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From YouTube: CQC board meeting – February 2018
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A
A
A
A
Agreed
was
anything
arising
from
the
last
set
of
minutes
that
anybody
wanted
to
raise
that
isn't
either
on
the
action
log
or
otherwise,
on
the
agenda
great
good,
so
we
then
move
to
the
work
of
the
health,
safety,
investigation,
branch
and
key
to
a
very
big
welcome
to
you.
Thank
you
very
much
for
coming
this
morning.
We
are
obviously
extremely
interested
as
a
bore
to
understand
how
you
see
the
branch
developing
and
working
and
the
interaction
with
us.
So
thank
you
and
can
I
just
hand
over
to
you.
Please.
A
B
Of
course,
thank
you
very
much
and
good
morning
to
everybody.
So
I
just
want
to
give
you
a
sort
of
a
5
minute
overview
of
the
background
of
the
HSI,
be
the
healthcare
safety
investigation
branch
and
what
we're
currently
up
to
so
we
really
have
more
name,
but
that's
to
improve
patient
safety
by
getting
the
most
out
of
learning
from
all
the
incidents
that
take
place
and
there's
four
ways.
I
think
that
we
are
looking
to
achieve
that.
We
want
to
introduce
safety
investigations
that
don't
apportion
any
blame
or
liability.
B
We
want
to
raise
the
standards
of
local
trust
investigations
and,
overall,
what
I
would
like
to
do
is
to
try
and
professionalize
safety
investigations
so
that
we're
introducing,
if
you
might
need
the
art
of
safety
investigation,
there's
a
discipline
in
its
own
right.
So
looking
at
full-time,
fully
trained
safety
investigators
that
that's
what
they
do,
it's
it's
not
in
addition
to
to
a
day,
job
and
and
fourthly,
I
guess.
B
The
output
from
the
investigations
will
be
public
reports
and
safety
recommendations
and,
in
my
view,
the
vast
majority
of
the
safety
recommendations
that
the
HSI
be
will
make
will
go
to
the
national
bodies.
The
idea
is
that
they
aren't
made
to
the
local
trusts.
We
are
looking
at
going
to
professional
regulators
colleges,
perhaps
even
the
CQC.
B
The
way
we'll
go
about
this
is
that
anybody
can
make
us
aware
of
an
incident
that
they
may
think
that
we
would
like
to
investigate.
We
have
a
website
where
we
publicly
stated
what
our
criteria
are
for
investigating
and
very
briefly.
There
are
three
criteria
or
therefore,
the
event
has
to
have
happened
after
the
first
of
April
17
when
we
keep
became
operational.
B
Secondly,
there
has
to
be
harm
or
the
potential
for
very
serious
harm.
Thirdly,
there
needs
to
be
an
underlying
systemic
issue
to
make
it
worth
us
looking
at
it
when
we're
not
interested
in
a
single
event,
in
a
single
trust
that
isn't
potentially
replicated
elsewhere,
we're
looking
at
systemic
problems.
And
fourthly,
we
want
to
make
sure
that
we
can
value.
There
is
value
in
the
HS
I
be
doing
the
investigation.
B
We're
only
funded
for
up
to
30
a
year,
so
we
need
to
pick
and
choose
fairly
carefully
where
we
place
our
resources
and
is
but
it's
important
that
to
understand
that
we
are
not
replacing
anything
else
in
the
system.
We
are
in
addition
to
the
local,
serious
incident
investigation
or
whatever
else
may
be
going
on,
and
we
might
not
necessarily
be
the
only
investigation
in
town
and
if
I
just
come
on
to
that,
we
don't
apportion
blame.
B
As
I
said,
it's
a
fundamental
part
of
our
type
of
safety
investigation
that
we
don't
apportion
any
blame
or
liability,
and
we
we
see
ultimately
a
change
in
in
the
culture
by
looking
at
actually
what
what
could
the
system
have
done
to
have
prevented
this
issue
happening?
Not
what
an
individual
could
have
done
to
change
it,
and
what
we
also
bring
is
through.
Our
investigators
is
a
wide
variety
and
background.
So
there
are
clinicians.
B
There
are
engineers,
there's
even
the
odd
pilot
or
two,
but
in
particular,
we've
got
a
lot
of
focus
on
human
behavior.
So
we
have
a
lot
of
human
factors:
specialists
to
look
at
the
behaviors
that
perhaps
led
to
the
incident
taking
place
so
that,
if
you
like,
it
are
the
principles
with
which
we
work,
we've
undertaken
so
far,
I
think
we
started
ten
investigations,
we've
published
five
or
six
interim
bulletins.
B
B
B
They
are
not
investigations
to
apportion
any
blame
or
liability,
but
what
we
have
been
asked
to
do
is
to
investigate
all
the
incidents
that
currently
the
each
baby
counts
criteria
applied
to,
so
that
that
tends
to
be
babies,
that
at
term
are
stillborn
or
there
are
brain
damaged,
or
this
is
recognized
or
they
died
within
seven
days
of
being
born
and
we've
been
asked
to
do
all
those
investigations
in
England
so
last
year
that
would
have
been
about
a
thousand
investigations.
So
that's
quite
a
big
change
for
us
to
try
and
take
on
this.
B
This
work
so
we're
working
up
to
start
this
work
as
of
April
May
this
year,
and
we
will
start
to
roll
out
teams
in
various
parts
of
the
country
to
undertake
these
investigations.
Now
these
are
the
same
principles,
but
the
one
of
the
big
differences
is
that
these
will
replace
the
local
trust,
serious
incident
investigation
and
so
the
recommendations
from
these,
the
each
investigation
will
be
into
an
individual
incident.
And
so
there
are
more
likely
to
be
recommendations
at
local
level,
and
then
we
will.
B
A
Thanks
Keith
I
mean
it's,
it's
really
interesting,
because
your
role
and
ours
are
very
different,
but
there
is
a
massive
overlap
in
the
the
the
objective
of
improving
the
safety
of
services
through
learning
from
what's
gone
wrong
in
the
past
and
how
things
can
be
improved,
so
I
think
hugely
welcome
the
fact
that
been
set
up
and
that
you're
here
does
anybody
want
to
raise
some
questions
or
Robert.
Please.
C
You
being
set
up,
thank
you,
and
the
question
I
have
is
this:
the
techniques
that
you
describe,
which
include
it
might
be
a
very
welcome
focus
on
no
Blaine,
but
also
human
factors
and
systemic
explanations
is
something
that
clearly,
you
will
be
deploying
in
your
maternity
service.
The
single
incident
investigations
as
well
as
your
national
level
ones.
C
How
would
you
suggest
that
those
skills
get
applied
more
readily?
Assuming
is
thought
that
they're
good
skills
and
I
believe
they
are
to
the
wider
range
of
investigation
that
is
currently
undertaken,
often
internally
by
providers
some
would
say
often
with
without
those
skills
and
without
the
resources
to
have
them.
B
Well,
I
think,
first
of
all
we're
still
in
a
development
phase,
as
we
actually
work
out
how
our
techniques
actually
go
down
in
the
various
settings
and
I
should
say
we're
not
just
in
into
acute
care,
we'll
be
looking
at
primary
care
and
anywhere
where
NHS
money
is
actually
spent
within
England,
but
I.
Think
as
we
develop
the
model
we
are,
we
are
working
with
higher
education
authorities
to
actually
help
with
the
training
we've
been
working,
particularly
on
maternity,
with
various
maternity
units
to
to
understand
how
again
we
can.
D
Key,
thank
you
very
much
for
that.
I.
Very
much
welcome
your
leadership
and
HSI
B's
leadership
on
improving
investigations.
When
things
go
wrong
in
health
care,
it's
something
that
I
think
health
care
generally
has
not
got
right,
making
sure
that
we
learn
when
things
go
wrong
and
make
changes
for
the
better,
and
this
is
a
great
step
forward.
D
So
we
look
forward
to
working
with
you
going
forward
as
Robert
was
indicating
I
hope
this
will
be
the
beginning
of
an
improvement
in
investigations
across
the
board,
and
you
will
be
seen
as
an
exemplar
that
everyone
could
learn
from.
We
have
been
critical
in
the
past
about
seriousness
and
investigations.
D
B
Absolutely
agree
and
I
think
by
demonstrating
consistently
that.
Actually,
this
is
what
we
do,
that
we
we
are
sensitive
with
the
information
that's
given
to
us
and
that
we
do
actually
get
the
most
out
of
an
incident
without
apportioning
any
blame
or
liability
time
and
time
again,
then
slowly
we
and
achieve
the
same
culture
change
that
you
want
to
do
as
well,
so
lose
them.
Then
Andrea!
B
E
Just
wanted
to
really
build
on
what
Ted
asked
so
I
mean
I.
Think
from
the
point
of
view
of
individuals
and
families
who
are
who
are
affected
by
these
safety
instance.
Two
things
particularly
matter
often
one
is
accountability
and
I.
Think
that
that's
you
know,
that's
not
what
you're
you're
part
of
the
whole
system
is
going
to
be
pursuing,
and
the
other
is
that
kind
of
sense
that
you
just
don't
want
this
to
happen
to
somebody
else
and
that's
the
point
that
Ted
was
making
about
real
learning.
E
So
you
know
it's
not
enough,
even
just
for
somebody
to
be
found
accountable
or
people
to
be
found
accountable
if
the
learning
doesn't
actually
happen
and
I
suppose
that-
and
we
know
that
people
that
that
learning
happens
better
in
that
environment,
where,
where
you
separate
that
out
from
the
processes
of
accountability
and
justice,
etc,
where
people
feel
they
can
speak
openly
and
really
learn
not
defensively.
But
I
just
really
wanted
to
ask
you
how
you
think
that
your
findings
will
help
feed
into
that
culture?
Change
so
you'll
be
producing
the
reports.
B
Well,
I'm
pretty
new
to
the
whole
system,
but
I'd
like
to
think
the
fact
that
we're
making
recommendations
to
the
to
the
regulatory
bodies
to
the
national
bodies
will
be
quite
a
difference
from
perhaps
what's
gone
on
before
when
I
on
I
understand.
A
lot
of
the
local
investigations
can
only
really
focus
at
the
local
level,
I'd
like
to
think
we
we're
not
going
to
go
down
that
route.
B
I
think
very
rarely
when
we
make
recommendations
there,
but
if,
if
we
can,
you
know
make
recommendations
to
people
like
the
GMC
and
go
actually
have
you
thought
about
this?
You
know
what
about
this
area
and
try
and
focus
the
attention
there.
I
think
there
is
more
potential
to
make
changes
that
will
actually
they
will
stay
and
they're,
not
short
term
shortcuts.
F
F
Think
that
there's
two
important
things
for
us
one,
the
the
Joint
Working
between
our
organisations,
is
not
just
kind
of
through
the
hospitals
and
primary
medical
services
Directorate,
but
with
adults,
social
care
as
well,
and
recognizing
our
independence
both
of
our
independence.
Because,
as
a
regulator,
we've
got
criminal
enforcement
powers
to
take
into
consideration
when
harm
has
happened
as
well
as
kind
of
what
you
want
to
do
around
learning
from
that,
but
also
to
make
sure
that
we're
making
the
connection
with
local
authorities
safeguarding
and
the
reviews
that
happen
there.
F
B
Yes,
and
actually
it's
worth
emphasizing,
we
are
really
trying
to
develop
our
techniques,
I
think
as
I
said
earlier,
and
we
would
welcome
more
people
making
us
aware
of
different
events
in
these
in
the
different
settings
so
that
actually
we
can
test
ourselves
and
see.
Do
our
take
these
work
in
in
all
these
different
care
settings
so
there
our
website
has
the
opportunity
for
anybody
to
raise
an
issue
with
us
and
I
would
really
ask
people
to
do
that.
Thank
you.
A
Keith
is
really
really
interesting,
as
I
said
a
few
minutes
ago,
I'm
and
I
think
we
have
a
overlapping
objective
around
improving
quality
and
safety.
So
your
really
interesting
I
hope
that
we
can
not
only
just
continue
a
dialogue
we
do,
but
if,
if
there
are
things
that
we
at
CQC
can
do
to
help
you
as
you
establish
and
develop,
please
feel
free
to
come
back
to
us
at
any
time.
I'm
sure
we
would
all
try
and
try
and
help
if
we
can,
unless
anybody
has
anything
else
David.
You
know.
G
Keith
and
I
have
met
on
a
number
of
occasions,
since
he
came
into
force
and
I.
Think
the
theme
of
the
meeting
is
just
how
important
that
relationship
is.
We've
got
a
zombie,
I
was
saying
a
independent
rule
that
we
need
to
play.
Well,
we
do
have
some
investigative
powers
when
that
the
organization
that
Keith
now
runs
and
leads
was
being
set
up.
There
was
a
debate
about
whether
that
should
come
to
CQC.
G
If
you
remember,
and
the
decision
was
taken,
no,
it
needed
to
be
independent
of
c2c
for
the
reasons
that
Keith
has
set
out
and
I
think
there
were
the
right
reasons,
but
this
interface
I
think
between
what
Keith
and
his
teams
all
do
and
what
we
do
is
an
important
one.
We
just
need
to
keep
the
right
distance,
I,
think
in
relation
to
this
and
work
at
that
relationship
and
I.
Think
I'd
be
confident.
We
can
continue
to
do
that.
G
Just
by
continuing
to
talk
on
these
issues,
we
can
do
memorandum
of
understanding,
x'
and
all
those
kind
of
architectural
things,
but
actually
the
most
important
thing
is
a
conversation.
I
think
the
other
thing
I,
pull
out
and
and
and
and
reona
we're
touched
on
this,
which
is
a
number
of
our
inspectors,
need
to
deploy,
investigates
investigative
skills
and,
as
case
begins,
this
journey
to
professionalize
investigation
and
I
think
there's
some
that
we
need
to
be
open
to
the
learning
that
we
can
take
as
well.
G
So
I
see
the
relationship
as
being
completely
reciprocal
in
that
I
think
the
learning
that
can
come
out
of
this
can
help
people
that
are
running
and
delivering
services,
but
I
think
those
of
us
have
a
responsibility
to
scrutinize
from
the
outside
services.
Can't
you
learn
together
how
to
do
that
as
well.
So
hugely
important
and
I'm
just
really
pleased
to
see
the
teeth
now
got
ten
investigations
underway
and
beginning
to
get
that
products
under
way.
G
I
think
it's
a
great
achievement
and
something
that
we
need
to
keep
keep
close
to
him
on
without
each
of
the
crowding
out
each
of
this
space
and
just
getting
the
appropriateness,
because
there'll
be
lots
of
people
that
will
have
a
view
on
us
getting
too
close
and
too
far
away,
and
we
just
and
I
would
have
a
view
on
that.
Quite
frankly,
we
need
to.
G
D
A
So
Keith
thanks
again
you're
very
welcome
to
stay
for
the
rest
of
the
meeting.
I.
Think,
though,
you
said
that
you
have
other
things,
you
probably
ought
to
be
doing
so
we
fully
understand.
If
you
decide
riveting
though
our
meeting
is,
you
need
to
go
and
do
something
else,
but
thank
you
very
much
for
your
time
and
every
success
in
your
endeavor
great,
thank
you
David.
We
need
to
move
on
then
to
your
report.
Please.
G
G
So
the
performance
report
is
covered
separately.
Well,
we've
got
the
quarterly
report
to
the
board,
so
I'll
not
touch
on
any
of
that.
During
this
particular
briefing,
paragraph
really
does
pick
up
the
learning
from
when
things
don't
go
as
they
should
do
and
go
wrong
in
a
sense
and
draw
attention
to
mend
it
house
and
the
fact
that
there's
been
a
serious
adults
review.
G
Safeguarding
review,
published
and
produced
on
mended
house,
which
I
think
board
members
would
have
seen
in
the
media.
We've
welcomed
the
review
published
a
statement
by
way
of
response
and
we've
also,
since
the
incidents
that
led
to
the
review
have
changed
the
way
that
were
registering
some
of
these
services,
which
the
board
of
tech
and
close
attention
to
as
that's
been
discussed
and
debated
and
then
agreed
as
a
position
statement.
G
Learning
was
also
one
of
the
themes
that
came
out
of
the
care
cup
review
into
Liverpool
Community
Health,
Care,
Trust
and
I'll
pick
this
up
with
the
next
item,
Peter,
which
is
the
review
of
the
fit
and
proper
person
regulations
if
I
may.
So
what
we've
tried
to
do
in
this
report
is
just
reflect
on
dr.
bill
care
cups
report.
He
was
commissioned
by
n.
It's
it's
improvement
to
look
at
the
trust,
not
tryst.
G
Apologies
for
this
probably
was
a
tryst
as
well,
actually
but
term,
and
the
oversights
of
Liverpool
community
health
care
trusts
from
a
period
2010
onwards.
In
his
report,
a
bill
made
I
think
it
was
ten
recommendations.
A
number
of
them
are
directed
to
wolves,
but
they're
also
directed
to
NHS
improvements
in
NHS
England,
and
in
considering
those
recommendations,
we've
accepted
all
those
recommendations
and
will
respond
to
them.
Some
of
that
response
will
be
done
jointly
with
other
agencies.
G
I
think
he's
deliberately
given
them
to
NASA
a
little
bit
as
we
as
keith
has
just
been
taking
us
to
a
lot
of
these
recommendations
in
not
so
the
local
services.
So
the
national
agency
is
about
the
oversight
which
is
I,
think
one
of
the
themes
that
Keith
was
developing.
There
is
a
specific
recommendation.
There
are
specific
recommendations
to
pick
up
on
the
fit
and
proper
person
regulation,
which
is
directed
at
the
Department
of
Health,
and
I
would
like
to
comment
on
on
that.
If
I
meant
Peter.
G
G
Recommendation
talks
about
CQC's
fit
and
proper
person
test
and
I
just
want
to
make
a
what
sense
to
me
to
be
a
pretty
important
point
that
we
don't
have
a
fit
and
proper
person
test.
What
we've
got
is
a
regulation
which
was
agreed
by
Parliament,
which
was
proposed
in
response
to
Robert's
reports
when
he
produced
his
report
on
Mid
Staffordshire
in.
G
2013
fell
just
over
five
years
ago.
Now,
what
we
and
I
think
one
of
the
issues
in
Roberts
report
is,
and
I
went
back
and
reminded
himself
of
this
when
this
bill
cops
report
was
published
here,
it
is
so
just
in
case
you
don't
know
what
it
says
on
page
under
the
nine
Robert.
Okay
by
the
serious
point
is
on
this
issue
of
fits
and
proper
person.
I
think
you
should
speak
to
this.
G
Think
there
is
a
narrative
that
says
that
CTU
say
he
should
actually
determine
whether
people
are
fit
and
proper
and
whether
that
determination
should
then
result
in
whether
there
should
be
able
to
be
employed
in
other
places.
I
understand
why
people
would
say
that,
but
that's
not
the
regulation
that
we
think
we've
been
given
to
operate.
G
So
when
the
report
bill
Kerr
cops
report
was
published,
the
Minister
for
State
for
Health
Stephen
Barclay
made
a
statement
to
Parliament
and
in
that
statement
he
talks
about
a
review
of
again
CQC
fit
and
proper
person
test
and
as
I
say,
it's
not
CQC's
test.
It's
a
regulation
that
agreed
the
proposed
by
governments
and
agreed
by
Parliament,
but
what
he
did
talk
about
was
a
review
that
will
address
the
operation
and
the
purpose
of
the
fit
and
proper
person
test
and
I.
Think
that
scope
is
important.
G
So
I
think
the
purpose
of
the
test
is
an
opportunity
for
the
review
to
consider
whether
the
response
to
Robert's
recommendations
and
the
regulation
that
we've
been
operating
in
is
the
score
that
people
want
to
see.
One
of
the
issues
that
came
out
in
the
minister's
statement
to
Parliament
that
there
was
around
an
individual
moving
from
the
NHS
in
England
to
another
part
of
the
NHS
in
the
United
Kingdom.
It
is
this
sense
or
people
who
were
seemed
to
fail.
G
Can
they
go
somewhere
else
and
that
should
be
employed
by
somebody
else
which
is
akin
to
some
of
the
issues
which
I
think
we're
in
the
that
sit
behind
the
idea
of
a
register
of
doing
all
where
people
are?
Can
the
bits
look
on
and
I
think
it
is
true
to
say
that
part
of
the
tension
we've
been
operating
in
Peter?
G
Is
this
issue
about
the
people
that
wanted
to
see
a
register
where
people
could
be
held
to
account
and
that
would
include
being
struck
off
a
register
and
what
it
is
that
we've
been
asked
to
deliver
through
the
application
of
fit
and
proper
person
regulation?
That's
a
bit
about
scorp
and
I!
Think
there's
something
that
we
as
an
organisation
needs
to
be
open
to,
which
is
the
operation
of
the
regulation
that
we
have
been
given
so
operates
and
again.
G
I
think
there
is
an
important
issue
about
whether
we've
operated
that
regulation
in
a
way
that
has
been
consistent.
My
personal
views
I
think
we.
That
is
exactly
what
we've
tried
to
do.
The
board
will
know
that,
since
a
regulation
came
in
in
2014,
we've
carried
out
a
review
of
our
implementation
in
1516,
without
action
plans
to
improve
the
way
that
we've
implemented
it.
G
We
didn't
know
when
we
published
that
guidance
that
bill
was
going
to
publish
his
report
in
February
or
make
the
recommendations
that
he
did,
but
I
think
we
genuinely
welcomed
the
fact
that
I
know
their
set
of
eyes
and
other
independent
person
would
come
to
look
at
fit
and
proper
person
test,
which
is
I.
Think
why
we've
welcomed
the
test.
We
will
the
review
that
was
announced
by
the
minister.
We
will
cooperate
fully
with
that,
so
the
best
of
my
knowledge
has
been
no
announcement,
yeah
of
an
individual
that
will
lead
that
that
work.
G
So
that's,
obviously
something
that
is
still
ongoing
within
the
department's
felt,
but
once
that
person
is
announced,
then
will
seek
to
work
constructively
with
that
person.
The
bits
that
I'd
want
to
stress
Peter
is
this
important
issue
about
scope.
This
has
been
contested
territory
since
we
started
on
this
regulation
and
trying
to
settle.
This
will
be
incredibly
welcome
for
all
of
the
staff
in
CQC
that
you're
trying
to
implement
this,
but
I
also
think
as
an
organization.
G
We
should
be
open
to
a
further
reflection
on
the
way
we've
operationalize
this
as
I
said
with
good
intent.
We've
tried
to
do
this
in
both
the
spirit
and
the
letter
of
the
regulation,
but
again
having
an
independent
review
of
the
way
that
we've
operated
I
think
we
should
embrace
that
rather
than
actually
be
concerned
and
worried
about
it,
and
that
would
be
the
mindset.
I'd
want
to
say
there's
more
in
the
update
and
I'm.
G
Sorry,
it's
in
two
paragraphs,
I
think
I
probably
should
have
obviously
in
drawing
this
all
together
in
one
paragraph
rather
than
to
the
responsibility
for
that
rests
with
me,
but
I
think
the
key
point
is
really
about
the
substance
of
the
review
and
how
we
should
position
ourselves
with
it.
Is
it
worth
just
pausing
at
that
point
and
I?
Don't
know
whether
Robert
wants
to
speak
on
this.
C
The
recommendation
in
the
first
place
at
one
point
perhaps
David
didn't
mention,
was
there's
amongst
those
recommendations
and
that
group
of
recommendations
was
the
idea
that,
if
the
fit
and
proper
person
test
or
regulation
was
to
be
used,
that
its
operation
should
in
fact
be
kept
under
reviewed,
in
effect
to
whether
it
was
an
adequate
answer
to
the
concerns
that
were
raised
in
the
report.
So
for
that
reason,
and
in
addition
to
the
fact
that
it's
well-known
that
many
people
have
not
been
satisfied
right,
they
were
wrongly
with
the
way
which
that
regulation
has
worked.
C
G
There's
been
a
lot
of
media
publicity
about,
and
speculation
in
relation
to
the
future
of
four
seasons:
healthcare
and
with
previously
briefed
the
board
on
the
engagement,
the
market
oversight
team
have
had
with
four
seasons,
healthcare
and
some
of
this
material.
Then
these
short
paragraphs
was
in
the
public
domain
in
that
second
week
in
February
and
I've
just
repeated
it
here
Peter.
G
Basically,
this
is
a
group
which
is
going
through
a
restructuring.
The
certain
milestones
in
that
restructuring,
which
we've
laid
out
in
the
report
and
Stewart
doing
a
direct
remark.
Oversight
and
his
team
along
with
Andrea,
are
all
very
carefully
and
closely
engaged.
Some
of
this
work
remains
confidential,
which
is
why
commercially
confidential,
which
is
why
we
don't
say
a
lot
in
the
public
domain
that
this
is
all
information
which
is
now
public.
So
we
can
repeat
it.
G
But
we
have
teams
on
the
ground
very,
very
good
change.
In
my
view
that
are
leading
this
work,
and
this
week
we've
published
reviews
in
the
park.
Well
and
past
few
days
we
publish
reviews
into
Birmingham
commentary,
and
now
let
me
get
this
year
the
way
around
and
we
publish
some
of
the
reviews
in
Teresa,
six
Plymouth
and
Oxford,
and
we've
got
reviews
which
have
been
underwear
in
Liverpool
this
week,
but
just
completed
burning
and
Coventry
and
Bradford
reviews.
I.
G
A
David
does
some
listening
to
you
talking.
It
just
reinforces
just
how
many
of
our
people
are
doing
some
really
great
things,
and
it
is
just
worth
sort
of
noting
and
thanking
them
here.
I
think
that
the
market
oversight
team
I'm,
like
privy
to
some
of
the
work
they've
been
doing
being
phenomenal
and
what
they
been
doing
recently.
A
The
local
system
reviews
have
been
really
superb
and
the
teams
involving
those
been
been
excellent
and
the
reports
that
were
about
to
publish
long
as
reports
that
we've
been
publishing
over
the
last
few
months
again
are
all
really
good,
so
I
think
just
a
big
thank
you
to
everybody.
That's
involved
in
in
all
of
those,
as
well
as
the
other
activities
that
aren't
in
your
report
today,
but
but
often
arise.
So
anything
anybody
wants
to
raise
in
relation
to
David's
report,
Wow
right
good
so
on.
A
I
You
Peter
in
a
moment
I
that
I'm
Kate
Harrison
Director
of
Finance,
talked
to
the
to
the
budget
over
the
last
quarter
and
my
chief
inspector
colleagues
about
the
the
operational
performance.
Let
me
focus
specifically
on
the
points
around
the
business
plan
and
our
risks,
which
are
included
in
that
in
the
report
in
terms
of
the
deliverables
that
we
set
out
in
the
business
plan
for
2017-18
I'm,
quite
pleased
to
report
that
the
majority
of
them
is
on
track.
I
Secondly,
we've
reviewed
the
current
risks
to
the
organization
and
wider
delivery
and
there's
no
changes
to
the
risks
that
they
set
out
in
the
business
plan.
They're.
Currently,
no
high
risks
listed
and,
finally,
we
continue
to
track
and
monitor
the
progress
that
we're
making
on
any
recommendations
made
by
internal
auditors
through
the
accountability
and
Corporate
Governance
Committee,
which
is
chaired
by
Porou
and
where
we
have
made
progress
and
most
of
these,
but
with
a
focus
on
a
number
of
actions
that
were
flagged
by
internal
or
what
it
is
as
high
priority.
I
But
that,
as
you
can
see
in
the
report,
are
currently
being
action.
So
there's
no
things
or
recommendations
that
we're
not
following
up,
though
there
are
two
or
three
things
where
the
time
it
takes,
for
example,
to
make
some
of
the
changes
to
our
governance
or
the
benefit
realization
simply
takes
time
to
develop
properly,
which
is
why
these
actions
haven't
been
closed,
and
quite
rightly
so,
until
we're
confident.
So
those
were
the
issues
I
wanted
to
highlight.
From
that
perspective,
cash
on
hand
to
you
on
the
budget.
I
J
J
We
are
forecasting
what
we
still
are
forecasting
in
beyond
forty
three,
a
surplus
of
around
ten
point:
two
million-
that's
largely
on
pay,
although
some
still
on
non-paid
you
to
the
continued
drive
of
efficiency
in
the
non
pay
area
and
link
to
that
is
that
we
in
colleagues
in
the
people
directorates,
are
moving
or
have
moved
to
in
all
ways
on
recruitment
model.
So
next
year,
we're
hoping
that
that
will
enable
us
to
have
a
steady
stream
of
people
coming
in
and
that
we're
not
under
spending
on
pay
and
just
to
finish
off
on
that.
F
C
C
J
Don't
think
there
is
an
issue,
I
think
the
the
the
it's
recognition
of
the
fact
that
we
need
to.
We
still
have
a
need
to
reduce
expenditure
next
year
in
year,
so
we
get
down
from.
We
will
have
a
budget
of
223
million
next
year,
the
following
year
we
will
have
a
budget
of
217
million,
and
so
we
still
need
to
take
money
out
of
the
system
and
we
need
to
obviously
achieve
quite
a
lot
of
the
change
as
well
during
that
period
and
investments.
I
think
it's
just
in
recognition
that
when.
C
J
Think
some
of
it
is
that
the
the
pay
and
to
spend
is
very
much
due
to
recruitment
hasn't
gone
as
well
as
it
might
have
done.
We've
heard
that
there
are
timing
issues,
there
has
also
been
spy
usage,
etc
that
we
we
hadn't
hooked
up
with
maybe
over
budgeted
for
in
terms
of
the
non
pay.
I
think
that
is
a
continued
drive
in
terms
of
efficiency,
getting
better
value
out
of
contracts,
keep
their
good
handle
on
what
we're
doing
in
terms
of
travel
and
subsistence,
etc.
So
I
think
it's
a
combination
of
the
two.
F
F
F
The
issue
for
as
I
think
is
that
this
is
activity
that
is
increasing
both
in
terms
of
people
referring
information,
food
to
us
and
those
referrals
being
areas
that
we
got
to
do
work
on.
So
we
are
looking
as
part
of
the
whole
registration
transformation
project,
how
we
can
better
record
what
we're
doing
so
that
we
can
reflect
that,
both
in
our
workforce
planning
and
management
of
the
of
the
activity,
but
also
so
that
we
can
report
that
better
to
the
board
in
terms
of
what
we're
doing
and
what
the
outcomes
are.
A
I
mean:
is
there
also
a
communication
issue
here?
I
mean
they're
both
that
there
are
people
reporting
unregistered
activity,
we're
in
actually
no
registration
is
required,
so
they
were.
They
were
misinformed,
but
I
guess
that
quite
a
lot
of
those
people
who
have
carry
on
services
that
should
have
been
registered
on
to
done
that
in
perfectly
good
faith.
They
just
didn't
realize
that
they
were
doing
the
registered
activity.
So
is
there
a
communication
process?
We
need
to
be
thinking
about
as
well.
There.
F
Colleagues
in
the
Health
Service
and
in
local
government
to
ensure
that
we're
sharing
information
and
sharing
risk
and
all
of
those
kind
of
things
is
a
really
important
part
of
making
sure
that
that
happens
and
and
I
think.
The
other
thing
is
as
being
just
clear,
and
you
know,
work
is
happening
on
what
our
website
looks
like
and
what
information
is
there
being
clear
about
what
is
a
regulated
activity
and
therefore
you
know
what
people
should
be
identifying
as
either
they're
going
to
be
doing
it.
So
they
should
be
registering
with
us
all.
F
F
We
shall
move
on.
Yes,
please,
okay,
so
I
then
wanted
to
move
on
to
inspection,
which
is
paragraph
7
and
slide
10,
and
just
to
highlight
that
we
and
the
kind
of
comes
a
little
bit
to
what
Kate
has
been
saying
about
the
impact
of
our
vacancies
on
the
expenditure
that
we've
had,
but
also,
obviously,
it
impacts
on
our
ability
to
deliver
on
our
activity
and
in
adult
social
care.
F
What
it
should
have
read
at
paragraph
B
is
that
23%
of
4,000
847
good
locations
that
we've
gone
back
to
not
715
I'm,
not
quite
sure
how
715
got
in
there,
because
it's
not
a
figure,
have
a
cogniser
at
all,
but
23%
of
nearly
5,000
good
locations.
We've
returned
to
have
deteriorated.
So
this
starts
to
come
to
John's
question
about
what's
happening
in
out
there
in
the
services
and
what
we
are
seeing
is
a
number
of
things.
F
When
we
go
back
to
requires
improvement
services,
we
see
a
greater
level
of
improvement
because
they
can
go
up
to
good
and
but
we
are
now
going
back
to
a
lot
more
good
services
and
we
are
rating
about
78%
of
services
as
good,
not
as
many
of
those
improve
to
outstanding.
We
are
seeing
some
improvement
to
outstanding,
which
is
fantastic
and
all
due
credit
to
the
providers
who
are
doing
that.
But
we
are
seeing
that
deterioration
and
the
more
good
services
we
go
back
to
them.
F
The
more
deterioration
in
terms
of
numbers
we'll
see
because
of
the
because
of
that
kind
of
quirk
of
the
statistics,
and
but
what
it
does
mean
is
that
we
are
seeing
a
real
challenge
to
sustain
in
good
quality
care
in
adult
social
care,
and
it
means
that
we
have
to
be.
You
know
very
vigilant
and
that's
the
reason
why
our
inspection
program
is
really
focusing
on
making
sure
that
we're
returning
and
to
services
and
well.
We
think
there
are
risks
and
responding
when
those
risks
are
flagged.
Doctor
is
by
others.
F
A
C
F
Management
system
say
actually
they
have
completed
the
mandatory
action.
I've
had
reports
back
of
areas
where
they
were.
They
followed
up
the
safeguarding
alert
with
the
individual,
but
actually
you
needed
more
information,
and
so
it
was
taking
a
longer
time.
So
they
didn't
take
the
box
to
say
that
they
had
actually
followed
it
up
and
passed
it
on
to
the
local
authority,
as
which
is
what
we're
requiring
them
to
do,
and
because
they
were
getting
that
further
information.
F
So
again,
it
went
out
beyond
the
bit
that
I'm,
really
asking
managers
and
teams
to
look
at
is
that
where
inspectors
are
getting
those
notifications
when
they're
out
on
inspection
and
then
they're
coming
back
and
they've
they've
missed
a
day
off
or
two
days
to
be
able
to
respond
to
it.
That
shouldn't
be
happening.
F
We
should
be
having
a
system
which
makes
sure
that,
if
staff
are
on
inspections,
the
notifications
that
are
coming
through,
they
are
getting
picked
up
by
somebody
else,
so
that
we
are
responding
appropriately
and
there
have
been
a
some
areas
where
we've
missed
out
on
that.
So
there's
work.
That's
going
on
at
the
moment
as
a
consequence
of
those
looking
at
this
to
make
sure
that
we're
on
top
of
that
I
mean.
C
M
A
N
Thank
you.
I've
got
a
point
about
whistle
blowing
hi
chocolate
before
that
can
I
have
a
little
bit
of
fun
because
it
is
on
the
health
and
safety
reported
accidents.
What
are
all
these
dangerous
objects?
There's
somebody
crushed
against
object.
Somebody's
struck
by
moving
object,
suddenly
striking
against
stationary
object
and
or
and
there's
a
near,
miss
I.
Just
just
I
got
some
enjoyment
I've
reading
it,
but
I
just
don't
see
some
dangerous
objects
around
the
CQC
world.
But
that's
not
the
point
I
want
to
to
major
on
on
that
whistle
blowing.
N
What
would
it
take
for
the
circle
is
on
page
40.
If
the
accidents
already
on
page
seven
whistle
blowing
trends,
what
would
it
take
for
the
little
gray
circle
to
turn
red
or
green
are
always
simply
just
counting
up
people
who
I
don't
know
I'm
looking
at
Andrea
that
you
may
know
the
answer
list,
what
would
it
take
for
this
or
the
gray
circle,
which
should
either
would
flag
green
or
flag
red?
Is
it
just
a?
Would
it
ever
go
one
way
or
the
other?
I
N
I
Concerns
that
we
receive
so
that's
the
simple
explanation
for
for
that,
so
in
terms
of
it
going
green
or
changing
that
would
be.
Would
we
want
to
be
to
want
to
hold
on
to
have
a
target?
It's
not
a
conversation.
We've
had
personally
I'd
say
we
are
interested
as
many
people
talking
to
us
as
possible,
because
we're
interested
in
everyone
raising
issues
and
concerns
so
highlighting
good
quality
care.
I
I,
wouldn't
want
to
put
a
number
on
that,
because
it'd
be
very
hard
to
say
what
would
be
good
or
what
would
be
bad,
I
think
as
many
people
as
possible,
who
feel
open
to
talk
to
us
because
of
the
huge
value
of
those
conversations
to
us.
That
is
that
it's
the
right
thing.
So
that
explains
why
it's
a
gray
circle
rather
than
greener,.
C
The
vast
majority,
in
terms
of
a
section
that
of
whistleblowing
reports
are
said
to
be
native
for
future
reviews,
could
I
just
suggest
I'm,
certainly
from
the
male
that
ends
up
in
my
inbox.
There
is
a
degree
of
frustration
of
I
think
amongst
those
who
he
communicated
to
us
in
relation
to
what
they
get
fed
back,
which
is
a
standard
for
a
rather
standard
form
letter
which
says
your
information
is
very
important
to
us.
It's
noted
for
future
response
and
I
suspect
a
lot
of
people
aren't
terribly
satisfied
with
that
response.
C
A
Discussed
that
particular
point
before
and
I
think
one
of
the
things
that
we
were
trying
to
do
better
was
to
close
the
loop
when
we
report
so
somebody's
raised
an
issue
with
us.
We
have
taken
it
into
account
in
in
in
an
inspection
and
either
we
were
satisfied.
There
wasn't
an
issue
or
we've
taken
some
action
or
whatever,
but
we
don't
always
reference
in
the
report
that
that
that
was
that
that
information
was
used
so
I
the
selling
when
we
discussed
it
before
there
was
an
intention
to
reference
but
I'm.
A
Jane
is
somebody
who
trips
over
things
from
time
to
time,
I
I,
don't
think
the
necessary
dangerous
state
statute,
as
stationary
objects,
I
think
it's
dangerous
people
walking
around,
but
but
more
seriously,
more
seriously.
Of
course,
this
is
not
just
within
CQC
premises,
I
mean
the
serious
point
is
this:
is
people
fill
out
out
on
inspection
and
some
of
our
people
do
operate
in
environments,
which
you
know
I,
don't
think
are
necessarily
as
safe
as
they
should
be.
From
a
personal
point
of
view,.
M
Chat,
thank
you.
Good
now
go
for
it.
Steve
I'm,
the
whistle
blowing
again,
it's
very
difficult,
sometimes
for
us
to
report
in
reports,
because
if
it's
a
single
handy,
GP
or
dentist
and
the
whistleblowers,
the
only
other
person
working
in
the
the
practice
to
identify
the
information
for
all
whistleblower
helped
actually
identifies
the
person.
So
it's
it's
actually
quite
tricky
in
our
sector
and
we've
certainly
had
some
have
to
be
careful.
What
I
say
some
interesting
cases
where,
where
it
has
helped
us
with
our
judgment
and
III,
will
I
promise.
You
be
brief.
M
Good
news
for
us
is
that
we've
had
full
recruitment
of
all
of
our
staff
for
some
time
now
for
some
months
and
I.
Think
that
has
contributed
to
the
to
the
very
good
showing
in
the
staff
survey
which
is
later
on
the
agenda.
I
do
lead
on
the
local
systems.
Review
I
spend
most
of
my
time
at
the
moment
on
them
and
out,
and
about
and
Andrea
has
been
fantastic
actually
in
providing
support,
particularly
for
one
report
where
I
couldn't
be
involved
myself
because
of
where
I
allegedly
live
and
work.
M
But
the
and
we're
learning
a
lot
but
I
wanted
to
put
it
as
performance
because
it's
not
in
the
performance
chart
but
and
we're
on
target
for
all
of
what
we
set
ourselves
on
the
local
systems
review
both
on
the
report
publication,
as
well
as
the
scheduling
of
the
inspections
which
are
over
a
14
week
period
for
those
new
members
to
the
board.
We
do
have
an
issue
with
perder
and
not
being
able
to
do
some
things
because
of
her
during
the
local
elections,
which
will
push
some
things.
M
We
are
consistently
at
26
days,
which
is
superb,
given
that
their
National
Audit
Office
were
concerned
about
report
publication,
the
KPI
that
we
declare
does
show
us
still
at
a
below
where
we
would
like
to
be
in
this
it's
at
84%.
But
they
are
a
backlog
of
reports
from
before
the
pre
April
period
and
include
a
number
of
reports
which
we
we
publish
as
part
of
the
KPI,
but
are
not
in
our
hands.
These
are
joint
reports
published
with
Ofsted
HMI
prisons
and
HMI
probation.
M
Those
reports
are
part
of
our
target,
but
they're
out
of
our
hands
when
those
reports
published,
but
the
performance
is
really
good
and
the
final
one
and
I'd
like
to
just
mention
is
the
four
quarter
non-compliant
graph,
which
has
improved
a
lot
it
and
shows
on
our
chart,
which
is
see
the
page
now
page,
eight
at
41
that
don't
have
an
inspection.
We've
actually
got
that
down
the
current
data
to
seven,
and
we
do
take
this
extremely
seriously.
The
graph
sort
of
legs
behind
slightly
where
the
work
is.
M
Of
course,
the
the
focus
is
on
the
third
quarter
rather
than
the
fourth-quarter,
because
you
need
to
prevent
them
going
into
the
fourth
quarter,
and
some
of
those
just
like
in
Andrea's,
well
and
Andrea
has
made
excellent
progress
as
well
is
how
people
who
are
non-compliant
in
one
area
and
then
non-compliant
in
another
area
and
they're
different.
One
as
they
go
through,
that's
all
I
wanted
to
say.
Thank
you
thanks.
D
Peter,
thank
you
can
I
just
just
come
back
to
a
couple
of
questions
have
been
raised.
The
whistleblowing
guy
I've
said
here
before
I
want
to
say
again
how
important
whistleblowers
are
to
us
to
identifying
risks
in
services,
and
you
know,
on
a
virtually
weekly
basis,
will
appear
to
an
inspection
schedule
and
we
are
using
whistleblowing
information
for
that.
So
it
is
vitally
important.
D
D
I
hope
they
see
our
reports
when
they
eventually
come
out,
but
of
course
the
reports
often
come
out
a
long
long
time
after
they've
done
that
they've
burned
the
whistle
and
the
reasons
have
Steve
raised
it's
sometimes
difficult
at
the
time
to
link
them
in
because
clearly
there
is
the
danger
they'll
be
identified
if
they
get
linked
in
to
what's
going
on
and
I
think
it
is
a
very
big
challenge
for
an
inspectors
to
make
sure
they
use
that
information
effectively.
But
don't,
if
you
like,
reveal
their
identity.
D
The
Horsell,
blowers
and
I
think
that's
a
big
challenge
for
them
and
they
are
I
think
work
very
hard
at
that.
Can
I
come
back
to
safe
gardeners.
Again
we
do.
We
do
monitor
those
alerts
and
concerns
very
closely
in
the
Directorate.
There
aren't
a
lot
in
hospitals
and
generally
we
are
within
the
KPI,
but
occasionally
we
before
below
it,
and
we
investigate
that
when
it's
occur.
D
The
the
graph
at
the
bottom
bottom
left
on
page
10
shows
that
we
have
to
do
235
units
of
inspection
a
month
and
we
are
achieving
that,
except
perhaps
in
December
when
clearly
this
all
the
time,
but
we're
over
achieving
it
in
January,
January
proved
to
be
a
very
busy
month
and
that's
unit
of
inspection
by
the
ways
is
equivalent
to
a
core
service
in
hospital
inspections.
So
that
is
a
lot
of
inspection
activities.
D
It's
it's
on
average
20
trusts
inspected
every
month
that
we
are
doing,
and
we
are
delivering
on
that
task
at
the
moment.
So
just
tribute
to
the
staff
that
are
doing
that
they're
working
very
hard
and
they
have
to
say,
with
a
new
introduction
of
next
phase,
there
have
been
some
IT
glitches
and
we'll
be
coming
back
to
that
under
the
staff
survey,
I
think
about
some
of
the
frustrations
of
the
IT
glitches,
and
they
have
been
really
managing
that
very
well
indeed
and
get
the
program
going.
So
it's
a
tribute
to
them.
D
The
other
important
aspect
of
what
they're
doing
at
the
moment
is
it
isn't
just
inspecting
it's
also
building
a
new
form
of
relationship
with
providers.
I
said
they
I've
been
on
some
of
the
meetings
with
them
when
they've
been
to
see
providers
as
part
of
the
relationship
management
and
the
feedback
I've
had
from
providers
so
far
has
been
really
very
encouraging.
I
think
they
are
finding
it
very
positive,
the
relationships
that
our
inspectors
are
building
that
and
that
that
makes
up
about
30%
of
their
time.
So
isn't
just
an
adjutant
to
inspection.
D
It's
very
important
part
of
the
regulatory
process
perhaps
go
over
to
the
Hey
next
page
page
11,
where
we
look
at
some
of
the
rating
improvements.
The
the
the
situation
in
hospitals
is
that
there
is
generally
improvement
in
ratings
and
that's
continued
this
year
we
think
think
I've
had
a
figure
I've
got
if
I
had
as
16
hospitals
moved
four,
so
trust
moved
from
requires
improvement
to
good
during
the
financial
year,
and
this
is
in
a
setting
where
those
services
are
durin,
always
pressure
and
I.
D
Think
we
need
to
recognize
the
very
good
work,
that's
being
done
by
services
under
pressure
in
improving
their
improving
their
care.
Having
said
that,
there
are
some
services,
as
we've
deteriorated
as
you'll,
be
aware,
not
not
nearly
as
many
as
have
improved,
but
we
I
think
the
fact
that
there's
some
deterioration
is
a
recognition
of
the
fragility
of
the
improvements
for
services
under
pressure
and
the
need
for
us
to
keep
focus
on
the
risk
out
there
in
the
hospital
sector
and
just
going
over
to
the
next
page
page
13,
terminus
13.
D
We
look
at
timeliness
of
reports.
You'll
see
at
the
bottom
left
that
we
asked
we're
still
not
achieving
the
KPI
consistently,
but
the
median
time
to
report
writing'
is
falling
fairly
consistently
coming
down
and
I.
Think
there's
a
lot
of
hard
work
going
into
turning
around
reports.
There's
a
bit
of
a
backlog
which
I
think
Steve
referred
to
as
well
in
his
sector
and
that
went
to
have
cleared
that
the
KPI
won't
be
reflecting
the
current
activity
as
much
as
we'd
like
it
to.
D
We
are
monitoring
next
phase
inspections
very
carefully
to
make
sure
they're
coming
in
on
time
again.
Some
IT
issues
around
the
data
means
that
we
haven't
got
the
full
data
on
that
yet.
But
the
initial
data
looks
very
encouraging
on
that.
So
I
think
that
will
improve
over
the
next
few
months
and
we
also
doing
some
work
to
make
sure
we
observe
between
independent
health
inspections
and
again
that
that
work
has
improved
a
lot
over
the
last
few
months.
So
that's
all
I
wanted
to
say
any
questions.
K
D
K
A
A
D
I
say
it's
not
just
the
inspections,
it's
the
relationship
between
inspections,
where
we're
trying
to
build
a
really
constructive
relationship
in
those
meetings
between
inspections,
where
we
share
areas
of
concern
with
trusts
and
if
you
like,
work
with
them
to
make
sure
they're
taking
action
on
them
and
I
think
that
that's
proven
very
positive.
For
instance,
a
data
analysis
we
share
now
with
trust
and
I
they're,
finding
it
really
helpful,
I
think
and
identifying
risks
themselves.
A
And
I
think
also
through
that
that
ongoing
dialogue,
our
understanding
of
the
truss
objectives,
aims
issues
and
everything
else
actually
makes
doesn't
probably
change
the
inspection
findings,
but
it
probably
does
Sharpe
and
some
of
the
recommendations
and
makes
them
more
in
the
context
and
therefore
more
helpful
I
don't
know.
I've
just
had
some
sa
positive
feedback.
E
A
specific
I
just
wants
to
ask
about
a
thorough
second
opinion
appointed
doctor
visit.
So
it
looks
like
the
the
the
numbers
are
going
up
and
indeed
exceeding
target
in
relation
to
the
CTOs,
but
there's
still
quite
a
way
off
target
in
relation
to
ect
and
I.
Just
wondered
whether
you're
confident
that
we'll
be
able
to
get
to
that
this.
D
Has
been
a
long-term
problem,
it
is
much
improved.
There
was
a
real
problem
recruiting
these
doctors,
so
we've
changed
some
of
the
remuneration
and
and
the
recruitment
processes
we've
now
recruited
a
lot
more.
So
we
should
be
able
to
improve
on
that
performance
quite
considerably,
but
we
do
need
to
keep
closely
monitoring.
G
They're,
not
necessarily
an
underlying
reflection
of
quality
and
how
we
both
analyze,
that
and
explain
that
publicly,
because
the
risk
is
people
will
see
deterioration
and
think
there
is
an
overall
deterioration
in
quality.
So
I
just
think
we
need
to
be
quite
careful
about
how
we
present
this
I.
Don't
know
whether
this
is
behind
your
question.
So
the
very
end
of
paragraph
eight
I
think
it
is
about
to
go
on
to
just
look
at
some
females
that
was
sent
in
relation
to
this.
Just
to
make
sure
I
get
this
son.
G
Absolutely
right
he's
talking
about
something
we'll
bring
back
at
the
end
of
kurta,
for
when
some
of
that
analysis
has
been
undertaken
because
I
think
is
a
hugely
hugely
important
point,
because
if
we
target
based
on
this
at
the
conversation
we
had
earlier,
you
bias
the
sample
to
it.
So,
if
you're
going
back
to
goods
because
there's
risk
you'll
see
more
deterioration
in
that
and
the
risk
is
that
people
will
go
to
there's
an
overall
deterioration,
and
we
just
need
to
be
careful.
G
G
That's
happening
there
as
well,
so
both
the
snake
and
the
ladder
of
the
rarity
needs
to
be
understood
and
the
risk
is
there's
an
oversimplification
of
what's
happening
because
it's
quite
a
complicated
story
to
tell
and
in
the
please
answer
yes
or
no,
is
this
getting
better
or
worse,
which
is
a
kind
of
question
that
I've
certainly
been
asked
in
formal
committees
of
Parliament's
are
looking
at
Shawn
Linton
that
journalists
would
answer?
Should
there
isn't
a
simple?
Yes,
it
is
a
no
it
isn't.
What's
going
on
here
is
actually
quite
complicated.
G
There
was
a
bit
when
we
were
doing
the
press
stuff
for
the
state
of
care
report
where
people
were
saying.
Please
answer
yes,
you
know.
Is
this
getting
better
or
worse
and
I
said
I'm
not
going
to
answer
that
question,
because
what
we're
doing
is
assessing
something
that
is
very
complicated
and
complex
or
more
tolya
or
assessment,
and
we'll
tell
it
in
a
simple
way,
but
we
will
not
over
reduce
this,
so
it
can
actually
be
misused.
So
what
we're
trying
to
do
is
just
get
a
rich
and
full
understanding
of
the
data.
G
A
C
Just
to
pick
up
a
couple
of
points
on
this,
we
spent
some
time,
beginning
of
the
session
on
the
National
Audit
Office,
very
formally,
study,
which
has
been
published
and
commented
on
in
board
meetings.
Previously
it
was
a
chance
for
us
to
talk
to
the
people,
actually
wrote
it
and
get
behind
the
their
report
on
that
and
get
some
the
sentiments
in
there,
and
there
was
nothing
that
came
out
of
that
discussion.
That
was
not
within
the
report.
C
C
C
A
couple
one
to
pick
out
was
around
the
developing
IT
technology
and
data
areas
of
the
strategy
and
looking
at
the
governance
and
assurance
processes
which
go
with
and
the
agile
approaches
which
are
going
on
in
there
and
a
commitment
by
management
to
come
back
with
how
we
are
flexing
our
assurance
and
our
governance
processes
and
the
right
assurance
process
to
go
with
those
so
that
we
make
sure
that
we
are
on
top
of,
although
making
sure
that
we're
making
the
right
right
progress
there.
Generally.
That
was
so.
A
N
Start
mine
and,
of
course,
liz
is
here
as
well
as
leading
on
a
very
important
piece
of
work
for
us.
So
if
we
can
there,
we
might
do
a
little
bit
of
a
double
act,
will
give
me
some
support
so
HealthWatch
and
HealthWatch
England
health,
local
HealthWatch.
We
have
laid
our
report
before
Parliament
called
speak
up
and
I
think
my
overall
assessment
will
be
that
we
are
in
a
much
much
better
place,
but
there's
still
a
long
way
to
go.
N
I
think
David
was
talking
to
Sir
about
how
CQC
has
got
the
overview
of
the
whole
systems
and
it's
under
and
I
think.
Maybe
you
might
say
that
local
HealthWatch
got
the
under
view.
They
stretch
across.
They
really
gripped
their
local
local
communities.
So
this
report
is
really
a
sort
of
showcase
I.
Think
what
at
the
conclusion
I've
come
to
after
three
years?
Is
that
the
in
a
way
the
strength
of
the
organisation
is
what
is
happening
day-by-day
blow-by-blow
on
the
ground?
N
So
all
those
myriad
of
local
changes
that
the
HealthWatch
are
making
out
there
on
the
ground-
that's
worthy,
that's
where
the
real
impact
of
the
organization
is
and
then
that
then
feeds
into
what
we
can
do
nationally
and
the
secret
of
getting
more
of
a
grip
on
all.
This
has
been
for
us
to
professionalize
and
I.
Think
we
have
done
that
now,
our
own
intelligence
handling,
and
not
only
do
we
are
we
doing
it
in
a
more
professional
way,
but
we're
also.
N
We
have
a
desk
a
support
desk
to
help
local
HealthWatch
with
all
their
research
work.
So
a
really
a
good
growing
picture
still
a
lot
to
do,
and
we
can
talk
about
that
under
the
strategy
but
and
it's
quite
a
big,
but
we
have
been
constantly
bedeviled
by
the
issue
of
local
HealthWatch
funding
and
on
the
second
page
of
report,
you'll
see
we've
we
finally
come
up
with
a
picture
that
really
expresses
this
and
I've
been
asking
for
the.
N
A
N
Know
that
we
work
them
hard,
a
health
hodge,
don't
wait,
I'm
just
talking
about
about
the
funding
and
this
picture,
which
shows
that
originally
40
million
pound
was
provided
to
fund
local
HealthWatch
and
you
can
see
if
it
was
adjusted
for
inflation.
It
be
gently
going
up,
it's
gone
out
through
the
they're
all
Commission's
through
through
local
authorities,
and
that
figure
has
gone
down
now
to
gone
down
after
27
million
and
that
masked
a
huge
variation.
Some
local
HealthWatch
are
getting
the
same
amount.
N
Some
are
getting
a
slightly
more
and
some
have
been
substantially
cut
and
they're
now
down
to
the
level
of
funding
of
the
previous
organization,
which
had
far
less
to
do
with
us,
the
the
the
local
links
so
we've
got
a
little
group.
I've
asked
them
to
look
into
what
exactly
a
where
camp
or
where
the
leave
is.
What
can
we
do
about
this?
You
know
if
anything
that
so
they'll
be
coming
back
to
us
in
March,
because
this
is
now
a
matter
of
urgency.
I'm.
N
Now,
writing
her
had
to
write
letters
to
Staffordshire
little
seems
to
come
back
to
Staffordshire
to
say
that
you
what
they
were
proposing
to
do
was
it
was
ultra
virus.
They
have
come
back
to
say
no,
they
will
they
will
stick
to
their
statutory
requirements.
We've
query
that
I'm
going
to
keep
that
under
strict
review
and
I've
each
year,
I
write
to
the
secretary
of
state
to
give
him
a
rundown
on
local
HealthWatch
on
the
funding
and
we've
told
them.
This
is
me,
oh
really.
N
We
have
reached
a
andrea's
point
tipping
point,
but
this
is
a
very
serious
situation.
So
a
lot
of
good
work
going
on,
but
it's
rather
like
standing
on
the
the
sandy
beach
when
the
one
that,
when
the
waves
come
out
and
feel
this
grains
of
sand
relentlessly
coming
away
from
underneath
your
toes
that
the
money
is
being
pulled
away
and
you
can
understand
it's
your
local
authorities
that
they're
in
a
very
difficult
situation,
but
we
don't
want
to
be
funding.
There
are
other
activities.
N
So
two
other
points
that
I
made
on
this
paper.
One
is:
we've
been
very
I'm
very
pleased
to
refresh
my
committee
I've
gotten
three
or
four
people
who
are
standing
down
at
the
end
of
middle
of
May
we've
just
recruited,
seven
new
members
who
bring
with
them
a
wonderful
cornucopia
of
skills
in
terms
of
consumer
change,
digital
local
healthwatch,
social
care,
public
health,
mental
health,
research
and
the
other.
N
Six
are
quite
good
as
well,
so
we've
got
a
nice
and
I
would
say
a
thank
you,
a
big
THANK
YOU
to
Care
Quality
Commission,
because
the
fact
that
a
lot
of
you
know
the
heavy
lifting
on
governance-
and
you
know
the
running
of
we-
don't
have
to
worry
about
that.
I'm
I'm
able
to
have
a
really
exciting
committee
of
people
who
are
more
expert
advice
for
the
obviously,
yes,
some
governance
responsibilities,
but
it's
it
works,
really
well
format
widely.
So
so.
E
Yes
sure
so,
I've
been
on
the
HealthWatch
England
committee
for
a
little
while
and
we're
just
at
the
very
early
sort
of
scoping
stages,
I
think
just
to
add
to
what
Jane
said
about
the
development
of
HealthWatch
generally
I
think
there's
been
a
welcomed
kind
of
shift
to
doing
more
sort
of
proactive
solutions
focused
work,
so
not
just
what
are
the
public's
experiences
of
services
as
they
are
at
the
moment.
But
how
can
how?
How
can?
E
How
is
the
public
effectively
engaged
in
what
the
new
forms
of
service
may
be,
such
that
you
know
we're
not
just
repeatedly
hearing
about
the
same
issues
about
access
difficulties
or
whatever,
but
actually
looking
at
service
redesigned
new
models
of
care
and
all
those
sorts
of
things
and
some
local
HealthWatch
have
done
very
good
pieces
of
work,
including
in
the
area
of
mental
health,
engaging
for
example,
groups
of
people
who
don't
traditionally
have
a
voice.
So
you
know
things
like
veterans
experiencing
mental
health
difficulties.
E
Deaf
people
experience
a
mental
health
evidence
on
so
pulling
some
of
all
that
together
and
we're
at
the
scoping
stage
in
the
in
the
work
on
mental
health.
So
we're
going
to
be
looking
at
particular
points
in
the
life
course
where
we're
both
getting
high
demand
on
the
issue
from
local
HealthWatch,
but
also
where
we
think
there
are.
You
can
make
an
impact.
It
fits
healthwatches
niche
where
there
is
serious.
E
There
are
serious
issues
for
particular
groups
of
people,
but
particularly
tricky
transition
or
intersection
issues
across
this
across
the
system,
so
very
keen
not
to
duplicate
a
huge
amount
of
work.
That's
been
done
on
mental
health
and
and
it's
being
done
on
mental
health
and
I.
Think
just
also
say
that
it's
very
I
think
it's
been
very
good
to
see
how
HealthWatch
and
HealthWatch
England
and
CQC
have
been
working
together
and
will
do
so
on
this
area.
A
E
You
very
much
you
had
in
your
papers
a
summary
of
our
our
strategy.
It
is
here
for
you
to
endorse
it's
already
been
through
HealthWatch
committee
who
have
approved
it.
If
I
take
you
on
to
the
first
slide.
It
just
takes
you
quickly
through
the
process
that
we've
been
through
in
order
to
arrive
at
our
strategy.
We
did
a
very
thorough
piece
of
consultation
work
both
with
the
network
and
with
key
stakeholders
right
across
the
sector.
E
So
when
we
talk
about
you,
we
mean
we
mean
the
individuals
and
we
also
mean
local
HealthWatch.
So
our
strategy,
in
brief,
is
then
to
ensure
that
views
your
views
are
used
to
help
improve
health
and
social
care.
So
we
got
to
have
that
impact
we
we
want
to
have
more
people
having
their
say,
and
at
the
end
of
that,
we
want
to
make
sure
that
you
have
high
quality.
You
experience
high
quality
health
and
social
care
services.
E
E
We
will
be
doing
significant
amount
of
work
on
identifying
people
who
are
at
least
heard
within
the
system
and
making
sure
that
we
get
their
voices
heard,
we'll
be
providing
information
directly
to
the
public
to
help
them
act
on
improving
health
and
social
care,
and
we'll
be
looking
at
the
use
of
partnerships
right
across
the
board
to
make
sure
that
we
can
deliver
within.
We
have
our
resources,
but
actually
there
are
far
more
resources
out
there.
E
If
we
think
about
the
whole
community
of
organisations
that
are
there
to
improve
people's
health
and
social
care,
our
goal
by
2023
is
that
we'll
have
over
a
million
people
sharing
their
views
with
HealthWatch
England
I
know
that
you'll
think
that's
not
a
very
big
number,
but
we've
done
a
lot
of
thinking
behind
the
scenes
about
how
we
arrive
at
that
number.
We're
currently
about
360,000
and
we're
looking
at
what
what
what
did
this
date?
E
What
does
the
data
tell
us
about
how
likely
it
is
that
the
public
are
to
share
information,
and
so
we'll
have
a
stepping
stone
to
get
us
there.
We
also
have
to
put
that,
within
the
back
drop
of
the
reduction
in
funds
to
lots
of
the
local
HealthWatch,
who
are
the
main
contributors
of
the
data,
though
we
will
be
going
directly
to
the
public
ourselves.
E
Our
final
objective,
then,
is
to
ensure
that
your
fuze
help
improve
health
and
social
care.
So
that's
the
gathering
information
from
the
public
gathering
it
through
local
HealthWatch
and
then
ensuring
that
that
has
a
big
impact
on
improving
the
design
and
delivery
of
health
and
social
care
across
at
a
local
and
national
level,
and
success
for
us
in
this
field
will
be
that
twice
as
many
of
our
recommendations
that
are
made
at
a
local
or
a
national
level
are
implemented
by
the
services
that
we
make.
E
Those
recommendations
to
what
we
have
done
in
your
packet
as
well
is
that
you
have
a
top-line
one-page
summary
that
describes
what
we
will
be
doing
across
the
next
five
years.
Where
we
are
at
the
moment
is,
as
I
say,
it's
been
approved
by
HealthWatch
committee.
We
are
working
on
the
detailed
business
implementation
plan,
which
will
come
back
to
your
committee,
I
think
in
April
or
May
I
think
it's
in
May.
So
that's
a
quick
drop
through
new
organizational
strategy.
K
Questions
or
comments
from
anybody,
john
less,
on
the
strategy,
which
I
like
also
the
presentation
of
it.
Thank
you
but
more
on
the
activity
to
deliver
on
it
and
in
particularly
ensure
your
views,
help
improve
health
and
care.
I
just
wondered
if
HealthWatch
is
using
its
network
to
get
actively
involved
in
the
what
matters
to
you
day
or
have
you
know
about
good.
K
But
you
can
I
just
described
what
it
is
if
some
of
you
started
up
in
Norway
in
2014,
and
it's
about
getting
a
whole
series
of
clinical
professionals
on
one
day
of
the
year
to
instead
of
asking
what
what
is
the
matter
with
you
ask
what
matters
to
you.
Yes,.
G
K
G
K
Much
bigger
deal
up
in
Scotland,
where
is
massive,
but
he
struck
me.
That
is
the
sort
of
simple
question
that,
if
the
ever
massive
clinicians
on
that
day
and
it's
June,
the
fourth
or
sixth
I-
think
ask
people,
but
instead
of
it
being
a
push
down
onto
clinicians,
equally
HealthWatch
could
create
a
poll.
Yes.
G
K
Q
F
I
did
a
word
search
and
it
and
actually
I,
think
you
understand
yourself
frankly,
because
the
work
that
you
are
doing
together
with
the
local
government
and
Social
Care
Ombudsman
on
the
priority
action
number
one
in
quality
matters,
is
really
very
important,
which
is
about
creating
a
much
easier
way
for
people
to
understand
what
complaints
in
and
social
care
and
system
is,
is
and
being
able
to
access
it.
So
I
just
wondered
how
and
also
that's
the
specific
area
that
I'm
interested
in
some
senses.
F
It
links
to
what
John
said,
which
is
how
how
is
HealthWatch
kind
of
connecting
and
making
the
most
of
those
other
other
things
that
are
happening
across
health
and
social
care.
That
can
make
a
difference,
particularly
as
Jane
is
highlighting
the
pressures
on
resources,
so
kind
of
you
know
creating
something.
That's
more
than
the
sum
of
its
parts
is
is
is
part
of
the
strategy.
I
would
have
thought
so
just
to
really
kind
of
link
those
things.
Those
thoughts
together,
Thank.
E
You
Andrea,
the
the
downside
of
reducing
it
to
one
side
of
a
form
is
that
you
lose
the
activities
that
will
take
place.
One
of
the
things
that
we're
very
clear
about
is
that
partnership
will
be
the
major
way
of
delivering
a
lot
of
this
and
therefore
quality
matters
as
a
partnership
initiative
will
be
a
high
priority.
So
I
think
once
you
get
to
the
business
plan
that
lays
out
the
activities
it
will
appear
in
there.
Okay,
Walter.
I
As
you
mentioned,
digital
and
investing
in
a
unified
system
together,
understand
and
share
people's
view
of
care
and
I'd
be
interested
to
hear
a
bit
more.
What
your
plans
are
on
that,
if
you
say
that
the
very
beginning
of
the
plan,
because
you
just
pop
putting
out
the
strategy,
then
that's
totally
fine.
Okay,.
E
So
we're
looking
to
see
how
we
can
create
some
generates
data
information
here
and
then
syndicate
it
out
to
the
152
HealthWatch,
so
that
they're
getting
quality
information
out
at
a
local
level
and
we're
also
getting
it
back
so
we're
in
the
early
stages
of
doing
the
requirements
around
that.
But
that's
one
of
our
aims.
The
set.
E
The
first
point
you
made,
which
was
about
professionals,
professionals
attitude,
will
in
the
scoping
of
the
strategy
we
went
out
and
spoke
to
lots
of
the
professional
organizations,
Royal
Colleges
professional
bodies
and
and
they
are
keen
to
work
with
us
again.
This
is
part
of
the
partnership
piece
to
help
their
membership.
Understand
why
it's
important
to
put
people's
views
at
the
heart
of
what
they
do
and
so
again
in
the
you
think
about
the
first
year
of
the
strategy
been
very
much
a
transition.
E
E
D
D
D
The
the
NHS
and
health
services
need
to
go
through
a
lot
of
change
to
meet
the
needs
of
the
changing
population,
and
is
there
a
way
in
which
and
I
think
it's
a
big
challenge
for
people,
because
people
always
worry
about
change.
So
it's
the
way
in
which
you
can
help
people
understand
the
change
you
contribute
constructively
to
it,
rather
than
just
if
you
like,
feel
worried
by
the
change,
because
I
mean
I
think
interacting
with
patient
groups.
D
Sometimes
there
is
a
great
fear
of
change
when
in
fact,
change
is
necessary
for
their
for
their
well-being.
Also,
the
professionals
think
and-
and
we
just
don't
get-
that
kind
of
positive
interaction
of
everyone
working
together
to
build
the
best.
Is
there
a
role
for
HealthWatch
in
that
it's
always
there,
a
bigger
role
for
health,
watching
that.
N
What
would
a
good
service
look
like
for
you,
at
which
point
they
start
to
come
up
with
some
really
useful
and
have
so
Richard
information?
So
that
is
exactly
the
area
we
hope
to
mainly
be
in,
although
obviously
we
do
just
take
in
stuff
on
the
spectrum,
whatever
anybody
wants
to
tell
us
which
could
be.
My
doctor
was
really
brilliant
because
it's
on
how's
it
quite
often
it's
things
that
are
really
complementary
to
that
service
was
really
difficult
and
it
didn't
work
for
me
at
all.
E
E
So
if,
for
example,
there
is
discussions
going
on
locally
about
Annie
or
or
stroke
services,
then
within
this
library
of
information
we
will
have
worked
with
the
college
of
emergency
doctors
or
the
or
the
Stroke
Association
to
have
have
think
you
have
resources
there
for
local
HealthWatch
to
say,
okay,
what
does
good
look
like
and
then
they
can
hold
the
ring
about?
What
does
good
look
like,
rather
than
be
battered
by
the
public
or
battered
by
the
professionals
and
I?
A
Excellent,
thank
you
very
much.
Mulder
and
Jane.
Thanks
to
your
colleagues
for
all
your
doing,
things
lives
as
well,
for
what
you're
doing
there
it's
great
and
you
asked
us
to
endorse
the
strategy.
Are
we
happy
to
endorse
the
strategy?
Anything
on
a
page
gets
endorsement
here
there
you
go
thanks,
Andrew
Hoda,
good
right,
so
we
need
to
move
on
to
the
staff
survey
and
we're
running
ahead
of
time.
So
we
we
may
not
have
the
key
people.
G
A
A
A
A
H
Thank
you
very
much
for
the
opportunity
to
address
really
the
the
results.
From
now
the
2017
staff
survey.
You
will
see
from
the
paper
that
there's
was
a
lot
to
say
and
we've
reflected
I'm
not
going
to
go
verbatim
through
the
paper,
but
there
was
just
a
few
comments.
This
erm
I
wanted
to
kind
of
pull
out
that
we've
made
reference
in
there.
That's.
There
was
quite
a
lot
of
results
that
were
static
and
when
you
look
at
an
overall
level,
it
appears
that
we
haven't
really
moved
on
year-on-year.
H
In
fact,
the
the
biggest
improvement
growing
questions
that
have
gone
up
by
about
three
percent,
so
a
near
fall
is
have
got
fallen
by
between
seven
and
ten
percent.
So
the
most
important
thing
to
note
when
we've
crafted
the
paper-
and
our
response
was
about
looking
at
the
variance
within
that.
So
so
there
are
questions
around
health
and
well-being
and
around
work-life
balance
that
have
a
high
degree
of
variants
that
have
in
increased
rather
than
decreased
year-on-year.
H
So
their
variance
within
the
schools
of
health
and
well-being
between
the
highest
performing
team
and
the
lowest
before
Patrol
performing
team
is
77
percent.
So
we've
really
got
a
lot
of
learning
that
we
can
do
within
the
organisation
that
about
how
we
are
managing
this
well
for
some
staff
and
not
well
for
others,
and
that
has
increased
that
variance
over
the
course
of
the
year,
which
means
that
we
also
have
made
a
difference
within
a
year
in
some
places,
which
is
important
learning
for
us.
It's
also
important
just
to
recognize
that's.
H
My
final
comment
is
that
we
did
a
lot
of
work
last
year
on
shaping
our
future,
where
we
got
a
lot
of
the
views
of
staff
about
why
they
would
be
excited
to
work
in
CQC
and
what
it
felt
like
to
be
part
of
CQC
and
building
on
the
work
that
we
did
a
few
years
ago
on
values
which
still
remains
one
of
our
strongest
results.
In
the
staff
survey.
H
People
said
that
they
felt
it
most
excited
when
they
were
recognized,
autonomous,
connected
supported,
knowledgeable
and
curious,
and
if
we
focus
on
those
six
areas
of
six
feelings
within
staff
and
kind
of
focus
on
developing
those,
then
over
the
course
of
the
next
year.
We
will
see
incremental
improvements
in
the
areas
that
we
perceive
to
be
stubborn
and
building
on
the
work
that
the
inspire
program
has
done
and
enabling
a
kind
of
positive
conversation
rather
than
a
negative
conversation
about
those
areas
of
learning.
A
Mean
it
just
seemed
to
me
that
this
is
a
mixture
of
really
good
news,
and
we
should
celebrate
that
and
not
really
bad
news,
but
some
areas
where
we
really
have
got
to
sort
something
out.
We
want
to
be
a
great
place
for
people
to
work
and
we
are
in
some
respects
and
we
clearly
are
falling
short
in
others.
So
I
mean
a
lot
of
the
focus,
Ruth,
I,
guess
and
colleagues
going
forward.
A
There's
got
to
be,
as,
as
you
were
saying,
I
mean
maintain
the
good
things,
but
actually
then
then
really
make
a
difference
on
the
things
where
people
are
not
happy
and
that's
as
I
read
it
very
much
what
you've
got
in
terms
of
your
your
you're
sort
of
recommendations
going
forward
yeah
David.
Do
you
want
to
say.
G
Anything
so
I
think
he's
I.
Could
it
would
continue
to
do
this
and
make
it
public
I?
Think
because
Ruth
has
said,
it's
been
pretty
static,
it's
been
about,
he's
been
64-62
and
around
that
area,
but
these
have
not
been
improving
scores
and
I.
Think
the
key
point
is
Ruth
called
out.
Helen
pulled
out
to
focus
on
is
this
issue
about
variation?
Part
of
the
answer
is,
within
the
organisation
at
70,
odd
percent
variation
between
teams
at
highly
performing
and
others
gives
us.
Those
high-performing
teams
give
those
a
clue
about
what
it
is.
G
That's
required
and
I
think
the
way
this
has
been
broken
down
to
look
at
issues
which
are
effectively
about
how
staff
feel
valued
and
supported
these
issues
around.
We
touched
in
the
performance
reports
about
what
about
people
feeling
that
there
work-life
balance
is
completely
out
of
kilter,
but
it's
important
stuff
around
just
attending
to
people's
well-being.
This
issue
about,
if
you,
if
you
feel
your
work-life
balance,
is
out,
you
don't
feel
in
control
of
your
work.
Lord,
that's
where
stress
and
anxiety
comes
in
and
beginning,
then
so
actually
address
the
work.
G
Lord
should
be
leading
in
its
own
right
to
addressing
those
feelings
being
feeling
out
of
control.
I
know
when
my
stress
and
anxiety
levels
are
up.
It's
when
I
feel
a
bit
out
of
control.
There's
things
happening
around
me
that
I
can't
I
can't
get
traction
on
and
purpose
on,
so
I
think
at
first
chunk
of
work
about
supporting
well-being,
and
so
the
point
I
think
Steve
mentioned
this
earlier
about
just
the
effort
that
primary
medical
services
Directorate
have
put
into
a
focus
on
well-being.
G
It's
pretty
clear
to
me,
and
Steve
has
made
this
point
on
a
number
of
occasions
that
the
improvements
that
we've
seen
in
the
staff
survey
around
PMS
or
in
in
my
mind,
no
doubt
due
to
being
fully
staffed
work-life
balance,
is
probably
slightly
better
and
but
there
has
been
an
attention
to
people's
mental
well-being.
I've
been
to
team
meetings
just
recently,
the
dental
team,
we're
part
of
their
conversation
was
about
mental
well-being.
So
how
can
we
do
a
bit
more
of
what
some
teams
are
doing?
G
It's
not
say,
other
teams
have
been
getting
it
wrong,
but
we
talked
earlier
with
Keith
Conrad
about
how
you
can
spread
learning,
and
it
seems
to
me
that
this
is
one
of
the
things
that
we
need
to
do:
I
think
the
equipment
and
technology.
This
is
why
Helen
I
think
was
dodging
some
of
the
bullets
in
relation
to
this
and.
G
Her
friends
with
her
but
she's
absolutely
right.
This
issue
about
whether
our
technological
platform
has
been
supportive
of
people
has
been
stubbornly
resistant
there.
The
words
that
I
would
use
for
five
years
now
and
we've
not
shifted
these.
We
had
a
really
good
goal,
I
think
earlier,
with
Helen
in
the
seminar
about
the
potential
for
data
and
it's
used
to
helpers,
but
how
critical
our
ability
to
do
that
is
dependent
on
changing
some
of
the
platforms
were
on
I.
G
Think
the
good
news
is:
we've
agreed
the
priorities
for
that
we're
beginning
to
invest
in
that
they're.
Not
so
good
news
is
that's
going
to
take
two
or
three
years
to
see
through
so
there's
a
sense
of
we'd
need
to
be
patient
about
some
of
those
things,
but
continue
to
be
focused.
The
other
stuff
that's
been
stubbornly
resistant
has
been
communication
and
change
where
our
staff
don't
feel
we
communicate
well
and
don't
feel
that
change
is
managed
well
and
when
we've
compared
that
against
other
benchmark
organizations.
That
again
shows
what
we
need
to
do
so.
G
There's
work
going
on
by
internal
comms
colleagues
about
how
we
can
actually
just
reflect
and
think
differently
about
how
we
can
do
communication
I.
Think
we've
done
a
lot
of
work
on.
Can
we
engage
people
more
in
know
what
the
changes
were,
making?
There's
no
external
pressure
now
on
us
changing
there's!
No
there's
no
program
needs
to
be
completed
by
your
dates.
G
We've
got
through
that
period.
My
personal
view
on
this
Peter
is
that
I
think
there
is
a
lot
of
communication
in
the
organization,
our
thinking
some
areas
we
almost
over
communicate.
There
can
be
Friday's
when
my
message,
the
chief
inspectors
message
repeat
the
same
thing
and
that's
an
issue
that
needs
to
be
sorted
out,
but
then
there
are
other
things
where
people
feel
they
don't
know.
What's
going
on,
and
my
personal
view
is,
this
is
less
about
communication
and
more
about
whether
people
feel
they're
engaged
in
the
changes
that
are
taking
place.
G
It's
things
are
being
done
to
us,
rather
than
we
are
involved
in
shaping
those
things.
So
I
think
well.
Helen
and
the
team
have
pulled
out
are
some
important
actions
which
are
taking
place,
which
will
allow
us
to
I
believe
net
progress
under
those
three
big
headings,
but
also
paying
particular
attention
to
some
things
that
we've
also
discussed
they're.
G
A
lot
of
the
analysis
went
and
sat
on
the
back
role
is
because
he's
very
shy,
he's
Paul,
but
has
done
a
fantastic
job
for
us
in
getting
under
this
and
they've
been
good
conversations
across
the
organization,
so
I
think
we
were
well
placed
really
to
actually
push
on
this.
We
have
already
published
the
raw
results
on
this,
but
this
we
said
we'd
bring
back
the
actions
that
we
were
putting
in
place.
So
I
think
what
will
be
helpful,
particularly
from
non-executive
to
director.
G
Colleagues,
is
whether
you
think
we've
pulled
out
the
right
issues
and
we've
got
the
right
actions
here:
the
executive
team,
about
a
good
goal
of
this
Alan
and
an
attained
about
a
good
goal.
I
just
want
to
echo
the
point.
This
is
an
Helen's
job
to
get
this
sorted,
its
senior
leadership
teams
and
managers
within
the
organization
to
get
this
sorted
and
it's
a
hugely
important
issue.
I
think
our
future
success
is
predicated
on
how
well
engaged
our
stuff.
G
That's
the
level
that
we
take
to
NHS
trust,
social
care
and
PMS
organizations,
and
it's
absolutely
right.
That's
the
level
would
say
to
the
way
that
we
operate
as
well,
but
I
do
want
to
say
this.
There
are
other
organizations
would
die
for
ninety
four
percent,
positive
on
our
direction
or
purpose
or
values
in
the
way
that
we
operate.
G
There
is
a
fantastically
strong
and
good
story
to
tell
in
this
and
by
looking
at
what
we
need
to
improve,
we
shouldn't
in
any
way
a
diluted
diminish
what
is
a
fantastic,
fantastic
set
of
data
in
relation
to
what
we're
doing
well,
and
that
echoes
the
point
that
you
were
making
so
I'm.
Sorry,
if
I've
repeated
what
Helens
already
said,
but
I
just
I
often
think
this
is
my
my
as
chief
executive
single
most
important
performance
indicator
is
the
staff
survey
and
so.
M
M
Despite
the
fact
is
the
busiest
time
we've
ever
had,
despite
the
fact,
we
were
working
under
extreme
pressure
to
deliver
a
series
of
programs
and
what
we
were
doing
this
started
about
three
years
ago,
where
we
started
to
focus
on
this.
This
isn't
a
last
year's
plan
in
order
to
improve
results
in
a
in
a
survey,
no
matter
how
important
the
survey
might
be.
M
So
it's
it's
about
encouraging
people
as
well
as
ensuring
performance
is
there
we
have
in
the
last
12
18
months,
though,
I
spend
quite
a
lot
of
time
on
on
well-being
and
we
do
have
the
benefit
in
being
PMS.
Is
it's
not
about
general
practice?
It's
we've
got
lots
of
individual
teams
doing
really
focused
work
within
it
and
the
best
feedback
we
get
are
in
our
smaller
teams
focused
on
clear
objectives
such
as
the
prison
work.
We
do
the
child
safeguarding
work.
M
We
do
the
medicines
optimization
work,
so
what
we
did
was
look
at
what
was
going
well
with
those
teams
and
try
and
roll
that
out
as
well.
We
introduced
a
a
marker
for
for
this
area
of
well-being
in
our
performance
management,
so
that
everybody
was
encouraged
to
look
and
what
we're
looking
at
now
is
the
enrichment
to
the
roles
and
the
feedback
they're
coming
which
isn't
in
in
any
survey.
M
But
the
feedback
is
our
staff
like
working
with
people
in
other
directorates
across
CQC
and
when
they've
got
the
opportunity
to
work
in
cross
Directorate
work
with
the
clear
objective
that
they're
working
to
improve
the
care
of
people,
whether
that's
in
PMS,
hospitals
or
prime
or
and
adult
social
care.
That
comes
back
as
a
very
positive
thing
for
them,
which
supports
the
director
of
travel
to
much
more
cross
CQC.
D
E
Thank
you.
Yes,
oh
deco,
David's
last
point
I
mean
I've
known
organizations
where
you've
got
low
scores
even
on
whether
people
understand
the
purpose
on
the
values
of
the
organisation.
So
I
think
this
level
of
commitment
is
to
the
valuation.
Puppet
is
really
to
be
strongly
noted.
Really,
you
mentioned
the
variation
by
team.
I
just
wanted.
E
Has
the
data
been
cut
in
other
ways?
I
mean
I'm
thinking
about?
Are
there
big
differences
but,
for
instance,
between
more
junior
and
more
senior
staff
or
according
to
different
equality
characteristics?
So
I'd
just
be
interested
to
know
that,
whether
there's
any
anything
else
lurking
in
the
data
that
needs
to
be
sort
of
attended
to
have
particular
groups
of
people
and
I
suppose
the
other
thing
was.
What
came
out
to
me
particularly
strongly.
E
Was
this
point
about
whether
people
have
a
say
and
a
voice,
and
and
your
point
Steve
that
sometimes
even
when
workload
is
high,
if
you
feel
you've
got
that
say
in
some
sense
of
control,
you
can
still
have
sort
of
decent
well-being
and
and
I
just
wondered
whether
there
are
sort
of
how
that
how
that's
going
to
be
kind
of
mainstreamed
into
business
as
usual,
so
I
know,
there's
a
Leadership
Program
going
on,
for
example.
So
as
well
as
sort
of
you
know,
initiative
that
comes
out
of
this
staff
survey.
E
Is
there
any
other
ways
in
real
business
as
usual
activities
that
that
key
point
about
people
having
a
voice
and
a
say
and
being
able
to
come
up
with
solutions
and
having
autonomy
appropriately
can
be
just
really
really
sort
of
built
into
that?
And
my
final
question
is
just
there's
obviously
workload
issues
and
we
know
in
adult
social
care,
for
example.
How
confident
are
we
that
we're
on
track
to
get
those
right
across
the
organization?
Because
there's
difference
is
there
in
terms
of
so.
G
H
H
H
There's
not
a
consistent
message
about
grades
lower
down
the
organization
versus
grades
higher
up
the
organization
feel
differently.
You
cut
the
data
in
different
different
ways.
You
would
get
a
different,
so
certainly
at
a
senior
level,
they
there
is
marginal
difference
about
how
they
feel
attached
to
the
purpose,
but
you
would
expect
that
and
other
people
more
lower
down
the
organization
feel
a
great
sense
of
well-being,
but
there
so
there's
learning
to
be
had,
but
there
certainly
wasn't
enough
of
a
difference
to
pull
them
out.
Sit
in
that
paper
here,
but
them.
R
Say
in
a
voice
in
the
in
the
way
people
work
and
and
what
they
do
is
absolutely
essential,
and
that
is
a
critical
part
of
the
work
that
we're
doing
around
quality
improvement
within
the
organization
so
leading
on
from
the
in
really
large
investment
that
we've
made
in
developing
leaders
within
the
organization.
The
next
stage
is
around
developing
quality
improvement
capabilities
and
that
will
be
done
across
the
whole
of
the
organization.
R
That's
been
taken
forward
alongside
this,
whilst
we
bring
in
some
partners
to
work
on
us
work
with
us
on
this
and
and
the
excitement
that
generates
within
those
teams
that
are
taking
forward
some
of
these
quality
improvement
and
tests
and
pilots,
and
it's
just
really
exciting,
to
see
any
is
fabulous
to
say.
Her
staff
respondent
when
given
the
opportunity
to
have
a
real
snag.
G
So
I
think
your
question
so
I
think
this
having
you
say
and
then
there's
feeling,
listen
to
and
I
think
what
the
staff
survey
is
shouting
at
is
on
is
feeling
listened
to,
not
having
to
say
so,
I
think
that's
the
trick
so
on
the
equipment
there'll
be
new
equipment
made
available
to
people
which
is
an
endeavor
to
address
immediately
some
of
the
issues
about
equipment,
albeit
that
some
of
the
underpinning
systems
will
take
a
couple
of
years
to
actually
introduce
themselves.
So
it's
just
trying
to
get
that
back.
G
The
other
thing
I'd
say
to
your
question:
Liz,
which
have
to
say
it's
very
opposite,
is
I.
Think
part
of
the
variation,
particularly
in
teams,
is
feeding
back
whether
people
feel
that
they
can
both
have
their
say
and
the
I
listen
to
immediately
and
I.
Think
that's
one
of
the
issues
why
we
need
to
look
at
those
higher
performing
if
I
can
do
that.
In
that
way,
higher
performing
teams
from
the
other
teams
is.
G
Are
there
some
things
just
getting
this
balance
between
letting
people
have
to
say
and
listening
to
them
and
then
doing
something
about
those
issues
losing
with
it
within
the
local
control
and
I?
Think
there
is
some
evidence
that
some
teams
have
a
better
culture
and
tradition
of
both
raising
these
issues,
supporting
each
other
and
address
in
which
attends
been
to
people's
well-being
and
actually
having
a
vacancy.
It
doesn't
explain
that
there's
something
about
the
leadership,
the
culture
of
those
teams
and
I.
G
Think
that
comes
through
this
as
well,
which
is
why
I
think
part
of
the
answer
is
within
the
organization
not
outside
of
the
organization.
I.
Think
the
other
bit
that
I
would
pull
out
is
I,
don't
know
a
home-based
workforce
as
big
as
ours
that
then
gets
people
working
in
teams.
So
again,
how
do
you,
who
do
you
look
to
and
who
do
we
reach
for
to
get
those
benchmarks
of
how
we
take
this
forward?
And
that's
not
it's
not
an
excuse.
That's
a
challenge.
G
We've
got
I
think
as
an
organization
about
how
do
you
create
that
sense
of
identity
where
you
write
the
work
on
purpose
and
values
is
hugely
hugely
important,
but
how
do
you
feel
connected
if
you're
working
on
a
big
Hospital
inspection,
you're
part
of
the
team
of
another
ten
people?
Now
you
feel
connected
if
you're,
a
single
inspect,
to
do
in
a
three
bedded
care
home
for
people
with
autism
and
you're?
Doing
that
by
yourself?
G
Do
you
feel
is
connected,
so
there
are
some
really
important
issues
that
need
to
be
teased
out
one's,
not
right
someone's
wrong,
but
that
is
a
sense
of
the
challenge
and
I.
Think
that's
why
some
of
this
stuff
has
been
resistant.
It's
not
that
people
haven't
wanted
to
get
this
right.
I,
don't
believe
anybody
in
CQ,
so
he
gets
up
to
do
a
bad
days
work.
But
there
are
some
really
tricky
issues.
We're
trying
to
do
and.
F
In
some
senses,
although
in
fact,
some
of
the
issue
of
variation
kind
of
applies
in
to
Apple
social
care
quite
significantly
and
and
registration,
so
I
wanted
to
pick
up
the
point
about
people
feeling
that
they've
had
to
say
had
a
voice.
I
absolutely
agree
with
David.
It's
also
about
whether
they
feel
that
they've
been
listened
to
and
responded
to.
F
And
you
know
there
is
quite
a
lot
of
work
and
it
goes
on
in
all
of
the
directorates
around
internal
co-production
and
people
being
engaged
in
the
development
of
their
areas
of
interest,
using
their
expertise
to
apply
across
and
understanding
some
of
the
kind
of
solutions
that
staff
have
got
to
the
some
of
the
problems
that
we've
got.
One
of
the
things
I,
don't
think
that
we've
done
as
well
as
we
could
have
done
is
actually
share
back
with
people.
F
When
that
has
shaped
the
solution-
and
you
know,
I
managed
a
thousand
people,
a
thousand
people
I'm
not
going
to
be
involved
in
every
single
decision
that
we
make
in
adult
social
care
somebody
will
have
been,
but
how
have
we
kind
of
shared
with
them?
But
that's
actually.
How
had
the
decisions
that
we've
made
have
been
shaped
so
I
think
there's
something
really
important
for
us
about
kind
of
completing
that
loop
and
it
goes
back
point
Robert
was
making
earlier.
F
People
are
bringing
information
into
its
from
the
outside
and
we
don't
complete
the
loop
it
makes
them
feel
dissatisfied
exactly
the
same
thing
happens
to
is
internally
as
well,
so
I
think
that
that's
a
big
message
for
us.
The
second
one
is
around
sorting
out
some
of
those
problematic
issues
and
really
understanding
how
that
plays
out
in
an
organization
that
runs,
as
David
is
quite
rightly
said,
with
over
sixty
percent
of
our
staff
living
at
home
working
from
home.
F
They
really
really
want
to
get
it
right,
and
then
your
computer
breaks
down
or
you
don't
have
a
printer
or
whatever
it
may
be.
Actually,
if
that
happens
to
me
here,
I
go
around
the
office.
I
kick
a
few
things.
You
know
somebody
makes
me
a
cup
of
tea
and
I
feel
an
awful
lot
better.
That's
really
quite
difficult
to
do.
If
the
only
thing
you
can
kick
is
your
cat,
so
you
know
we've
got
to
kind
of
think
and
what
advocating
people
kicking
cats
just
in
case?
F
Anybody
wants
to
suggest
that,
but
you
it
is.
We
have
to
think
about
how
we
support
people
in
that
environment
and
then
last
but
not
least,
is
the
thing
about
workload,
and
we
have
really
tried
to
address
that
both
in
terms
of
the
work
that
Ruth
and
her
team
are
doing
to
support
us
on
always
on
recruitment.
So
we're
in
at
NU
we're
planning
in
advance.
I
mean
I've
got
a
lot
of
people
who
will
be
retiring
this
year.
F
You
know
absolutely
making
sure
that
we're
not
waiting
until
they've
walked
off
the
premises
before
we
start
recruiting,
because
we
know
that's
going
to
happen,
so
you
know
actually
making
sure
that
we're
doing
that
in
advance.
Looking
at
the
investment
that
we're
making
next
year
to
make
sure
that
we
are
recruiting
to
that,
but
also
thinking
about
the
skill
of
our
staff,
because
we
have
had
some
difficulties
in
recruiting
the
people
that
we
need
to
be
inspectors.
F
How
do
we
grow
our
own
by
recruiting
people
who
can
be
assistant
inspectors
so
that
we
can
develop
them
and
and
use
them
in
the
future?
I'm
not
saying
that
we've
got
this
cracked,
yet
I
really
wouldn't
want
to
make
that
claim,
but
I
think
that
there's
a
good
understanding,
a
good
recognition
of
what
those
issues
are
and
real
commitment
from
the
managers
throughout
the
organization
then
across
into
the
other
directorates,
who
are
working
with
us
to
try
and
address
it.
C
Very
brief,
because
we
covered
the
the
business
about
home,
working
and
and
a
very
valid
point.
It
seems
to
me
that
we
know
necessarily
you
need
to
put
almost
unit
and
I
wonder
whether
it
would
not
be
helpful
if
only
recognition
of
the
huge
contribution
that
the
home
work
has
made
to
what
we
do
and
to
the
public.
C
Generally,
we
couldn't
perhaps
have
a
seminar
or
a
session
with
the
board
about
that
specific
issue
about
what
it
is,
the
we
as
an
organization
are
doing
in
relation
to
the
well-being
and
so
on
of
the
of
our
home
workers.
The
only
reference
in
this
document-
it's
not
a
criticism-
is
good
news.
They're
going
to
get
high-speed
broadband
today,
hallelujah
Cooke.
Could
we
all
have
a
bit
of
that
as.
C
A
You
that's
a
really
good
point.
I
was
going
to
go
on
and
say
people
going
to
let
you
off
today,
but
you
will
be
you're
so
much
a
part
of
the
solution,
but
you
come
regularly
to
the
board
anyway,
to
update
on
that,
but
could
I
just
ask
Helen
or
Ruth
that
the
you're
going
to
be
doing
periodic
review
so
we're
on
our
way
a
year
and
then
find
out.
We
haven't
made
progress
when
when
do
you
think
that
when
are
you
planning
the
next,
your
next
sort
of
review?
H
So
the
first,
what
we're
calling
a
pulse
check
so
2018
is
a
transition
year
for
us
in
terms
of
staff
survey,
we're
using
it
as
an
opportunity
to
test
how
we
approach
pulse
checks,
and
it
is
the
final
year
of
our
current
annual
staff
survey
contract.
So
so
we
are
going
to
use
April,
May
and
June
as
our
ability
to
kind
of
pulse
check
the
areas
of
detailed
research
that
we've
outlined
in
the
paper.
So
I
suggest
we
come
back
in
July
and
update
you
about
what
that's.
A
Good
to
me
all
right,
everybody
excellent.
Thank
you
very
much
for
all
the
work
that's
gone
into
this
and
all
the
work
that's
going
to
go
into
making
sure
that
this
time
next
year
there
are
all
excellent
results
without
this
variation
and
everything
else
fantastic.
Thank
you.
So,
the
last
item,
a
business
before
we
get
on
to
any
other
business,
is
to
embarrass
Katie.
Allen
I
can't
do
that
Cage.
If
you
sit
behind
the
lectern,
so
you
know
you
need
to
come
so
welcome.
A
So
this
is
this
is
to
recognize
outstanding
contribution
to
CQC.
Now
there
are
many
people
who
do
outstanding
things
which
I'm
not
aware
of,
but
in
your
particular
case,
Katie
I'm,
aware
of
what
you
do
because
I'm
part
of
the
problem
that
okay
from
time
to
time
that
you
have
to
deal
with
so
we
actually
earlier
in
the
in
the
board
meeting,
were
commenting
generally
on
the
quality
of
our
of
publications
and
reports
and
thanking
people
for
doing
it.
A
But
your
particular
role
and
where
I'd
been
involved
anyway,
has
been
primarily
around
both
the
state
of
care,
which
I
think
everybody
in
the
room.
Thinks
is
a
really
excellent
publication
and
our
annual
report
and
accounts,
which
at
least
Paul
and
I
think
is
an
excellent
publication.
Even
if
everybody
else
isn't
as
excite
by.
A
Is
okay
as
well
as
he
maybes
the
accounting
office?
He
has
a
sort
of
view
on
that,
but
can
I
just
read
out
the
nomination,
because
it's
not
just
from
the
nominations
and
from
me
at
all,
but
there's
my
personal
observations,
but
the
nomination
said
that
you
were
the
the
editorial
linchpin
that
held
everything
together
in
relation
to
the
state
of
care
and
made
sure
everyone
involved
was
get
fully
informed
and
up-to-date
Katie
was
unwaveringly,
hard-working
professional
and
enthusiastic
as
the
lead
content
coordinator
as
well
as
writing.
Articulate
and
informative
chapters.
A
Casey
worked
tirelessly
to
keep
the
editorial
team
updated
on
all
key
areas
and
guided
us
through
the
very
complex
and
ever-expanding
world
of
state
of
care.
So
that's
the
official
sort
of
citation
I
think
David.
You
and
I
would
add
to
that.
Keeping
you
and
me
happy,
as
we
got
increasingly
into
the
editorial
drafting
so
Katie
very
many
from
graduation
one
day.
A
G
A
You
shut
it
out,
so
it
can't
be
a
good
opportunity
to
play,
but
do
you
stay
and
have
some
lunch
with
us
in
a
moment?
Thank
you.
So
shall
we
move
on
to
just
chat
where
there's
any
other
business
from
the
board
itself?
Anybody
wanted
to
raise.
We
covered
okay.
So
then,
let's
move
on
to
questions
from
the
public
and
I
think
Robin.
You
were
probably
the
first
that
I've
got
anyway
here.
So
would
you
like
to
come
to
the
microphone
and
for
the
record
say
who
you
are
and
ask
your
question.
S
M
Thanks
very
much
and
it's
great
to
focus
on
the
most
practices
are
good
or
outstanding,
which
is
which
is
superb
for
patients
across
across
England,
because
they
will
know
that
they
can
get
really
good
care
and
I'm
going
around
the
country
at
the
moment.
Looking
at
a
number
of
our
outstanding
rated
surgeries
in
the
last
few
weeks,
I've
been
up
to
to
Liverpool
to
look
at
Brownlow,
which
is
extraordinary,
I've
been
to
Manchester
to
ham
coats
to
look
at
the
urban
village
surgery.
There
and
I
saw
three
in
Devon
two
weeks
ago.
M
Their
characteristics
of
outstanding
are
very
similar
to
actually
adult
social
care
and
in
in
hospitals.
It's
about
the
leadership
and
about
the
vision
and
the
focus
on
the
local
patients,
whether
for
example
in
Liverpool,
they
were
students
and
homeless
people
or
in
some
of
the
other
surgeries
where
they
have
a
much
more
elder
population.
What
you
find
is
fantastic
leadership,
focusing
on
the
needs
of
their
particular
population
and
getting
staff
to
own
that
vision
and
really
value
them.
We've
just
had
a
very
good
discussion
about
arrow
and
staff
survey.
M
If
you
go
into
an
outstanding
practice,
the
teams,
as
soon
as
you
walk
through
the
door,
you
get
a
feeling
for
the
fact
that
it's
outstanding,
they
know
what
they're
doing
they
care
about
their
patients.
They
really
want
to
go
the
extra
mile
for
their
local
population,
all
of
our
khloe's,
the
key
lines
of
inquiry.
M
All
of
the
standards
are
all
written
down,
and
a
lot
of
it
is
in
our
end
of
program
report
that
we
published,
because
every
practice
in
England
for
the
first
time
ever
and
probably
the
first
time
in
the
world,
were
rated
last
year
and
now
we're
going
back
to
them.
And
the
great
thing
is
that
we're
going
to
a
number
of
these
outstanding,
perhaps
and
they're
saying
that
it
actually
helped
them
with
the
recruitment
of
staff
and
of
doctors
and
we're
seeing
many
other
practices
get
even
better
broadening
what
they
do
and
focusing.
M
What
we
want
to
make
sure
is
that
they
maintain
the
standards
when
they're
outstanding,
and
we
want
to
do
whatever
we
can
to
encourage
the
good
practices
to
be
even
better
but
going
around
the
country
looking
at
them.
I
feel
really
really
optimistic
and
it's
a
fantastic
feeling,
and
you
can,
if
you
follow
me
on
Twitter
you'll,
see
some
other
journey
as
we
go
around
it's
great
stuff,
stiva.
A
I
might
just
also
be
worth
adding
that
we
are
doing
more
and
more
to
give
examples
of
outstanding
practice,
whether
that's
in
premier
care
or
wherever
else
anding
indeed
case
we're
still
in
the
room.
We
know
quite
a
few
examples
in
state
of
care
of
good
things
and
other
places,
so
I
think
for
both
practitioners
and
for
the
public
to
understand
those
sort
of
characteristics
of
outstanding,
seeing
examples
of
outstanding,
whether
it's
a
practice
or
yeah.
M
That's
why
I
said
we
were
using
our
website.
We
go
around
and
working
with
lots
of
me
lots
of
meetings
with
the
CCGs
with
the
BMA
and
the
college.
We
all
want
to
improve
the
quality
of
care
and,
of
course,
being
able
to
say
that
the
vast
majority
of
care
provided
in
this
country
is
good
or
outstanding
reinforces
the
public
messages
from
the
college,
the
BMA
and
others
that
investment
in
general
practice
is
a
good
thing.
M
We
know
from
evidence
around
the
world
that,
if
you
invest
in
primary
care-
and
you
have
really
good
primary
care,
lead
services,
the
outcomes
even
from
hospitals
are
better
and
it's
reinforced
in
our
local
system
reviews
that
prevention,
keeping
people
out
of
hospital
which
primary
care
general
practice
has
a
really
core
role,
working
with
social
care,
colleagues
and
with
hospitals.
That's
where
the
services
are
out
there
at
their
best.
Great.
Thank
you
for
that
question.
David.
P
Q
Q
We
did
a
lot
of
work,
surveying
the
effectiveness
of
the
social,
the
monitoring
activity
of
Social,
Care
Department
of
the
Council,
which
of
course
funded
us
and
I
wanted
to
ask
Jane
as
a
quick
one,
not
immediately
but
later
how
far
HealthWatch
is
local
HealthWatch
do
this
sort
of
thing
because
there's
a
great
deal
of
surveying,
I,
think
of
providers,
but
not
necessarily
of
those
who
produce
money.
But
my
main
point
is
about
it's
really
about
inspecting
the
parlour.
Q
Just
over
a
year
ago,
there
was
an
article
in
Nursing
Times
reporting
a
bit
some
research
by
sublegal
Steve
Moore.
He
was
a
commissioner
of
Social
Care
in
Dudley
and
he'd
asked
quite
a
large
number
of
care
home
workers
if
they'd
ever
seen,
abuse
or
neglect
in
their
previous
job.
That
was
a
good
point
and
so
didn't
get
interference
from
those
whistleblowing
worries
that
kind
of
thing,
and
he
got
138
responses
109
that
79%
of
those
said
they
had
either
seen
abuse
or
they
had
actually
suspected
it
of
the
109
who
responded.
Q
The
largest
number
was
psychological
and
he
asked
them
also
to
give
some
examples.
Two
of
the
ones
which
he
chose
to
highlight
were
some
nursing
staff,
including
the
seniors
who
thought
it
would
be
enormous
fun
to
give
everybody
all
the
Oh
residents
the
wrong
set
of
false
teeth,
because
they
wouldn't
let
their
no
funny
and.
Q
Q
It
said
this
would
not
be
enforced
so
that
it
would
seem
that
the
guidance
would
be
the
same.
I
have
to
say,
ineffective
guidance
that
we
had
about
eviction
and
banning,
and
also
the
gardens
on
cameras
that
came
out
in
2015
ie.
It
was
open
to
care
home
care
providers
to
pay
attention
or
not
pay
attention
as
they
wish.
So
I
am
still
hoping
me.
Of
course,
it
may
well
be
that
you
are
thinking
about
how
to
inspect
or
rather
how
to
investigate
and
that
that
is
not
connected
to
this
round
table.
Q
I
hope
that
is
happening
and
perhaps
I
will,
in
future
little
bit
about
what
is
being
done,
but
I
do
feel,
like
Steve
Moore
felt
that
there
is
a
real
need
for
something
which
is
more
penetrating
and
digs
down
deeper
and
gets
out
this
thing,
this
abuse
that
is
happening
quite
widespread
and
which
will
make
them
trust
that
you
always
talk
about
come
true.
Q
A
N
Notice
to
be
nice,
but
but
I
will
get
you
an
answer.
I
mean
as
far
as
you
adult
social
care
to
partners
concern.
We
will
most
likely
be
working
with
Minh
and
holding
them
to
account
through
the
help,
local
health
and
well-being
board.
So
that's
where
a
store,
if
your
institutional
link
might
be,
but
basically
we
stick
to
the
tasks
we've
been
given,
which
is
what
people
tell
us
and
whether
people
will
will
comment
to
us
on
what
the
social
care
department's
doing.
I.
N
N
When
that
HealthWatch
Coventry
is
not
as
much
done
as
abuse,
it's
just
a
this
is
telling.
Is
it
not
necessarily
done
as
abuse?
It's
just
something
that
you
know
heaven
forfend.
If
you
do
go
into
a
home,
somebody
said
to
me
at
Coventry.
The
trick
is
to
get
your
postcode
engraved
onto
your
false
teeth
because
they
go
into
a
bucket
to
be
cleaned
and
you
don't
get
the
right
ones
back.
I,
it's
not
done
as
abuse
is
just
on
as
thoughtlessness
I
think
would
be
a
nicer
thing.
You
can
say.
P
F
Just
kind
of
you
know
call
that,
for
for
what
it
is
you,
our
expectation
is
that
people
are
treated
with
dignity
and
respect
and
all
aspects
of
their
care
needs
to
kind
of
be
consistent
with
that.
And
if
somebody
has
got
false
teeth,
then
they
have
every
right
to
have
the
right,
false
teeth
for
good
sakes,
so
get
off
my
little
soapbox
on
that
one
just
to
to
clarify
a
couple
of
things
David,
and
thank
you
very
much
for
giving
us
advance
notice
of
the
area
that
you
wanted
to
cover
the.
F
As
you
quite
rightly
say.
Three
years
ago,
we
published
information
about
the
use
of
technology
and
surveillance
techniques,
both
for
providers
and
for
the
public,
and
we
have
committed
to
looking
at
that
and
to
taking
that
further
forward,
given
that
we
are
now
three
years
on
and
obviously
an
awful
lot
of
things
have
changed
since
then.
F
One
of
the
things
that
has
become
really
very
evident
to
me
in
the
last
few
months
while
we've
been
preparing
for
that,
is
that
that
there
has
been
our
to
change
in
terms
of
the
sorts
of
things
that
are
available
for
people
to
use
and
also
there's
been
a
change
in
terms
of
the
how
these
things
are
being
used
by
providers
and
the
public.
Now
as
compared
to
three
years
ago.
F
There's
also
quite
a
lot,
that's
going
on
within
CQC
in
DIF
and
all
three
of
our
directorates
looking
at
the
use
of
technology
and
how
technology
is
improving
the
quality
of
care,
and
that
might
include
surveillance.
But
it's
it's
other
other
aspects
as
well.
So,
actually,
yesterday
I
was
part
of
a
meeting
trying
to
bring
together
some
of
the
different
strands
of
this,
so
that
we
could
be
much
clearer
about
what
the
roundtable
that
you
referred
to
and
can
focus
on.
And
one
of
the
things
that
we
felt
was
going
to
be.
F
An
important
thing
for
us
to
do
is
to
bring
everything
together
into
one
place
so
that
we
have
a
resource
that's
available
for
the
public
for
providers.
But
also
for
our
inspectors
in
terms
of
what's
the
best
use
of
technology,
how
it
can
improve
and
support
better
quality
care
and
what
our
expectations
would
be
of
services,
but
also
of
our
inspectors
in
terms
of
how
they
use
that.
F
So
I
think
that
what
we're
doing
is
shape
is
is
shaping
the
round
table
a
little
bit
further
on
from
the
conversations
that
we've
previously
had
to
make
sure
that
it's
across
sector
roundtable
that
we
look
at
all
all
aspects
of
what
we're
doing
that
we
do
think
about
creating.
So
what
I've
got
in
mind?
Is
those
of
you
have
had
a
look
at
it?
F
We're
still
going
to
be
in
a
position
where,
as
a
regulator,
we're
never
going
to
know
absolutely
everything,
because
we're
not
going
to
be
there
all
the
time,
which
is
one
of
the
reasons
why,
as
Ted
said
earlier,
the
information
that
we
get
from
people
who
were
either
using
services
or
working
in
services
continues
to
be
really
really
important.
But
what
also
continues
to
be
important
is
that
our
staff
are
trained
and
supported
to
identify
those
clues
and
to
dig
deeper
when
those
clues
manifest
themselves
and
that's
something
that
we'll
continue
to
do
as
well.
F
A
T
Hi,
my
name
is
Joyce
Abbas,
Aki
and
I'm.
The
founder
of
a
social
enterprise
known
as
granted
smile
I
started
this
initiative
in
October
last
year.
What
we
do
is
we
basically
go
into
the
homes
of
chronically
ill
parents,
parents
with
chronic
illness
and
mental
health
conditions,
and
we
clean
their
homes
and
do
all
the
practical
house
chores
for
them
for
absolutely
free
by
December.
T
Maybe
there
are
other
practical
services
out
there
that
I
am
not
aware
of
that,
and
that's
why
I
haven't
had
the
support
that
we
should
have.
So.
My
question
is
basically
it's
AM
kind
of
just
check
and
that's
why
I'm
here
today,
because
I've
our
research
shows
that
one
in
four
families
have
children,
or
rather
one
in
four
children,
have
families
who
are
either
chronically
have
parents
with
chronic
illness
or
mental
health
condition
and
I'm
thinking.
Why
are
we
not
supporting
this
children?
Because
this
is
where
the
mental
health
starts?
F
Where
are
the
services
that
support
people
and
and
I?
Think
that
you,
our
message
from
the
local
system
review,
is
that
you've
got
to
concentrate
on
that
as
well
as
that,
the
heavy
end
is
important,
and
last
but
not
least,
I.
Don't
know
whether
mulch
or
Ted
would
pick
this
one,
but
the
children
and
young
people
mental
health
somatic
review
that
we
are
doing
again.
I,
don't
know
whether
that's
picking
up
on
some
of
the
preventive
and
supportive
mechanisms
that
need
to
be
there
because
you're
quite
right.
F
M
I'm
really
happy
to
have
two
minutes
on
this.
I
mean
I.
Think
what
sounds
what
you're
doing
sounds
really
helpful
and
really
good.
So
so
so.
So
thank
you
from
me
and
not
from
particularly
from
CDC,
but
from
being
the
the
work
we
do
with
the
voluntary
sector
in
health
and
social
care
is
so
important
and,
as
Andrea
said,
one
of
the
themes
that
are
coming
out
with
our
local
system
review
work,
which
is
over
65s,
but
it.
But
you
can
talk
about
the
whole.
M
A
H
A
U
V
Briefly,
to
have
the
last
word
really
it's
just
as
you
started
offering
his
celebration
really
and
I
just
want
to
offer
my
thanks
and
the
thanks
of
a
hundred
small
community
groups
in
Gloucestershire
that
were
part
of
the
national
pilot
that
we
brought
down
to
have
that
conversation
on
not
just
what
matters
to
those
groups.
But
why,
as
well?
It's
not
just
what
matters
we've
got
to
understand
the.
V
The
key
thing
for
me
is
that
we've
got
to
make
sure
that
we
involve
those
small
community
groups
all
the
way
through,
so
isn't
just
coming
down
and
saying
what
matters
to
you
and
why
they've
actually
got
to
be
part
of
that
celebration
of
the
House
of
Lords
and
onwards
with
us
as
well
or
else.
Actually,
it
does
become
a
little
bit
of
a
tick
off
box
really
and
we
disengage
those
people
really
well,
no
surprises
with
Duncan
Selby,
as
the
chief
exec
of
public
health
England
galvanizing.
V
All
the
way
through
on
this
work,
not
only
the
Care,
Quality
Commission,
but
other
arms
length
bodies,
public
out
of
England,
for
example,
has
been
really
exemplary.
So
the
work
was
done
slightly
outside
of
the
system,
so
independently
I,
you
know,
don't
work
for
an
organization
per
se.
I'll
just
give
a
little
voluntary
time
where
I
can
or
whatever
knowledge
of
of
the
system,
but
also
keeping
that
absolute
focus
on
people
and
communities.
It
isn't
surprising
that
a
number
of
invitations
have
come
my
way
to
say
actually.
Can
you
tell
us
the
how
bit?
V
How
have
you
managed
to
do
that,
and
you
know
whoever
is
in
Whitehall
or
beyond
and
always
get
the
same
reply.
It's
not
about
brand.
It's
about
the
way.
How
do
we
do
it?
So
thank
you
Peter
for
closing
it,
but
much
more
and
whatever,
but
thank
you
to
the
whole
of
the
CQC
for
that
belief,
that
commitment
and,
above
all,
understanding
the
purpose
so.
A
Other
people
make
their
name
by
opening
events,
I'm,
obviously
making
mine
by
closing
them.
Let
me
let
me
close
this
one
Bren
by
saying
it
was
a
was
a
fantastic
afternoon
and
in
the
House
of
Lords,
and
it
was
a
it's
a
great
pity
that
everybody
couldn't
see
what
you
did
that
afternoon
for
those
groups
of
mainly
disadvantaged
people
doing
fantastic
things
in
their
own
communities,
I
mean
it
was.
It
was
really
uplifting
just
to
sort
of
sit
and
watch
it.