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From YouTube: CQC Board Meeting – January 2020
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A
Right
good
morning,
everybody
welcome
to
the
first
board
meeting
of
2020.
We
have
apologies
from
Sir
Robert
Francis,
who
has
caught
duties
this
morning
and
from
jorah
Gill,
who
is
overseas
on
business.
We
also,
sadly,
have
an
apology
from
our
normal
represent
others.
We
normally
have
a
representative
of
one
of
our
of
our
networks,
but
unfortunately
she
can't
be
here
because
of
a
family
issue
this
morning.
So
that's
a
shame.
We
don't
have
any
declarations
of
interest
other
than
usual
ones
that
were
notified
to
me
in
advance.
As
anything,
anybody
needs
to
declare
very
good.
A
A
One
is
for
later
in
the
spring,
and
one
is
for
February.
So
the
two
that
have
one
that
is
for
today
is
is
david
labels,
review,
which
we
will
we
will
come
on
to
in
a
short
while
and
then
associated
with.
That
is
a
is
an
update
from
on
our
other
activity
in
relation
to
to
water
hall.
Those
are
the
two
things
for
today
and
then
later
on.
We
have
the
action
for
professor
Glynnis
Murphy's
report,
but
that
will
be
sometime
in
the
spring
when
that
comes
to
us.
A
So
I
hope
that
covers
the
action
nah.
There's
anything
anybody
wanted
to
raise
that
as
a
matter
of
rising
star.
Otherwise,
on
the
agenda.
Excellent,
that's
that's
fine!
So
we
move
swiftly
if
we
may,
to
the
National
Guardians
update
I'm
delighted
Henriette
that
you're
here
a'right
I,
was
disappointed
that
your
name
tag
hadn't
been
updated
to
dr.
Henrietta
Hughes
OBE.
A
Congratulations
on
on
that
was
really
good
to
see
it
in
the
New
Year's
Honours,
List
and
I
was
particularly
pleased
not
just
for
you,
but
because
I
thought
it
demonstrated
the
importance
of
speaking
up
and
the
speak
up
program
which,
obviously,
you
do
represent
if
you
like,
so
I
thought
it
was
terrific.
So
without
any
further
ado
can
I
hand
over
to
you.
Please.
B
Well,
thank
you
very
much
for
those
kind
words
and
also
for
giving
me
the
opportunity
to
give
an
update
on
our
progress.
Over
the
last
year,
we've
now
got
more
trained,
Guardians
in
a
broader
range
of
organisations,
so
the
network
is
of
over
500
Guardians
on
our
duck
tree
who've
all
been
trained
and
a
similar
number
of
ambassadors
and
champions
around
the
country
supporting
their
work.
The
organisation's
with
guardians
include
all
the
NHS
trusts
and
foundation
trusts.
B
But
what
I'm
pleased
to
say
is
that
there's
been
a
reduction
in
the
reporting
of
cases
as
anonymous
down
from
18%
to
12%,
and
also
that
88%
of
those
who
gave
feedback
to
guardians
said
that
they
would
speak
up
again,
which
I
think
is
very
encouraging.
But
worryingly,
the
numbers
of
cases
where
detriment
has
been
recorded
is
still
at
5%
and
I
think
this
is
a
real
concern,
as
it
was
at
5%
last
year
as
well.
B
So
we're
looking
to
see
how
organisations
can
support
individuals
who
say
that
they've
had
detriment,
and
certainly
you
know,
working
with
the
CQC
in
terms
of
strengthening
the
world
that
inspection
in
this
other
organizations
are
keen
to
submit
data
to
us,
and
so
we've
created
a
portal
so
that
all
types
of
organizations
with
Guardians
can
submit
data
and
I
think
would
be
quite
interesting
to
see
what
that
looks
like
in
the
future,
as
I've
previously
described
to
you.
The
implementation
of
the
Guardian
role
varies
and
we've
previously
found
that
guardians
without
ring-fence
time.
B
To
do
this
important
work
are
less
likely
to
meet
our
expectations
or
feel
that
they
meet
the
needs
of
their
workforce.
We
will
be
publishing
our
next
Guardian
survey
next
week
and
alongside
the
hundred
voices
report,
which
really
talks
about
the
stories
behind
the
data
and
the
annual
report.
These
will
be
laid
before
Parliament
for
the
first
time
this
year,
as
I've
described
to
you
before.
B
We
found
that
the
perceptions
of
guardians
appears
to
be
correlated
with
the
CQC
rating
and
in
that
what
I
mean
is
that
the
organization's
rated
outstanding
by
the
CQC,
their
guardians
are
much
more
positive
about
the
speaking
up
culture
and
the
role
of
their
leaders
and
managers
in
fostering
that
culture.
But
the
acid
test
is
what
to
the
workforce
say.
So.
We've
developed
a
metric
called
the
freedom
to
speak
up
index,
and
this
is
from
a
subset
of
questions
from
the
NHS
staff
survey
about
whether
workers
feel
encouraged,
knowledgeable
and
secure
in
raising
concerns.
B
And
what
we
found
is
that
the
Trust's
who
have
the
highest
freedom
to
speak
up
index
scores
also
appear
to
be
rated
outstanding
or
good
in
well-led
and
overall.
And
when
we
look
at
the
trends
over
the
three
years
and
that's
the
great
advantage
of
the
staff
survey
that
the
same
questions
get
asked.
Every
year
of
every
organisation.
B
We
found
that
a
hundred
and
eighty
trusts
had
an
improvement
in
their
freedom
to
speak
up
index
score
was
six
percentage
point
improvement
nationally
overall
and
London
Ambulance
Service
I
want
to
highlight,
because
they
were
the
most
improved
trust
with
an
eighteen
percentage.
Point
improvement
in
their
staff
survey
of
these
questions
in
the
three-year
period.
What
we've
published
a
report
where
we've
highlighted
good
practice
from
the
Trust's
with
the
highest
scores
in
each
type
of
trust,
so
that
others
who
are
struggling
with
this
can
actually
learn
from
that
and
use
those
insights
to
make
improvements.
B
We've
also
created
a
new
arrangement
for
case
reviews
to
enable
cases
referred
to
us
to
be
addressed
in
a
number
of
different
ways
and
to
ensure
that
the
voice
of
workers
is
heard.
Today.
We've
published
seven
case
review
reports
with
95
recommendations
and
in
the
paper
that
I've
put
in
for
the
board
today.
C
Thank
You,
Henrietta
and
I
agree
with
your
aim
to
make
Frieden
speaking
up
business
as
usual,
so
I'm
very,
very
pleased
to
hear
the
progress
you're
making
can
I
just
reiterate
some
of
the
things
you
said
about
working
with
us,
which
I
think
you
know
I
think
it's
been
really
very
positive.
We're
very,
very
pleased
to
have
supported
the
rollout
of
the
freedom
speak
up
Guardians
and
we
keen
to
follow
up
on
the
work.
You've
done.
C
Your
review
that
highlights
the
lack
of
protected
time
for
freedom
speak
up,
Guardians
I
think
is
important
and
we
will
be
building
looking
into
that
into
our
well
that
framework
going
forward.
Equally
the
issue
about
detriment
which
I
again
I
share
your
concern
that
that
doesn't
appear
to
be
getting
any
less,
and
you
say
it's
5%
overall,
but
actually
it
varies
between
trust.
Does
it
not
and
I
think
we
will
be
taking
that
into
account
more
in
our
wealth
and
inspections
going
forward?
C
It
is
really
important
that
people
can
feel
free
to
speak
up
about
their
concerns
without
fear
of
detriment,
and
so
we
would
look
very
badly
on
a
trust
that
that
actually
caused
any
detriment
to
people
speaking
up,
but
equally
I
think
Trust
got
to
be
careful.
Their
actions
are
not
perceived
to
be
detrimental,
even
if
that's
not
their
intention
and
I
think
the
kind
of
culture
they
create
that
encourages
people
to
speak
freely
is
really
very
important
and
that's
one
of
the
things
I
think
we
need
to
look
at
in
our
newly
developed
well.
B
One
thing
I
would
say
is
that
we're
really
keen
that
organizations
that
report
are
not
penalized
for
doing
so,
because
we
know
that
other
organizations
may
not
even
be
asking
the
question
so
I
think
there's
something
about
the
nuance
of
the
questions
that
get
asked
at
inspection
and
in
the
pre
inspection
request,
and
you
know
generally
so
that
organizations
who
are
really
attending
to
this
and
are
really
careful
about,
is
you
know
and
may
have
systems
and
plans
of
how
they
deal
with
it.
Don't
get
penalized
for
actually
reporting
it.
B
D
You
and
thank
you
Henry,
chair
and
I
was
just
going
to
say,
I'm
really
delighted
to
see
primary
care
and
integration
on
your
priorities
for
next
year.
I
think
we're
I
think
it's
fabulous
that
we're
looking
at
rolling
this
out
in
primary
care.
It's
such
an
important
area
and
and
we're
looking
forward
to
working
with
you
on
that,
and
particularly
around
integration,
I
think
so
many
times
things
can
go
wrong
in
between
different
providers
in
in
those
gaps
between
providers
and
I.
D
B
Thanks
very
much
and
I
think
the
fact
that
we're
both
GPS
means
that
we
do
have
a
good
insight
into
what
can
happen
when
there
are
organizational
boundaries
in
place.
I'm
really
pleased
at
some
of
the
cases
that
we've
highlighted
in
our
reports
actually
talk
about
speaking
up
across
organizational
boundaries,
because
that's
the
really
hard
thing
to
do
and
I
really
want
to
you
know,
create
those
connections
and
those
relationships
so
that
people
feel
really
comfortable
about
doing
that.
E
Marc,
thank
you
chairman
and
Henrietta
thanks
very
much
very
good
report
again,
just
in
terms
of
the
training,
it's
good
to
see
that
you've
got
an
elearning
product
you're
wanting
to
develop.
I
did
mention
last
last
year
that
engaging
with
providers
to
put
the
freedom
to
speak
up
process
and
Guardian
role
into
their
management
training
would
be
a
good
step
going
forward.
I
wonder
if
the,
if
you
have
evidence
of
providers
putting
that
into
their
own
management,
training,
yeah.
B
We're
seeing
examples
of
that
so,
for
example,
one
of
the
trusts
created
a
program
called
hot
potatoes,
and
that
was
for
the
managers
so
that
when
somebody
brings
something
to
you,
that
they've
got
a
plan
of
in
place
of
how
to
deal
with
that.
But
I'm
also
really
pleased
that
the
NHS
Leadership
Academy
with
the
new
Rosalynn
Frank
program
has
got
a
module
about
speaking
up
now.
B
This
is
for
first-time
managers
and
my
input
into
that
was
really
very
much
to
explain
that
managers
have
got
a
responsibility
in
listening
well,
but
also
knowing
how
to
escalate
concerns
themselves.
So
I
think
we
are
seeing
pockets
of
really
good
practice,
and
it's
then,
in
our
conferences
and
events
that
we
then
share
that
good
practice
between
freedom
to
speak
up
Guardian
so
that
they
can
take
that
back
to
their
organization
and
ensure
that
their
managers
are
supported
as
well.
B
We're
working
with
health
education
England
on
developing
this
e-learning,
because
we
want
this
to
be
something
which
is
completely
Universal
and
seen
as
completely
normal
to
be
doing
that.
But
I
agree
with
you
that,
where
we're
seeing
managers
really
getting
up
skilled
in
this-
and
we
actually
one
of
the
the
examples
was
from
one
of
the
Trust's
that
had
come
up
very
highly
in
the
freedom
to
speak
up
index.
So
those
organizations
have
got
a
lot
to
share
with
others.
B
I
think
the
main
thing
I
would
say
is
for
organisations
who
are
struggling
under
all
sorts
of
burdens
of
either
regulation
or
activity.
It's
actually
carving
out
the
time
for
their
managers
to
be
able
to
understand
and
learn,
but
also
the
time
to
listen.
When
somebody
comes
to
them,
so
we
can
provide
all
the
training
in
the
world,
but
actually
the
practicalities
of
somebody
having
that
time
to
listen
and
act
correctly
as
well.
It's
challenge.
E
A
B
So
what
we
did
was
we
fed
that
back
to
Ted
and
his
team
and
actions
have
been
taken
to
change
that,
so
what
I
would
say
is
in
terms
of
being
a
responsive
organization.
That's
exactly
the
type
of
support
that
we
need,
so
that
when
we
hear
things
that
are
impacting
on
guardians
and
the
frontline
and
on
their
well-being
that
we
can
ensure
that
we
get
those
changes
made.
So
that's
the
type
of
help
that
I
need
and
that's
the
type
of
help
that
I'm
guessing
perfect.
A
Good
I'm
glad
to
think
you
did
well
on
this
breeze
so
important
that
we
joke
about
so
many
so
that
that's
great
Henrietta
I
know
you
have
to
go
and
be
in
your
your
practice
this
afternoon.
So
thank
you
very
much
again
for
the
work
that
you
do
and
coming
here
today
and
congratulations
again
on
your
your
honor,
which
is
fabulous.
Thank.
A
A
I
know
that
both
you
and
I'd
hope
we
would
have
this
report
in
front
of
the
board
rather
soon
and
a
combination
of
I
think
you're
the
exhaustive
amount
of
work
you
were
doing
probably
delayed
if
I
about
a
month,
and
then
we
ran
into
the
pre-election
rules
ahead
of
the
general
election,
which
causes
another
two
months
delay.
So
it's
it's
a
shame,
but
we
are.
We
are
here
today,
which
is
the
the
important
thing.
A
So
thank
you
and
your
reporters
is
really
welcome,
even
though
for
CQC
it
makes
some
pretty
uncomfortable
reading
in
many
respects.
It's
clear
that,
although
abuse
wasn't
identified
in
2015,
we
let
people
down
Walton
Hall
by
not
understanding
sufficiently
the
environment
was
such
that
abuse
could
happen
and
I
think
it
had.
We
understood
that
better.
A
We
would
have
made
sure
that
the
provider
themselves
taken
action
which
hopefully
would
have
prevented
the
abuse
from
occurring
so
yeah.
We
we
absolutely
know
we
need
to
improve
how
we
regulate
mental
health,
learning,
disability,
and/or,
autism
services,
so
we
can
get
better
at
spotting,
poor
care
and
using
the
information
that
people
give
us
and
we
are
working
hard
to
it
to
improve,
and
we
want
to
involve
the
people
in
families,
carers
and
other
stakeholder
organizations
to
make
sure
that
we
we
get
it
right.
A
So
your
report
is
a
really
important
part
of
of
that
David.
We
all
the
board
have
had
a
obviously
opportunity
to
have
read
the
report
in
advance
of
this
morning
and
will
have
done
so
and
we
will
be
making
the
report
available
publicly
at
the
end
of
this
meeting.
So
given
that
could
I
suggest
that
without
obviously
stopping
you
saying
whatever
you
want
to
stay,
that
say
that
we
fundamentally
concentrate
on
the
recommendations
which
I
think
are
the
essential
next
steps
for
us
as
a
board.
F
F
Unfortunately,
that
meant
not
making
the
October
board
and
then
after
that,
of
course,
despite
the
reporting
in
it,
the
review
in
it
in
effect,
having
concluded
this
is
the
first
opportunity
to
and
submit
it
to
you
I
think
I.
There's
little
point
of
me
summarizing
the
seven
recommendations,
I'm
more
than
happy
to
take
the
discussion
as
it
flows.
I
think.
The
only
thing
that
I
would
say
is
that
they
cover
three
broad
areas.
The
first
are
essentially
general
recommendations
about
processes
that
I
identified
during
the
course
of
the
review.
F
The
second
area
was
really
about
the
Quality
Assurance
process
and
on
that,
of
course,
I've
also
referred
to
the
other
review
that
the
Commission
has
commissioned
from
Professor
Murphy,
who
will
look
at
it
in
a
much
broader
view,
but
just
from
the
material
that
I
saw
around
the
2015
and
2016
inspections.
I
had
concerns
about
the
way
in
which
the
quality
assurance
process
operated
and
when
it
operated
quite
late
in
that
in
the
piece
and
the
third.
Interestingly
enough,
given
dr.
Henrietta,
Hughes's
role
was
about
the
whistleblowing
process
within
CQC
and
I.
F
Note
that
they've
been
significant
improvements
since
2015-2016,
and
the
only
other
thing
that
I
would
emphasize
for
those
who
read
the
report
is
that
it's
necessary
for
them
to
read
the
three
warnings
that
I
issue
in
Chapter:
seven
about
the
recommendations,
I,
don't
overestimate
or
over
emphasized.
Nor
do
I
underemphasized
the
difficulty
that
I've
had
in
dealing
with
an
event
that
happened
now
in
essence,
nearly
five
years
ago
and
in
any
organization
doing
that
sort
of
archaeology
will
always
be
difficult
and
I
think
that's
an
important
caveat
to
place.
C
David,
thank
you
very
much
for
the
report.
It's
an
important
report
for
us,
as,
as
Peter
has
already
said,
we
are
determined
to
improve
the
way
we
regulate,
inspect
and
identified
poor
care
and
abuse
in
these
closed
environments
and
I
think
we
are
working
very
hard
to
do
that.
You'll.
Your
report
and
recommendation
they're
going
to
be
really
very
helpful
in
that
regard.
We
are
going
to
incorporate
them
into
the
work
that
is
already
underway.
C
Your
recommendations
are
helpful
in
taking
that
forward
and
we
are
committed
to
implementing
them
all
in
full
as
part
of
that
work
going
forward,
and
we
will
of
course
build
on
that
when
we
get
the
report
from
professor
Murphy's
report
in
due
course
and
I.
Think
that's
going
to
be
very
important.
Can
I
just
just
say
a
few
things:
I
mean
you.
You
do
pay
tribute
to
the
candor
openness
and
constructive
contribution
of
the
staff
you
spoke
to
and
can
I
just
pay
tribute
to
them.
C
Many
who
have
been
energised
by
the
publicity
coming
out
of
Wharton
Hall
to
speak
to
us
to
help
us
identify
the
problems
in
other
and
other
centers.
They
are
invaluable
to
us
and
I
think
they
don't
get
enough
recognition
for
the
support
they
give
us
in
the
work.
We
do,
and
finally
you
in
your
report,
you
highlight
the
fact
that
the
model
of
care
that
warden
Hall
was
a
model
of
care
that
causes
real
concern
in
itself.
C
We
are
publishing
the
the
second
phase
of
our
report
shortly
in
the
spring,
and
that
is
going
to
be
really
very
important
and
I
think
it
is
an
opportunity
which
we
must
not
let
slip
to
allow
the
to
move
forward
from
this
model
of
care
that
has
been
allowed
to
last
too
long
in
the
system
and
I
think
that
is
another
important
part
of
what
we
can
contribute
in
the
aftermath
of
this.
So
thank
you
very
much.
Thank.
G
And
then
Kate
Derry.
Thank
you
very
much
for
the
work
you've
done
on
this
important
issue.
I
think
everyone
around
this
table,
and
indeed
in
CQC,
who
watched
the
panorama
program
and
cannot
be
failed
to
be
horrified,
moved
and
determined
to
see
care
for
this
most
vulnerable
group
of
people
improve
in
the
future.
We
have
to
play
our
part
in
giving
them
the
voice
they
cannot
use
for
themselves.
G
There
were
clear
failings
on
the
part
of
a
number
of
organizations
and
professionals
interfacing
with
Walton
Hall.
It
seems
to
me,
and
your
reporters
highlighted
very
clearly
our
failings,
which
we
must
deeply
regret
and
be
responsible
for
as
a
non-exec
I
want
to
play.
My
part
in
helping
the
organisation
improve
care
for
this
group
of
people,
and
so
therefore,
I
have
two
questions.
One
for
you
and
one
about
my
furry
in.
A
A
F
John's
point
I,
think
and
I
make
this
point
early
in
the
report.
That
one
of
the
very
important
elements
to
bear
in
mind
is
the
context
at
the
time,
and
the
context
at
the
time
was
that
CQC
itself
was
going
through
a
very
fundamental
reform.
There
was
a
change
to
the
inspection
regime.
The
introduction
of
that
regime
into
the
private
or
the
independent
mental
healthcare
provision
I
think
was
rushed
and
possibly
added
to
the
pressures
on
staff
at
the
time
so
taking
on
board
at
the
Chairman's
point.
F
What
I
found
in
2015-16
was
indeed
an
organization
that,
in
in
this
element,
was
going
through
fundamental
change.
That
seemed
to
be
improving
the
processes
that
were
being
applied
for
inspection
as
regards
this
particular
Hospital
and
that
particular
region
and
that
area
of
care.
I
think
that
implementation
could
have
been
better
done
and
I
think
there
are
lessons
to
be
learned
for
any
organization.
F
G
And
if
I
may
just
ask
in
so
I
know,
there's
a
an
internal
wharton,
whole
group-
I
can't
quite
remember
known,
but
really
looking
at
this,
and
presumably
the
report
here
will
be
an
opportunity
for
them
to
come
to
the
board
or
the
subcommittees
to
discuss
with
us
where
they've
gotten
what
actions
are
being
taken.
Yes,.
H
I
know
Kate's
going
to
talk
in
detail
in
a
moment
about
about
the
the
work
of
that
group,
but
I
think
my
expectation
is
that
we
will
come
back
to
the
board
on
a
regular
basis.
I
think
what
we
want
to
ensure,
though,
is
that
these
actions
are
properly
embedded
in
the
in
the
work
that
we
are
doing,
and
that
means
embedding
some
actions
in
the
transformation
program.
It
means
separate
work
in
some
cases,
but
it
is
about
embedding
these
things
properly
into
what
we
do
as
opposed
to
an
action
plan.
A
I
So
if
I
could
just
echo
and
thanks
it's
been
given
to
you
and
David
for
these
recommendations,
so
I
just
wanted
to
provide
a
bit
of
assurance
to
the
board
about
how
we're
going
to
oversee
the
governance
of
this.
So
as
ever,
it's
critical
when
we
get
a
report
with
recommendations.
We
have
a
robust,
considered
response
and
then
we
track
that
response
to
ensure
it
does
what
it
was
intended,
which
is
improve
outcomes
for
people.
I
So
the
reason
why
I'm
speaking
to
this
is
I
am
currently
chair
of
a
program
board
called
improving
regulation
today
and
that
program
board
oversees
changes
that
we
need
to
make
to
the
way
we
regulate
in
the
next
kind
of
12
to
18
months.
So
relatively
short
term
changes
noting
the
longer
term
piece
of
work,
that's
going
on
about
our
strategy
and
future
future
direction.
So
I
chair
this
program
board
that
has
deputy
chief
inspectors
from
across
the
three
inspection
directorates
as
well
as
colleagues
from
legal,
so
Rebecca
sits
on
the
board.
I
We
have
overview
of
a
number
of
important
projects,
but
then
the
discussions
we've
had
is
that
it's
absolutely
critical,
that
the
recommendations
that
you've
got
david
has
a
kind
of
formal
home
within
a
governance
structure
where
we
receive
regular
high
light
reports
and
we
have
the
suitable
visibility
that
progress
is
being
made
and
that
if
people
are
hitting
blockers,
we
have
the
right
level
of
seniority
in
the
room
to
kind
of
overcome
those
blockers.
So
we've
received
your
recommendations.
We
will
start
working
them
up
into
a
robust
action
plan.
I
The
board
I
chair
will
have
oversight
of
the
progress
it's
making,
but
I'd
like
to
request
to
the
board
that
we
come
back
in
March
time
with
an
overview
of
that
action
plan
and
the
progress
that
we've
made
by
then.
Some
of
this
weave
action
already-
and
some
of
this
is
partially
actioned
as
some
of
this
needs
to
get
started,
but
I'd
really
like
to
come
back
with
a
kind
of
robust
picture,
with
good
consensus
from
across
the
organization
about
where
we
are
and
present
that
in
March.
If
that's,
okay,
sir
good.
J
You
very
much
for
the
recommendations
which
I
think
we're
you
know
really
glad
to
be
implementing
in
full
alongside
some
other
work
which
people
have
described.
I
I
think
the
detail
in
the
report
is
really
helpful,
as
well
as
the
specific
recommendations
and
I
just
wanted
to
pull
out
an
example
to
give
a
sense
of
of
it
and
how
it
links
to
some
of
our
other
work
and
what
it's
really
important
for
us
to
do
and
to
track.
As
Kate
was
saying.
J
So
you
make
a
recommendation
about
improving
the
information
that's
available
to
inspectors
and
I
think
our
inspectors
do
have
quite
a
bit
of
information
available
to
them
from
safeguarding
alerts
from
speaking
up
information
and
increasingly
I.
Think
from
the
voice
of
people
who
themselves
are
using
services
and
we're
very
determined
to
find
the
best
ways
of
hearing
from
people
themselves,
as
well
as
from
advocates
and
from
their
relatives,
and
you
know,
there's
a
whole
methodology
around
that.
J
But
I
think
the
other
thing
is
that
how
inspectors
use
that
information
is
through
a
lens
which
is
specific
to
more
closed
environments,
where
there
are
risks
of
toxic
cultures
and
where
people
need
to
spot
the
signs
of
those
particularly
toxic
cultures.
And
we
did
put
out
some
guidance
recently
that
enables
inspectors,
even
if
they
don't
identify
actual
abuse.
They
are
able
to
identify
those
worrying
signs.
J
The
risk
factors
for
the
potential
of
abuse
and
certainly
for
a
beautiful
culture,
zorb
or
cultures
that
are
damaging
to
people
who
are
living
in
quite
vulnerable
situations
and
and
I.
Think
that
what
that
does
is
so
it's
it's
about
having
the
right
information,
but
also
being
able
to
use
that
information
in
a
context
in
which
I
think
we're
increasingly
using
a
human
rights
framework
to
guide
the
whole
of
this
work
and
that
threads
through
our
work
on
mental
health
act.
J
Our
work
on
the
thematic
review
on
restraint
and
seclusion
segregation
that
several
people
have
mentioned
and
our
response
to
your
recommendations
and
to
I'm
sure
the
forthcoming
recommendations
from
Professor
Murphy,
so
I
think
we've
got
a
lot
of
work
to
do,
but
I
think
it's
about.
Looking
at
all
the
powers
that
we
have
and
Ted
has
mentioned,
you
know
that
we've
actually
closed
some
of
those
institutions
and
we've
rated
them
as
inadequate,
so
the
full
range
of
our
powers,
but
also
picking
up
on
the
detail.
J
That's
in
your
report
and
integrating
it
with
the
kind
of
work
that
we're
that's
in
train
to
make
sure
that
we
really
act.
So
it's
cut
is
something
about
we.
You
know
we
accept
all
the
recommendations
and
we're
going
to
implement
them,
but
we
want
to
implement
them
at
a
level
that
we
can
be
assured
really
makes
that
difference
to
people
who
are
living
in
vulnerable
situations.
I.
F
Wonder
if
I
could
just
add
a
word
to
that
certainly
I
absolutely
agree.
That
of
the
guidance
which
has
come
out
recently
will
obviously
help
in
identifying
these
sort
of
cultures.
I
do
make
the
point
that
both
the
notification
that
was
available
at
the
time
from
NHS
improving
lives
and
indeed
the
2015
report.
F
Think
you
need
to
involve
the
Inspectorate
level
in
implementing
these
changes
so
that
it's
fully
understood
and
appreciated
by
those
who
are
going
to
go
out
into
these
settings
day
and
day
out,
because
I
think.
Otherwise.
There
is
a
risk
that
this
will
be
being
seen
to
be
done
to
people
rather
than
done
with
them.
K
Just
trying
to
make
others
other
colleagues,
then
thanks
for
your
the
detail
and
the
sense,
the
clarity
of
the
recommendations
are
quite
important.
I
think
this
two
important
points
when
he
just
touched
upon
and
one
further
and
it's
important
in
a
way
we
take
the
recommendations
forward
that
both
colleagues
internally
and
also
people
have
been
involved
in
this
work
who
sits
outside
the
organization,
see
how
we
intend
to
employ
these
think
gives
both
colleagues
internally
and
others.
K
Confidence
in
our
work
I
reflect
on
what
we
would
ask
an
organization
to
do
in
a
circumstance
where
we
were
issued,
a
report,
we're
expecting
up
to
say
we
accept
the
recommendations
and
then
to
make
sure
they
have
an
action
plan
to
implement
them.
I
think
this
is
particularly
important
for
us,
because
this
works
it's
in
a
wider
context,
as
John's
already
mentioned,
and
there
are
there
are.
We
know
there
are
services
and
Ted's
mentioned.
There
are
services
that
are
not
providing
the
right
care
for
people
and
it's
important.
K
We
can
take
these
recommendations
forward
quickly
so
that
we
can
go
on
to
the
to
the
more
important
job.
The
equally
important
job
of
making
sure
service
users
are
provided
with
safe,
effective
environments
in
which
to
to
live.
So
thank
you
for
the
recommendations.
I
think
they
can
do
it
with
which
they'll
be
taken
forward.
It's
hopefully
clear
for
colleagues
to
see
and
I
think
it
helps
us
get
on
to
the
to
the
the
important
question
of
how
we
improve
services
for
for
people
who
are
experienced
in
those
services
today,.
A
H
I
think,
and
just
just
I
guess
in
that
spirit,
I,
that
this
this
piece
of
work
was
initiated
by
by
contact
from
mr.
Barry
Stoney
Wilkinson
I
do
want
to
record
publicly
our
thanks
to
to
mr.
Sami
Wilkinson
for
for
taking
that
brave
step
to
to
come
forward
with
information,
as
you
rightly
said
from
five
years
ago,
and
raising
that
issue,
I
think
what
it.
What
that
has
done
is
raised
some
really
important
points
for
us
and
we've
talked
about
the
recommendations.
H
H
I
will
be
doing
that
this
afternoon,
along
with
a
copy
of
your
report
and
again
just
to
repeat
Peters
assurance
that
we
will
be
coming
back
to
this
board
again
and
again
and
publicly
talking
about
the
work
we're
doing
to
to
to
make
sure
that
we
can
improve
the
service
we
offer
to
people
in
in
very,
very
vulnerable
circumstances,
which,
ultimately
is
what
this
is
all
about.
Thank
you.
So.
H
I'll
begin
with
talking
about
performance,
others
as
you
as
you
know,
this
is
the
intermediate
performance
conversation,
so
I
will
just
just
just
pick
out
some
key
highlights.
As
we've
said
in
previous
on
previous
occasions,
we've
been
doing
a
lot
of
work
in
registration.
Although
there's
this
and
we
we
did
say
that
we
were
going
to
bring
forward
new
key
performance
indicators
and
registration
in
the
new
financial
year.
H
I
think
I
think
what
we
are
starting
to
see
is
some
important
improvements
in
registration
and
if
we,
if
members
of
the
board,
want
to
talk
about
that
and
more
detail
very
happy
to
do
that
in
a
moment,
but
I
think
I
think
it
is
good
to
see
that
the
continuous
improvement
work
that
we're
doing
is
starting
to
pay
to
pay
some
dividends.
I.
H
Other
other
points
of
performance,
I
think
the
active
work
on
digital
publisher
is
going
on,
but
I
think
it's
still.
It's
still
a
challenge
for
for
getting
reports
published
quickly
and
it's
particularly
challenging
in
the
hospitals,
directors
and
I.
Think
you'll
see
on
the
on
the
report
that
that
are
still
not
where
we'd
like
it
to
be.
But
it
is
something
work
we
are
actively
working
on.
H
If
I
look
at
the
financial
position,
I
think
our
financial
position
is
it's
good.
We
are
projecting
a
full-year
surplus
at
the
moment
of
one
point:
six
million
pounds,
which
is
about
point
point,
seven
of
a
percent
and
our
capital
position
is
also
on
track.
With
a
forecast
of
thirteen
point:
seven
million
pounds
against
a
full-year
budget
of
fifteen
million
pounds.
H
Eight
percent,
that's
within
our
target
range
of
ten
to
twelve
percent
and
sickness
levels,
remain
low
at
at
three
point:
seven
percent
and
before
I
hand
over
to
to
Ted
I,
just
wanted
also
just
to
update
the
board
on
our
position
in
relation
to
our
annual
pay
rise.
As
board
members
will
know,
we
have
an
annual
pay
rise,
which
is
due
on
the
1st
of
September
each
year.
H
We
are
pleased
to
announce
that
we've
arrived
at
a
conclusion
or
an
agreement,
rather
with
the
the
trade
unions
and
we're
looking
to
pay
our
teams,
a
two
percent
pay
rise.
They
on
on
salary,
2%
on
allowances
and
also
improve
the
pay
for
those
who
are
least
well-paid,
and
for
some
colleagues
that
means
pay
rises
of
up
to
six
percent
at
the
very
lowest
end
of
the
pay
scale.
This
this
pay
rise
is
backdated
to
the
1st
of
September
and
will
be
payable
in
the
February
salary.
H
I
think
this
is
a
really
important
point,
because
I
think
it
demonstrates
that
we
are.
We
are
looking
to
to
provide
the
best
possible
boss,
possible,
pay
and
reward
at
proposition
for
our
people
and,
as
we
come
back
in
February
to
talk
about
the
people
plan,
we'll
talk,
then
about
our
pay
and
reward.
A
G
The
the
PMS
inspections
returns
to
rating
bar
chart,
which
is
showing
a
change
from
previous,
and
quite
a
number
of
17
require
improvement
and
inadequate
I'm.
Just
wondering
a
is
there
a
reason?
That's
suddenly
come
up
because
it
you
know
traditionally
PMS
has
been
very
good
at
that,
and
secondly,
what's
the
plan
to
get
that
back
on
track.
G
D
D
There's
internal
reasons
and
external
reasons,
for
this:
we've
had
focus
over
the
last
three
months
on
this
and
looking
at
our
scheduling,
looking
at
our
information
that
we've
sent
out
to
inspectors
about
when
they
need
to
return
and
making
sure
that
they're
clear
on
the
guidance
there's
some
information
that
we're
working
through
around
data
quality
in
this
area,
I
think
the
majority,
though,
of
these
practices
it's
related
to
external
factors,
so
particularly
with
our
inadequate
practices.
Quite
often
there's
a
negotiation
about
when
we
go
back
into
those
practices
which
involves
discussions
with
our
local
commissioning.
D
Colleagues,
sometimes
there's
reasons
why
actually,
it's
not
appropriate
for
us
to
go
into
the
practice
at
that
time.
For
example,
they've
they've
just
gone
through
a
complete
change
in
in
infrastructure
within
the
practice,
sometimes
there's
reasons
that
we're
trying
to
line
up
with
other
inspections
that
are
happening.
For
example,
we
have
a
situation
where
we've
made
a
decision
to
delay
going
back
into
practices
for
a
month,
because
the
acute
trust
that
they're
integrated
with
is
being
inspected
so
we're
aligning
those
inspections
to
all
all
meet
each
other.
D
A
Funny
enough
I
was
going
to
ask
a
different
related
question
or
which
is
that
it
really
is
important.
I've
made
this
point
before
it's
really
important
that
we're
where
we
are
missing
a
KPI
were
really
clear
about
what
is
happening
in
those
those
areas
where
we
were
in
returns
ratings.
It's
really
important
and
I
think
just
demonstrations
Rosie
that
you
have
that
we
know
what
is
going
on
and
there
we
haven't
just
lost
them.
A
There
is
a
positive
reason
why
we're
doing
what
we're
doing
and
an
action
plan
to
get
back
there,
because,
as
you
sort
of
inside
John,
you
know
those
this
is
actually
about
the
people
using
those
services.
So
it
is
important,
so
you've
obviously
demonstrated
that
and
and
and
perhaps
I
could
just
ask
now-
Ted
and
and
Kjus
that
sort
of
assurance
that
were
all
over
the
reasons
why
we're
not
going
back
when
we
should
have
gone
back,
and
there
is
a
a
an
understandable
reason
for
that.
C
Well,
we're
within
the
KPI
in
hospitals
and
I
think
a
lot
of
work
goes
into
making
schedule
effective
to
make
sure
we
get
back
to
services.
There
are
a
lot
of
complex
factors,
and
so
there
are
always
some
issues
that
will
delay
an
inspection
for
a
reason
for
good
reasons,
waiting
for
an
action
plan
or
waiting
for
other
events
to
take
place.
So
the
team
is
very
focused
on
delivering
the
inspections
on
time
and
that
and
I
think
they've.
They
plan
their
inspection
program
a
long
time
ahead.
I
So,
with
regard
to
adults,
so,
and
so
far
in
this
financial
year,
we're
almost
up
to
ten
thousand
completed
inspections,
so
just
that
rosie
talked
about
scaled
I.
Suppose
just
wanted
to
start
off
by
acknowledging
that,
and
we
take
a
risk-based
approach
as
to
how
we
prioritize
our
inspection
efforts.
So
we
are
almost
100
percent
for
our
and
returning
to
inadequate
services.
We're
way
up
into
the
90s
for
requires
improvement.
So
we
absolutely
focusing
on
risk.
In
our
our
judgments.
I
We've
talked
before
at
board
about
kind
of
regional
variation,
so
I've
got
particular
challenges
around
capacity
within
the
southeast
that
we're
taking
measures
about,
but
actually
because
of
that
regional
variation.
It's
slightly
bringing
down
our
overall
performance
but
again
similar
to
Ted's
we're
in
we're
within
KPI,
but
I'm,
absolutely
confident
in
the
processes
with
which
my
staff
are
making
risk-based
judgments
about
how
we're
prioritizing
the
services
where
we
inspecting
I.
A
Realize
from
your
answer,
Ted
that
I
didn't
actually
frame
my
question
as
I
meant
to,
but
but
no
he
said
it's
like
what
I
meant
to
say
what
I
meant
to
say
was
that
if
you
have
a
KPI
of
say,
95
percent,
you
need
to
be
worried
about
the
five
percent
that
you
may
be
within
KPI.
But
you
need
to
be
confident.
You
know
what's
happening.
C
C
Case
we
do
I
mean
we.
Yes,
we
have
a
focus
on
all
of
them,
including
the
ones
that
we
haven't
got
within
the
KPI.
But
having
said
that,
as
I
said
earlier
on,
I
think
there
is
an
issue
that
we
need
to
face
up
to,
and
that
is
if
we
have
a
very
rigid
KPI,
it
stops
for
that
flexibility
in
our
inspection
program
and
I
think
we
need
a
bit
more
flexibility
in
this
special
program
to
respond
to
events,
because
things
change,
yeah,.
A
H
Just
just
very
briefly,
I
think
one
of
these
we
we
have
invested
in
this
year
is
upgraded
performance
management
systems,
so
the
ability
now
to
drill
into
regional
and
team
level
performance
and
look
at
these
things
in
some
data
I
think
I.
Think
all
three
chief
inspectors
alluded
to
that.
So
I
think
the
way
we
manage
these
things
is
much
more
sophisticated
than
it
than
it
ever
was
that
it
is
down
to
individual
circumstances
which
are
all
logged
up.
E
Thank
you,
chairman
just
wondered.
If
I
could
ask
you
a
question
about
the
finance
report
that
Ian
referred
to
I
mean
clearly,
this
looks
very
positive
compared
to
the
first
half
of
the
year,
where
it
didn't
look
quite
so
good.
So
it
reflects
a
lot
of
hard
work
to
get
us
to
where
we
are
I
just
wondered
a
question
to
Chris,
where
they're
finishing
the
finance
year
and
lime
with
our
forecast
this
year,
whether
how's
that
impacting
on
our
work
for
next
year.
L
Thanks
mark
I
think
the
hard
work
we've
done
in
the
summer
and
autumn
to
get
the
financial
position
where
we
are
now
means
we
don't
have
a
significant
challenge
going
into
next
year.
We
have
the
usual
cycle
of
looking
our
business
plan,
our
budget
and
how
that
adds
up
and
how
that
compares
across
the
organization.
But
our
rate
of
spend
is
in
a
good
place
to
land
us
into
2021
and
too
early
in
the
year.
We
had
issues
and
we've
addressed
them,
but,
as
things
stand,
I
think
we're
in
a
healthy
position.
C
C
In
other
circumstances,
the
authorities
already
the
public
in
the
spring
of
our
hematocrit.
The
final
climatic
reports
about
restraint
situation
of
segregation-
that's
covered
again
in
in
in
the
paperwork
just
to
highlight.
Next
week
we
have
the
expert
advisory
group
meeting
to
decide
on
the
final
recommendations
in
that
report
and
I'm
determined
that
those
recommendations
will
be
strong
recommendations.
That's
going
to
make
a
real
difference
to
this
group
of
people
going
forward
we're
also
publishing
shortly.
Our
annual
review
of
the
Mental
Health,
Act
and
board
will
have
seen
the
drafts
of
that
I.
C
At
a
time
when
the
government
is
considering
legislation
to
revise
the
Mental
Health
Act,
and-
and
this
is
it
if
you
like-
a
new
approach
to
our
report
with
more
focus
on
human
rights
and
more
focused
on
the
individual
stories
of
patients
who
have
been
detained
under
the
Mental
Health
Act,
so
I
think
it's
an
important
move
forward
in
the
way
we're
explaining
what
we
find
in
our
reviews
of
the
mental
health
in
the
implementation
of
Mental
Health
Act
on
an
annual
basis.
And
finally,
the
maternity
survey
is
going
to
be
coming
out
shortly.
C
I
can't
discuss
the
results
of
that
before
it's
published,
but
having
said
that,
maternity,
as
the
board
knows,
is
one
of
the
areas
in
acute
services
where
we
feel
progress
has
not
been
made
as
well
as
it
should
have
done.
We
highlighted
that
in
state
of
care-
and
this
is
and
this
maternity
survey,
where
women
report
their
their
experiences
in
maternity
services,
is
a
very
important
marker
of
the
quality
of
maternity
care,
we'll
be
looking
at
it
very
closely.
I'll
be
writing
to
trust
where
we
have
concerns
about
the
outcome.
G
You
Ted,
my
question
is
cents
relates
back
to
something
Debbie,
Noble
said
and
I
know:
you've
you've
alluded
to
in
the
past,
but
many
of
the
providers
in
closed
environments
are
actually
private,
like
Cigna
to
private
organizations
with
NHS
patients.
But
part
of
our
mission
is
to
encourage
improvement,
but
also
in
in
an
ordinary
NHS
environment.
Then
organisations
would
have
access
to
other
organs.
Other
parts
of
the
service
that
would
assist
them
in
food
that
doesn't
exist
in
the
private
sector,
so
places
like
wormhole.
G
C
It's
not
infallible
and
we
still
have
stress
we're
concerned
about,
but
many
trusts
have
improved
quite
markedly
with
support
from
NHS
improvement
in
terms
of
independent
health
care,
even
if
they're
looking
after
NHS
patients,
which
the
majority
of
mental
health
providers
are,
there
is
not
that
support
package
in
place,
because
they're
sitting
outside
the
NHS
and
I
think
it's
important
that
that
support
is
found
to
help
these
services
improve.
We
can't
solve
the
problem
purely
by
regulation.
C
We
can't
disclose
hospitals
and
solve
the
problem,
so
there
needs
to
be
support
for
hospitals
to
to
drive
improvement.
I've
spoken
to
an
interest
improvement
about
this
and
asked
them
to
develop
a
support
package
for
these
independent
health
or
organisations,
so
that
when
we
find
inadequate
care,
we
have
something
or
the
system
has
something
to
offer
those
services
to
help
them
improve
and
I'm.
Very
keen
that
they
should
develop
that
that
process
Chris.
K
C
Companies,
I
think.
The
other
point
is
that,
as
I
said
earlier
on
the
fundamental
issue
here,
that's
driving
the
potential
for
this
poor
care
is
the
model
of
care,
and
we
need
to
address
that
and
I
think
the
work
we're
doing
post,
Walton
Hall,
but
also
the
work
in
the
thematic
reviews
can
be
very
important
in
driving
a
better
model
of
care
for
these
patients.
M
You
very
much
Peter
in
a
moment,
I'm
going
to
hand
over
to
Chris
Taylor
doctor
of
engagement
to
talk
about
some
important
updates
and
achievements,
I
think
from
from
his
team
and
colleagues
across
the
organization,
but
three
things
to
highlight
from
me.
First
of
all,
as
senior
information
risk
officer
for
the
organization
I'm
pleased
to
say
that
there
has
been
no
significant
things
to
report
over
the
last
month
on
our
information
or
cyber
security
risks.
M
Secondly,
in
line
with
all
other
public
organizations
and
government
more
widely,
we
have
stood
down
our
preparations
for
a
potential
No
Deal
exit
off
the
UK
from
the
u
by
the
end
of
this
month.
Given
that
there's
now
a
widely
hit
expectation
that
the
withdrawal
agreement
will
be
ratified
by
the
UK
and
the
EU
and
going
forward
CQC
will
contribute
to
the
Department
of
Health
and
Social
Care
negotiations
and
contributions
to
the
trade
negotiations
with
the
EU
and
other
countries.
And
thirdly,
I
wanted
to
highlight
that
tomorrow.
We're
publishing
a
report.
M
So
that's
the
result
of
our
first
regulatory
sandbox
into
new
technologies
in
Health
and
Social
Care.
A
regulatory
sandbox
is
a
is
a
for
modern
process
of
collaborating
over
a
very
quick
amount
of
time,
with
the
developers
of
new
technologies
providers
and
people
using
services
to
identify
what
good
actually
looks
like
in
the
deployment
of
new
technologies
and
what
gaps
might
exist
in
that
understanding
widely,
but
also
specifically
for
us
as
a
regulator,
and
this
first
sandbox
is
focused
on
digital
triage
tools,
particularly
primary
care,
but
also
and
other
area,
and
our
report.
M
That
highlights
that,
including
of
what
we
believe
is
a
good
description
of
what
actually
good
deployment
of
digital
tree
of
choice
looks
like
it's
coming
out
tomorrow
and
we
are
concluding
to
further
send
boxes
for
the
rest
of
this
financial
year.
One
on
the
use
of
machine
learning
and
diagnostics,
and
one
on
the
emergence
of
new
models
of
care
to
provide
personal
assistance
and
care
in
people's
homes
and
they're,
going
to
be
published
by
the
end
of
March
and
without
over
decree.
So.
A
Multi
colleges
before
we
leave
that
I
mean
the
sandbox
was
a
innovative
idea.
I
think
we,
we
saw
it
as
a
bit
of
a
parlor
to
see
whether
how
it's
going
to
work
given
where
you've
got
to
so
far.
Is
it
something
that
you
think
has
been
successful
as
an
approach,
and
we
may
need
some
formal
evaluation
later
on,
but
I
mean
just
your
immediate
senses
is
something
that
we
should
be
so.
M
Technologies
and
provide
us
that
we
haven't
had
in
this
way
before,
because
it's
a
very
focused
iterative,
quick
event,
and
while
there
is
a
very
clear
application
process
for
the
developers
and
services
that
we
work
with,
it's
obviously
relevant
to
anyone
deploying
these
these
technologies.
So
there's
definitely
I
think
it
benefit
in
the
type
of
process,
possibly
beyond
technologies
that
we
can
that
we
can
build
on
that.
M
It's
also
really
helpful
for
them
to
understand
what
we,
as
the
regulator,
are
looking
for,
and
while
there's
many
other
regulatory
and
other
bodies
involved
in
the
development
of
new
technologies,
all
the
way
from
the
beginning
of
the
research
and
the
evidence,
all
the
way
to
the
deployment
wanted
off
the
technologies
and
services
when
it
becomes
relevant
to
to
CQC.
These
conversations
coming
very
helpful.
H
H
Just
a
bill
that
I
think
what
it
what
this
does
do
is
it
is.
It
publicly
acknowledges
our
willingness
to
have
a
conversations
providers
around
new
and
novel
models
of
service
delivery.
I
was
with
a
provider
on
Monday
and
they
were
very
positive
about
the
the
pre
engagement
work
and
conversations
they've
had
with
us,
which
meant
they
were
able
to.
H
When
they
came
to
us
to
register
a
service,
they
ended
up
being
able
to
register
that
quickly
and
easily
and
they
weren't
wasting
time
building
a
service
which,
which
was
then
unregister
able
and
I
think
this
is
another
really
good
example
of
this.
These
are
these
are
interesting
and
novel
technologies,
and
what
we
want
to
do
is
make
sure
that
people
build
them
and
develop
in
the
right
way,
rather
than
rather
than
build,
something
which
they
think
is
registerable
and
then
find
that
we
say
no,
because
there's
some
there's
some
quirk
to
it.
H
They
said
it's
unsafe
in
some
way,
so
I
think
this
this.
This
is
a
really
positive
piece
of
work,
but
I
think
it's
part
of
a
broader
attitude.
If
you
will
that
the
Commission
has
around
around
being
open
to,
if
you
like,
free
application
advice,
which
I
think
is
really
very
important
for
people
to
know,
I
think.
A
I
think
you
had
an
important
point
more
to
the
that,
whilst
this
probably
mainly
will
be
about
use
of
technology
it
may
not
be,
it
could
be
some
other
innovative
provision
of
care
model.
So
I
think
it's
a
to
your
point
in
and
I
think
signalling
that
we
really
want
these
discussions.
We
obviously
want
to
see
innovation.
We
want
to
see
people
be
able
to
improve,
but
it's
got
to
be
in
a
way
that
were
able
to
be
satisfied.
It's
it's
safe
and
we
can.
A
K
And
so
just
a
few
other
things
too,
to
bring
the
board
up
to
speed
with
the
first
is
the
launch
of
our
podcast
series
so
see
the
conversation
we
had
with
both
public
groups,
so
the
other
stakeholders
and
providers.
It
was
clear
that
there
was
a
need
for
a
formal
where
we
could
continue
conversations
that
might
be
about
the
launch
of
particular
products
or
initiatives.
K
So
the
podcast
series
is
our
first
exports
into
into
trying
to
do
that.
To
try
and
take
issues
that
we
have,
we
may
have
a
news
day
on
and
but
to
have
a
longer
conversation
to
drive,
change,
to
think
about
changing
attitudes
or
behaviors.
On
a
particular
topic,
I'm
delighted
to
say
that
we
were
just
launched,
the
the
second
of
the
of
the
podcast
series.
We've
talked
about
the
first
four
in
the
board
report.
K
We've
got
so
far
to
9000
subscribers
who've
regular,
streamed.
The
first
two
podcast
receive
you
a
sense
of
where
that
sits.
The
nearest
comparison
guess
would
be
NHS
England's,
regular
series
they
get
between
200
and
1200
downloads
or
streams
per
month.
So
it's
so
it
isn't
a
competition,
but
it's
just
to
give
a
sense
of
where
we
are
in
the
in
that
work.
K
The
next
area
was
around
the
launch
and
coast
I
mentioned
earlier:
the
launch
of
the
give
feedback
on
care
service,
so
we've
sort
of
bita
launched
it,
which
means
basically
we've
done,
which
is
now
live
on
the
site.
We
intend
to
do
a
sort
of
formal
with
stakeholder
colleagues.
At
the
end
of
this
month,
we've
also
put
together
a
launch,
particularly
around
learning
disabilities.
We've
been
trying
a
number
of
what
we
call
spikes
areas
where
we
want
to
really
engage
with
with
people
who
may
not
use
this
service
more
directly.
K
So
we've
been
working
with
organizations
that
work
with
people
with
learning
disabilities
to
try
and
encourage
them
to
give
us
their
feedback
on
on
the
care
that
they
they
receive
and
the
first
week
since
the
service
has
gone
formally
live.
We've
seen
a
10%
increase
in
in
the
amount
of
feedback
we've
received,
which
is
good,
though
I
think
we
can
get
better.
As
we
formally
launched
the
service
instantly,
we've
got
a
better
uptake
from
people
searching
for
a
service
and
then
giving
us
direct
feedback
and
I
think
that's
really
important.
K
That
was
one
of
the
vehicles
that
were
there
one
of
them
that
measure
the
success
for
this.
But
how
easy
is
it
for
people
to
search
for
service
see
the
service
they
want
to
talk
about
and
then
offer
us
feedback.
So
we've
seen
a
significant
improvement
in
that
I
want
to
monitor
the
the
launch
of
the
service
formally
and
then
come
back
to
board
on
a
quarterly
basis
to
give
a
sense
of
how
that
how
that
feedback
is
working
it
just
to
go
back
to
the
point
we
talked
about
earlier.
K
Getting
feedback
from
people
who
use
services
and
their
families
is
a
vital
part
of
how
we
understand
the
quality
of
service
and
making
this
service
accessible
and
easy
to
use
and
making
sure
people
can
get
to
the
end
of
the
process
easy
easily,
as
well
as
making
collie.
The
information
available
in
the
right
format
for
inspectors
was
a
key
key,
an
important
task
as
part
of
this
work.
We
we
talked
about
it
internally
in
a
meeting
last
week.
K
I
think
what
was
really
pleasing
for
me
is
the
way
in
which
colleagues
from
intelligence,
colleagues
from
digital
and
colleagues
from
the
inspection
directorís
worked
together
to
make
this
a
good
service.
So
it
was,
it
was
a
really.
It
was
a
really
cross
organization
collaboration
to
help
deliver
to
deliver
this
service.
K
The
last
thing
I
want
to
do
is
talk
about
the
the
contract
award
for
experts
by
experience,
as
colleagues
know,
we've
we've
exercised
peers
have
been
part
of
how
we
regulate
services
for
a
number
of
years,
I'm
delighted
to
say
that
we've
we've
made
an
award
for
the
new
contract
to
choice,
support
some
things
that
were
important
to
me.
Obviously,
though,
we
look
at
organizations
based
on
the
quality
and
and
cost
basis
and
of
a
choice,
support
where
the
best
supplier
on
both
on
both
aspects.
K
It
also
gives
us
the
ability
to
harmonize
the
wall
package
for
experts,
bias,
variance
up
to
the
level
that
choice,
support
currently
offer
and
to
make
sure
we
get
consistency
in
the
quality
of
experts
that
are
used
on
inspection
and
elsewhere,
and
I.
Try
to
thank
colleagues
in
in
commercial
finance
who
provided
the
right
support
or
for
this
contract
to
be
to
be
puts,
but
and
it'll,
be
there,
be
a
phased
launch
of
this
contract.
Those
conversations
now
between
now
and
March,
with
a
formal
launch
at
the
the
1st
of
April.
C
I
just
comment
about
the
podcasts
that
Chris
I
haven't
heard
them
all
yet,
but
I
think
they're,
probably
stronger.
If
we
bring
in
people
from
outside
the
CQC
to
talk
with
us,
so
we
can
have
a
conversation,
I
think
conversational
podcast.
If
you
like
more
and
more,
they
draw
you
in
better
than
just
someone
speaking
to
a
microphone.
I
speak
as
someone
who's
just
spoken
to
microphone.
Okay,.
K
K
330
groups
outside
the
organization
about
how
they
join
together,
what
they
all
wanted
to
see
was
what
we
were
doing
if
they
wanted
just
ones
a
couple
of
examples
of
it
before
they
would
commit,
but
I
that
they've,
what
they've
heard
from
both
yours
and
for
the
give
feedback
on
care
pilot
has
been
positive,
so
I
think
we'll
get
more
interaction
with
colleagues
I
think
it's
just
just
a
good
opportunity
to
make
sure
we've
had
a
conversation
outside
to
say
the
report.
We've
got,
we've
got
reports
kind
of
lightly.
K
M
E
You
chairman
I
also
have
a
question
about
podcasts
and
I
have
listened
to
two
Ted's
and,
like
my
mic,
my
question
comes
really
about
how
we
are
promoting
these
podcasts,
because
I
only
found
out
about
it
by
reading
Kate's
blog.
So
just
wonder
what
the
process
is
to
making
it
very
public
today,
but
how
we
pushing
this.
K
Forward
for
our
providers
to
listen
to
this,
so
the
great
thing
about
being
a
regulator
is
that
providers
tend
to
read
the
information
that
we
send
to
them.
So
we've
got
a
regular
communication
with
providers
which
goes
out
to
different
groups
each
month
and
they
have
a
they
have
a
strong,
open
and
read
rate
so
that
that's
one
of
the
vehicles
for
providers
that
we
we
will
use
to
talk
about
the
information
it's
in
the
podcast
and
particularly
well
tailor
so,
for
example,
Ted's
what
was
particularly
relevant
for
conversations
within
NHS
services.
K
We
would
tailor
its
that
group.
We
also
asked
for
colleagues
who
work
in
other
organisations
to
support
this,
and
this
is
sort
of
a
mutual,
so
NHS
providers,
NHS
England,
the
kingsford
all
have
podcast
series
and
we
we
on
social
media.
We
actively
support
each
other's
podcasts
in
that
in
that
space
and
I
think
there's
other
opportunities
as
well.
So
as
we
go
to
events,
and
as
we
go
to
two
other
engagements
like
co-production
groups,
where
we
have
the
opportunity
to
engage
colleagues,
we
will,
we
will
make
sure
that
that
is
available.
K
I
think
it
will
develop
over
time
as
well.
I
think
people
will
be
interested
in
particular
topics
and
I
think
Ted's
point
about
making
sure
that
we
and
multiple
about
making
sure
that
when
we
talk
so
when
we
talk
to
the
digital
community
will
use
their
their
channels
and
their
networks
to
promote
that
that
podcast,
because
it
will
have
a
particular
relevance
to
them.
H
So
in
thank
you
and
just
just
to
finish
off
that
point.
We've
just
kicked
off
a
piece
of
work
to
look
at
new,
a
new
website,
new
intranet
and
again
part
of
that
is
looking
at
web
chat,
podcasts
on
how
to
embed
those
a
bit
more
dynamically
in
the
web
site
than
is
currently
the
case.
I
just
want
to
come
back
on
the
gift,
wrap
feedback
on
on
care,
really
because
I
think
it's
a
good
example
of
linking
a
piece
of
technology.
Investment
with
our
core
purpose.
I
mean
this.
H
This
meeting
has
had
a
recurring
theme
through
it
of
of
the
importance
of
feedback
and
the
importance
of
whistleblowing.
What
we've
done
here
with
give
feedback
on
your
care
is
we
have
designed
a
a
a
digital
service
that
actively
makes
it
easy
to
to
give
feedback
on
care,
but
it's
not
just
a
simple
form.
H
What
it
does
is
it
steps
people
through
the
importance
of
the
information
that
they're
giving
us
and
why
it's
important
to
give
us
detail
and
even
talks
about
things
like
that,
the
the
positives
and
negatives
of
being
anonymous
in
terms
of
the
feedback,
so
so
I
think
I
think
the
ability
to
have
a
almost
an
interactive
relationship
with
people
who,
understandably,
in
many
cases,
are
perhaps
quite
nervous
about
giving
feedback.
What
we
try
to
do
is
build
a
relationship
as
part
of
that
process,
so
I
think
I
think
it's
it's.
H
H
J
Thanks
for
much
and
I
wanted
to
just
talk
about
the
the
focus
on
learning
disabled
people
in
the
declare,
your
care,
so
this
seems
both
very
important
time
very
timely.
Given
all
the
work
that
we've
been
discussing
earlier
about
some
people
in
disabilities,
autistic
people
and
so
I
suppose
one
issue
is,
it
would
be
great
if
there
are
any
patterns
in
the
kinds
of
feedback
that
people
are
giving
that
it
would
be
good
to
be
able
to
feed
those
into
our
thinking.
J
It
would
be
great
to
have
a
discussion,
maybe
in
the
regulatory
Governance
Committee,
about
kind
of
how
experts,
by
experience,
you
know
where
they're
adding
the
most
value,
how
they're
supported
and
trained
what
the
dynamics
are
of
how
they
operate
within
the
teams
during
inspections
and
all
of
that
to
make
sure
that
you
know
it's
working
as
well
as
it
can
and
I
think
we'd
be
really
really
keen
to
have
that
discussion.
But
you
know
not
until
people
have
got
their
feet
under
the
desk,
so
to
speak.
Yeah.
K
K
So
what
we
intend
to
do
is
that
the
logic
of
each
of
these
spikes
is
it
that
colleagues
in
Intel
interesting
will
analyze
the
information
which
comes
in
and
they'll,
have
replied
to
provide
a
report
and
that
will
guide
sort
of
further
either
engagement
work,
but
they
will
indeed
further
area
regulatory
work
that
we
might
do
so.
I
can
certainly,
when
we
get
that
report,
I
certainly
bring
it
back
and
perhaps
also
to
the
regular
conference
committee.
So
we
can
talk
about
it
there
in
terms
of
exposed
by
experience.
K
One
of
the
things
that
was
really
horton
to
me
is
that
and
when
we
let
this
contract,
that
it
wasn't
just
about
the
act
of
people
going
on
inspections
and,
as
a
part,
two
of
the
contract,
which
is
very
much
about
how
people
who
are
experts
by
experience,
can
provide
their
support
and
to
us
outside
formal
inspections.
Before
before
and
after
and
if
we
really
want
to
create
and
always
on
a
view
of
quality,
we've
got
to
get
the
voice
of
people
not
just
at
the
time
of
inspections,
but
around
that
time.
K
So
part
two
is
a
gives
us
that
flexibility
to
test
and
trial
different
methods.
I
think
one
thing
has
been
really
pleased
about
choices.
Response
to
that
is
they've
suggested
they've
work
with
us
for
a
number
of
years,
but
it
suggested
some
of
the
things
that
they
might
do
and
might
do
differently
to
provide
that
support,
and
I'm
really
happy
to
bring
some
of
those
conversations
back
to
the
retinue
to
government's
committee.
K
A
J
So
yesterday
we
had
meeting
of
the
regulatory
Governance
Committee.
We
focused
a
lot
of
the
meeting
on
a
primary
care
update,
which
was
really
helpful.
One
of
the
things
that
we
discussed
was
some
some
concerning
general
data,
that
from
people
using
primary
care
about
that,
for
some
people,
like
lack
of
feeling
involved
or
not
feeling
supported
enough
in
management
of
their
own
health
conditions,
but
also
pressures
on
the
primary
care
system
in
terms
of
workload
and
breakin
C
rates,
and
things
like
that,
and
we
talked
about
what
that
meant
for
CQC
and
I.
J
Think
the
the
the
summary
kind
of
point
from
the
committee
was
that
our
ratings
must
reflect
the
quality
of
care
for
the
people
using
the
service.
So
we
don't
change
the
ratings,
but
at
the
same
time
we
are
very,
very
alert
and
sensitive
to
the
kinds
of
pressures
that
exist
in
primary
care,
and
we
want
to
reflect
that
in
how
we
frame
our
reports
and
our
our
work.
J
We
talked
about
wanting
to
ensure
a
strength
of
user
voice
in
all
our
work
in
primary
care.
We
touched
on
that
small
number
of
practices
that
don't
improve
or
that
go
in
and
out
of
a
kind
of
negative
rating,
and
we
just
talked
about
how
we
can
work
with
partners
to
try
and
support
improvement
in
a
kind
of
holistic
way.
J
We
touched
very
briefly
on
digital
and
I
think
that's
something
we
need
to
come
back
to,
but
clearly
there's
a
very
important
piece
of
work
that
needs
to
be
done
on
informing
the
public
on
how
to
make
safe
choices
about
using
digital
primary
care
services.
We
then
focused
on
research
in
CQC's
research
and
evaluation
activity,
and
it's
a
number
of
different
options
about
kind
of
the
future
and
where
our
research
and
evaluation
activity
could
go
and
I
think.
J
We
thought
some
of
the
areas
that
could
be
fruitful
would
be
understanding
our
own
impact
and
also
understanding
models
of
regulation.
So
you
know
what
what
are
the
best
models
of
regulation?
What
can
we
learn
from
other
sectors
from
other
countries
and
so
on,
so
that
we're
kind
of
ahead
of
the
curve
in
terms
of
our
own
regulatory
practice
but
I
think
not
expanding
a
huge
kind
of
research,
Enterprise
ourselves,
much
more
about
being
smart
with
existing
research
and
partnerships?
A
I
You
know
I
suppose
a
piece
of
my
main
takeaway
from
that
conversation
was
we're
really
interested
in
using
research
where
we
can
demonstrate
that
the
outcomes
about
improving
outcomes
for
people.
So
we
talked
a
lot
about
evaluation
and
not
just
just
evaluating
the
impact
of
our
independent
voice
products
in
terms
of
people,
hearing
the
messages
and
doing
things
different,
but
how
does
that
translate
to
actual
tangible,
improved
outcomes
of
people
using
health
and
care?
So
I
felt
that
there
was
a
real
takeaway.
That
said?
Yes,
let's,
let's
use
was
that
out
there.
I
C
I
think
that's
right,
great
ed,
well,
I'm,
afraid
I
missed
that
discussion,
but
it
sounds,
sounds
very
good,
but
I
just
want
to
emphasize
a
part
of
this
research
needs
to
be
about
understanding
how
a
methodology
can
be
as
evidence-based
as
possible
and
I.
Don't
think
we
should
just
assume
that
empirically,
if
we
go
looking
for
things
we'll
find
them,
I
think
we
know
sometimes
need
to
understand
and
we're
talking
about
getting
under
the
skin
of
some
of
these
closed
environments
earlier
on.
But
actually
how
do
we
do?
C
A
Anything
else,
so
it
was
a
really
good
discussion
and-
and
but
both
parts
of
the
media
talk
were
excellent.
Okay,
any
other
business
for
the
board
right.
So
that's
the
end,
then,
of
the
formal
board
meeting
I
have
been
notified
of
three
people
all
of
him
up
sitting
there.
They
want
to
ask
questions
taking
him
in
the
order
in
which
I
was
given
them.
Robin
I
think
your
first,
please.
G
A
D
You
very
much
Robin
for
that
question
and
absolutely
GP
access
and
and
people
being
able
to
get
in
to
see
primary
care
professionals
is
a
really
important
area.
So
just
in
terms
of
the
data
we
use.
Firstly,
we
use
a
range
of
national
data
sets
which
we
draw
from
a
range
of
organizations,
including
NHS
Digital,
from
public
health
England
from
some
of
the
NHS
business
services,
data
that
we've
got
and
also
we
work
with
NHS,
England
and
NHS
improvement
to
to
get
data
from
them
as
well.
D
That
gives
us
a
location,
specific
data
for
each
practice,
but
it
doesn't
give
us
we
don't.
We
don't
have
any
nationally
available
GP
waiting
time
data
in
that
we
do
then
look
at
how
we
can
understand
access
into
a
practice
in
a
number
of
different
ways
through
our
monitoring.
So
we
use
patient
survey
data,
so
every
practice
has
an
annual
patient
survey,
and
that
gives
us
answers
to
questions
like
the
percentage
of
respondents
who
found
it
easy
to
get
through
on
the
telephone.
D
The
percentage
of
respondents
who
are
satisfied
or
fairly
satisfied
with
GP
appointment
times
and
the
type
of
appointment
offered
and
those
type
of
questions,
so
that
gives
us
quite
a
lot
of
information
about
practice.
We
then
also
use
that,
in
conjunction
with
comments
we
get
from
NHS
Choices,
where
people
are
able
to
post
information
about
the
services
they
use
and
give
give
ratings
for
the
services
they
use.
D
We
get
information
from
local
stakeholders
like
commissioning
groups
from
local
HealthWatch,
and
we
also
ask
on
our
annual
regulatory
review
phone
calls
and
and
provider
information
collection
returns
that
we
we
ask
about
access
and
and
the
how
easy
it
is
for
patients
to
access
services.
So
that's
all
done
in
the
background,
but
then,
when
we
go
in
to
inspect
our
practice,
we
have
a
quite
a
detailed
list
of
key
lines
of
inquiry
which
actually
ask
about
how
a
practice
is
responding
to
people's
needs,
how
how
patients
can
access
those
services.
D
We
do
look
when
we
go
into
a
practice.
We
look
very
detailed
at
all
of
those
comment
cards,
so
they're
not
ignored.
Just
to
reassure
you
about
that.
We
we
look
at
every
one
of
the
comment
cards
that's
filled
in
we
meet
with
the
patient
participation
group
on
every
inspection
to
understand
their
perspectives,
and
we
also
discuss
with
people
in
the
waiting
rooms
about
their
perspectives
of
inspection.
D
M
Not
sure
Walter
does
anything
to
add
to
that,
but
if
there
is
some
specific
question
around
social
media,
of
course
you
know
if,
through
social
media
concerns
a
race
and
they're
being
brought
to
the
attention
of
CQC,
then
we're
already
able
and
have
responded
to
concerns
being
being
being
raised
across
across
sectors.
We're
also
actively
exploring
how
we
can
use
social
media
to
monitor
more
widely,
where
their
spikes
in
where
people
use
social
media
to
do
that,
whether
it's
Twitter
Facebook
others.
For
that.
M
The
reason
we're
exploring
that
a
lot
more
than,
for
example,
where
we
can
use
material
more
readily
without
interest
choices.
Is
that
it's
of
course
much
more
unmoderated
data.
It's
quite
skewed
in
terms
of
where
people
provide
services
and
we,
as
the
regulator,
also
want
to
be
very
open
where
we
start
using
their
data
and
how
so
the
reliability
and
usability
of
it
is
somewhat
different.
But
we
are
exploring
how
we
can
do
that
more
regularly
through
monitoring
of
social
media
as
well.
A
E
K
Thanks
for
question
David,
you
know
I
share
your
desire
to
encourage
and
promote
the
use
of
technology.
So
this
this
page
follows
a
number
of
things
that
we've
tried
to
do
so,
one
of
which
was
to
encourage
feedback
from
providers
and
people
use
services
about
what
was
working
well
around
the
use
of
technology
and
we've
published
a
report
which
sort
of
highlights
telling
examples
of
how
technology
is
being
used
to
improve
the
way
people
receive
health
and
care
services.
K
I
know
this
particular
this
particular
Izzard
is
a
more
general
bit
about
how
to
keep
how
people
can
stay
in
touch.
So
it
was
a
draft
of
it
that
I've
seen
that
will
have
ready
to
go
on
the
site
by
the
end
of
this
month.
So
that's
me
in
the
next
couple
of
weeks,
but
I
also
like
him,
want
to
try
and
get
more
feedback
from
people
using
those
services
so
that
they
can
be
the
information
that
we're
sending
as
it
has
real
meaning.
K
So
I
hope
that
page
as
it
goes
up
will
encourage
other
people
who
new
services,
other
organizations
that
you,
as
he
knows,
we've
written
to
to
give
us
their
their
experience
of
using
those
those
services
and
that
technology
to
help
improve
people's
linkage
to
their
families.
And-
and
we
talked
about
the
the
idea
of
how
technology
can
support
people
who
might
otherwise
be
lonely.
So
that
page
of
Copan
between
on
the
29th
I'll,
make
sure
that
we,
you
can
see
before
it
goes.
So
we
can.
E
Yes,
I
would
hope
that
something
would
come
out
very
soon,
well,
partly
because
that
would
stimulate
people
to
give
their
experiences
which
they
might
otherwise
not
to.
My
second
question
is
about
a
report
that
you
published
in
October,
called
identifying
and
responding
to
close
culture
as
I
suppose
it
was
inspired
by
the
Walton
experience
and
I'd
like
to
commend
you
on
that
report.
E
It
was
very
interesting
reading,
I
think
in
some
ways
very
novel
reading
coming
from
the
CQC
and
I'd
also
like
to
commend
you
on
the
signs
of
a
much
rather
tougher
approach
to
inspection
that
is
developing
I've
noticed
this.
Particularly.
There
was
an
article
in
one
of
the
professional
papers
vote
for
care
which,
from
solicitors
firms
was
saying
how
much
tougher
the
CQC
was
getting,
and
people
should
use
their
services
as
a
result,
people
in
care.
E
So
but
the
thing
about
this
report
was
that
it
was
how
to
spot
warning
signs
of
a
closed
culture,
and
that
isn't
the
same
thing
as
evidence
and
evidence
is
very
important.
Maybe
a
false
god-
and
this
puts
you
I
think
in
well.
My
feeling
is
this
puts
you
in
a
difficult
position,
because,
on
the
one
hand,
once
you've
seen
a
warning
sign,
you
have
a
sort
of
moral
duty
to
tell
the
public
and
the
care
users
about
it.
E
On
the
other
hand,
if
you
do
that,
and
you
then
given
an
inadequate
rating
you're
likely
to
have
a
legal
challenge
to
it,
because
you
haven't
actually
got
the
evidence
and
I
wonder.
Therefore,
if
something
like,
perhaps
Kate,
your
your
program
board
that
you're
doing
at
the
moment
would
look
again
at
this
question
of
how
you
would
actually
get
the
kind
of
incontrovertible
evidence
which
would
stop
reading
people
bringing
legal
actions
against
you
and
also
bring
this
these
closed
cultures
and
this
abuse
to
an
end.
Do
you
want
to
well.
C
Well,
thank
you
for
your
comments
and
challenge.
David
I
actually
think
we
need
to
do
both
I,
don't
think
it's
either
all
we
need
to
identify
circumstances
care
where
there
is
an
environment
or
a
culture
that
puts
people
at
risk
of
abuse
and
we
need
to
act
on
that.
We
don't
await
until
we
don't
have
sit
back
and
say
we
haven't
got
evidence,
we
can't
act,
we
need
to
act
on
the
risk
of
abuse
and
I.
Think
we
have
it
within
our
power
to
do
that
and
I
think.
C
We
need
to
be
bolder
and
acting
on
that,
because
now
our
job
is
to
protect
people
from
abuse,
not
to
wait
till
it
happens
and
then
intervene,
so
so
I
think
I
think
you're
right
to
say.
We
need
to
look
for
signs
of
evidence
that
proves
abuse
is
taking
place
and
we
need
to
improve
on
that
and
there
is
work
there
going
on
in
in
the
in
the
work
streams
that
we
talked
about
earlier
on,
to
look
at.
How
can
we
evidence
abuse
but
I?
C
Don't
think
we
should
step
back
from
looking
at
the
risk
factors
for
abuse
and
acting
on
that
as
well.
I
think
we've
got
to
use
the
full
panoply
of
the
evidence
in
front
of
us
and
we've
got
to
be
able
to
act
on
all
of
it.
If
people
are
at
risk
of
abuse,
we
need
to
intervene,
but
equally
we
need
to
look
really
vigilantly
for
evidence
of
abuse
going
on.
A
It's
quite
a
complicated
situation,
I
think
and
it's
a
routine.
We
will
be
returning
to
I
think
when
Professor
Murphy
report
comes
I,
think
that
would
be
another
opportunity
for
the
board
to
probably
discuss
some
of
that.
So
thank
you
for
your
question,
David
and
Andrew.
The
last
question
goes
to
you
this
morning.
O
O
Afterwards,
I
met
Sir
printer
and
she
kindly
replied
with
her
with
what
I
thought
was
a
an
interesting
and
indeed
an
honest
response
to
my
question
as
chief
people
officer
Trenor,
who
do
you
work
for,
and
I
sure
dad
it
was
first
time
at
met
pronoun,
and
she
had
no
advance
notification
that
my
question,
unlike
yourself,
I
think
it
would
be
helpful
for
patients
and
families,
those
who
regulate
their
staff
and
indeed
your
staff
for
the
CQC
to
step
back.
Consider
my
question:
who
does
the
CQC
four
and
respond
as
primitive
in
a
few
sentences?
A
I,
don't
think
we
need
to
step
back
and
consider
it
I
think
if
you
ask
any
person
who
works
for
CQC,
they
would
unequivocally
say
we
are
here
for
the
people
who
use
services,
they
are
the
people
we
work
for.
So
that's
the
absolute
clarity
as
to
our
approach.
It's
if
you
look
at
the
2008
Health
and
Social
Care
Act,
which
is
the
the
Act
that
that
set
us
up.
O
Gone
then
so
previously
you've
said
it's
not
your
policy
to
avoid
answering
difficult
questions,
and
then,
a
few
months
later
in
February
and
he's
not
here
today
and
you
said
other
than
your
question
to
Sir
Robert,
which
in
any
event
I
would
have
said
that
could
not
be
asked
in
a
board
meeting.
So
Sir
Roberts
not
here
but
could
I.
Please
ask
that
I
have
a
response
to
that
question,
because
I've
never
had
a
response.
Two
years
later
and
it's
highly
bred,
tvind
we've
talked
about
freedom
to
speak
up.
O
A
You
may
have
to
be
kind
and
send
me
the
question
again,
because
I
have
no
idea
what
your
question
was
off
the
top
of
my
head,
but
just
not
you
you
hear
when
Henrietta
was
was
presenting.
You
heard
what
some
of
my
colleagues
said.
We
are
passionate
believers
in
the
important
role
that
the
freedom
to
speak
up
and
and
and
that
the
the
benefits
that
flow
from
people
feeling
able
to
speak
up.
A
It
is
really
really
important,
so
I'm
not
sure
what
I
can
add,
but
and
I'm
not
sure
what
your
question
was,
but
if
you
send
it
to
me
again
we'll
deal
with
it,
Thank
You
Robin
and
thank
you
everybody
else
very
much
indeed,
for
coming
this
morning,
board
I
think
we
need
to
resume
in
45
minutes
time.
If
that's,
okay,
thank
you.