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From YouTube: CQC board meeting – July 2017
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A
Okay,
good
morning,
everybody
welcome
to
the
July
board
meeting
each
month.
It's
July
definitely
July.
So
welcome,
particularly
welcome
to
Professor
Edward
Baker,
the
Chief
Inspector
of
hospitals
designate
welcome
Ted,
it's
great
to
have
you
here
our
welcome
other
guests.
In
in
a
moment
we
have
apologies
of
absence
from
Louis,
Appleby
and
Eileen
Milner.
A
Are
there
any
declarations
of
interest
that
anybody
needs
to
make?
Okay,
that's
good
minutes
of
the
June
meeting.
Are
they
a
true
and
accurate
record
of
everything
we
discussed?
Okay,
good!
Thank
you!
That's
agreed
action
log.
There
are
three
items
on
the
action
log.
One
is
ongoing:
the
presentation
by
the
by
Paul
Elliott
on
the
mental
health
reports
and
improving
the
timeliness
of
inspection
reports.
That's
that's
ongoing
and
we'll
come
back
and
then
there
are
two
other
actions
which
are
both
David
in
your
your
report.
A
When
we
get
to
it
so
I
think
that
covers
everything
in
the
action
log
there
anything
else
arising
anybody
wanted
to
raise
okay
good.
So
then
we
can
move
to
the
first
stir
sort
of
a
substantive
item
which
is
to
talk
about
the
National
Guardium,
the
freedom
to
speak
up.
So
I
don't
know,
can
I
welcome,
first
of
all,
Henrietta
Hughes
may
recruitin
and
Nick
Harper,
and
if
you
want
to
come
to
where
there
are
microphones,
I
think,
as
everybody
knows,
dr.
A
Henrietta
Hughes
is
the
National
Guardian
and
you're
probably
going
to
kick
this
off
well.
I
do
know,
are
you
gonna?
Kick
it
off
or
we
going
to
go
to
our
other
guest
dr.
Nick
Harper?
Are
you
going
to
it's
going
to
start?
We
should
have
rehearsed
this.
Wouldn't
we
especially
since
we
all
had
dinner
last.
We
could
have
planned
this
a
little
better.
A
Would
it
be
sensible,
Nick
wait
for
you
to
start,
and
that
sets
a
really
really
nice
C,
but
before
you
do
can
I
also
just
welcome
Mary
courage,
who
will
also
be
speaking
later.
Mary
has
a
variety
of
roles
within
CQC,
but
one
of
them
is
you.
You
are
our
Speak
Up
champion
and
free
to
speaking
out
champion
so
you'll
be
speaking
about
what
we're
doing
as
an
organization
but
Nick
you
have
a
great
story.
So
why
don't
we
hand
over
to
you
just
set
the
scene
as
it
were.
B
Morning,
my
name
is
dr.
Nick
Harper
I'm,
a
consultant
and
a
statistic:
blackball
Victoria
Hospital,
where
I've
worked
for
nearly
20
years,
I'm,
the
deputy
medical
director
and
the
freedom
to
speak
up
Guardian
and
I
am
a
whistleblower
within
the
NHS.
I
was
compelled
to
speak
up
within
my
first
year
as
a
consultant
in
1998
and,
whilst
20
years
ago
seems
like
a
long
time.
I
think
my
experience
is
still
valuable
today.
B
B
The
performance
and
conduct
of
the
surgeon
was,
unlike
anything,
I
had
encountered
in
an
operating
theatre
previously,
eventually,
after
a
massive
transfusion
of
blood
and
blood
products,
the
surgery
had
to
be
abandoned
and
I
transferred
the
patient
to
the
intensive
care
unit
where,
sadly,
they
died
a
few
hours
later
that
evening,
at
home,
I
reflected
my
patient
has
died.
Barely
12
hours
after
coming
into
hospital
for
routine
surgery,
I
was
completely
shattered.
B
There
was
a
feeling
that
I'd
let
the
family
down
and
that
I'd
let
the
patient
down
I'd
never
encountered
a
patient,
not
surviving
surgery
under
circumstances
such
as
those.
My
immediate
thought
was
I
need
to
talk
to
someone
about
this,
but
who
can
I
talk
to?
We
don't
really
talk
about
this
kind
of
case
in
the
NHS.
B
Ultimately,
I
had
to
believe
that
this
was
a
one-off
case
and
I
continued
to
work
with
the
surgeon,
but
I
made
a
promise
to
myself
that
should
any
other
patient
come
to
significant
harm.
Despite
my
best
efforts,
I
would
have
to
take
some
form
of
action
over
never
that
the
next
11
months,
working
with
the
surgeon,
I
developed
a
significant
number
of
concerns
about
his
practice.
B
The
medical
director
decided
that
it
would
be
appropriate
to
perform
a
surgical
review
of
the
cases
I
had
raised,
but
unfortunately,
in
December
1998
before
that
review
was
complete.
There
was
another
patient
safety
incident
in
which
a
patient
came
to
harm
and
that
led
to
me
refusing
to
work
with
the
surgeon.
The
following
day,
the
entire
anaesthetic
Department
withdrew
support
for
the
surgeon
until
the
review
was
complete.
B
What
followed
over
the
next
seven
years
were
multiple
parallel
and
overlapping
processes
of
investigation
and
procedure.
These
processes
started
locally
and
more
and
more
cases
and
concerns
came
to
light.
As
the
investigation
began,
multiple
members
of
staff
were
involved
in
multiple
patients.
After
two
years,
the
GMC
became
involved
in
an
investigation
leading
to
GMC
processes,
and
then
the
police
started
a
criminal
investigation
leading
to
a
manslaughter
trial
in
September
2004.
The
surgeon
pleaded
guilty
to
the
charge
of
manslaughter
on
a
patient
he
had
operated
on.
B
In
1995,
two
years
before,
I'd
started
as
a
consultant
and
in
December
2005
he
returned
to
the
GMC
and
was
erased
from
the
medical
register
throughout
this
entire
period
of
time.
I
continued
to
work
as
a
full-time
consultant
anaesthetist,
while
simultaneously
being
heavily
involved
in
each
of
the
arms
of
the
investigations
that
were
ongoing,
I
had
to
appear
as
a
witness
at
a
GMC
hearing,
which
is
an
experience
I'd
be
glad
to
never
repeat.
B
B
Don't
feel
that
I
was
in
a
position
to
offer
them
any
formal
advice,
but
I
did
what
I
could
do,
which
was
to
listen
to
their
concerns
to
offer
them
what
support
and
reassurance
I
could
there
were
inevitably
personal
consequences
for
me
as
a
result
of
the
action
I
took
for
some
time,
a
significant
proportion
of
the
consultant
body
kept
me
distant
and
isolated.
I
was
treated
with
suspicion
if
I
was
in
a
room
of
consultants.
B
I
was
aware
that
they
were
talking
about
me,
but
they
weren't
talking
to
me
newly
appointed
consultant
colleagues,
were
advised
not
to
trust
me
and
warned
to
stay
away.
I
was
suffered,
I
suffered
attempt
to
intimidate
me
and
on
a
number
of
occasions,
I
was
publicly
verbally
challenged.
My
wife
and
my
family
were
subject
to
unfair
treatment
in
the
community
and
when
they
were,
endangered,
I
was
forced
to
report
it
to
the
police.
B
Once
at
a
moment
where
I
was
feeling
particularly
isolated,
made
contact
with
a
confidential
helpline
for
doctors.
They
made
it
very
clear
to
me
that
they
would
not
support
a
whistleblower
I
was
able
to
make
contact
with
public
concern
at
work.
The
whistleblowing
charity,
where
an
adviser
called
Anna
Meyers,
was
a
tremendous
support
and
help.
B
Anna
was
also
able
to
give
me
a
bit
of
a
reality
check
in
that.
She
advised
me
that
expecting
my
organization
to
be
grateful
for
the
concern
I'd
raise
was
a
bit
unrealistic.
I
had
raised
a
difficult
subject
that
no
organisation
would
be
glad
to
handle,
and
in
that
sense
you
gave
me
that
sort
of
advice
you
might
expect
from
a
close
friend.
B
Ultimately,
my
concerns
were
justified.
The
surgeon
was
judged
to
have
committed
multiple
acts
of
serious
professional
misconduct
and,
by
his
own
admission,
was
guilty
of
manslaughter
I
persevered
throughout
this
period
and
decided
I
had
to
try
and
turn
my
experience
into
something
positive.
I
began
to
work
first
locally,
then
nationally,
with
public
concern
at
work.
B
I
worked
with
the
hospital
to
develop
the
first
raising
concerns
policy
and
within
the
department
we
developed
a
system
for
recording
incidents
in
the
operating
theatre
and
investigating
and
following
them
up
in
July,
2005
I
was
actually
appointed
to
clinical
director
of
the
department
which,
for
me,
was
an
indication
that
the
organisation
had
faith
and
confidence.
In
me,
a
year
later,
I
was
appointed
deputy
medical
director
and
a
year
after
that,
the
director
of
infection
prevention
and
control.
B
If
there
had
been
a
freedom
to
speak
up,
Guardian
in
1998
I
would
definitely
have
spoken
to
them
and
I
would
probably
have
spoken
to
them
before
I
did
to
the
medical
director.
I
would
have
appreciated
the
fact.
I
could
have
a
discussion
in
which
my
confidence
was
assured
with
someone
that
could
give
me
advice
and
would
stand
by
my
side
and
support
me
through
whatever
processes
would
ensue.
B
The
Guardian
would
also
have
been
my
expert
friend,
my
Anna
Myers,
necessarily
delivering
a
dose
of
reality.
If
that
was
what
I
needed,
the
freedom
to
speak
up,
Guardian
should
be
at
the
vanguard
of
cultural
change.
The
raising
of
concerns
investigating
managing
and
implementing
change
should
simply
be
the
way
we
work.
B
That
way.
We
can
manage
concerns
when
they're
small
issues
prevent
them
becoming
large
issues
that
become
almost
unmanageable
when
speaking
up
becomes
business.
As
usual,
I
would
hope
that
the
role
of
Guardian
almost
becomes
redundant
and
the
need
for
whistleblowers
disappears,
although
I
would
have
to
say,
I
have
always
maintained
as
a
whistleblower
I'm,
not
the
issue.
The
issue
was
the
fact
there
was
a
whistle
that
needed
to
be
blown.
Thank
you
for
listening.
A
A
You
went
through
and
sticking
the
course
because
there
was
a
real
public
interest
in
you
doing
that
it
obviously
a
huge
personal
cost
to
you
and
your
family,
but
but
secondly,
and
I
can't
imagine
a
more
graphic
way
of
setting
out
why
this
is
such
an
important
issue
and
the
role
of
the
freedom
to
speak
up
Guardians
is
so
important.
So
thank
you
for
doing
that.
A
So
without
giving
any
of
my
colleagues
the
chance
to
hijack
the
rest
of
the
morning
right
but
I
by
talking
to
you,
let's
go
straight
to
Henrietta
and
you
couldn't
have
had
a
better
introduction
as
to
why
what
you
were
doing
is
so
important.
So
why
don't
you
go
into
your
presentation
and
updating
the
board
on
where
you've
got
to
thank.
C
You
very
much
and
I
think
what
we've
heard
from
Nick
just
really
exemplifies
the
values
that
we
need
in
the
NHS.
In
terms
of
you
know,
courage
and
an
inspirational
story,
but
also
you
know
the
amazing
way
that
Nick
has
used
his
experiences
for
a
positive
outcome
by
being
able
to
share
this
so
that
others
can
learn
from
it,
and
you
know
I
think
what
I've
really
learned
over
the
last
year
since
I
was
appointed
into
the
role
International,
Guardian
and
I
started
in
October.
C
So
for
me,
the
establishment
of
and
the
embedding
of
the
principles
from
Sir
Robert
Francis's
report
is
the
sort
of
first
step
in
this
say,
and
now
we've
got
a
freedom
to
speak
up.
Guardian
in
every
trust
in
the
country
and
I'm
really
talking
about
secondary
care
here,
because
then
it
is
England
responsible
for
primary
care
and
we've
got
nearly
500
people
who
hold
the
title:
I
the
freedom
to
speak
up,
Guardian,
ambassador
or
champion
across
the
country
and
I.
C
Think
that's
a
really
positive
thing
and
in
fact,
when
I
spoke
to
one
of
the
freedom
to
speak
up
Guardians,
she
said:
we've
got
3,000
people
working
in
this
trust,
I'd
like
all
of
them
to
be
freedom
to
speak
up
ambassadors,
so
I
do
think,
there's
something
about
the
the
public
movement.
You
know
the
social
kind
of
movement
here,
rather
than
this
being
something
which
is
a
an
elite
or
exclusive
activity.
C
The
other
thing
that
I
was
going
to
say
is
that
we've
got
Guardians
for
who
but
reflect
a
wide
range
of
different
job
roles
within
the
organisations,
including
nurses,
doctors,
therapists,
chaplains
facilities,
managers,
company
secretaries
and
some
board
members
and
some
non-executive
directors,
and
by
going
out
and
visiting
the
Trust's
and
actually
seeing
how
those
roles
are
being
implemented.
We've
learned
a
huge
amount
which
we've
then
shared
across
the
country
with
other
Guardians,
the
Guardians
some
of
them
are
on
their
own
in
in
the
post,
and
that
can
be
quite
lonely.
C
So
we
brought
together
the
guardians
into
ten
regions.
That
was
one
of
the
first
things
that
we
did
so
that
they
can
get
the
support
from
each
other,
the
bodying,
the
mentoring,
as
some
people
coming
into
post,
not
having
to
reinvent
the
wheel,
but
they
can
actually
learn
from
each
other's
experience
and
we're
providing
guidance
in
terms
of
recording
of
information
how
to
report
to
the
board,
because
for
some
people
this
is
they've,
never
even
gone
into
the
executive
part
of
the
hospital
before.
So
it's
really
quite
a
big
learning
curve
for
them.
C
C
Organizational
boundaries
are
extremely
porous
and
I
do
think,
there's
something
that
you
know
could
really
be
learnt
from
that
in
the
way
that
organisations
work
together
coming
together
into
stp
footprints,
but
also
a
trust,
for
example,
the
ambulance
trusts
and
the
community.
Mental
health
trusts
have
recognized
that
they
have
something
in
common
and
that
they
have
formed
their
own
national
networks
as
well.
We've
been
recording
some
information
about
how
many
people
have
spoken
up
and
to
the
end
of
March.
C
There
were
two
thousand
eight
hundred
and
fifty
members
of
staff
who'd
come
to
speak
to
a
freedom
to
speak
up
Guardian
and
approximately
25%
of
those
for
patient
safety
issues,
we're
now
starting
a
quarterly
recording
process
where
we'll
be
getting
a
bit
more
granular
detail
and
we'll
be
publishing
that
on
our
web
pages.
The
other
thing
that
we've
done
recently
is
a
survey
of
freedom
to
speak
up
Guardians,
and
we
will
be
publishing
the
results
of
that.
C
C
So
as
you're
well
versed
ly
that
it's
part
of
the
world
led
inspection
and
we're
seeing
some
of
the
early
outcomes
from
that,
but
we're
also
working
in
partnership
with
NHS
improvement,
with
NHS
England
in
primary
care,
with
professional
regulators
with
professional
bodies
associations,
but
also
with
all
the
other
campaigns
that
exist
so
that
we
can
then
develop
a
good
practice
guide
for
speaking
up
using
all
of
the
information,
but
other
bodies
have
put
together
for
freedom
to
speak
up.
The
other
thing
that
I
was
going
to
say
is
that
this
is
not
we're.
C
A
D
You
I
was
appointed
to
the
role
after
competition
and
it's
additional
to
my
day
job
as
it
were
so
since
appointments
I
have
been
gathering
my
support
networks
around
me
and
working
closely
with
colleagues
in
HR,
and
engagement
and
I've
formed
what
I'm
calling
a
reference
group
made
up
of
people
from
people
across
CQC
and
including
the
chairs
of
our
Equality
networks
and
our
star
forum
and
using
this
group
to
sort
of
guide
the
work
putting
together.
You
know
to
hold
me
to
account
for
the
work
plan
and
and
to
support
it.
D
More
generally,
I
am
recruiting
speaker
ambassadors,
who
will
be
provided
with
some
training,
be
entirely
voluntary
to
walk
to
work
really
on
the
model
of
our
dignity
at
work
advisers,
who
are
people
that
we
have
similarly
trained
to
support
people
when
they
need
help
if
they
feel
they
are
being
treated
unfairly
or
bullied
and
so
on.
So
the
idea
is
that
the
ambassadors
will
support
people
and
will
encourage
them
and
find
post
them.
So
this
is
about
using
some
of
our
sign
posting
people
into
some
of
our
existing
processes
and
I.
D
Think
it's
an
interesting
message
that
yes,
I
I
am
the
Speak
Up
guardian
and
please
come
to
me.
But
you
don't
need
a
guardian
to
speak
up.
We
need
to
get
into
the
habit
of
doing
it
as
a
matter
of
course,
as
Henrietta
has
said,
I've
been
supported
and
guided
by
Henrietta
and
her
staff
and
I've
also
been
working
with
one
of
the
associate
professors
from
ash
Ridge.
D
Professor
Megan
Reese
who's
recently
published
a
research
around
capacity
to
speak
up
and
her
research
have
covered
60
chairs
and
chief
executives
from
various
walks
of
life,
including
the
NHS,
the
military,
media
and
banking,
and
the
key
lessons
from
that
are
that,
of
course,
we
need
the
right
processes
in
place
and
good
policies
and
then
to
work
well
within
those.
But
what
really
matters
is
the
habits
and
it
becoming
a
way
of
life
to
speak
up.
D
The
research
has
shown
which
we
probably
were
already
aware
of,
but
it
makes
it
very
clear
that
those
in
positions
of
leadership
and
authority
generally
have
a
vastly
inflated
idea
of
how
easy
it
is
to
speak
up
to
them.
Share
information
with
people
who
have
power
over
one's
career,
so
I
think
it
is
a
bit
of
a
call
to
arms
from
me
for
not
just
to
the
people
here
present,
but
everyone
within
CQC
to
actively
consider
that
power
imbalance
in
all
interactions
with
people
and
to
actively
work
on
being
as
open
as
possible.
D
Speaking
up
well
is
really
important
and
Henrietta
has
said
listening.
Well,
that's
just
as
important.
Otherwise,
it's
all
going
to
be
lost,
I
will
be
bringing
to
boards
in
future
a
report
of
my
activity
and
identifying
themes
and
trends,
and
lessons
from
that.
So
this
is
the
start
of
an
ongoing
engagement
and
conversation.
D
Speak
up
in
the
CQC
land
will
encompass
everything
from
the
sort
of
concern
about
fraud
activity
at
that
end
of
the
scale,
but
this
is
speak
up
for
everybody
as
much
for
those
working
in
adult
social
care.
The
colleagues
who
support
us
from
strategy
and
intelligence
I
am
concerned
that
this
isn't
branded
as
a
hospital
activity
within
the
organisation.
So
it
is
for
everybody.
D
A
E
E
We
do
not
only
supporting
our
own
staff,
but
also
in
the
work
of
inspections
and
I'm
pleased
to
hear
that
Henry
S
is
getting
the
support
she
needs
from
organizations
across
the
piece,
but
can
I
just
ask
a
question
which
is
openly
as
to
whether
she
feels
there's
more
support.
We
as
a
board
could
give
her
what
she
would
be
looking
for,
and
also
the
the
other
bodies
who
are
party
party
to
this.
E
There
is
a
governance
process.
I
chair
a
chair,
a
small
accountability
liaison
board,
which
represents
all
the
bodies,
the
sponsor
the
office
and
visit.
The
event
we
have
here
today,
it
seems
to
me,
is
very
important
part
of
the
process,
but
and
in
many
ways
Henrietta.
What
would
you
recommend
to
us
and
boards
not
they're,
put
in
collectively
going
forward
in
relation
to
our
relationship
with
your
office?.
C
Thank
you
very
much.
My
experience
to
date
is
that
when
I
come
and
ask
for
something
the
response,
I
get
is
yes
absolutely,
but
we
could
also
do
this
this
and
this.
So
if
that
carries
on
then
I'll
be
continued
to
be
very
pleased.
I
think
there's
something
really
important
about
the
support
that
my
office
gets
and
that's
about
the
visible
leadership.
C
The
visible
demonstration
and
I'm
absolutely
delighted
that
so
many
people
around
the
table
are
wearing
a
visible
demonstration
of
that
and
I
think
it's
really
important
for
for
all
staff
who
are
working
in
trusts
in
commissioning
in
regulation
and
in
in
all
of
the
professional
bodies
to
see
that
they
have
a
really
key
part
to
play
in
this
and
any
organisation
that
doesn't
yet
see
that
they
have
a
part
to
play
in.
It
is
just
because
I
haven't
identified
and
persuaded
them
of
that
fact.
D
Help
with
any
data
that
you
need
from
from
local
HealthWatch
a
couple
of
comments,
one
is:
can
we
please
not
turn
Guardians
into
an
acronym
foot?
Suggs
is
the
most
awful
word.
You
know,
let's
not
lose
it
in
in
that
way,
that
would
be
terrible.
I
think
that
what
you're
doing
is
sending
a
wonderfully
strong
signal.
D
There
are
you,
as
we
are
here,
or
is
it
better
size
up
at
this,
and
quite
rightly
because
this
has
gone
on
far
too
long
and
must
stop
now
one
feels
a
couple
of
gleams
that
I've
found
on
my
Charles
one.
When
we
went
up
the
whole
CQC
board
went
up
to
Newcastle.
We
visited
the
emergency
hospital
up
there
and
they
said
that
they
they
recruit
when
they
recruits.
D
So
I
thought
that
was
a
really
interesting
and
I
mean
I,
haven't
heard
it
before
and
the
other
one
when
I
was
up
in
the
northwest
or
the
other
day
we
that
HealthWatch,
sometimes
here
we
all
often
hear
from
the
public
we
sometimes
hear
from
members
of
staff
and
likewise
for
CQC
I,
know
on
inspections.
But
on
this
occasion,
when
we
fed
back
to
the
hospital
the
issue-
and
they
moved
quickly
to
do
something
about
it,
they
also
said
we
are
mortified.
D
F
Thank
you
and
thank
you
repeat
him:
Roberts,
thanks
to
and
nichkhun
to
Henrietta
and
Mary,
for
the
presentations
that
they've
made,
and
particularly
to
Nick,
for
sharing
his
story
and
I
just
wanted
to
say
that.
Obviously,
the
focus
of
this
conversation
has
been
on
what's
happening
in
the
NHS
Roberts
review
was
focused
on
what
was
happening
in
the
NHS
and
therefore
the
recommendations
came
to
support
them.
Greetings,
Speak,
Up,
Guardians
within
service
organizations
and
we've
not
really
focused
on
adult
social
care.
To
quite
the
same
extent.
F
F
The
issue
of
whistleblowing
is
just
as
important
in
adult
social
care
and
in
some
ways,
even
more
difficult
for
people
because
of
the
very
small
nature
of
some
of
these
services
and
the
difficulty
for
people
to
feel
confident
in
doing
that,
and
particularly
a
firm
there,
they're
really
kind
of
trying
to
go
against
a
prevailing
culture,
which
does
not
encourage
that.
So
I
think
it's
very
important
that
the
way
that
we
do
our
inspections
and
we
focus
on
this
in
the
questions
that
we
ask.
F
Well,
we
ask
whether
her
services
well-led,
is
how
supported
our
staff
to
raise
concerns.
Are
they
responded
to
appropriately
and
does
the
management
and
the
provider
ensure
that
that
is
available
for
them?
So
I
think
you,
whilst
we've
generally
kind
of
talked
about
it
from
a
health
service
perspective
I,
think
it's
worthwhile
for
this
board
to
recognize
and
and
acknowledge
that
this
isn't
a
really
important
issue
in
adult
social
care
as
well.
A
G
Ted,
thank
you
big.
Thank
you
to
Nick
for
sharing
his
story
with
us.
The
culture
he
describes
may
have
stopped
me
in
the
events
he
described
may
have
started
20
years
ago,
but
the
culture
he
describes.
We
still
find
on
our
inspections
recently.
So
this
is
still
very
much
a
problem
out
there
in
the
healthcare
system
in
our
hospitals
and
I.
Think
it's
important
for
us
to
recognize
the
extent
of
the
cultural
change
that
we're
trying
to
drive.
So
we
fully
behind
Henrietta
in
our
work.
G
She
described
it
as
a
social
movement
and
very
much
a
social.
We
once
we
want
to
join
and
support.
I
think
something
that
often
goes
on
remark,
which
is
clear
very
strongly
to
me
in
our
inspections.
Is
that
often
the
unsung
heroes
in
an
spectrans
are
the
many
staff
who
raise
concerns
with
us
directly
either
call
themselves
whistle
blows,
but
often
not
just
raising
concerns
with
us
and
I.
A
So
thank
you
for
all
you're
doing
the
through.
Thank
you
for
coming
Nick.
Thank
you,
the
other
two
of
you
for
what
you're
doing,
and
we
will
see
you
again
at
the
board.
We
will
look
forward
to
even
greater
progress
when
you're
next
here.
If
you
want
to
stay
for
the
rest
of
the
meeting,
please
do
but
I
know
Henrietta.
At
least
you
need
to
rush
off
to
something
else,
but
you're
welcome
anyway.
So
with
that
David.
Can
we
move
on
to
your
report?
Please
thank.
H
You
so
this
is
largely
an
update
report,
there's
a
performance
report
which
follows
this,
which
I'll
present
with
some
help
from
other
colleagues.
So
I'll
do
this
at
some
speed
in
relation
to
the
updates.
So,
first
item
I
just
want
to
draw
attention
to
Andrea
led
the
publication
of
the
end
of
program
reports
on
adult
social
care
on
the
6th
of
July,
and
this
is
our
first
meeting
since
that
report
was
published
and
just
to
mark
the
publication
of
that
report
and
the
impact
that
it's
had.
I.
H
Think
in
terms
of
catalyzing,
the
debate
again
about
the
quality
of
adult
social
care
and
its
importance
and
I.
Think
in
an
urgent
question,
drew
some
commitments
from
government
in
relation
to
the
ambition
to
bring
forward
the
green
paper,
perhaps
later
this
year.
So
important
and
we've
previously
reported
on
digital
and
the
progress
and
you've
got
an
update
report
here.
H
I
spent
about
an
hour
down
on
Monday
going
through
the
progress
of
the
work,
there's
a
very
kind
of
visual
display
of
the
progress
in
making
and
I
came
away
from
that
hugely
encouraged,
that
this
work
has
got
traction
and
will
be
a
product
out
of
it
in
a
timely
manner.
The
importance
of
the
adult
social
care
work
is
that
this
will
provide
the
framework
if
you
wish,
in
which
the
EMS
and
Hospital
work
can
be
done.
So
once
the
frameworks
designed,
then
it
can
be
populated
with
that
other
data.
H
There's
a
brief
update
in
relation
to
cyber
the
department
felt
last
Wednesday
publish
their
response
to
then
fear
on
a
coldie
Cox
report,
the
review
of
data
security
concepts
and
ops
alves,
but
also
the
report.
The
thematic
report
that
we
undertook
on
set
there
to
save
care.
One
of
our
recommendations
in
that
report
was
about.
We
would
amend
our
assessment
and
inspection
framework
to
include
key
lines
of
inquiry
and
prompts
which
could
elicit
assurance
that
appropriate,
internal
and
external
validation
against
the
new
data
security
standards
was
indeed
in
being
carried
out.
H
This
is
the
information
governance
toolkit
which
is
being
revised
and
we'll
get
reissued
later.
Something
called
curse,
certs
I
think
is.
The
phraseology
has
been
given
to
this,
which
is
an
upgrade
on
the
information
governance,
and
the
important
point
here
is
that
we
were
not
trying
to
provide
a
technical
assurance
that
data
was
being
secured,
but
this
was
a
check
that
the
organization
itself
was
assuring
itself
that
the
appropriate
standards
were
being
followed.
H
We
stand
by
that
commitment
and
indeed
the
work
to
design
the
hospital
inspection
methodology
which
will
begin
later.
She
is
in
place
and
will
take
that
forward.
We
also
committed
to
training
our
staff
so
that
they're
aware
of
what
they
need
to
look
for
it's
a
bit
like
holiday.
Italian
is
this:
if
you
ask
the
waiter
the
station,
you
need
to
understand
the
answer,
so
it's
not
just.
Can
you
go
through
a
checklist?
H
Well
with
some
opportunities
mike
has
had
further
discussion
with
both
ministers
and
the
Department
of
Health,
and
there
might
be
some
opportunity
to
do
some
joint
work
with
NHS
digital
on
this,
in
addition
to
building
this
into
our
routine
inspections,
but
some
so
those
discussions
go
on
just
to
give
the
board
a
sense
of
again
momentum
and
continuity
on
that
following
the
Glanville
tower
fire.
This
is
a
item.
H
Seven
back
on
page
three,
we
were
asked
by
the
Department
of
Health
if
we
could
make
contact
with
all
registered
providers,
particularly
adult
social
care
providers,
which
we
did
and
in
fact
that
letter
asked
them
to
assure
themselves
again.
We
weren't
asking
them
to
send
the
assurance
to
us,
but
could
they
assure
themselves
that
their
fire
safety
procedures
are
up
to
date,
including
the
issues
in
relation
to
the
environment
in
which
care
was
provided
to
ensure
that
that
was
safe
as
well?
H
Who's
been
a
very
senior
in
the
fire
service
in
England
who
now
works
with
us
max,
has
led
an
action
plan
which
is
attached
to
this
agenda,
and
this
paragraph
is
just
giving
you
an
update
of
where
we
are
in
terms
of
reviewing
our
systems
and
procedures,
issuing
guidance,
notes
to
our
staff
and
reviewing
doors
and
and
quite
properly,
some
inspectors
who
spent
time
away
from
home
and
might
be
in
hotels
and
hotels,
which
are
more
than
four
storeys
high
rise.
There's
a
natural
anxiety,
I
think
for
any
of
us
find
ourselves
in
that
situation.
H
So,
amongst
a
range
of
things,
we've
done
is
just
issue
some
guidance
to
stack
paragraphs
AIDS,
there's
an
update
on
two
legal
cases
which
again
we've
not
put
into
our
discussion
at
the
board
in
a
public
session.
You've
been
briefed
on
this
in
private
session,
because
these
are
current
legal
cases
and,
to
some
extent,
Rebecca
has
just
reminded
me.
H
The
southern
health
case
is
still
not
finished,
while
serve
admitted
guilt
in
relation
to
this
is
still
a
further
here
in
per
sentencing,
so
the
Bekaa
was
I
advised
me
to
be
cautious
about
that
and
I
advise
you
to
be
cautious.
If
you
want
further
questions
on
it
as
well,
but
the
two
issues
just
to
draw
out
here,
we
were
challenged
in
relation
to
the
application
of
our
registration
guidance,
particularly
about
developing
person-centered
community
services
for
people
with
learning
disabilities.
H
H
H
The
effectively
rehear
the
case-
and
in
this
case
the
first
tier
tribunal,
actually
visited
the
sides
of
what
was
being
registered
and
they're
affirmed
the
judgment
that
we
derived
out,
but
they
added
their
own
information
in
because
the
debate
about
how
far
connected
with
the
community
this
was
their
commented
on
and
their
commented
that
Aldous
act
separate
from
the
community
was
not
part
of
the
community
and
so
I
think.
This
is
interesting
in
terms
of
our
future
decisions
about
the
degree
of
consideration
that
we
need
to
apply
to
this.
H
But
the
important
point
to
note
here,
I
think,
is
that
the
first
years
tribunals
judgment
was
that
CQC
had
not
acted
beyond
its
powers
and
therefore
I
think.
This
is
a
significant
challenge
to
our
judgement
and
I
know.
We
go
on
a
lot
about
consulting
on
these
things,
but
this
really
does
underline
the
importance
of
consultation
on
the
guidance
that
we
go
and
just
the
epital
energy
that
goes
in
at
board
level
to
make
sure
we've
got
these
things
right
and
then
consult
on
it.
H
So
I
think
a
significant,
a
significant
development
and
again
on
the
29th
of
June.
Southern
health
entered
a
guilty
plea
in
relation
to
the
prosecution
that
we
brought
in
relation
to
the
harm
that
had
resulted
I've
set
out
some
of
the
detail
in
relation
to
the
individual
case
and,
of
course,
with
Robert
Sir
to
my
left.
These
powers,
which
came
to
CQC
effected
from
2015,
were
as
a
result
of
Roberts
report,
and
we
were
using
these
new
powers.
The
issue
here
is
we
weren't
able
to
use
powers
before
the
15-day
at
the
April
15.
H
We're
now
clear
about
the
capabilities.
We
would
like
inspectors
in
CQC
to
develop
and
refine,
and
we
think
one
way
to
do
this
is
to
develop
professional
requirements
for
the
capabilities
that
we
want
to
see,
which
is
also
accredited
and
registered
by
hopefully
a
university
in
relation
to
this.
So
we
can
actually
have
some
capability
for
people
to
build
to
diploma
and
indeed
master's
levels
degrees
in
relation
to
this,
so
that
were
all
go
through
and
I
want
to
make.
H
One
correction
I
think
this
is
also
in
the
performance
report,
but
he
did
get
reported
in
this
report
last
month,
which
is
some
picture
you
might
erase
this
question.
We
said
there'd
been
an
increase
in
applications,
registration
applications
in
the
compared
to
last
year's
average
that
wasn't
actually
true.
What
we've
had
is
an
increase
in
complex
applications
and
I
want
to
correct
that
record
through
this
report.
But
we
also
pick
it
up.
H
I
think
is
a
very
last
paragraph
in
the
performance
report
and
then
just
to
celebrate
what
I
think
is
a
really
nice
recognition
of
a
lot
of
hard
work
that
has
gone
on
within
the
organisation.
Last
week.
Cqc
was
highly
commended
in
the
team
of
the
year
as
the
employers
network
for
equality
and
inclusion
Awards,
where
the
focus
on
ability
project
ting
was
nominated
for
the
work
they've
done
responding
to
the
2015
staff
survey
resource.
H
If
you
remember
these
stuff
rate
survey,
results
were
members
of
our
team's
individual
members
who
have
a
disability,
felt
they
were
not
being
supported
by
the
organization
that
led
to
a
piece
of
work
which
has
been
led
by
HR
colleagues,
but
also
the
disability
Network,
and
the
outcome
of
that
was
a
focus
on
ability.
Work
which
is
supported
by
the
network.
H
Hungry
is
our
champion
and
just
to
reinforce
a
few
good
week
that
she's
up
in
she
was
able
to
be
there
another
another
success
with
people,
but
again
going
back
to
Mary's
story
where
Mary
has
come
forward
to
address
an
issue
that
we
know
we
need
to
address.
This
group
is
supported
by
about
50
people
who've
come
forward,
who
want
to
make
a
commitment
to
improving
how
we
operate
as
an
organization.
So
a
nice
note
to
end
on
Peter.
Thank
you.
So,
as
you
say,
let's.
A
E
E
First
of
all,
to
underline
I
think
you're,
actually
right
that
it
is,
the
onus
is
on
them
to
get
there
right.
Surance
around
it,
I'm
just
a
little
concerned
that
we
make
sure
that
we,
when
we
start
to
do
the
inspections,
have
the
right
degree
of
skill
and
knowledge
and
experience
to
make
sure
that
we
can
do
exactly
what
you
said,
which
is
to
understand
what
they've
done
and
the
answers
that
come
back
and
I.
E
Just
recall
that
when
we
did
the
safe
data
safe
care
piece
of
work
that
we
did
go
outside
and
use
both
NHS
digital
people
and
commercial
provider,
their
joint
later
to
go
round
and
did
off
the
work
there.
I
think
there's.
There's
a
need
to
make
sure
that
we
get
the
right
level
of
skill
in
this
first
round
of
inspections,
where
we're
doing
this,
so
that
we
can
make
sure
we're
pitching
this
absolutely
right
and
that,
once
we've
learned
about
our
approach
and
also
the
first
time,
we've
done
it
on
on
each
individual
organization.
E
H
But
I
think
this
is
why
the
recommendation
that
we
made
so
in
a
sense
this
came
out
too
said
there
to
save
care
and
we
produced
up
the
boards,
and
we
said
that
we
needed
to
build
this
into
our
inspections
and
the
second
bit
of
it,
and
this
is
picks
up
on
your
point.
We
also
acknowledged
that
we
needed
to
ensure
that
the
people
doing
this
our
inspectors
doing
this
work.
We
were
actually
trained,
so
they
recognized
it.
But
the
reason
I
wanted
to
connect
the
NHS
digital
board
review
with
this
item.
H
I
should
have
done
it
in
a
way
the
report
was
laid
out
was
actually
the
offer
is
that
if
we
do
need
access
to
technical
help,
we
can
get
that
without
necessarily
going
to
a
commercial
organisation.
Now
we
need
to
develop
this
and
refine
it,
but
we're
not
there
I'd
hate
to
give
the
impression
that
were
there.
But
some
do
you
answer
simple.
I
Answer
to
your
question:
yes,
we
do
need
our
X
extra
support
on
this
and
expertise
and
we
will
get
it
and
I
think
we
may
get
it
from
within
the
NHS
where
it
exists,
but
we
may
want
to
look
outside
the
NHS
and
we
are
developing
our
framework
for
doing
these
inspections.
There's
some
things
that
we
will
almost
certainly
do
so.
The
front
line
actually
looking
for
how
people
leave
their
computers
and
whether
the
reparse
words
on
post-it
notes
and
things
like
that
around
the
place.
I
But
there
is
a
lot
of
the
questions-
will
be
aimed
at
more
senior
people,
whoever
leads
on
IT
and
data
security
within
a
trust,
but
also
who
leads
at
board
level
and
and
whether
it's
ever
being
discussed
at
board
meetings,
so
that
we
will
take
a
similar
approach
to
the
ones
that
we
take
for.
Other
aspects
are
well
made,
but
we
will
clearly
need
expertise.
K
The
digital
side
to
me
is
always
the
outside
in
view
where
we're
really
looking
at
things
like
social
to
allow
people
to
feedback
to
us
outside
patients
or
relatives
and
friends
of
patients
an
easy
way
to
access
into
us,
the
other
outside
then,
although
involving
our
own
people,
would
be,
you
know
other
possibilities
to
improve
the
efficiency
of
our
our
inspectors.
You
know:
do
they
have
to
type
in
reports
multiple
times
or
other
technologies
out
there
that
allow
them
to
do
it.
I
think
you
know
be
worth
just
having
a
review
about
digital
strategy.
K
H
Picture
and
I
was
freaking
about
this
yesterday
and
I.
Think
we're
committed
to
bring
a
report
to
the
board
in
September
and
I
do
think.
That's
important
I
think
it
provides
some
structure
and
set
some
milestones
and
targets
to
go
out
and
I
think
it's
right
that
we
continue
to
do
this
work
about
prioritizing
and
then
ensuring
those
priorities
of
an
investment
under
delivery
plan
to
support
them,
and
some
of
those
will
get
the
outside-in
comments
because
they
are
about
how
people
can
make
comments
analysis.
But
we
also
then
talked
about.
H
Let's
have
a
workshop
or
a
seminar
where
we
can
explore
this
and
actually
raise
some
of
these
points.
I
spent
some
time
with
Helens
team
this
week
in
relation
to
the
behavioral
insights
team.
They've
done
some
work
where
they've
taken
our
intelligence
that
we
make
publicly
available
and
they've
actually
compared
that
with
prescribing
practices
and
actually
looked
at
correlation
between
prescribing
practices
and
operation
of
GPS
and
surprise
surprise
by
combining
debt.
H
In
that
way,
it
actually
does
affirm
some
of
the
things
that
we've
been
saying
into:
shooting
our
own
data
sources,
but
I
think
the
whole
purpose
of
Helen
coming
in
is
to
help
us
to
do
this.
Her
background,
where
she's
done
this
is
combining
different
data
sources
and
beginning
to
use
these
so
I
think
we're
actively
exploring
those
kind
of
issues.
I
don't
want
to
give
any
suggestion
that
it's
sorted
and
is
nailed,
but
our
ambition
is
I,
think
to
try
and
do
that.
H
Let
let's
spend
some
time.
It's
clearly
a
priority.
Our
future
depends
on
it
and
to
say
I.
Think
we've
made
a
really
good
start.
I
think
your
echo
in
that,
but
there
is
just
more
to
do.
I
think
the
risk
for
us.
If
I
may
say
this,
though
I
think
we've
struggled
in
the
past
years
by
trying
to
do
everything
where
everything's
been
important
and
nothing's
been
important
and
for
the
first
time
I
feel
we're
in
a
position
where
we
have
a
list
of
priorities.
H
That
goes
one
two
three
and
we're
starting
at
1
and
going
through
it
so
providing
that
prioritization
is
being
done
in
the
right
way
and
I
think
it's
been
very
inclusive,
and
a
number
of
you
have
contributed
to
this
I
just
like
to
hold
a
discipline
about
this,
because
actually
we
just
need
to
start
delivering
some
of
these
and
our
staff
need
to
see
them
being
delivered
and
I
think
people
out
there
need
to
be
delivered.
Now.
H
If
there's
a
result
of
the
work
in
September,
we
need
to
look
at
more
capability
in
capacity,
then
I
think
we
can
look
at
that
and
there's
a
finance
report
there,
two
Shores
we
haven't.
We
have
some
opportunities
to
do
something
about
this
without
being
naive
about
it.
So
I
think
the
September
debate
is
quite
an
important
one,
just
to
make
sure
and
your
contribution
to
that
juror
will
be
hugely
hugely
important.
H
Given
your
background,
in
it,
expertise,
I
think
we're
now
in
a
position
with
you
and
Pete
and
Helen
to
add
to
what
we've
got
begin.
I
don't
want
to
lay
this
on
individuals.
This
is
an
organizational
thing,
but
I
think
I
feel
we've
got
the
capability
now
to
begin
to
do
this.
What
we
need
to
make
sure
is
that
we've
got
the
capacity
in
place
to
do
this,
and
you
know
I
think
that's
the
question
for
September,
quite
frankly,
so
a
long-winded
answer,
but
a
hole
to
do
something
so.
A
I
think
David
what
what
we,
what
we
thought
was
that
we
would
have
discussion
with
the
board
in
September,
but
it
would
come
formally
to
the
board
in
October
just
for
that
for
the
minutes.
So
there's
a
process
but
I
think
as
David
was
saying,
it's
really
important.
We've
got
by
September,
Peter
and
Helen
would
have
been
on
board
for
some
while
it's
an
appropriate
times
just
take
stock
and
check
the
going
the
right
direction.
Good
Andrew.
F
Thank
you
and
if
I
could
make
an
apology
to
the
board
and
to
David,
which
is
that
I
should
have
sent
through
something
for
the
report
around
quality
matters
and
the
launch
of
it
last
week,
which
goodness
only
knows
how
I
managed
not
to
do
that.
But
I
didn't.
F
Quality
matters
was
launched
last
week
and
was
a
very
positive
inclusive.
Event.
Involving
people
are
using
services,
their
carers
and
families
at
the
heart
of
it,
and
making
clear
the
principles
that
were
all
adopting
and
the
action
points
that
were
committed
to
taking
forward
and,
as
as
colleagues
know,
it's
aligned
with
the
shared
view
of
quality
that
we
had
with
the
National
Quality
board
in
terms
of
their
shared
commitment
to
quality
and
is
kind
of
endorsement
signed
up
to
by
other
organizations
such
as
HealthWatch
England
and
local
government
and
social
care.
Ombudsman.
F
Who
are
both
working
on
a
very
specific
first
piece
of
action.
Around
complaints,
and
so
I
just
wanted
to
be
able
to
record
that,
and
also
to
record
thanks
to
everybody
in
the
strategy
and
engagement
teams,
as
well
as
adult
social
care
for
all
of
the
work
they
did
to
get
us
to.
Where
we
have
and
to
report
that
the
Department
of
Health,
with
the
support
of
the
minister,
has
now
agreed
to
take
on
the
Secretariat
to
ensure
that
this
work
is
taken
forward.
Because
that
was
the
question
that
you
asked
me
last
time
was.
A
I
thought
it
was
a
great
event.
The
actual
launch
was
really
well
done,
but
obviously
almost
more
important.
That
is
the
work
that
led
to
the
launch.
It
was
great.
It
was
nice
at
the
event
that
you
were
complimented
on
the
leadership
that
you
personally
had
give
them
to
get
into
this
point,
but
maybe
this
is
an
opportunity
for
us
public.
Please
also
thank
everybody
else.
H
A
lot
the
report,
so
it's
self-explanatory,
so
I
think
you've
got
some
updates
in
terms
of
basic
performance
which
I
think
the
general
direction
is
upwards,
I'm,
positive
and-
and
it's
not
always
easy.
So
everything
is
going
up
all
the
time,
but
there
is
progress
being
made.
You
can
see
the
figures
in
terms
of
where
we
are
in
terms
of
the
current
under
spend
and
what
that
is
forecast
in
towards
the
end
of
the
year.
Five
point:
1
million,
which
plays
to
this
point
about
capacity.
H
If
we
need
it
during
the
year,
we've
got
an
opportunity
to
do
something
in
terms
of
the
registration
data
after
the
addendum
that
I
gave
you
can
see,
there's
improvement,
taking
place
in
registration
and
safeguarding
after
the
changes
at
NCSA
I
think
you
can
now
begin
to
see
some
of
these
figures.
Moving
back
to
achieve
the
target
after
changes
have
taken
place
and
I'm
personally
encouraged
by
that
and
optimistic
that
this
will
be
back
to
where
it
was
before
the
review
took
place.
H
We
had
an
earlier
conversation
on
mental
health,
which
some
important
performance
data
in
here
paragraph
6,
3,
well,
two
important
points
here:
one
is
in
hospitals,
the
frequency
theory.
Inspection
of
those
trusts
which
were
rated
as
inadequate
prior
to
April
17,
is
that
they
will
be
re-inspected
by
March
18
in
relation
to
inspection
frequencies
for
PMS
and
adult
social
care.
The
frequencies
at
which
we
are
publishing
are
6
months,
12
months
two
years,
and
so
why
is
this
important?
Why
is
it
flagged
here?
H
Because
when
we
look
at
managing
and
monitoring
performance
over
this
next
12
months,
it's
what's
included
in
the
baseline
and
what
we're
counting
from
so
this
is
about.
What's
in
and
what's
out
and
so
effectively,
Ted
will
be
accounting
for
two
targets.
One
is
the
inadequate,
which
will
be
done
by
March
18,
which
is
just
to
make
this
transparent.
It's
a
slightly
longer
period,
then,
will
be
when
the
new
frequencies
are
applied
from
April,
17
and
Andrea,
and
Steve's
teams
are
doing
it
in
accordance
with
the
frequencies.
Just
just
perfectly
enjoying
this
out.
H
It's
just
to
make
that
transparent,
I
don't
want
to
gloss
over
it
and
people
say
well.
We
weren't
here
when
that
was
discussed.
Many
few
Marten,
so
I've
been
said
that
again
now
I'll
go
through.
You
can
see
the
general
trend
that
we
had
in
the
state
of
care
report
about
improvements
on
re-inspections
begins
to
continue.
H
Enforcement
activity
is
not
quite
at
the
numeric
levels
that
it
was,
but
that's
because
the
inspection
is
not
at
the
numeric
levels
that
it
was
generated.
Those
towards
the
end
of
the
report,
I'm
not
going
to
go
through
the
business
planning
milestones,
Peter
the
amber,
amber
Reds.
It's
there.
It's
set
out
if
people
want
to
ask
questions
on
that
and
the
same
with
internal
audit,
Paul
I,
don't
know
whether
you'd
agree
with
this,
but
you
go
through
this
in
some
detail
at
the
audit
in
corporate
governance
committee.
H
We
are
going
to
report
this
as
a
routine
and
it
gives
the
wider
board
the
opportunity
to
raise
this,
but
believe
me,
I've,
been
scrutinized
by
and
by
Paul
and
colleagues.
At
that
meeting
strategic
risk
register
again.
I
don't
intend
to
present
in
any
detail.
It's
very
itself
evidence
I
hope
what
the
risks
are.
A
good
and
accurate
reflection
of
where
we
are
and
then
the
last
paragraph
is
really
just
flag
in
you've
got
the
full
performance
data
for
the
first
quarter,
but
I
think
finance
colleagues
were
finishing
off
the
financial
account.
H
So
it's
not
quite
the
final
first
quarter
report
here.
The
next
quarter
report,
which
you'll
get
in
November
I'm
flagging
in
30
no
marks
flagging
in
paragraph
13.
The
developments
and
the
changes
will
all
get
in
presentation
of
this
I'm
not
going
to
present
the
slides.
My
personal
view
is:
these
are
much
improved.
I,
find
them
much
easier
to
catch
my
eye
over
them
and
understand.
What's
going
on
I
hope,
that's
the
case
for
everybody,
but
as
I
say,
paragraph
13
is
really
about
the
further
improvements
to
it.
H
So
in
summary,
Peter
I
think
first
quarter
of
this
year,
I
think
he's
showing
good
progress.
Things
that
we
needed
to
improve
on
I
think
is
showing
either
strongly
improvements
or
there's
some
greens
of
improvements,
and
that
which
we
still
needs
to
worry
through
services
which
have
been
had
concerns
for
more
than
four
quarters.
H
I
think
the
chief
inspectors
would
begin
into
these
and
there's
some
evidence
in
this
that
were
actually
beginning
to
bottom
that
and
understand
precisely
what
it
is
that
sits
behind
it
on
what
actions
taken
to
make
sure
we
know
where
every
single
one
of
those
is
and
what
we're
doing
with
it
so
and
we're
in
a
good
position
in
relation
to
the
money.
It's
a
bit
of
an
understatement.
But
that's
we.
L
K
And
then
Paul
I
think
previously
was
reported
that
the
rollout
of
the
new
center
technology
in
Newcastle
was
being
vetted
and
it
wasn't
quite
meeting
and
understandeth.
We
would
expect
this.
Is
that
now
the
level
of
maturity
that
we
could
mark
it
off,
as
there
is
no
review
required
on
that
and
we're
quite
happy
with.
E
I
suppose
the
first
thing,
I
just
want
to
say,
is
I
do
think.
The
report
here
is
improving
they're.
Both
the
commentary
on
it
on
these
slides
and
the
slides
and
slides
are
going
to
take
a
little
bit
of
time
to
get
familiar
with,
but
the
commentary
I
think
is
is
is
is
good,
so
congratulations,
I,
think
to
Kate
and
to
Markham
to
the
team
on
that.
I
said
this
really
is
a
big
improvement.
E
Can
I
just
pick
up
one
of
the
internal
audit
points,
because
I
think
it
might
be
worth
saying
a
little
bit
about
the
audit
actions
they're
open,
because
colleagues
may
not
be
able
to
interprets
the
fact
that
23%
are
open
and
they
overdo
correctly
I
want
to
take.
You
want
to
say
something
about
about
video
actions
there
and
what
the
significance
is
and
just
to
reassure
the
boardroom.
M
Audit
report
we
set
out
what
it
is
that
we're
going
to
do
set
out
a
time
scale
for
that
on
occasions,
it
can
take
longer
than
planned.
The
fact
that
they're
overdue
doesn't
mean
that
we're
not
doing
anything.
It
does
mean
that
we're
just
taking
a
little
bit
longer
than
we
expected,
but
then
we
revise
the
date
and
make
sure
that
we
that
we're
on
top
of
what
needs
to
be
then
going
forward
and
report
that
back.
M
A
Doby
can
I
just
pick
up
on
one
of
the
things
which
oh
you
refer
to,
which
is
the
risk-based
frequency
commitments,
and
it
really
is
good
because
there
is
an
improving
trend
here,
but
I
think
it's
also
worth
saying.
It's
really
important
that
we
we
get
as
close
to
100%
on
this
as
as
possible.
A
I've
talked
a
lot
to
Steve,
who
isn't
here
today
about
understanding
better
the
date
or
in
PMS
and
dwelling
on
that
now,
but
clearly,
there's
a
lot
of
work
has
been
done,
so
we're
clear,
clearer
where
there
is
action
that
we
can
take
and
should
be
taking
and
where
there
are
reasons
why
we
we
haven't
taken
it,
but
it.
But
it
is
something
I
think
I'd
like
to
come
back
to
in
the
autumn,
just
no
PMS
alone,
but
across
the
piece.
H
So
the
November
board
report,
which
is
the
next
core
tool,
make
sure
there's
a
full
paragraph.
On
that
was
working
hand,
we
should
be
a
of
that
bottom
and
I
absolutely
get
the
importance
of
this
and
I'm
fully
behind
the
work,
but
I
don't
think
it'll
ever
beyond
represent
that's
not
to
be
argumentative,
because
there'll
always
be
something
there,
but
it
needs
to
be
at
whatever
it
is
99.5%
to
whatever.
But
that's
where
we
need
to
get
I.
H
H
A
But,
but
in
in
in
referencing,
stever
I
realized
that
when
I
was
giving
the
apologies
for
people
who
weren't
here
I
didn't
mention
Steve
Martin.
So
can
we
just
go
back
and
he
definitely
gave
his
apologies
right
anything
else
on
on
the
performance
or
finance
that
anybody
wants
to
raise.
Gosh
Kate
you've
got
off
really
likely
brilliant.
So
shall
we
move
on
to
the
local
system
reviews
and
don't
get
an
and
Charles
I
know
if
they're
out
there,
then
we're
running
ahead
of
ourselves
a
little
they're,
not
working
on
something
else.
K
H
So
I'm,
not
on
top
of
my
game
at
all
this
morning
and
I,
should
have
also
drawn
out
in
public
report
that
yesterday
we
published
the
controlled
drugs
report.
This
is
a
requirement.
We've
got
to
publish
on
an
annual
basis,
a
report
on
our
oversight
of
controlled
drugs
and
the
team
that
oversees
this
go
about
in
a
very
diligent
way
and
as
a
result
of
their
work
over
the
past
12
months,
we've
published
that
report
yesterday.
So
there's
the
this
is
something
that
came
out
of
shipment
I.
H
Think
in
terms
of
how
are
these
been
prescribed?
How
is
it
being
monitored
and
we
have
an
oversight
function,
which
means
that
we
have
a
quite
an
extended
network
of
people
who
work
in
different
bits
of
the
health
service,
who
are
responsibilities
to
this
that
we
draw
together.
So
it's
available
on
our
website
for
those
that
are
interested.
H
It's
the
kind
of
thing
that's
interests
of
those
people,
but
working
prescribing
and
administering
this
medication
rather
than
for
the
general
public,
because
it's
an
I
found
it
a
quite
a
technical
read
in
in
relation
to
it,
but
I
think
it
does
provide
some
assurance
of
improvements
in
practice
in
relation
to
the
management's
of
these
medications.
So
apologies
for
missing
Anna
all.
A
N
You
very
much
thank
you
and
morning.
Everyone
I
think
you've
seen
us
you'll
recall
at
the
last
board
meeting
we
said
we
would
return
to
let
you
know
the
progress
that
we've
made
with
the
methodology
and
the
outcome
of
the
test
of
the
methodology,
a
half
of
the
country
council.
So
today
and
I'd
like
to
update
you
on
the
feedback
we
had
from
the
council,
tell
you
some
more
about
the
site,
selection
and
the
schedule
and
obviously
take
any
questions.
They
have
around
the
methodology
and
the
order
to
its
that.
Okay.
Thank
you.
N
In
addition
to
that,
they
made
some
really
good
observations
around
the
system
overview
document.
They
felt
that
our
original
branding
of
a
system,
information,
return
implied.
It
was
about
a
date
in
return
rather
than
positive
information.
So
we've
taken
on
board
their
advice
around
the
questions.
We've
modified
them
accordingly
and
we've
revised
and
rebranded
as
the
system
overview
information
retain
or
swallow.
As
it's
known
now,
so
we've
developed
some
stronger
sub
Khloe's
and
prompts
than
an
assessment
framework
for
the
support
of
the
reviewers.
N
So
we
can
make
sure
that
they
can
get
down
to
that
detail,
that
we
need
about
person-centered
care
at
the
fronts
that
we've
got
that
assurance
from
the
senior
leadership
right
to
frontline
services.
We've
included
the
I
statements
with
support
from
think
local
personal
colleagues
they
sent.
It
was
very,
very
important
that
we
use
them
around
any
user
based
surveys
and
incorporation
service
users
into
the
evidence.
Core
is
very
important,
so
we
were
clear.
N
The
schedule
for
the
remaining
11
is
attached
in
the
paper
and
happy
to
take
any
questions
on
that
and
we
have
determined.
So
we
can
keep
a
close
eye
on
how
the
methodology
is
development
developing
and
support
the
reviewers
that
myself
and/or
Alison
Holborn.
The
senior
responsible
officer
will
be
on
site
for
at
least
the
first
five
reviews
so
and
we,
the
twelve
sites
that
have
been
selected
if
I
could
just
refer
you
to
those
are
highlighted
in
the
paper
and
follow
in
our
first
site
visit.
A
A
Ultimately,
today
we
need
to
agree,
approve
the
the
methodology,
so
this
is
the
opportunity
to
ask
whatever
anybody
thinks
they
need
in
addition
of
what
we've
already
been
presented
with
before
we
can
make
that
that
decisions,
if
anything,
if
you're
lucky
and
then
we'll
just
say
they
agree
with
me,
I
hope
any
any
questions
or
comments
from
anybody.
Paul.
E
Yeah
very,
very
helpful
document.
Thank
you
very
much.
I
had
two
or
three
questions,
I'm
saying
in
Louis's.
E
The
first
one
was
really
around
the
resources
to
do
the
work
and
and
I
noticed
your
comment
that
we
got
40
names
I
think
it
was
in
relation
to
going
out
to
local
authority.
Okay
I
wasn't
quite
sure
how
many
we
needed
and
how
many
we
got
signed
up
and
what
the
gap
might
be
between
that.
There
was
one
point
and
then
I
think
I
had
two
points
on
the
resource
management
bit
of
the
work
which
I
wasn't
quite
sure.
E
How
that's
very
given
that
use
of
resources
is
such
a
difficult
topic
in
hospitals.
I
wondered
whether
the
use
of
resources
be
at
the
resource
management.
It
was
how
well
mapped
out
that
was
and
how
difficult
that
was
again.
We
do
and
added
to
that
I
looked
at
the
other
slides
and
what
we
were
asking
for
in
terms
of
information
through
the
P
IRS,
and
they
were
just
I
think
three
items
that
we
were
asking
for
in
relation
to
use
of
resource
funding.
E
N
And
thank
you
Paul.
In
terms
of
the
size
of
the
team
that
will
be
on
site.
It
will
be
a
core
team
of
two
reviewers
which
will
be
internal
to
CQC
and
to
local
government
specialists,
professional
biases
and
one
health
professional
advisor
now
in
terms
of
the
SP.
A
procurement
we've
had
a
very,
very
generous
offer
from
the
LGA
and
they've.
N
Given
us
a
list
of
forty
names
of
the
former
chief
execs,
current
chief
execs,
former
directors
about
all
social
services
or
current
directors
of
adult
social
services,
who
have
agreed
to
provide
that
expertise
as
part
of
the
review
team
in
terms
of
the
health
professionals
were
using
our
existing
bank
of
special
professional
advisors
that
we've
used
on
the
comprehensive
inspection.
In
addition
to
that,
we've
also
been
in
contact
with
the
former
comprehensive
inspection
chairs.
N
N
O
O
So,
hence,
we
haven't
asked
a
large
amount
of
questions
in
our
PIR,
so
we
didn't
want
to
duplicate
what
they
were
actually
asking
overburdened
people
about
the
questions
around
the
use
of
resources
and,
secondly,
about
the
actual
piece
about
use
of
resources
were
actually
looking
at.
We've
turned
in
the
methodology
we're
now
looking
at
resource
governance,
rather
than
that
should
the
use
of
resources.
We
look
and
see
how
they
have
systems
and
processes
in
place
to
get
sure
that
the
resources
are
used
being
used
are
being
used
effectively.
E
We
would
be
able
to
compare
across
local
authority
areas
on
the
resource
management,
or
are
we
kind
of
just
gonna,
throw
up
for
us
examples
of
how
it's
done
in
different
places
and
how
people
measure
resource
management
and
governance?
Resource
Management
look
at
governance,
or
is
it
going
to
look
at?
Actually,
the
level
of
resource
management
and
they'll
be.
E
H
Is
this
is
a
tricky
issue
in
relation
to
this,
so
when
this
was
set
up,
the
means
by
which
local
systems
will
get
this
money
is
a
better
care
fund
and
that's
the
distribution
mechanism
and
in
the
cross
governments
agreement
about
how
the
Chancellor's
money
should
be
taken
forward
is
actually
allocated
as
part
of
the
spring
budget
was
taken
forward.
The
distribution
mechanism,
better
careful
and
we've
been
asked
to
look
at
the
interface
between
the
health
and
care
systems,
the
tracking
of
the
money.
H
H
If
I've
got
my
numbers
right
officer
in
law,
authorities
I,
either
Director
of
Finance.
If
there's
a
new
statute
or
responsible,
it's
supposed
to
sign
a
letter
saying
you,
we
got
this
money.
This
is
what
we've
done
with
it,
and
this
is
what
we're
getting
from
it.
So
I
would
expect
what
we're
looking
at
in
terms
of
what
are
your
arrangements
to
support
people
who
are
coming
out
of
hospital
to
cross-reference
to
some
degree,
to
the
account
that
the
section
one
five
one
office
is
going
to
make
back
to
CLG
in
relation
to
that
now.
H
The
issue
here
is
timing
of
we
will
go
on-site
in
Houlton
in
21st
of
August.
Will
they
have
evidence
of
the
money
that
they
I?
Don't
think
of
yet
got
the
guidance
didn't
go
out
until
last
week,
how
that
is
working
its
way
through
and
what
they're
doing
with
that
and
you'll,
not
from
the
press?
A
number
of
local
authorities
are
saying:
we
can't
make
long-term
plans,
because
this
isn't
long-term
money.
It's
given
for
three
years
are:
can
we
do
so
I
think
we
go
in?
H
Think
if
we
see
an
asymmetry
between
the
finance
plans
and
the
delivery
plans
that
excess
tracks
are
true,
we've
got
the
opportunity
to
raise
that
one
of
the
reasons
why
we
want
people
from
local
governments
and
Anne's
points
about
people
from
the
finance
background
is
the
people
to
understand
that,
so
the
issue
about
seniority
is
important,
so
people
can
actually
look
at
how
those
strategic
decisions
that
are
made
at
a
local
level,
not
just
by
local
authorities,
actually
come
together
with
the
money.
But
your
point,
we
are
not.
H
We
are
not
tracking
the
money,
which
is
why
money
is
referenced
in
the
way
that
it
is
in
those
provider.
Information
returns
and
that's
the
explanation
and
that's
you
know
we
could
wish
it
was
different,
so
we
could
do
it
a
different
way,
but
that
is
what
we've
been
asked
to
do
quite
carefully
has
to
do,
which
is
one
of
the
reasons
why
this
letter
has
taken
a
long
time
to
come
through
is
because
there's
been
a
lot
of
discussion
about
what
it
is
that
we're
being
asked
to
do.
E
Will
this
will
this
work?
Look
at
the
levels
of
support
that
are
available
financially
in
in
these
places
from
the
local
authorities,
and
will
it
be
drawing
out
whether
some
of
those
levels
of
support
seem
to
be
very
low
in
comparison
to
other
levels?
Well,
if
they,
if
that
happens,
to
be
one
of
the
problems
that
is
identified.
H
So
this
goes
right
to
the
heart
of
this
issue
about
it.
We
are
not
asked
to
comment
on
the
quantum
of
money
that
is
available
to
look
areas
to
make
the
needs
of
their
populations.
What
this
is
about
is
what
they
do
with
the
money
that
they've
got
and
remember.
Our
state
of
Terry
pointlessly
was
all
about
variation.
H
So
what
we've
got
is
some
people
with
similar
amounts
of
resource
that
are
performing
to
a
pretty
high
level
in
other
areas
of
performing
to
a
low
level,
going
back
to
the
selection
of
these
twelve
sites,
who
were
selected
on
a
dashboard
of
information
because
they
were
seen
not
to
be
performing
to
a
higher
level.
So
the
correlation
with
high
levels
of
delayed
transfers
occur
on
this
list.
H
Is
there
we
asked-
and
we
are
told
that's
when
the
next
list
is
released-
the
further
age
later
in
the
year,
which
I
think
partly
speaks
to
your
points
about
just
getting
all
of
this
stuff
out
now,
what
cetera,
I
think
there
was
a
judgment
to
do
this
in
in
tranches,
not
ours.
This
is
government
making
these
judgments.
H
Well,
we've
got
the
variation.
We
need
to
check
that,
but
we
wanted
to
look
at
some
good
places
as
well
as
places
are
known
to
be
struggling,
because
we
think-
and
we
continue
to
think
this-
that
it's
important
we
can
describe
what
good
looks
like
and
what
people
are
doing.
That
is
successful,
as
well
as
identifying
what
isn't
working
well
so
I
think
well
I'm,
saying
Paul
is
we've
been
given
a
specific
job
to
do
with
in
an
envelope,
and
what
you've
got
here
is
doing
that
job
within
that
envelope.
F
And
what
are
the
arrangements
that
are
around
that
that
enable
them
to
move
through
that
system
in
a
way
that
is
appropriate
for
them,
and
so
I
think
that
what
the
team
have
done
really
well
actually
and
I.
Do
commend
both
Anand
Charles,
for
you
know,
frankly,
a
very
impressive
piece
of
work
to
get
to
this
stage
of
the
methodology
when
we
actually
only
officially
got
the
proper
letter
two
weeks
ago,
and
we
were
really
only
asked
to
do
it
two
or
three
months
ago.
F
So
I
think
we
will
also
need
to
reflect
on
the
first
two
or
three
that
we
do
to
think
about
how
we
develop
the
methodology
to
make
sure
that
if
there
are
kind
of
new
issues
in
how
we
do
this,
we
can
improve.
As
we
go
forward,
but
what
I
think
this
slide
shows
for
you
is
what
the
focus
is
going
to
be
and
it
will
draw
out
you
know.
So,
if
we're
talking
about
how
do
we
maintain
the
well-being
of
a
person
in
their
usual
place
of
residence?
F
What
are
the
packages
of
support
around
that?
What's,
enabling
that
to
happen?
How
well
our
health
and
social
care
working
together
to
ensure
that
people
are
supported
and
to
maintain
their
well-being,
and
that
will
have
some
reference
to
what
are
the
what's
the
support?
That's
provided
from
adult
social
care,
as
well
as
what's
available
from
the
primary
medical
system,
medicine
and
also
from
community
health
services,
but
the
kind
of
crisis
management
side
of
it
in
terms
of
as
people
go
through
the
hospital.
F
Actually
thinking
through?
Whether
that's
the
right
thing
for
that
individual
or
not
so,
I
think
that
we're
we're
much
more
focusing
on
how
people
kind
of
get
through
the
system.
There
will
be
issues
that
this
will
throw
out
about
the
appropriateness,
I.
Think
of
the
wraparound
support
that
the
system
is
giving
individuals
to
enable
them
to
move
through
the
system
in
an
appropriate
way.
F
D
One
point
be
an
answer
but
kind
of
ask
Charles,
and,
and
will
there
be
space
summer
in
this
process
and
I'm?
Looking
at
your
qualitative
data
analysis
slide
here,
will
it
be
space
for
people
to
say
what
a
great
service
would
look
like
under
summer
system,
you're
we're
going
to
hear
from
poor
performers
and
hope
different,
better
performers,
but
will
it
be
space
for
people
to
say
what
a
great
service
would
look
like?
The
great
flow
would
look
like
in.
P
O
E
Real
James
pointed
him
there's
one
part
of
this,
which
is
about
the
actual
experience.
People
have
what
the
experience
they
would
expect
to
have
in
a
system,
but
we
sit
here
in
the
system
that
sits
here
around
carefully
talking
about
pathways
systems
and
bits
and
pieces.
There
was
a
time
when
members
of
the
public
had
a
relatively
clear
understanding
about
who
provided
their
service
when
and
how
and
who
they
should
go
to
if
they
wanted
information
or
help
or
whatever
the
more
we
get
into
this
I
suspect
less.
O
E
That
there
is
also
a
need
for
not
people
in
the
system,
talk
to
themselves,
to
understand
routes
and
so
on.
It
is
an
overall
confusion
about
the
overall
system,
which,
of
course,
it's
very
difficult
to
communicate
to
people
when
no
one
in
the
system
quite
knows
what
it's
going
to
be,
but
it
isn't
a
central
part.
Is
it
not
for
the
process.
F
F
In
the
contrary,
lines
of
inquiry
that
the
team
will
pursue
when
they
are
talking
both
in
the
site
visits,
but
also
I'm,
asking
people
who
are
in
the
local
area,
as
well
as
those
who
are
working
in
health
and
social
care,
to
help
us
determine
what's
actually
happening
and
and
I
think
the
fact
that
we
were
drawing
out
that
that
we
we
we
can
see
I
mean
HealthWatch
talks
about
this
all
the
time
lots
of
people?
Do
it's
nothing
new
that
new
folk
don't
understand
how
to
navigate
the
system.
They
don't
necessarily
have
the
support.
F
How
does
that
impact
on
the
way
that
people
do
flow
in?
Are
they
ending
up
in
A&E,
because
actually
they
have
no
idea
where
else
to
go
and
and
if
they
did
have
a
better
idea
of
where
else
to
go.
They
might
not
end
up
in
A&E
that
so
that's
just
a
very
simple
explanation
of
it.
But
it's
those
sorts
of
issues
that
we
would
expect
to
be
able
to
tease
out.
By
focusing
on
these
points
in
the
yeah.
E
N
Q
When
up
until
now,
when
we've
gone
to
look
at
an
organization,
GPS
adult
social
care
or
hospital
and
we've
been
able
to
have
a
pretty
good
idea,
those
organizations
do
have
systems
of
governance
which
have
some
relationship
with
what
goes
on
sometimes
very
good
relationships,
sometimes
not
so
very
good
relationship,
but
they
have
some
other
issues
gone,
and
it
seems
fair
enough
to
ask
that
question
of
them
here.
The
systems
are
really
weak.
Q
However,
there
will
be
things
inside
that
location
that
are
working,
but
that
may
not
be
generated
by
the
system,
so
there
might
be
a
GP
working
really
well
with
the
rest
of
the
firm
that
worked
really
well
with
the
discharge
person
in
a
in
a
hospital
and
you've
got
a
bit
of
really
good
practice
and
I.
Think
the
the
complexity
for
this
particular
piece
of
work
is
being
able
to
find
in
a
system
that
may
not
be
working
very
well.
Q
It's
a
really
good
practice
and
to
be
able
to
say
you
know
if
the
system
could
learn
from
that,
but
but
in
almost
certainly
the
organizations
within
these
systems
will
be
not
assisting
the
system
as
a
whole,
the
integrated
system
to
really
work
in
a
salon
tickety-boo
way,
and
so
we're
asking
questions
of
a
system
which
is
which
are
really
tough
questions
for
a
system.
That's
very
young,
not
very
capable,
but
underneath
that
I'd
be
staggered.
If
there
wasn't
some
really
good
bits
of
practice
which
the
system
could
then
universalize
a
bit
more.
Q
So
all
the
work
I've
done
in
locations
around
the
country
on
integration
generally
everywhere,
there's
a
there's
one
or
two
or
ten
or
thirty
good
little
bits,
but
I
wouldn't
say
they've
been
generated
by
a
system
they've
been
generated
by
some
human
endeavor
to
overcome
these
things.
Now
that's
the
thing
we're
looking
at
and
the
thing
we're
looking
at.
Q
If
we're
going
to
come
up
with
something
useful
at
the
end
of
it
is
how
does
the
system
look
inside
itself
find
the
things
that
are
good
and
then
replicate
it,
but
I
think
I
think
in
terms
of
everything
else,
we've
looked
at.
We've
got
to
get
used
to
the
fact
that
these
are
weak
institutions
as
integration
institutions,
as
against
all
the
other
institutions.
We've
looked
at.
F
Just
to
respond
to
that
pool
because
I
think
you're
absolutely
right
and
one
of
the
things
that
we've
been
working
on
and
is
included
as
a
appendix
four
is
the
relational
working
feedback
so
that
we
can.
We
can
actually
really
have
a
set
of
conversations
that
get
us
to
the
heart
of
how
people
are
working
together.
How
do
they
identify
that
good
practice?
And
how
do
they
share
that
or
you?
F
F
N
And
we
think
that
the
relationship,
audit
tool
and
the
way
we've
done
around
system
leadership
will
do
a
number
of
things
for
us
really.
It
will
introduce
what
we
think
is
a
common
framework
to
start
to
look,
how
relational
value
works
in
a
system
and
the
impact
that
has
on
the
quality
and
safety
of
the
delivery
and
I.
Think
your
point
about
weakness.
K
Ted
yeah-
this
is
more
of
a
general
question,
so
I
think
the
work
we're
doing
here
seems
quite
advanced
in
terms
of
the
methodology
that
you're
developing
and
candidate
that
you're
going
to
collect
and
the
way
going
to
collect
that
later.
I
was
just
wondering
if
any
of
the
lessons
learnt
here
could
be
fed
into
the
earlier
talk
around
the
single
shared
view
of
quality.
So
we
could
just
join
the
dots,
so
they
seem
there
seem
to
be
some
overlap,
obviously
not
direct,
and
this
is
very
specific
work.
K
O
We
could
take
the
single
share
view,
equality
into
account,
one
we've
developed
methodology,
so
the
key
questions
throughout
the
methodology
around
it.
The
same
five
questions,
we'd
use
through
single
shared
view,
equality,
and
we
also
took
into
character
that's
now
in
the
National
Quality
board
strategy
for
quality
and
also
is
reflected
in
quality
matters
which
we
published
last
week.
O
So
we've
taken
that
into
account,
and
obviously
this
time
we're
going
to
be
speaking
to
commissioners,
which
we
don't
normally
have
that
interface
with
commissioners,
and
we
we've
felt
that
we
should
keep
those
five
questions
in,
because
anybody
who's
commissioning
contracting
services
across
health
and
social
care
should
be
aware
of
those
questions,
and
so
it's
been
taken
into
account.
We
also
will
be
asking
when
we're
on
site
how
the
local
area
does
actually
think
about
those
those
five
areas.
I.
K
Was
thinking
the
question
which
is
around
the
process,
but
maybe
the
data
as
well,
because
you're
going
to
collect
some
rich
day
yeah
and
that
they
may
you
know
put
into
their
you
know
whatever
tools
and
systems
are
going
to
build.
So
there's
two
aspects:
one
is
the
process
that
you've
talked
about,
and
the
second
aspect
is
the
data
collection.
And
if
we
collect
that
data
moving
and
food
into
the.
G
So
I
just
commend
the
work
you
put
into
this
I
think
it's
really
very
exciting,
very
important
bit
of
work,
we're
talking
a
lot
about
systems,
and
this
is
about
systems
that
the
power
of
what
comes
after.
These
reports
is
going
to
be
very
flexing.
Experience
of
individual
service
users
and
the
Khloe's
are
pretty
well
balanced
between
the
system
and
the
individual
service
users,
but
I
suppose.
G
My
plea
is
just
that
the
we
gather
enough
information
about
individual
service
users
to
give
a
conclusions
about
the
system
power,
because
it's
so
easy
to
produce
conclusions
about
a
system
that
people
just
see
us.
If
you,
like
a
kind
of
you
know,
we've
got
to
just
do
the
process
better,
but
actually
this
is
about
some
some
individual
service
users
who
may
be
getting
very
poor
services,
and
that
needs
to
be
reiterated
in
this
report.
A
A
Excuse
for
not
getting
on
with
us
is
just
gone,
but
but
I
just
echo
what
others
have
said
as
well
to
both
of
you
I
think
in
the
short
time
you've
had
to
prepare
this
you've
made
fantastic
progress,
and
thank
you
very
much
indeed,
and
so
good.
Is
it
I'm
gonna
award
all
of
us
a
five
minutes
stretch
break
to
celebrate
your
success,
so
I
just
start
again.
If
we
can
please
literally
in
five
minutes
time.
Thank
you
very
much.
Thank
you.
Thank
you.
Both.
A
A
A
Okay,
let's,
let's,
let's
get
going
again
if
we
can
so
Jane
unaccompanied
by
your
chief
executive,
at
least
for
the
moment,
can
you
just
a
quick
update
on
HealthWatch,
please
of.
D
Course,
chairman
and
I
think
I'm
to
be
very
quick
points,
but
in
general
terms,
I
commend
this
report
to
you,
I
think
it's
wonderfully
straightforward
and
and
I
feel
quite
proud
of
the
of
the
work
that
the
team
are
doing
here
and
across
the
country.
D
Three
very
quick
points
to
perhaps
to
highlight
one
of
the
things
for
HealthWatch
is
getting
our
name
known
and
the
campaign
it
starts
with
you,
so
you
see
from
a
hashtag
it's
to
do
with
tweeting
and
it
does
take
us
back
to
the
basics
of
where
women
to
be
at
so
it
it
starts
with.
You
is
the
individual
that
the
person
that
people
need
to
we
need
to
help
them
to
tell
us
their
experiences,
and
this
one
has
really
managed
to
trend
I.
D
And
there's
even
talk
now
getting
us
onto
them,
maybe
onto
the
one
show
so
so
I
mean
I.
Think
this
is
not
the
appropriate
soar
knows
that
HealthWatch.
You
know
we
should
be
generating
nationally.
We
are
getting
the
getting
the
brand
known
and
that's
what
local
HealthWatch
look
to
us
for,
so
we
even
had
a
something
called
a
thunderclap
which
enabled
us
to
I.
Think
everybody
presses
a
tweet
button
at
the
same
time
and
we
reached
1
million
people
or
at
one
go
I
have
no
idea
what
that
means,
but
apparently
is
a
good
thing.
D
So
then
that's
our
comms
team
and
and
it's
you
is
something
they
have
developed
here,
which
is
something
that
local
HealthWatch
can
really
build
on,
and
it's
fantastic
point
to
I
have
spent
last
few
weeks
visiting
a
lot
of
local
HealthWatch
and
to
report
back
to
you.
They
all
seem
to
be
doing
good
stuff.
I
would
say
it
obviously,
but
but
not
just
collecting
evidence.
They
also
wish
I
really
impressed
with
everyone.
Pokken
tells
me
how
they
are
seen
as
being
a
safe
space
in
their
local
community.
D
For
some,
these
really
difficult
conversations
that
campaign
that
needed
to
be
had
so
there
are
trusted
and
they're
a
safe
space
and
they're
a
big
player,
there's
very
David
and
Goliath,
but
they
you
know
they
are
in
the
right
tables
and
enabling
those
conversations
to
take
place
which
again
I
think
it's
useful.
I
know
the
NHS
England
likes
it
and
we
are
going
to
do
more.
Of
that
third
point:
we've
just
had
our
national
conference,
which
was
good
up
in
Nottingham.
D
D
For
me,
the
interesting
things
for
the
conference
we're
now
working
on
a
new
strategy,
and
it's
all
about
how
do
we
nationally
land
the
evidence
that
local
HealthWatch
and
people
are
giving
us?
How
do
we
land
it
with
with
a
more
impact
local
HealthWatch?
Our
David
has
said
you
were
only
four
years,
older
and
infants
in
some
ways,
but
some
of
them
have
grown
up
very
fast
and
there's
some
really
strong
players
out
there
and
it's.
How
do
we
keep
up
with
them
and
provide
them
with
the
services
that
they
want?
D
And
final
point
is
really:
what
is
a
lot
of
people
quickly
get
into
governance,
but
they
talk
about
what
is
the
contract
between
HealthWatch
and
local
HealthWatch
and
other
partner
organisations?
What
is
it
your
member
on
an
understanding,
but
it's
you
know
how
exactly
do
we
relate
to
each
other
and
and
really
really
build
on?
D
F
Just
just
I
want
to
Joan
and
sorry
if
this
is
put
you
on
spot,
but
the
the
specific
piece
of
work
that
HealthWatch
England
is
engaged
with,
with
the
local
government
and
Social
Care
Ombudsman,
which
is
action
number
one
on
the
quality
matters
action
plan
about
creating
something
that
all
of
us
who
people
who
are
using
services,
their
carers
and
families
can
go
to
so
that
on
every
website.
My
view
or
dream
would
be
that
on
every
website.
It's
the
same
piece
of
a4
paper.
F
D
Don't
know
exactly
the
answer
to
that,
so
I
do
need
a
chief
executive
after
all,
but
I
do
know
that
everyone
came
away
from
the
work
and
the
launch
with
a
great
deal
of
excitement
and
commitment
to
action.
So
I
know
I'm
sure
I've
have
heard
from
Imelda
what
is
going
on
about
it
and
and
and
I
think
I'll
find
out
for
you
what
the
timing
is,
but
it's
definitely
in
hand
because
it
was
a
too
good
piece
of
work
to
let
go
that's
great.
Thank
you.
A
Okay,
so
seriously
I
think
just
commend
you
and
your
team
progress
has
been
made.
I
think
it's!
It's
really
encouraging.
Thank
you.
So
do
we
want
then,
just
to
note
that
and
then
move
on
to
the
market
oversight
to
survey
is
Ted
you're
doing
a
really
great
job
as
dawn.
Thank
you
very.
F
A
F
Just
to
say
that
welcome
Stuart,
who
is
our
director
of
market
oversight
to
the
board
to
get
this
is
the
first
time
we
brought
an
update
to
the
public
board
meeting
of
our
work
on
market
oversight,
which
of
course,
you
and
David
are
very
familiar
with
because
of
our
quarterly
meetings.
But
we
felt
it
would
be
helpful
to
share
that
with
the
board
and
to
do
that
in
public
session.
So
Stuart
will
introduce
the
item
briefly,
and
both
of
us
are
very
happy
to
take
questions.
Great
good.
R
Good
afternoon,
everyone
so
purpose
of
this
paper,
sensually
twofold
as
Andrea,
says,
to
provide
assurance
to
the
board
that
CQC
continues
to
fully
discharge
its
macht
oversight
responsibilities
and,
secondly,
to
provide
some
insight
into
feedback
that
the
unit
has
recently
received
further
to
a
provider
survey
specifically
of
the
market
oversight
providers.
Two
areas
that
I
am
sort
of
would
highlight
in
the
paper.
R
The
board
may
be
aware
today
that
the
living
and
sleep
in
matter
that
raised
in
the
papers,
obviously
and
sort
of
hits
the
press
today.
I
would
just
emphasize
that
we
continue
to
work
with
D
H
on
a
sort
of
no
names
basis
to
sort
of
illuminate
their
thinking
around
the
sector.
And
the
second
point
was
with
regards
to
the
feedback
and
well
Stu.
The
survey
results
and
cells
are
seen
as
quite
positive.
A
E
Peter
I
there
what
what
Peter
says
I
think
you're
doing
a
really
good
job.
You
know
that
that
comes
through
in
the
reports
you've
been
giving
us
over
the
year
and
I
think
in
this
sort
of
sum
up.
I
just
don't
go
to
the
one
of
the
points
in
the
key
areas
for
consideration
or
reflection,
as
you
put
it
coming
out
of
the
survey,
though
the
last
one
ammos
a
bit
m3m
owes
ability
to
identify
potential
market
failure.
R
Essentially,
that
is
going
to
come
down
to
one
of
the
exam
question
that
we're
being
asked
to
answer,
whether
that
is
fifth
purpose
and
relevant
for
the
way
that
today's
market
is
operating,
so
we
by
April
2018
the
unit
will
have
been
up
and
running
for
three
years.
It's
our
intention
in
the
sort
of
six
months
running
up
to
that
to
review
the
existing
guidance,
reflect
on
the
sort
of
regulation
and
really
work
through
what
would
be
the
optimal
framework
to
be
operating
in
and
then
reflect
on.
What
does
that
mean?
R
E
R
F
So
Peter
just
to
add
into
that
what
we've
also
had
a
broader
set
of
engagement
with
the
competition
and
Markets
Authority
from
a
policy
perspective
and
David
James,
our
head
of
adult
social
care
policy,
sits
on
their
reference
group
and
I've
met
with
them
as
well,
because
a
number
of
the
issues
that
they're
raising
our
issues
that
come
up
in
different
ways
with
us
through
our
quality
inspections,
as
well
as
the
the
work
that
Stuart
and
the
team
are
doing.
Former
market
oversight
perspective.
A
A
A
S
What
we
have
before
us
is
the
proposed
health
and
safety
strategy
for
CQC.
This
went
to
the
executive
team
a
few
weeks
ago.
It's
a
high-level
strategy,
so
it's
sort
of
the
next
step.
If
you
think
the
health
and
safety
policy
sets
out
what
our
legal
requirements
are.
This
strategy
sets
out
at
a
high
level
how
we're
going
to
meet
those
legal
requirements
to
ensure
the
health,
safety
and
well-being
of
our
staff.
S
It's
part
of
one
of
the
audit
recommendations,
so
it's
a
pretty
much
just
for
the
foundation
for
how
we
manage
health
and
safety
within
CQC
sitting
behind
it
is
a
fairly
detailed
action
plan.
So
it
is
quite
broad.
It
is
quite
high
level,
but
the
action
plan
that
sits
alongside
it
sets
out
all
of
the
actions
that
we've
got
to
meet
over
all
of
our
requirements.
A
key
part
of
it
and
I
think
an
area
that
we
wanted
to
improve,
particularly
is
about
key
performance
indicators.
A
S
That's
a
whole
topic
in
itself,
but
so
we're
looking
at
replacing
our
current
health
and
safety
database,
which
is
a
very
grandiose
term
for
something.
That's
not
that
grand,
but
we've
got
work
in
place
and
near
misses
any
organization
you
go
to
where
you
see
a
good
health
and
safety
culture.
You
see
a
high
incidence
of
reporting
of
near
misses
and
we
have
virtually
non
so
I
think
that's
indicative
in
itself,
so
part
of
it's
about-
and
it's
mentioned
in
here
about
rate
of
having
a
good
health
and
safety
culture.
E
It
simply
leaden,
implicit
and
sort
of-
probably
here,
but
because
we've
the
ball
oversee
just
this
process
and
the
strategy,
but
within
within
this
wasn't.
Our
V
is
the
intention
strategic
intention
with
regard
to
the
boards
and
ongoing
involvement
in
the
implementation
of
the
strategy
and
the
need
to
review
it
from
time
to
time
or
matters
of
that
nature.
I
simply
ask
that,
because
the
diagrams
and
so
on
have
all
the
areas
going
from
the
board
downwards,
which
I
can
fully
understand
that.
E
But
there
are
many
areas
coming
back
out
and
well
that's
reassuring
the
sense
it's
less
for
us
to
do
it
I'm
not
sure
whether
that
entirely
universally
reflects
our
responsibility
of
what
we
should
do
about
it,
but
that's
not
to
say
we
having
all
that
responsibility
wind
exercising
in
here
today,
but
it's
intuitively
terms.
How
do
we
take
that?
How
do
we
as
a
board
take
that
forward
in
terms
of
assurance.
S
E
This
will
come
back
to
a
CGC
through
the
audit
process,
but
I
think
there's
a
question
about
what
this
board
should
have
on
its
agenda
regularly.
You
know,
I,
don't
think
we're
the
kind
of
high-risk
operation
that
you
know
in
other
places
where
health
and
safety
is
number
one
on
the
agenda
each
each
month
for
each
of
us
wherever
the
board
needs,
but
nevertheless
I
do
you
think
in
order
to
generate
the
right
culture,
we
need
to
make
sure
that
we're
doing
the
right
things
here
to
be
seen
doing
the
right
things.
E
So
there's
something
to
me
about
within
the
quarterly
reporting
there
should
be
a
bit
on
health
and
safety,
and
that
may
be
around
some
some
key
metrics
that
kpi's
or
it
may
be
something
else
in
there.
I
don't
know,
but
it
should
be
something
which
comes
here
on
a
regular
basis.
That
was
that
was
first
point.
The
second
point
I
wanted
to
ask
is
max.
If
you
know
what
would
be
the
health
and
safety
risk,
that
would
be
the
one
which
we
you
most
fear
coming
to
pass.
S
Looking
at
the
what
we
do
as
an
organization,
we've
just
done
a
organizational
risk,
profiling
exercise.
So
it's
what
we
talked
about
last
time,
I
supposedly
she's.
Probably
a
tax
on
staff
is
probably
the
one
that's
most
difficult
to
sort
of
prevent,
but
also
might
have
the
more
serious
consequence
we
do.
Obviously,
quite
a
number
of
our
accidents
are
related
to
motor
vehicle
accidents.
So
that's
a
another
area
we
spent.
S
You
know
our
staff
travel
a
lot
for
work,
so
those
are
probably
the
sort
of
ones
that
might
result
in
this
in
the
more
significant
harm
if
you
like-
and
so
those
are
the
ones
as
well
as
I.
Suppose
you
know,
because
of
the
nature
of
the
the
places
our
inspectors
go
in.
There
is
some
sort
of
you
know
potential
depending
up
you
know
the
prevailing
were
dependent
on
the
prevailing
safety
culture
of
other
people's
organizations,
not
our
own.
So
it's
it's
harder
to
manage,
so
you
know
making
sure
our
staff
understand.
S
You
know
how
to
look
after
themselves,
which
you
know
they're
very
good
at
made.
You
know
they're
experienced
professionals,
but
it's
that
it's
you
know
most
Health
and
Safety
practice
says
that
you
should
control
the
workplace
and
that's
how
you
control
the
safety
of
your
staff,
but
we're
effectively
working
in
other
people's
workplaces
most
of
the
time
and
that's
where
it
that's
where
the
challenge
lies.
E
Know
by
the
question
some
boards
in
the
outside
world
sometimes
described
as
the
real
world
have.
There
are
specific
things
that
the
ball
members
are
encouraged
to
do
in
order
to
role
model
safety
and
I.
Wonder
whether
we
could
possibly
ask
for
a
few
suggestions
about
what
we
could
do
and
there
we
go.
S
S
But
I
would
accept
you
know
we're
not
a
sort
of
high
risk
high
incidence
operation,
but
it
still
it
does
show
a
sort
of
leadership
of
Health
and
Safety
and
I
think,
maybe
just
so
when
people
become
aware
of
things
it's
you
know
it's
follow-up
in
on
an
individual
basis
and
asking
and
people
notices
things
like
that,
as
well
as
just
sort
of
responsibility
on
us
all
really
to
be
vigilant
and
and
if
we
see
something
we
think
not
right
to
challenge
and
intervene
and
put
it
right.
So
you
know
it's.
S
Other
organizations
have
worked
for
this.
The
phrase
was
always
never
walk
past,
something
you
know
you
sort
of.
If
you
see
something,
stop
and
deal
with
it
and
I,
you
know
it's
true
of
a
number
of
things,
not
just
health
and
safety
related,
but
that's
sort
of
just
models,
good
behavior
that
you
want
everyone
to
do.
Oh,
it
seems
to
me
wrong.
A
With
that
taking
Max's
point
that
one
of
the
big
risks
is
what
happens
when
our
people
are
in
other
people's
premises
as
a
board,
we
are
pretty
good
at
shadowing
inspections
and
understanding
the
risks
that
people
are
taking
in
all
kinds
of
different
environments.
Getting
back
to
your
your
point-
and
that's
probably
a
very
important
thing
to
continue
for
lots
of
other
reasons
is
well
obviously,
but
particularly
for
them.
The
safety
reason
anything
else.
Anybody
wants
to
add
useful
debate.
Thank
you.
Thank
you
for
the
offer
of
that.
A
A
U
Thank
you,
Peter,
and
this
strategy
marks
the
culmination
of
12
months
of
work
working
with
people,
youth
services,
organizations
that
represent
people
in
our
youth
services
and
our
our
staff,
and
it
sets
out
an
ambition
and
a
work
program
for
the
way
in
which
we
want
to
engage
the
public
in
our
work
working
alongside
colleagues
from
other
areas,
particularly
HealthWatch,
and
also
sits
alongside
the
restructure
of
the
public
engagement
team.
That's
been
underway
for
all
our
statements.
I'll,
let
Holly
one
of
the
the
architects
of
the
new
plan
talk
through
some
of
the
key
points.
V
And
say:
I
guess,
four
of
the
drivers
for
this
public
engagement
strategy,
with
some
known
main
challenges
that
we
were
consistently
hearing
say
one
this
being
that
we
can't
do
all
of
this
ourselves,
and
also
it
might
not
be
right
for
us
to
do
so,
and
we
should
leverage
get
dis
variance
and
what
others
do
well.
So
our
first
objective
talks
to
that
and
says
that
we're
going
to
work
much
more
impart
nur
ship
with
organizations
that
represent
people
who
use
services
and
to
basically
strengthen
our
collective
voices
and
help
influence
improvements
to
care.
V
The
second
main
challenge
is
that
people
in
organizations
do
not
always
know
what's
happening
as
a
result
of
the
information
they
share
with
us.
So
we
want
to
continuously
encourage
and
enable
people
to
share
experiences
of
care
with
us
and
to
be
able
to
I
suppose
use
that
information
in
a
better
way
and
here
to
respond
and
tell
people
how
we've
used
that
and
how
that's
led
to
improvement,
and
a
third
area
has
been
that
people
struggle
to
find
information
on
our
site
that
helps
them
to
make
choices.
V
So
we
want
to
provide
and
promote
public
information
that,
on
a
24/7
basis,
helps
people
to
do
exactly
that.
And
fourthly,
we
know
that
we
need
to
improve
the
way
we
pay
back
to
the
organization,
what
people
think
of
us
to
drive
organizational
change
and
decisions,
and
we
want
to
do
that
through
improving
the
way
we
do
public
participation
and
use
the
insight
that
we
gather
in
terms
of
things
we're
going
to
do
differently.
V
I'll
just
pick
out
a
couple,
but
we
need
to
invest
time
and
resources
in
developing
partnerships
with
national
and
local
organizations
to
do
this.
Well,
we
need
to
really
understand
who
the
public
are
and
what
we
mean
from
that
they're,
not
a
homogenous
group.
They
have
lots
of
different
needs
and
if
you
look
at
the
different
generations
of
people,
they
engage
in
interact
with
each
other
differently
and
that
will
change
over
the
life
of
this
strategy.
So
we
need
to
be
flexible
and
adapt
to
that.
V
Just
to
mention
this
document
is
kind
of
internal
policy,
we're
planning
to
create
accessible
versions,
more
so
much
more
public
friendly
content.
That
explains
what
we're
doing
and
also.
Lastly,
we
are
currently
working
through
the
detail
that
sits
beneath
this
plan,
with
the
kind
of
in
an
implementation
plan
that
will
set
out
who
is
doing
what
and
by
when.
Thank
you
and.
U
Just
just
just
to
finish
the
feedback
that
we
get
from
this
work,
we
will
obviously
make
past
as
a
quarterly
report
which
will
come
to
the
board,
and
our
aim
is
also
do
an
annual
review
as
well.
So
the
board
will
get
a
separate
insight
into
how
the
work
of
this
work,
alongside
to
work
of
our
partners,
is
informing
how
we
operate
as
an
organization.
Thank
you,
No.
A
Thank
you
and
thank
you
both
and
indeed
others
that
have
been
involved
in
in
previous
board
meetings
and
in
all
kinds
of
different
situations.
We've
been
talking
about.
Well
how
if
we
got
the
right
public
engagement,
have
we
got
information
coming
in
and
so
on?
So
actually
having
a
stretch,
jannick
is
is
really
really
good
any
any
questions
or
comments
from
anybody
Oh
how
surprising
Jade.
D
U
A
Great
so
I
get
it
being
late.
Oh
obviously
been
let
off
lightly,
but
you're.
A
F
And
and
I
apologize
for
the
one
you
just
spotted
this
one
is
on
we've,
we've
been
very
clear
and
objective
to
which
is
absolutely
right
and
proper.
That
will
enable
the
voices
of
people
use
services,
their
families
and
carers
to
be
involved,
but
on
objective
one.
We
just
talk
about
people
in
youth
services
and
we
haven't
included
carers
and
families
and
carers
and
organisations.
So
just
think
if
we
could
up
front
include
carers
in
that
objective.
That
would
be
very
important
as
the
message
that
we're
sending
out
it's.
K
What
the
the
metrics
of
success
would
look
like,
so
you
know
some
people
talk
about
engagement
on
it
on
a
website,
but
sometimes
engagement
is
because
people
can't
find
what
they're
looking
for
and
on
a
website
and
they're,
not
really
engaged
I
wonder
if
you've,
if
you've
got
some.
You
know
online
surveys,
or
it's
very
easy
to
do.
Obviously
through
digital
means,
so
not
hard
to
do
offline
yeah,
but
have
you
got
metrics.
U
Of
success
so
for
online
in
part
of
the
trick
is
working,
so
we
do
do
we
do
do
online
surveys.
Part
of
the
trick
is
getting
to
where
you
want
to
quickly,
and
so
we
survey
on
on
that
feature.
We
also
check
paths
of
where
people
go
to
for
information
and,
if
there's,
if
there
are
call
the
sites
that
they
go
to,
that,
don't
give
them
the
information
that
they
want.
So
we
do
check
and
actually
just
pathways
to
make
it
easier
to
get
your
people
to
get
to
the
information.
U
That's
most
appropriate
I
think
if
there
are
some
general
where
we
as
well
as
doing
that,
the
work
with
them
with
with
online
surveys.
We
do
also
do
a
lot
of
work,
both
with
HealthWatch
and
with
other
colleagues
as
well
to
assess
how
people
perceive
us,
because
there's
a
lot
of
this
is
about
trust.
As
a
public
engagement
strategies
is
a
function
of
the
information
we
have,
but
also
the
trust
in
people
for
that
information.
U
And
so
we
assess
monthly
and
quarterly
people's
reaction
to
some
of
the
information
that
we
that
we
put
out
there
and
how
easy
they
find
it
to
provide
information
to
us.
So
I
think
a
combination
of
those
things
and
what
we
will
bring
back
at
the
quarterly
report,
but
also
at
the
annual
review.
So
we
get
a
sense
of
both
how
we're
doing,
in
a
sense
tactically
around
how
we
provide
the
right
information,
but
also
how
empowering
showing
as
an
organization
that
we're
creating
the
right
environment
for
people
to
share
information
with
us.
K
Agreed
I:
don't
if
there's
an
opportunity
to
work
with
the
digital
team,
because
most
people
don't
want
to
go
on
websites.
They
just
want
to
query.
They
want
to
go
on
a
search
box
and
I've
done.
If
there's
opportunities
to
first
equate
sort
of
metadata
I,
don't
if
you're
working
with
peat
and
the
team
to
create
that
sort
of
search
capability,
David.
U
Hayter
talking
about
about
taxonomy,
so
I
decided
I
was
going
to
do
it
today,
but
and
but
the
metadata
exactly.
This
is
another
word
for
taxonomy.
That's
one
of
the
same
thing,
so
we're
exactly
working
on
that
without
collision
from
the
digital
team
to
make
sure
that
the
information
we
collect
we
can
find
again
and
that
we
are
allowing
people
to
do
one
search
that
gets
into
the
information
that
they
want
to
go
as
a
Dylan
and
import.
But
isn't
it
a
really
important
point?
U
The
way
we
collect
and
the
way
we
flag
that
information
is
determines
how
easy
is
to
find
it
again?
The
other
thing
which
ones
do
in
a
digital
space
is
that
we
shouldn't
be
the
only
place
where
people
go
so
if
they
go
elsewhere.
So
we
talk
to
the
local
government
Ombudsman
about
how
people
go
into
the
system
to
complain
and
how
we
share
information
with
another
organization.
U
So
if
they
come
to
words,
but
actually
also
want
to
complain
how
we
can
seem
to
transfer
the
information,
so
the
lgo,
so
that
they
get
the
experience,
the
people
who
who
are
given
as
information
get
the
experience
they
want
as
well
and
I,
think
being
available
in
many
different
places
where
information
is
powered
by
what
CQC
are
saying
is
actually
important.
Place
was
to
get
it.
A
Good,
so
thank
you.
Are
we
all
happy
to
approve
the
strategy?
Great.
Thank
you
very
much.
Both
of
you
really
really
good
excellent.
So
before
we
kept
don't
get
calm,
calm,
calm
down,
got
to
that
point.
Yet
so
before
we
get
to
that
point,
have
we
got
any
other
business
for
the
board
from
the
board
members
Jane.
D
I'm,
sorry,
chairman,
don't
look
so
shocked.
I
miss
my
punch
line,
my
team
this
morning
and
I
just
wondered
about.
It
starts
with
you
campaign
I
thought
what
we
actually
achieve
and
they
said
it's
increased
I.
Don't
this
counts
now:
listen
to
Jorah
increased
our
website
traffic
by
90%
and
the
find
your
local
healthwatch
page
went
up
by
106
percent.
So
I
don't
want
to
let
them
down.
We
have
made
some
differences
right.
A
So
I've
got
one
other
bit
a
bit
of
business,
which
is
just
to
say,
sir
mike.
Finally,
this
is
your
last
meeting.
We've
said
goodbye
and
man
and
good
on
a
number
of
occasions,
but
we
can't
in
the
board
without
saying
a
huge
thank
you
on
behalf
of
very
many
people,
for
your
your
career,
originally
as
a
clinician,
obviously
huge
contribution
to
cancer.
A
But
as
far
as
this
board
is
concerned,
your
enormous
contribution,
it's
really
hard
to
overstate
the
the
the
contribution
you've
made
CQC
to
the
whole
Hospital
inspection
process,
and
if
Luis
were
here,
he
would
be
saying
the
safety
and
quality
of
what
happens
in
our
hospitals
and
I.
Just
on
behalf
of
everybody
just
want
to
say
thank
you
very
much
and
to
wish
you
every
success
in
many
endeavors,
which
I'm
sure
you
will
be
moving
on
to
in
the
months
ahead.
So
just
everybody.
Thank
you.
Mike
very
much.
A
W
You
miss
9.
My
name
is
Andrew
Ward,
okay,
background
in
public
protection
for
over
40
years,
and
thank
you
for
allowing
me
to
speak
I'll,
be
as
quick
as
I
can.
When
unasked
addressed
the
board
in
February
this
year,
I
welcomed
the
CQC's
focus
on
better
use
of
intelligence
and
I
said
patients,
families
and
staff,
or
your
best
intelligence
sources.
You
need
to
nurture
them,
encourage
them
be
kind
to
them,
understand
them
and
demonstrate
you
always
act
in
patient's
interests.
W
First
by
your
actions
since
February,
a
number
of
events
have
occurred,
or
briefly
mentioned
just
for
one
of
these
has
already
been
touched
on
one,
a
former
chief
executive
of
some
George's
who
was
deemed
by
the
Care
Quality
Commission
to
be
a
fit
and
proper
person.
Despite
complaints
from
former
NHS
staff
country,
received
a
suspended
prison
sentence
having
pleaded
guilty
to
fraud.
The
second
event,
an
NHS
foundation,
trust
and
you've
mentioned
this.
W
Southern
Health
pleaded
guilty
to
an
offense,
failing
to
provide
safe
care
and
treatment
in
I,
understand
and
I
understand
the
reasons
why
the
first
ever
prosecution
of
a
trust
brought
by
the
Care
Quality
Commission.
Thirdly,
Eileen
Chubb,
a
campaigner
in
the
care
sector
alleged
on
national
television
and
I,
quote
adding
directly.
We
have
47
cases
where
whistleblowers
identities
had
been
given
to
their
employer
by
CQC
inspectors,
a
horrendous
betrayal
of
trust
and
forth.
And,
lastly,
a
commercial
for-profit
information
organization.
W
Wilmington
plc
held
a
two-day
National
Patient
Safety
conference,
which
was
attended
by
many
NHS
executives
and
senior
members
of
this
board.
A
lot
of
people
attended
that,
although
I
do
know,
the
secretary
of
state's
health
suddenly
decided
for
its
own
reasons,
not
to
appear
in
person.
So
it
appears
to
me
that
there's
some
listening
happening
and
a
little
action
and
the
question
I
ask
myself
is:
are
the
CQC's
responses
to
that
listening,
timely,
appropriate
and
lawful
and
taking
the
four
examples.
I
spoke
of
on
fit
and
proper
persons.
W
W
All
your
actions
in
this
area,
B
to
B,
appear
to
be
far
too
little
too
late
on
prosecutions
you
have
set,
and,
in
my
view,
it's
a
carefully
chosen
example
with
southern
health,
but
just
as
Sir
Robert
has
warned
that
there
might
be
morbid
stuffs
in
future
I
assert
that
there
are
already
more
sudden
Health's
now
so.
Who
next
is
my
question?
On
whistleblowers?
W
You
already
have
clear
legal
guidelines
set
out
to
you
by
the
Information
Commissioner's
Office
on
lawful
and
unlawful
disclosure
of
whistle
blows
personal
information
in
the
memorandum
of
understanding
dated
April
2015,
which
is
published
on
your
website
so
sudden,
hypothetical
questions?
Can
you
assert
that
you
have
not
breached
the
law
in
respect
of
all
whistleblowers
with
whom
you
have
had
contact?
Even
if
you
lawfully
defend
every
decision
disclose
the
identity
of
whistleblowers?
Is
that
ethically
responsible?
W
Is
your
engagement
strategy
at
odds
with
effective
regulatory
compliance
monitoring
and
the
point
of
making
there
is?
Should
you
listen
less
to
providers
and
act
faster
on
whistleblower
concerns
and,
lastly,
on
patient
safety?
Think
about
who
you
are
not
listening
to
at
patient
safety
events,
for
example
those
who
have
the
microphone
taken
from
them
or
switched
off
and
I
know
one
example.
W
I
know
there
are
others,
while
speaking
those
who
cannot
attend
because
they
were
not
invited
or
they
cannot
afford
the
cost,
and,
unlike
you,
who's
attendance
at
these
events
is
funded
by
taxpayers
or
because,
like
will
pal
a
member
of
HS,
ID
expert
advisor
group,
they're
excluded
for
expressing
the
views
that
don't
conform
to
common
purpose,
on,
for
example,
duty
of
candor
and
safe
space.
So
those
are
just
things
that
I'd
like
you
as
a
board
to
think
about
not
expecting
officers
today.
Thank
you
very
much
for
listening.
A
A
Specifics
fit
and
proper
already
said
to
you
that
the
regulation
is
the
regulation
and
we
are
both
consulting
on
on
how
we
use
the
regulation
and
whether
there
should
be
some
changes
to
the
regulation.
So
we
are.
We
are
we're
aware
of
that
prosecutions,
we're
using
our
prosecution
power
more
as
a
matter
of
judgment
as
to
when
it's
used
and
also
the
obviously
it's
a
matter
of
having
both
the
the
situation
and
the
evidence
of
our
prosecutions
as
appropriate.
A
Miss
chap
may
well
say
that
there
are
a
large
number
of
situations
where
we
have
disclosed
unlawfully
identity
of
a
whistleblower.
All
I
can
say
is
that
of
the
specific
situations
that
have
been
brought
to
my
attention
in.
In
those
cases,
we
did
not
disclose
unlawfully
whistleblowers,
identity
and
clearly
that
is
not
something
that
we
would
ever
knowingly
contemplate
doing
and
then
finally,
I'm
afraid
I,
don't
know
what
the
conference
is.
W
Two
things
very
briefly:
first
of
all
and
come
on
a
good
point.
Healthwatch
Berkshire
have
highlighted
in
their
recent
published
report,
I
can't
remember,
which
pages
on
but
they've,
given
a
half
a
page,
they're
very
concerned
about
the
treatments
of
whistle
blows
in
their
area.
So
oh,
it's
interesting,
I,
don't
know
whether
the
freedom
to
speak
up
garden
can
do
some
case
reviews
on
on
what
went
wrong
there.
Maybe
you
want
to
have
a
look
look
at
that,
but
HealthWatch
Berkshire
have
highlighted
in
their
your
report
concerns
about
treatment
of
whistleblowers
in
their
air.
W
A
L
Blonde
moment
good
morning,
boys.
Thank
you
very
much
for
letting
me
speak
and
just
to
say
it
was
back
up
for
a
David
or
Andrew
rather,
and
the
unlawful
disclosure
of
virus
force
reporting
did
happen.
So
I
was
unloved
unlawfully
disclosed
to
the
people
that
I
had
to
force
it
on
by
the
CQC.
So
I'm,
definitely
one
of
those
people
and
what
I
wanted
to
ask
I
wanted
to
report.
L
One
thing
I'm
going
to
do
it
in
public
now,
because
it's
a
lot
easier
and
safer
and
I've
had
quite
a
serious
report
from
a
transgender
group
in
Devon
and
turns,
and
the
Devon
partnership
her
national,
the
trust
their
are.
Refusing
their
clients
advocates,
and/or
chaperones
in
consultations.
So
to
the
point
that
another
member
of
the
transgender
community
had
threatened
to
self
circle,
to
cut
their
cut
themselves
off
self
mutilate
themselves,
but
they
are
refusing
them
advocate
chaperones
and
consultations,
which
is
really
really
really
serious
for
them.
L
So
can
you
put
ng
for
National,
Guard
and
rather
than
NGO,
because
it
makes
it
looks
like
it's
a
different
body
all
together,
which
is
a
bit
confusing
and
my
main
question
you'll
be
glad
to
know
he'll
be
over
now
and
is
there
any
requirement
on
boards
and
I
don't
mean
the
CQC
board?
I
mean
trust
boards
to
do
I
know
you've
done
it's.
The
unconscious
bias
training.
When
you
do
an
inspection,
do
you
ask
them?
Have
they
done
unconscious
bias
training,
or
do
you
suggest
to
them.
I
L
L
Less
than
human
way
is
not
good
practice
for
the
people
to
repay,
to
care
for
and
look
after
so
their
actions.
They
don't
seem
to
have
learned
any
lessons
from
their
issue
a
number
of
years
ago.
The
acting
in
good
faith
and
I
certainly
think
that
maybe
putting
the
unconscious
bias
training
as
an
option
or
putting
it
somewhere
within
the
inspection,
because
the
if
the
board
have
that
kind
of
bias-
and
they
are
the
leadership
with
one
of
the
biggest
trusts
in
the
country,
then
the
staff
are
already
under
vast
pressure.
L
J
David
Howe
got
miracast
and
Johns
Wooten
maida
vale.
Last
time,
I
talked
to
you
a
little
bit
about
some
research.
I
did
into
the
evidence
underlying
criticisms
by
adult
social
care
of
Bob
Clinard,
based
on
the
KL
area,
about
kindness
and
compassion
and
I
noted
that
the
the
evidence
was
almost
always
observation
and
that
you
were
very
very
good
at
seeing
what
was
going
on.
As
far
as
you
could
see.
J
J
They
said
they
weren't
sure
about
how
kind
and
caring
the
place
was
because
on
the
one
hand,
they
deserved
some
kind
and
caring
interactions,
but
on
the
other
hand
they
talked
to
a
relative
who
was
a
bit
equivocal
and
said
well,
I
suppose
it
was
all
right,
but
it
wasn't
anything
special
and
that's
how
they
left
it
note
you
could
take
it
or
leave
it,
and
I
would
have
thought
that,
given
what
there
was
the
CCTV
there,
they
might
have
gone
back
and
looked
at
some
of
the
footage
which
I'm
assuming
it
had
been
kept
and
seen
to
see
whether
wish
was
true
well,
whether
the
kindness
didn't
come
and
compassion
which
was
being
shelled,
was
simply
for
the
basis
of
inspection
or
whether,
in
fact
it
was
an
on
going
thing,
but
they
didn't
do
that.
J
Instead,
they
seem
to
be
quite
hostile
to
the
CCTV
altogether
and
all
they
weren't
concerned
about
was
was
the
consent
and
was
the
invasion
of
privacy,
and
that
brought
back
to
me.
They,
my
own
experience
last
year
when
I
put
put
in
an
acoustic
device,
which
I
think
showed
that
somebody
was
not
being
turned
as
often
as
he
should
be
when
he
had
pressure
sores,
not
as
often
as
nice
will
say
or
to
him.
J
But
when
I
took
this
to
the
CC,
the
CQC,
they
did
not
look.
They
did
not
listen
to
the
recording
at
all,
and
it
also
reminds
me
of
a
case
in
Yorkshire,
where
somebody
had
put
in
a
covered
camera
and
again
was
he
who
C
would
not
the
inspectors
locally?
Would
not
look
at
the
footage
that
she
had
collected
least
not
initially
and
I.
Suppose
what
I
really
watch
says.
J
It
seems
to
me
that
if
you
have
got
evidence
of
this
kind,
then
the
CQC
should
be
looking
at
this
evidence
and
I
would
well
I
wonder
if
there
could
be
an
assurance
that
when
when,
when
such
evidence
exists,
it
will
be
looked
at
in
future,
and
you
will
not
just
think
about
issues
like
consent
and
privacy,
but
also
say:
look
I
have
a
force
and
some
extra
evidence
which
can
resolve
some
of
the
unresolved
questions
that
have
come
up
during
our
inspection.
So.
A
Thank
you,
David.
The
last
time
you
raised
this,
which
I
think
was
at
the
last
meeting,
but
it
may
have
been
the
one
before
David
gave
you
an
answer.
That
said,
we
were
going
to
be
reviewing
the
the
guidance
that
we
give
on
the
use
of
surveillance
which,
as
you
rightly
say,
it's
both
audio
and
and
and
video
and
I.
Think
as
part
of
that
review.
We
need
to
think
about
how
we
use
it
as
well.
So
I,
don't
think
I'm
very
honest.
You
want
to
say
anything.
A
A
T
The
other
aspect
of
the
inspection
process
going
forward?
Is
there
any
plan
to
perhaps
more
formalize
within
the
Academy,
the
assessment
of
prospective
inspectors
in
their
ability
to
write,
succinct
inspection
reports
in
a
certain
time
allocation
in
the
sense
of
them
a
more
examination
based
approach,
as
is
used
by
the
Royal
Colleges?