►
From YouTube: CQC board meeting - September 2021
Description
No description was provided for this meeting.
If this is YOUR meeting, an easy way to fix this is to add a description to your video, wherever mtngs.io found it (probably YouTube).
A
A
I
apologize
first
of
all
that
we
can't
yet
have
members
of
the
public
actually
join
us.
We
are
obviously
socially
distancing
in
this
room.
A
In
fact,
in
these
rooms
I
mean
we've
opened
up
a
number
of
meeting
rooms
to
get
us
all
in
and
it
just
isn't
it
it
just
isn't
possible
to
have
members
of
the
public
as
well.
But
of
course
we
will
continue
to
take
questions
from
members
of
the
public
and
deal
with
them
as
we
were
doing
when
we
were
having
to
operate
via
teams.
A
We
have
a
an
apology
from
belinda
black
who,
unfortunately,
is
unable
to
be
with
us
today.
I
want
to
welcome
paul
kirby
paul
you've
been
at
our
meetings
before
paul
is
the
chair
of
the
disability
equality
network.
I
also
want
to
welcome
tyson
heppel
to
his
first
board
meeting.
Unfortunately,
tyson
got
got,
got
pinged
and
is
having
to
self-isolate
until
getting
a
a
a
negative
pcr
test,
so
tyson
is
joining
us
remotely,
but
tyson
it's.
It's
it's
great
to
have
you
on
on
board.
A
So
that's
by
way
of
introduction
are
there
any
interests?
Anybody
needs
to
declare
that
aren't
already
known
excellent,
that's
good!
That
takes
us
to
the
minutes
of
the
21st
july
meeting.
Are
they
a
true
and
accurate
record
of
everything
we
discussed
yup?
Thank
you
so
we'll
take
those
as
approved
miraculously
there's
nothing
on
the
action
log.
I
haven't
been
notified
of
any
matters
arising,
but
is
there
any
matter
arising?
Anybody
who
needs
to
raise
good,
in
which
case
ian
will
come
straight
to
your
executive
team
report.
A
B
Thank
you
very
much,
peter
and
good
morning
everybody.
So
if
I
look
at
the
chief
execs
report,
I
gave
evidence
to
the
health
and
care
bill
committee.
Recently.
B
Our
focus
of
cqc
remains
our
future
role
in
providing
the
public
and
parliament,
with
with
oversight
of
integrated
care
systems,
local
authority
care
act,
duties
and,
of
course,
the
work
that
we
will
do
to
integrate
hospital
food
standards
into
our
on
into
our
work.
We
will
be
submitting
follow-on,
written
written
evidence
to
the
bill
committee,
and
we
have
also
talked
to
various
parliamentarians
about
our
perspective
on
on
various
aspects
of
the
care
bill.
B
In
addition
to
the
the
verbal
evidence
that
I
gave
in
terms
of
of
stakeholder
contact,
I
met
had
some
good
positive
meetings
with
amanda
pritchard,
who
is
the
new
chief
executive
of
of
the
of
nhs
england
and
peter,
and
I
also
met
the
right
honourable
sergeant,
javid
again
in
both
cases
discussing
our
role
particularly
around
how
the
health
and
care
system
recovers
from
the
pandemic
and
what
we
can
do
to
to
assist,
whilst
at
the
same
time,
of
course,
assuring
the
quality
and
safety
of
of
the
health
and
care
system
as
the
services
recover.
B
I
also
want
to
place
before
the
board
and
seek
the
board's
approval
for
the
responsible
officer
annual
report.
This
is
something
that
we
do
because
we
employ
a
number
of
doctors.
The
appendix
to
the
report
confirms
that
we
have
carried
out
the
necessary
work
to
revalidate
our
employed
doctors
and
that
they
remain
fit
to
practice.
There's
little
change
to
the
report
this
year
from
from
last
year,
nhs
england
have
helpfully
changed
the
the
rules
slightly
this
year
to
make
it
a
little
easier
post
pandemic
in
terms
of
revalidation.
B
I'd
also
like
to
place
on
record
my
thanks
to
nigel
acheson,
who
is
one
of
our
deputy
chief
inspectors
in
in
ted's
team,
who
has
done
the
work
to
make
sure
that
revalidation
takes
place.
It's
important
work
and
it
takes
a
fair
amount
of
time
time
to
do,
but
a
big
thank
you
to
to
nigel
on
behalf
of
the
board.
So
I'd
just
like
to
see
peter
the
board's
approval
for
the
information
which
is
contained
within
the
appendix
to
my
report,
so
we
can
revalidate
our
doctors.
Thank
you.
C
C
So
I
wonder
whether
nigel
would
perhaps
comment
on
on
that
back
back
to
us
and
and
whether
that's
something
that
we
should
review
and
secondly,
the
employment
checks
on
so
ads
and
spars
are
made
by
the
flexible
working
office,
and
I
just
wondered
whether
that
might
be
an
item
of
interest
for
the
rgc,
but
clearly
that's
mark's
responsibility.
But
it
seems
to
me
that
that's
very
much
tied
up
with
this
report
and
is
perhaps
worthy
of
further
further
review.
D
Thank
you
good
morning
board,
I'm
going
to
give
you
an
update
today
on
our
work
around
close
cultures.
So
you'll
all
recall
that
we
are
currently
piloting
a
new
quality
of
life
tool
that
we've
developed
with
work
university,
which
is
about
enabling
us
to
really
understand
the
experiences
of
people
with
learning
disabilities
and
autistic
people
and
the
care
that
they
receive.
D
So
this
is
about
looking
at
what
the
care
plan
tells
us
is
happening
and
then
really
seeing
it
from
the
person's
perspective
about
whether
that
is
their
experiences
of
the
care
that
they
are
receiving.
We
started
this
pilot
in
hospital
settings
and
we
are
continuing
to
do
that.
We've
now
rolled
it
out
to
adult
social
care
settings
and
we
are
finding
it
as
an
effective
tool
for
identifying
the
quality
of
care
being
delivered.
D
Was
that
and
I
look
forward
to
coming
back
to
board
at
a
later
date
to
provide
that
update
to
you
and
then
finally,
we've
been
prototyping,
how
we
can
use
our
intelligence
indicators
of
what
may
constitute
a
closed
culture
to
help
inform
our
inspectors
about
where
they
should
be
targeting
their
efforts,
and
that
will
be
role
being
rolled
out
shortly.
So
that's
all
I
intended
to
say
thank
you
peter.
E
Thanks,
kate
ted,
thank
you
peter
just
to
add
to
to
the
written
report.
The
the
inspection
teams
in
hospitals
have
been
very
busy
over
the
summer
as
you
as
you
can
see,
and
they
have
a
busy
program
going
into
the
autumn,
focusing
on
risk-based
inspections
and
targeting
all
the
areas
of
risks
that
we've
identified
through
our
monitoring
arrangements,
and
this
this
process
is
going
well.
E
I've
mentioned
this
to
the
board
report,
we'll
be
publishing
reports
very
soon,
around
trusts
that
have
actually
made
quite
significant
improvements
in
the
quality
care,
despite
managing
the
pandemic,
and
I
think
this
is
a
great
tribute
to
those
organizations
and
when
we
publish
those
reports,
I
look
forward
to
celebrating
the
success
of
colleagues
even
working
under
pressure,
but
also
delivering
for
their
patients.
I
just
also
want
to
highlight
the
pressures
on
urges
emergency
care
board.
Remember
I
mentioned
this
at
previous
meetings.
They
have.
E
E
We
had
a
workshop
with
chief
executive
chief
operating
officers
of
acute
and
ambulance
trusts
last
week,
and
they
are
describing
a
situation
that
really
is
unprecedented
in
terms
of
the
pressures
on
urgency,
emergency
care,
yeah
greater
than
they've
seen
in
previous
winters,
and
of
course
we
are
at
the
beginning
of
the
winter
virus
season.
So
I
think
everyone
is
concerned
about
what
the
next
few
months
will
will
bring.
E
I'm
glad
to
say
that
that
all
parts
of
the
system
are
really
working
together
well
to
try
and
support
services
going
forward,
and
we
will
continue
to
work
very
closely
with
other
parts
of
systems
such
as
nhs,
england
and
the
providers
themselves
to
support
services
going
forward.
The
workshop,
I
think,
was
very
useful.
It
was
built
around
our
patient
patient
first
guidance,
which
the
board
is
aware
of
which-
which
I
think
colleagues
have
found
very
helpful
in
focusing
on
safety
of
patients,
primarily
in
the
in
the
pressurized
urgency
emergency
care
system.
E
Can
I
also
mention
the
maternity
report
that
we
published
yesterday,
which
colleagues
would
be
aware
of.
I
won't
reiterate
the
issues
that
are
raised
in
the
maternity
report,
but
this
is
based
on
recent
inspections.
It
shows
that
many
of
the
issues
that
we've
identified
in
the
past
are
still
present
in
those
services
we've
inspected,
but
I
think
to
counterbalance
that,
there's
a
real
sense
of
acceptance
of
the
problems
across
the
whole
system
and
a
real
determination
to
do
something
about
it.
So,
while
the
issues
in
maternity
are
still
to
be
resolved,
I
am
very
optimistic.
E
A
Thank
you
ted.
If
nobody
wants
to
come
in
rosie
we'll
go
to
you.
F
Thank
you
very
much
peter
and
just
a
couple
of
areas
to
report
from
myself.
One
is
that
I
joined
the
chief
inspector
of
ofsted
at
the
lord's
public
sector
committee
to
talk
about
child
vulnerability,
and
it
was
an
opportunity
to
talk
about
the
importance
of
all
parts
of
the
system
working
together
to
see
how
we
can
improve
child
outcomes
for
children
across
health,
social
care,
education
and
the
wider
system.
As
well.
F
Just
to
reiterate
ted's
points,
we
are
continuing
to
see
unprecedented
pressure
in
primary
care
as
well
huge
demand
on
the
system,
and
we
have
held
several
listening
events
with
colleagues
in
primary
care
and
and
heard
what
they
are
experiencing
at
the
moment
and
can
I
just
say
thank
you
to
all
colleagues
working
across
the
system
who
are
working
incredibly
hard
at
the
moment
to
deal
with
that
that
pressure?
Finally,
I
just
want
to
mention
the
very
sad
attacks
that
we
heard
about
on
our
practice
in
manchester
last
week.
F
Sadly,
there
was
some
very
serious
injuries
as
a
result
of
an
attack
in
manchester
last
week,
and
subsequently,
someone
has
been
charged
with
the
assault,
but
I
just
want
to
take
this
opportunity
to
say
that
that
abuse
of
any
form
to
health
and
care
professionals
is
completely
unacceptable
and
we
need
to
make
sure
that
we
collectively
across
the
system
are
making
sure
that
that
message
is
is
out
there,
because
people
are
working
very
hard
under
very
difficult
circumstances,
and
any
kind
of
abuse
is
unacceptable.
People
need
to
be
treated
with
respect.
Thank
you.
A
Thank
you
very
much
rosie,
and
I
mean
I
just
just
on
on
the
points
that
both
you
and
ted
have
made.
I
mean
first,
I
absolutely
reiterate
the
the
pressure
that
everybody's
under
and
actually
also
in
in
social
care
as
well
kate.
So
this
is,
this
is
a
really
difficult
period
and,
secondly,
I
do
hope
that
the
media
and
other
commentators
will
will
say
what
you've
just
said.
A
It
is
unacceptable,
whether
it's
abuse,
physical
or
or
verbal,
whether
it's
in
general
practice
or
emergency
departments
or
anywhere
else,
and
I
think
as
a
board.
We
should
absolutely
deplore
any
action
like
that.
So
let's
now
have
an
experiment
and
and
invite
tyson
to
give
his
report
remotely
tyson.
A
This
could
be
an
experiment.
That's
going
to
fail.
It
has
failed
so
in
in
the
best
example
of
television
and
radio
people
who
then
find
that
the
person
they
were
about
to
interview
is
not
on
the
line,
we'll
have
to
move
move
on
and
hopefully,
maybe
come
back
to
tyson
later
on
mark,
let's,
let's
go
to
you
please.
G
A
H
Should
we
give
a
quick
update
on
some
of
our
engagement
and
publications
that
have
happened
in
the
last
last
month?
Firstly,
we've
had
really
good
engagement,
as
ian
mentioned
from
the
government
on
the
passage
of
the
bill,
but
also
from
mps
involved
in
the
development
of
of
the
of
the
health
and
social
care
bill.
In
particular.
H
Cqc's
position,
as
an
independent
voice
of
assurance,
has
been
an
important
feature
of
what
mps
from
all
sides
of
the
house
have
said
that
they
value
in
the
legislation
as
it
moves
forward.
H
H
Both
the
providers
of
service
and
the
public
groups
recognized
the
value
and
saw
the
report
as
an
ability
to
move
forward
on
some
of
the
key
issues
around
inter-team
relationships
about
about
training
and
support,
and
also
about
how
women
are
engaged
with
through
the
process
through
pregnancy
and
through
their
postnatal
period,
and
I
think
it's
a
testament
to
the
way
in
which
the
report
was
carried
out
and
the
way
in
which
we
gathered
the
voice
of
every
party
that
everybody
can
see
their
voice,
reflected
in
that,
and
I'm
really
delighted
to
say
that
james
titkin
who's
a
long
time
been.
H
An
advocate
for
change
in
this
area
is
supporting
us
in
our
in
our
journey
to
move
forward
in
this.
I
think
we're
delighted
at
the
response
to
this
report,
but
obviously
that
is
only
part
of
what
we
want
to
do
moving
forward.
We
want
to
really
encourage
the
change
that
we've
begun
to
see
across
all
services.
H
Just
a
note
for
the
board
that
we've
we've
published
the
inpatient
survey.
This
is
part
of
the
information
that
we
use
to
guide
our
thinking
around
people's
experience
of
care
for
reports
like
state
of
care,
so
these
are
important
elements
and
they
build
together
to
to
give
a
complete
picture
of
people's
experience
of
care
over
the
last
12
months.
H
I
also
want
to
talk
a
bit
a
bit
about
a
report
that
has
been
close
to
a
colleague's
heart
in
the
organization
for
for
a
long
time,
the
home
for
good
report
was
designed
to
show
that
community
support
for
people
with
learning
disabilities
and
or
autistic
people
is
complex,
but
it
is
possible-
and
I
think
what
the
report
does.
It
highlighted
exactly
how
people
can
be
supported
to
live
well
in
a
local
community
and
how
the
services
can
combine
to
give
people
a
better
quality
of
life.
H
And
again,
it's
been
brought
about
by
the
work
we've
we've
we've
worked
with
providers,
we've
worked
with
people
who
use
services
and
their
families,
and
it's
I
think,
it's
a
testament
again
to
the
to
the
team,
the
cross-functional
team
that
worked
on
the
report
that
we
have
made
it
clear
that
this
that
these
type
of
services
are
not
only
possible
but
desirable,
they're,
not
only
value
for
money,
but
in
many
respects
they
provide
much
better
value
for
money
than
the
services
that
they
replace.
We
know
there
is
some
way
to
go
in
this.
H
We
know
there
are
still
some
services
out
there
that
don't
meet
these
these
important
criteria,
but
this
is
for
us,
an
important
part
in
that
process
to
make
it
clear
to
all
people
who
operate
in
this
area
that
these
are
the
services
that
we
think
are
important
moving
forward.
I
just
want
to
commend
colleagues
to
look
at
the
report
if
they
haven't
done
so
already
and
look
at
the
the
conversations
that
were
happening
as
a
result
of
it.
I
Robert,
so
I
actually
had
a
question
for
kate,
but
we
skated
past
that
quite
quite
quickly,
so
I
apologize
for
not
waving
frantically
enough.
The
question
really
I
have
is
a
is
about
staffing
and
care
homes
and
perhaps
in
particular,
what
effect
if
any,
the
new
rules
about
vaccination
are
having
on
that,
but
also
there
is
obviously
the
wider
problem
that
was
well
publicized
in
relation
to
staffing,
and
I
just
wonder
whether
your
inspectorate,
yet
finding
that
that
some
providers
are
getting
into
almost
an
impossible
position
or
whether
that's
not
the
case.
D
Thank
you
robert.
So
the
the
question
of
workforce
comes
up
on
all
of
our
inspections.
So
do
the
providers
have
the
staff
with
the
right
skills
and
and
right
values
to
deliver
high
quality
care
providers
are
reporting
nationally
and
to
us
about
their
concerns
about
the
impact
of
vaccination
as
a
condition
of
deployment
that
will
come
into
force
on
the
11th
of
november,
with
various
different
figures
being
mentioned
about
the
numbers
of
staff,
who
won't
have
their
two
vaccines
done
within
within
the
time
frame?
D
We've
been
really
clear
about
our
approach
to
this.
So
obviously
the
government
has
changed
our
regulations
so
that
we
will
be
enforcing
against
this.
We're
really
clear
that
we
will
take
a
proportionate
approach.
We
will
look
at
how
services
led
in
in
the
round,
but
our
expectation
is
staff,
do
have
the
vaccinations
to
enable
them
to
provide
safe
care,
we're
seeing
a
multiple
kind
of
multi-layered
issue
around
workforce.
So
we've
got
the
issue
of
vaccinations.
D
We've
got
the
issue
of
tourism
really
booming
at
the
moment
and
staff
leaving
our
sector
social
care
sector
to
go
into
tourism,
and
then
we've
got
in
the
kind
of
the
implications
of
the
eu
exit
as
well.
So
all
of
that
in
the
pot
is
means
that
workforce
continues
to
be
a
big
area
of
concern
for
us
within
adult
social
care
and
that's
set
in
the
context
of
you
know,
prior
to
the
pandemic,
112
000
vacancies
and
turnover
rates
of
about
37.
D
What
I'm
really
keen
to
do
is
that
we
continue
to
look
at
it
through
the
lens
of
what
does
the
workforce
issue
mean
in
terms
of
the
quality
of
care
being
delivered,
and
we
will
continue
to
capture
that
when
we
go
out
on
individual
inspections,
but
it
will
also
inform
things
such
as
our
state
of
care
report
that
we
will
be
publishing
in
the
next
next
month
as
well.
A
Thanks
robert
and
given
the
size
of
the
room,
if
anybody
wants
to
come
in
at
any
time-
and
I
haven't
noticed,
do
do
shout
wave
your
arms
do
something
stephen.
J
Thank
you
peter.
I'm
not
sure
whether
this
is
a
rosy
question
or
a
ted
question,
but
are
you
picking
up
concerns
from
your
sectors
about
long
covid,
you've
both
described
the
the
pressures
that
your
your
sectors
are
under
and
they
are
enormous
and
they
are,
they
are
real,
is
long
kovik
going
to
add
to
all
of
that,
and
are
we
getting
any
sort
of
stable
understanding?
Well,
what
is
it?
You
know
what
what
are
the
what's
associated
with
it?
What
is
its
duration?
What
are
sensible
approaches
to
dealing
with
it
is.
E
F
Can
I
just
add
it:
it's
certainly
a
feature:
it's
at
the
moment,
it's
difficult
to
quantify
and
we
don't
have
the
data
to
quantify
it,
but
it's
certainly
a
feature
that
we're
seeing
in
primary
care
as
well
and
gps
are
reporting
that
they
are
seeing
increasing
patients
with
long
covert,
which
is
having
an
impact
as
well
based
clearly
on
the
patients,
but
also
on
the
demand.
A
Thank
you
both
sally.
K
Thank
you
peter.
It
was
just
a
quick
question
for
rosie
following
up
what
she
said
about
gp
access
before.
So,
whilst
I
absolutely
deplore
the
abuse
that
gps
would
be
under,
there's
a
real
problem,
isn't
there
with
access
to
primary
care,
and
I
suppose
different
patients
need
different
types
of
appointments
to
be
available.
Don't
they
we
need
to
treat
particularly
vulnerable
people
who
might
not
be
able
to
attend
appointments
online
or
understand
them
to
offer
a
mixture,
and
I
know
from
my
own
local
clinical
commissioning
group.
K
They
have
issued
a
advice
that
says
no
face-to-face
appointments
unless
absolutely
necessary,
and
it
must
be
really
hard
for
gp
practices
to
be
able
to
differentiate
the
service
that
they
offer
the
type
of
service
they
offer
to
different
patients
whilst
they're
under
so
much
pressure,
and
whilst
they
might
be
told
that
this
is
the
way
they
ought
to
operate.
So,
whilst
that
isn't
our
role
to
mandate,
how
gps
offer
access
is
there
anything
that
we
can
do
from
cqc,
both
in
terms
of
support
and
guidance?
I
suppose.
F
Yes,
certainly-
and
this
is
a
is
a
discussion-
we're
having
a
lot
at
the
moment
with
our
stakeholders
and
just
to
be
clear,
I
think
it's
really
important
that
people
get
the
access
that
meets
their
needs,
that's
safe
for
them,
and
that
could
be
a
variety
of
mechanisms
for
some
people.
F
A
face-to-face
appointment
is
right
for
some
people,
a
telephone
appointment
will
perfectly
well
meet
their
needs
and
telephone
consultation
and
digital
methods
of
consultation
have
been
used
for
many
years
prior
to
the
pandemic,
they're,
not
new
methods
of
consulting
and
certainly
in
out
of
hours
and
one-on-one.
They
are
being
used
very
regularly
as
well.
F
I
think
it
is
important
we
are
seeing
increasing
inquiries
about
access
into
the
cqc
from
patients
who
are
unable
to
access
services.
We
are
following
those
up
with
the
individual
practices.
I
think
we
also
have
to
recognize.
There
are
a
lot
of
patients
and
it
was
seen
in
the
patient
survey
that
are
actually
satisfied
with
the
access
that
they're
getting
and
the
patient
survey
did
did
confirm
that.
F
I
think
what
we
need
to
also
consider
is
how
we
make
sure
people
are
kept
safe
as
they're
accessing
services
and
the
we
need
to
think
about
infection
prevention
control
and
making
sure
that
practices
undertake
a
good
risk
assessment
to
make
sure
that
patients
coming
into
their
waiting
room
are
not
at
increased
risk
of
contracting
covert
and
other
illnesses
by
the
the
social
distancing
arrangements
in
their
waiting
room.
So
it's
a
complex
issue
which
we're
working
through
at
the
moment.
It's
very
important
that
people
do
get
access.
F
F
We
know
there's
backlogs
in
primary
care
as
well
and
that's
having
an
impact
on
the
demand
and
there's
no
doubt,
there's
enormous
demand
both
related
to
that
related
to
ongoing
covert
issues,
a
whole
range
of
different
things
that
are
driving
demand,
as
well
as
the
increasing
and
complexity
and
the
changing
demographics
that
we're
seeing
that
predate
covert.
That
we
knew
were
increasing
demand
in
primary
care.
So
it's
a
complex
issue.
A
L
Just
just
a
left
field,
question
rosie
and
with
with
these
technologies
like
zoom
and
teams
and
and
having
calls
there
and
sometimes
the
recording's
on
and
that
data
is
stored
outside
of
uk
and
sometimes
outside
of
europe,
because
it's
cloud
are
there
any
guidance
on
that
privacy
of
data?
Are
there
any
areas
that
we
could
advise
on
that.
F
Yes,
and
certainly
we
look
at
information
governance
as
part
of
our
inspection
protocols
and
look
at
what
practices
are
doing
to
make
sure
that
information
is
kept
safe
and
there's
a
whole
variety
of
new
systems
that
are
being
used
in
primary
care
to
enable
digital
digital
mechanisms
to
aid
consultations
that
have
that
information.
Governance
fully
thought
through.
So
we
it
is
something
we
look
at
and
we
do
have
guidance
around.
A
So
I
was,
I
was
going
to
say
to
the
board
that
had
we
been
able
to
connect
tyson
into
the
conversation,
he
would
have
said
that
he
had
nothing
to
add
to
the
written
report.
So
that's
fine
and
I
think
that
concludes
the
executive
director's
report.
A
So
I
think
we
can
move
on
kirsty
to
the
quarterly
update.
N
Thank
you,
kirsty
yeah,
so
quarterly
update,
including
performance
for
july.
So
this
is
the
last
report
we'll
receive
against
the
old
business
plan
so
going
forward
from
next
next
month.
There
will
be
performance
against
our
new
business
plan
just
for
board
to
note
so
I'll
run
through
a
few
areas
and
then
open
it
up
for
comment
and
discussion
from
board,
so
in
terms
of
registration
and
I'll
give
reference
to
a
diligent
page
numbers
as
we
go
through
just
to
help
board.
So
this
is
page
33..
N
So
it's
been
good
progress
of
late
we've
seen
an
18
reduction
in
the
volume
of
registrations
in
the
system
in
terms
of
average
days
to
process
which
are
kpi
simples
at
26.8,
complex
127.8.
N
Both
are
improving
trends,
but
it's
worth
noting
that
this
kpi
will
fluctuate
until
we've
moved
historical
applications
through
the
system
in
terms
of
safeguarding
which
is
the
following
page
page
34
performance
for
safeguarding
alerts
is
94
and
concerns
97
both
against
a
target
of
95
current
data
shows
the
alerts.
Kpi
is
back
where
it
needs
to
be.
An
assurance.
Review
has
been
carried
out
of
all
records
that
are
outside
of
the
kpi
to
make
sure
we
are
comfortable
with
those
and
it's
a
recording
issue
on
whistleblowing,
which
is
page
35
the
following
page.
N
We
continue
to
see
an
increase
in
whistleblowing,
there's
a
56
increase
from
this
point
last
year
in
terms
of
measures
we
brought
in
a
new
measure
in
april
to
record
our
action
within
five
days.
At
the
end
of
july,
we
recorded
our
initial
mitigation
within
five
days
in
77
of
cases
against
a
target
of
95
percent.
This
is
an
improving
trend.
N
It
was
it
we
had
a
sluggish
start
today,
it's
probably
fair
to
say-
and
we've
undertaken
a
review
of
all
cases
as
with
the
safeguarding
outside
of
outside
of
that
target,
to
make
sure
that
we
had
taken
all
the
action
we
needed
to
do,
which
we
found.
There's
no
concerns
with
that,
but
highlighted
areas
of
additional
chaining
and
communication
needed.
As
I
said,
the
current
trend
of
that
is
showing
a
stark
improvement
in
terms
of
regulatory
action.
N
So
page
36
in
the
pack
you'll
see
that
55
percent
of
our
inspections
were
triggered
by
risk
triggered
by
risk
we're
in
response
to
information
of
concern.
We've
received
demonstrating
how
valuable
that
information
is
it's
a
huge
proportion.
The
following
slide
shows
a
profile
of
inspections
and
it's
currently
missing
a
legend.
So
apologies
for
that.
So
the
orange
is
risk-based
inspections.
N
The
blue
is
non-risk-based
inspections,
so
you
can
see
the
volume
of
activity
we've
been
undertaking
in
terms
of
our
actual
inspection
delivery,
and
you
can
also
see
that
we've
recorded
11
percent
of
on-site
inspections
of
included
time
out
of
hours,
which,
which
is
a
high
proportion
in
enforcement.
94
percent
for
urgent
enforcement
action
was
served
within
three
days.
You
see
on
page
38
and
finally
of
last
couple
of
areas
hr.
N
So
this
is
page
42
to
46
and
another
apology
from
me
here
in
terms
of
the
the
size
of
the
font
and
some
of
the
the
blurriness
of
the
images,
it's
probably
fair
to
say
we
did
try
and
upload
a
revised
version,
but
if
you've
annotated
the
pack,
you
would
have
lost
that,
so
we've
had
to
unfortunately,
leave
it
as
is,
and
we'll
amend
that
for
next
time
to
apologies.
If
it's,
if
it's
hard
to
read
turnover,
is
stable
at
9.3
percent,
which
is
down
from
10.6
last
year.
N
Sickness,
currently
at
3.4
percent,
with
stress
anxiety,
remain
as
the
the
top
reason
black
asian
and
minority
ethnic
colleagues
make
up
13.7
of
our
workforce
with
9.7
in
senior
roles.
9.7
and
disabled
colleagues
make
up
8.1
of
our
workforce,
just
some
of
the
the
stats
coming
out
of
that
pack
in
terms
of
our
money
just
end
with
it.
N
At
the
end
of
july,
we
were
7.8
7.8
million
under
spent
year
to
date,
which
is
forecast
to
increase
to
12.5
million
on
our
capital
budget,
we're
under
spent
by
2.1
million,
but
we
are
anticipating
being
on
budget
for
the
year.
Our
budget
assumed
an
uplift
and
activity.
N
We
we're
not
seeing
this
as
we
adapt
to
our
ways
of
working,
for
example,
significantly
reduced
travel
costs
this
year,
we're
looking
at
what
plans
we
can
accelerate
forward
into
the
year,
but,
alongside
that,
we're
also
looking
at
what
our
future
budget
requirements
are,
what
this
means
for
fees
and
we'll
bring
that
back
to
the
board
in
in
due
course,
so
that
was
it
from
me
peter.
Thank
you.
Thank
you.
Chris.
D
Thank
you
thanks,
peter,
so
just
a
couple
of
extra
bits
to
add,
if
I
may,
on
on
chris's
update,
so
the
whistleblowing,
so
the
ask
we
introduced
of
our
staff
to
tell
us
the
immediate
mitigation
they're
putting
in
place
when
a
whistleblowing
came
in
was
a
new
way
of
how
we
expect
them
to
record.
The
report
was
saying:
77.
D
That's
the
year-to-date
statistic
just
to
give
board
the
most
up-to-date
figures,
because
this
is
such
an
important
issue.
In
august
it
was
85
and
we're
on
track
for
hitting
90
in
september,
and
it's
92
in
adult
social
care,
so
just
wanted
to
say
that
it
was
a
new
measure
we
introduced.
We've
done
the
deep
dive
to
make
sure
we
took
the
right
regulatory
operational
action,
but
that
number
is
absolutely
headed
in
in
the
right
direction
and
then
I
just
wanted
to
flag.
D
Chris
mentioned
these
11
of
inspection
activity
having
an
out
of
hours
component.
This
is
critical
and
this
is
critical.
It
came
out
of
our
learning
from
glynice
murphy.
It
came
out
of
our
our
learning
from
how
we
can
get
better
at
spotting,
close
cultures
and
actually
being
in
a
service
when
people
are
getting
up
in
the
morning
when
handover's
happening
at
nighttime
over
weekend
is
really
important,
and
I
know
blinder.
One
of
our
colleagues
has
asked
a
question
before
about
that
number.
So
we
clarify
what
constitutes
about
an
out
of
hours
visit.
D
We
built
it
into
our
system
now,
so
inspectors
have
a
way
of
recording
it
and
the
fact
we
can
now
capture
it
and
report
that
it's
up
to
11,
I
think,
is
really
positive
and
I'd
like
to
see
that
number
continue
to
go
up
as
well.
So
just
wanted
to
really
highlight
that
stat
about
the
amount
of
activity
that's
happening
out
of
ours,.
J
J
Do
we
know
what
that's
about
and
if,
as
in
the
right
hand,
chart
the
vast
majority
is
anxiety,
stress,
depression,
those
those
types
of
sort
of
mental
health
issues
is
that
associated
with
sort
of
return
to
across
the
threshold
inspections
and
back
to
the
office
or,
what's
what?
What
is
that
about?
We
know.
M
Thanks
so
we
usually
start
to
see
a
spike
in
sickness
at
this
time
of
year
as
flu
and
cough
and
and
season
starts
to
to
come
in.
So
I
think
we,
if
you
look
at
that
across
it
on
a
12
month.
I
can't
date
on,
but
I
think,
as
people
are
starting
to
travel
more,
we
will
see
more
of
that
happening,
because
obviously
people
have
been
stuck
at
home
and
isolating
for
for
a
while,
not
mixing.
M
I
think
the
start,
the
sickness
and
the
stress
and
anxiety
when
we
monitor
very
carefully
and
everyone
who
is
off
with
that,
has
a
as
a
program
and
has
a
stress
assessment
to
make
sure
that
we're
we're
keeping
a
close
eye
on
on
that
and
making
sure
that
we're
doing
the
right
things
to
get
people
back.
So
I
I
think
we
I'm
not
too
worried
about
that.
If
you
look
at
our
longer
term
trends
over
time.
A
I
Thank
you,
a
similar
sort
of
question
about
employee
feedback
and
diversity,
and
I'm
page
14,
maybe-
and
it
was
the
word
cloud
which
is
reasons
for
people
leaving-
and
I
I
wondered
a
career
progression-
is
the
first
one.
That's
obviously
positive
highest
salary
benefit,
probably
not
much.
We
can
do
about
it,
but
the
next
one
down
is
well-being
and
is
that
a
as
the
size
of
the
word
would
suggest
really
quite
a
small
number
or
is
that
something
we
ought
to
be
worried
about.
M
So
I
think
we
keep
a
track
of
that.
I
think
our.
If
you
look
at
our
turnover
rates,
it's
is
quite
low,
so
I
think
it
does
look
like
a
big
word,
but
actually
it's
not
that
many
people,
I
think
we've
got
lots
of
work.
We
do
around
our
well-being
and
maintaining
that,
but
you
know
people.
I
have
had
a
very
difficult
18
months.
We've
had
a
lot
of
particularly
our
front
line.
M
B
Yeah
and
just
to
add
to
that,
I
think
it's
also
true
to
say
that
the
there's
enormous
variability
between
different
directorates,
I
think
some
directorates
have
an
age
profile
which
is
profoundly
different
to
other
directorate,
so
things
like
career
progression
as
a
for
example,
will
will
be
stronger
in
some
directions
than
others
and
equally
the
well-being
issue
is
quite
variable.
So
I
think
in
terms
of
what
we
do
about
this,
the
the
answer
is
that
it's
reviewed
on
a
monthly
basis,
a
director
at
a
director
level
against
the
specific
issues
in
those
different
directors.
C
C
I
think
I'm
seeing
from
that,
that
starters
by
ethnicity
are
higher
than
the
labor
market
and
higher
than
our
cqc
workforce
mix,
which
is
good,
but
it's
slightly
lower
than
it
was
in
in
the
previous
report,
which
was
back
in
may.
Levers
are
also
higher.
So
that's
not
so
good
and
that's
why
we're
looking
at
this
data
and
over
time
I
I
think
you
know
we
have
the
opportunity
to
access
trends
and
consider
our
actions.
C
So
that's
why
I
think
this
chart
is
rich
with
information
and
and
thank
you
for
providing
it
starters
by
disability
are
lower
than
the
market
and
lower
than
our
workforce
mix
and
levers
higher
than
than
cqc.
But
I
think
we
recognize
there's
a
bit
of
a
reporting
issue
in
terms
of
self-reporting
on
on
disability,
but
that's
again
you
know
an
opportunity
for
us
to
review
that
and
to
react
accordingly.
C
I
have
to
say
I
I
do
hope
that
we
can
also
look
at
promotions
and
transfers
and
secondments
by
ethnicity
and
and
disability.
Going
forward-
and
you
know
I
just
commend
the
exact
team
for
these
charts,
because
it
does
give
us
this
opportunity
for
us
to
look
at
some
of
the
granular
detail
instead
of
those
headline
numbers
on
turnover
and
recruitment.
So
thank
you.
I
think
mark.
A
We
should
commend
you
because
I
think
it
was
you
who
very
much
helped
direct
us
in
this
this
this
way
so,
and
it
is
good
data
you're,
absolutely
right,
sally.
K
Thank
you
mark's
touched
on
one
of
the
points
I
wanted
to
make,
which
was
that
we
have
a
significantly
lower
percentage
of
colleagues
who
declare
a
disability
than
in
the
general
population,
and
I
wanted
to
ask
perhaps
not
for
now
is
whether
it's
simply
a
factual
level
of
staff
who
have
a
disability
or
whether
it
is
about
declaration
or
choosing
not
to,
and
I
think,
there's
an
important
distinction.
But
we
need
to
understand
what
that
is
and
then
just
a
couple
of
things
on
turnover
and
levers.
K
It
might
be
that
they've
just
joined
you
in
a
particularly
difficult
period,
or
it
might
be
that
there
are
other
reasons,
and
I
think
it's
worth
looking
at
that,
because
only
55
percent
of
our
staff,
who
leave
have
an
exit
interview.
So
there's
a
significant
amount
of
data
that
we
don't
have
as
to
why
those
people
are
leaving.
And
I
wondered
whether
that
might
change
the
word
cloud
a
bit,
so
I
don't
necessarily
need
answers
today.
I
think
it's
just
something
to
go
away
and
think
about
in
terms
of
the
data
that
we
report
back.
G
So
mark,
why
don't
you
you
start
answering
coming
on
the
first
question
sally?
If
that's
okay,
so
we
we
know
that
our
the
self-reporting
around
disability
data
is
not
where
we
need
it
to
be.
G
So
one
of
the
we
we
have
we've
signed
up
to
the
workforce,
disability,
equality
standards
and
we
know
as
one
of
the
actions
that
we
have
as
part
of
that
is
to
attempt
to
to
improve
that,
and
we
have
a
campaign
launching
shortly,
which
paul
has
done
the
video
for
which
we
will,
which
will
help.
Hopefully,
with
improving
colleagues
reporting
around
around
disabilities.
A
On
your
second
point,
I
mean
I
recall,
probably
about
three
years
ago
we
had
a
much
higher
proportion
of
people
leaving
in
the
first
12
to
18
months.
They
were
with
us
and
a
really
quite
considerable
amount
of
work
was
done
to
improve
both
the
the
the
interview
process.
So
people
knew
what
they
were.
They
were
letting
themselves
in
for,
and
you
know,
being
a
home-based
inspector
doesn't
doesn't
suit
everybody,
and
we
had
a
lot
of
people
who
thought
it
was
great
and
turned
out.
A
It
wasn't,
and
so
the
number
is
actually
much
lower
than
it
was,
but
it
might
be
something
we
need
to
keep
looking
at,
because
it's
obviously
very
wasteful
have
people
only
for
a
short
time.
Kirsty.
A
M
Update
first
then
pause
if
there's
any
questions
and
then
there's
a
few
extra
people
bits
just
to
update
people
on
so
in
terms
of
our
change
update
over
the
last
few
months,
we
have
been
focused
on
really
ensuring
that
our
portfolio
has
a
really
strong
alignment
with
our
strategy,
and
we
can
really
track
the
benefits
of
the
change
work
to
how
we
are
realizing
our
strategy
and
what
we've
been
doing
is
rearranging
our
portfolio
around
three
core
pillars
for
delivery.
These
are
a
regulatory
framework
which
is
our
sort
of
policy
framework.
M
One
is
the
other
one
is
our
regulatory
services
which
is
looking
at
us
or
systems
and
processes
and
ways
of
working,
and
then
the
other
pillar
is
our
organizational
design
and
development,
which
is
looking
at
how
we
organize
ourselves
the
skills
capabilities
we
need
to
ensure
that
we're
fit
for
the
future.
M
As
an
organization,
we've
also
been
focused,
quite
focused
quite
heavily
on
our
delivery
planning
and
really
looking
at
how
we
can
take
this
huge,
a
huge
area
of
work
and
break
it
down
into
deliverable
chunks
of
work,
and
what
we've
done
is
is
broken
the
work
into
into
four
key
stages
in
order
to
make
sure
that
we
can
deliver
in
in
a
logical
way
where
we're
starting
to
build
capacity
and
capability
on
an
iterative
basis.
M
The
first
one
of
these
chunks
we're
looking
to
deliver
at
the
end
of
this
financial
year
and
that
one
will
enable
us
to
develop
the
foundations
for
us
to
become
an
insight
driven
organization
with
a
strong
data
quality
and
will
enable
us
to
test
in
shadow
format.
Our
new
place-based
working
end
to
end
so
taking
us
from
registration
right
through
to
publication
of
our
of
our
inspection
findings.
M
Other
as
a
whole.
We've
made
some
really
good
progress
over
the
last
few
months
in
terms
of
building
capability.
M
In
terms
of
the
regulatory
framework,
we
now
have
been
focused
on
delivering
that
developing
our
single
quality
framework,
which
we
can
apply
across
the
full
lengths
of
our
services
regulatory
services,
starting
with
registration
and
taking
us
through
to
publishing
that
rating.
M
As
part
of
that
work,
we've
been
engaging
extensively
with
our
colleagues
to
ensure
that
we're
able
to
harness
their
knowledge
and
expertise
and
use
that
to
inform
our
detailed
design
and
thinking
in
terms
of
our
regulatory
services,
work,
we've
been
building
systems
and
processes
and
technology
to
support
our
new
ways
of
working,
including
transforming
our
data
and
insight
and
also
looking
at
our
new
regulatory
platforms.
M
The
transforming
and
data
insight
work
has
been
is
on
track
to
deliver
our
foundational
capability.
That
will
really
support
us
to
become
that
insight
driven
organization.
We
have
our
ambition
to
be,
and
we've
also
made
really
good
progress
with
our
regulatory
platform
in
terms
of
building
our
underpinning
architecture
and
our
digital
processes
and
new
systems
which
are
going
to
support
our
new
ways
of
working
in
the
future
in
terms
of
our.
So
that's
what
I
want
to
say
about
our
change
function.
I
don't
know
if
anyone's
got
any
questions.
M
The
question
I
will
so
in
terms
of
our
people
were,
over
the
last
quarter.
We've
been
focused
on
developing
our
talent
and
looking
at
how
we
can
start
to
grow,
build
capability
for
the
future.
We've
completed
our
senior
leadership,
talent
review
and
are
now
looking
at
developing
our
talent,
lower
down
the
organization
and
particularly
looking
at
how
we
can
bring
forward
our
work
on
our
level
three
and
level
five
management.
Apprenticeships.
M
I'm
really
pleased
to
say
that
we
have
in
terms
of
the
applications
for
those
apprenticeships,
we've
had
a
good
number
of
applications
from
our
black
and
ethnic
minority
and
disabled
colleagues,
and
all
of
those
who
have
applied
have
been
able
to
have
been
successful
in
getting
a
place
on
their
first
choice,
which
is
really
really
positive.
M
M
In
terms
of
our
diversity
and
inclusion
work
stream,
we
have
been
running
a
program
of
reverse
mentoring,
where
we've
had
our
very
senior
leaders
in
the
organization
matched
up
with
more
junior
colleagues
to
have
a
really
good
and
honest
discussion
about
what
it
feels
like
to
be
a
black
and
ethnic
minority,
both
working
in
cqc
but
also
wider.
In
terms
of
their
lived
experience.
M
M
We're
also
focused
on
building
our
line
management
capability,
particularly
as
we
move
through
transformation
and
making
sure
that
we
have
the
skills
in
place
to
release.
So
our
colleagues
feel
able
to
lead
their
transformation
within
their
teams
and
feel
supported
to
have
those
conversations
as
we
move
through
the
implementation
of
our
of
our
of
our
transformation
plan.
M
We've
developed
a
set
of
a
comprehensive
suite
of
training
and
programs
which
we've
labeled
the
successful
manager,
which
are
a
series
of
modules
which
are
going
to
support
managers
through
this.
Our
intelligence
and
data
colleagues,
where
the
digital
colleagues
have
been
the
first
first
cohort
through
and
have
reported
that
this
has
been
very
helpful,
particularly
in
managing
the
change
that
that
particular
team
are
going
through
at
the
moment.
A
Gosh
right
well,
in
that
case,
let's,
let's
move
on
but
great
report.
Thank
you
and
and
as
always
a
lot
of
good
information
in
there
for
the
board.
So
chris,
I
think
we
come
to
you
and
the
the
insight
report.
H
Yes,
so
this
insight
report
focuses
on
some
work,
we'll
be
doing
to
understand
how
nhs
hospitals,
in
particular
that
have
been
affected
by
kovid,
are
beginning
to
recover.
So
we
did
a
number
of
in-depth
pieces
of
work
looking
at
73
trusts
and
what
they
were
doing
to
manage
the
post
of
the
sort
of
the
first
waves
of
covid.
H
There
were
three
issues
I
guess
that
emerged
from
that
work.
I
just
want
to
quickly
touch
on
on
each
three
before
inviting
questions.
The
first
one
was
about
waiting
lists.
H
Now
it's
clear
that
the
media
will
report
an
increase
in
in
waiting
lists,
and
I
think
one
of
the
conversations
with
the
many
conversations
with
the
trust
focused
on
how
people
can
as
one
organization
and
some
examples
of
that
are
cancer
care
coordinators
that
act
as
advocates
for
for
patients
who
may
otherwise
find
it
difficult
to
navigate
different
parts
of
the
system
and
provide
some
of
the
support,
the
ancillary
support
between
bouts
of
activity.
H
If
there
are
elective
weight
increase
times
how
patients
can
be
involved
in
support
groups
and
therapies
that
are
therapeutic,
while
people
are
waiting
for
electric
surgery,
there's
also
an
issue
about
identifying
and
prioritizing
deterioration
in
patients.
How
do
you
keep
a
handle
on
people
that
are
waiting
and
are
deteriorating
so
that
you
can
minimize
the
risk
of
harm
and,
in
some
respects,
using
technology
as
a
solution,
so
home
testing,
remote
monitoring,
applications
that
can
support
the
information,
access
to
advice
and
correspondence?
H
It's
fair
to
say,
trust,
we're
cautious
about
all
of
these,
but
I
think
they
all
play
an
important
part
and
we
should
be
curious
about
their
their
impact,
both
in
the
short
term
and
the
long
term,
but
they
none
of
them
were
a
panacea,
but
all
of
them
helped
in
in
how
we
can
encourage
organizations
to
think
about
how
people
are
supported
during
a
wait.
H
The
other
more
obvious
areas,
increasing
capacity
and
indeed
some
of
the
organizations
were
focused
on
how
they
de-escalate
intensive
care
as
a
way
of
improving
access
to
capacity.
More
generally,
trust
talked
about
ring,
fencing
of
beds
for
elected
procedures,
and
some
talked
about
offering
mutual
support
and
aid
sharing
capacity
between
trusts,
in
a
way
that
you
might
expect
an
ics
to
perform
that
role
in
the
coming
months.
H
H
Which
brings
me
onto
my
third
point,
which
is
the
the
ideas
of
of
collaboration
and
many
of
the
best
examples
of
of
how
covert
is
being
managed
were
not
just
about
the
nhs
organization,
but
about
their
relationship
with
primary
care,
with
community
care,
with
adult
social
care
and
actually
with
the
community
and
voluntary
sector
organizations
in
their
local
area.
H
So
many
talked
about
the
challenges
of
dealing
with
groups
that
are
engaged
in
trying
to
support
people
between
elective
surgery
and
actually
using
some
of
the
resource,
particularly
of
the
third
sector,
to
provide
some
of
that
support.
It
is
fair
to
say
that
there
isn't.
H
An
important
point
that
was
raised
time
and
time
again
was
how
to
mitigate
increasing
health
inequalities
at
a
time
when
the
backlog
of
care
is
so
great,
and
I
think
the
organizations
talked
about
the
role
of
of
third
sector
organizations
locally
in
providing
an
early
warning,
an
early
warning
of
of
issues
and
problems
and
using
them
as
a
central
part
of
how
they
manage
to
recover
from
covid.
H
We
think
it's
an
important
report
and
that
it
gives
some
insight
into
what
different
organizations
are
doing
and
I
think
organizationally
it's
important
that
we.
We
continue
to
be
curious
about
how
organizations
are
managing
during
this
time,
and
we
look
to
celebrate
some
of
the
good
practice
as
well
as
guiding
other
organizations
towards
things
that
they
need
to
do
differently.
H
F
F
It's
it's
great
to
see
these
new
innovations
in
secondary
care.
What's
so
important
is
that
that's
thought
through
and
worked
through
with
primary
care
in
conjunction
and
with
all
parts
of
the
system
where
this
works?
Well,
it's
where
we've
had
clinicians
from
all
parts
of
the
system
sitting
down
to
work
out.
Those
pathways
where
it's
not
working
well
is
where
new
parts,
new
new
innovations
have
been
implemented
in
certain
systems
in
certain
parts
and
the
implication
in
impact
on
other
parts
of
the
system
has
not
been
identified.
F
I'd
also
just
like
to
mention
what
I
said
earlier,
and
I
think
it's
really
important
that
we
look
at
the
digital
and
with
remote,
consult
consultations
across
all
sectors
and
understand
what
is
safe
as
we're
doing,
and
the
conversations
are
happening
in
primary
care.
It's
really
important
that
we
look
at
this
across
all
of
the
different
parts
of
the
system
and
make
sure
that
we
are
consistent
in
our
messages
that
people
need
a
range
of
access
that
meets
their
needs
and
is
safe
for
their
current
clinical
condition.
E
Ted,
yes,
sir.
Thank
you.
Thank
you
peter,
and
thank
you
chris
for
the
work
got
this
got
into
this
report.
I
think
it's
really
very
valuable
report.
You
remember
board
members
that
we
discussed
our
concerns
about
these
very
issues.
Earlier
in
the
year
when
the
size
of
the
backlog
of
planned
care
became
apparent.
E
How
could
we
make
sure
that
that,
even
if
care
could
not
be
delivered
as
rapidly
as
we'd,
like
the
patients
were
receiving
good
interim
care?
In
the
meantime
of
being
supported
and
the
right
priorities
were
put
in
place,
and
I
think
certainly
the
work.
I've
done
with
trust
talking
to
trust,
but
also
the
the
the
work
that
chris
has
has
reported
in
this
report
shows
that
trusts
are
really
focused
on
trying
to
manage
the
the
backlog
of
activity
as
well
as
they
can
within
their
capacity.
E
But
remember
the
workforce
has
been
stretched
during
the
pandemics,
so
inevitably
they
need.
They
have
tensions
about
workforce.
They
have
tensions
about
capac
physical
capacity,
because
they're
still
got
infection
prevention
and
control
measures
in
place,
which
limits
his
physical
capacity
and,
as
I
discussed
earlier
on
in
this
meeting,
the
pressures
on
urgency.
E
Emergency
care
will
inevitably
have
some
impact
on
the
ability
to
trust
to
complete
plan
care
and
when,
when
we
talk
about
needing
a
new
model
for
urgency,
emergency
care,
I
think
one
of
the
elements
of
that
model
is
how
can
that
model
protect,
planned
care.
So,
every
time
you
get
a
surge
in
urgent
emergency
care
that
doesn't
have
an
effect
on
planned
waiting
lists,
and
I
think
that
is
something
we
need
to
explore.
Going
forward
into.
The
development
of
integrated
care
systems,
as
rosie
is
talking
about.
A
Ted
I
was
going
to
ask
either
you
or
chris
and
some
really
great
examples
of
of
different
initiatives,
and
I
just
wondered
how
we
were
making
sure
that
those
this
report
basically
is
shared.
Obviously
not
everything
will
apply
to
everybody,
but
there's
probably
a
nugget
for
everybody
to
pick
up
somewhere.
E
Well,
I
think
this
report
is
is
an
ideal
opportunity
for
us
to
share
that
good
practice.
E
A
lot
of
discussions
are
going
on
and-
and
I
think
one
of
the
really
strong
features
has
come
out
of
this-
is
that
collaboration
that
chris
was
talking
about
between
different
providers
in
areas
to
try
and
make
sure
that
patients
in
a
local
population
are
getting
the
the
care
they
need
is
priority
and
when
that's
being
done
well,
it's
having
quite
a
big
impact,
but
I
think
this
real
opportunity
for
us
to
use
this
report
as
a
way
of
sharing
best
practice.
Peter.
H
Chris,
I
agree
with
all
of
that
and
I
think
it's
important
that
we
can
share
this
with
frontline
staff
and
organizations.
H
I
think
it's
also
important
that
we
can
share
it
with
those
responsible
for
the
construction
of
the
ics
and
the
model,
the
model
of
performance
management,
and
I
think,
we're
having
some
really
good
conversations
with
nhs
england
about
how
we
use
some
of
the
what
we're
learning
from
this
to
build
an
understanding
of
what
google
might
look
like
in
an
ics
so
in
our
own
regulatory
oversight,
but
also
in
the
oversight
that
nhs,
england
and
others
will
offer.
I
think
it's
important.
H
We
look
to
these
outcome
measures
of
improvement
in
an
area,
so
I
think,
there's
a
number
of
channels
for
this
there's
some
direct
conversations
that
I
know
ted
and
colleagues
will
will
have
with
system
representatives
at
a
a
provider
level
and
a
frontline
level,
and
I
think
it's
up
to
us
to
continue
the
conversation
with
with
them
dhsc
and
nhs
england
about
how
this
forms
part
of
the
oversight
framework
for
ics
is
moving
forward.
I
Thank
you
very
welcome
report
and
it
seems
to
be
one
of
the
messages
that
comes
out
of
it
is
the
need
vital
need
for
appropriate
communication
with
and
from
patients,
and
in
that
regard,
two
weeks
ago,
healthwatch
england
put
on
its
website
some
advice
to
patients
about
what
to
expect
by
way
of
good
communication,
and
I
commend
it
is
only
about.
I
won't
really
believe
it,
but
it's
about
five
different
points
and
we've
asked
for
feedback
from
people
good
and
bad
about
how
they
experience
it.
I
But
what
I
would
suggest
is
that
that
we
consider
is
to
ask
actually
providers
what
are
they
doing
about
finding
out
what
the
expectations
of
their
patients
are,
because
it's
all
very
well.
The
system
talking
to
itself
about
the
need
for
improving
waiting
lists,
but
actually
you've
got
to
engage
with
the
patients
about
this
and
good
communication
is
clearly
the
key.
H
Just
to
say
to
robert,
I
absolutely
agree:
ted's
talked
very
eloquently
before
about
how
how
we
view
well
led
in
an
organization,
and
I
think,
the
engagement
with
service
users
between
an
organization
how
well
they
understand
the
the
service
users
is
a
key
part
of
how
an
organization
determines
it's
well
led
also
to
say,
if
you
look
at
the
driving
improvement
work,
all
the
organizations
that
we've
seen
improve
from
inadequate
or
requires
improvements
are
good
or
outstanding
fundamental
to
that
was
how
they
engage
their
frontline
staff
and
indeed
people
using
services,
and
without
that
we
don't
see
improvement
happening
in
organizations.
J
Stephen
and
then
we'll
come
to
you
mark
stephen
thanks,
peter
ted
I'd
be
interested
to
know
more.
I
think
I
heard
you
right,
you
were
using
the
phraseology
of
we
need
a
new
model.
J
Now
it's
it's
one
thing
to
say:
you
know
we
need
to
understand
the
best
of
what
is
happening
within
the
existing
system
and
encourage
ics
and
others
to
use.
It
is.
Is
that
what
is
meant
by
a
new
model,
or
is
it
actually
something
more
fundamental
that
this
system
is
not
what
we
need
and
we
need
something
different.
E
I
think
the
royal
college
resurgence
suggested
that
we
should
we
should
create
elect
more
elective
centers,
where
that
do
no
urgent
emergency
care
and
just
focus
on
elective
work,
and
that
may
be
one
model.
I
don't
think
we
know
the
answer
to
this,
but
what
we
should
say
is
that
every
winter
and
remember
the
waiting
list
was
going
up
before
covert
it.
This
is
kobit
has
exacerbated
a
pre-existing
problem.
F
Just
to
just
to
add
to
what
ted's
saying
I
I
agree,
we
need
a
new
model
of
care
and
I
think
we
need
a
much
more
proactive
model
of
care
rather
than
a
reactive
model
of
care
that
meets
people's
needs
in
the
most
appropriate
place
and
far
too
often
we're
seeing
people
end
up
in
hospitals,
because
they're
not
getting
their
needs,
met
at
an
earlier
stage
in
the
pathway,
and
so
I
think
we
do
need
a
new
model
of
care
and
what
we're
seeing
across
the
country
is
some
fantastic
innovations
that
systems
are
trying
to
meet
the
needs
of
their
population.
F
What
we
need
to
see
is,
is
those
innovations
rapidly
scaled
so
that
we
can
actually
get
those
new
models
of
care
embedded
that
will
actually
help
support
people
getting
the
right
care
in
the
right
place
at
the
right
time
and
support
the
pressures
on
the
system
that
we're
seeing
at
the
moment.
I
think
we
need
a
massive
acceleration
in
that.
J
Stephen
did
you
want
to
come
back
yeah
it
could.
I
just
did
so
who
needs
to
own
that
as
a
as
a
problem
or
a
challenge,
because
you're
both
saying
very
very
clearly
and
compellingly,
you
know
we
know
something
about
how
this
needs
to
work,
but
it
needs
to
be
scaled
and
it
needs
to
be
replicated
who
who
should
own
that?
J
H
Yeah,
absolutely
so
the
oversight
model
we
have
or
the
work
the
model
that
we
have
is
a
function
of
of
of
how
we've
constructed
it.
I
say
we
in
its
broadest
sense,
not
the
cqc
but
the
health
and
care
system,
so
how
we
pay
people
for
services,
how
we
govern
them,
how
we?
The
targets
by
which
we
set
for
which
they
that
is
of
that
is
the
function.
That
is
the
model
we've
got
today.
We've
got
the
model
that
works
to
the
things
that
we've
we've
we've
set
out.
H
I
hope
that
some
of
the
work
we'll
do
with
the
the
oversight
for
local
authorities
and
and
ics
will
give
some
ability
for
us
to
have
some
influence
over
that,
but
I
think
there
is
a
really
fundamental
element
about
how
we
encourage
services
and
those
who
have
oversight
for
them
to
think
differently.
H
About
that,
and
I
think
there
will
be
a
number
of
conversations
that
we
have
as
icss
are
formed
and,
as
I
said
earlier,
part
of
what
we
want
to
use
this
information
for
is
to
guide
the
development
of
ics's
so
that
we
can,
we
can
have
the
right
oversight
framework
and
with
the
right
oversight
framework
in
the
right
payment
framework.
I
think
we'll
have
the
model
that
we
need.
H
When
I
speak
of
we
there
is
secrecy
are
obviously
an
important
part
of
this,
but
there
are
the
dhse
nhs
england,
all
those
that
have
a
have
an
oversight,
responsibility
for
health
and
care
need
to
come
together.
In
this
regard,
I
think
we
have
a
part
to
play,
but
we
are
only
a
part
of
that
at
that
jigsaw
and
we
need
to
make
sure.
So
I
think
we
can
guide
others,
and
I
think
the
benefit
of
using
our
independent
voice
is
to
stimulate
debate,
to
encourage
the
right
action
to
take
place.
Rosie.
F
Yeah
I
I
just
also
want
to
add
that
I
think
the
ics's
have
a
huge
part
to
play
in
this.
I
think
they
that's,
where
the
they
understand
their
population
needs
and
they
need
to
be
driving
these
new
models
of
care,
but
also,
I
think
we
need
to
really
engage
with
the
public
and
we
need
to
work
out
how
we
can
encourage
the
public
to
have
a
part
to
play
in
this
as
well
in
their
local
communities,
and
we
we
need
to
talk
to
all
parts
of
the
system.
These
problems
are.
C
Thanks
chairman
chris,
very
good
report,
thanks
very
much
indeed
page
seven,
when
you're
talking
about
managing
staff,
who
you
know
already
burnt
out
through
the
pressures
that
they've
been
under.
I
just
wonder
if
this
report
is
not
an
opportunity
to
also
demonstrate
some
best
practice
by
organizations
in
managing
this.
I
I
happen
to
be
talking
to
the
hr
director
of
a
foundation
trust
this
week,
and
we
were
talking
about
this
and
he
he
mentioned
some
of
the
work
they
were
doing
in
terms
of
walk
arounds
by
senior
management.
C
To
demonstrate.
Support
self-help
guides
in
terms
of
managing
stress
anxiety
had
a
phrase
that
they
used
around
kind
managers.
Making
a
difference
had
a
poster
program
for
especially
those
staff
who
don't
see
the
support
system
so
night
shift.
Staff
who
particularly
haven't
in
this
organization
had
an
issue
around
hot
meals
on
night
shift,
and
so
they
had
a
campaign
around.
You
said
we
did
to
demonstrate
support
and
actually
the
appointment
of
a
health
and
well-being
advisor.
H
I
think
one
of
the
things
that
was
striking
to
me
in
the
conversations
that
we
had
was
that
the
most
important
one
of
the
early
most
important
things
was
to
say
it's:
okay,
not
to
be
okay
as
a
frontline
member
of
staff
and
actually
giving
people
the
permission
to
be
to
be
not
okay
and
provide
the
right
support
and
then,
as
you
say,
some
of
the
very
obvious
things
like
the
one
particular
the
meals
in
the
evenings.
H
You
know
typically
vending
machines
are
the
only
course
of
meals
for
people
out
of
hours,
but
deliberately
going
out
of
your
way
to
make
sure
if
you're
going
to
provide
a
seven-day
service
and
a
24-hour
service
that
isn't
just
for
service
users.
It's
also
for
for
for
colleagues
as
well-
and
I
think
so,
some
of
those
I
think
we'll
we
want
to
do
some
work
with,
and
it's
providers
an
agent
or
fed
around
how
we
share
that
best
practice
and
I
think
they'll
be
best
practice
from
other
sectors
as
well.
H
So
rosa
mentioned
primary
care
and
I
think
it's
some
really
good
examples
of
how
you
encourage
people
who
have
to
work
remotely
or
by
themselves
to
provide
the
right
support
for
having
informs
on
virtual
peer
networks.
So
there's
as
much
good
practice
out
there
that
we
have
to
be.
We
have
to
help
in
how
it's
how
it's
shared.
C
Yeah
chris,
I
just
wanted
to
just
follow
up
on
the
the
appointment
of
the
health
and
well-being
advisor.
What
was
really
interesting
that
this
hr
director
was
telling
me
was
that
that
person
focused
on
those
employees
who
are
living
on
their
own,
so
they
come
in.
They
work
a
10-hour
shift
and
it's
really
really
hard
work
on
on
acute
wards
and
go
home
and
they're
on
their
own.
So
worked
a
lot
there
to
support
them
and,
to
you
know,
engage
them
to
to.
C
You
know,
find
friends
and
social
activities
outside
of
work,
and
I
just
thought
that
was
a
really
practical
example
of
engaging
with
staff
and
and
helping
them
through
this
very
difficult
period.
H
H
We've
begun
some
really
good
conversations
with
nhs
confederation
nhs
providers
in
the
context
of
this
report
about
how
we
share
some
of
that
really
practical
guidance
about
how
how
we
move
towards
winter-
and
we
published
a
guide
for
for
clinicians
early
in
the
year
about
how
to
cope
with
them.
Urgent
emotions
account,
I
think,
we'll
try
to
redress
this
in
a
way.
H
That's
practical
for
people
who
have
to
manage
people
in
a
in
an
nhs
environment
and
we'll
probably
do
that
through
nhs
compared
to
nhs
providers
and
nhs
england,
because
they'll
it
isn't
just
about
the
regulator
talking.
It's
also
about
their
support
organizations
talking
about
what
they
do.
So
there's
a
number
of
opportunities
there
are
shows
that
that
nhs
england
are
are
taking
as
we
go
into
winter
and
I
think,
being
able
to
tell
some
of
these
stories
in
those
conversations
will
help,
but
it
it's
a
it's
a
a
constant.
H
It
requires
constant
attention
to
make
sure
people
are
learning
from
what
others
are
doing
and
actually
what
you
do
through
that
process.
You
pull
up.
You
pull
out
more
good
practice
because
people
say
well
actually
I've
done
that,
but
I've
also
done
this
and
I
think,
don't
I
don't
never
see
these
reports
as
a
as
a
completed
article.
H
They
are
really
their
they're
sort
of
fishing
for
for
other
good
practice,
other
good
ideas
and
we'll
continue
to
do
that
and
share
that
and
on
a
separate
note,
we
talked
earlier
on
about
the
use
of
the
website
and
the
development
of
the
website.
I
want
the
website
to
be
a
home
for
good
practice,
so
when
people
think
about
a
particular
issue,
they
can
come
to
us
and
we
can
share
our
understanding
about
good
practice.
That's
relevant
and
timely,
so
working
through
other
organizations
and
then
developing
our
own
content.
B
And
just
to
build
just
just
to
build
on
that
point,
I
think
we
should.
We
also
promote
these
reports
internally,
because
I
think
what
we
do
know
is
the
sort
of
there's
a
there's,
a
powerful
degree
of
sort
of
micro,
coaching
that
goes
on
as
inspectors
talk
about
specific
issues
on
inspection
and
some
of
that's
about
their
own
experience.
But
some
of
it's
about
taking
lessons
learned.
I
I
think
of
the
smiling
matters
report
that
kate
and
her
team
did.
B
You
know,
had
a
profound
effect
on
on
oral
health
in
in
care
homes,
and
that
was
about
individual
inspectors,
just
promoting
a
piece
of
work
that
we've
done,
and
I
think
this
is
another
good
example
of
that
and
ted
mentioned
earlier
on.
The
work
that
has
been
we've
done
been
done
with
urgent
and
emergency
care
and
again
that
sort
of
the
it.
It
feels
like
a
a
bit
hand-to-hand
combat
in
some
respects,
but
to
get
these
these
messages
out
there,
but
it's
something
that
we
do
internally
and
externally
thanks
peter.
Thank
you.
Dora.
L
It
was
more
of
a
question
for
chris
I
mean
at
the
moment.
I
guess
the
report
is
based
on
the
data
that
we
know
now.
So
it's
an
as
is.
But
if
you
look
at
the
macro
environment,
where
we're
seeing
people
leave
adult
social
care-
and
I
think
kate
said
you-
know-
opportunities
in
tourism
we're
seeing
definitely
sort
of
early
retirement
happening
in
in
sort
of
the
world
of
gps
and
we're
also
seeing
you
know
more
investment,
or
you
know,
government
pumping
more
money
into
into
services.
H
So
it's
this
report
is
designed
just
to
share
some
of
the
the
best
practice
from
a
variety
of
environments.
Those
73
trusts
will
work
in
a
variety
of
environments
that
have
all
the
things
that
you
describe
so
people,
adult
social
care,
handing
back
contracts,
gps
retiring
and
it's
and
there's
a
sense
of
collection
of
things
that
they
are
doing
is
to
is
to
help
manage
and
mitigate
some
of
those
issues.
I
do
think
there
is.
There
is
a
macro.
This
is
probably
what
sata
cares
about.
There
is
a
macro
conversation
about.
H
How
do
you
provide
the
right
environment
for
services
to
function
well
together,
and
some
of
that,
as
I
go
back
to
before,
I
said
about
the
it's
about
having
the
money
and
the
incentives
in
the
right
place
at
a
macro
level,
to
to
encourage
the
right
conversations
between
organizations,
and
I
think
what
we
can
do-
we
can
show
the
event.
This
is
an
example
of
the
advantage
of
how
it
works.
Well,
together.
H
I
think
we've
also
got
to
show
when
it
doesn't
work
well
together
and
what
the
what
the
consequences
have
been
not
working
well
together,
but
I
think
we've
got
to
be
mindful
of
what
do
we?
What
do
we
want?
The
the
the
changes
to
be,
and
I
go
back
to
something
we
talked
to
a
couple
of
boards
ago
about
the
work
that
has
been
done
to
help
understand
how
local
areas
are
functioning
today.
H
So
the
owners
do
some
work
on
a
health
index
which
gives
us
an
understanding
of
how
individual
areas
are
working,
and
I
think
it's
important
that
we
can
challenge
ics
and
local
authority
groups
to
talk
about
where
they
are
today
and
how
collectively
they
work
on
where
they
need
to
be
in
a
year's
time
and
the
more
we
can
give
that
that
sense
of
local
ownership
to
the
problems.
I
think
there
is
a
better
opportunity
to
drive
the
right
change.
H
So,
at
a
macro
level,
I
think
we
have
to
describe
the
problems
and
the
opportunities
in
the
same
way,
but
I
think
we
have
to
focus
on
what
we
think
the
the
ultimate
goal
should
be.
A
Great
chris,
it's
a
really
good
report.
It's
prompted
a
really
good
discussion
around
this
table
and
I
hope
it
prompts
discussions
around
the
the
system
because
it's
a
really
really
excellent.
So
thanks,
let's
move
on
jill
you're
extremely
welcome
nice
to
see
you
and
you're
gonna
talk
to
us
about
the
the
pulse
survey.
O
I
am
indeed
it's
I'm
delighted
to
be
here,
so
you
recall
that
this
is
the
latest
in
a
series
of
pulse
surveys.
We
agreed
a
couple
of
years
ago
nearly
that
we
would
we
would
go
to
a
survey,
a
full
survey
every
two
years
and
then
supplement
that
with
quarterly
pulse
survey.
O
So
this
is
the
the
latest
we're
bringing
the
responses
to
you
for
transparency
purposes,
as
we
always
do,
and
you'll
notice
that
in
the
this
particular
pulse
survey,
we've
done
our
kind
of
focus
on
mental
health
and
well-being,
which
allows
us
to
do
some
follow-up
work
on
the
mind
survey
that
we
undertook
earlier
in
the
calendar
year,
which
resulted
in
us
I'm
delighted
to
say
being
awarded
a
silver
status
by
mind
our
first
first
time
in
first
foray
into
the
mindset,
well-being
survey,
and
so
I
think,
that's
a
great
achievement
for
us
as
a
as
an
organization.
O
In
this
survey,
we
also
ask
the
standard
questions
that
we've
been
tracking
every
quarter
in
our
pulse
surveys
around
some
change
questions,
but
also
the
question
about
recommending
cqc
as
a
good
place
to
work
which
allows
us
to,
as
I
say,
track
our
performance,
whether
that's
up
and
down
or
steady
over
a
number
of
iterations
we've
had
a
healthy
response
rate
of
74.
O
O
The
feedback
on
the
resources
available
to
support
mental
health
and
well-being,
we're
generally
really
positive.
O
I'm
confident
that
means
that
we're
move
we've
got
the
right
range
of
support
and
tools
in
place
for
our
colleagues
and
that
our
colleagues
are
also
clear
about
what
is
available
to
them
and
how
to
access
it
and
feedback
about
support
by
line
managers
and
colleagues
remind
remains
really
high.
So
our
support
from
line
managers
high
at
82
positive,
that's,
fantastic
response
for
an
organization
of
our
size
and
also
the
result
report
that
people
feel
and
get
from
their
own
colleagues
and
their
own
teams
is.
O
It
remains
quite
high
as
well,
so
this,
I
think,
gives
us
a
sort
of
a
real
sense
of
the
support
that
is
on
offer
to
colleagues
with
through
anyway,
but
through
what
has
been
probably
quite
a
bumpy
period
over
the
last
18
months
and
the
question
when
we're
asking
at
macro
level
about
whether
we
as
an
organisation,
support
health
and
well-being
of
our
staff
has
increased
by
five
percentage
points.
Since
the
last
time
we
asked
that
question
in
november
19,
which
again,
I
think,
is
a
really
solid
improvement.
O
There
are
responses
about
workload,
questions
they
remain
on
a
par
with
where
we
were
in
2019,
so
right,
around
half
49
agreeing
positively
that
they
have
a
manageable
workload.
O
The
free
text
comments
that
supported
this
survey
indicate
that
that
workload
is
an
issue
for
some
colleagues,
but
actually
there
are
a
whole
range
of
other
issues
at
play,
and
so
we
need
to
recognize
that
people
bring
their
whole
self
to
work
and
therefore
they're
this
of
where
they
are
in
terms
of
their
mental
health
and
well-being
is,
is
beyond
the
realms
of
cqc,
and
actually
you
know
we
need
to
play
this
in
in
totality,
particularly
when
we're
looking
at
the
results
locally.
O
It
would
I'll
just
kind
of
focus
briefly
on
the
on
those
scores
for
the
two
chains,
specific
questions
that
we've
that
we've
included
they've
decreased
slightly
from
where
they
were
in
the
the
last
time
we
asked
the
questions
so
they're
slightly
less
positive
about
our
strategic
direction
and
feeling
informed
about
changes
that
are
happening
as
part
of
transformation
and
then
then,
when
we
asked
the
question
in
october
2020
and
in
march
2021,
so
at
the
moment
we've
got
a
43
positive
answer
around
the
the
sort
of
the
strategic
direction
question.
O
This
is
down
13
percentage
points
from
march
2021
when
it
really
did
peak
we've
just
done
a
huge
amount
of
work
around
our
strategy
at
that
point
and
communicating
that
with
our
organ
to
within
the
organization,
and
then
there
were
kind
of
the
questions
around
so
and
there's
a
slightly
higher
figure
of
56
agreeing
that
they
feel
informed
about
changes
that
are
happening
as
a
consequence
of
the
transformation
program.
O
When
we
compare
this
figure
with
previous
pulse
surveys,
it's
slightly
down
on
where
we
were
both
in
march
and
october,
but
as
we
move
into
implementation
of
transformation,
we
anticipate
that
these
scores
will
probably
go
up
and
down
a
bit.
I
think
it's
entirely
normal,
that
that
would
happen
in
an
organization
and
particularly
as
we
sort
of
move
closer
to
the
changes
and
the
implementation
of
them.
O
We
want
to
minimize
this,
obviously
as
far
as
possible,
and
so
we'll
be
ramping
up
our
engagement
activities
in
the
coming
weeks
and
months
as
the
as
we
move
through
into
implementation
and
we'll
be
providing
regular
opportunities
for
two-way
engagement.
O
More
regular
we've
had
a
fair
amount
of
engagement
since
sort
of,
probably
since
this
survey
was
live
actually
so
a
huge
amount
of
activity
in
terms
of
consulting
staff,
engaging
staff
throughout
the
summer
period,
which
of
I'm
hoping
will
kind
of
bear
fruit
in
the
autumn
time
when
we
move
to
a
full
survey,
so
I
think
our
pause
there,
I
just
it
would
be
really
really
important.
O
O
There
there's
always
room
for
improvement,
and
we
also
need
to
focus
and
maintain
our
our
focus
on
our
narrative
assigned
to
transformation,
so
we'll
be
using
the
data
from
this
survey
and
to
target
either
specific
areas
in
the
organization
where
we've
got
hot
spots
and
cold
spots
are
all
particularly
where
certain
groups
of
colleagues
are
are
actually
answering
less
positively,
so
that
we
can
understand
where
we
can
best
best
focus
our
attention
in
the
next
next
period.
A
Thanks
jill,
I
I
think
these
are
really
really
useful
and,
and,
as
you've
just
said,
they
give
us
as
an
organization
the
ability
to
to
respond
to
people's
concerns
and
needs,
and
I,
I
think,
really
good.
We
continue
this
program,
so
thank
you
for
doing
it
and
thanks
the
team
behind
it.
Questions
or
comments,
kate,.
D
Thanks
peter
so,
and
if
I
could
just
add
a
comment
around
workloads,
so
in
adult
social
care,
the
question
about
I
have
a
manageable
workload,
is
31
so
lower
than
than
the
over
overall
position.
If
I
reflect
on
inspectors
workloads
over
the
last
18
months,
so
in
adult
social
care,
65
of
our
inspections
are
are
risk-based
and
when
we
go
out
to
the
services
that
we're
concerned
about
we're
taking
enforcement
action
in
26
of
occasions,
which
is
massive,
it's
massive
in
terms
of
the
pressure
and
the
burden
outputs
on
inspectors.
D
It
also
has
knock-on
impact
people
like
rebecca's
service
of
legal
colleagues,
engagement,
colleagues
who
are
helping
us
share
the
information
in
a
timely
way
with
the
public
as
well.
So
there
is
a
huge
amount
of
pressure
on
inspectors
within
asc
and
across
the
organization.
D
When
I
talk
to
them
and
when
we
look
at
the
comments
in
the
poll
survey,
it
talks
about
not
having
a
balance,
so
inspectors
generally
at
the
moment,
aren't
seeing
good
they
used
to
love
having
a
portfolio
that
was
mixed
where
they
saw
the
outstanding
service.
They
had
a
load
of
good
services
and
they
had
some
services.
They
were
worried
about
and
taking
action
on.
D
So
in
my
bit
of
the
business,
we're
looking
at
things
like
how
we
redistribute
work
around
the
country
and
we're
also
looking
at
when
vacancies
arise,
where
we
might
need
to
move
them
to
other
bits
of
the
business
so
that
we
are
making
sure
we
got
the
right
staff
in
in
the
right
and
right
places
and
then,
finally,
very
briefly,
on
the
change
change
bit.
I
think
there
is
a
there
is
an
eagerness
of
okay
great.
D
What's
it
gonna
look
like,
and
I
think
my
view
is,
you
know
we
could
tell
so
you
know
you
could
have
a
small
group
of
the
exec
members
or
the
top
leaders
in
the
organization
sit
in
a
closed
room
and
design
it.
We
could
do
that,
but
we
don't
think
that's
the
right
thing
to
do.
We
think
the
right
thing
to
do
is
to
have
really
good
extensive
engagement,
because
our
frontline
staff
across
all
different
bits
of
the
business.
You
know
I've
got
really
great
opinions
on
what
should
networks
look
like
what
should
hubs?
D
Look
like
so
I
I
note
the
the
frustration
that
might
be
emerging
and
reflecting
in
this
poll
survey
and
what
I'd
say
is
that
frustration
is
there,
because
we
are
looking
to
design
our
organization
with
our
you
know,
with
all
parts
of
our
business
who
know
who
knows
what
it
should
look
like
and
will
help
us
come
up
with
a
much
better,
much
better
product.
So
I
recognize
it.
D
I
still
remain
absolutely
committed
that
we
are
taking
the
right
approach
and
I
think
engagement
in
the
connect
and
explore
and
we've
had
staff
from
all
different
bits
of
our
business
come
along
and
help
us
shape.
Our
thinking
is
testament
to
the
fact
we've
got
this
approach
right,
but
I
think
it's
just
noting
the
ongoing
anxiety
that
creates,
because
you
know
we
haven't
we're
not
doing
this
quickly
we're
trying
to
try
and
do
this
meaningfully.
Thank
you.
B
Thanks
peter,
can
I
just
just
pick
up
on
the
point
that
jill
made
about
the
free
text
comments.
There's
extensive
free
text,
comments
that
underpin
this
survey,
and
one
of
the
things
that
was
was
quite
striking.
Was
this
point
that
joel
made
about
people
bringing
their
whole
selves
to
work?
You
know
there
was
the
the
the
reasons
that
people's
personal
well-being
were
was
was
problematic.
In
some
cases
was
issues
of
divorce,
family,
breakup,
bereavements
and
a
whole
range
of
things,
and
so
that
does
link
into
into
into
this
issue
of
manageable
workload.
B
B
Beyond
what
you
would
normally
see
expect
to
see
from
a
from
an
employer-
and
I
think
it
just
does
talk
to
this
whole
thing
of
the
last
18
months-
has
has
rewritten
the
relation.
The
fundamental
relationship
between
an
in
between
an
employer
and
the
people
that
work
for
them
and
different
people
have
different
wildly
different
expectations
around
what
that
might
look
like,
and
then
that
manifests
itself
in
in
in
in
in
issues
of
of
well-being
and
we've
seen
that
earlier
on.
B
In
the
meeting
around
sickness
absence
and
the
conversation
we
had
there
about
people's
mental
mental
health,
so
I
think,
I
think,
probably
in
in
common
with
many
employers,
I
think
trying
to
work
our
way
through.
Where
is
the?
Where
is
the
place
we
want
to
position
ourselves
as
an
employer
is
really
is
really
important.
B
How
much
support
can
we
genuinely
give
people-
and
I
think
I
think
the
support
we
have
put
on
the
table
has
been
well
well
regarded
and
some
of
that's
straightforward,
like
you
know,
access
to
the
headspace,
app
and
and
the
quality
of
management
and
so
forth.
But
I
think
we
are
very
open
to
what
else
can
we
sensibly
do
as
opposed
to
just
putting
lots
of
things
on
on
the
table,
but
to
care
and
just
to
reiterate,
kate's
point
as
well
around
you
know
this.
B
B
I
see
a
positive
overall
trend
in
terms
of
where
we
were
in
2019,
where
we
are
now
and,
and
people
still
do
want
to
come
and
work
for
us
and
we
are
still
recruiting
people,
despite
the
fact
that
that
you
know
we're
still
we're
doing
a
number
of
things
around
fixed
term
contracts
and
so
forth,
which
in
some
respects
would
make
us
less
attractive
as
an
employer
thanks
peter.
A
So
so
I
think
one
of
the
things
you're
saying
I
really
resonates
with
me.
If
all
you
see
is
the
the
struggling
providers.
It
is
quite
depressing.
I'm
a
pre.
The
pandemic
I
used
to
spend
roughly
a
week
a
day
a
week,
visiting
a
provider
and
you
know
I'd
come
back
really
excited
and
energized
when
I
went
to
somewhere.
That
was
that
was
really
outstanding
and
come
back
quite
depressed
when
I
went
to
somewhere.
That
was
at
the
other
end
of
the
spectrum.
A
So
if
all
you're
seeing
is
the
that
the
less
good,
it
must
actually
be
quite
soul-destroying
after
a
while.
So
I
I
really
get
that
point.
Anybody
want
to
right,
stephen
and
then
robert.
J
Just
wondered
if,
if
there
are
kind
of
a
few
dots
that
might
link
together
sort
of
starting
with
about
half
of
the
organization
staff
feel
their
workload
is,
is
uncomfortably
heavy
sickness
absence
rates
going
up
a
big
change
agenda
coming
down
the
track
without
yet
being
able
to
describe
well
exactly
what
it?
What
will
it
mean
for
me
and
that's
a
kind
of
compounding
of
pressures
on
people,
and
I
absolutely
by
kate's
approach.
You
know
that
the
right
thing
to
do
is
kind
of
hold
our
nerve.
J
J
B
I
don't
think
there's
a
simple
answer
to
that.
I
mean,
I
think
I
think
what
we're
doing
around
communication
of
the
change
program
we're
talking
about
about
about
broad
timelines,
we're
talking
about
what,
when
we'll
make
decisions,
we're
we're
talking
about
that
sort
of
thing,
we're
trying
to
give
people
a
degree
of
certainty,
but
I
think
we
do
need
to
to
recognize
that
the
the
nature
of
the
work
that
we're
doing
is
we
are
working
in
amongst
a
health
and
care
system
which
is
under
the
most
pressure.
B
It's
been
in
a
generation
and
I
you
know
to
some
extent
that's
quite
difficult
to
fix,
and
so
so
I
think
we
will
continue
to
look
for
ways
to
inform
and
and
help
our
teams
understand
what's
going
on,
but
I
think
I
think
some
people
genuinely
want
an
answer
and
they
want
it
now
and
and
we're
simply
not
going
to
give
it
to
them.
So
there's
something
about
a
fundamental
difference
of
opinion.
B
If
you
will
in
terms
of
how
to
pursue
a
change
program,
I
would
probably,
but
that
said,
if
you
look
at
the
change
program
as
a
whole,
our
change
program
is
not
changed
for
changes
sake.
It
is
to
address
a
number
of
these
big
fundamental
issues,
around
workload,
around
consistency
and
so
forth
that
we've
that
have
been
long-standing
issues,
and
so
so
these
are
big
problems
to
solve
and
require
big
audacious
approaches
to
it
and
we'd
like
to
co-design
that
with
our
people
and
some
people
really
embrace
that
and
some
people,
some
people
don't.
A
E
Just
just
to
say
that
I
mean
I
agree,
steven,
the
the
the
number
of
colleagues
who
are
concerned
about
that
workload
is
something
we
need
to
take
on
board,
because
it
is
important
that
we
give
people
a
manageable
workload
in
their
working
lives.
The
figures
we're
getting
at
the
moment
for
this
pulse
survey
are
much
better
than
they
were
pre
pandemic
in
the
last
people
survey.
So
so
you
know,
we
need
to
be
clear
that
the
trend
is
improving.
E
It's
it's
slightly
less
than
you
know,
the
last
survey
of
which
we
did,
which
remember,
was
a
time
when
we
weren't
inspecting
very
much.
We
we
discussed
earlier
on
in
this
meeting
the
increasing
number
of
inspections,
the
increasing
whistleblowers
and
concerns
our
inspectors
are
managing,
and
this
this
all
adds
up
to
extra
workload
for
them.
So
I
think
the
real
message
comes
out
of
this
is
we
need
to
find
ways
of
smarter
working.
E
We
need
to
find
ways
of
being
a
more
effective,
efficient
regulator,
which
of
course,
takes
us
back
to
the
transformation
program,
and
I
suppose,
there's
probably
a
message
now.
Perhaps
we
need
to
remind
colleagues
that
the
transformation
programme
is
about
helping
them
and
their
working
lives.
Perhaps
that
message
isn't
strong
enough,
because
I
think
if
you
see
that
connection,
it's
really
important
and
what
we've
done
during
the
pandemic
in
terms
of
going
risk-based
inspection,
has
had
the
downside
that
their
inspectors
tend
to
see
the
the
poorer
services
rather
than
the
better
services.
E
But
it
has
given
them
a
much
more
streamlined
inspection
approach,
and
I
think
that
that
that
is
the
benefit
and
maybe
why
the
the
our
current
figures
are
better
than
they
were
pre-pandemic.
But
in
order
to
get
to
where
we
want
to
be,
I
think
we
need
to
see
the
transmission
transformation
through.
I
think
that's
the
message
here.
E
H
As
you
said,
there
aren't
any
simple
answers
to
this.
I
think
there
is
something
to
ted's
point
about
the
strategy
that
we
we
published
this
year
is
partly
a
function
of
what
people
wanted
to
see
different
about
the
organization.
So
it
didn't
didn't
come
out
of
a
conversation.
We
had
it,
as
you
know,
a
board
or
et
one
day.
It
came
from
lots
of
engagement,
so
there
is
something
about
reminding
people
of
where
we
are
today
and
and
why
it's
important
to
change
and
in
some
cases
why
the
status
quo
isn't
tenable.
H
So
it
probably
isn't
tenable
to
continue
to
write
30
page
reports
that
people
half
read
and
it
doesn't
when
no
action
is
taken
where
people
have
to
are
across
that
they
have
to
repeat
information
in
different
aspects
of
it.
So
how
do
you
create
a
a
better
view
of
quality?
It
does
require
change.
I
I
am
we're
talking
at
the
s
the
the
way
day
that
we
had
as
a
senior
leadership
group
about
moving
from
a
rules-based
system
to
a
tools
based
system.
H
So
we
we've
we've
created
a
system
which
people
in
the
summer's
degrees
follow
a
set
of
rules
to
deliver
an
outcome
of
a
regulatory
report,
and
actually
what
you
want
to
do
is
to
get
empower
people
to
create
a
view
of
their
patch.
What
do
they
think
of
their
patch?
But
that
is
a
cultural
change
and
it's
so
it's
so
there
was
no
practical
changes
in
our
cultural
changes.
I
think
with,
as
always
of
these
things
advocacy
from
people
like
me.
H
H
They
understand,
they
understand
the
benefits
of
it,
so
helping
them
to
create
an
environment
where
people
can
see
the
benefits
of
the
change
in
the
micro
for
them
for
their
job
now
for
their
job
in
the
next
six
months
is,
is
critical
and
in
some
senses
that
there
will
always
be
improvements
that
we
want
to
make,
but
getting
that
sense
of
what
would
be
different
for
me
in
a
few
months
time.
How
will
it
help
me?
H
It
was
important,
interestingly,
ted's
work
on
the
and
the
changes
to
the
some
of
the
inspection
reports
that
we've
done
in
urgent
mental
care
is
a
really
good
example
of
that.
I
think
people
see
the
genuine
benefit
of
of
those
services.
The
inspections
that
help
those
services
work
differently.
So
I
think
we
can.
We
can
use
that
as
in
part
to
help
sell
a
message
about
how
things
can
be
different
in
the
future.
Rosie.
F
Getting
lots
of
you
know
phoning
providers
to
have
a
conversation
about
how
things
are
going
and
providers
are
using
that
as
an
opportunity
to
talk
about
all
of
the
difficulties
they're
experiencing
and
sometimes
they're
having
to
deal
with
very
distressed
providers,
and
this
isn't
just
in
the
struggling
providers
or
the
inadequate
providers
that
we're
seeing
this
is
in
in
some
of
the
good
and
outstanding
providers
as
well,
and
so
the
emotional
impact
on
that
on
our
inspectors
as
well
will
be
a
factor
in
this.
F
I
You
and
at
last
robert,
we
come
to
you.
Well,
no
thank
you
well,
firstly,
actually
it
builds
on
what
is
being
said
about
the
remarkable
work
our
inspectors
are
doing,
and
I
just
make
the
comment:
firstly
that
depressing
it
may
be,
but
they
need
to
take
home
the
value
of
what
they
do
for
the
people
whom
they
are
serving,
and
that
is
in
many
many
ways,
they're
doing
that
many
times,
moreover,
than
they
were
before.
I
That's
only
going
to
the
the
so-called
bad
places,
but
I
can
understand
entirely
the
stress-
and
that
brings
me
to
the
point
I
was
originally
going
to
make-
which
addresses
ian's
very
perceptive
remarks
about
the
combination
that
people
have
often
between
the
problems
they
might
have
at
home,
which
will
have
been
building
up
during
the
pandemic.
Everyone
knows
that
and
and
the
stresses
and
strains
that
work
and
just
as
much
as
people
will
bring
to
work
with
them
the
mental
problems
that
are
not
mental
problems,
but
the
issues
they
may
have
at
home.
I
I
It
is
extraordinarily
difficult,
but
I
imagine
that
we
one
thing
that
is
probably
necessary
is
a
degree
of
clarity
about
how
far
one
can
go,
and
I
appreciate
that
might
need
to
be
varied
on
an
individual
basis,
but
also
to
have
a
set
of
tools
about
referring
people
who
need
support
to
where
they
can
get
support.
I
We
need
to
be
an
exemplar
on
this
field,
because
everything
that
we
are
seeing
amongst
our
staff
must
be
amplified
many
times
over
within
the
health
service,
and
I
think
together
we
need
to
struggle
towards
a
way
in
which
to
provide
people
with
a
safe
space
to
share
these
issues
at
the
least
not
fearing
that
if
they
mention
they've
got
a
problem
at
home.
That's
a
career
limiting
issue
because
I
think
there
are
probably
are
some
places
where
that
would
be
the
case.
I
We
certainly
shouldn't
be
in
that
category,
and
I
know
you
don't
intend
that.
Thank
you
kirsty.
He
wanted
to
come
in
yeah.
M
Thank
you
peter,
so
I
just
I
just
wanted
to
say.
I
think
when
I
look
across
the
scores.
There
is
quite
a
lot
of
variation,
particularly
in
t
and
different
teams,
and
I
think
it's
it's
sometimes
quite
easy
to
sort
of
take
the
negative
view
and
brat
and
look
at
that
across
the
piece.
But
there
are
there
are
some
areas
and
there's
certainly
a
few
in
my
area
where
the
teams
are
working
really
really
hard,
they're
up
to
their
eyes
of
transformation,
short
of
resources
and
things.
M
But
the
scores
aren't
too
bad,
and
I
think
there
are
other
areas
in
in
operations
where
that
is
also
the
case,
and
I
think
there's
some
really
good
learning
that
we
can
take
from
that.
In
terms
of
where
we've
got
those
hot
those
really
sort
of
hot
spots.
In
terms
of
positivity
that
we
we
should
be
looking
to
to
look
at
what
the
best
practice
is
there
and
then
share
that
round
across
the
organization,
particularly
in
those
teams
where,
where
where
the
scores
are
slightly
lower.
K
Thank
you
peter,
and
thank
you
for
the
report.
I
share
a
lot
of
the
concerns
that
stephen
and
robert
have
raised,
and
I
won't
reiterate
them,
but
sometimes
you
know
when
jill
talks
about
a
43
positive
score.
For
me,
that's
a
57
negative
score
and
I
think
we
really
need
to
look
at
the
variation
that
kirsty
described
across
the
organization
to
understand
where
people
don't
feel
supported
or
don't
support
the
future
direction
of
the
organization
or
or
all
of
those
things.
K
I
think
the
pressure
across
health
and
care
generally
is
huge.
Every
organization
that
I
come
across
says
that
their
workload
is
unmanageable
and
that
isn't
going
to
go
away
for
us.
We
need
to
recognize
that,
but
I
do
know
of
organizations
where
the
percentage
of
staff
who
feel
they
are
supported
is
a
lot
higher
and
I
think
we
need
to
recognize
the
workload
and
the
great
efforts
that
all
our
inspectors
and
our
support
services
are
putting
in,
but
think
quite
clearly
about
the
support
we
offer
and
that's
back
to
jill's
point.
K
I
think
about
how
you
do
this
through
management,
through
middle
management
and
line
management,
and
perhaps
that's
something
we
need
to
think
about
just
in
terms
of
the
future
model
that
kate
and
ted
and
rosie
talked
about
before
and
how
depressing
it
is
sometimes
to
only
go
into
services
that
aren't
good.
If
we
are
going
to
be.
We
need
to
think
about
this
for
our
regulatory
model,
because
if
we
are
only
if
we're
going
to
have
a
risk-based
effective
model
of
regulation
in
the
future,
it's
likely.
K
Although
we
need
to
recognize
good
practice,
we
are
going
to
be
more
involved
with
providers
who
aren't
good
and
that
will
have
an
impact,
won't
it
on
our
future
ways
of
working
and
perhaps
there's
something
we
can
think
about
about
how
to
encourage
staff
when
they
will
be
going
to
places
that
don't
fill
them
with
enthusiasm.
For
more
of
the
time.
A
P
Just
to
give
an
example:
what
happened
in
registration
about
two
years
ago
that
the
workload
was
very,
very
stressful
because
we
were
doing
with
unregistered
providers,
then
we
did
a
partnership,
then
we
did
complex
stuff
and,
and
it
wasn't
manageable.
But
since
the
registration
team
designed
something
now,
we've
got
a
registered
providers
team
and
we've
got
a
dentistry
team
that
focus
on
those
complex
work.
We
can
deal
with
other
works
as
well,
but
any
other
work
they
can
pass
on
and
we
fill
in
registration.
P
Our
workload
is
more
manageable
because
we're
not
doing
five
different
things
in
one
day
and
that's
a
stressful
thing
dealing
with
dentist,
then
gp,
then
hospital,
then
independent
ambulance,
but
generally
I
mean
they're
still
competing
issues,
but
generally
the
well-being
and
registration
has
improved,
but
you're
not
doing
so
many
different
juggling
things.
I
only
speak
to
registration,
but
I'm
just
saying
it's
a
positive
step
from
that.
Thank
you.
Paul
kate,
just.
D
Super
quick,
so
it's
really
important.
We
don't
lose
looking
at
and
celebrating
good
and
outstanding,
but
if
we
think
about
our
strategy,
we
want
to
have
a
really
strong
role
in
improvement.
Well,
how
do
we
know
how
services
should
improve
and
what
the
culture
should
be
and
what
the
component
should
be
of
an
outstanding
service
without
getting
out
there
and
seeing
it?
So
I
I
am
really
hopeful
that
we
can
start
seeing
a
bit
more
of
that
balance.
So
we
need
to
be
with
space.
E
Dead
go
on
well,
I
just
wanted
to
say
I
mentioned
earlier
on
that
we're
about
to
publish
a
report
on
the
trust
that,
despite
the
pandemic,
has
improved
dramatically,
and
that
was
a
very
uplifting
episode
for
our
inspection
team
has
gone
in
and
done
that
inspection
over
the
summer,
and
you
know
I
think
you
know
when,
when
that
report
comes
out.
A
Thanks
ted
go
on
jill
last
word
to
you.
Thank.
O
You
some
really
helpful
comments
and
reflections.
I
think,
shows
the
complexity
of
what
sits
behind
a
a
data
set,
because
actually
this
is
about
people
and
how
they
are
feeling
how
they
experience,
work
and
and
but
just
one
final
point
sally.
When
you
talk
about
kind
of
the
flip
side
of
48,
43,
positive,
being
57
negative,
it's
actually
there's
a
neutral
bunch
in
the
middle
and
in
that
particular
question,
it's
quite
a
it's
quite
a
reasonably
sized
36
of
those
who
are
kind
of
not
negative
or
positive.
O
A
F
I
have
bought
reinforcements
can
I
introduce
andy
ford,
who's
head
of
inspection
in
pms
and
tanibel
simpson,
who's,
our
inspection
manager,
who
leads
the
dms
work
and
just
to
open
with
a
few
words
of
introduction
from
myself.
F
F
This
is
a
contracted
service.
The
aim
would
have
been
to
complete
all
of
our
inspections
by
april
of
this
year,
but
unfortunately,
with
covid,
the
program
was
suspended
as
the
military
personnel
were
redeployed.
F
F
I
just
also
want
to
say
thank
you
very
much
to
gary
ford,
who
also
had
a
leadership
role
in
and
was
very
involved
in
this
program,
how
ahead
of
inspection
prior
to
andy.
F
Finally,
I
just
want
to
say:
we've
got
really
really
good
strategic
relationships
with
the
dms
personnel
and
the
contract
makes
a
really
positive
contribution
to
ensuring
services
experienced
by
you.
Uk
service
personnel
are
safe,
effective
and
well
led.
So
thank
you.
I
hope
you've
enjoyed
the
report
tanya
or
andy.
I
don't
know
if
there's
anything,
I'm
assuming
people
have
read
the
port.
I
don't
know
if
there's
anything
you
want
to
just
add
to
that.
Q
Thanks
rosie
so
hello,
everybody
and
thank
you
for
allowing
us
the
opportunity
of
current
exposing
this
set.
Well,
it's
quite
a
vital
piece
of
work
actually
to
use
the
board
it
as
a
head
of
inspection
it.
There
seems
to
be
quite
a
stark
difference
between
my
work
with
regulation
of
primary
medical
services
in
london
too.
Q
To
that
experience
that
we
experience
the
military
quite
clearly,
medical
services
and
military
have
got
a
massive
span
of
operations
pretty
much
throughout
the
whole
world
and
whilst
there
is
a
quite
a
quite
a
significant
proportion,
but
in
the
uk,
those
services
quite
clearly
are
on
board
all
military
assets
as
they
spread
throughout
the
globe
and
and
the
ability
to
drive,
change
and
improvement
within
all
of
those
services,
whether
they
be
aboard
a
nuclear
submarine.
Q
An
aircraft
carrier,
indeed
on
a
large
aircraft
base
within
the
uk
is
a
real
tribute
to
tanya
and
the
team
who's
worked
really
hard
and-
and
I
have
the
the
glorious
opportunity
of
engaging
with
some
inspirational
characters
and
senior
commanders
within
the
military
which,
which
all
tell
a
very
positive
story
of
not
only
the
work
that
that
tanya
and
her
team
do
but
work
from
from
hospitals,
director,
ted's
team,
from
from
mental
health
and
and
we've
even
started
to
tread
fairly
carefully
into
the
realms
of
looking
at
the
well-led
aspect
of
how
the
military
command
military
services,
which
is
which
is
testimony
to
the
negotiation
skills
of
tanya
and
ted's
team.
Q
I
believe
really
because
it
is
a
slightly
difficult
subject
in
a
very
hierarchical
society
that
they
they
work
in.
But
let's
work
for
us
for
the
future,
but
I'll
just
I
won't
take
up
too
much
of
your
time,
obviously
invite
questions
at
the
end,
but
if
I
could
just
hand
over
to
tanya,
you
can
fill
in
some
of
the
operational
details.
That
would
be
great.
Thank
you
great.
Thank
you.
Tanya
thanks.
R
Andy
so,
across
the
four
years
today,
we've
inspected
90
medical
centres
with
over
half
of
these
being
rated
as
either
inadequate
or
requires
improvement
in
safety
on
a
first
inspection.
R
We've
inspected
40
dental
centers
to
date
and
as
with
the
medical
centers,
the
most
non-compliance
relates
to
safety
and
specifically
poorly
poorly
designed
and
under-maintained
buildings,
and
once
again,
over
the
four
years.
Most
of
these
concerns
have
been
addressed.
We've
inspected,
10
regional
rehabilitation
units
and
have
judged
all
of
these
to
be
good
overall
in
terms
of
the
quality
of
care
with
regard
to
mental
health,
we've
inspected
nine
facilities
and
have
rated
across
the
whole
spectrum,
including
one
inadequate
overall
one
outstanding
and
the
rest
being
in
the
middle.
R
R
F
One
final
thing:
peter
can
I
just
say
I'm
very
sorry,
but
I
I
said
gary
ford,
it's
gary
higgins.
This
cold
is
impacting
on
my
my
brain
and
function.
I
think
so.
Apologies.
A
We
noticed
the
deliberate
mistake,
so
don't
worry
I
I
was
just
going
to
say
in
response
to
what
what
you
just
said
at
the
end
there
tanya
that
this
is
actually
a
huge
tribute
to
the
work
that
you
have
been
doing,
because,
unlike
everybody
else,
who
has
no
choice
but
to
be
regulated
by
us
that
they
do
have
a
choice
and
the
fact
that
it's
been
renewed
for
a
further
two
years,
I
think,
is
a
real
testament
to
the
work
that
that
you've
all
been
doing.
So.
Thank
you
very
much
for
that.
Any
robert.
I
I
But
the
question
I
have
was
whether
there's
anything
for
the
wider
inspector
at
all
the
wider
health
service
to
learn
from
the
work
that
is
done
in
defense,
medical
services,
particularly
in
relation
to
the
response
you
appear
to
get
to
unfavorable
reports
and
what
looks
like,
I
mean
a
pretty
rapid
turnaround
and
in
that
context
I
was
particularly
interested
in
what
said
there
about
the
defense
safety
panel.
Is
it
called
the
slp
safety
safety
review
panels,
which
is
not
something
I've
heard
of
in
the
in
the
wider
health
service?
Q
Thanks
for
the
question,
I
am,
let
me
reflect
on
in
two
ways.
Really,
I
think,
there's
a
at
the
moment.
I
have
the
opportunity
of
looking
after
not
only
london
and
primary
medical
services,
but
both
north
regions,
as
colleagues
are
away
on
holiday
and
actually
there's
quite
a
stark
difference
in
the
ability
to
drive
change
in
those
two
areas,
let
alone
the
difference
between
those
areas
and
the
military
services,
and
I
think,
basically,
it
falls
within
two
camps.
Q
Really,
I
think
you've
got
the
the
military,
have
the
advantage
over
the
nhs
in
some
ways
that
they
can
just
tell
people
to
do
things
to
support
each
other.
So
if
there's
any
organizational
reluctance
to
help
each
other,
then
that's
easily
overcomeable
within
that
hierarchy.
Q
Q
The
the
that
you're
able,
as
soon
as
there
is
a
failing
service,
they're
able
to
respond
very
quickly
and
very
promptly
with
the
absolute
type
of
service
they
need
to
do
to
get
better,
and
so
I
think
those
are
the
two
things
in
terms
of
the
the
quality
review
panel.
I'm
certainly
no
expert
on
that.
So
I'd
like
to
defer
that
to
titania.
R
Yeah
sure
so
you'll
be
aware
that
the
health
and
social
care
act
doesn't
apply
and
we
are
the
invitation
of
dmsr.
R
As
part
of
that,
we
have
been
supporting
over
the
past
four
years,
dmsr
to
set
their
own
regulations,
which
are
very
much
in
tandem
with
the
health
and
social
care
act
and
the
safety
panels
have
been
established
as
a
an
enforcement
route.
So
where
we
inspect-
and
we
have
major
concerns,
we
feed
into
that
safety
panel
and
then
dmsr
can
take
enforcement
action
in
line
with
their
own
regulations.
F
Can
I
just
add,
I
think,
some
of
them
what
the
clearly,
what
the
military
are,
experts
at
logistics
and
and
managing
logistics,
and
I
think,
certainly
the
inspection
I've
been
on
in
dms.
F
What
impressed
me
was
the
the
kind
of
level
of
detail
into
systems
and
processes
that
really
enabled
that
safe
care
that
sometimes
we
don't
see
in
some
of
the
providers
that
are
struggling
and
the
exactness
of
what
was
going
on,
and
I
think
there
is
some
learning
and
I
think
we
do
need
to
think
about
how
we
share
the
learning
between
different
sectors
across
all
of
the
sectors
and
ted
might
want
to
common
comment
as
well,
because
his
team
clearly
look
at
this
as
well.
E
I
think,
are
very
different
and
we
are
trying
to
get
the
health
services,
the
hospitals
I
regulate
and
other
services
to
respond
in
a
much
more
learning
and
developmental
way
to
regulation,
rather
than
in
this
defensive
way
that
they
traditionally
do.
It's
interesting
that
the
point
we're
making
about
the
military
is
actually
very
similar.
Point
you'd
make
about
a
lot
of
independent,
independent
health
services
who
respond
in
a
much
more
structured
way
to
to
challenges
from
regulators.
So
I
think
it
is.
E
It
is
an
issue
that
we
do
need
to
share
across
services
and
I
think
there's
an
opportunity,
we're
talking
about
well-led
assessments
of
military
well.
That
may
be
very
interesting,
but
I
think
there's
something
we
have
to
learn
both
as
ourselves,
but
also
to
share
with
the
other
services
we
regulate
from
that.
A
Great,
so
look
thank
you
very
much
indeed
for
the
report,
but
more
fundamentally,
thank
you
very
much
indeed
for
the
work
that
that
went
into
all
of
this.
I
think
it's
a
it's
a
really
good
example
of
of
what
we
can
do
as
an
organization.
So
just
please
pass
on
the
thanks
to
everybody
else
that
that
was
involved.
Q
Just
just
to
close,
I
think
one
thing
I
it'd
be
remiss
of
me
not
to
mention
is
that
the
support
our
military
colleagues
are
provided
to
the
nhs
during
the
covered
crisis.
They've
experienced
similar
issues,
identical
issues
to
our
colleagues,
clinical
colleagues
working
in
the
nhs
and
and
they
re
they.
They
deployed
a
vast
number
of
people
to
support
the
civilian
services
during
the
crisis,
and
they
are
now
returning
to
the
military
with
exactly
the
same
stresses
strains
and
workload
issues
as
we
have
experienced.
Q
A
S
No
pressure
there
then
thank
you.
The
the
the
report
is
obviously
in
your
in
in
your
pack
as
a
as
a
reminder,
the
regulatory
governance
committee-
it's
ro,
you
know
our
role
is
to
provide
assurance
in
relation
to
risks
related
to
our
regulatory
program
and
also
to
allow
importantly,
to
allow
deeper
dives
into
areas
where
our
board
agenda
just
couldn't
accommodate
the
time.
S
S
I
took
over
as
as
chair
of
the
committee
in
february
from
liz
says,
and
so
the
majority
of
what's
in
this
report
was
delivered
under
liz's
leadership,
and
I
think
it
would
be
helpful
if,
if
peter
you're,
you're
happy
with
this
for
for
martin
to
reflect
in
the
the
minutes,
are
our
thanks
a
regular
thanks
for
an
appreciation
for
for
liz's
leadership
in
relation
to
the
committee,
reflecting
the
fact
that
we
have
a
risk
remit.
S
S
S
I
think
what
we've
tried
to
do
is
reshape
the
forward
planning
for
the
meeting
to
focus
on
areas
of
effectiveness
and
efficiency
as
a
regulator,
to
spend
some
time
on
lower
attention
areas
and
to
have
a
broader
discussion
and
a
deeper
dive
on
some
persistent
problem
areas
that
that
we
we
see
the
and-
and
you
know
we're
very
grateful
to
for
the
considerable
amount
of
work
that
the
executive
have
put
together
in
in
in
delivering
some
very
comprehensive
and
and
thoughtful
pieces
for
us
areas
that
we
have
looked
at
include.
S
You
know
the
impact
of
the
of
of
the
the
pandemic
and
we've
done
deep
dives
for
each
directorate
on
lessons
learned.
Our
thematic
review
of
dna
cpr,
our
public
engagement
strategy,
lessons
learned
from
our
and
transitional
monitoring
approach
and
our
pro
insights
from
our
program
of
formal
maturity,
inspections
and
we've
tried
to
do
all
of
this
with
a
with
a
forward
lens.
How
is
it
going
to
inform
and
shape
our
future
regulatory
model?
S
So
you
know
the
the
report
is
in
your
pack
and
I
commend
the
report
to
you.
A
Thanks
very
much
mark
anybody
want
to
say
anything
other
than
I
absolutely
agree.
We
should
thank
liz
for
the
work
that
that
she
did
and
can
I
thank
you
for
the
work
that
you're
now
doing,
and
it's
really
good
great,
so
unless
there
is
any
other
business
from
the
board,
that
is
the
end
of
the
meeting
as
such,
but
we
do
have
two
questions
from.
A
I'll
cover
them
both
at
the
same
time
and
perhaps
ask
ted
and
rosie
to
answer
them
both
at
the
same
time.
So
the
first
question
is:
how
does
cqc
assess
the
quality
of
communication
between
hospitals
or
surgeries
and
their
patients,
and
then
the
second
question
is:
how
does
the
cqc
respond
when
coroners
deliver
verdicts
that
are
critical
of
surgeries
or
hospitals?
A
So
I
don't
know
which
of
you
would
like
to
respond.
First,
ladies,
first
rosie,
oh
rosie's,
giving
you
the
rosie's
giving
me
the
floor
says.
E
E
Clearly,
we
take
feedback
from
patients
and
the
way
that
the
quality
of
the
communication
with
hospital
is
really
important.
We
also
look
at
what
the
hospital
has
done
to
survey
the
views
of
patients
and
we
hear
from
bodies
such
as
health
watch
about
the
interaction
with
patients,
but,
of
course,
there's
specific
issues
around
how
the
hospital
manages
complaints
from
patients
the
duty
of
candor,
how
it
manages
serious
incidents
and
communicates
with
patients
and
involves
them
in
investigation
of
serious
incidents.
So
there
are
many
levels
we
look
at
the
communication
with
patients.
E
I
suppose
my
my
overall
conclusion
is.
I
would
like
to
see
hospitals
much
better
at
getting
patient
feedback.
I
think
one
of
my
sadness
is
that
hospitals,
too,
do
tend
to
rely
on
the
the
friends
and
family
feedback,
which
I
don't
think
is
sufficient
quality
to
give
them
the
the
depth
of
understanding
of
patient
feedback
that
they
should.
E
They
should
be
acquiring
and
when
we
ask
hospitals
to
to
demonstrate
patient
feedback
in
more
detail,
we
often
do
not
get
a
very
strong
response
on
that
and
I
think
that's
an
area
that
they
need
to
focus
on
in
terms
of
communication
with
coroners
coroners.
If
they
are
concerned
about
the
care
a
patient
has
received,
can
issue
a
notice
to
a
provider
or
any
other
body.
I
should
say
to
promote
the
prevention
of
future
deaths,
and
these
are
issued
by
coroners
and
coroners
have
been
issuing
them
increasingly
over
recent
years.
E
It
is
very
variable
and
different
coroners
issue,
various
variable
numbers
of
them.
I
I'm
always
very
grateful
if
coroners
copy
us
into
those
those
those
reports,
because
it
gives
us
an
opportunity
to
take
them
up
with
hospitals
directly.
E
We
do
ask
hospitals
share
them
with
us
in
any
case,
and
what
we're
looking
for
is
is
not
the
number
of
reports
we're
looking
for
evidence
that
the
hospital
is
learning
from
the
report
and
is
using
the
report
to
drive
improvements
in
safety,
and
I
think
that
is
really
very
important,
as
we
would
for
many
safety
incidents.
It's
important
that
hospitals
are
learning
and
driving
improvements
in
safety
and
that's
what
the
response
we
expect
to
see
from
them
in
terms
of
the
the
coroner's
response
so
I'll
hand
over
to
rosie.
F
You
very
much
and
very
similar
mechanisms
in
pms.
Thank
you
robin
for
your
question
and
we
work
with
the
local
patient
participation
groups
of
the
surgeries.
We
look
at
the
quality
of
communication
on
things
like
the
practice
website
and
we
hear
feedback
from
people
using
services.
We
would
like
to
get
more
feedback
from
people
using
services
to
inform
how
we
assess
that
quality
of
communication,
and
particularly
at
the
moment.
F
I
think
that
communication
is
vital
that
practices
and
providers
spend
the
time
engaging
well
with
their
patients
who
use
the
services
to
to
talk
about
service
changes
and
talk
about
how
they're
delivering
their
services
and
how
people
should
access
their
services.
F
I
think
the
other
thing
to
mention
is:
I
think
there
is
a
real
opportunity,
as
we
start
to
look
at
systems
in
more
detail
about
how
we
work
with
the
public
to
look
at
the
quality
of
communication
from
services
together,
because
sometimes
I
think
it's
important
that
services
work
together
to
give
effective
communication
to
the
members
of
the
public
about
a
whole
range
of
issues.
Our
coroner's.
The
coroner's
question
is
the
same
as
in
hospital.
So
thank
you.
A
Great,
thank
you
ted,
thank
you
rosie,
and
that
is
the
end.
Thank
you.