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From YouTube: CQC Board Meeting - March 2023
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A
Well,
good
afternoon,
everybody
and
welcome
to
the
public
board
meeting
of
the
Care
Quality
commission,
frequent
Watchers
will
know.
My
name
is
Ian
Dukes
I'm,
the
chair,
you'll,
see
we
have
more
people
in
the
room
than
usual.
That's
because
we
have
already
invited
in
our
presenters
for
the
first
session,
but
I'll,
introduce
them
or
they'll
introduce
themselves
in
a
few
minutes
time.
A
A
few
other
welcomes
just
before
we
start
Drew
Noble
over
in
the
corner.
There
is
our
equality,
Network
representative.
As
you
know,
we
always
have
somebody
so
welcome.
Drew
I'm,
usually
on
my
right,
Kate
Staples
I,
think
we
did
introduce
her
last
meeting,
but
she
hadn't
quite
joined.
It
was
just
observing,
but
she
has
now
been
appointed
as
our
legal
advisor,
so
all
sits.
Next
to
the
chair,
that's
very
helpful
to
me.
A
The
I
would
also
just
like
to
introduce
Jeremy
boss.
Jeremy
is
not
a
board
member,
but
he
has
for
some
time
being
the
independent
sorry
one
of
the
two
independent
members
of
our
audit
and
risk
Assurance
committee.
As
you
know,
our
audit
committee
chair
left
at
the
end
of
December.
We
don't
yet
have
approval
to
recruit
a
successor,
which
means
we
don't
have
a
chair
sitting
on
the
board
currently
but
Jeremy
kind.
A
He
agreed
to
take
on
this
as
an
intra
mole
and
I
I
can
tell
you
from
experience,
has
been
doing
a
tremendous
job
there.
So
Jeremy
thank
you
for
that,
but
it
also
to
enable
Jeremy
to
do
his
job
properly.
It
seemed
to
be
sensible
to
include
him
in
in
wide
abroad.
Discussions.
So
Jeremy
is
here
today
and
will
be
briefly
presenting
a
report
about
from
the
last
audit
risk
Assurance
committee
shortly
I
think
in
terms
of
introductions
that
I
hope
I've
included
everybody.
Oh
sorry,
Joyce!
A
Yes,
first
time,
you've
joined
us,
so
Joyce
Frederick,
a
number
of
you
will
have
met
her
before
a
director
of
policy
and
strategy,
so
she's
often
presented
here
but
has
now
joined
the
executive
team,
so
we'll
be
joining
us.
As
a
member
of
that
team,
at
Future
meetings,
I
haven't
been
notified
of
any
new
Declarations
of
interest.
I'll
take
those
later
on,
then.
Thank
you.
Very
much.
A
I
haven't
been
notified
of
any
urgent
matters
to
add
to
the
agenda,
but
I'll
just
say:
I
have
slaughtered
in
it'll
only
think
a
few
moments,
but
a
couple
of
board
appointments
that
I
will
slot
in
at
the
end
of
the
agenda,
but
we'll
explain
that
when
we
get
there
so
the
first
item,
and
indeed
the
the
main
item
on
the
agenda
today-
is
the
independent
review
until
the
handling
of
protected
disclosures
and
listening
learning,
responding
to
concerns
review
you'll,
forgive
us
if
we
are
slot
into
the
llrc.
A
We
find
that
easier
to
say
than
the
longer
description.
If
you
say
llrc,
that's
what
we
we
mean
the
I'm
not
going
to
give
a
long
introduction
to
this,
but
those
who
have
been
following
CQC-
and
we
know
that
includes
a
number
of
colleagues
who
are
I.
Think
listening
in
this
afternoon
have
a
particular
interest
in
two
pieces
of
work.
We
kicked
off
a
few
months
ago.
The
first
was
in
response
to
the
employment
Tribunal
for
Mr
Kumar,
which
we
lost,
which
caused
us
to
look
at
a
number
of
things.
A
Internally
and
I
went
through
the
Thunder
of
those
coming
later,
but
we
asked
Zoe,
Leventhal
Casey
I
still
tend
to
call
you
a
QC.
A
My
apologies
Casey
now
to
carry
out
an
independent
review
of
the
specifics
around
that,
and
there
is
a
a
very
long
report
to
as
a
consequence
which
I
will
comment
on
just
a
moment
and
then,
as
a
result
of
a
number
of
other
things
going
on
the
organization,
we
decided
to
carry
out
a
in
some
ways
related,
but
a
separate
review,
and
that
was
led
by
Scott
dureraj,
who
is
over
there.
Scott
had
literally
just
joined
CQC,
but
before
he
was
ever
allowed
to
start
his
proper
job.
A
We
poloined
him
to
to
lead
this
piece
of
work
and
then
he
in
turn,
set
up
a
structure
with
a
number
of
independent
people
who
are
allowed
to
introduce
themselves
in
just
a
moment.
So
there
are
two
reports
resulted
from
that.
They
were
circulated
to
the
board
as
part
of
the
board
pack
in
accordance
with
law
practice
a
week
ago,
but
the
management
team
hadn't
seen
them
before,
so
it
didn't
seem
appropriate
to
put
them
into
the
public
domain
immediately,
but
they
should
be
I
believe
in
the
public
domain.
A
A
So
the
way
we're
going
to
handle
this
I'm
going
to
hand
over
to
Scott
and
Zoe
and
colleagues
in
just
a
moment
to
say
a
little
bit
more
about
the
structure
to
very
briefly
introduce
themselves
and
then
going
to
ask
Zoe
to
talk
through
her
report,
Scott
and
his
colleagues
to
talk
through
the
work
that
they
have
done,
which
overall
I
would
think
will
probably
take
you
know
half
an
hour
or
so
from
here
30
35
minutes
and
then
we'll
allow
time
for
questions
from
my
colleagues.
A
The
management
team
other
than
getting
it
as
part
of
the
papers
last
week
have
not
had
an
opportunity
to
do
this.
So
we
don't
have
a
formal
management
response
that
will
have
to
follow.
But
I
am
going
to
ask
Ian
trenham,
as
the
chief
executive
just
give
some
immediate
responses
so
that
people
have
an
understanding
of
the
I
suppose
the
gut
reaction,
if
I,
can
put
it
that
way
of
the
management
team
to
to
what
they've
heard
and
then
I
will
just
flag
it
now.
A
But
there
is
a
briefing
for
colleagues
later
on
this
afternoon,
which
a
couple
of
people
Kate
and
Ali,
who
was
part
of
the
another
executive
from
this
board
who
sat
on
the
the
oversight
group
for
this
work
and
I'll
also
ask
Ali
to
talk
later
on
as
well,
but
they
will
be
leaving
us
at
about
four
o'clock
to
lead
a
discussion
with
our
colleagues
internally,
so
I
hope
I've
covered
the
the
main
points
in
terms
of
process,
so
Scott
and
Zoe
could
I
turn
over
to
you
to
our.
A
Firstly,
ask
you
to
introduce
yourselves
very
briefly.
Then
your
colleagues
can
introduce
themselves.
So
we
know
who's
here
and
then
Zoe
perhaps
turned
to
you.
First
of
all
to
cover
your
report.
Thank
you.
Thank.
B
C
D
You
I'm
Scott
duerage
I'm,
the
director
of
the
llr
review.
E
B
You
very
much
I'm
going
to
present
a
brief
summary
of
my
review
start
with
a
brief
introduction.
Secondly,
my
key
findings
and
thirdly,
my
recommendations.
B
By
way
of
introduction,
there
are
two
parts
to
my
review.
First
of
all,
I
was
asked
to
look
at
how
CQC,
as
a
regulator,
responded
to
the
concerns
that
Mr
shyam
Kumar
raised
with
it,
and
secondly,
I
was
also
asked
to
look
at
a
sample
of
other
cases
where
similar
concerns
had
been
raised
by
cqcs,
with
CQC
by
staff
members
within
NHS
trusts.
B
For
those
who
who
don't
know,
Mr
Kumar
is
a
consultant
orthopedic
surgeon
in
the
NHS,
and
he
was
also
at
the
time
a
specialist
advisor
with
CQC,
which
means
that
from
time
to
time,
he'd
attend
inspections
along
alongside
CQC
inspectors
to
provide
clinical
insight
into
surgery.
So
I
focused
on
number
one.
How
did
CQC
use
the
information
in
its
role
as
the
independent
regulator
of
healthcare
to
decide
whether
the
trusts
were
meeting
fundamental
standards?
Secondly,
whether
it
took
appropriate
action?
B
And
thirdly,
I
was
asked
specifically
to
look
at
whether
the
ethnicity
of
the
personal
persons
raising
the
concern
played
any
role
in
the
way
that
the
concerns
were
addressed
so
before
I
turn
to
deal
with
my
findings.
I
just
wanted
to
thank
everybody
at
the
CQC
and
Beyond
who's,
assisted
with
my
review.
It's
been
a
long
process
and
all
of
my
interviewees
have
given
very
willingly
of
their
time
and
I'm
very
grateful
to
them
and
also
to
all
the
wider
staff
within
the
organization
and
Beyond
who
who've
supported
me.
B
So,
in
terms
of
my
findings,
the
second
part
of
what
I
will
say
today,
Mr
Kumar
raised
three
sets
of
concerns,
and
there
were
at
least
two
other
sets
of
concerns
he
raised
which
were
properly
dealt
with
by
CQC.
So
the
three
sets
of
concerns
that
I've
looked
at.
First
of
all,
one
dates
back
to
2015,
which
is
obviously
some
time
ago.
He
wrote
to
the
CQC
following
an
inspection
at
a
hospital
in
the
Northeast
to
make
a
complaint
about
it.
B
His
concerns
related
to
clinical
issues
within
Orthopedics,
which
he
thought
were
not
being
properly
looked
into
and
an
issue
about
the
conduct
of
the
team
at
the
inspection.
Unfortunately,
what
I
found
is
that
it
was
never
properly
looked
into
and
he
never
received
a
proper
response
response.
It's
not
clear
from
the
records
that
there
are
whether
CQC
property
took
on
board
the
information
he
raised.
So
that's
the
first
set
of
issues.
The
second
in
2018
Mr
Kumar,
raised
concerns
with
CQC
in
his
capacity
as
an
employee
of
his
trust.
B
So
in
his
capacity
as
a
consultant
orthopedic
surgeon,
he
was
concerned
about
patient
safety
because
of
a
series
of
serious
clinical
incidents
that
had
Arisen
in
at
that
time.
In
Orthopedics,
I
have
found
that
he
wasn't
ever
properly
treated
as
a
whistleblower
by
CQC.
Nobody
ever
met
him
to
talk
to
him
and
to
hear
his
concerns
directly.
This
was
a
major
missed
opportunity.
I
found
CQC
did
go
into
inspect
shortly
thereafter,
partly
as
a
result
of
the
issues
that
he
raised.
B
But
it
didn't
focus
on
those
issues,
and
so,
although
CQC
engaged
with
the
trust
over
this
period,
I
couldn't
see
any
meaningful
regulatory
scrutiny
and
any
action
taken
to
hold
the
trust
to
account
in
terms
of
governance
or
in
terms
of
Duty
of
candor
and
the
third
set
of
concerns
he
raised.
Mr
Kumar
attended
another
inspection
in
2018
and
he
wrote
afterwards
raising
a
concern
about
resourcing
he.
He
was
the
only
special
advisor
providing
input
across
two
Hospital
sites
on
all
aspects
of
surgery,
and
he
raised
some
other
specific
issues.
B
Again
he
never
received
a
proper
response
at
the
time.
In
fact,
most
of
the
specific
issues
he
raised
were
addressed
by
CQC
in
the
inspection
process,
but
because
of
the
communication
problem,
he
he
was
unclear
about
what
happened
and
when
he
complained
about
it
he
didn't
get
a
response
until
it
was
raised
with
him
on
on
behalf
of
his
MP
with
the
ombudsman.
So
those
are
the
findings
and
I'll.
Just
then
move
on
to
touch
on
the
sample
and
the
recommendations,
but
before
I
do
in
terms
of
the
themes
that
I've
seen
coming
out.
B
First
is
the
importance
of
obviously
communication
as
a
key
way
of
ensuring
that
these
issues
don't
arise.
Secondly,
ensuring
that
CQC
can
and
does
grapple
with
clinical
issues
that
arise
on
inspections
and
as
part
of
its
monitoring
and
thirdly,
ensuring
that
CQC
is
properly
scrutinizing.
What
trusts
are
doing
in
these
areas
where
concerns
are
raised.
B
So,
just
briefly
to
summarize
my
findings
on
the
sample,
I
I
looked
at
18
other
cases
in
total
and
I
saw
a
lot
of
good
practice
within
CQC
in
dealing
with
how
in
dealing
with
concerns
raised,
I
saw
examples
of
really
positive
empathy
and
communication
with
people
raising
concerns
good
supportive
management
relationships
to
enable
those
concerns
to
be
properly
dealt
with
and
to
ensure
the
right
response
was
taken
and
really
positive
outcomes
from
those.
B
So
it's
important
to
note
that
many
examples
showed
that
speaking
up
had
made
a
really
positive
difference
and
that
CQC
had
helped
make
that
happen
by
taking
quick
and
effective
action
in
response.
However,
the
sample
did
also
throw
up
some
areas
for
improvement
and
I'm
going
to
touch
on
two,
in
particular.
First
of
all,
that
the
system
for
recording
and
monitoring
this
kind
of
information
is
seriously
problematic
to
find
out
what
would
really
happened.
B
B
B
Otherwise,
as
my
review
has
shown,
there
are
risks
that
issues
get
missed
or
not
focused
on
or
indeed
that
the
inspection
teams
are
not
able
on
site
to
deal
with
the
issues
that
arise,
and
there
are
two
aspects
to
this
recommendation.
Firstly,
the
rights
bars
need
to
be
on
the
right
inspections,
so
I've
recommended
that
the
existing
project
that
I
understand
is
progressing
to
do
this
via
intelligent
LED
matching
in
advance.
B
It
should
be
prioritized
and
adapted
and
improved,
and,
secondly,
spas
and
inspectors
need
to
be
trained
to
work
together
more
and
to
understand
their
joint
roles
more
especially
so
that
inspectors
can
engage
better
with
the
right
clinical
expertise
and
also
so
that
Spas
can
understand
the
numerous
competing
objectives,
sometimes
that
inspectors
are
dealing
with
on
site.
Fourthly
and
finally,
in
terms
of
recommendations,
I
would
recommend
new
or
improved
systems
for
accessing
and
monitoring,
whistleblowing
information
and
I
know.
This
is
a
theme.
B
That's
also
come
out
of
the
other
parts
of
the
report
which
you'll
hear
about,
so
that
there
is
a
consistent
way
of
putting
this
information
into
a
system
and
an
easy
and
accessible
way
of
extracting
it,
so
that
you
know
what
action
has
been
taken
and
there
needs
to
be
proper
training
for
this
to
be
done
over
time,
not
just
once
at
an
induction
stage.
B
I
think
that
this
training
needs
to
include
how
to
deal
with
allegations
of
race
discrimination
being
made
to
ensure
that
CQC
understands
its
important
regulatory
role
in
this
context
and
its
role
in
working
together
with
the
equality
and
Human
Rights
Commission,
and
this
will
generally
build
confidence,
I
think
in
dealing
with
these
issues
across
the
organization.
So
that
concludes
my
summary.
Thank
you
very
much
indeed
for
involving
me
in
this
important
piece
of
work.
A
Sorry
so
thanks
very
much
indeed
for
those
that
have
now
had
a
chance
to
look
at
it.
That
was
an
excellent
summary
and
about
six
minutes
of
200
and
so
odd
pages.
So
thank
you
for
that.
As
I
said
earlier,
we
won't
take
questions
on
sales
report.
Now,
let's
look
at
the
totality
of
it
and
we'll
we'll
take
questions
over
the
next
lot
before
I
turn
to
Scott
Kate.
Do
you
want
to
say
anything
about
a
way
of
introduction
to
this
piece
of
work.
H
Very
for
the
summary,
your
note,
as
you
read
through
the
review,
that
there
is
a
good
read
across
of
the
theme,
so
he
finds
in
Phase
One
and
the
themes
that
we
uncovered
in
phase
two
as
well
so
before
we
get
into
that.
I
just
want
to
start
off
by
saying
thank
you
to
Scott
who's
provided
incredible
leadership
on
this
work
over
the
last
six
months
or
so
I'd
like
to
thank
our
work
stream
leads
and
a
number
of
other
colleagues
who
have
made
the
report
possible.
H
In
particular,
I
want
to
thank
our
staff
forums.
Our
staff
for
Quality
networks,
who
have
engaged
with
the
report
that
you
find
in
front
of
you
and
also
I,
want
to
acknowledge
and
recognize
the
positive
change
in
relationship
that
we've
had
with
our
unions
over
the
past
few
months
accumulating
in
a
meeting
a
couple
of
us
had
last
week,
where
I
feel
increasingly
optimistic
that
we
will
be
able
to
work
together
to
think
about
what
we
do
next.
H
In
light
of
these
findings
and
finally,
I'd
like
to
thank
our
three
independent
panel
members
and
our
Peter
and
joy,
whose
expertise
and
challenge
I
think
has
really
added
a
robustness
to
our
approach,
and
finally,
this
wouldn't
have
happened
without
Mr
Kumar.
H
So
I'd
like
to
extend
my
personal
thanks
for
his
engagement
in
this
and
throughout
this
Mr
Kumar
has
been
absolutely
and
relenting
in
his
focus
on
wanting
to
improve
patient
safety,
but
also
he's
been
really
Keen
in
thinking
about
how
he
can
support
us
to
improve
as
an
organization
which
is
pretty
remarkable
in
light
of
what
happened
and
the
findings
of
the
employment
tribunal.
So
I
wanted
to
say
a
specific
thank
you
to
Mr
Kumar.
H
So,
turning
to
the
review
now,
it
would
be
fair
to
say
that
this
is
a
really
difficult
read
and,
as
you
work
your
way
through
the
chapters,
the
work
streams,
every
area
that
the
review
looked
at,
found
things
that
we
could
and
should
have
done.
Better
and
I.
Think
it's
really
important
as
an
organization
that
we
take
the
time
to
fully
digest
what
this
report
tells
us
about
how
we
work
before
the
Natural
Instinct
of
Leaping
leaping
to
action.
H
A
D
You
Ian
and
thank
you
Kate.
So,
let's
start
with
a
simple
context,
so
the
best
LED
organizations
are
one
ones
that
quickly
recognize
and
identify
their
own
failings,
respond
humanely
with
an
open
mind,
with
a
focus
on
learning
and
not
blame
and
take
accountability
and,
of
course,
more
importantly,
lead
in
the
addressing
and
delivering
their
own
improvements.
D
The
CQC,
in
my
view,
agreed
with
the
need
to
engage
both
openly
and
honestly
and
and
also
focused
on
rebuilding
trust
and
confidence
and
acting
in
a
way.
The
regulator
would
expect
that
of
those
organizations
for
which
it
regulates.
So
the
review
of
Mr
Kumar
case,
as
we've
just
heard,
is
covered
in
its
totality
in
phase
one,
which
is
Zoe's
report
and,
of
course
the
reports
are
online
in
two
parts
to
recognize
the
distinct
nature
of
a
fully
independent
report
and
a
report
that
had
independent
governance
and
some
independent
people
doing
the
work.
D
With
regards
to
phase
two:
where
extremes,
one
two
three
and
five
so
working
one
is
whistleblowing.
Two
is
speak
up,
three
is
legal
case
handling
and
five
is
how
we
hear
from
the
public
and
just
a
small
section
of
work
stream.
Four,
they
all
they
all
regard.
They
are
all
the
things
that
CQC
does
on
a
day
in
day
out
basis.
D
D
So
the
review
examined
on
the
basis
of
an
impact
and
intent,
and
the
review
team
and
I
want
to
highlight
that,
irrespective
of
the
absence
of
intent,
it
does
not
eradicate
her
in
any
way
it
minimize
the
impact,
so
the
impacts
on
Mr
Kumar,
his
family
and
the
impact
on
patients
to
wider
population.
The
impact
upon
the
CQC
with
regards
to
its
public
and
clinical
confidence
as
a
regulator
that
listens
inclusivity
is
supportive
and,
of
course,
learns
so
before
agreeing
to
take
on
this
review.
D
I
was
grateful
for
Mr
Kumar
Mr
Sharon
Kumar,
in
speaking
with
me,
ahead
of
the
review,
starting
because
I
wanted
to
connect
with
where
he
was
where
he
was
feeling
his
experiences
and
his
concerns
and
to
do
justice
to
those
that
see
the
important
role
of
the
CQC
and
all
of
the
staff
who
come
to
work
every
day.
Focus
on
that
safety
of
people
in
care.
D
D
We
were
presented
with
at
the
start
of
the
review
so
again
to
end
I
have
to
thank
Mr
Kumar,
who
really
helped
me,
establish
the
foundations
of
this
work
and,
as
always
as
we've
heard,
only
focused
on
wanting
to
be
heard,
and
the
sister
CQC
to
improve
I
do
need
to
thank
the
trade
unions
and
the
staff
networks,
who
helped
me
recruit
independent
colleagues
working
on
the
different
elements,
but
also
have
are
clearly
Partners
in
the
future.
D
Improvements
of
the
organization
as
well
to
end
I
I
did
hear
concerns
that
were
made
that
will
the
CQC
deliver
on
the
review
and
quite
uniquely
I,
think
we
then
did
spend
time
on
ensuring
there
was
an
evaluation
recommendations
for
the
work.
So
you
will
see
in
the
documentation.
D
There
is
a
strong
emphasis
on
recommendations
of
evaluation
and
how
that
should
be
done
and
the
time
scales
that
should
be
done
with,
and
also
continuing
with,
the
expertise
and
the
challenge
and
the
rigor,
which
should
help
and
aim
to
build
confidence
in
the
public
and
any
external
stakeholders
that
their
independent
panel
have
done
and
I
have
recommended
in
the
review
that
the
independent
panel
members
should
come
back
as
part
of
the
evaluation
process.
D
So
I
hope
it
builds
confidence
and
demonstrates
improvements
and
I
hope.
People
are
able
to
read
the
review
and
take
time
to
consider
what
it
says.
But
there
is
a
level
of
honesty
and
Candor
that
I
think
is
unusual
in
this
respect
and
I
did
want
to
just
address
the
issues
of
of
race
towards
the
end.
D
So
again,
remember
Mr,
sham
Kumon
didn't
raise
race
in
the
tribunal,
but
this
organization
agreed
with
me
that
we
should
consider
race
when
a
man
of
Indian
descent
had
been
disengaged,
and
that
is
a
very
proactive
step
and
one
that
I
haven't
seen
in
my
32
years
in
working
in
race
and
inequalities
and
Healthcare
leadership.
So
I
do
think
that
does
need
to
be
acknowledged.
D
So
at
that
point
we're
going
to
be
moving
on
to
the
independent
panel
members
around
our
Pitter
and
Joy.
A
Scott,
just
before
we
turn
to
the
panel
members,
could
you
just
say
a
little
bit
more
about
why
and
how
we
had
independent
people
engaged
I
think
it
would
just
give
a
little
bit
of
context
to
their
remarks.
Yes,.
A
D
So
normally,
when
you
do
these
kind
of
reviews,
it's
quite
important
to
separate
it
from
the
board
and
normally
we
would
have
had
the
senior
independent
direct
director,
but
he
was
due
to
Lee.
So
that's
why
Ali
stepped
in
and
Ali
was
really
helpful,
because
we
ethnicity
was
important.
The
clinical
leadership
and
also
for
Mr
Kumar
to
you,
know
to
start
building
that
psychological
safety
I
think
was
important.
D
But
we
did
need
a
view
independent
view
on
both
HR
OD
expertise.
The
legal
elements
of
whistleblowing
and
The
Wider
determinants,
as
well
as
race
and
human
rights
kind
of
perspective.
E
E
Firstly,
I
wanted
to
say
that
there's
been
a
huge
degree
of
willingness
by
all
of
the
staff
members
that
I've
engaged
with
in
the
CQC
over
the
last
few
months,
their
willingness
to
engage
and
participate,
despite
the
fact
that
they're
still
working
on
their
business
as
usual
pressures
and
bearing
in
mind
that
the
the
time
that
the
time
scale
was
quite
ambitious.
E
There's
also
been
a
noticeable
desire
in
in
many
quarters
to
to
do
things
differently,
which
is
is
more
than
helpful
and
needs
to
be
needs
to
be
capitalized
on
the
recommendations
are
very
challenging,
they're
hard-hitting
and
they're
and
they're
wide-ranging
as
an
HR
Director,
reflecting
upon
them.
E
What
I
particularly
welcome
seeing
was
that
the
the
recommendations
are
very
clear
and
they
give
a
really
solid
road
map
about
where
to
go
in
order
to
achieve
the
improvements
that
need
to
be
achieved,
and
then
finally,
it
was
to
pick
up
on
the
the
point
that
you
made
Scott
around
I
was
also
pleased
to
see
the
evaluation
is
built
into
to
the
review
and
also
continued
scrutiny,
both
of
which
I
think
could
be
really
helpful
in
driving
that
change
and
and
seeing
results.
F
Thank
you
Anne,
so
I
have
a
specialist
background
in
whistleblowing
law
and
practice,
and,
as
Scott
mentioned,
my
role
has
been
to
review
not
only
the
progress
but
also
advise
help
unblock
and
scrutinize
and
I've
observed
that,
throughout
the
period
of
the
review,
the
work
has
been
conducted
with
diligence
with
Candor
and
with
tremendous
Goodwill.
F
The
focus
really
has
been
on
Improvement
there's
been
due
regard
and
importance.
Looking
back
from
the
work
streams
by
each
workstream
lead
at
the
importance
of
the
work
to
public
trust
and
confidence,
the
importance
of
the
work
to
workers,
trust
and
confidence,
and
a
look
to
see
that
the
improvements
are
to
the
functions
and
to
the
resilience
of
the
CQC.
F
F
Often
the
trauma
they
experience
from
whistleblowing
is
too
high,
and
the
report
recognizes
this.
The
report
recognizes
that
whistleblowers
need
to
be
listened
to
and
the
information
they
impart
will
be
used
to
protect
public
and
staff
and
is
locally
to
go
a
long
way
to
improve
their
trust
and
confidence,
and
it's
hope
the
findings
will
do
so.
There
are
key
findings
about
consistency
and
Clarity
in
the
use
of
whistleblowing
processes,
communication
in
training
and
how
concerns
should
be
dealt
with.
F
There's
a
very
welcome
progress
in
a
New
Freedom
to
speak
up
policy
but,
of
course,
to
be
effective.
The
CQC
must
ensure
that
in
the
workplace
in
its
own
workplace
it
is
inclusive
and
that
workers
feel
psychologically
safe
to
speak
up.
Looking
forward.
I
think
the
real
test
will
be
in
the
implementation
phase
and
to
ensure
that
the
intended
impacts
are
achieved.
G
G
Think
what
the
review
tells
us
not
very,
unsurprisingly,
is
that
racism
unfortunately,
is
very
much
a
product
of
our
society,
and
it
really
isn't
surprising
that
the
review
found
a
lack
of
understanding,
a
lack
of
attention
being
paid
to
be
able
to
really
explore
and
to
delve
into
these
issues,
as
as
part
of
the
work
and
I.
Think.
G
I
think,
in
terms
of
responding
specifically
to
the
recommendations,
this
I
think
is
a
real
opportunity
for
the
CQC
to
really
critically
address
the
issue
of
Competency
and
capabilities
required
to
really
improve
on
Race
discrimination
and
racial
disparities
within
the
system
and
I.
Think
if,
if
it
was
to
be
able
to
grasp
the
mantle
of
that
and
to
really
think
about
how
it
does
does
that
well,
it
can
really
send
a
message
to
the
system
to
the
wider
system
on
how
they
can
improve
standards
and
measurements
of
progress
around
this
agenda.
G
So
I
really
look
forward
to
to
seeing
something,
that's
different,
something
that
can
be
at
PACE
and
something
that
can
be
Adept,
which
really
begins
to
address
some
of
the
the
widespread
issues
that
emerge
far
too
frequently
within
our
Health
and
Social
care
system.
Thank
you.
A
Okay,
thanks
very
much
indeed,
what
I'd
like
to
do
now
is
we
did
mention.
Ali
was
part
of
we
asked
as
a
non-executive
member
of
the
board
to
sit
in
on
the
oversight
group
I'd
be
interested
in
your
observations
just
about
the
way
it
was
handled,
because
this
is
obviously
the
first
time
the
board
have
had
a
chance
to
to
consider
this
and
I
say
that
I'd
perhaps
turn
to
Ian
just
to
give
a
few
quick
reactions.
I
A
Okay,
so
thanks
so
we've
heard
an
awful
lot
about
the
the
reports
and
the
process.
Ian
I
know
there's
a
bit
unfair
because
you
haven't
only
saw
this
a
few
days
ago,
but
any
initially
or
what
are
your
initial
reactions
thanks.
J
Very
much
I
I
think
this
we've
talked
a
little
bit
about
the
form
of
the
report
and
the
independent
component
of
it
and
I
think
the
idea
of
bringing
together
independent
experts
from
outside
working
alongside
colleagues
internally
has
been,
has
been
really
effective
and
it
was,
it
was
set
up
in
this
way
to
deliberately
give
us
a
lot
of
detailed
material
relatively
quickly
that
we
could
then
use
to
take
action.
J
Reflections
I
wanted
to
formally
record
some
thanks.
I
think.
Most
importantly,
I
want
to
thank
Mr
Kumar
himself
for
raising
the
concerns
in
the
first
place
and
in
particular
for
the
really
constructive
way
he's
talked
to
us
during
the
review.
I
know,
speaking
to
colleagues.
J
All
the
way
through
this
they've
talked
in
glowing
terms
about
Mr
Kumar's
approach
and
his
willingness
to
talk
to
us
I
mean
frankly,
he
could
have
quite
understandably,
refused
to
work
with
us
at
all
and
that
would
have
been
understandable,
but
instead
he
did
exactly
the
opposite
and
I
think
that's
a
real,
a
real
tribute,
a
real
tribute
to
his
desire
to
see
Improvement
in
Health
and
Social
care.
J
J
J
Thank
you
to
board
colleagues
Kate
taroni
for
her
day-to-day
executive
leadership
of
this
and
to
Ali
Hassan
for
his
non-executive
oversight.
I
know,
colleagues
again
have
really
valued
Ali's
insight
and
support.
Thank
you
also
to
Joe
our
Peter
and
Anne
for
for
your
honest
Reflections,
both
here
and
indeed
the
support
you've
given
us
all
the
way
through.
So
thank
you.
J
J
J
J
But
one
which
is
the
most
important
to
make
progress
on
is
one
around
culture
and
our
ability
to
walk
in
other
people's
shoes
in
terms
of
the
processes
that
need
updating
or
improving.
It's
clear
that
the
way
we
manage
Mr
Kumar's
disengagement
that
we
needed
to
be
clearer
about
about
how
we
work
with
specialist
advisors,
what
they
expect
of
us
and
what
we
expect
of
them
and
we
are
doing
a
full
review
of
our
complementary
Workforce.
J
J
J
J
The
report
also
covers
how
we
feed
back
to
those
who
tell
us
things
about
services,
and
this
I
think
is
a
particularly
challenging
area.
As
in
strictly
legal
terms,
we
are
interested
in
people's
experience
of
using
or
working
in
care
services,
but
we
cannot
always
investigate
each
individual
case
and,
whilst
that
might
be
technically
right,
it
is
hard
for
those
who
have
summoned
the
courage
to
come
forward
to
be
told
that
we're
not
going
to
pursue
their
case
on
an
individual
basis.
J
Our
recent
upgrades
to
our
website
and
Investments
and
other
technology
are
helpful
in
this
regard,
but
there
is
a
challenge
in
the
report
for
us
about
how
we
better
walk
in
the
shoes
of
those
who
have
told
us
important
and
often
very
personal
things
with
the,
except
with
the
with
the
expectation
that
something
is
going
to
be
done.
This
is
a
long-standing
and
difficult
issue,
but
one
which
we
will
have
to
continue
to
look
for
ways
to
improve
overall
I
think
this
report
is
wide-ranging
and
covers
a
number
of
issues.
J
J
J
Useful,
as
this
report
is,
though,
I
am
sorry
about
the
personal
toll
that
this
has
taken
on
Mr
Kumar.
It's
there
for
all
the
more
remarkable
that
he's
worked
with
us
in
the
way
that
he's
done.
I
would
like
to
finish
where
I
began
in
thanking
Mr
Kumar
for
his
determination
to
raise
the
issues
he
did
and
to
pay
tribute
to
the
way
that
he's
worked
with
a
number
of
colleagues
very
constructively
and
very
professionally
to
get
us
where
we
are
today.
J
Ian
I
know,
colleagues
will
have
some
questions
and
there
is
an
intention
to
bring
back
an
action
plan
at
our
mayboard
meeting
and
then
substitute
and
then
there'll
be
subsequent
updates
against
the
the
the
assessment
criteria
that
are
embedded
in
the
report.
But
that's
all
I've
got
thank
you
for
knowing.
A
Okay
thanks
so
much
for
him,
so
we've
got
about
15
minutes
or
so
for
or
longer.
If
needed,
for
any
questions.
My
colleagues
might
have
about
well
either
from
other
Executives
who
wish
to
add
because,
like
Ian,
you
haven't
had
long
to
digest
it.
You
may
have
a
perspective
to
add
or
to
my
non-executive
colleagues,
whether
you
have
questions
of
Zoe
and
her
report
Scotland
his
report
or
Ian's
Mutual
responses.
So
any
of
the
above.
K
K
Second,
point:
I,
guess
is
that
I
know
we
will
all
recognize
our
responsibilities
as
a
board
to
pick
up
Scott's
point
about
evaluation.
Does
anything
now
happen
and
there's
a
responsibility
on
us
as
a
board
and
non-executives
to
hear
that
point
and
and
really
make
sure
that
that
we're
following
that
up
and
then
there's
a
third
point.
It's
got
somewhere
in
your
report.
I
think
there
is
a
comment
about
how
the
protected
characteristics
and
what
I
did
just
want
to
ask
you.
You
rightly
explored
with
the
team
Race
and
racism.
K
Have
we
fully
explored
other
protected
characteristics
or
kind
of
May?
There
be
more.
We
need
to
do
on
that.
I
asked
that
with
some
trepidation,
but
but
it
seemed
to
be
important
whether
this
you
feel
with
the
team
is
a
is
a
comprehensive
assessment
of
how
we
handle
all
protected
characteristics
or
or
not
so
much
yet.
Thank.
D
You
thank
you
Stephen
yeah,
so
we
did
examine
a
number
of
elements
around,
especially
around
equality
impact
assessments
where
you
would
expect
LGBT
disabled.
You
know
all
across
protective
characteristics,
age
et
cetera,
to
be
written
about
understood
and
have
data
that
was
provided.
There
were
lots
of
gaps
in
data
across
the
protected
characteristics.
Obviously,
race
had
a
slightly
bigger
Focus,
but
we
did
examine
similar
challenges
across
other
elements
of
data
with
a
variance.
D
So
you
know
in
an
organization
when
you
talk
about
your
own
staff,
you
tend
to
have
binary
genders
pretty
well,
so
male
female
and
you
have
aged
pretty
well
on
there
because
of
Pensions
and
payments.
But
then
the
level
of
disability
declaration
Etc
can
be
very
variant
and
because
of
that,
the
level
of
knowledge
around
it
in
decision
making
the
knowledge
around
it
in
preparation
of
equality
impact
assessments
was
was
quite
variable.
D
Amongst
a
you
know,
along
the
organization
that
becomes
important
with
our
kind
of
inspection
and
assessment
criteria,
because
of
course,
when
you're
going
out
to
other
organizations,
you
really
need
to
understand
that
fully
because
of
our
mou
that
we
have
with
the
quality
Human
Rights
Commission.
So,
although
we
saw
more
of
a
consistent
nature,
that
was,
that
was
widespread
around
that
lack
of
competence
and
confidence
in
writing,
identifying
understanding
and
being
confident
about
race.
There
were
elements
that
were
not
as
sporadic
across
all
the
protected
characteristics
that
were
still
not
quite
at
the
standard.
H
You
sure,
if
I
could
just
pick
up
the
point
about
oversight
and
scrutiny
of
what
what
happens
next
so
I
think
it's
really
important
that
once
we've
had
a
chance
to
digest
the
report
and
the
recommendations
that
we
plug
those
recommendations
into
our
business
as
usual
reporting
so
later
on
the
agenda
today,
we've
got
our
business
plan
for
the
new
Financial
year,
with
kind
of
holds
where
the
recommendations
from
listening
learning
and
responding
to
concerns
review
will
were
appropriately
dropped
into
that
business
plan.
H
So
there
will
be
a
there'll,
be
a
as
we
report
on
our
performance
and
normal
monthly
board
meetings.
Proportion
of
this
will
be
captured
in
that,
but
also
Scott
said
it's
critical
that
we're
going
to
evaluate
this,
and
it's
got
my
recollection
as
we
were
thinking
about.
Maybe
a
six
and
a
12
month,
evaluation,
Point,
potentially
reconvening
this
group
of
colleagues
to
specifically
look
at
have
that
series
of
actions
you've
put
in
place
made
a
difference
that
you
expected
to
have
as
well.
M
Sure,
thank
you.
Yes,
I
clearly
like
to
add
my
thanks
to
others,
to
the
teams
that
have
undertaken
the
investigations
and
also
to
endorse
the
comments
for
me
and
about
the
response,
but
I'm
just
a
thing
in
particular
about
the
reference
to
how
we
can
better
engage
with
our
SBA
colleagues.
M
My
experience
of
of
Spas
is
that
their
motivation
for
being
an
SBA
is
to
improve
Healthcare
Services.
It's
it's
very
seldom
anything
else
at
all
and
I
think
the
onus
is
clearly
on
us
to
help
them
be
effective
in
that
and
for
us
to
respect
that
motivation,
because
I
think
it's
very
important
and
it
adds
an
awful
lot
to
our
work
and
it
adds
an
awful
lot
to
the
way
that
the
Health
Service
performs
for
the
benefit
of
patients.
I
I
really
welcome
those
those
those
recommendations.
Thank
you.
M
N
It
reminds
me
a
lot
of
what
we
do
around
our
work
with
the
public
relies
upon
Trust
the
trust
of
people
use
Services
the
trusted
people
working
services
to
tell
us
what
they
see
when
we're
not
there,
and
that
has
guided
now
a
rising
give
feedback
on
care
to
the
extent
that
it
it
provides
a
lot
of
the
evidence
for
50
of
our
inspections,
but
that
trust
is
only
possible
if
we
make
sure
we
are
responsive
in
the
right
way
and
use
the
information
we
get
in
the
right
way.
N
And
it
is
a
key
ingredient
that
we've
got
to
build
and
maintain
that
trust.
So
I
want
to
say,
particularly
thanks
to
the
way
the
the
diligence
of
the
recommendations,
because
I
think
that
gives
us
a
guide
for
the
things
that
we
need
to
do
both
in
terms
of
process
and
also
in
terms
of
culture,
about
how
we,
how
we
use
the
voice
of
people
who
use
services
and
staff
in.
So
it's
alongside
data
and
information,
but
I,
think
we've
got
with
those
recommendations.
N
C
L
O
So
I
think
so,
if
I
understood
you
correctly,
you
know
investigating
Mr
Kumar's,
you
know
complaint,
you
uncovered
18,
I,
think
other.
Would
you
say:
18
I
can't
remember
and
the
exact
number,
but
in
between
the
people
changes
the
process.
Discipline
changes
the
program
transformation.
O
What
are
we
going
to
do
in
between?
How
do
we
know
we
won't
get
another?
One
of
you
know
these
unfortunate
cases
in
between
a
period
of
now
and
whenever
all
these
other
things,
okay.
So
what
are
the
sort
of
I
take
on
board
in
what
you
said
that
we
should
reflect
and
ensure
that
you
know
we
build
the
right
actions,
but
what's
the
risk
of
something
else
happening
in
the
next
month
or
two
months
and
what
actions
short-term
actions
can
we
take
to
ensure
that
we've?
H
I
go
first
and
whether
Sean
you
want
to
come
in
as
well,
so
so
I
think
it's
important
so
that
the
additional
17
or
18
cases,
so
he
looks
at
so.
You
talked
about
finding
examples
of
good
practice
as
well
as
things
we
need
to
do
better
on.
H
H
So
we
we
have
the
opportunity
to
say
yes
I've
taken
action
within
five
days,
but
actually
we
don't
currently
capture
what
action
did
you
take
and
how
are
we
assured
that
that's
of
a
kind
of
quality
that
we
would
expect
so
so
the
the
new
processes
will
support
us
towards
the
end
of
this
year
and
Autumn
when
they
go
live,
but
in
the
in
the
meantime,
there's
really
strong
messaging
and
conversations
we
need
to
have
with
our
teams,
with
our
operational
teams,
Sean
and
I
as
Chief
inspectors
about
what
our
expectations
are
of
our
staff.
P
Which
was
to
say
that
I
think
the
recommendations,
particularly
the
ones
around
how
we
deal
with
whistleblown,
come
at
a
very
opportune
time,
because
we
are,
we
are
making
some
changes
to
our
to
our
ways
of
working
and
I.
Think
the
changes
to
technology
will
definitely
help,
but
I
wanted
to
reflect
more
widely
and
to
join.
My
colleagues
in
thanking
the
team
for
for
the
for
the
piece
of
work
for
the
report.
I
think
the
way
that
you
framed
it.
P
So
it's
quite
clear
about
how
implementing
it
will
lead
to
better
services
for
those
receiving
care.
Better
experiences
for
those
who
work
with
on
a
part-time
basis
and
those
who
work,
who
we
work
with
on
a
on
a
full-time
basis,
really
does
mean
that
you
know
you
can
add
my
commitment
to
the
commitment
to
my
of
my
colleagues
in
terms
of
how
we
implement
the
report
and
make
sure
that
we
don't
lose
sight
of
the
important
work
we
need
to
do.
A
An
observation
triggered
by
your
thought,
Jordan
had
some
questions
from
me.
I
mean
the
you
raise
aware
for
a
point
about
how
do
we?
You
know
I
mean
some
of
this
stuff
goes
back
to
what
Zoe
was
looking
at
the
original
case.
We've
got
five
six
years
ago,
so
I
don't
think
we're
pretending
that
it's
suddenly
all
changed
four
years
ago.
It's
just
the
the
case
that
triggered
it
was
many
years
ago.
So
it's
reasonable
to
think
that
some
of
these
are
ongoing.
Problems
is
a
good
working
assumption,
hopefully
less,
but
but
they
won't.
A
That
also,
of
course,
means
you
know
part
of
how
efficiently
or
quickly
it
ties
into
other
things
that
are
going
on
in
the
the
organization,
so
I
I,
don't
think
it'll
be
simple
to
do,
but
I
think
there
is
a
way
to
to
identify
things
that
are
most
important
or
could
be
most
quickly
fixed
and
as
people
will
sell,
I
think
we've
got
an
example
of
that.
The
next
item
on
the
agenda
is
a
a
new
speaking
up
policy,
the
old
one.
A
We
wasn't
right.
We
were
going
to
amend
it
anyway,
so
we've
kind
of
fast
forward.
To
that
I
mean
the
question.
I
will
be
asking
you
the
next
session,
but
I
think
it's
been
done
in
conjunction
with
Scott
and
Scott's
team,
so
that
what
we've
got
before
us
actually
ought
to
reflect
some
of
the
outputs
from
that.
So
there
are
things
like
that
can
be
done
quickly.
A
A
So
if,
in
particular
okay
example
are
people
uncomfortable
dealing
with
sensitive
racial
issues,
I
think
probably
a
lot
of
people
in
this
country
are
now.
Therefore
we're
not
going
to
say
I
haven't
heard
anyone
saying
well,
we
can't
do
anything
about
it,
because
it's
a
subtle
problem,
you
know
we
can.
A
We
need
to
try
and
do
some
things,
not
least
because
as
our
pivotal
problem
as
a
regulator
of
the
Health
and
Care
System
but
I
suppose
the
question
I'm
coming
to
is
is
how
far
can
we
go
and
it
would
be
the
first
question
because
that's
rather
suspect
there
are
limits
if,
if
we're
dealing
with
3
000
people
who
reflect
Society
at
large
and
then
the
second
question
leading
on
from
that
is-
and
this
may
be
a
bit
unfair
at
such
early
stage,
but
we,
it
is
important-
we're
trusted.
A
That's
the
reason
we're
doing
this.
We
are
the
independent
regulator
of
Health
and
Care.
We've
seen
some
dramatic
examples
in
very
recent
days
or
weeks
of
problems
in
the
rest
of
the
system.
To
what
extent
do
you
think
there
are
read
across
or
what
we
are
doing
here
and
the
outcomes
could
be
used
to
good
to
the
benefit
of
other
parts
of
the
systems
for
the
benefit
of
of
users?
So
so
there
are
two
questions
there
and
I
appreciate
both
of
quite
big
questions.
A
You
both
might
want
to
comment
on
the
first
one,
the
second
anyone
who
wishes
to
to
answer.
B
Thank
you,
I
mean
I
I,
agree
that
some
of
the
issues
that
we've
looked
at
are
issues
that
are
probably
reflected
in
society
at
large
in
in
terms
of
difficulty
and
sensitivity
around
dealing
properly
with
allegations
of
race
discrimination
in
terms
of
how
far
CQC
can
go,
and
the
reason
for
my
specific
recommendations
around
this
are
twofold.
Firstly,
CQC,
as
the
regulator
has
a
specific
obligation
under
regulation,
13.
B
4A
I
am
a
lawyer
after
all
to
ensure
that
care
and
treatment
must
not
be
provided
in
a
way
which
includes
discrimination
on
the
grounds
of
any
protected
characteristics.
So
cqc's
Workforce
as
a
whole
has
a
specific
obligation
to
act
on
that,
which
is
why
it's
so
important
that
the
organization
itself
can
do.
And
second.
B
The
second
answer
is
that
the
CQC
as
a
public
sector
as
a
public
organization,
as
a
public
body,
is
subject
to
the
public
sector
equality
Duty,
which
means
it
has
an
obligation
to
consider
in
its
functions,
how
to
eliminate
discrimination
and
what
steps
it
should
take.
So
it
has
to
Grapple
with
those
issues
as
part
of
its
functions,
and
that's
why
they're
so
important
I
think.
D
So
thank
you
for
asking
it
in
so
I've
got
a
an
academic
background
in
in
race
and
I've
I've
LED
during
covert
the
disparity
work
in
the
southeast
of
England
for
NHS
England,
with
regards
looking
covid,
there's
a
lot
of
stuff
in
the
media
and
in
the
Press
at
the
moment,
but
I
think
there's
a
difference
between
lack
of
competence
and
confidence
and
toxic
culture.
So
to
be
really
clear,
we
found
I
found
no
evidence
of
toxic
cultures,
toxic
behaviors,
those
kind
of
things.
D
D
Think
it's
just
important
that
we
really
are
clear
what
the
report
is
saying,
because
if
I
had
found
those
things
they
would
be
in
the
report,
but
I
didn't
and
I
just
wanted
to
state
that
so
I
think
some
of
those
colleagues
have
got
some
of
those
systemic
challenges
of
trying
to
do
the
right
thing,
but
may
not
have
been
given
the
right
skills,
knowledge
and
capabilities
and
confidence
to
do
that
and
that's
why,
having
an
honest
conversation
around
race,
racism
and
it's
affecting
Healthcare,
its
effect
on
clinical
staff.
Etc
is
really
critical.
D
When
we
remember
just
a
couple
of
years
ago,
during
the
pandemic,
all
of
those
faces
we
saw
or
over
60
of
those
faces,
we
saw
of
Health
and
Care
staff.
We
were
dying
where
black
and
minority
ethnic
staff,
so
it's
really
important
that
we
don't
lose
touch
with
that
and
we
look
at
some
of
those
systemic
issues.
But
I
just
want
to
be
really
clear.
A
Thanks
God
I
was
kind
of
behind
my
question,
but
but
thank
you
for
saying
it
because
it
is
hugely
important.
I
think
a
major
reassurance,
I'm
sure
to
colleagues
that
you,
you
didn't,
find
that
so
we're
not
going
to
solve
toxic
culture
problems
elsewhere,
but
I
suppose
I
I
I'm
still
working
on
the
presumption
that,
while
we're
not
doing
this
for
the
benefit
of
other
people,
that
if
we
set
these
standards
of
regulators,
both
what
we're
trying
to
achieve,
but
perhaps
more
importantly,
the
way
we
sought
to
identify
and
evaluate
it.
A
That
that
does
set
a
standard
that
you
know
we
we
may
not
impose
as
a
regulator,
but
but
it
sets
a
bar
by
which
we
would
measure
what's
happening
elsewhere
and
I.
Is
that
it's
probably
a
question
more
for
the
management
yep.
J
I
think
just
to
build
on
that
I
think
I
think
there
are
some
things
as
Scott
was
describing
that
we
can
do
in
terms
of
the
way
that
we
describe
issues
of
race
and
and
I
think
picking,
I
guess
linking
to
Steven's
Point,
probably
describing
other
protected
characteristics
and
how
we
openly
talk
about
it
in
a
way.
That's
that
that
is
structured
and
clear,
but
I
think
there's
also
something
in
in
here
about
who
our
partners
are.
J
You
know
we've
mentioned
the
trade
unions,
trade
unions
in
in
this
conversation
a
number
of
times
you
know,
can
we
find
Partners
where
we
can
make
common
cause
partners
that
can
help
us
scale
that
structured,
mature
conversation
that
Scott
and
colleagues
were
alluding
to
in
in
their
report,
and
we
can
be
a
catalyst
for
change.
We're
not
going
to
be
able
to
you
know
to
to
address
your
question
directly.
I,
don't
think
change
society.
You
know
a
single
bound,
but
can
we
change
Health
and
Social
care?
J
N
Just
a
final
thing
to
say
on
that
it
links
to
what
Ian's
just
said.
There's
a
really
important
point
about
part
of
our
role
as
an
organization
is
a
quality
of
outcome
for
people
who
use
services
and
go
back
to
my
point
on
trust.
N
We
have
to,
in
a
sense
reach
for
good
partnership
to
help
us
to
reach
to
a
higher
bar
than
we
might
expect
in
other
places
and
I
think
it's
important
that
we
have
the
Partnerships
and
the
trust
in
place
so
that
we
that
we
can
be
behavior
for
people
who
who
who
will
supply
or
Haven
for
people
to
give
us
information
so
that
we
can
build
the
right
environment
to
to
see
the
right
change
both
in
Health
and
Social
care
services.
So
I
think
we
should
give
ourselves
a
we.
N
We
have
an
important
job
to
improve
a
quality
of
outcome
for
everybody
that
uses
Health
and
Care
Services
and
the
way
we
do
that
is
I,
think
by
building
strong
Partnerships
with
a
with
a
range
of
organizations
and
a
range
of
people
that
will
help
us
to
achieve
that
and
I
think
we
we
we
shouldn't
limit.
Our
aspiration
we
should
seek
to
be
the
very
best
in
that
within
the
Health
and
Care
environment,
and
perhaps
within
a
public
sector.
A
Thanks
Chris,
well,
look
there's
no
other
comments.
Let
me
just
try
to
for
the
benefit
of
okay,
you're.
Well,
listening
in
the
minutes,
whatever.
To
summarize
what
I
think
we've
heard
and
also
be
clear
on
on
where
we
go
from
here,
I
mean
I
was
appointed
almost
a
year
ago.
I
can
confidently
say
this
is
the
most
sober
quiet
session
that
I've
had
the
privilege
of
chairing
the
year
and
I
think
that
reflects
both
the
the
issues,
but
also
the
way
it's
being
received
by
the
the
board.
A
No
one's
pretending.
This
makes
comfortable
reading
it's
very
difficult
reading
and
there
are
clear
this
complex
issues
like
the
one
that's
been
highlighted.
We've
talked
about
about
many
colleagues
having
and
I've
no
reason,
but
if
I'd
be
any
different,
frankly,
not
confident
in
dealing
with
sensitive
racial
issues.
So
we
need
to
address
that
on
the
other
recommendations,
on
the
other
hand,
give
some
balance.
A
Thank
you
Scott
for
reminding
us,
but
it's
usually
important
to
recognize
what
you
didn't
find,
as
well
as
what
you
did
find
and
I
think
Zoe
would
say
the
same
if
you
know
and
I
think
also,
we
should
offer
compliments.
I'll
speak
on
behalf
of
the
the
wide
award,
but
complements
the
management
team
for
the
way
they
address
this.
A
It's
not
going
to
be
easy
over
the
next
few
months
or
years
addressing
the
issues
but
I'm,
not
sure
many
organizations
would
have
had
the
courage
both
to
do
this
and
to
do
it
in
the
the
glare
publicity
so
I'd
like
to,
on
behalf
of
the
Indies,
to
say,
thanks
to
the
executive
for
the
approach
they
have
adopted,
as
Ian
said,
I
think
we
now
need
to
leave
the
executive
time,
the
executive
time
to
absorb
the
detail
and
the
recommendations
for
your
voice
of
Doubt
of
anyone
listening
I,
don't
think
Ian
intended
and
I'm
not
intending
that
to
mean
we're
going
to
take
ages
and
kick
the
can
down
the
road.
A
That's
not
what
it
means.
What
it
does
mean
is
the
consequence
of
a
lot
of
recommendations
produced
by
People,
based
on
what
they
saw
without
the
input
from
management
with
no
dispatch
runs
of
risk
that
some
things
might
be
done
slightly
differently
from
the
way
the
recommendation
was
framed,
and
it
also
has
to
be
fitted
in
with
a
lot
of
other
things.
So
I
think
we
need
to
give
the
executive
time
to
to
absorb
that
and
also
discuss
it
with
with
colleagues.
I've
already
mentioned,
there's
a
session
kickoff
session
later
on
this
afternoon.
A
So
what
we're
planning
on
suggesting
has
already
been
touched
on
is
that
the
we'll
see
here
more
formally,
the
Management's
response
to
to
this
and
how
the
pros
Take
It
Forward
in
May,
which
is
our
next
board
meeting,
there's
a
lot
of
detail
on
this,
which
I,
don't
think,
needs
to
feature
individually
in
the
business
plan.
But,
as
Kate
said,
you
know,
we
would
like
the
business
plan
looked
at
in
the
context
of
this
to
see
if
there's
ending
in
so
we
don't
have
the
the
board.
A
The
business
plan
today
for
formal
approval,
but
it'll
be
reworked.
The
board
will
consider
it
offline
if
necessary,
and
that
will
be
on
the
agenda
for
may
as
well.
So
we
can
consider
those
two
things
together
and
then
we
will
also
I
think
it
is
important
that
we
try
to
embed
things
into
business.
As
usual,
I
mean
that's
the
way
you'll
get
success
rather
than
having
a
separate
team
somewhere
else,
but
we
also
need
to
see
whether
or
not
what's
been
recommended
has
been
done
and
whether
it's
made
the
difference.
A
They're
subtly
different
points,
so
we
will
schedule
some
future
events,
timing
and
precise
format,
yet
to
be
determined
for
the
public
commitment
that
will
come
back
to
the
board,
so
we
can
can
see
what
was
done
and
the
evaluation
until
later
site,
as
I
said,
I,
think
the
very
positive
message
from
this-
and
it's
come
through
from
from
all
of
the
questions
I
think,
is
that
all
of
this
has
been
done
in
an
open
and
transparent
way
and
I
would
expect
nothing
less
of
the
regulator
of
a
system,
because
we
can't
ask
other
people
to
do
things
if
we're
not
prepared
to
do
it.
A
Ourselves,
I
think
it's
also
essential
that
we
do
this
to
help
maintain
trust
in
CQC.
So
again,
I
think
it's
hugely
important
that
we
have
done
it.
This
way,
as
I
alluded
to
in
my
question,
I
think
part
of
the
challenge
will
be
to
set
parameters
around
what
we
can
and
can't
do.
There
are
some
things
we
can
do
at
the
end
of
the
day.
We
are
products
of
society.
So
I
do
take
your
point.
A
A
A
lot
of
people
have
said
Thanks,
but
I
do
think
it
Bears
repetition
I'll,
do
it
in
three
buckets
if
you
like,
Zoe
Scott,
ladies
and
anyone
else
working
on
this,
for
the
huge
amount
of
effort
you
put
in
anyone
who,
by
the
time,
they've
got
around
to
reading
the
reports
will
know
that
even
writing
them
never
mind
doing
the
work
underpinning
of
them
was
a
major
undertaking.
So
thank
you
very
much
for
that.
A
Secondly,
I
think
should
mention
colleagues
we've.
A
couple
of
people
are
thanked.
People
who
contributed
to
this,
but
also
this
has
got
to
be
delivered
by
all
three
thousand
of
us.
So
it's
here
discussing
it
with
the
wider
board,
Neds
and
EDS,
but
the
end
of
the
day,
the
stuff
that
Zoe
was
looking
at.
A
For
example,
it
wasn't
people
around
the
stable,
so
we're
not
saying
shifting
in
a
responsibility,
but
I
think
we
have
to
find
a
way
of
gauging
all
three
thousand
people
everyone
from
has
got
a
part
some
more
than
others,
but
how
we
do
that
so
I'd
like
to
thank
people
for
engaging,
but
also
emphasizing
that
the
plan
or
the
recommendations
when
they
come
back,
have
to
find
a
way
of
not
just
what
the
executive
team
is
doing,
but
how
they're
going
to
support
3
000
people
bring
about
the
changes
and
last
but
absolutely
no
means
least
just
emphasizing
again
thanks
to
Mr
Kumar
when
this
was
kicked
off.
A
A
If
everybody
in
the
health
system
had
that
same
Focus,
probably
many
of
the
issues
we
Face
we
wouldn't
be
facing
so
I'll
just
add
my
thanks
to
him
for
the
way
he
he
stuck
with
us,
so
I
hope
he's
listening,
but
anyway,
we'll
be
in
touch
after
the
meeting.
I
hope.
Colleagues
would
agree.
That
say
first
summary
I'm
looking
to
those
who
presented-
and
you
will
agree-
I'll
get
it
right.
So
on
that,
why
don't
we?
A
A
Well,
unfortunately,
it
isn't
one
of
those
events
where
we
can
find
an
easy
way
of
leavening
the
mood
that
was
pretty
serious
stuff,
but
on
the
other
hand,
the
first
very
quick
response
to
that
is
the
speak
up
policy,
so
Kate
I
think
we're
going
to
be
joined
by
Mary
Christian
Carolyn
Jacobson.
Thank
you
very
much
indeed
a
lady
sorry
to
keep
you
waiting
just
a
few
minutes,
but
Kate
I
think
you
were
going
to
do
a
quick
introduction
to
this
and
then
we'll
hand
over
to
the
team
usual
rules.
A
When
we
get
there,
we
have
read
the
papers,
so
you
don't
need
to
go
through
the
detail
but
highlight
and
a
particular
points
and
then
we'll
go
to
questions.
H
Thank
you.
So,
as
we
said
with
the
previous
item,
there
are
some
pieces
of
work
that
have
been
in
train
anyway
during
the
review.
There
are
some
pieces
of
work
that
will
need
to
be
new,
and
this
is
an
example
where
Mary
has
worked.
Alongside
he's
been
the
workstream
lead
for
workstream
2,
which
is
around
freedom
to
speak
up,
but
also
Mary
was
our
original
Freedom
speak
up
Guardian,
so
Mary
established
a
role
in
CQC,
maybe
about
six
or
seven
years
ago.
H
H
As
you
have
a
chance
to
digest
workstream
2,
you
will
see
that
this
is
an
area
that
needs
some
serious
investment.
So
we
had
a
policy
when
we
first
established
a
role
that
was
of
a
good
standard.
We
had
good
investment
in
the
role
of
speak
up
that
eroded
over
time,
so
Carolyn
is
really
the
last
woman
standing
in
the
in
the
guardian
role
and
for
that
I
want
to
extend
my
significant
thanks
Carolyn,
because
there
was
three
of
you.
H
There's
been
one
of
you
for
maybe
about
a
year
or
so,
and
that's
a
huge
weight
to
carry
so
we
come
here
today,
I'll
shortly
hand
over
to
Mary,
with
a
new
speak
up
policy
that
has
been
well
engaged
and
co-produced
with
a
key
and
stakeholders.
H
I
hope
it's
something
that
board
feels
positive
about
and
can
approve,
as
a
kind
of
significant
step
in
the
right
direction,
to
start
addressing
the
issues
of
work
stream
one.
However,
this
is
the
kind
of
first
step
in
the
in
the
kind
of
Journey
we
need
to
go
on
to
get
back
to
where
we
need
to
be
around
speak
up,
so
it's
going
to
be
critical
to
land,
a
policy
that
reflects
how
we
want
to
be
working,
but
with
that
will
come
some
investment
and
some
renewing
our
colleagues.
Q
Thank
you,
Kate,
so
I'm
very
pleased
to
be
here
with
Carolyn
who
worked
with
me
on
the
work
stream
in
the
review.
You've
just
heard.
As
has
been
said,
there
was
already
work
on
a
policy
in
train
before
the
review
started
and
I
don't
need
to
add
any
context
to
what
you've
just
been
listening
to
so
to
set
about
this
work.
Q
We've
had
support
from
the
national
Guardians
office,
both
in
the
form
of
advice,
commentary
on
drafts
and
so
on,
and
we
asked
the
national
Guardian
to
point
us
in
the
direction
of
organizations
with
what
they
regarded
to
be
Exemplar
policies.
They
so
directed
us,
and
so
we
went
and
we
got
great
support
and
engagement
from
those
organizations.
Q
As
colleagues
will
be
aware,
NHS
England
has
the
responsibility
to
set
a
national
standard
policy
for
freedom
to
speak
up,
and
it
is
a
requirement
that
all
organizations
in
the
NHS
and
all
arms
length
bodies
who
have
an
interest
in
health
to
observe
that
so
the
policy
we're
presenting
today
is
compliant
with
that
National
Standard
as
I'm
sure
you'll
agree
is
if
it
is
befitting
for
us.
The
national
Guardian
describes
it
as
a
basic
minimum,
so
we
we
have
worked
to
make
sure
that
it's
a
good
fit
for
CQC.
Q
In
all
our
circumstances,
we've
been
able
to
take
account
of
the
emerging
findings
from
the
the
review,
not
just
because
we
were
both
involved
in
it,
but
in
being
interviewed
by
Zoe
as
part
of
the
inquiries
into
how
it
handled
concerns
being
raised.
It
was
possible
to
get
a
sense
of
what
was
coming
and
so
in
our
plans.
Q
Of
course,
a
new
policy
just
doesn't
fix
the
problem.
We
remain
alive
to
the
need
to
further
review
and
update
the
policy
in
the
light,
as
the
lessons
and
Reflections
from
the
review
sink
in
we're
also
recommending
that
we
use
the
improvement
tool
that
the
national
Guardians
office
provides.
This
is
a
reflection
and
planning
tool
for
boards
and
Senior
leadership.
Q
Teams
and
IT
addresses
both
understanding
and
confidence
and
behavior,
and
how
that
sets
the
tone
for
speaking
up
in
an
organization
the
principles
around
that
tool
are
are
detailed
in
the
review
findings,
so
we
are
recommending
this
policy
to
you
with
the
need
to
continue
to
work
and
reflect
and
develop
our
confidence
to
work
with
our
own
Academy
to
ensure
that
everyone
in
CQC
has
some
support
in
speaking
up
and
for
managers
and
leaders
in
listening
well
and
responding
well
when
concerns
are
raised,
so
we've
got
some
way
to
go
with
our
own
Academy.
Q
We've
got
to
update
and
get
that
material
out.
So
I
think
this
policy
can
be
seen
as
a
link
and
a
bridge
to
The
Wider
work
that
we
need
to
do
and
join
up
with
the
other
work
to
develop
culture
within
CQC.
That's
all
I
was
planning
to
say
and
we're
happy
to
take
questions.
Thank
you.
Okay,.
A
Thanks
just
one
or
two
questions,
I
know
just
before
we
do
we're
being
asked
to
approve
the
policy,
but
also
the
completion
of
improvement
tools.
So
can
you
just
say
a
little
bit
more
about
what
is
involved
in
the
last?
We
don't
need
the
detail,
but
what,
in
terms
of
time,
commitment
and
outputs?
What
are
we
being
asked
to
approve?
Well.
Q
It
it
is
a
it
is
an
assessment
tool,
so
there'll
be
an
element
of
self-assessment
and
then,
as
with
all
self-ass
assessments.
Looking
against
the
eight
principles
that
the
tool
has
for
great
speak
up
culture
and
to
see
where
we
are,
how
do
you
individually
feel
in
terms
of
your
own
knowledge
and
confidence?
How
do
the
senior
leaders
in
this
organization
feel,
and
what
do
we
need
to
do
to
address
that?
Q
A
Okay,
thanks
Belinda
and
then
I
think
Mark.
You
wanted
to
come
in,
but
into
us
first.
R
S
Yeah,
oh
contact,
Freedom,
speaker
up
and
they've.
They
I
mean
five
people
contacted
me
yesterday.
Well,
through
the
one
of
the
speak
up,
ambassadors
I
mean
it
varies
from
week
to
week.
It
is
often
inspectors
actually
but
I.
Suppose
they
make
up
a
large
part
of
our
Workforce.
S
It
seems
I
mean
more
recently.
There
have
been
a
lot
to
do
with
the
management
of
change
and
the
the
arrangements.
You
know
the
change
in
the
structures
Etc,
but
often
there
are
things
the
things
that
people
come
to
are
just
when
they
don't
feel
that
they've
been
heard
and
they're.
Just
it
often
we
can
resolve
things
quite
easily
by
just
giving
people
that
little
bit
extra
support
to
get
them
so
that
they
feel
that
they've
been
more
heard.
A
L
T
C
T
You
well
and
thanks
Mary
and
Carolyn,
for
this
really
excellent
report,
which
I,
which
I
support
I,
just
wanted
to
add
that
I'm,
in
my
capacity
I'm
delighted
to
say
that
I've,
taken
on
the
role
of
the
exec
sponsor
for
Freedom
speaker
Guardians
at
CQC,
I've,
sat
on
the
accountability
and
layers
on
board
for
the
national
Guardians
office
for
it
for
a
while,
now
and
I've,
seen
firsthand
that
really
powerful
benefit.
T
The
Guardians
can
have
an
offer
for
people
to
to
speak
up
in
the
in
in
The,
Wider
context
and
I.
Think
it's
it's
so
important
for
for
any
organization
to
do
this
really
well,
but
particularly
in
Health
and
Care,
because
we
know
that
if
people
who
see
problems
can
can
feel
able
to
raise
them,
then
it
can
help
us
talk
openly
about
the
the
ways
in
which
we
can.
T
We
can
address
that
and
improve
and
help
us
understand
problems
early
on,
and
we
heard
from
colleagues
in
the
last
item
about
how
important
he
didn't
speak
up:
Guardian
Israeli
organization's
culture
that
people
feel
in
a
psychologically
safe
environment
to
be
able
to
challenge
the
status
quo.
So
it's
great,
very
important
piece
of
work
and
I'm
really
looking
forward
to
supporting
the
work
of
the
Guardians.
Thank
you.
K
Thank
you.
Both
traffic
report
and
the
bitter
particularly
wanted
to
to
welcome
and
Mary
and
I,
had
a
bit
of
discussion
about
this
is
that
this
whole
policy,
this
kind
of,
is
integrated
multi-stranded,
and
it's
not
instead
of
good
management
in
in
a
sense,
don't
take
this
wrong
way.
K
Caroline
I
always
feel
that
the
more
we
could
minimize
the
number
of
cases
that
come
to
you
crucial
as
the
work
is
that
you
do
the
better,
because
we've
got
to
get
to
a
situation
where
our
managers
understand
that
creating
a
safe
environment
in
which
all
of
those
they
manage
feels
able
to
speak
up
to
them
is
absolutely
fundamental.
That's
actually
the
sort
of
management
culture
that
we
need
across
the
organization.
K
If
it
doesn't
work,
we
absolutely
need
people
like
Caroline
and
the
freedom
to
speak
up
guardians,
but
that's
kind
of
not,
instead
of
a
focus
on
trying
to
build
a
management
culture
over
time.
That
is,
that
is
welcoming
of
people
speaking
up
about
what's
going
on
in
their
in
their
normal
working
lives.
So
it's
that
kind
of
integration
that
I
really
welcome.
Thank
you.
U
Mark
I'd
welcome
this,
and
thank
you
very
much
for
the
for
for
for
getting
this
across
the
line.
I
I
think
this
is
it's
a
really
important
piece
of
our
foundations
for
a
a
speak
up
culture,
but
it
is
only
you
know
there.
There
are.
U
There
are
other
deeper
things
in
Julian's
Point
earlier
that
that
we
will
need
to
do
to
reinforce
this,
and
this
is
not
owned
by
one
person,
the
you
know,
I
think
I
think,
just
as
an
example,
you
know
the
triage
is
one
of
the
concerns
here.
The
Guardians
can't
be
the
go-to
person
for
every
day-to-day
trivial
ex
trivial
issue
around
the
place
or
a
substitute
for
a
conversation
with
your
with
your
manager.
Nor
do
we
want
serious
issues
that
actually
would
be
better
going
down.
U
Another
Channel
being
escalated
through
the
Guardians,
because
the
risk
is
the
the
a
you're
overwhelmed
and
B
resolving
those
issues
is,
is
delayed,
there's
lots
of
work
required
on
our
policies
and
getting
those
in
good
shape.
U
That
is
absolutely
not
your
your
responsibility,
so
there's
a
there's,
a
broader
team
effort
there
and
if
we
really
are
going
to
get
to
a
you
know
a
a
a
true
speak
up
culture,
the
sort
of
culture
that
that
I
think
every
great
organization
aspires
to
where
everyone
feels
confident
that
they
can
raise
issues
or
concerns
knowing
they'll
be
listened
to,
knowing
that
it
won't
cause
them
any
detriment
and
confident
that
something
will
happen.
U
You
know
that
requires
a
huge
cross,
functional
effort
in
terms
of,
if
you
have
to
do
training
in
a
different
way,
we
have
to
do
Communications
in
a
different
way.
We
have
to
be
open,
as
we've
just
been
about
things
that
have
gone
wrong
and
what
we've
learned
from
them.
You
know
it's
a
it's
a
big
Journey
for
the
all
for
the
organization,
but
I
you
know
commend
you
for
this
first
important
step
because
it
won't
work
unless
you've
got
some
of
these
big
foundation
pieces
in
place.
Thank
you.
S
But
we
do
try
very
much
to
let
Empower
staff
to
feel
that
they
can
get
at
local
resolution
so
that
we'll
we'll
say
to
them
go.
You
know,
go
and
talk
to
your
manager,
and
that
is
the
first
step
in
all
of
it
and
we'll
sign
post
people.
S
But
I
do
take
your
point.
There's
a
danger.
You
know
we
don't
want
staff
to
come
to
to
freedom
to
speak
up
with
everything
we
want
staff
to
feel
confident
and
safe
to
to
be
able
to
have
open
and
honest
conversations
with
how
this
about
how
they
feel
with
the
manager.
So
that's
what
we're
working
towards.
O
Unfair
question
by
Alaska
anyway:
how
far
do
you
think
we
are
from
the
best
in
class
that
you've,
seen
and
I
know
Mary
you've
been
on
you
know
on
on?
You
know,
speak
up
for
a
number
of
years,
as
Kate
pointed
out,
but
but
you
know,
sort
of
you'll
feel
have
have
auditing.
We've
got
to
go.
Q
I
think,
if
you
agree
it
we're
just
about
to
have
a
fabulous
new
policy
that
will
exceed
the
the
national
minimum
I
think,
together
with
the
review
that
we've
had
with
the
collective
Insight,
particularly
from
our
Hospital
teams
and
their
well-led
inspections,
which
it
can
includes
a
look
at
speaking
up
culture
I
think
we
have
good
Insight
I,
think
we
understand
that
information
is
our
lifeblood
and
that
we
want
to
we
want.
We
want
to
hold
ourselves
to
the
standards
that
we
expect
of
others.
Q
So
I
think
we
know
what
good
looks
like
we
we
regulate
against
it.
We
enjoy
the
support
of
the
national
Guardians
office.
Carolyn
is
linked
in
to
communities
of
Guardians.
We
know
what
good
looks
like
I
think
we're
back
on
track.
I
think
we're
on
our
way.
Long
way
to
go
but
starts
with
under
with
having
this
sort
of
support
and
moving
forward
is,
puts
us
in
a
different
place.
I
would
say,
would
you
agree?
Carolyn.
S
And
support
to
for
additional
resource
in
as
well
and-
and
you
know
a
commitment
to
that-
is
really
positive.
V
Yeah,
thank
you
for
a
great
report.
Mary
and
Carol
Carolyn,
my
question's
gone
along
the
same
lines.
Actually
as
to
what
support
can
we
provide
as
a
board
and
executive
team,
because
we
heard
earlier
about
intent
and
impact?
It
wouldn't
have
been
the
intention
to
Let
Freedom
to
speak
up
sort
of
deteriorating
that
way
and
we're
not
looking
at
best
practice
and
now
we've
got
and
having
a
new
policy
doesn't
in
an
in
and
of
itself
mean
that
we're
suddenly
going
to
do
it
really
well
and
meet
best
practice.
Q
I'd
ask
everyone
to
lean
into
it
to
not
to
to
have
a
look
again
at
the
chapter
in
the
review
on
speaking
up
to
read
through
the
policy
when
we
deploy
the
assessment
tool
really
engage
with
that
to
support
our
Guardians
when
they
come
to
board
and
retain
that
Curiosity
and
to
ask
yourselves
as
individuals
how
scary
am
I
as
a
person
to
speak
up
to.
Q
We
all
need
to
ask
that
of
ourselves
just
because
we
work
with
a
lot
of
very
pleasant
people
doesn't
mean
that
we
don't
look
very
scary
to
those
of
us
in
the
organization
so
and
we
forget
that
I
think
as
we
Rise
so
ask
yourselves
how
scary
am
I
and
go
that
extra
mile
to
make
yourselves
accessible.
That
would
be
my
ask.
Thank
you.
A
Thanks
Murray
I'll,
ask
myself
how
scary
I
am
when
I
leave
I
just
had
one
question
in
the
on
pages
four
and
five
you
talk
about,
who
should
I
speak
up
to
and
then
internally
and
externally,
I
know.
This
is
a
real
live
issue
in
from
the
financial
services
world
at
the
moment
as
to
whether
this
should
be
an
option
or
whether
one
should
make
it
clearer
that
the
expectations
you
speak
up
internally,
but
you
can
go
externally
if
you
feel
it's
necessary.
A
I
I
just
wondered
I
mean
in
this
case
it's
written
as
an
option
which
I
suppose
at
one
level,
and
it's
really
building
on
the
point
Stephen
made
seems
to
be
not
entirely
right
to
be
saying
to
people
when
you
could
talk
into
a
little
bit.
If
you
want,
you
can
write
to
MP
instead,
I'm,
not
sure
that
if
it's
intended
is
desperately
good
advice,
people
are
more
likely
to
get
a
responsive
for
raise
it
internally,
but
also
I
know.
This
is
an
issue
being
addressed
by
other
Regulators,
so
it
it
is.
A
Is
this
intentional
to
write
it
as
a
pure
auction?
It's
not
I
wonder
if
we
could
consider
changing
it.
If
it
is
intentional,
could
you
explain
why
it's
done
that
way.
Q
I'd
say:
we'd
followed
this.
The
nhsc
standard,
National
Standard
guidance
of
which
this
is
part
I,
think
it's
fair
to
lay
out
all
the
options,
and
my
experience
as
guardian
and
Carolyn's
too,
is
that
most
people
who
speak
up
want
to
speak
up
internally.
A
few
may
go
external,
but
generally.
The
second
choice
is
not
to
speak
up
at
all
and
that's
what
we
really
are
Keen
to
avoid.
A
Well,
we're
being
asked
to
approve
the
policy
and
the
the
tool
update
any
sent
can
I
just
make
one
suggestion.
It
says
that
the
this
would
be
reviewed
after
two
years.
It's
the
sort
of
policy
that
normally
would
be
reviewed
after
two
years,
but
bearing
in
mind
it's
brand
new,
quite
different
part
of
a
suite
where
we
haven't
updated
the
rest
of
it
yet
and
you're
going
to
complete
the
tool.
Maybe
we
should
bring
it
back
in
12
months
time
and
see
how
it's
working
and
whether
we
should
do
something
different
yeah.
A
A
Hello
money:
let's
apologies,
keeping
you
waiting
a
few
minutes.
The
so
smiling
matters
three
years
on
Kate
over
to
you.
Thank.
H
You
and
very
warm
welcome
Manny,
who
is
joining
Mary
who's
been
with
us
for
the
previous
item,
so
we're
here
to
talk
today
about
oral
Health
and
Care
Homes
following
a
important
publication.
We
shared
back
in
2000
and
2019,
where,
following
a
series
of
Dental
inspectors
going
out
into
our
Care
Homes,
we
found
a
concern
around
the
lack
of
understanding
about
nice
best
practice
when
it
came
to
good
oral
health.
H
We
found
an
absence
of
oral
health
care
plans
and
we
found
particular
issues
with
dentists
coming
out
to
Care,
Homes
and
care
and
residents
being
able
to
get
to
dentists.
So
we
published
that
report
maybe
four
years
ago,
with
really
clear
recommendations
and
then
last
year
we
went
back
out
to
find
out
what's
changed,
so
I
won't
spoil
Mary
and
Manny's
Thunder
bar
I
want
to
say:
we've
been
talking
a
lot
about
our
role
as
a
regulator
around
accelerating
Improvement
and
I.
Think.
H
So
it's
a
report
I
feel
really
proud
to
be
these
expert
sponsor
of,
but
also
this
is
what
we
do
when
we
do
this
well
and
I'm.
Looking
forward
to
us
doing
even
more
of
this,
which
is
taking
our
regulatory
insight
and
and
living
really
Punchy
reports
that
are
calls
to
action
that
make
a
difference
for
our
people
so
over
to
you,
Mary
and
Manny.
Q
Thank
you
Kate,
as
you
say,
further
proof
that
independent
Voice
work
works,
so
we
have
found
Improvement.
We
have
followed
this
up
through
50
inspections
and
when
you
consider
there's
been
a
pandemic
between
part
one
and
part
two
of
these
reports,
that
is
impressive.
There
is
much
improvement
to
celebrate,
but
also
some
heart
searching
moments
about.
Q
What's
still
to
do,
there
is
some
good
guidance
out
there,
there's
some
nice
oral
health
guidelines
and
some
excellent
resources
on
on
other
such
sources
as
Marie
Curie
and
so
on
lots
of
help
for
care
homes
in
delivering
this.
So
we
were
delighted
to
find
the
awareness
of
those
nice
guideline.
Q
Guidelines
had
shot
up
to
91
from
61,
so
that's
almost
everybody,
but
still
not
quite
when
we
looked
at
care
plans
and
whether
oral
health
care
featured
in
care
plans
that
had
doubled,
fantastic,
but
still
only
60
percent,
so
40
not
covered
in
a
care
plan.
Training
for
staff
had
also
doubled
again
to
60,
so
still
a
significant
40
percent
Gap
there
we've.
We
know
this
is
an
area
where
there's
a
lot
that
can
be
done
locally.
Q
We
had
we
Manny
and
I.
Both
took
part
in
a
recent
webinar
with
providers
to
talk
about
this
report
and
we
had
under
over
800
providers
join
us,
and
we
had
a
provider
opened
up
a
registered
manager.
Talking
about
the
action
she'd
taken
to
raise
awareness
amongst
her
staff
and
how
that
had
really
improved
the
quality
of
life.
Try
not
cleaning
your
teeth
for
two
days
and
see
what
difference
that
makes
to
your
life.
Q
W
Many
thanks
Mary,
as
Mary's
highlighted,
we
really
got
some
excellent
feedback
from
the
webinar
and
also
last
week.
I
was
at
the
British
dental
industry,
Association
showcase,
so
we
had
plenty
of
opportunity
to
speak
to
dentists
and
all
their
Care
staff.
Now
from
the
webinar,
which
was
predominantly
Care
Home
providers,
the
message
was
very,
very
clear.
The
message
was
that
they
were
very
keen
to
to
you
know,
put
oral
health
as
priority
alongside
the
nice
guidance
recommendation
of
making
it
a
priority
along
other
personal
tasks.
W
W
So
that's
one
in
four
Care
Home
providers
who
can't
access
NHS
Dental.
Now,
interestingly
enough
when
I
was
at
the
conference
and
I
got
to
speak
to
dentists
and
all
their
staff,
the
message
that
they
gave
to
me
was
very
clear.
They
were
very
keen
to
support
Care
Homes
and
there
have
been
pockets
of
really
good
practice.
W
For
example,
in
the
east
of
England,
some
localized
commissioning
has
resulted
in
Care
Homes
being
connected
to
dental
providers,
which
has
resulted
in
better
care
for
for
patients,
but
the
biggest
issue
dental
providers
face
is
the
current
contract
and
they'd
love
to
do
domicily
services
to
Care
Homes,
but
unfortunately,
their
current
contract
doesn't
allow
that
so
they
were
Keen.
Care
Homes
were
Keen.
The
difficulty
was
the
middle
commissioning
funding
Arrangement.
So,
as
I've
already
highlighted
there,
there
has
been
some
excellent
work.
W
Some
pilot
work
of
localized
commissioning
in,
for
example,
the
east
of
England,
so
we
have
got
Beacon
sites
which
show
it
does
work,
but
nevertheless
things
need
to
improve
and
may
I.
Also
add
things
are
changing
with
the
dental
contract,
as
many
of
you
would
know,
from
April
NHS
England
will
delegate
its
commissioning
of
dental
contract
to
icps,
so
I'm
being
an
optimist,
I'm
hoping
that
when
it
does
get
down
to
local
ICB
level,
we
should
see
a
lot
more
localized
response
to
the
needs
of
Care
Home
patients,
in
particular,.
L
A
H
But
this
is
why
we
are
so
excited
about
our
new
powers
going
live
on
Monday,
it's
been
a
gap
for
many
many
years
where
we
go
out
and
we
identify
challenges
with
providers
that
can't
be
fixed
by
providers
themselves
needs
to
be
fixed
by
commissioning
behavior
and
come
Monday.
We
finally
have
the
powers
to
have
the
ability
to
go,
inform
with
you
about
how
commissioning
is
happening,
be
that
commissioning
from
local
authorities
or
commissioning
from
integrated
care
boards.
K
Stephen
and
could
I
just
follow
out
what
case
you
said,
and
do
you
believe
that
icbs
have
the
funds
and
the
powers
to
fix
this,
or
is
there
some
sort
of
underlying
question
about
the
availability
of
funding
to
Commission
on
the
right
scale?
I
mean
I've
heard,
certainly
in
my
own
local
area
that
it's
just
difficult
to
get
enough.
Nhs
Dentistry
commissioned
there
aren't
enough
people
out
there
wanting
to
do
that
work
out
the
funding
provided.
H
H
So
if
we
think
about
other
areas
where
maybe
money
isn't
spent
on
prevention
and
as
a
result
of
that
people
end
up
in
crisis
and
end
up
getting
poorer
outcomes
in
in
work
in
in
in
places
that
aren't
best
best
for
them,
so
I
think
our
ability
to
look
at
how
integrated,
Care
Systems
work
is
the
requirement
for
them
to
focus
on
the
totality
of
their
population,
to
think
about
notionally,
having
a
single
pot
of
money
and
to
think
about
where
that
money
should
be
spent
to
get
best
outcomes
for
people.
H
So
I,
don't
think
it's
a
silver
bullet,
but
I
think
our
focus
when
we
go
out
to
integrated
Care
Systems
in
the
kind
of
coming
weeks
and
months
around.
How
do
you
understand
your
population?
How
are
you
supporting
people
to
access
the
Right
Care
at
the
right
time,
and
the
right
place
will
hopefully
support
the
conversations
to
flow
and
to
follow
in
that
direction.
But
I,
don't
know
Joyce
the
money,
whether
there's
anything.
M
M
Just
wanted
a
note
in
reference
to
the
comment
you
make
about
the
contract
I'm,
the
weather
Health
select
committee
are
reviewing
Dentistry
at
the
moment
and
are
taking
evidence
and
the
evidence
sessions
that
I've
seen
a
lot
of
the
people
providing
their
providing
evidence
to
this
select
committee
are
referencing
the
contract
as
an
issue
that
is
inhibiting
the
wider
provision
of
services,
so
I'm
I'm
I,
look
forward
to
the
report
of
that
of
of
that
group
in
due
course.
V
I
agree
with
Sean:
it
is
about
the
contract
and
many
will
know
better
than
me.
The
percentage
of
NHS
Dentistry,
that's
commissions,
which
I
think
is
about
50,
but
money
you
might
collect
that
percentage,
but
that
that
has
to
be
looked
at
and
fixed
for
commissioning
to
be
successful,
because
it
cannot
be
that
and
it's
and
it's
a
postcode
Lottery
as
in
where
that
50
falls
as
well.
So
there
are
areas
in
in
the
country
that
don't
have
any
NHS
Dentistry
at
all,
so
that
that
has
to
be
looked
up.
W
Just
just
to
respond
to
Joyce
absolutely
I
mean
we've
already
highlighted
this
in
our
state
of
care.
If
you
look
at
NHS
NHS
activity
in
2014-15,
it
was
commissioned
at
44.1
percent
per
100
000
population
in
21,
22,
it's
dropped
and
it's
dropped
to
49.1
percent.
So
there
is
a
reduction
in
activity
being
commissioned,
and
it's
also
coupled
with
NHS
dentists,
doing
less
activity
and
doing
more
private
activity.
W
So
you
also
need
to
factor
in
the
inequalities
there,
because
often
it's
often
it's
the
most
deprived
areas
which
have
the
least
Dental
activity.
So
London
has
the
greatest
Midlands
has
the
lowest.
But
yes,
it
does
have
an
impact
on
disproportionate
impact
on
deprived
areas.
N
Just
to
sort
of
build
on
that
point,
you're,
absolutely
right,
man,
it's
in
in
the
state
of
care,
I'm.
Looking
at
the
figures
in
front
of
me,
the
the
work
we
did
in
2021
showed
that
if
you
take
a
December
to
December
2020
2019,
there
were
six
there's
a
reduction
in
six
million
units
of
NHS
dentistry
in
that
period
of
time,
which
is
which
is
massive
and
that
it
just
a
link
to
Steven's
Point
that
isn't
uniform
across
the
country.
N
It
is
different
in
different
parts
of
the
country
and
that's
part
of
the
the
challenge
of
of
icbs
and
I,
and
the
ICS
Arrangements
is
how
do
we?
How
why?
What
is
different
in
the
areas
where
we
see
that
creative
Commission
of
NHS
Services?
What
what
are
the?
What
are
the
ingredients
which
causes
that
to
happen?
N
I
just
wanted,
if
I
may
just
return
to
the
to
the
the
point
of
this
paper
into
something
that
Mary
said
before,
when
we
did
this
piece
of
work
in
2019
I
think
it
was
the
first
time
we
looked
at
this
piece
of
work
in
in
this
way
and
we
used
a
variety
of
different
tools
to
try
and
understand
what
would
work
to
drive,
change
and
Improvement,
often
and
as
regulator.
You
think
yourself
well
we're
going
to
just
take
some
milk
reaction
against
some
organizations,
and
we
did.
N
We
did
a
number
of
bits
of
of
work
around
in
some
cases
directing
people
in
some
cases
working
with
system
leaders
in
some
case,
providing
some
information
and
I
think
that
what's
interesting
about
this
piece
of
work
is
the
effect
fact
that
it's
had
hasn't
been
a
cause
and
linked
to
a
number
of
different
types
of
interventions.
So
it's
not
a
big
thick
report
that
goes
that
goes
out.
Everybody
reads:
this
is
some
targeted
information,
some
nudging
of
conversations
that
have
happened
at
regional
and
local
level.
N
What
I
really
like
about
this
is
three
years
on
we've
been
able
to
see
it
at
the
the
tangibility
of
that
change.
I,
think
the
challenge
for
all
of
us
is
this
is
a
great
piece
of
work
and
there's
some
some
people
close
here
today,
colleagues
elsewhere,
that
have
contributed
to
it
this
this
I
think
this
is
an
opportunity
to
use
this
and
and
the
work
we've
done
before
in
in
driving
improvement
to
to
to
make
sure
that
what
we
do
at
the
time
we
write.
N
A
first
report
has
the
ability
to
be
Revisited
later
so
that
we
can.
We
can
demonstrate
the
value
of
the
things
that
we've
that
we
took
in
at
original
2019-2020
piece.
L
Thanks
so
much
Chris,
okay.
A
For
no
more
comments
I've
been
in
the
sense
we're
asked
to
just
consider
what's
happening,
but
I
mean
well
done.
I
did
have
two
comments.
One
I
think
we've
dealt
with,
which
is
just
making
sure
we'd
reflected
on
what's
working
about
this,
but
Kate
I.
Think
you
dealt
with
that
in
your
opening
remarks,
and
you
know
there's
lessons
for
this
about
having
the
right
sort
of
focus
now
use
something
bring
about
Improvement.
We
can't
bore
the
ocean,
but
there
are
some
things
where
we
can
make
a
difference
reasonably
quickly.
A
The
other
thing
simple
personal
request,
but
like
so
many
documents,
it's
very
difficult
to
find
out
when
this
was
produced.
Could
we
stick
a
date
on
the
front
page?
So
you
know
you've
got
to
go
a
long
way
through
this
before
you
find
out
when
it
was
produced
between
or
when
it's
on
the
Shelf
will
matter.
A
A
Moving
swiftly
on,
as
they
say,
we're
running
a
little
bit
behind
schedule,
but
I
think
we
can
make
it
up
on
the
next
couple
of
items
we're
now
looking
at
the
business
plan.
As
we've
already
said,
this
is
not
for
approval
at
this
stage.
But,
okay,
do
you
want
to
just
say
a
little
bit
about?
We
are
I
know
we'll
ask
Chris
to
talk
in
a
bit
more
detail.
H
Thank
you.
So
this
is
our
final
draft
of
the
business
plan
before
it
comes
to
board
in
May
and
as
I
mentioned
earlier,
when
we
were
talking
about
the
listening
learning
and
responding
to
concerns
review,
it's
really
important
that
we
have
the
opportunity
to
digest
that
review
and
for
that
review
to
plug
into
this
business
plan
as
well.
So
without
further
Ado
I
will
hand
over
to
Chris.
X
Thank
you
Kate.
It's!
Yes,
as
you
can
see
a
business
plan
for
2023
through
to
2026.
So
final
draft
we've
set
out
what
we
want
to
deliver
and
this
time
we've
tried
to
ensure
there's
a
clear
alignment
through
to
the
strategy.
So
you
can
see
the
the
the
the
the
structures
based
around
strategic
themes.
X
We've
also
tried
to
introduce
the
concept
of
all
KRS,
so
we've
got
objectives
and
then
key
results
and
tried
to
clearly
illustrate
how
how
they
will
work
in
the
organization
and
we're
going
to
try
and
flow
them
down
right
down
to
individual
objectives
in
the
organization
we've
pulled
together
a
summary.
So
we
you
can
see
the
kind
of
the
detail
of
the
structure
of
the
plan,
but
then
we've
to
help
illustrate
this.
X
For
the
reader,
we've
got
a
three-page
summary
one
around
objectives
and
two
around
key
results
and
as
care
to
the
end
of
alluder,
too.
We've
got
placeholders
for
in
three
areas
for
the
publication
of
the
llrc
review,
our
our
risks
that
we've
got
as
an
organization.
Nano
budget
is
included
there
as
well,
but
that's
all
I
was
going
to
cover
so
I
would
say
any
questions.
Okay,.
U
I
I
think
it's
very
helpful
and
I'll
follow
it
with
some
detailed
comments.
I
just
think,
I
I
think
it's
quite
important
in
a
few
places
where
we've
got
where
we're
talking
about
Improvement
and
we're
talking
and-
and
we
haven't
yet
got
to
the
to
the
measures
that
we're
going
to
use
to
make
sure
that
we
can
not
only
establish
a
measure,
but
we
can
try
and
establish
a
baseline
as
well.
U
So
we're
not
waiting
two
years
to
work
out
whether
we're
moving
the
the
dial
in
relation
to
that
and
just
to
mention,
because
it
came
up
in
in
in
in
rgc,
I.
Think
there's!
You
know
there
is
work
to
do
in
terms
of
our
it's
great
to
see
a
commitment
in
in
relation
to
out
of
hours
inspections,
but
actually
there's
work
to
do
in
terms
of
making
sure
that
we're
measuring
that
accurately.
It's
not
just
it's
not
it's
not
inspections
that
spill
out.
V
U
These
are,
these
are
inspections
that
are
intended
to
take
place
primarily
outside
normal
normal
working
day,
but
I'll
follow
up
with
some
decent,
but
I
think
it's
really
helpful.
A
Or
comment
I
mean
it's
not
like:
we've
never
seen
anything
like
this
before
and
you've
clearly
taken
on
board
comments
in
in
other
four
or
so
the
not
surprising
one
way.
If
we
don't
have
huge
numbers
of
questions,
but
if
they're
a
non
I
just
had
one
it's,
whether
it's
for
Eucharist
or
Ian,
but
and
obviously
the
plan
can
only
be
delivered
if
we've
got
the
money
so
with
two
sources
of
income.
Can
you
just
comment
on
where
we
are
on
having
certainty
on
that
income.
X
I
can
cover
that
so
we're
level
of
certainty
around
our
fee
income
in
terms
of
granting
Aid.
We
are
wearing
confirmation
from
the
Department
for
our
location
for
next
year,
which
includes
will
be
a
core
allocation,
but
also
include,
for
the
first
time,
additional
funding
around
local
Authority
assurance
and
integrated
care
system,
so
we're
hoping
to
receive
that
imminently
in
terms
of
our
allocation,
but
as
yet
we're
awaiting
confirmation.
A
L
A
Doubt
you'll
tell
us
PDQ
if,
if
there's
a
problem
there,
thank
you
I'd
love
for
no
questions
from
colleagues.
Thank
you
very
much.
Indeed,
I'd
like
to
be
catch
up
some
time,
I
wasn't
expecting
to
catch
up
quite
so
much.
A
J
Ian
there,
as
ever,
the
report
from
the
executive
team
is
split
into
two
components.
One
is
a
regulatory
matters
and
one
is
organizational
matters
if
I
kick
off
with
the
regulatory
matters
and
I'll
pause,
and
then
we
can
move
on
to
the
second
second
part,
so
I
think
take
the
report
as
read
in
terms
of
the
detail,
but
a
couple
of
things
I
did
want
to
pull
out.
J
One
is
that
we
continue
to
focus
on
Mental,
Health
Services
and
for
those
with
a
learning,
disability
and
autistic
people,
and
the
second
thing
I
wanted
to
particularly
pull
out
from
from
from
this
first
first
section
was
that
from
the
1st
of
April
we'll
begin
our
work
on
Assurance
of
local
authorities
in
terms
of
their
care
activities,
and
the
reason
this
is
important,
I
think,
is
because
one
of
the
largest
extensions
of
our
powers
in
quite
a
long
time-
and
if
you
add
in
the
work
we'll
be
doing
around
integrated,
Care
Systems.
J
This
is,
this
is
an
enormous
extension
of
powers,
but
I
think
more
importantly,
it
will
give
us
an
opportunity
to
really
understand
the
experience
of
people
who
use
services
and
I
think
we
touched
on
that
a
little
bit
there
in
the
previous
item
around
Dentistry,
but
I
think
ICS
is
again
and
again
it
will
be
the
vehicle
through
which
people
experience
Care
on
the
Cotton.
Some
important
conversations
around
inequalities
and
so
forth
will
be
for
the
first
time
able
to
to
really
have
a
really
good
view
of
that.
J
So
it's
a
really
important,
Milestone
I,
think
in
terms
of
in
terms
of
our
work,
so
I'm
going
to
pause
there
in
and
and
ask
questions
and
I'll
take
questions,
and
then
we
can
move
from
there.
L
A
J
You
so
moving
on
to
the
second
part
of
the
organizational
matters
part
of
the
of
the
report
again
take
taken,
has
read
this
detailed
performance
information
there
and
colleagues
can
can
pick
up
the
the
detail
as
needed,
but
I
think
it's
worth
just
making
the
point
that
during
this
first
quarter
of
the
calendar
year,
we
focused
on
areas
of
higher
risk
in
terms
of
our
our
work
in
healthcare,
as
well
as
in
adult
social
care,
but
in
adult
social
care.
J
We've
gone
beyond
that
and
we've
carried
out
a
number
of
increasing
capacity
inspections
and
that's
really
about
reviewing
whether
we
can
see
if
care
services,
if
care
homes
in
particular,
have
improved
enough
for
local
authorities
to
to
place
people
there.
We
worked
in
conjunction
with
directors
of
adult
social
care
and
as
of
the
16th
of
March,
we
had
400
and
we've
done
487
inspections
with
around
half
leading
to
expectations
of
increasing
beds.
That,
in
turn
translates
into
additional
capacity
in
in
local
Health
and
Care
Systems.
J
So
I
just
want
to
just
record
my
thanks
to
the
adult
social
care
teams.
We
began
with
a
target
of
300
inspections.
They're
now
487
I
I
think
that
number
is
probably
a
little
bit
higher
than
that,
as
we
sit
here
today,
so
a
fantastic
piece
of
work
by
adult
social
care,
colleagues,
so
I
I,
that's
all
I
really
wanted
to
say
other
than
just
just
to
just
to
record
that
that
fantastic
work
by
the
team.
Thank
you.
P
Just
thank
you.
Ian
I,
just
thought
it'd
be
helpful
if
I
gave
you
the
hot
off
the
presses
figure
from
yesterday
we're
now
up
to
545,
increasing
capacity
inspection
so
well
well
over
our
300
targets
and
just
to
underline
what
Ian
said
gratitude
to
the
teams
and
it's
not
just
being
the
adult
social
care
teams.
It's
been
teamed
from
around
operations
who
have
also
pitched
in
and
I
think
that
will
make
a
real
contribution
to
to
the
number
of
beds
available
in
the
care
sector.
K
Just
to
pick
up
on
that
same
point
and
to
ask
kind
of
is
great
work
terrific
to
have
expanded
Supply,
but
is
there
a
bit
of
a
leaky
package
here
because
later
on,
when
we
get
on
to
all
of
that
really
interesting
information
about?
What's
going
on
in
different
ICS
areas,
there
seems
to
be
quite
a
pattern
of
care
home
saying,
but
we
can't
fill
all
of
the
places
we
now
have
anyway.
K
So
you're
successfully
increasing
the
supply
of
places,
it
doesn't
get
us
all
the
way
does
it
to
those
places
actually
being
filled
on
a
on
a
funded
basis,
I'm
just
trying
to
sort
of
see
the
relationships
really
between
this
bit,
which
is
fantastic
and
the
later
information
about
the
the
actual
Trends
in
in
supply
of
filled
places.
Okay,.
H
This
has
been
a
bit
of
an
art,
not
a
science,
but
the
reason
why
we
wanted
to
ask
directors
of
Social
Services
to
identify
these
homes
for
us,
and
then
we
use
that
request
alongside
our
own
intelligence
was
to
say.
Is
there
a
care
home
in
your
patch,
where,
if
we
went
out
and
re-rated
we'd
probably
find
good
yep
does
that
care
home
have
spare
Bears
yep
and
if
they've
got
spare
beds,
do
they
accept
your
local
Authority
rates?
H
So
so
the
reason
why
we
went
through
the
Das,
the
director
of
adult
social
services
Rue
was
it
was
a
key
to
making
sure
we
targeted
our
efforts
to
rewrite
Services,
where
the
local
Authority
could
commission.
When
you
look
at
the
the
information
that
comes
in
the
report
that
we'll
be
discussing
next,
the
two
top
reasons
why
Care
Homes
say
that
they've
got
capacity?
That's
not
been
used.
H
The
first
is
Workforce,
so
they've
got
beds,
but
they
can't
let
people
in
because
they
don't
have
the
carers
to
staff
them
and
then
the
second
is
around
commissioning
Behavior.
So
so
this
is
our
our
little
contribution
to
supporting
system
pressures
and
we
have
a
notional
number
of
beds
released
as
a
result
of
this
work,
and
we've
come
to
that.
By
that
the
point
the
inspector
re-rates
and
Rings
up
the
local
Authority
we're
asking
the
home.
H
How
many
beds
might
this
in
theory,
open
up,
they'd,
say
10,
we
know
10
down
as
a
kind
of
to
give
us
a
flavor
of
what
additional
capacity
might
have
been
unlocked
from
that
work.
A
I
mean
perhaps
as
an
unfair
follow-up.
That's
talking
about
the
number
of
beds
that
are
made
available,
that's
important,
so
they
can
be
utilized.
We've
talked
before
about
problems
of
being
stuck
in
hospitals
unable
to
come
out.
Haven't
we
any
information
or
sense
of
what
it's
like
on
the
other
side
of
the
of
the
divide?
In
other
words,
are
we
seeing
impacts
in
hospitals.
M
I'm,
not
aware
that
there's
been
any
step
change
in
the
ability
of
hospitals
to
discharge
to
social
care
sites
recently.
But
but
we
don't
have
figures
from
very
recent
months,
so
there
may
be
I,
wouldn't
think
what
we
know
now
excludes
the
possibility
that
there
might
have
been
a
change.
A
N
Chris,
so
we've
from
the
work
we've
done
with
with
some
ICS
leaders.
It's
clear,
don't
forget
these.
These
these
beds
are
spread
in
different
parts
of
the
country,
so
I
think
we
are
beginning
to
see.
Certainly
it's
been
there's
been
some
Improvement.
N
The
key
thing
for
me
is
making
sure,
as
the
adult
social
care
survey
will
say
next
in
the
next
item,
the
the
ability
of
the
adult
social
care
provider
to
be
confidently
commissioned
by
the
by
the
the
the
the
local
Authority
and
or
by
the
NHS,
to
ensure
that
capacity
is
available
is,
is
I,
think
critical
at
the
moment.
So
we
want
to
make
sure
that
we
not
only
that
that
capacity
exists,
but
it's
but
it's
well.
It's
well
used
and
it's
well.
It's
well
understood
and
I.
L
J
J
There's
also
I,
think
the
number
of
of
locations
that
are
registering
and
de-registering
again,
first
of
January,
as
you
can
imagine,
is
a
is
a
there's,
a
lot
of
turnover
in
terms
of
in
terms
of
Care,
Home,
registration
and
KMD
registration.
So
I
think
that
sort
of
registration,
funding
and
Staffing,
and
then
our
work
are
some
of
the
factors
that
impact
on
this
and
and
Each
of
which
will
have
a
positive
and
a
negative.
So
it
is
quite
difficult
to
to
work
out
the
net
impact.
J
Although
you
know,
the
number
of
people
who
are
who
are
fit
to
be
discharged
and
are
still
in
hospital
remains
at
a
number
that
sort
of
comfortably
north
of
ten
thousand
at
the
moment.
So
it
is
quite
difficult
to
sort
of
net
these
things
off
in
a
very
pure
way,
but
I
think
it's
something.
It
feels
like
an
important
service
that
we
have.
J
We've
stood
up
over
the
last
three
months
and
there's
definitely
a
Reflection
Point
as
to
whether
we
keep
doing
this
on
a
kind
of
ongoing
basis,
rather
than
see
it
as
a
burst
of
work
and
I.
Think
that's
something
we
should.
We
will
reflect
on
in
terms
of
how
effective
has
this
actually
been
in
generating
localized
capacity.
L
A
Chris
tell
you:
I
mean
you've
noted
a
number
of.
A
In
here
seems
to
be
more
than
usual,
but
perhaps
I
just
forgot.
What
was
there
before,
but
is
there
anything
in
there
that
you'd
highlight
particularly
to
this
board
that
we
ought
to
be
aware
of.
N
I
think
that
there
is
a
as
you
say
there
is
a
growth,
though
this
time
of
the
year
often
is
when
both
government
and
other
organizations
are
thinking
about
the
the
the
impact
that
they
want
to
have
in
in
the
coming
Financial
year.
N
I
think
that
there
there's
been
a
number
of
consultations
recently
on.
In
fact,
the
output
of
one
today
on
the
role
of
ICS
is
in
the
future
and
I
think
that
there's
there's
been
a
number
of
conversations
about
both
in
terms
of
prevention
in
Health
and
Social
care
and
the
operation
of
of
systems
that
work
together.
N
N
No
particularly
the
work
that
Chris
ziki's,
the
director
of
mental
health
has
given
to
the
PAC
on
their
inquiry
into
improve
their
Mental,
Health
Services
I
think
there's
some
really
important
work
that
will
come
out
of
that
committee
that
will
hopefully
Drive
some
of
the
things
that
we've
been
saying
in
in
our
Mental
Health
Report,
so
I
think
it's
a
it
has
a
reflection
of
of
the
information
that
we
hold.
N
That
is,
in
some
cases
unique,
and
it's
also
a
reflection
of
the
the
growing
determination
I
think
to
make
system
Effectiveness
a
thing
of
both
the
way
in
which
government
will
work
and
the
way
in
which
the
government
departments
will
think
about
their
role
and
I.
Think
we've
we've
had
a
positive
impact
on
both.
A
Okay,
thank
you.
Kate
I
mean
the.
We
just
came
back
to
the
the
first
part
of
this.
We
touched
on
our
work
at
ICS
as
a
local
authorities
a
bit
earlier,
but
noticing
part
of
the
else.
This
is
all
very
because
last
minute,
as
well
level,
but
for
the
avoidance
of
doubt
and
bearing
mothers
and
public
board,
could
you
just
clarify
exactly
where
we
are?
What
we're
going
to
be
doing
at
each
and
when
we're
going
to
be
starting
I
think
it
might
be
helpful.
H
I
can
so
really
pleased
that
yesterday,
the
final
regulations
that
were
needed
to
commence
our
new
work
around
local
authorities
and
ICS
assessments
from
April
have
been
made
in
Parliament.
So
we
have
all
the
legislative
changes
and
commencement
orders
have
been
laid
to
enable
us
to
start
this
work,
which
is
fantastic.
H
At
the
end
of
February,
we
published
our
planned
approach
for
a
local
Authority
assurance
and
we
published
our
intended
approach
around
integrated,
Care
Systems
a
couple
of
weeks
ago,
and
they
are
still
ICS
there
still
a
few
more
conversations
that
are
needed
on
that
front,
but
for
local
authorities.
The
plan
is
that
from
April
we
will
spend
six
months
looking
at
two
quality
statements
across
152
legal
authorities.
H
So
we're
going
to
look
at
continuity
of
care
and
we're
going
to
look
at
assessing
needs,
so
we're
going
to
take
a
view
across
every
local,
Authority
and
aggregate
that
up
and
and
the
themes
from
that
will
be
featured
in
our
state
of
care
report
in
October
we're
going
to
do
up
to
five
Pilots
over
the
summer
with
five
local
authorities
who
hopefully
will
volunteer
to
come
and
work
with
us.
The
output
of
that
will
be
reports
that
we
will
publish
and
there
will
be
indicative
ratings
for
those.
H
We
have
a
proposal
around
how
we
will
select
those
pilot
areas.
So
we
need
volunteers,
but
also
we've
got
a
plan
about
hopefully
having
a
good
spread
across
the
country,
a
good
mix
of
urban
rural
Etc,
and
we
will
work.
H
We
continue
to
work
closely
with
the
association
of
directors
of
adult
social
services
in
the
local
government,
Association
to
put
that
offer
out
there
in
into
the
sector
and
then
from
September
through
to
December,
we'll
do
up
to
20
local
Authority
assessments,
and
that
will
be
the
start
of
our
formal
two-year
base
learning.
So
that's
local
authorities
integrated
Care
Systems.
H
We
have
been
very
aware
that
we
are
waiting
for
the
Patricia
Hewitt,
a
report
that
is
due
to
publish
kind
of
imminently
and
it's
important
that
that
lands
before
we
before
we
make
our
start.
Our
work
on
ics's,
but
our
current
plans
around
integrated
Care
Systems,
is
again
in
the
first
six
months,
starting
from
April
we'd.
Look
at
42
ics's
through
one
one
quality
statement,
which
is
around
Equity
of
access
and
again
aggregate
up
the
themes
of
that,
and
that
would
feature
in
static
care
and
also
towards
the
end
of
summer.
H
We
would
start
two
pilots
of
two
ics's
integrated
Care
Systems,
where
we
test
the
full
methodology,
publish
the
ratings
Etc,
and
then
we
commence
our
baselining
of
all
ics's
in
the
new
at
the
start
of
the
new
calendar
year.
So
that's
our
plans
with
both
but
great
that,
as
of
yesterday,
the
final
regulations
to
commence
this
work
have
been
laid
in
Parliament.
A
So,
as
you
say,
subject
to
whatever
comes
out
of
the
Hewitt
review,
I
think
technically,
due
this
week,
we'll
see,
we've
clearly
worked
with
a
lot
of
organizations,
including
those
who
will
be
subject
to
worry
I
think
you
mentioned
the
local
government
Association
are
there
any,
but
but
you
do
see
in
the
media.
Sometimes
people
talking
about
you
know
it
could
have
been
done
faster
or
slower
or
whatever.
Are
there
any
sort
of
unresolved
issues
out
there
about
what
we're
doing
or
is
it
all
now
agreed.
H
So
I
I
think
it's
important
to
recognize.
We've
spent
the
last
18
months,
working
with
an
expert
advised
group
of
people
with
lived
experience,
their
families,
local
government,
Health,
Partners
Etc.
So
our
approach
that
we
have
published
in
the
last
month
or
so
has
been
based
on
that
co-production,
and
we
are
incredibly
grateful
for
the
input
we've
had
from
from
local
government,
in
particular
around
local
Authority
Assurance,
to
shape
our
our
plans.
So
so
we've
got
to
a
point
where
I
think
there
is
Broad
support
for
our
approach
going
forward.
H
I
think
new
Assurance
assessment
always
comes
with
possibly
a
degree
of
trepidation,
which
is
why
the
fact
we
did
tests
and
learns
last
year,
which
is
our
pilots
and
the
fact
we're
going
to
do
some
more
pilots
as
these
new
powers
switch
on
from
Monday
I.
Think
that's
critical
in
terms
of
building
confidence
about
our
approach
as
well.
But
we've
got
to
this
point
in
the
day,
through
fantastic
kind
of
collaboration
with
our
people
who
services
and
our
stakeholders
to
design
the
approach
we're
going
to
be
going
live
with.
A
Thanks
so
much
indeed,
so
any
other
questions
or
comments
from
the
the
reporting
updates.
Okay.
Well,
thank
you
very
much
for
the
executive
team
for
those
updates.
Why
don't
we
move
on
Chris
I
think
we?
This
was
all
down
to
you
presenting
a
report,
you've
done
on
our
work
and
they
do
good
care
center.
Now
that
social
care
we
touched
on
it
already.
We.
A
N
So,
just
to
say,
with
thanks
to
colleagues
in
the
data
Insight
team,
as
well
as
the
engage
team,
this
is
the
first
report
of
its
kind.
That
brings
together
some
of
what
we
know
from
the
early
analysis
of
both
providers
and
ics's,
and
it
helps
to
pick
up
on
some
of
the
regional
Trends
and
differences
that
we've
begun
to
see
and
we've
actually
seen
through
state
of
care
over
the
last
two
to
three
years.
N
Just
to
give
you
a
sense
of
what
the
report
shows
and
obviously
you
you've
got
the
the
detailed
information
in
front
of
you.
The
scale
of
the
variation,
both
in
terms
of
its
breadth
and
depth
is
quite
significant
and
perhaps
more
significant
than
we
felt
two
or
three
years
ago.
Adjoining
regions
have
significantly
different
disparities
in
terms
of
quality
of
care.
N
N
N
So
we
want
to
use
this
information
to
help
inform
some
of
the
conversations
with
ics's
in
in
the
coming
weeks
and
months.
We
also
want
to
help
explore
and
address
the
longer
term
challenges
if
we
are
to
improve
outcomes
for
people
and
if
that
in
areas
where
there
is
higher
end
lower
degrees
deprivation.
N
What
are
the
challenges
for
local
leaders
in
different
areas
and
how
does
CQC
work
with
those
local
leaders
to
share
Innovation
across
a
local
area
and
to
help
its
tackle
the
problems
it
faces
in
terms
of
other
social
security
is
clear
that
the
workforce
shortages
are
still
the
significant
limiting
factor
in
driving
growth
into
the
outside
social
care
market,
and
this
has
been
felt
more
significantly
in
some
areas
than
others,
as
was
highlighted
by
the
sector.
Pulse
check
that
care
England,
pointed
pointed
out
and
produced
this
week.
N
Finally,
involving
the
importance
of
involving
those
responsible
for
delivering
and
receiving
care
together
can't
be
overstated.
We've
seen
already
many
good
examples
of
icses
that
have
that
have
really
looked
at
the
relationship
between
organizations
and
people
using
services
and
designed
service
transformation
around
them.
So
we
want
to
make
sure
that
we
can
use
this.
This
work
going
forward
in
in
the
in
the
months
to
come
to
not
only
describe
what
we
see
but
also
to
describe
where
we
see
good,
Innovative
and
outstanding
practice.
N
It
so
the
data
comes
from
three
I
guess:
key
sources:
the
data
that
we
hold
from
Partners,
such
as
NHS
England,
so
that
that
forms
a
basis
of
much
of
the
information
that
we
hold
about
the
NHS
the
data
we
we
glean
ourselves
from
our
own
inspection
activity
in
our
own
data
collection
and,
as
I
mentioned
earlier,
the
survey
work
that
we
did
that
was
unique
to
this
piece
of
work.
So
those
those
three
components
make
up
the
the
the
the
the
summary
of
the
information
which
forms
the
report.
N
Obviously
the
first
two
of
those
will
be
an
ongoing,
a
dissection
of
data,
and
we
will
we
hope
in
to
be
able
to
replicate
this
I.
Think
one
of
the
really
interesting
things
for
me
is
that,
as
as
we
move
to
our
new
model
of
of
working,
where
teams
are
coming
together
with
their
cross-sector
experience,
I'm
really
I'm
really
looking
forward
to
to
us
being
able
to
form
a
view
of
areas
through
the
work
that
teams
do
so.
N
Hospital,
inspectors,
working
and
teams
working
with
adult
social
care
teams,
working
with
primary
care
teams
to
form
a
view
of
a
patch
and
to
give
an
ongoing
commentary
about
what's
happening
in
that
area,
and
why
so
I
think
this
is
the
beginning
of
something
that
will
hopefully
drive
an
understanding
of
how
areas
are
performing
in
more
in
real
time,
which
again
will
help
us
I.
Think
in
trying
to
to
drive
improvements
and
change
in
each
local
area.
R
N
We've
been
talking
to
colleagues
in
adult
social
care,
Martin
Green
in
particular,
and
I
think
there's
a
way
of
making
this
a
regular
occurrence.
This
is
the
first
time
we've
done
this
work
and
I
think
Martin
would
say
that
they
they
just
completed
a
similar
survey,
but
I
think
the
way
we
can
do
this
together
to
form
a
constant
view
of
how
things
are
changing.
Going
back
to
my
conversation,
we
had
earlier
about
trust,
I,
think
there's
also
something
about.
Why
are
you
asking
these
questions?
N
Are
we
going
to
be
regulated
against
some
of
the
outcomes
and
actually
we're
looking
we're
looking
through
a
different
lens
when
we
ask
these
questions,
so
I
think
it's
about
making
sure
that
providers
feel
confident
about
how
we
use
that
information.
Hopefully,
today,
as
they've
seen,
the
outcome
of
this
they'll
see
that
what
we're
trying
to
do
is
to
form
a
picture
of
how
areas
are
performing
so
I'm
I'm,
confident
that
we
can
improve
the
participation
in
this
survey.
N
I
mean
just
to
say
it's
it's
it's
bigger
than
most
surveys
that
that
other
organizations
put
out
in
terms
of
in
terms
of
volume,
I,
absolutely
agree
with
you.
It
could
be
better
but
I,
think
we'll
as
we
gain
the
confidence
and
The
Trusted
providers
about
how
we're
using
this
information
I
think
we'll
more
regularly
be
able
to
get
into
it.
I
think
there
good
partners
and
and
Mark
and
his
team
have
demonstrated
this
on
numerous
occasions.
N
The
more
you
can
simplify
the
process
of
completing
the
information,
the
more
you
can
make
it
easy
to
complete
and
the
more
it
fits
in
with
their
view
of
how
they,
how
they
interact
with
us
more
generally,
I
think
we'll
be
in
a
much
stronger
position
and
again
I'm
really
excited
about
the
work
we've
got
on
the
provider
portal.
I
think
it
gives
that
ability
to
have
more
real-time
conversations
with
providers
than
to
provide
the
information
and
what
is
a
meaningful
way
for
us
that
enables
us
to
provide
more
content.
A
Caleb
Chris,
just
on
that
theme
just
be
quite
clear
understand.
You
said
that
the
survey
is
not
representative.
Well,
I
can
understand.
You
know,
statistically
that's
correct,
but
do
you
actually
mean
it's
not
representative,
in
which
case
what's
the
real
picture,
or
are
you
trying
to
say
that
it
may
not
be
represented.
A
C
N
I
I've
I
spoke
to
I've
spoke
to
colleagues,
colleagues
in
different
parts
of
social
care
in
care
England.
They
think
that
the
outcomes
here
are
exactly
the
same
as
the
outcomes
that
they've
received
elsewhere
with
the
survey
work
that
they've
done
so
I
think
this
is
representative
just
to
be
really
clear
in
a
in
a
technical
sense.
It
may
not
it's
a
small,
it's
a
small
sample
size
but
I
think
the
outcomes
and
the
information
that
we've
gathered
here
are
are
consistent
with
what
care,
England
and
other
organizations
have
gathered.
N
One
of
the
really
interesting
things
about
this.
Are
it
explores
I
think
in
in
some
interesting
detail?
What
organizations
need
to
be
financially
stable
and
I?
Think
one
of
the
interesting
things
that
Martin
I
were
talking
about
was
what
are
providers
looking
for
in
terms
of
financial
stability
and
being
able
to
recruit.
So
one
of
the
issues
is
the
challenges
around
Recruitment
and
I.
Think
you
know,
there's
a
it's
a
it's
a
sort
of
a
known,
a
known
issue
that
adult
social
care
organizations
are
struggling
to
recruit.
N
Part
of
the
issue
in
some
areas
relates
to
what
price
they
can
they
can
charge
at
and
the
other
in
in
other
parts
it
relates
to
have
I
got
con,
am
I,
do
I
know,
I'll,
have
the
continuity
of
funding
in
place
in
two
years
time
and
I
think
trying
to
tease
out
what
issues
are
in
what
part
of
the
country
at
what
time
will
be
will
be
interesting,
so
I
I
do
think
this
is
representative
I.
Think
talking
to
colleagues
who
who
are
outside
here.
N
They
they
confirm
that
the
information
is
is
representative
of
what
they
found
elsewhere,
but
I
think
there's
more
work.
We
can
do
to
increase
the
regularity
of
this
and
to
make
it
more
part
of
just
how
we
gather
the
information
more.
A
Generally
I
mean
it
sort
of
sounded
very
detailed,
but
I
that
sounds
right
in
whatever
assume,
but
I
think
the
risk
is
that
we
undermine
the
report
by
the
comment
that
the
pages
aren't
numbered.
But
it
does
say
here
it
gives
insights,
but
it's
not
representative
I
suggest
you
change
those
words
to
say
that.
A
We're
suddenly
racing
through
all
these
things,
Chris
I
just
heard
in
the
intro
you
referred
to
so
unused
capacity
of
between
10
or
whatever
it
wasn't
100,
or
they
originally
thought
it
was
a
typo.
But
then
I
see
that's
on
the
main
report.
So
what
sort
of
organization
has
a
hundred
percent
unutilized
capacity
I
mean
obviously
bankrupt.
N
What
so,
as
we
talked
about
about
this
early
in
terms
of
registration,
when
organizations
are
initially
registered,
they
will
have
a
news
capacity
at
the
point
where
they
they
establish
themselves
so
that
there
aren't
there
are
a
group
of
those
and
actually
there's
a
number
of
organizations
that
have
that
have
come
into
being,
that
weren't,
that
they're
not
taking
over
an
initial
organization,
but
they
are
relatively
relatively
small.
I
think
there
is
a
there
is
an
interesting
there.
N
Position
with
organizations
that
have
got
sort
of
in
that
20
10
20
capacity
range,
which
is
a
combination
of
what
they
would
need
in
terms
of
financial
stability,
to
to
feel
that
they
can
unleash
a
sort
of
another
area
of
their
of
their
organization
and
also
what
they
would
need
practically
to
in
order
to
recruit
the
right
staff
to
to
deal
with
that
and
I
think
this.
This
is
worth
one
of
the
things
that's
worth
exploring
further
about.
Well,
what
is
the
actual
barrier
to
unleashing
that
potential?
N
As
Kate
said
earlier,
we
focused
the
Tyson's
work
on
on
the
on
the
inspections
to
drive
up
capacity
have
mainly
focused
on
organizations
where
we
know
the
spare
capacity
can
be
utilized
because
it
it
they
will
conform
to
local
Authority
rates.
A
O
Just
a
good
guy
I
think
it's
really
good
by
the
way
Chris
I
think
it's
a
good
sort
of
solid
Dayton
will
always
vetted
and
improve
it.
I
think
over
time,
I'd
be
interested
in
where
you
see
this
going
because
you
you've
given
a
really
good
sort
of
overview
and
you
you
know
and
there's
certain
patterns
that
you're
sort
of
seeing
you
know
capacity
with
financial
stability
with
you
know
recruitment
over
time.
N
Absolutely
that
so
I
mean
what
I
try
to
do
with
this
is
to
set
a
a
baseline
deliberately
before
we
took
over
the
the
formal
assessment
of
ics's
and
and
local
authorities.
What
I
really
want
this
to
do?
Going
back
to
the
point,
I
made
I
really
like
this
to
become
perhaps
a
quarterly
update
on
on
how
we
see
areas
performing
across
both
you
know
Health
and
Social
care.
N
I
think
that
gives
it
gives
us
more
understanding
when
we
come
to
regulate
ics's
and
local
authorities,
and
hopefully
it
will
give
those
organizations
a
sense
of
the
what's
worked
and
what's
not
worked
in
other
areas.
So
I
really
like
to
see
this
become
a
sort
of
regular
feature.
That's
accordingly
feature
of
what
we
do.
That
gives
an
understanding
that
builds
into
a
state
of
care
which
is
obviously
once
a
year,
but
it's
it's
tan.
N
It's
tangibly
designed
to
be
an
aid
to
ics's
and
local
authorities
to
let
them
understand
how
their
area
is
working
with
their
thinking
about
their
one
year
or
three
year
plan.
They
can
look
at
our
information
and
it
can
act
as
a
guide
for
the
things
that
they
think
they
need
to
do
and
also
they
can
look
at
what
what's
happening
elsewhere
to
see.
If
anything,
they
can
learn
from
other
partners.
But
that's
exactly
what
I'd
like
to
try
and
do
with
it.
J
I
think
just
to
build
on
on
that
I
think
what
is
explicitly
not
attempting
to
do
is
to
kind
of
rate,
ics's
or
regions.
I.
Think
I
think
what
this
does
is
asks
a
really
important
set
of
questions.
It
demonstrates
variation.
It
asks
questions,
presents
the
information
in
a
slightly
different
way,
which
I
think
gives
it
gives
the
leaders
of
these
areas
an
opportunities
to
ask:
ask
those
questions
and
to
look
at
how
they
what
their,
whether
their
actions
have
driven
improvements.
J
It
is
explicitly
not,
though,
some
attempt
to
rate
things
in
a
in
a
fairly
crude
way,
which
which,
which
is
not
what
this
is
not
what
this
is
in
Tennessee.
So
it
was
important
just
to
kind
of
say
that
explicitly,
because
sometimes
the
the
this,
this
sort
of
these
tables
can
be
in
sort
of
misinterpreted
in
the
wrong
ways.
A
Chris,
it
would
presumably
be
useful.
You
say
you
won't
do
this
all
regularly,
but
as
the
ICS
has
mature,
sharing
it
with
them,
and
obviously
this
isn't
done.
This
is
I
mean
it's
one
of
the
powers
done
by
region.
A
So
you
you
start
to
away
from
the
potentially
misleading
National
statistics
and
the
shows
there
are
big
variations
around
the
national
averages,
but
it
doesn't
map
exactly
to
ICS
stroke,
ITB
region,
so
they
may
have
a
view
on
whether
there's
a
way
of
cutting
at
the
wood
a
slightly
different,
presumably
on
the
the
first
bit
I
mean
this
is
some
of
this
is,
is
just
cleared
down
to
to
a
e
so
sorry
down
to
to
NHS.
A
N
So
so,
yes,
just
to
say
on
the
on
the
regional
analysis,
this
is
our
we
will
be
able
to
get
into
a
more
granular
picture.
The
interesting
some
of
that
this
is
captured
at
the
moment
in
a
regional
Way
by
by
quality
in
NHS
England.
So
they
don't,
they
don't,
there's
not
yet
all
captured
in
a
way
that
splits
out
ics's
so
in
a
sense
we're
partly
working
with
nhse
on
how
this
will
work.
This
is
their
data,
albeit
cut
in
a
particular
in
a
particular
way.
N
N
Remember
that
Birmingham
was
one
of
the
areas
of
the
highest
rate
of
readmittance,
and
it
was
also
one
of
the
areas
at
that
time
that
had
the
the
the
least
availability
of
community-based
care,
so
there
was
there
was
there
was
less
support
for
people
outside
Hospital.
Therefore,
more
people
ended
up
back
in
hospital
and
I
think
those
are
the
sorts
of
those
are
sorts
of
links
that
we
tried.
N
A
A
If
we
move
on,
we've
got
a
number
of
governance.
Related
items,
I
mean
the
first
is
just
the
minutes.
They
were
circulated
previously
anyway,
as
our
normal
practice.
Any
comments
so
can
we
take
them
as
a
five
record?
Don't
see
any
comments?
Okay
approved?
There
was
only
one
action
Chris.
You
might
just
comment
on
this
because
the
due
date
was
down
for
today,
but
I'm,
not
quite
sure,
it's
shown
us
on
track.
So
where
are
we
on
this?
A
X
A
Yeah
so
you're
saying
it
would
have
been
closed
out
on
the
previous
report,
which
I
must
have
I
thought
it
was,
but
it
was
yeah
shows
us,
okay,
their
colleagues
are
happy
if
there
are
new
comments,
we'll
pick
them
up
on
the
next
report.
Okay,
the
so
we
got
a
couple
of
reports
from
board
committees.
The
first
is
the
arak
Jeremy
I
explained
earlier:
I
think
that
you
are
standing
in
the
shoes
of
but
delighted
to
have
your
oral
update
thanks.
Y
Thank
you
very
much
chair,
so
yeah
I
was
going
to
give
you
a
quick
oral
update
on
the
feedback
of
the
meeting
held
earlier
this
month
of
the
audit
risk
and
Assurance
committee,
probably
four
main
areas
to
discuss
briefly.
Firstly,
the
annual
reporter
accounts
for
2021-2022.
These
are
still
not
finalized,
not
a
position
we
want
to
be
in,
but
the
delay
is
because
the
National
Audit
office
is
still
waiting
for
reports
from
the
Auditors
of
the
local
government
pension
schemes,
in
particular
for
the
T
side.
Y
Y
Secondly,
we
did
the
normal
review.
You
would
expect
an
audit
committee
to
do
of
the
risk
register
of
the
particular
focus
on
those
risks
that,
where
there's
a
high
gap
between
our
tolerance
and
our
mitigation,
also
where
there's
a
where
our
mitigation
doesn't
seem
to
have
much
impact
on
risk
and
also
those
above
our
risk
tolerance,
and
we
continue
to
do
that
and
feedback
and
make
changes
to
the
risk
register.
Y
Y
Four
reports
reviewed
at
the
meeting
since
the
last
meeting
in
December
and
their
findings
are
presented
and
discussed.
There
are
still
five
outstand
Universe
to
say
they
will
be
complete
before
the
audit
opinion.
I
won't
go
into
detail,
but
we
did
do
deep,
Dives
or
updates
on
transformation
risk
in
operations,
transformation,
resourcing
technology,
data
insight
and
counter
fraud
as
well.
Y
So
there's
a
lot,
a
lot
of
detail
going
on
behind
and
then
finally
final
planning
for
the
2020
to
23
accounts,
which
are
going
to
happen
very
shortly
after
the
the
21-22
and
also
planning
for
internal
audit
for
next
year
as
well.
So
we
can
get
on
better
on
the
front
foot
in
terms
of
getting
that
work
started
earlier,
and
is
there
any
comments
from
colleagues
who
are
at
the
meeting
or
any
questions
that
was
my
report.
A
It
was
a
very
long
meeting
as
well.
Wasn't
it
Jeremy
four
hours
or
something
any
questions
from
colleagues
for
Jeremy
no
Mark.
Do
you
want
to
tell
us
where
you
got
to
run
the
last
rcg
meeting.
U
Thank
you.
Yes,
just
an
update
on
what
was
the
second
meeting
of
our
sort
of
relaunch
and
reshaped
regulatory
governance
committee
at
our
committee
were
we're
looking
at
the.
C
U
Of
our
regulatory
model,
how
we're
implementing
that
design
and
what
insights
we
have
as
to
that
it's
actually
effective
in
in
delivering
the
the
the
aim
of
that
of
of
that
design
broadly
are
meeting
falls
into
two
parts.
We
have
a
Core
paper
where
we
look
at
changes
to
regulatory
design,
either
things
we've
initiated
ourselves
or
things
that
are
changing
externally,
a
a
developing
set
of
kpis
relating
to
implementation
and
Effectiveness
and
and
any
third-party
insights.
U
We
we
can
draw
on
to
see
how
we're
we're
doing
I
think
we're
making
good
progress,
particularly
in
relation
to
focusing
down
on
a
suite
of
kpis
that
are
going
to
give
us
the
the
Insight
that
we
want.
U
The
the
two
significant
sort
of
changes
that
we
that
we
looked
at
were
first
of
all,
the
the
agreed
operational
posture
for
NHS
acute
services
and
GP
providers
during
the
winter
period
and
the
assurance
that
we
were
successfully
targeting
indicators
of
the
most
serious
risk
there.
So
it
was
a
good
test
of
our
risk-based
approach
to
regulation
and
we
were
encouraged
by
the
the
evidence
that
we
we've
seen
that
we
are
getting
to
risk
through.
U
The
other
key
area
which
which
Ian
and
Tyson
talked
about
earlier
and
and
Kate,
was
you
know
the
successful
efforts
to
safely
add
capacity
to
the
adult
social
care
sector
through
increasing
frequency
and
number
of
First
of
of
first
time
in
inspections,
an
area
that
we've
looked
at
at
the
board
before
is
you
know
our
surveillance
powers
under
the
regulation
of
investigatory
Powers
Act?
That
is
an
area
that
is
fraught
with
risk
in
that
you've
got
to
make
sure
that
you
do
this.
If
you
do
do
it,
you
do
it
right.
U
The
the
focus
of
our
discussion
at
rgc
was
on
the
on
the
proposed
controls
in
relation
to
that,
were
we
to
do
it
and
we
were
I
think
greatly
assured
by
the
the
rigor
of
the
of
the
governance
and
and
accountability
structures
that
that
are
in
place
in
relation
to
that
and
how
we
might
might
manage
it.
If
we,
if
we,
if
we
do
it,
the
the
Deep
dive
that
we
did
this
time
was
on
our
ratings
and
inspections
process.
U
It
was
helpful
for
all
sorts
of
reasons,
not
least
that
I
think
it
significantly
added
to
our
our
potential
Bank
of
of
of
of
of
kpis
for
our
for
our
Core
paper,
but
it
also
highlighted
something
that's
in
our
toolkit
and
our
ability
to
our
ability
to
suspend
ratings,
which
is
something
that
we
do
very
rarely.
We
looked
at
a
few
examples
where
we
have
done
it
and
I
I
think
it's
that
you
know
there's
opportunity
for
us
to
use
that
Tool
more
more
frequently.
U
Our
next
meeting
were
possibly
rather
ambitiously,
trying
to
do
three
deep
Dives.
We
do
we're
going
to
have
a
look
at
at
registration
and
and
what
insights
and
assurances
do
we
have
that?
What
we're
letting
through
the
front
door
is
of
the
of
the
right
quality
we're
looking
at
silent
Services.
U
You
know
those
those
Services
where
we
don't
have
the
benefits
of
insights
from
whistleblowers
or
people
speaking
up
in
the
in
in
the
service.
You
know
how
can
we
be
sure
that,
without
that
core
source
of
information
in
our
toolkit
we're
getting
to
the
right
risk
and
we're
also
going
to
have
a
look
at
our
our
role
in
relation
to
Market
oversight
and
the
the
interventions
that
we
have
available
to
to
to
help
shape
the
market?
So
that
will
be
for
the
the
next
meeting.
A
Pray
for
the
agenda.
Thank
you
for
the
report.
Mark
any
questions
for
Mark,
no
okay.
Well,
look
thank
you
for
that.
I
think
that
brings
us
on
to
any
other
business.
I
did
flag
at
the
beginning.
There
were
two
points:
I
wanted
to
pick
up
now
regarding
board
level.
Appointments
I'll
take
them
individually.
A
The
first
is
appointment
of
a
senior
independent
director.
It's
not
a
mandatory
regulatory
requirement,
but
it's
certainly
regarded
with
practice.
I
think
we
should
have
one
we
did,
but
our
that
was
Mark
Saxton,
who
stood
down
a
few
weeks
ago
since
the
last
board,
so
we
should
have
another
senior
independent
director.
A
I
have
talked
to
people
outside
the
room.
So
there's
no
big
surprise
for
if
anyone
listening
was
proposing
that
Bach
Chambers
should
take
on
the
role
Marx
worked
with
a
lot
of
boards
in
different
sectors,
both
public
and
private,
so
I
think
a
well
experienced
the
way
these
roles
would
operate.
So
Mark
is
very
willing
to
take
that
role
on
so
can
I
have
colleagues
agreement
that
he
will
become
the
senior
and
event
director.
A
Thank
you
very
much
on
any
other
and
it
links
a
little
bit
back
to
the
very
first
session
today.
Is
the
speak
up
Guardian
internally
that
role
or
a
bit
of
a
different
policy,
but
that
role
was
held
by
the
chair
of
the
audit
committee.
That
is
a
relatively
normal
construct
in
my
experience,
but
it's
not
a
mandatory
requirement.
A
The
board
chair
of
our
audit
stored
and
risk
committee
retired
from
the
board
at
the
end
of
December,
the
I
did
mention
earlier
when
I
introduced
Jeremy
that
we
have
not
yet
got
agreement
to
advertise
for
a
new
audit
committee
chair
so
realistically,
I
can
see
it
being
six
months
away
before
we
appoint
anyone
at
best,
or
rather
we
don't
appoint
before
one
is
appointed
and
I,
don't
think
we
should
be
without
but
Jeremy,
although
doing
a
great
job
showing
the
audit
committee
I,
don't
think,
is
the
right
person
to
take
on
the
role,
because
he's
not
a
member
of
this
board
and
I
think
it's
important.
A
It
should
be
a
member
of
this
board
that
takes
it
on
so
have
asked
Stephen
Marston
if
he
will
take
it
on
Stephen
in
any
event,
is
on
behalf
of
the
board,
providing
a
link
to
and
some
oversight
of,
the
NGO
which
I
know
from
feedback
from
then
is
is
going
well
and
thank
you
Stephen,
so
actually
I
think
there's
a
bit
of
synergy
here
anyway.
What
I
suggested
this
evening?
A
If
he
could
take
this
on
temporarily,
that's
not
to
say
it
will
necessarily
change,
but
I
think
you
know
we
would
expect
several
new
appointments
Neds
over
the
course
of
next
year
and
I.
Think
at
that
stage,
rather
than
have
three
people
on
the
board
now
who've
got
a
huge
number
of
responsibilities
and
three
that
have
none.
It
would
make
sense
just
to
look
again
but
I
mean,
as
I
say.
That's
probably
some
time
away
so
Stephen
very
kindly
agreed
to
to
to
take
this
on.
A
So
with
colleagues
agreement
I
would
like
to
say-
and
it
will
go
straight
on
the
website
straight
after
this
meeting
that
has
taken
on
the
speak
up
Guardian.
So
if
everyone's
happy
for
that
to
start
with
and
that
Mark
complements
the
the
point
you
made
earlier
about
you
having
the
executive
responsibility,
so
those
were
the
two
any
other
business
I
wanted
to
raise.
A
I'll
just
look
around
the
room
as
to
whether
anybody
else
wanted
to
raise
anything.
Okay.
Well,
look.
That
concludes
the
formal
business
of
the
meeting,
so
I'll
close
that
down.
A
A
N
The
further
follow-up
of
that
is
is
led
by
the
inspector
now
I
know
our
llr
review
and
the
recommendations
that
we've
we've
talked
about
today.
I
think
we
need
probably
a
more
consistent
approach
for
how
we
feed
back
to
people
and
how
their
information
is
is
being
shared
with
us.
So
we've
got
some
thoughts
about
how
we'd
more
consistently
do
that,
partly
through
the
use
of
technology
and
partly
through
the
way
in
which
we
may
change
some
of
our
systems
and
processes.
N
But
it's
fair
to
say
that
it
is
used
at
the
moment
to
to
give
people
acknowledgment
that
we've.
We
have
that
information
I
think
with
a
way
in
which
we
want
to
change
our
our
systems.
There'll
be
more
of
an
ongoing
dialogue
that
we'll
have
with
some
people.
The
other
thing
that
we'll
try
to
do
in
the
output
of
our
inspection
processes
is
to
give
more
real-time
feedback
on
what
people
are
thinking
about.
A
Okay,
thanks
very
much
and
I
know
we
have
touched
before
I'd
also
the
need
to
work
with
others
on
that.
So,
for
example,
certainly
the
social
care
sector
things
might
go
to
the
local
government
Ombudsman
and
we've
talked
about
how
to
Clarity
between
the
two
of
us
so
we're
clear
who
it
is
that
people
should
be
speaking
to
because
it
does
depend
on
the
nature
of
the
the
report.
A
Sean
a
question
for
you-
and
this
is
very
specific.
How
is
CQC
currently
regulating
the
University
Hospitals
Birmingham
NHS
Foundation
Trust.
M
Thank
you.
We
undertake
ongoing
monitoring
of
this
trust
as
well
as
we
do
with
with
many
other
trusts.
Obviously,
in
line
with
our
policies,
procedures
and
Regulatory
remit,
we
also
engage
on
a
frequent
monthly
basis.
Our
local
local
teams
engage
with
the
Trust
on
a
monthly
basis
to
discuss
any
issues
of
concern.
Recent
activity
regulator
activity
includes
the
identification
of
a
number
of
concerns
at
a
number
of
locations
in
the
trust.
M
As
a
result
of
those,
we
undertook,
unannounced
inspections
of
those
locations
in
December
of
22
last
December
we've
also
recently
in
February
of
this
year,
undertaken
a
maternity
inspection
as
part
of
our
maternity
inspection
program.
The
outcome
of
those
inspections
was
that
we've
taken
some
enforcement
action,
but
the
reports
from
the
inspections
will
be
published
in
the
next
in
the
next
weeks.
In
the
next
few
weeks,.
A
Okay,
thank
you
very
much
Sean,
and
there
is
a
another
one
for
you,
this
one's
slightly
more
General.
The
question
is:
how
is
CQC
currently
regulating
private
providers
and
Medical
Services,
particularly
those
that
are
providing
mental
health
services?
So
that's
a
question,
although
there's
a
rider
that
says
there
seems
to
be
increasing
activity
within
the
private
sector,
which
I
guess
is
behind
the
question.
M
I
guess
when
we're
not
aware
of
any
great
increased
activity
in
the
private
sector,
that's
true
to
say
that
we're
we're
doing
no
fewer
inspections
than
we've
done,
but
I
don't
think,
there's
any
great
increase
in
the
activity
in
the
private
sector
in
terms
of
mental
health,
independent
sector
providers,
we
regulate
those
along
in
line
with
our
risk-based
approach.
M
M
A
A
We
regulate
I,
guess
we'll
come
out
of
that
stage,
but
I
won't
put
you
on
the
spot
for
specifics
now
and
then
we
have
two
questions
both
from
one
of
our
internal
colleagues,
Michael
Matthew,
Egon
who's,
the
Unison
National
officer,
and
they
both
I
guess,
relate
back
to
the
first
session.
We
have
this
afternoon
to
some
extent
I
think
we've
probably
answered
them,
but
nevertheless
we
should
respond
to
the
questions
now.
I'll
take
them
individually.
A
So
the
first
question
was
what
lessons
of
the
chair
and
the
board
learned
from
the
llr
review
in
respect
of
how
they
listened
to
an
Engage,
The
Joint
trade
unions
at
CQC
Ian
is
I
was
going
to
ask
to
respond
to
this,
although
the
question
does
say
chair
and
board,
so
I
don't
actually
know
what
Ian's
going
to
say:
I'm
allowed
to
it.
If
it's
appropriate.
J
Thanks
thanks
and
I
think,
as
we
discussed
earlier
on,
I
think
the
we've
we've
just
seen
the
the
the
review
we've
had.
We
know
that
we've
had
some
very
positive
conversations
with
our
Union
colleagues
over
a
number
of
months,
particularly
around
transformation
and
wider
issues.
I
am
I,
am
I.
J
I
am
optimistic
that
we'll
be
able
to
read
that
report
together
and
as
Scott
mentioned
in
his
in
his
concluding
remarks,
the
trade
unions
are
a
key
partner
in
delivering
the
actions
in
in
that
report,
so
so
I'm
I'm
optimistic
that
we
can
learn
a
number
of
lessons
together
and
I'm,
particularly
interested
in
the
conversations
we
can
have
around
around
race
and
that
whole
issue
of
confidence
in
talking
about
race.
I
think
the
trade
unions
could
be
a
really
powerful
partner
in
in
developing
our
response
in
that
area.
Thank
you.
A
Okay,
I've
only
just
picking
up
a
an
inference
in
here
it
does
say
the
chair
and
the
board
how
they
would
engage
with
the
trade
unions.
I
mean,
as
we
said
before,
I
think
that
the
board
is.
It
is
a
unitary
board,
but
it
employs
the
executive
who
do
have
a
responsibility
for
leadership
of
the
group
as
a
whole,
and
that
would
include,
among
other
things,
engaging
with
the
trade
unions,
I
I.
Don't
think
it
would
be
the
right
answer
for
the
non-executive
members
of
the
board
to
to
deal
directly.
A
I
think
would
do
as
we
did
before
that
discussed
as
a
unitary
board
discussed
openly
with
the
management.
Some
challenges
and
the
management,
as
we
had
earlier,
have
taken
action
to
to
do
things,
including
the
review.
So
I
would
agree
with
what
Ian
said
entirely
from
our
perspective,
but
I
think
it's
probably
helpful
just
to
make
that
distinction
between
the
non-executive
members
of
the
board
and
the
executive
and
then
Ian.
The
second
question
the
similar
vein.
J
I
think,
as
I
said
earlier,
Ronnie
and
we
we
are
already
I-
think
meaningfully
engaged
with
the
trades
units
on
a
number
of
topics.
I
know,
Tyson
and
and
Kate
have
been
speaking
to
them
very
constructively
about.
What's
in
the
llr
review
itself,
and
in
fact
that's
that's
exactly
what
Kate
is
is
now
talking
to
Union
colleagues
and
I'd
expect
we'd
have
we'd
have
a
number
of
similar
and
positive
and
constructive
conversations.
In
The,
Same
Spirit
we've
been
having
them
over
the
last
few
weeks.
Thank
you.
A
Again,
just
as
a
point
of
detail,
I
hope
I'm
giving
the
right
clarification
here,
although
I
mean
the
work
was
commissioned
because
of
things
we
knew,
including
through
the
pulse
survey,
the
staff
surveys
we
did,
but
the
management
have
not
been
involved
directly
or
the
senior
leadership
are
not
being
directly
in
production
of
the
review.
I'd
only
saw
the
results
the
other
day
so
I
mean,
and
the
colleagues
outside
the
board
had
not
seen
the
report
until
a
few
moments
ago.
A
So
you
know
that
although
Ian's
certainly
thinks
Now
relationships
are
much
better
to
be
fair.
When
you
specifically
go
to
the
report
of
the
discussions
between
the
senior
executive
on
the
colleagues
here
about
the
content
of
the
porter
taking
place
as
we
speak,
I
mean
that
people
haven't
got
them
before
and
I
doubt
very
much
given
the
several
hundred
Pages
involved
and
then
the
next
style
they'll
be
going
through
the
new
TI
of
it,
so
I
think
again
just
building
audience
answer.
From
my
perspective,
the
answer
will
be
a
very
large
part.
J
A
Okay,
thanks
very
much
Ian,
so
I
think
that
brings
us
to
the
end
of
the
questions
as
well.
So
if
that's
okay,
I'll
formally
bring
the
whole
session
to
a
close.
A
What's
that
point
of
repeating
thanks
to
absent
colleagues,
although
we
have
noted
huge
thanks
to
the
people
that
loved
that
first
session,
but
thanks
to
my
colleagues
around
the
table
and
for
those
listening
in
we'll
see
you
in
about
two
months
time.
Thank
you.