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From YouTube: CQC board meeting – June 2018
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A
Number
of
people
to
welcome
around
the
table,
Chris
sure,
as
first
board
meeting
you've
been
out
Chris,
even
though
you've
been
our
Acting
Director
of
Finance
for
a
couple
of
months
now
so
so
particularly
welcome
to
you.
Welcome
to
David
Noble,
who
I
will
introduce
it
properly
in
in
a
moment,
but
but
welcome
I
think
everybody
else
around
the
table,
a
normal
attendees.
So
nobody
else
I
need
to
welcome
at
this
stage.
Lists
ace
can't
be
with
us
today,
so
she
has
apologized.
Is
there
any
interest
anybody
needs
to
declare?
A
Okay,
that's
good!
Our
minutes
of
the
May
meeting,
May
16th
meeting.
Are
they
a
true
and
accurate
record
of
everything
we
discussed
excellent?
Thank
you
very
much.
Indeed.
Unusually,
there
are
no
outstanding
items
on
our
action
log.
Is
there
any
matter
arising
that
anybody
needs
to
raise,
wants
to
raise?
Okay,
that's
good,
so
that
takes
us
david
straight
to
your
report
and
we're
going
to
start
with
the
independent
investigation
into
hill,
green
I.
Think
yeah.
Thank
you.
Peter.
B
As
you've
said,
this
item
is
independent
reporting
to
Hill
green.
So
about
12
months
ago
now
there
was
an
article
in
The
Times
newspaper,
commenting
on
our
regulatory
oversight
of
a
particular
care
home,
a
14
corn
road,
which
is
run
by
the
hill
green
group
and
the
article
alleged
that
there's
been
a
cover-up
in
the
way
that
CQC
had
exercised
its
regulatory
oversight
as
a
consequence
of
that
allegation
that
I
commissioned
an
independent
review,
which
was
led
by
support
Jenkins
QC,
and
the
purpose
of
today's
item
is
to
receive
that
report.
Now.
B
One
of
the
sad
SATA
circumstances
surrounding
this
case
is
not
only
the
incident
in
relation
to
the
individual
in
the
home,
but
suppor
tragically
died
at
the
beginning
of
this
year.
The
report
was
at
completion
he'd
virtually
completed
interviewing
all
the
people.
He
wanted
to
speak
to
a
significant
part
of
the
report
had
been
drafted,
but
it
wasn't
completed
upon
Paul's
pulse
at
death
through
Rebecca
David,
noble,
stepped
forward,
having
worked
previously
with
Paul
and
being
a
solicitor
by
his
own
profession
and
background
and
has
completed
the
report
for
us.
B
So
I
recommend
that
the
board
accepts
the
independent
report
and
also
recommend
that
the
board
accept
the
action
plan
is
working
progress
with
the
further
reports
coming
back
to
the
board
as
a
result
of
the
scrutiny
which
will
take
place.
But
if
I
may
just
stop
my
introductions
at
that
point
Peter
and
invite
Rebecca
to
just
make
some
observation.
C
Thank
you
David,
so
David
April
will
present
his
report.
In
just
a
moment.
I
have
been
asked
to
explain
one
matter
before
he
does
that,
which
is
that
the
timing
of
ongoing
criminal
proceedings
mean
that,
in
order
to
protect
the
integrity
of
those
proceedings,
the
discussion
today
will
focus
on
the
recommendations
for
CQC,
and
it
will
avoid
comment
on
the
particular
incident
that
is
referred
to
in
the
report
and
that
was
covered
in
the
original
Times
article
so
I'll
hand
over
to
David.
Now.
D
Thank
you
David
and
Rebecca,
and
thank
you
members
of
the
board
for
inviting
me
as
David
said,
it's
a
it's
a
slightly
difficult
moment
for
me
because,
regrettably,
of
course,
support
I'd
before
he
could
complete
the
report.
I
think
it's
probably
worth
my
saying
that
my
estimate
was
that
at
least
85%
of
the
report,
nearly
90%
of
it
was
either
in
final
form
or
in
almost
complete
final
form.
I
carried
out
two
further
interviews.
D
The
first
is
that
not
everything
was
perfect
in
the
regulation
of
14
Cohn
Road
and
in
regulating
Hill
Greene,
but
he
and
certainly
I
in
my
subsequent
involvement,
found
no
evidence
whatsoever
that
there
was
any
cover-up
at
CQC
and
I
think
this
is
an
important
point
just
to
emphasize
it's
in
relation
to
the
choice
of
proceedings
that
CQC
followed
with
civil
enforcement,
followed
by
criminal
enforcement,
and
this
is
covered
in
more
detail
in
the
report.
But
I
do
think
it's
worth
emphasizing
thing
that
CQC's
interests
at
the
time
were
in
protecting
the
safety
of
individuals.
D
Now,
when
you
look
at
the
enforcement
powers
of
that,
the
commission
that
you
have
it's
quite
clear
that
civil
enforcement
is
a
much
swifter
method
to
ensure
protection
of
individuals
and
criminal
enforcement,
which
is
typically
about
prosecuting
and
holding
people
to
account
after
the
event
and
using
that
as
an
example
for
the
future,
as
well
as
punishment
for
the
for
the
individuals
will
inevitably
come
later,
partly
because
the
investigation
process
is
longer
more
thorough,
more
difficult
to
pursue
and
more
time-consuming.
So
I
think
that's
to
put
that
conclusion.
In
its
context.
D
Second,
I
think
it's
important
to
say
that
there
was,
as
I
said,
a
clear
focus
at
CQC
on
ensuring
that
people
were
safe
and
that's
why
that
sequential
action
was
taken.
Now
both
of
us
say
that
there
are
elements
in
that
sequence,
which
could
have
been
quicker
and
the
recommendations
address
that
the
third
was
to
note,
as
we
do,
that
CQC
is
an
organization
committed
to
continuous
improvement
and
since
November
2015
it
has
changed
or
is
in
the
process
of
changing
its
approach
significantly
and
as
a
consequence.
D
The
fourth
and
final
general
point
I
think
I'd
make
is
the
one
that
he
makes
about
the
fact
that
the
focus
of
the
investigation
inevitably
was
on
adult
social
care,
because
that
was
the
setting
that
gave
rise
to
the
investigation.
But
some
recommendations
clearly
have
a
read
across
to
other
sectors
that
CQC
regulates
and
that
I
think
needs
to
be
followed
through
on
the
recommendations
themselves.
David
is
helpfully
summarized
some
of
the
most
important
ones.
D
Whilst
the
police
carried
out
their
investigation
and
then
consulted
with
the
CPS
before
determining
whether
or
not
to
prosecute
those
serious
crimes
which
CQC
can't
prosecute
I,
think,
though,
that
what's
needed
is
quite
clearly
a
memorandum
of
understanding
with
the
national
police
chiefs
Council
and
with
any
other
regulator
that
CQC
might
overlap
with,
in
these
circumstances,
to
ensure
that
investigations
can
proceed
either
in
parallel
or
with
less
of
a
delay.
After
the
first,
more
serious
crimes
have
been
investigated
and
decisions
made.
D
So
that's
the
recommendation
about
primacy
one
other
that
I
ought
to
emphasize,
because
I
know
this
from
reading.
What's
appalled
had
written
to
himself,
as
it
were
in
draft
notes,
is
the
approach
that
CQC
is
now
taking
in
relation
to
criminal
enforcement.
I
found
considerable
progress
had
been
made
in
the
way
in
which
the
powers
which
had
trance
had
the
new
powers,
which
had
come
to
CQC,
were
now
being
addressed
and
dealt
with.
D
Cqc
has
adopted,
as
the
report
shows
one
particular
way
in
which
criminal
enforcement
can
be
operated.
Sapore
had
also
identified
an
alternative,
but
was
persuaded
as
I
am
persuaded,
that
the
approach
which
CQC
and
now
following
is
perfectly
feasible
and
workable,
but
it
is
something
that
I
think
needs
to
be
kept
under
review.
D
The
only
other
ones
I
think
are
to
ensure
that
there
is
a
mechanism
for
ensuring
that
reports,
such
as
the
safeguarding
adult
report,
adults
report
that
Enfield
produced
is
picked
up
at
a
level
not
necessarily
just
at
the
local
level,
and
there
I
think,
because
the
of
the
nature
of
the
recommendations
which
are
made
in
those
sort
of
cross-cutting
reviews,
it's
important
that
CQC
escalates
those
across-the-board.
So
it's
not
just
dealt
with
in
the
region
where
the
SAR
is,
is
published
or
takes
place
beyond
that.
I.
D
Don't
think
that
I
need
to
say
a
great
deal,
because
the
recommendations
themselves
stand
as
they
as
they
are
I.
Think
there's
one
other
generic
thing,
which
is
worth
saying
and
that's
about
the
legacy
issues
in
relation
to
criminal
enforcement.
There
was
some
question
raised
in
one
aspect
of
the
investigation
about
whether,
at
the
time
that
notifications
came
in
from
2015
onwards,
the
processes
were
sufficiently
robust
to
pick
up
the
sort
of
actions
which
would
then
need
further
enforcement
and
looking
at
it.
A
David,
thank
you
very
much.
I
mean
I'd
like
to
put
on
the
record,
firstly,
our
gratitude
to
to
support
for
the
work
that
he
that
he
did,
because
it
was
a
quick
response
to
a
very
difficult
situation.
I'd
also
like
to
put
on
the
record
my
personal
and
the
board's
regretted
at
his
untimely
death
I'd.
Also.
They
would
like
to
thank
you
for
completing
the
task.
I
suspect
you've
been
unduly
modest
in
saying
it
was
relatively
straightforward.
A
I
suspect
it
was
anything
but
relatively
straightforward
to
pick
up
somebody
else's
work
and
completed
in
the
way
you
have.
So.
Thank
you
very
much
for
doing
that.
There
are.
There
are
a
number
of
recommendations
which,
as
you
say,
some
of
which
have
been
substantially
already
actioned
by
work
that
was
ongoing.
Others.
We
need
to
look
at
very
carefully,
so
I
think
as
a
board.
A
E
You
be
the
first
thing:
can
I
echo
Peters
thanks
to
you
and
indeed
to
support
for
the
work
that
was
being
done
here
in
the
very
clear
report
that
we
have
look
just
like
him.
I
might
follow
up
a
question
from
what
you've
just
been
saying
about
the
approach
to
criminal
enforcement
and
that,
just
like
a
bit
of
clarification,
when
you
talk
about
the
approach,
do
you
mean
the
as
it
were,
the
managerial
organizational
approach
to
how
we
set
about
criminal
enforcement?
Or
do
you
mean
the
philosophy
and
policy
which
underlies
that?
E
Because
you
talk
in
the
report
about
the
difference
between
or
the
priorities
in
relation
to
ensuring
the
safety
of
people
as
opposed
to
punishment?
And
it's
obviously
a
something
which
is
quite
a
live
debate
in
the
healthcare
process
at
the
very
end,
I.
Just
wonder
which
of
those
you
meet
mean,
or
maybe
you
mean
both.
D
Third
in
line
as
it
were
logically,
partly
because
the
first
two
will
feed
the
third
in
terms
of
the
evidence
that
has
to
be
gathered.
So
it's
not
an
issue
about
policy
that
supposed
it
was
more
about
the
managerial
aspects
and
the
approach
that
the
executive
were
taking
in
relation
to
the
support
that
is
necessary
to
run
effective
prosecutions,
especially
with
the
powers
that
the
Commission
now
has
and
the
complexity
of
those
prosecutions.
D
These
are
not
straightforward
prosecutions,
given
the
nature
of
the
regulations,
and
there
were
two
possible
ways.
One
is
using
specific
inspectors
to
do
that
work.
The
other
is
to
use
support
for
inspectors,
but
not
to
hand
over
the
prosecution
work
from
from,
as
it
were,
one
inspector
who's
been
involved
with
the
case
all
along
to
somebody
who
then
takes
over
the
the
criminal
work.
D
From
my
own
point
of
view,
I
was
certainly
persuaded
that
the
approach
which
the
Commission
has
adopted
is
it's
perfectly
workable,
but
I
think
it
is
something
that
the
board
may
want
to
see.
Evidence
of
as
the
prosecutions
go
through
that
this
solution
to
them
to
the
evidence,
gathering
and
the
processing
and
the
disclosure
obligations
is
being
handled
as
appropriately
as
it
can
be.
Thank
you
very
much.
F
A
big
about
a
news
thanks
very
much
p.m.
well.
First
of
all,
justice,
Earth
I
thought
it
was
a
really
excellent
report.
That's
very
clear,
very
thorough,
its
first
conclusion.
No
cover-up
is
very
emphatically
stated,
and
but
beyond
that,
it
does
make
some
quite
wide-ranging
comments
about
the
abouts.
The
CQC
processes
mentioned
them
already,
but
responsiveness
to
families,
clarity
of
decision-making,
consistency,
the
our
role
in
criminal
prosecutions
and
so
on,
and-
and
it
goes
without
saying
that
the
that
the
role
of
the
board
I
supposed
to
point.
F
A
Think
the
the
the
action
plan
will
come
to
future
board
meetings
and
it
will
be
an
action
plan
that
deals
not
just
with
the
with
the
specific
recommendations
in
the
report,
but
also
some
issues
that
get
raised
in
the
in
the
body
of
the
report.
Oh,
absolutely
to
your
point,
Louis.
We
will,
as
a
board
then
be
able
to
monitor
how
we,
as
an
organization,
are
dealing
with
all
those
those
points
and
I.
A
Think
the
point
David
that
you
you
made
an
answer
to
Robert's
question
is,
is
also
something
which
we
will
reward
money
to
Rebecca
as
time
as
time
goes
on.
This
is
these
are
complex
areas,
as
you
say,
and
we
need
to
make
sure
that
our
response
is
the
most
effective
that
it
can
be.
So
unless
anybody
has
anything
else
to
raise,
can
I
say
the
report
will
be
published.
The
recommendations
will
be
adopted
and
followed
through,
as
I've
just
said,
and
David
can
I.
A
B
If
I'm
a
on
the
thanks
Peter,
if
I
can
just
say
thank
you
to
our
staff,
who
are
now
cooperated
fully
with
both
David
and
support,
and
that's
commented
on
as
well
and
I.
Think
that
says
much
not
just
that.
The
way
the
board
had
received
the
report,
but
the
way
that
staff
have
joined
in
the
discussion
to
help
us
understand
what
went
on
and
what
we
improve
as
well,
so
and
I.
Think
amongst
a
thanks
to
David
and
others
thanks
to
thanks
to
staff
as
well.
B
So
there's
rather
a
lot
on
this
report.
So
if,
if
I
may,
I
will
try
and
do
they
set
pace
and
I've
got
one
or
two
supplementary
points
which
have
arisen
since
this
report
went
to
board
members
and
went
on
our
website.
But
the
first
item
is
a
performance
report
and
I:
don't
intend
to
present
each
individual
aspects
of
this
but
consistent
with
the
emergent
practice.
The
first
paragraph
is
that
work,
which
is
on
plan
and
examples,
are
of
our
HR
indicators.
B
Customer
services
response
the
progress
in
relation
to
complete
an
inspection
in
hospitals
and
primary
medical
services
and
then
the
following
paragraph.
So
those
areas
were
performance
is
not
quite
at
the
level
that
was
set
out
at
the
beginning
of
the
year
and
there's
some
analysis
an
explanation
of
why,
in
the
interest
of
time,
because
I'm
not
going
to
go
through
those
on
presenter
I
think
there
may
well
be
questions
around
the
table.
So
I
think
it's
probably
a
better
use
of
time.
H
F
H
I
Yes,
indeed,
they
are
Louis
and
and
I'm
sorry
that
that's
the
case.
It's
not
where
we
want
to
be
the
conversations
that
I've
had
with
the
team
to
get
underneath
that
and
to
understand
why
it
is
that
we
are
off
target
in
such
a
dramatic
way.
And
the
first
point
is
around
staffing.
So,
as
you
know,
the
business
plan
set
out
that
we
would
recruit
some
additional
staff
to
support
our
inspection
activity
and
particularly
to
help
us
to
focus
on
risk.
I
We
ensured,
in
terms
of
the
way
that
we
were
building
up
the
budget
and
we
did
not
anticipate
having
everybody
in
post
at
the
beginning
of
April,
and
there
is
there
kind
of
a
ramp
up
of
that,
so
that
we
would
expect
to
have
people
in
post
by
the
end
of
quarter,
one
so
at
the
end
of
end
of
this
month
and
moving
into
July,
and
we
have
made
considerable
progress
with
that.
But
obviously
we've
got
to
get
the
bodies
in
we've
got
to
get
them
inducted
and
able
to
do
the
inspections.
I
What
we
are
also
doing
is
looking
at
different
ways
of
working,
because
we
need
to
be
sustainable
as
we
are
going
forward,
and
you
know,
given
the
potential
of
risk
impacting
on
the
quality
of
adult
social
care
services,
we
need
to
make
sure
that
we've
got
ourselves
into
a
position
where
we
can
manage
that
activity
to
the
best
possible
effect,
and
that
is
looking
a
bit
more
of
a
skill
mix
in
the
teams,
so
that
we
can
some
of
the
activity
that
inspectors
are
currently
doing.
Others
can
do
so.
I
We
can
release
more
time
for
inspectors
to
actually
get
out
there
and
inspect
the.
The
second
issue
to
say
is:
we
do
have
a
backlog
of
inspections,
and
so
there
is
going
to
continue
to
be
a
missing
as
we're
clearing
that
backlog.
There
will
be
a
missing
of
the
target
as
we
clear
that
backlog,
but
absolutely
we've
got
to
clear
the
backlog.
The
other
issue
to
identify
is
that
the
team
are
indeed
responding
to
risk.
I
One
of
the
reasons
why
it
looks
a
bit
odd
that
we're
going
back
to
good
services
ahead
of
some
others
is
that
we
are
going
back
on
the
basis
of
information
that
people
have
shared
with
us.
That
gives
us
concern
that
the
rating
that
is
there
on
the
website,
it's
not
is
no
longer
valid
and
in
one
particular
area
in
the
country,
one
of
my
deputy
chief
inspectors
did
do
a
look
at
those
good
services
that
we'd
gone
back
to
if
you
like,
early
in
response
to
risk
only
all,
but
one
changed
their
rating.
I
So
actually
we
were
kind
of
acting
appropriately
on
the
information
that
we
got
and
judging
that
risk
appropriately,
so
that
so
that
was
kind
of
reassuring.
But
it's
not.
It's
not
doesn't
help
us
in
terms
of
the
overall
picture,
and
the
last
point
you
say
is
that
yes,
you
there
are
problems.
There
have
been
problems
with
the
IT
that
has
impacted
on
people.
I
E
So
sorry,
then
I
don't
want
to
comment
on
the
case
itself,
but
he
raised
a
question
in
my
mind
as
to
whether,
in
relation
to
a
controversial
public
concern
about
something
like
that,
where
the
way
the
CQC
is
the
right
place
for
people
to
contact,
whether
sort
of
campaign
or
or
otherwise,
and
if,
if
not
what
anyone's
meant
to
do
there
I
just
wonder
whether
there's
a
misconception
about
what
we're
here
for
but
I
may
be
wrong,
and
maybe
there
are
perfectly
valid
reasons
where
case.
Neither
raises
issues
for
us
I.
B
Think
he's
ever
such
a
good
point
and
one
of
the
side
paradoxes
of
if
Chris
day
was
here,
he'd
say
in
2012
our
own
prompted
recognition
was
about
22%,
I.
Think
he'd
now
say
it's
about
72%
ie
people
know
who
we
are,
and
if
you
remember
this
was
one
of
those
abets
about
work.
Lord
in
the
Public
Accounts
Committee
of
the
more
we
get
known,
the
more
people
will
refer
to
as
more
people
refer
to
as
the
more
work
that
generates
and
we've
been
trying
to
accommodate
that.
B
So
the
the
team
are
normally
very
good,
and
the
engagements
here
mean
normally
very
good
at
flagging.
Where
there's
a
report
out
which
is
like
is
produced
a
spike
in
referrals,
Panorama
programs,
particularly
reports
presented
in
the
media
of
incidents
of
abuse,
are
likely
to
lead
to
a
spike
in
calls
to
the
customer
service
center
up
in
Newcastle
I
think
you're
right
roberts.
I
think
there
is
an
issue
about
what
is
it
that
we
can
do
with
it,
but
I
think
what
I'm
trying
to
say
is
because
people
now
know
who
we
are.
B
It's
a
really
tricky
issue
when
people
do
tell
us
not
necessarily
about
their
experiences
but
about
their
views,
and
we
happen
to
be
the
repositories
to
them.
I
think
a
number
of
these
cases
can
be
quite
distressing
because
people
it
prompts
people
it's
a
bit
like
when
sexual
abuse
allegations
are
made
and
then
people's
disclose
themselves
about
something.
That's
happened.
B
It's
distressing
for
the
individuals
and
I
think
it's
pretty
tricky
for
our
staff
as
well,
but
I,
don't
know
what
the
solution
is:
Robert,
citizen,
we
prepare
our
staff
when
these
things
happen,
I
think
we
were
not
cause.
We
were
not
surprised
by
the
decision
that
then
led
to
increase
I,
think
it
was
a
volume
of
the
increases
that
took
us
aside.
I
mean
if
you
look
at
it
on
the
graph.
The
spike
is
pretty
significant.
B
Quite
frankly,
over
and
above
I
haven't
committed
the
figures
to
memory,
but
the
figures
were
pretty
impressive
in
their
size,
but
again
I
think
it
comes
back
to
some
of
the
things
another
board
have
commented
on,
which
is
the
support
of
those
people,
checking
the
calls
or
per
customer
service
center
and
I.
Think
you
know
in
tribute
to
Tracy
Forrester
and
her
team
I
think
they
are
really
pretty
sophisticated
in
how
they
deal
with
this.
These
kind
of
incidents
that
Coast.
H
H
J
H
J
B
If
I
take
the
rest
of
this
at
some
speed
Peter,
if
I
may
so
paragraph
three
just
wanting
to
update
the
work
that
Stewart,
Dean
and
Andrea
take
forward
for
us
in
relation
to
market
oversight,
you
were
briefed
last
month
on
the
oversight
of
provider
orchard,
which
is
the
first
stage,
six
notification
that
we've
made
in
relation
to
service
failure
and
business
failure
and
the
team
continued
to
work
hard.
Given.
B
Since
our
last
meeting,
there's
been
a
written
ministerial
statement
to
Parliament
announcing
the
terms
of
reference
for
the
review
of
the
fit
and
proper
person
requirement.
This
has
been
around
for
a
good
few
months
now
and
alongside
this
announcement,
Tom
Court
QC
was
announced
as
the
lead
reviewer,
and
that
term
review
begins
pretty
quickly.
B
Next
month
and
it's
an
important
issue,
the
important
issue
to
point
out
is
a
review,
will
consider
the
scope
of
the
operation
and
the
purpose
of
Britain
proper
person.
So
it's
not
just
about
what
we
have
done
but
is
about.
Is
this
regulation
attempting
to
deliver
the
policy
ambitions
of
our
government?
So
I
think
this?
B
Those
review
terms
of
reference
were
pretty
important
in
paragraph
five,
our
objective
was
just
to
advise
that
we
have
been
asked
and
we
will
submit
evidence
to
a
review
that
the
GMC
have
introduced
into
gross
negligence,
manslaughter
and
culpable
homicide
cases,
which
is,
as
a
result
of
a
particular
case
that
the
GMC
have
considered
and
that
review
for
the
GMC
will
be
carried
out
by
them.
Claire
marks
previous
presidents
of
the
Royal
College
of
Surgeons,
the
census
report
was
drafted.
B
B
So
one
of
the
things
that
we
need
to
do
is
consider
Norman,
Williams's
review
and
the
implications
for
CTC,
as
well
as
some
evidence
to
the
gmc's
case,
and
once
those
recommendations
are
made
and
I
think
they're
scheduled
to
be
made
in
early
2019,
we'll
have
to
review
those
as
well,
so
that
what
that
means
is
there's
some
quite
sensitive
and
delicate
issues.
But
when
Ted's
team
are
out
inspecting
may
well
get
raised
as
part
of
the
review
about
about
these
issues.
B
We've
also
given
evidence
this
week
to
the
Joint
Committee
in
Parliament.
This
is
Commons
and
Lords
which
come
together
to
provide
pre-legislative
scrutiny
for
the
Health
Service
safety
investigation
bill,
which
sets
up
the
health
investigations
board,
which
at
the
minute
is
part
of
NHS
improvements
and
establishes
it
as
a
legal
entity.
It's
own
writing
gives
its
legal
duties
and
it
ceases
to
become
a
board
and
will
become
a
body,
and
there
is
some
important
issues
there
and.
B
It's
here,
colleagues
to
note
I
wanted
to
put
into
the
public
domain
the
fact
that
some
work
on
general
practice
provider,
information
collection.
This
is
where
we
would
use
a
particularly
digital
tool
to
collect
information
on
GP
performance,
which
we'd
anticipated
launching
in
the
autumn
of
this
year
has
been
deferred
until
April
2019.
B
The
reason
for
this
is
to
give
us
sufficient
time
to
ensure
that
the
required
testing
is
in
place
so
that,
by
the
time
this
is
launched,
we
are
absolutely
confident
to
the
product
that
we've
got
I
think
we
arrived
at
the
view.
But
by
trying
to
do
this
in
the
autumn,
we
couldn't
satisfy
ourselves
that
we
woulda
done
the
requisite
testing.
Consequently,
the
reason
for
deferral-
the
work
will
continue.
B
Paragraph
eight
I
draw
attention
to-
and
this
is
I'm
specifically
asking
the
board
to
agree
to
this
statement.
Some
work
that
we've
undertaken
on
modern
slavery
and
Lucy
Wilkinson,
who
leads
on
our
work
on
e
quarters
in
Human
Rights,
who
I
think
will
be
known
as
many
in
the
board
is
sat
with
members
of
the
public,
such
as
Lucy's
commitments
of
the
work.
B
But
we
one
of
our
equalities
in
human
rights
days
that
Lucy
organized
the
modern
slavery,
Commissioner's
Office
made
a
presentation
about
the
incidence,
modern
slavery
and
if
you
think
that
one
of
the
risks
and
modern
slavery
is
its
occurrence
within
law,
paid,
often
loss
guild
workforces
and
that's
exactly
the
work
force
that
very
often
is
available
in
adult
social
care.
And
there
is
a
historic
case
of
modern
slavery,
going
back,
I
think
to
2010
that
a
commission
has
dealt
with
then
it
seemed
important
Pizza
that
we
considered
our
position
in
relation
to
modern
slavery.
B
So
only
private
sector
organizations
with
a
turnover
above
I
think
it's
five
million
pounds
that
are
required
by
law
to
produce
a
statement.
Some
modern
slavery,
I
think
NHS
England,
however,
also
have
on
their
websites
as
statements
in
the
lessons
of
modern
slavery,
so
Lucy's
led
some
work
on
our
behalf
following
discussions
with
staff
within
the
organization
with
the
Commissioner
for
slavery
to
modern
slavery,
to
actually
work
on
the
statement
which
is
appended
to
the
report
that
we're
considering
at
the
minute
I'm
grateful
to
Lucy
through
work
and
getting
us
to
this
position.
B
I
think
what
we've
got
is
a
clear
statement
of.
If
we
found
this
through
our
regulatory
activities,
what
would
we
do
if
there
were
circumstances
where
victims
of
modern
slavery
were
being
cared
for,
whether
there's
any
regulatory
requirements
for
us,
not
necessarily
so,
is
the
answer
to
that,
but
the
potentially
could
be.
How
would
we
deal
with
this,
but
I
think
this
is
an
example
of
some
good
work
across
the
Commission,
but
I
think
also
a
good
example
of
the
way
that
we
now
confidence
in
working
with
other
organizations.
B
B
I've
also
signed
the
Armed
Forces
covenant.
This
reflects
the
work
that
Ruth
Rankin
in
Steve's
team
and
Steve
has
done
within
the
inspection
team
on
inspecting
Armed
Forces
primary
medical
services,
where
we've
now
completed
that
round
of
inspections
of
Armed
Forces,
primary
medical
services
bases,
and
indeed
the
Ministry
of
Defense,
wanted
to
renew
the
contract.
B
So
I
think
we've
started
to
actually
do
repeat
visits
and
go
around
again
and
I
I'm
very
clear
from
having
spoken
to
the
Surgeon
General
that
they
think
this
is
making
a
contribution
to
improvements
in
the
quality
and
standards
of
the
work
and
the
Armed
Forces.
Covenant
is
effectively
covenant
of
those
organizations
that
support
the
work
of
the
Armed
Forces
signing
up
just
to
make
that
commitment
and
I
think
what
this
will
mean
is
that
there'll
be
a
logo
on
our
website.
So
I
should
give
some
impacts
of
that.
B
But
some
I
know
there's
a
number
of
our
staff
who
were
immensely
proud
of
the
work
that
they've
done
in
that
respect.
I
have
to
say,
as
I
am
to
paragraph
II
Lebanese
just
to
flag
on
recent
publications,
Andria's
work
on
improvements
in
adult
social
care
and
today
the
work
on
the
inpatient
survey,
which
I
think
has
some
pretty
important
messages,
quite
frankly
about
how
certain
standards
and
levels
of
performance
to
be
maintained
across
the
NHS
in
relation
to
patient
care
and
then
12
is
flagging.
B
Up-And-Coming
publications
improvements
in
general
practice,
we've
got
a
consultation
response
that
we
publish
later
that
I
think
you'll
consider
later
today,
learning
from
said
the
incidence
attended
during
the
local
systems,
reviews
and
the
beginning
of
July,
and
then
improvements
in
health
and
care
about
individuals.
Who've
made
a
difference
so,
if
I
stop
presenting
at
that
point,
Peter,
if
there's
questions
I'm
sure
we'll
do
our
best
runs,
but
if
I
could
invite
the
board
to
indicate
their
support
for
the
work
on
modern
slavery.
I'll
be
very
grateful.
Thank
you.
Thank.
K
That's
right,
the
driving
improvement
document
for
GPS
out,
and
it
does
include
one
of
the
practices
RAF
scrumped
and
Medical
Center
in
Lincolnshire,
so
one
of
the
Armed
Forces
prices,
which
has
improved
as
part
of
that
review.
But
it's
a
it's
a
it's
a
interesting
document
showing
improvement,
demonstrating
improvement.
K
It's
not
just
the
practice,
but
it's
the
million
or
so
patients
that
are
now
in
practices
that
have
been
proved
in
quality,
which
is
a
real
credit
to
our
teams
outside
inspecting
brats
is
the
rating
of
practices,
but
also
the
practices
themselves,
recognizing
as
a
problem
and
improving
which
we're
really
pleased
about.
Thank.
G
A
B
B
A
G
So
at
that
time
we
we
produce
an
annual
report
which
basically
summarizes
everything
that
we've
been
doing
during
the
year
to
support
the
approval
at
the
end
report
and
accounts,
and
this
is
that
report
they
because
it's
a
summary
of
what's
going
on
during
the
year.
There
is
nothing
in
here,
I
think,
which
is.
It
is
new
to
people,
so
I
don't
propose
to
go
through
it.
I
think
the
one
thing
I
would
bring
out
is
the
audit
reports
that
have
come
from
internal
audit
during
the
year
and
I.
G
Think
that
demonstrates
continuing
level
of
improvement.
As
members
may
recall,
these
reports
are
there's
a
force
for
a
level
of
assurance.
That
is
four
different
levels
of
assurance,
which
are
given
I,
can't
think
where
we've
seen
four
levels
of
things
get
their
report
ratings
given
before,
but
it's
a
standard
way
that
or
the
audit
internal
auditors
across
government
and
actually
on
government
rates.
G
There
were,
as
you
look
at
paragraph
14
you'll,
see
that
this
year
there
are
18
reports
last
year,
24,
that's
not
a
reflection
of
doing
less
work.
It's
a
reflection
of
the
individual
reports
were
probably
wider
in
scope
and
took
longer
and
the
proportion
of
limited
reports,
and
there
was
there
were
no
such
special
ones.
The
proportion
limited
reports
was
there
only
two
limited
reports.
G
Two
aspects:
one
was
around
disaster
recovery,
as
we
talked
about
last
time,
which
the
board
will
look
at
proposals
to
it's.
A
very
limited
area
of
disaster,
IT
disaster
recovery
that
we
need
to
just
look
at
what
we
might
do
on
that.
It's
not
at
all
to
you
is
there
anything
to
do
with
cybersecurity?
G
Oh
no,
that
is
just
disaster
recovery
and
it
relates
to
our
arrangements
with
outsource
providers,
essentially
at
what
other
providers
in
there
and
the
the
other
limited
rating
was
around
some
thought:
work
on
looking
at
hospitals
and
the
hospital
inspectorate's
reporting
the
the
timeliness
of
getting
their
reports
out,
essentially,
and
which
is
something
which
we've
talked
about
several
times
here,
which
will
be
coming
back
to
again.
I.
Think
on
that,
so
probably
not
surprising
that
there
was
a
limited
rating
there,
but
I
think
somewhere.
G
A
So
does
anybody
want
to
visit
note
and
comma?
Doesn't
anybody
want
to
comment,
or
are
we
happy
just
to
note
the
report
Paul
could
I
could
I
just
say
thank
you
to
you
and
people
on
your
committee,
because
I
know
that
those
of
us
not
on
the
committee
and
I
think
David
use
in
particular,
is
the
accounting
officer.
Ya.
Get
derive
huge
comfort
from
the
work
that
the
committee
does.
A
It's
a
very
effective
committee
also
allow
you
to
pass
on
thanks
to
tool
in
differently
independent
member
who
I
think
has
huge
value
as
well,
but
I
do
commend
what
you
do.
I
think
it's!
It's
is
it's
a
great
value
to
this
board?
So
thank
you.
So
we're
nope
we're
not
your
report
and
then
you
want
to
do
a
quick
update.
G
G
And
the
main
point
which
we
spent
time
on
was
the
intense
precious
that
those
local
healthwatches
are
under
for
funding
and
the
various
ways
they
are
looking
to
respond
to
that
funding
pressure.
But
it
is
getting
very
tough
for
them
and
there
is
almost
I
think
we
were
talking
about
your
sort
of
existential
problems.
G
L
Very
briefly,
just
to
thank
the
Audit
Committee
for
that
consideration
and
I
had
David
has
some
very
helpful
thoughts.
It
is
a
it
is
a
very
serious
problem
out
there
in
that
of
the
40
million
pound
that
was
originally
allocated
to
local
HealthWatch.
It's
you
know
it's
it's
headed
below
30
and
it's
not
heading
in
the
right
direction.
It's
going
down
beyond
that
and
it's
so
it
is
an
existential
threat.
As
you
say,
we
have
been
working
on
this
over
the
years
and
really
from
January
onwards.
L
We
gave
it
a
cut
with
goodness
or
a
complete
focus.
So
all
ideas
and
thinking,
please
it
is
the
problem
of
money
being
passed
from
one
government
department
out
into
the
local
authority
world.
It
cannot
be
ring-fenced
according
to
the
think,
current
thinking,
and
it
means
that
it
makes
it
more
difficult
for
all
concerned
recognizing
pressures
on
local
authorities
as
well.
But
thank
you
for
your
support.
L
A
Healthwatch
is
really
excuse,
me
is
really
important
and
we
have
to
make
sure
that
the
existential
threat
does
not
come
to
an
existential
ending.
So
we
really
did
need
to
make
sure
that
we
we
found
ways
of
making
sure
the
local
healthwatches
can
continue
their
really
important
work.
Good.
Thank
you.
So
I
think
we
move
on
Mary
how
nice
to
see
you
so
Mary.
M
Thank
you.
So
it's
feeling
very
pleasing
to
have
reached
the
stage
of
the
first
annual
report.
I
am
hoping
that
you
have
all
read
it,
and
so
I
won't
take
you
through
it
in
any
sort
of
detail.
I
just
like
to
highlight
a
couple
of
points,
and
also
to
give
you
a
sense
of
how
the
pace
of
this
is
joining
up
with
other
forces
at
play
within
CQC.
So
this
has
never
been
just
about
providing
support
to
people
to
who
want
to
speak
up
and
protecting
them
and
enabling
them
to
do
that.
M
Well,
this
is
about
actively
promoting
speaking
up
as
a
way
of
life
within
CQC
and
becoming
the
sort
of
place
where
any
concerns
are
welcomed.
Where
people
speak
up
well
or
listen
to
well
and
responded
to
well,
and
we
are
on
a
journey
with
that,
along
with
the
NHS
and
other
organisations.
Of
course,
the
work
that
the
board
will
be
familiar
with
around
shaping
our
future
has
also
had
a
real
connection
here
and
one
of
the
key
issues
highlighted
by
staff
in
the
conversations
around.
M
That
is
the
Neill
need
to
feel
connected,
and
there
is
a
whole
piece
of
work
going
on
with
that
which
the
board
will
have
seen
around,
particularly
for
the
home
working
based
staff,
how
we
can
help
them
to
feel
connected
and
I.
Think
the
ambassador's
that
have
been
recruited
in
the
name
of
speak
up
will
be
a
real
force
for
good
in
this.
M
The
reference
group
has
kept
me
on
the
straight
and
narrow
in
terms
of
having
a
group
to
answer
to
in
between
times
that
I
answer
to
yourselves,
you
may
have
noticed
that
I
put
you
all
down
as
the
sponsor,
because
this
is
where
I
report
to
and
where
I
will
come
directly
to
in
the
event
of
any
key
trouble.
The
Ambassadors
are
an
amazing
Bunch.
They
display
our
values
in
full
force.
All
three
training
courses
so
far
have
just
been
a
joy.
There's
a
real
willingness
to
take
this
on.
M
It's
a
great
relationship
as
I
come
from
hospitals
I've
been
involved
in
the
inspecting
of
this
out
there.
That
has
been
helpful,
I
think
for
the
first
Guardian
to
have
that
extra
insight
and
they're
very
supportive
in
in
coming
and
talking
to
staff
too
I've
also
been
delighted
to
accept
a
number
of
invitations.
Last
week,
I
had
the
opportunity
to
speak
twice
to
customer
and
corporate
services,
and
the
quality
of
the
debates
on
those
calls
and
of
the
questions
that
came
forward
were
really
heartening.
M
In
terms
of
the
the
widespread
support
there
is
for
this
next
year
is
about
making
those
ambassadors
as
effective
as
they
can
be
and
doing
far
more
of
the
promotional
work
and
I'll
bring
you
an
update
in
the
autumn,
I'll
be
asking
the
board
to
note
the
report
and
please
to
take
any
questions.
Thanks.
F
F
Is
that
something
like
the
number
we
would
expect,
given
that
we
have
96
ambassadors
and
47
complaints?
That
means
we
have
twice
as
many
ambassadors
as
we
have
complaints
and
I
just
want
to
get
an
idea
of
the
scale
that
we
would
expect
is
that
is
that
right,
it's
at
the
right
ratio,
and
should
we
is
that?
Is
that
not
enough?
Is
it
too
many
and
what
what
have
people
done
before?
F
M
M
M
We
won't
alter
it
ultimately
measure
this
by
the
number
of
cases
that
I
can
report.
That
would
be
an
important
part
of
it,
but
the
important
thing
will
be
the
staff
survey
and
how
people
whether
people
feel
this
is
a
safe
place
to
raise
a
concern
about
how
we
work
it's
42
percent.
At
the
moment,
that's
a
declining
figure,
I
I
think
we
need
to
look
out
for
halting
that
and
increasing
that
significantly
as
a
true
reflection
of
this
being
a
place
where
speaking
up
has
become
a
way
of
life.
N
You're
just
saying
there
Mary
is
exactly
what
I
wanted
to
say.
This
is
not
about
numbers
of
cases.
This
is
about
the
change
of
culture,
we're
trying
to
create
an
and
to
come
back
to
what
what
I
wanted
to
ask
I
mean
you've
said
before
on
several
occasions
that
the
leaders
often
totally
underestimate
how
approachable
they
are,
and
you
know
I
think
we
need
to
be
conscious
of
that.
So
have
you
a
sense
that
not
just
in
terms
of
numbers,
but
there
is
a
changing
culture
out
there?
N
M
Well,
all
the
signs
are
that
it's
positive
in
terms
of
the
goodwill
behind
this
and
the
acceptance
of
it
is
the
right
thing
to
do.
I
think
there's
less
evidence
yet
of
changes
in
the
individual,
behavior
and
team
behavior
I
think
this
time
next
year.
I
hope,
that's
what
we
can
can
say
and
that
people
will
be
socializing
that
in
conversation,
but
it
is-
and
in
the
developments
for
this
coming
year-
is
support
for
managers
about
responding.
N
Come
back
on
that,
so
just
as
you're
talking
that
I
was
thinking,
is
there
a
room
for
us
as
senior
managers
and
leaders
in
the
organization
to
actually
be
trained
about
how
well
we
should
respond
if
we
overestimate
how
approachable
they
are.
We've
got
to
show
leadership
in
this,
and
we
need
to
be
confident
that
people
will
raise
concerns
with
us
and
feel
free
to
raise
concerns
with
this.
So
do
we
need
to
do
more
as
a
board
or
as
executive
directors,
I'm.
I
In
a
way,
it's
just
to
follow
on
from
that
conversation,
because
I
think
Mary's
absolutely
right.
What
we
want
is
a
culture
where
people
feel
capable
and
confident
of
raising
a
concern
and
knowing
that
it
will
get
listened
to
and
responded
to
appropriately
and
and
I
think
that
we
are
seeing
some
some
changes
with
that.
I
But
I
do
think
it
depends
on
those
of
us
at
a
senior
level
and
being
good
role
models
for
that
and
demonstrating
that
when
people
do
raise
issues
with
us
that
we
consider
what
we're
going
to
do
about
it,
and
we
also
absolutely
crucially
feedback,
because
one
of
the
things
that
new
I
think
gets
picked
up
is
people
feel
that
they're
raising
issues
it
goes
into
a
void,
and
they
don't
know
so.
Yes,
yesterday
I
had
an
email
on
Monday,
so
it
had
an
email
from
an
inspector
raising
concerns
about
something
is
kalay.
I
Today,
I
responded
to
her
and
told
her
what
I'd
done
and
that
we'd
listen
to
it
and
all
of
all
of
those
kind
of
things
and
the
email
I
got
back
was
just
fantastic
because
you,
she
clearly
felt
very
appreciated
and
her
head
of
inspection
is
circulated.
The
whole
Blauman
thing
to
the
region
now,
but
just
as
in
a
demonstration
that
actually
you
know
that
there
has
been
a
response.
So
I
think
there
is
something
about
us
being
good
role.
Models
in
this.
O
Walter,
thank
you
very
much
Mary.
So
two
points
to
make
one
is
I,
am
one
of
your
ambassadors
and
I'm
very,
very
proud
to
be,
and
I
can
only
recommend
the
training
to
anyone
who'd
be
willing
to
do
so.
If
there's
more
interest
from
our
leadership,
then
I
really
recommend
doing
that.
The
the
second
point
I
wanted
to
make
is
that
I
think
we
should
look
at
the
staff
server
and
how
it
comes
out
this
year.
O
I
also
think
that,
as
we
continue
to
ask
for
a
360
feedback
at
all
levels
of
the
organisation,
we
should
be
very
clear
that
we
want
to
understand
how
we
come
across
to
our
colleagues
and
how
we're
responding
to
concerns
as
possible.
I
think
it's
personal
feedback
that
we
should
all
be
asking
for.
Robert.
E
Especially
I've
really
encouraged
by
what
we
see
here
and
particularly
by
the
number
of
ambassador's
you've
recruited
I,
think
that
there's
a
way
to
spread
the
culture
is
by
having
this
ever-increasing.
They
were
not
for
105
group
of
people
who
are
committed
in
all
parts
of
the
organisation
and
if
I
may
say
so,
it
looks
to
me
got
the
evidence
that
we
probably
have
a
higher
proportion.
First
off
head
of
staff
for
the
ambassadors
than
probably
any
NHS
trust,
and
there
may
be
a
lesson
for
them
to
learn
from
that.
E
Secondly,
I
think
can
I
commend
your
the
whistleblowing
freedom
speak
up.
Policy,
which
I
have
to
say,
is
a
model
of
clarity
compared
with
the
pretty
low
bar
set
by
quite
a
lot
of
the
NHS.
In
that
regard,
it's
a
document
which
seems
to
me
any
one.
Member
of
cell
ought
to
be
able
to
learn
standard
follow,
but
instead
is
finally
a
question
in
relation
to
the
the
hint
you
give
in
your
report
of
a
few
practical
difficulties
about,
for
instance,
getting
people
to
training
him
selling
and
I
wanted
to
know
whether
that
was
your.
E
M
It's
a
mixture
I
think
there
are
moments
of
operational
crisis
that
many
people
have
to
divert
I'm.
What
I'm
doing
is
talking
to
those
line,
managers
and
persuading
them
of
the
importance
of
releasing
staff
and
the
fact
this
is
a
corporate
agenda
and
a
social
movement
that
you
know
we
want
to
be
part
of,
and
that
in
fact,
getting
involved
in
this
work,
I
think
will
increase
individual
effectiveness
and
team
effectiveness.
So
I
think
there's
a
real
reason:
an
incentive
for
line
managers
to
release
release
staff
to
be
involved.
A
Mary,
a
huge
thank
you,
you
have
a
pretty
big
job
part
from
doing
this
and
I
hope,
you've,
I,
think
thrown
body
and
soul
into
into
this
work,
you're
on
your
enthusiasm
and
commitment
to
it
just
just
shines
through
from
the
written
report,
but
also
from
your
presentation
today.
So
just
on
sorry,
just
on
behalf
of
everybody.
Thank
you
very
much.
What
you've
done?
Please
continue
the
work.
It
really
is
important
and
you
promised
us
an
update
in
the
autumn
and
I
look
forward
to
that.
Thank
you.
Thank
you
good.
A
F
Yes,
the
RDC
bring
the
tree
Governance
Committee,
which
I
chaired
since
for
most
of
the
last
year
since
Michael
Mayer
stepped
down.
Several
members
are
on
of
the
border
on
the
are
on
our
GC
and
there
are
others
who
can't
keep
away
and
therefore
attend
Peter.
You
come
yourself
regularly
and
the
our
GC
and
the
last
year,
I
think,
has
had
two
parallel
tracks
in
a
way.
It's
continued,
the
previous
role
of
in
a
sort
of
rotational
way,
examining
different
parts
of
the
system
that
we
regulate.
F
So
it's
been,
it's
been
a
very
useful
place
where
perhaps
those
areas
of
CQC's
responsibilities
are
fully
aired
in
a
way
and
as
a
level
of
detail
that
isn't
always
allowed
and
by
time
the
board
itself.
So
that's
and
that
that
function
of
informing
board
members
has
been
very
important.
It
obviously
provides
comment
back
towards
the
chief
inspectors
and
executive
team
comment
on
issues
of
concern
on
future
priorities
on
our
methodology
and
on
the
likely
content
and
state
of
care
report.
So
there's
a
two-way
dialogue
which
I,
which
and
we've
continued.
F
So
it's
been
so
very
full
year
and,
as
things
stand,
we
expect
to
continue
those
those
two
tracks
rotational
discussion
of
our
key
areas
here
as
it
regulate
and
and
a
second
track
of
largely
improvement
based
specific
topics.
I
should
say
that
just
one
final
thing
in
view
of
today's
discussion,
that
one
of
the
other
areas
that
we've
talked
about
in
detail
and
are
planning
to
return
to
is
our
role
in
criminal
prosecutions,
so
I'll
leave
it
that
this
report
is
to
note.
P
Mark
chairman,
if
I
could
just
respond
to
Lewis
about
serial
attenders
I'm,
not
stalking,
you
I
just
want
to
say
that
by
attending
these
meetings,
I
found
it
extremely
helpful
as
part
of
my
induction
into
being
an
EDD
in
this
organization,
because
the
you
covered
the
whole
remit
of
the
organization
and
the
presentations
that
I've
attended
have
been.
You
know
really
excellent,
so
thank
you.
P
B
K
Think
the
constructive
challenge
is
also
helped
because
it's
helped
us
then
think
about
other
areas
that
and
to
follow
up
on
some
of
those
discussions.
We've
been
to
see
ministers
about
health
in
across
Prison
Service
with
Paul,
Elliot
and
others,
and
it's
been
I-
think
it's
a
really
valuable
part
of
what
we
do.
So.
Thank
you.
A
And
just
drive
to
Marc's
comment
after
two
and
a
half
years
here,
I
still
get
huge
values
coming,
my
induction
is
taking
a
little
longer
than
yours,
Marc
might
do,
but
seriously
it
is
a
very
valuable
forum
and
thank
you
very
much
for
what
you've
done
so
board
were
happy
to
note
the
report
and
that
takes
us
onto
the
people
update
and
so
Ruth
is
our
on
a
course
I
think
at
the
moment,
so
she's
not
joining
us,
but
Kirsty
you're
gonna
pick
it
up.
Please.
Yes,.
H
Thanks
Peter,
so
what
we've
got
today
is
an
update
of
asks
of
people
strategy
in
the
work
that
we've
we're
doing
in
that
space.
So
I
will
just
sort
of
put
a
few
highlights
out
as
a
report
that
we
we
sent
in
earlier.
So
just
in
terms
of
just
to
recap,
our
our
key
priorities
are
around
our
efficiency
in
our
fective
Ness
for
CQC.
Embedding
the
Qi
methodology
in
the
organization
embedding
the
intelligence-led
shared
and
a
shared
view
of
quality
work
that
we're
doing
be
sure.
H
We've
got
the
right
skills
and
capability
in
the
organization
to
do
all
of
that
work
and
also
making
sure
that
we
would
provide
a
healthy
working
environment
for
our
staff
and,
following
on
from
our
values
of
make
sure
we're
embedding
our
values
of
excellence,
caring
integrity
and
teamwork
in
all
the
things
that
we
do.
So
that's
also
overarching
priorities
for
the
for
the
people
Directorate,
but
I
just
wanted
to
put
on
and
put
out
a
couple
of
areas
for
us
to
focus
on
so
I
think.
H
Well,
once
we've
done
a
bit
more
thinking
in
that
space,
we're
also
looking
at
our
attraction
and
retention
policies
and
what
we
need
to
do,
what
policies
we
need
in
place
to
ensure
that
we
have.
We
can
keep
and
attract
this
the
work
that
we
need
for
the
organization
moving
forwards
and
we're
also
as
part
of
that
decant,
our
workforce
strategy.
H
One
of
the
things
that
we've
done
as
part
of
our
workforce
strategy
is
to
try
and
delegate
decision-making
further
down
the
organization
around
people,
so
we're
holding
people
to
account
now
around
around
budgets,
which
gives
them
a
bit
more
freedom
around
headcount
and
being
able
to
bring
the
people
in
that
they
need
as
long
as
it's
within
their
delegated
budget.
This
in
turn
is
freed
up
a
bit
of
resources
in
the
people
Directorate
to
enable
us
to
have
to
look
at
that
doing
that
work
around
that
flexibility
that
we
need.
H
So
looking
at
how
we
might
be
able
to
bring
bit
more
flexibility
into
that,
both
in
terms
of
being
able
to
move
people
around
various
directorates
and
also
around
the
skills
that
we
need
and
making
sure
that
we
we
have
those
people
with
the
skills
that
we
need
where
we
want
to
deploy
them
and
looking
at
that,
in
terms
of
both
are
our
employed
staff.
That
she'll
show
us
or
contingent
labor
and
our
on
our
support
staff
that
we
can
call
on
to
help
us
do
that.
H
The
other
area
we're
looking
at
is
workforce
around
is
our
workload
and
well-being
and
responding
to
some
of
the
feedback
from
the
staff
server.
We
know,
particularly
in
some
of
our
operational
and
frontline
directorates,
that
staff
are
feeling
under
pressure
for
workload.
We
know,
even
with
reference
some
of
the
issues
around
IT
this
morning.
That's
compounding
the
problem,
so
we
want
to
make
sure
I
was
I,
said:
we've
got
workforce
in
place
that
can
fill
Baker's,
so
we
can
fill
our
vacancies
quicker.
H
So,
there's
quite
a
lot
of
work
going
on
in
that
space,
because
that
is
really
really
important
to
ensure
that
our
workforce
feel
both
valued
and
are
well
I
feel
that
their
well-being
is
maintained.
We've
also
looking
at
the
diversity
and
inclusion.
This
is
a
really
important
subject
and
math.
Subject
matter
for
us,
we
want
we've
commissioned
a
report
from
Roger
Klein
to
look
at
the
experience
of
our
black
and
ethnic
minority
colleagues
in
CQC.
H
That
report
is
now
in
draft
and
we
now
do
some
work
across
the
organization
with
focus
groups
to
look
at
the
recommendations
in
that,
so
they
can
feed
into
that
and
help
shape.
That
report
and
we'll
we'll
bring
that
back
to
the
board.
I
think
it's
September
1
we'll
have
a
final
report
for
a
really
good
discussion
in
that
in
terms
of
what
does
that
actually
mean
for
us
in
CQC,
and
what
are
we
actually
going
to
do
to
turn
to
turn
turn
this
around
and
really
that
really
make
a
difference
in
that
space?
H
The
other
area
of
work
is
around
our
learning
and
development,
as
I
keep
saying.
If
we
need
it,
we
need
to
workforce
with
the
right
skills
to
do
the
job,
so
we've
been
looking
at
our
strategic
training
needs.
The
key
areas
for
that
are
around
quality
improvement,
our
regulatory
skills
program
to
ensure
that
our
inspectors
are
able
to
go
out
and
do
the
enforcement
and
take
the
regulatory
activity
do
the
regulatory
activities
that
they
need
to
do
in
the
right
way
and
driving
a
consistent
approach
to
that,
and
also
around
our
aspiring
managers
program.
H
So
really
diving,
deep
down
into
the
organization
and
looking
for
those
people
with
the
talent
to
become
our
future
managers
of
the
future
and
putting
a
program
in
place
to
support
that
so
I
think
it's
fair
to
say,
there's
a
lot
of
work
going
on
other
people
Directorate
at
the
moment.
This
is
just
a
snapshot
of
some
of
our
key
priorities.
I'm
happy
to
take
questions.
I'll
do
my
best
to
answer
them,
but
Ruth
is
the
expert
in
this
and
she's.
Not
here.
H
P
Thank
you
Kirsty,
a
very,
very
thorough
report,
a
couple
of
observations.
First,
if
I,
if
I
may
I,
think
it's
important
that
these
six
areas
that
you've
identified,
that
they
don't
become
initiatives
that
they
are
very
much
connected
to
what
we're
doing
in
the
organization.
So,
for
instance,
when
I
look
at
adaptability,
I
think
very
much
back
to
our
technical
and
digital
strategy
and
plans,
and
so
it's
very
connected.
P
If
I
look
at
workforce
strategy,
workload
and
well-being,
diversity
and
inclusion,
then
I
really
would
like
to
see
that
we
would
be
linking
that
to
some
of
the
challenges
we've
had
back
from
the
Roger
Klein
paper.
In
terms
of
our
red
standards
and
the
targets
we
have
around
selection
and
development
and
opportunity
for
career
development.
So
I
really
do
encourage
that
we
have
those
linkages.
P
Finally,
I
just
like
to
suggest
that
we
have
a
greater
emphasis
on
engagement,
I'm
sure
all
of
these
key
focus
areas
are
ones
that
we
will
be
wanting
to
communicate
with
our
people,
either
directly
or
through
our
representative
channels.
I
think
that's
an
important
part
and
coming
out
of
these
six
key
focus
areas.
P
I
think
there
is
an
opportunity
for
us
to
develop
some
really
exciting
kpi's
people
kpi's
that
we
can
report
on
on
the
progress,
because
the
paper
suggests
that-
and
there
will
be
coming
back
and
reporting
on
progress
against
each
one,
these
six
areas,
but
actually
we
could
do
that
through
the
KPI
route
and
see
it
for
ourselves.
So
thank
you
really
good
points.
Thanks
mark
Andrea
and.
I
And
so
it's
just
to
kind
of
you
know
give
that
reassurance
to
the
board
that
each
of
the
directorates
has
got
a
people
lead
that
sue
Howard.
For
me,
one
of
my
deputy
chief
inspectors
worked
very
closely
with
Ruth
and
the
rest
of
the
team
to
make
sure
that
all
of
those
initiatives,
our
sorry
I
used
that
word
Brock
I
apologize.
I
All
of
those
priorities
are
taken
on
board
within
the
Directorate
and
that
we're
actively
contributing
to
that,
and
that
also
helps
with
the
communications
point
that
mark
just
raised
as
well
to
make
sure
that
we're
being
consistent
across
the
organization
around
that.
But
I
would
just
like
to
end
by
saying
thank
you
for
the
work
that
everybody's
doing
in
the
people.
Directorate
is
enormous,
ly,
helpful
and
important
to
us
thanks.
J
Andrea
John
thank
you
is
very
good
report.
Thank
you.
Ruth
just
wanted
to
flag
up
that
induction
and
training
was
an
issue
raised
in
the
report
we
considered
earlier
and
increasingly
it
will
be
important
that
consideration
is
given
to
how
that's
handled
as
you
wish,
to
develop
a
core
team
culture
and
the
protocols
and
so
on
and
and
I
know
it's
not
specifically
mentioned
within
Learning
and
Development,
but
I
wouldn't
want
us
to
lose
sight
of
the
fact
that
it
is
really
quite
an
important
part
of
what
will
happen
as
the
strategy
unfolds.
E
H
H
It
is
about
getting
people
into
the
office.
Is
getting
teams
together,
really
building
that
sense
of
team,
even
if
it
is
a
dispersed
team,
but
really
making
sure
that
people
feel
part
of
something?
And
there
is
work
in
that's
in
that
piece
of
work
to
look
at
that
induction
and
training.
I.
Think
it's
probably
it's
it's
one
of
those
I
call
it
the
roadman
Road
surfacing,
but
it's
key.
We
have
to
do
it
as
part
of
our
our
training
program,
I,
suppose
our
specific
learning
these
analysis.
H
These
are
the
new
things
or
new
initiatives
that
coming
in
and
there's
some
sort
of
prerequisites
that
we
have
in
our
training
program,
and
that
is
one
of
them
in
terms
of
the
induction
piece.
So,
but
we
will
go
back
and
just
check
to
make
sure
it
is
fully
considered
up
to
date
with
the
QI
initiatives
and
things
like
that.
Thank.
L
Comment
was
about
workforce
strategy
and
the
very
welcome
news
that,
as
regards
recruitment,
that
will
be
delegated
to
directorates,
has
been
a
real
tough
issue
and
a
challenge
for
a
small
organization
like
HealthWatch
with
the
CQC
family.
One
of
the
issues
that
I
I
surprised
myself,
because
it's
probably
one
of
those
complex
and
technical
issues
that
you
can
pass
on.
One
of
the
issues
as
I
understand
it
was
that
we're
when
we're
we
are
recruiting
health
watching.
We
also
look
across
those.
Are
the
redundancy
pool
stretches
across
the
whole
of
the
organization?
L
H
Question
so
I
will
pass
on,
but
just
forever
I
will
just
I
think
there
are
rules
and
regulations
around
if
you've
got
people
in
in
redeployment,
pools
and
you're
looking
to
recruit,
you
have
to
go,
you
have
to
go
into
that
pool
first
and
that's
just
part
of
the
legislation
and
what
and
there's
some
people
rules
that
we
have
to
apply
to.
So
it's
just
one
of
those
things
we
have
to
do.
A
So
I
think
just
to
pull
this
together.
We
have
a
strategy,
we
don't
have
a
digital
strategy
of
people
strategy
and
so
on
separate
from
each
other.
We
have
a
strategy
which
are
very
connected
and
I
think
the
points
that
you
made
mark
and
others
in
different
ways
were
absolutely
spot-on.
So
this
is
this
needs
to
be
joined
up
and
it
is
and
I
think
your
point
about
KPIs
in
the
people
space
as
well
as
in
the
digital
space,
and
then
all
the
other
space
is
really
important.
So
so
thank
you
for
that.
A
Ruth
isn't
here,
but
I'd
like
to
echo
thoughts
that
came
from
that
side
of
the
table
that
she
and
her
team
done
done,
done
a
lot
of
good
work
as
have
lots
of
other
people.
This
is
really
really
important
that
our
people
are
really
really
important
and
I
think
we
will
probably
have
a
regular
update
at
every
future
meeting,
as
we
do
with
digital
and
other
things.
A
B
Thank
you
Peter,
so
one
item
of
any
of
the
business.
Unfortunately,
yesterday
you
know
our
websites
went
down
and
what
that
means
is
that
there's,
no
members
of
the
public
that
can
get
access
to
our
website.
Indeed,
well,
we've
been
in
the
meeting
for
me
to
check
whether
it's
being
put
back
up
again
there's
a
letter
from
a
member
of
the
public
saying
dear
mr.
B
and
I
can't
get
on
your
website
to
keep
getting
four
or
four
not
found,
and
so
that's
the
significance
of
that.
B
B
I'd
hope
that
caracal
get
back
to
me
and
say:
don't
worry
it's
going
to
be
fixed
in
the
next
ten
minutes,
but
given
she's
been
gone,
want
me
to
send
out
a
simple
need
for
it
that
I,
don't
think
I'm
going
to
be
able
to
say
that
the
other
consequence
of
this
is
from
the
report
that
we
considered
earlier
in
relation
to
hill
green.
The
plan
was
that
that
will
be
made
public
by
going
on
our
website
this
morning.
B
So
there's
a
big
outward-facing
issue
for
members
of
the
public,
who
would
depend
on
our
website
and
the
decision
that
we've
made
this
morning
in
relation
to
publication
of
our
response.
That
was
our
commitment
that
we
published
that
independent
report
we're
not
able
to
do
that
as
well.
We
will
look
at
workarounds
in
relation
to
this,
but
the
important
thing
is
to
get
the
website
back
up
and
running
and
that's
where
the
energy
and
focus
will
be.
You
can
say
it's
up
and
running
no.
H
B
I'm
told
it'll
be
back
up
in
the
next
few
hours,
but
so,
let's
see
so
I
think
we've
obviously
got
a
workaround
from
cares.
The
same
from
the
team
that
we're
working
on
this
we've
got
a
good
to
go,
but
he
will
take
time
to
get
it
up
and
running
so,
but
it
is
important.
I'd
saw
the
board
and
it's
important
I
did
that
in
public
session.
I
know
this
isn't
broadcast
live.
B
So
this
is
real-time
dissemination
of
the
information,
but
it
just
puts
on
the
record
and
then
I
can
net
this
commitment,
because
I
won't
be
here,
but
at
the
next
board
I
think
will
be
an
update
on
what
happened
why
it
happened.
What
has
been
done
to
fix
it
and
if,
for
goodness
said
this
ever
happens
again,
what
the
contingency
is.
B
Very
sorry,
members
of
the
public
there's
some
here,
but
it's
people
that
rely
on
our
website
that
we've
not
given
them
the
service
that
they're
requiring
that's
a
key
issue
and
I'm
sure
I
don't
need
to
sound
disappointed
because
I'm
sure
everybody's
disappointed,
including
the
people
trying
to
get
this
up
and
running
so
I,
think
our
emotions.
And
then
you
should
go
into
getting
it
up
and
running
and
getting
on
with
it.
So.
B
A
J
A
A
A
So
if
when
eventually,
this
gets
up
on
the
website,
Ian,
if
you're,
watching
or
watching
at
that
time,
you've
got
a
hard
act
to
follow
and
let
me
make
that
quite
clear.
I've
been
notified
of
some
questions
from
the
public.
We're
running
horribly
linked,
so
we're
gonna
have
to
keep
it
a
little
bit
brief,
but
I
I.
Q
A
R
Miss
Wyden
thank
you
for
allowing
me
to
speak.
My
name
is
Andrew
Ward
and
I
have
a
background
in
public
protection.
Recently,
Baroness
Dido,
Harding,
chair
of
NHS
improvement,
has
signaled
her
intention
to
drive
change
and
is
now
leading
the
move
of
NHS
improvement
away
from
being
on
I'm,
quoting
from
her
report
to
her
board
last
month,
a
pure
regulator
to
more
emphasis
as
an
improvement
agency.
R
R
Does
the
Commission
see
its
primary
role
as
a
regulator
or
as
an
improvement
organization,
and
little
example
came
to
my
mind
the
other
week
looking
at
Twitter,
how
does
sending
more
than
70
CQC
core
eggs
and
that's
a
quote
from
Dame
Jacqueline
Doherty
chief
executive
of
North
London
Northwest,
University
healthcare,
NHS
Trust,
who
tweeted
that
on
the
5th
of
June,
an
NHS
trust
for
several
days,
enhanced
regulation
assurance
and
improved
quality?
And
this
is
my
observation.
R
A
Parliament
as
your
your
first
question,
Parliament
is
really
clear:
if
you
go
to
2008
Act
that
set
us
up,
it
says
as
our
primary
objective
objective.
We
are
a
regulator,
it's
a
section
3
of
the
Act.
The
second
objective
is
to
encourage
improvement,
so
I
think
we're
absolutely
clear.
As
a
commission,
those
are
the
the
obligations
and
I
think
we
do
both
and
I.
Think
we've
already
had
Steve
was
showing
earlier
the
the
driving
improvement
in
general
practice.
A
We
do
a
lot
of
improvement
work,
but
our
primary
role,
as
set
out
by
Parliament,
is,
is
to
ensure
the
safety
and
well-being
of
service
users
as
to
whether
were
poor
value
for
money.
I
would
just
refer
you
to
the
nao
report
of
last
November
in
value
for
money
on
this
organization,
which
I
think
overall
was
a
pretty
positive
endorsement
about
what
we
do
so
I
hope.
Those
are
quick
answers
to
your
your-your-your
questions
and
then
very,
very
quickly.
Robin,
you
had
a
question
you
wanted
to
ask.
Q
Q
A
We
would
agree
with
you
the
website,
even
when
it's
up
is
quite
difficult
to
navigate
your
way
around.
So
it
is
an
absolute
priority
to
to
to
improve
the
website,
but
I
think
it's
important
to
understand
that
the
whole
approach
to
developing
the
technology
is
quite
a
quite
a
connected,
a
set
of
issues.
So
you
won't
see
a
suddenly
a
new
website,
but
you
will
see
improvements.
Just
you
don't
if
you
want
to
add
in
that
or
anybody
else
or
whether
that's
a
sufficient
answer
for
now.
I.