►
From YouTube: CQC Board Meeting 16 April 2014
Description
Agenda for the meeting of the Care Quality Commission Board held on Wednesday, 16 April 2014:
1. Apologies and declarations of interest 0:01
2. Minutes of the meeting held on 19 March 2014 1:15
3. Matters arising and action log 1:27
4. Chief Executive's report 2:33
5. Chief Inspector of General Practice update 34:12
6. Chief Inspector of Adult Social Care update 48:42
7. Chief Inspector of Hospitals update 59:27
8. Thematic review - topic selection 1:26:19
8A. Inequality in EOLC scope 1:48:47
9. Knowledge and information strategy 1:58:16
10. Oracle database and OBIEE licences procurement 2:32:09
11. New approach from HWE perspective 2:35:48
12. Audit and Corporate Governance Committee (ACG) report to the board 2:58:16
13. Board forward plan 2:58:39
14. Any other business 2:58:57
15. Questions from the floor 2:59:41
Read more about CQC's Board Meetings at
http://www.cqc.org.uk/public/about-us/our-people/board-members/board-meetings
A
Good
morning,
everybody
one
of
the
apologies
for
today
is
david,
who
of
course,
is
immobilized
at
home.
He
had
his
operation,
which
I
think
was
very
successful
on
saturday,
we've
also
got
apologies
from
camilla
and
jennifer,
who,
I
think
are
just
taking
an
easter
break
and
paul
is
taking
a
break
because
it's
his
40th
birthday
so
which
I
sort
of
vaguely
remember
mine,
but
it
is
now
quite
a
time
ago.
A
I'd
also
like
to
welcome
the
members
of
the
public,
both
david
who's
actually
physically
present
and
the
public
who
watch
this
on
youtube.
I
actually
checked
yesterday
and
our
last
board
meeting
there
were
462
viewers,
which
I
think
actually
is
pretty
impressive.
I
don't,
of
course
it
doesn't
tell
you
how
long
they
watch
for.
A
A
The
two
other
items
on
the
action
log
one
is
getting
health
watchers
perspective
on
the
acute
hospital
inspection
process
which
anna
is
going
to
cover
actually
under
item
11.
and
the
the
other
important
item.
As
you
can
remember,
we
had
quite
a
another
one
of
our
discussions
on
the
you
know
which
thematic
reviews
we
should
be
undertaking,
but
david
has
now
chosen
two
long
reviews
and
four
shorter
ones
and
we're
going
to
cover
those
under
item
eight.
A
B
Thank
you
michael
good
morning,
everybody.
So
last
april
we
launched
our
three-year
strategy,
so
the
first
two
numbered
paragraphs
in
this
report
are
really
just
giving
you
a
reprise
of,
I
think,
some
of
the
work
that
has
gone
on
to
deliver
the
first
year
of
that
strategy
over
the
past
12
months
and
pulls
out
some
of
the
progress
that
has
been
made
right
across
the
organisation.
B
I
I
want
to
emphasise,
michael
that
this
is
something
that
has
been
taken
forward
through
our
inspectors:
our
inspection
managers,
but
the
people
working,
designing
new
methodologies,
colleagues
in
intelligence
and
monitoring
and
colleagues
in
the
national
customer
service
centre
that
have
supported
this
and
then
finance
hr
staff
that
have
also
weighed
in
behind
this
and,
of
course,
hillary's
hillary's
team
in
change
management
have
contributed
to
this.
So
this
really
is
an
organizational
effort,
but
we've
landed
our
new
inspection
methodology.
B
The
new
structure
became
operable
from
the
first
of
april,
with
the
three
chief
inspectors
taking
on
responsibility
for
operational
staff
and
their
managers
and
the
academy's
begun
to
deliver
its
product.
I
think
over
a
hundred
of
andrea's
staff,
for
instance,
have
been
prepared
to
deliver
the
wave
inspections
in
adult
social
care,
so
that's
moved
beyond
being
a
concept
and
there's
now
a
product,
that's
available,
we're
virtually
complete
in
terms
of
appointments
to
deputy
chief
inspector,
steve
and
myself
have
with,
along
with
andre,
have
another
interview
to
do
later.
B
The
9th
of
april
we
published
9
handbooks,
seven
handbooks,
sorry,
which
set
out
the
changes
to
the
methodology
overview
reports
from
our
three
chief
inspector
colleagues
and
a
document
on
our
approach
with
courses
on
human
rights
they're
out
for
consultation.
That
consultation
lasts
until
june
of
this
year,
and
our
plan,
then,
is
to
revise
those
handbooks
and
they'll
be
available
in
september
and
that
will
align
with
the
regulations
which
we
cover
in
paragraph
four,
coming
into
force
from
the
first
of
october.
B
So
there'll
be
a
convergence
of
our
handbooks
setting
out
how
we
intend
to
inspect
and
the
regulations
sandwiched
in
between
paragraphs.
Two
and
four
is
paragraph
three,
which
is
just
flagging:
that
the
kerbil
will
go
back
into
the
commons
on
the
seventh
of
may
and
we'll
go
between
the
commons
and
the
lords
in.
What's
affectionately
referred
to
as
ping-pong,
and
we
expect
royal
assent
to
be
given
to
the
bill
around
the
middle
of
may
in
the
lesson
to
the
regulations
are
two
issues
I
just
want
to
pull
out.
B
So
I
think
that's
good
progress
and
I'd
want
to
acknowledge
the
work
that
colleagues
here,
but
also
colleagues
right
across
the
organisation
have
done.
I
think
the
relationships
with
the
department
of
health
have
been
very,
very
productive
and
positive
and
have
helped
immensely
on
those
issues
around
regulation.
B
B
So
we've
been
involved
in
discussion
with
nmc
about
recognizing
nurses
who
regulate
as
being
a
legitimate
part
of
their
revalidation,
so
not
just
their
clinical,
hands-on
practice
but
their
their
work
in
registration,
and
there
have
been
a
number
of
events
to
support
that
discussion.
The
academy
will
pick
up
on
ensuring
that
what
is
required
for
nurses
that
we
employ
to
be
revalidated
in
terms
of
their
continuing
professional
development
is
something
that
we
can
support
nursing
staff
in
steve.
B
I
don't
know
whether
you're
going
to
mention
it
later,
but
has
been
leading
on
this
work
and
one
of
steve's
colleagues
he's
going
to
be
the
lead
for
medical
revalidation.
The
numbers
are
much
less
for
us
of
doctors
that
we
directly
employ,
but
we
do
employ
a
number
and
we'll
need
to
attend
to
their
revalidation.
B
B
B
So
what
paragraph
7
is
highlighting,
michael,
is
that
we've
considered
that
judgment
considered
the
judge,
the
detail
of
that
judgment
and
have
issued
advice
for
our
own
staff
on
how
they
should
take
that
forward
and
issued
advice
and
guidance
for
providers.
So
they're,
aware
of
where
we're
how
we're
going
to
apply
this
one
of
our
members
of
staff,
rachel,
griffiths
who's,
recently
joined
us
to
take
on
the
role
of
looking
after
the
mental
capacity
deprivation
of
liberty.
Standards
work,
I
think,
has
done
a
very
good
job
in
actually
producing
this
guidance
very
quickly.
B
This
is
a
fast-moving
issue.
The
supreme
court
really
gave
the
advice
on
learning
disability
services,
yet
the
vast
majority
of
cases
I
think
we
will
come
across
will
be
people
who
don't
have
capacity
who
are
older
and
that
capacity
is
a
result
of
dementia,
alzheimer's
or
other
mental
illnesses
associated
with
old
age.
So
we've
had
to
interpret
in
our
guidance
of
staff
and
providers
what
the
supreme
court
determined
in
relation
to
services
for
people
with
learning
disabilities,
so
an
important
judgment.
I
think,
and
those
two
things
come
in
as
close
together.
B
I
think
they
were
within
this
the
same
working
week,
so
important
work.
There
item
is
monitors,
accountability
report.
I
don't
do
this
in
writing,
but
we
should
do
this.
A
monitor,
I
think,
are
the
only
second
organizations
who
have
been
told
by
the
national
audit
office
that
they
present
value
for
money.
C
Because
there
is,
there
is
confusion
about
when
it's
monitor
or
when
it's
cqc
I
mean
it.
Does
it
happen
if
somebody
comes
to
cqc
and
there
are
issues
that
are
relevant
to
monitor,
would
we
automatically
involve
them
and
vice
versa?
You
know
just
if
or
if
they
come
to
us
and
it's
a
monitor
issue,
do
we,
you
know
automatically
refer
it,
so
it
doesn't
matter
who
they
go
to
that,
whoever
get
whoever
receives
the
concern
will
then
make
sure
that
it's
handed
on
to
the
relevant
person.
B
B
This
was
more
an
issue.
They
were
raising
around
the
governance
and
leadership
of
the
organisation
than
about
quality
and
safety,
although
there
was
an
encroachment
into
quality
and
safety,
so
I
contacted
david
bennett
and
wrought
to
him
setting
out
some
of
the
concerns,
but
this
is
happening
on
a
number
of
occasions.
Mike,
do
you
want
someone.
D
Just
very
briefly,
to
add
to
that.
Yes,
I
think
we
have
contacts
at
a
number
of
different
levels
between
the
acute
policy
team,
for
example,
and
their
opposite
numbers
at
monitor,
and
I
have
links
and
regular
discussions
with
with
monitor
either
about
individual
trust,
and
certainly
if
we
heard
a
new
concern
and
if
it
was
a
foundation,
trust
and
if
it
was
either
about
their
finance
or
their
leadership,
then
we
would
undoubtedly
work
with
them.
C
And
are
we
clear
that
our
interfaces
are
robust?
So
if
somebody
comes
to
the
say
the
national
contact
centre
are
we
sure
that
that
would
get
through
to
the
right
people?
You
know
they're
not
going
to
say?
Oh
well,
that's
that's
monitors
job.
You
need
to
contact
them.
You
know
that
we
actually
do
get.
Do
you
see
what
I
mean.
B
I
think
our
ambition,
though
okay
and
I
think
this
might
be
behind
your
question-
is
that
it
doesn't
have
to
come
up
to
be
exchanged.
It's
exchanged
as
a
matter
of
routine,
and
I
think
we
are
in
this
stage-
and
I
suspect
this
is
what's
behind
this
recommendation
from
the
select
committee
about
how
we
take
this
to
scale
rather
than
we
actually
rely
on
personal
relationships
between
senior
people,
and
I
think
at
the
minute
our
performance
on
this
will
be
variable.
So
I
think
locally.
B
This
will
be
being
done
because
people
will
see
it
and
they'll
do
it
and
they'll
just
get
on
and
do
it,
and
I
think
there
are
other
cases
where
it
probably
does
need
to
come
up
for
the
connections
to
be
made,
but
our
ambition
should
be.
Actually.
This
is
just
the
way
we
do
business
and
I
think
we're
getting
closer
to
that.
E
So
I
presume
this
is
the
foundation,
trust
network
and
people
like
that,
because
because
actually
they'll
be
talking
about
our
people
on
the
ground,
rather
than
you
and
they'll
be
talking
about,
monitor
people
on
the
ground
and
so
that
it
seems
to
me,
you
know,
meeting
us
both
meeting
those
stakeholders
is
much
more
likely
to
lead
to
change,
and
so
I
think
I
think
you
know
going
through
those
stakeholders.
I
think
we
will
hear
the
real
stuff
that's
happening.
B
So
we
are
in
the
process
of
taking
that
forward
and,
as
I
say,
I
had
a
long
conversation
with
david
about
doing
this
and
I
have
to
say
it
was
a
very
easy
conversation
to
have
so
I
I
think
we're
in
a
good
place
in
relation
to
this
nine
and
ten
michael,
I
don't
intend
to
present
it's
an
update
in
relation
to
more
convey.
Dr
kirkup
has
been
given
the
secretary
of
state's
agreement
to
submit
his
report
later
in
the
year
rather
than
sooner
in
the
year.
B
B
Take
more
time
so
he
can
actually
get
through
the
volume
of
both
written
material
and
interviews
with
the
families.
I
think
so,
I'm
just
updating
on
on
that,
and
then
we
continue,
as
I've
already
inferred,
to
make
appointments
at
term
in
our
frontline
jobs,
our
frontline
management
jobs,
as
well
as
continuing
some
of
the
senior
appointments.
So
I
hope
that
helps.
A
A
The
department
of
health
actually
have
monitors
objectives
and
the
first
of
these
is
public
sector
providers
are
well
led
and
provide
high
quality
care
to
their
patients.
So
right
from
the
start,
there
is
room
for
ambiguity
about
who's.
The
regulator
here
also,
I
asked
claire
if
she
could
print
out
monitor's
new
risk
assessment
framework
which
has
just
been
published.
A
It
is
97
pages
long,
it's
actually
longer
than
mike's
handbook
on
acute
hospitals
inspections.
So
you
know
one
can
see
how
important
it
is
to
make
sure
that
we
are
coordinated
with
with
monitor,
especially
as
the
health
committee
also
referred
to
heavy-handed
regulation,
and
you
know
it's
clearly
very
important
that
that
doesn't
happen,
but
thank
you
very
much
david.
Perhaps
we
can
now
move
on
to
steve's
report.
I've
actually
asked
sorry
lois,
sorry.
F
F
It's
a
little
bit
better
for
acute
care,
but
it's
pretty
short
when
it
comes
to
mental
health
and
to
very
short
in
social
care,
and
it's
not
so
short
in
general
practice.
I
don't
think,
but
it
is
quite
it's
it's
sort
of
incoherent
in
the
sense
that
it
is
a
number
of
unconnected
items
which
are
meant
to
add
up
to
what
we
know
about
general
practice.
F
Now
you
know
that's
all
right
as
a
starting
point,
because
that
is
the
situation.
That's
the
information
that's
available
to
us,
but
but
part
of
the
plan,
presumably
will
be
over
a
period
of
time
to
build
up
a
sort
of
data
bank
of
the
things
that
we
really
want
to
know
and
I
suppose
it
would
be
useful
to
know
what
is
our
plan?
F
F
A
There
is
an
agenda
item
later
in
the
meeting
when
emma
roark
is
coming
to
talk
about
the
cqc's
knowledge
and
information
strategy,
and
I
wondered
lewis
whether
that's
probably
the
the
point
at
which
you
know
the
first
of
your.
You
know.
First
of
the
two
important
points
should
be
tackled
because
it
is
pivotal
to
this
new
knowledge
framework
that
she's
going
to
present
but
david
on
the
the
issue
of
care
homes
and
prosecutions.
B
B
Doesn't
say
this
report
is
a
vehicle
for
that,
so
no,
no
yeah
yeah.
No,
how
do
we
make
it
public?
I
think
yeah?
No,
quite
so,
and
so
I
think
we've
been
working
on
an
improved
variation,
an
approved
edition,
if
you
wish
not
variation
of
the
performance
report
where
one
of
the
issues
that
non-executive
members
of
the
board
have
raised
consistently.
B
B
Some
residents
had
been
abused,
there's
a
serious
case
review,
which
will
be
published,
and
one
of
the
things
that
we've
been
doing
differently
in
relation
to
that
case
is
conducting
a
root,
cause
analysis
of
what
we
did
or
didn't
do
in
relation
to
our
engagement.
With
that
case,
a
report
has
been
prepared.
B
What
we
intend
to
do
is
take
that
to
the
next
meeting
of
the
audit
and
risk
committee,
so
they
can
scrutinize
that
in
some
detail
in
much
the
same
way
that
the
last
audit
and
risk
committee
looked
in
some
detail
at
the
way
the
transformation
program
was
operating
and
then
from
that
committee
there
can
be
a
report
here
which
gives
the
opportunity
for
some
detailed
scrutiny
of
those
kind
of
cases,
and
it
will
allow
us
to
do
exactly
what
you
were
saying
saying.
What
is
it
from?
What
is
the
learning?
B
We
can
extract
from
the
way
that
we've
managed
this
case
and
how
can
that
learning
then
go
back
into
either
the
design
of
our
methodologies,
the
training
of
our
staff
or
the
way
that
we
make
decisions,
so
I
think
that'll
be
the
the
first
concrete
example.
I
think
lewis
of
something
that
hasn't
gone
well
from
our
perspective
that
well,
quite
frankly,
we've
not
got
it
right.
We've
got
it
wrong
and
what's
the
learning
to
take
from
that,
and
how
do
we
do
that?
B
So
I
think
I
hope
that
signal
in
a
different
way
of
actually
extracting
the
learning,
but
also
feeding
it
into
the
governance
in
an
appropriate
way.
So
I
hope
that
gets
us
close
to
what's
the
learning
to
be
extracted
and
what
the
individual
cases
are,
the
difficulty
on
and
again
this
is
this
being
a
public
board.
B
Is
it
worth
just
explaining,
michael
what
I
do
on
a
friday,
which
is,
I
circulate
a
report
to
non-executive
members
of
this
board,
which
updates
people
on
work,
that
is
in
progress
where
we've
got
concerns
from
a
case
being
raised,
and
that
might
be
a
referral.
That's
occurred
that
week
to
actually
a
public
resolution
of
an
issue
through
a
tribunal
or
a
court
case
or
a
criminal
conviction,
and
actually
the
awkwardness
in
reporting.
B
Some
of
that
publicly
is
about
putting
information
which
is
still
in
either
a
criminal
situation
or
there's
a
due
process,
which
is
still
in
train
that
has
not
yet
been
completed
into
the
public
domain
as
a
distinct.
I
think
what
you
were
asking
for,
which
is
where
we
know
what
the
lessons
are
from
those
kind
of
cases
or
there's
an
outcome
from
those
cases.
How
do
we
make
that
public?
So
I
think
how
we
make
the
lessons
public
and
the
outcomes
public
is
either
through
the
performance.
B
G
So
there's
learning
for
us,
but
I
think,
there's
also
a
really
important
question
as
we
develop
the
methodologies
and
the
inspection
regimes
about
the
learning
for
the
regulated
communities
and
what
we
can
tell
them
ahead
of
finding
issues
in
in
those
locations
about
what
they
need
to
be
paying
particular
attention
to,
because
it
has
proven
to
be
a
problem
in
a
number
of
instances
in
other
in
in
locations
which
we've
had
difficulties
with.
So
so
there's
something
about
feeding
back
to
the
community.
G
So
what
we've
learned
from
from
the
problems
we've
identified
and
I'm
not
at
all
sure-
and
maybe
we
have
a
number
of
mechanisms
for
doing
that.
But
I'm
not
I'm
not
really
sure
what
what
what
what
they
are,
and
I
think
it's
a
very
important
part
of
our
program
as
we
learn
as
as
we
have
a
a
kind
of
better
synthesized
view
about
what
it
is,
that's
happening
in
in
care,
homes
or
hospitals
or
or
gp
surgeries
that
we
we
have.
B
So
I
think
there
are
two
ways
to
do
this.
First,
the
root
cause
analysis
report.
We've
done
on
orcid.
U
will
publish
at
the
time
it
comes
to
the
board,
so
it
will
be
made
public,
so
it
will
be
there
for
people
to
look
at.
So
this
is
about
being
open
and
transparent,
and
people
being
able
to
look
at
that-
and
I
think
the
way
we
draw
out
these
lessons
is
in
the
state
of
care
report.
B
B
In
terms
of
real
time,
the
whole
purpose
of
things
coming
to
a
public
board
meeting
allows
us
to
be
so
where
we
published
at
that
time
and
where
we
take
root,
cause
analysis
reports.
My
ambition
would
be
having
gone
to
the
audit
and
risk
committee
will
then
come
here
as
a
report
and
any
report
that
we
do
will
be
available
for
the
public
to
actually
have
access
to.
So
it's
completely
transparent.
G
B
The
staircar
report
is
a
push
report
and
I
think
michael's
pointing
about
400
and
odd
people
on
our
website.
We
have
rss
feeds
that
go
everywhere
from
these
meetings,
so
I
there
is
a.
I
take
the
challenge
around
push
and
it's
a
really
really
important
point
that
we'll
give
consideration
to,
but
I
do
think
we
push
stuff
out
and
we're
trying
not
to
hide
stuff
and
actually
learn.
C
Quickly,
I
mean
we
are
always
being
sort
of
pushed
to
go
into
the
improvement
space.
Okay
and
that
will,
I
think,
there'll
always
be
pressure
for
that,
and
we've
said
that
we
would
we're
going.
We
encourage
improvement,
okay,
so
whether
we're
not
an
improvement
agency,
but
I
think
that
and
it's
this
is
not
just
for
us,
but
we.
I
really
think
that
we
need
to
have
a
sort
of
clear
narrative
for
each
sector
as
to
what
the
kind
of
improvement
methods
journey
is.
C
You
know,
for
example,
there's
the
failure
regime
or
success
regime
in
hospitals,
for
example.
So
that's
one
aspect
if
you
like,
and
I
think
we
have
to
be
very
clear-
that
we
don't
overstep
the
mark
and
you
know
generate
expectations
that
we
can't
fulfill.
That
doesn't
mean
that
we
don't
do
anything,
but
I
think
we
need
to
be
clear
about
what
our
role
is
in
that,
but
also
others
as
well,
because
I
still
think
it's
not
not
that
clear.
So
it's
about
sort
of
clarity
for
us
and
for
others.
F
A
H
H
This
is
a
way
of
investing
piloting,
most
importantly
evaluating,
and
we
would
support
that.
The
second
part
of
the
announcement
was
linked
into
the
negotiations
on
the
general
practice
gms
contract
and
that's
a
way
of
trying
to
encourage
more
professionalism.
Amongst
my
colleagues
as
gps,
and
I
think
for
a
long
time.
The
criticism
was
that
the
quality
outcomes
framework,
which
was
about
scoring
points
for
doing
things,
had
removed
some
of
the
professional
ethos
and
became
more
of
a
sort
of
bean
counting
type
thing,
and
particularly
as
a
practicing
gp.
H
H
It
is
at
the
moment
to
mean
prizes
and
so
40
percent
of
the
quaff
points
have
been
removed.
And
that
also
means
that,
as
a
as
a
regulator,
we
have
a
an
important
role
to
make
sure
that
patients
are
receiving
the
care
that
they
deserve
when
it's
not
just
about
counting
to
make
sure
they've
been
ticked
off
in
a
box.
H
So
and
that's
really
important
when
you
look
at
the
vulnerable
groups,
because
before
the
quality
outcomes
framework
came
in
and
I
think
it
was
a
really
really
good
invention
when
it
first
came
in,
but
it's
sort
of
overtaken
by
increasing
the
amount
of
income
proportion
of
income,
so
people
focus
on
the
points.
Not
the
human,
sometimes
is
that
in
the
past
the
more
vulnerable
groups
weren't
proactively,
called
back
to
some
surgeries
consistently.
H
It
does
start
to
put
back
in
some
of
the
things
that
we
lost
five
or
ten
years
ago,
so
so
actually
the
direction
of
travel.
I
think
I
personally
would
would
welcome
and
we'll
have
to
wait
and
see
what
the
impact
is,
and
we
are
mentioned
in
the
paper
around
our
role
as
ensuring
quality
and
I'll.
Have
you
take
questions
on
that?
Although
it's
not
my
not
my
paper,
obviously
on
revalidation,
just
to
pick
up
a
few
points,
david
is
absolutely
right.
H
Nigel
is
a
very,
very
senior
gp,
he's
our
senior
gp
advisor
and
also
he's
on
the
relevant
general
medical
committee
committees
and
is
the
lead
for
the
royal
college
of
gps
on
revalidation.
So
he's
he's
one
of
the
top
few
in
the
country
who
would
really
know
this
backwards,
and
it's
for
all
gps
who
are
not
practicing
clinically
but
work
for
us,
so
that
would
include
our
chief
inspector
of
hospitals,
but
my
personal
revalidation
goes
through
where
my
clinical
practice
is
so.
H
Clearly,
as
lewis
was
raising
the
question
earlier
on,
until
we
have
care.data,
we
are
really
working
with
what
are
behind
our
backs
across
general
medical
practice.
We
need
consistent
information
for
all
practices,
whereas
it
is
inconsistent
at
the
moment.
So
while
we
can
develop
the
intelligent
monitoring,
it
won't
be
as
good
as
it
is
for
the
hospital
side
until
we
have
care.data
and
I'm
I'm
hugely
disappointed
that
it
was
held
up.
But
I
understand
the
reasons
why
it
was.
H
We
started
our
work
as
a
directorate
on
time
last
tuesday
and
we
are
recruiting
well-
and
you
wanted
me
to
comment
on
a
little
bit
more
on
the
out
of
hours,
work
chair
and
we
didn't
put
the
figures
into
the
paper
because
they
change
every
day.
As
of
last
night,
our
wave
one
out
of
hours
were
that
we
have
inspected
31.
H
23
of
those
have
been
through
our
quality
panels,
remembering
that
we're
probably
six
months
to
nine
months
behind
hospitals
on
our
work.
The
lessons
from
hospitals
and
mike's
discussions
about
how
you
rate
are
very
similar
to
in
general
medical
practice
and
we're
learning
from
from
mike
and
his
team.
H
In
wave,
two
we've
got
12
practices
12
out
of
ours
providers,
which
gives
us
a
total
of
42,
and
we
plan
to
publish
a
report
in
june,
which
also
looks
back
at
the
2010
ministerial
review
of
out
of
hours.
Following
the
disastrous
case
in
cambridgeshire,
where
the
patient
was
killed
by
by
a
doctor,
we're
going
to
review
recommendations
that
I
made
with
david
colin
tomy,
then
that
will
be
in
june
we're
planning
to
publish
12
reports
on
the
24th
of
april
and
another
19
in
may,
but
again
learning
from
hospital
care.
H
We're
not
going
to
do
that
with
an
overarching
report
until
we've
got
enough
to
make
significant
judgments.
I
would
say,
however,
that
the
quality
of
care
that
we're
seeing
is
is
generally
good
and
that's
encouraging
for
me,
and
we've
seen
one
particular
area
turn
around
dramatically
following
an
intervention
by
cqc
last
year,
so
we're
seeing
that
our
work
is
having
an
effect
on
on
getting
the
organizations
providing
out
of
ours
better.
G
So
so
we're
getting
reports
from
quite
a
few
local
health
watch
in
this
area
and
and
what
that
kind
of
says
to
me,
and
this
is
to
be
tested
and
for
the
future.
I
think
what
that
what
that's
saying
to
me
is
that
we
have
two
sets
of
issues,
one
of
which
could
be
explored,
perhaps
in
inspections,
which
is
about
the
quality
of
information
that
dentists
provide.
G
So
I
mean
there's:
there's
a
local
health
watchers
saying
that
on
the
dentist's
own
websites
there,
that
there
is
poor
information
about
whether
or
not,
for
instance,
they're
still
open
to
nhs
patients
and
when
they
ring
it's
it's
wrong
and
they
aren't
and
so
on.
So
there's
something
about
testing
the
quality
of
the
information.
G
G
Rather,
as
you
would
an
estate
agent,
but
it's
kind
of
more
important
than
that,
and
and
I
I
I
just
wonder
whether
we
need
to
reflect
on
the
decision
about
moving
to
ratings
at
some
point,
because
I
think
quality
of
care
is
an
issue
which
we
feel
as
users
very
uncertain
about.
So
I'm
just
a
set
of
issues
to
be
further
discussed.
I
think.
H
H
Both
of
their
systems
are
not
anywhere
near
as
good
as
they
used
to
be,
and
I
think
we
we
need
to
not
pretend
we're
the
answer
to
everything
and
that's
one
of
the
problems
we've
got.
What
we
are
doing
is
is
developing
our
specialist
dental
team
and
they
should
have
the
flexibility
to
intervene
when
healthwatch
england
are
raising
important
issues.
So
that's
what
we
want
to
do
we're
moving
ahead
on
that
waiting
for
janet
to
start
in
in
a
couple
of
weeks
time.
Thank
you.
A
C
Just
a
quick
question
on
the
revalidation
issue
is:
is
that
are
we
considering
revalidation
for
second
appointed
second
opinion?
Appointed
doctors
so
adds
under
the
mental
health
act,
because
we
have
a
kind
of
issue
with
attracting
so
ads
and
and
responding
on
time.
So
I
just
wondered
if,
if
that
was
linked
into.
H
H
I
Thank
you
very
much
chair
I'll,
just
whiz
through
some
highlights
in
in
the
report
and
respond
to
some
of
the
comments
that
have
already
been
made
and
thanks
to
lewis
for
his
his
reflection
on
the
achievements
that
we've
had
in
actually
getting
the
provider
handbooks
out
and
and
as
I've
said
in
the
paper.
I
would
particularly
like
to
thank
rachel
dodgson
and
her
team
for
all
of
the
work
they've
done
on
the
adult
social
care
side.
I
But
everybody
else
that's
been
involved,
and
particularly
the
people
involved
in
our
co-production
groups,
both
internally
but
externally,
with
people
using
services.
Local
health
watch
has
been
their
honor
providers,
carers
and
some
of
our
national
partners,
which
I
think
is
one
of
the
ways
that
we're
wanting
to
address.
I
You
can
make
a
real
practical
difference
when
it's
implemented
and
is
consistent
with
some
of
the
things
that
we're
saying
we're
expecting
to
see
in
good
and
outstanding
services,
in
terms
of
people
being
supported
to
live,
meaningful
lives
in
residential
homes.
So
there's
a
variety
of
different
ways
that
we're
doing
that
lewis
is
absolutely
right,
that
the
intelligent
monitoring
and
the
the
availability
of
information
for
adult
social
care
is
not
as
well
developed
in
many
different
ways
as
it
is
for
hospitals
or
indeed,
and
primary
medical
services.
I
So
again,
that's
an
area
that
we're
thinking
about
how
do
we
work
with
others
to
get
information
out
out
in
a
way
that
is
helpful
and
one
of
the
things
that
I'm
very
mindful
of
is
that
mike
has
found
the
staff
survey.
You
know
very,
very
powerful
as
a
tool
for
the
hospital
regime.
We
don't
have
anything
like
that
in
adult
social
care.
I
mean
it
would
be
a
significant
challenge,
obviously,
to
have
something
like
that
across
25
000
locations,
but
you
know
thinking
through
well.
I
We
started
our
wave
one
inspections
we
have
had
and
they
are
going
ahead
and
the
quality
assurance
mechanisms
have
been
established
to
review
the
the
reports
that
are
coming
out.
Those
regional
ones
have
already
been
held.
The
first
national
one
is
this
week.
We've
had
some
some
teething
problems,
it's
fair
to
say
in
the
in
the
in
the
wave
one
inspections,
and
particularly
around
the
provider,
information
return,
which
is
a
new
element
of
what
we're
doing
asking
providers
to
give
you.
I
I
now
say:
don't
ever
work
with
children,
animals
and
I.t,
because
it
has
been
a
little
tricky
and
and
the
team
internally,
but
also
working
with
partners
in
in
the
provider
world,
who
have
been
very
patient
with
us
to
actually
get
that
information
out.
But
it's
been
an
important
part
of
the
evaluation
is,
is
asking
providers?
How
has
this
been
for
you
and
sort
of?
How
long
has
it
taken
to
complete
their
return?
Did
we
ask
the
right
questions?
I
Have
we
asked
questions
that
you
didn't
think
were
necessary
and
given
some
of
the
difficulties
that
we've
had
we're
absolutely
learning
by
doing
as
as
david
said
earlier,
because
we
have
got
to
compare
and
contrast
of
some
inspections
that
have
happened
without
the
provider,
information
return
and
some
that
will
happen
with
the
provider
information
return.
So
we
can,
you
know
through
this
first
wave
we
can
have
some
real
practical
focus
on
making
it
better,
both
for
wave
two
and
then
finally
for
the
roll
out
and
from
the
first
of
october
onwards.
I
The
other
thing
that
I
just
wanted
to
highlight
was
the
recruitment
of
our
staff.
As
you
know,
we've
got
one
remaining
vacancy
at
deputy
chief
inspector
level.
I'm
very
pleased
to
announce
that
we
have
now
made
an
offer
which
has
been
accepted
and
commands
today
that
that
will
be
sally.
Warren
will
come
and
join
us
sally
is
currently
the
director
of
programmes
at
public
health.
I
C
Thanks
emily,
it's
good
to
hear
about
all
the
progress,
but
I
was
I
had
a
quite
a
specific
question
in
in
terms
of
the
you
know.
The
consultation
at
the
moment
are
there:
is
there
a
particular
plan
in
place
to
consult
with
people
who
use
services
and
service
user
patient
groups,
because
I
know
that
there's
been
a
lot
of
co-production,
but
I'm
thinking
sort
of
broadening
it
broadening
it
out,
particularly
to
people
who
were
less
heard.
I
Thank
you
very
much.
Chris
day,
director
of
engagement
and
his
team
have
organised
a
host
of
regional
consultation
events,
which
is
part
of
that
part
of
that
activity.
Okay,
in
terms
of
trying
to
make
sure
that
we
we
get
out
and
about
and
and
speak
to
and
raise
the
profile
of
the
consultation
with
them.
I
You
know
information,
I'm
sure
is
going
out
via
healthwatch
as
well,
particularly
I'm
sure
the
ones
that
have
been
directly
engaged
with
us
we'll
be
we'll
be
doing
that,
and
there
are
a
number
of
speaking
engagements
and
opportunities
that
I've
got
over
the
the
next
six
to
eight
weeks,
where,
for
example,
carers,
uk
conference
I'll
be
speaking
there
and
speaking
new.
That
will
be
an
audience
full
of
people
who
will
be
able
to
provide
undoubtedly
their
views
on
on
what
we're
proposing.
B
K
makes
an
important
point.
I
think
what
we'll
do.
Okay
is
we'll
make
sure
there's
something
on
the
internet.
That
says
these
are
the
events
and
we'll
circulate
those
two
board
members
as
well
in
case
you
want
to
go
to
any
of
them,
but
I'll
we'll
pick
that
up
with
chris
as
well,
and
I
think
your
point
about
the
speak
out
network-
it's
interesting.
I
did
an
inspection,
the
other
friday
and
a
drug
and
alcohol
project
in
preston
and
they
were
active
in
the
speak
out
network.
B
D
Mike,
thank
you,
chad.
Just
on
the
separate
point
andrew,
you
mentioned
the
the
staff
survey
and
yes,
we
are
very
fortunate
to
have
that
in
the
hospital
sector.
Having
said
that,
I
am
also
finding
an
impression,
at
least
that
the
staff
survey
correlates
very
closely
with
focus
groups
that
we
then
hold
on
site
now.
D
I
think
we
ought
to
do
some
formal
evaluation
of
that,
because
if
we
could
demonstrate
in
the
in
the
hospital
sector
that
focus
groups
do
tell
us
much
the
same
or
corroborate
each
other,
then
that
is
a
technique
that
possibly
would
be
applicable
in
in
other
sectors.
So
I
think
we
need
to
think
about
how
we
would
go
about
that
that
form
of
of
evaluation.
I
Thank
you
very
much,
michael
min,
and
that's
really
helpful
to
know,
and
certainly
one
of
the
things
that
we
already
do
is
obviously
speak
to
staff
when
we
visit
to
do
to
do
our
inspections
in
the
domiciliary
care
agencies.
We're
piloting
in
in
wave
one
questionnaires
of
staff
in
advance
of
the
in
advance
of
the
inspection,
which
is
new
too,
and
we've
certainly
had
some
responses
to
that
which
is
very
encouraging.
I
A
Any
other
questions
for
andrea,
okay.
Thank
you
very
much
mike.
I
I've
also
made
an
additional
request
to
mike,
because
I
I
think
we
all
know
that
he's
been
on
this
well
on
this
visit
to
this
famous
hospital
famous
for
its,
I
suppose,
approach
to
lean
and
standardization
and
also
might
went
with
jeremy
hunt.
So
you
know
there's
a
special
significance.
This
trip,
so
I've
asked
mike
if,
as
well
as
his
report,
he
could
kindly
give
us.
D
Thank
you,
chad.
If
I
just
briefly
do
the
the
the
routine
stuff,
then
I'm
very
happy
to
come
on
to
virgin
mason.
I
mean
one
of
the
big
items
are
news
for
us
this
month,
but
it
applies
to
all.
All
three
of
us
is
that
our
new
directorates
have
come
into
being,
and
so
with
that
I
now
have
four
deputy
chief
inspectors
and
eight
heads
of
hospital
inspection
and
we
are
recruiting
more
heads
of
hospital
inspection
and
we've
got
some
interims
as
well.
D
In
terms
of
our
inspections,
we've
now
completed
the
inspection
phase
of
both
our
wave
one
and
wave
two
for
acute
hospitals,
which
means
that
we've
done
nearly
nearly
a
quarter
of
the
acute
hospitals
in
the
country.
Not
all
the
reports
are
out
from
those
yet,
but
because
there's
a
sort
of
two-month
lag
phase
between
the
inspection
and
the
report.
Of
course,
the
the
thing
about
this,
this
wave
has
been
that
we
have
been
rating
them
as
we
go
along
you'll.
Remember
that
we
rated
three
trusts
in
wave
one.
D
D
So
it's
a
lot
of
ratings
and-
and
we
have
to
be
able
to
justify
each
one
which
is
driving
us
to
think
about
the
point
that
lewis
was
raising
earlier
about
how
we
standardize,
we
make
sure
what
it
is.
We
are
we're
we're
rating.
I
mean
if
I
just
give
one
example,
the
the
issue
when
we're
assessing
outpatients
what
proportion
of
patients
are
seen
without
their
their
medical
records
being
available
now,
which
is
it,
impacts
on
patient
safety.
D
So
we
know
that
that
is
not
a
good
thing,
but
what
we
don't
have
across
the
country
at
the
moment
is
a
benchmark
of
what
good
looks
like
I
mean.
100
would
be
ideal,
but
is
99
or
98
acceptable,
but
is
anything
less
than
90
or
not?
So
we
need
to
work
with
people
to
to
develop
those
those
benchmarks,
and
I
I
don't
think
they
exist
anywhere
at
the
moment
in
the
nhs
but
we'll
work
on
that
mental
health
and
community
services.
D
And
then.
Finally,
I
would
just
like
to
add
my
thanks
to
the
people,
particularly
working
in
in
the
policy
teams,
alex
bayless
sue
macmillan,
amanda
hutchinson
for
all
their
work
on
the
provider
handbooks.
I
think
those
really
will
take
us
an
important
step
further,
because
what
we're
now
really
doing
is
linking
the
key
lines
of
inquiry
with
the
headings
that
we
need
to
be
looking
at
on
inspection
and
the
prompts
that
our
inspectors
will
need
so
that
again
that
will
drive
the
standardization.
H
Yeah
thanks:
it's
not
a
question,
but
it's
a
sort
of
an
amazed
of
birmingham
statement.
Really
I
mean
I
I
I
still
find
it
quite
amazing
that
hospitals
haven't
got
electronic
medical
records
and
having
family
who
are
in
and
out
of
hospitals
quite
frequently
as
well
as
looking
after
a
lot
of
patients.
H
It
just
is
amazing
that
the
records
are
not
in
computer
form
and
that
they
get
lost,
because
that
increases
the
risk
of
clinical
errors,
including
prescribing
errors
and
transcription
errors
to
us
in
general
medical
practice.
And
so
the
question
is:
is
there
any
progress
on
hospitals
coming
up
into
the
21st
century?.
D
There
is,
but
it's
slow,
I
suppose,
is
the
answer
steve
and
if
one
to
be
honest,
there
are
some
that
are
considerably
further
ahead.
A
lot
of
them
have
partial
electronic
patient
records,
and
then
you
know
when
the
records
are
missing
at
an
outpatient.
They
rely
on
those
partial
records,
it
isn't
satisfactory
and
it
is
an
area
where
primary
care
is
undoubtedly
ahead
of
the
secondary
sector.
D
F
Quite
a
lot
of
variation
and
slightly
misses
the
point
that
the
country
with
the
lowest
number
of
beds
per
head
is
actually
sweden,
where
most
people
think
the
health
care
is
better
than
it
is
everywhere
else.
So,
but
so
that's,
what's
behind
my
question?
What
are
you
finding,
if
anything
at
this
stage
about
this
very
emotive
issue
of
availability
of
beds
and
overall
quality
and
there's
a
sort
of
supplementary
here?
F
Which
is
that
that
when
we
talk
about
learning
lessons,
we
are
very
often
talking
about
learning
lessons
from
other
parts
of
the
nhs?
I
know
we
occasionally
go
to
other
to
the
us
and
there
are
lessons
there,
but
sometimes
lessons
on
a
grand
scale
are
better
learned
by
looking,
not
within
one
system
where
the
amount
of
variation
from
one
trust
to
another
is
quite
small
actually,
but
to
completely
different
systems
like
other
parts
of
europe.
F
So,
although
I've
got
some
doubts
about
this
report
about
number
of
beds
being
a
marker
of
something
on
its
own,
there
is
a
general
question
about
whether
we
can
learn
from
the
sort
of
ecological
variables
of
healthcare
across
europe
and
use
that
as
well.
As
you
know,
the
best
practice
that's
happening
in
you
know
a
particular
english
trust.
D
The
four
hour
wait,
it's
not
just
that
the
a
e
department
is
not
working
right.
It's
that
people
aren't
being
moved
on
through
the
hospital
to
the
acute
medical
unit,
the
medical
wards
and
discharge
and
how?
How
well
is
discharge
planning
being
undertaken
almost
at
the
time
of
a
mission
so
and
and
a
lot
of
hospitals
are
tackling
this,
and
some
of
the
hospitals
we've
seen
rather
than
just
open
more
beds
in
response
to
winter.
D
Pressure
have
been
much
more
proactive
in
working
with
their
ccgs
with
social
services
to
say
no,
we
don't
need
to
do
that.
What
we
need
to
do
is
to
make
sure
that
we
get
people
through
the
hospital
and
out
quicker.
So
I
think
we
need
to
look
at
length
of
stay
as
well
as
numbers
of
beds,
and
we
need
to
look
at
a
number
of
markers
and
one
of
the
things
that
we're
looking
at
when
we're
in
a
hospital
is
effectively
how
many
people
are
in
the
wrong
bed.
D
But
it
also
means
that
there
is
a
risk
that
the
patient
isn't
getting
the
right
care,
because
the
the
the
doctors
and
the
nurses
on
that
that
ward
may
not
be
appropriate
to
to
their
needs
and
you'll
also
have
heard
about
some
moves
of
patients
at
night
which
we're
all
trying
hard
to
to
reduce.
So
I
think
this
we
don't
need
just
to
look
at
bed
stock,
that's
quite
easy
to
measure,
but
we
need
to
look
at
how
well
they're
used,
and
I
think
the
swedish
healthcare
system
is
worth
us
looking
at
again.
D
F
If
I
just
just
to
emphasize
the
you
know,
I
think
we
can
be
held
back
at
times
in
the
debate
about
health
care
by
these
emotive
issues
like
beds
and
obviously
beds
are
important,
but
they're,
not
the
only
part.
You
know
how
many
beds
you
need
depends
on
what
else
you've
got
and
all
of
those
kind
of
things.
D
Though
I
firmly
believe
that
we
will
get
to
the
point
where
we
are
able
to
say
what
are
the
predictors
of
quality,
absolutely
and
and
then
I
think
that
will
be
very
helpful
in
the
improvement
agenda.
I
think
that's
one
of
our
contributions
to
the
improvement
agenda
is
being
able
to
point
that
out
and
so,
and
I
think
it
comes
back
to
where
you
know
whether
we
have
it
in
the
state
of
care
reports
or
an
individual
report
by
directorate.
D
C
C
D
I'm
sure
you'll
get
me
onto
twitter
sometime,
okay,
I
have
been
resisting
up
till
now,
but
it's
only
a
matter
of
time.
I'm
just
not
prepared
to
say
how
long
that
period
of
time
is,
but
in
terms
of
engaging
clinicians,
I
I
think
we
are
engaging
clinicians
a
lot,
both
those
are
in
in
expert
inspectors
if
you
like,
but
when
we
go
into
trusts,
we
are
talking
to
a
lot
of
clinicians.
D
We
have
the
the
four
more
focus
groups
with
senior
doctors,
junior
doctors,
senior
nurses,
junior
nurses,
allied
health
professionals,
so
I
mean
we
undoubtedly
even
with
those
typically.
I
suppose
we,
by
the
time
you've
had
15
20
25
in
each
of
those
focus
groups,
they're
you're,
getting
to
quite
a
number
and-
and
we
bump
into
a
whole
lot
as
we
go
around
and
we're
speaking
to
the
directors
of
the
a
e
service,
the
clinical
directors
or
of
the
maternity
service
whatever.
D
C
And
I
guess
it's
also
the
feedback
seeing
you
know
something
happen
for
the
from
sort
of
engaging
as
well
and
knowing
what
the
sort
of
this
is
partly
the
the
trust
themselves.
I
guess,
but
you
know,
if
you
give
your
views
and
then
you're
not
entirely
sure,
what's
happened
as
a
result.
That's
that's
that's
one
issue
and
so
the
the
reports,
for
example,.
D
D
Okay,
so
virginia
mason.
Thank
you
I
mean
I,
I
did
spend
two
and
a
half
days
in
seattle
about
three
weeks
ago
with
the
secretary
of
state,
and
he
gave
a
major
speech
there
about
what
he
wanted
to
do
to
drive
the
the
patient
safety
agenda
in
this
country.
With
a
sign
up
to
safety.
Our
campaign
we've
visited
two
different
healthcare
facilities.
D
One
was
called
group
health,
the
other
virginia
mason
group
health
was
mainly
actually
probably
of
interest
in
terms
of
primary
care,
and
I
think
that
steve
may
be
visiting
it
again
in
due
course
thing
that
struck
me.
There
was
that
75
percent
of
their
patient
contacts
were
either
by
telephone
or
email,
and
I
think
that
would
be
somewhat
different
from
that
this
country,
but
I
can
leave
our
chief
inspector
for
primary
medical
services
to
comment
on
that.
D
Virginia
mason
is
a
medium-sized
hospital
it's
by
by
this
country's
standards
in
terms
of
beds,
it's
quite
a
small
hospital.
It's
it's
got
less
than
400
beds,
but
I
think
they
get
people
through
the
beds
very
quickly.
It
now
has
a
major
reputation
for
safety,
but
that
wasn't
always
the
case.
So
14
years
ago,
my
understanding
is
that
it
was
a
hospital
in
trouble.
D
Financial
trouble
and
it
was,
it
could
have
gone
under
gary
kaplan
was
appointed
as
the
chief
executive
and
is
undoubtedly
credited
with
having
turned
the
hospital
round
charismatic
strong
leadership.
But
what
has
he
done?
He
very
early
on.
He
took
a
controversial
step,
which
was
to
take
his
32
senior
leaders
within
the
organization
to
toyota
in
japan,
and
I
think
a
lot
of
people
said
what
what
are
you
doing?
Spending
the
money
on
that
when
a
we
make
cars
in
the
united
states
and
b?
D
D
I
think
the
key
factor
here
was
they
were
completely
open
about
it,
with
their
own
staff,
to
or
emailed
all
staff
and
publicly
and,
of
course,
with
mary
mcclinton's
family
and
acknowledged
what
they
had
done
wrong
and
resolved
to
learn
from
it.
And
a
lot
of
the
discussion
we
had
when
we
were
in
virginia
mason
was
the
fact
that
almost
certainly
all
health
care
facilities
have
mary
mcclinton
moments.
It
is
just
how
you
deal
with
them.
D
That
means
actually,
they
report
an
awful
lot
of
potential
minor
patient
safety
alerts,
as
they
call
them
slightly
different
use
of
the
term
from
from
our
own,
but
they
are
they're,
proud
of
the
fact
that
their
staff
are
reporting
800
a
month.
Now
that
is
probably
10
to
20
times
the
number
that
we
would
expect
in
an
average
hospital
in
this
country,
but
they're
very
proud
of
that,
and
they
do
act
on
it
and
they
do
feedback.
What
what
about
outcomes?
D
Well,
the
I
think
the
best
evidence
is
their
claims
have
reduced
over
a
10-year
period.
Claims
against
the
institution
by
a
factor
of
at
least
three
and
their
insurance
liability
has
gone
down
by
by
a
similar
factor.
Now
that
is
at
a
time
when
I
can't
believe
that
the
trend
I
haven't
looked
it
up,
but
in
the
states
would
have
been
in
the
other
direction.
F
D
D
I
don't
know,
but
that's
something
that
we
could
follow
up,
and
what
I
also
should
have
said
is
that
gary
kaplan
has
already
been
working
with
a
number
of
hospitals
in
this
country,
particularly
in
in
the
northeast,
and
I'm
hoping
that
we
might
be
able
to
catch
up
with
him
again
when
he's
next
over.
For
that.
C
I
mean
I
think
I
was
going
to
ask
lewis's
question
as
well,
so
I
think
it.
You
know
it's
important
to
sort
of
understand
if,
if
this
care
was
actually
safer,
but
I'd
also
be
interested
in
the
you
know
the
financial
side
of
it,
because
the
nhs
spends
an
awful
lot
of
money
on
defending
litigation-
and
you
know
with
this
approach-
you
know
early
on
and
you
know,
would
it
actually
save
the
nhs
money
which
then
could
be
used
hopefully
on
on
more.
You
know,
better
patient
care.
D
Again,
could
we
get
the
details
of
the
money?
No,
we
were
only
there
a
short
time,
virginia
mason
themselves,
convinced
that
this
is
a
cost-effective
way
of
going
about
things.
Absolutely
yes,
so
they
do
invest
quite
a
lot
in
their
their
safety
team
in
their
kaizen
workshops
and
all
of
that,
so
it's
not
cost
free
from
the
start,
but
but
they
I
think
they.
D
They
believe
that
both
in
terms
of
of
it's
not
just
about
insurance
claims,
it
is
length
of
stay
numbers
of
complications
and
complications
are
very
expensive,
so
that
was
less
easy
to
demonstrate
what
they
could
demonstrate
with
the
claims
data,
but
but
they
they
believe
that
this
undoubtedly
has
led
to
cost
reductions
for
the
for
the
hospital.
The
care.
D
My
guess
and
again
I
didn't
have
time
to
look
at
them
in
detail,
but
my
guess
is:
they
were
actually
reporting
a
lot
of
the
so-called
near-misses
misses
and
things
that
could
have
gone
wrong,
but
didn't
actually
gone
wrong
so
that
they
probably
wouldn't
even
be
on
our
moderate
level.
At
the
moment
they
would
be
it's
something
that
might
have
gone
wrong.
A
A
A
A
So
perhaps
david
could
just
explain
how
he's
reached
this
recommendation,
and
I
think
it's
then
for
the
board
to
agree
that
those
reviews
are
the
right
additional
reviews
and
there's
also
an
additional
question
about
whether
the
review
should
be
sponsored
by
one
of
the
non-executive
directors.
And,
if
so,
and
if
the
board
agrees
that
should
happen.
We
should
perhaps
do
something
like
sort
of
an
email
volunteering
process
or
something
like
that.
But
david.
Perhaps
you
can
explain
your
choice.
B
Thank
you,
michael
thanks
for
the
introduction,
so
there's
nothing
to
add
about
how
we
find
ourselves
where
we
are
in
terms
of
the
proposal.
So
I
didn't
make
this
decision
personally.
We
sat
down
as
an
et
and
we
went
through.
We
went
through
this
and
it
wasn't
the
kind
of
brian
clough
conversation
where
I
allowed
people
to
express
their
view,
and
then
I
decided
what
we
were
going
to
do.
B
B
The
rationale
for
this
is
as
the
health
care
system
and
the
care
system
debate
these
issues
about
how,
in
this
part
of
the
22nd
century,
we
support
people
to
live
with
and
manage
and
reduce
long-term
conditions.
It
allows
us
to
speak
about
not
how
the
institutions
and
services
themselves
did
have
occur
to
those
people,
but
how
the
system
as
a
whole
is
delivering
it.
B
B
It
speaks
to
the
point
around
capacity
and
how
systems
are
working
to
take
these
decisions
and
actually
deal
with
these
issues
around
capacity
complaints
on
whistleblowing,
it's
not
so
much
about
how
we
will
do
it,
michael
you
and
I
spoke
earlier
this
week,
and
this
isn't
about
how
we're
dealing
with
complaints,
but
how
providers
are
dealing
with
complaints.
Michael
and
myself
were
speaking
about
whether
these
reports
are
additive,
not
duplicative
of
other
work
that
we're
doing
so.
B
B
B
These
four
michael
are
really
designed
to
help
us
develop
our
inspection
methodologies
as
well
as
say
something
about
what
we
find
through
the
thematic
reviews.
So,
like
the
other
two,
where
I
think
we
can
speak
about
what
the
system,
how
the
system
is
operating
and
whether
it's
effective,
these
four
smaller
pieces
of
work,
allow
us
to
speak
about
what
we
find
through
the
thematic
reviews,
but
also
help
us
to
polish
and
develop
our
methodology.
A
E
It's
how
we
add
to
the
knowledge
that
exists
in
these
two
areas,
because
I
think
we
said
not
flippantly
last
time
that
the
que
the
answer
to
the
question.
The
answer
to
both
these
questions
is
very
badly.
So
in
a
sense
we
know
the
answer
to
the
questions,
and
then
so.
How
does
the
review
add
to
the
knowledge-
and
I
think
that
has
to
it-
has
to
be
using
the
knowledge
that
we
have
through
inspections.
E
And
it
seems
to
me
that
is
one
of
the
places
to
start
with
old
people
there,
so
that
we're
basing
it
on
on
on
our
knowledge
and
then
we'll-
and
it
seems
to
me
very
quickly-
and
this
is
the
point
you're
making
about
the
the
four
shorter
ones
very
quickly-
we're
going
to
have
to
start
inspecting
integration,
because
that
very
quickly
is
going
to
be.
In
fact,
it
already
exists.
There
are
a
number
of
organizations
that
are
providing
integrated
services
that
are
themselves
integration
of
the
services
we
look
at.
C
Firstly,
I
think
the
paper
is
very
good.
You
know
I've
been
on
the
cqc
board
for
a
while,
and
I've
had
a
number
of
these
reports,
and
this
is
by
far
the
best
one.
I
I
think-
and
I
think
paul's
comments
are
valid.
You
know
because
the
two
larger
ones
are
about
kind
of
the
system,
and
I
guess
that
that
will
change
over
time
as
we
move
towards,
as
the
system
becomes
more
integrated.
C
So
I
think
they
are
really
good
and
what
I,
the
main
point
I
was
going
to
say
really
was
that
we
need
to
be
careful
that
I
know
we
say
all
sectors,
but
we
need
to
make
sure
that
we
do
do
that
because
there
will
be
very.
There
will
be
differences
across
in
say,
mental
health
or
learning,
disability,
older
people,
which
that's
not
just
difference
in
quality.
G
So
I'm
I'm
really
pleased
to
see
this
david
and
I
think
it's
really
helpful
that
you've
got
such
a
kind
of
reasoned
case
here.
As
kay
says,
it's
a
it's
a
a
a
good
paper
and
I'm.
I
absolutely
recognize
that
that
that
that
we
could
always
add
things
and
new
ideas
and
everyone's
got
their
preferences,
but
actually
there's
a
limited
resource
here,
and
we
need
to
focus
it
well,
and
this
looks
like
a
good
list
to
me
so
and
it
will,
it
will
take.
G
F
Well,
I
thought
this
was
much
better,
it's
obviously
more
strategic.
I
suppose
that
was
one
of
the
fundamental
area
of
unease.
I
think
last
time
that
it
seemed
a
little.
It
was
a
little
bit
thrown
together
and
the
and
didn't
add
up
to
something
beyond
the
individual
topics.
Here
I
think,
that's
different.
I
think
it
does
seem
like
there's
a
there's,
a
reason
why
these
topics
fit
together,
they're
sort
of
brought
together
by
certain
characteristics.
F
F
Of
course,
the
inspections
are
about
that
too,
but
they're
about
a
lot
of
other
things,
whereas
these
topics
can
be
about
that
issue
to
a
much
greater
extent.
So
I
think
I
think
these
have
been
well
chosen,
but
I
I
I
am.
I
do
have
two
comments
about
the
the
choices
I
I
agree
that
we
can't
really
spend
another
meeting
going
over
the
new
videos,
but
I
do
think
there's
two
comments
come
out
of
this.
F
And
so
it
is
it's
a
lot
of
investment,
a
high
public
profile,
and
there
are
growing
questions
from
the
field
about
how
it
is
how
it
is
working
for
patients-
and
I
suppose,
I'm
not
I'm
happy
to
go
along
with
the
choices
here,
but
I'm
not
absolutely
convinced
of
our
reasons
for
not
doing
it
and
the
the
reasons
are.
First
of
all
that
we
we've
got
the
mental
health
crisis
care
topic
already.
Iap
has
nothing
to
do
with
mental
health
crisis
care.
F
We've
got
another
a
a
another
reason,
I
think,
is
the.
Let
me
just
remind
myself
the
reasons
excuse
me
for
reading
the
appendix
that
you
didn't
want
us
to
to
mention
now.
Oh
yes,
another
one
is
the
the
value,
the
other
evaluations
of
iap
to
being
undertaken.
But
that
is
the
point.
The
evaluations
that
are
being
undertaken
are
largely
being
conducted
by
the
people
who
are
running
iampt,
and
that
is
that,
isn't
the
evaluation
that
patients
need
to
see.
F
F
That
is
not
going
to
be
addressed
by
the
any
of
the
evaluations
I
know
about,
so
I
don't
agree
that
we've
got
good
reasons
for
for
not
including
iap,
except
possibly
the
other
one.
The
third
reason
that's
given
here
is
that
a
lot
of
our
app
services
are
not
required
to
register
now.
This
is
this
is
an
extraordinary
anomaly.
F
Not
I
mean
we're
doing
to
relive
the
whole
of
that
now,
if
that
that's
correct,
if
that
particular
anomaly
has
got
in
the
way
of
doing
a
thematic
review
on
this
crucial
issue,
then
we
we've
got
to
go
from
here
and
say:
what
are
we
going
to
do
to
change
that
situation?
It
isn't
really
an
acceptable
position
where
we
can't
look
at
it's,
not
one
of
the
core
services
for
mental
health
inspections
either.
A
B
Well,
michael,
why
don't
I
have
some
conversations
with
lewis
and
if
we
involve
paul
mike
in
that
conversation
about
what,
within
our
mainstream
inspections,
we
can
do
there's
a
primary
care
dimension
to
some
of
this
as
well,
and
I
think
steve's
signaling
is
coming
as
well.
So
why
don't
we
look
at
that?
B
And
let
let's
come
back
to
that?
Let
us
think
further
about
this
issue
about
what
our
regulatory
reaches
and,
if
there's
a
solution
to
that,
so
on
both
of
those.
Why
don't
we
get
a
date
and
have
a
separate
conversation
and
perhaps
get
paul
to
come
and
join
us
and
we'll
see
what
we
can
do
in
relation
to
it?
And
if
somebody
from
steve's
team
needs
to
join
us
on
that,
then,
let's,
let's
look
at
how
we
can
do
that.
B
So
I
think
we
can
actually
reach
into
that
area
without
necessarily
doing
a
thematic
review
and
as
we
mature
our
approach
to
this
and
we've
got
the
resource
coming
on
stream
to
do
this
work
over
the
next
period.
Then,
when
we
come
back
to
look
at
these
topics
again,
I
think
one
of
the
issues
we
were
saying.
Should
we
just
roll
these
topics
forward,
or
might
there
be
other
priorities
that
we've
got
next
time?
B
We
sit
down
to
look
at
the
programme
for
the
year,
so
I
think
we
should
carry
these
forward,
but
there
shouldn't
be
a
guarantee
that
we're
going
to
do
these
that
didn't
get
done
next
year,
because
there
might
be
other
priority
topics.
This
point
about
how
how
much
more
we're
going
to
reach
for
integration
might
be
a
stronger
theme
next
year.
B
H
I
need
to
declare
a
conflict
of
interest,
a
past
conflict
of
interest,
and
I
was
part
of
the
research
team
and
technically
continue
to
be
with
richard
layard
around
iact
and
we're
party
too,
and
to
the
lobbying
that
we
both
did
very
hard
to
get
this
in
all
three
parts
of
political
manifestos
before
the
last
election.
So
I
believe
in
the
concept.
So
there
is
a
conflict.
H
I
see
this
as
a
primary
care,
stroke,
mental
health
issue,
because
it's
it's
actually
what
happens
in
primary
care
and
as
a
gp,
I
see
the
variation
in
both
access
and
in
quality.
And
so
what
we
were
talking
about
doing
with
paul
was
in
our
visits
to
ccgs,
looking
specifically
at
the
interface
between
primary
care
and
mental
health,
and
that
includes
iapt,
because
it's
the
single
most
negative
thing
that
comes
back
in
feedback.
H
When
we
talk
to
gps
about
access,
it's
the
mental
health
part
of
that
which
is
the
issue
I'll,
be
very
happy
to
include
you
and
others
in
the
next
meeting,
but
it
was
because
this
hadn't
been
chosen.
I
thought
we
could
do
that.
My
second
point,
just
to
support
paul,
is
that
leading
on
integration.
Both
of
the
two
major
themes
here
helped
me
enormously
in
taking
my
agenda
forward
and
that's
why
I
gave
it
the
support,
but
I
share
with
you
the
concern
about
iact.
H
A
Year,
you
right,
the
final
item
under
thematic
reviews
is
to
agree
it's
for
the
board
to
agree
whether
the
scope
of
the
thematic
review
on
end
of
life
care
is
appropriate.
Now,
there's
quite
a
long
paper
here.
I
I
think
it
is
worth
pointing
out
that
the
liverpool
care
pathway
review
actually
ask
the
cqc
to
do
three
things.
One
is
to
help
define
what
good
quality
actually
is
in
end
of
life
care
it.
It
also
said
recommendation
40,
the
end
of
life.
A
Care
should
be
incorporated
urgently
into
the
hospital
inspection
program
and,
of
course,
that's
exactly
what
mike
has
done
and
in
fact
these
sort
of
issues
are
interrelated
because
they're
already,
I
think,
evidence
mike
of
some
very
good
practice
like
in
salford.
There
are
actually
now
bereavement
nurses.
According
to
the
inspection
report,
which
sounds
like
a
absolutely
admirable
idea,
the
the
final
thing
was.
They
did
actually
ask
the
cqc
to
carry
out
a
thematic
review
within
the
next
12
months.
A
I'm
just
reading
from
their
recommendations
of
how
dying
patients
are
treated
across
various
settings,
from
acute
hospitals
to
nursing
and
care
homes,
as
well
as
in
hospitals
in
the
community.
So
I
think
that
the
only
question
here
is
whether
the
board
have
any
issues
with
the
scope
or
whether
it's
fine
to
go
ahead
on
the
basis
as
defined
outlined
described
in
this
paper.
A
I
It's
just
one
one
small
point:
a
chair
and,
and
apologies
for
colleagues
for
not
raising
it
previously.
But
when
we're
talking
about
the
questions
that
we
want
to
answer
on
page
nine,
which
is
about
what
good
practice
can
others
learn
at
a
local
level?
And
what
action
can
national
local
stakeholders
take
and
to
address
the
inequalities
that
we
might
see?
I
So
health,
education,
england
and
skills
for
care
to
to
take
both
the
health
and
the
social
care
perspective,
but
also
the
employers
organizations
again
across
health
and
social
care
and
then
the.
The
second
point
is
that
we've
identified
nhs,
improving
quality
because
obviously
the
improvement
agency
to
support
and
the
health
service
and
declaring
my
interest
as
the
former
chief
executive.
But
I
think
we
should
also
include
the
social
care
institute
for
excellence
to
to
pick
up
the
social
care
side
of
things
as
well.
F
Yeah,
can
I
say
I
I.
I
think
this
is
exactly
the
kind
of
thing
that
cqc
should
do.
It's
the
best
kind
of
work
that
we
can
do,
because
it
is
about
sometimes
marginalized
groups
at
a
most
at
a
particularly
vulnerable
time,
and
that
really
ought
to
be
at
the
heart
of
cqc
is
one
of
the
most
important
things
that
we
can
do.
So
I
think
this
is
a
really
important
and
very
good
excellent
piece
of
work,
and
at
least
it
has
the
potential
to
be
that
I
should
say.
F
So
there
are
some
people
who
get
to
the
end
of
life,
who
don't
it's
quite
difficult
to
define
exactly
what
their
condition
now
is,
but
it
includes
a
degree
of
dementia
and
it
includes
frailty
and
it
often
leads
to
you,
know,
breathing
difficulties
and
occasional
hospital
admissions.
You
know
there's
a
a
very
familiar
sort
of
pattern
here
and
I
just
want
to
check
that
that
that
sort
of
frailty
group
is
part
of
what
this
will
will
be
about
that
that's
a
slightly
different
way
of
looking
at
the
vulnerability.
F
I
want
to
check
as
well
that
that
the
information
that
is
collected
will
come
from
people
who've
relatives
who've
been
through
the
experience
of
having
somebody
die,
that's
referenced
in
the
full
description
of
the
work
it
isn't
actually
mentioned
in
the
summary.
I
just
wanted
to
check
that
it
is
part
of
the
work,
because
those
people
have
a
lot
to
say
about
the
experience
they've
had
you
know
previously,
and
then.
F
Thirdly,
I
just
wanted
to
check
that
we'll
have
that
that
what
we
are
looking
for
will
be
expressed
in
the
most
sort
of
human
terms,
and
I
say
that
because
there
is
something
slightly
odd
about
the
way
that
we
always
talk
about
personalized
care.
We
have
a
particular
way
of
talking
about
personalized
care,
which
is
the
most
impersonal
possible
way
of
describing
it
and
a
good
example
of
that
is.
That
is
the
nice.
F
I
mean
there's
nothing
wrong
with
it,
nothing
wrong
with
knives
and
it's
it's
description
of
end
of
life,
okay,
but
it,
but
it
isn't
what
you'd
want
the
care
to
be
judged
against,
so
that
you
know
it's
all
about
things
happening
in
a
timely
way,
holistic
assessments
and
all
that
sort
of
jargon
which
is
all
correct.
But
in
the
end
this
needs
to
be
turned
into.
F
D
I
think
the
the
answer
is
yes,
we
will
undoubtedly
look
at
frailty
and
indeed
there's
been
a
lot
of
work
done
on
the
different
trajectories
to
in
the
last
months
and
years
of
life
of
patients,
with
frailty,
for
example,
as
opposed
to
those
with
a
cancer
or
those
with
other
long-term
conditions,
and
we
certainly
want
to
do
that.
I
think
there
are.
There
are
huge
numbers
of
inequalities
in
end-of-life
care.
D
To
answer
these
questions,
please
pass
it
on
and
we
get
a
lot
of
information
about
care
in
the
last
three
months
of
life,
the
last
two
days
of
life,
but
what
we
also
find
is
that
there
are
huge
variations
by
big
geographical
areas
across
the
country.
Unfortunately,
it
wasn't
a
large
enough
scale
survey
to
be
able
to
get
down
to
the
individual
health
authority
or
local
authority
or
ccg,
but
it
it
the
sort
of
level
of
population
per
million
here
or
a
million
there.
D
There
are
big
differences
so
there's
that
geographical,
one
that
has
undoubtedly
inequality
by
diagnosis,
cancer
patients
get
a
better
deal
than
other
people.
There's
inequality
by
where
you
happen
to
be
with
hospitals,
doing
undoubtedly
the
worst
and
care
homes
and
and
home
doing
a
whole
lot
better.
D
Yes,
hospices
do
best,
but
if
they
didn't,
I
think
we
would
all
be
worried
and
but
then,
on
top
of
that,
what's
much
less
known
about
is
very
specific
vulnerable
groups,
because
the
data
aren't
collected
well
enough,
and
I
think
that
will
be
one
of
our
biggest
challenges
here.
How
do
we
get
information
on
homeless
people?
How
do
we
get
information
on
even
people
with
dementia,
but
we
we?
A
Lewis,
I
don't
want
to
volunteer
anybody,
but
your
passion
for
this
subject.
Would
you
like
to
be
the
no
and
it
really
did
come
across
in
in
in
what
you
said?
Would
you
well,
you
can?
Obviously
we
do
need
a
named
name
non-executive,
so,
if
you're
happy
to
be
the
name
non-executive,
that
would
be
really
good.
A
J
Okay,
thank
you
very
much
and
good
morning.
So
by
way
of
introduction
and
background
to
the
strategic
framework,
obviously
you're
very
familiar
with
our
corporate
strategy
and
our
ambitions,
which
include
better
information
for
inspection,
developing
a
more
authoritative
voice
on
health
and
social
care.
J
J
That's
required
in
the
organization
to
underpin
the
delivery
of
our
strategic
objectives
and
to
become
intelligence-led
the
conversion
that
we've
talked
about,
for
example,
in
our
operational
colleagues,
also
applies
to
our
analytical
colleagues
as
well,
so
as
whole
scale
transformation
in
terms
of
the
way
that
we
create
value
and
exploit
the
information
that
we
have,
that
we
want
to
source
from
others
to
become
intelligence,
driven
because
of
our
new
strategy.
Because
of
our
new
structure
and
our
new
operating
model.
J
The
five
work
streams
will
cover
the
what
we
believe
are
the
the
the
full
breadth,
the
the
dimensions
of
of
knowledge
and
intelligence,
and
to
to
respond
to
to
michael
and
lewis's
point
about
areas
where
we
are
less
data-rich
like
adult
social
care
and
primary
care.
I
see
that
broadly
sitting
across
both
quantitative
and
qualitative
for
the
next
board
meeting
we're
seeking
to
bring
a
paper
on
our
adult
social
care
strategy
as
an
action
from
the
previous
board.
J
We
ask
of
providers,
but
we
also
make
much
better
more
intelligent
use
of
qualitative
information
that
is
out
there
and
the
reason
why
we've
separated
the
two
out
is
that
we
believe
they
require
very
different
tactics,
very
different
solutions,
very
different
types
of
expertise
to
fully
exploit
this
information,
but
that
the
framework
as
a
whole,
guided
by
this
knowledge
and
information
work
stream.
We
have,
as
part
of
our
transformation
program,
will
ensure
that
the
the
two
work
streams
do
not
become
divergent.
A
C
Yep
thanks
emma
obviously
kind
of
really
crucial
that
we
get
this
right.
So
it
sounds
sounds
great.
I
mean
my
life,
it's
not
the
first
time.
I've
raised
this,
but
just
I'm
always
kind
of
concerned
about
the
weight
that
might
be
given
to
kind
of.
If
you
like,
the
qualitative
stuff,
particularly
the
voices,
the
voice
of
of
people
who
use
services,
you
know
because
it
you
know.
C
Oh
it's
anecdotal
or
you
know
so
it's,
but
sometimes
within
that
you
get
the
the
nugget
that
actually,
particularly
if
you
haven't,
got
other
information,
it
could
actually
be.
You
know
fundamental
to
you
know
it
could
be
indicating
a
real
problem
with
it
with
a
service.
We
may
not
know
that,
so
it's
it's
really
sort
of.
How
can
we,
you
know,
make
sure
that
the
qualitative
stuff
is
captured
and
used
in
the
best
way
and
not
sort
of
seen
as
the
sort
of
second
class
cousin
to
sort
of
quantitative.
C
You
know
how
are
they
going
to
be
sort
of
engaged
in
this
so
that
what
we
actually
you
know
deliver
meets
their
needs
and
also
the
international
contact
center
as
well,
because
you
know
obviously
that's
that's
crucial,
because
if
they
don't
find
it
useful
or
can't
use
it,
then
you
know
it
fails
really.
So
you
know
just
how
you're
going
to
make
build
that
into
the
strategy.
J
B
G
So
so,
just
on
on
the
first
of
those
those
points-
and
I
should
sort
of
start
by
saying-
I
read
the
cover
paper
and
I
thought
my
goodness,
what
is
this
going
to
be
about,
and
then
I
got
to
the
tree,
and
I
thought
oh
that's
great.
I
get
I
get
it.
It
gives
me
a
really
good
way
to
think
about
it.
So
I
I've
found
that
really
helpful
and-
and
so
I'm
kind
of
focusing
on
that
second
box
down
sort
of
on
the
third
layer
of
the
tree.
G
How
can
we
secure
access
to
agreed
and
needed?
And
I
think
the
needed
is
all
about
the
proactive
kind
of
new
information
that
we
don't
have
or
wouldn't
be
available,
which
is
really
important
directly
from
people
and
and
so
my
supplementary
to
to
case
is
how
how
far
you've
got
down
the
path
of
thinking
about
what
the
existing
sources
of
that
information
are
extra
to
those
that
are
in
the
system.
So
you
know
the
information
board
and
hscic
and
other
people
will
provide
system
information.
G
But
we
know
that
there's
an
awful
lot
of
an
awful
lot
of
the
service
user
organizations,
for
instance,
do
their
own
survey
work
and
there's
something
about
working
with
them
to
help
them
to
shape,
where
appropriate,
their
surveys.
To
pick
up
the
kind
of
information
which
we
need,
we
at
healthwatch
england
will
be
doing
data
collection
from,
in
addition
to
the
proactive
stuff
that
they
that
local
health
watch
give
us
we'll
be
doing
date,
sort
of
quarterly
data
returns
from
local
health
watch.
G
So
something
about
making
sure
that
we
too
are
asking
of
them
the
right
kind
of
questions
to
get
you
so
so.
There's
just
there's
a
there's,
a
both
an
engagement
with
all
of
those
user-facing
service
user
facing
bodies
to
collect
what
they've
got,
but
also
to
help
in
the
same
way
to
help
shape
what
they
might
do
going
going
forward,
which
I
think
is
hugely
important
and
outside
the
system.
E
In
literally,
why
we're
some
of
the
heroes
of
our
mid-staffs
and
and
in
a
sense,
their
official
data
lost
and
soft
data
won,
and
this
I
think
I
just
think
it's
very,
very
important
to
remember
that
in
these
discussions.
So
it's
in
a
sense.
The
the
mandate
for
soft
data
in
these
sorts
of
discussions
is
now
very,
very
powerful
and
very
hard,
and
so
in
a
sense.
E
E
J
J
So
as
part
of
our
restructure
as
part
of
the
transformation
program,
we
have
dedicated
an
entire
function
within
intelligence
to
quality
of
information,
and
that
is
split
into
surveys:
quality
of
innovation,
qualitative
analysis
and
local
intelligence
analysis,
the
ambition
being
that
we,
alongside
our
new
strategy,
we
have
a
much
better
organized
disciplined
sense
of
what
information
is
out
there.
What
has
value
and
we're
able
to
segment
that
information
both
by
sector
both
by
people
who
use
services
as
well.
We
find
that
a
lot
of
our
sources
don't
usefully
segment
population
groups.
J
So
one
of
the
things
that
we're
working
with
engagement
on
at
the
moment
is
how
we
can
get
a
better
sense
of
who
we
hear
from
and
who
we
don't
and
the
degree
of
utility
in
mechanisms
such
as
our
intelligent
monitoring
model
and
our
data
pack.
These
various
information
flows
have
it's
important
for
us,
as
I
think
it
is
in
the
document
not
to
see
more
data
as
better
data
that
we
need
to
be
quite
discerning
both
in
terms
of
bringing
in
both
qualitative
and
quantitative
information.
J
So
we
do
want
to
tackle
the
question
about.
Where
is
the
data
we
need
and
who
are
we
engaging
with
in
a
very
sort
of
considered
and
and
methodical
way,
so
there?
I
believe
we
have
the
that
the
form
that
follows
that
the
function
that
we
believe
we
need
and
the
quality
of
strategy
that
will
emerge
from
this
will
provide
that
those
individuals
with
direction
to
deliver
what's
required.
J
J
Colleagues
in
information
services-
and
it
did
do
some
some
interviews
with
inspectors
to
better
understand
what
it
is
their
needs
were
so
we've
got.
I
think,
the
beginnings
of
a
better
understanding
in
terms
of
what
what
technology
in
order
to
support
better
mobile
working
is
how
our
inspectors
better
want
to
engage
with
how
they
receive
information
and
how
they
utilize
it.
In
terms
of
content,
we're
on
quite
a
long
journey.
J
We,
as
you
know,
are
procuring
from
for
some
additional
support
in
that
space
that
will
cover
both
mental
health
learning
disabilities
community
and
acute
to
take
us
to
a
much
better
place.
That
is
much
more
supportive
to
the
workflow
of
an
inspector
on
an
inspection
is
much
more
intuitive
to
what
an
inspector
needs
for
adult
social
care
and
primary
care.
D
Mike
can
I
just
come
in
on
this
point
about
the
inspectors
on
on
the
ground,
because
I
think
there
is
a
huge
amount
we
need
to
do
to
skill
them
up
to
use
the
data
that
emma
will
provide
and
the
line
I've
been
taking
is
that
we
need
that
need
the
data
for
at
least
three
different
reasons.
One
is
for
planning
our
inspections.
One
is
for
probing
when
we're
doing
an
inspection,
and
the
third
is
judgment.
D
So
there
are
relatively
few
of
the
the
data
sets
that
are
sufficiently
robust,
that
in
themselves
we
use
them
for
for
judgment.
I
think
the
staff
survey
is
one
of
those.
I
think
the
the
the
cqc
inpatient
survey
is
one
of
those,
because
we
know
the
methodology
we
know
it's
robust
and
the
samples
are
large
and
unstable,
there's
a
whole
lot
of
other
information
which
is
really
useful
either
for
planning
or
probing.
D
You
can't
really
plan
an
inspection
of
a
maternity
unit
unless
you
know
how
many
children
are
being
born
there
each
year,
is
it
300
in
one
place
and
is
it
8
000
another?
You
need
to
know
that
something
that
a
lot
of
hospitals
don't
know
is
how
many
people
die
in
their
hospital.
In
fact,
there's
a
question.
I
often
ask
chief
executives,
you
know,
and
the
best
ones
know
precisely,
but
others
do
not
and
how?
D
D
The
things
like
the
friends
and
family
test
are
very
useful
for
that.
You
can
ask
questions
and
you
can,
but
we
also
need
to
be
sophisticated
in
how
we
use
it.
I've
seen
a
hospital
where
the
responses
that
have
come
into
cqc
about
that
hospital
were
almost
universally
negative.
I
think
it's
in
one
of
our
reports.
I
can't
remember
which
one
it
is,
but
19
out
of
21
comments
had
been
adverse
at
the
for
the
same
hospital
in
the
same
period.
D
F
F
There
is
a
an
obvious
mismatch
between
the
the
length
of
the
intelligent
monitoring
variables
and
the
number
of
key
lines
of
inquiry.
So
we
have
I
I
don't
know
how
the
inspectors
will
deal
with
the
very
large
number
of
key
lines
of
inquiry.
There's
just
so
many,
and
I
suppose
that
reflects
the
fact
that
we
don't
yet
know
what
the
data
will.
F
The
actual
figures
are
really
telling
us,
and
so
it's
rebalancing
those
two
things
so
that
I
think
this
takes
me
to
what
mike
you
are
giving
us
the
sort
of
second
use
of
the
information
where
the
inspectors
will
be
able
to
say.
We
would
like
to
know
how
you
explain
this
particular
finding
in
our
intelligence,
intelligent
monitoring
at
the
moment.
It
doesn't
feel
that
we're
we're
very
close
to
that
that
position,
and
so
thinking
of
how
we
get
there.
F
I
just
want
to
check
that
so
what
I
was
getting
at
this
morning
when
you
weren't
here
it
was,
it
was
whether
recognizing
the
gaps
in
the
available
data,
because
we're
very
limited
by
what's
available
at
the
moment,
but
recognizing
the
gaps
and
what's
available,
we're
able
to
say
from
as
a
matter
of
strategy
that
over
the
next
I
don't
know
three
years
might
be
less
might
be
one
year.
We.
F
What
we
really
want
to
know
to
allow
the
key
lines
of
inquiry
to
be
more
focused
is
is
are
the
following:
five
things
or
ten,
whatever
it
is,
and
so
those
are
the
things
that
we
would
like
to
know
and
they're,
not
those
things
are
not
available
at
the
moment,
but
for
us
to
do
our
job
properly,
they
need
to
be
available.
So
we
go.
We
we
go
to
whether
it's
the
department
of
health,
nhs,
england,
trust
themselves
and
say:
if
we're
to
do
our
job,
we
we
must.
F
You
must
provide
this
information
and
some
of
it
you
don't
even
collect
at
the
moment,
some
of
it.
You
do
and
it's
not
very
good,
but
but
from
a
strategic
point
of
view,
we
set
ourselves
a
task
of
transforming
the
intelligent
monitoring
into
a
coherent
and
valid
set
of
variables
over
over
a
a
defined
period
and
then
check
progress,
check
and
rely.
F
And
then
we
put
the
onus
on
provider
organizations
on
the
on
nhs
england
itself
to
make
sure
that
that
happens,
because
you
know
they've
got
to
make
sure
we
can
do
our
job
and
on
the
issue
of
complaints,
I
would
include
the
complaints
in
that.
I
I
like
the
idea
of
restlessness
and
but
it's
not
enough,
as
I
shoot
up
the
the
the
in
the
end.
F
I
I
this
is
where
I'm
repeating
I
do
apologize
for
repeating
myself,
but
I
do
think
we
have
a
tremendous
opportunity
to
lead
the
way
on
the
science
of
complaints,
and
probably
the
first
thing
we
would
do
is
stop
calling
them
complaints,
because
I
don't
think
it
is
just
about
complaints.
The
intelligence
that's
out.
There
is
more
than
that,
but
it
is
partly
about
understanding
who
doesn't
provide
information
who
which
patients,
which
families
don't
ever
provide
feedback.
F
And
that's
quite
a
large
number
and
what
their,
what
they
really
feel
about
the
service
that
they
that
they
get,
because
that
information
is
absolutely
crucial
and
it's
the
way
that
you
know
opinion
pollsters.
They
adjust
all
their
findings
according
to
who
they
didn't
talk
to
and
in
a
way
that
we
need
to
be
able
to
do
something.
That's
a
little
bit
like
that.
I
was
slightly
sorry
that
the
that
report
this
week
was
called
more
complaints.
F
No,
but
you
know
it
was
sort
of
it
was
a
jolly
title,
but
on
the
other
hand
it
isn't
more
complaints
that
are
needed.
It's
more.
It's
it's
better.
It's
better
information
that
isn't
a
complaint
and,
and
once
we've
got
that,
then
we've
got
the
basis
of
what
I
think
of
as
a
science
which
nobody
else
has
at
the
moment,
and
it
does
include
catching
those
nuggets.
But
it
also
means
balancing
it
against
people
who
are
who
don't
have
a
voice
in
the
system
at
the
moment.
J
Yes,
I
think
I
think
part
of
it
is
is
con
in
terms
of
the
the
the
the
information
driving
key
lines
of
inquiry,
or
at
least
supporting
the
development
of
key
lines
of
inquiry
is
probably
a
better
way
of
describing
it
is,
is,
is
in
part
the
way
that
we
present
the
information
so
in
terms
of
the
the
currently
the
data
packs
should,
I
think,
be
encouraging
that
relationship
better
than
it
currently
does.
So
our
next
iteration
will
promote
the
use
of
intelligent
monitoring
through
to
developing
the
lines
of
inquiry.
J
If,
on
your
your
final
point
about
the
complaints
and
who,
knowing
who
doesn't
provide
feedback,
I
think
that's
really
important
for
us
and
that's
one
of
the
reasons
why
we
need
to
think
about
how
we
segment,
people
who
use
services
to
understand
better
how
we
can
be
more
proactive
and
how
we
can
target
individuals.
So
at
the
moment
we
do
obtain
the
majority
of
our
information
through
mechanisms
where
it's
up
to
the
individual
to
to
link
in.
J
So
if
they
want
to
put
information
on
a
website,
for
example,
or
on
our
our
website,
then
then
they
they
they
take
themselves
there.
And
they
do
that,
and
I
think
we
do
need
to
balance
that,
with
with
a
much
more
proactive
attempt
for
particular
groups
in
the
community
that
we
need
to
hear
from
more.
K
K
Important
to
note
that,
under
michael's
stewardship,
we
are
doing
some
work
at
the
moment
about
the
way
that
we
handle
internal
and
things
that
come
to
us
from
the
external
environment
and
part
of
that
is
to
disaggregate
what
is
actually
being
told
to
us
and
to
understand
how
to
engage
with
it
better.
So
we
are
in
the
process
of
disaggregating.
K
A
Thank
you
emma.
I
just
had
one
point
myself
or
two
points.
Actually,
on
page
nine
there's
a
list
of
investments
that
cqc
needs
to
make.
I
don't
think
we
should
discuss
them
now,
but
it
does
apart
from
oracle,
which
eileen's
going
to
touch
on
in
a
moment,
there's
about
10
10
million
pounds
of
investment,
and
I
think
if
camilla
was
here,
I
think
she
would
undoubtedly
ask
you
know.
A
A
Can
we
do?
We
have
the
power
to
ask.
The
reason
for
this
question
is
if
we
knew
the
name
of
everyone
or
their
relative
and
an
email
address,
or
a
mobile
phone
number
that
just
gives
us
the
ability
to.
You
know,
for
example,
for
the
call
center
to
do
out
outbound
calling
to
find
out.
You
know
how
their
relatives
are
being
treated
whether
they've
got
concerns.
A
I
was
also
very
taken
by
mike's
point
that
the
response
rate,
the
bereavement
response
rate
was
40,
which
is
you
know
incredible
that
you
know
if
we
had
better
knowledge
or
if
we
were,
if
it
was
in
our
power
to
actually
request
the
names.
I
think
that
would
be
extremely
helpful
for
our
intelligence
gathering.
I
don't
know
andrea
whether
we've
got
that
power.
I
So
so
we
have
been
doing
that
as
part
of
the
inspections
that
we're
undertaking.
At
the
moment,
it's
going
to
be
one
of
the
things
that
we
will
evaluate
in
terms
of
finding
out
how
useful
that
is
and
how
much
we
get
back.
What
we
also
do
is
use
our
experts
by
experience
and
to
telephone
some
of
the
the
people
using
those
services
and
and
and
to
so
it's
more
of
a
qualitative
conversation
as
opposed
to
completing
a
survey.
I
It
is
despite
the
fact
that
we're
trying
to
do
those
things,
so
we
do
have
the
ability
to
do
that.
I
think
that
we
all
always
have
to
be
mindful,
particularly
in
domiciliary
care
services,
that
folk
are
very
often
very
reluctant
to
share
their
opinions
of
of
the
service,
particularly
if
they
have
concerns
because
of
the
concern
that
they
might
have
about
what
would
happen
subsequently.
I
I
There
were
practical
things
for
us
to
get
over
in
getting
that
from
a
residential
point
of
view,
it's
easier
because,
obviously,
when
we
go
in
for
inspections,
we
can
speak
to
people
very
often
we
can
speak
to
relatives
who
are
there
one
of
the
things
that
we're
also
exploring,
though,
is
and
again.
This
is
tricky
for
us,
because
we
do
unannounced
inspections
and
there's
good
reasons
for
that.
I
A
So
it
would
be
very
good
if
you
could
deal
deal
with
this
issue,
including,
I
think
paul's,
very
important
point
that
so
much
of
the
information
here
is
is
necessarily
qualitative.
Is
it's
not
just
that?
It's
not
quantitative.
I
mean
it
is
just
the
nature
of
the
issues
in
certainly
in
adult
social
care
seem
to
me
to
be
qualitative
issues.
You
know
they're
not
prone
to
you.
D
A
A
K
K
So
this
was
not
a
discretionary
spend.
It
is
something
we
would
have
to
do.
Just
less
than
a
month
ago,
the
department
of
health
alerted
us
to
the
fact
that
they
had
been
offered.
They
are
in
the
same
position
as
us
in
terms
of
renewing
their
licenses.
They
have
been
offered
a
discount
rate
if
orders
could
be
placed
by
the
end
of
april
for
license
renewal,
and
we
are
keen
always
to
achieve
value
for
money.
K
We
had
worked
through
the
the
best
and
most
plausible
procurement
route
for
us
already,
and
then
this
stepped
in
allowing
potential
savings
of
in
the
region
of
a
quarter
of
a
million
pounds
which
is
important
to
us
to
achieve.
It
has
meant
that
the
people
working
on
this
procurement
have
pulled
out
all
the
stops.
We
have
achieved
the
I
haven't
been
at
cqc
long,
but
I'm
assured
it's
the
fastest
agreement
to
a
business
case
that
there
has
been
around
a
major
procurement,
thus
far
involving
the
department
of
health.
K
So
I
commend
them
for
that
and-
and
I
you
know,
can't
make
it
more
exciting
than
the
fact
that
this
is
something
we
would
be
doing
already
and
in
engaging
with
the
various
parts
of
the
procurement
on
offer
procurement
cycle.
This
is
has
been
tested
and
we
are
provided
with
internal
assurance.
The
cqc
and
assurance
from
the
department
of
health
is
the
best
route
to
go.
So
I'm
asking
for
you
to
endorse,
what's
been
set
out
here,.
A
Any
comments
or
is,
is
the
board
happy
with
going
for
option
two
and
the
discount,
I'm
assuming
we're
getting
the
discount
or
the
government
is
getting
the
discount
because
april
30th
must
either
be
oracle's.
You
know
the
end
of
oracle's
financial
year
or
something
to
do
with
that.
They
just
want
to
get
the
revenues
in.
So
thank
you
very
much.
A
A
G
Thanks
very
much
so
I'm
I
I
I
I'm
not
going
to
talk
through
the
detail
and
I'm
conscious
that
you've
only
just
got
it
anyway.
So
that
probably
isn't
the
point,
but
I
think
I
wanted
to.
I
undertook
to
bring
something
to
the
board,
to
give
you
a
sense
of
what
we
were
trying
to
achieve
when
camilla
asked
a
question
at
the
last
board
meeting.
Well,
what
would
healthwatch
bring
to
the
inspection
process?
G
So
I
thought
it
was
a
a
good
opportunity
sort
of
now
we've
gone
through
the
first
waves
of
hospital
inspections
and
as
we're
starting
inspections
in
the
other
sectors
to
to
reflect
on
what
we'd
learnt
and
what
our
ambition
was.
I
have
to
say
this
is
not
just
from
the
health
watch
perspective,
catherine,
who
I
would
have
catherine
ray
carter
chief
executive.
G
It
was
part
of
realizing
an
ambition
that
there
was
a
very
positive
and
potentially
synergistic
relationship
around
the
inspection
process
and
I
think
for
lots
of
reasons,
partly
because
the
inspection
process
has
been
so
up
in
the
air
and
in
development
and
most
particularly
because
local
health
watch
didn't
really
exist
until
this
time
last
year
and
have
been
in
setup
mode.
We've
be
we
haven't.
G
Well,
it's
patchy
in
two
respects,
because
one
is
what
one
respect
is
that
local
health
watch
haven't
always
been
able
and
haven't,
had
the
capacity
of
the
the
the
capability
to
be
involved,
and
the
other
is
that
cqc
hasn't
always
remembered
to
engage
with
them
or
or
do
it
in
a
way
which
is
fit
for
their
purpose.
So,
there's
learning
on
on
both
sides,
which
is
is
reflected
in
here
and
and
just
thinking,
particularly
about
the
local
health
watch
aspect.
Dimension
of
this.
G
G
G
So
so
we
have
an
item
in
our
budget
and
business
plan
for
next
year,
which
is
around
supporting
local
healthwatch,
engaging
with
the
inspection
process
and
there'll,
be
a
whole
host
of
work
around
that
including
training
and
data
for
them
and
and
all
sorts
of
things
which
will,
which
will
hopefully
arrive
at
a
point
where
it's
there's
a
much
more
consistent
engagement
from
local
health
watch
when
inspectors
want
to
talk
to
them.
So
so
that's
a
kind
of
general
proposition.
G
The
second
phase
is
about
actually
during
the
inspection
and
the
way
that
local
health
watch
and
cqc
might
work
together
and
the
the
things
that
local
health
watch
might
contribute
to
that,
and
perhaps
the
surprise
in
in
the
box
is
the
third
phase,
which
is
post
inspection
and
two
things
to
say
about
this
and
then
I'll
be
very
happy
to
take
questions.
So
I
think
the
first
thing
is.
G
This
is
not
in
any
way
suggesting
that
local
health
watch
become
part
of
the
inspection
function,
but
but
it
is
to
recognize
that
local
health
watch,
hopefully
will
have
things
which
they
can
usefully
contribute.
That's
that's
that's
point
one,
but
second
is
that
local
health
watch
is
located
in
the
community.
G
So
a
variety
of
things
which
they
can
do
in
that
respect,
but
that
that
being
in
the
community
is
one
of
the
things
that
I
think
is
really
important
to
to
sort
of
wrap
around
the
notion
of
local
health
watch.
It's
you
know
they're
there
they
should
be
engaged
with
local,
voluntary
and
other
third
sector
organizations.
They
will
be
at
the
health
and
wellbeing
board.
Ccg
very
often
they'll
be
engaging
with
the
providers,
so
they
have
they.
G
They
they
have
a
a
series
of
their
own
local,
intelligences
and
relationships
which
should
help
them
to
help
all
of
us
improve
services.
And
that's
why
phase
three
is
there,
but
that's
why
phase
two
also
talks
at
the
very
top
about
providing
a
community
narrative
ahead
of
inspection.
So
it's
it's.
It's
kind
of
that
sense
of
community,
so
more
work
to
be
done
on
this
paul
bate
and
on
behalf
of
all
the
inspectors.
G
E
Comment
really
the
we
often
talk
around
this
table
about
the
importance
of
improvement,
but
we're
not
allowed
to
be
involved
and
by
the
look
of
it
you
are
now.
That's
really
significant.
I
think,
because
we
have
a
foothold
in
the
next
step,
and
it's
been
a
constant
worry
to
me
that
we
had
no
relationship
with
the
next
step,
almost
by
statute,
no
relationship
with
the
next
step.
E
But
actually
you
know
the
local
health
watchers.
If
we
can
build
this
up
so
that
in
a
sense
they
are
representing
the
community
and
looking
at
the
improvement
activity
as
it
happens
or
doesn't
happen,
then
all
the
inspectors,
through
cqc
and
healthwatch,
have
have
a
view
of
improvement
without
being
involved
in
it,
and
that
is
potentially
I
mean,
starts
to
deal
with.
E
The
worry
that
I
think
we've
all
had
about
the
the
the
problem
that
we
have
we'll
be
judged
on
the
impact
of
something
that
we're
not
involved
in,
whereas
actually
there
is,
there
is,
as
I
say,
the
foot
or
a
toe
hold
in
that
improvement.
So
how
that
the
training
for
that
develops,
I
think,
is
potentially
really
important.
You
know:
how
can
we
assist
healthwatch
localities
to
actually
what
should
they
be
looking
for?
I
I
So,
given
that
it's
based
on
the
local
authority
area,
some
of
the
conversations
that
we've
had
separately
about
whether
we
should
be
when
we
get
to
this
the
ability
to
do
this
and
presenting
reports
for
by
local
authority
area,
which
would
map
onto
healthwatch,
which
is
saying
well.
This
is
what
we're
finding
in
in
in
the
hospitals
sector.
This
is
what
we're
finding
in
prime
medical
services.
I
H
Yeah,
thank
you.
I
mean,
as
usual,
I
would
agree
with
andrea,
so
we're
building
out,
which
is
very
similar
in
prior
medical
service
to
to
adult
social
care,
so
we're
building
our
model.
As
we
said
earlier
about
integration
from
the
bottom
up,
our
inspection
managers
will
be
linked
to
ccgs,
which,
by
definition,
then
aggregate
up
into
local
authority
areas.
H
And
we
need
a
meeting
to
talk
through
that.
I
think
I'd
like
to
have
a
meeting
at
least
where
social
care
is
involved,
because
we
also
need
to
bond
the
our
inspection
managers
with
andreas
locally
so
that
they
can
cross
represent
us
at
times,
rather
than
just
one
of
the
sectors,
because
I
think
this
concept
of
of
the
one
cqc
and
doing
things
once
when
you
can
is
really
really
important
even
to
at
a
local
level,
not
just
with
us
being
together.
A
D
D
We
will
be
doing
a
particular
inspection
in
the
next
quarter
so
that
we
can
get
information
from
them
before
we
go
on
site
and
and
absolutely
the
point
that
that
handler
is
all
ready
made
about
these
three
blobs
and
the
that
the
fact
that
at
the
third
phase,
local
health
watch
are
always
invited
to
the
quality
summit
and
we've
already
had
a
webinar
where
we've
tried
to
engage
with
local
health
watches
in
the
areas
where
we've
already
inspected.
Just
to
get
their
experience
of
that.
F
And
I
suppose
I've
become
more
aware
of
this
because
having
met
james
titkam
and
through
his
involvement
with
cqc,
which
I
find
rather
extraordinary.
Actually
maybe
it's
well
known,
but
I
I
hadn't
been
aware
of
how
unpopular
people
can
be
for
raising
serious
and
valid,
ultimately
vindicated
concerns
about
their
local
service,
and
there
may
be
some
complex
reasons
for
that.
A
G
So
a
few
things
I'll
just
deal
with
that
I
mean,
I
think
one
of
the
reasons
for
wanting
to
bring
this
here
is
to
try
to
join
up
the
thinking
across
all
three
inspectorates.
So
I
just
welcome
what
you
both
have
to
say
about
making
sure
that
this
is
fit
for
purpose
across
the
piece
and
it
does
absolutely
take
for
granted
that
ongoing
need.
G
G
None
at
the
moment
now
in
some
respects,
I
don't
think
that's
a
bad
thing,
because
whistleblowers
I
mean
whistleblowers
should
go
wherever
they
need
to
wherever
they
can
and
if
they
find
their
way
to
local
health
watch.
That's
right,
but
and
healthwatch
will
will
you
know
we've
done
quite
a
lot
of
work
with
them
on
on
what
they
should
do
in
those
circumstances.
G
But
actually
whistleblowers
are
much
better
coming
to
cqc
and
and
others
in
the
system
who
are
better
able
to
act
more
quickly
and
the
first
thing
we
do
if
we
got
a
whistleblowing
would
be.
If
we
were
aware
of
a
whistleblower,
it
would
be
to
pass
it
straight
to
cqc,
because
that's
that
that
that's
the
place
that
something
could
be
done
about
it.
G
So
I
think,
there's
an
issue.
There
is
an
issue
there,
it's
the
kind
of
no
wrong
door
thing
and
wherever
it
comes
in,
we
should
make
sure
that
it's
properly
dealt
with
whether
there
is
separately,
a
role
for
local
health
watch
to
support
those
who
have
whistleblown
and
are
then
condemned
within
their
own
communities.
I
think
is
a
a
another
question
which
we
haven't
yet
had
to
face,
but
I
I
hear
what
you're
saying
we'll
take
it
away
to
think
about.
A
Anna,
thank
you
very
much.
I
think
anna
is
going
to
slip
away
now,
there's
only
two
other
items
on
the
agenda.
One
is
the
acg
report,
but
essentially
john
took
us
through
it
at
the
last
board
meeting.
So
I
don't
think
unless
any
board
members
want
to
that,
we
need
to
go
through
that,
go
through
it
again.
I
think
the
points
are
made
very
clearly.
A
The
board
forward
plan
is
actually
not
quite
a
forward
plan.
It's
the
agenda
for
the
next
board
meeting,
basically
which
again,
unless
colleagues
think
there's
anything
wrong
with
that
agenda.
We
we
could
just
sort
of
say
that
that's
fine,
I
don't
know
if
there's
any
other
business,
any
other
issues
that
are
on
the
board's
mind.
A
B
Sorry
I
apologize-
I
should
have
done
this
earlier,
but
lewis
has
just
reminded
me
that
I'd
just
like
to
confirm
that
malta,
gohold
and
one
of
our
colleagues
from
our
hr
departments
interviewed
for
our
national
patients
safety
advisor
earlier
this
week
and
I'm
pleased
to
be
able
to
confirm
that
we've
done
the
references,
etc,
etc
and
that
james
titkam
has
been
permanently
appointed
to
that
pause.
So
we
can
announce
that
today.
A
L
I
was
very
pleased
to
hear
andrea,
saying,
stressing
that
people
in
social
care
were
very
reluctant
to
report
concerns
about
it,
and
I
imagine
that
that
consideration
was
very
much
in
her
mind
last
october,
when
she
scouted
the
idea
of
using
audio
and
video
monitoring
as
part
of
the
inspection
process.
And
so
I
would
really
like
to
ask
her
if
there
is
any
if
she
can
give
an
update
on
her
thinking
and
on
particular
particular
about
sort
of
four
points.
L
L
L
A
I
Thank
you
very
much
to
respond
to
david's
first
point.
Thank
you.
At
the
same
time
as
publishing
the
three
provider
handbooks
for
adult
social
care,
we
also
produced
an
overview
to
those
provider
handbooks,
which
is
this
beautiful
document
here
and
the
on
page
10.
We
set
out
the
issues
associated
with
the
use
of
cameras
and
mystery
shoppers
actually
more
on
the
covert
surveillance
side
rather
than
the
overt,
but
I
mean
you
make
a
very
good
point
about
that
as
well.
A
Yeah
and
I
think
on
david's
second
point-
it
really
does
come
back
to
the
issues
we've
been
discussing
earlier
about
how
to
obtain
information
on
sectors
where
there
is
no
readily
available
information.
I
hopefully
the
next
board
meeting
will
be
able
to
address
david's
point.
You
know
directly
when,
or
certainly
as
far
as
social
care
is
concerned.
A
J
Thank
you
chair
two
questions.
If
I
may
one
concerns
the
cqc
website
whether
it
might
be
possible
to
develop
this
so
that
members
of
the
public
who
have
an
interest
in
particular
services
such
as
hospitals,
could
receive
an
email
alert
if
there
are
inspection
activities
ongoing
or
in
the
immediate
future,
because
it
can
be
fairly
difficult.
J
A
K
K
So
we
are
really
at
the
beginnings
of
that
work
and
really
drawing
our
thinking
together
and
inviting
thinking
from
people
who
have
a
view
on
what
it's
like
to
try
to
navigate
some
of
our
information
largely
on
the
website,
but
in
other
ways
as
well.
So
that's
ongoing
and
it
is
going
to
not
be
an
instant
fix
is
what
I
would
say.
But
it's
going
to
be
done
thoughtfully
with
a
view
to
what
works
and
and
what
is
proportionately,
affordable.
Also.
J
And,
very
briefly,
if
I
may,
a
question
about
dentistry,
the
out
of
our
services
are
being
inspected
for
primary
medical
services.
Is
there
any
intention
to
inspect
whatever
out
of
our
service?
There
might
be
in
dentistry,
because
I
am
mindful
that,
where
I
to
get
a
acute
toothache
tomorrow
evening,
my
dental
surgery
will
be
closed
for
four
consecutive
days
and
it
would
be
quite
a
long
time
to
wait
until
tuesday
morning.
A
Well,
on
that
note,
I
I
hope
that
you
don't
get
a
tooth
severe
toothache
over
easter,
but
finally,
I
did
want
this
meeting
to
end
at
12
20
exactly.
I
haven't
quite
achieved
that,
but
I
think
we've
had
a
very
productive
meeting
and
just
two
final
points.
First
of
all,
to
wish
all
the
ward
colleagues
a
good
easter
break.
A
A
That's
one
way,
I
think,
perhaps
of
having
a
role
in
improvement,
but
I
think
it
is
a
very
important
issue
which
I
think
future
board
meetings
need
to
come
back
to
the
there's.
Then
the
issue
of
intelligence,
which
I
think
we've
had
a
good
discussion
about,
but
it
remains
highly
very
important,
especially
this
whole
area,
as
I
mentioned
earlier,
that
paul
raised
about
the
the
importance
of
qualitative
intelligence,
particularly
in
adult
social
care.
A
A
What
role
the
ck
cqc
can
have
in
making
integration
more
effective.
So
those
are
the
themes
that
I
took
from
this
meeting,
in
which
I
you
know,
I
hope
reflect-
are
reflected
in
future
future
board
meetings.
So
thank
you
very
much
for
today,
and
I
say,
we've
almost
made
the
12
20,
which
I
think
is,
is
very
good,
helped
by
the
fact
that
we
did
have
some
apologies,
but.