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From YouTube: CQC Board Meeting - April 2016 (with subtitles)
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A
A
We
have
apologies
this
morning
from
michael
maher
and
from
from
steve
and
mike
has
an
appointment
somewhere
else
will
arrive
at
some
point
during
the
meeting,
but
not
quite
sure
how
early
he's
going
to
be
able
to
get
here
minutes
of
meeting
of
the
23rd
of
March.
Are
they
true
and
accurate
record
of
everything
we
discussed?
Okay,
that's
agreed.
Thank
you
very
much
indeed.
So
the
action
log
everything
I
think
he's
either
not
do
or
what
everything's,
not
you
at
the
moment.
So
that's,
okay!
So
well,
let's
hope,
yeah!
That's
it!
That's
a
positive!
A
B
Peter
good
morning,
everybody
I'll
do
this
very
briefly,
because
it's
a
report
which
shone
17
pages,
but
it's
really
updates
on
positions
and
circumstances
and
situations
at
some
I
think
members
of
the
board
should
be
familiar
with.
So
the
monthly
performance
report
is
there
which
reports
on
febuary
and
that's
at
annex
one.
B
The
only
thing
I'd
pick
out
of
naught
from
that
report
is
productivity,
for
the
first
time
is
on
plan
with
expectations,
and
you
can
see
in
the
bottom
paragraph
on
page
one
that
both
adult
social
care
and
pms
of
continue
to
increase
productivity
of
inspectors
and
that's
responsible
for
that
improvement
in
performance.
I,
don't
intend
to
present
any
more
detail
in
the
lesson
to
the
performance
report:
the
nice
there.
It
speaks
for
itself,
you've,
scrutinize
this
and
previous
meetings
and
the
trends
of
a
parent
they're.
B
Continuing
with
that
one
exception
of
improvements
in
productivity
through
Andrea
and
Steve's
teams,
which
is
very
positive
and
good
news.
The
other
good
news
is
that
pms
have
completed
the
dental
inspections
and
Mike,
and
his
team
have
completed
all
the
non-specialist
acute
trusts,
which
was
a
commitment
that
we
made
to
Parliament,
and
we
discharge
that
by
at
the
end
of
March,
the
reports
are
still
to
be
produced
and
they'll
be
done
over
the
next
three
months.
B
What
follows
next
n
is
some
updates
from
the
various
directorates
from
under
you've
got
an
update
in
relation
to
the
dispatches
programme
of
the
action
that
has
been
taken
in
relation
to
the
branches
in
both
harringay
and
intended
action
in
relation
to
tower
hamlets
branches.
To
carry
out
an
inspection
purpose
of
that
is
just
to
ensure
that
those
people
who
clearly
got
sub
optimal
care
from
the
R&J
branch.
If
the
services
transferred
to
the
tower
hamlets
bradshaw,
receiving
acceptable
care
reporting
on
page
bottom
of
page
for
an
error
in
the
provider.
B
B
Action
was
taken
across
the
senior
management
team
to
ensure
that
the
problem
was
put
right
and
an
apology
was
issued
to
those
people
that
axiom
detect
and
the
word-
and
it's
important,
I-
think
in
the
interest
of
our
transparency
that
we
report
out
to
the
board
and
use
that
analysis
to
improve,
see,
visit
around
and
I.
Don't
have
any
specific
updates
to
bring
to
the
attention
of
the
board.
Over
and
above
the
improvements
in
productivity
that
I've
already
referred
to
so
I'm
not
dwell
on
that.
B
A
mic
if
he
was
here
would
draw
attention
to
the
issuing
of
section
29,
a
warning
notice,
which
we
did
and
we
published
that
through
a
letter
before
we
publish
the
final
report.
This
isn't
what
we
normally
do,
but
was
a
reflection
of
the
significant
concerns
around
the
governance
at
southern
health
that
we
found
on
the
most
recent
inspection
and
again
I
just
wanted
to
draw
that
to
the
board's
attention.
B
We've
now
received
confirmation
from
the
Secretary
of
State
about
the
thematic
review,
which
is
something
that
he
asked
us
to
do
following
the
southern
health,
which
is
an
investigation
into
deaths
across
at
the
NHS
mental
health,
acute
and
maternity
settings.
Do
you
remember
this
was
questioned
about
how
was
southern
in
the
relation
they've
carried
out
inquiries,
an
outlier
from
the
NHS?
It
was
this
something
that
was
consistent
and
we
were
asked
to
undertake
this
review
to
actually
arrive
at
of
you
I.
Don't
think
anybody
had
robust
evidence
so
actually
say?
B
Mental
health
policy
team
have
been
doing
some
work
around
approved
mental
health
professionals.
These
are
this
professionals
that
need
to
be
involved
in
a
decision
to
detain
somebody
under
the
Mental
Health
Act,
and
this
is
something
that
flows
from
the
mental
health
crisis
care
Concord
out.
Where
we've
undertaken
a
number
of
pieces
of
work.
B
Following
the
publication
of
that
report
last
year
we
were
probably
asked
about
four
or
five
different
things
on
the
classicist
care
concorda,
and
the
review
that
we've
carried
out
in
relation
to
approved
mental
health
professionals
now
completes
all
the
activity
that
we
were
asked
to
undertake
on
the
crisis
care
concorda
in
terms
of
content
and
the
review
of
PS
its
local
authorities
that
are
responsible
for
making
the
arrangements
for
it
PS
and
taking
that
forward.
We
do
not
have
any
logistic
hours
to
regulate,
am
hp's
and.
B
So,
there's
a
limit
in
a
sense
to
what
we
do.
I'm
not
suggesting
are
proposing
that
we
should
ask
for
any
extension
of
our
powers
in
this
respect.
So
what
we've
done
is
set
out
what
it
is
that
we
can
do
and
the
contribution
we
can
make
I
think
the
concern
here
is
whether
there's
sufficient
II
am
HP
is
available
to
actually
satisfy
the
demand
for
assessments
under
the
mental
health
legislation.
B
The
work
we've
been
doing
jointly
with
Ofsted
in
relation
to
the
special
education
on
these
disability
inspection
program
is
now
complete.
Hambrook
is
going
to
be
published
later
this
month
and
will
begin
to
make
a
contribution
to
those
things
for
that
inspection
program
from
may
of
next
year
and,
finally,
the
data
security
review.
If
you
remember
last
August
a
secretary
of
state
assisted
a
review
of
debt
security
in
the
NHS.
We
were
asked
to
produce
this
by
the
end
of
January
of
this
year,
which
we
did.
B
That
report
has
been
sent
through
to
him
and
the
decision
about
publishing
that
sits
with
the
Secretary
of
State.
He
will
have
to
take
a
view
on
that.
I
think
there
is
I,
think
it's
highly
likely
that
this
report
will
be
published
after
the
European
referendum
and
I
think
this
is
as
much
to
do
with
when
the
pre-election
period
starts
as
anything
else
so
and
I
just
wanted
to
draw
attention
to
that.
B
We're
not
being
pursued
on
this
report
we're
not
being
asked
about
this
report,
but
it
is
something
that
we've
signed
off
in
Santino
just
wanted
to
draw
that
to
the
board's
attention.
It's
not
a
big
issue
as
far
as
I'm
concerned,
but
it
is
something
just
for
the
board
to
be
aware.
That's
the
report
Peter
having
a
fact
perfect.
C
Very
much
and
first
of
all
on
the
investigation
of
deaths
and
learning,
disability
and
mental
health
patients.
I
think
this
is
a
really
important
piece
of
work.
Actually,
the
it's
it's
obvious.
This
has
become
quite
a
a
major
issue
and
about
safe.
It's
probably
one
of
the
highest-profile
issues
on
patient
safety
in
the
NHS
at
the
moment,
and
our
role
in
this
will
be
will
be
very
important.
C
C
So
there's
some
way
in
which
all
of
deaths
are
at
least
looked
at
by
specimen,
and
the
medical
examiner
role
may
well
help
that
when
it
comes
in
and
secondly,
that
there's
there'll
be
an
investigative
system
which
is
then
places
priority
on
deaths
where
they
may
have
been.
There's
an
opportunity
for
learning
and-
and
there
may
be
other
reasons
as
well.
C
Maybe
public
concern
family
pressures
and
so
are
the
other
reasons
why
certain
deaths
will
be
investigated
more
than
others,
but
there'll
be
a
system
in
which,
once
every
deaths
been
considered,
there
is
a
that
decisions
are
made
as
to
which
go
forward
into
a
full
investigative
process
and
then
there'll
be
a
proposals
for
renewed
learning
locally
and
also
nationally.
That's
one
of
the
main
problems
and
so
I.
C
My
prediction
is
that
that's
where
we'll
get
to,
and
so
the
question
is,
how
long
will
we
take
and
before
we
get
to
that
at
that
point
and
I
I
think
we
should
get
on
with
this
I
think
there's
a
lot
of
frustration
in
people
outside
that.
This
is
another
round
of
discussion
about
the
nature
of
the
problem,
whereas
in
fact
the
solutions
are
reasonably
clear
already
and,
and
so
I
just
want
to
make
sure.
C
We've
got
the
right
time
scale
for
this,
which
is
short,
has
to
be
short
and
but
also
that
we're
engaging
some
of
those
rather
disillusioned
groups
and
is
often
that
you
know
there's
a
history
to
this
whole
problem
and
part.
A
core
part
of
the
history
is
the
keeping
the
families
at
arm's
length
and
and
I
just
want
to
make
sure
that
we
in
doing
this
work,
don't
repeat
that
problem
and
that
they
so
that
we
don't
mirror
the
reasons.
C
B
Thanks
Lewis
I,
don't
know
that
I'd
want
to
predict
what
the
outcome
is
and
I
think
this
is
a
genuine
piece
of
work.
I
think
I'm,
not
sure
that
I've
been
involved
in
some
of
the
conversations
that
you
obviously
have
been
in,
but
I
think
there
was
a
genuine
desire
to
want
to
understand
this
process
better
without
prediction
it-
and
we
go
into
this
with
an
open
mind.
B
The
timetable
for
this
is.
We
are
aiming
to
publish
a
report
by
December
of
this
year
and
we
will
work
with
trusts.
We
will
work
with
families
affected
by
these
issues
and
with
other
national
bodies.
We
aim
to
do
some
field
work
as
well
as
some
wider
evidence
gathering
from
people
that
have
got
a
view
about
this
and
want
to
make
a
contribution.
So
when
our
said
wells
have
been
waiting
for
the
Secretary
of
State
to
come
back
to
us
on
the
request
which
sent
in
a
team
have
been
looking
at.
B
What
are
the
methodologies
for
how
we
will
check
this
forward?
I'm
personally,
not
aware
that
at
the
national
level,
anybody's
done
any
work
in
relation
to
speaking
to
families?
It's
not
just
learning
disabilities
as
well.
This
is
all
better.
So
a
number
of
the
cases
that
have
come
to
us
by
wet
row
of
complaints
have
often
come
from
families
who
have
talked
about
how
they
felt
isolated
from
and
separated
from
processes
that
go
on.
So
it
is
an
important
part
of
what
we
are
aiming
to
do.
B
We're
already
collecting
some
of
that
information
and
making
that
connection
between
open
and
reflective
learning
cultures
which
exists
in
some
of
the
Trust's
I
mean
again
it
might
was
here
it
reflect
on
that
and
I
think.
Our
objective
is
to
make
some
recommendations
for
improvements,
so
I
think
we
have
done
some
background
work
on
this
and,
as
I
say
following
this,
approval
will
now
go
on
the
next
stage
of
it.
So
I
really
don't
know
what
we're
going
to
find
in
relation
to
it.
B
I
I'd
want
us
because
of
the
point
you
began
with
just
how
important
this
is
to
learning
that
sort
of
the
thing
that
we
actually
lead
with
I.
Don't
think
this
is
an
accountability.
Review
I
think
this
is
a
review
that
genuinely
goes
into.
How
do
we
learn
if
you
remember
safety
is
one
of
the
lowest
performing
areas
of
all
all
of
our
inspections
in
this,
and
this
is,
as
you
said,
a
key
contribution
to
safety,
so
I
do.
B
A
genuine
area
where
we
are
going
to
make
a
contribution
to
inform
in
what
it
is
that
goes
on
so
now
that
you've
raised
this
issue
about
the
kind
of
discussion
out
there,
and
perhaps
some
of
the
kind
of
I
don't
know
skepticism
about
what
we're
going
to
do.
We
can
actually,
you
know,
move
forward
in
that
context
and
no
that's
the
context
that
some
people
are
approaching.
D
I
mean
this
isn't
looking
at
how
deaths
are
investigated,
that
is
it
unexpected
deaths
or
is
the
old
deaths,
because
there's
a
lot
quite
a
lot
of
confusion
in
people's
mind
that
people
with
mental
health
problems
with
learning
disability
they
can
die
up
to.
Is
it
20
years
earlier
or
10
20
years
earlier,
but
that
main
causes
of
that
is
the
main
cause?
Is
its
smoking,
I
think
and
I'm?
D
B
So
I
think
these
are
the
deaths
which
are
care
for
people
in
services
where
there's
learning
to
be
extracted
from
the
way
those
deaths
of
second
place
and
I
would
not
use
in
the
terms
of
reference.
The
best
of
my
knowledge,
unexpected
deaths,
but
clearly
there
is
an
aspect
of
that,
but
I
don't
think
this
is
a
public
health
investigation
into
why
some
people
died
early,
there's
just
to
get
it.
So
I
think
it's
driven
by
what
happens
to
people
in
services
rather
than
yeah.
B
D
C
I
think
it
you're
absolutely
right
either.
My
view
is
that
the
unexpected
expected
divide
is
very
unhelpful
in
this
situation
and
because
there's
a
sense
in
which
deaths
are
slightly
downgraded
because
of
well.
They
were
expected,
and
some
of
us
the
thought
to
be
that
the
scene
is
unexpected,
actually
had
preventable
factors
long
before
they
got
to
that
point.
So
I
think
my
understanding
is
that
we
will
ignore
that
well,
not
ignore,
but
we
won't
be
driven
by
that
that
dichotomy
and
yeah
so
I
think
that
will
solve.
E
Somebody
made
the
point
about
it.
Sorry,
it's
quite
difficult
period
be
easy
enough
to
describe
a
problem.
It's
not
awful.
How
do
you
know
move
it
on
into
into
action
and
making
something
happen
and
HealthWatch
you'd
expect
me
to
her
blow
a
trumpet
HealthWatch
is
involved
in
this
southern
cross,
the
magic
review
that
David's
described
and
we
are
very
happy,
but
what
works
with
us
seems
to
be.
If
you
can
get
the
right
people
round
a
table,
we
sort
of,
I
think
HealthWatch
can
provide
a
bit
of
a
safe
space.
E
Some
purpose
on
these
big
tricky
discussions.
We've
got.
You
know
lots
of
several
big
beasts
in
the
jungle
that
are
trying
to
sort
themselves
out,
so
we're
very
happy
to
help
in
any
way.
But
the
key
thing
is
this
point
that
was
made
about
moving
on
from
the
problem
into
actually
making
some
real
change
happen.
Now,
we've
got
some
track
record
and
making
some
real
change
happen.
Great.
F
Poor
poor
we've
wanted
coming
toyota-
oh
well,
I'm
any
was
going
to
say
was
on
this
point
about:
will
it
be
just
a
reviewer
and
then
it'll
be
six
months
or
nine
months?
And
then,
with
a
bit
of
luck,
things
will
move
to
action,
I'm
part
of
the
governance
and
seek
uses
to
look
at
all
the
thematics
in
advance
and
check
out
the
scoping
I'm
in
this
particular
case,
we'll
be
doing
two
things:
we're
responding
to
a
specific
request
on
sector
estate
and
we
will
meet
that
request
and
under
the
powers.
F
What
we
don't
intend
to
do
and
Paul
Elliott
was
very
clear
about.
This-
is
wait
until
the
end
of
the
review
before
we're
thinking
about
how
any
of
the
proposed
recommendations
can
be
implemented.
She'll
be
working
with
partners
across
the
system
so
as
they
suggest
a
whole
series
of
hypotheses
that
we
might,
and
we
might
find
that
as
we're
developing
those
we're
also
anything
now
how
they
can
be
put
into
practice
quickly.
F
B
I'm,
just
whispered
to
peter
is
there's
normally
a
lead
board
member
for
a
review,
so
I
don't
know
whether
we've
identified
early
board
member
for
the
thematic
review.
But
if
there's
a
contribution
that
you
others
want
to
make
you
want
to
make
then
I
think
that's
an
opportunity
to
satisfy
yourself
that
your
prediction
is
either
going
to
be
fulfilled
or
and
not
fall.
Fair
Thank.
D
B
I
say
I'm
slightly
more
open-minded
about
where
this
is
going
to
go.
If
you
remember,
where
did
this
come
from?
It
came
from
southern
being
criticized
for
not
carrying
out
reviews
for
the
deaths
of
those
people
in
services
and
I.
Think
there
was
a
genuine
at
very
genuine
inability
to
say
whether
that
was
something
that
was
generalizable.
That
was
happening
everywhere,
whether
that
was
a
one-off
so
that
that's
a
bit
about
being
open-minded,
I
really
don't
know,
and
it
wasn't
about.
B
Do
some
high-profile
cases
get
reviews,
but
it
was
does
every
case
get
the
review
that
it
deserves.
Your
point
about
reviewers
I
think
Roberts
where's.
This
point
previously
is
germane
to
this,
but
it
really
is
about
how
do
organizations
generate
a
learning,
culture
and
I?
Think
that's
what
we're
looking
to
explore
and
open
up
and
make
a
contribution
to
that
debate.
A
D
Looking
at
what
trusts
are
doing
around
the
review
of
deaths
and
particularly
in
terms
of
their
response
to
the
massage
and
report
at
Southern
and
in
what
comes
out
of
that
is
that
there
are
some
places
that
are
doing
some
good
work
in
reviewing
what's
happened.
Clearly,
there
are
others
where,
where
that
may
not
be
the
case
and
I
flagged
up
that
piece
of
work
to
the
team
that
are
working
with
Paul,
Elliott
and
Paul
beta
around
this,
and
so
that
they
can
take
that
forward
into
it.
C
C
So
then,
that
so
I
hope
that
our
role
will
will
will
be
strengthened
here
as
well,
so
that
when
we
examine
what
is
happening
to
people
who
are
detained
under
the
Mental
Health
Act,
the
contribution
that
amps
are
able
to
make
or
for
that
matter,
the
obstacles
to
making
it
I
think
that
needs
to
be
a
crucial
part
of
what
we
observe
I
think
we
can
play
a
role
even
though
we're
not
regulating
their
employers.
We
can
play
a
role
in
there
in
strengthening
their
function,
and
this,
maybe
is
the
springboard
to
do
them.
B
If
I
didn't
draw
this
out
so
towards
the
bottom
of
the
paragraph,
what
we
do
set
here
is
that,
as
part
of
our
mental
health
act
reviews,
we
will
begin
to
gather
the
evidence
about
how
this
were
always
being
discharged
and
how
it's
making
a
contribution.
So,
as
you
say,
a
very,
very
important
issue
about
people's
rights
in
the
way
that
the
decisions
are
made
about
their
detention
and
indeed
treatment.
So
we
are
proposing
to
do
that.
I
think.
B
B
Those
discussions
going
on
in
both
th
and
the
Department
for
Education
about
establish
a
new
social
work.
Bobby,
there's
a
debate
about
whether
that
all
of
a
separation
between
children
and
adults
were
the
other.
Three
home
countries
are
not
separating
children
and
adults
were
there
is
a
debate
taking
place
about
whether
that
should
be
my
personal
view
is
social
workers
generic?
It
should
specialize
at
postgraduate
level,
so
there
is
some
really
really
important
debates
going
on
about
this,
which
sir
found
this
debate.
B
But
what
we're
saying
is
our
role
in
relation
to
this
is
to
ensure
that
when
we
carry
out
our
mental
health
act
reviews,
we
will
assess
the
evidence
of
how
these
professionals
are
working
to
support
the
delivery
of
appropriate
mental
health
services
at
a
local
level.
So
that's
I
think
what
we're
going
to
focus
on
there
is.
B
There
are
bigger
debates
going
on
so
I
think
what
we're
trying
to
do
is
position
this
in
a
thoughtful
and
intelligent
way
about
how
we
can
make
a
contribution
to
this
debate,
whilst
holding
on
to
the
scope
that
we've
got
and
not
letting
that
scorp
Creek
beyond
what
it
is
that
were
capable
of
delivering.
So
that's
what
we're
trying
to
do
I
think
we
do
need
to
make
a
contribution
to
these
bigger
debates,
and
you
know
we
touched
on
some
social
care
issues
at
a
dinner
last
night.
We
very
rarely
touch
on
social
work.
B
B
But
the
key
issue
is:
it
is
part
of
the
bigger
debates
about
the
future,
some
of
these
professional
goals,
but
our
role
is
going
to
focus
on
the
Mental,
Health
Act
reviews
and
just
making
sure
that
it's
Aaron,
you
know
commend
Paul
Elliott
is
done
a
fabulous
job
in
the
time
he's
been
employed
by
us
by
spent
in
our
mental
health
capability
capacity
and
I.
Think
we're
now
much
more
prior
to
being
the
way
that
this
work
is
taken
forward
than
we've
been
here
to
Robert.
G
Keeping
the
question
about
the
hospital
inspections
or
not:
firstly,
I
thought
it
right
to
note
that
we
completed
a
hundred
percent
of
the
acute
non-specialist
trusts
which
is
really
good
and
we're
making
good
progress
with
with
others.
I
just
had
a
question
about
the
ambulance
trusts
which,
if
we're
looking
for
outliers,
seems
to
be,
is
there
forty
percent
only
done.
We've
got
two
reports
out,
neither
which
give
us
Hugh
how
cause
for
Hope
in
terms
of
them?
How
good
ambulance
trusts
are.
B
B
That's
where
the
Prioress,
who
will
go
for
the
teams
that
have
now
completed
the
non
a
non-specialist
acute
trusts
will
now
check
forward
the
work
in
relation
to
ambulance
trusts.
I.
Think
the
points
about
the
robustness
of
this
and
the
criticality
of
amblours
to
the
services
is
absolutely
well
made
and
I
think
the
other
one
that
we're
also
taking
forward,
which
has
a
similar
issue,
is
the
function
of
111
services.
B
Peter
and
I
were
in
a
better
way
there
for
the
NHS
England
board
yesterday-
and
this
was
one
of
the
points
I
was
making
about
what
we
have
found
in
relation
to
one
more
one
services
and
the
importance
of
those
services
of
the
system,
and
there
is
some
fertility
in
those
services
and
do
we
need
to
wait
until
the
end
of
our
inspection
program
before
we
flag
it.
You
remember
what
other
things
that
paul
elliott
it
is.
B
We
think
you
should
attend
to
these
issues
rather
than
wait
to
the
end
of
it
where
we
actually
said
at
the
end,
if
we
know
something,
then
what
we've
been
trying
to
do
is
fly
get
early
and
paint
your
your
comments
about
ambulance
trusts
are
in
that
hey
that
spirit,
really
there's
a
sign.
There
is
more
predictability
about
what
we're
going
to
find
in
some
of
the
ambulance,
trusts.
I
think
so
we
should
sit
read
some
of
those
issues
now
not
at
the
end
of
the
inspection.
If
thank
you
differ.
E
It's
just
a
question
about
the
number
trends
in
reinspection
across
the
sexes
and
what's
happening
there,
and
is
there
any
risk
that
that
trend
may
offset
against
our
need
our
rate
of
first
inspections
and
make
it
harder
to
receive
to
achieve
the
target?
It's
just
a
sort
of
background
information
on
that.
Given
we
have
a
fixed
full
of
inspectors,.
B
B
Care
I
think
re
inspections
are
factored
in
both
adult
social
care
and
pms
went
for
high-risk,
first
or
theoretically.
It
shouldn't
back
Lord
this
and
come
through,
but
again
just
to
come
back
to
the
predictability
points
we
will
need
to
accommodate
any
changes
that
take
place
and
under
tech
there's
reinspection
us
on
when
they
arise.
B
What
I
think
I'd
want
to
have
more
confidence
in
is
in
an
independent
health
care.
I,
don't
think
we
know
what
the
rate
of
reaction
is
going
to
be
with
any
degree
of
confidence
in
independent
health
care,
so
more
positive
and
confidence
about
PMS
and
adult
social
care
and
reassessment
and
in
a
second
I'm,
slightly
less
confidence.
Now
you
know
it's
it's
an
extension
of
Roberts
point
I
think
we
I
think
we
know
what's
going
to
come
out
of
the
ambulance,
service
and
I,
think
we're
less
clear.
B
D
I
never
miss
an
opportunity-
oh,
oh
and
invited
so
just
to
reassure
you
Jennifer
and
you
absolutely
right.
We
we
need
to
make
sure
that
we
are
returning
to
inadequate
services
and
we're
returning
to
requires
improvement
services
within
an
appropriate
time
scale,
both
to
ensure
that
people
are
protected
from
harm,
but
also
to
give
providers
the
scope
and
time
to
it
and
make
the
improvements
and
that
they
need
to
make
and
that
we
can
see
that
they're
being
sustained.
D
So
our
expectation
is
that
we
would
go
back
to
inadequate
services
within
six
months
and
that
we
would
go
back
to
requires
improvement
services
within
12
months.
In
the
meantime,
we
would
be
monitoring
what
was
happening
with
those
services,
in
particular,
if
there
had
been
breaches
of
the
regulations
and
we've
been
asking
providers
to
providers
with
action
plans
and
to
reassure
us
that
they
are
taking
the
action
that
they
need
to
take
and
to
make
the
improvements.
We
had
factored
that
in
into
this.
D
The
previous
year's
analysis
of
what
we
needed
to
do
because
of
vacancies
and
those
sorts
of
things
you.
We
have
not
kind
of
kept
pace
with
the
numbers
of
inspections
that
we
needed
to
do
to
complete
the
comprehensive
program
at
the
original
date
that
we've
set,
but
in
planning
the
activity
for
2016-17.
Absolutely
taking
that
into
account.
Pay
tribute
to
where
Paul's
team
led
by
Gavin
Kevin
D
who's
done
an
absolutely
amazing
job,
helping
us
all
of
that
modeling
so
that
we
can.
We
can
focus
our
efforts
on
that.
D
We
look
at
the
activity
on
a
monthly
basis,
and
one
of
the
things
that
we're
looking
at
is
how
many
inspections
have
we
done
and
how
many
of
those
inspections
have
been
returned
inspections
and
about
twenty
percent
of
the
root
of
the
total
inspections
are
returned
inspections
and
that's
actually
over
the
last
two
months.
I've
got
figures
in
front
of
me
for
is
pretty
consistent.
So
that's
what
we've
built
in.
D
B
B
England's
report
to
publish
but
I'm,
very
happy
in
the
private
session
say
a
little
bit
more
about
that,
but
it
is
being
published
this
week.
We
have
contributes
to
it
with
content,
with
the
way
that
our
positioning,
that
is
being
represented,
there's
work
going
on
behind
that
and
Paul's
monthly
carried
out
the
negotiation
about
final
draft
in
on
our
behalf
with
a
bit
of
well
II
from
me.
B
A
B
I,
would
you
wanna
go
straight
to
Paul
a
night,
so
I
think
you've
seen
it
erations
for
this
before
I
think
an
awful
lot
of
work
he's
been
done
on
this
I
would
like
to
say
well
done,
sir,
robin
wilson
and
krista
from
the
finance
and
opposing
planning
chains
for
the
way
that
they've
done
this
and
accommodated
change
after
change
after
change
with
huge
patience
and
forbearance.
B
B
This
is
this
is
our
statements
of
what
it
is
that
we're
going
to
make
happen
this
year
beyond
our
normal
business
as
usual,
so
we're
going
to
carry
on
inspecting
and
delivering
on
our
program,
but
we're
setting
out
our
key
four
priorities,
and
essentially
this
is
a
business
plan
set
of
priorities
which
demonstrate
we
will
complete
the
review
of
regulation
that
we
started
in
2013.
But
it's
also
the
beginning
of
the
new
five-year
strategy
as
well.
B
So
we're
going
to
do
two
things
in
this
year:
we're
going
to
finish
off
what
we
started
in
terms
of
changing
the
way
that
we
regulate
health
and
care
services
in
England,
but
we're
also
going
to
start
the
work
where
we'll
build
on
those
foundations.
I
think
is
a
word
that
we've
used
in
the
strategy
and
begin
to
improve
and
develop
and
refine
the
way
we
take
this
forward.
B
So
the
document
sets
out
the
four
priorities
for
the
organization
delivering
our
regulation
ship
in
the
future
of
regulation,
but
also
to
slightly
more
inward
facing
about
how
we
can
continue
to
be
more
efficient
and
effective
organization.
This
isn't
just
because
the
money
that
we've
got
available
to
us
is
reducing
it,
because
we
need
to
do
that
and
demonstrate
we're
an
effective
organization,
our
ability
to
hold
others
to
account
for
our
effective.
B
They
are
demands
that
we're
able
to
demonstrate
the
same
quite
frankly
so
priority
3
is
about
how
can
we
demonstrate
we're
an
effective
organization?
What
are
the
improvements
that
we
can
make
to
the
way
that
we
operate?
How
can
we
become
much
more
cost
efficient
as
an
organization
and
then
the
fourth
priority
is
really
about?
How?
How
can
we
measure
the
impact
of
the
work
that
we
do?
B
It
merely
left
so
for
others,
but
issue
the
challenge
from
the
National
Audit
Office
reports
about
doing
out
measures
in
our
business
plan,
which
can
demonstrate
we've
delivered
the
business
plan.
So
there's
a
much
clearer
position
been
taking
on
care
pies
and
we
draw
attention
to
that
in
the
report
and
I
draw
a
distinction
between
kpi's
or
are
we
delivering
the
business
plan
from
measures
of
the
assessment
of
the
impact
that
we
make
in
the
way?
And
that's
why
these
juxtaposed?
In
these
two
issues
and
business
plan
itself,
I
think,
has
been
produced.
B
I
think,
in
a
simple
style,
a
nicely
simple
style
which
builds
on
previous
years
documents
and
a
hope
sets
out
our
priorities.
Who
is
this
document
for
I?
Think
this
document
has
multiple
audiences
I
think
it's
for
people
who
use
services
who
are
interested
to
know
what
we
see
as
our
priorities
and
how
we
go
forward.
I
think
it's
for
the
sectors
that
we
regulate
the
health,
social
care
and
primary
medical
services
sectors.
So
we
signal
to
those
sectors
what
our
priorities
are
on.
B
B
In
relation
to
this
issue
about
236,
my
advice
to
the
board
is
that
236
is
sufficient
resource
for
us
to
discharge
our
responsibilities
next
year,
which
is
I.
Think
the
implicit
implication
in
this
message
being
sent
to
the
media
and
my
part
of
my
confidence
of
this,
a
mechanist
recommendation
to
the
board-
is
that
the
executive
team
have
gone
through
this
and
we
have
a
plan
I
think
in
relation
to
the
way
that
some
will
make
arrangements
for
the
delivery
of
this
program
within
the
resources
that
we've
got
available.
B
B
So
we
can
go
at
this
with
some
confidence
and
I
detect
the
opportunity
to
remind
the
board
I
think
there's
only
Kate
on
the
board
at
this
time,
but
I
think
the
budget
in
2012
when
I
began
this
job
was
under
than
60
million.
So
even
at
the
end
of
this
program,
when
it's
217
million
we're
still
fifty
seven
million
upon
where
we
began
in
two
thousand
and
twelve,
so
I
think
it's
really
important
to
focus
on
what
we've
got.
B
Not
what
we've
not
got
based
on
last
year's
budget,
particularly
when
we
did
Spencer
49,
was
meant
to
37.
So
it's
a
bit
of
context
and
I
don't
want
to
lay
on
too
thickly,
but
it's
important.
We
are
able
to
contact
Isis.
So
to
summarize,
Peter
and
colleagues,
what
we've
got
is
a
business
plan
that
has
been
through
many
many
iterations
in
both
the
organization.
The
executive
chairman
are
thinking
pre
work
with
the
board.
B
I
commend
it
as
a
good
piece
of
work
to
the
board
and
it's
SAT
within
the
financial
envelope
of
236,
which
is
an
envelope
that
I'm
confident
we
can
deliver
our
responsibilities
during
2016
17,
so
I
invite
the
boy
to
consider
this
business
plan,
and
I
invite
you
to
approve
it,
and
then
we
can
publish
it
both
within
the
organization
and
to
our
stakeholders
and
members
of
the
general
public.
Thank
you
thank.
A
You
David
Kate
when
he
can
sit
here.
So
if
you
do
need
to
intervene
and
correct
anything
that
I
or
David
or
anybody
else
says
you
can
have
to
struggle
for
for
a
microphone
and
I
just
want
to
pick
up
the
last
point:
Debbie
was
making
other
the
comparison.
We
need
to
make
that
the
budget
is
or
what
we
actually
spent
last
year,
not
some
figure
that
we
one-time
thought
we
might
spend.
What
didn't
and
I
personally
have
been
through
this
at
some
length
and
some
of
the
other
non-executives
all
you
were
you
were
there.
D
Always
have
fun
and
I
mean
I'm,
it's
fine,
you
know,
I
don't.
I
think
it's
it's
a
good
piece
of
work,
but
I'm
sort
of
structure
that
I
anything
in
its
about
involving
service
users
and
I
know
that
we're
going.
We
do
do
that,
but
I
was
just
sort
of
thinking
about
the
experts
by
experience,
and
it
seems
to
me
that
there's
a
there
is
a
little
bit
of
work
that
needs
to
do
it
to
down.
D
Three
build
an
effective
learning
and
values-based
CQC,
but
I.
Think,
given
that
there's
nothing
in
the
business
plan
about
involvement
and
the
fact
that
we're
just
starting
new
contracts
with
with
experts
by
experience
and
we're
changing
I
just
think
it
would
be
a
very
good
time
to
do.
It
just
do
a
bit
of
a
review
and
for
it
to
be
in
business
plan.
F
Palka
I'm,
thank
you
so
so
the
business
plan,
the
stretchy
mesh
together
doing
it
so
we'll
discuss
the
stretch
a
bit
in
the
private
section
and
and
then
in
more
detail
in
the
publishing
in
May
and-
and
that
certainly
does
talk
about
how
about
involvement
in
these
folks.
But
it's
my
experience
as
you.
F
As
you
say,
we've
got
the
the
new
contracts
in
place,
which
sort
of
strengthen
our
commitment,
and
we
do
have
equipment
in
the
business
plan
as
to
how
we
measure
the
effectiveness
of
how
we
and
we
inspect
services
and
one
of
the
ways
in
which
there's
measures
are
that
says.
Experts
by
experience
say
they
were
actively
involved
in
our
inspections
and
judgments.
So
we
will
be
measuring
it,
but
I
think
they.
The
suggestion
is
that
we
make
something
concrete
or
specific
in
the
business
plan
in
terms
of
activity.
F
H
A
Okay,
I
think
he
pulls
touched
on
the
the
right
pointer
in
an
ideal
world.
We
would
have
published
the
strategy
and
the
business
plan
and
the
budget
in
for
probably
in
that
order
or
the
set
in
the
same
time,
the
combination
of
the
need
to
consult
on
the
strategy
and
then
the
purdah
periods,
delaying
the
publication
mean
that
this
coming
out
in
a
sense
in
the
wrong
order.
So
what
I
suggest
we
do
is
in
the
next
board
meeting
when,
as
Paul
said,
we'll
have
all
three
to
discuss.
A
We
can
then
make
sure
that
we've
picked
this
up.
So
I
didn't
disagree
with
you.
I
know
lots
of
other
bits
of
work
that
aren't
specifically
referenced
in
the
business
plan
that
will
have
to
be
done
over
the
next
12
months.
So,
let's,
let's,
let's
come
back
to
that
next
next
month,
but
absolutely
not
to
lose.
The
point
is
that
okay,
yeah
other.
C
This
is
the
wider
public,
and
so
that's
that's
mentioned
in
the
document.
It's
in
that's
that
first
diagram
are
not
a
big
fan
of
these
composite
box
diagrams,
but
actually
this
is
quite
a
good
one,
and
and
that's
one
of
the
reasons
and
but
but
what?
What
I'm?
Not
then
clear
about
is
what
we're
doing
about
it.
It
doesn't
and-
and
I
think
that
there's
been-
this
has
been
a
long-standing
issue
in
a
way
that
where
it
is
obviously
quite
difficult
issue,
it's
not
you
know,
public
confidence
isn't
just
a
button.
C
I
have
to
say,
but
and
in
the
way
the
two
documents
come
across,
but
and
but
if
we
can
get
that
right
in
the
strategy
and
then
set
out
what
we're
going
to
do
about
it
in
the
coming
year,
that
would
help
otherwise
I
there's
a
slight
feeling
that
we
would
like
to
be
able
to
achieve
it.
But
we're
not
absolutely
sure
what
we're
doing
about
it.
G
Well,
actually,
I
for
once
found
this
less
so
paid
for
many
things
and
isn't
Danny
Ferry
pays
and
it's
enabled
me
to
spot
two
things.
The
perhaps
have
not
spotted
before,
therefore
ask
a
question
about,
and
they
one
is
a
point
about:
are
we
being
over-ambitious
and
one
is
whether
we
lack
ambition
and
won?
The
first
point
relates
to
the
KPI
about
the
staff
survey.
G
Only
to
increase
week,
staff
engagement
by
one
point,
I
know
quite
sure
what
one
point
means,
but
that
sounds
to
belittle
unambitious,
there's
no
mention
anywhere
of
any
concern
about
bullying
and
harassment
and
so
on,
which
has
been
a
concern
and
I
wonder
whether
that
ought
to
be
mentioned.
That's
that
sort
of
one
little
box,
the
other
box,
is
any
likely,
but
a
variance
of
nought
percent
on
the
budget.
I've,
never
known
any
organization
has
ever
achieved
that.
What
is
that
being
over-ambitious?
E
I
think
I'm
Robert
raises
incredibly
important
point
about
our
staff
and
staff
survey
is
a
key
measure
that
we
use
to
engage
and
understand
how
a
staff
of
feeling
I
think
around
the
engagement
index.
I
think
it's
right
to
note
that
we
actually
already
have
a
high
engagement
index,
so
it
actually
requires
a
significant
shift
to
move
that
upwards.
E
So,
although
1%
might
seem
exceedingly
modest
and
it
is
quite
realistic
when
you
already
have
a
high
school,
so
we
could
put
some
higher
number
in
and
we
are
working
very
hard
with
all
the
stuff
that
has
come
out
of
the
staff
survey,
particularly
around
bullying
and
harassment,
which
are
important
issues
and
I.
Think
of
two
particular
directorates
that
are
actually
doing
a
lot
of
focused
and
bespoke
work
with
Starfire.
E
So
we
can
certainly
put
it
in,
but
I
wouldn't
want
you
to
leave
you
in
any
doubt
that
people
say
this
and
we
don't
do
anything
with
it
be.
The
work
is
ongoing,
so
very
happy
to
look
at
that
around
the
engagement
index.
I
think
one
percent
is
realistic.
Realistically
ambitious,
it
was
I
think
the
ambition
word
is
right
and
I.
B
B
The
sorry
Jen
we
will
collect
bullying
and
harassment
as
both
where
allegations
coming
will
collect
those,
but
we
also
do
it
as
part
of
the
staff
survey
so
to
the
KPI
point
to
think
what
we
wanted
to
do
is
distill
the
KPIs
that
we're
going
to
be
part
of
the
way
we
measured
the
business
plan.
It's
not
a
reduction
of
the
total
number
of
data
that
we
collect
so
I.
Think
to
this
reporting
on
I'd
I
personally,
don't
have
a
problem
about
including
the
bullying
or
us,
but.
A
E
Sorry,
take
you
a
step
back
in
the
conversation.
I,
wouldn't
want
k
to
think
that
experts.
My
experiences
is
the
is
the
only
game
in
town
I've
got
here,
our
own
CQC
HealthWatch
joint
publication
on
how
we
work
together
to
get
the
voice
heard,
including
the
the
ambulance
service
in
Yorkshire,
which
sounded
really
good
piece
of
work
by
everyone
round
the
table,
but
I
do
think
that
listening
to
Lewis
and
decay
to
others,
there's
a
bigger
piece
of
work.
You
have
here
HealthWatch,
that's
all
we
do
is
listen
to
the
patient
voice.
E
G
G
G
I
think
it's
a
but
the,
but
what
we
did
here
on
Monday
was
that
the
executive
team
have
done
a
lot
of
hard
work
to
get
at
the
detail
behind
what
the
budget
could
be,
comprised
that
tears
and
and
are
confident
I
think
that
they
can
get
to
that
within
within
they've,
got
the
resources
to
AK
at
the
plan
and
that
they
can
actually
control
the
costs
to
within
that
I.
Think
that's
fair
catch.
Is
that
to
say?
Do
you
want
to
just
count
on
that?
Yeah.
E
Absolutely,
I
think,
that's
a
good
summary
and
I
think
a
lot
of
the
hard
work
has
been
done
by
the
executive
team
and
we
had
do
have
it.
We've
had
the
trajectory
going
up
it's
coming
down
over
the
following
year
to
prepare
us
for
future
years,
so
we've
got
that
profile
and
the
confident
that
we
can
deliver
that.
But
at
the
same
time
you
know
there
has
to
be
underpinned
by
really
robust
reporting
to
the
executive
team
to
the
board
and
we're
going
to
stay
on
top
of
that
this
year.
G
G
But
that
doesn't
need
to
be
worked
on
that
and
then
the
third
bits
just
pick
up
on
it,
because
I
at
the
same
point
is
Robert
about
nor
percent.
As
a
variance
I
think,
we
should
probably
just
put
a
figure
in
of
millions
of
pounds.
Whatever
the
figure
happens
to
be,
it
is
rather
than
a
percentage
figure
along
against
the
budgets.
So,
within
a
figure.
A
G
B
Long
as
it's
a
minus
normally
not
a
positive,
that's
the
I
think
that's
what
we're
trying
to
get
out
is.
This
is
the
incentive
it's
a
good
challenge,
but
as
ever
you
bring
real
and
value
to
this,
and
so
I
think
the
issue
is.
We
cannot
always
spend
our,
but
that's
the
message
that
I
want
to
give
us
accounting
officer,
so
that's
set
in
a
way
that
says
we
must
come
in
on
that.
We
know
it's
going
to
be
tied.
We
understand
by
6
13
million
this
year.
B
No,
let
me
do
the
reflection,
33.9,
13
million,
so
I
think
the
key
issue
here
is:
we
haven't
got
that
latitude
next
year.
We
need
a
financial
discipline
across
the
organisation,
which
I
think
is
partly
the
point
that
you're
making
from
the
previous
points
that
we
need
to
get
to.
So
as
long
as
that
is
a
number
that
is
variance
is
minus
not
bring.
Our
plus
number
is
what
we
should
be
able,
because
we've
been
pretty
clear
as
an
executive
team
I've
been
clear
with
my
colleagues
that
some
so
we're
not
overspending.
B
G
Then
I
understand
what
is
meant
but
I.
Don't
think
that's
what
percent
means
that
so
I
think
you
actually
want
a
ceiling,
which
is
we
will
not
ever
spin
and
anything
up
and
if
any
look,
if
it
looks
as
they
were
going
to
do
that
and
that's
a
matter
which
is
serious
and
yes,
if
I
could
edited
by
our
picture.
B
If
I
may,
if
one
of
the
things
I
think
is
coming
from
this,
is
one
or
two
tweaks
going
to
be
required
to
this
before
we
publish
it
this
week.
So
if
I
could
just
have
some
license
with
care
to
put
in
a
figure
in
relation
to
that
and
we'll
put
a
form
of
words
in
which
is
what
I've
just
said,
which
is
we're
not
going
to
overspend
our
budget
and
that's
what
we're
setting
out
to
do.
Okay,
people
are
happy.
A
With
that
and
then
pour
on
your
point
about
the
sort
of
the
medium
term
and
the
glide
path
from
where
we
are
now
to
where
we
going
to
be
I
mean
I
think
this
is
really
really
important.
We
discuss
this
a
bit
on
Monday
and
so
I
do
think
as
a
board
and
as
an
executive
group.
This
is
going
to
be
a
really
high
level
of
priority,
because.
A
We
have
to
do
this
in
an
orderly
way
to
make
sure
that
we
are
able
to
fulfill
all
our
obligations
within
the
money
that
we've
got.
I
ab
him
very
confident
we
can
do
that,
but
we
can
only
do
it
if
we
plan
well
in
advance
and
so
I
think
that
is
going
to
be
a
major
piece
of
work
over
the
next,
not
just
next
12
months,
but
actually
over
that
the
whole
period
of
the
strategies
it
happens.
G
If
I'm-
just
that's
absolutely
right,
Peter
I
think
we.
The
important
thing
to
remember
is
that
we've
not
only
got
a
glide
path
in
terms
of
reduction
in
our
budgets
over
that
period
of
time,
but
we
have
a
lot
that
we
need
to
do
in
terms
of
investment
over
that
time
to
achieve
the
changes
that
we
want
to
make
to
be
that
more
effective
and
efficient
organization.
G
Those
things
don't
come
without
some
cost,
so
there
is
within
the
glide
path,
also
some
one-off
type
of
expenditure
to
get
to
that.
It's
planning
that
which
is
absolutely
essential
as
well
as
we
go
forward.
So
it's
it's
a
quite
a
complex
task.
The
visit
is
a
tough
task,
but
it's
one
that
we
need
to
actually
plan
out
how
we
can
do
it.
One
hundred
percent
agree.
F
Can
pick
up
one
lewis's
comment
about
public
confidence?
If
that's
helpful,
yep
I'm
show
you
say
three
or
four
points
and
as
as
David
said,
public
accounts
committee
and,
as
other
people
said
as
well,
we
do
survey
people
about
our
world,
not
just
about
asking
them
to
share
their
experiences
with
us,
and
people
are
increasingly
confident
and
took
about
our
only
approach.
So
that's
positive,
but
will
you
know
it
will
keep
to
keep
doing
that
before
an
important
part
of
our
own
evaluation?
F
And
we
have
the
share
your
experience
and
work,
which
is
a
good
opportunity
for
people
are
in
air,
provide
receiving
any
form
of
care
or
or
their
loved
ones,
to
tell
us,
as
you
know,
about,
and
that
already
exist
through
the
phone
lines
through
when
through
the
website
and
through
forms,
one
of
the
things
that
we're
doing
and
the
the
next
phase
of
our
digital
work
and
is
to
to
roll
out
things.
I
absolutely
talked
about
in
the
past,
to
make
it
even
easier
for
people
to
give
us
their
their
experiences.
F
F
I
think
we
might
cover
that
in
the
rgc
updates
to
follow,
but
clearly
there's
something
about
people's
are
confident
in
us
is
at
least
partly
determined
by
how
well
we
close
the
loop
when
we
are
told
about
things
so
that
people
are
not
left
hanging.
People
know
what
we've
done
about
it,
and
we
also
have
that
the
public
engagement
strategy,
which
is
published
on
our
website
from
January
2015
we've
talked
about
how
we
can
improve,
how
we're
engaging
with
people
and
I
think.
F
Okay,
you've
previously
asked
if
we
can
bring
that
back
to
the
board
and
viewers
to
do
that
after
the
main
strategy
has
been
published.
So
we're
expecting
to
do
that
in
the
next
few
months.
That
might
be
good
opportunity
to
talk
in
a
bit
more
detail
about
how
the
hell
are.
Plans
are
being
implemented.
C
F
They
simply
called
the
qualitative
told
it's
our
ability
to
look
at
all
those
hundreds
of
thousands
of
bits
of
information,
whether
it's
direct
to
us
or
whether
it's
on
social
media
or
through
friends
and
family
tests,
whatever
it
might
be
to
look
at
that
data.
The
people
is
writing
down
and
draw
out
the
themes
and
trends
from
it.
So
we
can
look
in
the
business
plan
as
to
whether
we
can
bring
that
out
and
more
fully,
but
certainly
that's
the
intent.
When
we
talk
about
things
like
cgc
insight,.
B
So
what
I
propose
we
do,
given
that
we're
in
the
last
knockings
are
tweaking,
is
we'll
put
a
sentence
in
probably
in
priority.
Three,
which
picks
up
on
cares
bit
about
reviewing
engagement,
pics
upon
Jones
bit
about
working
with
HealthWatch
England,
picks
up
on
Paul's
point
about
digital
and
then
lands
it.
The
respondent
concerns
is
in
there,
so
we'll
find
a
way
just
connecting
those
four
things
in
that
way
to
draw
it
out,
so
the
opacity
I
think
which
is
being
referred
to
is
removed.
B
This
is
work
that
would
go
on
and
I've
been
encouraging,
Paul
and
Chris
to
continually
review
how
we
engage
with
people.
Not
so
we
lose
the
tradition,
k,
I,
think
you're,
absolutely
right
with
this.
It's
absolutely
central
to
our
values,
but
we
just
need
to
rethink
this.
I
think
this
point
that
polls
just
made
about
digital
the
fact
that
HealthWatch
England
is
closer
associate
more
closely
associated
with
both
present
opportunities
that
we've
not
hit
it
too
hard
that
we
actually
need
to
take.
B
E
Was
very
good
actually
the
whole
thing
very
out
of
it
and
horribly
sick
think.
The
only
comment
I
just
wanted
to
make
was
that
clearly,
some
of
the
comments
made
today
are
about
inclusions
of
other
things
that
we
value
in
the
activity
that
the
CQC
carry
out
carries
out,
and
some
of
those
things
are,
as
mentioned
in
the
evaluation,
the
wider
evaluation.
E
So
the
point
I
want
to
make
is
that
when
we
get
to
look
at
the
evaluation,
it
may
be
useful
to
see
if
there
are
some
things
that
could
be
pulled
out
of
that
for
next
year's
KPIs,
that
we
do
value.
So
if
you
like,
it
says
kind
of
pyramid,
isn't
it
these
are.
These
are
extracted
and
and
measurable
from
what
is
a
much
bigger
sort
of
base
of
the
pyramid,
which
is
information
on
our
impact,
which
we
hold
revalue.
E
A
Thank
you
good.
That
was
actually
a
really
really
helpful
debate.
Some
really
good
points
came
out.
So
if
the
board
is
happy
to
approve
the
business
plan
subject
to
the
tweaks
that
we
have
agreed,
we
then
it
then
goes
to
D.
H
will
require
to
get
get
get
D,
H
sign
off,
and
the
intention
is
to
publish
next
week
we
all
content
with
that
perfect.
Thank
you.
That
was
really
good.
C
And
well
yesterday,
yesterday
evening,
I
chaired
the
rgc
regulatory
governance
committee
in
Michaels
absence
and
just
remind
you
that
a
proper
report
will
come
back
to
the
next
board
meeting.
So
this
is
a
sort
of
overnight
summary
of
what
was
talked
about
yesterday,
thanks
very
much
to
Martin
for
preparing
it
for
today.
So
so,
there's
a
paper
tabled
I'm
just
going
to
highlight
one
or
two
of
the
issues
that
came
out
it.
Essentially,
the
meeting
yesterday
was
receiving
reports.
I
prefer
was
the
general
theme
of
it
and
it
was
quite
a
meaty
meeting.
C
So
apologies
if
I
don't
represent
every
important
point
that
would
that
came
through
it,
but
just
at
just
to
mention
one
or
two
things,
and
not
quite
in
the
order
that
they're
on
the
the
written
report.
But,
first
of
all,
we
we
received
two
internal
audit
reports
and
one
which
was
about
evidencing
regulatory
decisions
and
the
other
one
about
quality
of
external
external
facing
analysis.
And
the
common
theme
of
these
two
reports
was
and
strengthening
the
evidence
on
which
we
base
our
decisions.
C
C
I
think
that
there
was
a
sense
that
this
that
we've
been
on
a
southern
evolution
over
the
last
couple
of
years,
starting
with
and
scrambling
around
I
do
think
anybody
said
that
that
I'm
intently
I
have
tried
to
get
the
the
best
data.
We
could
looking
at.
What's
available,
trying
to
use
everything
that
was
around
to
make
the
best
we
use.
C
We
could
have
what
people
had
previously
collected,
feeding
that,
through
into
our
evaluations
of
services
and
I,
think
we're
now
into
a
new
phase
where
we
can
be
taken
more
refined
position
and
we
can
be
more
challenging
of
what
people
tell
us
as
well
as
what
decisions
we
ourselves
make
and
we
can
make
sure
our
inspection
teams
are
better
informed
with
the
key
key
bits
of
information
about
a
service
before
they
go
in
and
so
on.
So
so,
although
these
two
reports
were
considering
certain
bits
of
the
evidence
system,
the
implication
is
much
broader.
C
So
it's
a
it's
a
continuing
piece
of
work.
This
was
a
phase
one
report
and
it's
about
how
we
respond
when
people
raise
concerns
with
us
about
a
service
and-
and
the
themes
I
suppose
were
about
making
sure
that
people
get
a
get
a
reasonable
response.
It
may
not
be
us
who
has
to
do
has
to
respond
directly.
C
So
it
was
a
very
helpful
report
here,
but
man
I
must
say:
I
was
struck
not
just
by
the
issue
of
responding
well
and
getting
the
clarity
right,
but
but
also
by
the
sheer
volume
of
concerns
that
are
raised
with
us,
that
that
is
really
striking.
How
many
people
come
to
us
to
raise
concerns
and
getting
it
right
for
so
many
people
is
a
quite
a
major
major
task,
so
that
was
the
subject
of
the
report
in
the
discussion
and
as
further.
There
are
further
reports
to
come.
C
The
third
thing
was
the
was
a
about
adult
social
care.
We
had
a
series
of
papers
and
presentations
about
social
care
and,
to
some
extent
this
follows
what
I'm
sorry.
This
is
a
slightly
over
familiar
theme,
but
what
follows
an
inspection
of
a
care
home
that
I
went
on
as
an
observer,
and
but
it
triggered
a
number
of
points
which
are
about
the
broader
way
in
which
we
inspect
care
homes
and
the
adult
social
care
function
and
just
to
summarize
a
couple
of
points.
C
C
Give
us
give
us
Palast
to
and
to
do
the
right
thing
in
a
very
reasonably
urgent
and
very
robust
way
when
standards
are
falling
encounter,
and
for
me
this
is
one
of
the
main
things
we
one
most
important
things
that
CQC
does,
and
it
was
a
reassuring
presentation
about
the
robustness
of
our
and
our
approach.
There
was
a
specific
point
which
is
about
telling
relatives
when
care
homes
essentially
do
badly
in
our
inspections
and
and
although
we
require
care
homes
to
put
the
rating
on
their
website
and
on
and
display
it
at
the
care
home.
C
There
are
obvious
problems
in
that
one
is
some
care
homes,
don't
have
a
website,
so
there's
a
rather
intriguing
way
of
avoiding
putting
things
on
your
website.
Don't
have
one
and
and
and
some
of
course
are
displaying
the
rating,
but
it's
not
in
a
way
that's
visible
to
the
residents
and
certainly
not
to
the
relatives
who
might
be
calling
in
and
not
really
checking
the
notice
board,
and
so
that's
an
area
I
think
that
we're
trying
to
grapple
with
and
possibly
using
beauty
of
Canada.
C
If
you
want
to
say
any
more
just
to
mention
that
point,
I
think
this
is
a
very
important
point
about
our
relationship
with
the
public
and
with
and
the
families
of
people
who
are
residents
informing
them.
When
something
has
been
found
that
they
should
be
aware
of
whether
it's
good
or
bad,
actually,
a
masseur
and
and
again
I
think,
there's
a
sense
that
we
are
doing
better
on
this
than
me
sometimes
come
across.
A
D
To
say
that
I
was
joined
at
the
committee
with
Deputy
Chief,
Inspector
Sally
woman
for
the
registration
and
discussion
that
we
had
and
Debbie
Westhead,
who
not
only
is
the
deputy
chief
inspector
for
the
north,
which
covers
the
area
of
the
inspection
that
Lewis
attended,
but
also
leads
on
our
continuous
improvement
group
within
adult
social
care
and
for
enforcement
across
the
whole
of
CQC.
In
terms
of
taking
and
forward
our
developments
in
that
area,
and-
and
those
of
you
who
know
Debbie
will
know
the
energy
with
which
she
goes
about
these
things.
D
In
terms
of
trying
to
tackle
that,
and
particularly
on
this
at
the
issue
that
Lewis
has
raised
before,
and
we've
discussed
around,
ensuring
that
the
information,
the
findings
that
we
have
them,
an
inspection
are
shared
with
people
in
a
very
proactive
way,
and
what
Debbie
was
able
to
describe
was
where
we
have
effectively
and
used
the
duty
of
candor
regulation.
In
the
sense
of
saying
there
has
been
a
serious
kind
of
incident
in
the
sense
of
harmonic.
D
The
arrangements
that
we're
making
to
ensure
that,
albeit
I,
completely
take
the
point
that
some
of
the
smaller
services
may
not
have
their
own
website,
but
the
vast
majority
do
that
we
will
be
expecting
to
follow
up
after
they've
had
their
grace
period.
For
when
the
report
is
published,
to
make
sure
that
the
rating
is
indeed
on
the
website.
D
We
have
issued
fixed
penalty
notices
where
that
has
not
been
the
case
and
indeed,
and
issued
12
fixed
penalty
notices
from
one
particular
provider
who
was
failing
to
improve
their
website
there,
so
that
they
could
do
it
in
low
and
be
old
after
we
did
that
they
did
indeed
improve
their
website.
So
so
there
are
things
that
we
are
very
proactively
doing
to
try
and
improve
this
situation.
E
You
this
is
my
first
appearance,
I'd
say
the
regulatory
Governance
Committee
doesn't
sound,
that's
gonna
be
very
exciting,
but
it
was
really
good.
It's
absolutely
where
I
asked
of
key
business
competency
is
I
thought
there
was
some
I,
don't
sound
too
girlish
enthusiastic,
but
there
was
some
very
good
learning
going
on
there
and
it
gave
me
a
lot
more
confidence
about
her.
What
the
inspection
process
they're,
also
a
couple
of
opportunities
for
CQC
to
lead
the
field
in
this
area
that
we
were
looking
at.
E
One
was
when
we
were
talking
about
the
information
that's
required
for
inspections,
&,
poor's,
sort
of
you
bringing
it
down
to
what
we
still
pretty
much
know.
Now.
What
are
the
most
important
things
we
need
to
know
and
there's
another
line
of
salt
out
there,
which
says
that
there
are
lots
of
inspections
going
on
and
there's
a
wish.
Isn't
there
that
not
everybody
will
be
asking
for
all
different
sets
of
information
and
I.
E
Think
there's
a
real
opportunity
for
CQC
to
take
some
leadership
in
identifying
that
information
set
for
inspections
that
might
actually
lighten
the
regulatory
burn,
which
has
to
be
a
good
thing.
That
was
one
and
the
other
one
I
think
we
were
all
very
impressed
by
the
presentation
on
the
telephone
service
and
the
calls
that
come
in
and
the
way
that's
being
dealt
with.
E
There
was
a
certain
feeling,
it
short
cause
Carol
any
better,
but
it
really
felt
I
mean
I
aliens
had
she
been
sitting
and
listening
in
some
of
these
calls,
it
really
felt
that
we
are
doing
this
in
a
way.
That's
compassionate
and
is
getting
results,
but
also
is
controlling
it.
So
I
know
from
our
experience
in
HealthWatch.
If
you
do
gets
only
on
the
telephone
and
you're,
not
you
just
tell
you
you're
answering
always
like
a
human
being,
rather
than
a
member
of
a
pressure
organization.
E
A
F
Am
in
those
two
internal
order
of
these
so
buy
something
I!
Think
one
of
the
things
that
we've
fine
when
it
through
the
strategy
ongoing
discussions.
Is
people
ask
the
question
if
you're
regulating
us
and
then
who
is
checking
that
you're
doing
the
things
that
the
board
has
a
role
there
in
the
impound
to
the
rest.
But
so
internal
audit
is
an
important
element
and
those
reports
go
to
the
bottom
health
as
well,
the
one
on
and
the
quality
assurance
of
external
analyses.
F
That
was
a
follow-up
report,
as
Lewis
says
in
light
of
E
and
the
mistakes
we
made
on
GP,
intelligent
monitoring,
and
it
showed
a
substantial
improvement
in
the
work
and
I
think
one
of
things
that
we
say
a
lot
to
providers
is
when
you
get
a
report
that
shows
there
are
things
which
aren't
right.
How
are
you
learning
from
them
and
when
we,
when
we
come
back
to,
is
pretty
important,
I
think
to
the
individuals
who
were
am
responsible
for
the
intelligent
monitoring
that
they
did
exactly
in
turn
into
the
same
spirit?
F
So
it's
been
quite
a
lot
of
cultural
change.
Work
in
intelligence
and
I
wanted
to
sort
of
take
that
opportunity
safer
and
we
Rourke
and
her
team
and
could
have
could
have
respond
in
a
very
different
way.
But
I
don't
think
we
have
seen
I
think
the
figure
of
seventy-four
percent
of
their
cells
improved,
wouldn't
have
seen
that
improvement
without
that
part
of
CQC
being
willing
to
learn
from
what
had
happened
in
the
past.
A
Does
seem
to
me
those
also
there's
a
connection
between
one
of
the
points
you
made
earlier
on.
The
more
users
of
service
are
aware
of
our
role
and
have
confidence
in
it
and
then
refer
to
our
website
for
the
information
then
there's
another
way
of
getting
a
read
across
into.
When
did
you
last
inspect
the
service
that
I'm
using
all
my
family
using?
And
what
did
you
find
when
you
were
there?
So
all
these
things
sort
of
connect
to
each
other
palki,
just
sorry,
I'm,
fair
question,
probably,
but
just
just
for
my
image.
G
Knew
you're,
gonna
I
was
gonna,
make
point
benefit
of
others.
Broadly
speaking,
there
are
four
grades.
If
you
like
of
assurance
report,
starting
at
the
the
best
you
could
do,
is
full
assurance,
then
you
get
moderate
assurance.
Then
you
get
limited
assurance
and
they
get
Mary
short
now
there
happen
to
be
four
grades.
G
Don't
necessarily
read
those
across
directly
against
our
grading
system
rating
system,
but
it's
not
long
way
different
from
that
and
I
think
what
I
would
say
is
that
the
audit
committees
really
focus
on
where
you
have
limited
assurance
or
no
assurance,
which
is
really
not
very
health.
That's
where
we
tend
to
focus
our
attention.
G
A
Is
there
any
other
business
everybody
wanted
to
raise
after
that
great
so
that
ends
the
the
business
of
the
public
ball.
We've
got
depending
on
which
clock
I
look
at
one
minute
or
my
watch
there's
no
minutes
so
which
will
just
take.
If
there
is
a
point
that
somebody
from
the
public
wanted
to
raise
and
Jade
you
put
your
hand
up
first.
So
would
you
like
to
come
to
the
microphone
here
and
say
for
the
everybody.
H
Morning,
everybody,
my
name,
is
Jay,
Taylor
and
I'm
here
this
morning
in
a
sort
of
patient
safety
campaigning
capacity.
I
also
am
a
health,
professional
and
I
manage
an
intermediate
care
team
in
reading.
That's
my
substantive
post
at
present,
there's
a
just
one
thing
that
came
up.
You
were
talking
about
and
the
the
thematic
review
of
deaths,
and
one
thing
that
struck
me
from
the
start
is
that
there
is
lots
of
discussion
about
families
being
involved,
which
is
brilliant,
have
been
been
on
both
sides
of
this
as
I'm
sure
many
of
us
in
the
room.
H
But
the
thing
I
want
to
bring
up
this
morning
is
and
I'm
aware:
we've
got
limited
time
is
the
theme
I
wanted
to
bring
up
with
bias
and
unconscious
bias,
and
I
was
hearing
as
well
that
you
were
talking
about
engagement
and
engaging
with
with
with
the
wider
public
and
I
just
wanted
to.
Can
I
just
have
a
show
of
hands
who
likes
stories
here
who
likes
stories?
Okay,
right
can
I
tell
you
a
short
story.
H
Tobias
is
actually
kind
of
brainwashed
and
he's
put
into
this
simulation
and
in
this
simulation,
he's
told
to
kill
Beatrice
who
is
actually
in
love
with
and
as
the
theme
unravels
Tris
realizes.
She
has
to
find
some
kind
of
way
to
grab
his
attention
and
to
bring
him
back
and
to
help
him
to
realize
that
you
know
what
he's
doing
is
is
not
a
good
way
forward
and
she
manages
to
work
that
out
and
she
manages
to
stop
him
doing.
H
What
he's
doing
and
I
think
that
there's
a
story
to
be
learnt
left
all
of
us,
because
we
all
been
human
beings.
We
all
have
unconscious
bias
and
I'll
just
share
with
you
an
incident
in
my
career
where
I
was
guilty
of
unconscious
bias,
15
or
so
years
ago.
I
was
working
in
an
inpatient
unit
and
there
was
no
means
of
identifying
patients
really
at
all.
The
means
of
identification
was
by
a
member
of
staff,
remembering
through
visual
memory,
people's
identities
were
no
wristbands.
H
There
were
no
photographs
as
a
result
of
this
I
gave
somebody
the
wrong
tablet,
and
it
was
only
it
when
you
say
only
it
was
over
clone
tablet.
It
wasn't
going
to
do
the
person
any
harm.
I
told
the
patient
straightaway
I
this
patient
wasn't
able
fully
to
to
to
describe
is
you
know,
I
did
identify
himself
to
me.
H
H
Well,
you
know
there
are
lessons
to
be
learnt
there
and
that
I
should
have
known
that
that
means
of
identification
was
never
going
to
with
notin
was
never
going
to
bring
me
accuracy
and
and
I
think
there's
a
there's
also
lessons
to
be
learnt
as
well
in
terms
of
all
of
us
here
and
how
we
think
about
unconscious
bias
and
how
we
react
to
each
other
and
the
wider
public
and
I
don't
want
to
offend
anyone.
But
I
think
that
there
are
instances
of
unconscious
bias.
H
Perhaps
how
this
board
refers
to
staff
who
trying
to
raise
concerns.
I
think
there
are
prejudices
that
maybe
we
don't
want
to
admit
to,
but
I
think
they
need
to
be
explored
more
and
I
think
there
are
other,
really
sorry
Robert,
but
I
think
there
are
in
terms
of
the
freedom
to
speak
up,
review,
I
I,
don't
actually
really
no
one
whistleblower,
who
agrees
with
with
the
recommendations
and
I,
think
it's
very
difficult
for
me
to
to
say
this,
and
hence
why
I
wanted
to
share
my
own
failings
in
terms
of
my
drugs.
H
Oh,
but
I
think
we
need,
and
I've
mentioned
this
to
Peter
I-
think
we
need
a
recall
of
everyone
who
whistleblowers
who
took
part
in
that
to
look
at
that
again
to
look
at
how
we
can
move
forward,
because
there
is
somebody
on
Twitter
said
the
other
day,
there's
literally
Human
Wreckage
happening
all
the
time
and
behind
every
whistleblower
there
is
a
human
life.
There
is
a
family.
H
There
is
a
patient,
usually
who
sometimes
don't
even
know,
what's
been
happening
to
them,
and
there
are
staff
who
are
living
with
these
things,
a
living
for
years
with
them
not
ever
being
addressed
and
resolved
and
I
know
it's
a
really
difficult
issue
to
come
to
grips
with,
and,
and
it's
very
difficult
for
us
to
admit
to
our
mistakes.
But
if
I
can
do
it,
you
know
very
publicly,
then
I'm
sure
you
know
other
people
can.
H
A
You
no
thank
you
very
much,
I'm
not.
I
don't
think
that
any
particular
response
right
now
to
the
various
points
you've
made
is
appropriate,
but
what
I
can
say
is
that
every
one
of
us
have
just
heard
what
you
have
just
said.
So
thank
you
very
much
indeed,
and
that
we
are
now
over
running,
but
anyway.