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From YouTube: CQC board meeting – September 2017
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A
Okay,
good
morning,
everybody
welcome
to
the
CQC
September
board
meeting.
We
have
an
apology
from
absence
from
Kate
Harrison,
otherwise,
I
think
we're
all
here.
Are
there
any
declarations
of
interest
that
need
to
be
made?
Okay,
excellent
minutes
of
the
meeting
of
the
19th
of
July?
Are
there
true
and
accurate
record
of
everything
we
discussed?
Okay,
thank
you
that
takes
us
to
the
the
action
log.
There's
a
an
action
around
HealthWatch
England
Jane.
Can
you
update
thank.
B
You
this
was
that
part
of
the
quality
matters
drive.
Healthwatch
England
said
that
it
would
work
with
the
local
government
Ombudsman
to
do
two
things.
One
is
a
simple
one-page:
how
wonderful
how
to
make
a
complaint
about
Social
Care,
and
the
second
thing
was
a
developer
link
through
to
a
process
for
making
a
complaint
about
Social,
Care
and
I'm
pleased
to
say
that
this
was
part
of
Andreas
Atlas
presentation
to
the
minister.
Yesterday,
Jacob
lamp
from
HealthWatch
England
was
there
and
it
will
be
signed
off
in
early
October.
A
D
Thanks
Peter
good
morning,
everybody
so
we're
going
to
try
a
different
way
of
presenting
the
performance
aspects
of
this
report
on
a
monthly
basis
were
my
executive
director
and
chief
inspector
colleagues
or
take
responsibility
for
presenting
the
bits
of
the
performance
report,
so
I
think
if
the
rehearsal
that
has
been
done
today,
it's
works
and
I.
Think
Eileen
is
going
to
just
kick
off
on
the
corporate
services
performance
date
and
then
we'll
pass
seamlessly
for
a1
chief
inspector
to
the
other
to
talk
about
the
performance
of
their
individual
directorates,
etc.
D
I
just
want
to
make
one
comment:
if
I
may
upfront
Peter
in
relation
to
the
performance
on
an
enforcement
activity
where
there
is
a
paragraph
in
the
covering
report
and
slide
deck
around
the
decline
in
month-on-month,
published
a
completed
enforcement
activity
and
there's
a
suggestion
in
that
that
this
is
about
shifting
the
balance
between
warning
notices
and
civil
and
criminal
actions.
I
think
that's
a
statement
too
far.
I
think
there's
just
been
a
decline
in
activity
and
I
think
we
need
to
monitor
this
as
we
go
forward
rather
than
say.
D
There
is
a
reason
for
this.
So
I
think
that
correction
falls
to
me
to
make
in
the
meeting
and
in
subsequent
performance
reports,
we'll
look
at
that
and
and
get
to
the
bottom
of
it
in
a
way
that
I
don't
feel
that
we
were
able
to
do
just
to
this
meaning,
but
so,
if
I
hand
over
to
Eileen
and
Eileen
I'll,
just
say
a
few
sentences
on
overall
performance,
I.
B
Have
thank
you,
David
and
let
me
just
run
through
the
the
headlines
that
fall
out
of
that
section
of
the
performance
report.
That's
called
our
resources
and
to
talk
first
of
all,
all
about
the
CQC
budget
and
at
this
moment
in
time,
across
pay
and
non
pay,
spend
we're
suggesting
that
we
might
17/18
with
an
over
9
million
pound
underspend
and
in
large
part.
B
That
is
they
good
things,
because
it
actually
means
that
we
continue
the
trend
of
really
being
very
thoughtful
and
mindful
about
the
way
that
we
spend
our
money
and
being
committed
to
CQC,
working
within
and
reducing
envelope
of
expenditure,
and
we
are
also
mindful
there
that
we
do
have
some
priorities
and
investments
that
we
want
to
make
and
if
we
think
principally
about
areas
such
as
our
digital
and
intelligence
capabilities,
which
will
allow
CQC
to
work
differently
and
enhance
not
just
what
we
do.
But
the
experience
of
those
that
work
with
us.
B
We
are
very
proactively
looking
to
see
if
we
can
bring
forward
some
areas
of
investment
to
utilize
potential
under
spends
this
year
and
again.
I
think
that
is
a
a
good
thing
to
do.
But
this
is
a
situation
that
we
monitor
very
carefully
and
talk
across
each
directorates
about
trends
in
spend
and
what
that
will
do
to
inform
the
picture
for
1819.
If
I
go
to,
then
our
workforce
data
and
to
to
see
there
to
go.
B
B
So
they're
always
on
campaign
I
think
is
a
good
and
useful
thing
to
report
to
the
board
in
terms
of
the
demographics
of
people
leaving
us,
we
are
with
a
guitar
workforce,
that's
been
with
us
for
a
period
of
years
as
a
period
of
years
that
sees
quite
a
large
number
of
people
coming
to
retirement
age.
So
very
significant
cohorts
will
be
leaving
us
not
just
this
year.
But
really.
If
we
look
three
to
four
years
ahead,
we've
got
a
workforce
that
it
does
have
that
profile.
B
We
also
increasingly
see
that
people
who've
been
with
us
for
are
not
huge
amount
of
time
developed,
skill
sets
which
are
market
attractive.
So
we
do
see
across
our
provider
set
that
there
is
really
some
enticement
of
CQC
staff
to
go
and
work
in
other
areas,
and
that
does
again
create
a
pressure
for
us.
But
it's
you
know
it's
realistic
and
it's
testament
to
the
skills
that
our
staff
have
and
the
degree
to
which
providers
in
particular
take
regulation
and
regulatory
skills
seriously
and
then
I
would
say.
E
F
B
And
so
it's
actually
in
terms
of
target
is
relatively
low
in
public
service
terms,
you
will
often
find
a
sickness
absence
rate
of
about
7%
quoted
as
a
norm,
but
we're
not
in
no
way
complacent
about
what
our
sickness
represents,
because
I
think
we
are
interrogating.
What
data
tells
us
and
what
it
tells
us
is.
We've
got
some
geographic
areas
where
sickness
absence
is
higher.
I've
also
got
some
where
it's
lower.
B
When
then,
that's
obviously
how
you
get
an
average,
but
it's
understanding
drivers
for
key
areas,
certain
types
of
work
that's
happening
and
also
patterns
of
long
term
sickness
and
just
understanding,
those
and
actually
building
into
our
systems.
What
I
would
call
rien
a
Balma
packages
which
are
all
together
stronger
and
more
robust
than
those
we've
had
in
the
past.
So
there's
no
complacency
around
saying
that
it's
hovering
around
3.8,
which
is
actually
reasonably
good.
B
F
C
C
Think
that
what
you
can
see
in
the
report
is
that
the
Apple
social
care
and
registration
teams
are
indeed
working
very
hard
and
under
some
pressure
from
a
registration
point
of
view,
we've
got
quite
high
volumes
of
applications
coming
through
to
us
and,
of
course
we
have
no
control
of
those.
It's
what
comes
through
the
door
and
and
how
we
respond
to
that
is
driving
our
performance
there
and
in
adult
social
care.
C
We
of
course
completed
the
first
initial
round
of
comprehensive
inspections
at
the
end
of
January,
but
there
has
been
no
pause
at
all
for
the
adult
social
care
teams.
We're
already
going
back
to
requires
improvement
and
inadequate
services
where
we
are
seeing
some
improvement,
but
not
all
of
them
are
improving
and
we
are
now
also
going
back
to
good
services.
Again.
C
A
number
of
them
are
remaining
good,
but
we're
also
seeing
deterioration
in
those
services,
and
so
that's
leading
to
a
higher
level
of
enforcement,
action
and
kind
of
engagement
with
providers
to
encourage
them
to
improve
and
what
you
can
also
see
from
the
slides
around.
Do
we
respond
to
informations
of
concern?
C
We
have
high
volumes
and
coming
through
into
adult
social
care,
and
that
obviously
has
an
impact
and
on
inspectors.
So
that's
just
to
give
you
the
overview
and
just
concentrate
on
three
areas:
registration,
inspection,
frequency,
timelessness
and
reports
on
the
registration
timeliness,
and
that
would
that's
a
slide
17
in
your
pack.
You
can
see
that
our
performance
in
July
just
dipped
to
82%.
C
There
are
a
number
of
reasons
for
that.
First
of
all,
this
capacity
our
sickness
is
in
that
area
is
about
pipes
enter
a
little
bit
over
that
and
we
have
some
vacancies,
not
that
many,
but
do
you
do
have
some
vacancy,
so
we're
about
9%
below
the
target
establishment
of
what
some
of
my
staff
called
up
right
inspectors
who
can
actually
go
ahead
and
do
the
job,
and
that
obviously
has
an
impact.
C
Targets
in
terms
of
timeliness.
So
I
think
that
there
is
a
follow-through
from
those
lower
performance
levels
at
the
beginning
of
the
year
in
NCSA,
and
hopefully
the
improvement
that
we've
seen
from
NCSC
and
the
tremendous
work
that
am
Tracy
and
the
team
have
done
there
to
bring
that
and
back
up
to
close
to
the
target
level
will
feed
through
as
we
go
on
through
the
year,
supported
I
hope
by
the
work
that
we're
doing
on
both
the
registration
transformation
program.
C
But
the
continuous
improvement
that
we're
doing
in
that
area
too
and
then
just
wanted
to
move
on
to
slide
35
and
36,
which
gives
you
the
inspection,
frequency
in
Tamil
illness
and
the
demand
in
adult
social
care
and
what
we've
scheduled
in
adult
social
care.
And
what
that
shows.
You
is
that
we
are
in
the
main
getting
to
the
services
that
we
said
that
we
would
do
86%
of
them.
C
We
got
a
target
of
90%,
so
we're
not
hitting
the
key
performance
indicator
that
we
expected,
and
that
is
an
issue
for
us,
because
obviously,
if
we're
kind
of
already
falling
behind
one,
we
said
that
we
would
go
to
places
that
will
increase
the
numbers
that
we
need
to
do
as
we
go
through
this
year
and
into
next
year.
We're
obviously
prioritizing
and
trying
to
make
absolutely
sure
that
we're
getting
to
inadequate
services
and
requires
improvement
services.
And
it's
the
lower
risk.
Good
services
that
we
that
have
fallen
out
of
the
key
performance
indicator
target.
C
And
then,
last
but
not
least,
on
reports.
We
again,
our
kind
of
overall
picture
on
on
reports
is
shown
in
law.
So
much
on
my
which
one
I
should
be
telling
you
to
look
at
52
and
54
and
so
I'm
52.
What
you
can
see
is
that
84%
of
our
reports
are
coming
out
within
the
key
performance
indicators
target
of
50
days,
which
is
really
good
and
that's
that's
improving,
but
we
still
have
got
to
get
to
the
90%
that
we
said
that
we
would
would
achieve,
and
the
teams
are
working
very
hard
on
that.
C
But
what
you
can
see
on
slide
54
is
that
the
average
number
of
days
for
Social
Care
report
his
reducing,
has
come
down
to
36.
So
there
is,
there
was
an
issue
about
making
sure
that
we
target
those
areas
but
have
proved
to
be
of
taking
a
lot
longer
and
of
push
those
outside
of
the
key
performance
indicators
target
and
bringing
that
back
in.
But
actually
their
teams
aren't
working
hard
to
try
and
achieve
that
which,
I
think
is
shown
by
the
average
number
of
days.
G
Well,
it's
partly
a
question
about
the
registration.
If
I
understood
you
correctly,
that's
what
you
were
overseeing,
but
also
the
it
it
does
reflect,
what's
also
in
the
section
on
inspection
and
not
just
in
adult
social
care,
but
it's
hard
to
know
which
points
in
the
message
to
bring
it
up.
Since
we've
divided
this
that
there's
quite
a
dramatic
change
in
performance
between
April
and
July.
Did
you
refer
to
it,
but
on
several
of
the
indicators
there?
If
there
is
a
huge
change
and.
G
Don't
mean
to
imply
that
figures
aren't
correct,
but
they're
very
unusual
change.
Let's
just
take
one,
for
example:
NSC
and
CSC
respond
to
calls
promptly
went
from
49%
I.
Think
I
got
this
right
up
to
84%
within
three
months,
which
is
in
one
sense
fantastic,
but
in
another
concern
that
it
was
49%
in
the
first
place,
I
mean
what's
behind
these,
but
these
very
large
variation.
So
it
isn't
one
in
your
registration
section,
the
slide
16
we
went
from
16%
I've
got
it
right
so
56%.
Rather
so
it's
560
or
56%
up
to
narrow,
87%.
A
B
So
I
think
all
those
you're
referring
to
is
performance
and
ncsc,
which
Peter
has
kindly
had
us
report
on
I.
Think
in
just
about
every
meeting
since
since
April,
and
we
had
pre,
warned
the
board
that,
as
ncsc
completed
its
modernization
process
and
began
to
embed
new
ways
of
working
and
training
people
that
there
would
be
a
significant
dip
in
performance
and
that's
shown
by
the
figures.
B
What
you're,
seeing
by
way
of
performance
recovery
represents
an
enormous
amount
of
hard
work,
really
well
thought
through
training
and
some
changes
in
technology
that
are
enabling
people
to
not
just
hit
performance
targets,
but
their
performance
targets
that
are
more
stretching
than
those
that
went
before.
So
it's
not
been
easy
and
I
wouldn't
want
anybody
to
feel
that
this
has
been
a
trivial
process.
It's
required
huge
amount
of
planning
huge
amount
of
hard
work
on
behalf
of
everybody
up
in
Newcastle
and,
as
I've
said
before
and
Peter's
kindly
had
his
report
on
it.
A
I
think
the
key
point
there
is
is
that
there
was
a
massive
dip
in
performance
which
I
was
gonna
say
was
planned,
I
mean
it
would
be
nice
to
have
avoided
it,
but
it
wasn't
a
surprise
because
it
came
out
of
planned
action,
and
so
what
you've
now
seen
is
a
recovery
back
to
where
we
should
have
been,
and
indeed
were
previously.
So
it's
that
dip.
That
is
the
issue
rather
than
the
fact
that
we're
now
back
where
we
should
be.
D
D
That
meant
there
was
a
backlog
that
backlog
then
works
its
way
into
the
registration
figures
and,
as
they've
now
got
through
their
backlog,
they're
pushing
that
through.
So
it's
the
registration
teams
that
are
doing
that,
so
this
was
a
necessary
change
that
took
place
at
ncsc,
and
you
know
the
team.
We
are
bad
in
previous
reports
and
I.
Think
I've
made
the
point
in
presenting
it
previously,
there
would
have
been
a
dick
we.
It
was
an
expected
dip,
but
I
think
to
the
point
that
Eileen's
making
I
think
you
know.
D
D
G
That's
very
helpful
and
very
reassuring
as
long
as
it
means
that
the
alerts
that
came
through
in
that
period,
even
though
we
didn't
respond
to
them
as
quickly
as
we
intended
there,
was
that
there
are
no
consequences
to
that,
because
in
the
end
this
isn't.
This
is
a
KPI
which
is
about
problems
in
the
service
and
people
reporting
that
isn't
it.
It
isn't
just
about
the
KPI.
G
D
And
satisfaction,
I've
done
a
clipped
explanation
of
this.
The
previous
report
said
what
we
were
doing
to
make
sure
that
the
alerts
and
concerns
were
getting
through
and
I
think
the
team
have
been
working
hard
to
make
sure
that
they
do
get
through
and
nonno
lost
in
the
changes
that
have
taken
place.
So
as
far
as
I'm
at
I
am
able
to
reassure
you
nor
we
can't
get
into.
Will
you
give
me
under
percent
guarantees?
I
can't
give
you
a
guarantee
about
anything,
but
in
terms
of
our
people
were
to
mitigate
exactly
that
risk.
A
I'm
not
sure
it
gives
you
any
reassurance
please,
but
in
the
board
meetings,
when
the
dip
was
taking
place,
we
did
discuss
this
and
gain
as
best.
We
could.
The
reassurance
that
you
were
looking
for
that
despite
the
different
performance,
the
things
that
are
critically
important
about
safety
were
being
were
being
dealt
with.
So
you
know
this
is
this
is
not
something
which
has
come
out
with
a
blue
if
you
like
it's
something,
we've
been
closely
monitoring
and
I
would
also
just
reinforce
David
what
you've
just
said
about
what
Tracy
and
the
team
have
done.
A
F
All
right
anybody
else,
sorry
Robin,
it's
Lee
I
want
to
ask
about
the
whistle
berry,
slice
and
I.
Don't
have
Andrew
the
right
person
to
ask
or
is
someone
else's
bailiwick.
It's
not
clear
to
me.
F
Is
the
pie
chart
which
I
find
informative?
Firstly,
it
is
encouraging
to
me
that
nearly
two
and
a
half
thousand
people
in
this
year
of
sorting
good
thing
to
do
to
inform
the
CQC
of
a
problem
and
it's
useful
to
know
what
happens
as
a
result
of
that.
My
analysis
of
this
slide
and
my
arithmetic
is
always
potentially
shaky,
and
my
colorblindness
may
also
be
a
problem,
but
as
far
as
I
could
see
in
terms
of
positive
action,
as
opposed
to
either
noting
or
doing
nothing
with
with
the
information.
F
F
Just
wonder
whether
we
look
into
that
figure
a
little
bit
in
the
sense
that
if
some
member
of
staff
is
sufficiently
concerned
about
some
issue
to
raise
it,
the
CQC,
whether
it
is
surprising
for
the
majority
of
those
concerns
to
be
noted
for
further
review,
which,
unless
there
is
some
follow-up
which
we
know
about
it,
may
be
a
and
not
terribly
encouraging
message
to
give
to
the
whistleblower
we
may
and
so
I.
Just
wonder
wasn't
analysis
we
either
have
done
also
be
doing
behind.
I
mean.
B
I
will
step
in,
but
I
think
also
would
invite
the
chief
inspectors,
if
they've
got
a
view
on
whistleblowing
and
how
it
helps
to
inform
what
they
do.
I'd
also
invite
them
into
that
space.
The
the
majority
of
whistleblowing
alerts,
the
two
and
a
half
thousand
that
Robert
refers
to
come
into
ncsc
in
one
form
or
other
and
I.
B
That's
another
area
that
we're
having
a
big
push,
because
actually
that's
to
do
with
people
not
recording
what
they've
done
quite
as
accurately
or
as
well
as
we
would
like
them
to
do
so
that
that's
the
figure
I
think
we
do
need
to
push
on,
because
that
you
know
that
is
a
significant
number
of
things.
We've
been
told
where
we
can't
say
categorically
what
we've
done
with
them.
So
that,
for
me,
is
an
area
that
we
just
need
to
get
better
at
being
able
to
get
the
intelligence
out
of
it's.
B
Not
so
things
don't
happen,
it's
just
the
recording
of
it
needs
to
get
better,
but
I
think
you
know.
Two
things
occur
that
people
who
do
come
to
us
as
whistleblowers
in
some
level
of
distress
report.
How
well
they
feel
that
they
have
been
support
and
helped
by
the
people
who
are
there?
First
point
of
contact,
so
I
think
that's
important.
Second,
is
just
how
seriously
those
to
whom
these
whistleblowing
alerts
are
passed
on,
do
take
them
and
galvanize
to
work
with
them,
but
also
I.
B
Think
the
third
point
I
said
to,
but
I
will
indulge
myself
with
the
third,
which
is
that
whistleblowing
has
connotations
that
everything
is
super
serious,
but
we
do
have
to
record
some
things
as
whistleblowing
which
have
a
lower,
much
lower
level
of
risk
attached
to
them,
and
that
is
recognized
by
the
people
who
are
joining
them
to
our
attention.
So
that's
what
I
would
say,
but
would
invite
the
three
chief
inspectors
to
give
their
perspective
and.
C
They,
the
information
that
we
get
from
whistleblowers
and
indeed
from
members
of
the
public
who
share
their
information
with
us
directly
through
the
website
as
well,
and
the
organizations
that
we
work
with
who
provide
us
with
concerns
from
people
using
services,
their
families
and
carers
absolutely
critically
important
for
as
an
adult
social
care.
And
it
can
do
a
number
of
things.
Sometimes
it
immediately
galvanizes
it
to
go
out
the
following
day,
because
we
believe
that
there
is
serious
concern
in
terms
of
harmonic
lect
for
people
who
are
using
services.
C
In
other
circumstances,
it
will
help
the
inspector
to
build
up
a
picture
about
what's
happening
with
that
service
and
enable
us
to
take
appropriate
action
and
either
put
that
into
the
pot
in
terms
of
understanding
what
the
service,
how
the
service
is
performing,
how
quickly
we
need
to
go
out
there,
but
also
when
we
do
go
out
there.
What
it
is
that
we
should
be
focusing
on,
and
that
has
also
been
incredibly
helpful
to
us
in
terms
of
the
the
way
that
we
handle
this.
H
Yes,
I
just
like
to
support
that,
so
it
I
think
underestimated
how
important
whistleblowing
is
indeed
in
our
inspections
are
targeting
for
inspections.
We,
a
lot
of
our
focused
inspections,
are
driven
by
concerns,
has
been
raised
by
whistleblowers
and
that
isn't
always
reflected
in
the
report
where
the
concerns
are
race
is
always
clear
that
that's
the
intelligence
we're
working
on,
but
it
often
is
and
where
whistleblowing
doesn't
raise
a
concern
that
triggers
an
immediate
inspection.
It
is
always
taken
into
account
in
the
planning
of
feature
inspections.
H
I
Steve,
thank
you.
It's
similar,
but
slightly
different
in
that
a
number
of
whistleblowers
that
we
will
hear
from
are
in
very
small
practices
and
therefore
we
can
use
the
information
as
Ted
would
to
prioritize
inspection,
but
sometimes
we
have
to
protect
the
well
always
we
have
to
protect
the
whistleblower
and
therefore,
is
that
quite
difficult
for
our
inspection
teams,
because
they
have
information
from
in
very
small
practices
where
the
whistleblower
would
be
readily
identified,
and
over
the
last
three
years,
we've
already
also
taken
the
hit
in
the
press.
F
Well,
that's
all
extremely
encouraging.
You
know
absolutely,
if
particular
I,
think
in
the
adults
eyes
with
care
and
say
to
my
observation
of
reports,
and
so
on
is
how
often
an
inspection
has
been
in
a
scandal
has
been
uncovered
because
of
the
whistles
there
I
just
wonder
whether,
when
this
is
what
people
have
said,
we
need
to
reek
attic
rise.
F
What
what
we
do
here,
because
quite
rightly
blowing
technically
might
be
someone
may
be
asking
about
house
it
may
blow
whistle
or
whether
it's
appropriate
to
or
just
passing
on
a
piece
of
information
of
interest,
or
they
might
be
passing
on
a
concern.
And
therefore,
is
it
slightly
different
from
saying
something
is
a
complaint,
because,
whereas
a
complaint
you
know
there
is,
is
it
concerned
and
I
wonder
whether
we're
giving
you
an
unintentionally
false
impression
of
inaction,
we're
actually
no
action
is
expected
and
I
wonder.
F
Therefore,
whether
ersity
we
ought
to
be
considering
what
the
expectation
of
the
so-called
whistleblower
is
in
what
action
they
seek.
Is
that
expecting,
and
sometimes
they
may
have
no
expectation,
and
secondly,
whether
there
is
some
way
of
grading
this
in
a
way
which
indicates
more
closely
that
the
action
matches
the
concern
I
mean
where,
as
I'm
not
sure,
this
there's
no
criticism
of
it,
because
it's
better
information
that
we've
had
before,
but
I
just
think
it
could
be
looked
at.
A
That
and
I
think
that
this
is
this
is
not
scientific,
but
my
anecdotal
experience
of
sitting
in
on
calls
is
that
I've
been
very
impressed
with
the
way
things
get
triage
and
they're,
not
masu
whistleblowing,
but
from
all
sources
of
information
and
the
things
that
need
to
be
dealt
with
very
very
urgently.
In
my
say,
non-scientific
anecdotal
experience
has
been
being
very
good,
so
I
I
don't
have
a
concern
from
what
I
know
that
we
are
acting
quickly,
but
I
think
the
optics
around
what
you've
just
been
talking
about
are
important
did.
I
Since
April
we've
had
658
GP
reports,
97%
have
been
within
the
90
percent
KPI,
which
I
think
is
extraordinarily
good
performance
in
dentistry.
It's
ninety
nine
point:
zero,
two
percent.
It
will
never
be
a
hundred
percent
because
we
do
work
with
other
directorates
and,
for
example,
the
hospital
team
have
a
different
KPI
to
us.
They
are
65
days
and
that
our
out
of
hours
of
one
more
one
go
in
in
tandem
with
them
and
therefore
some
will
be
slightly
later,
but
we've
been
looking
at
how
we
improve
things.
I
Yesterday
it
seems
a
week
ago
now,
but
yesterday,
where
we
talked
through
how
they
monitored
the
practices
in
general
practice.
But
we
do
the
same
with
dentistry
and
I
was
hugely
impressed
by
the
care
that
people
take
and
this,
of
course,
this
will
be
even
more
important
as
we
move
in
the
next
phase
to
a
more
risk-based
where
we
will
inspect
outstanding
and
good
practices
much
less
frequently.
A
G
Luis,
it's
very
helpful
if
I
was
gonna,
ask
about
that,
but
and
glass
then
about
the
again.
This
isn't
just
about
PMS
I'm,
afraid
it's
about
that's
the
same
issue
on
in
the
different
status,
but
the
graphs
for
mandatory
action
respondent.
This
is
about
responding
information
of
concern
and
mandatory
actions.
I
must
apologize,
I'm,
not
absolutely
sure
which
mandatory
actions
were
talking
about
in
the
individual
section
sectors,
but
we're
below
target
on
all
three
and
on
PMS
we
we
have
again
have
this
rise
from
April.
G
Doesn't
do
too
often
say,
for
example,
on
PMS
the
figure
looks
like
it's
about:
70
percent,
not
89,
I.
Think
there's
a
been
a
repetition
from
one
slide
to
the
next
and
and
in
fact
on
hospitals
we
say
89
percent
again,
whereas
it
looks
higher,
it
must
be
higher
because
all
the
figures
are
higher
than
89,
so
it
can't
possibly
be
an
average
of
89
percent,
so
I
think
I
think
we
seem
to
be
below
target
on
all
three
areas.
We
seem
to
have
the
average
figure
wrong
on
two
of
them.
E
G
J
Not
to
talk
about
data
alone,
just
is
just
to
clarify
the
data
of
the
on
these
slides,
I.
Think
you're,
referring
to
the
slides
which
are
28,
29,
30
31,
the
the
bars
show
absolute
volume
and
the
lines
show
percentages
so
acknowledge
that
it's
a
bit
confusing
with
the
legend
on
the
side.
So,
for
example,
on.
D
J
J
G
C
I'm
not
saying
it's
not
I'm,
just
trying
to
explain
the
at
the
timings
and
then
obviously
PMS
is
not
at
night
89%,
because
nothing
gets
above
76%.
So
so
there
is
a
problem
in
the
presentation
of
the
graphs
which
you're
right
to
point
out.
God
knows
why,
when
none
of
us
brought
to
that
beforehand,
but
week
I'm
sure
we
can
sort
that
out
separately
in
terms
of
what
that
means
there
were
there
will.
There
will
be
two
to
potential
reasons
why
that's
happening
one.
C
Certainly
one
of
the
issues
that
we
have
sometimes
in
adult
social
care
is
a
reluctance
for
people
to
close
off
as
safeguarding
alert,
because
they
have
passed
it
on
to
the
local
authority,
which
is
what
we
should
be
doing,
and
but
they
want
to
kind
of
keep
an
eye
on
it
and
feel
that
keeping
an
eye
on
it
is
best
done
by
keeping
it
open.
It
is
not
best
on
by
keeping
it
open.
I
If
you
want
me
to
respond
from
my
bid,
you'll
see
the
numbers
are
tiny
and
the
graphs
aren't
sitting
next
to
each
other,
because,
frankly,
we've
only
had
one
concern
in
four
months
and
thankfully
that
was
acted
on
pretty
quickly.
The
concerns
are
also
which
is
graph,
31
I.
Think
if
you
look
at
the
numbers,
they're
tiny
compared
with
adult
social
care
and
when
you've
got
tiny
numbers
like
that,
the
errors
of
incorrectly
coding
them
not
closing
them
down,
and
the
fact
that
most
aren't
actually
concerns
Shyne
out
in
the
in
the
data.
I
We
know
about
every
single
one
of
those
and
we
are
late
on
a
few
and
what
we've
done
is
put
our
business
support
staff
in
to
highlight
these,
and
they
go
through
this
during
the
week
to
support
our
inspectors
now,
because
because
these
numbers
are
so
small
across
the
large
number
of
inspectors,
these
are
things
that
don't
happen
very
often
and
therefore
it's
not
like
the
business
as
usual
in
social
care.
What
it
is
normal
to
pick
up
their
concerns
during
the
week
and
and
so
we're
doing
something
to
flag
this
up
with
inspectors.
H
H
So
that's
a
we
celebrated
that
last
week
and
then
we've
got
a
hundred
percent,
which
I
think
reflects
the
work
that
the
the
teams
are
doing
to
monitor
very
carefully
what's
going
on,
but
also
to
escalate,
if
there
any
delays-
and
we
mostly
not
on
a
week-by-week
basis
now
so
I-
think
there
has
been
a
lot
achieved
in
this.
But
this
demonstrates
this
is
an
area
we
need
to
keep
focus
on
I'm.
G
G
I
A
H
Thank
you.
Thank
you
very
much
and
hospitals
launch
the
next
phase
of
inspection
in
June
and
the
first
core
service
inspections.
Under
the
next
phase,
inspection
took
place
in
August,
and
so
that
is
activity
very
much
going
on
at
the
moment.
It's
the
first
world
led
inspections
will
be
taking
place
very
shortly.
H
So
it's
a
time
of
great
transition
for
the
hospital
inspection
teams,
I
have
to
say
they've
adapted
to
it.
Marvelously.
There's
that
the
proprietary
work
we
we
did
has
been
I,
think
well-received.
The
teams
I
think
are
well
established
in
their
new
role
and
they
have
to
take
on
a
much
stronger
monitoring
role
with
regular
relationship
visits
with
trust
and
I've,
been
on
some
of
those
visits
with
with
the
teams
with
trusts
and
I,
and
that
pregnant
we're
progressing
that
very
well
as
well.
H
So
overall
I
think
the
next
phase
has
started
out
well,
but
it
is
early
days
and
I'm
sure
there'll
be
things
we
can
learn,
and
one
of
the
things
we
have
incorporated
in
the
next
phase
is
there's
a
very
different
approach
to
writing
reports
because,
as
the
body's
aware,
one
of
the
key
areas
of
concern
in
our
current
performance
is
the
timeliness
of
reports.
Now
we're
doing
a
lot
of
work
on
that
at
the
moment
to
try
and
improve
its
the
the
average
length
of
time
for
report.
H
Publication
is
coming
down,
but
we
still
not
achieving
the
KPI
nearly
well
enough
and
further
work
is
necessary
at
the
moment.
Most
of
the
reports
being
published
or
independent
healthcare
reports
with
some
follow-up
reports
from
NHS
trusts,
predominately
from
the
independent
health
care.
Some
of
those
Steve's
already
highlighted,
get
involved
in
challenges
and
legal
process
and
that
delays
the
old
report,
but
actually
overall,
there's
still
an
issue
about
the
focus
of
inspection
teams
in
delivering
reports
within
the
within
within
the
time
scale.
H
We're
working
with
on
that
we're
reorganizing
their
works,
make
sure
they
have
protected
time
for
reports.
We're
monitoring
intermediate
metrics.
We
are
looking
at
streamlining
the
whole
process
and,
where
necessary,
given
them
support
by
report
writing
coaches
to
help
them
do
the
for
the
report
to
the
more
timely
way,
and
that
is
bearing
fruit
in
in
that
the
time
scale
is
coming
down.
But
we
recognize
there's
more
to
do
on
that
with
the
next
phase.
The
first
reports
on
that
will
be
coming
out
within
the
next
month
or
two,
and
we
can
we
have.
H
These
are
much
shorter
reports
and
they're
deliberately
designed
to
be
a
leaner
process
for
production
and
that
we
hope
will
mean
that
we
can
consistently
deliver
within
the
KPIs.
We
are
monitoring
it
very
carefully
with
intermediate
kpi's
making
sure
the
draft
reports
it's
a
little
bit
very
rapidly
and
then
the
process
beyond
that
is
monitored
carefully.
So
I
am
hopeful
and
I
expect
that
under
the
next
phase
will
be
driven
reports
more
reliably
within
KPI,
but
there
is
still
of
those
reports
as
that
are
in
the
system,
predominately
independent
healthcare.
D
Are
we
back
to
you
yeah
thanks?
So
the
vast
majority
of
this
is
reports
which
I'm
asking
the
boy
to
naughts,
with
one
exception
and
I
think
that's
item
six,
which
is
a
local
systems.
Reviews
where
I
will
ask
you
to
make
a
decision
to
change
the
scheme
of
delegation
in
respect
to
these
local
systems
reviews.
So
if
I
do
it
a
Peter
and
people
want
to
stop
me
as
we
go
through,
then
that's
fine
and
so
item
five
is
the
responsible
officer
report.
D
You
know
that
clinicians
needed
to
be
revalidated
and
as
an
organization
we
have
a
duty
to
nominate
somebody
who
will
sure
that
all
the
practitioners
which
are
associated
with
CQC
employed
by
or
in
contract
with
the
organization
the
set
to
practice
or
Nigel
Sparrow
is
one
of
Steve's
team.
As
a
clinician
himself
was
appointed
our
responsible
officer
and
what
he
is
required
to
do.
D
What
we
as
a
board,
are
required
to
do
is
each
year
assure
ourselves,
by
undertaking
an
audit
that
the
appropriate
arrangements
are
in
place
to
ensure
that
that
oversight
of
the
revalidation
has
taken
place
and
we're
then
obliged
to
provide
that
audit.
So
the
department's
health
to
the
chief
medical
officer,
and
that
in
effect,
is
a
pyramid
of
assurance
that
the
doctors
that
were
employing
are
in
place.
D
So
what
I'm
doing
through
this
report
is
not
bringing
you
what
will
be
not
far
short
of
100
pages
of
assurance
data,
many
of
which
are
blank,
is
actually
confirming
that
our
Nigel
is
under
tech
and
this
work,
as
as
the
clinician
who
has
oversight
of
our
second
opinion
doctors-
these
are
the
psychiatrist.
Lewis
will
be
familiar
with.
D
Who
do
the
second
opinion,
doctors
on
a
range
of
procedures,
where
they're
required
ect
being
the
one
that
comes
to
mind
as
I'm
speaking,
so
both
our
clinicians
that
we
employ,
who
predominantly
are
working
with
Ted
and
Steve's
team,
have
been
through
this
validation
and
the
details
are
in
the
report.
It's
19
doctors
are
prescribed
connection
to
CQC
and
we've
been
through
that
and
then
the
second
opinion
appointed
doctors
have
been
through.
D
So,
basically,
what
I'm
advising
the
board
is
that
the
requirement
that
is
placed
upon
us
and
there
is
a
requirement
to
bring
this
to
the
board,
which
is
why
it's
here
has
been
discharged
through
Nigel's
work
and
then
my
meeting
with
Nigel
on
local
systems,
reviews
you'll,
avoid
or
recall
that
term.
The
Secretary
of
State's
asked
us
to
carry
out
20
local
systems,
reviews
using
section
4
she
ate
of
the
Health
and
Social
Care
Act.
These
are
thematically.
D
Reporting
that
would
begun
those
we've
completed
the
inspections
in
sorry,
not
inspections.
Reviews
are
just
as
my
self
reviews
in
Halton
and
then
last
week
in
Bracknell
and
stork
on
Trent.
Those
reviews
have
gone
well.
No
Steve
attended
one
I've
managed
to
get
on
a
couple
of
days
on
two
of
the
reviews:
incredibly
well
led
by
Alison
open
as
an
SRO
and
unfolded
on
site
leader
of
teams,
with
good
buy-in
from
a
that's
the
Local
Government
Association
and
our
own
specialists
advisers.
We
get
used
in
health
setting
on
our
health
inspections.
D
The
thematics
our
scheme
of
delegation
says
that
it's
myself
as
chief
executive,
that
will
sign
off
somatic
reviews,
which
is
a
practice
that
we've
used.
They
are
brought
to
the
board.
So
you
know
what
we're
doing,
but
the
final
sign-off
sits
with
me.
We
don't
think
that's
appropriate
for
local
systems,
reviews
which
are
a
pretty
large
operational
exercise.
To
be
frank.
D
So
what
I'm
asking
for
the
board
to
agree
that
the
local
system
review
report
should
be
signed
off
by
a
chief
inspector
and
I'm,
asking
if
you'll
agree
a
change
to
the
scheme
of
delegations
for
these
local
systems?
Reviews
on
this
in
reality,
Steve?
That
will
do
this,
because
all
these
reports
will
go
through
the
program
board
that
has
been
obviously
in
the
development
of
the
local
strategic
review.
So
the
actual
tasks
will
be
done
by
Steve
item
7.
D
So
what
paragraph
7
is
doing
is
publicly
confirming
that
it's
appalled,
Jenkins,
currently
of
matrix
chambers,
but
previously
head
of
the
government
legal
departments
and
permanent
secretary
to
the
Attorney
General,
who
will
actually
carry
out
that
review
and
attach
to
the
chief
execs
report,
are
the
full
terms
of
reference,
which
is
what
Paul
will
work
to
and
he'll
bring
that
report
once
it's
completed,
which
we
anticipate
being
this
year.
But
it's
impossible
predict
these
things
before
people
start
them
and
you'll
bring
that
bring.
His
final
report
to
the
board
once
completed.
D
There's
an
important
piece
of
work
going
on
in
relation
to
the
independent
inquiry
into
child
sexual
abuse,
and
we've
been
invited
to
submit
evidence
to
that.
Given
some
of
our
background
and
experience
an
Ursula
Gallagher
who
leads
the
safeguarding
committee
in
CQC,
but
who
has
a
background
in
safeguarding
as
drafted
at
the
evidence
and
will
attend
the
seminar
on
our
behalf,
I
just
wanted
to
confirm
publicly
that
we're
aiming
to
publish
the
state
of
care
report
on
the
10th
of
October
and
you've
got
discussion
later
today
in
private
session.
D
In
relation
to
that,
and
then
lastly,
I
wanted
to
know
it's
not
Islands.
Last
meeting,
but
just
so
I'm
sure,
on
behalf
of
the
board,
offer
congratulations
to
Eileen
on
her
appointment
as
chief
executive
of
the
Education
and
Skills
Funding
Council,
which
she'll
begin
in
November
I
also
wanted
just
a
report
that
we've
appointed
Jeremy
Cox
from
outside
of
CQC
into
a
role
of
director
of
quality
improvement.
Disease
was
beginning
to
grow
our
capacity
around
quality
improvement
within
the
organization
and
is
a
very
important
appointment.
In
my
view,
I
think
Jeremy's
in
week.
D
Two
and
it'll
be
good
to
give
the
board
the
opportunity
to
have
some
discussion
with
him,
probably
in
the
new
year,
when
he's
got
his
feet
under
the
table
and
is
moving
along.
The
consequence
of
Ted's
appointment
as
chief
inspector
and
I
think
this
is
Ted's.
First
meeting
last
one
was
as
designate
the
consequence
of
that
is
Amanda
Stanford
has
been
pointed
interim
deputy
chief
inspector
from
a
strong
internal
field.
Ted
and
I
interviewed
and
Amanda's
now
begun
that
rule
and
the
permanent
rule
is
out
for
now.
D
A
A
H
A
A
H
A
E
Is
the
end
of
a
process
that
began
about
15
months
ago
in
constructing
this
document
and
product
and
the
the
draft
came
to
the
board
a
pilot
board
in
June
and
there's
three
things
really
to
say
in
introducing
this?
The
first
is,
it
is,
whilst
it's
about
equality
and
human
rights,
it's
completely
in
line
with
the
strategy
of
the
board
of
the
CQC
of
encouraging
improvement
and
the
the
content
of
this
is
actually
demonstrating
from
our
work.
E
Our
inspection
reports,
initially
those
places
that
are
outstanding
and
one
of
the
main
ways
in
which
they've
achieved
that
outstanding
is
being
very
good
on
equality
of
human
rights.
So
we've
mined
our
own
work
to
come
up
with
a
lot
of
evidence
which
demonstrates
that
people
have
used
this
as
a
used
equality
as
providing
a
dividend
rather
than
actually,
as
it's
normally
seen
as
a
set
of
deficits.
So
there
is
quite
a
change
in
the
way
in
which
we're
talking
about
equality
here
from
so
it's
a
part
of
that
debate.
E
But
for
us
it's
primarily
a
part
of
the
of
the
stream
of
work.
We've
done
on
her
we're
encouraging
improvement,
and
so
it's
part
of
our
mainstream
work
in
encouraging
improvement,
and
we
are
publishing
it
to
all
of
the
providers
with
a
view
to
them
looking
at
it
to
encourage
improvement.
The
second
thing
is,
as
the
quality
matters
document
we
talked
about
last
time.
E
This
has
been
both
constructed
and
published
as
a
partnership
document,
and
the
appendix
two
has
got
a
list
of
the
partners
involved,
and
the
particular
nature
of
this
is
there's
two
very
different
sorts
of
partners
involved
in
this.
One
is
a
set
of
organizations
with
the
deep
expertise
and
equality.
E
Human
rights
and
the
others
are
a
varieties
and
providers
and
provider
organizations,
and
so
we've
been
able
to
being
able
to
gather
from
partners
not
just
detail
of
different
provision,
but
a
lot
of
expertise
in
where
the
debates
about
changing
practice
on
equality
and
human
rights
are,
and
that
is
just
as
the
quality
matters
discussion.
We
had
last
time
that
takes
time
and
effort,
but
it's
really
worth
it,
because
it
now
means,
as
we
publish
this,
we're
publishing
it
into
through
a
variety
of
channels
and
with
a
variety
of
different
contents.
E
And
the
third
thing
is
the
first
time
I
think
we,
as
a
commissioner
published
a
product
this
way
and
as
I've
been
making
my
introduction.
There
is
a
stumbling
I
make
over
what
we're
doing
here,
because
I'm
used
to
I'm
of
an
age
where
we
liked
things,
and
there
are
documents
and
the
beginnings
and
middles
and
ends.
E
This
is
not
that
this
is
a
thing
called
a
product
because
it
isn't
simply
a
beginning,
a
middle,
an
end,
because
it
has
a
variety
of
different
web-based
enablement
to
make
the
thing
work,
and
this
is
incredibly
exciting
that
I
think
in
terms
of
driving
improvement
a
reader.
If
that's
the
right
word,
can
pick
up
this
document
and
can
work
their
own
story
through
it.
You
can,
for
example,
will
just
work
through
all
of
the
issues
on
workforce.
E
We
learn
a
lot
from
that
and
people
say
we'll
give
us
all
sorts
of
assistance
in
using
it
and
that's
very
different
from
reading
a
book
of
reading
a
document,
so
I
think
there
are
these
three
different
issues:
it's
encouraging
improvement,
it's
about
partnership
and
it's
a
very
different
form
and
all
of
them
I
think
are
really
very
interesting.
The
third
I
think
is
brand
new
and
we've
got
to
see
how
this
goes.
L
Thank
you
know
that
I
can
add
much
to
what
Paul
said
really
other
than
and
to
thank
Paul
for
his
kind
of
unstinting
support
for
me
and
leading
this,
and
just
to
say
that
really
we
hope
I
hope
it
will
do
three
things
it.
Firstly,
it
makes
an
argument
there
is
a
new
argument
about
equality
and
human
rights
and
how
it's
a
solution
rather
than
the
problem.
Secondly,
that
is
quite
inspiring
and
the
outstanding
providers,
a
studies
are
very
inspiring
in
it
and
the
thirdly.
Thirdly,
that
is
quite
practical.
L
So
what
we've
done
is
we've
done
things
like
we've
put
questions
for
reflection
in
it,
we've
embedded
tools
and
more
detailed
things
behind
the
main
report.
So
yeah,
it's
been
an
interesting
process
to
develop
it
I'm,
not
sure
I've
always
followed
CQC
kind
of
protocols
in
doing
it,
but
yeah
I
hope
at
the
end
of
it.
It's
it's
come
out
good,
really
and
the
next
six
months
are
probably
going
to
be
as
hard
and
getting
it
kind
of
working
as
the
last
nine
months
or
whatever
in
developing.
It.
A
Is
really
exciting
on
two
counts:
I
mean
working
backwards,
the
the
fact
that
it
is
a
completely
different
way
of
presenting
this,
and
it's
not
the
traditional
report
that
you
and
I
grew
up
with
I
think
he's
really
exciting,
but
I
was
really
struck
by
the
first
message.
This
is
this
is
a
a
positive.
A
F
Comments:
questions
Robert
well
just
to
say,
is
not
an
expert
in
this,
or
indeed
very
much
I
found
looking
at
this
as
a
document
which
is
likely
to
be
extremely
useful,
which
is
not
to
be
said
for
huge
numbers
of
documents
emanating
from
public
bodies.
Today's
you
need
to
have
the
obligations
of
putting
this
stuff
into
practice,
and
it
is
properly
called
a
resource
rather
than
something
which
would
be
should
be
left
gathering
dust
on
the
shelf
and
I
congratulate
all
those
who.
G
G
But
you
know
the
the
and
the
examples
very
good
examples,
and
but
it's
very
easy
to
have
people
saying
the
right
things.
Reason
to
have
the
policy
that
says
the
right
thing
and
accept
we're
we're
talking
about
the
workforce,
race,
equality
standard,
where
there
are
obviously
some
actual
measures
that
are
meant
to
be
demonstrably
for
organizations
that
we
inspect
to
be
able
to
convincingly
demonstrate
that
they've
adopted.
What's
here
and
I.
G
Suppose
it
would
be
good
to
get
to
the
point
where
we
know
what
we
are
looking
for
and
when
we,
when
we
go
out,
I
mean,
for
example,
there
aren't
very
many
people
who
run
the
still
who
are
here
at
the
very
first
board
meetings
in
2013
but
Paul.
You
will
remember
that
I
was
really
very
keen
that
we,
as
part
of
our
inspections,
introduced
a
requirement
on
trusts
to
demonstrate
that
they
were
providing
the
same
level
of
service
to
people
with
learning,
disability
and
dementia
and
other
people
who
might
be
subject
to
this.
G
The
security
document
and
now
so
on
in
terms
of
access,
for
example,
and
specialist
specialized
treatment
and
so
on.
And
that
would
still
be
quite
a
quite
a
good
goal
for
us
to
to
aim
for
with
the
with
the
service.
So
how
will
we
know
and
can
is
there
something
we
can
do?
That's
that's
quite
specific
I'll
say
that's
quite
specific
that
we
expect
at
the
the
people
we
inspect,
can.
C
I
answer
that,
from
an
inspection
point
of
view,
because
I
think,
actually
you
know
it's
it's
the
practicality
of
us
taking
it
out
and
using
it,
that's
the
most
important
thing
and
but
before
I
say
that
can
I
just
add
my
congratulations
to
Lucy
and
the
rest
of
the
team.
I
think
this
is
a
fantastic
resource
and
the
fact
that
it
is
building
on
things
that
are
working
out
there
and
services
that
we've
already
inspected
across
all
of
our
three
sectors.
I
think,
is
very
powerful
and
the
partnership
that's
developed.
C
C
And
then
we
do
follow
it
upon
inspection,
so
there
is
that
and
I
think
that
one
of
the
things
that
as
we
progress
with
the
way
that
we
use
some
of
our
analytical
tools
in
the
future,
because
I'm
sure
that
poor
Lucy
probably
got
to
go
through
a
whole
load
of
different
reports
to
find
these
things
in
the
future.
We'll
be
able
to
do
that
automatically.
C
So
the
tools
that
the
intelligence
team
will
have
and
I'm
sure
that
we'll
be
able
to
pull
out
from
an
assessment
of
our
inspection
report,
some
of
the
things
that
people
have
done
and
that
we've
reported
on
the
second
thing
is,
is
that
we've
also
set
for
ourselves
from
this
year
onwards
a
set
of
equality
objectives
which
each
of
us
have
got
people
within
our
directorates.
Who
are
leading
on
that?
Looking
at
very
specific
areas
around
equalities.
C
For
example,
how
are
we
supporting
people
in
care
homes
from
the
lesbian,
bisexual,
gay
and
transsexual
and
communities
to
be?
You
know
and
supported
appropriately
and
make
sure
that
we're
actually
focusing
on
that?
So
I
think
that
we
can
use
it
both
to
inform
what
we're
doing
on
monitoring
inspection
and
also
to
help
us
to
progress.
H
Again,
congratulations,
Lucy,
I
think
it
is
Marvis
document
and
I
think
it
is.
It
is
potentially
very
important
in
our
interaction
with
providers
and
challenging
them
on
their
leadership
and
culture
and
as
we've
identified
in
our
inspection,
so
far,
leadership
and
culture,
absolute
fundamental
to
delivering
high
quality
care
and
I
think
this
document
is
not
just
about
equality.
H
So
so
this
will
really
drive
improvement
to
just
come
out
to
Lucy's
point
that
there
is
a
section
which
does
link
some
of
the
the
common
factors
to
improvement
to
our
key
lines
of
inquiry
and
I.
Think
the
challenge
for
us
is
to
make
sure
that
we
use
those
tools
we
have
in
the
framework.
They
have
to
ask
the
right
questions
and
to
look
at
the
key
lines
of
inquiry
through
the
telescope
of
this
document.
G
H
That's
a
challenge:
whenever
we
look
at
leadership
and
culture,
isn't
it
you
could
not
people
can
learn
the
right
answers
without
actually
it
meaning
the
reality
and
for
us,
the
key
element
is
actually
linking
what's
really
happening
on
the
ground,
with
what
the
organization
believes
is
happening
on
the
ground.
So
when
we
go
in
and
test
these
key
lines
of
inquiry,
we
need
to
ask
the
organization's
how
they're
approaching
this,
but
we
also
need
to
ask
the
staff
and
the
patients
and
the
service
users
how
they're
experiencing
it
and
making
sure
the
two
are
connected.
C
That
was
just
what
I
was
going
to
and
the
absolutely
critical
thing
is.
You
know
ensuring
that
we're
connecting
what
people
are
telling
us
they're
doing
with
the
experience
of
people
are
using
services,
their
families
and
carers
and
then
demonstrating
that
in
the
reports
that
we
write,
so
that
we
can
see
that,
and
we
can
both
celebrate
the
good
and
the
outstanding
services
that
are
getting
this
right,
but
also
encourage
improvement
in
those
services
that
need
to
improve.
A
Think
the
pause
was.
This
is
really
really
good,
but
it's
a
tool.
So
you
could
say
now:
I
haven't
used
this
and
still
actually
be
delivering
everything
that's
in
there.
That
would
just
it
would
be
my
my
immediate
response,
but
you've
heard
from
at
least
one
chief
inspector
that
they
will
ask
the
direct
question.
So
there
you
go
okay,
good.
Are
we
happy
to
move
on
so
Louis's?
G
This
is
a
quick
all
report,
because
there'll
be
a
written
report
coming
to
the
next
board
meeting
and
just
to
make
the
point
for
both
members
who
weren't
there
I've
now
taken
over
the
chair
of
that
committee
from
Michael
Meyer.
We
we
had
one
main
topic
for
discussion
and
it
over
broke
down
into
a
number
of
areas
and
that
the
topic
was
PMS
for
primary
medical
services
and
I.
Suppose.
G
The
first
point
that
came
across
in
the
meeting
was
that
we
were
it
was
how
broad
the
scope
of
what
we
call
primary
medical
services
is
including
some
areas
that
we
hadn't
previously
looked
at
so,
and
we've
looked
at,
for
example,
the
prisons.
To
some
extent
we've
never
looked,
I,
don't
think
it
what's
happened
in
the
Sark's.
G
The
sexual
assault,
referral
centers,
very
sensitive,
an
important
area
of
the
health
says
quite
a
small
area
of
the
system,
but
very
important,
and
and
we
decided
that
we
would
make
an
effort
to
include
all
of
these
relatively
circumscribed,
smaller
areas
of
inspection
and
we
try
and
bring
them
to
our
GC
in
the
future.
But
as
to
the
presentations
we
there
were,
there
were
three
areas
of
PMS
that
were
presented.
One
was
in
general
practice
in
general,
so
I
suppose
what
we
think
of
as
the
main
part
of
PMS
and
there
I
think.
G
The
a
lot
of
the
discussion
was
about
the
point.
We
were
touching
on
a
short
while
ago
with
the
performance
report,
and
that
is
this
point
about
what
happens
to
services
that
have
been
or
inspected
and
rated
as
requires
improvement
or
rated
as
inadequate,
and
that
that
issue
of
improvement
and
how
some
improve
and
some
don't
I,
think
could
I
I'm
expecting
I'm,
hoping
and
I'm
planning
for
that
to
be
a
theme
of
how
our
GC
works
over
over
the
next
year,
while
I
chair
it
and
it
is
a
complex
issue.
G
Obviously
the
improvement
is
not
just
the
role
of
the
responsibility
of
CQC,
but
others
across
the
the
health
landscape
and
that's
something
we'll
return
to
in
future
meetings.
So
three
areas,
general
practice,
second
area-
was
defense
medical
services.
So
this
is
an
unusual
piece
of
work,
which
is
essentially
an
external
commissioned
by
the
mo
D
I
think
to
inspect
defense,
medical
services
and
so
far,
I
think
we're
probably
about
halfway
through
looked
at
primary
care
and
Dentistry
mental
health
and
hospitals
still
to
come.
G
Is
that
right,
Steve,
not
hospitals,
okay,
so
mental
health
and
something
else
I
thought
still
rehabilitation
sort
of
got
there,
and
so
the
there
will
be
a
report
in
due
course.
We
were
hearing
a
sort
of
interim
report
so
far
and
the
third
area
was
about
online
providers
of
primary
care,
where
it's
fair
to
say
that
there
have
been
concerns
about
that.
G
What
about
a
number
of
issues
about
how
they
might
operate,
including
about
the
about
prescribing,
including
about
our
own
powers
in
relation
to
providers
and
also
individual
doctors,
who
may
or
may
not
come
come
from
or
be
registered
in
this
country?
So
a
number
of
issues
again
it's
an
area
where
we
expect
to
have
a
full
report
as
a
later
point.
So
a
very
good,
interesting
meeting.
Some
of
the
subjects
will
come
back
when
they've
been
fully
explored
either.
A
A
M
This
question
follows
on
from
the
July
board
meeting
and
it
relates
to
the
health
and
safety
activities
within
the
Commission
I
thought
to
mention
that
I
have
a
background
in
school
teaching
and
having
passed
taken
interest
in
a
health
and
safety
at
work.
In
that
context
and
been
a
safety
representative
for
my
trade
union.
The
first
part
of
the
question
is
to
ask
whether
there
is
a
safety
committee
with
representatives
from
trade
unions.
D
So
we've
got
a
reasonably
active
health
safety
and
well-being
committee
and
the
trade
unions
have
formally
recognised
in
our
policy
for
me
attend
that
meeting.
All
the
representative
trade
unions
are
present
at
the
meeting
and
they
serve
meeting,
which
is
conducted
with
good
positive
relationships
between
people,
I
think
if
the
trade
unions
were
here,
they'd
say
that
as
well.
So
this
is
something
that
we've
looked
at
recently.
D
M
You
and
the
second
part
of
the
question
relates
to
illness,
which
was
a
topic
earlier
in
this
board
meeting
again
looking
at
my
own
background,
it
has,
it
certainly
is
the
case
in
school
teaching.
That
stress
is
a
major
cause
of
illness
and,
in
fact,
people
leaving
the
profession.
Is
there
any
evidence
that
that
stress
contributes
to
illness
within
the
Commission.
D
D
Think
in
some
of
the
material
that
Eileen
presented
today
there
was
a
kind
of
gray
shading
in
the
diagram
which
said
elder
and
some
of
those
were
ill
health
retirements
for
people
who
find
a
job
not
for
them,
and
then
I
think
you've
got
exits
of
people
who
say.
Actually
this
isn't
the
job
Steve
referred
earlier
in
the
meeting
to
our
visit
to
one
of
the
management
teams,
and
this
is
one
of
the
issue
we
were
exploring
if
you're
taking
enforcement
action,
oh
you're,
going
through
a
tribunal
where
you've
got
to
justify
the
case.
D
D
My
arms,
if
this
isn't
too
indiscreet
slightly
more
sweaty
than
they
would
be
on
a
normal
day,
because
the
public
board
meeting
is
even
for
somebody
that
has
been
around
for
39
years
and
anxiety,
provoking
things
sort
of
my
point
is
that
stress
and
anxiety
are
inherent
in
the
work
that
we
do.
The
issue
is
when
that
stress
and
anxiety
become
unmanageable.
It
begins
to
tip
into
something
that
is
actually
causing
people
to
be
away
from
work
or
not
be
able
to
function.
D
So
on
that
through
the
people
director
of
HR,
we've
done
a
lot
of
work
on
a
stress
management
policy
and
toolkit
I'm,
one
I
know
Andrea's
done
it
because
she
told
me
she
was
aware
doing
it.
One
of
four
hundred
managers
in
the
organization
that
a
mental
helmet
mental
health
awareness
course,
which
is,
would
we
be
able
to
recognize
the
presence
of
anxiety
and
stress
in
any
of
our
workforce
and
would
would
be
able
to
engage
appropriately.
D
We
have
stress
management
standards.
What
triggers
stress
in
the
workplace,
which
are
part
of
this
toolkit
we've
got
guidance
for
managers
about
their
responsibilities
but
also
recognizing
stress
and,
of
course,
will
be
manages
its
best
as
well.
We
we
just
think
this
is
staff.
I
know
of
a
small
number
of
managers
are
away
from
work
at
the
minute,
where
stress
is
the
reason
that
has
been
given
but
I
think
what
I'd
say
Robin
is
I.
Think
we've
taken
these
issues
responsibly.
D
It's
been
a
theme
from
our
staff
survey
about
work-life
balance
and
specific
actions
have
been
taken
in
response
with
the
staff
survey
about
mental
wellbeing,
about
the
operation
of
training
courses,
we
do
have
a
contract
with
an
occupational
health
provider
in
relation
to
the
availability
of
that,
and
just
going
back
to
the
point
that
you
were
raising
or
sickness
level
is
at
about
3.7
percent.
It
is
law
for
most
public
sector
organisations
and
I
think
we
need
to
constantly
monitor
that
and
understand
it.
I
suspect
we've
got
one
or
two
people
who
work
at
whor.
D
No,
you
don't
ring
in
sick
when
you've
got
a
cold
I.
Think,
though,
where
stress
is
beginning
to
erode
people's
capacity
for
being
able
to
cope
with
a
job
of
just
daily
living,
I
think
we
do
know
about
laws
actually
and
but
I
think
it
is
important
that
all
of
our
managers
are
aware
of
the
impacts
of
that.
So
we're
not
complacent
at
all.
D
D
M
D
Got
those
telephone
lines
Robin
I
think
this
is
not
about.
Is
this
stuff
available?
It
is
the
people,
see
it
as
being
helpful
and
would
they
approach
it
I
think
what
we're
trying
to
do
in
the
organized
ensure
that
managers
and
teams
support
individuals
that
are
under
pressure
so,
for
instance,
I
think
it's
increasingly
the
case
in
the
majority
of
our
teams,
not
in
all
teams,
the
member
of
staff
is
undertaken
enforcement,
active
activity
which
will
be
stressful
by
its
nature.
D
As
I've
already
said,
then
Lewis
was
pursuing
some
of
the
issues
around
concerns
and
alerts.
One
of
the
things
that
the
supportive
teams
are
doing
is
saying,
while
you're
doing
that
enforcement
action,
we
will
take
your
concerns
off
you
and
we
will
do
that
as
just
as
a
practical
example
of
how
people
will
do
that.
We've
got
managers
for
home
based
teams
during
Friday
afternoon
at
tea
afternoons,
which
is
they'll,
do
a
Monday
morning
meeting
this
is
a
week.
We've
got
coming
up,
but
all
then
there
were
Friday
afternoon.
D
How
are
we,
what
are
you
doing
for
the
weekend,
which
is
just
about
connecting
people
who
work
in
their
own
homes
and
feel
in
part
of
a
team
and
so
I
think
there's
lots
of
initiatives
like
that
virtual
coffee
mornings,
which
is
not
about?
Can
we
get
a
management
message
out?
But
if
you've
got
ten
people
living
across
300
square
miles
of
North
Yorkshire?
How
do
you
create
a
team
and
one
of
the
ways
people
have
been
doing,
that
is
by
using
Skype
for
virtual
coffee
mornings
to
support
each
other
and
so
I?
D
Think
in
our
stronger
teams?
I
think
we've
just
got
to
accept.
We've
got
some
really
strong
teams
and
some
things
we
feel
less
strong
in
the
strong
teams,
though
the
kind
of
things
that
you'll
see
doing
and
in
some
of
our
office
based
teams,
you'll
see
people
like
not
in
playing
the
guitar
going
to
the
pub
and
doing
all
those
kind
of
things
which
are
important
for
our
sense
of
connection
and
well-being.
I
think
Moltres
started
the
cycling
club
with
people
who
want
to
do
that
kind
of
stuff.
We've
got
book.
D
A
One
of
the
things
that
increases
my
stress
levels
on
these
occasions
is
trying
to
keep
meeting
running
vaguely
to
time
it's
12:20
I
would
you'd
finished
at
12:30.
Nobody
also
notified
me
of
anything
you
wanted
to
raise.
Is
there
anything
from
anybody
that
was
urgent?
They
wanted
to
raise,
in
which
case
now
exactly
12:30?
We
will
finish.
Thank
you
very
much.