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From YouTube: CQC Board meeting - October 2020
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A
Good,
let's
go
so
welcome
to
the
public
board
meeting
for
october.
I
particularly
want
to
welcome
moena
stewart
who
is
from
our
disability,
equality
network
and,
moreover,
you're
extremely
welcome
and
do
please
contribute
as
you
wish,
as
we
go
through
the
meeting.
We
have
one
apology
for
for
absence,
which
is
from
rosie
rosie
bennyworth
other
than
that
we're
all
here.
A
That's
good.
We
are
quora
that
then
moves
us
on
to
the
minutes
of
our
september
meeting.
Are
they
a
true
and
accurate
record
of
everything
that
we
discussed?
A
Thank
you
we'll
take
those
as
approved
there's
one
item
in
the
action
log,
which
is
around
the
freedom
to
speak
up
guardian
six
monthly
report
that
is
on
our
agenda
for
today.
So
that
is
done.
Was
there
anything
else
arising
that
anybody
wanted
to
raise?
That's
not
otherwise,
on
the
agenda,
somebody's
hand's
gone
up
who's
who's.
That.
B
It's
me
chairman,
mark
mark
sorry,
yes
yeah.
I
just
wanted
to
say
the
item
13
about
people
metrics
and
kpis
that
kirsty
and
I
had
a
good
meeting
and
that
is
moving
forward
with
the
involvement
of
the
people
that
directorate.
So
it
was
an
action
that
we
both
had
and
we've
we've
started
the
progress,
the
process.
A
C
Thanks
thanks
peter,
as
you
would
expect,
kovit
has
somewhat
dominated
our
work
over
the
last
month.
I
think
it's,
I
think
it's
fair
to
say
that
we've
seen
just
just
from
news
coverage
alone,
we've
seen
that
the
pace
of
work
nationally
around
covet
is
it
has
increased
and
we've
seen
that
as
citizens.
C
In
the
same
way,
we've
seen
that,
as
as
a
regulator
and
the
work
that
we've
been
we've
been
engaging
in
over
the
last
month
or
so
really
is
to
try
and
establish
an
appropriate
tempo
of
work
over
the
coming
months
in
an
environment.
I
think
which
we
described
in
state
of
care
as
being
in
a
covered
era.
I
think
we
need
to
recognize
that
we're
in
a
period
now,
where
covert
is
going
to
remain
a
pretty
intrusive
part
of
our
lives
for
the
foreseeable
future.
C
The
prime
minister
talked
about
sort
of
when
we
first
talked
about
the
second
wave
as
needing
to
have
some
restrictions
in
place
for
the
next
six
months,
and
I
fear
we'll
that
the
given
given
given
the
current
progress
of
the
virus
and
what's
going
on
internationally
I'd,
expect
that
kobit
will
be
part
of
our
lives
for
most
of
the
coming
calendar
year.
And
we
as
an.
C
That's
that's
exactly
work
that
we're
doing.
I
I
think
this
time
around
it'd
be
fair
to
say
that
we
are.
We
are
better
prepared
and
also
those
that
we
regulate
are
better
prepared.
So
I
I
think
the
first
time
around
there
was
a
sense
that
that
that
the
virus
wasn't
understood.
C
We
were
all
we
were
all
struggling
to
make
sure
that
that
that
was
a
real
focus
on
on
supporting
people
with
covet
and
that
focus
is
still
there.
But
I
think
we
now
have
better
tools
and
techniques
and
approaches
that
we
can
deploy
both
on-site
and
also
off-site.
We've
got
a
very
much
clearer
view
as
to
the
sorts
of
work
we
should
be
doing
and
the
source
of
work
that
perhaps
is
of
a
lower
order
of
priority.
C
I
know
individual
colleagues,
particularly
the
the
chief
inspectors,
will
talk
in
more
detail
about
areas.
The
code
would
work
in
their
particular
areas,
but
our
overall
intention
is
to
continue
to
focus
on
looking
for
risks
in
providers
and-
and
we
are
just
to
reiterate
the
point
which
we've
made
a
number
of
times.
We
are
not-
and
I
say
again,
not
doing
routine
inspections
at
the
moment
we
are
focusing
in
on
on
areas
of
of
risk,
we're
looking
for
those
things,
which
are
perhaps
exceptions
that
we
need
to
need
to
need
to
do.
C
But
fundamentally,
we
are
about
looking
for
risk
and
then
responding
to
that
on
behalf
of
the
public
we
launched
the
state
of
care
report
last
week
stated
care,
as
you
know,
is
our
annual
report,
and
in
it
we
talked
about
the
importance
of
providers
being
able
to
deliver
safe
care
for
all,
not
just
those
people
with
with
covid
and
chris.
C
I
know
we'll
talk
a
little
bit
more
about
about
that
in
a
moment,
but
but
our
fundamental
point
is
that
is,
that
is
that
we
were
making
a
point
about
about
equalities
and
making
sure
that
that
everybody
gets
gets
the
care
they
need
and
that
with
a
particular
emphasis
on
on
on
making
sure
that
providers
can
appropriately
recover
some
of
the
services
which
were
understandably
suspended
during
during
the
beyond
the
first
onset
of
covid.
C
But
we
can't
continue
to
see
services
suspended
indefinitely,
particularly
if
we,
if
we
accept
the
notion
that
kovitt
will
be
with
us
for
the
next
six
to
12
months.
C
I
would
like
to
just
take
this
opportunity
publicly
to
thank
all
of
my
colleagues
for
the
work
they
put
into
around
state
of
care
and
thank
chris
day
for
his
leadership
of
bringing
it
all
together,
which
he
does
so
so
well
each
year.
But
but
it
is
very
much
a
team
effort
and
I
I
think
it
reflects
an
annual
report
of
of
us
as
a
regulator
which
reflects
the
the
work
that
three
and
a
half
thousand
people
do
to
to
pull
together.
C
C
In
terms
of
of
some
of
the
practical
things
we've
done,
we've
gone
live
with
the
transitional
regulatory
approach
and
we've
gotta
say:
we've
got
a
training
program
which
is
rolling
out
as
we
speak
and
we'll
be
going
live
with
that
over
the
next
next
few
weeks
across
all
of
our
sectors
and
all
of
our
all
of
our
inspectors.
C
This
transitional
approach
will
evolve
over
the
next
next
next
few
weeks
and
months
into
our
future
regulatory
platform
in
in
may
of
2021,
in
line
with
our
strategy
and
october,
is
black
history
month
and
also
speak
up
month,
and
we've
run
a
number
of
events
internally
this
month
to
promote
both
subjects
to
to
to
all
of
our
colleagues,
to
make
sure
that
people
are
aware
of
our
topics
and
in
terms
of
looking
forward,
we
will
continue
to
work
on
ensuring
that
we're
making
a
constructive
contribution
to
the
national
effort
on
covid.
C
C
We
will
do
that
and
we're
trying
to
deal
with
deal
with
the
problems
of
today,
whilst
at
the
same
time,
thinking
ahead
and
thinking
longer
term,
making
sure
that
our
internal
transformation
activity
continues
on
track
as
far
as
it
possibly
can
to
try
and
support
the
rollout
of
our
new
strategy,
as
I
say,
which
we
are
expecting
to
put
out
in
may
of
next
year
and
finally
is
the
plug
on.
C
In
terms
of
the
strategy,
we
launched
a
discussion
document
at
the
beginning
of
october,
and
and
that's
now
with
with
with
providers
it's
with
colleagues
internally,
it's
with
a
number
of
other
stakeholders
and
we're
trying
to
get
a
conversation
going
around
around
our
our
future
strategy
and
what
should
be
in
it
for
for
the
new
year
and
in
the
new
year,
we'll
be
running
a
consultation
process,
but
my
plug
would
be
to
anyone
listening
is
that
if
they,
if
they
haven't
seen
our
discussion
documents
on
our
website,
please
do
take
a
look
and
and
give
us
your
give
us
your
thoughts.
A
So
thanks
ian,
and
can
I
just
add
my
thanks
chris
to
your
you
and
your
team
for
the
state
of
care
report
which,
yet
again,
I
think,
is
a
really
really
comprehensive
review
of
of
health
and
social
care
and
very,
very
well
written.
So
thank
you.
Does
anybody
want
to
raise
anything
or
shall
we
move
on
liz.
D
Thanks
very
much
ian,
you
mentioned
the
transitional
regulatory
approach
and
that
being
rolled
out
sort
of
as
we
speak
and-
and
I
just
wondered
it-
it
may
be
too
early
to
say,
but
I
just
wondered
if
there's
any
learning
from
that,
yet
to
feed
into
our
long,
the
longer
term
outcomes
and
benefits
that
we're
looking
to
achieve
from
from
our
future
regulatory
model.
But
you
know
obviously
evolving
from
this
transitional
approach.
C
I
think
it's
probably
too
early
at
this
stage
to
to
capture
specific
learning
in
terms
of
its
external
impact.
I
think
what
we
have
seen,
though,
is
the
way
that
we
have
designed
the
approach.
The
way
we're
carrying
out
the
training
using
things
like
super
users
and
that
kind
of
that
that
clear
evolutionary
approach
from
the
start
has
been
has
been
really
powerful.
C
We
saw
that
during
the
emergency
support
framework
during
the
early
part
of
the
code
process
and
we've
reused,
that
that
learning
again
for
the
transitional
regulatory
approach
and
again
we're
seeing
that
that's
seen
as
a
very
positive
way
of
training
people,
it's
a
way
of
being
able
to
train
people
remotely,
obviously,
because
all
the
training
is
having
to
be
done
remotely.
So
I
think,
in
terms
of
the
training
and
rollout,
I
think
we've
learned
a
number
of
lessons
I
think
there's
some
more
positivity
there.
C
I
I
think
it's
too
early
to
tell,
though,
in
terms
of
of
of
what
impact
that's
having
on
providers.
I
think
providers
said
they
they
they
liked
the
emergency
support
framework
and
surveyed
them
over
the
summer,
but
the
questions
and
that
and
the
breadth
of
the
work,
we're
doing
as
part
of
the
transitional
approach
is
much
broader
and
maybe
you
know
we'll
get
some
different
learning
as
we
roll
this
down.
Thanks
thanks
ian.
C
Do
you
want
to
to
kate
to
kate.
E
Morning,
all
so,
I'm
going
to
start
with
an
update
on
our
activity
in
adult
social
care
around
covet.
So
as
a
friday,
we
have
had
regulatory
action
with
over
17
and
a
half
thousand
of
our
social
care
providers,
and
the
majority
of
those
actions
have
been
our
emergency
support
framework,
our
structured
monitoring
conversations
to
provide
support
to
providers,
but
also
to
identify
risk
and
respond.
E
So
over
the
summer
board
will
remember
that
we
developed
a
new
methodology
around
infection
prevention
control
ipc,
and
we
were
really
keen
that
as
well
as
looking
at
ipc
on
every
single
regulated
conversation,
we
have
with
providers
every
time
we
go
out
and
inspect.
E
We
are
having
a
kind
of
laser
focus
on
ipc,
but
that,
in
addition
to
looking
at
ipc
as
triggered
by
a
risk,
we
wanted
to
go
out
and
see
what
best
practice
was
for
ipc
so
that
we
could
shine
a
spotlight
on
it
and
encourage
all
providers
to
you
know,
follow
follow,
suits,
are
there
as
ready
as
possible
for
for
wave
two
and
winter.
E
E
So
it
covers
eight
areas,
it's
important
to
say
that
our
our
judgments,
when
we
go
out
and
look
for
assurance,
I'm
not
a
guarantee
that
a
service
is
not
going
to
get
covered
in
it.
It's
about
saying:
have
they
got
the
best
ingredients
in
place
to
stop
clover
coming
into
their
home
and
if
it
comes
into
their
home,
that
is
managed
as
effectively
as
possible,
so
it
doesn't
spread
to
other
residents
and
staff.
So
we
look
across
these
eight
areas.
We've
developed
our
eight
eight
ticks
of
ipc
assurance.
E
So
when
you
go
to
the
web
page
to
look
at
one
of
the
400
plus
ipc
inspections,
you
we've
published,
you
will
be
able
to
kick
through
on
a
detailed
report,
but
you
will
also
be
able
to
see
on
the
front
screen
that
will
show
across
the
eight
areas
whether
we're
assured
somewhat
assured
and
not
assured,
and
just
a
reassured
board
where
we
are
finding
instances
where
we
are
not
assured.
E
Depending
on
what
we
find,
we
will
obviously
take
the
the
required
regulatory
action
to
ensure
that
those
issues
are
addressed
and
people
and
people
receive
safe
care.
So
we
have
undertaken
a
whole
lot
of
ipc
activity.
We
were
planning
on
continuing
to
do
that
through
autumn,
so
we
have
500
ipc
inspections
booked
in
across
the
country
to
happen
between
now
and
the
end
of
november.
E
With
those
two
focuses
what's
best
practice
and
responding
to
risk,
we've
also
been
asked
to
support
government's
winter
plan
and
they
have
asked
us
whether
we
can
use
our
ipc
methodology.
E
When
government
has
asked
local
authorities
to
identify
potential
air
potential
cases
where
people
with
a
covert
positive
test
might
be
discharged
from
hospital
to
keep
them
safe
and
to
stop
the
spread
of
the
spread
of
covet.
So
a
government
asked
arsenal
authorities
to
identify
these
places.
That
request
went
out
middle
of
last
week
and
we
are
primed
and
ready
to
respond
to
those
places
once
local
authorities
identify
them.
E
So
it
might
be
a
repurposing
of
a
current
service,
that's
already
registered
with
us,
in
which
case
we
will
go
out
and
do
an
ipc
inspection,
with
a
increased
focus
on
ensuring
that
people
can
be
zoned
and
cared
for
in
a
way.
That
means
that
there
isn't
a
risk
of
that
or
there's
a
reduced
risk
of
that
spreading
to
other
people
in
the
home.
E
If
local
authorities
and
other
health
leaders
decide
that
they
want
to
establish
a
new
service,
we
are
also
primed
and
ready
in
registration
to
prioritize
the
registration
of
new
services
for
this
purpose
as
well.
So
so
we've
got
500
ipc
inspections
booked
in
and
we
are
ready
to
re-prioritize
in
response
to
local
authorities
identifying
to
us
where
these,
where
these
designated
schemes
might
be
for
people
with
a
covered,
positive
discharge
to
be
discharged
to
a
couple
of
other
things.
E
E
So
in
our
in
our
statement,
ted
talked
really
clearly
about
our
expectations
of
hospitals,
about
good
timing,
discharge
planning
and
the
critical
need
to
understand
someone's
coding
status
at
the
point
of
discharge
to
help
inform
decision
making
about
where
they
may
go
to.
I
was
really
clear
that
we,
as
the
regulator,
would
absolutely
support
care
homes
if
they
didn't
feel
able
to
admit
someone
safely
and
rosie,
made
a
statement
that
said.
E
Actually,
this
is
not
about
care
working
in
isolation,
they're
supporting
people
with
increasing
complex
needs,
and
it's
absolutely
critical.
If
this
works,
there
is
system
support
around
care
homes
to
enable
them
to
care
for
people
and
safely,
so
lots
of
lots
of
ipc
activity
as
well
as
going
out
and
and
responding
to
risk.
So
that
was
the
update
I
wanted
to
do
on
cover
to
peter,
and
then
I've
got
two
other
things,
but
should
I
pause
there.
F
F
My
question
is
about
something
we
discussed
last
week
in
relation
to
restrictions
on
visiting
care
homes
in
the
context
of
what
you've
just
been
saying
about
infection
control-
and
I
imagine
you
would
agree
that
infection
control
should
be
the
servant
of
the
care
needs
of
people
in
homes,
not
the
dictator
of
of
what
it
is
thought
people
need,
and
there
seems
to
be
in
there
has
been
in
this
past
week,
increasing
the
public
concerns
being
expressed
about
the
restrictions
on
visiting
and
the
exclusion
of
a
care
home
resident
from
participating
in
those
decisions.
F
But
I
was
just
wondering
what
you
feel
we
cqc
and
in
particular,
your
inspectorate
can
do
to
to
reinforce
the
need
for
homes
and
those
who
control
infection
to
take
account
of
the
decisions
and
choices
and
risk
assessments
made
by
residents
who
are
competent
to
make
those
decisions
and
also
the
balance
of
best
interest
for
those
who
can't
in
relation
to
the
well-being
they
gain
from
seeing
their
families
in
in
proper
circumstances,
rather
than
through
a
window
or
an
ipad.
F
G
E
We've
been
talking
about
this
a
lot
over
the
last
couple
of
weeks
and
our
very
clear
message
to
providers
is:
they
need
to
follow
government
guidelines.
They
need
to
pay
sufficient
attention
to
what
the
local
risk
levels
are
and
what
the
advice
is
from
their
directors
of
public
health,
but
actually
we're.
E
You
know
seven
eight
months
now
into
a
pandemic,
and
I
think
at
the
beginning,
providers
made
the
decisions
they
needed
to
make
to
keep
their
current
residents
safe,
and
I
would
absolutely
recognize
that
I
think
we
all
know
all
these
months
on
the
impact.
This
is
having
on
some
people's
mental
well-being
about
not
being
able
to
regularly
see
their
loved
ones
in
person.
So
what
we
expect
now
is
we
expect
providers
to
follow.
E
Government
guidelines,
pay
attention
to
local
risks,
but
wherever
possible,
we
want
to
see
a
proactive
approach
to
making
visiting
happen
on
an
individual
basis
where
it's
safe
to
do
so
and
what
we
will
be
doing
when
we
go
out
and
inspect
services
is
we
will
be
looking
at
their
approach
to
visiting.
How
are
they
making
it
happen
where
it
is
safe
to
do
so,
but
also
we
will
be
looking
at
that
person-centred
approach,
so
we
don't
want
to
see
a
blanket
approach,
but,
like
some
of
the
conversations
we
have
around
do
not
attempt
resuscitation.
E
We
don't
want
to
see
a
blanket
approach
to
this.
We
want
to
see
an
individual
conversation
which
takes
into
account
best
interest
in
the
mental
capacity
act
and
all
that
stuff
around
people
being
allowed
to
make
up
what
might
be
perceived
as
unwise
decisions
while
recognizing
that
care
homes
have
that
really
difficult
juggling
act
of
doing
what's
right
for
the
individual,
while
noting
what
might
be
the
potential
impact
on
their
workforce
and
other
residents
as
well.
But
the
key
message
is
good.
A
E
Two
two
brief
things
to
update
board
on,
so
the
first
is
we're
due
to
publish
tomorrow
a
long-awaited
and
very
important
report
into
restraint,
seclusion
and
segregation.
So
board
will
well
remember
that
this
is
a
piece
of
work.
That's
that's
been
undertaken
for
about
the
last
two
years.
We
published
an
interim
report
last
year
and
we
are
delighted
to
have
got
to
the
point
that
we
are
ready
now
to
share
this
report
tomorrow.
E
It's
particularly
important
because
there
have
been
a
number
of
reports
over
the
last
10
years
about
the
issue
of
ensuring
people
with
learning
disabilities,
autistic
people
and
people
with
mental
health
get
the
right
support
in
the
community
to
keep
them
well,
and
should
they
be
an
impatient
that
they
get
the
right
support
and
and
their
human
rights
are
are,
are
upheld.
So
a
really
critical
report.
It's
really
benefited
from
some
fantastic
involvement
from
family
members
and
people
who
have
experienced
being
impatient
themselves.
E
So
I'd
like
to
take
this
opportunity
now-
and
we
will
no
doubt
when
we
discuss
this
further
at
boards,
to
thank
the
many
people
who
have
helped
get
this
report
to
where
it
is
so
critical
report.
I'm
really
looking
forward
to
publishing
it
tomorrow
and
really
looking
forward
to
the
report
driving
some
action
on
this
on
this
really
important
topic.
A
So
kate,
it's
a
critical
report
in
the
sense
that
it
is
critically
important.
It's
also
critical
in
the
sense
that
it
is
very
critical
of
the
current
arrangements
and
we
really
need
to
hope.
The
report
draws
yeah
further
attention
and
and
action
as
a
result,
liz
and
then
robert.
D
Thanks,
kate,
yes,
I
I
first
of
all
I
just
really
like
to
commend
the
the
work
that's
been
done
to
to
get
us
to
this
point
of
being
ready
to
share
the
fundings
and
particularly
the
way
that
that
people,
with
their
own
experience
of
segregation,
seclusion,
etc,
have
been
involved
in
their
family
members
and
providers
and
people
with
different
kind
of
professional
and
academic
expertise
to
to
come
up
with
what
I
hope
will
be
a
set
of
recommendations
that
really
do
drive
change.
D
I
suppose
my
question
is
just:
do
we
plan
to
track
what
happens
to
our
recommendations,
to
ensure
that
they
really
do
this
time?
Make
a
difference
on
this
huge
human
rights
gender,
because
we
do
know
that
there
have
been.
You
know
good
reports
in
the
past,
but
sadly,
action
has
been
insufficient.
E
Thank
you
liz.
So
I
think
we
would
really
welcome
the
opportunity
to
come
back
to
the
next
public
board
to
a
discuss
the
report
and
the
reaction,
but
also
to
share
with
the
board
our
intention
about
how
you
can
continue
to
have
the
scrutiny
and
oversight
of
what
we're
seeing
out
there
in
terms
of
how
the
sector
is
responding
to
the
report
and
improving
outcomes
for
those
individuals,
but
also
how
we
are
implementing
the
actions
that
will
be
there
for
us
as
well
to
change.
E
So
we'd
really
welcome
to
come
back
to
talk
about
the
report,
how
it's
landed
and
reaction
from
stakeholders
and
then
how
this
board
can
give
us
that
kind
of
public
scrutiny
about
how
we
are
implementing
the
recommendations.
A
F
Thank
you
well,
firstly,
to
echo
liz's
praise
for
this
report
and
it
is
a
very
powerful
report
and
I
believe
it's
made
powerful
by
the
use.
That's
been
made
up
and
the
listening
given
to
the
experiences
of
service
users
and
their
families,
and
I
would
like
to
think
that
had
sufficient
attention
being
paid
by
those
who
commissioned
services
over
the
years
to
those
experiences,
we
might
not
be
where
we
are
now.
F
But
my
question
really
is
it
leave
bill's
actual
conversation
about
visiting
because
what's
true
of
visiting
in
care,
homes
is
more
even
more
acute
here
in
relation
to
the
deprivation
of
people's
human
human
rights
and
relate
here,
and
I
just
wonder
what
it
is
that
I
mean
we
there
are
in
the
report
some
really
good
recommendations
to
ourselves
as
to
what
we
can
do,
but
I
worry
a
bit
about
what
happens
in
relation
to
the
individuals
who,
even
today,
are
suffering
from
a
form
of
seclusion
and
isolation
that
there
just
shouldn't
be.
F
When
we
see
it,
we
can
tell
ask
commissioners
to
do
something
about
it.
We
can
we,
we
can
ask
safeguarding
boards
to
look
at
it,
but
our
inspectors
are
facing
actually
having
to
meet
people
who
are
being
currently
deprived
of
their
human
rights.
Now
I
would
just
like
your
assurance
that
there
is
something
we
as
an
organization
can
do
in
relation
to
the
residents
of
people
and
services
that
we
view
as
totally
unacceptable.
If
that
be
the
case,
so
so
I'm
sure
kate
can
answer.
A
E
I
was
going
to
say
one
thing,
and
then
I
see
ted's
next
to
speak,
so
he
might
want
to
say
a
bit
more
about
what
we've
been
doing
in
terms
of
when
we
go
out
and
see
these
services.
I
was
just
going
to
quickly
say
that
we
only
get
changed
when
everyone
who's
involved
with
this
does
something
different.
So
this
is
about
providers,
commissioners,
the
regulator-
and
we
really
look
forward
to
having
that
conversation
publicly
in
the
coming
days
when,
when
we're
able
to
share
the
recommendations
in
the
report.
H
H
I
think
when
people
read
it
when
it's
published
tomorrow,
they'll
see
the
power
of
it
and
the
power
particularly
of
the
stories
about
individuals
and
how
the
system
has
tr
has
treated
them,
how
it
has
let
them
down
and,
as
robert
said,
how
it
has
it
has
not
respected
their
human
rights,
and
I
think
it
is
absolutely
clear
from
the
case
studies
in
it
that
this
is
a
wholly
unsatisfactory
situation
and
something
must
be
done,
and
this
is
real
a
test
for
the
strength
of
our
voice
that
we
can
get
this
system
change.
H
Of
course,
we
must
look
to
ourselves
to
take
more
effective
regulatory
action
where
we
can
and
just
coming
to
robert's
point
about
individuals.
We
have
been
supporting
individual
care
and
treatment
reviews
since
the
interim
report
was
published
in
may
of
last
year,
and
we
are
very
much
reviewing
what
has
come
out
of
those
and
exploring
ourselves
whether
we
as
an
individual
regulator
could
take
more
action
about
individuals
who
who
are
not
being
looked
after.
Well
by
this
system,
but
equally,
I
think
the
challenge
has
to
be
to
the
wider
system.
H
There
have
been
many
reports
and
this
report
must
not
be
another
one
of
those
reports,
and
certainly
kate,
and
I
speaking
to
families
and
to
individuals
affected.
We've
promised
that
we're
going
to
do
absolutely
everything
to
make
sure
this
report
does
not
become
another
report
that
doesn't
really
make
a
difference,
and
it's
absolutely
clear.
We
have
to
follow
this
up
to
make
sure
action
is
taken
to
protect
these
individuals
thanks.
I
A
So,
as
you
say,
we
we
will
have
a
a
a
more
detailed
discussion
in
the
november
board,
but
I
think,
fed
to
your
your
point
and
to
lizzy's
point.
This
is
something
we
need
to
keep
on
our
our
radar
screen
in
in
successive
meetings
to
to
monitor
the
progress
that
we're
making
ourselves,
but
but
also
the
the
commissioners
and
others,
because
it's
it's
such
a
fundamental,
commissioning
point
that
needs
to
be
addressed
I'll,
be
happy
to
move
on.
Moving
on
to
test.
H
So
ted
back
to
you,
thank
you
yeah!
Thank
you
so
so
to
over
the
last
few
weeks,
the
number
of
covered
cases
in
the
community
has
been
going
up,
as
everyone
is
aware,
and
it's
affecting
different
parts
of
the
country
in
different
ways.
We've
been
in
communication
with
other
stakeholders
and,
of
course,
with
providers
themselves
about
the
impact
he's
having.
H
It
is
already
clear
talking
to
emergency
departments
across
the
country
that
the
number
of
people
attending
emergency
departments
is
increasing
and
in
many
ways
winter
is
coming
a
few
weeks
early
this
year,
and
I
think
that
very
much
reflects
the
fact
that
that
that
we're
working,
we're
operating
in
at
a
time
of
resurgence
of
I'll
come
back
to
emergency
departments.
H
In
a
moment,
inpatient
numbers
of
kobe
cases
are
going
steadily
up,
they're,
not
yet
at
the
critical
levels
they
were
last
spring,
but
the
the
trajectory
is
clearly
causing
a
lot
of
concern,
particularly
in
some
parts
parts
of
the
country,
and
I
think
so
so
we
we
are
well
aware
that
providers
are
under
pressure
because
of
the
the
resurgence
of
kovid
and
we
are
doing
everything
we
can
to
support
them.
H
In
that
context,
as
the
the
board
knows,
we
used
a
development
of
the
esf,
the
emerging
support
framework
to
monitor
the
assurance
around
infection
control
across
all
nhs
trusts.
We
reported
last
time
about
that
and
we
have.
We
continue
to
monitor
nasochemical
infections
with
nhsi
to
make
sure
that
trusts
are
implementing
effective
infection
control
procedures.
Where
we
found
problems,
we
we
associate
trust
with
the
support
that's
available
nationally,
but
equally,
where
necessary,
we
will
undertake
inspections
and
enforce
reduction.
H
We
have
done
that
in
a
small
number
of
trusts
over
the
last
few
weeks,
and
we
will
continue
to
monitor
that
very
carefully.
As
he
had
mentioned,
we
we
are
now
rolling
out
the
track.
The
transitional
monitoring
app
as
part
of
our
transitional
regulatory
approach,
the
transitional
molecular
gravity-
is
built
on
what
we
learned
from
the
emergency
support
framework
and
going
forward.
We
are
focusing
in
hospitals
on
two
areas.
H
With
kobe
present
that
was
very
well
received,
and
I
have
a
lot
of
very
positive
feedback
and
I
know
trusts
and
why
the
systems
have
found
it
useful.
I've
written
to
all
nhs
trusts
say
look.
This
is
important.
Please
make
sure
your
board
is
aware
of
it
and
we
will
be
coming
back
to
you
to
ask
you
how
you're
using
it
and
we're
using
the
transitional
monitoring
app
as
a
tool
to
go
back
to
all
nhs
trusts
over
the
next
three
or
four
weeks.
H
We
will
speak
to
every
trust,
with
an
emergency
department
to
see
how
they're,
using
that
guidance,
that
that
resource
to
make
sure
they're
providing
the
safest
possible
care
under
the
pressures
they
face,
and
we
so
by
by
mid-november,
we'll
have
a
very
good
view
about
how
trusts
are
managing
emergency
department
pressures.
Now,
as
we
go
into
winter,
we
will
be
undertaking
some
risk-based
inspections
of
emergency
departments,
but
we
want
to
combine
services
under
pressure.
H
While
we
need
to
continue
to
to
do
risk-based
inspections,
we
think
our
main
role
is
to
provide
support
so
that
people
are
accessing
the
resources
they
need
to
provide
the
best
care
possible,
and
so
we
are
a
balanced
approach
going
forward
and
we
are
now
developing
a
similar
approach.
Around
maternity
people
will
remember
in
state
of
care
last
week
that
we
highlighted
our
ongoing
concerns
about
safety,
maternity
services.
H
We're
working
with
other
stakeholders
across
the
system
to
ensure
that
that
that
trusts
are
getting
the
support
they
need
to
make
sure
they're,
providing
the
safest
possible
maternity
care,
and
we
will
be.
H
Can
I
just
highlight
a
few
reports
that
chris
is
going
to
talk
about
in
in
a
few
minutes
in
the
because
I
think
they're
important
just
to
note
them
in
passing
tomorrow.
We're
publishing
ionizing
radiation,
medical
exposure
regulations
report,
that's
irma
report,
which,
which
is
report
aimed
at
professionals.
So
it's
not
a
report
for
the
general
public.
But
having
said
that,
it
is
an
important
report
on
an
important
area
of
regulation
that
we
undertake,
and
can
I
just
pay
tribute
to
the
emma
team.
H
Who've
continued
to
provide
regulation
of
the
30
million
ionizing
radiation
medical
exposures
every
year
in
this
country
over
the
last
period
during
the
cobiah
epidemic
and
they've
continued
to
provide
that
regulation,
and
the
report
is
a
great
account
of
the
work
they've
been
doing
during
covid
to
make
sure
that
we
we're
maintaining
our
vigilance
around
ionizing
radiation
and
they've
also
responded
at
the
same
time
just
before
the
kobe
pandemic,
to
an
international
review
of
the
uk's
ionizing
media,
the
regulation
of
ionizing
radiation.
H
So
so
they
have
had
a
busy
year,
and
I
think
the
report
is,
if
you
like,
a
reflection
of
the
work
that's
gone
in
so
can
I
pay
tribute
to
them
that
two
other
reports
have
come
out
recently.
One
is
a
report
that
came
out
last
at
the
same
time
a
state
of
care
on
mental
health
care
within
acute
trusts.
It's
an
important
report.
H
And
if
you
talk
to
emergency
departments,
they
will
say
to
you
that
there's
a
rising
numbers
of
people
attending
emergency
departments,
but
there's
a
particular
increase
around
people
with
acute
mental
health
needs,
and
this
report
is
really
very
important
about
talking
about
how
mental
health
services
and
acute
trust
can
work
together
to
make
sure
that
people
get
the
care
they
need
with
their
acute
services.
There's
also
a
couple
of
other
reports.
H
One
is
an
update
on
inpatient
mental
health
rehabilitation
services,
which
we
produced
a
report
on
a
year
or
so
ago,
and
one
on
child
and
adolescent
mental
health
services
as
well.
Those
are
both
update
reports
and,
I
suppose
I
think,
they're
both
important
in
their
own
right,
but
they
both
reflect
the
fact
that
reports
we
published
a
year
or
so
ago,
while
they
were
important
at
the
time,
the
progress
that
we
we
wanted
to
see
on
those
in
those
both
those
areas
has
not
taken
place
now.
H
A
Oh,
thank
you,
ted
and,
and
again
just
reflects
the
the
sort
of
breadth
and
depth
of
the
the
activity
that's
going
on,
but,
like
you
I'd
like
to
particularly
thank
the
irma
team,
because
they're
sort
of
yeah
pretty
unsung
heroes
in
our
organization,
but
they
do
a
great
job.
So
thank
you.
A
Any
questions
for
ted,
no,
so
rosie
right.
C
Over
to
you,
yes,
I
wish
that
were
true,
and
so
I
just
want
to
pick
up
some
things
from
primary
medical
services
and
integrated
care.
I
think
first
thing
is
provider.
Collaboration.
Reviews
board
will
be
aware
that
we've
had
a
program
after
provided
collaboration,
reviews.
That
is
now
that's
now
rolling
forward,
we're
on
site
again
for
the
next,
the
next
franchise
review.
So
that
program
is
continuing.
C
It's
also
worth
noting
that
we
were
asked
a
couple
of
weeks
ago
to
do
what's
referred
to
as
a
section
48
thematic
review,
we
were
asked
by
the
secretary
of
state
to
carry
out
a
review
on
end
of
life.
Care
planning,
particularly
do
not
attempt
cpr.
I
think
there
was
there's
a
real.
C
There
was
a
there's,
a
concern
from
from
some
people
that
blankets
do
not
attempt
cpr
orders
and
blankets,
personalized
care
planning,
particular
end
of
life
is
being
used
inappropriately,
and
our
view
is
that
is
that
the
end
of
life
care
in
particular
must
be
personalized
and
so
we're
doing
a
piece
of
work.
C
That's
going
to
look
at
the
information
that
we
have
from
members
of
the
public
already
plus
do
some
deep
dives
into
individual
cases
to
understand
exactly
what's
going
on
and
and
and
if
and
I'm
sure,
we'll
find
some
some
very
good
practice.
And
we
want
to.
We
want
to
put
that
on
the
table
in
the
way
that
we
have
with
a
number
of
other
in
a
number
of
other
topic
areas,
but
also
where
we
see
where
we
see
poorer
practice
that
we
can
address
that
as
well.
C
We're
also
we've
also
had
some
so
a
number
of
reports
around
access
to
gp
appointments
and
real
concerns
that
that,
particularly
during
covert
people
have
struggled
to
access
gp
appointments,
and
we
want
to
understand
that
the
what
is
going
on
there,
whether
and
exactly
what
that.
What
that
means
from
a
public
an
individual
member
of
the
public
point
of
view.
C
So
we're
shaping
up
some
thematic
work
at
the
moment
around
around
gp
appointments,
so
we
can
understand
exactly
the
size
and
shape
of
the
problem,
because
we're
conscious
that
that
we
have,
we
have
a
range
of
different
reports
ranging
from
gps
that
are
doing
a
fantastic
job
through
to
to
people
who
are
concerned
that
their
gp
is
closed
and
and-
and
we
just
want
to
understand,
understand
that
in
more
detail
and
we're
working
with
with
colleagues
at
healthwatch
in
particular,
as
well
as
pulling
our
own
information
from
from
give
feedback
on
care.
C
So
a
number
of
things
going
on
there
and
we're
going
to
shape
that
piece
of
work
over
the
next
week.
But
I
thought
sorry,
the
next
next
six
months
rather,
but
I
just
wanted
to
make
board
a
word
of
that
topic
that
we
are
looking
at.
We
are
also
doing
a
number
of
special
measures.
Practice
inspections.
There
are
about
100
gp
practices
in
special
measures.
So
again
we
are.
C
We
are
doing
some
specific
inspections
on
those
special
measures
prior
practices
to
make
sure
that
the
public
can
be
assured
that
that
that
good
care
is
being
delivered
and
where
we
have
got
got
issues,
then,
of
course
we
can
take.
We
can
take
action.
The
other
thing
I
wanted
just
to
flag
was
the
inspection
of
safe
houses.
Work.
We've
signed
a
memorandum
of
understanding
between
ourselves
and
the
home
office
to
to
start
a
programme
of
inspection
of
safe
houses
for
people
who
are
victims
of
of
trafficking
and
modern
slavery.
C
We
think
this
is
probably
the
first
of
it
that
this
program
is
the
first
of
its
kind
in
the
world
and
and
we're
hoping
to
to
produce
some
insights
into
into
how
well
people
who
are
incredibly
vulnerable
are
looked
after
and
then
finally,
just
to
note
that
we
are
working
with
our
colleagues
ofsted
on
a
special
educational
needs
and
disabilities
program
of
inspections
and
again
that
the
second
stage
of
that
will
be
delivered
in
november.
C
And
then
a
third
stage
in
in
the
early
part
of
2021,
probably
in
january.
So
we'll
be
we'll
be
sharing
the
results
of
that
with
colleagues
at
offstage.
So
a
quick
sort
of
cancer
through
quite
a
lot
of
work.
That's
going
on
in
primary
medical
services
and
integrated
care.
A
Thanks
ian
I,
I
was
particularly
pleased
about
that.
The
safe
houses
work.
I
mean
it's,
it's
it's
so
important
in
its
own
right,
but
I
think
it
also
reflects
really
well
on
rosie
and
her
team.
The
home
office
have
asked
us
to
do
this
work,
so
that's
really
good.
Thank
you.
Thanks.
J
Thank
you
peter.
I'm
just
going
to
pick
up
the
people
bits
and
then
I'm
going
to
hand
over
to
chris
who's
going
to
just
talk
through
the
performance
report
for
this
month.
So
just
in
terms
of
people
just
a
couple
of
things
to
to
make
you
aware
of,
we
have
our
all
staff
conference
at
the
beginning
of
november
connect
and
share.
This
is
the
first
opportunity
we've
had
really
to
get
the
entire
organization
together
to
talk
to
connect
and
to
talk
about
our
new
strategy
and
and
our
priorities
for
the
organization.
J
I
think
it's.
I
think
that
the
technology
really
gives
us
that
opportunity
to
do
that.
It's
running
over
the
next
three
to
over
three
days,
and
we
have
a
range
of
speakers
which
are
coming
together
to
give
us
a
comprehensive,
comprehensive
program
around
our
strategy,
our
leadership
and
our
and
our
focus
for
going
forward.
So
I'm
really
really
looking
forward
to
that.
J
I
think
the
other
area
in
our
people
work
that
we
just
wanted
to
highlight
is
we
are
continuing
to
focus
on
making
sure
our
colleagues
are
supported
during
this
busy
period
for
us,
and
particularly
through
the
working
at
homes
through
the
pandemic.
We've
now
got
our
entire
workforce
has
been
working
at
home
now
pretty
much
since
march,
which
is
which
is
a
a
different
environment
for
some
others.
It's
just
business
as
usual,
but
we
want
to
make
sure
that
people
are
are
supported.
J
We
have
launched
recently
a
a
good
work
habits
campaign
to
just
to
give
them
some
helpful
tips
about
how
to
maintain
that
healthy
work-life
balance,
whilst
working
through
home
and
to
help
to
keep
their
focus
on
on
wellbeing.
So
we
have
a
a
happy,
healthy
and
engaged
workforce
during
this
period,
I'm
going
to
hand
over
to
chris
now
who's
going
to
talk
just
through
the
performance
data.
K
Thanks
kirsty
just
a
few
headlines
for
me
in
terms
of
registration
at
the
end
of
august,
simple
about
simple
applications
is
continuing
to
improve
it's
taking
14
half
days
on
average
to
process,
and
that's
where
we
see
most
of
the
volumes
with
eleven
hundred
processed
in
month.
Complex
applications
is
117.6
days,
but
with
much
lower
volumes
with
only
37
processed
in
months.
K
So
both
those
areas
will
continue
to
pro
monitor
the
the
progress
of
changes
we've
made
in
terms
of
our
internal
processes
in
terms
of
regulate
reaction,
kate
referenced
some
figures
earlier
for
ac,
but
so
just
build
on
those
with
a
complete
picture,
and
this
is
azat
monday.
I
thought
we'd
be
better
to
give
a
complete
picture
so
from
the
start
of
the
year
until
until
right,
up
to
the
start,
this
week,
we've
undertaken
over
19
000
calls
with
locations
which
is
43
percent
of
applicable
registered
services.
K
I've
also
undertaken
1630
inspections,
1460
with
a
site
visit
and
of
those
inspections
that
were
triggered
by
risk.
54
percent
are
triggered
by
information
of
concern,
whether
it's
safeguarding
whistleblowing
information
of
concern
or
complaints
linked
to
that
we're.
Seeing
a
an
ever-increasing
volume
of
whistleblowing
cases
august
had
the
most
the
highest
volume
received
in
the
last
12
months
and
that
that
continues
to
to
trend
that
way.
K
Some
areas
of
strong
performance,
just
to
mention
97
of
safeguarding
alerts,
have
been
referred
to
within
one
day,
which
is
ahead
of
the
the
95
target.
K
Safeguarding
concerns
with
mandatory
actions
recorded
within
five
days
on
target
95
percent
and
100
percent
of
unfor
urgent
enforcement
action
is
undertaken
within
three
days
last
year
on
finance
revenue
budget
is,
is
a
similar
trend
to
what
we've
discussed
last
month,
which
is
forecast
to
be
4.4
million,
understand
the
end
of
the
year.
This
includes
a
potential
1.8
million
short
fall
on
income.
Capital
budget
is
forecast
to
be
3.3
million
overspent.
K
A
Thanks
chris,
just
that
that
19
000
number
is
is
quite
significant.
Isn't
it
we've
never
done
anything
like
that
before?
I
think
we
should
really
sort
of
note
it
and
congratulate
colleagues
on
it,
but
also
then
think
about
how
we,
how
we
sort
of
build
on
that
for
the
future,
really
really
really
impressive.
A
Nobody
wants
to
come
in
gosh
we're
on
a
roll
mark.
Your
luck
may
run
out
here
who
knows,
but.
A
A
Well,
come
back
to
mark
chris,
can
you
talk
about
strategy.
I
Yes,
well,
I've
got
I'll,
try
to
condense,
seven
and
a
half
pages
of
exec
summary
into
something.
That's
that's
meaningful
for
the
group
just
to
touch
on
some
things
that
people
have
already
mentioned.
Ted
mentioned
the
patient
first
review
and
the
a
of
a
e.
What
I
really
like
about
this,
I
think
what
the
feedback
we've
had
so
far
is
it's
written
by
a
cpc
with
frontline
conditions,
so
it
tells
a
really
important
story
about
what
people
can
do
practically
as
they
approach
winter.
I
So
it's
already
some
good
feedback,
as
ted
mentioned.
I
think
it's
a
good
way
operating
for
us
to
provide
practical
guidance
and
assurance
around
what
how
services
can
kind
of
adapt
and
change.
There's
been
a
conversation
already
about
right,
support,
right
care,
right
culture,
which
I
think
gives
again
some
really
practical
expectations
that
we
have
as
an
organization
about
how
or
how
providers
meet
fundamental
standards
when
dealing
with
autistic
people
and
people
with
learning
disabilities.
I
As
temperature,
we've
also
published
three
mental
health
supports
alongside
the
state
of
care.
They
talk
about
particularly
access
to
services
and
rehabilitation.
So
how
you,
how
you
encourage
people
to
get
access
early
and
how
we
make
sure
those
services
are
available
and
also
how
the
wider
health
and
care
system
supports
rehabilitation
for
people.
I
said
care
out
last
week.
I
I
think
that
the
messages
about
what
the
fragility
pre-covered,
particularly
around
nhs
emergency
services,
maternity,
mental
health,
the
ongoing
fragility
of
the
outer
social
care
service
and
also
the
volatility
in
some
parts
of
the
primary
medical
services
was
well
understood
by
the
stakeholder
comments
that
we
had
back
equally
understood.
There's
a
need
to
in
order
to
have
a
local
understanding,
local
plan
for
action.
I
It's
important
that
local
providers
and
leaders
can
come
together
to
develop
a
plan,
that's
meaningful
to
all
of
their
the
people
in
their
in
their
care,
so
it
minimizes
what
the
moment
our
growing
inequalities
in
the
way
people
receive
those
cares,
and
this
and
the
notion
of
having
a
long-term
deal
for
out
of
social
care
with
a
workforce
plan
behind
it
was
again
something
that
that
hit
a
home
with
with
colleagues.
I
think
that's
something
we'll
return
to
again.
I
I
think
these
reports
are
important
because
they
they
continue
to
surface
problems,
that
we
need
to
have
long-term
action
on.
So
we're
very
much
we're
hopeful
that
we'll
continue
those
discussions
with
both
parliamentarians
providers
and
public
groups
as
we
go
into
the
autumn
of
winter.
There
are
three
ports
out
which
look
at
how
cqc
is
driving
improvement
in
the
wider
system.
I
We
just
want
to
touch
upon
those
because
they
link
to
the
conversation
about
the
strategy
and
they're
looking
at
partly
about
how
we
focus
on
the
relationship
between
inspectors
and
providers,
how
we,
how
we
demonstrate
that
we've
got
accessible
guidance
to
drive,
change
and
improvement,
and
I
think
there's
some
important
lessons
there
about
making
sure
we
understand
the
environments,
the
environment,
that
providers
are
operating
in
building
on
the
relationships
that
we
have
with
providers
and
also
working
with
other
parts
of
the
system
to
drive
meaningful
change
and
critically
involving
people
who
use
services
in
that
change.
I
There's
also
report
about
the
well-led
framework
and
again
I
think
that
shows
the
importance
of
leadership
in
action
that
directly
links
to
service
improvements
and
that
leadership
isn't
just
a
function
of
governance
and
processes.
It's
also
about
culture
and
engaging
people
and
service
users
in
that
work,
and
also
the
strong
alignment
between
cqc's
well-led
framework
and
other
organizations
plans,
particularly
the
nhs
people
plan.
So
all
of
those
things
are
fed
into
the
conversation.
I
The
discussion
documentary
published
recently
on
the
strategy
and,
as
colleagues
have
said,
it's
a
it's
a
design
to
have
engage
a
conversation
over
the
next
few
months
before
a
formal
consultation
in
in
the
new
year.
There's
been
a
positive
feedback
from
it,
but
also
extensive
conversations
that
are
ongoing
to
help
understand
where
we
might
need
to
develop
our
thinking
further,
so
that
when
we
get
to
a
formal
consultation,
we'll
have
not
just
the
basis
of
a
plan,
but
also
how
we
can
implement
that
plan
successfully.
I
In
addition
to
that
work,
we've
got
some.
We've
had
some
parliamentary
activity,
we've
ted's,
given
some
important
evidence
as
select
committee
on
29th
september,
looking
at
safety
and
maternity.
I
He
talked
in
particular
about
blame
culture
and
whistleblowing
and
how
we
need
to
shift
from
that
to
a
learning
culture
where
people
can
express
concern
and
operate
together
to
drive
change
and
improvements.
Rosie
has
given
some
important
evidence
to
the
independent
inquiry
on
child
sexual
abuse,
and
ian
has
also
met
with
a
number
of
members
of
the
health
select
committee
in
terms
of
reports
to
come.
I
won't
we
cover
what's
already
been
covered,
but
just
to
say
on
the
on
the
report
coming
out
tomorrow.
I
I
I
think
one
of
the
things
that
the
ambiguity
of
other
reports
is
just
who
needs
to
do
what
by
when
and
I
think,
we've
given
a
really
clear
sense
of
what
action
needs
to
be
taken
by
whom,
in
order
to
drive
the
right
change-
and
I
think
that's
something
that
we
can
rightfully
be
proud
of,
but
it's
not
a
piece
of
work.
So,
what's
not
one
day
in
the
media,
this
is
an
ongoing
campaign
to
make
this
work.
I
The
mental
health
out
report,
which
is
also
our
assessment
of
mental
health
services
more
generally,
will
come
to
the
board
next
month
and
we
published
it
in
in
late
november,
ted
mentioned
the
irma
report
and
I
think
particularly
looking
at
how
people
have
focused
on
changes
as
a
result
of
covit.
So
how?
How
is
that?
The
treatment
of
diagnostic
services
operated
during
kobe
period
is
an
important
thing
that
we
shouldn't
forget
that
their
organizations
have
adapted
to,
and
finally,
we've
got
the
next
spike
of
give
feedback
on
care.
I
As
mentioned
earlier,
we've
got
a
an
exemplary
service.
Now
we
give
feedback
on
care
and
we've
been
working
really
well
with
partners.
The
next
spike
is
on
all
the
people,
targeting
all
the
people
and
their
families
to
get
their
feedback
on
on
services.
As
we
approach
winter
there's
been
a
tremendous
amount
of
involvement
from
the
public
engagement
team,
but
also
from
organizations
that
represent
different
groups.
I
L
Mark
can
we
come
back
to
you
now
sorry
about
earlier?
No
thanks,
peter
apologies,
sure
one
from
missile
on
information
and
cyber
security
risk
there's.
There
are
no
issues
to
report
this
month.
Excellent.
A
Okay,
so
is
there
anything
anybody
wants
to
raise?
We
haven't
covered
on
the
executive
team
reports,
brilliant
thanks,
everybody,
so,
in
which
case,
let's
move
on
to
the
freedom
to
speak
up
guardians,
six
monthly
report-
and
I
I
think
we
have
with
us
carolyn
jenkinson,
uma,
dafter
and
julie
lindsey-
is
that
right?
Are
you
all
three
here.
G
Yeah,
so
I'm
going
to
take
us
through
the
report
so
morning,
everybody
and
thanks
to
the
board
for
receiving
our
freedom
to
speak
up
report
today.
We're
grateful
to
have
the
opportunity
to
share
it
with
you
and,
as
you
know,
we've
got
three
guardians
now
in
cqc
and
we've
been
in
post
since
april
this
year,
and
we've
been
working
over
the
last
six
months
really
just
to
raise
awareness
about
our
new.
G
You
know
appointments
and
also
about
planning
how
best
to
operationalize,
having
three
guardians
across
the
commission,
and
so
we've
been
working
hard
on
that
and
we've
got
a
good
idea
about
what
we
need
to
do
and
but,
as
it's
been
said
already
earlier
on
in
the
board
meeting
and
just
wanted
to
draw
your
attention
to
october
being
speak
up
month,
and
we
were
really
fortunate
here
at
cqc
and
to
start
off
the
month
we
had
an
event
which
was
attended
by
over
a
hundred
people
within
cqc
ian
opened
up
our
our
day.
G
We
had
a
talk
from
henrietta,
the
national
guardian
and
our
very
own.
G
Sir
robert
also
joined
us,
which
we
were
grateful
for,
and
then
we
also
had
a
speaker,
an
external
speaker
who
talked
about
the
importance
of
listening,
and
that
was
professor
megan
ritz,
and
it
was
a
really
good
day
and
there
was
some
really
really
rich
and
powerful
discussion
during
the
day,
which
gave
us
a
lot
of
things
to
focus
on,
and
actually
it's
really
helped
us
formulate
what
what
we
need
to
do
next
and
within
our
organization
to
really
develop
our
culture
even
further.
G
We
talked
a
lot
about
the
importance
of
listening,
because
speaking
up
is
is
very
often
around
and
once
you
do
that,
you
need
to
feel
that
you've
you've
been
heard,
and
so
we
really
need
to
focus
on
that
and-
and
we
also
heard
from
staff
that
they
want
to
know-
what's
happened
as
a
result
of
them
speaking
up
and
goes
back
to
that.
So
what
question
that
we
always
ask
when
we're
regulating
providers?
G
You
know
what
what
is
the
so,
what
as
a
result
of
what
you've
done,
so
we
want
to
focus
a
lot
more
on
that
as
we
go
through
the
next
part
of
the
year
and
it's
fair
to
say,
like
many
other
organizations
we've,
you
know
still
got
a
lot
more
to
do
and
we're
not
complacent
at
all,
and
we
know
you're
not
complacent,
either
as
a
board
and
we've
still
got
more
to
do
in
our
culture
and
but
we
do
think
that
we're
making
a
little
bit
of
progress-
and
you
can
see
in
the
report
we've
given
you
some
data
on
the
last
six
months
activity
and
there
isn't
much
there
for
us
to
provide
any
meaningful
analysis
on
and
actually
one
of
them
the
speak
up
guardians
one
of
the
three
of
us
is
omar
is
a
an
another
analyst
expert.
G
So
she
can't
do
it
then
there's
no
hope
for
any
of
us
and
but
what
we
can
tell
you
just
from
looking
at
what
comes
through
that
there
tends
to
be
two
camps
with
things
that
come
through
towards
and
a
lot
of
what
comes
through
is
very
much
based
on
simple
misunderstandings
that
grow
and
grow
and
grow
amongst
people
and
and
often,
and
we
just
need
to
either
us
or
our
ambassadors,
just
need
to
intervene
a
little
bit
and
just
and
help
sort
those
misunderstandings
out,
and
we
know
don't.
G
We
have
had
two
contacts
in
in
recent
times
from
two
whistleblowers
who
wanted
to
raise
things
and
we've
progressed
those
into
more
formal
investigations.
G
And
you
did
ask
us
last
time,
we
we
talked
to
you
and
whether
you'd
seen
any
we've
seen
any
increases
in
concerns
coming
through
as
a
result
of
the
pandemic,
and
we've
had
a
look
at
that
data
and
we
haven't
got
anything
to
report
on
that
relates
to
the
pandemic
and
we've
we've
noticed
a
slight
increase
in
contacts,
and
since
we
presented
about
our
role
at
one
of
ian's
all
calls,
and
so
we
think
that
was
worthwhile
doing
and
we've
we've
only
had.
One
concern
come
to
us.
G
That
directly
relates
to
the
pandemic,
where
somebody
raised
some
concerns
about
going
out
and
inspection
and
the
and
the
ppa
issues-
and
I
just
want
to
end
and
before
we
open
up
to
any
questions.
Just
to
note
really
that
we
are
very
grateful
for
the
support
that
we've
received
from
the
organization,
and
we
particularly
want
to
just
note
that
we
have
received
a
lot
of
support
from
executive
leaders
as
well
as
the
board
and
so
robert.
We
were
really
grateful
for
you
coming
to
our
and
this
the
speak
up
day.
G
G
A
So
carolyn
you
made
the
point
that
a
lot
of
the
referrals
to
you
were
really
the
result
of
misunderstandings
that
that
had
festered.
So
I
so
I
guess
the
the
question
in
my
mind
is:
are
there
are
there
generic
learnings
that
come
out
of
those
that
that
we
need
to
to
absorb?
To
I
mean
there
will
always
be
misunderstandings,
I
I
suppose,
but
it
would
be
nice
if
there
were
fewer
of
them
and
that
they
got
untangled
before
they
festered.
A
G
I
mean
I
don't
I
don't
think
there
are
generic
things,
but
I
do
you
know
it
comes
down
to
a
lot
of
that
of
working
from
home
messages
that
get
read
in
the
wrong
way.
Don't
they
sometimes
on
email,
so
making
sure
our
managers
and
leaders
think
about
the
things
that
they
say
in
an
email
and
and
how
that
is
received
is
often
very
important.
A
Yeah-
and
I
do
sometimes
wonder
if
there
isn't
the
other
side
of
that
sorry,
I
don't
disagree
at
all
that
it's
up
to
managers
to
think
or
any
of
us
to
think
carefully
about
what
we
put
into
an
email,
but
but
but
sometimes
maybe
this
is
a
generic
point.
People
need
to
to
to
to
find
a
way
of
of
of
going
back
if
they
are
offended
or
unclear
or
whatever,
rather
than
let
it
escalate
yeah
it
sort
of
takes
two
to
tango,
perhaps
anyway
mark
saxton.
You
wanted
to.
B
Come
in
and
then
robert
thanks
chairman
carolyn,
thanks
very
much
for
the
report
and
thanks
for
articulating
it
so
well
a
couple
of
questions
barriers
you
mentioned,
and
I
just
wonder
what
the
barriers
are.
B
I
imagine
that
in
the
world
at
the
moment,
some
of
the
barriers
are
access,
and
you
know
people
finding
they're
finding
you
in
the
organization
in
in
a
team
setting,
and
I
wonder
whether
some
of
the
barrier
barriers
may
also
be
about
knowledge,
so
the
knowledge
of
the
the
guardian
and
who
you
are
and
what
you
do
and
you
sort
of
refer
to
a
spike
in
your
contacts
following
your
work
with
ian
in
one
of
his
sessions.
B
So
I
just
sort
of
wonder
wonder
about
about
that.
If
you
could
comment
on
that
access
and
knowledge
and
how
you're
going
to
build
that
and
then
also
about
ambassadors,
I
thought
that's!
It's
really
good
that
you've
got
training
lined
up.
Could
you
just
sort
of
help
me
to
understand
how
many
ambassadors
will
we
then
have
fully
trained
within
within
the
cqc?
G
Yeah,
I
I
don't
think
the
barriers
are
so
much
about
staff,
not
knowing
how
to
get
hold
of
an
ambassador
or
aus,
and
I
mean
I
you
know.
Maybe
there
is
some
of
that
and
we
constantly
do
need
to
keep
raising
awareness.
But
there
is
quite
a
lot
of
information
on
our
webs
on
our
internet,
about
the
speak
up
role
and
we
do
go
out
and
talk
to
team
meetings
and
things,
and
I
think
sometimes
not
all
staff.
G
We
and
it
may
be
that
we
actually
can't
change
what
they're
raising
with
us
and
there
isn't.
The
solution
isn't
what
they
actually
wanted.
But
we
need
to
show
that
they
could
do
that
and
there
weren't
repercussions
and
they
could
do
it
in
a
safe
way,
and
you
know
and
educate
them
really
that
it
is
okay
to
speak
up
in
terms
of
the
ambassadors
and
julie
might
want
to
say
something
because
julie
tends
to
to
lead
with
the
ambassadors
a
bit
more
than
I
do.
G
N
That's
right:
carolyn
we've
got
at
least
60
ambassadors
that
are
currently
trained
and
working
voluntarily,
and
then
we've
got
some
train.
The
trainer
training
that's
been
put
together
by
the
academy,
which
is
really
positive
so
that
we'll
have
some
trained
ambassadors.
Who
will
be
able
to
train
new
ambassadors,
so
it'll
be
an
ongoing
internal,
so
yeah.
It's
it's
good.
O
I
just
thank
you
peter.
Does
this
really
to
echo
what
carolyn
was
saying?
I
think
what
we've
heard
is
most
people
saying
that
it's
not
that
we
don't
know
how
to
speak
up
or
whom
to
speak
up
to.
We
just
don't
feel
bad,
because
we're
not
sure
anything
is
done
as
a
consequence
of
speaking
up.
So
I
think,
as
carolyn
said,
one
of
the
actions
that
we
should
take
away
is
to
actually
talk
a
little
bit
about
what
we
did.
You
know
following
that
speak
up,
so
people
feel
that
you
know
there
is.
O
A
F
Thank
you
well.
Firstly,
thanks
for
inviting
me
to
your
event
the
other
day.
I
I
really
enjoyed
that
my
question
actually
partly
about
opera
operation
operations,
analyzing
the
what
you
do,
and
I
wondered
in
terms
of
barriers
is:
is
there
any
form
of
perceived
barrier
in
relation
to
how
people
get
in
touch
with
you,
bearing
in
mind
we're
not
in
an
office,
you
can't
have
a
auto
conversation
very
easily.
F
Are
there
means
of
communicating
with
you,
the
guardians
or
your
ambassadors,
anywhere
outside
the
cqc
email
system,
because
the
one
fear
in
some
organizations-
I
don't
know
if
it
exists
in
ours-
is
that
anything
goes
into
the
system
is
recorded,
and
you
know
other
people
know
about
it
before
you
do
anything.
So
is
there
that
concern
or
not.
G
And
we
haven't
heard
that
concern
and
it's
not
something
that
I
think
we've
discussed
actually
that
we
don't
have
a
way
of
contacting
us
through
an
external
mechanism.
We
do
have
a
speak
up,
email
address.
That
goes
into
a
specific
inbox,
but
I
mean
maybe
again
that's
something
for
us
to
consider.
F
G
A
Okay,
so
listen,
julie,
uma
and
carolyn.
Thank
you
very
much,
not
just
for
coming
to
the
board
now,
but
more
particularly
for
for
what
you're
doing
in
the
organization
in
this
role.
On
top
of
your
your
your
other
role,
so
it's
really
really
important
and
really
helpful,
and
you
know
as
ever.
A
If
not
only
will
we
see
you
again
for
the
for
the
next
update,
but
if
there's
anything
you
need
from
us
as
a
board
to
support
your
work,
then
then,
at
any
time
please
get
in
touch
so
great,
and
thank
you
again
for
for
being
here
today.
A
Good
excellent,
so
that
then
I
think
paul
takes
us
on
to
the
acgc
audit
committee
report.
Please.
F
Peter
a
routine
meeting
in
many
ways,
I
think,
and
the
report
updates
on
the
things
that
we've
been
looking
at.
F
F
I
think
within
hwe
and
and
the
not
in
the
control
environment,
but
the
identification
of
risks
there
in
a
very
sensible
and
way
and
the
way
which
highlights
what
is
really
at
the
top
end
of
their
risk
register.
In
that
respect,
and
I
thought
that
that
was
very
good.
We
appreciated
that
and
also
to
note
that
I
think
the
collaboration
between
cqc
and
hwe
is
continuing
to
improve.
F
There
are
still
points
of
of
of
slight
irritation
in
a
way
which
I
tend
to
be
around
the
way
that
procurement
works,
that
we're
a
bit
top-heavy
in
terms
of
process
for
some
of
the
things
that
hwe
need
to
do.
But
kirsty
and
her
team
are
doing
a
great
job
of
trying
to
smooth
that
out
as
far
as
possible,
and
it
does
seem
to
be
less
of
a
an
irritation
than
than
was
say
a
year
or
so
again.
F
So
so
I
think
that's
good.
I
think
it's
really
important
as
well,
because
the
my
observation
would
be
that
the
work
that
healthwatch
england
is
doing
is
increasingly
important
and
relevant
to
everything
that
we
do
and
and
and
general
actually
to
the
sector
as
a
whole.
So
I
I
I
think
that
was
a
a
really
positive
session
around
that.
F
Always
I
don't
actually
just
pay
tribute
to
our
always
risk
of
finance
committee,
which
is
absolutely
fabulous,
but
I'd
also
like
to
confirm
what
paul
has
just
said
that
relations
with
cqc
and
how
they
work
together
has
visibly
improved
in
my
my
time-
and
I
take
no
credit
for
that
personally
at
all-
it's
entirely
due
to
to
others,
and
it
has
resulted,
I
think,
in
nature.
F
Both
parties
have
a
much
better
understanding
of
hwe's
finances
and
what
costs,
what
and
who's
paying
for
it,
and
why,
in
a
way
which
probably
wasn't
the
case
in
the
past,
I
think
all
that
is
really
good
news.
Great.
A
Thank
you
so
that
takes
us
to
any
other
business.
If
there
is
any
silence,
is
golden.
We've
got
two
questions
from
robin
pike,
so
the
first
is:
how
does
cqc
capture
outpatient
experiences
with
hospitals?
Many
patients
find
the
arrangements
for
making
appointments
to
be
difficult
ted.
It's
a
hospital's
point.
Do
you
want
to
answer.
H
Thank
you
peter.
The
I
think
robin
is
entirely
right
to
raise
this
as
an
issue
we
do
pick
up
and
have
picked
up
on
our
inspections,
dissatisfaction
with
some
hospital
outpatient
services,
particularly
the
high
volume
services
such
as
ophthalmology
and
fracture
clinics,
and
I
think
we
we
seek
that
feedback
from
the
patients
both
in
the
clinics
themselves
was
also
looking
at.
H
The
trust
feedback
and,
of
course,
could
give
feedback
on
care
is,
is
a
very
vital
resource
in
that
that
feedback
is
reflected
in
our
inspection
reports
and
in
any
enforcement
action.
We
take
on
terms
of
improving
the
responsiveness
of
outpatient
clinics,
so
that
is
an
ongoing
theme
and
there
has
been
an
ongoing
theme
and
if
you
look
at
the
ratings
for
outpatients
you'll
see,
this
is
reflective
in
that
going
forward.
So
I
think
robin
is
right.
Is
an
area
to
keep
focus
on
during
the
kobe
pandemic.
H
I
have
to
say,
as
the
pandemic
has
progressed,
that
positive
feedback
has
become
more
measured
and
I
think
some
patients
are
finding
remote
consultations
difficult
and
certainly
we
are
challenging
organizations
where
we're
getting
that
feedback
to
ensure
that
they
do
consider
the
needs
of
all
their
patients
and
don't
transfer
to
complete
remote
outpatient
clinics.
So
I
think
this
is
an
ongoing
area,
but
as
we
go
back
to
routine
inspections,
we
will
need
to
focus
again
on
outpatients
going
forward.
A
Thanks
ted
and
then
robin's
second
question
is:
how
does
cqc
currently
monitor
patient
access
to
nhs,
dental
services
and
rosie
would
normally
answer
this
question.
What
I
can
say
to
you
robin
is
is
actually
currently
we
don't.
A
Our
focus
is
on
quality
and
safety,
but
as
ian's
standing
in
for
rosie
said
earlier,
we
are.
We
are
looking
generally
at
access
into
general
practice
as
a
result
of
of
covid,
and
I
think
and
that's
likely
to
extend
across
into
dental
services
as
well.
So
that's
a
sort
of
half
an
answer
robin
and
if
rosie
wants
to
add
anything,
she
can
do
that
either
outside
the
meeting
or
at
our
next
meeting.
So
I
hope
that's,
that's,
okay.
A
Those
were
the
only
two
questions
we
had
from
the
public.
So
on
that
note,
I
think
we
can
end
this
meeting.
So
thank
you
all
very
much
indeed,.