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From YouTube: CQC board meeting - December 2018
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A
A
It
would
not
be
appropriate
for
him
to
come
and
give
it
to
us
this
morning,
so
those
are
two
apologies
I
want
to
welcome
Holly
Sutherland,
who
is
the
co-chair
of
our
race
equality
network
and
is
participating
in
today's
board
meeting
and
I
also
want
to
welcome
Debbie
Westhead,
who
is
going
to
be
the
acting
chief
expect
to
arrive
at
out
social
care
after
Andrea
moves
on.
So
those
are
the
welcomes
and
apologies.
I
will
welcome
you
in
in
a
few
minutes
sitting
at
the
end
there
for
your
your
item.
A
A
A
Okay,
so
can
I
now
welcome
Cathy
Kerr,
who
has
done
the
external
report
for
us
independent
report
on
are
safeguarding
alert
incidents,
Cathy
you're
very
welcome
and
Ursula
Gallaher,
who
has
been
a
fairly
frequent
visitor
to
our
borders?
You
know
who
actually
led
the
response
to
the
for
us.
So
Kathy
can
I
hand
over
to.
B
B
That
was
the
response
that
was
led
to
look
at
practice,
which
was
led
and
earth
shields
leadership
through
the
safeguarding
committee
and
second,
was
to
look
at
an
internal
audit
that
was
undertaken
to
look
particularly
at,
but
particularly,
was
focusing
on
some
of
the
system,
issues
that
had
contributed
to
this
issue
arising
and
to
look
at
how
systems
could
be
improved.
So
my
remit.
B
First
of
all
was
to
look
at
those
two
internal
reports
and
to
provide
some
assurance
for
the
board
on
the
steps
that
had
been
taken
internally
to
respond
to
and
learn
the
lessons
from
this
incident.
I
was
also
asked
to
look
at
the
findings,
the
findings
of
the
internal
work
and
to
look
at
the
consequences
of
any
impact
for
individuals,
and
these
are
people
aware
that
being
a
concerned
raised
about
their
safety,
whether
there
had
been
any
impact
from
the
delay
of
that
referral
to
the
local
authority.
B
B
So
there
is
an
issue
about
the
volume
of
cases
coming
through
and
there
are
some
recommendations
about
considering
how
some
of
that
might
be
triaged
at
an
early
point
in
in
those
coming
to
CQC's
notice.
There
is
also
so
that
so
that's
what
a
particular
practice
issue
that
this
is
identified
in
the
report.
The
internal
audit
focused
particularly
on
some
of
the
system
changes
and
there
are
particular
recommendations
there
about
how
CQC
works
if
actually
determine
as
a
whole
system,
so
how
the
different
bits
of
CQC
work
together
when
a
change
is
being
made.
B
So
one
of
the
things
that
that
was
apparent
in
this
is
there
was
a
there
was
a
new
IT
system
being
implemented
for
good
reason
to
try
and
streamline
referrals
safeguarding
referrals,
but
that
was
done
in
slight
isolation
from
the
business.
So
there
was
that
wasn't
a
really
strong
join
between
the
IT,
the
technical
side
and
the
operational
side
of
the
business
in
implementing
that
change.
So
there
was
some.
There
is
some
learning
there
and
some
recommendation
about
how
that
is
is
better
joined
in
the
future.
B
So
there
are
some
particular
kind
of
technical
aspects
to
the
recommendation.
So
that's
so
that's
the
focus
on
the
internal
elements.
If
you
like
I,
was
also
asked,
then
secondary
was
to
look
at
the
impact
for
individuals.
There
was
a
very
detailed
process
of
triage
and
rhe
triaging.
All
the
cases
where
there
was
a
concern
that
there
had
been
an
impact
from
the
delay.
My
report
focuses,
in
particular
on
nine
cases
where
there
is
still
some
uncertainty
about
whether
there
was
any
impact
for
individuals
as
a
result
of
the
delay
in
the
referral
being
made.
B
There's
a
recommendation
about
some
action
quickly
with
the
local
local
authorities
involved
to
try
and
reach
determination
on
those.
There
were
also
a
number
I
think
that
the
time
of
writing
report
was
26,
where
we
were
still
a
CQC
was
still
awaiting
confirmation
from
the
local
authorities
about
the
outcome
of
their
investigation
of
the
referral
once
it
was
made.
B
So
there
was
some
follow-up
needed
to
conclude
those
particular
cases
and,
on
the
back
of
that
also
some
discussion
to
be
had
with
the
local
authorities
about
what
contact
should
be
made,
if
any,
with
individuals
and
their
families
about
the
consequences
of
an
impact
of
any
delay
and
finally,
the
third
area
of
ours.
After
look
at
was
this
link
with
with
local
authorities.
B
That
protocol
is
in
the
process
of
being
updated
and
there's
a
recommendation
that
that
is
really
used
and
that
CQC
really
used
that
to
try
and
build
some
bridges,
particularly
with
those
local
authorities,
whether
it
hasn't
been
a
really
easy
communication
flow
around
around
some
of
these,
these
cases
and
the
final
recognition
to
in
relation
to
the
work
with
local
authorities.
There
is
clear
evidence
of
CQC,
as
it's
grown,
as
it's
developed
as
an
organization
working
much
more
closely
in
closer
partnership
with
external
partners.
B
The
recommendation
about
that
continuing
and
a
final
recommendation
that
falls
out
of
all
those
is
that
actually-
and
it
does
tie
in
with
that
point
about
actually
making
sure
that
all
bits
of
the
activity
within
CQC
are
kind
of
held
together.
There's
a
recommendation
that
the
safeguarding
committee
ought
to
be
tasked
by
the
board
with
making
sure
that
all
the
actions
arising
from
this
incident
are
held
together
and
so
there's
a
single
report
back
to
the
board
from
the
different
strands
of
activity
that
happening.
I.
A
C
Recommendations
are
very
procedural
and
system
based.
However,
there
is
an
acknowledgement
within
the
report
that
no
contact
was
made
with
families
or
individuals
affected
I
just
want
to
check
how
we
are
ensuring
or
how
we
can
ensure
that
the
human
impact
is
considered
at
all
stages
and
in
a
timely
manner.
B
If
I'd
come
back
on
that,
first
of
all,
Holly
and
then
call
it
CQC
colleague
might
want
to
comment.
I
think
it's
a
really
important
point
that
you
make
and
is
actually
one
that
I
discussed
with
colleagues
in
the
course
of
my
investigation
and
so
I
think
and
I
think
I
do
refer
to
it
explicitly
in
the
report.
B
Our
conclusion
was
that
we
ought
to
treat
this
in
the
same
way
as
any
other
if
any
other
referral,
and
that
we
ought
to
in
discussion
with
the
local
authority
who
would
take
the
lead
in
a
safeguarding
investigation,
would
take
a
decision
in
discuss
discussion
with
them
about
what
contact
should
or
shouldn't
be
made.
There
is
a
specific
recommendation
in
my
report
that
that
does
need
to
be
concluded
and
I
would
say,
as
a
matter
of
some
urgency,
to
determine
in
discussion
with
the
local
authorities.
B
What
action
does
need
to
be
taken
to
contact
to
contact
relatives
in
the
normal
course
of
a
safeguarding
investigation
that
the
local
authority
is
leading
because
that's
their
responsibility?
You
would
expect
there
to
be
some
contacts
with
the
individual
and
and
all
their
relatives,
and
it
may
be
that
that
has
already
happened.
There.
Also,
though,
needs
to
be
here
to
be
a
further
consideration
about
what
contact
there
might
need
to
be
to
discuss
with
the
relatives.
The
potential
impacts
of
this
particular
delay,
but
I
think
important
point
to
make.
E
Just
wanted
to
add
to
that
when
we
began
the
the
process
for
managing
the
incident.
I
think
the
other
thing
that
we
were
aware
of
was
actually
the
impact
on
the
staff
that
had
been
involved
in
not
making
those
referrals
because
actually
for
them,
they
acutely
felt
the
consequence
of
what
had
been
an
inverter
inadvertent
mistake
and
they
were
as
concerned
as
anybody
else
that
something
might
have
been
missed
as
a
result
of
something
so
the
other
thing
we
worked
very
hard
on
over
a
LAN,
and
it
was
that
was
the
communications
message.
E
F
G
I
think
a
big
lesson
for
me,
going
forward
with
our
big
change
program
is
to
import
the
lessons
into
that
to
make
sure
that,
alongside
the
digital
change,
we
contemporaneously
and
deliberatively
consider
the
people
processes
that
need
to
meld
with
that.
To
ensure
this
sort
of
thing
is
preventable,
as
we
can
make
it
Andrea.
H
Thank
you
just
a
couple
of
comments
that
the
first
is
to
say,
as
others
have
already
Kathy
a
huge
thank
you
to
you
for
the
work
that
you've
done
and
the
presentation
of
this
report,
which
I
think
is
tremendously
helpful
and
sets
out
some
clear
messages
for
us
going
forward.
I
think
to
pick
up
on
the
point
that
Holly
was
raising
and
you
do
make
a
very
specific
recommendation
about
what
we
should
be
doing
in
relation
to
the
conversations
with
the
local
authorities
about
the
impact
on
individuals
and
what
we
should
appropriately
do
with
them.
H
Going
forward
and
I
think
that
we
should
absolutely
take
on
board
that
recommendation
and
move
forward
and
I
know
that
Ursula
working
with
her
team
is
is
already
on
the
case
as
it
were,
which
I
think
is
is
helpful.
The
second
thing
to
say
is
that
the
recommendation
you
make
about
the
link
with
local
authorities
and
our
work
with
local
authorities
and
the
work
on
the
Memorandum
of
Understanding.
H
And
then
the
third
thing
is,
as
Paul
has
just
picked
up,
I'm
very
glad
to
hear
Paul
that
you'll
pick
that
up
as
part
of
the
audit
committees
ongoing
work
program,
because
I
think
that
you,
we
all
sat
there
in
July
2018
and
when,
when
it
came
to
Ursula
and
I,
whether
scratching
of
our
heads
and
how
on
earth
could
this
happen
and
the
review
that
we
did
from
an
internal
audit
perspective
which
is
commented
upon
in
your
report.
Kathy
demonstrates
that
actually
it
had
been
picked
up.
H
There
was
potential
solutions
at
that
point,
but
people
hadn't
really
understood
properly
what
the
impact
was
going
to
be,
and
also
there
hadn't
been
the
direct
collaboration
with
people
in
the
Operations
Directorate
who
knew
what
this
meant
and
knew
what
they
might
have
been
doing.
You
know
remembering
that
the
vast
majority
of
our
staff
has
sitting
at
home
as
home
workers
in
front
of
a
screen.
There's
not
the
kind
of
normal
camaraderie
and
sharing
of
information
that
you
might
get
in
an
office
environment.
H
So
I
think
that
as
picking
that
up
really
thinking
through
how
we
can
proactively
identify
risk
and
how
we
can
ensure
that
we
do
talk
to
the
people
who
use
in
the
system
at
the
time
that
we're
making
these
changes,
because
those
changes
were
made
for
very
good
reason,
which
was
to
help
our
staff
to
do
the
right
thing
more
easily.
But
unfortunately,
in
these
circumstances-
and
we
didn't
quite
get
it
right.
H
So
we
need
to
make
sure
that
we
do
pick
that
up
and
it's
it's
going
to
be
helpful,
I
think
for
and
staff,
as
well
as
others
that
we're
working
with
and
ultimately
these
people
affected,
that
we
do
them.
E
Peter,
if
I
may,
just
one
final
thing,
I'm
sure
the
board
would
like
to
thank.
There
are
teams
of
people
who
are
continuing
to
work
with
us
to
support
this
matter
music.
Some
of
these
conversations
and
the
team,
particularly
Winley,
who
worked
to
support
Cathy
in
terms
of
the
independent
reviews
so.
A
You've
read
half
the
note
to
myself
Ursula
the
other.
The
other
half
was
was
was
Thank
You
Ursula
for
the
work
that
you
did
at
the
time
in
particular,
and
the
people
who
were
working
with
you
at
the
time
to
respond
to
this,
because,
whilst
getting
into
this
situation,
wasn't
our
finest
hour
I
think
the
way
that
we
responded
was
exemplary.
So
I
wanted
to
thank
you
and
the
team
and
then
finally
Cathy
that
once
again,
thank
you
very
much
for
giving
up
so
much
of
your
time
to
do
this
fantastic
report
for
us.
I
I
There's
a
significant
piece
of
process
improvement,
work
which
is
underway
in
the
registration
area,
and
my
expectation
is
that
the
the
monthly
performance
run
rate
will
improve
significantly,
but
I
doubt
that
it
will
improve
to
an
extent
that
we
will
be
on
plan
by
the
end
of
the
year.
So
my
expectation
is,
we
will
we
will
finish
the
year
under
planning
registration,
safeguarding
I.
Think
we've
just
talked
a
lot
about
from
from
the
report.
We've
just
seen.
I
think
I
think
we're
slightly
under
plan
in
that
area.
I
But
I
do
I
am
hopeful
that
the
work
that
we've
done,
The
Fairly
forensic
work
that
we've
done
are
on
in
safeguarding.
We
will
be
able
to
improve
our
performance
in
the
long
term
and
I
think
that
one
of
the
key
points
is
that
we
are
probably
referring
to
many
incidents
as
safeguarding
incidents
and
I.
Think
the
total
number
of
safeguarding
instance
will
come
down
over
time
and
I
think
that
will
probably
change
them
the
overall.
A
So
I
suppose
I
I
had
a
question
Ian,
which
was
we've
got
the
data
on
on
on
performance
of
safe
safeguarding
alerts,
and
what
we
don't
have
in
here
is
what
happens
to
those
that,
where
we
missed
the
target
and
I
just
like
some
reassurance,
if
not
now,
follow-up,
that
we
are
confident
that
those
that
are
just
behind
the
target
are.
Nevertheless,
you
know
action
quickly,
rather
than
lost
or
not
actions,
that's
not
the
case,
but.
H
To
give
you
that
reassurance,
Peter,
any
of
the
alerts
that
are
missed
on
the
five-day
target
are
investigated
by
the
team,
and
very
often
it
is
it's
only
a
matter
of
days.
We
don't
see
it
kind
of
extending
out
and
for
any
length
of
time
and
it
we
have
had
a
couple
of
issues
that
have
been
to
do
with
the
system
and
a
couple
of
issues
that
have
been
to
do
with
cover
for
members
of
staff
who
are
on
annual
leave
and
that
not
being
handled
as
well
as
we
would
expect.
D
It
did
raise
the
the
more
general
issue
of
what
what
is
happening
about
care
homes,
where
there
has
been
an
inadequate
rating
and
in
particular,
what
happening
where
there
are
repeated
inadequate
ratings
and
I
suppose,
because
it
was
highlighting
I
suppose
it
was
getting
at
the
fact
that
how
do
we
know
anything
is
changing.
Is
there
a
really
a
drive
to
improve
in
the
care
home
sector
and
in
the
performance
report
that
she
this
month?
D
Rather,
you
can
see
why
some
of
those
figures
are
concerned,
because
there
are
there's
279
accounts
currently
or
adult
social
care
services.
I
should
say
rated
inadequate
this
year,
they've
been
135
that
have
been
rated
inadequate
again
for
a
second
time.
The
numbers
in
special
measures
are
higher
they're
353,
so
we've
got
279,
inadequate
and
even
more.
D
H
It's
effectively
starting
the
clock
ticking
very,
very
loudly
on
the
Henschel
for
those
services
to
be
closed
down.
If
improvements
are
not
made.
What
we
do
see
with
those
services
is
that
over
80%
of
them
do
improve
on
on
the
next
inspection,
and
that
may
well
be
as
a
result
of
if
it's
one
of
the
larger
corporates
then
drafting
in
their
quality
assurance
and
support
teams
in
some
areas,
their
local
authorities
do
a
lot
of
work
to
support
services
and
to
get
them
to
improve.
H
Sometimes
it's
a
change
of
leadership
that
makes
the
difference
and
that
we
can
see
that
where
we
have
said
that
they
are
inadequate
more
than
once.
That
is
when
we
start
doing
and
start
taking
our
enforcement
action
and
signaling
that
we
will
be
putting
in
at
what
we
call
a
notice
of
proposal
to
cancel
their
registration,
which
is
a
process
that
we
have
to
go
through.
There's
lots
of,
and
it
can
take
some
time,
I
call
it
the
slow
boat
to
China
route,
sometimes
in
terms
of
the
amount
of
time
it
can
take.
H
H
We
will
take
further
action
because
essentially,
if
you're
only
ever
doing
anything,
because
we've
told
you
to
actually
that's
probably
a
breach
of
regulation
17,
which
is
about
good
management
and
good
governance
of
the
service.
So
we
would
being
more
proactive
about
taking
action
in
that
respect
as
well.
D
So
there
is
good
news:
is
they
get
better
but
the
bad
news?
Is
they
don't
get
that
much
better
and
I?
Just
suppose,
seeing
that
and
seeing
that
set
out
so
that
we
can
be
reassured
about
the
timeline
on
behalf
of
those
you
know
several
thousand
people
who
are
probably
not
getting
even
with
improvement,
getting
the
right
standard
of
care,
I.
H
Was
guess
what
I
was
just
about
to
do
lewis?
And
I
think
that
one
of
the
reasons
why
debbie
is
absolutely
the
right
person
to
pick
this
up
for
the
future
is
because
debbie
is
our
enforcement
lead
for
the
whole
of
the
organization
currently
as
Deputy
Chief
Inspector,
and
has
been
absolutely
instrumental
in
improving
our
approach
to
enforcement
and
improving
our
way
of
holding
providers
to
account
and
because
you're
absolutely
right.
This
has
an
impact
on
people.
H
None
of
us
would
want
our
loved
ones
to
be
living
in
a
service
or
being
supported
at
home
by
a
service.
That's
rated
as
inadequate,
and
none
of
us
would
want
any
of
our
family
members
and
to
be
working
in
a
service
like
that,
because
actually,
that
has
a
really
detrimental
impact
on
staff
and
contributes
to
the
high
level
of
turnover
that
we
see
in
adult
social
care
as
well.
H
So
there
were
a
myriad
of
reasons
as
to
why
we
need
to
be
proactively
tackling
this,
but
it
does
also
point
up
to
the
fragility
of
the
adult
social
care
sector,
which
is
that
very
often
it.
You
know,
people
will
be
teetering
around,
but
actually
they
don't
have
the
wherewithal
and
the
resources
to
either
make
that
signal.
African
improvement
that
we
want
to
see,
or
indeed
to
a
sustained
and
the
good
performance
that
we're
seeing
in
other
services
as
well.
So.
I
Just
to
build
on
on
Andrea's
last
point
that
I
think
it
is
worth
noting
that
you
know
this
is
not.
This
is
not
something
that
CQC
alone
has
the
responsibility
to
deal
with.
I
mean,
frankly,
you
wouldn't
put
your
own
relative
if
you
were
a
private
payer
into
an
inadequate
home,
but
local
authorities
are
continuing
into
Commission,
have
the
Commission
care
from
those
from
those
institutions.
So
there
was
something
here
about
the
responsibility
of
commissioners
to
Commission
the
Commission
services
of
an
adequate
quality
yeah.
B
Sorry
about
that
and
just
to
add
as
well
that
the
inspection
reports
do
make
it
as
clear
as
we
possibly
can.
The
action
that
we
are,
we
are
taken
to
keep
people
safe.
So
members
of
the
public
she'll
be
able
to
see
that
I've
just
I've
just
checked
one.
That's
online!
Now
it's
absolutely
clear
that
that
we
have
taken
action
and
we
will
continue
to
monitor
as
well,
but
Ian's
absolutely
right.
B
A
G
Was
wondering
if
in
quarter
one
next
year,
we
might
consider
resurrecting
the
review
of
what
we
measure
and
how
we
present
it
so
that
it's
aligned
with
the
transformation
that
were
wanting
to
bring
about,
but
also
makes
it
much
more
obvious
and
transparent?
When
change
takes
place,
because
at
the
minute,
it's
somewhat
impenetrable
in
terms
of
the
graphs
and
the
displays
IIIi.
A
H
What
we're
trying
to
do
now
is
to
expand
that
to
provide
better
information
about
the
use
of
surveillance
and
other
but
other
aspects
of
Technology.
This
is
now
going
to
be
a
web
resource
which
will
be
developed
over
time
with
new
topics
added
in
and
requiring
peeping
people.
Sorry,
what
are
the
topics
they
would
like
us
to
cover?
H
We
had
a
very
good
presentation
yesterday
from
April
Cole
in
the
policy
team,
with
the
trade
associations,
who
were
very
positive
in
responding
to
the
information
that
we've
put
there
and
the
things
that
they
would
like
us
to
do
in
the
future.
So
it
is
something
that
I'm
I'm
very
glad
that
within
my
final
couple
of
months,
we
did
actually
update
that
information,
because
it
was
a
very
significant
part
of
my
second
year
here.
J
This
looks
really
good.
Thank
you
very
much
two
points.
The
first
is
I
just
wondered
how
we
keep
track
on
how
these
policies
are
being
put
into
practice,
because
there's
a
lot
of
really
good
kind
of
policy
development
coming
out
of
this,
and
the
second
thing
was
something
terribly
specific,
which
was
the
plan
to
set
up
a
register
of
potentially
violent
persons
and
I
mind
the
wrong
place.
A
K
That
I,
just
just
a
build
on
Andrea's
point
and
I
know
David,
has
been
involved
in
some
of
the
development
of
this.
This
is
a
developing
resource
and
I
think
it's
important
that
we
can
signal
for
the
public
what
they
can
expect
in
the
use
of
technology
and
also
signal
to
providers
how
they
can
demonstrate
their
compliance
with
the
five
key
questions.
So
the
resource
will
adapt
and
change
over
time,
but
it
will
it's.
K
L
Next
week
we'll
be
publishing
the
thematic
report
on
never
events
and
be
grateful
to
all
the
comments
from
board
members
which
we
incorporate
into
the
final
text.
It
comes
out
next
week
and
I
hope
you'll
be
pleased
with
the
final
document.
What
we're
we're
positioning
this
there
I
mean
clue.
There
are
some
technical
things
you
can
do
to
improve,
how
never
events
are
managed
and
we
are
suggesting
those
but
I.
L
Think
fundamentally,
the
lesson
we've
drawn
from
this
is
that
actually
the
fact
that
never
events
keep
occurring,
despite
all
the
attempts
people
have
made,
the
well-intentioned
attempts
people
have
made
to
reduce
their
occurrence
is
a
is
a
reflection
of
the
underlying
safety
culture
in
healthcare
and
in
the
NHS
and
the
services
we
regulate.
And,
of
course,
a
lot
of
our
reports
have
commented.
L
Finding
that
improving
the
safety
is
required,
that
there
is
an
underlying
issue
about
culture,
and
we
often
reflected
that
in
it
in
terms
of
staff
not
being
able
to
raise
concerns
or
not
filling
their
concerns.
I
listened
to
or
acted
upon,
and
lessons
not
being
learnt
from
investigations
into
when
things
have
gone
wrong,
and
what
we
try
to
bring
out
in
this
report,
which
comes
out
next
week
is,
is
a
kind
of
sense
of.
L
Why
is
that
happening
and
I
think
it
is
easy
to
think
if
we
just
tell
staff
they've
got
to
do
better,
things
will
improve,
but
actually
I
think
we've
got
to
question
some
of
the
underlying
cultural
issues
that
are
drive.
This
is
driving
that
behavior
in
the
system
and
in
individuals,
and
what
we've
tried
to
do
is
open
debate
about
that.
L
What
we're
calling
for
is
cultural
change
around
safety
in
the
NHS
which
has
been
called
for
before,
but
what
we
very
much
hope
is
that
the
insights
in
this
report
will
help
drive
forward
really
positive
change.
We've
had
some
really
very
good
feedback
on
it
from
external
bodies,
so
we're
very
hopeful.
It
will
have
the
impact
we
want
it
to
have.
A
H
Thank
you,
so
the
board
received
in
June
this
year
support
jenkins
and
because
of
his
sat
on
untimely
death
in
february
David
nobles
independent
report
into
our
regulatory
actions
of
14
Kong
Road,
which
was
operated
by
Hill
green
care
limited
and
although
sapore
and
David
concluded
that
there
was
a
strong,
clear
focus
at
CQC
on
ensuring
people
were
safe.
He
also
said
that
not
everything
was
perfect
in
the
regulation
of
the
service
or
in
CQC's
policies
and
practices
in
place
at
that
time,
which
was,
of
course,
November
20
2015.
H
The
two
counts
that
were
brought
and
was
fined
three
hundred
thousand
pounds.
And
we
were
awarded
full
costs
in
the
judgment
that
was
being
that
was
made
in
November
of
this
year.
I'm
not
going
to
go
through
all
of
the
recommendations,
because
I'm
going
to
assume
that
you
have
all
read
them.
But
to
pick
up
on
the
point
that
I
think
his
was
wanting
to
ask
me,
which
was
that
there's
lots
of
good
things
here
for
us
that
we're
expecting
people
to
be
doing.
H
And
how
are
we
making
sure
that
that
is
happening
throughout
the
organization?
Because,
whilst
this
was
an
adult
social
care
issue,
one
of
the
things
that
support
was
quite
keen
to
ensure
was
the
CQC
did
not
respond
to
it
as
just
an
adult
social
care
issue
that
there
were
aspects
of
the
way
that
we
operated
and
our
policies
and
procedures
which
applied
across
the
board.
I.
H
We'd
be
much
clearer
about
our
expectations
of
that
and
inspection
managers
who
were
doing
the
quality
assurance
and
the
peer
review
that
happens
on
that
people.
Who
are
aware
that
that's
what
they
need
to
be
picking
up
on.
So
there's
a
day-to-day
way
of
doing
that.
The
second
thing
to
say
and
Debbie
can
give
you
more
detail
of
this.
We
are
introducing
next
year
our
professional
skills
regulatory
training
program
and
that
will
really
strengthen
the
training
support
that
inspectors
across
the
organization
will
get
around
both
our
civil
and
our
criminal
enforcement
activity.
H
And
last
but
not
least,
we
do
also
have
Quality
Assurance
mechanisms
whereby
we
will
identify
specific
themes
that
we're
wanting
to
look
at
and
Steve
Holmes
who
works
in
the
adult
social
care
world.
On
this
there
were
others
who
sit
in
Steve
and
Ted's
directorates
will
look
at
those
particular
particular
themes,
look
at
the
outputs
and
outcomes
and
inspect
inspections
and
make
sure
that
that
has
been
that,
if
there's
further
learning
to
be
done
that
we're
identifying
it-
and
you
didn't
quite
get
to
your
second
question
so
I'll.
Let
you
get
in
on
that
one.
H
J
You,
yes,
there
is
a
reference
to
a
register
of
potentially
violent
persons
and
I
wanted
to
know.
Firstly,
what
this
is:
is
it
literally
a
register
of
people
who
might
be
violent?
If
so,
if
you
are
a
person,
who's
considered,
potentially
violent,
you
have
a
right
to
challenge
that
or,
and
what
are
the
ethical
implications
or
I'll
have
I
completely
misunderstood
it
I.
H
Have
to
confess
that
I
don't
know
the
absolute
detail
of
that.
This
is
something
that
has
been
taken
through
from
the
health
and
safety
at
work
side
of
things,
and
we
have
been
looking
also.
We
have
had
other
incidents
where
members
of
our
staff
have
knew.
In
fact,
we
had
two
members
of
staff
who
were
physically
attacked
and
the
the
person
who,
on
an
inspection,
the
person
who
did
that
was
convicted.
H
H
J
A
M
G
M
B
B
We
continue
to
do
a
lot
of
work
around
supporting
the
local
networks
to
secure
more
funding
locally
or
at
least
reduce
the
impact
of
the
cuts
from
local
government
funding
to
the
network,
and
we
are
s
we
estimated
before
our
conference
in
October
that
our
interventions
have
actually
saved
her
in
the
in
the
region
of
half
a
million
pounds
that
would
have
left
the
network.
Had
we
not
have
done
our
interventions
and
that
takes
the
that
takes
the
form
of
quite
hands-on
ringing
up
commissioners
dealing
with
councillors
who
are
on
health
and
well-being
boards.
B
B
The
second
thing
I
just
wanted
to
focus
on
was
the
work
that
HealthWatch
England
has
been
doing
on
the
NHS
long
term
plan
we've
been
very
active
in
in
in
two
streams
of
works,
specifically
that's
on
engagement
and
clinical
priorities
and
and
we've
also
submitted
a
lot
of
evidence
to
many
of
the
other
work
streams
and
I've
documented
for
you.
There,
the
the
sorts
of
experiences
that
we
have
been
able
to
submit.
B
So
it's
over
80,000
people's
experience
of
using
Health
and
Social
Care
has
gone
into
supporting
the
work
for
many
of
the
work
streams
on
the
10-year
plan.
The
other
part
of
that
that
I
just
want
to
highlight
for
you
is
that
we
have
entered
into
an
agreement
with
NHS,
England
and
NHS
improvement
that
once
the
plan
is
launched
very
soon.
B
Hopefully,
then,
we
will
run
a
big
engagement
programme
throughout
the
whole
of
the
country
and
every
part
of
the
country
helping
local
STP
areas
work
out
how
they
engage
properly
with
their
their
public,
and
we
will
be
starting
that
public
engagement
part
from
January
and
we
will
be
bringing
in
a
program
manager
probably
this
week,
hopefully
so
that
one
I
just
wanted
to.
Let
you
know,
because
that's
a
sort
of
different
piece
of
work
and
I
think
really
important.
B
It's
the
first
time
that
HealthWatch
has
had
that
real
recognition
that
we
are
here
to
help
everybody
do
their
job
better
and
we
will
be
delivering
access
to
the
public
in
every
community
in
the
country.
The
third
thing
I
just
want
to
bring
to
your
attention
is
our
annual
report,
which
you
will,
if
you
haven't
received
copies
of
in
your
inbox.
At
the
moment
you
will,
by
the
end
of
today
it
gets
laid
before
Parliament
in
tomorrow
and
sets
out
what
our
work
of
the
last
year
I'm
very
happy
to
take
questions.
Peter.
N
Thank
you,
I
think.
It's
really
good
work
and
I'm
really
pleased
that
HealthWatch
I
was
going
to
say,
is
taking
off,
but
you
know
what
I
mean
it's
becoming
more
prominent.
You
know
across
the
whole
country
because
it
was
a
bit
a
little
bit
patchy
in
the
last
few
years
and
I,
particularly
like
the
work
you've
been
doing,
asking
the
most
vulnerable
people
for
their
opinions
as
sort
of
work.
We
did
a
few
years
ago
and
it's
nice
to
keep
the
pressure
up.
N
N
It
is
heartening,
however,
that
I
think
all
of
the
practices
that
I
know
of
who
focus
on
the
homeless
have
been
rated
outstanding
across
England
and
I.
Think
that's
a
real
credit
to
them.
It
shows
that
if
you
focus
on
the
needs
and
the
most
vulnerable
and
you
focus
on
the
most
vulnerable
and
on
people,
you
can
deliver
outstanding
care
and
it's
a
message
for
all
GP
surgeries
across
the
country
that,
if
you're
really
committed
to
what
you're
doing
you
can
do
it.
N
And
you
know
I've
spoken
about
the
Bevin
practice
in
Bevin
house
in
Bradford
a
number
times
they've
recently
taken
over
the
York
Street
practice
in
Leeds.
They
are
the
best
surgery
I've
been
into
in
the
five
years,
I've
been
chief
inspector
and
they
focus
on
the
care
of
homeless
people,
sex
workers
and
asylum
seekers,
stroke
refugees
and
whenever
I
see
anybody
who's
really
interested
in
how
you
can
do
general
practice,
I
suggest
they
go
and
visit
them
and,
and
so
I
think
the
way
you're
doing
keeping
the
pressure
on
these
excellent.
Thank
you.
B
Steve's,
just
just
so,
you
know,
we
are
also
talking
to
an
alliance
of
organizations
called
the
health
and
well-being
alliance
of
which
there
are
organizations
that
represent
homeless
people's
sex
workers,
gypsies
and
travellers,
and
we're
looking
to
see
where
we
can
add
value
across
the
country
on
the
bits
of
work
we're
doing
because
they
can't
cover
the
whole
country.
So
I
think
we
need
to
keep
this
a
priority.
Absolutely
Chris.
A
A
H
No
just
to
introduce
Stuart
Stuart
Dean
is
our
director
mark
oversight,
and
what
we
wanted
to
do
is
to
give
you
a
bit
more
visibility
around
the
work
of
the
team
and
some
of
the
issues
that
we
have
been
coping
with
recently
and
I
will
hand
over
to
Stuart.
Thanks.
O
The
design
of
the
scheme
assumes
that
the
market
can
generally
cope
with
business
failure,
so
market
oversight
has
no
powers
to
actually
prevent
the
financial
failure
of
particular
providers
and
there's
more
detailed
sort
of
guidance
and
information
relating
to
the
scheme.
Participants
that's
published
on
CQC's
website
so
to
put
some
sort
of
further
color
around
it.
There
are
currently
58
providers
in
the
scheme
that
covers
approximately
25%
of
the
registered
beds.
O
We
don't
sort
of
possess
accurate
information
for
home
care
hours,
but
our
working
assumption
is
that
it
broadly
equates
to
a
similar
percentage
of
the
home
care
market.
Since
the
scheme
was
launched
in
April
2015
we've
seen
a
twenty-eight,
centage
point
deterioration
in
risk
across
the
market
oversight
portfolio.
O
That
sort
of
number
is
derived
by
considering
the
highest
two
levels
of
risk
in
our
operating
model
prior
to
was
issuing
a
stage.
Six
notification
in
terms
of
notifications
we've
issued
thus
far.
One
was
a
with
regards
to
a
single
location
and
therefore
one
local
authority,
and
the
second
that
we
issued
last
month
was
a
corporate,
wide
notification
where,
ultimately,
we
issued
stage
six
notifications
to
96
local
authorities.
O
I
think
I'd
also
take
the
opportunity
to
really
emphasize
that,
in
addition
to
the
issuance
of
stage
six
notifications,
as
and
when
the
sort
of
circumstances
warrant
that
it's
important
to
appreciate
the
foreseen
influence
that
market
oversight
has
on
operators
in
the
scheme
and
I.
Think
I
would
summarize
that
into
three
broad
strands
diversities
certainly
improve
financial
discipline,
particularly
in
the
charitable
and
third
sectors.
The
second
is
enhanced
financial
stability,
as
a
result
of,
but
by
engaging
with
providers
to
understand
where
the
challenges
are
in
their
businesses.
O
So,
within
sort
of
the
scheme
we
operate
a
Six
stage
operating
model
Stage
one
is
binary.
If
you
meet
the
entry
criteria,
you
are
captured
by
the
scheme
and
Stage.
Six
is
where
we
issue
the
notification
to
local
authorities.
Stages:
two
to
five
then
indicate
varying
degrees
of
risk
and
put
some
color
around
that
we
operate
our
engagement
on
a
risk-based
approach
so
for
providers
that
are
categorised
as
stage
two.
We
may
meet
them
at
least
annually
for
those
that
are
classified
as
Stage
five.
We
would
typically
be
engaging
beyond
the
executive
management
team.
O
So,
in
addition
to
discharging
our
regulatory
responsibilities,
we
also
analyze
the
quarterly
financial
turns
from
the
providers
that
are
in
the
market
oversight
scheme
and
that's
with
the
intention
to
understanding
how
they
market
is
performing.
The
sort
of
latest
analysis
here
demonstrates
a
continued
margin
attrition,
despite
providers,
changing
their
sales
mix
towards
more
sorry,
higher
margin,
private
paid
clients
and
also
resolving
own
economic
situations.
O
The
situation
remains
worst
for
home
care
providers
where
arc
all
but
failed
earlier.
This
year
and
allied
health
care
has
effectively
gone
through
to
insolvency
processes
and
that
sort
of
business
failure
is
something
that
is
new
this
year,
so
in
2018.
I
would
also
suggest
that
the
continued
outflow
bed
capacity,
despite
a
rise
in
the
number
of
sort
of
elderly
people
in
the
population,
demonstrates
problems
continue
to
exist
in
the
care
home
market
as
well.
O
This
point
in
time,
I
think
it's
difficult
to
see
the
existing
market
fragility
improving
in
the
short
term
as
occupancy
remains
under
pressure.
There's
evidence
to
suggest
that
commissioning
volumes
seemed
to
be
stalling
and
there
is
no
abatement
to
the
increase
in
staff
costs,
particularly
Agency
costs.
Okay,
any
questions.
A
Sure
it's
a
fantastically
good
report,
given
that
an
awful
lot
of
what
you
actually
do
has
to
be
confidential
for
obvious
commercial
reasons,
I
think
you've,
given
us
a
fabulous
flavor
of
what's
going
on
I
know
because
I'm
behind
your
corporate,
not
corporate
veil,
your
confidentiality
veil,
just
how
much
work
you
and
the
team
are
doing
every
day.
It's
really
really
valued
and
appreciate
it's!
Oh
thank
you.
Are
there
any
any
any
questions
for
the
steward
yeah.
P
Link
the
very
last
statement,
which
is
there's
little
evidence,
suggests
that
market
fertility
will
reduce
we've.
The
discussion
we're
having
early
on
about
enforcement,
that
the
point
of
enforcement
seems
to
me
is
to
enforce
the
fact
that
we
CQC
are
saying
services
are
not
good
enough,
but
that
only
is
really
helpful
if
they're
replaceable
and
a
fragile
market
makes
that
very
difficult,
no
impossible
makes
it
very
difficult.
P
So
actually
the
fertility
of
the
market
does
have
an
impact
upon
our
capacity
to
carry
a
daily
task,
and
so
the
market
oversight
gives
us
information,
which
actually
then
demonstrates
why
some
of
the
things
we
will
be
doing
if
the
market
wasn't
fragile,
we'd
be
more
active
at
suggesting
other
people
coming
into
that
market.
So
other
people
coming
into
a
fragile
market
is
unlikely
to
happen
and
I
think
that
that
has
an
impact
upon
what
we
do,
as
well
as
an
impact
on
the
lives
of
thousands
of
people
and.
O
I
think,
in
fairness,
the
sort
of
reality
as
to
what's
happening
in
markets,
certainly
in
particular
regions-
is
that
the
providers
are
moving
from
a
situation
whereby
they've
been
price
takers
in
the
sort
of
medium
pass
to
positions
of
being
sort
of
price
makers.
So
if
they
are
the
sort
of
lust
and
sort
of
provider,
the
standing
they've
got
that
stronger
position.
The
challenge
is
whether
they've,
actually
you
know
whether
the
good
providers
out
there
in
particular
sort
of
locations
actually
have
the
spare
capacity
to
take
on
you
to
provide
more
care
Andrea.
Thank
you.
H
The
second
point
builds
on
the
comment
that
we
were
making
earlier
in
the
ER
made
earlier
about
the
role
of
commissioners
in
all
of
this,
because
there
is
something
about
the
responsibility
of
local
authorities
to
shake
the
local
market
and
to
do
that
in
a
way
that
actually
does
enable
good
quality,
adult
social
care
to
be
available.
And
for
that
to
be
available
in
the
different
ways
that
people
want.
It
I
absolutely
understand
that
they
are
between
a
rock
and
a
hard
place,
given
the
reductions
in
in
funding.
K
Chris,
just
a
sort
of
further
build
on
that
point,
I
think
it's
it's
important
and
interesting.
The
work
we've
done
in
the
systems
to
help
understand
the
impact
of
potential
failure
and
fragility
in
one
part
of
the
system
to
the
impact
that
has
on
the
wider
system
and
I
think
that
our
reports
that
are
due
to
to
come
out
on
a
second
round
of
this
work,
I
think
well,
we'll
give
them
further
weight
to
that
point
and
something
we'll
pick
up
again
in
the
state
of
care.
K
Understanding
that
not
the
impact
of
a
service
failure
in
one
part
of
a
local
area
will
have
knock-on
impacts
into
other
is
something
that
we
should
be
mindful
of,
as
we
do
our
work
for
state
of
care
for
next
year,
but
also
in
our
work
in
the
system.
Reviews
on
this
work.
It's
an
important
point
to
use
enough
information
not
just
to
help
manage
the
market,
but
also
to
see
the
effects
of
it.
K
A
F
Right,
Paul
and
then
Robert
gentleman
over
there,
yeah
yeah
I
just
wanted.
Your
report
covers
the
25%
of
beds
which
are
within
our
purview
but
there's
obviously
75%
of
beds,
which
are
not
directly
within
our
scheme.
I
was
wondering
whether
I
was
wondering
whether
you
had
any
news
on
what
was
happening
in
the
smaller
end
of
the
market.
If
you
like,
and
whether
the
pressures
there
were
accelerating
or
not.
O
O
M
M
H
Let
me
see
what
I
could
think
of
soak
up
a
couple
of
things.
One
is
what
we,
even
even
in
the
work
that
we're
doing
and
that
Stewart
and
the
team
do
we're
not
here
to
prevent
anything.
We
can't
prevent
what's
happening.
I
think
that
Stewart
is
quite
right
to
identify
the
influence
that
he
and
the
team
have
had
in
terms
of
strengthening
and
some
of
the
approaches
that
individual
providers
have
had,
but
we
don't
have
any
powers
of
intervention
at
a
national
level
and
we
absolutely
don't
at
a
local
level.
H
Neither
do
we
have
the
information
or
nor
the
expertise
for
us
to
be
looking
at
the
financial,
health
and
status
of
every
single
provider
that
we've
currently
got.
There
have
been
occasions
where
we've
called
on
the
good
offices
of
Stewart
and
his
team
to
look
at
certain
things
you
in
particularly,
for
example,
in
in
hospitals
when
they've
and
they've
had
some
issues
with
independent
providers,
but
we
don't.
We
don't
have
kind
of
the
the
wherewithal
to
do
that
on
a
regular
basis
across
the
whole
piece.
H
So
there's
a
push
for
transparency
from
that
point
of
view,
but
we
are
not
an
economic
rating
regulator
and
whilst
there
are
aspects
of
the
way
that
providers
manage
their
finances,
which
we
will
assess,
obviously
at
registration
to
make
sure
that
they,
you
know,
we
can
register
them
appropriately.
That
ongoing
monitoring
is,
is
not
part
and
parcel
of
what
we
do,
and
but
we
are
Dave.
James
in
policy
is
looking
with
the
CMA
as
to
what
more
we
can
do
to
assist
them
in
the
work
that
they're
doing
to
to
increase
that
transparency
during.
Q
Just
a
general
question:
I
mean
I,
guess,
there's
organizations
who
have
got
two
stages:
five
and
six
and
have
managed
to
turn
themselves
around.
Are
there
good
practices
or
lessons
learnt
all
that
we're
not
into
prevention,
but
we
could
share
with
other
organizations
to
say
look.
You
know
these
are
some
of
the
things
that
people
in
your
similar
situation,
where
your
margins
are
quite
low,
we're
in
a
difficult
geography.
Q
O
We
walk
a
fine
line
between
discharging
our
regulatory
responsibilities
and
not
dipping
our
toe
into
shadow
directorship,
so
we
aren't
able
to
advise.
Nor
should
we
be
advising
directors
as
to
what
actions
may
or
may
not
be
appropriate.
What
we
can
talk
to
and
what
we
sort
of
do
talk
to,
bearing
in
mind
every
sort
of
that
there
will
be
nuances
to
every
sort
of
situation
is
sort
of
the
different
levers.
O
We
know
we
operate
to
sort
of
encourage
the
directors
to
understand
the
different
levers
that
they
may
be
able
to
pull
to
resolve
particular
challenges.
We
will
then
sort
of
have
a
discussion
with
them
as
to
the
plausibility
of
pulling
a
particular
lever
and
having
indeed
having
the
expected
outcome.
O
So
you
know
that
to
answer
your
question,
the
challenges
there
are
one
of
Shadow
directorship
nuance
of
situation,
but
you
know
we
will
try
to
be
as
sort
of
helpful
as
we
can,
but
equally
needs
to
be
an
appreciation
that
the
vast
majority
of
operators
that
are
in
the
market
oversight
scheme
are
in
because
of
size
as
a
result
of
that
they
are
generally
quite
sufficient.
Gated
management
teams
who
are
drawing
on
sort
of
independent
expertise
from
market
consultants
to
try
and
I
guess,
provides
some
further
color
around
the
impact
of
sort
of
market
oversight.
O
If
I
consider
a
static
population
of
names,
then
I
can
certainly
point
to
a
trend
of
sort
of
evidence
whereby
those
that
have
been
in
the
scheme
longest
have
moved
down
the
operating
model.
There
are
a
cohort
of
names
which
aren't
going
to
move,
because
the
problems
are
would
require
a
difficult
sorry,
a
different
capital
structure.
The
challenge
that
we're
facing
in
terms
of
the
overall
risk
deterioration
in
the
portfolio
is
one
of
how
the
market
is
operating
and
what
we've
been
seeing
is,
as
the
larger
operators
have
resolved
some
of
their
own
economic
situations.
O
They
have
been
picked
up
by
medium
sized
organizations
that
were
outside
of
the
entry
criteria
for
the
scheme.
Picking
up
sort
of
those
locations
or
contracts
has
brought
them
in
to
meeting
the
entry
criteria,
but
they
are
then
entering
scheme
at
a
higher
level
of
risk,
which
we
then
need
to
work
through
with
the
particular
air
operators
in
question.
O
C
A
A
A
R
You
so
I'm
I'm,
Helen,
McNamara
and
head
of
organizational
development
and
Farah
and
Kiran
and
with
me,
they'll
introduce
themselves,
as
we've
all
got
some
small
little
something
to
say
about
this.
This
agenda.
From
my
perspective,
thank
you
for
putting
it
on
the
agenda
today.
This
is
an
update
really
on
our
or
decline
report.
R
Actually,
so
we
asked
order
to
come
in
and
do
an
independent
piece
of
analysis
for
us,
and
we've
been
working
really
since
with
Roger
since
February
this
year
and
I
just
wanted
to
explain
that
this
is
a
continuous,
continual
conversation
about
the
work
that
we
need
to
do
around
inclusion
and
from
the
moment
that
Roger
started
working
with
us,
we've
taken
on
board
all
of
the
recommendations
that
he
has
set
out
before
him.
He
gave
myself
and
Ruth
Bailey
some
verbal
recommendations
in
April.
R
Then
in
motion
and
train
a
series
of
actions
which
we
and
the
people
team
have
been
working
with
partners
across
the
organization,
including
fara,
to
to
put
into
practice
and
to
put
into
place,
and
that
will
set
the
kind
of
direction
of
travel
really
through
2019
and
beyond.
And
it's
something
that
obviously
started
as
a
reaction
to
an
issue
within
our
DME
community,
but
is
something
now.
That's
is
much
more
broader
than
that.
It's
about
setting
out
a
strategy
for
inclusion.
S
Representative
we've
got
Holly
here
today
and
every
board
meeting,
and
so
we
just
want
to
formalize
some
of
that
and
take
the
opportunity
today
is
a
bit
of
a
milestone
to
say:
we've
got
this
vision
for
inclusion
that
we
can
start
to
then
talk
to
the
entire
organization
about
and
demonstrate
the
board's
kind
of
commitment.
So
we're
asking
to
sign
off
on
that
as
well.
Today,
Andy.
T
A
A
Think
Karen
on
your
your
your
challenge,
I'd,
like
to
think
that
we
were
ahead
of
you
on
the
challenge,
the
things
that
we've
actually
already
done.
I
I
hope
demonstrate
the
board's
commitment,
but
that
doesn't
mean
we
won't
accept
your
challenge
to
carrot,
carry
on
doing
so
and
Farrah
thanks
for
the
nice
things
that
the
you
said.
Thanks
for
your
your
your
response
to
IANS
challenge
back
back
to
you,
if
I
can
put
it
way,
Holly
did
you
want
to
say
anything.
A
So
I
have
a
an
email
from
from
marks
accident
who's
ill,
but
he
wanted
just
to
support
the
Roger
Klein
recommendations
and
in
particular
he
wanted
us
to
consider
focusing
and
tackling
three
critical
areas
to
demonstrate.
Our
commitment
first
is
to
address
the
challenge
from
the
employee
survey.
There
are
people
lack
confidence
in
equal
opportunities
for
career
planning
or
promotion.
J
Thank
you
first
well,
I
just
really
like
to
commend
this
work.
I
think
I
think
the
Roger
Klein
report
has
been
really
important.
Firstly,
because
it's
it's
great
to
have
that
data
and
the
recommendations
all
there
in
one
place,
and
you
know
it's
just
been
said
knowing
who
has
faith
in
promotion
opportunities?
That's
really
really
important,
but
secondly,
because
it
seems
to
me
and
I'm
not
obviously
not
so
close
to
it
that
it's
it's
triggered.
J
Some
of
that
real,
honest
conversation,
which
is
exactly
one
of
the
things
that
people
felt
wasn't
quite
there
in
the
culture.
So
it's
it's
really
started
something
happening,
I
think
which
it's
very
good
and
I
just
wanted
to
touch
on
a
couple
of
things,
and
you
mentioned
leadership
and
the
role
of
the
board
and
I
know
Peter
put
out
a
communication.
J
Didn't
you
earlier
in
the
year
sort
of
about
the
importance
of
inclusion
at
the
board,
which
seemed
to
me
to
be
a
very
good
thing
to
do
on
the
the
vision
statement,
I
mean
I
personally
I
think
we
should
agree
it
I
I,
wonder
whether
there's
even
more,
we
could
do
to
to
develop
sort
of
why
it's
so
important,
specifically
for
CQC
what
it
means
for
our
core
business
work.
Our
work,
the
work
of
our
inspection,
of
our
registering
of
everything
else
that
that
it
threads
through
into
it'll
make
the
work
better.
J
So
there's
there's
lots
of
generic
reasons.
Why
inclusion
is
so
important,
but
I
think
I,
just
wonder
whether
we
could
add
to
add
to
what
we've
got
but
absolutely
agree
it,
but
also
add
to
it
and
and
I
suppose.
The
other
thing
is
the
importance
of
kind
of
accountability.
So
we
should
keep
this
conversation
going
at
the
board
regular
intervals
and
see
how
it's
all
going
and-
and
if
there
are
questions
about
which
pieces
of
it
to
prioritize,
you
know
the
board
can
kind
of
get
involved
in
supporting
that
decision-making
as
needed.
J
D
My
question
follows
on
from
the
last
part
of
what
Liz
said.
Actually
the
I
mean
the
report
is
very
good.
Roger
support
is
excellent
and
it's
it's
quite
a
tough
report
in
some
ways,
because
it's
got
some
very
specific
target
recommendations
which
which,
if
we,
if
we're
saying
here,
we're
adopting
them,
then
we
just
need
to
be
clear
that
it's
because
they're
not
easy
and
and
there's
going
to
come
up
a
point
of
reckoning
quite
soon,
where
we're
either
hitting
them
or
not.
Hitting
them.
D
S
S
D
Mean
that
does
sound
like
we
haven't
yet
got
the
baseline.
So
maybe
that's
you
know.
We
should
be
seen
that
quite
soon,
if
we're
going
to
have
stretch,
targets
won't
be
stretch
targets
if
we
haven't
got
a
baseline
and
I
just
think.
We
need
to
see
that
quite
quite
soon
impossible
I
mean
very
much
with
you,
but
I
think
it.
We
that
the
pace
of
getting
to
the
starting
point
is
going
to
be
quite
important.
L
Gone
Ted.
Well,
thank
thank
you
very
much
and
again.
This
is
a
very
exciting
bit
of
work.
So
thank
you
for
taking
it
on
with
such
enthusiasm
and
I,
look
forward
to
seeing
us
make
progress
and
that,
hopefully,
we'll
be
able
to
measure
it
collector
that
the
point
I
wanted
to
make
is
you're
talking
about
benchmarking
in
here
in
response
to
Roger
clients,
report
and
you
talk
about
civil
service
and
as
with
what
is
it
cetera,
I,
just
kind
of
felt.
L
Why
don't
we
identify
people
or
organizations
that
are
really
good
at
this
and
going
you
know
whoever
they
may
be
and
just
go,
learn
from
them,
because
I
mean
I
get
so
much
inspiration
for
going
into
into
health
care
organizations
are
really
good,
and
you
know
you
can
learn
so
much
from
the
culture
and
the
attitudes
and
the
approaches
they
are
take
and
just
to
kind
of
get
that
stretch
into
our
targets.
Let's
go
and
find
someone
who's
doing
it
really
well
and
learn
from
them.
C
As
an
important
enough,
let
me
get
my
words
out
in
an
informal
way.
We
have
as
chairs
of
network
being
reaching
out
to
other
kind
of
other
organizations
with
various
networks,
to
kind
of
build
that
and
to
understand
what
they're
doing
and
to
also
share
our
good
practice.
We
had
a
Georgina
from
the
organizational
development
team
and
I
had
a
meeting
with
nice
to
have
a
conversation
about
what
they're
doing
where
they
could
learn
from
us.
A
H
Quick,
so
thank
you
very
much
brilliant
to
see
this
and
some
of
the
measures
that
we've
already
put
in
place,
I
think
have
been
good
so
having
somebody
from
the
Equality
Network
at
the
board,
I
think
has
been
been
good
and
it's
been
lovely
to
have
Holly's
today
and
David
previously
and
Farah
first
first
time
around.
So
that's
that's
good
and
also
I've
recently
been
involved
in
interview
panels
where
we've
had
an
independent
panel
member
as
well,
and
that
was
very,
very
helpful.
H
H
And
the
particular
one
that
I
wanted
to
pick
up
on
was
for
us
to
think
think
back
to
Roger
Clyne
seminal
work,
which
was
about
the
snowy
white
Pink's
of
the
NHS
and
frankly,
in
CQC.
They
extend
down
to
base
camp.
It's
not
just
the
peaks,
and
we
do
have
an
issue
that
we've
got
to
address
there
and
the
the
the
goal
that
has
been
suggested
for
us
is
the
same
proportion
of
BMI
staff
at
executive
grades
as
at
bands
a
and
B,
and
that
they
should
be.
U
Just
want
to
say,
I've
been
working
with
these
guys
and
they
are
really
passionate
and
enthusiastic
for
what
they
do.
So
just
want
to
recognize
that
formally,
but
I
also
think
in
terms
of
our
setting.
There's
those
measures
and
targets.
I
think
we
should
be
doing
that.
I
think
it's
quite
hard
to
if
we
haven't
got
a
proper
benchmark.
U
But
what
I'd
really
like
to
see
is
a
setting
a
KPI
for
this
for
the
organisation
that
we
put
in
our
performance
report,
and
we
come
back
to
you
regularly,
because
this
was
that
old
adage
of
what
gets
money,
monitors,
gets
managed
and
I
really
do
think.
If
we
really
are
really
clear
about
this
and
really
set
that
out
and
put
it
it's
fun
to
centre
of
some
of
the
things
we
look
at,
we
will
start
to
really
make
progress
on
it.
So.
A
Bring
this
to
an
end,
I'm,
sorry,
because
I
think,
there's
you
know
a
good
discussion
taking
place,
but
can
I
just
ask
the
board
formally
to
agree
that
we
published
the
Roger
Klein
report
agreed
that
we
endorse
the
actions
that
the
the
the
group
are
taking
and
thirdly,
that
we
agree
the
vision
for
the
inclusion,
narrative
and
the
board
commitments
which
is-
and
we
just
said
we
shouldn't
we
will
take
on.
But
we
shouldn't
do
so
likely
because
they
are,
they
are
good
things
but
demanding
we
happy
with
all
of
that
say.
A
V
You
so
as
we're
short
of
time,
I
won't
dwell
on
the
paper
and
move
very
very
rapidly
to
to
Sandra
Stella
and
Phillip
who've
come
to
share
a
number
of
things
with
you,
they're
going
to
tell
you
why
they've
become
involved,
I
speak
up
ambassadors
they're,
going
to
tell
you
what
they're
doing
differently
as
a
result
of
that
involvement
and
that
I've
also
give
them
given
them
carte
blanche.
To
tell
you
what
they'd
like
to
tell
you
so
there's
a
bit
in
the
middle
I'm,
not
sure
about
myself,
but
just
very
rapidly.
V
You
can
see
from
the
paper
that
the
housekeeping
development
continues.
The
new
policy
is
in
place
very
excitingly.
We've
got
sign-off
to
merge
our
dignity
at
work,
advisers
and
ambassadors
and
become
that
has
started.
We
have
celebrated
speak
up
months
with
events
and
with
method
messages
and,
very
importantly,
for
us
made
a
clear
link
with
Black
History
Month
working
with
members
from
the
race
equality
Network,
who
are
themselves
members
of
our
speak
up
group
so
and
very
important.
In
that
too,
we
are
starting
to
absorb
the
messages
from
the
staff
survey.
V
The
headline
figure
with
which
we
are
holding
ourselves
to
account
on
our
effectiveness
is
unchanged.
42
percent
last
year,
42
percent
this
year
feel
that
CQC
is
a
safe
place
in
which
to
raise
a
concern.
Clearly,
that's
not
good
enough.
There
is
huge
variation
within
and
amongst
teams
and
we're
doing
some
work
to
it
all
that
further
and
to
understand
the
reasons
very
mindful
that
in
the
bullying
and
harassment
figures,
email
is
by
far
the
single,
the
top
score
of
the
method
for
bullying.
V
So
I
think
there's
really
something
in
that
for
us
to
get
our
teeth
into
to
explore.
I
think!
That's
probably
enough
for
me.
At
this
stage,
I'm
going
to
hand
over
to
Sandra
hi
I'm
Sandra
Miller
from
internal
engagement,
strategic
change
and
engagement,
lead
so
I
mean
to
start
with
I.
Think
if
I
tell
you
a
bit
about
why
I
decided
to
get
involved
in
the
Speak,
Up,
family,
I,
suppose
I
suppose
the
three
main
things
really
that
inspired
me
and
motivated
me
I.
V
Think
first
of
all,
I've
been
in
the
organization
for
a
very
long
time,
both
within
CQC
and
its
predecessors
and
I.
Think
it's
fair
to
say
that,
because
I've
been
being
around
for
some
time,
I
have
a
number
of
friends,
colleagues
and
networks
into
various
groups
across
the
organization
and
so
I
felt
as
though
I
had
I
believe
I
have
a
fairly
good
sense
of
what's
working
well,
what's
working
less
well
based
on
people's
lived
experience
within
CQC.
V
So
that
gives
me
quite
a
good
insight.
I
think
as
as
a
black
woman
within
CQC,
but
also
outside
of
CQC
I,
have
a
particular
see
things
through
a
particular
lens
of
being
a
black
woman,
and
so
my
lived
experience
has
taught
me
that
there
are
occasions
where
I've
needed
to
speak
up
in
the
past
and
sometimes
I
have
and
other
times.
I
haven't.
V
Actually
I
haven't
been
bold
enough
and
so
I
think
that
gives
me
a
good
sense
of
some
of
the
conditions
that
make
it
easier
for
people
to
to
speak
up
for
colleagues
to
speak
up
and
some
of
the
conditions
which
hinder
people
finding
their
voice
within
the
organization
and
I.
Think.
The
third
and
final
thing
for
me
is
that
my
profession,
I'm,
a
social
worker
and
a
psychotherapist,
so
I'm,
really
interested
in
passionate
about
people
and
people's
well-being,
and
so
I
felt
I
might
have
some
basic
skills
to
to
actually
support
colleagues
to
speak
up.
V
So
you
know,
based
on
my
sort
of
lived
experience,
professional
background
and
my
knowledge
and
awareness
of
what
is
actually
happening
across
the
organization,
intermarry
interested
and
passionate
to
take
on
this.
This
role,
I
think
three
things
strike
me
in
terms
of
the
stories
that
I've
been
privy
to
across
the
organization,
I
think
in
terms
of
speaking
up.
V
Firstly,
I
would
say
that
there
are
a
number
of
people
who've
had
who've
spoken
to
me
about
concerns
with
the.
What
I
would
describe
is
the
inconsistent
application
of
our
policies
and
procedures,
particularly
around
flexible
working
and
and
and
I
think.
This
particularly
has
resonance
for
our
staff
in
the
lower
grades,
actually
where
there
are
fewer
flexibilities
for
home-based
working,
for
example,
and
this
can
be
a
bit
of
a
bit
of
a
sticking
point
for
for
some
of
our
colleagues
I
think.
V
Secondly,
performance
management
tends
to
rear
its
head
and
and
and
what
I
mean
by
that
is
that
there
are
performance
management
conversations
which
take
place
with
line
managers
where
and
performance
management.
You
know
that's
a
good
thing.
Those
conversations
need
to
happen,
but
I
think
sometimes
for
some
line
managers.
They
do
still
need
some
support
to
ensure
that
those
performance
management
conversations
are
held
within
the
context
or
hooked
onto
our
values
and
behaviors,
and
that
those
conversations
are
still
still
pay
attention
to
basic
dignity
and
respect.
V
So
that
kind
of
feeds
into
that
conversation
we're
having
currently
about
organizational
change,
but
it's
not
exclusive,
it's
not
always
exclusive
to
change.
It
can
be
viewed
much
more
broadly,
that
some
colleagues
don't
feel
sufficiently
engaged
and
enfold
in
in
those
decisions
that
impact
them
I
mean
I,
I'm
I'm
in
the
internal
Engagement
Team
new
to
that
team,
but
I've
been
supporting
some
of
the
work
with
Mary
to
put
together
the
comms
and
engagement
infrastructure
around
speak
up
to
ensure
that
our
colleagues
know
who,
where
and
how
to
to
raise
concerns
if
they
need
to.
V
So
that's
that's
practically
what
I've
been
doing
in
my
in
my
day,
job
and
and
I.
Think
finally,
I
suppose,
I
suppose,
one
of
my
my
challenges
for
from
that
from
the
board
to
our
most
junior
colleagues
really
I
I
spend
a
bit
of
time,
probably
every
week.
Some
would
say
too
much
time,
but
you
know
just
a
very
simple
hello:
how
are
you,
what
is
it
you
do
in
CQC
could
actually
go
quite
a
long
way.
V
You
know
so,
if
I
think,
if
we
just
committed
to
just
once
a
week,
engaging
speaking
with
smiling
at
saying
hello,
what's
your
name,
what
you
do
at
CQC
to
one
individual
that
we
don't
know
or
with
that
we
maybe
feel
a
little
bit
uncomfortable
with,
because
we've
not
had
much
to
do
with
them.
Actually,
that
would
go
quite
a
long
way,
although
I
recognize
that's
not
going
to
solve
the
entire
challenge.
V
The
conversation
we've
just
been
having
about
Rogers
report
speaks
to
me
about
the
culture
of
this
organization,
and
you
know
that
there's
clearly
work
to
do
and
I
think
speak
up
also
requires
a
cultural
change
and
and
and
that's
bigger
than
saying
hello.
But
how
do
you?
How
do
you
create
a
new
culture?
You
start
to
behave
differently,
step
by
step.
I,
think
the
the
final
thing
I
am
going
to
stop
now.
T
C
W
This
was
a
role
that
I
really
became
very
interested
in
as
soon
as
I
heard
about
it,
because
I
thought
it
provided
a
really
good
opportunity
where
we
could
work
with
our
staff
in
a
positive
manner
to
help
them
to
bring
to
our
attention
issues
and
matters
that
could
be
dealt
with
in
a
very
positive
and
constructive
way,
hopefully
with
a
good
outcome
for
all
concerned,
and
one
of
the
reasons
why
I
really
wanted
to
do.
This
role
was
because
I
reflected
on
my
own
experiences,
both
in
my
personal
life
and
in
a
previous
role.
W
So
what
have
I
been
doing
with
my
team
I'd
be
working
in
a
way
that
I'm
hoping
is
started
to
make
them
feel
that
speaking
up
is
very
valuable
and
has
a
real
purpose
and
a
purpose
to
help
people
work
in
a
way
that
is
comfortable,
serves,
serves
their
own
personal
values,
but
also
serves
the
purpose
of
the
organisation
and
reflects
the
cultures
and
values
of
that.
So
I've
been
doing
some
work
with
the
team
to
think
about
what
we
want
from
one
another.
What
sort
of
things
help
us
do
our
job?
W
Well,
what
behaviors
we
expect
from
one
another
and
to
be
solution,
minded
and
considerate
to
everybody's
thoughts
and
ideas.
At
this
stage,
my
reflections
are
that
I
think
we
are
slowly
developing
and
improving
the
culture.
I
think
there
is
much
more
awareness
within
the
teams
and
there's
clearly,
though,
extra
work
that
needs
to
be
done.
I
think
this
is
really
important
and
thinking
about
this
in
the
context
of
the
hospital's
Directorate,
we
go
and
inspect
our
hospitals
and
we
consider
in
well-led
speaking
up
and
how
good
that
service
is
at
managing
that
aspect
and
I.
W
X
Hello:
everyone,
my
name's
Phil
Wales
and
I'm
Academy
senior
learning
advisor.
We
were
asked
to
think
about
a
number
of
things
that
Mary
said
there
in
terms
of
our
route
into
becoming
a
speaker
ambassador.
So
if
I
just
give
you
a
very
brief
insight
into
kind
of
my
journey,
I
guess
the
kind
of
roots
of
it
will
lay
in
what
what
is
and
was
our
dignity
at
work
scheme
and
advisors
that
we
had
in
place.
X
So
going
back
a
number
of
years
ago
now,
I
had
a
couple
of
opportunities
to
kind
of
speak
to
a
couple
of
dignity
at
work
advisors
when
we
weren't
in
the
place
that
we
are
now
as
an
organization
and
we've
heard
some
comments
from
colleagues
about
that
kind
of
journey
of
cultural
change
is
ongoing.
I,
don't
think
we
ever
get
to
a
point
of
kind
of
stasis.
X
Cuz,
nothing
ever
stands
still,
but
certainly
we
were
in
a
different
place
than
we
are
now
as
an
organization,
and
it
was
a
very
positive
and
beneficial
experience
that
I
had
personally
just
having
that
sense
of
feeling
empowered
to
the
word
speaker,
weren't
used,
but
to
enable
something
to
happen,
which
was
of
benefit
to
me,
and
one
hopes
benefit
to
the
kind
of
wider
organization
kind
of
indirectly
result
of
that.
So
from
there.
X
It
was
simply
a
question
of
well
actually
do
you
want
to
be
part
of
the
change
you
want
to
see
in
the
world
around
you.
I
was
the
kind
of
question
that
had
to
kind
of
answer
for
myself,
and
so
it
seemed
a
very
logical
thing,
then,
to
become
a
dignity
of
work
advisor
which
I've
been
for
several
years
now
and
being
in
any
Academy
being
in
quite
the
privileged
position
of
helping
to
facilitate
the
training
that
we
had
for
dignity
at
work,
advisors
and
then
moved
from
there
into
the
world
of
speaker.
X
X
But
there
will
be
any
one
of
a
number
of
things
that
potentially
could
happen
in
an
organization
of
this
size,
scale
and
complexity,
where
things
could
go
wrong
and
we
need
to
make
sure
that
we
are
having
a
safe
environment
as
possible
for
people
to
have
that
opportunity
that
voice
to
speak
up.
So
what
influence
am
I
having
well
I.
Guess,
that's
a
really
difficult
question
to
answer.
X
I
hope
that
it's
about
kind
of
modeling
that
culture
of
kind
of
openness
that
you
want
to
see
within
your
immediate
colleagues,
making
that
opportunity
to
kind
of,
say
hello,
so
I
was
just
kind
of
smiling
as
sundar
said
about
well,
you
know.
Maybe
we
should
say
hello
to
our
colleagues
how
many
of
us
start
an
email
with
with
good
morning
or
good
afternoon
or
hi.
It's
nice,
to
kind
of
you
know,
send
an
email
to
you
again
and
so
forth.
C
It's
more
a
statement
really,
but
just
to
thank
Mary
for
the
opportunity
to
work
together
in
October
and
also
to
kind
of
go
to
what
Sandra
says
and
the
clear
links
between
what
the
Roger
Klein
report
is
saying
and
what
Speak
Up
are
trying
to
do.
That.
Bmi
staff
are
more
likely
to
enter
the
disciplinary
process
and
I.
Think
a
lot
of
this
is
about
empowering
managers
to
have
open
conversations
to
have
sometimes
challenging
conversations
and
to
make
decisions
and
support.
C
L
A
So
I
think
freedom
to
speak
up
is
really
important
in
to
the
board
and
I
hope.
We've
demonstrated
that
in
the
past,
but
you've
all
demonstrated
it
today
in
in
in
in
in
action
as
it
were
so
Mary
and
your
team,
and
and
though
not
just
to
the
three
that
are
here
today,
but
all
the
others
we're
working
with
you
can
I
just
say
on
behalf
the
board.
Thank
you
very
much.
What
you're
doing
this
is
this
is
important
to
us
and
I
think
we're
making
very
good
progress.
So
thank
you
very
much.
Thank
you.
A
Stay
with
us,
Bert
Turks
we're
just
coming
to
the
end.
He
said.
Hopefully
it's
some.
The
old
joke
was
that
the
you
waited
ages
for
a
bus
and
then
three
came
at
once.
Well,
I
had
to
wait
ages
nearly
three
years.
In
fact,
before
cqc
won
its
first
award
at
least
one
I
was
aware
of
and
guess
what
we've
got
two
more
so
and
I
just
thought.
A
So
congratulations
to
everybody
that
was
involved
in
that
and
then
secondly,
Helen
Aaron's,
who
most
of
you
will
know,
has
been
named
as
one
of
the
20
most
inspirational
women
in
data
and
technology,
and
it's
well
worth
I
recommend
you
to
google
Helen
Lorenz
and
read
the
interview
she
gave
to
the
female
lead.
Is
it's
really
good?
It
ends
with
with
with
the
quote
that
your
own
self
belief
is
the
only
limitation
in
what
you
can
achieve.
A
He
always
goes
above
and
beyond,
to
support
others
and
uses
innovative
approaches,
working
practices
and
technologies
to
enhance
CQC's
performance
I'm
not
going
to
read
out
the
whole
citation
because
it
goes
on
quite
a
long
time,
but
it's
really
good
stuff,
but
just
that
get
to
the
jump
to
the
end
of
the
citation
jonathan
has
shown
excellence
in
developing
clear
templates
and
methodologies
that
are
easy
to
use.
His
communication
skills
reflect
his
awareness
of
organizational
values.
His
caring
approach
has
been
notable
when
people,
including
the
executive
team,
have
overshadowed
Jonathan,
so
I
think
very
big.
A
Robin,
you
asked
you
are
you.
You
asked
a
question
when,
when
a
coroner
delivers
a
narrative
verdict
that
is
critical
of
a
hospital
care
home
or
GP
surgery?
How
does
CQC
respond
and
we
will
get
you
a
written
response
to
that
and
David?
You
wanted
to
raise
something
I.
Think
in
regard
to
the
item
we
were
discussing
earlier.
I
know
you're
in
correspondence
we
or
communication
with
Chris
Dane.
The
team
so
can
I
ask
if
you
can
carry
on
with
that,
but
you
have
first
pick
at
the
the
next
board
meeting.