►
From YouTube: CQC Board Meeting 20th March 2013
Description
Agenda for the meeting of the Care Quality Commission on 20th March 2013:
1. Apologies 00:00:01
2. Minutes of Last Meeting and Matters Arising 00:01:29
2. Chief Executive's report 00:02:09
4. Finance Report January 2013 00:40:47
5. Risk Register 00:46:31
6. Healthwatch England Business Plan 01:01:53
7. Revised Scheme of Delegation & Accountability Framework 01:18:15
8. Report back from Audit & Risk Assurance Committee on 19 March 01:46:13
9. AOB 01:50:53
Read more about about CQC's board meetings at http://www.cqc.org.uk/public/about-us/our-people/board-members/board-meetings
A
Can
I
just
welcome
claire
luxton,
who
has
joined
us
last
week,
who
will
be
taking
the
minutes
of
the
meeting
today
and
is
going
to
be
responsible
for
our
corporate
governance
going
forward
and
malcolm
you're?
Here,
probably
everyone
knows
malcolm,
but
malcolm
is
deputizing
for
amanda.
Today,
I
think,
thank
you
malcolm
now.
I
think
in
we
have
three
people
in
the
audience.
I
just
like
to
sort
of
tell
you
who
they
are
david
hogarth
is
for
who
has
a
particular
interest
in
domiciliary
care.
A
Roger
goss
from
patient
concern
is
roger
here.
No,
he
may
he
may
be
coming,
and
robin
pike
is
robin
pike
here.
Yeah
robin
is
with
the
hertfordshire
patients
forum,
so
welcome
when
we
never
maybe
we'll
have
an
informal
chat
over
coffee
in
between
right,
apologies
from
amanda,
sherlock
and
from
allison
beale.
I
think
lucy
robbins
is
joining
us
in
a
minute.
B
Right,
yes,
steve
hitchens,
I'm
vice
chair
of
new
london
housing
trust
whose
subsidiary
is
a
registered
provider.
A
Thank
you
and
I
think
we
won't
need
to
have
a
decoration
from
anna
bradley
every
time.
Everyone
knows
that
she's
with
healthwatch,
and
so
we
know
that
hannah
the
minutes
of.
C
A
C
Please
so
there's
a
lot
in
this
report.
Chair
and
colleagues
a
previous
meeting,
we
agreed
that
we
would
contain
some
high-level
performance
information
in
this
report.
I
do
apologize
there's
a
lot
in
this
report.
We
agreed
at
a
previous
meeting.
We
would
put
some
high-level
performance
information
in
this
report
and
in
paragraphs
one
we've
set
out
the
progress
as
at
the
10th
of
10th
of
march
in
relation
to
the
inspection
programme.
C
The
figures
are
in
that
report
in
self-explanatory.
Basically,
the
northern
region
malcolm's
region
are
now
at
the
position
that
they've
completed
the
inspection
programme
and
all
judgments
will
be
loaded
on
to
crm
by
the
25th
of
march
are
on
the
verge
of
completing
their
program
and
confident
that
they
will
have
completed
it
by
the
31st
of
march,
with
old
judgments
loaded
on
crm
by
the
7th
of
april.
C
600
of
those
are
scheduled
that
will
leave
200
outstanding,
a
redeployment
of
some
inspectors
from
central
and
the
north
that
have
completed
their
program
to
help
with
that
program,
and
a
priority
is
now
being
given
in
the
south
to
adult
social
care,
independent
health
care
and
ambulance
rather
than
dentists,
because
the
commitment
that
we
made
around
dental
inspections
is
now
discharged,
so
very,
very
good
progress.
C
I
think,
to
the
end
of
the
year
chair
in
relation
to
the
efforts
that
has
been
put
in
by
staff
right
across
the
commission
to
get
to
that
programme
and
of
that
balance
that's
left.
I
think,
there's
been
some
risk
assessment
to
ensure
that
those
high
priority
services
are
actually
being
seen
and
those
bits
of
the
commission
which
have
completed
the
program,
assisting
the
other,
the
southern
region,
to
help
them
with
that
programme.
C
So
good
progress
and
that
updates,
what's
in
paragraph
a
in
the
report
and
brings
it
absolutely
bang
up
to
date
as
of
a
review
meeting
which
took
place
yesterday
afternoon.
So
I
commend
that
work
to
the
board.
I
just
like
to.
A
Add
to
that
I
was
with
malcolm
and
his
team
in
leeds
yesterday
as
it
happens,
and
I
they
they're
doing
a
terrific
job,
malcolm.
I
thought
that
the
aurora
was
great.
The
work
they're
doing
is
great
and
they
were
you
know
really
up
for
it.
I
thought
so.
I
really
enjoyed
the
visit.
So
congratulations
to
you
and
your
team.
You
got
you,
you
completed
your
inspections.
The
first
yeah.
D
D
Thank
you
for
that,
and
it
will
give
me
a
great
pleasure
to
take
that
message
back
to
the
team
and
the
north.
But
it
is
a
full
team
effort
across
the
commission
and,
as
david
said,
we've
now
got
over
70
inspectors
from
other
regions
working
in
the
south
good.
B
A
B
C
B
Think,
I
think,
doesn't
I
think
we
want
to
at
the
appropriate
time.
It
may
be
sensible
to
wait
for
the
end
of
march,
but
at
some
point
I
think
you
know
the
board
should
actually
commend
the
efforts
of
the
inspecting
teams
to
deliver
this
program.
I
mean
we've
had
our
concerns
about
the
you
know
the
quality
in
such
a
rush
and
dramatic
sort
of
end-of-year
rush,
and
maybe
there
ought
to
be
some
review
of
you
know
how
competent
we
were.
B
A
Yeah,
actually,
I'm
going
to
ask
malcolm
you
to
give
a
few
comments
about
your
views
on
hospital
of
the
efficacy
of
hospital
inspections
later
on
in
in
the
meeting.
So
we'll
have
more
of
a
roundtable
discussion
about
that.
So
just
to
put
you
on
warning,
I
will
be
coming
back
to
you
later,
david,
okay,.
E
C
Right,
thank
you.
Just
on
the
issue
about
quality.
All
through
this
past
few
months,
there
have
been
checks
and
balances
put
in
place
in
each
region
on
quality,
so
we
can
bring
forward
further
detail
on
how
that
work
has
continued.
C
C
Then
progress
on
inspection
reports
where
we
are
in
terms
of
registration
again,
I
just
want
to
pull
out
the
good
progress
which
has
been
made
on
primary
medical
services,
registration,
it's
ahead
of
plan
and
progressing
well,
the
10th
of
february,
almost
93
of
providers
would
receive
their
notice
of
decision
and
that
work
continues
and
I'm
confident
we'll
get
to
discharging
our
responsibilities
around
registering
primary
medical
services,
not
just
the
issue
about
quality,
has
been
raised
as
a
compromise
on
completing
the
program,
but
there
were
also
concerns
around
enforcement,
and
I
think
these
figures
demonstrate
that
enforcement
activity
has
actually
increased
over
this
period.
C
Rather
than
I
think
the
fear
also
did
a
decrease,
so
I
hope
the
board
takes
some
satisfaction
from
those
figures
and
then
finally,
the
customer
services
center
up
in
newcastle
continue
to
process
large
volumes
of
contacts
with
the
commission
and
ensure
that
they're
dealt
with
in
the
appropriate
way.
Once
they're
received
in
to
the
organization.
F
There
are
a
couple
of
spikes
that
are
timed
with
the
publication
of
the
the
front
of
the
francis
review
and
they're
consistent
with
when
we
that
we
get
other
media
activity
around
around
whistleblowing,
but
actually
there's
been
a
genuine
upward
trend
anyway,
despite
the
spikes
has
been
a
genuine
trend
in
whistleblowing
calls
to
ncsc
over
the
last
six
or
seven
months,.
B
David
talked
about
contacts
for
ncsc,
the
report
says
calls:
do
we
encourage
email,
contact
or
other
forms
of
contact?
B
I
mean,
obviously
people
write
letters
occasionally
still
these
days
and
is
there
a
program
because
handling
calls
is
quite
intensive
and
I
just
wondered
if
there's
we're
trying
to
develop
a
trend
and
make
access
easier
and
of
higher
quality
to
and
some
of
the
computer
pro
generated
programs
which
are
quite
clever,
not
letting
you
go
further
until
you've,
given
all
the
details
that
are
required,
I
don't
know
if
there's
any
working
hand
on
this.
C
So
the
call
center
in
newcastle,
I
think,
is
a
pretty
modern
and
sophisticated
call
center
and
I
think,
was
acknowledged
when
it
was
in
the
top
50
of
the
call
centers
in
the
uk,
and
I
think,
that's
a
reflection
of
the
fact
that
they've
got
that
technology
in
but
to
the
first
part
of
the
question
steve.
We
get
still
get
large
volumes
of
letters.
C
We
get
emails
and
there's
ability
for
telephone
contact,
email,
letters
and
physically
written
letters
to
be
received
into
the
organization,
they're,
all
logged
and
processed
and
there's
a
tracking
system
which
follows
that
through
to
ensure
that
none
of
these
are
lost
as
they
go
through
the
system
and
the
degree
of
accuracy
or
the
way
that
the
call
center
operates
is
very
high
and
stands
comparison
with
the
best
and
they
generate
data
which
allows
them
to
benchmark
their
performance
against
other
call
centers
and
they
actually
use
that
to
drive
their
own
performance
and
monitor
their
performance.
C
C
If
I
take
some
of
these
at
pace,
chair
so
I'll
provide
an
update
here
on
the
health
select
committee
report
which
we
received
following
the
previous
chair,
dame
george
williams
and
himself
appearing
at
the
committee
in
september,
they've
made
a
number
of
recommendations
tours
in
their
report,
which
we
are
considering.
C
We
had
been
committed
to
reporting
back
to
the
select
committee
by
the
26th
of
march,
and
that
was
agreement.
We'd
do
that
with
the
department
who
were
also
going
to
report
back
on
the
26th
of
march,
but
given
the
secretary
of
state
will
make
his
statement
to
parliament
on
the
26th
of
march
about
the
government's
initial
response
to
francis
and
that
will
contain
content
on
some
of
the
recommendations
that
the
select
committee
made
to
us.
C
What
we've
agreed
with
the
clerk
to
the
committee
is
that
we'll
report
in
april,
when
the
department
also
reports
the
secretary
of
state
health,
I
think,
is
appearing
at
the
select
committee
on
the
21st
of
april.
So
our
response
will
coincide
with
that
and
then
that
response
can
demonstrate
how
we
are
responding
to
those
specific
recommendations
from
francis
that
the
government
are
intending
to
take
forward.
C
So
the
work
is
to
hand
it's
all
been
done,
but
we
await
the
government
response
and
then
we
can
be
more
definitive
in
our
response
to
the
select
committee
and
we'll
send
that
in
alongside
the
department
of
health's
response,
there
is
an
interrelationship
and
interdependence
between
the
policy
context
that
is
being
set
for
regulation,
the
department
and
the
work
that
we
need
to
do
to
take
it
forward
and
that's
what
we'll
try
and
bring.
E
Forward,
it's
particularly
on
the
response
to
the
health
select
committee
report
and
I'm
mindful
that
the
committee
said
that
cqc
must
reform
its
culture
and
I
think
it's
common
knowledge
that
it's
known
that
that
was
directly
related
to
my
treatment
and
as
such
I
would
value
providing
some
input
into
the
response
on
that
issue,
and
I
think
it's
also
important
for
me
to
put
on
record
that
I
don't
feel
it
has
been
addressed
as
yet.
C
Sure
the
culture
of
the
organization
is
a
huge
priority
for
me
and
I'm
determined
that
we'll
change
that
and
I
do
believe
I've
begun
to
make
changes
which
are
about
improving
the
culture.
I'll
present
later
in
this
report,
the
pulse
survey
that
we
conducted,
which
is
reported,
which
I
think
demonstrates
that
there
is
progress
being
made.
But.
C
A
To
that
david,
I
mean
I've
been
around.
I've
met
a
lot
of
quite
a
lot
of
people
around
the
organization
now,
and
I
think
there
is
huge
amount
of
goodwill
for
the
organization
and
for
the
changes
that
we
want
and
I
think
the
communications
that
you're
having
weekly
you
know
that
you
send
out
to
people
are
actually
read.
I
mean
I
mean
my
experience,
that's
pretty
unusual
frankly,
and
I
think
the
quite
the
colloquial
way
that
you
do
it
has
gone
down
really
well.
A
E
I
would
just
like
to
clarify
that
I
agree
that
david
has
made
a
positive
impact
on
the
culture
and
I'm
very
pleased
that
staff
are
much
more
feel
more
engaged
and
there's
better
morale.
I
was
particularly
relating
it
to
my
situation,
which
is
particularly
the
context
of
the
recommendation
in
the
health
select
committee
report,
so
just
to
be
quite
clear
on
that.
G
Sorry
don't
prolong
this
this
conversation,
but
I
I
I
kind
of
feel
I
I
need
to
to
understand
what
the
the
context
means,
because
I
mean
I
I
think
my
my
instinctive
thought
is
that
the
context
must
be
the
culture
of
the
board,
because
that's
the
place
where
you
as
a
board
member,
are
operating
fundamentally
and
if
you're
content
that
the
culture
of
the
organization
is
changing,
then
it
must
be
the
culture
of
the
board
that
you're
concerned
with,
and
I
think,
if
I
would,
I
would
like
to
have
a
spade
called
a
spade.
G
If
that
is
the
case,
and-
and
I
think
that
then
is
an
issue
which
we
as
a
board
need
to
be
clear
about
in
terms
of
what
it
is
that
you
specifically
think
needs
to
change.
So
we
can
consider
that,
because
not
having
been
a
member
of
the
board
at
the
time
at
which
you
felt
it
necessary
to
take
the
action
you
did
means.
I
don't
know
what
the
issue
is.
E
Yeah
I
mean
I
absolutely
support
that
and
as
far
back
as
december
2011,
I
made
it
very
clear
that
I
would
like
some
kind
of
facilitated
dialogue
or
mediation
to
actually
so
I
could
explain
the
situation
and
we
could
have
a
sort
of
dialogue
and
indeed
that
was
supposed
to
happen
and
hasn't
happened.
So
I
suspect
that
that
is
actually
goes
to
the
heart
of
the
fact
that
the
situation
is
is
continuing
because
that
forum
hasn't
been
provided.
G
It
to
say
that
I
do
feel
as
a
member
of
the
board
that
whatever
it
is,
that
we
need
to
do
in
order
to
put
this
thing
to
this
feeling
to
to
to
rest,
I
feel
we
need
to
do
because,
as
a
board
member
who
has
you
know
it
sort
of
post
dates
the
original
situation.
I
want
to
have
the
confidence
that,
as
a
board,
we
are
able
to
work
together
without
this
being
an
ongoing
issue.
A
As
you
know,
I
think
we
are
making
a
number
of
new
appointments
to
the
board
in
april.
Hopefully,
five
new
appointments
to
the
board.
A
C
Thanks
chet,
these
things
are
all
of
a
piece.
Next
item
is
in
relation
to
the
miss
staffordshire
public
enquiry
report.
C
We
set
out
that
there
were
38
recommendations
by
robert
francis
in
relation
to
cqc,
where
we
need
to
lead
there's
another
75
recommendations
that
he
made
where
we
need
to
make
a
contribution
to
taking
forward
one
of
those
recommendations
and
the
prime
minister
in
his
statement
to
parliament
on
the
day
that
robert
francis
publishes
reports,
the
announcement
of
the
creation
of
the
chief
inspector
of
hospitals,
role,
which
we
are
making
progress
on.
C
We
are
working
on
including
robert
francis's
recommendations
in
our
business
plan,
so
we
can
operationalize
how
we
take
forward
those
recommendations
through
2013-2014
and
we'll
consider
that
later
this
morning,
chair.
Additionally,
as
I've
already
indicated,
the
secretary
of
state
will
make
a
statement
to
parliament
on
the
26th
of
march
about
the
government's
initial
response
to
robert
francis's
recommendations.
C
A
number
of
those
initial
responses
will
cover
some
of
our
responsibilities.
The
appointments
of
the
chief
inspector,
for
instance,
will
be
further
information
around
the
relationship
with
monitor.
There
will
be
further
recommendations
around
a
distress
and
failure
regime
which
will
require
cqc
engagement.
C
There
are
a
number
of
elements
of
the
initial
response,
though,
which
is
subject
to
independent
reviews:
camilla
cavendish,
don
berwick,
etc
are
all
carrying
out
reviews
and
they're
not
likely
to
report
until
the
summer
may
june
july.
I
think
are
of
the
dates
which
is
set,
and
the
secretary
of
state's
intention
is
to
make
a
further
report
to
parliament
beyond
the
initial
response
in
the
october
of
this
year,
which
will
pick
up
the
recommendations
which
will
come
from
those
further
reviews.
C
So
I
think
what
we've
got
is
a
response
to
francis,
which
will
take
place
in
phases
or
waves,
and
I
think
the
issue
for
cqc
is
to
be
clear
about
those
phases
and
waves
and
respond
in
a
timely
way
to
each
one
as
we
move
forward.
So
we've
been
trying
to
leave
some
space
in
our
business
plan
for
next
year,
so
we
can
accommodate
to
those
changes
as
they're
being
determined
so
it'll
mean
that
we
will
need
that
flexibility
as
we
go
through
the
year.
C
That
leads
me
to
the
strategy
document
which
we
will
publish
in
april
alongside
the
business
plan,
we'll
also
publish
the
outcome
of
the
consultation
on
the
strategy
which
took
place
from
september
to
december,
and
this
will
set
out
our
high
level
objectives
for
a
three-year
period
and
a
clear
statement
of
purpose,
which
goes
back
to
the
select
committee
challenged
to
us
about
whether
we
were
sufficiently
and
unambiguously
clear
about
our
purpose.
This
document
will
make
a
very
clear
statement.
C
So
again,
this
will
inform
our
report
back
to
the
select
committee
moving
on
to
grant
thornton
their
report
is
under
production.
I
previously
reported
to
the
board
that
I'd
hope
that
that
report
will
be
available
as
to
as
the
end
of
february.
C
That
timeline
was
subject
to
the
availability
of
key
individuals
for
interview
that
wasn't
possible
within
that
time
window.
There
are
also
some
further
interviews
which
have
taken
place
this
week
and
in
light
of
the
way
that
they've
convened
their
findings
of
the
report,
they
want
a
further
conversation
with
one
more
individual
and
that's
set
next
week.
The
drafting
of
that
report
is
currently
underway
and
chair.
You've
set
a
board
meeting
on
the
25th
of
april,
where
the
board
can
receive
that
report
and
consider
its
contents.
C
There
will
be
a
process
which
allows
those
people
that
are
referred
to
in
the
report
to
actually
see
the
sections
which
comment
on
their
contribution
and
people
will
be
allowed
to
see
those
bits
as
we
move
towards
the
finalization
of
that
report
and
eventually
production,
aggregated
assessments.
This
is
the
work
that
jennifer
dixon
who's,
the
chief
executive
of
the
nuffield
trust
has
been
leading
for
the
secretary
of
state.
C
I
think,
is
the
phrase
that
she's
used
of
how
that
could
be
introduced
over
a
period.
I've
already
covered
the
next
item
on
that
dave.
Sorry.
B
I
think
exactly
as
david
said,
there
will
be
some,
I
think,
there's
a
general
support
for
the
the
view
around
ratings
may
well
be
different
in
in
health,
as
it
is
to
social
care
and
jennifer's
report.
I
think
on
friday,
we'll
we'll
talk
through
that,
in
particular
in
terms
of
how
that
would
go
forward.
I
think
that'll
be
very
important
for
us,
because,
obviously,
then
we
will
need
to
look
at
how
we
align
that
with
the
other
actions
that
we
have
around
our
own
strategy.
C
And
the
other
work
which
is
going
on
in
real
time
is
the
work
on
a
single
distress,
failure
regime,
I'm
not
sure,
we've
quite
settled
the
language
on
this
appropriately,
but
the
prime
minister's
response
to
parliament
to
francis
was
the
development
of
a
single
fairly
regime
and
he
went
on
to
say
where
a
board
can
be
suspended
by
the
failure
of
quality,
as
well
as
the
failures
in
finance.
C
C
Part
of
the
issue
here
is:
if
there
is
a
requirement
for
legislation
to
give
to
this
function,
then
that
will
mean
the
current
support
bill
which
is
introduced
into
parliament
in
may.
I
understand,
will
need
to
have
government
amendments
moved
in
it
to
allow
those
changes
to
take
place
so
the
design,
the
policy
design
work,
is
being
carried
out
with
some
speed
to
ensure
that
if
there's
legislative
change
required
that
can
work
its
way
into
the
bill.
C
I've
touched
briefly
already
on
the
staff
pulse
survey.
This
was
a
sample
of
25
of
cqc
staff.
It
was
carried
out
by
gfk
the
independent
organization,
who
actually
did
the
survey
in
the
summer
response
rate
was
81,
which
I
have
to
say,
is
very,
very
high
and
gives
some
reliability
to
the
figures.
C
I'll
not
present,
all
of
them
sure
they.
The
figures
are
there.
What
they're
demonstrating
is
some
clear
movement
in
relation
to
satisfaction,
positivity
about
looking
ahead
to
the
future
commitment
to
cqc
people,
feeling
that
cqc
is
a
good
place
to
work
and
being
proud.
Morale
has
improved,
but
the
baseline
of
this
is
that
there's
still
some
very
low
figures,
which
we
and
just
not
satisfactory
are
acceptable,
and
we
need
to
do
more
to
make
progress
on
those
figures.
Improving
morale
confidence
that
we're
going
to
manage
changes
effectively.
C
Confidence
that
we're
effectively
communicating
throughout
the
organization
and
those
statements
from
the
pulse
service
really
do
need
to
influence
our
action
plan.
Our
business
plan
moving
forward,
particularly
the
issue
that
we've
pulled
out
at
the
top
of
page
eight,
which
is
really
about
effective
systems
and
processes
which
help
people
to
do
their
job.
I
think
this
is
really
about
how
we
use
the
findings
of
surveys
like
this,
to
support
staff
to
do
the
job
that
we're
asking
them
to
do.
G
Thanks
very
much
just
on
the
this
process
and
the
the
asses
assessment
of
our
progress
with
this
process,
and
I
just
wonder
whether
we
need
to
be
clear
clear
for
ourselves
that
actually
we're
going
into
a
period
of
unprecedented
change
in
an
organization
as
both
in
terms
of
the
work
that
we
do
and
the
way
that
we
do
it
in
the
and
the
way
that
we
structure
and
organize
ourselves
to
do
it
and-
and-
and
it
is,
it
seems
to
me
inevitable.
G
All
the
evidence
shows
that
when
you
do
that
that
very
the
very
nature
of
that
uncertainty,
no
matter
how
much
process
is
documented,
creates
a
a
concern
in
the
organization
which,
just
it
just
is,
and
we
have
to
expect
that
to
happen.
And
I
I
wonder
if
there's
something
just
a
kind
of
reality
check
on
these
figures.
I
think
we
should
kind
of
expect
some
of
this
to
get
worse
over
the
next
period
to
get
better
beyond.
And
I
I
I
don't
want
to
kind
of
set
ourselves
up
to
expect
something
that
perhaps
isn't
realistic.
A
Yeah,
I
mean
interesting,
I
mean
absolutely.
I
don't
can't
disagree
with
what
you
say,
but
I
mean
I
think,
the
way
the
strategic
review
was
done,
and
this
predates
me,
so
I
don't
have
any
credit
for
this
myself,
but
actually
involving
or
enabling
people
to
be
involved
in
that
strategic
review
has
actually
reaped
a
lot
of
benefits.
I
mean
certainly
the
inspectors
and
compliance
manager.
D
Well
speaking,
really
from
my
experience
in
the
north
I
mean
david
has
used
the
phrase
engagement
rather
than
consultation,
and
that's
the
approach
that
we've
taken
with
the
staff
so
rather
than
you
know,
coming
out
with
a
set
of
proposals
and
having
a
very
black
and
white
discussion
about
them.
We've
set
up
mechanisms
that
over
the
next
few
months
will
give
staff
an
opportunity
to
to
contribute
in
a
in
a
positive
way
to
the
the
process
of
change.
D
I
mean
the
morale
in
the
north
is
high
and
getting
higher,
and
it
will
be
interesting
to
see
whether
you
know
the
changes
that
will
come
over
the
next
few
months
will
we'll
dent
that.
But
I
think
staff
in
broad
terms
are
in
good
good
heart
and
looking
forward.
F
I
think
one
of
the
key
parts
to
the
to
the
change
program
is
recognizing
the
need
to
change.
I
think
I
take
your
point
honor
about
the
fact
that
there
could
be
some
bumps
along
the
way.
I
think
the
key
thing
that
will
drive
us
through
the
engagement
that
we've
had
both
at
senior
leader
level
and
and
also
right
way
through
the
organization,
is
getting
that
common
purpose
around
the
reason
to
change.
F
I
think
we've
identified
that
and
we're
using
that
to
drive
the
discussions
around
what
we're
there
for
we
need
to
do
so.
I
don't
doubt
there'll
be
bumps
along
the
way,
but
I
do
think
we're
in
a
better
place,
because
we've
got
a
common
vision
and
the
common
vision
goes
right
through
the
organization.
Doesn't
just
stay
in
one
place,
steve.
B
I
think
that's
right.
I
also
think
we've
got
a
responsibility
at
this
level,
so
we're
preparing
our
business
plan
and
and
how
we're
going
to
take
it
forward.
I
think
with
so
many
different
factors
buffeting
us
at
the
moment
and
we're
not
buffeting
influencing
us,
possibly,
I
should
say
such
as
the
francis
report.
I
think
we've
got
to
be
very,
very
clear
with
staff
that
our
purpose
is
fixed,
because
if
we
appear
to
be
changing
our
mind
and
chopping
and
changing
that
uncertainty
will
grow.
So
I
think
it's
you
know.
B
I
think
you
know
we
will
discussing
the
business
plan
at
some
point.
I
think
it's
really
important
that
it's
clear
we
think
it
through
and
we
stick
to
it
and
make
sure
people
know
in
the
organization
from
top
to
bottom,
that
we're
intent
on
delivering
it.
I
think
that
gives
the
confidence
that
it
you
know
is
difficult
to
capture.
Okay,
thanks.
C
David,
my
ambition.
There
are
some
organizations
that
have
managed
large
scale
chains
that
have
managed
to
keep
their
engagement
scores
high,
and
I
think
we
should
be
ambitious
to
do
that
and
I
think
you're
right
to
put
the
reality
check
in
because,
as
chris
said,
there
will
be
bumps
along
the
way.
But
it
is
possible
to
actually
change
programs
where
engagement
stays
high
and
that's
my
ambition.
C
C
This
might
be
in
danger
of
being
overshadowed.
But
there's
been
some
good
and
interesting.
Work
done
with
the
fertilization
and
embryology
authority
about
removing
some
duplication
of
where
they
look
at
laboratories
and
we
look
at
laboratories
and
we
wanted
to
remove
that
duplication
between
fertilizer
nation
and
embryology
authority
and
ourselves,
and
we
just
set
out
the
work
that
is
being
put
in
place
to
allow
that
to
happen.
C
The
information
government's
committee
goes
live
on
the
first
of
april
and
I
just
set
out
the
progress
chair
in
relation
to
establishing
the
committee
and
making
sure
that
we
can
discharge
that
responsibility
that
we
were
given
about
the
governance
of
how
confident
people's
personal
information
is
being
maintained
across
the
system
and
the
responsibilities
we
were
given.
C
We're
currently
consulting
on
a
publication
of
warning
notices,
and
the
issue
here
is
that
there's
been
a
a
legal
view
that
warning
notices
are
challengeable
and
we've
needed
to
work
out
how
we
can
develop
a
system
that
allows
us
to
publish
warning
notices
in
good
and
real
time
in
the
interest
of
people
using
services.
So
they
can
be
clear
when
they're
selecting
a
service.
C
What
the
implications
are
with
that
issue
about
any
judgments
we
make
should
be
challengeable
within
the
legal
principles
of
challenge,
so
we're
currently
out
for
consultation
on
how
we
will
just
bring
those
two
processes
together
in
a
way
that
makes
sense
at
item
12.
I'm
just
advising
that
I
received
a
letter
from
the
department
on
behalf
of
the
secretary
of
state
asking
requiring
that
I
become
the
qualified
person
in
relation
to
section
36
of
the
freedom
of
information
act.
C
E
Is
this
just
the
fact
that
a
change
of
name
or
is
this
something
different
from
the
cqc,
because
I
I
guess
what
I
would
be
concerned
about
is:
is
the
governance
around
that,
because,
obviously
we
need
to
be
open
and
transparent
as
a
public
body,
and
so
I
I
guess
I
want
to
know
whether
there's
sort
of
implications
for
this
on
that.
Whether
there
needs
to
be
a
sort
of
clear
governance
process
around
it.
C
So,
as
I
understand
this,
the
as
I
understand
this
chair,
the
the
act
provides
for
the
ability
for
a
decision
to
be
made
where
information
is
not
disclosed.
If.
C
In
the
opinion
of
the
qualified
person,
disclosure
would
either
inhibit
the
free
or
frank
provision
of
advice
or
exchange
of
views
or
would
otherwise
prejudice
the
effective
conduct
of
public
affairs
that
qualified
person
to
date
has
been
the
secretary
of
state.
I
think
what
the
letter
effectively
does
is
in
respect
of
that
judgment
decision
in
relation
to
cqc.
C
H
I
read
this
and
I
wasn't
quite
sure
whether
I
understood
it
or
I
didn't
understand
it
it.
It
was
all
in
plain
english,
but
I
wasn't
sure
at
all
what
the
con,
what
the
consequences,
what
the
effect
of
it
is
in
the
past,
confidential
material
has
usually
been
described
in
the
act
or
the
regulations
by
certain
classes
of
information.
H
Now
this
seems
to
be
an
ability
to
designate
material
as
exempt
from
disclosure
in
circumstances
other
than
it
fitting
a
particular
class
of
information
or
document,
and
I
wonder
whether
there
are
any
guidelines
about
how
and
where
this
is
used
and
whether
there
is
any
record
of
subsequently
of
it
being
used,
because
it's
it's
the
sort
of
it's
it's
the
sort
of
provision
which
arouses
anxiety
if
it
isn't
explained
carefully
what
is
happening
and
I'm
concerned
that
we
shouldn't
have
a
situation
where
anxiety
about
secret
decision
making
is
being
been
fostered
in
a
way
which
is
actually
completely
unnecessary.
C
So
such
a
what
we'll
do
is
we'll
bring
back
a
more
detailed
paper
which
will
cover
those
issues
to
a
future
board
meeting
and
just
set
that
out.
I
think
it's
designed
to
cover
the
situations
where
there
may
well
be
a
broad
range
in
discussion
where
the
unthinkable
is
thought,
and
certainly
within
government.
C
But
let's
set
that
out
in
a
paper
chair
and
and
then
try
and
remove
that
anxiety
and
introduce
clarity.
G
Just
just
to
say,
I
think
I
think
what
worth
saying
that
actually
there
is
a,
although
there
are
these
questions
about
transparency,
in
the
way
that
you
you
might
use
this
power.
G
I
think
there's
something
very
strongly
to
be
welcomed
in
us
being
given
this
power
rather
than
having
it
sit
with
the
secretary
of
state,
which
opens
these
decisions
to
political
decision-making
as
opposed
to
potentially
or
political
influence,
whereas
I
think
we
should
be
clearly
making
it
in
in
the
public
interest
in
terms
of
the
the
responsibilities
that
that
we
have,
and
I
I
think
that
that
that
must
be
a
good
thing
across
the
system.
So
I
wouldn't
want
to
lose
sight
of
the
benefits.
Then
we
have
to
make
sure
we
use
it
responsibly.
C
And
then,
lastly,
cherry
I'm
just
drawing
out
the
fact
that
castlebeck
care
group
has
gone
into
administration
at
the
beginning
of
march.
I
just
the
last
item
drawing
out
that
castleberry
group
has
gone
into
administration
at
the
beginning
of
march.
The
issue
from
my
point
of
view
with
this
is
continuity
of
care
and
the
continuity
of
the
quality
of
care,
while
the
administrators
make
provision
for
the
transfer
or
the
sale
of
these
services
to
other
providers.
C
There's
been
a
long
history
of
this
trying
to
be
secured
as
a
group
and
sold
as
an
entity.
I
think
this
is
now
flagging
that
that's
not
possible
and
the
administrators
will
actually
take
this.
Take
this
forward.
C
As
I
say,
the
key
issue
from
our
point
of
view
is
the
continuity
of
care
for
individuals
and
the
quality
of
care,
but
we
stand
ready
to
actually
deal
with
that
once
these
services
are,
you
know,
new
ownership
there'll
be
some
registration
requirements
that
we'll
need
to
put
in
place
for
the
transfer
of
ownership
and
responsibility
for
that,
but
I
thought
it
was
important
just
to
draw
that
to
the
board's
attention.
Thank
you.
G
One
more
you
say
in
this
last
paragraph
david,
that
the
16
active
locations
are
being
monitored
and
and-
and
you
you
say,
also
that
seven
of
them
don't
have
registered
managers,
so
so
so
there's
there's
clearly
a
a
degree
of
not
insignificant
risk,
at
least
potentially
here.
What
does
monitor
mean?
What
are
we
actually
doing.
C
So
monitor
will
mean
anything
from
this
frequent
contact
to
a
national
level,
with
the
current
managers
of
castlevania
had
a
number
of
conversations
in
correspondence
with
we've
got
a
provider
manager.
C
It
means
that
I've
had
a
number
of
conversations
with
the
person
who's
currently
responsible
for
the
group,
the
provider
manager
has
conversations
with
them
at
a
local
level.
Inspectors
are
in
contact
with
the
individual
homes
to
ensure
that
there
is
appropriate
staffing,
leadership
etc
in
place,
and
I
think
what
we're
flagging
here
anna
is
that
we're
more
vigilant
than
we
would
otherwise
be.
C
These
homes
have
maintained
standards
over
the
past
period
rather
than
have
declined
in
standards.
But,
of
course,
this
is
a
bigger
threat
and
risk
to
staff,
morale
and
security,
etc.
That
might
otherwise
have
been
the
case
if
they
have
transferred
or
maintained
in
one
group.
So
monitoring
is,
it
can
be
anything
from
telephone
calls
to
check
how
things
are
to
actually
unannounce
inspections
and
turning
up
to
check
how
quality
has
been
maintained.
C
The
other
thing
I'd
say
is
that
I
think
it's
also
for
commissioners
to
continue
to
monitor
the
quality
and
safety,
and
it's
also
for
castle
bet
to
continue
to
provide
that
appropriate
care.
And
I
think
we
need
to
hold
the
ring
on
making
sure
that
others
do
their
jobs
as
well
as
that.
We're
actually
checking
the
standards
of
quality
and
safety.
A
Okay
thanks
david
very
much
just
add
just
one
thing:
we've
invited
robert
francis
to
come
to
a
meeting
in
june
or
july,
so
we
can
have
a
full
discussion
about
the
france's
report
at
that
time
and
then
just
I'm
just
conscious
that
there
is
a
lot
going
on
and
if
non-execs
feel
that
they're
not
there's
too
much
going
on
they're,
not
fully
up
to
speed.
I
mean
I
just
encourage
you
to
have
informal
chats
with
me
in
between
board
meetings.
I
I
However,
we've
now
got
the
february
figures
and
we're
working
through
with
auditors
on
the
year-end
numbers
and
some
provisions
going
in
in
march,
so
the
forecast,
I
think,
is
fairly
accurate.
There
will
be
additional
provisions
to
put
in
in
in
march,
but
we're
seeing
that
in
february
the
underspend
was
reduced
by
a
further
million
on
staff
costs
and
a
further
half
a
million
on
non-staff
costs.
I
So
that
is
a
the
reason
for
that
really
is
because
of
the
the
increased
spend
on
bank
inspectors
to
deliver
the
year-end
programme
and
we're
going
to
see
a
similar
position
in
march
with
an
overspend
on
the
budget
in
march,
similar
nature
about
a
million
on
staff
costs
and
another
half
million
on
known
staff
costs.
So
the
financial
forecasts
for
the
full
year
anticipate
to
be
in
or
around
the
honor
around
the
figures
that
you
see
here
about
a
1.3
million
underspend
on
total
revenue
costs.
I
I
Some
additional
consultancy
costs
that
we're
incurring
through
february
and
march,
but
if
anything,
the
forecast,
the
full
year
forecast
will
be
closer
to
budget
than
what
you're.
Seeing
here
in
this
report.
On
page
three
of
the
report,
we
set
out
some
of
the
variances
on
non-staff
costs.
Again,
most
of
the
adverse
variances
relate
to
the
the
additional
staff
and
bank
staff
that
we've
brought
in
in
the
second
half
of
the
year.
I
I
The
favorable
variance
on
depreciation
arises
really
as
a
result
of
some
of
the
actions
taken
at
the
end
of
last
year.
We're
working
through
that
with
the
auditors
at
the
moment
that
variance
the
forecast
variance
of
3.2
may
reduce.
As
we
finalize
the
year-end
figures
in
preparation
for
the
year-end
accounts.
I
I
Just
moving
on
the
capital
expenditure
again
is
very,
very
will
be
very
close
to
budget
just
a
slight
underspend
on
our
capital
budget
of
11
million
in
the
year,
mainly
because
some
of
the
projects,
I
think,
were
just
a
little
bit
slow
to
start
during
the
year,
but
by
and
large,
where
we
finished
most
of
the
big
projects.
I
I
think
we're
seeing
healthwatch
costs
increase
as
we
go
forward,
and
the
budget
for
1314,
I
suspect,
will
be
fully
spent
on
a
full
year
basis.
I
Cash
flow
on
page
four
again,
our
total
grant
in
aid
will
be
slightly
underspent.
In
the
year
we
had
an
allocation
of
60
million
on
revenue
grant
in
air
and
12
million
on
capital
that
will
be
underspent
in
accordance
with
the
some
of
the
shortfalls
that
I've
just
previously
mentioned.
I
So
all
in
all
our
are
given
that
we
were
well
below
the
budget
in
the
first
half
year
we're
seeing
a
lot
of
catch-up
in
the
period
from
october
to
march
again,
because
mainly
because
of
the
bank
inspectors
bringing
in
additional
staff
to
deliver
the
program
and
we're
just
going
to
see
a
small
shortfall,
then
in
the
on
a
full
year
basis,
our
interim
audit
has
commenced.
The
auditors
are
going
through
the
interim
order.
At
the
moment.
I
I
have
a
further
meeting
with
the
department
of
health
this
friday
to
discuss
the
way
forward
on
1314,
and
we
will
be
taking
account
of
some
of
the
issues
that
weren't
identified
when
we
had
the
initial
budget
allocation
back
in
october
november
time
and
I'll
update
the
board
fully
on
that
in
april.
I
A
J
The
work
has
been
gone,
ongoing
to
revise
and
bring
back
to
the
board
a
strategic
set
of
risks
that
align
to
the
strategy
of
the
organisation
and
this,
given
that
the
strategy
itself
is
yet
to
be
signed
off
remains
a
work
in
progress.
But,
as
I
hope
you
can
see
from
the
work
that's
been
done
and
the
annex
to
this
paper.
J
So
there
has
been
a
bit
of
revision
of
this
since
you've
seen
it
at
last
time,
but
it
hasn't
markedly
changed
in
terms
of
the
of
the
words
we
are
in
a
position
where
we
need
to
do
further
work
on
this
once
the
strategy
has
been
finalized
and
you
would
expect
that
below
this
they
will
sit
and
there
are
a
wide
range
of
corporate
delivery.
J
The
issue
that
the
board
will
have
to
come
back
to
at
some
point
is
what
its
risk
appetite
is
around
all
these
risks.
If
you
have
a
look
at
the
annex
itself,
the
risk,
tolerance
and
all
of
these
risks
is
low,
and
that
is
something
the
board
itself
has
to
keep
under
review
as
it
as
does
its
satisfaction
or
otherwise,
with
what
the
current
risk
score
is,
whether
that
the
mitigations
are
working
and
whether
or
not
there's
more
or
less.
That
needs
to
be
done
in
relation
to
each
of
those.
J
So
at
this
stage
the
board's
invited
to
accept
the
register
and
approve
it
for
what
it
is
recognizing
that
it's
a
work
in
progress.
But,
of
course,
any
comments
that
you
have
would
be
extremely
welcome
and
will
feed
into
the
next
iteration.
H
David
would
it
be
helpful
if
I
just
added
my
recommendation
to
the
board
to
adopt
accept
this?
The,
as
alistair
correctly
pointed
out
the
adoption
of
the
strategic
plan.
The
new
strategic
plan,
when
that
happens
in
a
few
weeks
time
will
lead
to
a
further
review
of
the
risk
register,
and
the
arac
committee
is
planning
a
workshop
in
the
summer
where
that
takes
place
with
the
further
report
to
the
board
to
enable
you
to
approve
a
revised
risk
register
stemming
from
the
new
strategic
plan.
J
Well,
I'm
sure
john
might
say
as
well
that
you
might
be
reassured
by
the
work
that
was
done
yesterday,
which
was
focusing
entirely
well
not
entirely,
but
very
much
in
the
time
that
we
spent
on
that
very
issue
and
then
thinking
through
what
the
nature
of
the
mitigations
would
need
to
be
and
look
like
in
order
to
provide
the
board
and
the
chief
executive
with
the
right
sort
of
assurances
and
the
information
that
we
were
required
to
do
that.
And
I
think
we
probably
spent
about
90
of
the
time
on
that
yesterday.
J
A
To
them
yeah,
I
think
the
point
I'd
like
to
just
to
pursue
that
a
little
bit
further
is
that
this
is
such
a
fundamental
issue
to
what
the
whole
purpose
of
cqc
is.
I
mean
if
we
can't
assure
ourselves
of
that,
then
what
is
the
point
of
us
is,
I
would
say
so
I
mean
you
can
delegate
this
to
some
extent
to
the
iraq
to
do
some
ferreting
around,
but
actually
you
know
we
have
got
to
be.
We
when
we
finish
a
strategic
review
and
we
put
in
place
the
changes.
A
The
acid
test
is,
frankly,
you
know,
could
have
made
stabs
a
more
convey.
A
winter-born
view
happen
again,
or
it
may
happen
again,
but
it's
much
much
less
likely
to
happen
again
than
it
has
in
the
past
I
mean
there
will
always
be
a
residual
risk
around
that
area,
but
you
know
we
have
got
to
get
a
lot
more
comfortable
with
knowing
what
that
risk
is
and
what
we're
doing
to
reduce
that
risk
down
to
an
absolute
fraction,
because
so
long
as
we
don't
know,
I
think
people
can
stand
back
and
say
well.
H
David
david,
I
think
we're
very
clear
about
the
risk
and
we,
as
alistair
said
steve,
and
I
and
other
members
of
the
eric
committee
and
david
bien,
spent
a
significant
part
of
yesterday
afternoon,
exploring
this
issue
in
preparation
for
the
workshop
in
the
summer.
H
There
are
two
issues,
though
the
first
issue
is
identifying
the
risk.
The
second
issue
is
putting
in
place
the
mitigating
actions
in
order
to
reduce
the
risk,
and
it
is
the
putting
in
place
the
mitigating
actions,
which
I
think
has
been
the
real
challenge
for
the
commission.
Work
has
been
starting
some
time
ago
and
the
on
particular
areas,
development
and
david-
has
been
taking
that
forward
very
thoroughly
over
the
last
six
nine
months,
with
much
of
the
that
coming
to
fruition
in
the
new
strategic
plan
which
we're
talking
about.
A
G
I
mean
I
I
I
I
take
that
point
entirely.
I
I
want
to
address
the
the
primary
question
that
you
ask
about
how
we
assure
ourselves
that
we're
in
the
best
possible
position
to
identify
these
the
these
potential
failures
of
the
system
and
there's
there's.
It
seems
to
me
that
there's
pos,
there's,
there's
two
answers
to
this.
G
It
does
the
trick,
but
I
think
there's
another
thing,
and
I
I
I
this
is
the-
and
this
is
the
more
immediate
and
and
really
quite
troubles
me,
which
is
that
there
is
a
real
change
risk
which
is
not
identified
in
here,
which
is
that
actually,
as
we're
putting
in
place
the
plans
for
the
medium
to
longer
term,
we
drop
a
ball
to
you
know
to
to
to
use
that
or
full
phrase,
and
and
that
that
really
does
concern
me
and
I
think,
there's
a
sense
in
which
we
we
need
to
have
something
very
much
at
the
forefront
of
our
sense
of
what
the
risks
are
for
the
organization
which
is
associated
with
the
fact
that
we
are
undergoing
this
very
huge
change.
G
And
we
do
need
to
have
probably
some
ad
hoc
and
more
temporary
but
very
focused
mitigations
in
place
to
give
ourselves
that
assurance
on
a
regular
and
routine
basis,
rather
than
feeling
that
it's
built
into
the
system.
So
I
think,
there's
something
kind
of
in
trim,
and
I
don't.
C
A
Yeah
I
can't
go
to
k
then
and
then
to
steve
I
mean
that
you're,
that's
a
point
that's
well
made.
I
think
we
should
come
back
to
the
board
next
time
and
spell
out
what
we're
going
to
do
in
this
transitional
period.
Come
so,
can
we
just
go
to
k
and
then
to
because
I
mean
we
don't,
let's
not
lose
that
point.
Okay,.
E
I
mean
this
is
an
issue
that
I've
raised
many
times
and
was
really
fundamental
to
the
fact
that
I
went
to
the
public
inquiry
and
I
think
if
we
are
going
to
get
to
grips
with
it,
we
do
need
to
make
sure
we've
got
the
expertise
in
the
organization,
because
I
think
that
will
be
a
major
stumbling
block.
If
we,
if
we
don't
do
that.
B
Steve
so
anna's
point
is
well
made
and
we
questioned
the
chief
executive
on
this
very
point
yesterday
at
arak,
and
he
gave
a
comprehensive
and
the
perfect
answer.
He
said
it's
got
to
all
be
in
the
business
plan,
so
I
understand
the
need
for
ad
hoc
arrangements,
but
david,
I
think,
is
really
right
that
it's
got
to
be
in
the
business
plan.
We've
got
to
know
where
we're
going.
We
want
to
have
that
sense
of
direction
and
that
sense
of
change
is
going
to
happen.
B
I
think
we've
got
to
be
vigilant
as
a
board.
That's
our
role,
but
I
think
having
a
document
that
we've
signed
off.
That
is
then
at
the
heart
of
where
we're
going
over
the
next
one
year
and
three
year
period
is
the
key
to
delivering
this
in
a
strategic
manner.
A
C
I
think
the
the
the
work
that's
going
on
at
the
moment
is
really
testing
and
questioning
the
way
that
we've
looked
at
data
and
intelligence
in
the
past.
I.
B
C
B
A
I
think
just
going
back
to
kate's
point,
though
what
I
think
we
might
do,
I'm
just
thinking
we're
probably
two
months
away
from
doing
this,
have
a
give
a
presentation
to
the
board
about
the
predictive
metrics
that
we're
developing
at
the
moment
and
how
and
how
that
joined
up
with
the
inspections
can
give
us
greater
assurance
that
we
are
able
to
spot
the
failing
hospital,
the
failing
care
home
earlier
than
we
have
in
the
past.
So
should
we
I'm
guessing?
Where
are
we
now?
A
G
Well,
I
I
I
I
I
don't
know
what
all
the
answers
are,
but
I
just
think
there
might
be
something
to
be
taken
away,
which
is
I
want
to
take
the
points
entirely
about
the
strategic
change
process
and
the
business
plan.
G
I
think
we
have
to
be
able
to
say
that
that
we've
had
our
our
eyes
in
the
ears
in
an
appropriate
fashion,
over
managing
the
risk
in
the
interim
as
well,
in
a
really
kind
of
focused
way
and
there's
something
about
giving
ourselves
that
assurance.
I
think
maybe
it's
it's
a
small
little
program
of
work
which
might
include
what
you
suggest
david,
but
something
else
which
is
just
just
focused
on
that
question
for
the
next
six
months
or
so.
C
I
think
this
is
a
hugely
important
conversation
david,
if
I
may
say,
and
so
when
the
business
plan
is
brought
forward
for
publication.
What
we'll
do
is
we'll
set
the
strategic
risk
register
as
part
of
that
business
plan,
and
I
think
anna
you're
absolutely
right
about.
We
have
a
program
which
will
change
over
effectively
a
two-year
period
and,
whilst
we're
changing
that
over
that
two-year
period,
we
need
to
calculate
what
the
risk
of
change
is
as
well,
and
that
needs
to
be
factored
into
the
business
plan.
C
So
we
are
thinking
about
and
bringing
forward
proposals
about
what
capacity
we
need
to
manage
change
as
well
as
what
additional
capacity
we
need
to
just
to
think
through
the
changes
that
nick
referred
to.
I
think
the
key
issue
here
david
and
you've
identified
this
previously
is
as
well
as
what
nick
has
said
about
what
is
the
model
and
qrp
has
a
lot
of
very,
very
strong
things
in
its
favor.
It
is
a
model
that
is
there
to
predict
risk.
C
C
I
didn't
mention
it
in
my
report,
but
could
have
done,
is
the
work
that
mike
farah
has
been
asked
to
look
at
in
terms
of
data
burdens
and-
and
I
think
the
issue
there
is
a
conversation
about
the
relevance
of
data
rather
than
the
volume
of
data,
because
I
think,
there's
information
that
we
need
that
isn't
yet
collected
that
we
need
to
start
putting
in
place
of
process
to
collect
and
that's
right
across
the
system,
not
just
for
cqc.
I
think
so.
I
think
there's
some
really
important
work
on
david.
We'll
pick
that
out.
C
I
think
your
suggestion
of
a
presentation
once
the
mckinsey's
work
is
coming
to
some
conclusions,
is
a
really
good
one
to
actually
share
what
that
thinking
has
been
and
we'll
make
arrangements
to
bring
that.
I
think,
may
will
be
a
good
time
to
do
it
quite
frankly,
rather
than
push
it
into
june.
So
yeah,
let's
try
and
just
lock
that
down
and
we'll
make.
A
A
border
under
no
illusions:
we
should
not
take
comfort
from
the
fact
that
we
are
inspecting
hospitals
in
the
way
we
inspect
them
at
the
moment,
because
the
inspections
are
far
too
shallow
and
just
not
deep
enough
to
really
get
under
the
skin
of
a
big
hospital.
So
I
mean
that's
the
that's
the
real
risk
that
I
feel
that
we
have
at
the
moment
is
that
we
simply
don't
have
the
methodology
to
really
get
to
understand
what
is
happening
in
these
big
big
hospitals.
A
G
So
so
so
what
I've
I've
sent?
The
board
is
a
very
short
presentation
about
the
priorities
we're
proposing
to
address
sorry
exactly
what
I've
sent
is
a
very
short
presentation
about
the
priorities
that
healthwatch
are
proposing
to
address
in
the
next
period,
and
I
I've
done
that
deliberately,
because
we
have
been
explicit
about
a
commitment
to
consulting
with
the
cqc
board
as
well
as
with
others
about
our
priorities.
G
I
have
to
say
that
the
the
kind
of
time
scale
for
the
setup
of
healthwatch
means
that
we're
doing
this
in
a
rather
pragmatic
way.
So
we've
held
a
number
of
roundtable
events
and
discussions.
We've
had
some
region
with
stakeholders,
we've
had
some
regional
events
with
emerging
local
health
watch,
five
of
them
and
taken
thoughts
from
a
fairly
significant
number
of
people,
but
at
a
fairly
high
level.
So
this
hasn't
been
a
kind
of
formal
consultative
process,
but
it
has
been
an
engagement
process
and
this.
G
This
is
an
important
part
of
that
for
us
to
make
sure
that
the
cqc
can
see
how
this
would
fit
with
what
it
is.
Also
doing.
There'll
be
a
also
a
discussion
with
the
department
of
health
about
our
proposals
for
our
business
plan.
G
I
mean
to
cut
to
the
very
end
of
this
proposal
this
this
paper,
you'll
you'll,
see
under
the
heading
of
so
these
pages
aren't
numbered,
as
always,
so
under
the
heading
of
establishing
health
watch,
england
is
an
effective
organization
which
is
the
fourth
of
our
our
priority
areas
that
one
of
the
things
we
propose
to
do
is
develop
a
strategy
for
healthwatch
england
with
a
longer
term
plan,
and
that
will
happen
during
the
course
of
this
year.
G
We
we've
had
quite
a
a
conversation
at
the
committee
about
what
I
would
call
consumer
rights.
G
There
are
a
set
of
eight
consumer
rights
which
are
find
their
genesis
in
a
a
speech
made
by
john
f
kennedy
in
not
a
bad
genesis,
I
always
think
which,
which
we
think
we
want
to
focus
our
our
work
on
and
our
our
contribution
to
discussions
in
health
and
social
care,
partly
because
we
believe
that
one
of
the
deficits,
if
you
like
in
thinking
about
the
consumer,
patient
user
carer
interest,
is
that
it
has
not
been
a
conversation
about
rights.
G
It's
been
a
con,
a
conversation
where
we
as
consumers,
have
been
grateful
for
what
we've
had
or
got,
and
very
often
we're
right
to
be
grateful,
but
where
we
haven't
felt
able
to
speak
up
in
the
way
that
perhaps
we
would
in
other
consumer
environments,
so
conversation
about
right
seems
to
be
quite
helpful
to
the
the
shift
that
we
need
to
see
in
health
and
social
care.
G
So
I'm
now
making
no
apology
for
talking
about
consumers,
and
I
want
to
appeal
to
the
consumer
rights
and
what
you
see
in
terms
of
these
priorities
at
the
top
are
two
of
those
eight
rights.
So
the
right
to
be
heard
and
the
right
to
redress
and
we've
picked
these
two
up
and
clearly
we
can't
achieve
both
of
these
things
in
a
short
space
of
a
year.
G
These
are
kind
of
longer
term
ambitions,
but
we've
picked
these
two
things,
particularly
because
the
right
to
be
heard
is
very
central
to
the
whole
conversation
and
the
whole
set
of
changes
in
health
and
social
care.
G
There's
a
moment
here
where
everyone
is
thinking
about,
how
do
we
properly
take
account
of
consumer
views
and
interests
and
the
decisions
that
we
make,
whether
that's
about
individual
care
or
or
it's
about
big
policy
decisions
at
the
national
level
and
part
of
our
role
at
healthwatch
england
is
to
help
the
system
think
about
how
to
do
that
and
to
challenge
it
to
do
it?
Well,
not
to
do
it
for
them,
but
to
challenge
them
to
do
it.
Well,
so
that's
really
what
that
objective
is
about
the
second
one
is
about
the
right
to
redress.
G
G
This
is
about
complaints
and
concerns
and
the
importance
of
not
just
having
systems
which
collect
collate
report
and
respond,
but
actually
making
sure
that
the
whole
of
the
system
sees
concerns
and
complaints
as
the
valuable
source
of
intelligence
and
information
for
improvement,
which
other
other
sectors
frankly
already
see
the
benefits
in
so
there's
there's
quite
a
shift
here
and
I
think
one
of
the
things
there
is
a
of
course,
a
complaints
review,
which
is
part
of
the
response
to
francis
it's
one
of
the
things
that
uncleared
is
doing.
G
It's
very
much
focused
on
hospitals.
I
think
one
of
the
things
that
we're
concerned
about
is
the
joins.
G
You
know,
as
a
user
of
health
and
social
care
services,
with
with
a
more
complex
set
of
knees,
actually
finding
the
right
place
to
go,
to
make
your
complaint
and
making
sure
you're
not
passed
from
one
section
to
another
and
that
the
system
responds
as
a
whole
in
a
way
which
is
fit
for
purpose,
I
think,
is
a
real
challenge,
add
to
which,
of
course,
while
we
know
something
about
hospital
complaints,
I
think
we
know
extremely
little
about
primary
health
care
and
social
care
is
a
different
system
again.
G
The
third
is
obviously
about
local
health
watch
being
our
major
preoccupation
until
now,
we've
done
lots
of
work
continue
to
do
lots
of
work
to
support
local
health
watch,
as
I've
reported
at
the
board
before
I
think
local
health
watch
will
be
commissioned
to
a
very
great
extent
by
the
first
of
april,
but
not
all
of
them
will
have
had
time
to
to
mobilize
and
get
themselves
up
to
speed
to
deliver
full
service
for
another
six
months
or
so
at
least.
So.
G
G
G
So,
as
my
chief
exec
keeps
saying,
we're
sailing
the
ship
and
building
it
simultaneously
as
our
local
health
watch-
and
I
should
say
in
in
relation
to
to
catherine
that
I
would
have
wanted
her
to
be
here
to
present
this
actually
because
I
think
this
is
about
what
we're
going
to
be
doing,
and
it
would
be
for
her
to
be
here
and
do
that.
But
she
couldn't
make
this
particular
meeting.
G
A
A
Look-
and
I
want
just
one
thing-
the
fundamental
standards
that
francis
was
talking
about,
which
he
developed
actually
in
the
evidence
he
gave
to
the
select
committee
after
he
did.
His
report
is
something
that
we
want
to
really
get
a
grip
of
and
do
a
lot
of
consultation
with,
because
he
very
much
said
to
get
traction
on
these
fundamental
standards.
A
G
A
E
Yeah,
it's
good
to
see
healthwatch
they're
sort
of
getting
off
of
the
ground,
and
I
mean,
as
you
say,
the
sort
of
consumer
model
is
quite
new
to
health
and
social
care,
and
I
I
suspect
that
there
may
be
some
sort
of
resistance
to
that.
It's
quite
potentially
a
political
issue
and
I
I'm
not
saying
whether
it's
right
or
wrong,
but
that
there
is
likely
to
be
some
resistance
and
so
it'd
be
interesting.
E
Just
to
hear
you
know
whether
there's
a
sort
of
communication
job
to
be
done-
or
I
don't
know,
but
I
I
just
wondered
if
you
considered
that
I
also
on
the
right
to
redress-
and
you
may
not
be
able
to
answer
that
now
I
mean
had
you
had
any
thoughts
about
what
that
actually
might
mean,
because
in
other
areas
it
it
can
mean
sort
of
getting
some
compensation
or
getting.
You
know
some
way
to
sort
of
compensate
what
what's
happened.
E
So
I'm
not
entirely
sure
what
that
could
mean
in
health
and
social
care
and
then
the
final
thing
is
it's
a
request.
Actually,
I
know
in
the
presentation.
You've
mentioned
vulnerable
groups
and
sometimes,
if
you
talk
about
vulnerable
groups,
it
potentially
sets
people
apart,
and
I
wondered
if
it
would
be
possible
to
say
people
in
vulnerable
situations,
thinking
being
that
it's
the
situations
that
cause
people
to
be
vulnerable
rather
than
being
part
of
a
group
and
it
kind
of
changes,
the
emphasis
so
but
obviously
that's
very
much.
My
own
little
hobby.
G
F
The
use
of
consumer
views
in
what
you're
talking
about
there
and
I
think,
there's
two
really
important
points
for
me.
One
is
in
the
development
of
local
health
watch.
F
One
of
the
reasons
to
gather
user
views
is
to
drive
change
to
drive
improvement
in
those
services.
I
think
there's
some
really
important
work.
We
need
to
do
around
the
development
of
our
intelligence
model
so
that
the
information
you
gather
is
helpful
to
that
change.
I
think
that's
a
really
that's
a
really
important
point,
and
I
certainly
you
know.
I
really
really
really
welcome
the
idea
of
publishing
the
only
report
with
with
the
voice
of
the
consumer
at
its
heart,
and
I
think,
there's
something
we
can.
F
A
J
Okay,
alistair
yeah,
I
just
wondered-
I
mean
there's
mention
in
the
tracking
of
the
the
recommendations
in
francis
and
I
was
wondering
whether
healthwatch
was
planning
to
publish
its
own
separate
response
to
francis
in
any
way,
shape
or
form
and
how
that
might
be
shared
with
the
board.
A
G
Okay,
well
I'll
start
I'll
start
backwards,
so
response
to
francis.
Yes,
we
are
planning
to
publish
our
own
response
to
francis
it.
G
It
won't
be
covering
290
recommendations,
but
but
but
but
we
do
plan
to
to
publish
something
and
we
are
explicitly
not
going
to
be
part
of
the
government
response
to
francis
and
that's
a
an
in
principle
decision
which
I
believe
to
be
important,
which
is
that
I
I
think,
although
we
are
part
of
the
statutory
arrangement,
it's
very
important,
that
we
retain
that
sense
of
our
independence
to
speak
to
the
system
and
to
the
government,
and
so
we
are
doing
something
slightly
separate
around
the
same
time
frame.
G
I
I
I
see
no
reason
why
we
shouldn't
share
with
the
board
in
in
confidence
until
it's
it's
published.
What
we're
proposing
to
say.
I
wouldn't
wish
there
to
be
any
surprises.
It's
not
quite
done
and
dusted
just,
but
probably
in
the
next
24
hours
we
could.
We
could
arrange
to
do
that,
the
vulnerable
groups
or
people
in
vulnerable
situations.
I
mean,
I
think
I
take
that
away.
Okay,
I
mean
it's
a
it's.
It's
a
point
well
made.
G
It
makes
me
wonder
whether
there
are
both
actually
I'm
not
sure
whether
everyone
who
might
fit
into
these
categories
is:
is
a
person
necessarily
in
a
vulnerable
situation
and
maybe
actually
there's
something
about
vulnerable
groups
and
people
in
vulnerable
situations,
because
but
but,
but
I
think
I
I
take
that
away
and
think
about
it.
I
mean
this
is
a
very
shorthand
version,
but
there's
opportunity
to
finesse
it
in
in
the
final
business
plan
on
compensation
and
right
to
redress.
G
I
mean
that
might
be
a
a
a
a
concern
that
needs
to
be
addressed,
but
I
think
my
starting
point
on
this
is,
what's
very,
very
clearly
documented
in
all
the
research
which
has
been
done
with
consumers
actually
in
any
sector,
which
is
that
what
people
want
more
than
anything
else,
is
to
know
that
it's
not
going
to
happen
again
to
someone
else.
They
want
the
benefit
of
their
experience.
G
To
be,
someone
else,
doesn't
have
the
same
experience,
and-
and
actually
it's
rarely,
that
compensation
is,
is
their
primary
motivation
for
complaining
and
yeah.
What
a
great
thing
that
is,
because
it
means
people
are
complaining
for
for
the
benefit
of
the
system,
and
I
I
I
think
we
should
absolutely
embrace
that
there
there
are
occasions
I
think
they're
probably
reasonably
well
addressed,
or
there
is
the
opportunity
to
address
them
where
compensation
is
the
right
answer.
G
I
think
this
is
this
is
much
more
about
getting
concerns
and
complaints,
our
primary
purpose
here,
getting
concerns
and
complaints
into
the
system
so
that
and
getting
the
system
to
take
to
take
note
and
your
your
first
point
about
resistance
to
the
consumer
agenda.
Yeah
I've
been
very
mindful
of
this
in
the
time
that
I've
been
the
the
chair
of
healthwatch
england,
and
for
months
and
months
as
the
chair
of
healthwatch
every
time
I
spoke
I've
to
every
time.
I've
mentioned
any
person
who
might
use
services.
G
I've
talked
about
in
the
same
mouthful:
consumers,
users,
patients,
carers,
families
and
friends.
It's
such
a
mouthful
by
the
time
you
get
to
the
end,
and
the
fact
is
that
most
people
have
there
are
lots
of
different
variants
on
the
theme
of
what
is
the
right
way
to
talk
about
people.
I
I
think
we
need
to
be
sensitive
to
that.
I
we.
G
We
certainly
try
to
be
in
the
conversations
that
we've
had
with
people,
but
I
think,
as
time
has
passed,
I'm
becoming
a
bit
more
robust
about
the
sense
that
I
think
there's
a
an
advantage
in
thinking
about
this
through
consumer
the
consumer
rights
agenda,
partly
because
I
think
it's
it's
there.
G
There
is
a
a
readiness
for
a
change
of
mindset
really,
so
it
may
not
be
the
term
for
the
future
always,
but
it's
not
a
bad
term
for
now,
and
I
would
want
to
argue
that
case
a
little
so,
but
there
will
certainly
be
a
need
to
communicate
about
it
and
to
discuss
it
with
people
and
and
for
us
to
make
the
case,
and
I
think
one
of
the
things
that
we
will
want
to
do
as
part
of
our
kind
of
setup
work
is
a
piece
which
we
will
want
to
share
publicly
on
what
it
is
to
be
a
consumer
champion.
A
Good
thanks
very
much
anna,
I
think,
we'll
I
think,
we'll
press
on
up.
Let's
peel
the
desktop
for
coffee,
I
think
we'll
have
coffee
at
11.
If
that's
all
right,
so
schema
delegation
alice.
Are
you
doing
this?
I.
J
Am
david,
thank
you
very
much,
wow
right
deep
breath.
This
is
probably
possibly
not
the
most
exciting
paper.
That's
ever
come
to
the
board,
but
I
would
submit
that
it's
quite
important.
J
This
is
the
last
of
the
the
key
governance
documents
that
have
been
fundamentally
reviewed
over
the
last
period
of
time,
and
this
is
the
first
fundamental
review
of
this
schema
delegation
since
cqc
started
and
we've
taken
the
opportunity
to
not
merely
update
it
but
think
about
it
in
a
slightly
different
way
and
hopefully
a
way
that
makes
it
a
more
pragmatic
and
a
more
comprehensive
document.
J
It
is
long
you
may
not
believe
it,
but
we
have
made
every
attempt
to
keep
it
as
short
as
possible,
but
it
is
long
because
it
has
an
awful
lot
in
it,
and
the
intention
is
that
it
is
a
complete
document,
so
it
contains
a
number
of
important
annexes
which
I'll
come
on
to
just
recently.
I
was
thinking
about
it
and
I
think
perhaps
the
scheme
of
delegation
is
not
now
the
most
accurate
title
for
it.
J
The
benefit
of
that
is
it
does.
It
would
create
a
slightly
more
palatable
acronym
if
we
can
call
it
the
scheme
of
delegation
and
authority,
though
those
have
been
working
on.
It
might
say
that
the
acronym
currently
is
the
most
descriptive
okay.
So,
what's
different
and
what's
important
in
this
well
there's
a
couple
of
things
that
I'd
like
you
know
the
board
to
focus
on.
J
First
of
all
that
we've
taken
the
opportunity
to
break
the
schema
delegation
to
two
parts,
and
the
proposal
is
that
they
would
be
handled
in
future
in
a
slightly
different
way
to
the
way
they've
been
handled
in
the
past.
In
the
past,
the
board
has
taken
responsibility
for
approving
any
changes
and
in
all
changes
to
the
entire
scheme,
and
that
world
has
meant
and
would
mean
in
future,
that
every
minor
change
around
particularly
the
regulatory
delegations,
would
have
to
come
to
the
board
for
approval
in
practice.
J
In
the
past,
they've
often
gone
to
the
chair.
For
chairs
action
and
then
subsequently
needed
approval
by
the
board.
I
don't
think
that
is
particularly
a
good
use
of
the
board's
time.
So
the
proposal
here
is
that
this
part
one
sets
out
very
clearly
what
the
pat,
what
the
powers
reserved
to
the
poor
board
are
and
what
it
will
continue
to
take.
J
Responsibility
for
and
approve
and
in
the
second
part
delegates
to
via
david,
as
the
chief
executive
and
accounting
officer,
makes
a
series
of
executive
delegations,
and
the
proposal
would
be
that
if
you
approve
that
that
changes
to
part
two
would
be
approved
by
the
chief
executive,
we
could
of
course
have
a
system
of
reporting
those
changes
to
you
as
and
when
or
whatever
frequency,
by
whatever
means
you
felt
appropriate.
J
The
approach
taken
here
has
been
to
expand
this,
so
what
it
seeks
to
capture
are
all
the
important
key
regulatory
decisions,
whether
or
not
they're
captured
in
statute,
so
that
there's
clarity
as
much
for
individuals
and
the
organization
about
who
is
authorized
to
what
to
take
what
kind
of
regulatory
decisions
and
in
support
of
that
and
within
the
scheme
of
delegation.
Your
cup
of
paper
says
that
page
three
is
actually
a
page.
Four
we've
got
a
series
of
principles
that
we
have
used
to
marshal
and
to
structure.
J
That's
that
scheme
and
in
essence,
what
we've
been
trying
to
do
with
these
principles
and
in
the
structure
of
the
scheme,
particularly
around
the
regulatory
delegations,
is
striking
appropriate
balance
between
getting
decisions
made
at
the
appropriate
level
where
it
aligns
with
roles
and
responsibilities
so
that,
as
far
as
possible,
the
more
routine
decisions
are
taken
at
a
lower
level.
So
balancing
a
principle
of
subsidiarity
with
ensuring
that
there's
the
mechanism
for
and
the
recognition
of
the
need
to
escalate,
where
that's
appropriate.
Now.
J
Some
of
that
it
makes
it
very
plain
where
escalation
is
required
in
the
sense
that
the
delegation
specifies
certain
decisions
to
be
made.
But
of
course,
in
this
there
will
always
be
a
requirement
for
an
element
of
judgment
to
be
applied
where
there
may
be
a
novel,
contentious
or
a
particular
regulated
decision
which
may
be
routine.
That
might
have
considerable
impact.
J
J
So
within
the
scheme,
it
structures
the
delegations
around
roles,
so
people
can
be
clear
around
what
delegations,
what
powers,
what
what
responsibilities
they
have
got
rather
than
having
to
move
through
the
scheme
and
piece
that
together,
but
in
the
annex
annex
b,
it
also
groups
them
around
around
the
topic
and
and
the
issue.
J
There
are
five
annexes
to
the
to
the
scheme.
The
first
are
the
financial
delegations
and
john.
I
think
it's
true
to
say.
A
lot
of
these
are
are
drawn
from
the
department
of
health
and
mirrored
the
requirements
that
they
would
expect
to
see
as
a
parent
department,
we've
got
a
bunch
of
nxb
and
it
sees
the
standing
financial
instructions
again.
A
lot
of
them
are
required
by
the
department
of
health
and
importantly,
I'd
like
to
board
the
focus
on
annex
d
now,
annex
d,
this
lays
out
the
policies
which
is
proposed.
J
These
are
corporate
policies
that
the
board
retains
responsibility
and
ownership
of,
by
which
I
mean
that
if
those
policies
have
changed
or
amended,
they
would
come
to
the
board
for
approval,
and
the
implication
of
that,
of
course,
is
that
the
other
policies
would
be
signed
off
at
the
executive
level
and
the
underlying
philosophy
behind
what
we've,
how
we've
structured.
J
That
is
that
anything
that
mark
that
is
strategic,
that
characterizes
the
cqc
as
a
as
an
employer,
the
nature
of
that
employer
and
and
and
the
nature
of
the
culture
of
the
cqc
that
should
be
reserved
to
the
board
and
then
annex
e
we've
updated,
which
you'd
seen
before
the
accountability
framework.
So
we've
updated
that
in
line
with
with
the
schema
delegation
now.
J
The
final
thing
I
would
I
would
say
by
way
of
introduction
is
that,
whilst
there's
been
an
enormous
change,
there
will
be
further
changes
to
this
per
force
across
the
year
as
we
make
changes
organizationally
or
structurally,
and
indeed,
as
we
might
make
changes
to
the
regulatory
model.
J
The
creation
of
new
roles
of
chief
inspector,
they
will
have
to
be
there,
their
powers
and
so
on
will
have
to
be
encompassed
in
this.
So
we
I'm
afraid
we'll
be
coming
back
to
you,
regardless
of
whether
you
approve
part
one
and
rt.
We
will
be
coming
back
to
you
to
explain
how
we've
restructured
that
thanks
john.
H
H
You
very
much-
and
I
thought
that
might
be
the
answer,
but
secondly,
more
significantly,
I
have
been
in
a
number
of
meetings
with
you,
where
you
have
expressed
concern
about
particular
decisions
being
delegated
to
the
executive,
rather
than
being
retained
at
the
board.
In
all
of
those
cases,
I
felt
that
your
judgment
was
right
and
the
previous
scheme
of
delegation
was
wrong
and
I
want.
I
would
like
to
be
reassured
that
you
are
satisfied
that
the
level
of
delegation
is
now
appropriate.
A
Well,
I
I
would
like
to
have
one
line
in
this
saying
something
about
good
sense
and
judgment.
I
mean
the
truth.
Is
I
don't
know
john?
I
have
not
read
every
black
page
on
this
thing
and
I-
and
there
are
211
pages
of
gloop
here-
that
I
have
not
read.
I
don't
so
I
don't
know
is
the
answer.
I
can't
answer
your
question.
A
All
I
know
is
what
you
had
before,
which
meant
that
really
important
decisions
will
be
made
at
the
director
of
at
the
deputy
there
at
malcolm's
level
and
not
coming
to
the
board,
was
completely
wrong
and
actually
really
important
decisions
about
the
fundamentals
cqc
is
about
I.e.
Is
that
hospital
safe
or
not
we're
being
taken
away
from
this
board?
Now?
I
just
want
assurance
that,
through
all
this
gobbledygook
here
alistair
that
actually
those
decisions
and
that
responsibility
is
here
not
down
in
the
organization
somewhere.
So
the
answer
is.
A
A
G
I
I
I
I
feel
not
not.
Unlike
you,
I
I.
I
have
a
an
observation
on
this
particular
point,
because
I
think
I
think
this
is
the
the
critical
issue
I
mean.
I
don't
think
we
can
be
responsible
for
making
all
of
those
for
making
all
the
regulatory
decisions
at
the
board
clearly,
but
one
of
the
things
that
I
find
missing
from
here,
so
there's
a
couple
of
questions.
G
One
is
about
the
way
in
which
those
decisions
are
made
internally
and
one
of
the
things
that
troubles
me
slightly
on
my
cursory
reading,
and
it
is
a
cursory
reading
but
kind
of
looking
through
this
document
is
that
an
awful
lot
of
the
scheme
of
delegation
at
the
operational
level
is
about
individual
point
responsibility
for
decisions
and
I'm
not
sure
I
feel
comfortable
with
leaving
those
decisions
in
the
hands
of
individuals.
G
It
seems
to
me
that
there's
something
which
often
needs
to
be
more
corporate
and
collective
about
some
of
these
big
decisions,
whatever
the
level.
If
it
came
to
the
board,
it
would
be
a
collective
decision,
of
course,
so
I
I
there's
something
I
want
to
ask
david
really
about
at
the
at
the
more
operational
level
about
this
kind
of
point
responsibility
as
opposed
to
group
responsibility.
G
There's
something
about
then
for
me
also
about
the
way
in
which
we
review
decisions
that
are
made
on
the
board's
behalf,
and-
and
that's
not
in
here,
because
this
is
a
scheme
of
delegation.
But
actually
wherever
decisions,
significant
decisions
are
being
made
about
regulation.
G
It
seems
to
me
that
we
need
to
be
comfortable
that
they
are
being
reviewed
both
within
the
organization
and
at
the
appropriate
level,
the
appropriate
level
of
decision
at
the
board,
so
that
we
can
assure
ourselves
that
the
right
kinds
of
decisions
are
being
made
using
the
right
kinds
of
criteria.
Bearing
in
mind,
we
can't
make
them
all
ourselves
and
then
you're.
Quite
right,
david,
there's
a
question
about
the
sort
of
judgment
that
is
taken
to
bring
some
decisions
to
the
board
regulatory
decisions
to
the
board.
G
But
I
don't
see
the
the
the
the
sense
that
that
might
be
required
on
one
or
two
occasions,
and
I
do
have
this
sense
of
kind
of
obfuscation
by
a
level
of
detail
and
it's
not
deliberate,
but
it
is
it's
very
difficult
to
see
because
there's
so
much
detail
and-
and
I
want
to
make
one
other
slightly
unrelated
point,
which
is
in
relation
to
2.5
in
the
cover
paper-
and
I
think
this
is
this-
is
about
how
the
board
has
been
worked
to
operate
and
how.
G
I
think
we
really
one
of
the
things.
I
think
we
really
need
to
change.
So
it
talks
here
about
us
being
the
place
which
approves
reports
and
it
talks
about
reports,
and
that
is
what
happened
so
we've
got
in
our
papers
today
a
report
to
be
approved,
and
I
don't
think
a
board
can
approve
a
report
at
you
know:
50
80
pages,
whatever
it
is
which
is
going
to
go
to
to
the
secretary
of
state
or
parliament
or
anything
else.
G
What
we
can
approve
are
a
set
of
recommendations
which
we
wish
to
make
on
the
back
of
a
report,
and
I
think
that
is
the
important
thing,
so
I
mean
there's
something
about
getting
the
right:
the
right
request
to
the
board
about
what
we
approve,
and
that
is
a
matter
of
judgment
and
it's
it.
It
is
not
about
reports.
It's
about
recommendations.
It
seems
to
me.
B
Steve,
I
think
that's
right.
I
I
wouldn't
want
to
down
with
even
faint
praise.
What's
it
been
done
here,
because
it's
a
tremendous
amount
of
work,
and
I
think
it's
really
important
and
some
of
the
stuff
that
we
did
with
deloitte's
flagged
up
some
real
problems
in
the
system
of
delegation
and
what
occurs
to
me
is
that
actually,
the
changes
that
can
come
down
the
track
are
going
to
be
even
more
significant.
B
I
mean
what
powers
will
the
inspect
chief
inspector
of
hospitals
have,
and
I
think
that's
going
to
be
a
really
critical
set
of
delegations.
I
think
this
is
an
improvement.
I
think
it
will
be
a
mistake
to
kick
this
into
the
long
grass.
I
think
we
should
accept
this
as
work
in
progress,
because
I
think
it's
a
step
in
the
right
direction
and
it
clarifies
some
of
the
issues
that
we've
already
had.
Reports
from
external
independent
consultants.
Advisors
are
really
weak
in
our
setup.
B
So
I'd
like
to
say,
you
know
pick
up
alice's
point
of
that.
This
is
this,
is,
you
know,
definitely
a
first
iteration,
though
we've
got
to
find
a
better
way
of
able
to
deal
with
this.
C
Okay,
so
I
have
read
all
288
pages
or,
however
many
it
is,
I
think,
just
on
the
point
versus
group
decisions.
C
C
I
think
the
issue,
then,
is:
what
is
the
challenge?
That's
in
the
system
and
each
region
has
a
committee
which
is
about
challenging
to
ensure
it
can
get
consistency
of
decisions.
So
I
draw
a
distinction
between.
C
I
think
you
were
making
this
yourself
anna
between
the
monitoring
and
the
actual
taking
of
decisions
and
as
we
try
and
delay
the
bureaucracy
of
this
organisation,
there's
a
balance
to
be
struck
here,
and
I
don't
know
what
the
perfect
balance
is,
if
I'm
being
brutally
honest
with
you-
and
this
is
an
attempt
just
to
set
it
out
clearly
and
unambiguously
of
what
that
is,
I
think
the
issue
then
is
is
how
do
we
report
those
decisions
to
the
board
and
that
I
think,
means
a
change
from
our
standard
reporting
of
all
these
kpis
that
have
been
produced
historically,
so
it
reflects
more
on
the
decisions
that
are
being
made
rather
than
just
numbers
which
come
forward.
C
I
don't
again
down
with
fair
prayers
the
work
that
goes
into
those
numbers.
I
think
there
are
important
numbers
that
we
should
collect,
but
I
think
it's
the
kind
of
information
about
our
decisions
that
need
to
come
to
the
board,
not
some
of
the
numbers,
so
just
just
to
come
back
on
that
point,
anna.
In
terms
john
of
your
question
to
david
and
the
detail
of
this,
I
think
what
we've
tried
to
do
in
2.5
take
absolutely
the
point
about
the
just
to
choose
the
choice
of
language
that
you're
making.
C
Although
I
think
on
this
report,
this
was
one
of
the
reports
that
I've
asked
is
circulated
to
board
members
and
its
developments
or
board
members
are
able
to
comment
as
it's
being
developed.
So
you
should
not
be
surprised
by
anything.
That's
in
this,
because
you
should
have
had
the
opportunity
to
comment
beforehand
on
this
report
and
that's
my
commitment
on
all
others
about
how
we
do
that
and
we
will
use
workshops
and
seminars
as
a
way
of
actually
structuring
that
before
we
get
into
the
drafting
of
it
as
well.
C
So
I
hope
we
can
continue
to
do
that
and
get
the
most
appropriate
system
to
get
your
proper
engagement
in
them.
But
on
this
issue,
2.5
is
the
issue
david
that
you
raised
about
what
is
it
that
should
come
to
the
board
and
how
that
should
be,
and
this
was
sparked
by
the
decision
around
the
trust
special
administrator
being
appointed
to
mid-staffordshire.
If
I
remember
correctly,
our
last
meeting,
sorry
2.6
so
2.6
is
proposing
that
responding
to
that
special
administrator
request
from
monitor
is
something
that
be
delegated
from
you
to
me.
C
A
Feel
that
with
that,
the
danger
is
that
we
lose
sort
of
common
sense,
yeah,
okay-
and
I
don't
want
to
be
in
a
position
in
six
months
time
when
something
important
has
happened,
and
we
said
well,
why
didn't
we
know
about
it?
And
someone
said
oh
well,
it's
in
section
16.1
on
page
280.
what
I
mean.
I
will
not
do
that.
I
know,
but
sometime
in
the
future,
that
might
happen.
I
just
would
like
to
feel
that
there
was
some
common
sense
in
here
as
well
over
road
everywhere
things.
A
You
know,
I
mean
I
feel
completely
happy
that
you
will
raise
with
me
anything
that's
important,
but
but
I
mean
I
just.
I
am
just
very
conscious
of
the
fact
that
just
looking
backwards,
you
know
this
organization
has
had
a
schema
delegation
which
effectively
kept
important
things
away
from
coming
to
the
board,
and
I
mean
it
you
know.
So
that's
my
concern.
Okay!
Well,
maybe
malcolm.
D
I
don't
know
if
it
addresses
the
point
of
common
sense
or
not,
but
the
message
I
mean
from
an
operational
perspective,
very
pleased
with
the
revisions
to
the
scheme
of
delegation,
as
in
in
relation
to
regulatory
decisions.
The
the
broad
message
I've
given
in
my
region
is,
if
in
doubt,
escalate
if
in
doubt
pick
up
the
phone,
you
know
don't
stick
to
the
narrow
black
letter
of
this
scheme
of
delegation
or
the
existing
scheme
of
delegation,
if
you
think
and
when
I
used
to
call
it
shades
of
grey.
D
I
can't
really
say
that
anymore,
but
if
you
know
with
the
bigger
decisions,
we're
dealing
with
shades
of
grey,
it's,
not
black
or
white,
if
you're
not
sure,
pick
up
the
telephone
to
the
next
person
in
the
line
and
whether
it's
delegated
to
a
head
of
regional
compliance
to
a
ddo
or
to
amanda
or
not,
I
would
always
bring
up
the
complicated
things
for
a
further
review
and
discussion
at
the
appropriate
level,
so
that
that
to
me
is
the
common
sense
overlay
to
all
of
this.
If
in
diet
estimate
yeah,
can
I.
G
Come
back
david
because
I
I
I
I
think
in
so
I
want
to
focus
our
attention
on
the
covering
paper
here
which,
on
the
principle
so
so
regulatory
decisions
we
serve
to
reserve
to
the
board
for
decision
two,
four,
two
five
and
two
six
and
and
and
I
think
the
problem
is
that
what
we
don't
have
here
is
something
which
makes
it
clear
that
that
some
regulatory,
just
ordinary
regulatory
decisions
are
of
such
an
enormity
for
a
variety
of
possible
reasons,
which
we
probably
need
to
kind
of
give
some
exposure
to
that.
G
Actually,
your
escalation
locally
should
come
all
the
way
up,
and
what
this
doesn't
allow
for
is
that
those
decisions
might
end
up
at
the
board
and
it
seems
to
me
we
need
to
have
that
in
here.
There's
the
possibility
that
the
escalation
process
doesn't
stop
with
the
executive.
It
stops
with
the
board
and
and
that
isn't
that
isn't
in
here
now.
Obviously,
that
creates
some
fuzziness
for
for
staff,
because
it's
not
a
clear
delegation.
It's
not
saying
you
can
make
all
these
decisions,
it's
saying.
G
Actually,
some
of
them
are
so
important
and
then
then
we
have
to
stop
and
think
well
and
what
is
so
important.
Look
like
you
know
how
what
this
question
of
judgment-
and
you
can't
you
can't
always
describe
it,
but
you
can
give
some
in
in
perfect
detail.
There
are,
no,
you
know,
rules
don't
apply
here,
but
there
are.
There
is
some
sense
of
I'm
sure
we
could
elaborate,
which
would
describe
the
the
kind
of
dimensions
of
importance
that
you
would
need
to
consider.
But
I
think
that's
what's
missing.
A
Yeah
see,
I
think,
malcolm
on
your
point,
that
if
the
worry
list
of
hospitals
had
come
to
the
board
had
always
come
to
the
board,
we
would
have
been
asking
here
some
quite
penetrating
questions
about
you
know,
which
ones
should
we
be
really
worried
about
you
know
and
and
that
discussion
has
never
happened
at
this
level,
and
I
and
that's
what
concerns
me
about
where
we've
been
in
the
past,
that
actually
we've
been
blinded
from
what
is
really
important
in
the
in
what
we're
doing,
because
it
was
regarded
as
being
operational.
A
It's
not
operational,
it's
completely
our
whole
core
purpose,
and
I
I
don't
want
this
board
to
be
in
a
position
where
what
we
think
is
really
important
is
being
it's
not.
It
has
no
visibility
at
this
level
and
somehow
people
have
felt
well.
We
shouldn't
ask
about
that
because
it's
like
operational,
but
actually
it's
it's
much
more
than
that.
A
B
I
mean,
I
think
the
issue
for
the
board,
I
think,
is
a
question
of
having
confidence
in
the
executive
team
and
I
think
if
we
don't
have
that
no
system
of
delegation
is
going
to
be
workable
anyway,
and
so
it's
really
important
that
actually
some
of
the
structural
changes,
some
of
the
the
new
organization
is,
is
really
put
in
place
and
we
test
it
and
when
we
develop
those
relationships.
A
B
But
but
you
know
we
are
not
experts
in
this
field
and
we
will
expect
the
executive
officers
to
advise
us
to
make
recommendations
that
we
then
test
and
some
of
that
process
is
very
discursive
and
sometimes
there
are
decisions
going
to
have
to
be
made
in
a
very
short
space
of
time
and
I
think,
all
of
those
in
any
organization
I've
been
involved
in
depend
on
a
very
strong
relationship
between
the
chief
executive
and
and
the
chair.
Yeah,
and
you
know,
we've
got
every
indication
that
is
developing
really
really
well.
A
Don't
misunderstand
me:
I'm
not
saying
that
we
want.
I
want
more
information
here,
because
I
don't
trust
david
and
his
team
to
deal
with
it.
I'm
not
saying
that
at
all
I'm
saying
that
the
the
these
decisions
about
hospitals
and
care
homes
and
care
groups
are
really
important.
That's
why
we're
here
and
therefore-
and
it
is
a
judgment
this-
it's
not
just
being
an
expert
about
mrsa
levels
or
something
it
is.
It
is
a
judgment
and
I
think
I
don't
want
us
to
be
out
of
that
judgment.
A
That's
what
I'm
saying
and
I
think
there's
the
direction
of
travel
on.
This
is
right,
but
to
john's
question,
do
I
know
that
that
my
concern
is
being
addressed?
I
don't
really
know
that
it
is
being
addressed
and
I
would
like
I'd
like
I'd
like
you
to
come
back,
maybe
at
the
next
meeting
dave
as
you've
read
all
211
pages
of
it,
and
I
think
you
have
an
understanding
of
this,
which
is
much
deeper
than
mine
to
giving
me
your
view
or
giving
us
your
views
as
to
what
this
means
in
practice.
A
Thank
you
chair.
That
is
delegation.
C
Yeah,
no
I've
got
the
message.
I
think
there's
two
things
to
unpick
from
this
one
is
but
before
I
say
that,
so
what
we've
tried
to
do
anna
to
your
appointing-
and
I
think
this
is
something
that
I'd
ask
other
board
members
to
think
about.
I
think
we've
tried
to
capture
this
in
210
and
211.
C
C
I'm
not
saying
one
is
more
important
than
the
other,
but
greater
resonance
because
it
touches
more
people.
So
I
just
met
that
distinction
about.
We
do
need
in
our
decision
making
to
build
in
the
head
room
for
appeal
and
what
we
were
trying
to
do
in
211
was
do
exactly
that
now.
I
think,
to
the
point:
that's
being
discussed
about
the
confidence
whether
the
issues
are
being
considered
operationally
are
actually
coming
to
the
board
in
real
time
to
allow
the
board
to
engage
with
those
and
to
shape
and
influence.
C
How
we,
as
an
organization
in
the
name
of
cqc,
are
actually
taking
that
work
forward,
then
I
wonder
whether
that's
an
issue
about
decision
making,
as
it
is
about
early
discussion
about
the
issues
as
those
decisions
are
being
taken
in
real
time
and
therefore
what
I'll
take
away
david
is:
let's
look
again
at
the
language
to
make
sure
we've
got
the
appropriate
decision
making
and
we've
got
that
headroom
in
that
allows
appeal
to
actually
be
built
into
our
decisions.
C
We'll
pick
up
the
common
sense
bit
david
about
that,
and
and
if
I,
if
I
may
suggest,
that
what
we'll
do
is
bring
forward
a
report
which
proposes
how
we
should
report
those
key
issues
of
significance
and
find
a
way
of
actually
drawing.
Also
the
attention
of
the
board-
and
I
think
that'll
be
a
mixture
of
things
that
we
do
in
between
board
meetings,
because
that's
the
rhythm
that
these
are
going
to
operate
at
and
actually
what
perhaps,
either
in
a
chief
executive's
reporter
in
a
performance
report.
C
We
can
pull
out
about
those
high-level,
important
decisions
that
are
being
made,
and
I.
A
G
A
G
A
Okay
thanks
very
much.
A
lot
of
work
has
gone
into
this
report
and
I
don't
mean
to
be
sort
of
critical
of
that.
I
just
don't
feel
totally
comfortable
with
at
the
moment.
That's
all
okay
right!
Thank
you.
I'm
john
quick
feedback
on
the
iraq
committee
of
yesterday.
H
H
We
discussed
first
of
all,
the
progress
towards
the
2012-2013
annual
report
and,
in
particular,
the
statement
of
corporate
governance,
and
this
will
be
coming
to
our
meeting
on
the
30th
of
april
to
be
finalized,
and
then
we
will
recommend
it
to
the
board
and
you
send
for
the
board
to
adopt
that,
along
with
the
rest
of
the
annual
report,
if
it
wishes,
we
consider
the
volume
of
sort
of
the
work
which
has
been
undertaken
to
quantify
the
costs
of
cqc's
corporate
governance,
and
I
can
assure
you
that
it
is
significantly
less
than
the
two
percent
standard
benchmark
which
is
applied
to
organizations
like
ours
on
risk.
H
We
discussed
a
number
of
issues
which
you've
already
had
a
little
bit
of
flavor
of
we
received
a
report
from
david
bien
on
emerging
risks.
H
C
Do
no,
I
thought
that
was
absolutely
accurate
and
just
to
reiterate
the
point
that
I
think
the
strategic
risk
register
needs
to
be
presented
as
part
of
the
business
plan
when
that
comes
for
final
approval,
and
I
think
that
begins
to
draw
together
the
work
of
iraq
and
the
work
of
the
board
in
terms
of
how
we
move
forward.
A
Okay,
good
any
other
business,
any
other
business
for
the
public
part
of
the
meeting.
No
excellent!
Well,
I
think
we'll
close
the
public
part
of
the
meeting
now
and
have
a
cup
of
coffee
and
then
gather
back
in
15
minutes.
Thank.