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From YouTube: CQC board meeting - June 2022
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A
We
were
hoping
that
this
would
be
a
physical
meeting,
but
you'll
all
be
aware
of
the
rail
strikes
and
with
most
of
our
members
living
somewhere
away
from
london,
it
proved
impossible
to
get
together.
So
hopefully
this
will
be
the
last
one,
but
that's
not
within
our
control.
A
Just
a
few
words
of
introduction
and
then
I'll
be
against
the
formal
business
of
the
meeting.
I
have
an
apology
from
jorah
gill,
one
of
our
board
members.
He
may
be
able
to
join
us
later
on,
but
I
suspect
not
and
rebecca
lloyd
jones.
Our
chief
legal
officer
has
continued
to
be
on
jury.
She's,
been
jury
service
she's
been
there
for
about
eight
weeks
now,
so
obviously
an
interesting
trial.
A
I
also
wanted
to
welcome
sean
o'kelly
who's
just
joined
us
both
as
a
chief
inspector
and
as
a
board
member.
We
seem
to
be
having
a
few
connection
problems
with
sean,
so
I'm
going
to
ask
ian
trenholm
to
just
introduce
him
at
an
appropriate
time
later
on,
and
can
I
last,
but
by
no
means
least
welcome.
This
month's
equality
network
representative
who's
sariato
latunji,
welcome
sarri
out
to
this
meeting.
A
If
I
move
on
then
at
the
formal
business,
are
there
any
declarations
of
interest
that
people
need
to
declare
okay,
we
circulated
the
minutes
of
our
last
meeting.
They're
here
for
approval.
Do
people
have
any
comments,
or
can
I
take
those
as
approved?
A
Thank
you,
yep,
okay.
We
then
have
the
matters
of
rising.
My
apologies,
my
screen,
glitched
there.
There
is
only
one
item
on
the
corporate
performance
report.
A
There
were
some
things
that
we
wanted
clarified,
that
is
on
track
and
we'll
do
that
at
a
future
meeting,
so
that's
showing
as
a
green
status
on
the
grounds
that
it
will
happen
by
the
due
date.
So
I
have
no
other
comments
to
make
unless
there
are
any
queries
in
that
case,
could
we
just
move
straight
on
to
the
executive
team's
report?
A
B
Thanks
very
much
ian,
so
I
think
if
I
can
ask
board
members
to
take
the
the
first
section
as
read,
there
are
three
things
that
I
particularly
want
to
draw
attention
to.
One
is
pressure
across
the
system:
one
is
the
leadership
review
and
one
is
board
changes.
So
I
think,
in
terms
of
pressure
across
the
system,
there
are
a
couple
of
specific
areas
that
we're
concerned
around
ambulances
and
maternity,
and
I
think
what
that
is
is
they
are.
B
They
are
tangible
symptoms
of
of
enormous
pressure
across
health
and
health
and
care
systems.
I
think
I
very
much
recognize
that
there's
a
public
narrative
that
the
world
is
somehow
back
to
normal
and
we
see,
as
we
see
in
many
parts
of
our
lives,
we
can
continue
to
go
about
our
normal
business
and
certainly
the
the
the
the
news
media
tend
to
talk
about
delays
to
check
in
for
holidays
rather
than
delays
at
the
doors
of
general
practice
or
emergency
departments.
B
But
I
think
I
think
we're
seeing
on
the
ground
that
those
those
delays
are
are
very
real
and
are
very
tangible
and
are
very
important.
So
I
think
this
does
remain
a
concern
for
us,
and
we've
been
looking
at
ambulance
services
in
particular
recently,
where
we've
got
some
some
concerns
around
leadership
and
culture
in
some
places
and
and
we've
we've
talked
we'll-
be
talking
continuing
to
talk
about
that
over
the
over
the
next
few
months,
and
there
are
specific
providers
where
we
have
well
we've
taken
action
or
we've.
B
B
It's
about
how
individual
providers
work
collaboratively
together
to
come
up
with
responses
to
to
to
addressing
this
pressure
in
in
a
particular
place,
and
our
our
response
from
us
from
a
cqc
point
of
view,
is
inevitably
limited
by
by
the
powers
that
that
we
have,
but
I
think
it
what
we
have
tried
to
do
is
to
bring
together
frontline
professionals
to
to
to
understand
the
problem
in
some
in
some
detail,
but
also
to
help
improve
collaboration
between
organizations.
B
We
know
that
we
have
a
very
powerful
convening
power
which,
which
we
know
have
used
well,
can
bring
people
together
and
can
start
to
have
conversations
that
maybe
they
wouldn't
otherwise
have
had
on
their
own
and
in
all
cases,
what
we
try
and
do
when
we
bring
people
together,
is
to
try
and
come
up
with
practical
things
that
people
can
can
use,
enhance
guidance
and
and
so
on.
The
people
can
use
to
try
and
improve
the
services.
So
again,
there
are
there's
a
steady
stream
of
those
of
those
products.
B
I
want
to
move
on
to
talk
about
leadership
and
the
leadership
review.
The
leadership
review
was
carried
out
recently
by
sir
gordon
messenger
and
dame
linda,
pollard
and,
and
that
report
was
publicized
recently.
There
are
some
recommendations
for
us
in
that
report
and
and
I'm
pleased
that
that
they
are
already
areas
we
we've
been
doing
some
work
on
and
they
will
be
embedded
within
our
single
assessment
framework.
B
One
of
the
one
of
the
real
positives
about
about
our
single
assessment
framework
work
is
that
we're
looking
to
try
and
bring
in
one
place
all
of
the
work
we
do
around
providers
and
systems
and
when,
when
new
insights
come
from
things,
like
sir
gordon's
review
to
gordon
and
dame
linda's
reviews
come
come
out,
we
can
very
quickly
integrate
them
into
our
into
our
core
assessment
methodology
and
start
start
going
out
and
testing
the
degree
to
which
those
recommendations
have
been
have
been
adopted
in
the
system.
B
So
I'm
hoping
that,
from
the
end
of
this
calendar
year
that
single
assessment
framework
we're
bringing
in
will
be
a
really
important
tool
and
will
help,
I
think,
amplify
some
of
the
recommendations
that
that
come
out
through
a
range
of
different
views,
both
the
ones
that
we
know
about
in
the
past,
but
also
those
reviews
that
are
to
come
and
finally,
the
third,
the
third
area
that
just
that
that
I
wanted
to
talk
about.
B
That's
been
a
big
part
of
what
I've
been
involved
in
over
the
last
last
last
few
weeks
is
around
board
changes.
We
recently
announced
that
that
rosie
will
be
leaving
us.
Rosie
benny
will
be
leaving
us
at
the
end
of
july
to
join
the
healthcare
safety
investigation
branch,
as
their
interim
chief,
investigator
and
kirsty
shaw
will
be
leaving
us
at
the
end
of
august
to
become
the
chief
operating
officer
at
homes.
England,
I
think
it'd
be
fair
to
say
both
rosie
and
kirsty
have
made.
B
I've
played
really
pivotal
roles
in
in
the
development
of
cqc
over
the
last
over
the
last
few
years,
and
I
think
both
of
them
will
leave
will
have
really
significant
legacies
and
I'm
sorry
to
see
both
of
them
go.
But
but
I
also
know
that
both
of
them
are
going
on
to
really
important
and
high-profile
public
service
jobs
and
and
they'll
continue
to
with
their
their
their
respective.
You
know
their
respective
significant
contributions
to
public
service
will
be
continued
in
their
in
their
new
roles.
B
We
will,
of
course,
have
the
opportunity
to
say
a
proper
thanks
to
to
both
rosie
and
kirsty
at
our
july
meeting
and
thank
them
properly
for
their
for
their
contributions.
But
but
I
wanted
just
to
just
just
to
announce
that
publicly
and-
and
I
think
I
am
now
gonna
pause
and
I
hope-
welcome
sean
sean
o'kelly
to
the
call.
I
think
sean
is
now
on
on
the
call.
C
So,
thank
you.
Yes,
apologies
for
joining
a
little
bit
later.
I
had
some
issues
with
the
it.
I
hope
you
can
hear
me
now
just
to
say
yes,
it's
great
to
have
joined
it's
great
to
be
in
this
position.
I
look
forward
very
much
to
working
with
everyone
on
the
board
and
the
whole
of
the
cqc
staff.
I've
just
come
from
the
east
of
england,
where
I
was
recently
acting
as
the
regional
director.
C
Before
that
I
was
essentially
the
regional
medical
director
for
the
speaking
of
the
last
few
years.
I've
also
been
the
medical
director
for
nhs
improvement,
working
with
trusts
in
special
measures
and
challenge
provider
status
and
before
that
medical
director
in
three
three
trusts
small,
medium
and
large
in
the
southwest
of
england.
C
In
the
past,
I've
had
experience
at
the
department
of
health
working
with
the
dcmo
and
the
cmo
and
prior
to
that,
a
period
of
time
in
in
the
us,
as
a
associate
professor
of
pediatric,
cardiac
anesthesia,
which
is
my
professional
background.
So,
as
I
said,
I'm
very
much
looking
forward
to
working
with
everyone
and
helping
the
cqc
achieve
its
it's
its
objectives
and
its
mission.
I'll
I'll
leave
it
there
thanks
again.
B
Fantastic,
thank
you.
Sean
thanks,
and
so
can
I
just
in
is
welcome
to
the
welcome
to
the
board
and
welcome
to
the
the
executive
team.
So
so
I
think
in
in
light
of
both
sean
joining
us
on
monday
and
and
of
course,
colleagues
are
starting
to
to
starting
to
leave
us
I'll,
be
pushing
putting
in
place
some
interim
arrangements.
B
Sean
will
be
will
be
doing
his
his
core
job
of
chief
inspector
of
hospitals,
but
also
he'll,
be
acting
as
interim
chief
inspector
of
primary
medical
services
and
working
with
colleagues
within
the
director
group
and
the
regulatory
leadership
function
to
to
offer
medical
leadership
in
in
the
primary
medical
services
area
and
kate
will
be
taking
on
leadership
of
the
integrated
care
system.
Work
alongside
becoming
the
interim
chief
operating
officer.
B
Other
executives
will,
of
course,
take
on
specific
additional
duties
and
will
be
work,
liaising
with
external
stakeholders
to
cover
particular
meetings
and
and
types
of
work,
to
make
sure
that
both
rosi
and
and
kirsty's
responsibilities
are
covered
in
the
interim
work
and
over
the
next
few
months,
we'll
be
we'll
be
reflecting
on
on
what
we
need
from
an
executive
point
of
view
and
and
be
looking
to
potentially
make
additional
recruitments
and
so
on
to
cover
specific
areas.
B
We
will
of
course
be
looking
at
the
way
we
use
our
director
carder,
the
next
tier
down,
as
well
as
our
national
professional
advisor
cardra
again,
who
are
an
important
part
of
what
we
do
and
again
we'll
be
talking
about
how
we'll
be
using
them,
moreover,
but
but
in
the
short
term,
I'm
redistributing
kirsty
and
rosie's
responsibilities
across
the
current
team
with
support
from
from
the
next
tier
down.
So
I
think,
that's
all.
B
D
Thank
you
very
much
ian
for
that,
and
may
I
welcome
sean
to
to
the
party
and
probably
in,
if
I'd,
ask
this
question
next
next
time
he'd
be
having
to
answer
it
rather
than
but
it's
about
leadership
and
what
you've
said
and
sort
of
drawing
some
threads
together
really
the
first
from
the
about
the
messenger
report,
and
I
should
probably
declare
that
I
was
amongst
those
whom
he
interviewed
and
I
just
wondered
what
to
to
what
extent
a
report
which
is
said
to
be
radical
in
many
ways:
changes
our
perception
of
how
we
assess
leadership
for
in
terms
of
our
regulatory
function,
or
does
it
not
and
allied
to
that
is
what
you've
reported
about
the
ambulance
services
and
we
all
know
what
terrible
pressure
the
ambulance
services
have
been
under
up
and
down
the
country,
but
underlying
what
you've
told
us
and
what
I
think,
we've
known
for
some
time,
is
that
certainly
in
some
ambulance
services,
maybe
many
of
them
there
has
is
an
underlying
cultural
leadership
issue.
D
And
I
I
wonder
what
it
bearing
in
mind
the
length
of
time
that
has
been
going
on.
I
wonder
what
we
are
able
to
do
to
as
it
would
change
that
picture,
because
it
strikes
me
that,
from
the
point
of
view
of
the
patient
and
the
public
that
the
issue's
been
going
on
for
too
long-
and
these
are
of
course
challenging
times,
but
it
has
been
going
on
too
long.
So
it's
really
they've
both
come
up,
unfortunately,
at
the
same
time,
but
they
do
seem
to
have
some
association.
B
Yeah
thanks
thanks
robert,
I
think
one
of
the
things
that's
really
important
about
our
single
assessment
framework
is
that
it
is
a
set
of
of
questions
that
that
link
back
to
the
five
key
questions
that
that
that
you
are
responsible
for
for
creating.
B
B
I
guess,
but
I
think,
unless
we
can
strive
for
that
bold
ambition,
then
we
will,
we
will
all
be
continuing
and
by
us
and
and
everyone
else
in
the
system
will
continue
to
talk
about
culture
in
a
slightly
abstract
way.
So
so
I
think
I
think
that's
something
we
can.
We
can
do
very,
very
specifically
in
terms
of
ambulance
services.
Specifically,
we've
got
a
program
of
work,
we're
doing
to
look
at
at
what's
going
on
in
ambulances,
particularly
working
with
nhs,
england
and
department
of
health
and
social
care.
B
Colleagues
as
well,
and
I'm
hoping
that
that
will
give
us
some
insight.
But
I
think
there
is
still
this.
What
is
culture
question
which
which-
which
I
think
I
would
I'm
determined
that
we
can,
we
can
try
and
distill
down
and
be
much
clearer
about
about
what
that
means
and
how
it's
defined.
A
Okay,
if
not
rosie
over
to
you.
E
Thank
you
very
much
ian
and
following
on
the
conversation
about
ambulances
and
urgent
emergency
care,
my
first
report
talks
about
the
work
we're
doing
in
urgent
emergency
care
and,
as
you
are
aware,
we've
recently
been
into
ten
systems
and
scheduled
all
of
our
inspections
across
the
urgent
emergency
care
pathway
and
that's
given
us
a
huge
amount
of
information
both
at
system
level,
but
also
when
we've
aggregated
that
together.
E
In
addition
to
that,
we
held
a
really
good
workshop
with
250
stakeholders
from
across
the
urgent
emergency
care
system,
both
at
local
level
and
national
stakeholders,
and
our
plan
is
to
pull
that
information
together
to
pull
out
the
learning
and
to
be
able
to
share
that
best
practice
that
we've
been
seeing
in
advance
of
next
winter,
so
that
actually
systems
can
see
and
learn
from
what
we've
experienced
over
the
last
few
months.
So
that
work
is
underway.
E
The
second
section
of
my
report
is
just
to
flag
that
claire
fuller
has
released
her
report
around
primary
care
and
integrating
primary
care
in
in
the
ics
landscape.
We
very
much
welcome
this
report
and
we're
bringing
a
paper
to
the
july
board
to
have
a
further
discussion
about
this,
as
I
think
it's
really
a
critical
piece
of
work
looking
at
the
future
of
primary
care
and
the
future
of
integration
at
neighbourhood
level.
So
very
much
welcome
that.
A
A
F
Okay,
thanks
and
good
morning,
all
so,
I'm
just
going
to
bring
together
the
update
on
local
authority
assurance
and
integrated
care
system
assurance
and
let
let
the
board
know
that
we've
made
really
good
progress
in
identifying
two
local
authorities
and
two
integrated
care
systems
who
are
interested
in
being.
F
So
a
big
thank
you
to
those
for
places
to
enable
that
to
happen
in
order
to
deliver
that
we've
been
successful
in
recruiting
a
small
internal
team
who
will
be
leading
this
work
with
some
expertise
that
we're
also
drawing
on
from
the
sector
and
the
output
of
those
tests
and
learn.
F
Pieces
of
work
will
be
an
opportunity
to
for
us
to
reflect
on
our
methodology
and
to
make
sure
that
we
are
plugging
in
the
right
requirements
when
we
think
about
the
digital
platform
we're
building
when
we
think
about
the
skills
and
capabilities
and
capacity,
we
need
in
the
organization
to
deliver
this
ambitious,
ambitious
programme
from
april
23,
so
so
good
progress
on
those
two
fronts
and
then
just
a
brief
note:
liberty,
protection
safeguards.
F
The
consultation
from
the
department
of
health
and
social
care
is
live
at
the
moment.
We
have
we're
in
the
middle
of
submitting
our
response
to
that.
It's
not
only
about
the
new
liberty
protection
safeguards,
but
it's
also
about
revisions
to
the
mental
capacity
act,
codes
of
practice,
so
quite
a
a
kind
of
technical
response
about
the
codes
of
practice
just
to
make
ball
aware-
and
there
will
be
opportunities
at
a
later
date
for
us
to
spend
some
more
time
together.
F
Thinking
about
our
our
potential
role,
around
liberty,
protection
safeguards
as
well.
The
department
of
health
and
social
care
said
they
want
to
digest
all
the
feedback
they
get
from
the
consultation
first
before
they
then
consider
when
a
go
potential
go
live
date.
Maybe
thank
you.
A
G
G
I
mean
it's
really
good
news,
but
I
just
wondered
how
we
got
to
select
the
participants.
I
wondered
if
it
was
to
do
with
patient
acuity
or
whether
it
was
to
do
with
inequalities
or
or
resourcing
challenges
that
we
know
the
sector
suffers
from.
I
just
wonder
if
you
can
give
some
background
to
that,
and
perhaps
what
you're
hoping
to
learn
from
from
this
exercise.
F
Okay,
so
should
I
do
local
30
first
and
then
rosie,
you
might
want
to
say,
for
local
authority,
obviously
already
established,
unlike
integrated
care
systems,
we
wanted
to
make
sure
we
had
a
good
geographical
spread
so
that
we
were
looking
at
different
types
of
geographies
when
it
came
to
those
two
local
authorities
and
rosie.
Do
you
want
to
come
in
on
the
ics
rationale?
Yes,
certainly
we
had
a.
E
Selection
of
criteria
looking
at
again
a
mix
of
different
demographics,
geographical
spread
size
of
ics's
and
the
two
ics's
we
have
chosen
are
are
very
different
in
terms
of
their
makeup,
their
size,
their
demographics
and
the
the
kind
of
inequalities
that
might
be
visible
in
those
ics's.
E
So
we
very
much
looked
at
getting
as
broad
a
spectrum
and
what
we're
trying
to
learn
is
really
we've
done
a
huge
amount
of
co-production
with
stakeholders
to
get
to
this
point
in
terms
of
developing
our
methodology,
we've
worked
extensively
with
most
of
the
systems
across
the
country
and
national
stakeholders,
and
we're
really
starting
to
put
that
into
practice
in
terms
of
this
is
what
we
think
our
methodology
should
look
like,
and
how
does
that
actually
work
in
practice,
and
it
does
it
tease
out
those
areas
sufficiently
enough?
F
Yeah
so
they're
going
to
be
happening
through
july
and
august
mark,
so
we
will
be
digesting
the
output
of
that
come
the
end
of
august
and
then
there'll
be
a
conversation
in
september.
F
So
there'll
be
a
formal
process
where
the
output
of
our
learning
will
go
to
to
the
exact
team
and
then
a
conversation
at
boards.
So
in
the
next
two
months,
there'll
be
lots
of
lots
of
busy
work
on
these
test
and
learn
places.
A
The
lexicon
changes
tesla,
not
pilot
belinda,.
H
F
Thanks
belinda,
so
I
so
we
haven't
stopped
our
focus
on
this,
so
our
expectation
now
is
that
there
aren't
restrictions
and
people
are
able
to
see
their
loved
ones
as
as
they
as
they
wish
to.
So
it's
still
a
key
area
focus
when
we
go
out
into
every
care
home.
We
are
still
getting
a
small
number
of
concerns
raised
by
individuals,
families
that
we
follow
up
as
we
have
been
doing,
particularly
over
the
last.
F
You
know
last
six
months
with
a
real
focus
on
on
what
that
is
about
so
yeah
this.
I
think
this
is
the
first
month
in
maybe
24
months
that
I
haven't
mentioned
visiting,
but
it
doesn't
mean
we
haven't
stopped,
haven't
stopped
our
focus
on
it
linda
when
we've
been
been
going
out
and
inspecting
thanks.
A
Right,
kate,
thanks
very
much
I
mean
if
you
just
look
back
at
the
points
that
are
being
raised
there,
there's
a
combination
of
current
and
go
forward
points,
but
a
number
of
observations
about
the
the
current
state
of
things
which
obviously
we
were
reflecting
in
our
state
of
care
report
coming
up
later
this
year.
I
Thank
you
ian
on
performance,
not
much
to
add
to
the
written
report,
I'd
like
to
say
how
grateful
I
am
to
the
operation
t
operations,
teams
for
a
strong
performance
in
may,
despite
various
distractions
like
half
term
the
platinum
jubilee
celebrations
and
our
our
team
is
being
encouraged
to
participate
in
a
steady
drumbeat
of
transformation
com
communications
as
our
transformation
program
really
quickens
pace.
But
having
said
that,
I
just
want
to
pull
out
two
areas
and
expand
on
those
slightly.
I
The
first
on
registration,
really
strong
performance,
3,
264
applications
completed
in
may,
that's
compared
to
2795
in
april
a
15
uplift
and
on
average
that's
512
better
than
the
preceding
two-month
period
and
also
despite
demand
and
the
number
of
applications
coming
in
still
being
very
strong.
The
number
of
overall
number
of
applications
in
the
in
the
system
remains
steady,
so
I
think
strong
performance
in
may
on
on
registration
and,
finally,
just
really
to
highlight
our
inspection
performance,
which
has
also
remained
strong.
I
Notwithstanding
all
I
said
about
at
the
beginning
about
what
else
has
been
going
on
in
in
in
may,
998
inspections
were
undertaken
in
may
that
compares
to
920
in
april
and
already,
and
we
have
995
inspections
either
planned
or
have
already
been
undertaken
for
june.
So
just
to
bring
out
it
could
add
a
few
numbers
to
the
to
the
written
report
that
was
submitted
a
week
ago.
Thank
you.
G
Thank
you
chairman
tyson
thanks
a
lot
and
congratulations
on
the
registration
performance
and
also
the
improvement
in
timeliness.
It's
really
good
to
see
in
terms
of
inspection
volumes
I
just
wanted.
Could
you
give
me
a
little
bit
of
an
insight
into
the
split
between
the
physical
crossing.
G
I
forget
the
words
that
we
use
sorry
but
crossing
the
threshold
and
also
the
dma,
and
I
just
wondered
whether
the
inspection
performance
or
volumes
have
in
any
way
been
challenged
this
month
because
of
the
problems
with
transport
access.
I
Thanks
mark
on
your
first
point,
these
are
all
these
are
all
physical
crossing.
The
threshold
inspections,
the
the
the
dma,
the
performance
of
the
dma
team,
is,
is
counted
separately
and
comes
together
with
our
overall
figures
on
regulatory
contact
and
and
their
performance
remains
strong,
but
the
figures
I've
just
given
you
are
our
physical
crossing,
the
threshold
that
our
inspection
teams
have
done.
In
terms
of
in
terms
of
the
transport,
I
mean
transport
disruption.
I
The
these
figures
are
worth
of
may
so
they
would
have
covered
the
the
tube
strike
in
in
london.
A
two-day
tube
strike
in
london,
and
I
think
that
I
I
think
the
the
impact
upon
our
operations
was
minimal,
largely
because
I
think
where,
where
our
teams
were
expecting
were
due
out
on
inspection-
and
they
were
expecting
there
to
be
some
disruption,
they
would
have
traveled
by
public
transport
that
the
night
before
and
probably
stayed
overnight.
I
I
shadowed
an
inspection
of
an
independent
hospital
in
central
london
on
on
the
first
of
the
days
of
the
of
the
under
london
underground
strike
in
london,
and
the
teams
were
the
teams
were
already
there
by
the
time.
By
the
time
I
arrived
I
live
in
london,
I
was
able
to
walk
once
I
once
had
got
off
the
train
at
a
chairing
cross,
but
the
teams
were
already
there.
So
I
think
the
impact
on
honest
within
the
cqc
has
been
fairly
minimal
and
I'm
expecting
that
to
be
the
pattern
for
june
as
well.
A
J
Yeah
thanks
e
n
thanks
tyson
and
just
to
pick
up
on
your
last
comment.
Actually
around
regulatory
and
inspection
activity.
More
generally,
so
we're
obviously
delivering
a
thousand
roughly
crossing
the
threshold
inspections
every
month,
which
is
a
significant
achievement.
But
you
said
that
didn't
include
our
direct
monitoring
work.
So
can
you
give
us
a
sense
of
how
many
of
the
people
that
we
regulate
we're
kind
of
touching
over
a
year?
Really,
I
think,
there's
sometimes
a
perception
that
we
don't
see
people
for
very
long
time
and
clearly
there's
an
awful
lot
of
activity.
I
I
think
there
are
three
there
are
three
elements
of
this,
and
one
one
is
the
number
of
physical
inspections.
One
is
the
amount
of
monitoring
we
do
as
a
result
of
of
of
the
dma
team,
and
the
third
one
is
a
is
a
quality
statement
that
we
we
publish
on
the
website,
having
used
our
intelligence
and
data
to
look
at
those
providers
that
we
think
are
probably
of
less
risk
to
us
and
I
think
from
memory
overall
we
will
be
impacting
on
about.
I
I
think
chris
chris
asher
has
talked
before
about
impacting
on
about
if
it's
770
percent
of
all
providers
during
the
course
of
the
year,
but
but
I'll
I'll
check
that
figure
sally
and
make
sure
that
if
I've
got
it
very
wide
at
the
mark,
I'll
correct
it
in
the
minutes.
But
but
yes,
it's
a
lot
more
than
the
physical
inspection.
We
now
have
quite
a
complex
arsenal
in
order
to
keep
to
keep
her
to
keep
an
eye
on
quality
across
the
system.
A
Thank
you
thanks
just
quickly
for
me,
as
one
of
my
questions
already
asked
by
mark,
but
the
other
is
on
the
registration
teams.
You
said
a
higher
volumes
of
application,
they
processed
applications.
Am
I
right
and
saying
that
to
some
extent
that
is
tackling
into
a
pre-existing
backlog?
A
So
when
we
talk
about
processing
applications,
that's
what
we
receive,
but
we're
either
staying
on
top
of
or
eating
into
the
backlog.
And
then
can
you
just
say
a
couple
of
words
about
the
technological
improvements
we're
making
in
this
area.
I
The
the
backlog
has
actually
gone
up
over
the
over
the
last
period,
and
that's
because
I
mean
the
way
in
which
we
count.
The
back
dog
is
quite
complex,
but
the
the
strictly
speaking
the
backlog
has
increased
because
the
managers
have
been
working
on
their
existing
workload
rather
than
rather
than
sort
of
opening
things
up
being
in
progress
and
and
reducing
the
backlog.
I
And
I
think,
although
performance
in
registration
has
tended
to
go
up
and
down
over
over
the
months,
it
does
look
as
if
we
had
continued
to
make
some
good
some
good
inroads
and
good
inroads
into
it
in
terms
of
the
technology
and
technological
advances.
So
those
are
broadly
connected
with
the
regulatory
platform
and
there's
a
lot
of
work
going
on
with
the
teams,
including
trade
training
for
the
team,
so
they
can
take.
I
A
It
would
be
useful
just
keep
an
eye
on
the
the
backlog,
given
the
importance
of
people
coming
into
the
market,
but
thank
you
very
much
for
that
yeah
we're.
I
see
we
have
guests
for
the
next
session
to
already
join.
So
perhaps
if
we
can
deal
with
the
remaining
items
reasonably
quickly
mark
that
there
wasn't
really
anything
in.
K
Your
written
report
is
there
anything
you
wish
to
add.
No,
no
just
to
confirm
that
this
month,
there's
there's
no
significant
cyber
or
information
security
issues
to
report.
Okay,.
A
L
Super
full
quick
items
from
me:
we've
recently
met
with
the
shadow
minister
of
health
to
discuss
the
occupant
report
in
our
role
in
regulating
maternity
services.
You'll
know.
Colleagues,
last
time
we
talked
a
bit
about
the
maternity
roundtable
that
we
were
due
to
have
just
before
the
the
last
board.
The
answer
went
very
well.
L
It
was
a
really
good
listening
event,
co-designed
with
stakeholders
and
and
both
providers
and
people
use
services
that
the
there
is
the
report
from
that
event
still
being
finalized,
but
there
are
probably
three
or
four
themes
that
are
particularly
important.
L
Obviously,
staffing
pressures
is
one
and
a
lot
of
conversations
from
the
woodwinds
who
took
part
saying
that
they
were
a
lot
of
them,
have
felt
they're
in
sort
of
survival
mode,
and
there
was
a
real
sense
of
of
midwives
taking
the
option
of
retiring
early,
rather
than
maintaining
maintaining
their
their
sort
of
role
as
a
midwife
and
but
but
actually,
at
the
same
time,
lots
of
really
good
examples
of
how
teams
were
turning
it
around
and
what
teams
are
doing
differently
to
support
retention
and
and
growth.
L
There's
a
lot
about
cross
team
working.
What
does
good
care
look
like
from
different
perspectives?
How
how
do
people's
ability
to
speak
up
when
things
go
wrong?
How
do
you,
how
do
you
create
an
open
culture
versus
a
blane
culture,
and
how
do
you
support
that
by
really
good
training
that
operates
together
where
people
are
are
working
together
and
that
cross
team
working
sort
of
also
sort
of
moved
over
into
a
close
trust
in
respectful,
a
multi-professional
team
teams
and
team
working?
L
There
was
also
a
sense
that,
if
staff
felt
safe,
then
it
was
more
likely
to
lead
to
patient
safety
as
well.
So
there's
a
there's
a
from
that
round
table
the
next
steps
are
to
finalize
a
full
report
with
an
output
that
we'll
look
to
talk
a
little
bit
about
what
it
means
to
be
well
led
in
maternity
services,
something
in
focus
on
later
and
perhaps
lead
to
some
other
partnerships
that
we
might
we
might
do
later
in
the
year.
L
L
Second,
I
just
want
to
talk
about
the
external
studio
advisory
group
and
what
we
talked
about.
First
of
all,
I
know
yourself,
chair
and
belinda
came
to
the
last
meeting
thanks
very
much
for
for
your
attendance.
We
talked
about
a
couple
of
things,
but
probably
most
of
note
was
a
single
assessment
framework
would
kind
of
quite
be
in
the
context
of
what
a
year
in
the
life
of
a
care
home,
for
example,
might
be.
L
I
think
the
the
importance
there
about
gathering
people's
experience
should
be
a
continuous
process
right
throughout
the
year,
and
there
are
also
some
questions
about
ckc
how
to
implement
this
approach,
to
ensure
it's
consistent
across
different
areas
and
different
geographies,
and
we
talked
to
talk
to
a
degree
about
the
technology
and
the
support
for
that
in
terms
of
how
we
can
judge
where
we
make
decisions
in
one
one
part
of
the
country
with
the
information
against
the
against
another
part
of
the
country
and
how
their
technology
can
act
as
an
enabler
for
those
conversations.
L
There
was
also-
as
I
think
I
mentioned
earlier,
some
conversations
about
the
wider
funding
of
services
and
our
role
in
calling
that
out,
and
we
talked
a
little
bit
about
how
we'd
used
state
of
care
as
a
vehicle
for
for
doing
that,
and
there
was
lots
of
concerns
raised
about
long-term
issues
around
funding,
particularly
in
in
domiciliary
care.
We
went
on
to
have
a
first
conversation
about
this
year's
state
of
care
where
we
talked
about
some
of
the
themes
of
state
of
care.
We
particularly
alongside
those
things
I've
just
talked
about.
L
We
wanted
to
focus
on
mental
health
services
for
people,
particularly
for
children,
actually
young
people
as
they
leave
a
child
that
lessens
services
and
go
into
adult
services.
We
feel
from
some
of
the
work
we've
had
work
with
groups
with
public
groups
and
also
for
our
own
feedback,
that
that
is
an
area
of
growing
concern
just
to
say
in
addition
to
eastside.
Tomorrow
we
have
the
first
of
the
provider
implementation
steering
groups
around
the
single
assessment
framework.
L
So
this
is
where
that
test
and
learn
really
hits
the
road
in
terms
of
the
feedback
that
we
get
from
providers
and
we're
doing
exactly
the
same
thing
with
regards
to
ics's
and
local
authorities
next
week.
Next
wednesday
final,
two
things
we've
got
a
because
we
all
care
campaign
that
the
the
next
spike
in
in
that
work
is
around
deaf
and
hard
of
hearing.
As
you
know,
it's
our
year-long
campaign
to
encourage
behavioral
change
and
support
people
to
give
their
feedback
in
care.
L
You'll,
probably
know
from
the
work
we've
done
over
over
the
months,
there's
been
a
significant
rise
in
give
feedback
on
care
which
more
people
trust
in
us,
with
their
information
to
help
drive,
drive
for
change
and
improvement
in
services,
and
indeed
it's
formed
a
large
feature
of
our
responsive
inspection
activity
over
the
last
two
years.
This
particular
campaign
been
really
strongly
supported
by
paul
kirby
and
colleagues
in
ncsc
to
to
get
their
their
message
and
a
voice
out
about
the
the
deaf
and
hard
of
hearing
audience.
L
Future
spikes
will
include
long-term
conditions,
learning
disabilities
and
autism,
and
also
an
m55s
group
that
would
particularly
want
to
focus
on,
and
finally,
the
we've
just
launched
the
the
the
annual
statutory
report
we
have
on
controlled
drugs
as
and
say
it's
an
annual
report,
an
update,
secrecy's
oversight
of
the
controlled
drugs
regulation
during
during
this
year
and
last
year.
It
highlights
some
of
the
issues
we
found
through
our
inspection
activities,
but
probably
two
or
three
that
are
particularly
of
interest
providers.
L
There's
a
need
for
providers
to
to
include
control
drugs,
governance,
the
the
audit
checks,
etcetera,
which
were
a
problem
before
code
as
part
of
their
covered
recovery
plans
and
the
degree
to
which
providers
have
got
this
as
a
focus
of
those
plans
is,
I
think,
important.
L
Those
leading
working,
local
health
and
care
systems
need
to
collaborate
to
reduce
the
risk
of
avoiding
harm
associated
with
drugs
control
drugs.
So
to
what
extends
our
health
and
care
staff
working
together
to
make
sure
that
individual
understands
that
that
the
drugs
that
they've
administered,
and
indeed
they
are
complementary
to
each
other,
and
how
linked
to
that?
How
health
and
care
professionals
prioritize
and
personalize
the
patient
care
in
the
context
of
controlled
drugs,
so
how
they
really
understand
the
relationship
one
has
on
the
other
unconscious
time
chair
so
I'll
I'll,
leave
it
there.
A
There's
no
questions.
I
I
just
make
an
observation
from
my
past
experience,
but
I
was
pleased
to
see
that
we
picked
up
on
the
online
safety
bill.
I
think
there
is
a
it
did.
I
know
from
other
quarters
that
these
things
from
a
real
risk
people
don't
naturally
think
about
what
is
or
isn't
regulated
and
to
the
extent
they
think
about
it,
there's
a
presumption
everything
is
and
it's
a
real
risk,
if
that's
a
presumption
and
things
that
aren't
regulated
and
they're,
inappropriate
or
so
easily
available.
A
So
I
think
it
is
an
important
area.
We
may
not
be
responsible
if
I'm
regulated,
but
that
doesn't
mean
to
say
there
won't
be
concerns
if
harm
is
caused.
So
thank
you
for
that
response.
Let's
move
on
our
next
session
is
an
update
on
the
learning
disability
program.
Kate,
tyrone,
I'm
going
to
hand
you
in
a
moment
to
lead
this,
but
we
are
joined
by
debbie
ivanova
from
cqc
who's,
our
director
for
people
with
learned,
disability
and
autistic
people
and
alexis
quinn.
A
F
Happiness,
thank
you
so
much
so.
The
purpose
of
our
discussion
today
is
opportunity
for
us
to
talk
to
board
about
the
progress
we
have
made
in
changing
the
way
we
regulate
services
for
people
with
learning
disabilities
and
autism
following
the
out-of-sight
report
and
the
work
of
of
glynis
murphy.
So
it's
a
chance
for
us
to
show
board
what
we've
been
busily
doing,
but
also
to
invite
board
to
say
what
sounds
good.
What
should
we
be
doing
further
and
faster?
Are
we
on
the
right
track?
F
F
Where
else
might
we,
in
the
health
and
care
landscape
want
to
take
a
similar
approach
to
the
approach
you're
going
to
hear
about
during
this
session
today
and
then,
finally,
we
wouldn't
have
been
able
to
do
what
we've
done
so
far
without
our
expert
advisory
group.
So
we
have
benefited
from
the
start
of
this
program
by
a
having
debbie,
even
over's,
focused
leadership
on
this,
but
also
having
a
group
of
experts.
F
F
I
know
alexis
is
a
mum
she's,
a
teacher
she's,
an
author
she's,
also
someone
who
has
experienced
the
most
unacceptable
types
of
care
and
alexis
will
talk
to
us
a
little
bit
about
that
now
and
then
I'm
gonna
hand
over
to
debbie
even
over,
to
draw
out
some
key
points
on
the
paper
and
then
have
a
discussion
that
says
what
are
your
reflections
on
how
we're
doing
and
where?
Where
might
we
go
next
to
this
work?
So
without
further
ado,
a
very
warm
welcome
alexis.
M
Thank
you
thanks,
kate,
so
I
guess
just
a
recap
for
those
that
that
don't
really
know
me
so
I
was
teaching
back
in
a
grammar
school
in
2013.
I
just
had
a
baby
and
then
my
brother
died.
Really.
All
I
needed
was
some
ot,
maybe
some
psychological
support
to
manage
my
autistic
grief,
but
that
wasn't
available
in
the
community
and
I
was
admitted
to
a
psychiatric
unit
for
a
72-hour
rest
now:
psychiatric
hospitals
and
other
congregate
settings.
M
You
know
exacerbate
for
many
autistic
people
and
people
with
learning
disabilities,
the
more
troubling
features
of
those
conditions.
Most
of
you
will
know
that
autistic
people
thrive.
You
know
on
routine
structure,
predictability
and
so
noisy,
chaotic,
changeable
and
very
sensitively.
Charged
environments
aren't
very
helpful.
M
So
as
soon
as
those
doors
shut,
I
was
overwhelmed
and
this
kind
of
distress
cycle
started.
You
know
where
I
get
essentially
overload,
have
a
meltdown
be
restrained,
be
segregated
and
it
would
just
go
round
and
round
and
round
and
round,
and
it
was
very
difficult
to
stop
so
I
was
routinely
restrained,
injected,
etc
and
subject
to
mechanical
restraint
and
long-term
segregation.
M
Now
in
2016
I
escaped
the
hospital.
After
my
section,
3
had
been
renewed
for
a
further
year.
I
was
about
to
be
transferred
to
a
medium
secure
unit.
Six
weeks
after
my
escape,
I
was
back
working
again
teaching
in
a
prestigious
british
curriculum
school
and
I
now
work
at
the
restraint
reduction
network.
M
I
guess,
and
then
you
started
doing
the
rss
work
and
I
was
I
was
interested
but
skeptical.
You
know,
and
I
don't
have
much
tolerance,
I
guess
for
empty
promises
or
some
sort
of
political
rhetoric.
However,
you
you
guys
have
really
delivered,
you
know
from
the
outset.
You've
listened
to
people,
you've
included
them.
You've,
prioritized
our
voices
and
been
true
to
know
what
what
people
have
told
you.
You
know,
and
you
now
see.
M
I
think
what
what
we're
seeing
and
your
new
inspection
process
is
picking
up
on
the
fact
that
people
might
not,
you
know,
might
have
a
nice
care
plan,
but
actually
none
of
it's
happening.
You
know
or
that
for
17
people
on
the
ward,
everything's
fine,
but
there's
that
one
person
like
I
was
that
was
detained.
M
You
know
in
a
long-term
segregation
who
are
routinely,
you
know
having
their
rights
violated,
sleeping
on
the
floor
on
a
mattress,
and
actually
you
know
you
guys
are
saying
now
that
that's
not
okay
and
you're
not
going
to
rubber
stamp
such
things
as
as
good.
So
I
think
we're
grateful
to
you
for
that.
You
know
I
I
certainly
am
so
you
might
think
you
know
that
kate
and
debbie
maybe
rolled
me
rolled
me
out
today
to
say
what
a
good
good
job
they've
done.
M
But
actually
I
think
if
you
knew
me,
I
wouldn't
do
that.
Not
if
it
wasn't
true
for
me-
and
I
know
a
lot
of
the
families
that
that
we're
connected
to
the
culture
of
the
cqc
has
changed.
You
know.
Families
have
much
more
trust
in
in
the
inspection
process
and
and
believing
that
that
you'll
follow
through
you
know
on
on
getting
safe,
safe,
appropriate
care
for
people.
So
I'm
grateful.
M
You
know
that
your
progress
report,
your
out
of
sight
progress
report,
actually
told
the
truth,
and
that
must
again
you
must
have
been
a
bit
a
bit
of
a
challenge,
and
you
know
we
all
know
that
care
isn't
where
it
needs
to
be,
but
not
many
organizations
are
willing
to
say
that
you
know,
and
it's
us
I
guess
that
suffer
as
a
result
of
that.
So
thank
you.
That's
the
end
of
my
five
minutes.
I
believe
thank
you.
F
Thank
you,
alexis
and
people.
Who've
had
the
pleasure
of
hearing
you
talk
or
read
your
book
know
that
you
tell
it
how
it
is
and
that's
why
we
have
benefited
so
much
by
having
you
around
the
table
stirring
this
with
us.
So
thank
you.
Thank
you
so
much
for
joining
us
alexis
debbie
do
you
want
to
come
in
and
just
draw
a
few
bits
from
the
paper
and
then
we'll
hand
back
to
ian
as
our
chair
to
invite
comment
and
challenge.
N
Yes,
it's
been
a
it's
great
to
have
this
opportunity
today
to
look
at
what
has
been
achieved
and
set
our
priorities
alongside
alexis,
really
powerful
story
and
actually
I'll
spare
alex's
blushes,
but
hearing
her
speak
was
one
of
the
biggest
motivators
for
me
to
get
involved
and
to
lead
this
work
through.
N
It's
also
learning
disability
week,
the
purpose
of
which
is
to
raise
awareness
of
what
it's
like
to
live
with
a
learning
disability.
Hence
my
very
colorful
background,
so
a
great
opportunity
to
have
this
discussion.
I
wanted
to
start
off
really
by
saying
that
leading
this
work
over
the
past
15
months
has
been
an
absolute
privilege
for
me.
It's
shown
us.
N
I
think
what
can
be
done
when
we
focus
in
on
people's
experience
and
look
at
what
does
that
mean
in
terms
of
stretching
our
role
as
a
regulator
recognizing
our
responsibility
to
be
part
of
the
change
that
needs
to
happen.
It's
not
easy
and
when
we're
taking
a
strong
line
in
our
regulation
in
27
of
the
1231
inspections
and
services
for
learning
disabilities
in
the
last
year
did
not
meet
the
regulations
so
had
breaches.
N
40
of
hospitals
inspected.
Have
breaches
alongside
shaping
that
model
of
care
in
our
registration
and
you'll
see
in
the
paper,
the
specialist
registration
team
has
already
had
impact
with
50
applications
withdrawn
before
they
get
to
being
going
into
the
process,
and
we
have
11.
I
think
it's
11
notices
of
proposal
in
process
at
the
moment
to
refuse
to
register
a
service
that
doesn't
need
right
support
right
care,
right
culture.
N
This
inevitably
has
an
impact
on
the
market
and
it's
a
difficult
time.
So
it
isn't
easy.
We've
tried
to
balance
that
with
seeking
to
improve
services,
particularly
through
the
work
on
supported
living,
but
it
has
to
be
the
right
thing
to
do.
We
need
to
be
shaping
the
market
and
we
can't
be
responsible
for
improving
more
mini
institutions
where
people
live
in
large
groups
and
their
needs
are
not
met
where
they're
not
part
of
the
community.
N
N
I
think
we
need
to
keep
up
this
focus.
We
need
to
keep
doing
what
we've
done
this
year
plus
take
a
closer
look
at
health
needs.
Too
many
people
are
still
dying
young
and
with
now
I
see
people
being
brought
into
the
the
leader
work,
so
the
the
looking
at
the
deaths
of
people
with
a
learning
disability
and
autistic
people
that
happen
too
early
looking
at
community
support.
N
How
do
services
offer
the
support
needed
to
stop
people
going
into
hospital,
not
just
the
focus
on
getting
people
out
and
also
getting
our
staff
to
feel
really
confident
on
how
they
can
be
part
of
highlighting
and
reducing
restrictive
practice.
So
we
need
to
keep
up
that
focus.
I
think
kate
already
mentioned.
We
need
to
look
at
how
we
can
use
some
of
this
learning
across
other
groups
of
people
who
draw
on
services
and
then
I
think
the
other
bit
that
needs
to
really
tie
in
is.
N
We
need
to
focus
on
ics's
responsibility
here,
how
they
recognize
plan
and
commission
to
meet
people's
needs.
We
need
to
look
at
this
in
both
our
ics
and
our
local
authority
assessment.
So
that's
kind
of
my
highlights
and
I'm
really
keen
to
hear,
hear
your
views
and
questions.
We've
also
got
rebecca
bowers
here
who
has
been
leading
the
work
on
inspections.
If
there
are
any
questions
around
that
area,.
F
Great,
thank
you
debbie.
So
I'm
back
to
you
pleasing
for
any
comments,
reflections
or
challenge.
A
H
Okay,
hi,
I
read
alex's
your
book
alex,
it
was
fantastic
and
I
read
it
when
kate
recommended
it
many
many
months
ago
in
one
of
your
blogs,
so
I'm
psychic
actually
that's
my
profession,
so
it
gave
me
a
wonderful
insight.
So
thank
you
for
that
and
I
suppose
my
other
two
questions
really
are.
How
can
you
maintain
the
focus
you
know
so
we
keep
it
in
the
public
eye
and
what
areas
do
you
know?
H
I
see
it
naturally
lending
itself
to
sort
of
a
dementia
setting,
or
you
know,
seeing
problems
in
maternity
services
and
with
people
covering
up.
What's
happened
and
there's
been
some
concerns
and
lots
of
reports
about
that.
So
how
do
you
see
it
extending
to
other
services,
mental
health
services
and
also
you
know,
people
with
learning
disabilities-
do
die
much
younger,
as
do
people
with
a
diagnosis
of
schizophrenia.
H
F
I
go
first
and
then
hand
over
to
debbie
find
so
and
belinda
if
we
think
about
how
we
are
how
we've
organized
ourselves
at
the
moment
as
a
as
an
organization.
So
the
fact
we
have
a
director
for
people
with
learning
disabilities
and
autism.
We
have
a
director
for
mental
health.
He
has
a
director
with
a
focus
on
inequalities
and
and
in
integrated
care
systems.
F
So,
as
I
said,
debbie's
leadership
on
this
over
the
last
18
months
has
just
accelerated
what
we
wanted
to
do,
I
think,
keeping
the
heat
and
the
focus
and
the
pressure
on
through
we
had
outside.
We
then,
as
alexa
said,
published
quite
a
hard-hitting
follow-up
report.
That
said
not
enough
progress
that
had
an
impact
on
improving
outcomes
for
people,
so
we
will
continue.
We
will
continue
to
shine
at
a
spotlight
on
this.
We
will
continue
to
inspect
and
close
services.
F
If
they're,
not
good
enough,
we
will
continue
to
stop
new
services
coming
online
if
they're
not
the
model
of
best
best
practice
that
we
expect
to
see.
So
we
aren't
stopping
on
this
agenda.
What
we
desperately
need
to
see
is
we
need
to
see
all
the
other
parts
of
the
system
doing
their
bit
as
well.
So
as
we
called
for
a
long
time
ago,
we
need
that
consistent
crisis
response
in
the
community.
F
That
means
that
alexis
doesn't
go
for
a
72
hour,
say
that
ends
up
being
a
a
years
years,
long
stay
with
horrible
outcomes
for
her.
We
need
that
crisis
response
in
the
community
that
just
holds
the
person
steady
during
a
period
of
crisis,
and
we
haven't
got
that
yet
so
we're
not
going
to
stop
talking
about
this
and
we're
not
going
to
stop
putting
the
pressure
on
as
to
where
we
go
next.
So
your
thinking
is
the
same
as
ours.
F
Dementia
services,
understanding
risk
of
close
culture,
maternity
wars,
mental
health,
long
stay,
hospitals
et
cetera.
There
are
many
other
areas
of
focus
that
I
think
we
we
need
to
give
a
bit
more
consideration
as
to
where
we
go
to
next,
because
it's
a
huge
amount
of
work
to
deliver
what
debbie's
done
and
we
need
to
make
sure
we
are
we're
prioritizing
the
way
that
we
need
to
debbie.
Would
you
is
there
anything
you
would
want
to
add
to
that.
N
I
think
it
just
keeping
up
the
independent
voice,
publications
having
a
having
a
set
of
of
articles,
so
we're
going
to
have
the
one
coming
out
about
acute
hospitals
and
people's
experience
in
acute
hospitals
in
september,
and
then
a
little
bit
later.
There's
going
to
be
a
one
on
how
autistic
people
are
managing
to
access,
gps
and
dentists
and
other
primary
care.
N
We
need
to
just
keep
that
focus
and
keep
looking
at
this
as
a
whole
system-wide
issue
and
keep
keep
the
attention
I
think
on
it,
rather
than
it
being
stories
of
of
the
awful
care
people
are
receiving.
There
will
inevitably
be
those
because
that's
what
is
still
being
found-
and
we
are
still
obviously
finding
those
things
in
hospitals,
but
what
we
also
try
to
do
is
each
time
that
happens
have
a
really
strong
media
statement
around
that,
so
we're
making
clear
this
is
just
not
acceptable.
N
So
the
focus
is
coming
from
from
both
those
ways.
What
what
needs
to
be
done,
but
also
where
care
is
just
not
good
enough.
H
G
Thanks
ian
and
and
firstly,
huge
thanks
to
alexis,
I
found
that
hugely
powerful,
very
moving
actually,
and
I
think
what
you
did
alexis
is
kind
of
prove
to
all
of
us
just
how
important
the
work
is
that
kate
and
debbie
and
all
of
their
colleagues
are
doing
so.
Certainly
from
my
point
of
view,
I
mean
strongly
strongly
supportive
of
the
work
that
kate
and
debbie
and
colleagues
are
doing.
G
The
bit
I'd
quite
like
to
follow
up,
though,
is
is
where
debbie
finished,
which
is
sort
of.
How
would
you
want
the
role
of
ics's
then
to
develop
in
this
space,
because
we're
just
at
a
point
in
time
where
we
can
shape
how
ics's
are
set
up?
We
can
try
to
define
what
what
good
is
and
the
capabilities
that
they
need
in
order
to
feed
into
that
discussion.
N
So
I
think
this
I
think
this
is
where
there
are
some
posts
in
the
legislation
who
are
going
to
be
responsible
for
services
for
people
with
learning
disabilities.
N
But
if
you
think
about
that,
I
think
it's
one
or
two
pose
and
then
there's
all
these
other
priorities.
So
I
think
it's
going
to
be
very
much
about
how
do
we
continue
to
keep
the
focus
that
actually
it's
not
just
about
acute
care?
It's
not
just
about
older
people,
services.
It
is
about
a
whole
range
of
people.
Mental
health
needs
and
and
learning
disability
needs
often
are
the
ones
that
then
just
drop
to
the
bottom.
N
So
it's
going
to
be
about
keeping
the
focus
on
that
and
making
sure
that
people
really
do
understand
what
is
the
needs
across
the
whole
of
their
population?
So
what?
What
is
the
ics
planning
to
do
to
me?
You
need
the
people.
Do
they
know
how
many
people
are
out
of
the
area?
Do
they
know
how
many
people
need
to
come
back?
What's
their
plan
for
actually
the
community
support
the
services,
the
crisis
intervention?
N
What's
the
plan
for
those
local
services
to
actually
meet
that
population's
need,
and
then
I
think,
alongside
that,
what
have
they
learned
from
the
leader
reports?
What
are
they
learning
from
those
action
plans?
Are
they
implementing
them?
Are
they
checking
that
those
are
following
through
looking
at
things
like
annual
health
checks
and
the
gp
services,
not
just
the
numbers,
but
the
quality?
Are
they
looking
at
both
mental
health
and
physical
health?
How
are
they
intervening
early?
A
So
I've
done
it
again.
Thanks
debbie,
I
was
just
saying
I
think
we
probably
have
time
for
three
more
questions
from
sally
mark
and
robert
take
them
in
that
order.
Sally.
J
Thanks
ian
and
thanks
to
alexis,
particularly
for
for
sharing
her
story,
I
live
with
family
members
with
learning
disabilities
and
autism,
and
I
know
how
traumatizing
poor
treatment
can
be,
so
you've
been
very
brave
coming
forward,
and
I
applaud
you
for
that.
J
I
was
trying
to
reconcile
before
today
our
report
from
last
time,
kate
and
debbie,
which
we
spoke
about
in
terms
of
the
the
shocking
nature
of
improvements
that
haven't
yet
taken
place
and
then
today,
which
is
obviously
quite
positive
in
terms
of
cqc,
and
what
alexis
has
to
say
about
our
change
in
culture.
J
My
question
is
about
how
we
hold
other
people
to
account
in
this.
Do
we
have
any
powers
to
do
so,
and
is
there
a
role
for
people
like
alexis
and
other
patients
and
members
of
the
public
to
be
able
to
tell
such
powerful
stories
to
a
wider
range
of
people
than
just
our
board?.
F
Shall
I
start
so
so
we,
and,
as
a
result
of
our
original
out
of
sight
report,
the
department
of
health
and
social
care
set
up
a
group
called
building
the
right
support
chaired
by
the
the
care
minister
and
the
minister
for
mental
health.
So
that
is
the
formal
route
where
all
the
key
stakeholders
who
have
a
role
in
making
this
change,
we're
calling
for
sit
around
the
table,
and
there
is
a
route
for
people
with
lived
experience
with
this
care
and
families
to
influence
that
and
at
each
one
of
these
meetings.
F
Debbie
comes
along
with
our
hard-hitting
stories
from
the
work
that
rebecca
bowers
and
her
team
have
done
to
say
that
we
are
still
not
seeing
improvements
when
it
comes
to
the
quality
of
care.
So
that
is
the
official
forum.
I'm
sorry
that
the
government
has
set
up
in
response
to
our
out
of
sight
report
and-
and
we
will
continue
to
kind
of
challenge
and
play
a
really
key
role
in
that
debbie.
Do
you
want
to
come
in.
N
I
think
just
to
say
that
we
absolutely
know
this
isn't,
isn't
job
done
and
and
now
actually
the
the
report
that
I
that
the
follow-up
report
to
the
out
of
sight
that
we
bought
last
time
actually
so
clearly
shows
that.
But
that
is
part
of
our
way
of
putting
pressure
on
the
system,
putting
pressure
on
people
to
recognize
that
these
changes
need
to
happen
and
certainly
the
building
the
right
support
delivery
board,
which
happened
yesterday.
N
N
Not
so
there's
a
subgroup
of
the
what's
good
looks
like
called
the
called
the
what's
good
looks
like
subgroup,
and
alexis
is
a
member
of
that
group
as
I
am,
and
that
group
is
actually
coming
together
to
to
issue
a
report
fairly
soon,
which
we
don't
want
it
to
be
just
another
report
that
sits
there.
N
But
it
will
actually
indicate
what
all
of
the
all
of
the
organizations
who
are
part
of
the
building
the
right
support
delivery
group
need
to
do
to
change
their
principles,
the
actions
that
they
need
to
do
and
the
way
they
need
to
move
forward
alexis.
I
know
you're
writing
a
a
a
forward
for
that.
I
don't
know
whether
you
want
to
add
anything
about
the
impact
we
hope
that's
going
to
have.
M
I
think
I
think
mostly
my
forward
has
been
very
similar
to
your
out
of
sight,
progress
reporting
that
it
really
is
just
saying
how
things
are
right
now
and
that
we
really
don't
need
any
more
reports
other
than
the
ones
that
I
guess
you're
doing
debbie
to
say
you
know
things
haven't
changed
that
you
know
and
and
that
that
it
needs
to-
and
I
hope
that
we're
not
here
in
ten
years.
A
Thanks
both
mark
saxon.
G
G
I
also
want
to
say
that
the
clintus
murphy
report
had
a
significant
impact
on,
I
believe,
all
board
members
and
a
significant
impact
on
our
organization
and,
but
more
importantly,
is
our
response
to
that
report
that
we
follow
eagerly
here
at
the
board
level.
But
I
have
two
questions
so
thank
you.
Alexis
again,
you
know
really
really
impactful
message
or
talk
from
you.
I
have
two
questions.
I
think
there
to
debbie
so
debbie.
G
I
just
wondered
alongside
the
rejection
or
withdrawal
of
poor
registration
applications
have
we
had
an
increase
in
better
applications
from
more
caring,
safer
services?
N
Thank
you
mark
the
first
question.
I
actually
can't
answer.
I
don't
know
whether
we
have
an
increase
in
applications
for
services
for
people
with
a
learning
disability,
but
what
we
do
have
is
an
increase
in
people
talking
to
us
early,
which
is
what's
really
important,
because
it's
at
that
point
that
we
need
to
be
able
to
shape
the
model
and
that's
not
just
in
adult
social
care.
So
I've
been
having
early
conversations
with
nhs
england
at
the
moment
about
their
plans
for
some
of
the
hospitals.
N
We
do
still
have
a
problem
about
some
of
these
things
can
just
be
built
in
in
already
existing
places
without
us
having
a
say
to
it.
So
there's
still
some
of
those
issues
that
we
need
to
tackle,
but
people
are
beginning
to
understand
that
we
have
a
model
of
care
and
they
are
also
beginning
to
talk
to
us
early
when
they're
beginning
to
plan.
However,
still
too
many
things
are
getting
to
the
stage
of
coming
to
us
that
are
just
not
acceptable.
N
O
Hi
hi
mark.
Yes,
we
in
terms
of
training
and
hello
everyone.
Yes,
we
do
have
a
training
plan
for
our
staff,
that
is
mandatory.
O
O
So
all
our
staff,
we
expect
they're
inspecting
services,
people
learn,
disability
across
the
health
and
social
care
sector
need
to
have
attended
that
training
and
carried
that
out
we're
in
the
process
of
developing
a
second
stage
of
training
with
our
national
expert,
which
will
be
very
much
looking
at
restraint,
seclusion
and
segregation
and
actually
how
to
identify
that,
and
with
that
clear
focus,
as
we've
said,
you
know,
you
said
how
important
glenn's
murphy's
approach-
and
the
report
was
around.
O
You
know,
leading
our
change
and
the
focus
on
observation
that
we've
used
in
our
new
approach
has
been
critical
to
us
understanding
the
culture
of
services
and
so
we're
having
a
massive
focus
on
that
in
terms
of
our
ongoing
development
and
training
for
our
staff.
So
yes,
and
it
will
be
mandatory-
I
hope
that's
helpful.
A
Thank
you
very
much
indeed.
Colleagues,
probably
last
question
robert
francis.
D
Thank
you
ian
and
thank
you
alexis
for,
for
what
you've
told
us
and
everything
you're
clearly
still
doing
for
us,
and
it's
really
arising
out
of
your
story
that
my
question
arises.
I
mean
for
a
long
time
and
it's
not
just
in
in
this
field.
D
I
have
long
held
the
view
that
insufficient
attention
is
paid
to
the
significance
of
individual
stories
such
as
yours,
in
that
we
always
look
at
things
in
a
quantitative
way
and
add
up
numbers,
and
the
numbers
often
conceal
the
real
evil
that
is
being
done
to
some
people,
and
the
question
really
I
have
is:
is
this
that
when
someone
like
you
comes
forward
asking
for
help
with
your
story,
it
seems
to
me
that
there
are
two
immediate
issues.
D
One
is
really
seek
the
core
cqc
business,
which
is
what
are
the
implications
for
the
system
for
the
place
where
the
service
is
being
provided
and
and
so
on.
But
it
seems
to
me
that
what
you
identify-
and
it's
not
just
in
the
field
of
mental
health
services-
is
the
gap
about
how
do
we
then
ensure
that
you,
the
individual
who's,
brought
this
to
light?
D
Who
has
lived
that
experience
is
actually
properly
looked
after
now
and
then
now,
sometimes,
of
course,
the
story
comes
too
late
for
that,
because
we're
talking
about
something,
that's
historical,
but
quite
often
the
story
is
something
that's
about
ongoing
care,
and
at
the
moment
I
mean
we
do,
I'm
sure,
refer
individuals
or
refer
the
story
to
the
provider,
that
someone
is
accountable
with
doing
that.
But
I
just
wonder
whether
there's
a
feeling
that
both
we
and
the
system,
more
generally
could
do
something
more
immediately
to
to
remedy
whatever's
happening
to
the
individual.
F
I
think
any
one
of
us
can
take
if
I
kick
off
and
then
alexis
or
whatever
you
want
to
come
in,
so
so
in
a
situation
that
you've
described
robert.
The
first
question
would
be:
is
this
a
safeguarding
issue
or
a
police
matter?
Does
it
need
to
be
referred
to
a
statutory
organization
that
needs
to
take
specific
action?
If
someone
has
been
abused?
The
other
component
is
that
if
it's
an
individual
complaint,
then
we've
got
our
ombudsman
roots
for
people
to
have
their
their
complaints
addressed.
F
However,
we
want
to
know
everyone's
individual
experiences,
and
I
remember
debbie
saying
to
me
early
on
in
this
process.
She
said
that
he
said
to
me:
if
there's
a
service
providing
outstanding
care
to
19
people,
but
one
person
is
having
their
human
rights
abuse.
How
can
that
be
a
good
service,
and
I
I
think
that
needs
to
be
our.
I
think
that
needs
to
be
our
mantra
if
one
person
is
having
an
experience
like
alexis
did
in
the
service
she
was
at.
That
is
not.
That
is
not
acceptable.
F
That
is
not
a
good
rate
of
service,
so
there
is
a
challenge
we
need
to
give
ourselves
to
say.
Every
individual
voice
is
incredibly
important
and
we
need
to
make
sure
that
yeah
what
one
person's
rights
being
abused
is
enough
to
warrant
us
saying
that
a
service
is
not
meeting
standards.
Debbie,
do
you
or
alexis
want
to
come
in.
N
She
might
have
to
go
because
she's
speaking
at
another
event
afterwards.
I
just
think
robert.
It's
really
important
that
we
keep
a
focus
on
safeguarding
I'm
starting
to
worry
a
little
bit
about
some
of
the
thresholds
of
safeguarding
and
whether
it's
consistently
across
the
whole
country,
whether
it's
applied
consistently
between
different
settings.
Do
we
expect
something
different
in
terms
of
safeguard,
safeguarding
for
somebody
in
hospital
somebody
who's
in
the
care
home,
for
example.
N
So
I
do
think
it's
a
really
important
question
and
whilst
we
we
can
tell
from
the
the
information
that
chris
gave
us
that
more
and
more
people
are
talking
to
us,
I
still
worry
about
the
breadth
of
people
that
are
talking
to
us.
Is
it
the
person
who's
in
seclusion?
Is
it
the
person
who
who
is
detained?
Is
it?
Is
it
the
person
with
dementia
who
is
in
in
in
the
bed
in
the
corner
of
a
large
care
home?
N
Probably
not
so
we
still
have
to
really
kind
of
make
sure
that
we
are
reaching
out
in
as
many
ways
as
we
possibly
can
to
get
information
from
people,
and
I
know
alexis
did
say
to
me
the
other
week
that
she
knows
that
people
are
still
thinking.
I
don't
know
how
to
contact
cpc,
so
we've
still
got
more
work
to
do
so.
N
It's
both
the
response
in
terms
of
safeguarding
the
response
in
terms
of
listening
and
making
sure
that
those
people
are
then
supported
in
that
service,
because,
of
course,
as
alexa
said,
people
knew
she
wanted
to
talk
to
us.
So
they
moved
her
out
of
the
way
when
we
came
in
so
we
we
just
need
to
make
sure
all
of
the
doors
are
open
to
enable
people
to
have
that.
That
say,.
A
Okay,
kate
and
colleagues.
Thank
you,
I
think,
to
add
how
impressive
alexa
says
she
is,
as
you
say,
speaking
at
another
conference
up
in
the
north
of
england,
so
dialed
in
stepped
out
of
that
island
to
join
us
today.
I
I,
I
think
everyone
agreed
very
impressive
session
and
then
credit
to
the
executive
way
that
that
you
know
we
start
with
a
session
someone
telling
us
how
bad
cqc
was,
even
if
that's
offset
by
the
major
changes
that
some
of
the
people
in
this
virtual
room
have
made.
A
I,
I
think
one
of
the
challenges
for
us
and
I'll
just
just
leave
this
rather
than
to
have
another
debate,
but
deb
you
made
the
point
about
shaping
the
market
and
that's
the
debate
we
started
to
have
elsewhere.
I
mean
we
are
providers,
we
aren't
explicitly.
We
have
no
regulatory
powers
to
tell
the
people
exactly
what
to
do,
but
I
think
there's
a
clear
expectation,
we'll
have
a
role
and
how
we
can
do
that.
I
think
is,
is
a
point.
A
We
need
to
debate
right
across
the
piece,
but
certainly
including
this
area
and
I
suppose,
as
a
related
point,
one
of
the
challenges,
I
always
think
with
commentators
on
these.
There
is
an
alexis
said.
The
one
thing
we
don't
want
is
another
report,
but
but
it's
it's
it's
one
thing
to
comment
on
what
is
happening
or
or
not
happening,
and
and
to
continue
to
do
that.
A
But
I
suppose,
if
things
don't
change,
then
the
question
is:
why
not-
and
maybe
it's
related
to
shaping
the
market,
but
I
think
the
challenge
for
us
is
to
advise
others
on
what
policy
interventions
could
be
made.
That
would
make
a
difference
and
it
may
be
a
series
of
them
over
time,
but
it's
very
difficult
to
sit
back,
know
that
you've
got
a
identified,
a
problem
and
then
just
not
see
any
changes.
A
So
I
think
a
thought
for
the
team
and
anything
you
can
bring
back
to
the
board
on
what
adventures
are
needed
and
any
thoughts
on
shaping
the
market.
I
think,
would
be
very
interesting
for
us.
If
I
could
close
the
session
down,
I
mean
just
just
starting
again
with
alexis.
I
mean,
I
think,
it's
a
shame,
she's
gone,
but
I
think
her
story
is
both
shocking
and
inspiring.
A
I
spent
an
hour
with
her
recently
just
to
get
to
know
her
better
and
I
didn't
stop
telling
other
people
about
the
days,
mainly
the
inspiring
bit
rather
than
the
shocking
bit,
but
I
would
like
to
thank
her
we'll
do
that
afterwards,
but
debbie
and
rebecca
thank
you
for
joining
us
and
your
contribution
and
kate
for
leading
that
session
very
good.
Indeed.
So,
thank
you
we're
a
few
minutes
behind
scheduled,
however,
not
too
bad.
A
If
we
could
carry
on
we're
now
having
an
update
from
the
national
guardian,
we're
joined
by
jane
chiggy
car
jane,
I
can
see
you
have
actually
joined
us,
so
perhaps
I
should
just
hand
over
to
you
to
give
your
update.
P
P
I
can't
believe
it's
six
months
since
I
was
here
before
I
don't
know
where
that
time
has
gone
and
on
the
day
after
mid-summer's
day,
so
time
flies
when
when
you're
busy-
and
indeed
it
has
been
a
very
busy
time-
and
I
hope
that
the
report
that
we've
laid
before
you
helps
to
give
some
more
detail
to
just
a
few
opening
remarks
that
I'd
like
to
make
and
then
allow
plenty
of
time
for
discussion,
because
I
feel
that's
where
the
the
the
checking
challenge
and
the
would
be
really
really
helpful
for
me
as
a
national
guardian.
P
So
in
terms
of
just
by
way
of
background,
I
come
to
the
board
on
a
minimum
of
twice
a
year.
As
I
say,
I
came
last
six
months
ago
when
I
was
new
in
post
and
hopefully
the
paper
will
give
you
enough
depth
for
the
moment.
P
But
you
will
soon
be
having
our
annual
report,
which
is
due
to
be
laid
before
parliament
just
before
recess
it's
in
its
final
stages
of
of
formatting
and
sorting,
and
that
will
be
coming
to
the
board
to
supplement
what
you
have
today
in
terms
of
headlines.
I'd
like
to
give
you
the
network
is
ever
growing
a
freedom
to
speak
up
guardians.
P
We
now
have
over
850
guardians,
it's
increased
from
when
the
paper
for
you
was
written
in
in
over
hundreds
of
organizations,
and
we
have
a
a
steady
rise
in
cases
reported
to
guardians.
Since
the
outset
of
the
national
guardians
office,
we
now
have
over
70
000
cases
that
have
been
raised
to
guardians
which
might
not
have
been
raised
within
their
organizations
had
the
valuable
additional
route
of
speaking
up
not
been
present.
P
I
am
very
aware
that
the
guardian
route,
as
set
out
by
sir
robert
in
the
francis
report,
is
an
additional
route
from
existing
hr
direct
line
management,
other
routes
of
speaking
up
within
an
organization,
and
they
are
all
vital.
The
freedom
to
speak
up
guardian
isn't
a
panacea
for
sorting
the
rest,
but
it
is
an
important
additional
route
and
those
cases
continue
to
grow.
P
What
we
do
see,
though,
which
is
a
real
worry,
is
a
steady
increase
in
the
proportion
of
cases.
Where
detriment
is
indicated.
It
is
not
huge,
but
it
for
those
people
who
are
speaking
up
and
then
suffer
detriment.
It
is,
it
is
absolutely
can
be
life-changing,
and
so
that's
a
very
worrying
sign
and
I'll
talk
some
more
about
that.
In
a
moment,
if
you'd
like
me
to
the
implementation
of
the
guardian
role
in
itself
is,
is,
is
work
in
progress
and
what
we
see
is
variation
in
how
the
role
is
implemented.
P
Clearly,
individual
organizations
will
have
their
own
take
on
how
they
want
the
role
to
work
for
them,
but
what
we
do
see
in
our
recent
survey
that
there's
a
link
in
the
report,
for
you
too,
shows
that
some
guardians
still
do
not
have
protected
time
to
carry
out
the
role.
It
is
a
busy
role,
both
case
handling
and
the
proactive
work,
and
if
guardians
aren't
given
protected
time
in
order
to
do
that,
then
that
may
have
implication
implications
for
how
they
can
fulfill
that
role
in
a
meaningful
and
impactful
way
for
the
organization.
P
What
that
also
says
to
me
is
the
importance
of
the
cqc's
role
in
inspection
of
the
well-led
domain,
and
particularly
when
it
comes
to
speak
up
culture,
which
is
obviously
the
freedom
to
speak
up
guardian
role.
Implementation
is
part
of
that
and
my
team
work
really
closely
with
your
teams
on
that,
and
I'm
really
really
pleased
about
that
and
I'll
continue
to
emphasize
the
importance
of
that
work,
because
without
that
regulatory
support
for
the
implementation
of
changes
to
culture
and
organizations
we're
not
going
to
get
to
where
we
want
to
be.
P
The
report
talks
about
lets.
You
know
about
the
new
training
that
we've
produced
last
month,
which
I
think
is
two
months
ago
now
on
the
fourth,
the
final
follow-up
with
health
in
england
for
leaders
and
my
ask
of
you
today,
as
a
board,
is
to
commit
to
undertaking
that
short,
sharp
piece
of
e-learning
training.
In
order
to
then
have
the
conversation
as
a
board
around
for
your
own
organization.
P
You
know
for
us
and
cqc
how
speaking
up
is
going
for,
for
you
both
for
internal
staff
and
obviously
the
speaking
up
arrangements
externally,
and
I
think
it's
a
really
good
time
that
that
training
is
here,
because
I'm
told
that
by
the
end
of
this
month,
nhs
england
will
be
launching
their
new
policy
on
speak
up
the
universal
policy,
which
will
speak
to
all
organizations
with
nhs
contracts.
That's
including
primary
medical
services,
that's
including
obviously,
the
trusts
and
and
and
wider,
and
what's
really
important-
that
will
also
apply
to
national
bodies.
P
So
I
would
urge
you
to
use
that
as
a
reset
opportunity
for
your
own
speaking
up
arrangements
alongside
that
guidance
and
obviously
delighted
to
speak
with
you
about
that
final
things.
I
want
to
just
talk
to
you
about
is
a
technical
issue
and
that's
to
let
you
know
about
a
change
to
our
complaints,
progress
process.
P
So,
historically,
the
way
the
ngo
was
set
up.
Complaints
were
about
the
office
itself
and
the
way
we
conduct
our
business
were
handled
by
nhs
england,
an
improvement
that
now
has
been
taken
in-house
to
cqc,
as
indeed
we
work
and
we
are
cqc
employers
and
ian
is
our
accounting
officer.
So
the
complaints
process
from
the
first
of
april
is
now
sitting
within
cqc.
So
it's
a
technical
change,
but
it's
an
important
change
to
a
previous
process.
P
I
think
I'd
like
to
just
let
you
know
that
there
hasn't
been
progress,
which
is
highlighted
in
the
report
on
the
adult
social
care
white
paper,
commitment
to
working
with
the
ngo,
with
the
department
of
adult
social
care,
working
with
the
ngo
to
see
how
the
freedom
speak
up
role
can
be
implemented
in
adult
social
care.
P
Unfortunately,
due
to
some
technical
issues,
around
funding,
release
and
vehicles
for
funding
that
work
hasn't
been
able
to
start
yet
because
department
of
health
and
social
care
haven't
been
able
to
tell
us
how
and
when
the
funding
will
be,
but
I
know
they're
working
on
it.
So
that's
why?
If
you're
wondering
why
I
don't
have
a
progress
report
on
that
really
important
piece
of
work-
and
I
know
kate,
tyrone
and
colleagues
are
very,
very
keen
to
see
how
that
work
emerges
to
give
that
important
speak
up
route
to
adult
social
care.
P
A
Thank
you
jane,
take
questions
from
I
was
gonna,
say
anyone
asked
mark.
I
see,
you've
got
a
question
there,
but
perhaps
mark
well,
let's
speak
to
mark
first
but
robert.
It
might
be
useful
to
have
any
observations
you
have
given
your
your
links,
obviously
to
this
function
and
the
the
I
suppose,
the
worrying
statistics
that
we
see
about
a
things
moving
in
the
wrong
direction,
any
observations
from
you
or
on
that
and
indeed
from
anyone
why
we
think
that
is
happening
but
mark.
G
Chairman
and
thank
you
jane
can
I
say.
Firstly,
I
really
like
your
heavy
branding
behind
you
as
you're
talking
to
us.
I
think
that
looks
really
great
and
it's
a
super
report
I
did
go
into.
The
annual
report
speak
up
report
and
notice
that
the
last
year,
the
speak
up,
was
very
heavily
impacted
by
covid
and
a
great
increase
in
questions
arising
out
of
covid
to
the
speak
up
guardians.
G
I
just
wonder
how
you
see
that
reshaping
as
we
go
forward,
because
I
noted
that,
for
instance,
cases
dealing
with
bullying
and
patient
safety
decreased
in
that
year
of
the
speak
up
guardian
report,
and
I
just
wonder
whether
you
think
there's
going
to
be
a
reshaping
going
forward
in
terms
of
the
cases
that
your
very
very
good
system
picks
up
and
deals
with.
P
Thank
you
mark.
I
think
that's
a
a
really
interesting
and
important
question.
I
mean
it's
it's
you
know.
We
don't
know
what
cases
are
going
to
come,
what
it's
going
to
look
like
until
we
see
it.
I
think,
personally
speaking
to
guardians
when
I
visit
their
network
meetings
and
when
I'm
out
and
about,
I
think,
obviously,
items
related
to
covert,
for
example,
ppe
and
things
like
that.
That
is
all
abated,
so
we
will
see
a
shift
in
those
particularly
covered
related
worker
safety
issues
that
were
being
raised.
P
P
Sadly,
I
don't
think
I'm
hearing
that
there's
going
to
be
a
great
change
at
the
moment
in
the
amount
of
cases
around
bullying
and
harassment,
and
also
we've
changed
our
our
coding
to
actually
capture
if
it's
not
full
bullying,
but
it
is
behavioral
if
it's
civility
and
respect
and
we're
trying
to
capture
that,
because
those
are
important
issues
that
workers
are
bringing
up
to
their
freedom
to
speak
up
guardians
as
well,
and
I'm
not
sure
whether
that
is
still
the
impact
of
cobit.
P
I
think
people
have
changed
generally
society,
I
see
in
terms
of
social
media
and
and
interactions
with
people
in
terms
of
what
impact
negative
impact
that
might
have
had
on
on
wider
behaviors,
and
maybe
that
is
still
being
reflected
in
the
workplace
in
terms
of
our
health
and
and
social
care
workplaces.
P
D
Ian,
would
you
like
me
to
train
us?
Okay,
sorry,.
D
Oh,
thank
you.
Well,
I
think
firstly,
jane
and
her
office
are
doing
fabulous
work,
but
I
think
we
need
to
remember
that
the
the
freedom
to
speak
up
agenda,
and
indeed
my
report,
which
was
now
quite
a
long
time
ago,
is
not
just
about
the
freedom
to
speak
up
national
guardian.
That
was
but
one
of
20
recommendations.
D
The
reality
of
freedom
speak
up
and
what
needs
to
be
done
about
it
is
that
it
is
everyone's
business.
It
is
a
cross-cutting
agenda.
It
particularly
needs
the
right
sort
of
leadership,
cultural
leadership,
and
we
had
a
bit
of
a
discussion
about
that
earlier.
But
if
you're
looking
for
one
barometer
of
how
effective
leadership
is,
then
look
at
their
freedom
to
speak
up.
Figures
in
their
staff
survey
would
be
the
start
of
the
for
ten.
D
D
The
pressures
from
the
top
four
results,
but
above
all,
as
jaina's,
has
alluded
to
the
workforce
shortages,
which
mean
that
people
who
are
have
things
to
speak
up
about
are
quite
increasingly
pressured
not
to
do
so
for
entirely
the
wrong
reasons
that
people
who
are
short
of
time
short
of
resource
and
want
to
get
a
job
done
whatever
that
job
might
be,
don't
resent
being
told
that
something
is
being
done,
which
is
wrong
when,
of
course
they
should
good
leaders
would
accept
and
welcome
that
this
is,
of
course,
not
a
problem.
D
D
So
I
think
our
role,
if
I
may
put
it
this
way
broadly-
and
I
know
we
do
this-
is
that
wherever
we
go
out
wherever
we
go
and
inspect
anywhere,
we
should
be
looking
at
the
freedom
to
speak
up
culture
there
and
not
just
about
concerns,
but
how
free
people
are
to
contribute
towards
the
improvement
of
their
organizations.
Organizations
where
that
is
done,
where
there
is
a
tradition
of
civility
of
listening
to
people
and
acting
on
what
they
say,
probably
never
need
a
freedom
to
speak
up
guardian.
D
To
be
honest,
and
I,
but
I
mean
there
is
a
long
way
to
go,
and
this
is
a
boulder
that
will
continue
to
have
to
be
pushed
uphill
long
after
jane
and
I
have
have
left
the
scene,
I'm
afraid.
But
there
we
go.
A
You
have
to
challenge
there
for
what
we
should
be
looking
at
in
inspections.
Robert,
maybe
leave
that
on
the
table
for
a
moment
just
go
to
mark
your
question.
Q
Thank
you,
jane
and
and
for
all
the
reasons
that
we
heard
about
you
know
your
work
is
more
important
than
than
than
ever.
You
know
I
was
going
to
sort
of
echo
robert's
point
that
you
know
the
problems
are
not
related
to
the
health
service
and
there's
some.
You
know.
One
of
the
things
I
wanted
I
wanted
to
commend
you
for
is
your.
You
know
your
focus
on
the
you
know.
Q
One
of
the
barriers
to
speaking
up,
which
is
fear
futility,
is
the
other
one,
but
that's
relatively
easy
to
deal
with,
but
fear
is
the
big
problem,
and
safety
in
speaking
up
is
quite
an
intangible
thing
to
measure
at
times.
You
know
there
are
some
good
measures
around
the
you
know.
You
want
the
proportion
of
people
speaking
up,
who
feel
the
need
to
remain
anonymous
to
fall
so
that
people
are
more
more
open,
but
it
is
a
really
big
problem
out
there
wearing
another
hat.
Q
We
we
did
a
survey
across
10
000
corporate
employees
across
across
europe.
The
end
of
last
year
and
43
of
people
who
had
spoken
up
said
that
they
had
experienced
retaliation.
I
mean
that's
a
just
a
shocking
statistic
and
those
people
will
will
be
advocates
against
speaking
up
in
the
organization,
so
you're
you're
really
right
to
focus
on
on
this
and
one
of
the
things
I
would
commend
your
office
on
for
what
you
do.
Q
You
know
your
pansex,
your
your
efforts
to
learn
and
capture
best
practice
from
other
sectors
and
this
pan
sector
network
that
you
run,
I
think,
is
a
best
practice
and
I
would
commend
you
for
that.
A
Thanks
yeah.
P
P
In
my
encouragement
when
I
go
and
work
with
organizations
and
talk
with
boards,
the
national
new
national
guidance
to
come
reflects
that,
and
obviously
we're
working
really
hard
with
yourselves
to
make
sure
that
inspection
through
the
regulatory
framework
addresses
that
as
well,
because
it's
it,
and
indeed
you
know
general
support.
Messenger's
recent
publication
of
his
review
makes
reference
to
the
fact
that
sometimes
speak-up
culture
can
be
seen
through
a
very
narrow
lens
and
was
encouraging
us
to
make
sure
that
we
widen
it.
P
So
thank
you
for
your
ongoing
support
and
I
look
forward
to
obviously
presenting
our
annual
report
to
you
outside.
It
will
be
between
the
next
meetings
and,
if
you
have
any
questions,
comments
want
me
to
come
back
earlier
than
six
months.
Please
just
ask
and
yeah.
Thank
you
very
much.
A
B
Well
again
again,
I
think
it's
it's
a
it's
something
that
we
need.
We
are
already
doing
a
lot
of
work
in
terms
of
of
looking
at
cases.
I
suppose,
probably
the
only
area
that
I
would
gently
disagree
with
robert
on
was,
I
think
he
made
a
reference
to
counting
numbers
or
which
may
not
be
may
not
have
been
the
the
thing
he
said,
but
I
think
we
do
look
at
individual
cases.
Otherwise
we
don't
investigate.
Then
we
do
look.
B
We
do
we
do
look
and
say
is
an
individual
case,
particularly
important,
and
if
it,
if
it
is,
that,
may
very
well
trigger
an
inspection
and
and
a
deep
examination
of
something.
So
so
I
think
we
don't
just
count
the
numbers
in
in
this
area
and
I
think
really
it's
a
question
of
of
keeping
at
it.
Really.
B
I
think
that,
as
robert
reilly
said,
this
is
this
is
something
which
is
on
people's
agenda,
but
I'm
not
sure
it's
there
yet
and
and
how
we
broaden
it
out
and
how
we
scale
it
generally,
one
or
two
conversations
around
how
to
scale
this,
the
the
influence
of
ngo,
which
is
which,
which
may
be
something
short
of
more
guardian.
So
I
think
a
number
of
things
really.
A
Thanks
very
much
so
jane.
Thank
you
very
much
indeed
for
joining
us.
Thank
you
for
your
report
and
well
done,
even
though
some
of
the
the
conclusions
are
a
bit
depressing.
I
think
one
point
coming
out
from
what
mark
said,
though,
is
that
it
would
be
wrong
to
think
that
this
is
solely
a
problem
for
the
health
system.
To
some
extent,
it
is
a
societal
problem
that
doesn't
give
any
excuses.
A
P
A
Right,
robert
last
formal
item
on
the
agenda
is
your
update
on
healthwatch
england.
I
think
we're
being
joined
or
are
joined
by
louise
ansari.
So
can
I
just
have
to.
D
Sit
over
to
you.
Thank
you.
Actually,
we're
we're
not,
and
louise
I'm
afraid
has
had
to
present
her
apologies
owing
to
an
unavoidable
diary
clash
with
some
a
legacy
obligation
in
relation
to
her
previous
job.
But
she
assures
me
she
will
be
present
for
future
reports,
so
stepping
bravely
off
the
bench
is
chris
mccann
to
to
to
be
the
new
louise,
at
least
for
this
meeting
so
I'll
just
hand
over
to
him.
R
As
I
said
so,
as
robert
said,
I'm
stabbing
in
for
louise
today
for
those
of
you
who
don't
know
me,
I
chris
mccann,
I
am
the
director
of
communications
and
say
campaigns
at
healthwatch
england,
effectively,
I'm
louise's
deputy,
so
hopefully
you've
all
had
the
chance
to
read
the
report
that
was
sent,
and
I
think
it
does
give
an
outline
of
an
organization
that
that's
really
sort
of
delivering
a
pace.
At
the
moment.
I
think
louise's
note
at
the
top
of
the
report.
R
Captures
captures
it
well
just
in
terms
of
sort
of
the
range
of
activity
that
we've
been
doing
around.
You
know
creating
impact
on
policy
and
practice,
highlighting
the
key
issues
that
patients
and
people
are
experiencing
and
healthcare
and
coming
to
us
with.
So
we've
continued
to
have
a
major
impact
in
the
media,
particularly
around
issues
like
nhs
dentistry,
which
is
an
area
where
the
amount
of
feedback
that
we
are
receiving
has
expanded
almost
exponentially
pre-pandemic.
R
It
was
about
five
percent
of
what
we
heard
and
though
it's
regularly
pushing
up
around
22
to
25
percent
of
what
we
hear
and
it's
gone
from
being
sort
of
relatively
mixed
to
almost
overwhelmingly
negative.
We
launched
our
campaign
on
accessible
information
which,
in
the
initial
phase,
had
a
focus
on
people
with
sensory
impairments,
and
that
was
an
opportunity
to
influence
the
accessible
information
standard
which
is
mandated
within
in
the
nhs
and
we're
moving
on
to
focus
on
accessible
information,
specifically
around
people
who
don't
speak
english.
R
We
had
the
opportunity
to
engage
deeply
in
the
and
the
form
and
the
delivery
of
the
full
review
of
primary
care.
We
sat
on
the
expert
reference
group
on
that
and
we're
very
pleased
to
see
some
of
the
areas
that
we
pushed
over
pushed
on
around
community
of
care
and
the
benefit
of
neighborhood
care
teams
being
reflected
in
the
in
the
final
output
of
dr
fuller's
report.
R
We
continue
to
engage
with
local
healthwatch
to
make
sure
that
they
are
able
to
develop
with
the
integrated
care
systems,
which
you
know.
We
know
we'll
be
going
live
officially
from
july
1st
and
we
can
also
continue
to
roll
out
a
comprehensive
training
offer
to
the
local
health
watch
network
to
try
and
ensure
that
we're
providing
with
them
with
them,
with
as
much
capability
and
capacity
to
deliver
for
the
populations
of
their
local
areas.
R
More
internally
focused
we've
had
a
a
complete
review
of
our
finance
and
procurement
processes
to
make
sure
that
we're
properly
aligned
with
cqc
systems
and
reporting-
and
I
would
like
to
to
highlight
the
the
really
impressive
way
that
the
cqc,
finance
and
procurement
teams
have
have
have
helped
us
to
develop
that
particularly
ryan
mills,
who's,
our
finance
business
partner
and
ben
groves,
the
management
department
and
so
we've
developed,
more
aligned
processes
and
we've
also
developed
new
processes
for
our
dispersal
of
income
to
local
health
watch.
R
And
then
I
suppose
it
would
be
remiss
of
me
not
to
mention
the
fact
that
in
april
we
had
the
announcement
that
our
august
chair,
sir
robert,
will
be
stepping
down
from
the
role
in
november
2022
and
just
to
reflect
on
the
the
high
impact
that
robert
has
had
as
chair
and
how
he
has
played
a
real
role
in
developing
and
improving
health
watch
england
as
an
organization
improving
our
profile
and
improving
how
we
operate
generally.
So
I'm
happy
to
take
any
questions.
I
write
the
report.
A
Okay,
thanks
very
much
today,
chris,
the
message
that
you
are
playing
louise
today
haven't
reached
me,
but
welcome
any
there's,
no
questions
in
the
box
at
the
moment.
Let's
just
quick
up
with
one
for
me,
the
report
did
in
relation
to
wakandan,
say
that
will
be
undertaking
work
on
maternity
services
and
see
how
evidence
can
support
the
review.
Can
you
just
say
a
little
bit
more
about
what
that
will
mean
in
practice.
R
Well,
at
the
minute,
we're
still
we're
still
scoping
that
work,
so
it's
very
early
stages.
So
what
we'll
do
initially
is
have
a
look
at
do
a
bit
of
an
evidence
review
of
what
we
already
have
on
the
books
and
then
we
will
go
out
to
local
healthwatch
to
try
and
understand
what
they're
hearing
about
it.
Once
we
have
an
understanding
of
sort
of
that
sort
of
background
level
of
knowledge
we
we
will
we'll,
then
sort
of
tailor
our
approach
and
see
if
we
do
some
sort
of
bespoke
engagement
on
it.
A
J
Thanks
ian
and
thanks
chris
and
louise
in
her
absence,
I
am
it's
obvious
that
you're
doing
sterling
work
across
a
whole
number
of
fronts
and
the
length
of
the
report
shows
that
I
just
had
a
question
about
risk,
because
when
you
and
louise
came
to
audit
committee,
you
talked
about
funding
for
healthwatch
and
robert
might
want
to
comment
as
well.
J
But
I
noted
on
the
report
that
you're
now
operating
at
about
around
terms
50
of
the
funding
compared
to
the
level
when
healthwatch
started,
and
that
feels
like
a
significant
risk
and
a
potential
problem,
and
I
just
wanted
to
flag
that
again
because
we've
talked
about
it
at
audit
committee.
But
we
haven't
necessarily
talked
about
it
here.
So
any
comments
that
you
have,
I
think,
would
be
helpful.
R
That
issue
around
funding,
not
just
for
healthwatch
england,
but
more
broadly,
for
for
the
for
local
healthwatch,
is
something
that
that
we
do
are
very
attuned
to
so,
and
the
network
in
particular.
We
know
that
there
are
some
healthwatch
who
are
operating
on
on
very
limited
budgets
and
we
continually
sort
of
monitor
to
see
where
those
issues
might
arise,
and
we
make
interventions
with
the
commissioners
to
try
and
see
what
we
can
do
to
mitigate
that
we're.
R
We
are
continuing
our
conversations
with
with
dh
about
you
know
how
we
can
better
get
the
impact
of
of
the
of
the
reduction
in
funding,
whether
it
might
be
something
we
can
do
in
terms
of
how
the
mechanism
of
how
of
how
the
funding
is
delivered
to
local
health
watch,
in
particular
just
to
create
a
bit
more
transparency,
and
we
also
do
look
at
opportunities
to
bring
in
income
from
external
partners
to
work
with
local
help
flash
to
to
help
with
their
what
their
budgetary
pressures.
R
But
I
think,
as
robert
will
confirm,
it
does
sit
right
at
the
very
top
of
our
risk
register.
And
you
know
it's
something
that
we
do
put
a
lot
of
thought
into
and
do
do
a
lot
of
work
behind
the
scenes
to
try
and
mitigate
those
impacts.
D
Sorry
could
I
just
come
in
on
this
funding
point.
It
is
a
matter
of
considerable
concern
and
a
risk
in
particularly
in
relation
to
the
network.
There
are
some
parts
of
the
country
where
you
wonder
how
they
managed
to
do
any
work
at
all.
If
I
can
give
you
one
example-
and
I
won't
name
the
part
of
the
country,
but
there
is
a
pro
one.
D
We
are
doing
our
best
to
persuade
the
local
authority
to
change
its
mind,
but
what
we're
told
is
what
they
receive
is
a
matter
for
them
to
allocate
anything
that
the
department
of
health
says
is
but
guidance,
and
they
have
a
number
of
other
priorities
which
of
course,
we
all
understand,
but
I
personally
fail
to
understand
how
any
health
watch
living
in
a
big
city
environment
can
actually
do
anything
effective
at
all
at
that
level,
and
that's
not.
D
That
is
probably
the
worst
example,
I'm
aware
of
at
the
moment,
but
there
are
many
others,
and
it
is
an
area
of
significant
concern
to
me,
as
I
indicated
in
my
letter,
notifying
my
retirement,
and
I
think
it's.
G
More
questions
mark
thanks
them.
Thank
you,
chairman.
Chris
thanks
very
much
for
coming
in
and
briefing
us
on
on
this
report.
It's
as
always
with
healthwatch.
It
seems
to
me
you
go
where
the
challenges
are
so
to
hear
about
access,
elective
recovery,
access
to
dentistry,
gp
access,
digital
healthcare.
These
these
are
great
reports
to
have
just
a
couple
of
comments.
G
If
I
may
one
when
you
say
that
the
largely
negative
feedback
that
that
you're
hearing-
and
this
has
a
big
impact
on
staff
on
the
front
line-
and
so
I
really
hope
that
providers
are
listening
to
that
feedback
from
you,
because
they
need
to
support
their
members
of
staff
on
the
front
line
and
help
to
build
morale.
G
So
I
think
that's
really
important,
because
the
other
point
I
would
like
to
make
there's
a
heavy
emphasis
on
accessibility.
Be
it
the
information
standard,
be
it
access
to
dentists
or
gp
access.
Can
I
make
another
plea?
One
of
your
great
reports
in
the
past
was
on
patient
transport
and
access
to
treatment
and
patient
transport.
G
It
was
an
incredibly
powerful
report
and
actually
got
ministerial
action,
and
I
think
you
know
when
we're
talking
about
elective
recovery
and
people
coming
back
to
the
system
is
how
they
get
to
the
system,
and
you
know
I've
just
asked
whether
we're
going
to
do
another
report
on
that
on
the
transport
challenges
which,
when
you
read
some
of
those
stories
in
that
report,
it
was,
it
was
really
really
challenging
to
read.
So
I
just
hope
that
we,
you
know
you
can
well
that's
in
the
plan
for
another
future
review.
R
We
don't
currently
have
a
plan
for
after
a
flagship
report
on
that
non-emergency
train
patient
transport
issue,
but
we
do
continue
to
to
engage
with
that
with
key
stakeholders
on
an
ongoing
basis.
Like
a
lot
of
the
insight
that
we
based
that
2019
report
on,
is
still
valid,
and
we
know
that
issues
around
about
patient
transport
were
something
that
was
a
big
issue
during
the
pandemic
and
continues
to
be
so.
R
So,
although
you
might
see
a
flagship
report
like
the
2019
report
around
it,
we
you
will
continue
to
see
interventions
with
us
on
the
issue
and
we
do
continue
to
press
the
case
behind
the
scene
on
non-emergency,
patient
transport.
A
L
Just
say
chris
thanks
for
a
great
report.
I
just
wanted
to
press
that
point
about
the
partnership
work.
I
think
healthwatch
has
been
a
really
strong
partner
for
us
in
our
everything
from
legitimacy
care,
maternity
services,
ics
and
local
authority
dentistry,
and
particularly
as
we
move
to
state
of
care,
the
work
will
be
involved
in
the
5
000
voices,
where
chris's
team
are
providing
case
for
the
evidence
of
how
people
experience
care
across
a
pathway.
L
I
think
that'd
be
very
good
back
to
our
early
conversation
and
the
point
you
made
robert
about
this
is
it's
important
to
talk
about
the
people's
experience
care,
not
just
a
series
of
numbers.
I
think
that'll
be
quite
useful
and
powerful
in
this
year's
state
of
care,
so
just
to
thanks
to
you
and
the
team
chris
for
that
support.
R
A
All
right
well,
thank
you
very
much
indeed,
everyone
chris
any
thanks
for
standing
in
for
louise,
don't
take
it
the
wrong
way.
We
look
forward
to
seeing
her
next
time.
Thank
you.
Coming
this
time,
I.
A
And
thanks
for
the
great
work
you
know
the
report.
We
also
note
the
for
funding
difficulties,
so
there
will
no
doubt
one
way
or
another
be
a
resolution
of
that.
But
thank
you
for
the
update.
We
know
that
we'll
close
the
that
session.
A
That
brings
us
to
the
end
of
the
obviously
into
the
form
of
business.
Can
I
check
with
colleagues
whether
there
is
any
other
business
points
people
want
to
raise.
A
It
doesn't
look
like
it,
so
I
think
that's
the
end
of
the
agenda,
just
two
other
things.
So
what
are
the
subject
heading?
We
do,
as
you
know,
and
I'm
addressing
this
comment
particularly
to
members
of
the
public
disney,
but
we
do
provide
the
opportunity
for
members
of
the
public
to
pose
questions
to
be
addressed
by
the
board.
We
do
have
a
couple
again
from
robin
pike,
I'll
take
them
individually.
A
B
Thanks
thanks
ian,
and
thank
you
robin
for
the
the
question
just
a
couple
of
things
to
say
there
really,
there
is
published
guidance
on
the
nhs
in
england
and
improvement
website
entitled
visiting
healthcare
in
inpatient
settings
that
was
published
on
the
8th
of
march.
I
think
the
latest
version
is
version
four.
It
sets
out
the
principles
that
hospitals
need
to
follow
and
that
there
are.
There
are
four
key
points
to
that
guidance
providers
are
expected
to
facilitate
visits
in
a
risk
managed
way.
B
They
should
be
enabled
to
be
there,
and
there
are
also
recent
government
recommendations
published
on
the
14th
of
april
this
year
that
visitors
to
hospitals
should
continue
to
wear
a
face
covering
and
it's
I
know
robin
also
went
on
to
ask.
How
are
we
ensuring
the
hospitals
are
adhering
to
this
to
these
guidelines
and
recommendations,
and
the
guidance
and
recommendations
have
been
updated
in
our
inspection
framework
for
acute
core
services,
which
means
when
we
go
and
look
at
acute
core
services?
We
take
these
guidance,
these
guidelines
into
consideration.
B
B
We
do
have
concerns
these
are
follow-up
by
the
followed
up
by
the
local
team,
conducting
the
inspection
and
additionally,
our
national
center
has
been
coding
inquiries
by
sectors
when
contacts
are
around
visiting
issues
and
you'll
have
heard
kate
tyrone
talk
about
this
in
relation
to
adult
social
care
sector,
but
this
we're
talking
here
about
hospitals
in
particular
and
other
nhs
settings,
and
between
march
and
may
there
are
122
visiting,
frequently
asked
question
inquiries
of
which
seven
related
to
hospitals,
so
the
majority
related
to
non-hospital
settings.
B
This
information
is
always
passed
to
the
local
team,
contributing
to
the
wider
ongoing
view
of
quality
and
safety
of
provision.
So
I
robin
you
can
see
that
it
is
something
that
that
we
that
we
do
continue
to
take
seriously
and
it
links
back
to
the
guidance
that
nhs
england
produced
on
a
national
national
level.
Thank
you.
A
Thanks
very
much
for
your
comprehensive
response
and
then
the
other
question
I'll
take
in
the
first
instance,
but
might
ask
chris
day
to
add
the
question
said:
if
the
commission
decides
to
reduce
the
number
of
its
public
board
meetings
to
six
a
year,
will
it
conduct
some
of
its
strategic
meetings
in
public
as
to
parliamentary
committees?
A
It's
probably
worth
clarifying
a
number
of
things
implied
in
that
question,
so
we
have
made
the
decision
to
reduce
the
number
of
meetings
to
be
quite
clear,
though
we're
not
reducing
public
meetings
at
the
expense
of
others,
like
I
think
most,
if
not
all
arms
length
bodies,
we
hold
board
meetings,
part
in
public
and
part
and
private
under
reduction,
applies
to
board
meetings
in
total,
so
there'll
be
a
similar
reduction
in
public
and
private.
A
As
I
said
previously,
that
was
a
recommendation
from
the
board
effectiveness
review,
which
is
something
we
decided
to
accept,
but
I
think
importantly,
it
does
bring
us
very
much
in
line
with
all
the
other
albs
that
we've
looked
at.
I
think
the
vast
majority
have
six
meetings
a
year,
some
maybe
one
less
five
for
example.
A
So
I
think
this
is
just
good
practice
that
allows
us
time
to
do
things
between
meetings,
which
currently,
I
think,
becomes
a
little
bit
difficult,
we're
planning
for
one
meeting
as
soon
as
we
finish
the
previous
one,
which
is
not
effective.
A
A
So
I
think
that
the
comparison
is
not
quite
right,
but
we
therefore
we're
not
proposing
to
the
extent
we
have
private
meetings
to
in
some
way
open
those
up,
but
I
do
want
to
assure
you
that
we're
not
in
any
way
attempting
to
reduce
the
amount
of
of
what
goes
into
the
public
domain.
A
So
we
have,
as
part
and
parcel
of
this,
also
been
looking
at
how
transparent
we
are
as
an
organization
to
make
sure
that
we
are
putting
as
much
on
the
public
domain
on
a
timely
basis
as
we
can
and
chris
you've
been
looking
at
this.
So
perhaps
I'd
ask
you
to
add
a
couple
of
words.
Sure
thank
you.
Thank
you.
Ian.
L
L
The
first
one
mentioned
today
was
which
is
the
external
studio
advisory
group,
which
meets
every
six
to
eight
weeks,
and
it
looks
at
some
of
the
issues
that
cqc
is
seeking
to
drive
on
both
in
terms
of
policy
in
terms
of
what
it
does,
but
also
how
it
improves
care
in
health
and
social
care,
and
we
bring
together
the
voice
of
people,
you
services
and
the
voices
of
providers
in
in
those
discussions,
and
I
think
that
they're
very
fruitful,
but
we
also
cc
uses
a
wide
range
of
methods
to
engage
people
to
build
what
we
feel
a
constructive,
two-way
dialogue.
L
So
people
use
services
and
organizations.
So
last
year
we
engaged
just
over
27
and
a
half
thousand
people
in
co-production
activities,
and
so
far
this
year
we've
engaged
fourteen
thousand.
L
We
use
a
combination
of
face-to-face
and
online
process
to
do
that
with,
I
think,
called
system
lab
which
allows
us
to
develop
and
have
conversations
with
people
your
services
and
providers
together
on
particular
topics,
and
they
they've
used
us
they've,
used
being
used
recently
to
help
us
to
sort
of
have
a
view
on
our
role
in
improving
safety
and
maternity
and
also
to
design
design
our
new
assessment
framework
so
we'll
continue
to
deliver
and
work
with
those
areas.
A
Thank
you
very
much
indeed
chris,
and
obviously
we
always
keep
that
under
review.
So
I
hope
that
answered
the
two
questions.
I
think
that
brings
everything
to
an
end
for
those
of
you
listening
by
the
webcast.
I
hope
you
found
the
meeting
interesting
and
useful
and
we
hope
that
r
t
willing
will
be
able
to
hold
our
next
meeting
together
as
a
board
in
reverend
place,
but
thank
you
very
much
indeed.
Everybody.