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From YouTube: CQC Board Meeting – December 2015 (with subtitles)
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A
B
A
Meeting
longer
than
the
timetable,
but
I
think
we
will
keep
the
timetable.
Do
colleagues
accept
the
approve
the
minutes
of
the
last
meeting
good
I.
Think
the
only
item
on
the
axon
rob
has
struck
me
was
that
we
were
supposed
to
have
an
update
on
the
staff
survey
results
of
this
meeting,
but
that's
been
put
back
to
Dan.
He
said
that's
when
we're
going
to
have
it
say
David.
Would
you
like
to
give
us
your
report?
Please,
and
thank
you
Michael
good
morning,
everybody
and.
C
I'm
going
to
try
and
do
four
or
five
things
in
presenting
this
report
and
I'd
like
to
take
the
performance
and
the
very
brief
item
on
the
public
accounts
committee,
where
I
said
I'd
provide
an
oral
update
together,
rather
than
set
them
as
two
separate
items
but
and
firstly,
Michael.
If
I
could
just
point
you
publicly
and
pay
tribute
to
the
way
that
you've
stepped
in
to
charity
Keesee
over
these
past
settlements,
and
just
thank
you
on
behalf
of
the
board,
a
thing
for
everything
that
you've
done
over
this
period.
C
I
know
how
much
you've
given
to
CQC
over
this
period
and
how
much
time
you've
made
available
to
me
personally,
but
also
to
the
responsibilities
of
the
chair
and
we're
both
very
grateful
and
very
appreciative
of
what
you've
done.
So
so.
Thank
you.
I'm
sure
I
speak
for
everybody
in
that,
thanks
also
to
Luis
very
covering
the
regulatory
Governance
Committee
as
well.
I,
really
don't
underestimate
how
to
busy
people
have
got
to
create
the
tax
check
on
additional
responsibilities,
and
thank
you
thank
you
to
you
as
well.
C
Attached
is
an
annex
which
gives
the
very
fine
detail
and
reports
up
until
October
in
relation
to
the
performance
of
both
registration,
our
performance
again
in
delivering
the
inspection
program
and
also
our
performance
in
relation
to
producing
reports
within
the
50-day
target.
In
addition
to
this,
and
following
the
public
accounts
committee,
a
delivery
progress
report
was
circulated,
I
think
in
advance
of
the
meeting
and
I
would
like
to
refer
to
both
the
naxos
in
just
walking
through
our
performance.
C
The
lesson
to
inspection
targets
as
a
sudden
introduction,
the
the
charts
in
the
performance
report
to
looking
at
the
picture
as
at
the
end
of
October,
there
are
signs
of
improvement
in
performance.
In
those
figures,
it
could
then
refer
to
the
additional
report
which
was
circulated
yesterday.
The
delivery
plan
and
you'll
see
on
page
2
of
that
delivery
plan.
It's
a
much
more
up-to-date
position
in
relation
to
performance
against
the
program
and
I
think
what
this
report
is
beginning
to
demonstrate
are
the
improvements
which
are
indeed
taking
place.
C
I
think
we've
used
a
metaphor
of
a
petrol
tanker
previously
beginning
to
turn
and
I.
Think
this
report
is
some
evidence
of
improvements
beginning
to
be
made.
There
is
more
to
do
as
you
can
see
in
bold
there's,
some
two
and
a
half
thousand
inspections
behind
the
program
plan
and
in
the
table
that
sits
below
that
some
bold
statements,
there's
a
detail
of
what
the
gap
is
compared
with
a
plan
expressed
as
both
percentage
and
in
terms
of
real
numbers.
C
Correct
me,
if
I'm,
if
that's
wrong,
so
I
present
this
information,
Michael
and
colleagues
on
the
basis
that
there
are
a
in
prudence
taking
place
again
on
the
performance
reports.
If
we
look
at
the
inspection
final
reports,
I
think
what
the
evidence
is
in
relation
to
the
October
figures
and
again
in
the
November
figures,
is
continuing
improvement
in
the
number
of
reports
which
are
produced
within
50
days
and
I.
Think
there's
a
steady
trajectory
is
emergent
and
I
think
that
bar
charts
on
page
seven
begin
to
set
out
the
detail
of
some
of
that
progress.
C
If
I
could
come
back
to
the
delivery
plan
update,
this
is
in
relation
to
the
public
accounts
committee.
I
think
what
we've
done
on
slide.
Three
is
set
out
a
pretty
high
level
and
there's
detail
that
sits
behind.
This
is
the
two
themes
if
you
wish,
which
are
an
essential
part
of
this
delivery
plan.
Firstly,
there's
the
work
which
is
to
undertake
improvements
in
productivity
in
each
of
the
Directorate
and
I
think
the
improvements
have
been
made
through.
C
There
have
been
capability
issues
which
have
been
raised
with
individual
members
of
staff
in
relation
to
whether
their
performance
and
productivity
is
satisfactory
and
were
that's
identified
as
an
issue.
People
are
offered
support
and
in
one
or
two
cases,
that's
led
to
people
not
continuing
their
employment
with
CQC.
C
So
I
think
we've
improved
our
productivity
and
we've
calculated
that
to
do
about
14th
out
14
hundred
inspections
or
the
trajectories
from
the
low
points
at
the
beginning
in
the
year
and
I
think
this
is
reflected
in
my
comments
about
improvement.
The
second
area
second
theme:
that's
behind
this
delivery
plan,
other
way
that
we've
used
the
resource
that
we've
got
available
during
this
current
financial
year.
Financial
resources
to
pay
overtime
to
inspectors
were
that's
appropriate.
C
Lastly,
on
the
delivery
program
were
reflecting
on
the
work
which
is
being
undertaken
for
the
remainder
of
this
year
to
plan
the
work
for
next
year.
Significance
of
this
is
that
the
delivery
of
the
program
was
always
scheduled
to
be
completed
in
the
financial
year
1617
and
therefore
will
continue
to
monitor
and
assess
this.
It
has
to
be
said.
C
The
program
continues
to
be
at
risk
with
to
an
hour
thousand
inspections
adrift,
and
one
of
the
issues
that
we
need
to
address
as
part
of
the
planning
over
the
next
few
weeks
is
whether
it's
possible
to
catch
up
those
additional
inspections.
The
other
thing
that
we
can't
be
confident
on
is
how
many
inspections
will
do
between
now
and
sep
tember,
which
will
require
repeat
inspections,
and
they
will
need
to
be
factored
in
so
in
December
and
January.
C
The
executive
team
will
consider
the
continuation
of
the
program
and
the
planning
for
next
year
and
that
will
be
brought
back
to
this
board
in
January
of
next
year,
so
Mike.
Well,
if
I
just
say
one
more
thing
about
the
public
accounts
committee,
the
process
following
a
public
accounts
committee
is
that
the
Department
of
Health
rights
to
the
treacherous
right
back
to
the
public
accounts
committee
in
a
process.
That's
layered
out
by
the
Treasury,
where
they've
got
to
do
that
within
a
six
week
period,
they
will
consult
with
those.
C
C
In
addition,
we
were
asked
in
the
report
that
they're
published
to
write
to
directly
to
the
public
accounts
committee
in
july
of
next
year,
outlining
our
progress
in
relation
to
recruitment
of
inspectors
and
in
terms
of
delivering
the
program
which
we
will
do
and
the
work
that
I've
just
outlined
will
inform
that,
in
addition,
the
national
audit
office,
when
they
produced
their
report,
presented
the
report
to
CQC.
They
did
that
at
the
regulated,
regular
order
and
Corporate
Governance
Committee.
C
There
is
an
action
plan
against
each
of
their
recommendations
and
Paul,
and
the
Audit
Committee
continue
to
orbit.
See
that
I.
Think
one
of
the
things
that
will
need
to
do
is
bring
together
the
actions
under
the
Public
Accounts
Committee
report
and
the
nao
report.
I,
don't
think
we
should
be
running
to
separate
responses
into
one.
C
So
I
think
the
mouth
storms
in
terms
of
accounting
to
Parliament
are
going
to
be
in
july
with
a
further
letter,
a
further
period
of
field
work
from
the
National
Audit
Office,
which
will
take
place
during
second
and
third
quarters
of
16-17,
with
a
report
of
any
time
from
november
from
the
National
Audit
Office,
and
a
further
public
accounts
committee
in
February
of
2017
their
plans.
Those
plans
can
change,
but
that's
what
set
out
at
the
present
time.
C
So
if
I
pause,
Oh
mark
I,
think
the
substance
of
this
is
the
performance
report
and
the
progress
against
the
report
and
further
information
which
would
produce
as
a
result
of
the
Public
Accounts
Committee,
which
were
calling
the
delivery
plan
the
delivery
program.
That's
how
we
will
continue
to
refer
to
this
piece
of
work.
D
Just
take
questions
about
the
performance
report
them
just
in
relation
to
opposite,
where
the
backlog
of
registration
applications
could
I
ask
what
we
consider
the
risks
to
service
users
and
it
the
system
in
relation
to
that,
and
how
do
we
mitigate
that
and
the
second
in
relation
to
delays
in
inspection
reports
with
is
there
has
have
we
considered,
or
should
we
be
considering
whether
the
gap
where
there
is
a
gap
can
be
filled
by
any
form
of
interim
report?
Understanding
that,
of
course,
more
reports
produce
more
work,
but
I.
E
There's
been
a
process
gone
through
for
that
which
obviously
will
take
us
and
beyond
the
50
days
and
a
separate
conversation
that
we've
had
is
about
trying
to
make
sure
that
we
can
separate
that
out
and
actually
really
focus
on
and
that
we
need
to
that.
We
need
to
be
looking
at
so
just
to
give
you
a
little
bit
more
context
to
the
deep
to
the
figures.
To
answer
the
question
about
risk.
E
E
If
the
other,
the
final
things
say
is
if
there
are
significant
issues
of
risk
and
concern
that
are
raised
with
those
either
by
people
who
use
in
services
or
bi
or
by
commissioners,
for
example,
or
providers,
and
then
obviously
the
teams
are
looking
at
that
in
terms
of
where
they
should
prioritize
their
work
in
responding
to
that
level
of
risk.
So
there's
a
variety
of
different
things
that
the
teams
will
be
taking
on
and
to
do
that.
Good.
D
I
got
some
supplementary.
Is
there
other
cases
where
actually
that
there
is
really
no
problem
at
all?
And
this
is
where
a
perfectly
respectable,
efficient,
useful
business
is
being
prevented
from
getting
in
getting
going
and
thereby
depriving
the
public
which
we
ought
to
be
spending
less
time
on
the
wii
wii?
Maybe
I
don't
know
I
just
thought
so.
E
This
is
one
of
the
things
that
we
set
out
in
the
in
building
on
strong
foundations
in
terms
of
the
potential
for
as
looking
at
registration
in
the
future
in
a
much
more
kind
of
risk-based
way,
so
that,
if
we
have,
if
there
is
the
kind
of
new
information
that
we've
got
ahead
of
the
consideration
of
the
registration
application
gives
us
that
confidence.
Then
we
can
move
forward
in
a
faster
in
a
different
way
and
that's
going
to
be
part
of
the
consultation
again
that
we
put
out
in
January.
E
G
If
I
just
sort
of
remind
people
what
the
various
steps
are
and
but
then
there's
a
very
legitimate
question,
you
just
asked.
First
of
all,
we
do
always
provide
immediate
feedback
to
the
trust
at
the
end
of
an
inspection,
and
what
we've
heard
from
trusts
themselves
is
that
they
want
more,
rather
than
less
immediate
feedback.
G
The
other
bit
of
major
work
that
we
are
doing
is
looking
at
how
we
can
make
our
reports
a
whole
lot
shorter
and
clearer,
while
at
the
same
time
collecting
all
the
evidence
and
making
sure
we've
got
all
that
and
that
been
active
working
on
that
at
the
moment.
But
I
think
the
question
is
whether
the
letter
to
the
trust
should
should
or
should
not
be
published
and.
C
C
Adult
social
care
and
primary
medical
services-
I
think
the
effort
is
going
into
getting
them
out
within
the
50
days
rather
than
sending
out
an
additional
one,
and
I
think
that's
the
key
challenge.
I
think
we
should
get
it
right
and
get
them
out.
Quite
frankly,
I
think
that's
where
I
thought
there
should
be
a
streamlining
it
and
getting
the
report
sound
rather
than
sending
an
additional
report.
C
So
is
the
more
room.
Yes,
there
is
and
I
think
I
outlined
some
of
the
things
in
presenting
it,
and
it's
in
that
additional
paper
that
came
round.
That
is
more
than
can
be
done
in
relation
to
how
we
can
work
smarter,
how
we
can
work
more
efficiently,
how
we
can
take
process
out
how
we
can
do
later
that
how
we
can
ensure
get
it
right
first
time
and
not
have
to
have
a
sequence
of
quality
checks
built
in
all
of
which
contribute
delays.
C
So
I
think
we
are
at
the
beginning
of
that
process
and
not
at
the
end
of
it,
I'm
absolutely
clear
that
people
right
through
the
organization
working
very
very
hard
to
do
that
and
as
his
work
in
place
to
do
this.
Just
as
an
aside,
I
was
finishing
up
some
things
on
friday
afternoon
and
out
walked
one
of
andrea's
change
from
the
southeast.
It
spent
all
afternoon
schedule
in
their
work
for
the
remainder
of
the
year,
and
the
first
thing
they
said
was
we're
confident
we're
going
to
get
there.
C
C
Balancing
what
we're
asking
stuff
to
do
and
the
expectations
and
the
systems
and
processes
that
we
build
and
does
that
kind
of
classic
you
build
this
as
you
would
ideally
want
it
to
be
delivered,
and
then
you
actually
realize
that
actually,
the
reality
delivering
it
to
the
standard
that
it's
been
built
is
really
really
challenging
and
it's
impossible
and
difficult
and
I
think
there's
a
seminal
lesson
in
there
about.
How
do
you
design
something
to
be
lean
from
the
beginning?
C
C
It
you'd
be
refined
if
you'da
tested
it
again,
you'd
have
gone
out
and
done
it
and
that
isn't
the
reality
of
where
we
were
I'm
under
no
doubts
about
that,
for
whatever
the
public
accounts
committee
have
said,
I
do
think
we
were
in
special
measures
in
2012
and
we
needed
to
get
out
of
it
and
we
weren't
going
to
be
able
to
negotiate
a
3
4
5
year
period
to
get
out
of
it.
We
needed
to
move
quickly.
I
think
that
is
the
political
reality.
I
think!
That's
what
we've
done.
C
My
disappointment,
that
the
public
accounts
committee
is
the
work
that
has
been
under
tech
and
wasn't
acknowledged,
I
think
people
that
work
phenomenally
hard
to
actually
change
the
way.
We've
done
it
without
a
discussion
here
about
the
language
we
use
about
that.
We
shouldn't
make
any
claims
that
we've
transformed
anything,
but
we
have
changed
things
quite
dramatically
from
what
we've
done
and
I
think.
That's
absolutely
right
that
we
should
do
that
and
so
Anna.
C
We
need
to
be
much
more
open
and
inclusive
throughout
the
organization
about
how
this
is
going
to
be
done,
I
think
every
manager
and
every
member
of
staff
through
the
organization
as
we
go
through
this
next
four
year
period,
I
mean
the
last
paragraph
in
my
report.
This
morning
is
just
saying
where
we
are
in
relation
to
the
financial
position.
I
think
it
is
now
clear
that
we
will
take
twenty
five
percent
reduction
in
our
grants
in
egg
from
the
Department
of
Health
over
the
four
years
to
2019
20.
C
So
I.
Don't
it's
not
an
option
that
we
don't
work
to
become
more
efficient
and
you
know,
as
I
sit
here
this
morning.
It's
not
been
the
best
couple
of
weeks
in
my
existence
is
cheap,
exactly
this
organization,
but
I'm
absolutely
confident.
We
can
do
that
and
and
that's
what
we're
focused
on
and
that's
what
we'll
do
and
we'll
bring
that
back
in
January
to
the
board
with
a
business
plan
that
is
beginning
to
set
that
out
and
I
hope
that
which
is
some
of
the
loan
all.
A
F
We
know
we've
still
got
variation
in
that
I'm
glad
something
that's
been
communicated
clearly
through
the
bit
as
david
says
that
we've
had
and
we've
spent
less
time
on
and
as
we
built
that
the
model
and
it's
getting
our
systems
and
processes
right,
so
that
it
becomes
simple
and
easy
to
do
the
right
thing.
We
touched
on
some
of
the
regulatory
Governance
Committee
yesterday
afternoon,
but
it's
important
to
link
that
through
to
the
productivity,
rather
than
being
something
that's
happening
to
the
side.
F
The
apt
is
Mike
set
of
being
clear
about
what
needs
to
be
in
a
report
and
what
doesn't
and
therefore
what
evidence
can
be
collected
and
collected
easily
and
how
we
pre
populate
that
evidence
from
the
intelligence
that
we
have
both
makes
inspectors
lives
easier.
It
makes
quality
assurance
quicker
and
easier
all
steps,
and
it
means
that
reports
can
come
out
a
lot
faster,
so
we're
expecting
the
necks
of
a
change
in
productivity
to
Easton
Park,
come
from
better
systems
and
processes
and
better
implementation.
F
I
Thanks
the
trajectory
of
our
inspections,
the
run
rate
of
your
life
is
going
to
be
sensitive
to
quite
a
few
assumptions.
So
I
think
when
we
come
back
in
January
okay,
we
could
we
codify
those
and
set
them
out
to
sea.
I
mean
I'm
just
thinking
if
we
do
have
to
do
a
whole
lot
more
of
reinspection,
zor,
enforcement's
and
stuff,
like
that,
it's
going
to
be
quite
sensitive
to
the
target
date.
Isn't
it
so
if
they
could
be
set
up,
we
can
chew
on
them
a
bit.
J
So
this
is
not
about
forms
of
other
reporting
in
general,
because
cup
of
things
and
first
of
all,
could
I
just
ask
you
to
clarify
how
and
when
will
talk
about
the
southern
health
report
that
came
out
a
few
days
ago
and
this
to
remind
everyone.
This
is
followed
the
death
of
corners,
Sparrowhawk
and
an
event,
tragic
event
that
we've
had
quite
a
strong
interest
in
this
board
and
it's
complicated
by
the
fact
that
the
report
is
not
actually
published.
J
J
So
these
are
the
two
very
important
issues
to
us
and,
apart
from
discussing
the
report
itself,
the
implications
nationally,
because
we
don't
know
that
these-
this
is
a
this
problem
applies
only
to
this
trust
and
the
implications
for
how
CQC
conducts
its
work,
I
think
could
be
very
important.
It's
very
important
case
for
us,
so
I'm
just
looking
for
an
assurance
that
that
will
return
to
it
at
the
right
side,
the
earliest
time
and
in
public
session.
C
I'm
just
happy
to
give
that
assurance
Lewis
and
there's.
As
you
rightly
said,
it's
a
report
which
was
leaked
and
therefore
I
think
it's
not
completed
yet.
As
I
understand
what's
been
in
the
media,
work
is
to
hand
to
complete
it.
A
number
of
us
have
considered
that
leaked
report
and
some
of
its
implications,
and
I
think,
you've
pulled
out
those
that
are
those
questions
which
are
raised
through.
C
That
report
I'm
very
happy
to
bring
back
a
report
to
the
January
meeting,
which
actually
goes
through
this
and
will
bring
that
back
in
open
session,
and
we
can
lay
out
our
reflections
on
the
final
reports
and,
as
you
fileted
those
issues.
What
it
says
about
the
numbers
is
this
something
that
has
happened
elsewhere.
How
a
family
is
engaged?
What
are
the
implications
for
CQC
and
we
can
lay
that
out
in
in
a
written
report
to
the
public
board
meeting.
J
Yes
searching
about
this
is
on
a
related,
but
slightly
different
point.
Just
just
briefly.
I
could
just
remind
everyone
that
we've
had
two
reports
which
are
about
especially
about
mental
health
published
since
we
last
met,
and
one
is
our
mental
health
act
report
and
which,
amongst
other
things,
reported
that
there
had
been
227
deaths
of
people
while
detained
under
the
Mental
Health
Act
in
the
previous
year.
That's
a
fairly
typical
number.
J
In
fact,
most
of
those
deaths
of
people
who
are
older
people
died
of
natural
causes,
but
not
all,
and
even
when
they
are
the
deaths
of
all
the
people
met
by
died
of
natural
causes.
They
that
doesn't
mean
that
there
weren't
elements
of
prevention
that
could
have
been
been
stronger
and
and
this
issue
of
it
as
an
equivalent
issue
in
a
way
to
southern
health
as
an
issue.
How
how
and
by
whom
these
deaths
are
investigated
and
I.
J
Just
say
that
we've
probably
talked
about
this
a
couple
of
times
at
this
board
and
it,
and
it
is
a
it-
is
problematic,
because
the
responsibility
for
mental
health
act
matters
is
shared
different
responsibilities.
But
I
just
hope
that
by
that
over
the
next
few
months,
that
the
will
get
to
the
point
where,
because
of
pressure
from
other
groups,
gets
in
custody
committees,
and
so
on,
will
get
to
the
point
where
we're
a
little
bit
clearer
on
how
these
deaths
are
investigated.
J
Very
important
people
rels
us
that,
following
a
decision
by
the
Supreme
Court
about
the
eligibility
for
assessment
under
deprivation
of
Liberty
safeguards,
the
number
of
assessments,
number
of
applications
for
assessment
nationally
went
up
from
13,000
to
137,000
and,
as
a
result,
the
system
is
in
a
state
of
collapse
and
chaos.
You
would
be
had
a
tenfold
increase
in
activity
overnight
and
and
therefore
there
is
a
56,000
case.
J
Backlog
of
of
the
assessments
is
absolutely
extraordinary
state
of
affairs
and
which
I,
don't
suppose
the
Supreme
Court
had
in
mind
when
it
made
that
decision
just
the
law
of
unintended
consequence,
which
is,
of
course,
the
one
law
that
no
government
can
ever
change
and
I.
Just
would
like
us
to
note
that
and
to
lend
our
support
to
what
I
hope
will
be
measures
through
the
Law
Society
of
others
to
to
try
and
correct
what's
become
a
system
in
chaos.
H
Before
you
do
David,
would
you
mind
if
I
decided
one
thing,
because
I
just
want
to
furiously
agree,
but
but
but
but
say
in
relation
to
suggest
in
relation
to
the
to
the
discussion
about
and
the
investigation
of
death
that
there
is
a
I
mean
there
are
a
variety
of
cases,
but
there
were
three
deaths
and
hundreds
which
we
have
talked
about
here
before
and
which
the
local
HealthWatch
in
Nottingham
have
been
very
engaged
in
talking
with,
in
particular,
NHSC
about
the
investigation
and
reporting
of
that
investigation
around
those
deaths
and
it.
H
So
it's
a
it's
a
classic
case.
It
seems
to
me,
and
it's
taken
years
and
I
actually
have
to
confess
I'm,
not
quite
sure
whether
it's
even
yet
been
published.
So
we
have
been
promised
it
and
promised
it
and
promised
it
and
it
has.
But
what
we
do
know
about
it
is
that
it
doesn't
ultimately
meet
the
needs
of
those
people
who
who
needed
to
have
the
investigation
done.
The
friends
and
family
of
those
who
died
so
so
I
just
think.
H
That
might
be
something
quite
helpful
in
having
that
discussion
at
the
board,
with
at
least
a
case
study
or
two
of
what's
happened
and
how
it
happened,
because
it
really
does
expose
the
difficulties
of
getting
a
kind
of
clear
line
of
sight
about
responsibilities
and
and
managing
expectations
of
the
public.
Who
directly
involved.
C
Michael
Dugher
just
a
couple
of
things:
Louis's
resin
of
southern,
which
I
was
going
to
cover
in
comments
and
I'm
grateful
frame,
resin
resin
that
and
I
would
like
just
to
draw
attention
to
paragraphs
five
we're
under
yeah
and
her
team
are
carrying
out
work
in
relation
to
enforcement,
but
also
operation
magnify,
which
is
the
focus
on
illegal
workers
in
the
care
industry.
Where
we've
been
undertaking
joint
work.
C
Interestingly,
in
terms
of
the
discussion
about
how
many
care
beds
exist
in
England
at
annex
two
there's
an
analysis
which
has
been
produced
by
pulse
colleagues
at
the
analyst,
which
is
showing
that
at
the
national
level
in
2010,
there
were
four
hundred
and
sixty
thousand
care
beds
in
England
and
in
2015
there's
four
hundred
and
sixty
four
thousand.
It
is
a
one
percent
increase
within
that
you've
had
a
reduction
in
care
homes
and
increase
in
nursing
homes.
C
It
doesn't
say
these
are
all
operating,
it
doesn't
say
they're
all
full,
but
in
the
debate
about
how
many
places
are
around
it's
an
interesting
contribution
to
that
discussion
and,
of
course,
if
a
care
home
causes
in
a
particular
area
which
is
dependent
on
that
care
home,
then
the
impact
locally
could
be
quite
significant,
but
some
important
information
sees
updating
on
out
of
ours
and
dental
and
mike
is
showing
the
most
recent
inspection
reports
that
are
produced
last
thing.
I
wanted
to
draw
attention
to
michael
is
in
light
of
the
Paris
and
events
in
Belgium.
C
Government
had
issued
at
based
on
saying,
safe
we've
issued
that
within
we've
got
over
400
people
that
come
to
work
in
London,
and
the
issue
about
people
being
safe
in
London
is
a
key
issue,
not
just
London
nothing
but
is
a
key
issue.
So
we've
already
run,
what's
called
a
silver
command
exercise,
which
is
a
desktop
and
gold
commanders
were
colleagues
in
the
executive
team
are
engaged
and
will
look
to
be
doing
that
in
January.
So
this
isn't
do
we
have
procedures?
C
It's
have
we
tried
these
procedures
and
do
we
all
know
what
it
is
that
we
need
to
do
if
this
is
something
which
were
cold
on
to
put
in
place
recently
had
a
fire
alarm
test
in
this
building,
and
it
was
clear
that
people
didn't
know
where
to
go
so
I'm
actually
testing.
This
is
a
key
issue,
can
see
people
shaking
that
people
didn't
know
where
to
go,
because
this
is
the
first
time
we've
done
a
fire
alarm
in
this
building
which
we've
been
in
for
just
a
few
weeks.
C
A
A
J
Personal
thanks
to
martin
for
doing
what
he
usually
does,
which
is
preparing
overnight
a
summary
of
last
night's
meeting.
And
so
it's
a
short
summary
and
a
full
summary
will
come
to
the
next
book.
I'm
going
to
focus
on
the
first
of
the
two
items,
mainly
at
yesterday's
meeting
and
I'm,
going
to
focus
on.
J
Although
some
restrictions
on
the
movement
of
the
president
had
been
introduced,
and
so
I
was
very
well,
we
collectively
the
inspectors,
I
must
say-
were
very
professional,
very
very
impressed
by
them
and
they're
very
concerned
about
safety
very
concerned
about
the
about
fire
safety
as
well.
And
there
was
a
strong
concern
about
hygiene
and
infection
and
the
general
in
sanitary
state
of
the
care
home.
It
was
badly
stained
in
lots
of
places,
including
what
we
appeared
to
be
fecal
staining
on
the
walls,
and
it
was
so
full
of
ingrained
stains
and
cobwebs.
J
J
And
so
what
this
race
for
me
was
what
we
do
if
we
don't
immediately
close
again,
what's
the
appropriate
level
of
urgency
of
action
and
that
we
can
initiate,
when
we
don't
immediately
close
closer,
please
and
that's
past
that,
partly
because
we're
quite
dependent
on
other
agencies
to
clean
the
local
authority.
If
we
are
taking
urgent
action-
and
they
may
not
pick
up
the
urgency
because
they
haven't
been
on
the
inspection.
So
the
first
question
is
what
agent
action
do
we
can
we
take,
and
how
does
that
work?
J
How
can
we
be
certain
we're
responding
with
an
appropriate
level
of
urgency?
And
the
second
issue
was
that
the
the
owner
of
the
there
were
some
odd
history
to
the
ownership
of
this
care
home,
which
involved
an
application
for
ownership
by
a
GP
who
had
in
fact
been
struck
off
or
dishonesty
and
the
he
was
not
allowed
to
be
the
owner
and
but
another
member
of
his
family
was
the
owner
and
so
the
registered
owner.
And
so
that
and
that
allowed
we
were
told
his
continuing
involvement
in
the
day-to-day
running
of
the
place.
J
Even
though
he
wasn't
read
the
registered
owner
and
thought
to
be
unsuitable.
Now.
This,
for
me
is
a
very
important
question
because
it
also
feeds
into
the
broader
issue
of
the
maneuvers
that
can
be
taken
by
providers
to
avoid
being
prevented
from
registering
changes
of
names
and
just
ahead
of
the
head
of
the
posse,
so
to
speak
ahead
of
the
report.
J
Now
there
are
already
requirements
placed
on
providers
to
go
some
whale
to
doing
that
about
displaying
ratings
and
that
sort
of
thing
putting
on
their
website.
And
but
you
know,
then
some
relatives
live
some
distance
away.
They
may
not
call
in
often
enough
the
prominence
of
any
rating
on
notice
boards,
sometimes
not
very
great
and
I-
think
we
should
be
writing
to
relatives
to
tell
them
what
has
what
the
judgment
has
been
and
that's
a
debate
we
need.
J
We
need
to
have
and
but
I
think
we
can't
simply
rely
on
providers
who
haven't
who
have
shown
themselves
ever
mind.
They
might
be
telling
them
something
good.
So
that's
the
one
thing,
and
but
I
think
also
that
we
can't
rely
when
they
have
been
responsible
for
very
poor
care.
We
can't
rely
on
them
to
pass
on
that
information
to
the
relatives
sort
of
paying
for
the
for
the
for
the
rest
and
finally,
just
quickly.
J
There
was
a
final
issue
which
wasn't
specific
to
this
care
on
which
was
about
it's
relevant
to
the
performance
discussion
we've
just
had
because
it
was
about
the
delays
that
inspectors
report
in
the
completion
of
reports
having
completed
an
inspection.
So
so
the
issue
here
is
that
sometimes,
when
they
produce
a
report,
the
extent
of
challenge
from
a
provider
is
so
great
that
it
takes
and
far
longer
to
respond
to
the
challenge.
J
They
did
the
original
report,
for
example,
they
inspect
has
told
me
of
a
I,
may
get
the
numbers
wrong
here,
but
you'll
get
the
general
idea,
but,
and
they
wrote
a
30
page
report
on
a
particular
care
home
inspection.
The
the
provider
challenged
every
point
in
that
inspection
and
and
that
challenge
was
something
like
70
pages
long,
so
about
twice
as
long
as
the
actual
report
and
and
then
they
had
to
the
inspectors
had
to
reply.
J
So
they
produced
the
reply,
which
was
over
100
pages
long,
so
among
three
times
longer
than
the
original
report
and
took
them
something
like
11
days
to
complete
it
and
which
meant
that
the
next
inspection
they
had
to
carry
out
at
the
next
care
or
had
to
be
postponed.
So
I
just
think
that
we
need
to
have
that
in
mind.
This
is
what's
happening
out
there
in
the
field,
the
games
that
providers
can
play
to
put
us
off
and
to
make
it
us
a
little
less
bold
about
what
we're
prepared
to
say
in
case.
J
We
have
to
justifying
it
legally
in
some
sense
and
and
I'm
afraid
what
I
am
absolutely
certain
is
vexatious
challenge.
I
think
we
have
to
the
very
least
the
public
residents
and
families
need
to
be
aware
that
that's
what
providers
do,
but
also
I,
think
we
need
to
have
them
pretty
to
be
looking
at
what
measures
we
can
take
to
reduce
this.
This
problem
thanks
thanks,
thank.
A
E
I've
just
like
to
give
the
board
and
some
assurance
about
what's
happening
in
that
particular
care
home.
We
know
that
we've
had
feedback
now
from
the
fire
safety
officer
that
the
fire
safety
issues
have
been
addressed,
and
we
also
know
the
environmental
health
followed
up.
Dammit
Lee
with
the
home,
although
we
don't
have
the
output
of
that,
and
but
what
we
also
know
is
that
there
are
squads
of
cleaners
and
decorators
and
they're
sorting
out
the
environment.
E
So
so
there
is,
there
is
change
that
is
happening
in
that
specific
home
and
we'll
obviously
follow
through
with
the
weather
report
and
any
further
action
and
keep
Louis
and
colleagues
up
to
date.
But
to
pick
on
before
and
key
issues
that
Louis
identified
and
I
won't
go
into
the
level
of
detail
that
we
discussed
last
night.
But
on
registration.
E
I
think
that
there
there
is
an
important
issue
and
which
we
touched
upon
earlier
in
terms
of
the
risk
assess
with
associated
with
assessing
and
registration
applications,
and
it's
very
important
that
we
kind
of
made
sure
that
we
use
the
information
and
at
the
point
of
registration
and
make
make
decisions
at
that
stage.
And
indeed
did
when
this
was
very
first
registered
and
some
considerable
time
ago
and
about
two
organizations.
Two
regimes
ago
and
restrictions
were
put
in
place
am.
But
it
is
something
that
we
need
to.
E
We
need
to
be
mindful
of
and
absolutely
aware
as
them
Lewis
and
highlights
that
there
are
some
good
reasons
why
people
will
change
registration
and
we
need
to
as
David
particularly
reminders
that
the
committee
last
night
not
automatically
think
that
everybody
is,
is
out
to
play
the
system.
But
clearly
there
are
some
examples
where
people
are
changing,
either
their
registration
of
the
way
that
they're
delivering
services
in
a
way.
E
That
actually
would
cause
us
concern
around
what
that
means
with
the
history
of
that
service
and
what
that
means
about
the
ownership
and
and
ability
for
them
to
either
deliver
or
sustain
good
quality
care
and
there's
a
number
of
things
that
were
looking
at
a
part
of
registration
improvement
project,
but
also
in
terms
of
how
we
present
information
to
the
public
and
the
website.
And
so
it's
not
as
difficult
as
it
currently
is
to
see
what
the
history
is
of
the
service
on
that
site.
As
an
example,
and
that's
something
which
is
an
issue.
E
E
But
we
will
look
at
what
more
we
can
do
to
follow,
that
up
and
and
we'll
report
back
on
on
that
terms
of
dealing
with
failure
and
Lewis
is
Right.
The
our
inspectors
do
an
incredibly
difficult
job
and
sometimes
have
to
make
very
difficult
decisions,
balancing
the
risk
to
people
at
the
point
of
identifying
very
poor
care,
because
there
was
a
risk
in
closing
services
down
and
moving
them
and
doing
that
very
quickly.
E
And
but
we
we,
we
support
inspectors
in
making
those
decisions
with
a
very
clear
decision
tree
and
that
actually
new
sets
the
level
of
criteria
against
which
urgent
action
needs
to
be
assessed.
But
we
are
concerned
about
some
of
the
some
of
our
ability
to
kind
of
manage
this,
both
in
a
practical
sense
of
what
happens
if
we
do
have
to
urgently
close
service.
E
But
also,
what
are
the
other
options
that
are
available
to
us
and,
as
colleagues
may
remember,
I
undertook
following
the
closure
of
the
old
village
school,
which
happened
in
February,
which
I
think
we
discussed
at
the
board
meeting
in
September
to
follow
up
with
other
others
in
in
the
system
to
see
what
we
could
do
about
that.
And
we
have
a
meeting.
E
That's
scheduled
for
the
beginning
of
februari,
with
NHS
England,
with
the
association
of
directors
of
adult
social
services,
with
providers
with
people
who
are
speaking
on
behalf
of
people
using
services,
action
on
elder
abuse
and
others
to
to
explore
both
the
practical
things
that
we
can
do
better.
But
also
what
some
of
the
other
changes
may.
E
We
may
need
to
either
ask
for
terms
of
regulatory
changes
or
changes
to
our
practice
and
I
can
report
back
to
the
board
subsequent
to
that
meeting
and
I'm
very
grateful
to
Ruth
Holt
at
NHS,
England
and
others
for
their
help
in
and
all
of
that
and
last
but
not
least,
the
issue
about
challenge.
And
we
are
seeing
some
increase
in
the
challenge
that
we're
getting
in
a
variety
of
different
ways
and
Louis's,
given
one
example
of
that
which
is
around
factual
accuracy.
K
G
A
I
hope
board
members
are
satisfied
with
the
Lewises
excellent
report,
memories
response.
I
say
it's
really
one
of
the
reasons
why
the
rgc
is
is
so
important
if
we
can
now
go
on
to
the
the
the
last
item
that
we
have
this
morning,
which
is
essentially
a
review
of
the
important
work.
That's
been
done
by
health
watch
over
the
last.
A
Effectively
over
the
lot,
the
last
reported
quarter
and
jane
is
going
to
give
us
a
no
wonder
if
you
couldn't.
Oh,
you
think
a
man
is
going
to
give
it.
Okay,
sorry
slightly
confused
that
who,
who
was
going
to
give
us
the
report?
Well
Hannah,
if
you
could
just
take
us,
take
us
through
the
report.
Please.
H
Hey,
thank
you
I'm
very
happy
to
pick
take
people
through
the
report,
but
what
I
would
normally
do
is
is
is
work
on
the
basis
that
people
have
read
it
and
just
take
any
questions
so,
rather
than
rather
than
walk
through
at
Michael
and
I.
D
And
I
was
interested
in
the
and
somewhat
depressed
frankly
by
what
was
said
in
your
report
about
funding,
a
lot
of
press
has
actually
said
it,
but
the
votives
there
and
I
think
personally.
I
have
particular
concern
about
the
proposition
that
the
reductions
in
allocation
of
funding
to
local
healthwatches
seems
to
be
in
areas
which
we
are
likely
to
have
the
most
concern
about,
and
and
whereas
one
would
have
hoped
you
might
be
the
opposite,
because
the
need
for
HealthWatch
in
such
areas
must
be
greater
and
I
wondered
what
either
health
watching
you.
D
H
Yes,
so
and
I
think
it's
an
interesting
and
but
but
then
perhaps
not
surprising
fact,
because
local
HealthWatch
is
funded,
as,
as
I
know
you
will
know,
by
the
local
authority
and
in
areas
where
there
are
particularly
significant
pressures
on
the
local
health
and
care
economy
is
likely,
therefore,
that
the
funding
available
for
local
HealthWatch
is
also
going
to
be
under
under
pressure.
And
yet,
as
you
say,
the
challenges
in
those
environments
are
often
the
greatest
I.
H
H
So
some
of
them
have
experienced
quite
significant
budget
cuts
in
in
in
the
three-year
period,
and
we
do
quite
a
lot
of
work
with
those
that
ask
for
it
to
support
them
through
that
process
and
with
some
success.
So
there's
there's
there's
help
that
HealthWatch
England
can
offer
to
local
HealthWatch
in
their
local
negotiations.
H
In
the
case
of
those
ten
asking,
I
mean
asking
only
the
questions,
and
this
is
all
that
that
we
can
do
asking
the
question
whether
they
could
be
confident
that
local
off
that
local
HealthWatch
would
still
be
able
to
deliver
on
its
statutory
duties
and
how
they
plan
to
monitor
that.
In
the
period
in
over
which
this
funding
had
been
given.
We
had
a
variety
of
responses
which
some
of
which
were
quite
illuminating,
some
of
which
actually
made
it
clear
that
some
local
authorities
didn't
understand.
H
What's
actually
functions
of
local
HealthWatch
were,
and
certainly
not
at
the
level
at
which
we
got
a
response,
although
I'm
sure
the
commissioners
at
working
level
understand
so
there's
a
job
of
work
to
be
done
with
commissioners
and
local
authorities.
So
what
you'll
also
see
in
this
report
is
some
work
that
we've
just
started
doing,
which
is
to
work
with
commissioners
directly.
H
This
is
all
about
hearts
and
minds,
and
that
is
all
we
can
do.
What
we've
also,
of
course
done
is
kept
the
Department
and
ministers
very
much
aware
of
what
of
these
pressures
and
and
the
way
in
which
funding
is
is
changing.
So
what
could
CQC?
Do
you
and
I
I
guess,
put
put
its
own
weight,
perhaps
a
bit
behind
some
of
that
that
discussion
and
express
concern,
but
I
think
that
is
the
sum
total
of
what
we're
able
to
do
in
the
current
current
situation.
One.
D
D
H
So
there's
a
southeast
London
group
of
local
HealthWatch
who
deliver
procure
a
lot
for
their
back
office
services
together,
and
there
are
two
instances
now
where
local
HealthWatch
have
a
bid
for
of
the
contract
when
it's
come
up
of
another
local
HealthWatch.
So
they
are,
if
you
like,
delivering
in
a
number
of
areas
still
with
a
root
in
the
community
in
each
of
the
communities
but
but
but
but
managing
them
together
to
operate
more
efficiently.
H
So
there
are
a
whole
host
of
these
things
happening
and
it's
very
much
in
the
committee's
mind,
at
HealthWatch
England,
to
have
more
of
that
kind
of
discussion
with
local
HealthWatch
during
the
course
of
the
next
year
and
support
them
in
whatever
ways
it
seems
appropriate
to
support
them
to
bring
about
sensible
change
so
yeah
very
much.
The
issue.
I
Thanks
I
just
had
a
quick
point
about
primary
care.
I
thought
the
people's
experiences.
A
primary
care
report
was
a
really
good
one.
11,000
people
talk
to
about
primary
care
and
it
shows
high
levels
of
satisfaction
with
primary
care,
which
is
fantastic,
considering
the
strength
with
primary
care
is
under
and
access
is
the
biggest
thing
I
far
that
came
out
and
I.
It's
just
a
question
for
Steve
to
came
to
reflect
on
our
model
for
inspections
of
primary
care
and
the
extent
to
which
we're
getting
under
the
skin
of
access
issues.
B
Very
good
question-
and
it
comes
back
from
when
we're
talking
to
patients
as
well
and
links
into
access.
During
the
week
out
of
hours,
seven-day
working
we've
been
having
some
discussions
with
NHS
England
as
well
about
how
we
look
at
access
in
the
responsive
part
of
what
we
do.
Many
surgeries
still
closed
for
an
afternoon
and
many
of
the
poor
surgeries
we
find
patients
have
greater
problems,
getting
hold
of
a
GP
during
the
day
majority
of
our
good
and
I.
B
Think
as
we
move
the
model,
Ford
I
think
we've
got
to
refine
how
we
both
look
at
access,
not
just
in
the
face-to-face
consultation
but
the
different
ways
of
accessing
GPS.
Many
of
the
outstanding
practices
now
are
looking
at
Skype
consultations.
They
have
extended
hours
and
access
directly
to
the
multi
professional
team,
so
I
think
it
part
of
when
we
take
the
model
forward.
We
need
to
be
much
much
better
at
doing
that
and
leading
that
into
the
future
ratings.
It's
very
important
just.
I
B
Of
where
we
know
that
younger
people,
young
adults,
find
it
frustrating
and
the
older
you
are,
it
seems
to
be
easier.
There's
all
sorts
of
things
about
the
demographic,
and
so
those
are
exactly
the
sort
of
things
we
need
to
look
at
your
absolutely
right
and
linked
into
continuity
of
care
as
well.
So
that's
part
of
the
thing
we're
looking
at
as
part
of
responsive
thanks
like.
H
I'm
very
glad
you
thought
it
was
good
report
and
I.
Just
what
just
would
would
say:
I
mean
people
haven't
read
it.
I
think
it's
it's
a
really
good
description
of
what
HealthWatch
is
able
to
do
now,
and
so
it
has
some
really
important
material
in
it,
but
actually
it
has
its
it.
It
just
shows
how
the
network
has
matured
and
the
quality
of
the
work
that
it's
doing
so
I
went
to
the
Select
Committee
last
week
for
their
investigation
to
the
future
of
primary
care
and
and
I
was
able
to
speak
from
that
evidence.
H
You
know
very
far
from
the
anecdotal
kind
of
the
fear
that
the
HealthWatch
would
only
be
about
anecdote,
and
you
know
those
who
speak
loudest
and
a
lot
of
the
work
that
local
HealthWatch
had
done
has
been
very
focused
on
groups
of
the
population
who
would
otherwise
not
have
a
voice.
So
people
with
disabilities
people
with
hearing
problems,
people
with
language
difficulties,
they've
gone
out
there
and
made
it
their
business
to
talk
particularly
to
those
people
so
and
so
I,
just
kind
of
want
to
say
I.
H
L
My
question
and
you
have
kind
of
touched
on
this-
is
just
thinking
you
know
what
your
reflections
are
on
having
meghna
chair
for
is
it
for
years
and
five
or
four
three
and
a
half
thing
at
what
for
reflections
any
other
reflections
you
have
as
the
outgoing
chair
of
HealthWatch,
you
know
what
you've
learnt,
what
you
think
might
be
challenges
for
the
future.
Aside
from
what
you've
already
touched
on
today,
so
okay
I
think.
A
These
are
very
important
questions,
but
we
were
rather
looking
to
this
afternoon's
meeting
to
have
a
chance
to
have
a
debrief
from
hammer
on
these
issues.
So
if
it's
okay
with
you,
we
could
leave
it
to
to
this
afternoon,
because
these
are
very
important
questions,
but
I
think
there's
afternoon
gives
them
a
chance
to
you
know,
be
absolutely
freely
about
them.
A
M
The
fact
that
very
often
you
find
that
four
domains
are
inadequate
or
requiring
improvement
and
then
rather
suspiciously
you'll
find
that
the
caring
domain
is
classified
as
good
and
this
time
I
wanted
to
say
something
slightly
other
way
around
I
went
to
visit
somebody
in
London
suburbs,
recently,
who've
just
been
put
in
a
care
home
and
I
want
to
see
how
she
was
getting
on.
I
read
up
the
recent
report
and
everything
was
wrong:
either
was
requiring
improvement
or
it
was
inadequate.
M
M
Oh
no,
she
said
the
staff
are
very,
very
nice
which
indeed,
you
had
said
in
your
report,
but
she
I
never
actually
found
out
why
she
wanted
to
get
out
I
think,
basically,
because
she
was
an
independent
person
didn't
like
being
in
care
homes,
but
it
wasn't
the
stuff.
So
there
I
went
and
looked
at
the
report
in
more
detail.
The
caring
part
of
the
report
and
I
have
to
say
that
you
know
seemed
to
me.
You
had
been.
You
said
that
a
require
improvement.
M
Three
people
had
been
given
their
porridge
in
a
glass
instead
of
a
bowl,
there
was
no
choice
of
jam
or
marmalade.
Well,
I
don't
have
that
at
home
either
some
people
who
had
protective
aprons
put
on
them
without
being
asked,
but
maybe
they
had
been
asked
some
time
before.
The
reason
I
think
in
fact,
why
you
got
this,
gave
this
requiring
improvement
was
that
they
made
the
mistake
of
leaving
a
door
open
and
the
man
inside
and
only
half
the
wrong
half
of
his
pajamas
on
so
that
I.
M
Don't
think
that
is
what
the
public
means
by
caring.
I'm
going
to
be
going
into
hospital
myself
next
in
in
the
next
three
months,
and
I
want
obviously
that
my
knee
should
be
replaced
properly.
I
don't
want
to
get
mrs,
a
or
c
diff,
but
I
next
to
that
I
want
kindness
and
compassion.
I
want
them
to
come
when
I
need
need
need
need
to
urinate
and
I
want
them
to
laugh
at
the
feeble
jokes
that
I
will
make.
M
Those
are
the
things
that
really
matter
to
me
and
that's
what
I
think
the
public
really
means
by
caring,
but
with
the
methods
you
are
using
at
the
moment,
you're,
not
finding
out
that
sort
of
thing.
You
are
finding
out
these
sort
of
things
which
are
of
some
importance,
some
of
them,
but
they're,
not
what
the
public
really
wants
and
I
go
back
to
the
old
scene.
E
A
Think
Mike,
if
you're
happy
with
that
I
think
mr.
hogatha
I'm
sure
Mike
would
be
really
interested
to
hear
how
well
first
of
all
I'm
sure
the
whole
board
hopes
that
everything
goes
well
with
the
knee
replacement
and
say
yes,
the
dose
perhaps
slightly
less
important
than
the
than
the
than
the
knee,
but
it
would
be
very
interesting
at
the
next
meeting
you
come
to
too
well.
Certainly
before
that
meeting
for
you
to
give
feedback
to
Mike
on
how
it's
gone,
I
think
that
will
be
very
valuable.
N
N
I
was
a
little
disappointed,
perhaps
to
read
the
balance
between
the
interests
of
the
dental
profession
and
interests
of
the
patient,
and
a
cursory
glance
at
reviews
of
dental
practices
will
show
that
many
patients
are
not
satisfied
with
their
dental
practice.
They
don't
find
it
responsive
or
effective,
and
some
patients
are
left
in
great
pain
for
days
on
end
because
they
can't
get
an
appoint
to
see
an
NHS
dentist.
B
Thank
you.
We've
discussed
dentistry
at
the
board
on
a
number
of
occasions
and
we
inspect
10%
of
dentists
every
year
on
a
risk-based
approach,
and
we
work
very
very
closely
with
a
general
dental
council
and
NHS
England
that
we've
set
up
a
regulatory
board
across
the
organizations
to
share
information
to
help
us
with
that
risk-based
approach,
because
data
is
not
as
forthcoming.
B
If
you
like,
compared
with
hospitals
or
even
GPS,
we've
made
a
decision
consciously
here,
not
to
rate
dentistry
for
a
number
of
reasons,
but
we
will
respond
reactively
if
we
hear
of
complaints
or
if
NHS
England
is
picking
things
up
through
the
contracting
system,
we
will
go
into
dentists
and
the
inspections
are
very
thorough
and
that,
if
you've
read
any
of
the
reports,
but
the
reports
are
are
very,
very
clear.
But
there
is
no
current
appetite
for
rating
dentists.
B
N
The
question
concerns
the
inspection
of
duty
of
candor
and
David.
Julian
Miller
recently
commented
that
patient
complaints
within
the
NHS
are
often
met
with
all
of
silence
and
I.
Wonder
how,
in
practical
terms,
duty
of
candor
is
currently
being
inspected
across
the
three
domains,
particularly
actually
in
general
practice.
A
G
Mike,
we
always
inspect
a
duty
of
candor
in
all
our
comprehensive
inspections,
and
we
would
on
any
focused
inspection
if
we
thought
it
was
a
problem,
if
anything
have
been
drawn
to
our
attention.
We
do
this
alongside
our
inspection
of
how
well
incidents
are
being
reported
and
whether
they
are
then
being
investigated,
whether
they
are
being
learned
from,
and
what
we're
now
doing
is
to
look
at
a
sample
of
instance.
G
We've
got
look
at
all
of
them,
but
to
see
if
those
that
are
rated
as
being
of
moderate
severity
or
greater,
whether
there
is
evidence
that
the
patient,
all
the
family,
have
been
involved
in
a
dog
with
appropriately,
and
we
also
look
at
a
sample
of
reports
that
have
been
rated
as
either
no
harm
or
no
harm
to
make
sure
that
they
have
been
appropriately
reported.
That
way,
so
I
think
we
are,
and
we
also
our
staff
whether
they
are
aware
of
what
the
the
duty
of
candor
means
and
so
that
they
would
know
that.