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From YouTube: CQC Board Meeting - September 2023
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A
So
I
failed,
my
own
test.
The
microphone
was
off.
Let
me
start
again
for
the
benefit
of
everybody.
Welcome
to
colleagues
around
the
ball
table.
Welcome
to
everybody
joining
us
on
the
live
stream
or
by
later
recording.
This
is
to
the
public
board
meeting
of
the
Care
Quality
Commission
on
27th
of
September
Wednesday,
the
27th
September.
A
So
we
have
a
number
of
things
on
the
agenda
to
cover
this
afternoon,
we'll
try
to
keep
moving
reasonably
quickly,
I'd
like
just
to
mention
or
clarify
one
or
two
changes
or
apologies.
Sean
O'kelly
is
unable
to
with
us
due
to
a
minor
operation,
but
we're
delighted.
Welcome
Nicola,
wise
who's,
head
of
inspections
and
we're
deputized
for
Sean.
Today,
as
you,
regular
listeners
will
know
or
Watchers
will
know,
we
always
have
a
representative
from
our
qualities
network
representative
in
that
group.
A
So
today
we
are
welcome
Drew
Noble
from
the
lgbtq
plus
I.
Don't
think
I
have
any
other
administrative
arrangements
to
mention
so
just
as
a
final
administrative
Point.
Are
there
any
new
conflicts
of
interest
to
declare?
Okay
and
anything
else,
people
want
to
put
on
the
agenda
urge
your
business,
not
otherwise
on
the
agenda.
No
okay.
A
So
let's
move
straight
away
to
a
really
very
important
topic,
which
is
the
update
on
the
listening
learning,
responding
concerns
review,
my
board
colleagues
know,
and
anybody
watching
in
we
spent
some
time
on
a
couple
of
sessions
earlier
this
year,
considering
the
outputs
from
the
reports
that
were
done
and
were
presented
by
those
responsible,
and
we
pulled
together
a
an
analysis
of
the
actions
that
would
be
required
by
management
to
respond
so
with
the
overwhelming
theme
that
the
recommendations
are
accepted,
but
we
needed
a
little
bit
more
granularity,
so
that
could
be
tracked
so
I
think
we're
going
to
be
Kate,
turoni
and
Kate
Staples
presenting
it's
okay
over
to
you.
B
Thank
you
so
we're
almost
six
months
since
the
publication
of
the
listening
learning
and
responding
to
concerns
a
review,
and
this
is
our
first
opportunity
to
come
back
together
as
a
group
in
public
to
update
you
all
on
progress
against
the
significant
number
of
recommendations
that
were
in
the
in
the
llrc,
which
is
how
we
describe
listening
learning
responding
to
concerns
review
in
a
way,
that's
slightly
easier
to
articulate.
So
the
paper
in
front
of
you
shows
the
work
that
Kate's
been
leading
along
with
other
directors
and
colleagues
in
the
organization.
B
It
reflects
areas
where
we've
made
good
progress
and
it
reflects
areas
where
there
is
more
work.
To
do.
You'll
note
that
there
has
been
a
huge
amount
of
activity,
but
we
are
really
Keen
as
an
organization
that,
as
well
as
ticking
things
off
the
list
that
we've
done
the
act.
The
required
actions
that
we're
also
measuring
and
evaluating
impact
on
kind
of
changes
in
in
culture
as
well,
but
without
further
Ado
I'll
hand
over
to
Kate
to
bring
to
life
highlights
from
the
paper.
C
Thank
you
Kate.
It
Bears
repeating
that
the
llrc
was
a
watershed
moment
for
CQC.
It
was
an
opportunity
for
a
long
hard
look
at
the
way.
We
do
things
the
way
we
did
things
and,
more
importantly,
it
was
an
opportunity
for
colleagues
around
this
table
to
pause
for
thought
and
and
really
commit
to
doing
something
to
affect
sustainable
change.
C
Those
of
you
who
are
familiar
with
the
detail
of
the
recommendations
will
know
that
some
are
deeply
practical
mechanistic
things
relatively
easy
to
achieve
in
a
short
frame
time
frame.
Others
are
much
more
far-reaching
and
will
require
sustained
effort
over
months
and
years
actually
to
get
lodged
and
become
part
of
the
DNA
of
the
organization.
C
The
progress
chart
you
can
see
at
the
last
page
of
of
the
report
gives
you
a
sense
of
of
where
we
now
are,
and
in
putting
that
chart
together,
we
have
been
careful
to
be
honest
and
I
I
just
want
to
sort
of
dwell
a
little
bit
on
a
point
that
Kate
made
in
her
brief
introduction
about
monitoring
progress
and
making
sure
that
things
are
actually
being
delivered
and
being
done
in
the
period
since
the
paper
was
submitted.
C
We
that's
a
group
of
us
being
led
principally
by
staff
talent
in
a
performance
team.
Who's
done
a
fantastic
job
have
been
thinking
about
how
to
hold
ourselves
to
account
for
delivery
and
the
the
way
we
propose
to
do
that
going
forward
is
to
ensure
that
each
of
the
recommendations
is
mapped
to
one
of
our
ET
subcommittees,
which
will
own
the
responsibility
of
receiving
regular
updates
on
progress,
but
critically
where
it
is
said
that
an
action
has
been
completed
and
an
impact
has
been
delivered.
C
We
will
want
evidence
to
be
provided
to
that
committee
so
that
we
can
say
yes,
we
we
agree.
Some
sustainable
and
meaningful
change
has
been
delivered.
So
we're
going
to
start
rolling
that
out
in
the
next
few
weeks
and
I
think
when
next
year
at
board
in
November,
so
we
should
be
able
to
give
you
an
insight
into
into
how
that's
going.
C
I
also
want
to
just
highlight
the
the
measure
cut
twice
and
cut
once
phrase.
That's
in
the
paper
and
I
want
to
highlight
that,
because,
given
the
importance
and
given
the
the
very
resonant
subject
matter
of
some
of
the
recommendations,
particularly
those
about
our
racial
fluency
and
about
reasonable
adjustments
for
colleagues
who
need
them,
it's
tempting
to
want
to
rush
to
action
and
get
something
in
place
quickly.
C
But
the
measure
twice
and
cut
once
approach
is
specifically
focused
on
making
sure
that
when
we
Act,
we
know
that
we
are
choosing
the
right
course
of
action
and
something
that
will
stick
so
in
in
terms
of
racial
fluency.
For
example,
Tyson
has
done
some
wonderful
work
over
the
summer
and
I
have
to
sort
of
name
check,
blessing
hail
as
well
from
from
from
the
network
in
thinking
long
and
hard
about
what
sort
of
training
and,
frankly
challenge.
C
C
So
it's
it's
taken
a
bit
of
time
to
get
there,
but
what's
being
promised
and
what
hopefully
will
come
out
of
that
session
is
going
to
be
all
the
more
impactful
as
a
consequence
and
similarly
on
some
of
the
more
external
facing
elements,
work
streams,
one
and
five,
which
relate
to
whistleblowing
from
the
sectors
and
information
coming
into
the
organization
from
outside
I'm,
going
to
name
check.
C
Another
group
of
people,
that's
Hayley,
Moore,
Jill,
Morrell,
Helen,
Laurens
and
Tracy
Forrester,
all
of
them,
in
addition
to
busy
portfolios
of
responsibility,
have
set
aside
time
to
think
about
ways
of
bringing
to
life
those
work
streams
and
some
incremental
improvements
are
already
evident
and
there
is
a
good
flight
path
leading
forward
that
will
will
yield
benefits.
So
there's
there's
been
a
great
slew
of
activity.
Much
of
it
won't
have
been
visible
to
many
colleagues
across
the
organization,
but
it
is
being
done
and
happy.
Today,
questions.
D
Kate,
firstly,
thank
you,
I
think
it's
really
important
and
really
helpful
to
have
this
sort
of
regular
progress
report.
As
you
said
in
your
comments,
I
mean
this
was
a
really
important
report
for
the
board
for
the
whole
organization
and
and
so
it's
critical
that
we
do
follow
it
up
carefully
methodically
and
with
a
real
impact.
So
a
big
thank
you
to
to
to
you
for
all
of
that.
D
C
You're
right
that
the
the
approach
we
took
to
implementing
an
NRC
recommendations
was
not
to
make
them
something
other,
because
that's
the
fastest
way
for
them
not
not
to
be
effective,
but
to
make
them
part
and
parcel
of
what
we
do
daily
on
a
daily
basis.
C
So
that
has
been
happening,
certainly
in
relation
to,
for
example,
racial
fluency,
where
Nadu
Rahman
has
been
part
of
a
little
working
group
that
we've
set
up
to
make
sure
that
the
all
of
the
aspects
of
that
work
are
moving
forward
in
Tandem
and
all
pointing
in
the
same
direction
and
similarly
with
culture.
The
the
things
that
are
emerging
in
conversations
about
the
way
things
are
around
here
are
feeding
into
the
work
that
cater
is
leading
on
culture
and
the
nascent
culture
plan
that
Jackie
Jackson
has
been
preparing.
E
Mark
so
so
again,
thank
you
really
valuable
to
sort
of
see
the
progress
probably
there
are.
There
will
be
two
challenges
that
organizations
face
when
they're
trying
to
make
this
degree
of
change.
The
first
one
is
the
the
gap
between
intent
and
action,
and
this
really
addresses
that
there's
there's
a
real
action
following
the
intent
to
sort
of
make
that
change
the
the
second
one
is
actually
persistence.
The
the
only
concern
that
I
would
have
about
this
being
an
action-based
approach
is
that
when
the
actions
are
done
doesn't
mean
the
work
is
done
right.
E
That's
near
the
beginning
of
the
journey,
not
the
end
of
it.
Because
so
could
you
say
a
little
bit
more
about
how
other
than
just
a
reporting
that
a
change
has
been
made
an
impact's
been
had.
But
how
do
we
make
sure
that
this
then
becomes
that
natural
way
of
working
and
doesn't
snap
back
to
older,
more
established,
deeper
behaviors.
C
But
I
think
to
some
extent
you
can
hardwire
some
of
it
in
processes
provided
the
processes
align
with
human
nature.
The
more
the
process
and
human
nature
are
at
odds,
the
less
likely
the
process
is
to
stick,
but
I
think
it
picks
up
a
conversation
that
we
were
having
this
this
morning
about
the
extent
to
which
we
as
individuals
particularly
around
this
table,
but
also
across
the
organization,
take
the
time
to
reflect
and
take
the
time
to
reflect
particularly
on
what
it
is
we
need
to
do
and
what
it
is.
B
One
one
thing
to
add:
if
I
may
and
Joyce
might
want
to
come
in
on
this
as
well.
So
obviously
our
commitment
wasn't
just
that
we
self-report
on
how
we're
doing,
but
that
we
have
a
proper
evaluation
around
impact
and
that
impact
being
embedded
and
that
evaluation
is
happening
now
and
it
will
come
to
to
a
future
board
as
well
and
some
of
the
evaluations
that
sitting
in
a
team
that
reports
to
Joyce
and
we're.
Having
ongoing
conversations
with
colleagues
who
helped
us
with
the
original
report
for
that
kind
of
external
challenge
as
well.
F
Yeah,
just
to
add
to
that
the
evaluation
looks
at
not
just
the
data
that
you
see
in
front
of
you,
which
is
how
we're
delivering
against
those
actions,
but
if
they
are
embedded,
what
are
the
impact?
They
have
there's
also
the
independent
oversight
built
in
as
part
of
that
evaluation.
So
we
have
the
people
who
were
involved
in
the
original
report
coming
back
and
helping
us
say
we'll
have:
are
we
actually
making
a
difference
because
you're
absolutely
right?
We
could
do
so
many
actions,
but
it
actually
doesn't
make
a
difference
on
the
ground.
G
Thank
you.
It's
really
good
to
see
the
progress
that
we're
making
on
this
and
I.
Thank
you
and
the
team
for
your
working
for
the
clarity
in
Candor
that
have
been
shared
about
how
progress
is
continuing.
G
It's
also
really
positive
and
reassuring
to
hear
that
the
focus
is
on
making
sure
things
are
done
well
and
they
embed
I'm
interested
to
understand
I
suppose
over
the
next
six
months
or
so
whether
you
see
focus
being
equally
spread
across
all
of
the
different
streams
of
what
we're
looking
at
or
whether
they're
particular
areas.
Where
there'd
be
more
attention
given
to.
C
More
acute
in
prioritizing,
because
we
know
that
we've
got
an
awful
lot
on
transformation
continues.
C
Colleagues
in
operations
groups
will
be
changing
the
ways
they
work
in
the
coming
weeks
and
months.
C
So
we
need
to
be
both
realistic
and
ambitious
and
I
think
we
need
to
be
intentional
about
which,
which
areas
we
focus
on
to
achieve
progress,
making
sure
that
we
always
do
make
progress
and
don't
allow
ourselves
to
sort
of
come
to
a
standstill,
and
it
will
be
a
combination
of
importance
and
capacity
and
capability
at
any
given
moment
and-
and
the
paper
refers
to
a
relatively
extended
time
period
for
rolling
out
elements
of
training
on
racial
fluency,
precisely
to
accommodate
the
need
to
do
it
properly
across
the
whole
of
the
organization
and
take
into
account
other
aspects
of
activity.
H
Thank
you,
yeah
I'm
I'm,
very
pleased
to
see
this
reporting
I'm
very
encouraged
by
the
the
Candor
of
the
chart
on
page
four
I.
Think
it's
it's
great
to
to
to
see
that
and
have
the
confidence
to
show
where
we
are
still
quite
away
from
the
Target
and
where
we're
we're
struggling
to
start
the
prep
to
the
the
the
pro
the
process
of
improvement.
H
I
think
that's
not
surprising,
with
such
a
range
of
of
recommendations,
but
it's
really
helpful
to
to
see
this
and
it'll
be
helpful
to
continue
to
see
that
what's
particularly
encouraging,
of
course
is
that
there's
been
very
good
progress
on
learning
and
there's
been
very
good
progress
on
listening
and
and
there's
more
green
there
than
than
in
the
other
columns,
and
that's
a
large
part
of
what
this
whole
exercise
was
about.
H
Having
said
that,
there's
quite
a
lot
of
red
still
on
there,
where
we
know
it's
going
to
take
longer
and
it's
going
to
be
harder.
I
think
one
of
the
challenges
of
aggregating
84
recommendations
and
Reporting
it
in
this
format
is
that
we
lose
a
little
bit
of
the
color
about
well.
H
What's
in
the
what's
in
the
red,
so
I
think
you're
going
to
have
to
have
to
find
a
way
of
helping
us
to
understand
where
really
important
things
that
we're
struggling
to
get
traction
or
find
a
solution
for
where,
where
those,
where
those
are
I'm
looking
at
Freedom
to
speak
up,
for
example,
where
it's
pretty
easy
to
make
rapid
progress
on
the
low-hanging
fruit,
but
actually
really
making
developing
a
a
true
speak
up
culture.
H
There's
a
lot
of
heavy
lifting
late
on
in
the
in
the
game
in
relation
to
that,
and
we
don't
want
to
end
up
with
some
red
at
the
end
of
the
day
in
relation
to
this,
if
we
can,
if
we
can
start
to
help
with
with
that
Pro
process,
that
would
be
really
good
and
then
my
you
know
my
question
was:
how
are
we
communicating
this
internally,
because
I
suspect
some
of
our
colleagues
internally
will
be,
will
be
seeing
the
same
challenge
of
saying?
Well,
you
know,
what's
in
the
red,
what's
in
the
green.
C
Take
it
thematically
and
deal
with
areas
such
that
they
get
the
attention
they
deserve,
so
freedom
to
speak
up
is
one
that's
getting
a
lot
of
focus
and
it
is
a
focus
of
the
let's
talk.
C
Conversation
that
Ian
LED
last
week
next
month,
we'll
be
focusing
on
racial
fluency,
because
it's
Black
History
Month,
partly,
but
also
because
there
are
lots
of
things
coming
on
stream,
so
that
we're
doing
it
thematically
and
one
of
the
things
I
have
committed
to
is
after
this
conversation
today
at
board,
is
to
write
a
short
article,
so
that
colleagues
who
aren't
watching
today
will
know
that
we
talked
about
it.
C
We
had
a
serious
conversation,
we'll
we'll
hear
what
the
board
wants
us
to
do
and
we'll
also
have
an
up-to-date
version
of
where
we
are
and
an
honest
assessment
of
of
the
work
we
still
have
to
do.
A
I
Thanks
I,
just
wonder
if
you
could
explain
the
scarring
to
me:
okay,
because
I
don't
really
fully
understand
how
moderate
distance
to
Target.
Far
from
how
did
you,
you
know,
arrive
at
those.
C
They
are
it's
not
algorithmic,
it
is
a
judgment.
It's
a
judgment
made
by
the
the
action
owner
in
the
first
instance
tested
occasionally
to
destruction
by
the
performance
management
team
led
by
Steph,
and
it's
it's
it's
trying
to
get
a
sense
of
you
know.
Are
we
a
couple
of
days
away
from
completing
it
or
is
it
months
away
and
it's
it
is?
It
is
a
bit
subjective,
but
it
is
designed
to
be
subjective
with
with
a
bit
of
challenge.
J
In
my
view,
organizational
cultural
changes
much
more
about
how
we
do
things
rather
than
just
what
we
do
or
what
we
don't
do,
which
is
what
you
refer
to
and
I'd
like
to
see
that
aspect
of
how
we
do
things
Incorporated
really
quickly
into
our
behaviors
I.
Don't
see
the
need
to
wait
for
a
long
time
for
that
or
to
carry
out
a
subsequent
analysis
or
whatever
so
I
would
just
put
that
before
you,
that
that
is
more
important
than
if
you
like,
just
the
transactional
aspects.
J
It
is
partly
about
ways
of
working,
but
it
is
not
just
the
technocratic
parts
of
ways
of
working.
It
is
the
emotional
part
and
the
engagement
with
people,
so
I
suppose
I'm
asking
for
your
assurance
that
that
could
be
addressed
perhaps
rather
more
quickly
than
you
were
suggesting
in
your
presentation.
G
J
B
I
go
first
and
then
can
I
hand
to
Mark.
You
might
want
to
talk
about
speak
up.
Thank
you,
David
for
the
the
question.
So
Kate
talked
about
this
work,
plugging
into
the
wider
piece,
we're
doing
a
moment
at
the
moment
around
culture,
where
we
want
to
look
at
kind
of
all
aspects
of
how
we
work
as
an
organization,
our
values,
our
behaviors
associated
with
those
values,
and
how
we
kind
of
plug
expectations
in
at
all,
at
all
points
in
in
the
way
that
we
we
work
together.
B
So
that
is
a
that
is
activity,
that's
underway
at
the
moment,
but
will
take
place
in
the
next
couple
of
months.
So
this
isn't
a
this
isn't
a
long
piece
of
work.
This
is
a
piece
of
work.
That's
starting
now,
and
this
work
will
touch
on
some
of
the
stuff
is
in
the
pulse
survey
around
how
we
work
together
as
an
organization
as
well
as
well
as
the
Ambitions
and
and
progress
we're
making
around
freedom
to
speak
up
also
so
so.
B
K
Thank
you
and
I
I
agree
with
your
your
statement
there
David
that
the
engagement
part
of
this
is
is
is
crisky
important
and
we
can
start
doing
that
and
I
won't
talk
about,
speak
up
because
that's
the
next
agenda
item.
But
if
I
speak
about
reasonable
adjustments
together
with
our
colleagues
in
the
disability,
equality
Network,
we
we've
already
started
in
fact
nearly
completed
the
engagement
piece
around
recent
adjustments.
K
What
we've
done
is
a
We've
seconded
one
of
our
colleagues
from
the
inspection
Community
to
spend
time
with
a
significant
number
of
colleagues
across
the
organization
who
are
in
need
of
reasonable
adjustments,
just
to
really
deeply
understand
what
are
the
challenges
that
people
are
experiencing
and
and
what
it
is
that
would
actually
transform
their
experience
at
working
at
CQC
and
and
that
that's
that's
a
process
that
is,
is
almost
complete
now
and
it
will
inform
and
embed
the
the
work
that
we're
that
we're
doing
as
a
follow-up
to
that
to
exactly
Kate's
point
about
measuring,
twice
and
cutting
once.
J
If
I
may
just
briefly
come
back
on
that,
okay
to
understand
that
this
is
part
of
a
much
bigger
process,
but
you
know
on
the
basis
that
the
longest
journey
starts
with
The
Next
Step
that
you
take
or
the
first
step.
It
does
seem
to
me
that
we
have
a
lot
of
information
that
we've
gathered
already.
That
could
indicate
changes
that
could
be
made
pretty
well
straight
away.
B
So
so
I
agree,
but
also
so
I
would
point
to
the
example
that
Mark's
given
so
we're
not
waiting
for
a
cultural
plan
to
get
on
and
make
the
changes
in
the
organization
that
the
llrc
talked
about.
So
llrc
said
we
could
do
a
lot
better
with
how
we
support
colleagues
who
have
additional
needs
when
it
comes
to
interviews
when
it
comes
to
supporting
them
to
work
well
at
CQC,
so
that
that
activity
has
been
progressing
at
pace.
B
So
there
is,
when
you
get
into
the
detail
of
this
report,
there
is,
there
is
a
wealth
of
activity
that
has
already
happened
and
is
making
a
difference.
What
is
to
be
discussed
further-
and
you
will
see,
is
how
that
all
draws
together
into
the
bigger
cultural
plan,
but
we're
not
waiting
for
that
to
get
on
and
take
some
of
the
actions
that
are
in
the
report.
A
Thanks
David
I
I
had
a
couple
of
questions.
One's
always
been
dealt
with,
but
true
could
I
just
turn
to
you.
Kate
made
the
observation.
This
cake
made
the
observation
earlier
that
I
was
working
with
our
networks.
I
think
I
saw
you
nodding,
but
do
you
have
any
comments
on
that.
L
Certainly
I
think-
and
we
would
like
to
you
know,
express
our
thanks-
that
we
have
been
involved
today
in
a
lot
of
the
work
experience
that
are
part
of
the
llrc
findings.
I
think
we've
had
some
really
meaningful
conversations.
L
Certainly
the
work
that's
been
allowed
to
in
regards
to
reasonable
adjustments
is
one
of
many
conversations
that
we've
had
around
this
and-
and
you
know
it
it-
it's
a
great
demonstration
of
colleagues
from
modernized
communities
being
given
a
platform
to
share
what
it's
like
to
work
at
CQC,
some
of
the
challenges
that
are
faced,
but
also
how
we
can
improve
the
way
that
we
regulate
and
monitor
Services
as
well.
So
I'm
really
thankful
for
the
opportunities
to
do
so
and
wish
to
continue
to
kind
of
build
upon
the
foundations.
I've
been
set.
A
Thanks
very
much
Drew
I
was
going
to
ask
anyway,
but
it
seems
to
me
to
some
extent
of
relates
to
David's
question
as
well.
I
mean
I.
Think
I
would
you
know,
commend
the
senior
executive
I.
Think
one
of
the
changes
we've
seen
over
the
last
several
months
is
greater
engagement
with
a
new
sort
of
organizations
like
the
networks.
I.
A
Think
that
that's
great
and
to
your
point
David,
you
know
we
didn't
wait
for
the
plan
or
the
management
didn't
wait
for
the
plan
to
to
start
doing
that
so
I
think
it's
a
good
example
of
a
step
that's
been
taken.
The
the
other
question
I
was
going
to
ask
I,
think
has
probably
been
dealt
with
so
I'll
frame
it
more
as
a
an
action
for
the
future,
but
I
think
it's
great.
A
A
Another
big
picture
we've
got
overall
aim
we're
trying
to
achieve
so
it's
probably
related
to
the
point
earlier
about
which
of
these
things
are
most
important,
but
I
think
as
we
come
back
of
course,
do
keep
on
with
the
rather
more
granular
assessment
Because.
Unless
we
can
do
that,
we
can't
demonstrate
to
people
we've
done
what
we
said
we
do,
but
it
would
be
very
helpful
as
well
to
have
some
sort
of
high
level
qualitative
assessment.
A
As
said,
and
having
done
all
of
this,
are
we
actually
achieving
what
it
is
we're
set
to
do
not
easy
I
know,
but
but
I
think
that
would
be
very
helpful
at
some
stage.
It
will,
of
course,
be
informed
by
other
things,
we'll
be
seeing
like
pulse
surveys,
but
I
can
be
helpful
unless
there's
any
other
questions.
A
Let's
move
on
with
Kate
in
particular
staples
thanks.
So
much
for
that.
We
now
have
a
moving
on
to
freedom
to
speak,
update
something
to
approve.
What's
doing
so,
Mark
I
think
this
is
with
you
and
are
we
going
to
join
By
Carolyn.
G
A
A
Hi
Karen
welcome
so
I
just
introduced
the
topic
Mark
over
to
you.
K
Thank
you
very
much
and
welcome
Carolyn
I,
just
wanted
to
introduce
by
saying
that
there's
freedom
to
speak
up
agenda
is
incredibly
important:
I'm
the
executive
sponsor
for
for
freedom
to
speak
up
and
We've.
What
we,
what
Caroline's
going
to
talk
about
in
a
little
bit
here
is
about
our
Improvement
plan
that
we've
got
to
to
to
support
improvements
in
Freedom
speak
up
capability.
This
is
this
work
that
we've
spent
a
bit
of
time
ratifying
this
with
the
national
Guardians
office
and
I.
K
Think
to
the
point
that
we
talked
about
just
now
about
measuring
twice
and
cutting
once
we're
taking
a
little
bit
of
time
to
make
sure
that
we
we
get
this
right
and
we
don't.
We
don't
rush
to
action
too
quickly.
There
is
work.
That's
ongoing,
but
I
think
it's
important
that
we
we
take
that
time
in
it
and
we
had
earlier
on
this
morning
was
I.
Think
there's
a
there's.
The
really
key
element
of
freedom
to
speak
up
is
about
how
we
engage
with
the
organization.
M
You're
also
instructors
yeah,
so
thank
you.
Everybody
and
I
mean
we're
continuing
to
do
as
much
work
as
we
can
on
raising
awareness
about
Freedom
speak
up
and
and
as
as
you'll
have
read
in
the
paper,
we
want
to
get
some
additional
resource
so
that
we
can
and
be
more
proactive
with
the
work
we
do
because
most
of
the
work
that
I
do
it's
more
reactive
and
work
so
responding
to
people
when
they
they
come
to
me
and
we
want
to
be
able
to.
M
You
know,
obviously
do
far
more
proactive
work
so
hoping
that
you
would
approve
the
paper
and
the
ask
for
additional
resource,
and
we
would
move
on
that
and
I've
been
very
supported
by
markets,
but
it's
made
a
huge
difference
actually
having
Marcus
the
exec
sponsor
for
this
work
and-
and
we've
is
freedom
to
speak
up
month
next
month,
Ian
and
and
myself
and
Mark.
M
We
led
him
and
all
staff
Call
last
week
about
freedom
of
speak
up
and
and
actually
some
of
the
feedback
that
I've
had
from
that
has
been
positive
and
I.
Think
staff
want
to
see
more
of
the
executive
team
talking
about
Freedom
speaker
what
they
think
about
and
being
able
to
raise
issues
that
they
want
to
talk
about.
I
mean
Ian.
M
Does
a
lot
of
that
work
in
his
curious
conversations,
but
Mark
and
I
plan
to
do
a
bit
more
and
we've
got
a
bit
of
a
plan
to
do
sort
of
a
National
Road
show
if
you
like,
to
try
and
reach
out
to
more
people
and
and
to
encourage
people
to
come
and
talk
talk
to
us.
So
has
anybody
got
any
questions
at
the
moment.
D
Think
it's
it's
important
and
indeed
chatting
to
Mark
earlier,
it's
very
hard
to
know
how
much
resource
is
going
to
be
enough,
because
we
don't
really
know
how
much
unpenned
demands
there
may
be
in
the
organization
to
to
have
a
freedom
to
speak
up
Guardian
that
people
can
talk
to,
but
I
hope
we
can
work
on
the
basis
that
if
we
agree
this
is
the
next
step,
then
you
know
we
will
keep
it
under
review
so
that
there
is,
you
know
we
don't
overload
the
two
additional
freedom
and
speak
up
Guardians
if
it
turns
out
that
they
are
kept
very
busy.
D
So
very
much.
Welcome
that.
The
the
other
point
that
I
wanted
to
make
is
that
this
is
very
closely
related
to
the
finding
in
the
staff
survey
about
feeling
safe
to
challenge
the
way
things
are
done
here,
which
I
think
we'd
all
recognize
is
a
poor
result.
You
know
it's
a
it's
a
very
low
rating
of
from
staff
in
the
organization
about
feeling
it
safe
to
speak
up,
and
this
set
of
interventions.
D
If
you
like,
the
big
risk
in
in
creating
identified
colleagues
who
are
freedom
to
speak
up
Guardians
is
that
other
people
feel
when,
in
that
case,
I
don't
need
to
bother.
Actually,
this
has
to
be,
in
addition
to
a
culture
in
which
managers
are
open
to
hearing
really
actively
hearing
concerns,
worries
problems,
whistleblowing
cases
from
staff
and
their
team
members.
So
this
is
a
reinforcement
of
a
of
a
culture
that
encourages
people
to
speak
up
whenever
they
see
problems,
issues
concerns
that
they
have
it's
not.
Instead
of
it.
Thanks.
N
N
So
it's
in
terms
of
numbers
of
people
and
numbers
of
speed
that
speak
up
Guardians,
that's
part
of
the
process
almost
but
conceptually
I
think
you
make
a
really
good
point
that
you
know
if
you
are
succeeding
at
a
speak
up
culture
in
the
organization,
you
almost
don't
need
a
speaker
Guardian,
because
your
line
managers
are
having
routine
conversations.
I
think
it.
You
know,
we
know
from
from
work,
we've
done
in
things
like
Qi
programs
and
other
improvement
work.
N
People
are
just
saying:
oh
I,
think
it
would
be
good
if
we
did
this
in
a
different
way
and
people
are
being
listened
to
and
managers
are
being
are
in,
you
know,
are
working
constructively
with
their
teams
and
equally
I
hear
frequently
examples.
Were
you
know,
an
individuals
had
a
particular
problem
with
something
and
they've
they've
praised
their
manager
for
the
way
in
which
the
manager
has
stepped
in
and
being
constructive.
N
If
we
are
seeing
increases.
Why
are
we
seeing
increases,
and
that
might
mean
more
guardians,
or
it
might
mean?
Let's,
let's
look
at
the
the
broader
cultural
work,
we're
doing
and
the
support
we're
giving
for
managers
and
they
might
may
list
a
different
response,
but
I
think
it's
absolutely
the
right.
The
right
point.
A
H
Thank
you.
I
I
strongly
support
this,
and
thank
you
for
your
your
help
and
support
so
far
in
relation
to
this
I'm
glad
that
there
is
more
resource
coming
to
help.
You
I
think
I'm
I'm,
also
glad
that
you've
addressed
the
administration
and
support
as
well,
because
we
want
our
Guardians
listening
and
acting
on
concerns,
not
not
dealing
with
admin,
and
we
know
I
know
drew
that
you
know
our
Network
colleagues.
H
One
of
the
challenges
is:
is
admin
support
for
what
they
do
in
it,
so
anyone
who's
doing
something
in
addition
to
their
day
job,
it's
important
to
cover
the
admin,
support,
I,
think
it's
we've
really
got
to
be
great
at
this.
You
know
if,
if
I'm,
if
our
model
of
Regulation
is
is,
is
increasingly
about
listening
to
to
feedback
and
ensuring
that
people
are
comfortable
raising
their
concerns
with
us,
then
we've
got
to
be
exemplars
in
how
we
do
this
internally.
The
two
big
barriers
are
always
fear
and
futility
and
I.
H
Think
we've
got
to
be
careful.
That
futility
is
an
easy
one
to
deal
with,
or
at
least
an
easy
one
to
deal
with
superficially,
because
you
could
just
do
lots
of
comms
about
how
you've
listened
and
acted
on.
What
you've
been
told,
fear
is
deeply
cultural
and
the
the
controls
and
and
protections
that
you
need
in
place
to
ensure
that
people
don't
suffer
detriment
12
months
on
when
it
becomes
the
end
of
a
Performance,
Cycle
or
they're
not
turned
down
for
another
job.
H
Two
years
on
when,
when
they're
applying
for
a
move
within
within
the
organization,
those
things
are
really
hard
to
track
and
I
suspect.
Quite
a
lot
of
those
will
be
some
of
the
red
issues
that
we
get
to
in
the
llrc
actions
as
well.
But
it's
really
important
to
for
us
to
do
that.
H
It's
really
important
for
us
to
deliver
on
everything
in
that
in
that
action
in
the
that
relates
to
this
theme
in
the
in
in
the
amongst
the
84
recommendations
in
the
llrc,
and
it's
really
important
that
we
continue
to
give
you
the
the
support
that
you
need
so
I
guess
you
know
I
I'm,
hoping
that
we're
going
to
work
out
how
we
can
see
more
of
you
and
hear
more
from
you
as
another
triangulation
point
for
us
in
terms
of
judging
how
much
progress
we're
making
on
that
on
that
Journey.
E
Just
one
one
quick
comment-
and
it
probably
relates
between
the
three
items
we're
discussing
here:
freedom
to
speak
up,
psychological
safety
and
then
a
broader
culture
conversation.
E
It's
also
just
an
acknowledgment
that
we're
doing
this
in
unusual
in
an
unusual
timing
coming
out
of
the
back
of
covert
the
disruption
that
that
has
caused
changes
in
the
way
of
working
and
also
a
fact
that
we've
always
had
a
dispersed
organization
and
it
will
remain
dispersed
of
hybrid
working,
so
creating
that
psychological
safety
that
trust
in
a
hybrid
environment
might
require
different
actions
to
doing
that.
E
If
you
are
all
in
the
same
physical
space,
so
there's,
maybe
also
as
you're
adding
the
resources
in
it
would
be
good
to
see
if
you're
already
thinking
about
how
they
can
actually
touch
an
organization
that
is
dispersed
that
works
in
a
hybrid
way.
What
are
those
day-to-day
behaviors
that
we
can
Implement
that
changes
that
sense
of
trust
and
and
safety.
J
Thank
you,
chair
in
in
your
brief
presentation,
which
I
thank
you.
You
mentioned
about
becoming
proactive
rather
than
merely
reactive,
and
it
seemed
to
be
an
important
part
of
that.
Following
on
what
Mark
said
earlier
about
fear
and
futility,
you
know
being
two
great
concerns.
M
I
mean
people
do
come
for
comfort
and
I
do
do
I
mean,
although
I
say
that
all
of
the
majority
of
the
work
that
we
do
is
reactive.
That's
because
spend
most
of
the
time.
Just
you
know
dealing
with
people
when
they
have
come
forward
for
for
support,
but
we
do
go
back
and
check
with
people
as
well
to
make
sure
that
they've
not
they
don't
feel
that
they've
suffered
any
detriment
from
from
speaking
up
and
and
but
that's
more
of
an
informal
follow-up.
We
don't
do
anything
very
formal
monitoring.
J
Thank
you,
I
I
understand
at
that
point.
My
point
really
was
slightly
different
to
that.
It
was
saying
that
you
know
at
any
level,
in
an
organization
from
shop
floor
to
board
whatever.
There
are
those
individuals
who
feel
more
self-confident
about
speaking
up
than
others,
and
there
is
a
danger
in
any
organization
that
you
listen
to
the
people
who
come
forward
and
do
that,
and
there
is
then
either
a
significant
minority
or
a
substantial
majority.
One
doesn't
know
who
are
not
coming
forward
because
they
don't
feel
the
self-confidence
to
do
that.
J
In
addition
to
the
points
that
Mark
has
raised
about
fear
of
futility,
but
there
is
that
aspect
now
for
this
to
be
really
effective,
I
I
think
we
need
to
think
about
how
best
we
can
address
that.
M
Completely
and
some
of
the
things
that
we
do
I
mean
yesterday,
went
to
one
of
the
networks
on
their
all
staff.
Call
did
a
presentation
about
what
Freedom
speak
of
is
how
you
can
talk
to
me.
The
sorts
of
things
that
you
might
want
to
come
and
raise
talked
about
going
to
your
line
manager.
So
we
try
to
raise
awareness
in
a
lot
of
different
ways
and
the
other
thing
that
we
I
say
we,
because
there
are
some
freedom
to
speak
up
ambassadors
that
help
and
support
a
bit.
M
But
if
we
get
some
intelligence
as
well
I
mean
you
know,
I've
I'm
inspector
by
background.
So
if
I
get
a
little
sense
that
something
might
not
be
quite
right,
we'll
we
will
seek
people
out
a
little
bit
to
a
certain
extent,
I
mean.
Obviously
we
don't.
We
can't
just
be
doing
that
all
of
the
time,
but
sometimes
people
just
need
that
little
bit
of
support
so
yeah
very
aware
of
that,
thanks
David.
M
N
I
just
come
out
on
the
back
of
that
I
think
I
think
to
answer
your
kind
of
underlying
question.
David
I
think
I
think
that's
it's
not
entirely
Carolyn's
job
I
think
Karen
can
talk
to
the
freedom
to
speak
up
part,
but
I
do
think
you
know
what
we.
What
we
are
doing
is
looking
for
ways
to
design
in
opportunities
that
people
can
can
talk
about
things.
N
So
if
we
look
at
transformation,
for
example,
you
know
we're
creating
opportunities
for
inspectors
to
be
part
of
the
design
team
where
the
designers
are
working
alongside
inspectors
in
real
time
where
we've
gone
live
with
our
our
first
release.
We've
we've
listened
to
what's
been
said:
we've
recycled
that
that
information
back
in
I
have
I
I,
run
a
series
of
Curious
conversations
which
are
groups
of
about
10
people,
and
we
just
sit
and
sit
and
talk
about
any
any
issues
that
they
want
to
want
to
talk
about.
N
I
know
a
number
of
other
colleagues
run
similar
calls
or
face-to-face
meetings.
So
we
try
and
create
those
spaces
where
people
feel
that
confidence
to
speak
up
about
whatever
it
is
that
they
that
they
they
want
to
talk
about
and
I
think
it's.
You
know
it
would
be
fair
to
say
that
you
know
if
I
think
back
to
my
own
experience.
N
You
know
when
I
was
25
30
years
of
age
in
my
first
job,
I
would
not
have
emailed
the
chief
Constable
of
Surrey,
please
to
tell
him
what
I
thought,
but
I
probably
would
have
spoken
up
if
something
was
genuinely
dangerous
or
illegal,
and
so
that
I
think
there
is
something
here
about
creating
a
series
of
opportunities
for
people
to
talk
about
a
range
of
things
which,
which
is,
which
is
what
we're
trying
to
build
into
the
range
of
Engagement
mechanisms
and
and
speak
up.
The
speak
up.
Guardian
process
is
kind
of.
N
It
is
an
important
component
of
that,
but
it's
there's
a
lot
of
other
things.
I
think
that
go
into
that,
but
this
whole
issue
of
culture
change.
This
whole
issue
of
of
people
development
is
really
important
because
we
do
need
our
inspectors
in
particular,
to
have
the
self-confidence
to
call
out
things
that
they
see
when
they're
on
inspection
and
and
I
think
that
building
of
self-confidence
is
part
of
our
overall
organizational
development
activity.
So
I
think
it's
a
big
package
of
things.
L
True,
you
wanted
to
comment,
thank
you
and
and
Carolyn.
Thank
you
for
the
work
that
you've
done
today
on
this
and
we
as
a
quality
Network
chairs,
handle
some
matters
of
concern
at
a
local
level.
We
share
themes
and
Trends
with
our
executive
sponsors,
and
we
sign
pause
to
the
treatment
speaker
process
where
appropriate
and
recognizing
the
comments
that
colleagues
have
raised
in
regards
to
that
level
of
fear
in
futility.
A
No
comments
from
others,
I
mean
just
one
from
me.
Other
also
be
aware
of
summary
I
mean
it
was
obviously
so.
Thank
you
very
much
for
the
papers.
There's
obviously
huge,
widespread
agreement.
We
know
it's
got
a
cost,
but
that's
absolutely
essential
that
this
is
important.
So
no
problem
with
with
that,
the
point's
been
made
that
you
know
this
is
a
step
a
bit
of
a
guess,
as
this
is
right,
so
we'll
come
back
and
look
at
it
again.
A
In
that
context,
just
to
say
I
I
mean
a
different
way
of
saying
the
poydian
patronum
made
that
if
you've
got
the
culture
perfectly
right,
there
wouldn't
be
any
need
for
any
of
this,
so
I
suppose
I've
liken
it
using
West
management
speak
to
a
second
line
of
defense.
You
know
if
something's
not
going
right,
there
is
a
way
that
people
can
get
their
voice
heard
in
another
way.
A
It
would
be
completely
naive
to
think
that
we
will
get
the
stage
of
no
reporting
I
mean
the
immediate
response
and
any
board
I've
ever
sat
on
as
if
there's,
no
speaking
up,
say,
there's
something
wrong
with
the
process,
not
that
the
organization
is
perfect.
So
we
work
on
the
assumption
that
we'll
be
reporting.
A
Would
it
be
really
helpful
from
you,
I
think,
is
to
understand
and
report
back
to
the
board
on
themes
emerging
as
to
why
it
is
that
people
felt
it
was
necessary
to
do
that,
because
I
think
that
will
instruct
maybe
it'll
import
to
culture,
but
but
also
some
of
the
process.
Things
we're
talking
about
so
it'd
be
really
helpful
in
a
year.
A
N
Thanks
Ian,
if
I
could
just
try
and
talk
to
both
papers,
perhaps
at
the
same
time,
and
then
colleagues
can
can
answer
answer
questions
either.
I
and
colleagues
learn
to
questions
on
one
level,
I'd
like
to
sort
of
apologize
for
the
length
of
the
papers
in
the
in
the
in
in
the
pack,
because
but
I
think
it
does
talk
to
the
fact.
There's
quite
a
lot
going
on
at
the
moment
and
I.
N
Think
it's
that
there's
a
significant
amount
of
of
work
that
we
are
doing
in
The
Wider
World
we've
got
a
wider
World,
which
is
which
is
very
much
under
under
pressure.
I.
N
Think
what
we're
seeing
that
translating
to
is,
as
we
see
the
sectors
that
we
regulate,
Under
Pressure
we're
seeing
increases
in
the
amount
of
risk
that
that
that's
that's
there
we're
seeing
increases
in
the
amount
of
enforcement,
no
enforcement
notices
that
we
have
to
issue
increasing
in
the
amount
of
increases
in
the
amount
of
things
like
safeguarding
activity
and
exploring
that
for
I
expect
to
explore.
Explore
that
takes,
take
takes
time
and
takes
and
takes
energy
to
do
the
work.
N
I
think
also,
as
a
consequence
of
that
is
also
becoming
more
complex,
and
what
we're
continuing
to
try
and
do
is
to
balance
speaking
for
those
that
use
Services
with
making
sure
that
we
are
trying
to
take
into
account
the
context
in
which
people
are
trying
to
deliver
services
and
I.
Think
that's
a
that's
a
constant
challenge
for
us
to
do
things.
At
the
same
time,
challenges
like
Workforce
availability
in
services
are
a
big
issue.
N
I
think
the
cost
of
living
crisis
in
sectors
that
are
high
uses
of
power,
food
and
and
Industrial
consumables
again
are
placing
enormous
financial
and
and
practical
pressure
on
on
those
who
are
delivering
services,
and
we've
got
a
number
of
things
on
our
agenda
that
that
talk
to
to
that.
N
But
I
think
we
have
a
series
of
pieces
of
work
in
our
report.
Things
like
the
national
maternity
program,
urgent
and
Emergency
Care,
dementia
care,
Intermediate,
Care,
Services
for
learning,
disabled
and
autistic
people
and
they're
all
aimed
at
balancing
our
inspection
and
Assurance
work
with
making
contributions
towards
Improvement
and
I.
Think
you
know
when
we
talk
about
our
strategy.
We
talk
a
lot
about
about
making
a
contribution
to
Improvement
in
all
of
our
transformation.
N
Work
is
trying
to
make
us
more
effective
in
that
space,
so
we're
trying
to
make
sure
that
we
are
true
to
our
core
purpose
of
providing
the
public
with
Assurance
as
well
as
promoting
Improvement.
N
That
is
stating
the
obvious
one
of
the
largest
expansions
of
our
powers
since
we,
since
we
came
into
into
being
as
an
organization
over
a
decade
ago,
we're
looking
forward
to
welcoming
119
new
colleagues
from
the
mnsi
program,
which
is
currently
hosted
within
her
health
health
service
investigation.
Branch
they're,
coming
across
to
us
on
the
1st
of
October
I.
N
We
said
for
a
long
time
that
we
want
to
make
ourselves
easier
to
do
business
with
providers
constantly
tell
us
that
that
we're.
You
know
that
that's
sending
us
paperwork
and
just
dealing
with
it
dealing
with
us
is,
is
hard.
We
know
that
opening
up
the
portal
will
make
the
whole
of
that
Much
More
Much
much
easier.
It
will
also
mean
that,
from
a
from
a
reporting
point
of
view,
internally
and
externally,
that
will
also
improve.
We've
had
some
really
constructive
conversations
with
our
trade
unions.
N
Over
the
last
few
months,
we've
resolved
both
last
year's
pay
dispute
and
and
and
and
also
We've
made
sure
that
we've
been
able
to
give
our
colleagues
a
good
pay
rise
this
year
as
well,
and
I'm
really
grateful
to
the
the
constructive
way
in
which
Trade
union
colleagues
have
talked
to
us
on
a
range
of
topics
and
I'm
looking
forward
to
working
with
them
closely
over
the
coming
year,
as
we
think
about
our
pay
scheme
in
the
future
and
I
say
all
of
this
really
to
just
to
make
the
point
that
we
are
at
a
point
in
in
our
in
our
development
as
an
organization.
N
It's
probably
arguably
one
of
the
busiest
times
we've
ever
seen
where
we're
we're,
transforming
the
organization
we're
trying
to
make
sure
that
we're
doing
our
day,
job
as
it
were
in
a
in
an
environment
which
externally
is
is
pretty,
is
pretty
tough
and
I
just
wanted
to
make
sure
that
we
were
kind
of.
We
were
all
as
a
board
completely
sighted
on
that
I.
Think.
N
It
will
mean
that
we're
making
Investments
for
the
medium
term
I
think
there
is
always
the
always
the
the
risk
at
this
at
this
sort
of
at
this
time
of
year,
and
at
a
point
in
where
we
are
seeing
such
busyness
externally
to
focus
on
the
here
and
now,
I
think
what
what
we're
trying
to
do
is
pull
off
that
that
really
difficult
trick
of
of
being
of
focusing
on
the
here
and
now,
as
well
as
making
sure
we're
making
Investments
for
the
future,
whether
that's
the
entire,
whether
that's
in
technology,
whether
that's
in
terms
of
organizational
design,
whether
that's
in
in
terms
of
culture,
which
is
obviously
a
conversation
that
we've
just
been
we've
just
been
having
so
I,
think
lots
of
lots
of
important
items
are
on
the
agenda.
N
Lots
of
important
pieces
of
work
in
the
in
the
report
and
happy
to
take
questions
and
obviously
colleagues
can
contribute
as
well
thanks
Ian,
okay,.
O
Thank
you.
Yeah
I
had
a
question
page
24
about
key
result
to
the
and
it's
partly
a
clarification
and
partly
a
question
and
I.
Think
I
might
have
raised
this
before
anyway,
but
it
states
that
85
percent
of
inspections
since
Financial
year
were
triggered
by
risk
and
then
in
the
color
coded
section
further
on.
It
says
that
the
target
of
increasing
inspections
triggered
by
risk
is
not
met.
So
I
just
wanted
to
understand
and
I
do
appreciate
that
either
risks
are
increasing
or
we're
identifying
them
better.
O
I,
don't
know
which
of
those
two
things,
probably
a
combination.
But
what
is
the
Target
and
given
that
we're
trying
to
increase
the
number
of
risks
triggered
inspections?
What
how
are
we
going
to
what's
the
strategy
around
regulating
and
identifying
good
and
outstanding
practice
thanks.
P
I'm
Chris
will
correct
me
if
I've
got
this
wrong,
but
I
think
the
the
measure
is
increasing
from
the
percentage
from
last
year
and
whilst
we're
at
85
this
year,
I
think
last
year
we
were
slightly
higher.
So
that's
why
the
measure
in
the
business
plan
is
not
met,
although
85
is
still
is
still
a
lot
of
risk
at
the
moment
as
we
are
going
through
going
through
the
the
state,
the
sort
of
hopefully
the
end
stages
of
our
transformation
program.
P
We
are
particularly
focused
on
risk
at
the
moment,
but
I
think
there
will
be.
There
will
be
discussions
about
about
how
we
how
we
operate
during
the
winter,
because
last
year
the
adult
social
care
colleagues
did
a
lot
of
increasing
capacity
inspections
during
the
winter
and
but
also
I.
P
Think
as
we
look
to
adopt
our
single
assessment
framework
going
into
the
new
year,
I
think
that
will
be
much
more
agile,
then,
when
it
comes
to
looking
at
good
providers
and
then
judging
whether
they
are
outstanding
or
indeed
requires,
Improvement
providers
who
are
good
so
I,
think
our
focus
on
risk
will
continue
in
the
immediate
term.
But
but
the
the
before
measure
was
slightly
down
on
last
year.
I
think
that's
right.
Chris.
J
If
I
made
sure
it's
really
a
comment
to
to
Ian
Ian
I
think
you
you
passed
rather
quickly
over
the
the
fact
that
you'd
successfully
resolve
the
pay
situation
and
I
think
you
know
it
is
worth
commenting
that
that's
a
great
achievement-
and
you
know
you,
you
did
it
sort
of
Austria.
Really
it's
tremendous
to
do
that.
Most
organizations
are
comparable
to
ours,
have
not
had
that
success
and
I
just
think
it
should
congratulations
to
be
given
to
you
and
your
team
and
bringing
that
off.
N
Thanks
David
I
think
I
think
my
colleague
Jackie
Jackson
who's.
Our
our
director
of
people
really
deserves
the
credit
for
that.
Jackie's
done
a
lot
of
work
with
colleagues
in
the
trade
teams,
but
also
I
think
there's
a
there's
some
credit
to
our
Trade
union
colleagues
for
for
coming
to
the
table,
sort
of
it
takes
two
to
tango,
I,
think
and
I.
Think
they've
they've
been
very
constructive
recently
as
well,
which
has
been
really
helpful.
J
Q
Thank
you.
Thank
you.
I
wanted
to
amplify
the
point
about
at
this
board.
We
are
between
between
now
and
and
export
in
November
will
conclude
the
pilot
stages
for
the
local
Authority
Assurance
assessments.
So
we've
completed
the
field
work
in
five
of
those,
and
we
are
now
at
that
stage
of
writing
reports
with
indicative
ratings
and
sharing
those
with
the
local
authorities
and
following
that
will
be
in
discussions
with
dhsc
about
us
moving
formally
from
Pilot
mode
into
delivery
mode.
Q
So
it's
it's
been
a
significant
amount
of
work
to
get
to
an
organizational
design
to
deliver
that.
We
are
on
track
to
deliver
that
and
it
looks
as
if
our
methodology
and
our
quality
statements
that
we've
used
have
got
to
the
heart
of
whether
a
local
Authority
is
implementing
the
Care
Act
or
not,
and
the
feedback
from
the
councils
involved
has
been
positive.
Q
They
have
all
felt
as
if
they
as
if
our
process
had
an
anticipatory
impact
on
them,
looking
at
their
own
services
and
the
quality
of
people's
experience,
and
it's
been
very
successful
at
bringing
in
the
voice
of
lived
experience
in
those
areas
with
independent
meetings
with
those
people
and
really
bringing
their
voice
through
so
I
I
think
we
can
assure
ourselves
as
a
board
actually
this
process
and
this
new
significant
Duty
that
Ian
was
outlining.
Q
You
know
it
is
all
significance
and
will
be
a
weighty
amount
of
work
and-
and
the
other
point
I
wanted
to
make
is
that
both
the
LA
work
and
the
ICS
work
gets
us
back
into
systems
work,
and
so
some
of
the
questions
that
are
raised
in
the
update
insights
paper
about
Dementia
or
Intermediate
Care.
We
now
have
an
opportunity
at
system
level
to
start
asking
those
questions.
So
it
is
really
a
significant
moment
for
CQC
and
moving
into
this
Territory
between
now
and
Christmas
time.
A
It's
like
five
ouch
for
the
update
James,
so
they
don't
we'll
be
hearing
more
next
meeting
or
before
I
mean
the
I
suppose
we
have
to
accept
the
fact
that
the
local
authorities
are
positive
to
some
self-selected
through
the
pilots,
but
but
that's
not
the
track
from
the
progress.
What
I
found
particularly
pleasing
was
the
anticipatory
element,
because
again
a
big
I
think
a
big
shift,
or
so
in
the
last
little,
while
is
say,
do
the
make
sure
we're
doing
our
work
in
a
way
that
encourages
Improvement.
A
So
if
the
sheer
fact
of
this
is
coming
up
is
requiring
people
to
look
again
at
what
they're
doing
and
do
things
better,
I
mean
that's
a
that's
the
real
win
for
the
system.
Isn't
it
rather
than
the
fact
that,
ultimately,
out
of
this,
they
may
get
a
rating
Christy.
O
Thanks
I
just
wanted
to
amplify
that
again,
because
my
son
happens
to
be
a
sort
of
community
activist
worker
in
the
north
west,
and
he
told
me
that
the
moment
the
local
Authority
assessments
were
introduced.
He
saw
a
change
in
the
local
authorities
he's
working
with,
so
it's
felt
from
both
sides,
not
just
from
local
authorities,
saying
they're
doing
it,
but
actually
from
people
working
within
the
community.
So
you
know
that's
very
positive
really,
and
it
shows
that
there
is
an
impact
on
Improvement.
A
Turn
into
a
mini
self-congratulatory
session,
but
thanks
very
much
so
well
done
any
other
questions
for
yeah,
okay.
Well,
look
Ian
I
mean
you
covered
a
huge
amount
in
the
old
school
role,
update
and
I.
Think
we
get
the
point
that
there's
a
huge
amount
going
on
and
it
in
some
ways
it
makes
enormous
critical
time
for
this
organization,
because
there's
a
a
few
things
are
going
to
get
slightly
worse.
We
would
throw
a
period
of
a
few
things
peaking
and
going
down,
but
just
at
the
moment,
everyone's
very
busy
so
well
done.
A
We
I
think
move
on
to
the
corporate
performance
report
and
so
Kate
ready
hand
to
you
in
the
moment
to
Mark
Sutton
and
Chris
Usher
I
think
we're
going
to
invite
Stephanie
tarant
for
your
team
Chris
to
join
us.
Welcome,
Stephanie,
whatever
we
discuss
or
agree,
we
end
up
giving
you
all
the
hardware
to
you
anyway.
So
it's
probably
very
sense
when
you
join
us
right,
Kate
I'll
hand
this
to
you.
B
So
I'm
presenting
to
you
today,
performance
of
the
first
quarter
of
this
financial
year,
23
and
24.
B
I'm,
going
to
hand
over
to
Chris
shortly
to
talk
you
through
the
performance
report
and
an
update
on
finance
and
we've
got
Steph
here
to
support
us
with
questions
and
then
Chris
will
hand
back
to
me
where
I
will
just
walk
you
through
the
final
page
in
the
pack.
Talks
about
risks
that
exceed
tolerance
and
I'm,
just
going
to
give
board
a
brief
update
on
where
we
are
with
those
red
wrists
that
exceed
tolerance
but
I'll
hand
over
to
chrisner.
R
Yeah
thanks
Kate,
so
this
is
our
chord
one
performance
report,
including
July,
where
possible
acknowledging
there
wasn't
a
a
board
in
August.
There's
a
lot
in
here,
so
I'll
just
run
through
some
headlines,
and
it's
also
a
new
format
report
that
we've
that
we've
included
that
in
in
this
in
this
return,
so
we've
chunked
this
up
by
the
strategy
themes
so
just
looking
under
people
and
communities,
so
the
key
result,
one
which
is
safeguarding
alerts
and
whistleblowing.
R
So
we've
met
some
of
our
corporate
kpis.
However,
as
the
report
shows,
we've
we
have
not
met
our
Target,
that's
primarily
due
to
a
temporary
issue
following
the
gore
life
of
a
contact
service
in
July,
largely
related
to
our
ability
to
refer,
probably
one
safeguarding
alerts
to
local
authorities.
R
Please
just
say
that
was
resolved
at
PACE
and
levels
are
now
back
where
they
expected,
but
for
this
reporting
period
it's
Sean
has
not
met
is
similar,
similar
story,
if
you
like
in
incse
response
times
in
in
first
quarter,
ntsc
exceed
North
targets.
However,
in
July
we've
seen
a
dip
in
performance
on
safeguarding
and
mental
health,
outlines
again
larger
due
to
the
impact
of
our
contact
service
are
all
out
and
we've
seen
an
improvement
from
them.
R
That
point
we're
now
close
to,
if,
if
not
on
target
again,
so
both
those
areas
just
just
just
had
a
dip
in
performance,
as
we
say
just
moving
further
ahead.
A
key
result
to
just
under
our
our
smarter
regulation
theme.
R
Sorry,
people
in
communities
we've
for
the
year,
July
16
of
our
inspections
have
been
carried
out
based
on
people's
experience
and
feedback.
So
I
think
this
is
an
important
demonstration
just
in
the
impact
of
people's
feedback
on
our
approach.
So,
yes,
we'll
we'll
inspect
based
on
risk,
but
in
16
of
occasions
we've
actually
responded
directly
to
the
feedback
we've
had
from
the
public
kind
of
demonstrating
how
this
really
informs
our
approach
and
how
we're
able
to
adapt.
R
I
was
going
to
talk
about
inspections
triggered
by
risk,
but
I'll
not
touch
on
that,
because
we've
just
covered
that
so
I'll
I'll
scan
from
that
one
in
terms
of
out
of
hours
Inspections
just
moving
on
to
to
our
next
theme
on
Smart
regulation.
So
we
aim
for
10
of
site
visits
to
be
undertaken
out
if
I
was
We've,
we're
seeing
progress
in
this
area,
we're
currently
at
10.2
percent
we're
at
9.2
last
year.
R
It's
worth
noting
with
this
measure
that
there
is
still
work
to
do
on
defining
kind
of
out
of
hours
and
what
what
our
definition
of
that
and
that
will
in
it
help
and
enhance
our
reporting
around
this.
But
as
the
measures
stand
in
the
business
plan
we
are
showing
we
are.
We
are
meeting
that
that
Target
that
we
set
out
on
key
result,
seven,
which
is
around
registration
applications.
R
Currently
29
of
registration
applications
are
over
10
weeks
old
in
the
system
that
is
an
increase
from
last
year.
So
we're
aiming
to
to
reduce
that.
But
currently
that's
that's
proving
a
challenge.
It
is
worth
noting,
though,
that
the
volumes
of
application
received
is
increasing
increased
by
7.8
from
from
that
period.
So
it's
the
story
of
a
a
larger
backlog,
but
with
increased
volumes
as
context
just
moving
on
to
some
of
our
key
results
around
protected
characteristics,
so
key
results.
R
17
we're
seeing
we've
seen
good
progress
in
this
space,
so
we're
aiming
to
increase
the
percentage
of
colleagues
with
protected
characteristics.
So
colleagues
of
mine
are
minority
and
ethnic
origin
has
increased
from
14.7
in
the
end
of
22-23
quarter,
four
to
fourteen
point:
nine
percent
year
to
date,
and
similarly,
those
declaring
a
disability
has
increased
from
10.8
to
11.7
over
the
same
period,
so
both
heading
in
the
right
direction.
R
However,
we
are
seeing
a
a
challenging
in
in
moving
nudging.
The
dial,
if
you
like,
on
those
colleagues
reporting
protected
characteristics
which
is
key,
result
18.
That's
kind
of
stayed
steady
through
through
each
month
of
the
year,
so
more
work
to
do
in
that
space.
R
We've
included
a
couple
of
pages
on
Milestones,
so
we
have
a
number
of
Milestones
within
our
business
plan,
sum
up,
independencies
with
a
wider
transformation,
both
enroll.
Now
a
single
assessment
framework,
as
well
as
our
new
regulatory
platform.
It
shows
some
progress
we've
made,
but
in
a
number
of
areas
there
is.
There
is
more
work
to
do
which
links
to
a
lot
of
the
key
results.
I've
I've
talked
about
I'll,
not
judge
on
risk,
as
Kate
referenced
that
she
will
come
back
to
that.
R
There
are
seven
risks
that
occur
in
the
outside
of
our
exceeding
our
tolerance
that
we
set,
which
I'll
I'll
hold
on
talking
to.
So,
if
I
just
finished
with
our
finances
at
the
end
of
July,
there's
a
1.3
million
service
on
Revenue
expenditure,
we're
currently
forecasting
a
3.7
million
deficit
for
the
year.
This
includes
1.9
million
of
work
that
is
currently
unfunded
in
relation
to
our
covert
inquiry.
R
The
remaining
pressures
relate
to
peer
agreements
which
have
been
handled
in
year,
not
part
of
budget
setting,
so
we're
kind
of
actively
looking
to
to
mitigate
those
pressures.
Our
Capital
budgets,
1.8
million
others
spent
for
the
year
to
July.
That's
forecast
currently
to
be
1.4
Million
by
the
end
of
the
year,
but
current
indications
are
that
will
increase
and
we'll
see
that
overspend
increase
by
the
time
we
report
on
this
next
time.
I'll
pause
there.
A
Well,
if
we
it's
just
I,
will
take
this
separately
after
the
question
that
I
asked
we'll
come
back
to
that
and
outside
tolerance,
but
questions
on
any
other
aspect
of
the
report.
Belinda.
I
Thanks
and
I'm
back
to
my
out
of
hours
again,
but
but
just
you
know,
for
me
an
out
of
hours.
Inspection
is
not
one
that
starts
in
hours
and
finishes
after
out
of
hours
and
and
I
probably
said
that
overboard.
Meeting
we've
ever
spoke
about
out
of
hours,
though
I'll
say
it
again,
but
I
know
that
you
were
looking
at
things.
P
P
We
will
put
some
momentum
behind
it
and
I'm
sure
we'll
talk
about
the
regulatory
governance
committee
in
a
couple
of
weeks
time
and
we're
still
talking
to
the
to
the
unions,
about
it,
we're
looking
at
the
health
and
safety
aspects
and
the
remuneration
aspects,
and
when,
when
that
goes
live
we
will
then
adopt
the
new
definition
and
the
new
definition
is
that
the
entire
inspection
takes
place
outside
of
ours
or
takes
place
entirely
at
the
weekend
or
bank
holidays
or
a
substantial
part
of
it.
P
At
least
three
hours
happens
before
8
A.M
and
6
p.m.
So
so
we're
getting
there
we're
just
not
not
quite
there
yet
and
I
think
when
we
move
move
into
the
new
the
new
world.
That's
when
we'll
adopt
the
new
definition
you're
quite
right.
The
definite
definition
we've
got
at
the
moment
is
is
not
it's
not
it's
not
the
one
we
want
to
carry
on
with.
P
A
You
said
this
way:
Christine
and
then
Stephen.
O
Preempt,
just
did
think
that
it's
worth
noting
that
key
result
19,
which
is
increased
positive
sentiment
on
recommending
CQC
as
a
place
to
work,
is
recorded
as
met
and
I.
Wouldn't
want
it
to
look
like
the
board
feels
complacent
about
that
that
it's
recognized
by
the
board
that
there
is
a
concern
around
it.
So
I
just
wanted
to
say
that
in
this
section.
B
Thank
you
Christine,
so
it
is
met
technically
because
it
had
improved
on
the
previous
stat.
The
previous
stat
was
something
like
36,
so
none
of
us
are
resting
on
our
laws.
Thinking.
That
is
a
good
enough
statistic.
You
know
in
an
Ideal
World
everyone
working
at
CQC
would
would
recommend
it
as
a
place
to
work.
So
so
good
point
and
the
action
is
still.
This
is
not
a
good
news
story
on
that.
One.
D
Thank
you
Chris
and
others
for
the
report.
Thank
you,
Steph.
The
one
request
I
think
I
would
make
for
future
reporting
is
the
use
of
the
rating
Monitor
and
on
hold,
because
I
think
the
majority
of
items
here
are
not
in
fact
regulated
as
whether
they're
met
or
not
met
they're
just
monitor,
I.
Think
probably
it
will
be
more
useful
if
we
had
a
sense
of
well
what
what
does
good
look
like?
What
are
we
trying
to
achieve
here?
D
So
we're
not
just
kind
of
watching
it,
but
we
we
have
a
sense
of
direction
and
purpose
as
to
well.
Where
are
we
trying
to
get
to
and
then
you
report
on
whether
we're
getting
there?
So
it's
really
just
a
request
that
we
try
to
remove
these
various
monitors,
never
mind
the
on
holds
second
question:
Chris
was
you.
D
R
Thanks
for
that
Stephen,
so
I'll
approach,
this
Revenue
Yes,
except
we
have
got
a
problem
and
a
challenge
with
the
covert
expenditure,
because
that's
currently
not
funded
so
that
aside
I
think
Revenue.
We
we
should
be
on
budget
Capital,
less
confident.
That
is
a
challenge
at
the
minute
and
I
as
I
alluded
to
I've.
R
Seen
our
kind
of
latest
figures
increasing
and
overspending
that
territory,
which
at
the
this
moment
in
time,
I
I
will
I
would
say,
would
be
a
challenge
to
to
come
back
on
budget,
so
that
one
is
is
very
much
work
in
progress,
Revenue,
more
confident.
A
The
before
we
come
to
risk
first
of
picking,
I'll
proceedings,
but
I
do
take
your
Point
Monitor.
This
isn't
very
helpful
whether
or
not
we
could
put
something
in
there
or
whether
we
should
draw
out
a
distinction
between
performance
indicators,
which
is
where
we
want
to
see
whether
we're
performing
at
a
level
we
want
versus
other
things
which
are
factors
for
information,
and
there
are
certain
things
about
volumes
of
what's
going
on
in
the
sector.
It's
interesting
I
think
for
us
to
know
as
a
board,
because
we
have
to
respond
to
that.
A
But
if
it's
without
our
control,
I
would
probably
record
it
separately
or
not
have
monitor,
but
we
we
can
sort
that
out.
I
just
want
to
be
clear.
There
are
a
number
of
things
in
here
where
we've
got
gaps
on
measures
or
on
the
milestones
we
say
have
no
update.
So
how
soon
will
it
be
before
we've
closed
those
gaps
and
they're
going
to
be
able
to
have
some
updates.
L
True,
thank
you.
One
new
edition
of
figures
around
sexuality
under
key
result,
17
and
I-
think
this
is
the
first
time
that's
been
included.
So
thank
you
for
for
drawing
together
that
information,
and
we
know
that
there's
been
a
historic
challenge
around
declaration
for
not
just
sexuality,
but
a
number
of
productive
characteristics
which
may
very
well
be
as
a
consequence
of
some
of
the
findings
mentioned
already
from
the
poll
survey.
L
I
also
recognize
that
there's
a
higher
percentage
for
the
lgbtqia
plus
Community,
as
not
stated,
so.
This
works
for
us
to
do
as
a
network
to
address
that
and
I'm
hoping
that
those
figures
are
going
to
increase,
as
we
continue
the
important
work
that
we're
doing
around
culture.
L
I
also
want
to
just
acknowledge
the
fact
that
we're
also
doing
some,
you
know
quite
fantastic
work
with
the
diversity
and
inclusion
team
around
Recruitment
and
and
hopefully
that
will
again
contribute
to
an
increased
rate
of
Declaration
from
the
outset
when
somebody
joins
the
organization.
Thank
you
thank.
A
You,
okay
thanks
Drew
I,
appreciate
that
so
Chris
I
don't
know
whether
you're
okay
going
to
take
this,
but
there
are
a
number
of
things
where
we
are
showing
our
risk,
as
now
being
outside
appetite
you're
exceeding
tolerance
of
the
phrase
you
use
and
the
concept
of
an
appetite
approved
by
the
board
is
relatively
new,
so
I
appreciate
this
is
settling
down
and
these
things
are
unheardly
subjective.
A
But
if
we're
saying
these
things
are
not
within
the
appetite
the
board
has
described,
can
you
give
us
a
brief
overview
of
with
say,
keep
it
brief
and
the
circumstances,
but
why
and
what
are
we
doing
about
it
and
what
sort
of
the
times
go?
I
think
for
the
future.
A
If
we're
going
to
report
to
the
board
things
that
are
outside
appetite,
it
would
be
helpful
to
have
that
in
the
report,
because
that's
really
the
suppose
the
feature
of
a
dynamic
risk
management
framework
is
that
the
key
point
about
identifying
is
out
of
Aphrodite
is
to
say
so.
So
what
do
we
then
do
about
it?
But
for
now,
if
you
just
give
the
board
a
brief
overview,
that'd
be
helpful.
Yeah.
B
Happy
day,
thank
you
so
the
first
one
on
your
on
the
risk
Annex
that
is
outside
appetizers.
We
do
have
effective
governance
Frameworks
in
place.
This
is
one
where
there
has
been
work
undertaken,
but
not
sufficient
in
order
for
it
to
bring
down
the
exceeding
tolerance
judgment
that
it's
got
so
there's
been
an
important
piece
of
work.
B
Sash
has
been
leading
around
how
we
make
decisions
underneath
the
exec
committee,
so
we've
done
a
refresh
of
our
ET
subcommittee's
refresher
terms
of
reference
installing
exec
colleagues
as
chairs
of
those
subcommittees,
so
their
formal
subcommittees
to
the
board.
We
are
in
in
train
of
creating
a
new
subcommittee
to
support
us
with
organizational
prioritization
that
we
will
update
you
all
on
soon.
So
there
is
work
in
motion,
but
it's
not
sufficiently
progressed
to
bring
down
that
that
judgment.
B
The
next
one
is
we
don't
deliver
transformation
effectively
within
the
organization,
a
huge
topic
that
I
won't
get
into
now.
The
key
thing,
I
would
say,
relates
to
a
comment
Ian
made
earlier,
so
we
went
live
with
some
really
new
important
ways
of
working
back
in
July.
We
listened
to
our
colleagues
who
work
in
the
organization
who
said
that
they
needed
a
bit
more
time
to
get
ready
for
the
new,
the
second
wave
of
new
functionality,
new
ways
of
working
to
go
live.
B
We
listened
to
that
and
we
we
planned
our
approach
based
on
that
feedback
from
staff.
So
it's
still
a
high
high
risk.
It's
still
exceeding
tolerance
because
we're
in
the
kind
of
final
six-ish
months
of
delivering
this
pretty
epic
transformation
program.
But
the
way
we
are
mitigating
that
is
demonstrating
to
our
people
how
we're
listening
and
kind,
of
course
correcting
according
to
their
their
feedback.
B
The
third
risk
is
the
risk
around
getting
the
right
data
from
external
stakeholders.
Helen
Lawrence,
who
reports
to
Mark
Sutton,
had
a
session
that
arak
our
audit
and
risk
Assurance
committee,
maybe
about
a
month
or
so
ago,
around
the
work
they're
doing
in
in
TDI
our
data
and
insight
directorate
to
have
a
dedicated
resource
to
to
address
the
issues
around
getting
timely
accessed
information
from
Partners
but
again,
and
that
work
needs
to
have
progressed
further.
For
that
risk
to
come
down
a
couple
of
others.
The
risk
around
not
attracting
and
retaining
our
Workforce.
B
This
is
for
very
specific
Pockets
within
our
organization,
so
Pockets
within
technology
Pockets
within
legal.
So
this
is
a
specific
risk.
I
think
in
legal.
The
risk
is
as
high
as
ever
much
of
the
challenge
that
Kate
Staples
and
her
team
are
having
to
deal
with
predominantly
around
retaining
Fab
we're
getting
great
colleagues.
We
support
them
and-
and
they
do
some
fabulous
work
for
us
and
then
and
then
they
move
on.
B
So
that's
an
outstanding
at
risk.
Anthony,
stapen
Technologies
doing
some
interesting
work
around
how
we
can
get
people
in
and
grow
them
within
Technologies,
so
that
risk
remains.
But
it's
it's
with
a
kind
of
specific
pockets
of
the
organization.
B
We've
got
a
risk
around
keeping
our
ensuring
our
colleagues
of
sufficient
engaging
culture
change
that
we've
already
talked
about
before
lots
of
lots
of
work
underway
to
support
our
colleagues
to
of
change
needs
to
be
presented
as
a
coherent
cultural
plan
that
you'll
be
seeing
in
a
month
or
two's
time,
and
then
the
last
two
red
dress
exceeds
tolerances
around
our
operational
Workforce
being
productive
and
ensuring
that
we
accurately
And
Timely
assess
the
quality
of
care
out
there
and
providers
just
a
flag
to
board
that
both
of
those
risks
will
be
having
a
deep
dive
in
regulatory
governance
Committee
in
a
couple
of
weeks,
Time
chaired
by
Mark
Chambers,
where
they
will
get
into
the
depth
of
mitigation.
B
A
Thanks
very
much
Kate
I
mean
for
those
color,
that's
familiar
important,
to
say
we're,
not
saying
that
all
is
fundamentally
broken,
but
I
think
it's
a
part
of
the
process.
So,
honestly
that
says
you
know
things
on
others
we
would
like,
and
we're
going
to
have
to
make
some
actions
to
deal
with
it.
I
appreciate
some
of
these
are
not
within
our
control
to
deal
with,
I
mean
if
a
Market's,
very
hot
in
certain
skilled
areas,
I
think
anybody
would
be
surprising.
A
If
a
lot
of
organizations
would
have
to
report,
they
find
it
very
difficult
to
get
the
I.T
stuff.
They
need
any
other
questions
or
comments
for
any
of
the
team,
including
Stephanie,
okay,
well,
Stefano.
He
got
a
relatively
light
at
that
time.
Some
updates
a
few
things
your
boss
has
committed
you
to
delivering
in
November.
Thank.
A
Moving
swiftly
on,
as
they
say,
pulse
survey,
results,
I
think
we're
going
to
be
joined
by
Jackie
Jackson.
Thank
you.
A
Oh
Jackie,
so
Kate
should
I
just
hand
over
to
you
and
Jackie
to
obviously
we've
seen
the
paper
and
the
results
but
comment
on
a
bit
more
detail
and
I
will
allow
time
for
questions.
Thank
you.
B
Thank
you
thanks
all,
so
we
are
having
a
conversation
today
about
our
pulse
survey
that
we
took
that
undertook
in
we
undertook
in
May
of
this
year
with
a
real
focus
on
diversity
and
inclusion.
So
we
needed
to
get
really
key
information
from
this
survey
to
inform
the
equality,
diversity
and
inclusion
strategy
and
the
workforce
and
disability,
race,
Workforce,
disability
equality
standards
and
the
race
of
quality
standards.
B
The
item
with
which
we
will
have
next
just
want
to
note
the
timing
of
this,
so
the
survey
happened
in
may.
We
had
very
early
insights
from
the
organization
Who,
provided
the
survey
for
us
ahead
of
last
board,
but
not
sufficient
in
order
to
have
the
full
conversation,
then
so
I
just
want
to
note
the
time
that
has
elapsed
in
terms
of
us
having
this
conversation,
but
also
to
say
we
haven't
not
been
doing
anything
over
the
summer
since
we've
had
these
findings.
B
I
will
hand
over
shortly
to
Jackie
to
talk
you
through
the
findings.
I
think
it
would
be
fair
to
say
they
are
very
disappointing
results.
There
are
the
odd
the
odd
there
are
some
examples
of
where
we've
seen
Improvement,
but
nowhere
near
where
we
would
want
our
organization
to
be.
We
all
know
that
having
Workforce
means
that
we
are
providing
a
high
quality
of
service,
and
it's
really
important
that
our
people
are
are
positive
and
feeling
well
supported
to
do
to
do
their
job.
B
So
we
take
these
results
very
seriously
and
there
is
a
there
is
a
wealth
of
action
happening
on
on
the
back
of
that,
so
without
further
Ado
I'll
hand
over
to
Jackie
to
bring
to
us
some
of
the
highlights
from
the
paper.
S
Okay,
so
there's
such
a
lot
of
information-
that's
been
shared
in
the
pack
and
board
have
got
the
full
Suite
now
I,
don't
intend
to
go
through
any
specific
line
by
Lane
I
think
what
we
can
highlight
is
engagement
in
the
survey
was
significant
at
over
2
000
colleagues,
who
took
part
that
said
I
think
just
to
Echo
Kate's
words.
S
You
know
that
the
contents
were
concerning
and
saddened
to
read
and
I
think
it
would
be
naive
not
to
acknowledge
that
in
seeing
that
I
think
prior
to
the
survey,
which
was
a
golden
thread
to
llr
and
also
transformation
and
the
work
with
Nadia
and
the
staff
networks
and
Mark
would
already
started
to
undertake
a
considerable
work
program
in
terms
of
some
elements
that
were
highlighted
in
the
pool
survey.
S
Just
as
a
reminder,
the
pull
survey,
a
number
of
questions
were
specifically
targeted
to
inform
our
dni
strategy
and
the
Resendez
reports.
So
that's
given
us
quite
Rich
data
in
terms
of
the
work
we
already
started
to
do
and
what
new
still
needs
to
be
undetic
and
in
terms
of
colleagues
who
got
protected
characteristics.
S
S
So,
in
terms
of
thinking
about
colleagues
with
disabilities,
we
are
overhauling
and
looking
at
the
end-to-end
recruitment
program,
to
support
colleagues
who
want
additional
support
and
take
that
one
step
further
to
looking
at
the
recruitment
areas
that
we
actually
Target.
So
we
can
be
an
employee
of
choice
for
those
in
society
with
disabilities.
S
We
have
got
internally
the
inclusive
leadership
pathway
and,
as
of
the
last
tranche
of
colleagues,
39
people
were
on
the
program
and
seven
colleagues
had
gained
promotions,
so
we're
tracking
that,
through
looking
at
feedback
and
monitoring
the
performance
of
colleagues
who
actually
undertaking
the
training
undertaking
workshops
to
really
start
and
unpick
the
findings
from
the
survey
a
lot
of
the
data
in
there.
Whilst
we
are
concerned
about
it,
it's
quite
hard
to
disseminate.
S
So
we
need
more
work
to
be
able
to
really
understand
what
what
we've
been
told
and
what
the
response
is
and
Technology
can
cover
that
off
in
some
of
the
workshops
that
she's
been
arranging
and
hosting
a
lot
of
work
and
reasonable
adjustments
with
our
staff
Network.
S
Colleagues,
in
terms
of
how
we
support
colleagues
throughout
the
employment
life
cycle
and
with
with
Mark's
sponsorship,
a
good
piece
of
visionary
work
done,
which
will
start
to
inform
further
the
work
that
we've
already
started
and
then
working
with
tu
colleagues
as
well,
because
I
think
we've
got
to
acknowledge
that
our
tus
work
with
many
organizations
and
can
bring
their
thoughts
and
ideas
and
what
they've
seen
work
really
well,
so
that
we
can
work
with
them
to
implement
where
we
think
of
it
and
CQC
I'm.
Just
I.
T
Thanks
Jackie
just
to
build
on
Jackie's
point
we'll
be
engaging
widely
with
staff
from
September
to
November.
For
example,
there
will
be
externally
facilitated
focus
groups,
we'll
be
supporting
directors
to
have
conversations
with
their
teams,
we'll
also
be
engaging
with
the
quality
networks
and
other
expert
teams,
for
example
mental
health
and
well-being,
Estates
health
and
safety.
So
we
can
further
explore
the
results
and
that
will
enable
us
to
tailor
our
interventions
in
the
short
and
long
term.
S
Just
to
add,
I
think
as
well
there's
a
golden
thread
with
the
work
that
we're
looking
at
here
with
the
llo
report
and
also
the
work
on
culture
and
transformation
and
the
speaker,
Guardian
I,
think
it's
just
something
part
of
one
Global
offering
and
I
think
the
important
thing
is
also
to
make
sure
it's
joined
up
and
it
isn't
a
sailored
approach,
I'm
so
happy
to
take
any
questions.
A
D
Firstly,
thank
you
Jackie
and
our
colleagues.
It's
really
important
to
have
this
information
painful
there.
It
is
so
good
good
for
you
for
collecting
it
and
Reporting
it
in
the
in
the
honest
and
Frank
way
that
you
you
have,
and
please
can
we
keep
tracking
progress.
Two
much
more
specific
points.
One
of
the
most
significant
changes
from
the
previous
survey
is
the
proportion
of
discrimination
that's
attributed
to
senior
leadership
kind
of
what
do
you
make
of
that
and
the
second
quite
specific
question
there
are
two
responses
in
here.
D
Do
we
need
to
do
a
piece
of
work
about
people's
experience
of
working
from
home,
because
you're
much
more
likely
to
get
emails
that
you
may
then
find
offensive
if
you're
not
in
the
office,
people
are
clearly
finding
an
awful
lot
of
benefits
and
gain.
Hence
the
work-life
balance,
question
which
is
strongly
positive,
but
I
wonder
whether
it's
worth
asking
people.
D
Are
you
also
seeing
some
negatives,
particularly
around
sense
of
team,
the
ability
to
have
those
softer
conversations,
the
socialization
that
goes
with
being
in
the
office
I
just
wondered
whether
this
is
giving
us
some
indicators
that
it
might
just
be
worth
Consulting.
Colleagues,
specifically,
what's
your
experience
of
working
from
home
versus
working
from
the
office
and
do
we
need
to
have
another
look
at
that
thanks.
S
So
if
I
come
to
leadership
first,
clearly
the
data
it
you
know
is
telling
us
the
story.
I
think
the
challenge
with
this
at
the
moment
is
in
terms
of
the
backup
data
we
have.
So,
if
we're
to
look
at
some
of
our
casework
speak
up
Guardians,
albeit
anonymous,
it
doesn't
really
speak
to
the
reporting
of
the
pulse
survey,
which
that
makes
it
quite
difficult
to
try
and
unpick.
S
So
I
think
that's
where
the
workshops
that
were
starting
to
run,
to
starting
and
picking
to
your
point,
exactly
specific
questions
and
giving
colleagues
the
opportunity
to
speak
in
a
secure
environment,
their
experience
or
observations,
thoughts,
what
they
would
like
to
see
and
because
it's
only
by
doing
that
and
having
those
good
conversations
that
we're
going
to
be
able
to
drill
down,
because
the
survey
was
so
important
only
goes
so
far.
And
for
me
it's
about
the
start
of
that
conversation,
and
it's
certainly
not
the
end
of
it.
S
That's
the
start
and
where
we
should
be
where
we
should
be
highlighting.
The
other
thing
with
leadership
is
I
think
there
is
a
link
to
working
from
home,
and
it's
about
the
the
the
the
human
touch
and
I
think
you
know
all
of
us,
regardless
of
our
position,
have
good
days
and
bad
days,
and
actually,
how
do
we
check
that?
How
our
email
is
landing
to
somebody
who
is
again
having
a
good
day
or
a
bad
day,
so
I
think
that
fits
into
our
leadership.
S
Management
training,
that's
already
in
hand
which
actually
needs
to
reflect
some
of
the
findings
from
the
workshop,
and
also
some
of
the
content
from
this
and
and
just
being
able
to
sort
of
like
go
through
what
we
are
hearing,
what
we're
observing
methodically
and
documented
in
to
what
we've
either
already
gotten
trained,
or
what
we're
going
to
implement
collectively
and
take
an
ownership
because
it
doesn't
land
on
any
one
person's
shoulders.
This
is
all
of
our
responsibilities.
B
Can
I
just
come
in
on
the
the
homework
and
point
that
I
think
is
you
know
that
you've
made
Stephen,
so
I
think
I
think
it's
really
important
to
acknowledge
that
up
there
with
why
people
work
at
CQC,
along
with
purpose,
is
the
flexibility.
So
it's
something
that
really
matters
to
our
people
and
I.
Think
any
sort
of
hint
that
that
isn't
isn't
going
to
be
what's
on
offer
would
would
not
be
a
message.
We'd
want
out
there.
B
However,
when
we
talk
about
culture
and
we
talk
about
how
you
create
a
good
culture,
I
think
it
would
be
really
important
to
have
conversations
with
teams
about
how
to
ensure
that
you
are
coming
together
for
good.
You
know
whether
it's
away
days
or
you
know
shared
learning
Etc.
So
might
there
be
more?
B
People,
isn't,
you
know,
wouldn't
be
continuing,
wouldn't
be
helpful,
but
also
I,
don't
think
a
dictat
that
says
this
is
how
this
is,
how
we
should
work,
but
I
think
we've
got
like
to
do
in
terms
of
having
a
conversation
as
the
organization
about
what
does
good
look
like
when
it
comes
to
team
bonding
team
spending
time
together
in
person
as
well.
A
I'm,
just
gonna
be
clear
of
a
couple
of
questions
about
the
the
suggestion
from
Stephen
was
doing.
Some
work
about
working
from
home
I
mean
it's
something
we
have
talked
about
before,
because
the
you
know
we
never
set
out
to
design
the
model
we've
got.
You
know,
covid
made
a
switch
one
way,
and
then
we
sort
of
drifted
back
a
bit.
A
So
I
don't
have
a
good
feel
for
whether
if
we
were
to
work
out
the
ideal
model,
what
we've
got
us
anywhere
close
to
it
I
mean
it
must
be
close.
Otherwise,
we've
been
having
the
positive
results,
but
you
know
what
I
mean.
A
Intellectually,
we
haven't
looked
at
it,
so
I
I
do
think
it's
worth
capturing
Steven's
Point
as
to
going
beyond
what
you're
saying
I
think
of
looking
at
what
works
well
and
what
doesn't
work
well
but
of
taking
stock,
firstly
of
how
people
find
it
are
they
spending
the
right
amount
of
time
at
home
versus
the
office
I'm,
not
talking
about
necessarily
a
radical
shift,
dragging
people
in
but
I'm
saying,
rather
than
spending
all
the
time
at
home.
A
You
know
how
many
physical
interactions
do
you
need
with
colleague
six
of
which
one
but
then
to
the
extent
people
are
working
from
home.
Are
there
any
other
things
we
could
do
to
downplay
some
of
these
other
problems,
including,
for
example,
use
of
email,
so
I'll
leave
it
with
you
to
think
about
it,
but
I
think
it's
a
very
good
point.
A
Actually
a
lot
of
people
don't
think
I
think
it's
worth
looking
at
it,
both
from
a
relevant
or
theoretical
perspective,
but
also,
of
course,
capture
the
good
practice
internally,
where
it
exists,
and
obviously
it
may
be
evidence
of
what
doesn't
work
and
there
are
a
couple
other
questions.
I
should
sorry
a
couple
of
other
comments.
I
come
to
those
for
Tyson.
Did
you
want
to
respond
to
that?
I.
P
I
just
wanted
to
respond
to
yeah
I
think.
There
are
probably
two
issues
here,
because
I
agree
with
Stephen
and
I
remember
when
I
started
working
from
home
for
the
first
time
at
the
start
of
code,
but
it
was
a,
it
was
a
different
experience,
actually
could
be
quite
lonely
at
times
and
I
think
I
think
doing
some
work
with
our
people
about
what
it
feels
like
is
absolutely
right.
P
But
but
you
would
expect
the
good
grizzled
Ops
director
to
say
this.
Is
this
I
don't
think
that
people
working
from
home
is
just
about
it's
just
about
flexibility
in
their
work-life
balance?
P
A
You
know
we
don't
want
to
mandate
exact
ways
of
working,
but
you
know
some
guidance
and
maybe
even
some
minimum
standards
I
mean
I
really
would
struggle
I
think
say
if
we
were
employed,
somebody
who
had
never
met
physically
another
member
of
staff
for
a
certain
period
of
time.
I
see
lots
of
hands
going
up,
so
apologize
so
I'm
not
getting
quite
the
right
order.
L
You
tasting
very
well,
but
there
what
I
was
really
going
to
say,
but
I
just
want
to
highlight
the
the
absolute
benefits
of
working
from
home
or
that
level
of
flexibility
that
that
offers,
because
typically
around
colleague,
well-being
and
caring
Arrangements
in
the
flexibility
that
offers
to
many
colleagues
and
you
know,
particularly
but
not
limited
to
Lone
parents
and
the
the
financial
expense
that
people
are
in
catering
having
to
commute
and
search
as
well,
so
I'd
be
really
Keen
for
us
to
to
be
considerate
of
the
the
overwhelming
benefits
that
colleagues
have
found
when
we
were
able
to
move
into
a
more
flexible
Arrangement.
E
That
thank
you,
so
one
ask
and
one
potential
suggestion.
Starting
with
this
is
this,
is
you
know,
I
think
we
have
to
remember
this
was
done
in
May
and
actually
this
is
a
time
of
great
change
and
fast
change.
So
we
may
not
be
in
the
same
situation
now
as
we
were
in
May,
but
you
know
important
to
look
at
that.
The
the
one
part
of
this
is
we're
asking
a
lot
of
the
organization
in
terms
of
change.
E
We're
putting
them
through
a
lot
of
change
and
change
is
difficult
and
it
also
is
not
organizational
change.
It
always
comes
back
to
personal
change.
I
think
there's
a
really
critical
message
here
for
leadership
and
that's
the
board
as
a
totality
non-ex
directors
and
executive
team
and
the
executive
team
to
say
there
is
a
desire
here
from
the
organization
to
see
some
personal
change
about
how
the
leadership
handles
and
the
culture
it
creates.
E
I
know
we're
starting
that
work,
but
it's
important
to
think
about
that
at
a
collective
level,
for
the
board
at
an
individual
level
for
each
leader
to
say
what
what
am
I
going
to
do
differently
to
Foster
the
future
culture
that
I
want
to
see.
That
is
one
where
people
do
feel
free
to
speak
up
where
there
is
not
a
view
that
challenging
conversations
are
harassment,
but
they
are
constructive
and
supportive,
so
I
think
there's
there's
that
message.
I
think,
there's
a
degree
of
ownership.
E
We
have
to
take
and
and
and
drive
that
through
an
individual
and
Collective
level.
So
it
needs
to
be
on
the
agenda.
The
the
suggestion
was
I
think
it's
a
build
really
on
what
Stephen
sort
of
said.
I
think
there
that
there
may
be
a
correlation
between
working
from
home.
But
what
is
really
clear
is
that
you
need
trust
at
the
very
heart
of
this,
and
and
actually
things
like
working
from
home
reduce
the
opportunity
to
build
that
trust.
E
But
this
is
also
an
organization
that
has
to
be
by
its
nature,
highly
accountable
and
every
individual
has
to
be
accountable.
So
I
think
the
other
part
of
in
this
in
this
audit
or
looking
at
what's
changing
working
from
home
is
how
do
we
drive
that
supportive
accountability?
We
can't
we
can't
duck
away
from
challenging
and
difficult
conversations,
because
they're
essential
to
the
job
that
we
do,
but
you
you
have
to
do
it
in
a
way
that
it
comes
across
as
supportive,
not
as
harassment
or
or
bullying
and
I.
E
Q
Thanks
very
much
I
wanted
to
welcome
the
report
as
well
and
I've
welcomed
the
discussion
that
I've
had
in
my
functional
area
to
get
underneath
some
of
these
issues
there,
but
also
the
conversation
here
and
I
think
it
is
right
that
we
are
as
transparent
and
as
open
and
as
respectful
as
we
can
be
with
with
with
these
findings
as
a
relative
newbie
to
CQC.
Q
I
do
recognize
that
the
enormous
strain
created
by
both
the
transformation
and
new
ways
of
working
but
I
also
wanted
to
I
suppose
make
point
about
as
I
look
across
other
public
services.
Many
public
services
are
under
strain
as
a
result
of
increased
demand
and
of
distress
by
the
consequences
of
that
demand
that
we
are
seeing,
and
we
are
an
organization
that
will
see
that
stuff
coming
through
our
doors.
That's
a
consequence
of
the
General
Health
and
Social
care
State
as
it
were,
and
then
combined
with
an
easy
ability
to
get
behind
with
work.
Q
Because
of
that
demand
and
because
of
the
ways
of
working
can
create
a
very
toxic
response
and
other
public
bodies
are
experiencing
similar
to
ours.
So
I
to
State
the
obvious
commitment
from
executive
level
to
support
the
initiatives
that
are
underway
and
to
and
to
try
and
make
those
as
successful
as
possible,
but
I
think
even
where
we
can't
solve
the
problem
of
the
demand
or
speed
up
the
transformation,
because
it's
too
risky
to
speed
up
and
we
need
to
do
it
right.
Q
We
can
and
should
create
that
culture
where
people
feel
that
they
can
speak
out
and
speak
up
so
I.
Think
staff
will
really
welcome
the
board's
support
for
that
visible
support
in
this
meeting
and
and
further
engagements,
actually
at
board
and
executive
level,
to
sort
of
demonstrate
that,
as
we
go
along
very
much
the
point
that
Mark
is
making
that
we
can
be
very
visible
with
our
Behavior
without
solving
a
problem
and
people
under
understand
that,
because
we
cannot
control
the
whole
of
the
problem,
but
we
can
control
the
way
we
behave
with
it.
J
Thank
you
Jackie
and
Nadia
mine's,
a
question
for
you
really
about
the
workshops
that
that
you've
mentioned
one
of
the
things
that
business
schools
around
the
world
have
come
to
realize
quite
recently
is
the
problem
of
trying
to
give
the
opportunity
for
people
to
demonstrate
leadership.
Firstly,
when
you're
in
a
distributed
organization,
but
secondly,
when
a
lot
of
people
are
now
working
from
home,
it's
a
sort
of
double
whammy
and
a
lot.
A
lot
of
people
were
finding.
You
know
just
don't
feel
empowered
to
do
that.
Not
not
my
business,
not
mine,
I.
J
H
A
H
H
We
need
to
give
them
the
full
respect
of
seeing
the
the
scores
without
trying
to
rationalize
that
the
world
has
changed
since
two
things.
For
me,
I,
you
know
I,
like
Stephen
I
was
kind
of
quite
struck
by
the
the
the
chart
on
primary
reason
of
continuing
to
work
here.
I
was
I
was
not
particularly
surprised
by
the
element,
but
was
surprised
by
the
order,
which
was
kind
of
almost
upside
down
from
from
other
organizations
that
that
I
would
have
been
more
familiar
with.
H
But
one
of
the
things
that
you
know
struck
me
was
the
the
the
significant
Gap
there
between
really
strong,
buy
and
and
drive
for
our
purpose
and
values,
but
a
but
a
very
low
score.
For
you
know
low
on
the
list
is
our
vision
and
is
that
indicative
of
of
us
of
opportunities
to
much
better,
integrate
the
the
two
to
get
people
more
in
more
bought
into
what
we're
trying
to
do
and
and
why
we're
trying
to
do
it?
H
That
was
one
question
and
then
my
second
question
is
about
bullying
and
harassment
and
discrimination.
Where
the
you
know
the
we
should
not
be
seeing
any
red
on
this,
and
this
is
at
least
the
second
time
that
I've
seen
survey
scores
here
which
raise
questions
and
concerns
around
this
area,
and
you
know,
we've
been
previously
told
that
we've
been
responding
and
dealing
with
this
differently.
H
So
again,
you
know,
what's
going
to
be
different
in
terms
of
our
response
there,
how
we're
going
to
eliminate
red
from
this,
because
you
know
that's
those
are
incredibly
damaging
indications
of
incredibly
damaging
events
for
people
who
deserve
better
protection.
B
If
I
could
go
first
and
then
hand
to
Jackie
for
the
second
point,
so
so
Mark
slide
39,
where
the
prime
reason
for
continuing
to
work
is
around
work
like
balance
and
flexibility.
Second,
is
purpose
and
values
the
the
explanation
as
to
why
vision
is
so
low,
so
I
think
this
is
another
example
where
the
this
has
given
us
headlines,
but
we
don't
have
the
the
granular
decks
or
the
explanation
under
so
I.
I
am
using
a
degree
of
interpretation
that
my
exec
colleagues
may
want
to
come
in
on
I.
B
Think
I
think
people
believe
in
what
we
we're
about
as
an
organization
are
passionate
about
us
getting
out
there
and
regulating
so
that
people
get
safe,
Health
and
Social
care,
I,
think
people
different
parts
of
the
organization
are
in
different
places
when
it
their
views
about
how
we
are
getting
from
where
we
are
to
where
we
need
to
be
so
I
think,
there's
still
really
good
buying
for
our
strategy.
B
Regulated
the
eyes
of
people
lived
experiences,
understanding,
quality
and
risk
within
a
place,
but
actually,
as
Mark
said,
we're
in
quite
a
painful
place
at
the
moment
where
our
people
are.
You
know
some
of
our
new
changes
switched
on
some
they're
still
having
to
use
old
systems,
and
that
is
one
where
I
am
very
hopeful
that
in
maybe
nine
to
12
months,
I'm
giving
ourselves
longer
than
six
months,
because
I
think
next
six
months
are
still
going
to
be
pretty
difficult.
B
I
really
would
hope
to
see
that
come
back
out
again,
but
Nadi.
That
might
be
one
where,
when
we
do
our
workshops,
we
can
try
and
tease
out
a
bit
more.
It
almost
feels
like
a
contradiction,
so
you
believe
in
our
purpose
and
values,
but
you're
not
liking
our
vision
as
I
say:
I'm
interpreting
it
that
people
are
finding
this.
S
I
think
with
the
bullying
harassment
I
think
we
need
to
take
a
blended
approach
and
and
wire
everything
together
in
terms
of
providing
safe
spaces.
So
this
is
not
exclusive.
To
see,
managers
speak
up
working
with
the
national
Guardians
office
using
OS
Staffing.
It
works.
S
Well,
you
know
good
communication
with
Trade
union
colleagues,
if
something's
brought
by
membership
to
them
and
I
think
it's
about
how
we
join
that
up
and
make
sure
that
colleagues
have
as
many
Avenues
as
we
can
possibly
think
of
so
that,
if
you
feel
it's
all,
you
need
to
speak
to
somebody
about
something
you've
witnessed
or
something
you're
experiencing
yourself.
You
can
choose
the
Avenue
that
best
suits
you
and
I'm,
not
sure
I.
S
S
That's
something
that
we'll
need
to
look
at
in
terms
of
what
else
can
be
done
and
probably
ask
colleagues
and
what
next
because
I
think
a
lot
of
this,
we
can
have
conversations
about
what
we
think
are
the
answers,
but
actually
is
that
hitting
the
spot
and
I
think
we
need
to
get
some
endorsement,
that
we
are
following
the
right
path
and
I.
Think
I
think
this
is
the
same
with
bullying.
H
And
if
I
could
follow
up,
you
know.
One
of
my
concerns
is
that
the
the
scores
around
we
we
did
you
raise
it,
and
were
you
satisfied
with
how
it
was
dealt
with?
You
know.
The
second
schools
are
bad
as
well,
and
the
trouble
is
that
very
quickly
gets
into
the
culture
that
there
is
no
point
in
using
any
of
those
challenge
because
good
channels,
because
nothing
will
happen
so
I,
agree
with
this
response,
but
I
think.
S
S
And
just
just
to
add,
I
think
as
well.
This
is
another
one
because
if
you
were
to
have
a
look
at
some
of
the
data
that
you
would
normally
go
to
to
endorse
and
substantiate
that
that's
not
there.
So
it's
not
it's
not
questioning
the
the
validity
of
this.
But
again
it's
it's
about
how
you
unpick
the
data
that
you
see
in
front
of
you
to
then
do
something
more
about
and
I
think
that's
one
of
the
challenges
we've
got
at
the
moment
in
terms
of
some
of
the
backup
data.
H
Yeah
well,
although
this
is
our
reality,
because
culture
is
what
it
feels
like
to
be
here
almost
regardless
of
the
of
any
data
that's
available.
U
To
build
in
some
conversations
to
be
having
with
leaders
as
part
of
the
transformation,
we
talked
a
little
bit
about
what
it's
like
to
lead
in
the
organization
at
the
moment
and
I
think
there's
a
there's,
a
really
interesting
sort
of
link
to
the
purpose
of
the
organization
and
the
reality
is
of
action
today.
So,
as
we've
talked
about
in
other
conversations,
it's
a
fast-paced
organization
with
lots
happening
both
in
terms
of
transformation
but
also
in
terms
of
operational
delivery.
U
I
think
this
goes
right
back
to
how
do
we
encourage
leaders
of
teams
to
have
good
conversations
with
their
people
they're
starting
a
conversation
about?
What's
the
use
of
email
and
actually
there's
a
really
interesting
point
about?
How
do
you
have
good
conversations
with
with
with
people
that
are
two-way,
because
the
problem
with
email?
Essentially
it's
a
one-way
Channel?
You
don't
actually
know
the
intent
of
an
email
that's
sent,
but
you
can
infer
intent
from
a
conversation
either
face
to
face,
or
indeed
even
on
over
over
teams.
U
But
it's
it's
about
giving
people
the
sense
that
it
is
as
important
to
have
the
right
conversation
as
it
is
to
get
their
message
out
and
I.
Think
that
the
encouraging
the
conversations,
particularly
with
Frontline
leaders,
that
the
time
taken
to
have
a
conversation
is
well
spent
against
the
other
challenges
that
they
have
and
then
indeed
there
are
many
challenges
that
Frontline
leaders
have
so
I.
Think
there's
something
about
how
we
encourage
that
conversation,
because
it
builds
trust.
U
U
I
think
that,
often
in
in
the
organization
there's
a
layer
which
the
information
is
communicated
in
a
one-way
process,
and
we
don't
hear
the
feedback
back
up
into
the
the
executive
so
giving
leaders
not
just
the
power
to
do
that,
but
the
but
the
encouragement
to
have
those
conversations
two-way
with
their
teams.
I
think,
will
be
important.
Part
of
our
cultural
Journey
that
we've
talked
about
earlier.
L
Thank
you,
as
has
been
mentioned,
and
you
know,
these
are
truly
disappointing
results
and
absolutely
weren't
they're,
very
serious
interventions
that
colleagues
have
already
mentioned
and
I
do.
However,
I
want
to
highlight
one
area
of
positivity
in,
in
that
our
equality
networks
are
the
second
highest
scoring
and
under
the
what
we're
doing
well
section
I
think
that's
to
be
able
to.
We
is
in
LGBT.
L
Plus
network
have
recently
inherited
leaderships,
or
we
can't
take
all
the
credit
by
any
means,
but
certainly
you
know
it's
to
the
to
the
creative
art
or
the
network
leaders
who
have
brought
it
to
to
the
point
where
we're
at
we're
working
really
well
with
Jai,
Nadia
and
team.
In
regards
to
the
likes
of
addressing
some
of
the
issues
around
building
harassment
and
discrimination.
L
Ian
I
know
that
we've
had
some
calls
with
you
and
Jackie
recently
and
so
I'm
pleased
that
that's
already
started
I
do
want
to
share
a
plea
or
an
offer
to
our
colleagues
around
the
table
in
that
we
are
here
to
support
you
in
the
work
that
you're
doing
locally.
In
addition
to
the
work
are
doing,
we
represent
our
our
sub
communities.
A
Oh
thanks
Drew
both
for
the
the
comment
and
giving
us
the
positive
feedback
with
more
questions.
I'd
really
have
to
make
it
last
two
or
three.
Otherwise
we're
going
to
be
open
to
sell
the
time,
Christine
and
then
Belinda
and
then
did
you
want
something:
okay,.
O
Yes,
thanks.
I
would
hope
that
that
the
the
amount
of
time
we've
given
this
as
a
board
will
reassure
people
out
there
that
we
are
genuinely
taking
this
seriously,
but
I
just
felt
that
the
pain
is
now
and
most
of
the
actions
we're
talking
about
are
in
the
future.
So
what
Comfort
can
we
give
people
that
we're
listening
and
things
are
going
to
get
better
now
or
soon.
O
N
I
mean
I
think
I.
What
the
point
I
was
going
to
make
more
broadly
was
that
if
we
look
at
the
surveys
over
the
last
few
years,
the
surveys
in
20
20
21
during
covid
were
significantly
better
than
this,
despite
a
very
similar
working
environment.
So
I
think
we
should,
and
we
can
also
look
at
the
fact
that
in
those
surveys,
the
the
results
in
Marx
group
were
relatively
poor.
Results
in
Mark's
group
now
are
very
good,
and
one
of
the
characteristics
of
this
survey
is
the
variability.
N
All
who
are
particularly
struggling
at
the
moment
with
under
Tyson's
leadership,
to
improve
a
range
of
things
and
I
think
what
we
are
seeing
is
we're
starting
to
see
those
green
shoots
of
recovery,
we're
starting
to
see
people
with
the
small
ad
hoc
surveys
that
we're
doing
starting
to
report
much
more
positively
about
about
their
experiences
have
changed
their
experiences
of
of
where
they
see
us
going
and
all
of
these
things.
So
you
know
I,
don't
think
in
saying
all
of
that
we
should
be.
N
We
should
be
wildly
overconfident,
but
I
think
two
things
there.
One
is
the
speed
with
which
this
changes
it
has
gone.
It's
went
very
high,
then
it
went
down
and
and
I'm
confident
that
it
will
come
back
up
again
and
there,
but
there
are
lots
and
lots
of
of
individual
actions
which
are
in
place
and
I.
Think
underpinned
by
the
point
you
made,
which
is,
we
are
taking
this
incredibly
seriously,
that
give
me
confidence
that
there
is
a
road
out
of
this.
A
I
Similar
point
to
Ian,
really
that
when
you
break
it
down
to
the
executive
directorate
teams,
you
know
we've
got
some
really
good
results
in
the
technology
data
and
insight
and
the
regular
customer
and
corporate
operations.
So
I
just
wanted
to
stress
that
you
know
it's
not.
Yes,
we've
got
soon
as
overall
there's
some
very
bad
results
and
it's
disappointing,
but
you
know
in
some
areas
you
know:
we've
really
seen
good
results
from
the
team
foreign.
A
Summarize
all
that
discussion,
so
a
number
of
observations
trying
to
put
it
together
and
also
one
last
question
for
Kate
I
mean
firstly
thanks
very
much
for
for
for
the
report
and
despite
the
fact,
the
the
results
are
poor,
bad.
A
Whatever
phrase
we
used,
we'll
give
some
credit
for
the
fact
that
as
organization
I
think
the
fact
that
you
know
we're
showing
this
not
just
with
the
board
but
with
our
people
in
public
the
agency
or
Executives
who
deserve
credit
for
that
degree
of
openness
like
a
lot
of
organizations
that
wouldn't
have
done
that
so
I.
Think
that
says
something
about
culture,
at
least
that
you
know
it
does
hold
everybody
to
account
now
to
deal
with
it
because
we're
being
so
so
open
about
it.
A
The
there
are
a
number
of
suggestions
which
perhaps
ask
you
to
take
away
some
really
helpful
observations
and
I.
Think
two
or
three
people
commenting
on
this,
that
Stephen
a
comment
about
working
from
home
and
just
understanding
the
implications
of
that,
whether
it's
looking
at
guidance
elsewhere,
experience
elsewhere
through
Academia
or
other
businesses,
are
their
own
experience.
That
would
be
extremely
helpful.
A
So
really
well
done
too
all
even
if
we've
got
a
very
poor
position,
as
you
say,
Christine
I
mean
you
know.
We
spent
double
amounts
of
time.
A
lot
of
I.
Think
that
says
something
I
hope
if
any
of
our
colleagues
are
listening,
the
board
really
does
want
to
see
this
as
one
of
our
top
three
or
three
issues
to
address.
So
you
know,
we've
seen
observations
and
comments
from
James
and
from
Drew
about
the
underneath
Mark
about
the
actions
of
this
board.
A
A
Just
one
last
question:
for
you
Kate
one
of
the
things
that
struck
me
what
I
joined
this
organization
was
the
number
of
people
commented
about
the
the
values
and
they're
clearly
quite
important
to
a
lot
of
people,
but
equally
in
my
18
months
here,
we've
never
had
any
discussion
about
values
at
the
board
and
it
made
me
reflect
on
it
to
be
fair.
A
A
couple
of
other
colleagues
mentioned
it
most
organizations
would
review
or
refresh
their
values
every
few
years
and
I'm
not
sure
that's
been
done
for
a
best
part
of
a
decade
here.
So
well,
that's
a
refreshold
about
changing
them.
People
are
heavily
committed,
a
lot
of
them,
but
it
would
now
be
a
good
time
for
some
sort
of
relocal
refresh
the
values,
perhaps
as
part
of
the
culture
work
which
would
come
back
to
the
board.
B
Thank
you
and
yeah
and,
as
you
say
in
the
results,
we've
just
seen,
it's
the
second
most
important
thing
for
people
about
why
they
work
here,
so
values
really
matters
to
our
people.
So,
very
briefly,
the
last
time
values
were
co-produced
extensively
at
were
10
years
ago,
and
approximately
only
a
quarter
of
our
star.
Our
people
are
here
who
were
here
when
those
values
were
originally
established,
but
that's
not
to
say
they
don't
still
have
high
resonance
with
people
today
and
so
I
I
think.
B
As
part
of
the
conversation
we're
going
to
have
around
culture,
we
want
to
start
with.
We
want
to
start
a
conversation
with
our
people
with
our
networks,
with
all
the
other
fabulous
forums
we've
got
around.
Are
they
still
the
right
values?
Do
they
need
a
refresh?
Do
we
need
to
make
them
more
action
orientated?
B
Do
we
want
to
do
something
different
with
them
and
I
think
that
needs
to
be
the
starting
point
for
the
conversation
that
then
says
yep
it's
either
reconfirming
or
tweaking
or
changing
the
values,
depending
on
what
the
view
is
in
the
in
the
organization
and
obviously
around
this
table,
and
then
what
are
the
associated
behaviors
behavioral
expectations
and
how
we
hold
each
other
to
account
for
for
the
culture
we
want
to
have
in
the
organization
as
well,
so
in
the
kind
of
coming
weeks
and
months,
we're
going
to
hone
down
our
thinking
on
that
and
then
have
a
conversation
in
November
with
board
and
be
really
Keen
to
hear
your
thoughts
also
on
it.
A
N
But
just
just
to
reinforce
that
point
we
want
to
do
that
very
rapidly.
We
don't
want
to
turn
this
into
a
very
long
period,
not
long
thing
that
that
behaviors
thing
is
something
we
want
to
do
really
really
quickly.
A
A
Can
we
just
move
on
very
quickly?
We
have
one
last
item.
We
are
running
badly
high,
but
let's
try
and
stick
to
the
agenda
and
take
a
late
break.
So
we
have
two
documents
here.
You
want
us
to
approve,
which
is
the
workforce,
racing
quality
standard
and
the
disability
standard.
So
the
reports
Kate
I'll
hand
to
you
in
a
second,
but
just
one
observation
for
me
on
behalf
of
LED
colleagues
might
save
some
questions.
A
You
may
have
noticed
comments
in
there
along
the
lines
of
The
Wraith
status
of
the
non-execs
were
unknown.
You
might
have
found
that
was
a
little
bit
surprising,
the
same
on
disability,
the
clarify
where
that's
there.
This
data
is
drawn
from
our
systems
since
non-executives
are
appointed
by
the
Secretary
of
State.
They
hold
that
data.
This
organization
doesn't
apparently
with
the
exception
myself,
because
I
am
logged
into
the
system.
So
my
details
are
in
here
at
yours.
Aren't
I've
made
two
suggestions
to
take
of
account
the
approval.
A
The
problem
is:
this
is
as
of
a
few
months
ago,
and
the
composition
of
the
board
has
changed
significantly
since
then.
So
I
see
zero
point
in
going
back
and
working
out,
but
it
might
have
been
six
months
ago,
but
I
have
asked
for
the
words
to
be
tweaked
a
little
bit
just
to
explain
why
it
is
that
that
is
the
case.
A
We
don't
hold
the
data
because
and
then
I'd
like
to
suggest
that
looking
forward,
subject,
of
course,
the
agreement
of
LEDs,
who
would
have
to
disclose
the
data
that
we
do
actually
capture
it
internally.
So
next
year
we
can
have
reflective
of
the
lot
but
to
anyone
listening
and
particularly
our
colleagues
in
the
organization
they
may
have
found
it
very
odd
that
the
implication
given
that
any
D
is
going
prepared
to
divulge
that
information.
B
Thank
you
so
I'll
shortly
hand
over
to
Nadia
I
think
these
are
two
pieces
of
work.
We
can
feel
pretty
proud
of
I
think
an
idea.
You've
benefited
Tuesday
and
I've
heard
you
say
from
the
work
you've
done
on
the
with
the
networks
around
this
and
obviously
our
two
exec
colleagues,
as
as
sponsors
of
the
work,
two
things
that
I
want
to
point
out.
That
I
think
is
really
positive.
B
I
think
the
honing
down
in
each
of
the
in
each
of
the
reports
around
three
priority
areas
as
with
everything
that
you
could
go
after
so
many
different
things,
but
I
think
for
both
the
were
res
and
would
dares
to
nail
down
the
real
Clarity
around
the
three
priority
areas.
They're
going
to
go
after
I
think
should
really
help
us
in
our
ambition
of
making
this
deliverable
and
measurable
as
well,
but
without
further
Ado
over
to
Nadia.
T
Thank
you
Kate
and
there's
quite
a
lot
in
the
plan,
so
I
wanted
to
draw
out
some
key
priorities
that
are
relevant
to
both
plans.
Firstly,
recruitment
with
respect
to
race.
We
are
focusing
on
recruitment
in
terms
of
improving
our
representation
at
exec
level
and
then
the
internal
Talent
pipeline,
so
grade
A's
and
B
for
disability.
This
is
more
focused
on
the
experience
in
terms
of
our
reasonable
adjustments
offer
the
second
priority.
I'd
say
that's
relevant
to
both
is
inclusion.
T
We've
discussed
a
lot
about
bullying,
harassment
and
discrimination
and
we'll
be
working
on
that
as
a
priority,
because
it's
relevant
to
to
both
characteristics
and
then
finally,
inclusion
from
our
workplace
adjustment
support
perspective
and
also
our
psychological
safety,
and
that
we're
providing
to
colleagues.
That
will
be
a
key
focus
of
the
inclusion
work
that
we
will
be
doing.
T
We're
hoping
that
the
conversations
that
we
start
now
from
September
to
November
on
the
survey
should
support
that
level
of
growth
in
psychological
safety.
Most
organizations
that
welcome
feedback,
respond
to
feedback
and
keep
people
engaged
with
feedback
show
that
they
are
safe
to
challenge
and
to
speak
up
to
leaders
and
people
are
more
engaged
with
the
organization
and
they
also
feel
more
of
a
sense
of
belonging.
So
we're
hoping
that
some
of
that
work
will
support
the
activity
that
we've
got
planned.
Within
These
and
within
both
plans
in
terms
of
adjustments
with
disabilities.
T
There's
a
massive
book
of
work
in
terms
of
improving
our
reasonable
adjustments
offer,
including
the
implementation
where
I
believe
we
probably
have
struggled
historically
wider
to
those
adjustments.
We're
also
working
on
other
adjustments
and
support
that
people
will
need,
and
that
will
impact
both
disabled
colleagues
and
colleagues
from
an
ethnic
minority
background,
for
example,
caring
responsibilities,
gender
identity,
their
General
working
Styles.
A
P
P
The
two
of
the
big
priorities
have
got
to
be
around
recruitment,
which
is
well
captured
in
the
in
the
plan,
because
we
are
very
good
at
attracting
interest
from
from
people
from
ethnic
minority
backgrounds,
less
good
at
shortlisting
and
appointing
them
and
I
think
also.
The
the
data
around
discrimination,
in
particular
is
worrying
and
I
I
think
is
part
of
work
stream.
Three,
when
we're
talking
about
psychological
safety
and
inclusion,
I'd
be
Keen
for
us,
also
to
particularly
focus
on
the
work
we
can
do
around
discrimination.
Thank
you.
Thank
you.
A
Excited
Ali
I
think
was
first,
the
Newmark.
G
Thank
you.
It's
a
really
clear,
helpful
report
and
I
think
the
clarity
of
the
actions
as
well
as
the
data
is
really
useful
to
understand.
I
agree
with
what
Tyson
said
about.
There
are
some
areas
that
which
clearly
Improvement,
but
there
are
also
clearly
some
areas
that
are
striking
and
really
draw
a
lot
of
attention
to,
such
as
the
rates
of
bullying,
harassment
and
abuse
for
a
college
with
disabilities
too
I
think
similar
to
the
previous
report.
We
discussed
it'll
be
helpful
to
continually
analyze
the
level
of
data
we
have
to
understand.
G
Actually,
how
do
these
characteristics
intersect
with
other
ones,
to
understand
whether
specific
nuclei
of
concerns
or
whether
they
spread
more
widely
within
groups
of
characteristics,
and
also
to
keep
making
sure
that,
as
we
undertake
other
pieces
of
work,
that
impact
on
this
we're
building
a
more
rounded
comprehensive
base
to
understand
how
we're
doing
and
supporting
and
valuing
our
colleagues?
Thank
you.
K
A
K
It
was
just
saying
the
similar
vein
to
Tyson
just
a
huge
thanks
to
the
disability
equality
network.
We've
had
recently
the
appointment
of
six
new
co-chairs
we're
all
working
incredibly
hard
and
the
focus
around
reasonable
adjustments,
I
think
is,
is
critical
and
thanks
for
your
support,
Jackie
and
Nadia
on
on
that
work.
K
I'm
really
excited
about
what
that's
going
to
deliver
for
us,
because
that's
going
to
make
a
significant
Improvement
to
the
experience
of
colleagues
with
disabilities
at
CQC,
but
they're,
disability,
quality,
Network,
I'm,
actually
working
on
a
huge
raft
of
of
change
and
improvements,
which
I
think
is,
is
is
exciting
in
itself
and
all
supporting
the
the
the
aims
of
the
workforce,
disability,
equality
standards.
B
N
Think
one
of
the
things
that's
that's
what's
been
quite
striking
is
it
you
know
we
have
been
able
to
offer
direct
support
for
people
who
need
a
different
computer
or
a
different
or
a
different
workspace
to
work
in,
but
neurodiverse
colleagues
I
think
have
a
have
a
much
more
sophisticated
set
of
of
needs
to
enable
them
to
to
contribute
and
I
think
a
lot
of
the
work
this
this
year
has
been
on
deepening
our
understanding
and
with
that
group
of
colleagues
and
I
think
we
have
made
a
we've
made
some
progress
in
that
area,
but
I
think
there's
definitely
more
more
to
go.
N
A
Here
it's
an
area
that
you
feel
very
strongly
about
any
other
comments,
so
we're
being
asked
to
approve
this
I
mean
it's
it's
pretty
factual
really,
so
it's
helpful
to
have
the
interpretation,
but
as
far
as
the
document
goes
looks
like
we're
approving
that.
So
thanks
very
much.
Thank
you
very
much
both
of
you
for
spending
the
time
with
us
this
afternoon
appreciate
it.
A
So,
let's
take
a
well-earned
comfort
break
for
those
I
apologize,
the
colleagues
here
and
anyone
listening
in.
At
this
rate,
we
are
we're
running
about
half
an
hour
behind
schedule,
we'll
see
if
we
can
catch
some
of
that
up,
but
otherwise
I
hope.
Another
inconvenience
you
too
much
if
we
do
run
over,
but
let's
try
and
come
back
in
10
minutes,
maybe
a
little
under
if
that's
at
all
possible
thanks
very
much.
A
Welcome
back
everybody,
sorry
to
rush
or
tea
break
I
hope
you
managed
to
suitably
refresh
I'll
try
to
make
up
a
little
bit
of
time.
Let's
see
how
we
can
do
that.
The
next
item
on
the
agenda
is
the
national
complaints
team
report,
Kate,
Staples
I.
Think
Bob
just
come
straight
to
you
on
this.
So
over
to
you.
C
Just
to
highlight
for
emphasis
first
of
those,
the
increase
in
the
number
of
complaints
received
during
the
reporting
year,
coupled
with
a
vacancy
rate
in
the
team,
meant
that
there
were
more
people
complaining,
but
we
were
slower
in
responding
to
their
complaints
than
we
would
like
to
be.
So
our
performance
has
dipped
in
that
regard.
C
In
terms
of
actions
we've
already
taken
to
to
respond
to
that
pleasingly,
the
team
is
back
up
at
full
strength,
but
what
we've
also
instituted
is
some
monthly
case
management
disciplines
to
make
sure
that
we
are
pushing
through
on
responding
to
complaints
in
a
timely
fashion.
C
So
hopefully
the
report
for
this
year
will
show
an
improvement
again
in
throughput,
looking
ahead
to
what
we
can
anticipate
in
the
complaints
here,
23-24
as
a
result
of
the
transformation
program,
we
are
anticipating
an
uptick
in
the
number
of
complaints
that
come
through
to
us,
so
we
are
trying
to
get
ahead
of
that
by
ensuring
that
we
have
connections
with
colleagues
across
the
organization
on
which
we
can
call
should
complaints
come
through
specifically
around
the
new
transformation
and
new
ways
of
working
and
within
my
director.
What
we're?
C
Also
looking
at
is
ways
in
which
we
can
build
more
resilience
in
the
team
to
ensure
that,
even
if
there
is
more
complaints
activity
in
in
this
current
complaints,
here,
we
are
better
able
to
handle
it
and
in
terms
of
delivering
a
better
outcome.
Essentially
for
those
who
are
complaining
we've,
we
are
constantly
trying
to
improve
the
way
we
Forge
connections
and
learn
from
and
share
Insight
with
colleagues
across
CQC,
so
that
the
complaints
exercises
never
purely
a
process
or
a
mechanistic
one.
C
We
do
try
to
seek
the
learning
from
complaints
that
are
upheld
and
feed
that
back
into
the
CQ
CQC
system
to
make
sure
that
we
we
build
on
it
for,
for
future
reference,
I'll
pause
there
and
happily
take
any
questions
from
colleagues.
O
I
I
note
the
analysis
and
also
the
supplementary
paper
that
was
in
the
reading
room
that
I've
had
a
look
at
I
wondered
if
there
was
any
feedback
from
the
people
making
the
complaints
about
how
satisfied
they
were
with
the
way
they
were
investigated
and
the
outcomes.
C
It's
a
mixed
picture.
Some
are
satisfied
with
the
service
orbit
orbit,
not
necessarily
with
the
answer
or
the
outcome.
Some
are
dissatisfied
with
both
and
in
a
sense
that's
that's
to
be
expected.
I
think
there
is
an
underlying
issue
to
some
extent
and
I
think
we've
picked
up
or
picked
up
on
it
in
this
morning's
board
about
the
extent
to
which
there
is
a
mismatch
between
external
stakeholders,
expectations
as
to
what
we
can
do
and
our
ability
to
do
what
they
would
like
us
to
do.
C
The
there
tends
to
be
a
greater
level
of
dissatisfaction
from
individual
complainants
who
think
we
have
the
power
to
do
something
in
response
to
something
bad.
That
has
happened,
and
that's
that's
not
always
the
case.
So
there
is
a
mismatch
and
we
we
do
constantly
try
and
think
of
ways
of
correcting
that.
A
A
Maybe
we
should
be
better
at
explaining
our
scope,
but
but
just
in
terms
of
understanding
performance,
clearly,
there's
a
big
difference
between
something
we're
not
doing,
as
others
should
have
done,
but
it's
in
our
scope
versus
those
things
that
are
out
of
scope
and
if
anything,
it
seems
to
me
the
outer
scope.
Concerns
are
growing,
as
as
people
have
worries
about
the
system
and
they
turn
to
us
to
try
to
fix
things.
C
I
mean
one
of
one
of
the
interesting
things
that
that
emerge
from
a
series
of
one-to-ones
I
had
with
with
colleagues
across
the
directorate
was
the
extent
to
which
human
interaction
at
a
very
very
early
stage
could
be
really
helpful
in
heading
off
extended
correspondence,
and
that's
something
I
think
to
bear
in
mind
is:
is
making
sure
that
we
don't
simply
rely
on
electronic
means
or
relatively
mechanistic
processes,
but
think
about
that
human
interaction,
because
some
of
some
of
the
the
colleagues
that
they
really
are
wonderful
that
giving
stakeholders
a
jolly
good
listening
to,
which
is
really
really
important
at
an
early
stage.
C
A
The
other
related
point,
though,
give
what
you
just
said
is
the
phso,
and
indeed
my
the
board
previous
by
the
hour
chart,
put
out
some
joint
guidance
on
complaints
handling
which
were
the
end
of
the
NHS
a
year
or
so
ago.
But
I
don't
know
if
we've
looked
at
how
our
processes
compare,
but
I
mean
one
of
the
key
things
there
was
that
human
interaction
showing
you
got
the
point
at
an
early
stage
makes
a
huge
difference.
So
if
we
haven't,
perhaps
we
could
make
sure
we've
looked
at
that.
C
C
J
Thank
you.
Thank
you.
Jack
Kate
I'm,
not
sure
whether
I
I
may
have
missed
this
in
the
report.
So
forgive
me,
but
in
terms
of
complaints
do
do
we
have
a
formal.
You
said
we
did.
This
happened
log
because
other
organizations
that
I
serve
we've
instituted
that
so
that
the
the
complaint
in
a
sense,
although
it
may
well
be
resolved.
The
point
is
that
it
is
also
logged
in
that
form.
In
other
words,
you
said
so
we're
clear
about
what
you
said.
J
This
is
what
we
did
and
then
there's
an
outcome
to
that.
I
don't
know,
I
couldn't
see
it
in
the
report,
but
if
it's
there
pointed
out
to
me,
if
not
perhaps
you
would
consider
it.
J
C
Whether
it
is
in
log
form
we'll
check,
but
we
certainly
do
cat
capture
the
points
that
are
coming
out
of
the
complaints
and
feed
them
back
to
colleagues,
to
make
sure
that
there
is
an
opportunity
to
respond
and
reflect
and
adjust
behaviors
as
a
consequence.
So,
yes,
we
do
whether
it's
as
formal
as
a
log
I
will
go
and
check,
because.
J
A
No
just
not
like
it:
okay,
well
Kate!
Thank
you
very
much
indeed,
for
that.
We've
now
got
a
an
interesting
session
on
it's
a
policy
position.
That's
been
put
to
the
board
by
the
management
on
reducing
restrictive
practices
of
Joyce
I.
Think
you're
going
to
lead
on
this,
but
we're
going
to
be
joined
by
Rebecca
bows
and
Jackie
Wilson
again,
she's
been
out
like
a
Jack
In
The
Box
today,
I
won't
say
much
until
they
arrive.
A
D,
thank
you
for
joining
us,
so
Joyce
I'll
turn
to
you
in
just
one
second,
but
just
to
this
is
really
just
down
to
hear.
What's
going
on
and
discuss,
but
it's
it's
a
policy
position.
The
management
wish
to
promote
it's
very
important.
It
is
in
line
with
our
strategy
there's
a
video
which
people
explain
in
a
moment
in
terms
of
output
other
than
just
noting
what
it
is
being
proposed.
A
And
discussing,
we
are
proposing
that
the
a
bit
more
detail
on
this
will
come
to
the
regulatory
governance
Committee
of
this
board
at
a
future
meeting.
That
is
the
Forum
in
which
we
consider
the
way
we
practically
go
about
handling
our
regulatory
obligations.
So
we're
not
being
asked
to
approve
anything,
but
if
people
want
something
looked
at
in
more
detail,
let's
capture
that
and
that
can
be
added
to
the
work
of
the
rgc
when
they
come
to
look
at
it.
F
F
V
Thank
you
Joyce,
and
it's
good
to
be
here
today
at
public
board.
Thank
you
for
inviting
us.
As
you
already
know,
my
name
is
Rebecca
Bowers
I'm,
the
director
for
people
with
learning
disability
and
autistic
people,
people
I'm,
joined
by
Jackie
Wilson
here
for
one
of
our
policy
managers.
V
V
We
have
set
three
Ambitions
for
people
with
a
learning
disability
and
autistic
people
through
our
expert
Advisory
Group.
One
of
those
is
about
reducing
restrictive
practice.
The
other
is
about
health
and
well-being
to
reduce
mortality
by
better
GP
access,
and
the
third
is
around
Community
provision
to
reduce
admission
into
Hospital.
V
These
Ambitions,
alongside
our
business
plan
objectives,
will
direct
our
work
over
the
next
two
years
and
the
policy
Position
will
set
the
direction
for
the
sectors
and
inform,
are
reducing
restrictive
practices,
strategy
and
priorities
going
forward
since
the
publication
of
our
outside,
who
cares.
Our
work
in
this
area
has
very
much
focused
on
services
for
people
who
are
Autistic
or
people
with
a
learning
disabilities.
Joyce
has
already
mentioned.
V
V
We
have
a
full
engagement
plan
to
include
the
notion
of
a
clamp
of
a
campaign
and
a
call
to
action
for
us
all,
foreign
for
external
stakeholders
and
Chris
day.
Our
director
for
engagement
will
give
some
indication
of
what
that
will
look
like
a
little
later
on
and
after
Jackie
has
given
some
key
headlines
around
the
policy
internally,
our
staff
will
be
undertaking
specific
training,
promoting
the
reduction
of
restrictive
practice.
That's
been
commissioned
through
building
a
reduction,
restraint,
Network
and
hopefully,
as
Joyce
has
already
mentioned.
W
Thanks
very
much
Rebecca,
so
to
summarize
the
policy
what's
important
to
know
about
this.
Firstly,
we
expect
services
to
listen
to
and
understand
people
and
to
use
this
understanding
to
reduce
the
need
for
restrictive
practices.
So
this
policy
is
about
prevention.
Where
possible,
we
recognize
that
organizational
culture
has
a
role
to
play
in
this.
A
positive
culture
will
promote
trust
between
people
who
use
the
service
and
staff,
and
that
kind
of
culture
and
context
is
vital
in
helping
people
to
live
their
best
lives.
W
W
So
what
we're
about
is
tailoring
services
to
people
to
reduce
restrictive
practices
in
cases
where
restrictive
practices
such
as
restraint
or
segregation,
have
to
be
used.
We
expect
providers
to
analyze
and
learn
from
their
use
and
to
better
tailor
care
to
the
individual
in
future,
but
also
to
learn
from
the
incidents
and
report
to
the
board
or
equivalent
of
the
organization.
W
V
Okay,
so
before
we
do
play
the
video
Curtis
thanks
for
waiting
Chris
did
you
want
to
just
give
a
little
bit
of
background
in
terms
of
the
campaign?
Please.
U
Thanks
so,
as
colleagues
have
said,
this,
this
piece
of
work
stands
right
back
to
the
outer
site,
who
cares
report
which
taught
for
the
first
time
about
people's
experience
of
of
of
restrictive
practice.
So
what
we
wanted
to
try
and
do
with
the
work
now
with
the
policy
position,
is
to
offer
clarity,
clarity
about
what
we
felt
was
acceptable
for
people
using
Services
Clarity
for
what
we
expect
from
people
delivering
Care
at
the
front
line
of
care
Clarity
for
Commissioners
Clarity
for
providers.
U
So
this
this
piece
of
work
is
in
an
effort
to
create
that
Clarity
that
has
been
sought
by
by
a
variety
of
colleagues,
just
want
to
pay
tribute
to
the
colleagues
in
the
room
and
colleagues
in
CQC.
Who've
put
this
piece
of
work
together
and
also
to
Alexis
Queen,
who
you'll
hear
about
shortly
in
the
video
I.
Think,
a
combination
of
her
testimony
to
to
to
make
that
change
possible
and
also
our
our
determination
to
keep
this
issue
alive
from
the
from
the
first
out
of
sight.
Report
is
I
think
it
is
really
important.
U
So
we've
already
published
a
Blog,
but
the
idea
is
that
we
would
use
that
blog
and
use
the
information
in
a
statement
to
have
ongoing
conversations,
particularly
with
partner
organizations
who
often
are
instrumental
in
beginning
that
change
in
the
wider
system,
Commissioners
and
providers,
and
also
people
at
the
front
line
of
care.
So
they
really
understand
the
implications
of
this.
U
What
we're
seeking
to
change
as
a
result
of
this,
we
want
to
encourage
a
better
way
of
working
once
we
want
to
encourage
move
away
from
areas
of
of
service
that
we
feel
are
toxic
to
people's
needs.
We
we
know
that
some
of
this
is
acts
in
detriment
and
often
can
prolong
people's
use
of
services.
So
the
video
we
played
shortly
but
I,
think
this
will
be
an
ongoing
campaign
for
us
as
we
go
into
this
year.
V
X
You
hi,
my
name
is
Alexis
Quinn
I'm,
an
autistic
person
and
was
previously
detained
in
inpatient
settings
for
four
years.
During
that
time
restraint
it
was,
it
was
part
of
my
life.
I
would
have
a
sensory
overload,
I'll
be
restrained,
I'll,
be
secluded,
and
then
I
would
wait
for
that.
That
overload
to
happen
again,
not
much
proactive,
trauma-informed
care
really
was
going
on
and
for
me,
I
think
what
was
happening
is
that
staff
were
focusing
on
risk
and
management
of
distress.
X
I
mean
in
doing
so
we're
objectifying
parts
of
me.
You
know
pathologizing
them
and
that
led
really
to
a
response.
Force.
So
what's
really
important
about
this
policy
document
that
the
CQC
are
suggesting
and
setting
out
is
that
it
it
insists
on
a
proactive
way
of
managing
and
caring,
really
actually
caring
for
people
in
settings.
X
So
just
if
you,
if
you
don't
mind,
just
my
indulging
you
with
a
little
anecdote
but
I
was
being
transferred
between
to
secure
Services
in
the
back
of
a
caged
ambulance,
you
know:
I
was
folded.
In
half
to
get
inside,
I
was
sat
on
a
very
sort
of
narrow
plastic
bench.
There
was
no
seat
belt,
my
hands
were
handcuffed
together.
X
My
legs
were
tied
together
with
leg,
straps
I
was
in
there
for
about
four
hours
and
there
was
surveillance
in
inside
the
inside
the
vehicle
and
and
there
was
no
toilet.
So
you
know
when
I
arrived,
I
was
I
was
soiled
and
you
know
quite
stinking,
and
you
know,
but
understandably
very
sort
of
upset
and
distressed
and
the
staff
you
know,
opened
the
doors
to
the
cage.
There
was
two
staff
on
one
side,
two
staff.
On
the
other
side.
You
know
the
idea.
X
I
guess
was
that
I
was
gonna,
kick
off
or
I
was
gonna,
try
and
run
away.
You
know,
but
obviously
my
legs
were
tied,
but
I
couldn't
go
very
far,
but
nevertheless
you
know
the
four
staff
waiting
for
me.
Also,
a
nurse
from
the
unit
I
was
being
transferred
to
that.
I
knew
very
well,
and
she
came
up
to
the
vehicle
and
I
was
stood
there
as
I,
say,
soiled,
handcuffed,
leg,
strapped
and
she
said
to
the
staff
she
said:
take
those
those
handcuffs,
those
legs
straps
off
Alexis.
X
We
were
standing
outside
and
the
staff
sort
of
looked
at
each
other
and
were
like.
You
know
you
for
real
and
you
just
take
them
off
and
this
you
could
see
the
stuff
which
is
like
really
perplexed.
X
You
know
like
this
woman's
dangerous,
like
you,
you
know,
and
she
said,
take
them
off
now,
anyway,
the
staff
took
them
off
reluctantly
and
she
came
up
to
me
and
she
gave
me
a
big,
a
big
hug
and
you
know
I
think
this
is
a
really
important
story,
because
what
it
what
it
does
is,
it
shows
different
perceptions.
X
You
know
one
member
of
Staff
saw
the
humanity,
the
other
saw
the
risk
and
when
we
see
Humanity
we're
much
more
likely
to
respond
with
compassion
with
kindness,
you
know
with
with
love
and
so
I'm
really
pleased
to
welcome
this
policy
document
from
the
CQC,
because
what
it
does
is.
It
makes
clear
that,
like
that
nurse,
everyone
has
to
find
the
humanity
in
people.
It
is
not
okay,
just
to
see
risk
and
just
to
respond
with
Force.
It's
not
okay
to
see
otherness
and
difference.
X
Actually,
we
need
to
support
with
compassion.
We
need
to
be
proactive
and,
as
the
statement
also
says,
you
know,
this
requires
working
in
a
way
which
is
you
know
proactive.
It
means
not
considering
restrictive
practices
as
the
status
quo
as
part
of
the
job,
but
rather
something
that
you
know
is
is
rare.
X
Restrictive
practice
should
be
rare.
It's
a
failure
to
meet
a
person's
needs
now,
after
I'd
be
been
restrained.
I
was
often
expected
just
to
get
on
with
it,
but
what's
really
needed
is
what
this
policy
document
does,
and
it
suggests
you
there
has
to
be
reassurance.
There
has
to
be
compassion.
There
has
to
be
somebody
that
helps
the
person
to
feel
safe
again,
and
so
this
statement
might
increase
opportunities
for
post-incident
support
and
how
wonderful?
X
If
managers,
you
know,
prioritized
opportunities
for
post-incident
learning,
so
that
staff
could
learn
from
what
happened
and
break
those
cycles
of
restraint.
Seclusion
repeat,
you
know
and-
and
you
know
think
about-
you
know
how
we
can
minimize
trauma
both
for
staff
and
the
person,
and
finally,
this
policy
will
send
a
clear
message
that
we
need
to
work
relationally
from
the
moment.
The
person
enters
a
service
until
they
leave,
and
this
policy
I
know
would
have
made
a
massive
difference
to
me.
X
It
would
have
made
a
massive
difference
to
the
staff
supporting
me,
because
what
it
does
is
it
sets
out
expectations,
and
you
know
in
setting
out
at
a
policy
level
those
expectations
you
know.
Hopefully
this
can
transfer
into
some
kind
of
practice,
practice
change.
Now,
of
course,
it's
not
the
answer
to
all
of
the
problems,
but
for
sure
it's
part
of
the
solution.
V
Q
Q
As
Alexa
said,
this
is
about
Liberty
and
it's
about
Deputy
and
whilst,
whilst
this
process
will
be
about
understanding
with
providers
and
staff
and
making
sure
that
we
undertake
the
work
that
we
do
in
a
learning
way
and
in
a
supportive
way,
it
does
mean
potentially
that
we
should
send
a
very
strong
signal
to
the
boards
of
those
organizations
or
the
management
teams
that
it
is
their
responsibility
in
this
policy
to
review
not
just
their
approach
but
also
individually.
What's
happening
to
people
and
I.
Do
think.
Q
That's
a
strong
leadership
expectation
that
we
should
send
as
well
as
operating
the
policy
in
a
in
a
in
an
absolutely
fair
and
supportive
way,
and
recognizing
that
sometimes
it's
an
appropriate
use
of
of
of
that
kind
of
restraint.
But
the
rare,
the
Rarity
that
has
been
suggested
on
the
video
needs
to
become
the
norm.
Thank
you.
I
I
NHS
England
have
been
doing
work
in
it
since
2016
2018
done
loads
of
projects
and
they've
seen
massive
reductions
in
restrictive
practice
in
areas
where
they've
targeted,
I
think
my
concern
is
that
sometimes
restrictive
practice
is
necessary
and
we
don't
want
to
demonize
the
use
of
appropriate
restrictive
practice
that
should
be
used
rarely
and
should
be
thoroughly
reviewed
when
it
has
been
used.
I
So
I
I
think
you
know
plea
for
that,
really
is
that
we
need
a
more
balanced
approach
and
you
know
restricted
practice
ranges,
isn't
it
from
locking
the
door
on
a
dementia
unit
to
restricting
people's
access
to
outside
space.
It's
not
all
about
restraints
exclusion,
which
are
the
sharper
ends
of
restrictive
practice
and
I.
Think
the
plea
really
is
that,
whatever
practice
that
Health
and
Social
Care
staff
use,
it
should
always
Bloom
with
care
and
compassion.
I
V
Was
just
going
to
say
absolutely
Belinda
that
that's
what
our
policy
position
is
trying
to
set
out
for
that
balance
and
and
to
yeah
that
whole
person-centered
approach
think
about
people's
best
interests.
V
You
know
and
just
making
sure
we're
doing
the
right
thing
at
the
right
time
across
the
Health
and
Social
care
sector
for
people
to
lead
their
best
lives
really.
So,
thanks
for
that.
J
David
I
thought
that's
an
excellent
film
if
I
may
say
so.
It
really
hit
the
point.
Two
things
questions
for
you
really
are
you
familiar
with
Professor
Joy
duxbury's
work
at
Manchester,
Metropolitan
on
red
reduction
of
restraint,
because
she's
done
some
really
good
papers
on
that
and
if,
if
you're
not
may
I
recommend
that
that
you
look
at
them
and
the
second
thing
is
Ben
Higgins
Who
is
the
chief
executive
of
something
called
restraint
reduction
network
is
that's
part
of
absolutely.
V
And
we've
worked
closely
with
him
and
the
reduction
straight
Network
to
commission
our
training
for
our
staff
internally.
So.
J
Yeah
that
would
go
quite
a
long
way
to
answering
Belinda's
point,
I
think,
which
is
you
know,
they've
taken
the
quite
a
grown-up
view
about
it
is
necessary
at
times
it's
about
sorting
out
when
it's
necessary
and
not
lurching
towards
it
as
a
sort
of
well
we'll
we'll
in
case
something
goes
wrong
will
be
quite
extreme
about
this,
but
his
work,
the
that
network
is
informed
by
Joy
duxbury's
work,
do
look
at.
A
O
Thank
you,
I
mean
I,
I
was
moved
by
Alexis's
experience
as
well,
and
I
think
she
highlights
very
clearly
the
the
sort
of
extreme
end
of
restrictive
practice
and
restraint.
I.
Think
one
of
my
concerns
is
that
restrictive
practices,
particularly
for
people
with
dementia
and
residential
care,
has
become
the
norm
in
many
situations.
O
You
know
locking
doors
between
floors,
locking
access
to
to
external
environments
and
if
I
had
my
way,
you
know
you'd
have
the
the
model
of
the
dehoge
effect
if
anybody's
heard
of
it
in
in
near
Amsterdam,
where
actually
people
can
move
freely
all
around
the
campus
and
that's
the
ideal,
that's
what
we
would
love
to
see,
but
the
reality
is
that
there
are
a
lot
of
particularly
smaller
providers.
But
sometimes
you
know
the
the
high-end
providers
in
Social
care
were
actually
doors,
are
locked
and,
and
sometimes
that's
because
the
premises
don't
allow
for
safety.
O
There
are
stairs
that
people
will
fall
down
or
or
things
like
that
and
I
think
that
locking
doors
and
that
restrictive,
restrictive
practice
was
particularly
an
issue
during
covert
where
people
were
having
to
be
isolated.
For
you
know,
14
days
and
that's
very
difficult
for
someone
with
dementia
to
be
asked
or
to
be
forced
to
stay
in
their
room.
So
there's
a
lot
of
issues.
It's
complex
and
I
think
there
needs
to
be
some
balance,
although
not
too
much
balance
and
possibly
some
work.
O
Looking
at
how
we
can
help
those
who've
got
the
least
in
the
way
of
resources
as
provide
us
to
recognize
that
they
can
change
their
practice
and
to
to
do
things
differently,
because
I
think
there
will
be
some
catch
up
with
people
for
whom
the
culture
is
restrictive
before
they
actually
recognize
that
they
before
they're
able
to
implement
change
so
I,
just
just
sort
of
think
those
are
things.
I
don't
quite
know
what
the
solution
is,
but
those
are
things
to
take
into
account.
A
The
other
questions,
I
think
I
did
say
one
of
the
things
that'd
be
to
consider
in
the
regulatory
governance
committee
and
you'll
remember
anyway
Christine,
so
it
may
be.
That
particular
point
would
be
worth
picking
up
when
you
have
the
discussion
there,
because
I
think
what
I'm
hearing
is
is
violent
agreement.
We
need
approach,
violent
agreement
with
generally
what
you're
saying,
but
just
a
little
bit
of
concern
around
the
application
of
this,
that
the
margins
and
making
sure
there
aren't
unintended
consequences
yeah.
A
So
if,
if
I,
don't
think,
we
need
to
report
back
on
that,
particularly
but
I
think
if
you
could
pick
it
up
in
the
rgc,
what
would
also
be
helpful
at
some
stages,
as
I'm
sure
you'll,
be
reviewing
the
efficacy
of
this
in
practice?
So
they
would
just
be
useful
to
make
sure
we
are
doing
that,
and
we
understand
that
the
margins,
whether
it's
achieved
its
aims,
I
think
you're
indicator.
A
That's
really
combination
of
two
things:
one
is
providing
guidance
as
to
what
is
good,
reminding
providers
of
their
obligations,
but
also
that
consistency
between
our
approach
and
their
approach
and
I
think
having
a
document.
We
can
hang
our
hats
on
that
achieves.
That
would
be
really
helpful.
Joyce
sorry.
F
It
wasn't
about
just
we're
doing
an
assessment,
and
then
we,
you
know,
tell
providers
what
what
they're
doing
badly
and
and
then
sort
of
come
down
and
hard.
But
we've
got
a
raft
of
different
regulatory
levers
that
we
can
use.
One
would
be
providing
guidance
to
would
be.
How
do
you
support
Improvement
in
the
sector?
F
How
do
you
support
learning
and
understanding
and
that's
what
we
intend
to
do
and
that's
part
of
the
Improvement
campaign
that
Chris
was
talking
about
and
the
work
that
the
policy
is
delivering
I
think
what's
at
the
center
of
this
policy,
is
to
make
sure
that
it's
person
centered.
So
if
even
if
people
can't
think
well,
how
do
I
do
this?
F
A
Sorry
I
haven't
got
my
phone,
which
is
awesome,
good,
very
impressive.
Thank
you
for
joining
us.
We
I
think
gonna
have
James
White
join
us,
so
Nina.
If
you
could
bring
James
in.
A
We
have
probably
set
our
presenters
in
a
possible
task
of
delivering
a
lot
of
insights
in
a
very
short
space
of
time.
James
welcome,
I,
don't
think
most
of
the
LEDs
on
the
board
will
have
met
Jane,
so
I
mean
you
can
introduce
himself,
but
just
say
he
is
the
interim
head
of
Market
oversight.
A
An
apotheos
I
think
was
an
excellent
opportunity
for
him
to
meet
you
and
you
to
meet
him.
We
only
allowed
10
minutes
for
this.
James
were
actually
about
half
an
hour
behind
so
use
the
10
minutes,
but
if
we
could
ask
you
that
to
run
over
in
his
deck
he's,
given
an
introductory
slide,
which
shows
a
sort
of
highlights
or
key
elements
of
our
process,
I'm
very
aware
that
some
of
the
newer
LEDs
may
not
be
familiar
with
that.
A
So
you
will,
if
you
haven't,
covered
it
yet
as
part
of
your
induction
program,
you
will
in
due
course,
if
you've
got
any
more
immediate
questions
on
the
process
we
go
through.
Perhaps
you
take
that
offline
with
James.
What
I'd
like
James
to
do
is
focus
on
some
of
the
learnings
from
what
we
are
David
James
over
to
you.
Y
Thanks
Ian
look
given
I've
only
got
five
minutes.
I'll,
probably
jump
straight
in
in
terms
of
my
background.
I've
been
with
CQC
five
years,
formerly
head
off
before
this
role,
so
I'm
going
to
provide
some
further
details
with
regards
to
actions
available
to
Market
oversight.
Y
So
one
of
the
options
available
to
us,
which
is
in
the
paper
is
we
can
instruct
an
independent
Business
review
of
a
provider's
business
that
would
normally
be
carried
out
by
an
external
accountant
with
a
restructuring
and
turn
around
background
and
that
ibr,
an
independent,
Business
Review
would
really
be
focusing
on
any
aspect
of
the
provider's
business
which
we
have
serious
concerns
around.
So,
for
example,
if
we're
concerned
around
the
show
term,
Financial
projections
and
cash
flow,
the
ivr
would
focus
on
that
and
provide
feedback
and
advice
to
us.
Y
Y
If
we're
seriously
concerned
about
that,
we
want
to
know
what
their
plan
B
and
what
their
plan
C
is.
Should
they
not
be
able
to
raise
those
monies
from
those
shareholders?
So,
as
I
said,
it's
all
about
mitigating
the
risks
we've
identified
I'll
now
move
on
to
look
at
the
financial
performance
of
the
mo
providers,
which
is
in
the
slides
for
the
periods
of
31st
of
March
2023
I.
Think
my
general
comment
is:
it
continues
to
be
a
challenge
in
time
for
the
mo
providers.
Y
During
that
period,
we've
seen
further
compression
of
ebitda
margins
and
ebitdam
is
probably
our
best
proxy.
We
have
for
our
Market
oversight
providers
in
terms
of
profitability
and
look
that's
really
down
to
probably
two
key
factors.
Interacting
Staffing
challenges
remain
in
terms
of
Recruitment
and
Retention
has
made
it
difficult
for
those
providers,
and
the
general
inflationary
environment
is
also
contributed,
and
in
terms
of
that
inflationary
environment,
probably
one
of
the
key
drivers.
Y
There
has
been
that
spike
in
utilities
during
those
winter
months,
I'll
now
look
at
the
I
suppose
the
sub
sectors
we
look
at
within
the
ascmo
providers.
Y
Firstly,
care
homes
for
older
people,
it's
been
pleasing
to
see
staff
costs
have
been
moving
in
the
right
direction,
but
but,
unfortunately,
those
staff
savings
which
providers
have
been
able
to
make
have
really
been
outweighed
by
again
those
General
inflationary
environment
and
in
particularly
those
Utilities
in
terms
of
domiciliary
Home,
Care
Providers,
the
continual
Trend,
which
we've
seen
over
the
last
two
years
in
it
and
it
has
been
decreasing
recently
is
hours,
have
continued
to
reduce
and
look
that
that's
really
a
deliberate
decision
by
the
management
teams
of
those
providers
to
try
and
protect
their
profit
margins
as
best
they
can.
Y
The
key
Drive
of
their
revenue
is
La
work
and
what
they've
been
doing
there
with
the
LA
work
is
certainly
looking
at
it
contract
by
contract
in
terms
of
profitability
and,
if
they're
not
satisfied
with
the
the
profitability
they're
taking
action
such
as
refusing
additional
hours
letting
contracts
run
to
the
end
of
their
term
or
or
not
re-tendering,
on
work.
The
final
sub-sector
is
the
specialist
providers
within
Market
oversight
providers.
Y
Look,
it's
been
pleasing
to
see
agencies
declined
for
the
last
two
quarters
through
to
that
March
quarter,
but
for
some
providers
it's
some
really
elevated
levels
and
and
the
problem
that
has
for
specialist
providers
is
that
because
of
their
High
acuity
teenage
of
specialist
providers.
A
lot
of
that
carries
one-on-one.
So
it
really
does
bite
into
the
profit
margins.
When
you've
got
a
nurse
there
delivering
one-on-one
care
and
it
can
take
it
from
a
you
know:
profitable
care
provision
to
a
loss,
making
provision
just
from
the
use
of
that
Agency
use.
Y
I'll
now
move
on
to
the
final
part
of
the
pack,
which
was
around
the
outlook
for
the
ammo
providers
and
look
we've
had
some
more
recent
data
since
that
31st
of
March
quarter
and
we're
obviously
in
constant
engagement
with
our
providers
and
look
I,
think
I
can
say
it
remains
a
challenging
time
for
our
providers.
Y
It
will
remain
challenging,
but
there
are
some
green
shoots
recovery
there
Oculus
occupancy
for
older
people's
Care
Homes,
as
at
the
first
of
September,
it's
slowly
and
steadily
increasing,
and
it's
reached
86.8
percent,
which
is
pleasing
to
see
that's
past.
Our
estimate
of
Breakeven
for
those
Care
Home
operators
in
terms
of
Staffing
and
recruitment.
Y
Think
when
agency
gets
embedded
in
certain
levels
in
businesses,
it's
a
long,
hard
fight
to
reduce
that
and
try
that
try
and
bring
that
down
to
levels
that
the
providers
want
them
to
reach
and
finally,
in
terms
of
La
fee
uplifts,
we've
kind
of
seen
broadly
a
kind
of
eight
to
ten
percent
increase
for
the
2023-24
Financial
year,
and
look
that
that
is
a
a
material
increase,
but
it
needs
to
be
given
the
inflationary
environment.
These
providers
have
been
operating
in,
particularly
particularly
with
the
national
living
wage
increase
in
it.
Y
I
think
you
know,
close
to
10
percent
looks
like
that's
really
my
summary
of
that
pack.
I'm
just
wondering
if
anyone
has
any
questions.
A
Like
so
motion,
D,
James
and
I
think
we've
only
just
instituted
the
idea
of
how
the
market
oversight
coming
to
to
talk
to
this
board
with
no,
yes,
it's
it's
a
I
know.
It's
a
real
concern
to
government
unusually
important
part
of
my
work,
but
also
I,
think
it's
quite
useful
just
put
out
the
public
domain,
some
of
the
learnings,
what
James
has
brought
out,
which
perhaps
we
didn't
cover
last
time
it
is
in
addition
to
the
the
early
warning
bit
of
the
system.
A
If
you
like
is
actually
the
fact
that
we
go
in
in
some
of
these
cases
is
it's
of
a
contributor
to
avoiding
failure.
So
we
can't
over
complain
that
claim
that
we
can
never
talk
about
examples,
but,
but
you
know,
I
think
there
is
a
real
value.
Add
from
this
organization.
This
function
in
that
area,
questions
from
anyone,
James
a
comment
and
I'm
Stephen
question
yeah.
Q
You
anticipate
me
Jess
I,
just
want
to
Echo
the
point
that
you
make
we're
not
supposed
to
be
a
deterrent,
but
we
are
meant
to
be
a
beacon
and
I
wanted
to
point
out
that
it's
a
really
important
function
for
local
authorities
to
to
it's
not
just
to
function
up
to
government
to
give
them
as
it
were,
Assurance
or
or
risk,
but
but
local
authorities
work
with
us
on
the
potential
consequences
of
if
we
have
to
get
to
a
stage
six.
Q
A
D
Really
helpful,
thank
you
very
much
indeed
a
couple
of
questions
it
raises.
For
me,
one
is
kind
of
extrapolating
these
trends.
D
Where
is
this
possibly
taking
us
because
there's
been
a
decline
in
profitability,
I
think
from
some
other
papers,
we've
seen
recently
there's
an
overall
shrinkage
in
Supply
and
there
are
increasing
imbalances
across
the
country
where
providers
can
keep
going
if
they
can
access
these
self-funded
Market.
But
it's
a
lot
harder
if
you're
reliant
on
the
local
Authority
funded
Market,
because
the
rates
aren't
going
up
so
kind
of
where.
Where
do
we
go
with
this?
We
can
monitor
it.
D
A
Y
You
know
recent
government
support
has
helped
in
terms
of
the
msif
funding
and
we
are
entering
into
the
you
know
coming
into
the
winter
months.
So
who?
Who
knows
exactly
what
that
might
mean
in
terms
of
you
know
that
that
64
million
dollar
question
it's
it's
probably
not
really
Market
oversight,
it's
a
place
to
I
suppose
answer
that
other
than
I
note.
Your
comment
about
the
self-under
point.
Y
In
terms
of
you
know,
we've
certainly
seen
that
in
terms
of
Care
Homes,
where
they've
got
that
greater
focus
on
self
funders
it
it
can
assist,
but
that
that's
certainly
Julie
noted.
But,
as
I
said,
it's
probably
not
really.
A
question
I
can
ask
in
terms
of
Market
oversight,
statutory
function
to
to
basically
identify
Financial
sustainability
concerns
for
potentially
difficult
to
replace
providers.
N
I
think
it's
a
really
good
question
Stephen
and
it's
something
we
constantly
talk
about
when
we're
when
we're
looking
at
specific
providers,
I
think
a
couple
of
things:
one
is
what
you're
in
essence
describing
is:
do
we
want
to
step?
Do
we
want
to
step
into
the
market
management
space
yeah?
Can
we
be
more
proactive
in
managing
the
market?
I
think
short
answer.
That
is
no.
We
can't
because
we
don't
really
have
the
the
legal
virus
to
do
it.
I
guess.
N
Ultimately,
it's
a
responsibility
of
government
and
it
is
a
conversation,
a
live
conversation
we
have
the
government
around.
Who
is
the
provider
of
last
resource?
In
the
event
a
large
Care,
Home
Group
goes
goes
bus
or
multiple
large
Care
Home
groups
go
bus
and
it's
a
conversation
that
that
James
and
colleagues
have
in
a
very
sophisticated
way
with
government
with
named
named
providers
and
talk
to
Banks
and
so
forth.
I
think
the
opportunity
for
us,
though,
because
I'm
I
think
I
think
it's
always
important.
We
think
about
the
symptoms
of
opportunities.
B
N
Authorities
and
ICS
and
ICS
organizations
in
their
very
many
in
various
forms,
where
I
think
we
can
use
those
relationships
to
start
to
have
conversations
around
whether
the
right
amount
of
money
is
being
paid
locally
and
so
on,
and
whether
the
right,
the
right
types
of
service
are
being
are
being
delivered
because
I
think
you
know
we
had
earlier
on
the
pack.
There
was
the
the
point
about
increases
in
volumes
in
registration
applications.
N
Some
of
that
is
driven
by
this
in
the
sense
of
providers
looking
for
specialty
ways
of
delivering
Services
changing
their
registration
in
order
to
find
more
profitable
ways
to
exist,
to
being
in
a
position
to
explain
that
and
and
then
and
then
work
collaboratively
with
local
Authority
Partners
is
probably
a
space.
We
could
probably
do
more
in
over
the
course
of
time,
but
but
in
terms
of
tangibility
Provider
of
last
resource
type
or
operator
of
Last
Resort,
as
you
would
see
it.
N
O
I
think
this
this
links
a
little
bit
to
to
the
previous
topic
about
restrictive
practice,
because
one
of
the
most
dangerous
areas
that
I
understand
is
specialist
providers.
So
autism,
severe
learning,
disability,
challenging
behavior
and
also
I,
don't
quite
know
how
the
market
oversight
works.
But
it
may
well
be
that
the
national
level,
a
provider,
a
specialist
provider
like
that
is
doing.
Okay,
but
that
actually,
in
certain
areas,
they're
about
to
hand
back
a
contract
and
I
heard
of
one
area,
I
think
they're
getting
a
2.2
percent
fee
increase.
And
then
it's
really
about
viability.
O
So
you
could
have
just
a
local
area
rather
than
an
overall
providing
about
to
sort
of
exit
the
market,
but
that
they're
exiting
the
market
in
one
area
and
because
it's
Specialists
and
you
leave
the
sort
of
specialist
skills.
It's
more
likely
that
you're
going
to
end
up
with
more
restrictive
practices
and
more
difficulties.
So
I.
Just
wonder
how
we
deal
with
that
and
how
we
reflect
that.
Y
Yeah,
look
that's
a
really
good
point
and
in
terms
of
parameters
for
entry
into
Market
oversight,
it
has
been
set
up
under
the
regulation
so
that
it
captures
large
National
providers,
but
also
Regional
providers
of
scale.
So
it
may
well
be
those
providers
where
you're
talking
about
a
regional
presence.
They
could
well
be
in
Market
oversight
because
of
those
parameters
and
in
terms
of
contract
handbags.
That's
something
we
have
ongoing
engagement
with
providers
in
Market
oversight
to
to
understand.
Y
One
is
that
is
that
occurring
to
what
does
that
mean
around
Financial
sustainability,
but
it
also
helps
us
understand
the
wider
market
and
that's
something
in
terms
of
Market
oversight.
We
do
act
as
something
I
suppose
almost
on
its
broker
in
terms
of
a
bit
like
a
sponge.
In
terms,
we
get
a
lot
of
data
and
information
and
engagement
with
providers,
and
we
do
filter
that
back
to
wider
government
so
that
you
know
it
informs
them
in
their
decision
making
and
understanding
of
the
market.
But
your
point
is
well
made
around
that.
Y
A
J
Sorry,
David
James,
some
of
the
some
of
the
comments
I
get
from
local
authorities
or
from
the
integrated
care
board,
is
their
worry
over
in
the
care
Market.
The
highly
leveraged
large
organizations
who
they
fear
could
just
suddenly
walk
away
from
it
because
of
purely
Financial
considerations
in
a
sense
beyond
the
capability
of
their
own
management
to
deal
with
because
they're
highly
leveraged,
so
an
instruction
might
might
come
down
get
out
of
this
Mark,
just
as
it
did
with
circle
in
the
NHS
does
I?
Can
you
look
at
that
or
not?
Y
It
is,
it
is
out
of
scope.
We
look
at
Market
exit
if
it's
due
to
business
failure
and
essentially
service
cessation,
but
if
a
provider
within
Market
oversight
might
well
be
private,
Equity
based
decides
that
it
can
deploy
its
capital
elsewhere
in
maybe
another
sector
and
get
a
better
economic
return.
We're
not
in
a
position
as
regulator
to
stop
them
exiting
the
market,
and
it
might
well
be
their
business.
May
prosper
in
the
hands
with
another
operator
in
terms
of
assets.
Y
J
Yeah,
but
can
you
take
account
of
the
fact
that
we
know
that
these
some
of
these
organizations
are
heavily
leveraged,
because
you
know
they're
they're
accounts
demonstrate
that?
Does
that
allow
you
to
sort
of
have
a
word
early
on
about
what
kind
of
alternative
provision
might
be
around
Etc
or
is
that
do
you
have
to
wait
for
it
to
be
triggered?
Yeah.
Y
Look
unfortunately,
when
a
provider,
whether
it's
highly
leveraged
or
not,
we
we
look
at
a
lot
of
I
suppose
factors
in
terms
of
assessing
their
financial
sustainability
and
high
leverage
would
be
one
of
those
factors,
but
in
terms
of
alerting
allies
in
terms
of
their
duties
under
Section
48
of
the
Care
Act,
to
ensure
no
cessation
of
care
in
in
as
a
result
of
business
failure,
we
we
can
only
inform
them
of
that.
When
we
make
a
stage
six
notification,
we
can't
act
as
I
suppose
as
a
de
facto
credit
rating
agency.
A
I
was
going
to
say,
I
think
he
can
probably
explain
more
to
you
later,
but
just
just
to
be
clear,
James
correct
me.
If
you
disagree
with
this,
but
you
know
if
there
are
limits
to
what
we
can
do
when
looking
at
Financial
structures
or
groups.
But
but
of
course,
if
a
group
is
highly
leveraged
and
that's
visible,
let's
say
within
the
UK.
Certainly
if
it's
big
enough
to
go
onto
the
scheme,
then
it
is
the
sort
of
thing
that
that
we
we
do
look
at.
A
We
would
probably
probably
bring
it
real
structure
struggle
to
have
any
side
of
a
company
here
that
was
highly
profitable
in
the
UK,
but
could
be
much
more
profitable
somewhere
else
living
business
and
just
decided
to
chop
down
to
redeploy
the
capital
that'd
be
difficult.
The
more
likely
scenario
is
that
before
you
got
there,
the
UK
operation
or
an
entity
as
a
result
of
being
highly
leveraged
and
other
things
were
starting
to
look
dodgy,
in
which
case
yes,
I
would
think
James
would
be
cooking
it
up
under
Market
oversight
and
I.
A
Think
that
is
the
the.
If
you
look
at
the
examples
of
where
we've
had
to
report
things
in
the
past
and
it
then
it
does
cover
that
so
I
wouldn't
want
the
message
to
get
out
that
you
know
we're
oblivious
to
high
leverage
where
it's
visible
and
available
to
us.
It's
looked
at
and
steps
can
be
taken,
and
you
know
James
and
colleagues
I
mean
it's
a
reasonable
size
team.
A
They
do
go
in
and
talk
to
people
and
have
a
pretty
good
understanding
of
the
the
structures,
which
is
why
you
know
James
and
his
colleagues
come
from
things
like
insolvency
and
restructuring
backgrounds.
But
James
can
explain
more
detail
when
you
get
that
stage.
If
there
are
no
other
comets,
James
look
I'm.
A
Sorry,
we
didn't
give
you
enough
time
to
really
display
your
wells,
but
thank
you
very
much
a
for
covering
that
so
succinctly
and
also
we
should
thank
you
for
stepping
in
as
the
interim
head
of
this
area
at
a
very
short
notice,
I
mean
it
seems
to
have
been
seamless
from
my
perspective.
So
thank
you
very
much
indeed
for
that.
Thank
you.
A
A
few
last
items
there
is
one
item
to
approve,
which
is
the
2023
performance
summary
I,
think
we're
being
asked
to
prove
the
principle
rather
than
a
specific
document,
so
perhaps
Kate
or
Chris
I
think
we
have
mentioned
this
plan
before.
But
if
I
could
ask
you
to
very
briefly
mention,
what's
being
proposed,
I
might
ask
Jeremy
to
comment,
because
this
was
on
the
audit
committee
agenda
the
other
day
and
then
we'll
take
any
questions
see
whether
people
have
any
before
we
agree.
R
Where's
Stephanie
welcome
to
Steph's,
also
Keen,
to
get
a
train
home,
so
I
I
mean
every
year
we
produce
an
annual
reporting
accounts
that
will
include
a
summary
of
our
performance
for
the
year
in
question
that
will
outline
how
we've
delivered
how
we've
made
progress
against
our
strategy.
Etc.
The
challenge
we've
got
is
the
last
two
Financial
years
are
Under
reporting
accounts
has
been
severely
delayed
due
to
issues
with
local
government
pension
schemes.
R
The
auditing
of
that
which
is
completely
out
of
our
control
and
is
is
affecting
organizations
other
than
us,
but
it
has
meant
in
the
example
we've
just
been
through
that
it
was
15
months
after
the
end
of
the
financial
year
before
we
published
our
new
reporting
accounts.
R
What
we've
been
Keen
to
do
to
bridge
the
gap
is
to
create
a
standalone
document
around
our
performance
for
the
financial
year,
22-23
that
we
can
publish
and
and
detach
ourselves
from
the
annual
reporting
accounts,
which
will
obviously
be
will
be
published
in
in
future
in
due
course.
So
that's
what
this
summary
document
is.
We
will
to
publish
it
onto
our
website
in
due
course
and
offer
any
comments
or
questions
on
that.
A
Thanks
Chris
Jeremy:
do
you
want
to
make
a
couple
of
words
about
the
role
of
the
Eric
yeah.
Z
It
wasn't
something
we're
doing
accidentally
because
we
knew
that
the
accounts
were
going
to
be
late
again,
and
the
other
point
to
make
is
that
as
we
sit
at
the
moment,
this
is
consistent
with
the
draft
and
we
report
on
accounts,
albeit
that
that
won't
be
formally
audited
and
covered
until
later
on,
but
but
it
is
consistent
with
it
and-
and
we
can
give
that
Assurance
from
our
app
that
we've
gone
through
the
same
process
as
we
would
have
done
for
the
annual
accounts.
A
Okay,
so
it
would
say
it's
a
plan.
We're
proposing
I
think
the
reason
it
comes
here
is:
we
don't
have
to
do
this
so
we're
taking
on
a
few
risks,
at
least
in
theory,
not
least
that
the
document
could
have
numbers
in
it.
When
we
finish
the
audit
change,
it's
a
probably
unlikely
that
it
would
and
be
our
say.
A
The
risk
is
pretty
small,
because
this
is
unaudited,
we're
not
claiming
it
is,
but
I
think
the
concept
of
being
able
to
explain
to
the
world
something
about
our
performance
of
what
we're
doing
six
or
nine
months
earlier
than
audit
regulations
will
allow
us
to
do
is
in
personally
very
sensible,
so
not
subject
toward
it,
but
we
will
do
our
very
best
through
Jeremy's
our
act
to
make
sure
that
it
is
factually
accurate.
So
we
have
a
process
for
doing
that.
A
E
A
question
I
think
it's
a
very
sensible
idea,
given
the
the
reality
that
we
face
in
terms
of
when
the,
when
the
audit
of
accounts
will
be
available
once
the
accounts
are
published.
Is
this
going
to
be
sunset
and
removed?
Is
it
something
that's
a
temporary
document,
that's
so
transient
and
then
disappears
and
is,
or
would
they
both
exist
in
parallel.
R
U
Sorry,
sorry,
thank
you
yeah.
My
view
has
been.
This
would
be
sunsetted
and
be
replaced
by
so
you
wouldn't
have
had
to
be
two
narratives
on
one
year,
but
as
Chris
said
that
the
fact
that
it
takes
15
months
to
get
the
last
bit
of
the
account
signed
off
means
that
this
should
this
should
be
a
precursor
to
what
will
be
the
full
accounts.
E
And
then
maybe
an
S
then,
which
is
I,
think
that's
a
sensible
approach,
just
to
sort
of
say
this.
This
would
be
then
Sunset
replaced
by
an
audited
accounts.
The
the
the
only
thing
I
think
we
need
to
plan
for
is
if
there
were
a
Delta
at
what
threshold
do
we
need
to
publish
any
kind
of
explanation
of
the
Delta
that
existed
between
a
previous
document
that
was
in
the
public
domain
and
a
future
document,
so
just
just
understanding
what
those
tolerance
is.
A
I
think
it's
difficult
to
pre
agree
a
threshold
because
we're
slightly
the
probability
is
that
there
won't
be
differences.
The,
but
it's
a
good
question.
We
we
do
think
about
it,
but
I
think
it's
difficult
to
make
decisions
now.
I
mean
there
is
one
bit
of
logic
of
leaving
it
out
there
as
a
parallel
document,
which
is
that
most
people
we
due
respect
to
the
accountants
in
the
room
which
I
suppose
my
heritage
as
well.
But
most
people
don't
get
beyond
the
performance
report
when
they're
reading
the
document.
A
So
there
is
actually
some
logic
in
having
a
separate
performance
report
and
then
leaving
the
other
100
Pages
for
those
who
are
interested
in
understand,
government
accounting,
I
apologize
if
I've
in
any
way
offended
you
Jeremy,
but
you
wanted
a
comment.
No.
Z
So
I
guess,
if
we
did
have
some
sort
of
inconsistency
that
we
found
then
I
think
we
would
need
to
explain
that
in
some
way,
either
in
the
accounts
or
or
as
an
addendum
to
the
document
I'm,
not
in
favor
of
sun
setting
reports,
because
you
can't
take
them
away
they're
out
there,
aren't
they
people,
don't
undownload
them
do
that.
But
so
we
have
to
in
some
extent
we
have
to
explain
and
be
transparent,
is
probably
the
right
approach.
Yeah
yeah.
N
I
mean
I
think
what
we
did.
What
we
did
this
this
last
year
was
we
wrote
the
annual
report
and
account
it
took
a
long
time
to
be
to
be
finished
off,
and
then
we
just
did
a.
We
just
did
a
re,
a
refresh
of
the
forward
and
the
summary
because
we
realized
that
it
was
kind
of
it
was
dated
because
of
the
because
it
was
from
the
coping
period.
A
Okay,
so
I
think
we're
proving
the
principle
at
some
stage
when
we
have
reports
back
on
progress
of
the
array
we
can
readdress
and
consider
what
we're
doing
here.
A
Thank
you
very
much
indeed,
Chris,
simply
off
to
input
Jeremy
board
effects
from
this
review
was
down
for
me
from
all
report.
To
note
this
is
very
quick.
All
I
would
say
to
colleagues
just
for
confirmation
is.
We
did
a
board
effects
review
very
limited
in
the
scope
this
year.
In
the
sense
it
was
purely
internal
there
weren't
that
many
recommendations
coming
out
of
it.
I
sat
down
with
Sasha
we
either
have
addressed
or
in
the
process
of
addressing
the
things
in
there.
A
Some,
which
we've
seen
the
only
other
bit
over
flag.
Is
that
combining
also
with
the
results
of
the
sort
of
review
of
the
skill
set
or
the
board,
the
will
probably
be
some
training
programs
or
development
programs
for
the
board
as
a
whole,
with
a
particular
focus
on
the
LEDs,
to
the
extent
that
the
executive
may
have
seen
some
of
this
earlier,
but
the
timing
of
that
will
depend
on
the
speed
at
which
we
can
get
the
final
appointment
of
the
board.
A
We
are
still
recruiting
for
a
new
full-time
RX,
chair
or
permanent
Eric
chair
to
replace
Jeremy,
so
I'll
take
a
view
on
when
there's
a
good
time
to
run
it.
Ideally
I'd
like
to
wait
till
we
have
a
full
board,
but
we
we
can't
wait
forever
and
we're
in
the
hands
of
government.
For
that.
A
The
midst
of
the
board
meeting
were
circulated
in
advance.
I.
Don't
think
we
got
any
comments.
So
are
we
happy
to
take
those
as
approved?
Thank
you
very
much.
The
action
logs
only
got
one
item
on
it.
It's
shown
as
green,
because
it's
due
in
November,
so
that's
fine,
the
any
other
business
from
anybody
before
I
close
the
meeting.
Okay.
Well,
we'll
close.
The
meeting
at
that
stage-
apologies
to
those
of
you
listening
in
who
may
be
an
inconvenience
some
apologist.
A
My
colleagues
are
running
over,
but
it
was
such
an
important
topic.
We
discussed
earlier
on
people
I
think
that
had
to
be
the
right
thing
to
do
so.
Thank
you
very
much
for
bearing
with
us
I'll
close
the
formal
bit
of
the
meeting
down,
but,
as
usual,
we
do
have
one
or
two
questions
from
the
public
that
we
have
said
we
will
take
there's
actually
four
today.
A
The
first
is
actually
rather
unusual.
One
I
mean
it's
it's
from
a
commercial
organization
who
clearly
wants
to
do
a
war
business
with
the
with
the
Health
and
Care
System,
but
it
was
asked
so
I
think
it's
only
right.
We
should
give
it
an
answer.
A
Chris
I
think
you're
going
to
do
with
this.
So
from
it's
a
from
a
Claire.
He
answer
this
for
who's,
the
chief
product
development
officer
of
turntable,
and
the
question
was
what
is
the
correct
channel
for
a
software
provider
working
with
the
NHS
organizations
to
Monitor
and
improve
quality
of
queer
to
engage
in
the
ongoing
CQC
transformation
program?.
U
U
In
fact,
we
recently
published
a
a
an
article
which
focused
on
a
number
of
areas
of
innovation,
so
we're
always
interested
to
hear
Innovation
that
comes
from
organizations
in
different
areas
and
we'll
we
we're
usually
used
to
forming
an
idea
about
what
we
think
about
that
and
sometimes
using
those
as
case
study,
so
you'll
see,
for
example,
in
state
of
care,
which
will
come
out
in
a
couple
of
weeks.
There's
a
few
examples
of
innovation
that
we've
seen
both
in
technology
and
also
in
terms
of
how
services
are
delivered
that
we'll
use.
U
So
if
you've
got
if
you've
got
a
good,
Insight
I
think
my
my
email
address
is
certainly
available
through
the
through
the
board
and
other
colleagues,
we're
always
interested
in
in
in
good
ideas
around
case
studies.
What
we're
really
interested
in
as
well
is
how
it's
adopted
in
an
area
so
good
idea
with
with
an
idea
about
how
it's
a
it's
been
adopted
in
one
or
another
or
a
number
of
organizations,
but
we're
really
Keen.
So
please
get
in
touch.
A
Okay,
thanks
very
much
Chris,
and
then
we
have
three
from
Mr
Robin,
Pike,
Nicola
I.
Think
in
Sean's
absence
you're
taking
the
first,
which
was:
how
does
the
CQC
regulate
the
performance
of
hospitals
in
their
management
of
two-week
Council
referrals.
AA
Thank
you.
So
the
first
thing
I
would
say
is
that
NHS
England
monitor
the
performance
of
hospitals
in
regards
to
the
two
week
rate.
Standard
inspectors
and
inspection
teams
do
review
this
whole
Suite
of
cancer,
awaken
time
standards
alongside
other
metrics
as
part
of
ongoing
monitoring
of
providers,
and
that
informs
both
our
engagement
approach,
but
also
does
informal
inspection
and
within
our
inspection
framework,
we
do
have
specific,
prompts
around
timely
access
to
diagnosis
and
access
to
care.
AA
U
This
picks
up
a
really
important
point
about
the
relationship
between
organizations
and
people's
experience
of
care
through
a
pathway.
So
we
have
a
number
of
ways
in
which
we
do
that.
Probably
the
most
obvious
is
that,
through
the
use
of
give
feedback
on
care,
when
people
describe
their
their
care
Journey
towards
they
don't
talk
about
individual
organizations,
they
often
talk
about
the
relationship
between
primary
care
or
adult
social
care
and
secondary
care.
So
we
use
we
get.
We
get
a
lot
of
information
through
that
route
and
that
helps
inform
our
view.
U
Secondly,
we'll
work
with
local
Partners,
so
they
may
be
groups
that
represent
people
locally
or
they
may
be
organizations
that
are
that
are
part
of
a
delivery
in
an
area
and
we'll
use
both
to
form
a
view
of
how
discharge
Arrangements.
U
A
really
important
point
and
a
really
important
question
as
I
think
we
described
earlier
in
the
conversation
we're
currently
testing
our
approach
to
both
ICS
and
local
Authority
assessments.
Part
of
that
assessments
will
be
most
if
all
ics's
and
all
local
authorities
have
have
a
view
about
how
they
intend
to
engage
or
how
they
do.
Engage
people
who
use
services
in
their
area
and
I
guess
part
of
our
approach
is
looking
at.
U
What's
the
what's
the
theory
and
practice
of
that
in
an
area
and
how
do
people
who
work
in
that
who
work
for
the
for
people
that
represent
people
using
Services?
How
do
they
feel
about
that?
That
engagement,
that
they're,
having
we're
setting
out
under
a
number
of
different
areas
of
our
work,
to
look
at
the
relativity
of
that
in
different
areas?
So,
what's
working
well,
where
are
local
authorities
or
ICS,
is
challenged?
U
We
want
to
use
an
understanding
of
that
to
really
guide
both
ics's
and
local
authorities
in
terms
of
what
good
practice
looks
like,
but
but
critically
for
me
and
the
work
of
an
ICS
and
the
work
of
blog
Authority
in
this
area
starts
with
their
understanding
of
people
in
their
area.
We've
said,
in
other
places
that
icsdla
start
in
different
places,
but
understanding
where
people
who
use
their
services
start
is
the
is
the
start
point
to
how
they
address
the
issues
in
their
area.
A
Okay,
very
comprehensive
answer:
thanks
very
much
I
did
Chris,
so
that
also
deals
with
all
of
the
questions
from
the
public.
So
for
those
listening
in.
Thank
you
for
very
with
us
and
we
look
forward
to
seeing
you
at
the
next
meeting
in
November.