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From YouTube: CQC board meeting - December 2020
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A
Welcome
everybody
to
the
december
public
board
meeting.
We
have
two
apologies
for
absence.
The
first
is
from
our
chief
executive,
ian
trenholm
ian's
father
died
at
the
weekend
and
I'm
sure
the
whole
board
would
wish
to
join
me
in
sending
our
condolences
to
ian
very
sad
for
ian,
and
then
we
also
have
an
apology
from
from
kirsty
shaw
who's
having
treatment
for
her
back,
and
I
know
from
personal
experience
how
incredibly
painful
back
problems
are
when
they
hit
you
so
kirsty.
A
A
Okay,
that's
excellent!
That
takes
us
to
the
minutes
of
the
18th
of
november
board
meeting.
Are
they
true
and
accurate
record
of
everything
we
discussed?
A
Yep
excellent,
good,
thank
you.
So
they
are
approved.
Looking
at
the
action
log,
there
was
one
action
for
kirsty
to
talk
to
you
mark.
I
don't
know
whether
that's
happened.
B
Yes,
some
emails
are
pinging
between
us
and
trying
to
set
up
a
meeting
for
later
this
week.
Excellent.
A
Right
so
we
will
we'll
we'll
take
that
off
our
action
log
and
we'll
leave
you
in
cursed
eater
to
continue
as
as
you
as
you
wish
right.
So
that
would
normally
take
us
to
the
report
from
professor
murphy,
but
I
don't
know
whether
we
are
running
a
little
ahead
of
time
and
investor
murphy
is
here
yet
or
not.
A
It's
my
fault
for
being
ahead
of
time,
so
what
we,
what
we
might
just
do
liz
while
you're
with
us,
while
we're
waiting
for
for
no
I'm
sorry
I'm
on
the
wrong
and
that
doesn't
work
either
looking
for
any
other
business
that
we
could
sensibly
take
without
while
we're
waiting-
and
I
don't
actually
think
is
it
yes,
kate
just
funny.
D
A
I
think
I
think
I
think
that
would
and
then
we'll
just
break
off
from
that
and
when,
when
professor
murphy's
with
us
and
go
to
her
report,
so
yeah-
let's,
let's
let's,
let's
do
that-
and
the
first
item
on
the
chiefix
hex
report
was
something
that
kirsty
was
gonna
cover
off,
but
I
don't
know
whether
anybody
else
has
anything
to
say
or
we
just
take
it.
A
As
read
on
the
the
managing
the
covered
risks,
I
mean
the
really
good
news
is
that
the
department
have
now
agreed
that
our
colleagues,
when
they're
on
inspection
can
be
can
be
tested,
which
is
something
we've
been
wanting
for
a
long
time.
So
that's
that's
really
good
and
the
plans
are
just
in
place
to
to
make
that
happen.
So
that's
that's
good.
Is
there
anything
anybody
needs
to
add
to
that?
A
No
ex
excellence
like
that
that
that
that
is
good
news.
Chris
we
have
exiting
our
preparations
for
exiting
the
eu.
Anything
you
need.
E
E
Yes,
this
is
the
last
board
meeting
before
the
end
of
the
transition
period
for
uk
to
leave
the
the
eu
just
wanted
to
give
the
board
an
overview
and
a
bit
of
assurance
around
our
work
here.
E
So
we've
been
working
across
the
organization
to
ensure
that
there
is
no
significant
impact
on
cqc
with
regard
in
regards
to
extend
the
eu
so,
for
example,
our
data
centers
our
systems,
our
commercial
and
contracts,
work,
I've
all
been
assessed
and
we
we
ensured
that
we've
been
able
to
continue
our
our
operation
on
the
first
of
january
without
being
affected.
E
That
is
only
part
of
the
insurance
we
offer
to
the
wider
system,
though
we
continue
to
work
with
dhsc
to
make
sure
that
we
can
understand
and
effect
be
their
eyes
and
ears
on
the
ground
after
the
first
of
january,
for
any
significant
concerns
from
the
sectors
that
we
regulate
so
whilst
making
sure
that
we
ourselves
are
okay
by
the
by
the
end
of
the
transition
period.
E
We
want
to
also
provide
the
support
to
dhsc
to
give
them
early
insight
if
there
are
any
other
concerns
that
emerge
in
the
course
of
the
coming
weeks
or
months,
so
just
to
give
the
board
an
update
on
on
those
important
pieces
of
work
that
will
continue
up
to
them
this
year
and
then
into
early
next
year.
Where
we'll
continue
to
provide
that
insight
back
to
dhsc.
I'd
like
to
take
any
questions.
A
D
Yeah,
thank
you
and
good
morning
all
just
to
give
you
an
update
on
where
we
are
with
our
infection,
prevention,
control
inspections
and
our
designation
settings.
So
our
teams
exceeded
the
target
of
achieving
500
ipc
inspections
during
october
and
november,
so
we
delivered
521
and
of
those
that
also
includes
inspections
of
designated
settings.
So
a
massive
thank
you
to
all
those
inspectors
who
are
out
basically
undertaking
those
those
inspections.
So
just
a
quick
reminder.
D
As
part
of
the
winter
plan,
the
department
asked
us
to
go
out
and
inspect
services
that
have
been
put
forward
from
local
authorities
to
enable
people
to
be
discharged
from
hospital
with
a
covert
positive
test.
There
are
now
112
designation
schemes
around
the
country.
D
We
were
also
undertaking
inspections,
where
we
wanted
to
find
good
ipc
practice
that
piece
of
work
accumulated
in
the
last
insights
product
and
we've
decided
that
that's
no
longer
a
priority
for
the
next
couple
of
months.
So
we
squeezed
all
the
learning
we
could
out
of
those
good
ipc
inspections
and
we're
moving
on
to
can
solely
focus
on
risk,
and
then
our
third
strand
was
around
responding
to
risk
those
inspections.
So
work
continues.
D
We
committed
to
doing
a
further
900
of
these
risk-based
inspections
through
december
and
january,
and
we
are
on
track
with
that.
And
finally,
since
we
last
came
together
as
board,
chris
day's
team
and
my
team
have
been
working
visibly
together
to
produce
a
kind
of
weekly
narrative
around
what
we're
seeing
out
there
around
ipc
inspections,
designation
settings,
but
also
emerging
themes
and
risks
within
regions
that
we
are
sharing
with
ministers
and
other
key
stakeholders
to
help
drive
action
as
and
when
required
so
peter.
D
If
I
could
just
pause
and
see
if
chris
wants
to
add
anything
else.
To
that
final
point
about
the
weekly
narrative
that
that's
okay,.
E
It's
it's
certainly
covered
in
the
in
this
week's
in
the
board
insight
report,
but
I
think
kate
makes
an
important
point.
We
wanted
to
provide
a
regular
dialogue
with
dhsc
about
what
we,
where
we
see
the
risks
in
terms
of
the
how
the
scheme
operates
and
any
potential
gap
between
what
we,
what
we
know
the
system
demands
and
what's
available
through
the
designation
scheme.
E
So
this
this,
the
idea
of
providing
a
weekly
update,
which
is
both
to
the
ministers
and
also
a
public
version
of
it
as
well,
is
to
give
that
real,
real-time
information,
so
that
the
appropriate
decisions
can
be
taken
both
at
the
regional
level
by
local
authority
colleagues
and
indeed,
by
dhsc
and
nhsc.
So
we
hope
that
will
provide
a
stimulus
for
for
further
discussions
and
I'll
I'll
talk
a
bit
more
about
it.
When
we
get
to
the
inside
report
thanks
kate,
great.
Thank
you.
A
Chris
kate,
the
next
the
next
item-
probably
better
taken
after
we've
heard
from
professor
murphy,
I
think
but
ted.
Do
you
wanna
talk
about
him?
I
can
see
from
from
a
hospital's
perspective.
Thank
you
that.
F
That's
really
helpful
peter
because
the
I
think
it's
important
to
correlate
what's
going
on
across
the
whole
health
and
social
care
system,
as
the
members
of
the
board
will
will
know
nhs
trusts
under
enormous
pressure
at
the
moment
because
of
the
weight
of
curving
patients
and
also
trying
to
maintain
the
non-coveted
services
which,
which
they're
working
very
hard
to
try
and
achieve.
F
We
have
been
monitoring
things
very
closely.
You'll,
remember
that
earlier
on
this
year,
we
used
our
new
methodology
to
make
sure
that
all
trusts
had
the
right
assurance
in
place
and,
where
necessary,
provided
them
with
support
to
improve
that.
We've
been
monitoring
those
chemical
infection
rates
since
then,
and
where
we've
identified
specific
risks,
we've
undertaken
inspections
and,
on
occasion,
taken
enforcement
action
to
make
sure
poor
practice
has
been
addressed.
F
We've
been
building
on
this
now
by
launching
a
program
which
we're
just
launching
of
focus
the
program
of
of
sustained
focused
inspections
of
infection,
french
and
accra
control
across
trust.
Looking
particularly
again
at
the
trustwide
leadership
and
assurance
of
of
infection,
perfection
and
control,
and
as
we
take
those
forward,
we
will
continue
to
use
our
enforcement
action
where
necessary
to
address
poor
practice,
but
also
to
to
help
trust.
A
Great
thank
you
ted.
Does
anybody
want
to
ask
anything
in
which
case
we'll
we'll
pause
on
the
the
update
and
welcome
professor
murphy
you're
extremely
welcome
and
thank
you
before
we
go
any
further?
Can
I
just
thank
you
very
much
on
behalf
of
of
all
of
us
for
the
the
huge
amount
of
work
you
put
in
both
to
the
first
first
report
you
did
and
for
the
report
that
you're
going
to
provide
us
with
today.
A
C
Thank
you
very
much,
I'm
very
pleased
to
see
you
all
and
I'm
aware
that
you've
got.
You
know
a
long
agenda
and
not
an
awful
lot
of
time.
So
what
I'm
going
to
try
to
do
is
to
whiz
you
through
my
second
report
starting
and
I've
got
it
up
on
the
screen
next
to
me.
So
apologies.
If
I
look
away
from
time
to
time,
I'm
consulting
the
report,
but
starting
with
page
five
and
what's
happened.
C
The
progress
that's
been
made
since
march
2020
when
I
presented
my
first
report,
I'm
very
aware
that
you've
had
a
really
difficult
year
and
that
you're
having
to
struggle
with
all
sorts
of
things
that
are
covered
related.
Quite
apart
from
the
issues
that
were
raised
in
my
my
first
report
and
events
at
walton
hall.
So
I
just
wanted
to
say
that
I
do
appreciate
how
much
time
and
effort
has
gone
into
this.
C
Given
the
enormous
number
of
other
things
you
were
trying
to
do,
and
there
have
been
a
number
of
different
work
streams
that
are
relevant
to
my
second
report,
because
they
relate
to
the
kinds
of
things
that
were
happening
in
walton
hall.
C
One
of
them
is
the
restraint,
seclusion
and
segregation
review,
which
was
very
thorough
and
looked
at
over
120
settings
and
sent
out
lots
of
questionnaires
and
found
really
quite
shocking
levels
of
care
and
many
of
the
kinds
of
characteristics
of
services
that
were
found
in
morton
hall,
such
as
high
staff
turnover,
a
lot
of
agency
use
and
a
belief
that
restraint
and
segregation
and
seclusion
were
the
kind
of
only
solutions
to
behaviours
that
they
were
seeing
amongst
their
service
users,
and
the
recommendations
of
that
report
are
actually
quite
similar
to
some
of
the
recommendations
from
my
first
review
and
and
we'll
see
later
on
that
they
relate
closely
to
this
second
review
as
well.
C
There
was
also
a
whole
trash
of
work
going
on
on
closed
cultures,
something
which
paul
elliot
had
started
before
he
left,
and
I
I
recognize
that
there
are
been
a
number
of
work
streams
in
the
closed
cultures
work
and
they
have
made
considerable
progress
in
looking
at
risk
factors
for
closed
cultures,
how
you
might
identify
close
cultures,
and
I'm
I'm
aware
that
there's
been
a
considerable
amount
of
staff
training
on
closed
cultures
as
well,
so
that
that
whole
transition
work
has
been
very
important.
C
I
think
in
relation
to
trying
to
prevent
another
wharton
hall,
and
then
thirdly,
there's
been
work
on
a
quality
of
life
tool.
This
arose
partly
out
of
the
rss
review,
because
some
of
the
people
contributing
to
it
found
that
the
behavior
support
plans
were
very
poor
in
many
of
these
settings
and
suggested
that
a
tool
be
developed.
That
could
look
in
in
closer
detail
at
how
people
were
being
supported
in
their
behavioral
support
plans
and,
in
particular,
to
concentrate
on
what
their
resulting
quality
of
life
was,
because
that's
really
the
crucial.
C
That's
really
the
crucial
issue
in
any
service
that
you
can
produce
a
good
quality
of
life
for
your
service
users,
and
so
there
has
been
work
going
on
to
develop
what
they've
called
a
quality
of
life
tool
and
I'll
come
back
to
that
later
then,
following
that
in
my
report,
I've
done
a
table
of
where
cqc
is
up
to,
as
I
understand
it
in
relation
to
the
various
recommendations
I
made.
This
is
on
page
eight
and
in
relation
to
recommendation,
one
from
the
first
review.
C
There's
been
a
lot
of
work
done
on
developing
dashboards,
so
that
inspectors
can
see
at
a
glance
what
a
service
is
like
that
they're
going
to
visit
in
relation
to
things
like
rates
of
restraint.
C
C
The
second
ring.
Second,
recommendation
from
the
first
report
was
about
doing
more
unannounced
visits
and
decoupling
provider
information
reports
from
inspections,
so
that
services
were
less
able
to
guess
when
an
inspection
was
coming
up
and
less
able
to
prepare
for
it
and
producing
faster
reports.
And
my
understanding
is:
there's
been
a
lot
more
unannounced
visits
and
out
of
hours
visits
and
there
are.
There
is
work
going
on
to
speed
up
inspection
reports.
C
The
third
recommendation
was
about
closer
working
with
local
authorities
and
ccgs
in
relation
to
allegations
and
safeguarding
concerns,
and
I
understand
that
there's
a
better
process
for
sharing
information
with
nhs,
england
and
the
dashboard
is
will
be
helping
with
making
inspection
teams
aware
of
a
allegations
that
have
been
made,
but
also
allegations
that
have
been
retracted,
because
that
was
a
major
problem
in
immortan
hall
that
it
seemed
like
service
users
were
making
allegations
and
then
they
were
retracting
them,
and
we
can
only
guess
why
that
was.
C
But
obviously
one
of
the
worries
is
that
an
unscrupulous
staff
team
would
lean
on
service
users,
withdraw
their
complaints
so
that
whole
issue
of
withdrawn
complaints
is
an
important
one
and
it
that
will
be
more
visible
now
to
inspection
teams.
C
Then,
in
relation
to
interviews
and
observations
with
service
users
and
family
carers,
the
mental
health
act
reviewer
has
been
conducting
online,
extended
interviews
with
family
carers
and
with
patients
and
staff
and
advocates,
and
so
that
is
going
well.
Despite
the
covet
restrictions,
inspectors
are
also
being
trained
in
talking
mats
as
we
speak,
I
understand
the
first
20
inspectors
are
being
trained
in
that
and
a
method
for
communicating
with
people
who
have
limited
communication
skills
about
their
experiences
within
a
service.
So
I
think
that's
really
important.
C
Work
and
observations
are
getting
both
both
informal
observations
and
more
formal
observations
are
receiving
more
priority
in
inspections.
C
I
understand
there
has
been
work
on
figuring
out
how
to
decide
when
a
service
needs
a
so-called
level
two
inspection,
in
other
words,
that
it's
the
service.
That's
so
worrying
in
terms
of
its
features
that
relate
to
closed
cultures,
that
it
needs
a
more
thorough
inspection
and
the
closed
cultures
document
is
going
to
be
used
to
decide,
partly
whether
a
level
2
inspection
is
needed.
C
C
Ratings
of
cultures
themselves,
I'm
going
to
come
back
to
in
a
minute
and
likewise,
I'm
going
to
come
back
to
the
whole
issue
of
surveillance
in
a
minute
and
then
the
last
recommendation
from
the
first
report
was
about
registration,
and
there
is
now
your
right
support,
right
care,
right,
culture
document
which
has
been
published
and
which
will
hopefully
make
a
difference
to
the
registration
of
the
walton
halls
of
the
future.
C
This
was
from
a
systematic
review
of
all
published
research,
and
when
you
do
your
first
trash
through
the
literature
you
find
thousands
of
papers,
but
then
using
a
very
systematic
process.
You
find
it
down
to
only
the
papers
relating
to
detection
of
abuse
in
services,
for
people
with
learning
disabilities
and
autism,
and
I'm
going
to
summarize
the
main
findings.
We
found
48
directly
relevant
studies
and
we
later
ran
two
workshops:
two
half-day
workshops
for
cqc
staff,
in
which
we
persuaded
the
academics
that
had
written
these
papers
to
come
and
present
their
findings.
C
So
about
50
in
most
studies,
were
the
perpetrators
of
the
abuse,
was
staff
about
25.
In
most
studies,
the
perpetrators
of
abuse
were
other
residents,
and
then
the
remainder
were
family
members
and
so
on,
so
that
that
comes
from
studies
which
have
looked
at
all
the
safeguarding
alerts
in
a
particular
area.
C
So
clearly,
staff
perpetrating
abuse
was
not
uncommon.
It
was
also
clear
from
studies
that
have
looked
at
safeguarding
alerts,
that
it
was
relatively
difficult
to
substantiate
allegations
of
abuse
that
came
up
as
safeguarding
alerts.
C
Most
studies
showed
less
than
50
percent
of
those
alerts
resulted
in
a
finding
being
substantiated.
C
C
The
two
main
conclusions
from
those
reviews
of
serious
case
reviews-
then
there
are
a
number
of
studies
and
there
weren't
very
many,
and
they
were
on
the
whole.
Rather
small
studies
asking
people
who'd
raised
concerns
whistleblowing
concerns,
either
family
members
or
staff
about
their
experiences
of
doing
so,
and
the
findings
consistently
show
that
family
members
and
staff
found
it
very
stressful
doing
this.
C
They
found
the
process
complex,
they
found
it
frustrating
and
they
found
it
lengthy
and
they
were
extremely
worried
about
what
the
staff
against
whom
they
were
making
allegations
would
do
either
to
them
or
to
their
family
members,
and
there
was
one
study,
one
or
two
studies
that
interviewed
people
with
learning
disabilities
or
autism
about
what
they
knew
about
abuse
and
their
experience
of
reporting
abuse,
and
it
was
clear
that
service
users
did
have
some
understanding
of
abusive
behavior
didn't
always
have
good
strategies
for
dealing
with
it,
not
surprisingly,
and
it
was
clear
that
they
needed
training
in
in
how
to
recognize
abuse
and
what
to
do
about
it.
C
It
was
also
clear
from
those
studies
of
staff
and
service
users
and
families
who
are
raising
concerns
that
there
was
a
need
for
support
for
whistleblowers
and
obviously
speak
up.
Guardians
are
part
of
that.
Then
there
were
a
number
of
studies
that
looked
at
what
are
essentially
indicators
of
closed
cultures.
C
One
of
the
groups
of
researchers
were
the
researchers
from
hull,
who,
I
think,
cqc
has
spoken
to
a
number
of
times
already
and
they
looked
at.
They
interviewed
staff.
Professional
staff
who'd
been
going
into
services
that
later
turned
out
to
be
abusive
and
asked
them.
What
they've
noticed
about
that's
those
services
and
they've
produced
a
an
excellent
list
of
I
don't
know
about
30
or
40
things
to
look
for
as
indicators
of
concern,
and
then
there
was
an
australian
group,
chris
bigby
and
colleagues
who
took
a
different
tack.
C
They
went
into
services,
worked
in
them
for
hundreds
of
hours
and
developed
measures
of
group,
home
culture,
so
they've
developed
a
group
and
culture
scale
which
they've
done
a
lot
of
work
on
and
statistically
it's
very
robust
and
they're,
trying
it
in
australia
with
group
homes
to
see
how
it
relates
to
quality
of
life
for
the
service
users,
and
then.
Lastly,
we
found
a
couple
of
papers,
mainly
from
a
dutch
researcher
called
dr
nymeyer
on
surveillance
technology.
C
It
is
very
commonly
used
in
the
netherlands,
91
of
homes
used
some
kind
of
surveillance
technology,
and
this
was
data
from
a
few
years
ago.
Now
and
nightmare
examined
what
people
thought
about
it
and
to
what
extent
it
was
helpful
and
his
conclusions
were
that
and
I
I
should
say
that
it
covered
a
whole
series
of
types
of
technology
from
movement
sensors
through
cameras
that
could
be
viewed
from
a
staff
office
through
bracelets.
C
That
are
that
would
allow
you,
through
particular
doors
in
the
building
and
not
through
other
doors
and
video
cameras,
and
what
he
concluded
was
that
these
were
a
acceptable
but
be
helpful,
provided
they
were
person
centered.
C
C
Now,
one
of
one
of
the
things
that
I
guess
I
concluded
from
reviewing
the
literature
and
from
looking
at
things
like
the
restraint,
seclusion
and
segregation
review,
was
that
cqc
does
actually
have
some
power
to
press
services
towards
improving
what
they're
providing
because
services
are
so
keen
to
get
good
or
outstanding
ratings,
and
that
is
that
is,
I
think,
something
that
is
going
to
be
helpful
in
ensuring
that
services
are
moving
in
the
right
direction.
C
And
what
I
mean
by
that
is
that
a
lot
of
what
you
inspect
when
you
go
is
about
paperwork.
C
So
inspectors
spend
a
lot
of
time
in
manager's
office,
going
through
paperwork
and
checking
that
staff
numbers
are
right
and
checking
on
staff
turnover
and
checking
on
behavior
support
plans
and
numbers
of
restraints
and
so
on.
And
if
a
service
is
knows
it's
about
to
be
inspected,
then
it's
not
unusual
for
there
to
be
a
major
effort
from
senior
staff
within
the
service
within
the
provider,
so
not
necessarily
based
at
that
service
to
come
and
to
assist
the
service
to
get
its
paperwork
into
order,
and
I
think
that's.
C
But
what
you
can't
do
in
that
kind
of
way
is
to
improve
people's
quality
of
life,
and
so
it
seems
to
me-
and
it
I
think,
that's
the
conclusion,
also
of
the
rss
review-
that
inspections
need
to
be
very
focused
on
the
outcomes
and
not
so
much
on
the
process,
and
part
of
that
obviously
has
already
been
started
in
relation
to
all
your
work
from
the
previous
report.
C
What's
what's
already
been
done
in
relation
to
recommendations
from
the
first
report,
so
the
further
development
of
quantitative
indicators,
such
as
staff
turnover,
frequency
of
restraints
and
so
on,
that
needs
to
continue
so
that
it's
all
available
to
inspection
teams
on
the
dashboard
and
also
obviously
to
mental
health
reviewers
on
the
dashboard,
I
think
the
work
to
figure
out
exactly
what
the
threshold
of
risk
of
abuse
should
be
for
a
level
two
inspection
also
needs
to
continue
and
unannounced
and
out-of-hours
visits.
C
I
think,
need
to
continue
and
they
they
seem
to
be
producing
important
results.
C
More
in-depth
family
interviews
with
carers
likewise
need
to
continue
and,
if
possible,
more
in-depth
interviews
with
service
users.
I
think
training
the
inspectors
in
an
augmentative
and
alternative
communication,
like
talking
mats,
is
going
to
turn
out
to
be
very
important.
So
I
I
look
forward
to
hearing
how
that's
gone
later
on,
but
that
needs
to
continue,
and
likewise
the
implementation
of
the
rights
right
support
right
care.
C
Right
culture
needs
to
happen,
and
I
was
I
have
been
worried
about
the
fact
that
there's
a
new
40-bed
unit
in
merseycare
planned-
and
we
can
perhaps
come
back
to
that
in
the
discussion
and
then
in
terms
of
new
recommendations
that
don't
appear
in
the
previous
review.
C
I
think
also
that
cqc
should
consider
trialling
the
group
home
culture
scale,
because
I
suspect
it
will
be
very
good
at
picking
up
whether
a
residential
service,
be
it
or
hospital
or
a
care
home
in
social
care,
is,
is
developing
into
a
closed
culture
and
the
quality
of
life
tool
that's
been
developed,
I
think,
should
also
be
trialled
because
it
will
help
cqc
to
move
away
from
being
process
driven
to
being
more
outcomes
driven
and
lastly-
and
I
know
this
work
is
already
started-
that
there
needs
to
be
some
guidelines
on
the
use
of
surveillance
technology
of
one
kind
or
another.
C
I
think
there
are
times
when
surveillance
is
useful.
Often
it
will
be
overt
surveillance
and
I
think,
although
people
are
reluctant
to
consider
surveillance,
I
think
there
are
times
when
it
really
is
is
necessary
and
clearly
there
are.
There
are
times
when
the
possibility
of
abuse
really
trumps,
the
right
privacy.
A
Well,
you've
certainly
provided
a
huge
amount
of
food
for
thought
for
discussion.
So
thank
you
very
much
for
for
that.
What
I'm
going
to
do
in
a
moment
is
ask
kate
to
to
respond.
I
mean
you've.
You've
covered
a
lot
of
the
the
work
that
we've
been
doing
since
your
first
report,
but
kate
might
want
to
update
a
little
on
that
and
and
and
and
respond,
and
then
I
will
will
open
it
for
wider
discussion.
A
Could
I
just
say
to
my
my
board,
colleagues,
as
we
think
about
what
what
points
we
want
to
raise
with
professor
murphy,
that
I
think
it's
totally
right
that
we
talk
about
the
impact
of
the
the
right
care
rights,
support
right,
culture,
consultation,
consultation,
a
paper
and
its
impact
on
on
on
registration
of
services,
but
it's
not
appropriate
in
the
public
board
to
talk
about
any
particular
provider.
A
I
mean
you
know
all
know
that,
but
I
will
just
remind
you
of
that,
but
other
than
that,
I
think
we
we
should
be
talking
about
the
the
impact
on
registration,
but
lots
and
lots
of
food
for
thought
but
kate.
Why
don't
I
come
to
you
now?
Please.
D
Thank
you
thank
you,
peter
and,
and
a
massive
thank
you
to
professor
murphy,
so
really
keen
to
welcome
your
report
that
you're
releasing
today
and
the
huge
amount
of
work
that's
gone
into
it,
and
it's
particularly
important
to
celebrate
the
fact
that
it's
evidence-based
and
grounded
in
that
academic
literature
that
you've
just
described
to
us
and
is
also
focused
on
the
experiences
of
people.
D
So,
firstly,
I
want
to
speak
briefly
about
what
we've
achieved
so
far
that
professor
murphy
has
touched
on.
It's
been
an
extremely
tough
year
for
health
and
social
care
in
light
of
the
pandemic,
but
it's
been
really
important
that
we
haven't
slowed
the
need
to
make
progress
on
this
critical
critical
agenda
so
since
receiving
glenn.
This
is
professor
murphy's.
First
interim
report:
we've
increased
the
amount
of
unannounced
inspections
that
we're
doing
to
services
where
there
are
the
potential
for
close
cultures.
D
We've
produced
new,
comprehensive
guidance
for
our
inspectors
about
how
to
inspect
such
services,
and
we
we've
trained
over
2000
of
our
staff
to
to
do
so.
We're
working
with
warwick
university
to
develop
this
specialist
care
planning
tool.
That's
been
referenced
already
called
the
quality
of
life
tool,
which
enables
us
to
ensure
that
people
are
have
a
person-centered
care
plan,
and
that
is
what
is
being
delivered
for
them.
D
We've
also
introduced
twice
monthly
course
with
all
of
our
staff.
If
there
are
queries
or
questions
about
the
regulation
of
close
cultures,
they
have
the
ability
to
get
advice
and
information,
and
also
we've
developed
a
suite
of
communication
tools
for
our
inspectors
to
help
enhance
their
communication
for
with
people
with
a
learning,
disability
or
autistic
people.
D
So
some
of
the
things
that
we've
done,
but
it's
really
important
that
we
we
all
recognize
that
there's
much
much
more
for
us
to
do.
We've
seen
far
too
many
times
over
the
past
few
years
that
people
with
a
learning,
disability
and
autistic
people
just
aren't
getting
the
right
care,
and
that
was
particularly
brought
into
sharp
focus
in
our
report
into
restraint,
seclusion
and
segregation
called
out
of
sight
and
who
cares.
D
So
our
out-of-sight
report
found
that
people
are
placed
in
hospital
without
proper
assessments.
They
often
don't
receive
the
therapeutic
intervention
they
need
and
there
isn't
an
unrelenting
focus
on
getting
them
better
and
getting
them
back
home,
and
that
has
been
reflected
again
in
professor
murphy's
report.
D
I'm
also
really
grateful
for
those
in
the
system
who
are
really
keen
to
change
things.
It's
a
really
difficult
thing
to
get
right.
There
are
huge
workforce
challenges
to
overcome
in
order
to
ensure
that
there
is
that
consistent
crisis
response
in
the
community
to
stop
people
inappropriately
ending
up
in
inpatient
care.
D
However,
I
think
we'd
all
agree
that
progress
has
been
too
slow.
Transforming
care
has
been
with
us
now
for
five
years
and
there
hasn't
been
the
sufficient
progress
needed
to
to
improve
outcomes
for
people,
and
we
all
can
and
should
should
do
better.
D
So,
if
I
can
just
briefly
update
board
on
our
plans
about
how
we
want
to
do
better
going
forward
early
next
year,
we
will
be
leading
a
program
that
will
help
identify
unacceptable
care
and
use
our
regulation
as
a
lever
to
make
sure
that
people
are
getting
the
care
that
they
they
they
deserve
and
need.
So
in
order
to
make
this
happen,
debbie
evanova
who's.
D
D
We
need
to
do
more
in-depth
inspections
that
gets
to
the
heart
of
what
it
feels
like
to
receive
care
by
those
people
in
receipt
of
it.
Our
reports
will
describe
in
more
detail
going
forward
what
it
looks
and
feels
like
to
be
careful
in
that
service
and,
more
importantly,
to
describe
what
the
culture
is
and
what
restrictions
may
be
maybe
taking
place.
D
This
will
also
help
inform
commissioners
who
are
buying
these
services
about
the
potential
experience
for
those
in
receipt
of
that
care
and,
finally,
enforcement.
We
will
use
the
full
range
of
our
enforcement
powers.
This
includes
stepping
up
our
restrictions
of
emissions
for
services,
whether
care
is
inadequate
or
unacceptable,
which
includes
the
use
of
restrictive
practice.
This
is
directly
linked
to
professor
murphy's
recommendation:
five,
where
providers
are
using
high
levels
of
restraint,
seclusion
and
segregation,
we
need
to
take
stronger
action
and
where
services
don't
approve,
we
will
be
taking
further
action
as
well.
D
So
we
can't
do
this
alone
and
we
don't
want
to
do
this
alone
in
order
to
improve
outcomes
for
this
group
of
people,
we
need
everyone
in
health
and
care
to
be
working
together.
To
make
this
happen.
That's
colleagues
in
nhs,
england,
in
the
department
of
health
and
social
care
in
local
government,
local
clinical
commissioning
groups,
but
also
those
who
provide
services.
D
And,
finally,
if
I
could
just
say
a
couple
of
reflections
in
relation
to
the
wider
recommendations
that
professor
murphy's
outlined,
so
professor
murphy
flags,
the
the
key
issue
about
the
fact
that
there's
a
huge
amount
of
research
broadly
in
this
area,
but
when
you
distill
it
down
about
what
what
the
components
are
and
that
that
can
create
abusing
in
organizations
there's
a
there's
a
gap.
D
So
we're
really
keen
to
explore
further
what
the
links
are
between
culture
and
abuse
and
organizations,
and
as
we
sit
here
today,
as
advocates
for
people
who
use
services,
we
should
also
be
advocates
for
further
academic
research.
That
can
better
help
us
understand
how
close
cultures
can
develop
and
how
we
can
better
safeguard
and
protect
people
and
from
abuse.
So
it's
a
piece
of
work,
we're
keen
to
take
forward,
potentially
in
partnership
with
other
experts,
then
we
will
go
away
and
do
some
further
thinking
on
what
that
might
look
like.
D
But
it's
really
clear
that
this
is
in
addition
to
the
immediate
actions
we
have
taken
and
we
will
continue
to
take
in
the
coming
weeks
and
months
in
relation
to
speak
up
and
guardians.
We
all
know
that
speak
up.
Culture
is
absolutely
crucial
in
all
settings
and
providers
should
be
supporting
whistleblowing
and
reporting
of
concerns
to
ensure
that
staff
have
access
to
a
speak-up
guardian
to
raise
concerns
as
and
when
needed.
D
We
think
we
can
do
more
to
draw
this
out
in
our
assessment
of
services
and
consider
how
we
use
our
regulatory
powers
to
ensure
that
providers
are
fostering
a
culture
that
enables
the
process
of
raising
complaints
and
allegations
as
as
straightforward
as
possible
for
staff
and
finally
and
surveillance.
We
are
supportive
of
testing
the
use
of
surveillance
in
relation
to
things
such
as
digital
providers
and
unregistered
providers.
D
As
professor
murphy
states.
In
her
report,
there
are
rare
circumstances
where
covert
surveillance
may
be
justifiable.
D
However,
we
also
need
to
think
about
opportunities
to
where
we
can
be
prepared
to
use
covert
surveillance
where
we
just.
But
the
issue
is
where
we
suspect
abuse.
We
would
need
to
act
on
that
immediately
to
ensure
that
we
were
ensuring
that
people
were
being
kept
safe.
D
So,
in
summary,
very
much
welcome
the
report
and
the
recommendations,
a
big
thank
you
to
professor
murphy
they're
in
line
with
the
changes
we
have.
I
want
have
taken
and
want
to
continue
to
take.
We
have
much
more
to
do
to
adopt
our
approach
and
professor
murphy's
report
and
research
will
enable
us
to
to
do
that
at
pace,
and
I
really
look
forward
to
bringing
back
to
board
details
of
how
we
will
implement
this
in
the
coming
weeks
and
months.
Thank
you,
peter.
A
Thank
you,
kate,
professor
murphy.
I
I
I
will
obviously
at
the
end
give
you
any
an
opportunity
of
any.
A
I
suspect
my
colleagues
will
be
raising
points
so
that
will
obviously
require
a
comment
back
from
you,
but
at
any
time,
if
you
want
to
speak
just
just
just
wave,
please
get
my
attention
ted.
You
wanted
to
come.
F
F
I
think
that
the
fact
that
you
provide
us
with
the
academic
background
as
kate
has
mentioned,
to
actually
take
forward.
Our
approach
to
regulating
these
services
is
really
important,
because
I
think
a
lot
lot
has
gone
wrong
in
the
past,
because
there's
been
an
assumption
that
the
solutions
are
simple
and
you've
made
it
very
clear.
This
is
a
complex,
difficult
area
and
we've
got
to
be
really
thoughtful
and
your
thoughtful
recommendations,
I
think,
are
really
powerful.
F
It's
now
up
to
us
to
take
those
forward
to
make
sure
they're
really
effective
and
then
caters
out
like
that,
really
clearly
the
our
report
out
of
sight,
I
think
again
highlighted
the
concerns
we
have
about
these
services
and
I
think
it
is
now
down
to
us
to
make
sure
that
we
follow
through
on
your
report.
We
follow
through
on
our
report
and
make
a
real
difference
to
people
using
services,
and
I
think
that's
a
challenge
to
us.
F
We
know
that
transforming
care
has
been
going
on
for
a
while
has
not
achieved
what
it
should
have
done.
It
is
now
down
to
us
to
make
sure
that
the
progress
is
made,
and
I
think
we
we
all
accept
that
challenge
and
we
have
to
rise
to
it
to
make
a
difference.
People
using
these
services
can,
I
just
say
just
to
highlight
something
that
that
that
kate
was
talking
about
there.
F
I
think
you
have
made
it
very
clear
the
importance
of
really
good
research
into
some
of
these
difficult
problems
we
regulate,
and
I
think
we
as
a
regulator
need
to
become
more
vocal
using
people's
voices
to
demand
that
research
is
done
into
the
areas
that
matter
to
people
using
services.
F
A
Thank
you,
ted.
Like
you,
I
was
very
struck
by
the
the
research
need.
It
was
striking.
Professor
murphy,
given
this
is
a
worldwide
issue
who
how
little
research
at
the
end
of
the
day,
though,
that
there
was
and-
and
it
just
seems
to
me
ten-
it's
it's-
it
goes
even
further
than
your
suggestion.
I
I
think
we
should
be
thinking
about
how
we
can
make
that
research
come
about.
Rather
only
some
further
research
come
about
right
right,
rather
than
just
calling
for
other
people
to
do
it.
That's
probably
what
you
meant.
E
No,
a
sort
of
linking
to
that
point
really,
I
suppose
again,
like
other
colleagues,
professor
murphy,
I
really
welcome
the
report.
I
particularly
welcome
the
focus
on
outcomes,
and
I
think
this
is
the
point
about
using
people's
experience
of
care
more
effectively
in
determining
how
organizations
are
performing.
E
I
think
there's
a
there's
a
note
that,
over
the
last
six
months
in
particular,
we've
taken
significantly
more
enforcement
action
by
using
ironically,
the
the
kobe
period.
E
Time
has
increased
people's
direct
contact
with
us
about
how
services
are
performing,
and
I
think
we've
been
more
potent
in
our
ability
to
use
that
voice
the
voice
of
people
to
take
the
right
action,
and
I
think
that
what
this
report
does
it
should
read
of
our
efforts
around
how
we
translate
the
voice
of
people
into
the
the
action
that
we
take
as
a
regulator
to
make
sure
that
that
people's
experience
of
care
is
the
way
we
would
want
it,
and
I
think,
there's
a
they
say,
there's
some.
E
I
think
we've
we've
taken
so
much
over
the
last
six
months.
That's
helped
in
that
space,
but
I
think
there's
much
more
to
do,
and
your
report
is
a
welcome
reminder
that
that
is,
that
should
be
a
key
feature:
the
outcomes
that
people
experience
should
be
a
key
feature
of
how
we
regulate
as
an
organization
thanks
chris.
G
Thank
you
very
much,
peter
and
and
professor
murphy.
Thank
you
very
much
for
a
really
really
useful
report,
which
I
think
can
be
mined
over
time.
In
terms
of
you
know
the
recommendations,
but
also
the
depth
of
the
research
behind
it.
G
I
I
just
wanted
to
pick
out
a
couple
of
things,
so
I
I
I
very
much
welcome
kate's
point
about
a
line
of
accountability
and
including
accountability
back
to
this
board,
about
how
we're
progressing
on
implementing
the
recommendations,
and
I
wanted
to
pull
out
a
couple
of
a
a
couple
of
those
where
I
think
it's
going
to
be
really
important,
that
the
that
we
as
the
board,
keep
on
top
of
progress
in
in
and
pace
in
a
sense
of
doing
this,
given
the
wealth
of
priorities
that
everybody
is
facing.
G
The
more
you,
the
more
insight
we
get
into
our
regulatory
approach,
but
also
the
more
that
you
hope
that
people
will
have
an
opportunity
to
say
what's
happening,
not
have
to
wait
until
they're
trying
to
do
that
terribly
stressful
thing
of
raising
a
major
complaint.
So
that
seems
to
me
to
be
terribly
important
to
you
know
that
we
crack
on
with
that.
G
The
second
area
was
about
data
and
evidence
on
things
like
the
the
use
of
restraint
and
use
of
seclusion
and
those
things,
and
we
know
that
sometimes
that
data
has
been
patchy
or
people
aren't
defining
things
in
exactly
the
same
way
and
it.
What
we
don't
want
is
to
be
in
a
position
where,
because
there
are
different,
you
know
different
interpretations
of,
what's
meant
by
seclusion,
for
example,
that
we're
not
confident
enough
to
draw
use
that
data.
G
So
I
think
some
real
real
attention
to
making
sure
that
we
get
reliable
evidence
and
that
people
comply
with
submitting
it,
because
that
those
are
outcomes
that
matter
to
people.
So
it's
not
about
with
the
paperwork.
Is
there
to
go
it's
about
what's
actually
happening.
And
thirdly,
the
point
about
using
that
full
range
of
our
regulatory
approaches.
G
You
know
we've
got
a
lot
of
leverage
if
you
like,
and
we've
said
in
the
in
the
restraint,
seclusion
and
segregation
review,
that
there
are
models
out
there
that
are
not
fit
for
purpose,
and
I
think
we
do
have
leverage
to
influence
the
kinds
of
services
that
are
in
in
in
this,
for
for
people
with
learning
difficulties
and
autistic
people,
and
also
that
we're
in
the
position
to
to
to
pick
up
the
risks
of
abuse
and
those
closed
cultures
and
using
the
full
range.
G
I
mean
it's,
not
always
enforcement,
but
it's
about
setting
setting
expectations
so
that
everybody
out
there
knows
that.
That's
what
we're
doing
so.
I
think
it's
for
me.
It's
about
pace
and
it's
about
just
making
sure
that
we
really
keep
on
top
of
those
things
and
that
we've
got
that
accountability
right
and
we
expect
that
same
accountability
of
those
that
we
regulate.
Thank
you.
A
Thanks
rosie's
hand's
gone
down,
but
jorah's
has
gone
up
so
dora.
Let
me
let
me
come
to
you.
H
Thank
you
speech
and
thank
you,
professor
murphy.
I
was
really
going
to
ask
a
question
of
professor
murphy
to
you
know.
Looking
at
the
recommendations-
and
I
was
going
down
sort
of
page,
39
and
and
sort
of
you
know
she
sort
of
indicates,
there's
some
real
opportunities
for
us
to
collect
more
sort
of
quantitative
data
to
provide
better
insights
that
lead
to
better
outcomes,
and
it
seems
to
me
that
you
know
recommendation
one.
H
Three
four
five
were
opportunities
to
to
collect
data,
and-
and
so
the
question
was,
does
the
professor
see
this
the
correlation
between
those
data's
as
an
opportunity
for
us
to
get
better
sort
of
trend?
Analysis
of
what's
going
on
chris's
point?
If
it
was
simple,
it
would
be
one
single
date
appointment
and
we
would
have
solved
it.
H
So
is
the
opportunity
really
here
is
sort
of
correlation
between
the
interviews
between
what
we're
seeing
in
terms
of
restraint
and
sort
of
interviews
with
you
know,
a
number
of
participants
is:
is
that
where
the
real
opportunity
lies
and
for
us
to
sort
of
use
insights
to
lead
to
better
outcomes.
C
Yes,
I
I
think
that
is
exactly
right
and
I
think
one
of
the
reasons
that
it
has
been
so
difficult
to
detect
abuse
in
some
settings
is
that
it
requires
a
whole
series
of
different
bits
of
evidence
to
be
put
together.
C
And
actually,
I
think
cqc
is
in
a
unique
position,
because
it
is
the
inspector
and
the
regulator
of
health
and
social
care
nationally
to
collect
all
of
the
kinds
of
data.
C
That's
needed,
and
I
I
think
you
are
in
a
position
to
be
part
of
research
into
how
the
various
factors
that
we've
been
talking
about,
combine
to
produce
a
really
high
risk
setting,
because
I
think
that
would
be
helpful
for
inspectors
if
they
knew
that
fact
that
x,
y
z
and
q
were
the
main
things
that
were
going
to
tell
you
that
a
service
was
about
to
be
abusive
or
was
already
being
abusive.
B
Thank
you
chairman,
and
professor
murphy,
thanks
very
much
indeed
for
this
report.
I'm
I'm
pleased
to
see
that
we
have
responded,
but
we
recognize
there's
still
a
lot
for
us
to
do.
The
literature
research
was
was
fascinating
and
I
couldn't
help
but
think
that
there
was
a
tremendous
crossover
between
the
work
of
bigby,
for
instance,
and
a
broader
sort
of
industrial
psychology,
people
management,
organizational
development
themes
so,
for
instance,
bigby
talks
about
alignment
to
values,
talks
about
regard
for
customers,
perceived
purpose,
working
practices,
being
client,
centered
and
orientation
to
change
and
ideas.
B
He
seemed
to
me,
you
know
very,
very
strong
themes
in
terms
of
a
broader
management
of
organizations,
and
I
wonder
whether
you
think
that
as
we
progress
and
as
we
develop,
perhaps
some
some
of
our
own
research
or
research
through
others,
whether
we
should
make
closer
links
to
that
sort
of
broader
people
management
area,
rather
than
just
in
this
specific
area
that
you
have
researched.
C
Yes,
I
think
that's
a
really
interesting
question
and
there
were
a
couple
of
studies
that
took
measures
of
organizational
culture
from
a
a
very
broad
and
more
industrial
kind
of
setting
and
tried
to
apply
them
in
health
care
settings.
So,
for
example,
one
of
pisa
cruz's
studies
used
an
established
measure
of
organizational
culture.
C
I
I
felt
and
she
felt
that
it
wasn't
as
productive
as
it
could
have
been,
because
there
is
something
I
think
about
health
and
social
care.
That
is
specific,
although
I
agree
with
you
that
you
can
see
some
themes
that
would
cross
over
into
other
kinds
of
organizations
what
I,
what
I
do
think
is
that
probably
the
group
home
culture
scale
would
be
useful
in
other
health
and
social
care
settings
not
just
in
learning
disabilities
and
autism,
because
I
think
it
probably
does
pick
up
issues
that
are
going
to
be
relevant
in.
C
B
Yeah,
thank
you.
I
mean
I
thought
the
groupon
culture
scale
the
the
work
that
big
is
doing
and
in
your
report
you
say
that
they
they're
expecting
to
report
on
their
work,
their
further
research.
I
just
wonder
whether
whether
you
were
aware
of
the
time
scale
of
that,
so
that
we
can
follow
that
closely.
C
I'm
not
certain
of
the
time
scale.
I
have
had
a
conversation
with
them
since
we
ran
our
workshops
about
whether
they
might
be
interested
in
their
group
home
culture
scale
being
used
over
here
in
the
uk
and
they're
very
keen
to
see
that
happen,
so
I
think
they'd
be
up
for
doing
some
joint
research.
A
Fascinating,
I
I
think
this
whole
area
of
research
is
is
really
important
and
interesting.
Colleagues,
does
anybody
want
to
ask
anything
or
raise
anything
further.
A
A
No,
I
I'm
so
grateful
to
you
and
it's
been
a
fabulously,
important
report
and
clearly,
as
a
board,
we
will
be
thinking
very
carefully
about
how
to
take
forward
the
recommendations
that
you've
made
in
your
your
part,
two
report,
as
well
as
continuing
to
monitor
progress
in
implementing
the
recommendations
from
the
the
the
first
report,
and
I
suspect
we
will
be
coming
back
to
you
for
some
informal
discussion
around
how
we
might
take
forward
research
and
and
other
aspects
that,
as
we
digest
your
report,
we
might
want
to
come
back
and
just
discuss
with
you.
A
A
Good,
thank
you.
Thanks.
Bye,
bye,
now,
you're
welcome
to
stay,
but
you've
probably
had
enough
of
us
so
I'll.
Let
you
go.
Thank
you
right.
So
boy
that
takes
us
back
to
the
executive
update
and,
I
think
ted
we
just
about
reached
the
point
where
you
were
gonna
talk
about
emergency.
F
Departments,
yes,
thank
you
peter.
So,
as
I
was
saying
earlier
on,
the
system
is
under
enormous
pressure
at
the
moment
and
that
has
particularly
been
felt
at
the
front
door.
Hospitals
where
the
normal
winter
pressures
are
being
super
added
to
the
pressures
of
covid,
particularly
with
the
resurgence
of
the
pandemic.
F
That's
now
going
on
across
the
country
and,
of
course,
the
social
distancing
and
other
infection
control
measures
that
hospitals
are
taking
are
reducing
some
of
their
capacity
for
patient
flow,
and
this
is
leading
to
crowding
in
emergency
departments
and
to
delayed
ambulance
handovers
we're
monitoring
this
situation
very
carefully
across
the
country
on
a
regular
basis
and
where
we
identify
a
higher
risk,
we're
going
to
inspect
and
there's
a
regular
inspection
program
going
on
at
the
moment.
F
Looking
at
emergency
departments
across
england,
I
have
to
say
that
the
the
early
inspections
we've
done
have
shown
some
really
concerning
practice
and
we've
had
to
take
enforced
production
in
all
of
them.
So
far.
These
are
obviously
the
high
risk
services,
but
I
think
there
is
a.
I
am
really
concerned
about
the
level
of
crowding
in
emergency
departments
when
we
produced
our
patient.
First
guidance
earlier
on:
in
the
autumn,
we
made
it
very
clear
that
the
measures
had
to
be
hospital
and
system-wide
emergency
departments
cannot
cope
with
crowding
just
by
themselves.
F
I'm
glad
to
say
that
the
emergency
cons
emergency
department,
clinicians
that
we've
been
working
with,
have
developed
their
own
assessment,
self-assessment
tool
which
they
are
proposing
their
colleagues
across
the
country
use
to
make
sure
they're
using
patient
first
effectively.
This
seems
an
excellent
proposal
from
our
perspective
and
we'll
encourage
people
to
use
it.
F
We
will,
of
course,
be
assessing
ourselves
in
our
contacts
with
organizations
going
forward
and,
of
course,
infection
control
in
crowded
environments
in
emergency
departments
is
a
is
a
problem
as
well,
and
I
think
it's
important
to
emphasize
that
the
two
are
very
closely
linked
going
forward
and
we'll
be
monitoring
that
situation
very
clearly
going
forward.
I
mentioned
on
previous
board
meetings
that
we
were
undertaking
focused
emergency
department,
sorry
focus
maternity
department.
F
Inspections
are
based
on
risk
as
well,
and
the
light
of
the
publication
last
week
of
the
oculus
reports,
which
was,
I
think,
an
important
report
identifying
the
avoidable
harm
that
is
still
occurring
in
maternity
services.
It
is
very
important
going
forward
that
that
maternity
services
focus
on
their
safety
and
we'll
be
using
an
inspection
program
going
forward
to
to
assess
that
and
to
implement
changes
where
necessary,
we're
working
very
closely
with
other
parts
of
the
system,
nhs
improvement,
so
moral,
ecologies,
etc.
F
To
make
sure
that
steps
are
taken
to
improve
safety
and
maternity
services,
the
board
will
remember
that.
We've
highlighted
previously
that
38
of
services
are
requires
improvement
for
safety.
We
think
we
think
they
can
do
much
better
than
that
in
terms
of
the
specific
recommendation
the
epidemic
report
last
week
that
we
should
be
looking
at
women's
voices
when
assessing
maternity
services
and
making
sure
that
services
are
listening
to
the
women
using
those
services.
F
I
I
I
have
to
just
to
confirm
to
the
board
that
that
is
very
much
part
of
our
focused
inspection
of
maternity
services
going
on
at
the
moment,
we
think
listening
to
women's
voices
is
a
very
important
part
of
driving
the
quality
and
safety
of
those
services.
A
Mark
your
hand
is
up,
but
I
think
that's
just
left
over
from
from
the
last
item-
sorry
yeah,
good!
Okay!
Does
anybody
to
come
in
on
anything
ted's
just
said,
okay,
so
rosie
thanks
ted
rosie.
I
think
it's
over
to
you.
Please.
I
Thank
you
peter.
The
first
thing
I
wanted
to
mention
was
the
dna
cpr,
a
review
as
board
members
will
know.
We
published
our
interim
report
on
the
third
of
december,
and
I
hope
people
have
had
chance
to
read
that.
I
just
want
to
take
this
opportunity
to
thank
all
the
many
stakeholders
who
have
very
proactively
worked
with
us
on
that
that
review
and
continuing
to
work
with
us
on
this
important
review.
I
I
think
we've
been
very
keen
that,
through
this
review,
we
encourage
best
practice
that
we
encourage
people
to
be
having
conversations
about
their
their
wants
and
their
wishes
at
the
both
at
the
end
of
their
life,
but
also
throughout
any
any
treatment
that
they're
receiving
and
that
they
are
taking
an
a
very
kind
of
active
partnership
role
in
those
decision
makings
and
this
review.
I
We
very
much
want
to
pick
out
the
best
practice
and
as
well
as
sharing
the
learning,
so
we're
currently
undertaking
the
field
work,
and
we
are
looking
to
be
publishing
the
the
report
at
the
end
of
february
from
that
that
point
of
view,
but
that
work
is
going
very
well.
I
The
second
part
of
the
report
in
the
et
report
is
around
the
joint
targeted
area
inspection
programme,
which
is
a
program
where
we
undertook
a
series
of
inspections
with
offstead,
her
majesty's
inspector
of
probation,
her
majesty's
inspector
of
constabulary
and
fire
and
rescue
services,
and
the
report
here
outlines
the
findings
that
we
found
for
peop
for
children
and
young
people
with
mental
health
issues.
I
And,
as
you
can
see
from
those
findings
there,
there
is
still
a
lot
of
work.
That
needs
to
be
done
to
improve
how
people
are
working
together
to
look
at
children's
mental
health
and
moving
on
from
that.
The
the
next
part
of
the
report
looks
at
our
joint
program
with
ofsted
looking
at
areas
and
how
well
they
are
providing
for
children
and
young
people
with
special
educational
needs
and
disability
and
the
the
report
outlines
the
interim
findings
that
we
have
found
from
our
interim
visits
in
autumn
2020.
I
We
are
continuing
those
visits
until
spring
of
2021
and
there
will
be
further
interim
findings
published
in
january
21.
and,
finally,
I
just
want
to
mention
which
isn't
in
the
report
the
the
ongoing
work
we
are
doing
around
provider
collaboration
reviews.
I'm
really
pleased
to
see
the
information
that
has
come
out
in
the
insight
report,
which
chris
will
talk
about
later
today,
around
urgent
emergency
care
and
we're
looking
forward
to
the
the
final
report
being
published
for
that.
I
But
we
are
now
going
to
be
shortly,
embarking
on
our
cancer
programme
looking
at
cancer
services
and
how
providers
in
local
areas
have
worked
together
to
look
at
how
they
they
can
meet
the
people's
people's
needs,
who
have
suspected
cancer
or
diagnosis
of
cancer.
Thank
you.
Peter.
A
Thank
you
rosie.
Any
anybody
want
to
come
in,
so
we've
now
got
a
a
number
of
items
that
kirsty
would
have
introduced
and
obviously
isn't
here
what
I'm
going
to
suggest.
Oh
sorry,
I'm.
J
I'll
run
through
these,
so
there's
five
areas
to
update
on
in
terms
of
vaccination
program,
there's
covert
vaccination
programs.
In
terms
of
our
regulation,
we
don't
intend
to
run
a
specific
inspection
program,
a
vaccination
sites
and
informed
the
department
of
health
and
social
care
of
this.
Our
activity
will,
however,
be
in
line
with
the
transition
regulatory
approach,
maybe
based
around
potential
risk.
So
for
most
providers
there
will
not
be
any
registration
changes
and
there
would
simply
notify
us
of
any
new
sites.
J
We
want
assurance
that
the
right
procedures
have
been
followed
at
sites
we'll
do
this
through
our
transitional
monitoring,
approach
and
relationship
management,
and
only
expect,
if
there's
a
risk-based
decision
to
do
so,
we'll
keep
this
position
under
review
and
review
our
approach
and
continue
to
engage
with
key
stakeholders
clinic
clinical
professional
groups
and
other
regulators
to
provide
joint
up
assurance
and
oversight
of
the
vaccination
program
in
terms
of
performance
a
few
areas
to
pull
out
this
month.
J
This
is
the
october
performance,
so
in
terms
of
registrations
really
working
hard
to
make
sure
we've
got
providing
a
timely
turnaround
for
applications.
Simple
about
simple
applications
is
tracking
it.
18.6
days
and
complex
is
114.4.
J
What
the
one
page
dashboard
doesn't
show
is.
The
volume
of
applications
in
the
system
is
has
come
down,
which
is
which
is
good
progress,
and
we
continue
to
track
both
of
those
areas
in
terms
of
regulatory
action.
Between
april
and
october,
2018
locations
have
been
inspected,
1884
with
a
site
visit.
Those
with
a
site
visit
included,
449
inspections.
J
They
were
conducted
as
part
of
infection
prevention
and
control,
thematic
and
71
designated
settings.
This
is
obviously
the
position
at
the
end
of
october
over
excluding
the
thematic
reviews.
75
of
inspections
with
the
site
visit
were
conducted
due
to
risk
and
over
half
of
inspections
were
triggered
by
informational
concern
between
april
and
october
and
by
concern
that
could
be
whistleblowing,
safeguarding
concerns
or
complaints.
J
Now,
in
terms
of
our
financial
position,
budget
is
forecast
to
be
8.1
million
under
spent
at
the
end
of
the
year.
This
includes
potential
one
and
a
half
million
shortfall
on
income
capital
position
has
improved
vastly
after
previously
reporting
a
potential
overspend.
J
That's
now
come
back
in
line
and
we
think
we
will
deliver
just
just
within
a
capital
budget
allocation
for
the
year
I'll
pause
there.
Anyone
any
questions
for
continue
with
the
other
areas.
B
Thanks
chairman
chris
thanks
very
much
just
two
questions
on
those
particular
sections:
the
vaccination
program,
the
healthwatch
report,
says
or
raises
a
concern
around
communication
around
back
vaccinations.
Perhaps
is
a
question
more
for
rosie,
but
are
we
going
to
be
monitoring
the
effectiveness
of
the
communication
to
reach
those
that
need
the
vaccinations
and
to
get
them
in
and
get
them
vaccinated?
B
That's
one
question
and
if
I
could
just
ask
another
one
on
the
finance,
where
you
state
that
we've
got
a
potential
one
and
a
half
million
shortfall
on
provider
income,
I'm
sure
that
is
related
to
pressure
on
providers
in
terms
of
beds
utilization
for
us.
Maybe
that
has
an
impact
on
our
bad
debts
and
on
our
aging
of
debtors.
And
I
wonder
if
you
could
just
comment
on
that
for
us.
I
About
the
vaccination,
so
it's
it's
a
it's
a
very
interesting
question
mark
in
terms
of
what
our
our
role
is
specifically
around
the
vaccination
program,
and
we
are
working
through
the
details
of
that
with
a
cross
across
organizational
group.
At
the
moment
we
know
that
the
ccgs
have
a
very
clear
assurance
process
around
the
setup
and
the
the
the
initial
setup
of
the
coveted
vaccination
sites
and
we'll
be
looking
at
all
of
the
issues
around
communication
and
the
it
and
everything
else.
I
As
part
of
that
assurance
process,
we
very
much
at
present
are
planning
a
risk-based
approach,
so
we
will
be
only
only
taking
inspecting
or
taking
action
if
we
identify
specific
risks
and
concerns,
but
we
are
continuing
to
work
through,
as
we
understand
more
details
of
the
vaccination
program
as
it
emerges,
continuing
work
to
work
through
what
our
our
role
is
at
the
moment.
I
At
the
moment,
we
do
not
have
specific
plans
around
the
communication
identifying
communication,
but
if
we
were
to
hear
significant
risks
and
people
not
getting
communicated
to
when
they
were
expecting
a
vaccination
or
when
they
they
needed
a
vaccination,
then
we
would
be
following
that
up.
B
Right,
thanks
rosie,
I
really
it's
just
linking
to
access
that
general
broad
issue
that
we've
raised
before,
and
how
access
and
communication
and
getting
this
vaccination
job
done.
So
it
seems
to
me
you
know
very
critical
area
for
us.
I
Yes
and
we
are
continuing
to
work
on
the
the
access
issues
and
we'll
be
continuing
to
to
monitor
those
as
we
go
through
the
next
few
weeks
and
and
months,
because
I
think
people
are
concerned
about
the
the
increased
pressure
that
the
vaccination
will
program,
although
it's
very
exciting
that
it's
happening
there.
Nonetheless,
it
will
create
increased
pressure
on
an
already
very
pressured
system,
and
so
we
need
to
absolutely
monitor
that.
J
Yeah
there's
so
there's
probably
two
things:
the
the
income
variance
is
probably
there's
a
variety
of
reasons
that
would
drive
that,
and
and
providers
x
in
the
market
will
be
one
of
those.
So
it's
something
we
want
to
disclose
from
what
the
figures
I've
seen
lately.
That
position
isn't
turning
out
as
bad
as
we
projected,
but
it
is
something
we're
tracking.
J
Alongside
that,
our
age
debt
position
is
something
we're
closely
tracking,
so
we're
looking
at
our
total
income,
but
also
the
debts
that
we're
carrying
that
kpi.
We
look
at
mainly
over
60
days
and
is
holding
quite
steady.
What
our
concern
is
more
is
ensuring
that
things
don't
tip
into
that
and
that's
proven
quite
challenging.
We
have
it.
We
have
an
outsourced
provider
who
manages
that
for
us
so
between
us
and
then
we're
we're
just
ensuring
that
that
situation
stays
in
a
positive
place.
J
A
I
mean
this
is
this
is
an
issue
we
have
to
some
extent
every
year.
Chris
isn't
it
I
mean
we,
we
we
when
we
do
the
budget
and
set
the
fees
we
make
assumptions
on
the
number
of
providers
and-
and
you
know
sometimes
those
assumptions
nearly
always
the
assumptions
aren't
100
how
it
turns
out-
and
I
think
that's
probably
what
we've
seen
here.
It's
it's,
not
a
very
big
variation
on
our
our
overall
income.
J
A
J
A
few
more
just
a
few
more
from
me
so
in
terms
of
success
profiles
and
my
performance,
so
key
progress
being
made
in
terms
of
the
people
plan
priorities.
This
includes
the
launch
of
success
profiles,
a
new
my
performance
section
on
a
learning
system.
J
Success
profiles
are
also
integral
the
development
of
our
new
talent
approach
will
be
rolled
out
initially
at
exec
and
grade
a
level
in
in
the
final
quarter
of
this
year
before
being
rolled
out
across
the
organization
next
financial
year.
I
will
also
enable
a
focus
on
inclusion
and
succession
planning
link
to
in
inclusion,
so
sport,
uk
disability,
history
month,
a
series
of
workshops
have
been
developed
to
provide
colleagues
with
the
opportunity
to
learn
more
raise
an
awareness
of
disabilities
and
ultimately
improve
the
experience
of
our
disabled
colleagues.
J
The
first
workshops
of
our
cultural
intelligence
program
also
started
this
month
with
leaders
face
focusing
on
emotional
intelligence
through
a
cultural
lens
feedback
has
been
extremely
positive
and
will
support
delivery
of
our
ambitions
for
diversity.
Inclusion
strategy.
J
Having
attended
the
workshop
myself,
I
can
vouch
for
for
how
how
good
that
was
and
last
bit
for
me
in
terms
of
our
annual
accounts,
so
2019
20
annual
accounts
were
still
a
a
laying
date
for
those
we've
had
significant
delays
due
to
the
assurance
that
any
or
seek
from
local
government
ordered,
as
relating
to
the
valuation
of
pension
assets
and
liabilities,
the
the
impact
has
largely
been
felt
by
the
pandemic
on
on
local
government
auditors.
J
So
we're
hoping
to
have
some
good
news
on
that
shortly,
but
it's
likely
to
be
into
the
new
year.
A
Before
chris
on
the
news
shortly,
but
anyway
we
live
in,
we
live
in
hopes.
Paul
roux
wants
to
come
in
chair
of
the
audience.
K
Yeah,
it
was
just
a
small
point
in
relation
to
that
that
particular
thing
where
that
item,
which
it
describes
as
to
receive
the
assurance
required
from
our
local
government,
launches
rating
to
the
valuation
of
our
pension,
assets
and
liabilities.
I
just
want
to
emphasize
this-
is
not
our
pension
assets
and
libraries.
It's
the
local
government
schemes,
pensions
and
asset
liabilities,
and
we
have
a
share
of
that,
because
some
of
our
staff
are
members
of
those
schemes.
K
So
it's
very
much
remote
from
us
and
therefore
difficult
for
us
to
to
influence
the
the
progress
on
this,
which
is
frustrating,
but
it
is
as
it
is.
A
Thanks
paul,
it's
an
important
point
and
it
is
very
frustrating
because
you
know.
A
Would
have
laid
these
accounts
before
the
summer
recess,
and
you
know
here
we
are
at
christmas,
so
it's
it
is
frustrating
and
absolutely
outside
our
control,
but
there
we
are
mark
something.
I
I
I'm
assuming
it's
another
nil
report
from
you
on
on
cyber
security,
at
least
I
hope
it
is.
Yes,
I'm
very
pleased
to
report
that
there's
nothing
to
report.
Peter
silence.
Silence
is
golden
mark.
Thank
you
very
much
on
that
one
anyway,
chris
over
to
you.
E
Hi,
so
a
couple
things
to
report
on
from
my
side.
First,
in
terms
of
parliamentary
activity,
we
submitted
some
written
evidence
to
the
joint
science
sector
technology
and
health
and
social
care
committee
into
the
learnings
from
coronavirus
and
the
evidence
that
covers
our
role
in
our
pandemic
and
also
our
findings
from
our
regulation.
E
During
the
period
it
seems
to
be
published
shortly,
but
the
informal
feedback
we've
had
is
it's
been
very
useful
in
grounding
both
their
their
thinking
in
the
committee
and
also
where
else
they've
gone
for
assurance,
so
strong
support
for
our
work.
There,
a
number
of
colleagues
ian
k
kevin,
hosted
an
online
event
which,
in
light
of
today's
discussion
around
out
of
sight,
who
cares
the
event
heard
from
a
person
with
autism
about
their
lived
experience
and
you
can
get.
E
We
engage
parliamentarians
and
this
and
their
the
people
that
work
for
them
on
the
recommendations
of
the
review.
There's
actually
a
debate
in
the
lords
today
using
part
of
that
report
as
well
and
again,
there's
been
strong
support
for
the
for
the
messages
within
that
report
and
for
the
actions
that
we
take.
Next,
we've
been
doing
another
piece
of
work
with
the
all
party
parliamentary
group,
particularly
on
learning
disabilities
and
again
the
the
future
of
transformation
care.
E
Kate
and
ted
spoke
at
that
recently,
alongside
the
minister
and
colleagues
of
manchester
england,
improvement,
families
and
other
parliamentarians
again,
I
think
it
was
important
to
have
our
voice
in
that
discussion,
both
in
terms
of
what
we
think
the
perspective
of
where
we
are
today
and
also
what
needs
to
happen
next,
and
I
see
a
number
of
these
threads
if
you
like,
of
activity
as
a
as
a
series
of
pieces
of
work
that
will
lead
to
the
right
change
in
in
the
wider
system.
E
Just
in
terms
of
report,
we've
already
touched
on
a
couple
of
reports
and
those
we
haven't
touched
on
yet
the
just
just
for
note
really,
the
community
mental
health
survey
and
the
mental
health
act
reports
have
I've
just
been
published.
They
are
important
documents.
E
They
help
give
a
sort
of
a
state
of
play
of
how
we
think
mental
health,
ld
and
autism
services
are
working,
but
they
also
provide
some
of
the
material
for
our
later
investigations
that
we'll
do
over
the
course
of
the
coming
six
six
months
as
we
prepare
for
next
year's
state
of
care.
E
There's
also
an
ins
I'll
talk
about
the
inside
report
in
the
next
gender
item,
but
we've
also
launched
or
about
to
launch
our
next
spike
in
give
feedback
on
care.
Causeway,
remember:
we've
been,
we've
had
a
number
of
folk
areas
of
focus
for
this.
This
important
work
where
we
seek
views
of
people
use
services,
their
families,
etc
on
their
experience
of
services.
E
So
far,
we've
seen
a
61
increase
in
in
people's
providence
that
feedback
back
to
us,
partly
because
we've
improved
the
the
system,
but
partly
because
of
the
campaigns
that
we've
run
with
partner.
Colleagues.
The
next
spike
is
focusing
on
carers
and
again
we're
working
with
a
number
of
organizations
over
the
course
of
the
new
year
to
help
improve
our
understanding
about
how
carers
have
experienced,
particularly
during
the
period
of
covid.
E
So
we'll
aim
to
report
back
on
the
the
findings
from
that
in
a
future
insight
report
have
to
take
any
questions.
Peter
no
thank.
F
Thanks
chris
ted
you
wanted
to
come
in.
Can
I
just
comment
on
the
two
mental
health
reports
there.
The
mental
health
act
reports
I've
discussed
with
the
board
before,
and
it
shows
some
excellent
examples
of
how
mental
health
services
have
responded
to
the
kerbin
pandemic
and
details
how
we've
monitored
services
during
that
period,
but
I
just
particularly
wanted
to
to
emphasize
the
community
mental
health
survey.
A
G
Yes,
just
to
to
to
echo
the
importance
of
these
reports
and
on
the
community
mental
health
survey
report,
I
think
one
of
the
quite
striking
findings
that
seems
to
come
up
year
after
year
is
a
level
of
dissatisfaction
not
only
with
the
weights
and
the
response
times
in
crisis
and
so
on,
for
mental
health
support,
but
also
for
the
support
that
people
are
wanting,
but
not
getting
it
with
life
issues
so
finance
and
it's.
This
is
a
growing
issue
in
relation
to
pandemic.
G
And
so
it's
just
a
plea
really
that,
as
we
look
at
this
integration
agenda
that
we
do
think
about
how
well
the
services
link
link
people
in
to
that
support
that
people
need,
and
in
the
case
of
employment,
of
course,
individual
placement
and
support
is
an
expectation
on
mental
health
services,
so
that
you
know
you
would
expect
mental
health
services
to
be
supporting
people
with.
With
that,
but
just
to
plea
to
think
holistically,
as
well
as
on
the
actual
response
to
people's
direct
mental
health
needs
thanks.
I
There
is
a
huge
opportunity
to
to
look
at
a
more
holistic
approach
for
people
with
mental
illness
and
mental
health
problems,
and
we've
already
captured
some
of
those
really
good
examples
with
some
of
our
practices
and
some
of
the
outstanding
practices
that
we
work
with
already
work
with
people
like
citizens,
advice,
bureau
and
local
partners
to
give
people
that
that
life
support
that
they
need
more
generally,
I
think
there
is
a
huge
opportunity
with
developing
primary
care
networks
and
the
agenda
around
place
for
organizations
to
think
really
holistically
and
work
with
all
of
the
local
voluntary
sector
organizations
and
and
the
other
wide
organizations
such
as
the
department
of
work
and
pensions
to
look
at.
I
Actually,
how
do
we
really
give
people
the
support
that
they
need?
We
are
doing
a
provider
collaboration
review
looking
at
mental
health
next
year,
so
I
think
there
will
be
a
real
opportunity
for
us
to
capture
that
innovation
and
to
capture
the
ways
that
best
practice
that
systems
are
putting
in
place
in
that
that
that
that
review.
F
You
just
just
to
come
back
on
what
this
was
saying.
This
this
survey
was
before
the
kobe
pandemic
hits
that
the
field
work
was
done,
so
it
doesn't
reflect
the
impact
on
people
using
mental
health
services
of
the
code
pandemics.
I
think
it
is.
It
is
likely
from
from
what
we've
heard
that
there
that
the
people's
experiences
deteriorated
during
the
pandemic
because
of
the
all
the
restrictions
of
society.
So
I
think
this
is
emphasizes
the
importance
of
this
work
going
forward,
which
is
why
we
wanted
to
to
bring
it
to
the
fore.
A
Yeah
really
really
important
liz.
You
may
you
may
remember
I
or
you
may
not,
but
I
I
did
a
a
review
a
couple
of
years
ago
on
the
funding
for
the
various
organizations
that
provide
personal
debt
advice,
and
there
were
various
recommendations
in
in
in
my
report
about
the
sign
posting
that
can
come
from
both
primary
care
and
from
community
care
organizations,
and-
and
I
have
to
say
the
the
professions
have.
A
You
know
responded
very
well
to
that
as
far
as
I'm
aware,
but
it
is
all
part
of
a
really
big
integrated
set
of
issues.
I
I
I
quite
agree
and
nobody
will
be
surprised.
I
know,
there's
a
funding
and
a
deficit
in
all
these
advisory
services.
You
know
the
demand.
This
is
again
well
pre-covered,
but
you
know,
demand
was
vastly
outstripping
supply,
so
real
issues,
great,
really
important
issues.
A
Anybody
want
to
raise
anything
else
on
the
report
from
the
executive
and,
if
not
chris,
I
think
we
go
on
to
you
and
the
insight
report.
Please.
E
Yes,
and
so
this
is
just
to
remind
people
why
what
these
interference
reports
are
for
they're,
designed
to
help
everyone
in
health
and
social
care,
understand
and
learn
from
both
the
pandemic
and
also
the
how
services
are
changing
over
time.
They
they
should
be
they're
designed
to
share,
reflect
and
reflect
on,
what's
gone,
well,
understand
and
learn
from
what
hasn't
and
help
the
system
prepare
better
in
the
future.
There
are
three
issues
in
this
report
that
I
want
to
bring
to
the
board's
attention.
E
The
first
one
is
about
regional
data
on
the
designation
scheme
that
allow
people
with
kodi
positive
test
results
to
be
discharged
safely
from
hospital
into
registered
homes.
E
As
I
said
before,
we
provide
a
weekly
update
on
this
to
provide
the
assurance
to
dhc
and
and
also
the
national
partners,
about
that.
We
understand
what
is
happening
now
that
the
destiny
scheme
is
up
and
running.
We
can
look
at
the
numbers
of
approved
settings
across
the
regions,
and
the
table
in
the
report
shows
the
number
of
designation
beds
that
are
covered
by
alternative
arrangements
and
also
by
those
that
are
part
of
the
designation
scheme.
E
You
see
within
that
quite
a
wide
variation
from
the
lowest
figures
of
designations
per
100
per
100
care
home
beds
in
the
southeast
to
the
highest
level
being
in
london.
So
it
gives
an
opportunity
to
understand
why
that
is
so.
This
is
not
trying
to
suggest
that
something
is
bad
or
good,
but
I
think
it's
important
that
we
can
spot
the
variation
and
try
and
both
ourselves
and
our
partner
or
organizations
delve
into
why
that
is,
and
by
comparing
the
provision
of
the
approved
destination
base
against
the
average.
E
You
can
some
somehow
get
a
sense
of
where
the
pressures
in
different
parts
of
the
system
might
be,
and
if
you
look
at
the
information
we've
compared
both
designation
scheme
beds
and
all
sorts
of
general
pressure
because
of
the
reduction
in
beds-
and
you
can
see
a
sort
of
a
in
some
cases-
the
net
migration
of
nursing
home
beds
into
residential
care
beds,
which
is
probably
a
reflection
of
the
difficulty
of
maintaining
registration
of
a
nursing
home
with
the
with
the
staffing
issues
in
in
some
parts
of
the
country,
but
also
the
general
migration
out
of
the
system.
E
And
it's
important
to
keep
track
of
this
more
regularly.
We
will
do
in
segregated
care
at
the
moment
because
of
the
the
importance
the
crucial
importance
of
adult
social
care
will
play
in
managing
the
the
movement
of
people
out
of
out
of
secondary
care.
So
the
report
is
designed
to
give
that
transparency
that
understanding
of
that
of
the
challenge
both
nationally
and
regionally
in
these
areas.
E
So
we
can
see
where
the
pressure
points
might
be
as
the
as
a
as
as
covert
itself
moves
through
different
parts
of
the
of
the
country,
and
we,
I
really
want
to
make
sure
we've
got
clarity
on
risk
clarity
on
capacity,
so
that
national
and
local
organizations
contain
the
right
decisions
to
support
organizations
to
make
the
right
to
make
the
right
plans
for
a
now
and
over
the
next
two
to
three
months.
E
The
next
area
is
about
how
providers
collaborate
to
provide
urgent
emergency
care
during
the
pandemic,
and
we
wanted
to
highlight
some
good
practice
here
in
advance
of
the
full
report
which
will
be
published
in
january,
and
I
won't
sort
of
go
through
all
the
recommendations
there.
But
there
are
a
number
of
areas
there,
which
are
particularly
important
as
with
many
other
reports
where
we
talk
about
system
collaboration,
the
pandemic
was
a
catalyst
for
innovation
and
change.
E
That
was
happening
as
a
result
of
the
need
to
get
different
answers
and
different
solutions
very
quickly
where
there
was
good
quality
relationships.
There
was
better
outcomes
and
better
faster
joined
up
decisions
and
providers
did
express
the
concern
about
the
mental
health
and
resilience
of
their
staff,
particularly
as
they
approached
winter.
Some
manager
stresses
said.
The
pandemic's
impact
on
star
resilience
was
the
biggest
risk
they
had
and
there
are
good
examples
of
collaboration
to
ensure
staffing
levels
were
managed
well
across
the
system,
but
little
evidence.
This
was
widespread.
E
Some
people
told
us
that
they
had
very
positive
experience
of
the
care
they
received,
which
was
associated
with
obviously
with
good
outcomes,
but
there
were
some
complaints
about
the
disjointed
care
and
the
experience
of
the
lack
of
communication
between
services
and
pathways,
which
is
something
that's
been
common
in
our
pcr
work
providers,
told
us
that
communication,
communicating
well
with
the
public
and
services,
was
a
challenge
for
them,
particularly
at
the
point
of
from
the
point
of
covid,
and
I
think
it
relied
a
lot
on
the
relationships
that
existed
to
make
that
communication
work
well
for
different
reasons.
E
Some
people
of
groups
have
missed
out
on
the
care
they
needed
a
lack
of
capacity
in
some
places.
The
closure
of
some
services,
particularly
some
mental
health,
dental
and
primary
care
services,
affected
some
of
the
the
people's
access
to
those
those
care.
At
certain
points,
over
the
the
last
six
months,
we
found
inequalities
in
some
places
so
for
people
who
need
care,
as
well
as
for
staffing,
different
different
care
providers.
E
These
these
inequalities
varied
in
terms
of
whether
people
were
felt
protected
as
employees,
whether
people
felt
they
had
access
to
the
right
services
and
care,
and
finally,
digital
technology
was
used
more
widely
to
offer
people
access
to
services,
and
some
systems
were
trying
to
address
the
negative
impact
of
a
potential
negative
impact
of
digital
services,
around
service
user
choice
and
some
were
addressing
the
issues
around
digital
digital
inclusion.
I
said
there'll
be
more
information
on
this,
as
we
as
we
as
we
get
to
the
final
report
in
january.
E
There
were
also
some
good
examples
of
really
good
practice
around
around
person-centered
care
around
how
inequalities
were
managed
and-
and
I
think
there
are
a
number
of
areas
where
we
hope
that
we
can
drive
a
good
debate
both
nationally
and
locally,
to
encourage
providers
to
work
differently
together.
E
As
ever
with
the
insight
report,
there's
a
regular
update
on
the
on
the
information,
the
data
that
we
hold
for
issues
that
relate
to
the
outbreaks
staff
absenteeism,
the
the
deaths
of
people
detained
under
the
mental
health
act,
better,
better
people
with
learned
disabilities
and
those
in
social
care
settings.
E
We
want
to
make
sure
we
maintain
an
accurate
log
of
this
as
we
go
forward
to
make
sure
that
we
can
both
track
the
information
ourselves
and
to
see
what
it
tells
us
about
the
quality
of
care
that
people
receive
in
a
region.
E
Peter
there's
probably
much
more,
I
could
go
through,
but
that
they're
the
key
points,
I'm
happy
to
take
any
questions
or
comments.
So
so
chris
I
mean
just.
A
Are
they
are
hugely
valuable
both
to
us
as
an
organization
and
to
to
the
outside
world,
and
I'm
really
grateful
for
the
work
that
goes
into
producing
them?
Robert?
I
think
you
were
the
first
to
put
your
hand
up
and
then
paul
and
then
mark
robert.
K
I'd
just
like
to
try
and
tie
up
some
some
of
what
you
say
in
that
report
with
our
next
item
actually
relation,
firstly,
to
the
experienced
people
that's
reported
to
us
and
through
through
our
hospital
discharge
report
about
the
lack
of
joining
up
still
between
people
being
discharged
from
hospital
and
the
care
they
could
expect
to
get
once
they've
been
released,
and
I
wonder
and
there's
something
like
82
percent
of
people
were
reporting
that
some
issue
around
that,
and
I
just
wonder
whether
we
can
keep
track
of
that
in
any
way
and
in
terms
of
monetary
and
the
other,
relating,
I
suppose,
to
the
pcr
point
that
our
recent
insight
into
dentistry
has
revealed
a
really
concerning
aspect
which
is
often
neglected.
K
I
think
about
people
not
being
able
to
find
nhs
dental
care
and
a
huge
confusion
around
what
their
rights
are,
where
they
can
go
and
so
on
with
the
fear
that
actually,
in
that
field,
there
is
a
building
problem
which
is
well,
which
you're
only
beginning
to
see
the
tip
of
the
iceberg.
Bearing
in
mind
the
knock-on
effect.
K
Health
or
leaving
one's
oral
health
behind
like
that.
E
Great
rosey
mars,
coming
on
the
on
the
dental
point,
if
I
just
say
on
the
point
on
the
first
point,
you
made
around
access
and
joining
up.
I
really
want
to
use
we've
been
working
sort
of
with
colleagues
in
in
healthwatch,
and
we
don't
want
to
use
healthwatch
information
to
guide
some
of
our
thinking
around
future
insight
reports.
I
think
this
is
a
conversation
we
want
to
return
to.
E
The
other
thing
that
I
wanted
to
point
out
is
there
are
some
really
good
examples
of
really
good
join
up
in
services?
This
is
not
impossible
to
do,
but
it
is
about
those
relationships
and
it
is
about
common
endeavor.
So
we
wanted
to
try
not
just
to
describe
it
as
a
problem,
a
national
problem,
because
it
isn't.
There
are
some
really
really
good
examples
of
this.
E
We
want
to
try
and
guide
colleagues
both
nationally
and
locally
to
why
it
works
in
some
areas
and
what
the
ingredients
for
that
are,
but
I
think
the
work
we'll
do
with
with
healthwatch
colleagues
to
understand
that
further
and
to
come
back
to
it
time
and
time
again
over
the
course
of
the
next
few
months.
Will
be
will
be
important
rosie,
you
might
want
to
say
about
something
more
healthy,
well,.
I
Just
just
about
the
first
point
about
the
the
transfers
of
care,
I
think,
as
I've
said
on
several
times
before,
I
think
the
quality
of
care
people
get
depends
partly
on
what
they
receive
in
the
providers,
but
actually
there's
significant
impact
on
the
quality
of
care,
as
people
transfer
between
the
different
providers
in
the
system.
I
And,
firstly,
I
know
mark's
team
have
done
a
fantastic
job
in
providing
kind
of
intelligence
packs
for
local
local
areas,
which
look
at
things
like
delayed
transfers
of
care
rates
and
other
issues,
and
certainly
our
medicines
team
as
well.
Look
cross-sector
to
look
at
actually
things
like
medicines
issues
as
people
are
discharged
from
hospital,
because
there
are
significant
potential
risks
and
harms
if
those
pathways
are
not
fully
considered.
I
think
it's
really.
I
A
really
vital
part
of
our
future
strategy
is,
is
being
able
to
look
at
those
those
transfers
in
more
detail
and
those
relationships
between
the
providers
in
a
local
area,
so
that
we
can
make
sure
that
we
can
have
our
our
maximum
impact
on
on
ensuring
that
people
get
safe
care
as
they
move
in
different
parts
of
the
system.
I
In
terms
of
dental
access,
we
are
also
monitoring
dental
access
and
working
with
stakeholders
around
dental
access,
and
we
are
starting
a
small
scale
pilot
initially
around
dental
access
in
london
to
to
understand
that
in
more
detail
and
understand
what
the
opportunities
are
for
us
to
look
at
it.
Our
teams
across
the
country
are
following
up
areas
where
they
are
aware
of
dental
access.
I
Some
of
it
actually,
though,
is
is
difficult
for
us
to
explore
without
a
section
48
notice,
because
actually
some
of
it
is
very
much
related
to
how
the
system
works
together
and
as
the
pcr
report
outlines,
we.
We
are
aware
that
there
is
a
significant
impact
on
other
parts
of
the
system.
If
people
can't
get
good
dental
care,
people
end
up
in
any
people
end
up
in
general
practice
where
there
isn't
the
skills
or
understanding
just
to
highlight.
I
We
have
picked
up
some
brilliant
practice,
though,
for
example
where
the
dentists
were
closed,
there's
one
area-
I
think
it
was
surrey
from
memory
where
actually
they
employed
the
dental
nurse
in
the
a
e
department
to
actually
be
able
to
support
people
with
with
dental
problems.
So
there's
really
innovative
ways
that
systems
can
get
around
this
if
they
think
broadly
and
think
laterally
about
how
to
do
that.
F
I
think
well
yeah,
I
just
the
I
think
the
the
health
watch
data
about
discharge
reflects
very
much
what
we
find
in
our
surveys,
robert,
and
I
think
it
is
really
important
issues
I
reinforce
everything.
Rosie
said
there,
but
time
and
time
again
we
see
in
our
reports
importance
of
collaboration
and
and
collaborative
leadership
between
different
parts
of
the
system,
and
I
think
this
is
this
is
incr.
It's
increasingly
important
to
all
of
us.
F
I
think
that
that
this
is
vital
for
providing
safe
and
good
quality
care,
and
I
emphasized
earlier
on
that
the
real
problems
with
emergency
departments
and
the
and
the
need
for
system
collaborative
system
leadership
to
manage
that
problem.
F
K
Thanks
peter
and
that's
chris,
your
team,
this
is
it.
This
is
always
an
interesting
report
that
comes
through
yeah.
The
the
thing
I
was
just
going
to
focus
on
was
that
the
new
item
around
designated
settings
and
and
the
the
data
that
comes
in
there
and
I'm
kind
of
struggling
to
interpret
it,
because
I
I
I
understand
that
there's
these
figures
don't
show
the
full
picture.
K
I
I
guess
you
know
that
the
comments
would
be
about
the
south
west
and
you
you
say
that
the
information
suggests
a
potential
shortage
of
provision
in
the
south
west.
Is
there
an
intention
to
come
back
with
an
answer
to
this
because
leaving
it
hanging
there
seems
to
me
to
be
quite
a
a
a
a
a
dangerous.
E
Thing
to
do
so,
so
it's
in
a
sense,
it's
deliberately
provocative.
So
this
is
this
is
a
monthly
report
that
we
give
weekly
to
to
the
dhsc
and
to
others.
I
know
two
things
that
that
are
an
issue.
One
is
that
alternative
settings.
At
the
moment
there
is
less
grip
on
what
the
capacity
of
those
alternative
settings
are.
E
So
we
know
very,
very
discretely
how
many
beds
there
are
in
a
designated
setting,
but
we
don't
quite
know-
and
there
isn't
an
absolute
record
because
it's
not
with
its
outsider,
our
our
responsibility,
what
what
the
what
an
alternative
possession
might
be.
So
the
reason
why
I've
captured
it
in
that
manner
paul
is
exactly
to
sort
of
tweak,
dhc
and
others
and
say
well
how
many,
what
what's
the?
E
E
We
will
come
back
to
this,
so
we're
coming
back
to
this
on
a
weekly
basis
with
dhsc,
as
we
try
to
get
a
better
grip
of
the
things
that
are
outside
directly
outside
the
designated
scheme
setting,
but
we
wanted
to
be
really
clear
that
we
were
not
in
a
sense
we're
not
assured
that
there
is
the
capacity
beyond
what
we
know
in
the
destination
scheme
to
cope
with
it
with
the
the
demand
that's
coming
from
the
nhs.
One
final
point
on
this
paul
is
that
in
a
different
different,
we
don't.
E
We
want
to
be
really
clear
that
that
we
and
kate's
team
and
and
kirsten
do
a
fantastic
job
registering
new
services
very
quickly.
So
this
there
is
not
a
cqc,
not
a
block
in
this
regard
at
all,
so
any
gap
in
provision
is
entirely
about
the
the
amount
of
capacity
and
the
amount
of
alternative
settings
that
the
desktop
is
coming
forward
and
not
cqc's
ability
to
to
register
those,
and
it
was
an
important
point
for
us.
We
want
to
really
clear
about.
E
A
Okay,
paul
so
mark
and
then
liz.
B
Thanks
chairman
chris,
very
good
report,
as
as
always
workforce
capacity
and
capability,
when
I
was
reading
that
I
was
saying
yeah,
it's
it's
good
to
see
that
there's
some,
you
know
transactional
work
going
on
to
try
to
improve
rostering
and
create
greater
efficiencies
and
take
pressure
off,
but
I
kept
coming
back
to
staff
well-being,
and
you
know
I
was
particularly
you
know.
B
Thinking
about
what
we
hear
about
staff
burnout,
about
stress,
about
emotional
pressures
and
I
think
is:
is
there
not
possibility
that
this
insight
report
could
give
us
some
insight
into
that?
That,
in
turn
would
would
help
the
department,
and
so
they
would
be
hearing
this
directly
from
the
people
on
the
front
line.
E
Yes,
I
think
I
mean
what
we've
tried
to
do
with
the
inside
force
is
always
based
on
what
we
know
from
our
regulatory
activity
and,
as
I
think,
we've
said
in
a
report,
it's
important
to
to
note
that
trust
themselves
see
this
and
I've
got
such
capsule
design
primary
care
see.
E
This
is
a
number
one
issue
to
to
to
how
they
are
going
to
successfully
navigate
the
winter
period,
and
I
think
we
will
absolutely
work
with
not
just
ourselves
but
also
work
with
other
organizations
with
common
interest
here,
to
highlight
this
and
to
highlight
two
things.
E
I
guess
what
how
some
organizations
and
some
local
systems
are
choosing
to
deal
with
it
and
also
to
highlight
the
the
general
problem
of
burnout
and
capacity
and
we've
seen
some
innovation
around
how
organizations
are
shared
resource
rosie
mentioned
wanted
a
minute
ago,
but
there
are
some
real
real
ongoing
concerns
about
how
people
as
mental
health
is
managed
and
supported
during
what
will
be
a
very
long
winter.
So
we
are
looking
for
how
organizations
are
managing
this.
E
Well,
we'll
continue
to
talk
about
it
and
there
is
a
wider
consideration
about
how
we
share
that
good
practice
that
happens
in
some
areas,
with
with
a
with
a
wider
system
and
there's
some
conversations
with
nhs
england
a
moment
about
how
we
bring
together,
the
ics
leads
to
share
some
of
this
good
practice
with
them
the
inside
port,
designed
to
provoke
some
of
those
conversations,
and
we
hope
that
that
will
happen
both
locally
and
and
nationally
rosie.
Do
you
want
to
jump
in
before.
I
Yeah,
certainly
just
two
things
on
that.
Just
to
add
to
what
chris
has
said,
one
is,
I
think,
the
the
imperative
of
system-wide
workforce
planning
is
more
than
ever
at
the
moment.
It's
really
vital
that
systems
work
together,
because
actually,
what
you
don't
want
is
is
the
kind
of
robbing
peter
to
pay
paul
across
systems,
so
the
shortages
lead
to
people
moving
around
the
system
and
leaving
a
gap
elsewhere.
I
So
I
think
that
the
best
examples
have
we
we've
seen
have
been,
where
there's
that
really
good
joined
up
working
across
the
system
to
look
at
good
workforce
planning,
I
think.
Secondly,
it
just
highlights
the
really
important
need
for
a
good
culture
within
organizations
and
for
cult
for
organizations
to
really
value
and
support
their
staff.
I
We
know
that
there's
a
direct
link
between
staff,
well-being
and
quality
of
care
patients
get
and-
and
we
need
to
absolutely
kind
of
recognize
that
and
encourage
providers
to
really
consider
and
support
their
staff,
which
are
clearly
through
very
challenging
and
difficult
times
at
the
moment.
G
Yeah
thanks
very
much
a
really
helpful
report.
I,
like
others,
I
really
welcome
the
identified
good
practices
and
the
and
the
ambition
to
see
those
embedded
more
widely.
I
just
wanted
to
pick
up
on
the
good
practices
in
relation
to
inequality,
and
I
noticed
that
today,
michael
marmot
has
published
a
further
report
on
basically
saying
that
there
were
health
inequalities
already
pre-pandemic
and
they've
been
exacerbated
and
intensified
in
some
particular
respects
by
the
pandemic
very
interesting
report.
G
But,
given
that
that's
happening,
I
just
wondered
whether
we've
got
the
scope,
perhaps
given
the
opportunity
of
primary
care
networks
and
ics's
and
so
on,
to
to
put
a
particular
spotlight
on
this
issue
about.
You
know
how
you
redress
inequalities,
because
it
seems
like
they
that
it's
becoming
more
and
more
of
an
issue
since
the
pandemic.
I
I
was
just
going
to
say,
I
think,
that's
that's,
absolutely
right
liz
and
I
think
part
of
what
we're
trying
to
do
with
the
provider
collaboration
reviews,
starting
with
the
urgent
emergency
care
set
of
reviews,
but
certainly
with
all
of
the
other
reviews
that
we're
undertaking
from
now
on,
we'll
have
a
spotlight
on
inequalities
and
what
a
good
practice
people
have
put
in
place
to
deal
with
those,
and
our
final
report
will
have
a
lot
more
of
those
case.
Studies
and
examples
in
it
that
our
teams
have
pulled
out
through
the
field
work.
I
But
I
think
it
is
absolutely
something
that
is
very
much
a
priority
for
us.
If
you
look
at
dental
access,
for
example,
and
and
robert's
mentioned,
the
the
healthwatch
findings
around
dental
access,
a
real
concern
that
that
access
has
potentially
kind
of
widened
those
in
their
qualities
over
the
last
few
months,
potentially
with
the
move
to
digital
use
of
consultations,
and
things
like
that.
That
works
very
well
for
a
lot
of
people,
but
there
is
also
the
potential
for
that
to
to
widen
inequality.
I
So
it
is
something
we're
very
alive
to
and
very
much
wanting
to
pick
up
best
practice
down
the
learning
through
the
pcr
program
that
we're
doing
and.
E
I
think
there's
that's
absolutely
right.
I
think
it's
a
wider
point
about
the.
The
reason
why
pcrs
are
important
is
because
they
help
identify
how
to
manage
demand
because
a
lot
of
the
the
good
practice
examples
are
about
public
health
and
how
organizations
are
working
together
to
improve
public
health
and
access
to
the
right
information
to
actually
manage
demand
before
it
before
it's
created,
and
I
think
that's
an
important
element
of
why
the
pcrs
are
so
important.
E
They're,
not
just
about
understanding
how
organizations
operate
to
manage
people
through
a
system
they're
also
about
how
they
encourage
people
to
stay
well,
and
I
think
that'll
be
an
important
element
about
our
work
as
we
as
we
move
forward.
A
So
again
chris
thanks
to
you
and
to
the
team
that
put
all
this
together,
I
think
a
really
really
useful
set
of
reports,
I'm
going
to
suggest
that
we
just
give
ourselves
a
five
minute
stretch
break
and
then
come
back
to
the
the
health
watch.
So,
according
to
the
clock
here,
it's
13
21.
If,
if
we
start
again
at
13
26,
if
that's
okay,
but
literally
five
minutes,
just
done
stretch
thanks
eating
yup.
So
robert,
can
we
come
to
you
then
on
the
healthwatch
england
report.
Please.
K
Well,
I
certainly
don't
want
to
steal
him
elder,
thunder
and
I'm
sure
she'll
be
with
us
in
a
second
I'd,
just
like
to
highlight
some
a
number
of
things.
K
Firstly,
we
do
talk
in
this
report
about
our
stakeholder
updates,
which,
to
my
mind,
have
been
really
useful
pieces
of
information
and
the
what
I
was
talking
about
in
relation
to
dentistry
came
out
of
the
last
one,
and
I
think
it's
a
real
example
of
the
sort
of
area
where
health
watch
nationally
and
locally
comes
together
to
produce
really
powerful
information,
and
I
think
that's
been
seen
also
through
all
the
reports
that
are
mentioned
in
el
melda's
reports.
But
one
can
highlight
the
discharge
report.
K
The
digital
report,
dr
zoom,
and
and
finally,
I
just
like
to
highlight
the
work
that
healthwatch
has
been
doing
on
care
home,
visiting
guidance,
which
I
think
was
an
urgently
required
piece
work
with
which
allow
in
which
we
engage
very
constructively
from
both
sides
really
with
the
department
of
health.
And
I-
and
I
believe
the
current
guidance
was
a
considerable
improvement
on
what
had
gone
before.
K
K
Significance
as
it
were
to
to
others,
and
also
to
remind
us
once
again
that
healthwatch
is
really
the
only
game
in
town
that
connects
locals
gruesomely
from
the
patient
people
who
actually
experience
and
need
services
with
national
policy
making
in
a
pretty
direct
way.
So
that's
all
I
wanted
to
say,
and
I
rather
hope
the
melbourne
is
here
to
take
over.
A
Welcome
in
elder,
I
can
say
that
robert's
even
more
more
welcoming.
C
Well,
I
don't
know
that
I
want
to
add
a
lot
to
what
robert
has
already
said,
because
you've
got
the
report
in
front
of
you.
It's
a
very
full
report
and
it's
just
a
way
of
keeping
you
up
to
speed
with
the
work
that
we're
doing
just
if
I
shine
the
light
for
a
moment
on
the
work
that
we
did
around
hospital
discharge,
which
I'm
not
sure
whether
robert
talked
about
or
not.
I
think
I
was
about
a
minute
late,
getting
in
so
politically.
I.
C
Okay,
well,
that's
been
a
really
useful
piece
of
work.
We
we
wanted
to
make
sure
that
we
really
understood
people's
experience
of
the
rapid
hospital
discharge
and
and
so
went
out
across
the
country
speaking
to
people
speaking
to
staff,
who
are
working
on
the
front
line,
either
in
social
work
or
in
community
services
or
in
care
homes,
and
we
did
that
very
early
on
working
with
the
people
who
wrote
the
guidance
in
nhs
england
so
that
we
could
help
them
with
their
winter
planning.
C
So
they
could
learn
from
the
best
and
change
for
the
winter,
and
I
think
that's
been
a
really
great
piece
of
work.
Robert
probably
talked
to
you
about
the
work
on
dentistry
too,
which
I
think
you
many
of
you
will
be
familiar
with.
C
We
published
a
report
last
week
on
the
impact
of
covidon
dentistry,
which
for
many
people
was
already
a
really
difficult
service
and,
in
particular
parts
of
the
country,
particularly
parts
of
the
west,
really
poor,
but
covert
is
it's
now
the
whole
country
are
having
real
trouble
accessing
nhs,
dentistry
and
it's
causing
a
huge
amount
of
anxiety
and
pain
to
people.
C
So
the
only
other
thing
I
just
thought
I
would
talk
about
briefly
is
the
work
that
we've
been
doing
on
realigning
our
strategy.
We've
we've
been
working
hard
with
stakeholders
and
with
our
committee
and
we'll-
and
I
have
talked
to
briefed
ian
on
our
direction
of
travel
for
our
new
strategy.
C
But
our
strategy
will
be
building
very
much
on
what
we've
done
already
building
on
the
strong
foundations
that
we've
built,
but
turning
our
attention
now
to
make
sure
that
we
and
local
healthwatch
really
get
into
the
communities
that
are
seldom
heard
and
that
we
bring
forward
those
voices
so
that
we're
really
understanding
the
impact
on
particular
groups
of
people
and
during
the
course
of
this
year
we've
been
we've
been
sort
of
laying
the
foundation
of
that
work
and,
as
we
go
into
next
year,
with
the
new
strategy,
that'll
be
absolutely
core
to
the
work
that
we
do
so.
C
So,
for
example,
we'll
be
doing
some
work
on
on
the
move
to
digital
and
and
really
we're
interested
in
looking
at
who's
left
behind,
but
we're
also
working
with
the
local
health
watch,
who
have
much
better
links
into
communities
and
really
looking
to
see
exactly
what's
going
on
there,
how
we
can
build
their
capacity
to
do
that
better
and
we
have
a
project
going
on
at
the
moment.
That's
that's
really
building
the
foundations
so
that
we
really
know
what's
happening
at
a
local
level.
C
A
And
melder,
I
I
think
it's
just
fantastic
the
transformation
from
where
healthwatch
was
two
or
three
years
ago
and
and
what
we,
what
we,
what
we're
now
getting,
as
you
say,
both
from
healthwatch
england,
but
actually
through
you
from
from
the
local
health
watchers
is,
is
fabulous.
So
thank
you,
rosie.
You
wanted
to
come.
I
Thank
you
very
much
because
I
know
we
have
a
really
productive
working
relationship
with
healthwatch
and
have
been
kind
of
doing
quite
a
lot
of
work
around
gp
access
and
dental
access,
and
it's
been
it's
been
great
to
have
that
relationship
and
I
think
I've
been
encouraging
inspectors
to
reach
out
to
local
healthwatch
as
well,
and
I
think
there
is
an
opportunity,
as
we
look
at
how
we
develop
more
our
place,
based
thinking
in
terms
of
how
we
then
link
and
and
work
very
closely
with
local
health
watch
and
expand
those
relationships,
brilliant
rosie,
and
if
there's
anything
we
can
do
to
facilitate
national
to
local.
E
In
the
meeting
just
another
one,
as
I
said
to
thank
amalda
and
the
team,
I
think
there's
been
a
really
strong
sense
of
collaboration
between
healthwatch
and
cqc,
on
the
on
sharing
information
and
sharing
the
data
and
driving
the
right
conversations
both
locally
and
nationally,
and
I
think
we've
we've
worked
together
well
to
sort
of
help
understand
where
we
might
collectively
join
forces
to
present
the
right
information
to
colleagues
both
in
in
national
organizations
as
well
as
people
locally.
E
So
I
think
just
to
say
thank
you
to
you
and
to
the
team
amelda
for
that
work,
because
it's
it
makes.
I
think
it
makes
our
collective
is
more
powerful
that
we
can
do
that
work
together.
C
Thank
you.
Thank
you
chris,
and
I
think
one
of
the
things
is
we,
I
think,
we're
much
more
confident
organization
than
we
were
and
I
think
we're
confident
in
that
we
bring
a
particular
type
of
insight
to
the
table.
It's
not
the
only
insights
needed,
but
it's
a
particular
type
that
has
a
particular
richness
put
together
with
other
people's
data.
You've
got
something
very
powerful.
B
Great
mark,
thank
you,
chairman
and
imelda.
Thank
you
again
for
another
fabulous
report
for
from
you
and
your
team.
I
was
really
struck
by
the
sort
of
forward-looking
view
of
of
healthwatch
really
interested
in
terms
of
your
brand
promise,
brand
values
and
tone
of
voice
piece
of
work.
I
think
that's
going
to
be
something
that
we
look
forward
to
hearing
hearing
about.
B
B
I
always
remember
the
transport
report
and
the
work
that
you
did
there
and
the
influence
that
that
you
had
with
the
department
there
and
we're
going
to
be
doing
a
piece
of
work
next
year,
as
rosie
has
said
about
a
provided
collaboration
review
around
mental
health
provision,
I
just
wonder
whether
there
isn't
a
an
opportunity
to
to
work
together
there,
for
specifically
with
with
healthwatch
in
terms
of
you,
know,
daycare
and
emergency
care
in
terms
of
mental
health.
It's
just
a
question
perhaps
to
take
away
and
think
about.
Yes,.
I
Yes,
absolutely,
it
was
what
I
said
and
yes
I
I
would
actually
I
I
very
much
hope
that,
while
the
team
have
got
you
involved
in
the
other
provider,
collaboration
reviews
as
well
with
cancer
and
and
learning
disabilities,
as
well
as
the
mental
health
one,
but
I
will
I
will
we
will
go
back
back
and
make
sure
that
that
is
absolutely
happening.
Thank
you.
Rosie.
A
K
Well,
if
no
one
else
says
I'd
just
like
to
say
what
I
didn't
say
before,
but
we
can't
take
it
for
granted
that
all
this
work
that
she
emailed
her
reports
on
has
been
done
by
a
team
which,
like
everyone
else,
has
been
doing
it
from
home.
And
frankly,
I
reckon,
if
you
were
in
the
local
health
watch,
the
support
you
would
be
getting
now
is
no
different
at
all
and
of
the
same
quality
as
it
was
before.
K
A
Thank
you.
No
thank
you
very
much,
so
any
other
business
for
the
board
from
anybody.
Well,
I
I
just
have
one
item
which
is
paul.
This
is
your
your
last
meeting
and
I
I
can't
thank
you
enough.
A
Your
contribution,
as
chair
of
the
audit
committee
has
been
enormous,
but
that
has
only
been
a
really
quite
small
part
of
your
contribution
to
to
the
board
and
the
organization,
and
I
imagine,
if
you
think,
back
to
how
how
it
was
when
you
first
joined
it
and
how
it
is
today,
there
is
very
little
little
resemblance
between
the
two
and
a
very
large
part
of
the
the
the
reason
we
have
been
able
to
develop
so
successfully
over
that
that
six
and
a
bit
years
is
down
to
your
contribution,
and
so
just
for
all
of
us.
A
Thank
you
very
much
indeed,
for
all
you
have
done,
and
I
and
I
I
hope,
our
paths,
both
mine
and
yours
personally
and
cqc's
and
yours
will
will
cross
in
the
future,
but
but
thanks
again,
paul
terrific
and
there's
a
there's,
a
there's,
a
there's,
a
silent
virtual,
hang,
clap.
K
Going
on
there,
thank
you
peter.
It's
been
a
privilege
and-
and
it's
been
a
game
of
two
of
two-
not
two
halves
and
a
bit
of
extra
time
as
well
so
and
it's
been
throughout.
K
I
think
one
of
the
great
things
is
that
the
whole
organization
has
been
on
an
upward
trajectory
from
a
very
low
base
to
start
with,
but
now
from
quite
a
high
phase,
and
I'd
like
to
just
thank
everybody
who
sort
of
provided
help
and
assistance
and
advice
to
me
and
the
sort
of
comradeship
that's
gone
with
that
as
well,
both
around
the
the
thought
table
and
in
the
organization
as
a
whole.
So
thank
you
very
much
and
yes,
I
hope
we
will
keep
in
touch.
A
Great,
thank
you
paul
thanks
very
much
indeed,
so
if
there
is
no
other
business,
that
is
the
end
of
the
board
meeting.
As
such,
we
have
two
questions
from
one
member
of
the
public,
robin
pike,
and
I
I
will
just
read
them
out
both
of
them
because
I
think
rosie
they
probably
fall
to
you
to
answer
both
of
them
please.
I
You
so
I
think
the
first
one
we've
covered
essentially
in
the
executive
team
report
and
chris
usher
covered
it,
but
essentially
we
we
are
not
planning
a
full
inspection
program
of
copied
vaccination
sites,
but
we
will
be
taking
a
risk-based
approach
and
following
up
and
any
concerns
we
hear
about
vaccination
and
we'll
also
be
looking
at
the
impact
on
on
access
as
well
and
and
following
up
any
concerns
that
we
hear
around
access.
I
As
a
result
of
of
that,
so
we
we,
I
think,
we've
covered
covert
vaccination
in
terms
of
one
more
one.
We
regulate
one
one.
You
know
a
variety
of
ways
and
this
is
going
to
continue
with
the
111
first,
so
we
receive
as
sitrep
data
from
nhs
england
and
where
we
have
any
concerns
about
that
data,
we
will
take
appropriate
action.
We
also
look
at
triangulating
the
data
that
we
get
with
discussions
from
with
the
ccgs
locally,
with
the
providers
and
with
other
parties.
I
I
We
have
also
regular
engagement
with
ed
consultants
and
urgent
care,
specialist
advisors
who
work
in
the
area,
and
they
advance
warn
us
of
any
kind
of
emerging
issues,
and
we
also
have
a
regular
engagement
meeting
with
nhs
england
as
well,
so
there's
a
whole
variety
of
ways,
we're
looking
at
one-on-one
services
and,
in
particular
the
impact
of
the
rollout
of
nhs
111.
First.
A
Great
rosie,
thank
you
very
much
indeed,
and
that
that
does
then
conclude
the
meeting.
I
just
want
to
wish
everybody
a
very
happy
and
covet
free
christmas,
and
I
will
see
see
you
all
other
than
you
paul
around
the
table
in
the
new
year.
Well,
I
hope
I
see
you
somewhere
as
well,
so
thanks
everybody
and
see
you
soon.