting
into
and
out
of
a
e
as
a
as
a
consequence
of
their
performance.
We're
looking
at
we're
looking
already
at
some
linkages
that
sort
of
link
the
care
pathway
from
adult
social
care
into
secondary
care
and
back
out
again
to
see
what
the
relationship
is
like
between
performance
in
the
secondary
care
environment
and
that
and
the
adult
social
care
environment
that
that
links
to
it,
because
I
think
that
will
be
an
important
piece
of
work.
I
But
what
I
wanted
to
come
here
today
was
of
an
offer
to
say
I
think
it's
important.
We
have
that
data
to
begin
that
conversation,
what
I
wanted
to
bring
back
to
you
with
some
early
themes
that
we
could
then
have
have
a
conversation
at
a
board
with
the
the
analysis
info.
The
analysis
I'm
talking
about
is
basically
coming
in
by
the
end
of
the
most
of
it
comes
in
by
the
end
of
this
month.
Effectively.
So
I'll
have
the
most
of
the
information
to
do
that
analysis.
B
I
Absolutely
remember
we
spoke
about
it,
I
think
one
or
two
meetings
ago,
because
you,
when
you
first
talked
about
it,
I
think
there's
a
lot
of
logic
between
trying
to
get
coordination
about
those
about
those
messages.
So
our
ambition-
and
this
is
basically
so
they
I
think
the
eighth
is
when
for
memory
is
when
parliament's
back.
I
think
I
think
that's
the
date
effectively
that
we're
we're
both
we
could,
where
we
could,
we
could
work
out
whether
it's
better
to
do
one
than
the
other
or
whether
we
link
them
inside.
I.
B
B
But
but,
but
on
the
specific
proposal
for
this
in-depth
review,
just
just
just
a
a
couple
of
comments
really
I
mean,
I
suppose
it
depends
what
where,
where
we
think
we
want
to
go
with
this.
But
for
me
the
that
the
question
might
be
a
bit
broader,
because
I'm
not
sure
it's
just
about
residential
care.
I
think
it's
about.
B
It
may
also
be
about
domiciliary
care
and
there's
something
about
whether
or
not
people
are
able
to
be
cared
for
in
an
appropriate
location,
home
or
residential
care,
rather
than
finding
themselves
in
hospital
being,
arguably
the
inappropriate
location
for
for
their
needs.
So
I'd.
Quite
I
encourage
you
to
think
about
broadening
it
and
the
other
thing
is.
I
don't
think
this
talks
about
a
link
between
admissions
and
the
quality
of
adult
social
care,
and
I
don't
think
it
is
just
about
the
quality
of
adult
social
care.
I
B
Well,
it's
partly
about
registration,
but
there's
also
a
question
about
affordability
actually,
for
for,
and
that
will
become
an
issue
going
forward.
So
there
may
be
something
about
what
people,
what
consumer
users
of
those
care
services
experience
is
of
access
and
what
the
barriers
to
access
might
be,
which
may
be
that
they
don't
know
their
way
around
the
system
and
who
to
go
to
and
how
to
get
what
they
need.
It
may
be
that
they
there's
an
affordability
anyway,
there'll
be
a
number
of
issues,
but
I
don't.
G
One
of
the
point
I
was
going
to
raise
is
that
cqc
publishes
two
reports:
it
it
publishes
the
state
of
care
which
is
a
sort
of
commentary
on
health
and
social
care,
but
it
also
produces
an
annual
report
which
is
about
you
know
what
we've
done
in
our
performance
and
I
wasn't
sure,
for
example,
if
the
healthwatch
report
was
was
more
akin
to
our
annual
report
or
our
state
of
care.
It
is
so
it's
different.
G
So
when
you
talk
about
an
annual
report,
it's
different
from
our
annual
report
and
I
and
I
think
it
probably
links
into
steve's
point
in
that
it
I
mean-
I
don't
know
whether
that
would
go
into
the
state
of
care
or
the
annual
report,
but
it's
the
annual
report
yeah.
So
it's
about
you
know,
obviously
being
being
clear.
I
mean
there
can
be
an
overlap
but
yeah,
okay,.
E
E
Coming
in
terms
of
that
work,
as
distinct
for
the
reporting
to
parliament,
to
which
we
account-
and
I
think
this
afternoon
we've
got
a
further
report,
which
is
our
draft
annual
report,
which
I
think
we're
looking
to
report
to
parliament
in
july
of
this
year.
Just
to
draw
out
those
distinctions.
I
think
the
points
that
we
made
about
what
we
can
report
on
in
terms
of
analysis
of
activity
are
well
made
and,
as
chris
said,
we'll
take
those
away
and
look.
B
H
So
nigel
thompson's
joining
us
for
this
item
now
to
the
head
of
user
involvement
at
cqc.
This
is
a
paper
where
we're
asking
for
board
approval
and
it's
something
we've
debated
over
april
and
may
in
them
in
the
executive
team
and
have
asked
for
a
number
of
revisions
too.
I
think
it
plays
heavily
to
earlier
agenda
items
about
the
consultation
that
we
make
sure
that
we
really
are
using
or
listening
to
the
voice
of
using
and
co-designing
with
with
users
of
services
in
everything
we
do.
Nigel.
N
Yeah,
thank
you
paul.
It's
just
it's.
The
statement
of
involvement
is
a
statutory
responsibility
for
us
to
publish
a
statement
of
how
we
involve
and
engage
people
in
our
work.
So
that's
how
we
involve
people
to
use
services
in
in
in
all
features
of
our
work
and
also
how
we
listen
to
and
take
into
account
the
experiences
of
people
who
use
services.
N
This
statement
is
a
revised
statement
we
committed
at
the
beginning
of
cqc
to
revise
the
statement.
The
delivery
of
this
statement
was
deferred
following
the
completion
of
the
strategy
review,
and
it
takes
into
account
a
number
of
responses
to
that
review
from
people
who
use
services
about
the
things
that
cqc
should
be
doing.
N
The
statement
itself
was
written
with
people
who
use
services
that
it
reflects,
to
a
large
extent
their
views
and
about
the
way
in
which
we
should
deliver
our
business.
Interesting
enough
to
a
very
clear
theme
from
that
was:
we
must
have
a
statement
of
involvement
which
makes
clear
commitments
and
promises,
but
also
one
that's
achievable
one
that
actually
where
we
are
able
to
actually
deliver
on
what
we
say,
and
I
hope
that
the
statement
again
reflects
that.
B
I'm
feeling
repetitive,
but
I
so
I
I
really
like
some
of
what's
in
here,
and
I
think
I
I
I
see
some
enormous
strength
in
and
and
sort
of
development
of
what
we're
doing
in
terms
of
involving
the
public.
I'm
talking
about
consumers
and
users
in
the
intelligence,
work
and
around
inspections,
and
even
some
around
culture,
change
and
training,
and
I
think
those
are
all
al
all
great.
B
I'm
I
I'm
back
in
the
space
of
the
consultation
and
fundamental
standards
and
those
kinds
of
things,
and
I
I
think
it
it
will
be
very
important
that
we
are
clear
that
we
have
ways
of
doing
that
and
at
the
moment
I
think
it
hangs
quite
heavily
in
this
document
on
the
panel
made
up
of
people
who
use
services
from
diverse
communities
as
a
kind
of
way
of
of
of
sounding
board
for
some
of
those
things.
So
I
just
I
I
just
don't
get
that
that
from
this,
yet
as
it
stands.
N
N
I
think
you've
made
a
point
about
that
about
the
panel.
Certainly
that's
that's
an
important
issue
for
us
going
forward
and
we
welcome
the
board
of
views
on
how
we
take
that
forward,
because,
certainly
in
terms
of
the
francis
recommendations,
it
quite
particularly
talks.
Doesn't
it
they're
about
about
a
people's
consultative
council
that
is
able
to
inform
the
board
about
the
fusion
experiences
of
people
who
use
services
in
their
work?
So
that
certainly
is
an
element
going
forward.
N
N
So
we
currently
work
with
four
support
organizations
and
we
have
a
range
of
people:
services,
people
with
mental
health
issues.
People
have
disabilities
carers,
people,
dementia,
a
whole
range
of
up
to
about
350
people
at
this.
At
this
moment
in
time,
we're
in
discussion
with
currently
about
reprocuring
that
contract
that
we
have
and
and
with
a
view
to
our
to
the
expansion
or
the
the
expected
expansion
of
the
need
for
experts
by
experience
going
forward.
A
H
D
N
We
certainly
are
we
in
discussions.
For
example,
I
was
with
nhs
england
yesterday
talking
to
people
that
carry
out
a
similar
function
to
us.
For
example,
we
also
talked
to
monitor.
We
talked
to
a
range
of
people
across
the
sector
and
all
of
them
have
a
number
of
people
that
in
particular
areas
there's
certainly
areas
which
I
think
we
we
certainly
think
we
could
learn
from.
D
Everything
I
just
I
mean,
there's
nothing
I
object
to
in
this
paper.
It's
all
very
you
know
it's
all
fine,
but
I
just
wonder
whether
it's
enough-
and
I
think
we
ought
to
be
doing
much
more
and
one
of
the
you
know.
The
competitive
instinct
is
a
good
way
of
trying
to
find
out
what
more
we
could
try
and
develop,
or
try
and
copy
other
people's
ideas
or
even
invent
new
ideas.
Let's
be
a
bit
bolder.
B
I
I
think
it's
such
a
good
question
john,
and
it's
bearing
john's
blushes,
but
actually
one
of
the
organizations
that
the
public
and
stakeholder
organizations
think
did.
This
particularly
well
was
the
food
standards
agency.
Certainly
in
its
early
inception,
I
don't
know
how
how
it
has
been
laterally
and
another
one
is
the
is
ofcom
so
so
to
people
in
regulatory
space
course,
none
of
them,
neither
of
them
in
health
and
social
care,
where
I'm
not
sure
that
we
have
done
it
as
well
as
we
have
in
other
sectors.
B
B
J
J
Right,
thank
you
chair.
Yes,
this
is
a
paper
really
asking
the
board
for
retrospective
approval
for
the
registration
of
gps,
the
toronto
five,
as
we
called
it
the
business
case
it's
taken
to
the
board
for
approval
because
of
the
sums
involved.
The
capital
is
over
5
million
and
the
overall
spend
is
over
10
million
pounds.
J
J
Now
one
of
the
difficulties
that
we
had
here
with
the
registration
business
case
was
identifying,
and
this
is
quite
common
actually-
and
we
see
this
in
a
number
of
areas
across
across
cqc
and
indeed
the
public
sector
identifying
benefits,
as
well
as
the
the
total
costs
and
as
we
went
through
the
registration
process
for
gps.
Looking
at
the
online
aspect
of
registration,
the
original
business
case
was
set
up
in
a
way
that
we
had
envisaged
online
services
for
all
registration
processes
to
be
made
available
to
all
providers.
J
J
Methodology,
rather
than
doing
a
lot
of
the
development
ourselves,
which
was
going
to
cost
more
money.
So,
following
discussions
with
the
department,
we
agreed
that
we
would
submit
a
further
business
case
in
the
future
in
respect
of
the
online
services
and
refresh
the
business
case
for
gp
and
primary
medical
services
providers.
J
The
there
were
a
number
of
other
things
that
transpired
over
the
last
12
months,
where
we
did
a
lot
of
compliance
improvement
work
at
the
time
we
had
with
our
operational
colleagues,
we
regarded
that
work
as
effectively
business
as
usual
work,
so
it
was
not
included
in
a
business
case
that
went
to
that
got
approval
by
the
department
of
health.
So
the
the
we
took
the
view
that
it
was
much
better
to
revisit
the
business
case
for
for
gp
registration.
J
The
original.
The
top
line
shows
the
original
business
case
with
an
mpv
of
12.8
million,
because
we
included
a
lot
of
benefits
in
that
original
case,
which
now
we're
seeing
are
more
properly
and
more
appropriately
reflected
in
an
online
services
business
case
to
be
submitted
at
a
later
date,
because
it
wasn't
really
attributable
some
of
the
benefits
that
we
put
in
the
business
case.
Even
though
it
was
approved
by
the
department
of
cabinet
office.
J
We
considered
that
they
weren't
really
attributable
to
the
registration
of
gps,
so
they
should
come
out
and
you'll
see
in
the
benefits
the
costs
we
put
in
additional
costs
of
about
fifth
additional
benefits
for
compliance
improvement,
which
weren't
in
any
business
case.
At
the
time.
It's
not
exactly,
I
have
to
say
to
the
board.
This
is
not
where
we
want
to
be.
There
were
so
many
unknowns
in
terms
of
the
registration
program.
J
At
the
time,
the
benefits
were
difficult
to
identify
the
some
of
the
costs,
as
I've
said
around
the
compliance
improvement
work
that
was
done
a
year
earlier.
You
know
weren't
included
in
a
business
case.
So
what
we've
taken
the
view
here,
that
this
more
properly
reflects
the
gp
registration
and
the
registration
process,
and
that
a
new
business
case
will
come
forward
to
the
board
and
the
department
of
health
for
online
services.
J
J
This
has
gone
through
the
department
of
health
process
by
the
way
we've
taken
the
department
through
the
stages
of
this,
and
they
have
given
their
approval
to
this
business
case
and
agreed
that
some
of
the
benefits
should
go
forward
into
a
further
business
case
to
be
submitted
later.
So
this
has
all
been
approved
by
the
dh.
J
I
haven't
attached
the
business
case
here.
It
runs.
The
detailed
business
case
itself
runs
to
about
60
pages
that
the
department
have
approved.
I
can
make
it
available
to
board
if
anyone
wants
the
that
level
of
detail,
but
I'm
asking
the
board
to
give
retrospective
approval
to
the
costs
as
their
as
a
required
board
approval
for
that
level
of.
D
F
I'll
make
it
just
a
a
json
point,
but
we
are
normally
quite
careful,
but
in
this
report
I
still
don't
should
know
but
don't
know
what
bms
stands
for
and
I
did
work
out
what
t5
stands
for
if
we
could
just
make
sure
that
all
the
abbreviations
are
identified,
at
least
once
in
a
report.
It
would
be
very
helpful
for
public
documents.
B
E
John
church,
all
right
david
and
I'm
a
regular
attender
at
rick,
and
we
consider
this
at
the
last
meeting
and
it
will
inform
the
work
we're
doing
in
terms
of
changing
the
governance.
I
think
we've
touched
on
it
on
two
or
three
of
the
items
we've
looked
at
today
around
delegations
at
what
level
decisions
are
made,
etc,
etc,
and
it
comes
to
this,
I
think
the
key
issue
here
is
as
being
able
to
demonstrate
by
what
we
do
that
we're
actually
taking
these
things
forward.
A
C
A
E
I
think
there's
confusion
on
my
behalf,
chair
and
I
will
actually
address
that
and
naomi
and
myself
will
make
sure
steve
gets
a
letter
that
just
laid
it
out.
I
think
the
worry
was
that
we
weren't
taking
something
forward
and
we
are
indeed
taking
it
forward,
but
let
me
clarify
that
and
let
me
accept
responsibility.