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From YouTube: CQC board meeting – April 2017
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A
Right
good
morning,
everybody
welcome
to
the
CQC
public
board
meeting
a
particular
welcome
to
those
of
you
who
have
come
from
the
public
to
be
with
us
today.
We
have
one
apology
for
absence.
As
most
of
the
board
will
know,
david
bins,
father
died
at
beginning
of
the
week,
and
david
is
in
the
north
of
england.
Making
the
the
relevant
arrangements
are,
since
his
apologies
and
I'm
sure
the
whole
board
would
want
to
send
their
condolences
to
David
auntie's
and
his
family,
which
we
do
other
than
that.
A
A
The
next
item
is
around
inspection
report.
Timeliness,
which
we
know
is
one
of
the
issues
that
we
really
are
trying
to
grapple
with,
and
but
if
I
could
just
ask
each
of
the
chief
inspectors
in
turn
just
to
update
the
board
on
where
we
are
in
relation
to
each
of
those
areas.
So
Andrea
can
I
come
for
us
to
you
since
its
first
on
them.
The
list
here.
B
Thank
you
so
the
as
you
as
you'll
see,
we
kept
the
key
performance
indicator
target
for
adult
social
care
at
ninety
percent
for
completion
within
fifty
days
throughout
the
year,
and
we
have
been
making
steady
progress
towards
that
target
and
also
ensuring
that
the
average
numbers
of
days
that
it's
taking
as
to
completely
put
has
was
dropping
and
it's
a
slight
increase
towards
the
end
of
the
program,
which
is
probably
accounted
for
by
the
amount
of
time
that
people
are
taking
to
complete
the
inspections
and
and
then
and
then
finish
the
report.
B
So
we're
keeping
on
top
of
that
in
terms
of
management
terms,
of
trying
to
make
sure
that
we
make
sure
that
we
continue
to
improve
we're
doing
a
number
of
things.
So
we
have
been
looking
at
the
report
that
we
are
writing
for
those
services
that
we
are
going
back
to
which
remained
good
and
trying
to
ensure
that
we're
focusing
the
writing
of
those
reports
in
a
way
that
makes
it
much
more
effective
and
efficient
and
for
the
inspectors
to
complete
them
quickly.
B
Secondly,
we
are
also
looking
at
one
of
the
aspects
of
how
how
this
is
impacted
on
within
these
50
days,
that
we
have.
There
are
ten
days
that
are
allowed
for
factual
accuracy
from
the
providers
and
then,
and
very
often
that
can
be
a
bit
of
a
two
and
a
throw
in
terms
of
requesting
additional
information
from
the
inspector
and
and
how
they
deal
with
that.
B
So
we
provided
guidance
to
our
inspectors
to
help
them
in
dealing
with
some
of
those
situations
so
that
they
can
deal
with
them
in
a
much
more
effective
and
efficient
manner
and
last
but
not
least,
were
obviously
using
when
really
pay
tribute
to
the
team
and
sector
supportive
in
helping
us
with
the
management
information
on
this.
Looking
at
the
tracking
through
and
the
the
dates
that
we've
got
for
the
completion
of
the
reports,
so
we're
flagging
up
to
inspectors
and
to
their
managers.
B
C
Thank
you
Steve
a
mess
here.
Thank
you.
Peter,
we've
we've
them
we've
been
taking
this
as
one
of
our
top
priorities.
The
priority.
Obviously,
that
was
absolutely
top-
was
to
complete
the
programs
and
when
we
look
at
PMS
here,
PMS
is
a
composite
of
the
general
practice
program
which
we
completed
on
time
in
January
and
Dentistry,
which
has
a
different
completion
date.
April.
We
finished
that
two
weeks
early,
we
completed
the
GP
program
with
a
lot
of
bank
input
and
we
had
some
sickness.
C
One
of
the
problems,
we're
reporting
is
it's
an
accumulative
total
and
therefore,
we've
had
problems
for
quite
some
time
which
don't
drop
off
the
radar.
If
you
know
what
I
mean
so
it's
really
difficult
to
get
to
the
KPI
when
she
started
with
problems
and
in
the
areas
with
the
worst
performance
and
thickness.
That's
where
we've
got
additive
problems
now
and
so
we're
trying
to
address
it
on
a
individual
inspector
and
team
basis.
We
can.
B
When
that
happens,
we
republish
reissue.
The
report
with
the
enforcement
action
included
in
the
report,
and
the
logic
of
the
presentation
at
the
moment
takes
that
second
date
as
the
date
by
which
we
we
judge
it.
So
so
those
two
problems
that
one
it
double
counts.
It
because
we'll
see
it
in
the
first
time
and
then.
Secondly,
when
we
reissue
the
report,
it
will
take
the
date
and
that
it's
been
reissued
and
compared
to
the
inspection
undertaken
and
that
will
inevitably
be
after
50
days
and
in
some
cases
quite
considerably
after
50
days.
B
So
that
will
raise
the
average
number
of
days
and
all
so
it's
only
about
three
or
four
percent,
but
it
will
make
a
difference
to
the
to
the
key
performance
indicator,
target
and
completion.
So
that's
something
that
we've
identified.
The
team
are
addressing
that
in
terms
of
the
logic
model,
I'm,
not
quite
sure,
when
that'll
change
in
term
is
the
presentation,
the
report.
So
these
figures
are
understated
just
a
little
better,
so
that
the
board
is
aware.
I
think.
A
It's
great
that
there's
a
lot
of
action
going
on
I
mean
I.
Notwithstanding
the
data
I
mean
probably
the
single
biggest
complaint
that
I
get
when
I
talk
to
providers
is
the
delay
in
getting
the
reports.
I
mean
this.
Is
you
know
this
is
important,
but
we're
taking
actions
and,
as
we've
also
discussed
in
other
in
other
parts
of
the
meeting,
that
the
real
quantum
leap
will
be
when
we've
we've
gone
through
our
digital
transformation.
So
these
are.
These
are
important
things
that
we
can
do
at
the
moment.
There's
something
beyond
that:
Mike
hospitals.
D
As
Steve
was
saying
in
terms
of
dealing
with
backlogs,
we
had
a
big
onslaught
on
a
backlog
at
the
end
of
last
year
and
therefore
public
published
in
quarter
four.
So
actually
our
quarter.
Four
figure
of
course
looks
worse
because
they
had
already
breached
by
the
time
we
were
doing
that
backlog,
but
I
think
what
we
are
doing
is.
Firstly,
we
are
setting
intermediate
performance
indicators
within
the
Directorate,
for
when
the
first
draft
should
be
available
from
each
of
the
course
services.
D
The
inspectors
writing
those
when
they
should
get
to
our
quality
assurance
panels
etc,
so
that
we
are
very
actively
tracking
it
I
think
as
Andrea
was
saying,
and
also
making
sure
that
inspectors
timetable
themselves
that
have
time
to
do
that,
writing
immediately
after
an
inspection,
rather
than
immediately
going
out
on
another
one.
What
we
can
say
is
that,
in
terms
of
the
median
and
mean
times
for
reports
coming
out,
there
are
very
very
consider
improvements.
D
I've
got
the
graphs
here
if
you
would
like
to
see
them,
but,
for
example,
on
mental
health,
where,
a
year
or
two
ago
we
were
averaging
a
hundred
days
that
stand
now
to
averaging
just
over
40
days.
So
that
means
that
we
are
getting
into
the
point
where
we
should
be
able
to
get
a
major
improvement.
Okay,.
A
E
You
Peter,
and
so
in
relation
to
enforcement.
In
the
12
months
running
up
to
January
2017,
we
have
1775
published
enforcement
actions,
a
published
enforcement
action
just
going
back
to
Andrews.
Explanation
of
the
previous
figures
means
an
enforcement
action
which
has
concluded,
and
that
means
conclusion
of
any
appeal.
E
In
addition
to
that,
we
have
1187
enforcement
actions
in
progress,
so
that's
where
they
haven't
concluded,
which
does
include
appeal
proceedings
and
out
of
those
enforcement
actions.
The
majority
in
all
sectors
is
a
warning
notice,
with
87%
for
hospitals,
76
for
effort,
social
care
and
54%.
In
PMS
we
have
538
locations
in
special
measures
and
those
are
shown
in
terms
of
their
movements
in
the
quarterly
report.
F
F
The
main
drivers
for
the
non
pay
have
been
changes
in
behavior
and
awareness,
increased
budgetary
control
and
we've
had
much
improved
contracts
which
have
driven
out
value
from
third-party
contracts
and
suppliers,
and
we've
had
a
real
improvement
in
the
cost
of
travel
and
accommodation,
which
has
been
facilitated
by
improvements
in
the
I
teen
and
estates
infrastructure.
So
the
end
of
year
position
is
still
being
worked
through,
but
I
think
we
can
safely
say
that
this
will
be
the
first
year
that
we
have
spent
less
than
we
did
the
previous
year
since
CQC
said
that
which.
E
A
D
No
just
to
report
that
these
are
the
first
two
trusts
that
have
had
to
go
back
into
special
measures
at
North,
Lincolnshire
and
ghoul,
and
United
Lincolnshire
Hospitals
Trust,
and
we
are
working
on
these
very
closely
with
colleagues
at
NHS
improvement
on
what
needs
to
be
done
to
turn
them
back.
Okay,
thank.
A
You
following
the
budget
and
the
additional
money
that
was
rewarded
in
the
budget
for
adult
social
care.
We
expect
to
be
asked
by
the
Secretary
of
State
to
do
some
work.
We
as
out
of
today's
meeting.
We
are
still
waiting
a
letter
from
the
secretary
of
state
to
confirm
that
so
we've
watched
this
space
a.
A
A
The
probably
those
were
the
biggest
impact
to
the
pursuit
of
them
outside
world.
There
are
various
consultations,
so
we
had
been
due
to
publish
the
response
to
the
next
phase.
Consultation
that
closed
back
in
February
that
we
will
now
publish
immediately
or
soon
after
the
the
election
is
as
is
possible.
A
We
then
had
a
a
third
consultation
and
that's
going
to
have
to
now
slot
in
in
in
early
autumn,
and
at
this
stage
it's
too
early
to
be
precise
as
to
to
what
the
date
will
be
around
that
there
are
some
other
consequences,
all
of
which
are
perfectly
manageable.
But,
for
example,
we
have
a
couple
of
vacancies
on
the
board
non-executive
director
of
vacancies.
We
were
about
to
advertise
for
those
that's
now
put
on
hold
until
after
the
election
we
then
run
into
the
summer
holidays.
A
A
A
E
So
the
definition
of
these
these
describes
persons
that
we're
talking
about
here
are
those
that
fall
into
the
criteria
under
the
Act
there's
a
number
of
heads
that
you
might
fall
under,
but
basically
you
have
to
be
making
the
disclosure
in
the
public
interest
and
it
could
be
because
you
think
there's
been
a
criminal
offense
failure
to
follow
a
legal
obligation,
miscarriage
of
justice
or
actually
for
our
purposes.
Most
people
who
come
to
us
will
be
doing
so
because
they
think
that
the
health
or
safety
of
an
individual
has
been
endangered.
A
G
A
G
May
be
related
can
help.
I
must
admit:
I've
not
looked
at
these
regulations
yet,
but
knowing
that,
whether
someone
is
always
not
a
whistleblower
occupies
the
time
of
an
employment
tribunal
forever,
and
there
are
all
sorts
of
results
that
come
out,
some
of
which
are
potentially
surprising
there
and
therefore,
as
a
is
the
difficulty
whether
someone
comes
it
and
the
definition
is
controversial
or
can
be,
how
do
we?
G
What
is
our
obligation
relation
to
reporting
is
if
someone
claims
to
be
blaring
a
whistle,
and
so
is
that
something
which
we
will
report
about,
because
it
seems
to
be
important.
We
are
sort
of
making
the
sort
of
assessment
that
an
employment
try
people
makes
because
otherwise
we
won't
actually
have
a
measure
what's
going
on
with
it.
We're
sorry
that
sounds
a
bit
unclear,
but
without
going
to
the
legal
definitions
as
best
I
can
do
listen.
E
H
And
questions
for
the
chief
inspectors
that
the
about
to
external
developments
and
what
the
not
since
we
last
met
there
was
a
publication
on
care
homes
by
the
independent
age
organization,
and
that
was
quite
a
lot
of
relevant
findings
and
had
to
used
our
data
I,
just
sort
of
not
surprising,
irrelevant
and
but
one
among
many
findings.
One
of
them
was
the
most
newsworthy
it
turned
out.
Was
the
geographical
variation
in
the
ratings
of
care
homes
I
felt
very
strongly
about
it?
Was
the
Northwest
did
so
badly?
H
In
fact,
Greater
Manchester
did
pretty
badly
and
I
just
wondered
whether
that's
something
we
should
or
could
be
investigating
more
and
perhaps
reporting
on
more
in
the
way
that
we
report
progress
and
over
they
in
the
into
the
next
phase
and
if
I
could
just
bring
a
completely
different
subject.
The
other
topic
relevant
to
our
previous
work
is
the
concern
over
maternity
services
in
Shrewsbury
and
Telford,
and
the
positive
get
a
perspective
from
Mike
on
the
the
investigation.
B
On
the
independent
aid
report
that
guess
the
they
used
our
data
extensively
and
to
create
that
analysis,
we
have
tended
to
use
the
analysis
on
a
kind
of
local
basis
for
a
couple
of
purposes,
one
in
presenting
information
to
local
authorities.
So
we
have
kind
of
provided
information
in
conversations
with
our
partners,
both
from
a
commissioning
and
safeguarding
perspective
in
local
authorities.
So
the
liaison
that
my
team
zoom
there
and
we've
also
to
additionally
kind
of
presented
the
information
by
the
non-government
areas.
B
So
we
kind
of
seen
the
picture
across
the
country,
and
it
was
a
very
interesting
analysis
that
the
end
age
did.
Yes,
it
showed
that
the
Northwest
was
not
doing
quite
so
well,
but
there
were
other
pockets.
There
wasn't
quite
the
north-south
divide
that
people
were
claiming
there
are
other
pockets
of
problematic
areas
in
the
south,
as
well
as
across
the
Midlands.
So
what
two
things
that
we
are
thinking
of
doing
in
terms
of
presenting
this
information
more
broadly?
B
The
first
is
that
much
as
Mike
did
in
terms
of
the
end
of
the
first
stage
of
hospital
inspections,
we're
going
to
have
a
round
up
of
our
findings
than
the
first
phase
of
adult
social
care
inspections,
and
the
data
analysis
has
been
done
at
the
moment
and
we
will
look
at
what's
the
appropriate
geographical
level
to
do
that.
And,
secondly,
we'll
think
about
that
in
terms
of
the
the
work
that
we'll
do
for
the
state
of
care
report
as
well,
so
trying
to
represent
that
information
in
that
way.
B
D
My
understanding
is
that
tradesmen,
Telford
is
not
a
statistical
outlier
in
that
way,
but
that
does
not
mean
the
wrong
things
to
be
learned,
and
we
will
certainly
want
to
learn
from
from
that.
We
have
recently
undertaken
an
inspection
of
sure
as
Bria
and
Telford.
The
report
is
not
true
yet
so.
I
can't
comment
on
that,
except
to
say
that
we
did
ensure
that
our
national
professional
adviser
for
maternity
services
was
part
of
the
inspection
team.
A
Had
a
slight
concern,
looking
at
the
dashboard
with
my
magnifying
glass
case,
clients,
the
otherwise,
it
would
appear
that
there
are
some
some
inspections,
Riaan
spec
shion's
of
inadequate
providers
that
are
behind
schedule
that
are
outstanding
and
that
worried
me
so
I,
don't
know
whether
a
I've
read
this
right
and
B.
If
I
have
one
DS
that
we're
doing
about
it
and
redundant.
A
B
You
very
much
and
grateful
that
you
identified
correctly
before
the
meetings
that
I
was
able
to
follow
up
and
we've
looked
at
both
the
inadequate
overdue
inspections
and
the
requires
improvement,
overdue
inspections
and
looking
at
each
of
those
records
and
again,
there's
a
variety
of
reasons
of
why
this
has
happened.
And
so
yes,
the
presentation
of
the
information
is
there,
but
some
of
those
services
have
closed
and
it's
just
not
kind
of
fed
through
in
terms
of
the
information
in
our
database.
B
So
it's
not
actually
it's
so
it's
showing
up
as
overdue
when
when
it's
actually
been
undertaken,
and
so
we
need
to
check
and
sort
that
out,
and
there
are
couple
of
services
where
we
would
have
been
going
back,
but
they
were
dormant.
So
this
is
largely
and
dumb
flu
care
and
they
were
dormant,
and
so
we
didn't
go
back
because
there
wouldn't
be
anything
to
inspect,
but
actually
they've,
now
reactivated
and
so
they've
reactivated.
And
obviously
the
kind
of
base
chain
goes
back
to
the
original
inspection.
So
that
makes
it
look
overdue.
B
But
what
this
has
identified
is
that
there
were
a
variety
of
things
that
we
need
to
do
both
in
terms
of
making
sure
that
we're
managing
risk
across
the
portfolio
of
both
inspectors
and
teams
and
services
so
that
an
individual
inspector
who's
got.
You
know
lots
of
risky
services
and
lots
that
they
should
be
going
back
to.
Actually
you
were
not
expecting
them
to
and
to
do
all
of
that
they
get
support
from
other
members
of
the
team
and
we've
introduced
new
ways
of
working.
B
So
it's
the
first
of
April
to
enable
that
to
happen
much
more
flexibly.
And
secondly,
there
are
clearly
some
data
issues
which
may
be
about
the
way
that
we're
recording
things
not
the
way
that
it's
being
presented,
but
the
way
that
we're
recording
things
and
the
logic
of
how
that
then
is
presented
so-
and
we
will
be
addressing
that
back
and
with
the
sector
support
team.
So.
B
B
B
We've
got
to
complete
a
program
by
doing
all
services
by
this
date
it
is
we've
got
to
go
back
to
inadequate
within
six
months,
requires
improvement
within
12,
etc,
etc
and
newly
registered
services
within
12
months,
and
making
sure
that
we're
actually
and
proactively
managing
our
management
information
and
our
deliveries
against
those
targets,
as
opposed
to
what
we
were
doing
in
the
last
financial
year.
Thank.
C
I've
been
I,
think
Andrea
gave
an
excellent
answer.
Actually
I
would
add
a
couple
of
points.
One
is.
It
does
include
on
the
data,
some
of
those
that
are
inadequate,
that
we've
reinstated
and
are
remaining
in
adequate,
and
it's
about
risk
management
of
those
taquitos
in
special
measures.
Some
of
those
will
include
these
are
just
GP
surgeries
and
Urgent
Care,
those
that
are
about
to
be
taken
over
or
merged
by
other
organisations
or
are
dormant,
so
I
mean
that's
the
only
addition
to
Andrea's
point,
but
we
are
moving
in
a
different
way
now.
C
So
we're
going
to
be
looking
at
formally
scheduling
it
with
a
date
in
the
diary
for
six
months
and
one
year,
rather
than
waiting
just
for
the
inspector
to
prioritize
that
in
there
in
their
in
their
portfolio,
so
we're
trying
to
be
a
little
bit
more
lean
about
it
as
well
going
forward.
But
again
it
comes
down
to
risk
management
and
and
prioritization
locally.
H
Yes,
no
I'm,
never
not
on
the
same
project
and
it's
a
good
point
and,
under
you
said,
a
very
positive
about
I,
think
which
I
agree
about
the
changing
nature
of
our
role
in
a
way.
So
there's
been
this
comprehensive
round
of
inspections,
and
now
we've
got
a
set
of
findings
and
I
hesitate
to
ask
for
more
information
in
this
dashboard
because
it's
quite
data
heavy.
But
this
probably
has
moved
to
being
one
of
our
main
concerns.
H
Now
I
would
say,
whereas
initially
we
were
adding
up
the
numbers
now
I
think
we
need
to
see
that
the
progress
in
the
chair,
the
trajectory
and
that
partly
means
I
think
the
the
plan
for
re-inspection
at
the
point
you're
making
and
the
change
in
I
suppose
than
that
we'd
like
to
see
the
numbers
going
down,
of
course,
and
and
also
the
the
time
that
people
have
been
in
their
current
situation.
So
just
here,
we've
got
what
538
organisations
and
special
measures.
H
398
of
them
are
in
social
care
and
we've
had
the
conversation
before
about
what
exactly
special
measures
means
in
social
care.
But
it
does
mean
what
it
definitely
means
is
that
there
are,
and
thousands
at
the
how
many
thousands
of
people
who
are
getting
their
care
home
care
in
an
organisation
with
that
is
under
special
measures
and
I.
Think
that
we
we
need
to
be
looking
at
the.
How
long
that's
been
going
on.
B
Just
just
say,
because,
obviously
this
is
reporting
and
our
on
last
year's
beta
and
Maltese
team
in
performance
and
planning
is
already
looking
at.
What
should
the
best
board
look
like
for
the
future?
On
the
basis
of
you
know,
it's
not
a
comprehensive
programme,
we're
seeking
to
finish.
It
is
actually
essentially
managing
risk
and
and
also
spotted
where
improvement
could
be
happening
so
that
we're
going
back
and
identifying
that
and
being
able
to
inspect
a
report
on
that
as
well.
B
So
so
I
think
that
there
will
be
we've
got
a
discussion
planned
at
et
met
with
sometime
soon
anyway,
as
to
exactly
how
that
will
look,
so
that
we
can
make
sure
that
we're
kind
of
reporting,
much
more
and
with
the
different
set
of
information
for
you.
So
we
we
get
to
the
heart
of
what
it
is
that
you're
saying,
which
I
would
completely
agree
with
good.
A
C
So
this
is
thank
you,
so
this
is
a
new
way
of
reporting
and
it
does
a
number.
Obviously,
if
you
look
at
the
chart
varies
enormously
across
the
three
directorates
and
in
adult
social
care,
where
their
performances
is
excellent.
If
you
think
about
the
volume
of
both
concerns
and
alerts,
it's
business
as
usual
there
in
PMS,
it's
some
very
different
because
we're
we
the
serious
alerts.
We
thought
straight
away.
The
very
few
concerns
that
we
get
just
like
in
general:
medical
practice.
C
C
About
50%
of
the
concerns
going
to
PMS
are
not
real
safeguarding
concerns
of
those
50%.
We
should
do
better,
and
so
what
we're
doing
within
PMS
is
having
now
taken
on
the
business
support
team.
They
are
going
to
be
trained
to
do
a
daily
report
of
outstanding
queries
and
report
directly
to
the
inspector,
because
this
hasn't
been
a
higher
priority
to
the
inspectors
and
it
should
have
been,
and
so
what
we've
done
in
PMS
is
changed
the
system.
So
we
should
start
to
see
an
improvement
now
because
I
believe
it's
unacceptable
at
the
moment.
C
The
other
thing
I
would
say
is
that
Ursula
gala
has
taken
over
the
CQC
responsibility
for
the
safeguarding
now,
and
this
is
the
first
time
we've
reported
following
her
change
in
leadership
and
she's,
been
burrowing
down
into
the
data
and
into
the
systems
to
see
how
we
can
improve
across
CQC
and
I.
Think
we'll
start
to
see
an
improvement
in
the
next
few
months.
Thanks.
A
I
mean
I
share
your
your
general
concerns
dee.
This
is
worrying
when
it
was
about
safeguarding
alert
so
whether
it's
next
month
or
so
needs
a
little
longer.
He
would
be
good
if
we
could
have
a
report
back
as
to
how
much
of
this
is
data.
How
much
of
this
is
a
real
problem?
Insistence
it's
a
real
problem.
You've
done
about
it,
yeah.
G
B
It
is
an
issue
of
concern
and
it's
something
that
we
are
monitoring.
The
one
of
the
issues
for
us
in
adult
social
care
as
compared
to
the
other
directorates,
is
that
our
age
profile
is
older
compared
to
the
age
profile
of
the
other
directorates
and
and
the
older
people
are
including
myself
and
the
older
people.
B
Director
have
been
rolling
out
mental
health
awareness
and
training
for
all
managers
so
that
they
can
actually
support
their
staff
and
a
much
much
better
way
and
new.
So
that's
another
way
that
we're
trying
to
handle
this
I
mean
I've
kind
of
answered
that
more
broadly
on
on
CQC
basis.
But
it
is
a
specific
issue
for
us
in
adult
social
care,
but
it
is
something
that
we're
trying
to
address
across
the
board.
I
Paul,
just
won't
just
get
alms,
completing
things
on
productivity,
where
there's
some
interesting
changes
between
genuine
fairy
I'm,
assuming
that
the
move
from
being
a
hundred
and
thirty
percent
productivity
in
PMS
in
January
down
to
seventy
something
in
in
February,
is
all
through
with
actually
completing
the
inspection.
The
push
to
get
the
inspections
can
be
planned
of
January,
but
and
wasn't
it
people
weren't
daily
working
in
February?
It's
just
that
they're
doing
other
things
around
reports,
and
things
like
that.
Is
that
because
st.
so
variance
also
hold.
C
Kosair
they
were
working
very
hard
in
February
and
also
on
the
digital
work,
completing
the
dental
program.
But
yes,
it
was
a.
It
was
an
artificial
push
to
get.
The
reports
through
now
is
about
report
writing
as
well
as
inspecting,
but
it's
I
think
board
should
understand
that
the
amount
of
work
our
inspectors
are
doing
now
is
actually
equal
to
what
it
was
before.
It's
just
more
very.
B
And,
and
also
the
productivity
is
measuring
specific
inspections.
All
of
our
inspection
teams
are
doing
other
things
as
well
and
particularly
in
terms
of
the
report
and
febrile
have
a
slight
dip
because
of
the
after
holidays,
and
we
we
would
have
had
higher
levels
of
annual
leave
absence
during
that
month
as
well,
and
as
only
28
days.
A
So
I
think
we
should
just
recognize
that
there
are
some
this
user
to
come
out
of
the
dashboard
and
that's
why
we
have
the
dashboard.
It
highlights,
and
that's
great
but
there's
also
an
awful
on
a
very,
very
good
data
in
here.
Good
news
data
and
just
congratulations
to
everybody.
Who's
worked
to
produce
these
results
because
they
are
overall,
extremely
good.
So
we're
happy
to
move
on
to
the
neck
off.
Look
at
that
didn't
even
come.
C
You
own
people
will
love
them
met
or
heard
from
James
and
Amanda.
James
is
a
and
one
of
our
national
clinical
leadership
fellows
here
at
CTC
part
of
the
program
which
also
involved
nice
and
NHS
England
and
for
organizations,
and
he
has
been
during
his
year
here,
working
very
closely
with
our
teams
on
the
online
digital
provision
of
health
care
and
has
been
doing
brilliantly
well.
C
And
the
report
is
there
for
everyone
to
read
and
and
we're
very
happy
to
take
questions,
but
to
say
that
we
have
already
inspected
15
providers
of
services
which
largely
provide
medicines
online,
of
which
we
have
taken
some
form
of
enforcement.
Action
on
each
of
them
of
a
total
number
of
providers
that
we
currently
have
registered
is
46
and
we
will
be
completing
the
inspections
of
those
services
by
August
and
so
I
think
it's
probably
worth
just
pausing
there,
James
and
Amanda
here,
to
help
with
answering
the
difficult
questions
and
with
you
thank.
I
Thought
yeah,
I,
guess,
there's
a
conundrum
here,
because
what
we're
seeing
is
a
more
modern
way
that
people
are
seeking
to
use
the
internet
to
get
their
medicines
and
in
a
lot
of
areas
of
life
it
has
provided
a
really
welcome
improvement
to
what
people
get
in
terms
of
services.
But
this
seems
to
be
indicating
that
in
this
particular
area
we
have
significant
concerns,
I
guess,
I,
guess
what
I
was
wanting
to
get
is.
Are
we
in
looking
at
them
from
a
risk
perspective
at
those
MCS
riskiest?
First?
I
C
I
think
setting
I
would
say
is
that
we
CQC
support
innovation
and
recognize
that
this
sort
of
activity
will
be
an
important
part
of
the
health
provision
within
within
England
going
forward.
And
what
we're
not
seeking
to
do
is
prevent
innovation
and
the
implementation
of
these
good
ideas
across
the
health
system
and
we're
working
closely
with
NHS
England
and
other
regulators
and
commissioners.
C
We
would
really
love
to
find
some
really
good
examples
of
care,
and
we
hope
that
within
those
46,
we
will-
and
we
hope
that
by
publishing
our
guidance,
not
just
for
providers
but
also
for
patients,
that
those
that
are
about
to
be
inspected
will
be
learning,
and
this
isn't
about
being
punitive
for
the
sake
of
being
punitive.
It's
about
protecting
patients
to
make
sure
they
get
safe,
effective
care
because,
clearly,
from
a
responsive
point
of
view,
patients
are
saying
that
they
would
like
access
to
these
former
services.
C
But
we
would
expect
that
these
services
are
providing
the
same
safe
care.
You
would
expect
from
a
good
and
outstanding
general
medical
practice
anywhere
in
England,
and
therefore
the
standards
are
explicit
and
fair
for
everybody
to
see.
It's
very
sad
that
in
those
first
thirteen
that
we've
gone
to
they've
included
services
that
we've
had
to
cancel
their
registration
as
well
as
suspend
others
as
well.
And
we
only
take
that
serious
level
of
enforcement
action
when
we
need
to.
But
we
will
not
fear
from
doing
that
when
we
have
to
to
protect
patient
Oh.
A
Syrio
we've
talked
about
this
a
lot
of
an
IEE.
It
doesn't
seem
to
me
to
be
any
inherent
reason
why
a
new
delivery
mechanism,
if
I,
can
call
it
that
should
necessarily
not
be
safe.
Two
things
need
to
happen.
One
is
the
things
that
you
would
normally
have
in
a
bricks-and-mortar.
I
think
call
it
that
provision
needs
to
be
in
place
and
I
think
what
you've
found
in
some
of
the
services
you've
you've
inspected,
even
those
basics
aren't
in
place
and
then.
A
Secondly,
there
are
some
additional
things
you
need
to
have
in
place,
because
you
only
got
the
patient
in
front
of
you
when
you're
doing
this
and
those
haven't
always
been
there,
but
they
don't
seem
to
me
to
be
things
that
are
completely
insurmountable
and
to
your
point,
Steve,
if
you
can
get
those
so
in
place,
so
that
it's
that
it's
safe
and
these
new
new
delivery
mechanisms
are
the
sorts
of
things
that
sections
of
the
population
being
rate
will
find
very,
very
valuable.
I.
C
Mean
I
personally
believe
this
will
be
a
core
part
of
the
offer
in
primary
care
going
forward
and
part
of
our
remit
as
CQC's
to
encourage
improvement,
and
it
has
the
outcome
and
it's
a
more
joinder
service,
some
of
the
basics,
including
identification.
The
patient
in
front
of
you
also
things
that
you
would
expect
in
any
sir
anywhere
in
the
country.
We're
not
asking
for
anything
which
is
extraordinary.
G
Glad
to
see
that
well,
firstly,
the
work,
that's
being
done
in
this
era
that
gives
tremendous
and
a
great
benefit
potentially
to
the
public
I'm
glad
to
see
what
your
work
is,
including
system-wide
collaboration,
because
one
of
the
things
that
would
concern
me
is
whether
there
are
gaps
in
the
regulatory
system
through
which
patients
in
particular
can
fall
in
terms
of
protection
and
I
suspect.
There's
some
very
big
gaps
but
and
in
one
says
we
can
only
regulate
what
we're
allowed
to
regulate.
C
J
So
we
are,
we
are
taking
steps
and
to
work
at
a
national
level
to
look
at
the
wider
regulatory
landscape,
both
through
contacts
directly
with
the
department
health,
but
also
working
with
the
National
Quality
board
and
the
the
final
component
of
that
is
we're
going
to
be
holding
a
roundtable
with
the
other
four
nation
regulators
to
look
at
the
wider
landscape
throughout
the
UK.
As
our
remit
applies
to
England,
there
are
other
quality
regulates
in
the
rest
of
the
UK
and
so
collaboration
between
them,
as
well
as
essential,
but
I
think
Roberts.
Point
James.
D
A
World
and
there's
nothing
in
this
modern
age
that
you
can
do
to
stop
that
happening.
So
it's
really
important
that
people
understand
that
using
those
services
that
are
not
regulated,
potentially
dangerous
and
therefore
the
safe
thing
to
do
is
to
only
use
a
service.
That's
been
regulated,
I.
Think
that
the
point
you
correctly.
C
Another
lie:
we've
really
just
started
on
that
journey,
and
we
need
to
do
more
generally
about
cqc
regulation,
I
think
in
promoting
the
ratings
to
the
public
across
all
social
care,
hospitals
and
general
practice.
This
is
going
to
be
a
really
big
issue
going
forward,
not
just
for
what
we're
seeing
at
the
moment,
which
is
the
online
consultation
and
prescribing
of
medication.
C
Some
of
the
providers
will
be
providing
online
consultations
by
video.
Some
of
those
are
likely
to
be
NHS
providers,
as
well
as
private
providers
and
then
we're
starting
to
get
into
artificial
intelligence
and
machine
diagnosis
of
which,
of
course,
without
humans
being
involved,
we're
not
in
scope
for
regulation.
We've
also
got
problems
with
services
which
are
based,
as
you
said,
offshore,
but
also
those
based
on
Shore
serving
patients
offshore.
C
So
it's
hugely
complex
and
James
and
Amanda
were
very
much
involved
in
a
National
Quality
board
seminar,
the
other
day
where
leaders
from
NHS
England
and
the
other
regulators,
including
MHRA,
which
we
working
very
very
closely
with,
were
present
and
have
committed
to
take
this
board
in
a
very
joyful
way,
which
was
reassuring.
Thank.
A
You
I
hit
goodbye
just
in
summary,
thank
you
all
three
of
you
very
much
for
what
you
doing.
This
is
really
really
important
and
pace,
and
the
rigor
with
which
your
chart
you're
you're
you're
pursuing
this
is
very
much
appreciated.
So
thank
you
and
we
will
see
you
again
from
that's
great
good
thanks,
so
we
will
move
on
to
our
own
effectiveness.
We
had
a
review
from
Deloitte,
not
suggesting
we
have
a
long
discussion
about
it
this
morning.
A
If
you
go
to
the
executive
summary,
it
says:
we've
noted
a
number
of
areas
of
strength
in
relation
to
the
current
board.
In
particular,
we
found
board
members
to
be
of
a
high
caliber
and
highly
engaged.
Overall.
We
are
of
the
view
that
CQC
board
is
an
effective
board,
with
a
small
number
of
changes
to
how
it
operates.
It
could
become
even
more
effective
and
when
delight
we're
taking
me
through
the
report,
they
use
slightly
different
words
to
say
that
they
said
this.
A
As
I
said
earlier
in
the
meeting
the
election
and
perda
surrounding
it
means
there
will
be
a
delay
in
filling
the
vacancies
that
we
have
on
the
board,
and
what
I
would
propose
to
the
board
is
that
when
we
have
got
those
new
appointments
made,
we
have
a
discussion
about
how
we
take
the
recommendations
forward
and
particularly
the
recommendations
around
board
development
is
that
is
that
acceptable
to
everybody?
I
mean
by
world
world
will
note
the
report
and
move
on
good.
I
Again
to
say
a
few
words
thank
you.
You
know
yes,
just
a
very
few
words.
This
was
a
very
much
working
meeting
on
5th
of
April.
A
lot
of
the
work
was
about
getting
us
up
to
speed
or
bring
us
well
up
to
date
with
things
which
used
to
be
looked
at
ahead
of
the
year-end
processes,
which
would
be
looked
at
at
the
next
days
in
QC
meeting
next
month.
So
things
like
looking
at
the
internal
reports
which
have
been
produced
in
the
last
period
for
since
the
last
meeting,
etc,
etc.
I
The
the
the
one
thing
I
think
that
we
spent
quite
a
bit
of
time
on
was
management
insurance
process
which,
in
the
second
of
those
took
place
last
year,
and
this
was
I-
think
the
it's
been
going
for
two
to
three
years.
This
measure
insurance
process
and
I
think
there
were
a
couple
of
things
to
note.
One
was
that
the
ratings
that
we're
getting
out
of
that
management
insurance
process
are
improving.
I
Scrutiny
chemically
internal
audit
coming
through
peer
reviews
coming
through
ET
challenge,
actually
at
each
other.
In
that
respect,
which
I
thinks
it
means
that
the
culture
of
being
honest
with
ourselves
still
pertains
in
that
respect,
so
I
think
that's
a
powerful
tool
which
we've
got
there
more
powerful
person
we
realized
in
the
beginning,
and
we
need
to
keep
it
that
powerful
going
for
going
forwards.
Well,
there
are
still
things
to
be
improved
in
there
and
their
challenges
which
have
been
set
out
for
people,
but
that's
an
encouraging
it.
I
I
They
should
get
completed
before
the
end
of
the
reporting
period.
If
you
like,
which
is
really
this
month
and
the
function
statement.
Audit
is
progressing
then
ago,
on
that
we
also
have
a
session
with
the
nao,
whose
value
for
money
team,
which
was
useful
just
to
understand
where
they
were
coming
from,
where
they
got
to
into
defeating
some
thoughts
around
that
very
much
there's
that
that
is
still
very
much
working,
bracelet
the
early
stages
and
some
respect
to
the
work.
That's
being
done
couple
times
a
year.
I
We
have
a
session
with
HealthWatch
England,
and
that
was
good
because
I
think
we're
seeing
progress.
Looking
Jayne
over
there
Imelda
Redmond
who's,
the
new
choose
active,
effective.
There
is
came
to
talk
to
us
about
things
and
actually
I
think
we
we
sort
of
a
positive
input
commentary
from
that
and
the
have
watch
England's
own
audit
committees
is
keeping
a
close
eye
on
that,
so
that
those
thing
but
main
main
points
that
I
was
condemned
for.
A
For
one
thing,
I,
don't
think
we
do
is
to
ask
you
to
convey
back
to
colleagues
that
are
on
the
Audit
Committee
that
aren't
sitting
around
this
table.
What
a
great
job
they're
doing,
I'm
and
I
occasionally
come
to
your
meeting
as
an
observer,
but
I
do
also
read
all
the
minutes
of
the
meetings
and
sell
and
it's
a
very,
very
effective
committee.
So
what
you
might
do
is
just
pass
our
thanks
to
as
I
say
those
of
your
colleagues
that
aren't
around
the
table
here
a
little
bit.
K
The
regulatory
Governance
Committee
does
deep
dives
into
important
areas
of
the
CQC's
work
and
in
fact,
yesterday
the
committee
looked
at
an
internal
audit
report
on
our
ratings
process,
because
internal
audit
produces
reports,
most
of
which
are
really
the
province
of
the
committee.
That
put
Paul
is
just
described,
but
other
reports
are
most
relevant
to
the
regulatory
Governance
Committee.
So
yesterday
we
discussed
the
internal
audit
report
on
our
ratings
process,
its
strengths
and
weaknesses
and.
K
A
A
Okay.
So
we've
got
only
a
few
minutes
that
we've
got
five
minutes
so
there
any
questions,
members
of
the
public
robbing
your
hand
wind
up
very
quickly.
Would
you
like
to
go
first
come
sit?
There
turn
the
microphone
on
and
then
say
who
you
are,
even
though
we
know
who
you
are
and
ask
your
question
and.
L
C
Steve,
that's
me,
thank
you
so
part
of
the
primary
medical
services.
Directorate
involves
prisons
and
detention
centers,
and
we
have
a
comprehensive
set
of
inspections
in
partnership
with
HMI
prison,
all
of
which
their
reports
are
published
on
our
website
on
and
on
there.
They
come
out
as
a
joint
report.
So
there's
access
to
it.
C
But
if
there's
anything
specific
you
want
to
know,
if
you
can
send
me
an
email
I'll,
give
you
a
very
detailed
response
and
links
to
the
reports,
but-
and
we
have
a
whole
dedicated
team
that
do
prisons
and
detention
centers
and
having
been
on
I,
went
to
Felton
prison
and
I
thought
the
way
they
work
very
well.
It
was
very
good
with
the
HMI
prison
team,
a
lot
of
respect
or
mutual
understanding,
and,
of
course,
we
can
take
enforcement
action,
whereas
HMI
prisons
have
a
slightly
different
way
of
doing
things
and
it's
symbiotic.
L
Ok-
and
this
follows
really
from
your
March
board
meeting,
then
the
speed
with
which
a
hospital
trust
can
move
from
being
inadequate
to
high
rating,
particularly
good,
and
this
seems
really
quite
variable
in
that
some
trusts
have
moved
and
remedied
shortcomings
quite
quickly,
whereas
other
Hospital
trusts
have
remained
in
special
measures
for
and
do
indeed
still
remain
in
special
measures
for
some
time
now.
I'm
thinking,
particularly
of
the
Barnes
Hospital
trust
I,
should
declare
that
I'm,
a
patient
of
the
of
the
dress.
L
The
issues
behind
this
movement
from
inadequate
to
better
rating
seem
to
me
not
to
be
primarily
financial,
as
that
particular
trust
has
had
a
lot
of
rebuilding
and
more
to
do
with
the
affective
domain
and
the
question
I'm
asking
really
is
whether
all
board
members
might
find
it
helpful
to
visit
some
hospitals
and
share
the
experience
of
a
patient
who
can
find
themselves
at
times
sitting
in
a
waiting
area
in
a
state.
Rather
the
Wilderland
a
little
bit
like
Guildenstern,
better
HAP's
and.
D
Thank
you,
Peter
I
mean
we
now
do
have
a
small
number
of
hospitals
that
have
have
moved
up
to
grades,
if
you
like
so
Hinchingbrooke
Cambridge
Tameside
Morecombe
Bay,
for
example,
have
gone
from
inadequate
to
good
at
University.
Hospital
Bristol
has
gone
from,
requires
improvement
to
outstanding
and
I
think
they
should
all
be
congratulated
on
on
that.
D
Think
if
you
look
at
the
the
ratings
grids
for
whips
Cross,
for
example,
it
remains
inadequate,
but
there
are
fewer
cells
on
the
grid
that
are
inadequate
than
the
were
before,
and
we
will
very
shortly
be
publishing
report
on
new
erm
as
well.
So
I
think
it
is
a.
It
is
a
supertanker,
but
I
have
definitely
observed.
Progress.
I
would,
of
course,
have
liked
to
see
past
Provost.
All
of
us
would,
but
it
is,
there
is
progress
there.
So
if
every.
A
Personally,
I
do
some
of
that,
and
indeed
to
link
back
to
your
first
question,
I'm
shadowing
inspection
of
a
prison
in
in
a
couple
of
weeks
time,
and
if
I'm
not
at
the
may
board
meeting,
you
all
know
they
didn't.
Let
me
out
the
the
other
thing.
I
do
I
spend
more
time.
Doing
is
just
going
very
informally,
so
not
as
part
of
one
of
our
inspector,
but
to
spend
two
or
three
hours
with
it
could
be
a
care
home.
A
It
could
be
a
hospital,
it
could
be
Mental,
Health
Trust,
it
could
be
general
practice
could
be
anything
or
anything
that
we
regulate
so
that
I
can
get
a
in
a
different
context.
Your
personal
feel
for
what's
going
on
what
the
challenges
are
and
the
risk
of
embarrassing
them.
To
give
you
an
example,
last
week,
I
went
to
Dorset
County
Hospital.
A
District
General
Hospital,
relatively
small
district,
General
Hospital
rated
as
requiring
improvement.
If
you
look
at
the
inspection
report
as
last
summer,
Mike
I
think
you've
got
a
long
list
of
recommendations
and
to
your
point
about
it,
not
being
money
that
was
required
to
fix
they
I
thought
they
were
exemplary
in
what
they
were
doing
in
taking
our
list
of
recommendations
that
had
become
part
of
a
board
agenda,
part
of
their
quality
committee
agenda.
A
They
were
working
through
and
their
expectation
whether
it
turns
out
to
be
delivered
or
not
remains
to
be
seen,
of
course,
is
that
when
we
next
inspect
them,
they
will
have
addressed
all
the
recommendations
and
that
should
be
sufficient
to
move
them
from
requiring
improvement
to
good
so
I.
Just
let
was
an
exemplary
way
of
going
about
it
and
to
your
point
it
these
recommendations
were
not
things
that
require
huge
amounts
of
money
to
fix,
so
yeah
I,
think
I,
know
our
my
colleagues
around
the
table
spend
time
in
different
ways
with
different
providers.
A
E
M
I
come
from
labor
chaos
and
John's,
wouldn't
move
out
my
first
forums
to
Michael
Maier,
whether
the
regulatory
Governance
Committee
addressed
the
question
of
whether
people
assessing
care
homes
for
their
elderly
kids
can
rely
on
the
ratings
given
in
adult
social
care
and,
in
particular,
the
ratings
of
the
rate.
Either.
A
good
rating
in
the
caring
domain
and
I
think
I'll
leave
it
at
that
and
Christmas
at.
A
Very
very
well
done
David
I
I
think
it
might
be
more
appropriate
if
Andrea
answers.
The
question
like
what
we
had
yesterday
was
a
process
talking
about
the
assurance
we
were
getting
from
from
the
internal
audit
work,
but
under
you
talking
about
significally
about
care
homes,
you
like
to
answer
the
question
and.
B
What
were
our
process
is
to
ensure
that
there
was
consistency
in
the
way
that
we
were
applying
the
key
lines
of
inquiry
around
and
the
question
of
caring
and
also
reflecting
the
characteristics
of
caring
in
the
judgments
that
we
were
making
and
I
know
that
Debbie
shared
with
you
and
something
that
I've
said
before,
which
is
that
very
often
we
are
rating
services
and
care
homes
and
indeed
domiciliary
care
services
and
I.
Think
this
is
reflective
across
to
the
other
two
sectors
as
well.
B
Respect
effectiveness
is
responsiveness
in
them.
Well,
they
are
not
being
rated
as
highly
and-
and
we
know
as
well,
but
there's
significant
turnover
in
adult
social
care
services
in
terms
of
the
numbers
of
staff
when
we're
changing.
So
it
remains
a
concern,
but
I
think
that,
in
terms
of
what
my
staff
are
doing,
they
are
being
consistent
and
we're
following
through
a
process,
but
I
think
that
that's
not
to
be
complacent
about
the
situation
that
members
of
staff
in
adult
social
care
services
are
coping
way
out
in
the
field.
Good.