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From YouTube: CQC Board meeting - September 2020
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A
A
A
That's
good
on
the
action
log.
There
are
only
two
items.
First
is
completed,
and
the
second
is
not
yet
due
were
there
any
matters
arising
that
anybody
wanted
to
raise.
A
Okay,
so
ted
can
sorry
not
ted
ian.
Can
I
go
straight
on
to
you
please.
B
Thank
you.
Thank
you
very
much
peter
I
they
said.
We've
got
a
fairly
long
agenda
today
and
it
outlines
the
work
that
we
have
been
doing
and
are
going
to
be
doing
over
the
next
few
weeks.
But
I
thought
I'd
just
take
a
moment
just
to
outline
some
of
the
context
for
the
work
that
we're
doing.
B
I
think
going
into
the
crisis
so
going
to
the
covert
19
crisis
was,
in
some
respects,
a
straightforward
activity,
in
the
sense
that
many
of
the
institutions
that
we
that
we
regulate
were
closing
services
down
and
society
as
a
whole
was
limiting
its
own
ability
to
move
around
and
our
ability
to
move
around
and
do
the
work
that
we
do
was
was
somewhat
curtailed.
B
I
think
we
we
always
knew
back
in
march
that
that,
in
some
respects,
closing
down
things
was
was
was
easier
than
opening
things
up
and
we
were.
We
were
even
then
recognizing
that
that
we
would
enter
a
period
of
time,
and
I
think
we
are
now
entering
that
period
of
time,
where
we
have
to
make
much
more
complicated
and
sophisticated
decisions
in
terms
of
how
we
open
up
and
and
resume
our
our
our
core
work.
I
think
it's
worth
reiterating,
though,
that
we've
never
stopped
regulating
during
this
time
period.
B
We've
used
new
and
different
approaches
all
through
all
through
this
period,
and
we
will
continue
to
iterate
and
produce
new
and
different
approaches
to
to
the
act
of
regulation.
So
I
think
the
challenge
coming
out
of
regulation.
Sorry,
the
challenge
rather
coming
out
of
covid
for
for
us
as
a
regulator,
is
that
we
need
to
move
quickly
as
circumstances
change
and
circumstances
are
changing
both
nationally
and
and
locally
simultaneously.
B
And
we
need
to
make
the
public
aware
of
what
we're
doing
so.
They
can
have
the
assurances
that
that
that
we
offer
around
the
safety
and
quality
of
health
and
social
care,
and
we
need
to
inform
providers
about
what
we're
doing
and
keeping
them
on
board
in
terms
of
our
approaches.
So
they
know
what
we're
doing
and
at
the
same
time,
we
need
to
take
the
opportunity
to
to
to
to
to
change
what
the
way
that
we
do
do
things
internally
and
continue
with
the
work
we're
doing
on
transformation.
C
B
That's
the
context
in
which
you
know
a
number
of
the
things
on
our
agenda
today
should
should
be
seen,
so
I
I
said
I
think
we
you
know
in
overall
terms
the
the
the
road
map
that
I
set
out.
That
sort
of
headline
road
map
that
I
set
out
at
our
last
meeting
around
now
next
and
future
is
on
track.
We
are
we're,
we
have
started.
B
Our
training
started
the
rollout
of
our
transitional
regulatory
approach
and
we're
confident
that
we'll
be
able
to
be
going
into
providers
in
early
october
with
that
new
approach,
but
also,
I
think
it's
also
worth
saying
that
that
we
need
to
stay
flexible.
I
think
I
think
that
the
way
that
the
coronavirus
performs
is
he's
on
is
some
extent
better
known
than
it
was
back
in
march,
but
I
feel
I
still
think
it
still
remains
a
topic
of
much
much
debate
and
concern.
B
B
I
think,
as
board
members
will
be
aware,
there's
been
some
press
reports
around
the
need
for
cqc
inspectors
to
be
tested
prior
to
going
into
the
people
that
we
that
we
regulate
it's
worth
just
being
really
clear.
Our
teams
have
undergone
training,
they've
been
issued
with
ppe,
they've,
undergone
personal
risk
assessments,
and
we
also
do
individual
provider
risk
assessments
before
we
go
on
site.
B
This
is
a
topic
that
we
have
been
we've
taken
very
seriously
right
from
the
start
and,
as
I
said,
we
have
continued
to
regulate
during
this
time
period.
We
have
continued
to
go
on
site
with
providers
all
the
way
through
this
this
time
period.
So
in
some
respects
nothing
has
changed
in
absolute
terms.
B
Although
the
volume
of
the
work
that
we're
doing
on
site
is
now
increasing,
we
made
a
request
to
the
department
of
health
and
social
care
that
our
inspectors
should
be
tested
on
the
same
basis
that
other
visiting
professionals,
particularly
in
care
homes,
should
be
treated,
and
then
they,
the
chief
medical
officers,
come
back
to
us
formally
and
said
that,
given
the
nature
of
the
work
that
we
do,
that
our
our
colleagues
do
not
are
not
engaged
in
in
hands-on
close
personal
care
with
people,
there
isn't
a
need
for
us
to
receive
the
weekly
testing
that
that
other
people,
particularly
care
workers,
are
currently
receiving.
B
That's
a
conversation
which
will
which
will
continue,
and
if
and
if,
in
the
event
that
events
change,
then,
of
course
we
will
revisit
that
about
that
topic.
But,
as
I
say,
we're
doing
so
many
other
things
in
terms
of
ppe
and
and
training
and
risk
assessments
and
so
forth,
but
that
I'm
confident
that
our
our
teams
don't
represent
a
a
significant
risk
to
to
care
homes.
We
have
been
approached.
B
We
have
found
that
some
providers
have
attempted
to
to
to
be
pro
proactive
with
us
and
try
and
stop
us
from
visiting
their
sites.
We
have
been
very
robust
with
those
providers
and
made
it
very,
very
clear
that
we
are.
We
will
continue
to
to
visit
where
we
think
that,
where
we
think
that
is
necessary,
that's
entirely
our
decision
to
make.
So
I
think
that's
a
that's.
An
important
point
to
make
and
kate
in
particular,
has
been
it's
been
very,
very,
very
direct
with
some
providers.
B
Who've
attempted
to
perceive
that
this
lack
of
testing
is
in
some
way
a
block
to
us
coming
on
site.
Well,
it
absolutely
isn't,
and
I
want
to
reassure
the
board
and
reassure
the
public
that
that's
absolutely
not
the
case.
B
I
I
think,
as
I
said,
we're
going
to
be
talking
a
lot
in
this
meeting
about.
I
feel
like
the
technicalities
of
what
we've
been
doing
over
over
the
last
few
months,
what
we're
going
to
continue
to
do
in
terms
of
of
our
strategy
and
so
forth,
but
I
would
like
to
just
take
a
moment
to
pay
tribute
to
a
number
of
my
colleagues.
Who've
made
some
very
significant
contributions
to
their
own
communities.
B
I
think
we
often
forget
that
the
people
have
had
lives
outside
work
and
I
think
never
has
that
been
more
true
than
over
the
last
of
the
last
few
few
few
weeks.
Each
week
I
run
two
all
colleague
calls
and
invite
guests
to
talk
about
what
they've
been
doing.
B
I've
heard
from
colleagues
who
have
returned
to
work
as
icu
nurses,
I've
heard
from
colleagues
who've
started
up
community
groups
to
feed
and
support
thousands
of
people
right
across
the
country.
We've
been
I've
heard
from
colleagues,
who've
helped
the
premier
league
with
their
infection
prevention
and
control,
and
our
colleague
talfik
is
actually
a
network
representative
on
this
call
with
us
today.
B
It
had
also
came
on
one
of
the
calls
and
talked
to
us
about
about
what
it
feels
like
during
ramadan
to
be
in
lockdown
and
and
the
challenges
spiritually
and
practically
that
that
offered,
which
gave
us
an
insight
into
into
different
different
cultures
and
ways
of
living.
So
I
I'm
really
grateful
to
to
my
colleagues
for
for
a
going
the
extra
yard
from
a
work
point
of
view,
but
also
there's
some
fantastic
examples
of
of
fantastic
work
outside
of
work.
B
Looking
ahead,
I
think
in
the
coming
months
we
will
we'll
be
going
live
with
our
our
on
your
approach.
B
Our
transitional
regulatory
approach,
which
which
ted
and
others
will
be
talking
about
later
on
the
agenda,
we'll
be
looking
to
publish
data
care
during
october,
so
that'll
be
our
annual
review
of
of
what's
going
on
in
in
the
health
and
care
world,
we'll
continue
to
design
our
strategy
and
we'll
be
commencing
conversations
with
with
our
stakeholders
with
providers
with
the
public
around
some
of
our
our
thinking
around
what
our
strategy
due
out
in
the
early
part
of
next
year,
will
be
all
about
and,
of
course,
we'll
continue
to
to
work
hard
on
our
own
internal
transformation.
B
You
know
we,
although
we've
made
lots
of
changes
in
terms
of
externally.
I
think
it's
also
worth
worth
noting
that
that,
as
the
health
and
social
care
system
in
the
round
transforms
and
changes
with,
a
regulator
need
to
transform
and
change
and
and
bring
in
new
approaches
and
reorganize
ourselves
internally,
in
order
to
be
as
effective
regulator
as
we
possibly
can
be
so
a
fair
amount
going
on,
it
would
be
fair
to
say,
but
but
some
and
some
exciting
and
exciting
new
ways
of
thinking
and
doing
things.
Thank
you,
peter.
A
I
I
I
was
on
mute.
I
thought
I
was
cleverly
unmuting
myself,
but
I
was
actually
muting
myself.
I
apologize
thank
you
I
was
saying:
does
anybody
want
to
come
in
or
shall
we
move
on?
Nobody
wants
to
come
in
kate.
I
think
it's
over
to
you.
D
So
we've
been
very
busy
in
adult
social
care
having
conversations
with
almost
65
active
providers
in
the
country,
so
I've
got
over
25
000,
adult
social
care
active
locations
of
those.
We
have
had
almost
17
000
emergency
support
framework
discussions
and
we've
gone
out
and
crossed
the
threshold
on
724
occasions
and
each
time
we
cross
the
threshold.
We
publish
our
findings
so
that
our
most
up-to-date
information
is
out
there
with
the
public.
D
So
we've
been
doing
emergency
support
framework
monitoring
conversations.
D
All
of
our
inspectors
at
early
on
into
covid
did
a
piece
of
work
where
they
looked
at
their
portfolio
and
they
identified
those
services
that
were
most
at
risk
according
to
a
matrix
that
we
developed
and
in
circumstances
where
inspectors
have
not
been
able
to
get
sufficient
assurance
from
conversations
with
providers
and
intelligence
that
sits
in
a
variety
of
other
places,
including
give
feedback
on
care
and
healthwatch
we've
gone
out
and
crossed
the
threshold.
D
So
we
developed
this
new
ipc
methodology
with
a
set
of
bespoke
questions
about
ensuring
providers
have
had
up-to-date
training
that
they
are
using
ppe
effectively,
that
they
have
the
ability
to
zone
and
cohort
people
should
then
be
the
need
for
them
to
do
so.
So
we
developed
a
set
of
questions.
We
developed
a
set
of
best
practice
examples
with
links
to
guidance
and
organizations
that
can
help
provide
us,
and
we
shared
that
all
externally.
D
So
this
was
about
being
really
transparent
with
the
sector
about
what
we
were
looking
for
when
we
were
going
out
and
doing
our
ipc
inspections,
so
ipc
was
looked
at
on
every
every
time.
We
crossed
the
threshold
because
of
risk,
but
also
we
were
really
keen
to
see
what
best
practice
looks
like
when
it
comes
to
ipc.
So
we
can
talk
about
it
and
encourage
other
providers
to
be
as
prepared
as
possible
for
a
potential
wave
to
or
difficult
winter.
D
So
we've
done
a
bespoke,
300
inspections
where
we
went
out
to
services
where
we
thought
we
were
likely
to
see
good
ipc
practice,
and
that
happened
during
august
and
the
findings
of
that
are
that
in
we
found
about
90
of
insurance
across
all
areas
with
those
providers.
So
I
want
to
take
the
opportunity
to
thank
the
care
sector
for
doing
in
general,
an
absolutely
fantastic
job
when
it
comes
to
good
infection,
prevention
and
control.
D
In
a
very
small
number
of
instances,
we
found
providers
who
didn't
have
up-to-date
ipc
policy
and
who
were
not
using
ppe
effectively.
D
So,
in
those
circumstances,
we
are
quick
to
respond
and
are
able
to
take
swift
regulatory
action
to
ensure
that
people
are
kept
safe
and
that
can
look
anything
like
a
kind
of
warning
notice
which
is
published
through
to
restricting
the
providers
ability
to
take
on
new
residents
or
even
to
close
if
we
are
so
concerned
about
the
the
safety.
So
my
main
message
is
we've
gone
out.
Ipc
is
a
key
area
of
focus
in
everything
that
we
do
broadly.
The
sector
is
doing
a
really
good
job.
D
With
this,
and
in
a
small
number
of
cases
where
we
have
significant
concerns,
we
won't
hesitate
to
use
our
regulatory
tools
to
ensure
that
people
are
getting
safe
care
rapidly.
So
looking
forward
in
terms
of
ipc,
our
plan
is
to
continue
to
focus
on
infection
prevention
control.
Through
our
monitoring
conversations,
we
will
continue
to
look
at
it
on
any
inspection.
So
if
we
go
out
because
we're
concerned
about
safeguarding,
we
will
still
have
a
focus
on
ipc.
D
We
plan
to
continue
to
do
bespoke,
ipc
inspections,
where
we
think
we're
going
to
find
good
practice.
So
we
can
keep
on
talking
about
that
and
due
to
the
increasing
concerns
at
the
moment
about
care
homes
and
we're
starting
to
see
an
increase
in
outbreaks.
D
When
we
receive
information
that
causes
us
concern
about
ipc
practice,
we
will
go
out
and
cross
the
threshold,
so
this
will
remain
a
real
real
focus
for
us
and,
as
I
say,
every
time
we
go
out
across
the
threshold,
we
publish
our
findings
so
that
we're
being
really
transparent
with
the
public
about
what's
going
on
with
those
individual
services
and
then
the
themes
from
that
will
feed
into
our
insights
report
as
it
does
in
the
report.
D
We're
going
to
talk
about
later
today
and
we
will
revisit
the
topic
again
in
november,
and
probably
one
final
thing,
I'd
like
to
say
on
this:
is
we've
been
looking
at
the
relationship
between
the
quality
of
care,
the
quality
of
previous
ratings
of
care
services
and
covered
outbreaks,
and
it's
preliminary
at
the
moment.
But
today
we
are
not
finding
a
link
between
the
quality
of
the
care
provided
and
the
covered
outbreaks.
D
There
is
a
question
about
the
speed
with
which
a
provider
once
it's
been
identified
can
manage,
contain
it
and
stop
it
from
spreading.
But
the
fact
that
a
provider
has
had
a
covered
outbreak
in
the
last
six
months
does
not
equate
to
that
being
a
poor
provider.
So
I'd
just
like
to
make
that
point,
so
I'm
going
to
go
on
and
talk
about
market
oversight.
Do
you
want
me
to
pause
peter
and
just
ask
if
anyone's
got
any
questions
on
what
I
said
around
our
covered
approach
to
date,.
E
Yeah
robert,
please,
thank
you
peter,
firstly,
kate.
Please
congratulate
your
team
on.
Obviously
what
is
fantastic
work
going
on
in
very
difficult
circumstances
in
relation
to
infection
control.
E
E
And
my
feeling
is
that
if
you
asked
some
elderly
people,
not
all
of
course
and
gave
them
the
choice
of
running
a
risk,
quantifiable
or
not
or
getting
covered
and
maybe
risking
their
lives
and
being
able
to
see
in
the
latter
stages
of
their
life,
their
family,
they
would
choose
the
latter.
Now.
I
appreciate
that
that
can
cause
huge
complications
in
relation
to
how
one
administers
a
home
and
protects
everybody's
interests.
But
what
concerns
me
is
that
I
don't
see
that
aspect.
E
D
Thanks
robert,
so
I
think
I
think
that
really
important
issue
you've
just
raised
just
amplifies
the
challenge,
our
providers
that
have
been
wrestling
with
for
six
months
without
balance
of
keeping
their
service
safe,
keeping
their
staff
safe,
keeping
their
residents
safe
and
the
the
very
natural
instinct
I
I
can
imagine,
many
providers
have
or
just
wanting
to
lock
down
and
just
you
know,
maintain
a
bubble,
and
we
saw
you
know
care
workers
moving
into
care
homes.
D
So
we
saw,
I
think,
people
trying
to
do
the
right
thing,
but
that
balance
of
keeping
people
safe
and
not
ending
up
with
large
numbers
of
people
whose
mental
health
has
been
significantly
affected
through
isolation
and
not
being
able
to
have
contact
with
families.
So
I
think
it
is
a
real
it's
a
very
real,
ongoing,
ongoing
dilemma.
D
We
have
seen
some
really
good
examples
where
providers
have
struck
that
balance
and
we
will
be
sharing
it
in
publications
where
we
talk
about
where
providers
have
made
garden
rooms
available,
where
they've
had
rotors,
where
they've
done
things
virtually
in
the
home,
so
that
family
members
can
still
come
in
the
care
provider
alliance.
D
Put
out
a
message
to
all
of
adult
social
care
providers
a
couple
of
months
ago
where
they
talked
about
the
importance
of
being
person-centered
in
the
approach,
and
I
wholly
support
that
so
my
message
to
providers
is:
we've
got
government
policy
that
needs
to
be
adhered
to.
Providers
need
to
be
aware
of
their
local
risk,
so
the
direction
given
from
their
local
directors
of
public
health,
about
what
the
risk
level
is
within
the
place
they
operate,
but
we
absolutely
expect
to
see
bespoke
approaches
to
visiting.
D
So
if
you
are
a
small
supported
living
service
for
three
adults
with
learning
disabilities,
you
might
have
a
visiting
policy.
That
looks
like
this.
If
you
are
a
large
nursing
home,
where
all
your
residents
on
the
ground
floor
have
double
doors,
that
open
up
onto
the
garden,
I'd
expect
to
see
something
different
and
then
one
layer
below
that
is
that
individual,
that
individual
care
plan
that
says
that
sensor
has
capacity.
D
So
it's
a
really
it's
a
hugely
tricky
balance
that
our
providers
have
had
to
strike
and
that
we
our
position
on
this
is
our
expectation,
as
we
see
high
quality,
person-centered
care
plans
demonstrating
to
us
how
they've
weighed
up
the
individual's
capacity
and
ability
to
make
informed
decisions
with
the
risks
potentially
for
you
know
other
other
residents
or
care
stuff
as
well,
but
a
very,
very,
very
tough,
very
tough,
juggling
act
that
people
are
doing
on
a
daily
basis.
E
Thank
you
just
one
question
really
arising
out
of
that
is
whether
you
see
the
care
home
providers
being
influenced
at
all,
by,
as
it
were,
risk
avoidance
for
themselves
in
terms
of
their
fear
of
criticism
or
worse
or
litigation
in
relation
to
the
outbreaks
that
will
will
potentially
happen
and
whether
that
has
been
informing
their
policy
more
perhaps
than
it
should
be,
or
whether
there's
anything
could
be
done
to
alleviate
the
their
concerns.
In
that
regard,.
D
So
I
think
I
think
that's
a
very
real
concern
and
the
point
I
made
earlier
about
there
not
being
they're
not
currently
being
evidence
of
a
link
between
poor
equality,
services
and
outbreaks
is
really
important.
I
think
it
can.
It
could
be
easy
to
make
a
leap
that
says
if
a
service
gets
an
outbreak,
it's
because
they've
done
something
wrong
and
that's
not
that's
not
what
we're
saying.
So.
D
You
can
actually
understand
why
providers
air
on
the
side
of
caution,
issues
with
insurance
issues
with
encouraging
new
people
to
move
into
the
home
and
I'll
mention
that
under
the
market
oversight
item
in
a
minute.
But
I
I
absolutely
think
that
fear
of
litigation
fear
of
being
blamed
fear
of
the
the
ability
to
run
a
sustainable
business
if
people
start
leaving
the
home
or
not
or
not,
moving
into
it
because
of
an
incorrect
assumption
that
if
a
provider
gets
an
outbreak,
they
must
be
a
poor
provider.
B
B
As
a
regulator,
I
mean,
I
think
our
job
is
as
a
regulator
is
to
is
to
ensure
that
that
there
are
a
set
of
standards
which
are
unarguable
and
and
that,
and
if,
if
people
drop
below
those
standards,
then
we
will
absolutely
take
enforcement
action
and
up
to
including
prosecution
and
closure,
if,
if,
if
that's
appropriate
and
kay,
was
describing
describing
that
in
her
remarks,
but
I
think
I
think
we
also
have
a
parallel
activity,
which
is
to
support
those
providers
who
were
genuinely
ambitious
for
their
for
their
service
users.
B
And
so
in
the
circumstances
you
were
describing
there
around
a
provider
that
is
interested
in
in
taking
a
managed
risk
in
order
to
improve
the
overall
quality
of
life
for
one
of
their
one
of
their
their
residents.
Then
that
is
something
that
that
we
can
have
a
sensible
conversation
with
them
about
and
that's
exactly
what
kate's
team
are
doing
on
a
day-to-day
basis.
B
So
I
I
I
don't
see
this
as
a
binary
either
or
there
are
set
of
standards
which
are
unarguable,
but
I
think
also
that
you
know
supporting
supporting
ambitious
providers
is
something
again,
which
I
think
is
is
part
of
what
of
what
we're
about
as
well.
So
it's
that
perennial
challenge
of
a
regulator.
I
think,
but
it's
been
brought
into
particularly
sharp
relief
during
coven,
and
particularly
on
this
topic
around
ipc
thanks
peter.
A
D
Okay,
so
if
I
just
move
on
and
talk
I'll,
give
you
an
update
on
market
oversight
which
relates
to
the
conversation
we've
just
had.
So
when
we
look
at
occupancy
levels
in
care
homes
since
the
start
of
the
financial
year,
so
we've
seen,
as
you
know,
significant
increase
in
deaths
and
for
a
number
of
months
kind
of
minimal
slash.
D
You
know
zero
new
admissions
for
some
services,
some
caring
services
around
the
country,
so
there's
been
a
almost
a
10
drop
in
in
care,
home
occupancy
levels
and
then
care
homes
have
had
the
additional
challenges
around
the
extreme
ppe
costs
that
were
experienced
in
the
beginning
and
are
still
now
for
some
and
then
the
significant
financial
implications
of
having
staff
off
sick
and
needing
to
backfill
etc.
D
So
that
has
presented
a
massive
challenge
for
the
care
home
sector,
which
has
been
supported
through
short-term
but
much
needed
investment
from
government
which
has
been
passported
to
care
homes
via
local
government
in
home
care.
D
The
situation
has
been
less
stark,
but
there
is
still
it's
still
being
notable
that
for
home
care
providers
that
fall
within
our
market
oversight
scheme
that
those
providers
were
reporting
delivering,
five
percent
less
care
than
they
were
they've,
been
commissioned
to
by
local
authorities
or
by
people
who
fund
their
own
care
so
and
when
we've
looked
into
that,
that
has
often
been
certainly
in
the
beginning,
people
declining
to
have
a
care
worker
visit
or
having
a
family
member
move
into
the
home
to
provide
that
support.
D
The
final
financial
impact
today
has
been
less
because
local
authorities
have
continued
to
fund
at
the
level
they
commissioned,
rather
than
the
level
that
the
hours
were
actually
delivered
at.
There
is
a
risk
should
the
conversation
arise
about
whether
providers
should
have
to
back
pay
some
of
those
those
costs,
but
but
yeah
the
main
issue
has
been
in
care
homes
and
the
thing
to
flag
is
that
short-term
investment
from
central
government
through
local
government
to
care
homes
and
the
ability
for
camps
to
defer
their
paye
and
their
national
insurance
contributions?
D
All
of
that
is
winding
up
now
at
the
point
that
we
are
moving
into
autumn
and
winter,
so
that
we
will
continue
through
market
oversight,
keep
a
very
close
eye
on
the
stability
of
those
those
providers
within
the
scheme.
D
And
then,
if
I
just
move
on
to
restraint,
seclusion
and
segregation
and
close
cultures.
So
a
hundred
percent
of
our
staff
have
had
training
now
on
the
supporting
guidance,
so
training
to
support
our
staff
to
identify
where
close
culture
may
be
occurring
and
to
to
support
them
to
understand
how
they
should
go
out
and
regulate
services
in
those.
D
Advisory
group
about
two
weeks
ago,
where
50
of
the
50
people
who
were
in
the
room
with
me,
were
people
with
lived
experience
of
segregation
or
seclusion
or
family
members
of
people
who
have
experienced
it,
and
the
purpose
of
this
expert
advisory
group
is,
from
the
very
start
of
our
close
cultures,
work
that
we
are
working
incredibly
closely
with
providers.
Other
commissioners,
people
who
lived,
experienced
families
and
a
variety
of
other
people
to
think
about
how
do
we
develop
the
best
tools?
D
So
our
first
conversation
at
the
first
group
was
around
how
should
inspectors
you
know
what
are
the
key
ingredients
for
identifying
high
quality
person-centered
plans,
and
how
do
you
triangulate
that
to
ensure
that
that
is
the
experience
that
someone
is
is
having,
so
you
can
have
a
fabulously
glossy
person-centered
player,
but
actually,
how
are
we
assured
that
that
is
what's
happening
for
individuals
on
a
day-to-day
basis?
D
A
couple
of
the
highlights
is,
we
are
doing
work,
as
you
know,
about
drawing
together
the
various
intelligence
we
have
about
what
could
indicate
a
closed
culture
into
our
transitional
monitoring.
App,
that's
going
live
in
autumn.
That
ted
will
talk
about
later
on
in
this
session,
two
publications
that
are
going
to
be
happening
during
autumn
and
again
just
to
pick
up
something
that
comes
up
in
the
later
paper.
D
So
we
are
due
to
publish
very
shortly
our
our
refreshed
approach
to
how
we
register
care
services
for
people
with
learning
disabilities
and
or
autism,
so
previously
known
as
registering
the
right
support,
refreshed
and
refocused,
and
it
will
now
be
called-
is
now
called
right,
support
right
care,
right
culture,
so
that
is
about
how
we
use
our
powers
and
levers.
D
We
have
as
the
regulator
and
when
it
comes
to
registering
services,
to
ensure
that
when
new
services
are
coming
into
the
market,
they
can
demonstrate
the
fact
that
they
are
small
person-centred
focused
on
supporting
people
having
a
life
and
accessing
their
community,
etc.
So
that
publication
will
be
coming
out
imminently
and
we've
got
restraints,
inclusion
and
segregation
shortly
following
so
just
a
flag.
There's
a
few
important
publications
that
kind
of
link
together.
D
We've
almost
got
a
triangle
of
close
cultures
and
how
we
regulate
right
care
right,
support,
right
culture,
about
how
we
register
services
are
the
right
model
and
then
our
approach
to
restraint,
seclusion
and
segregation,
so
that
we
can
really
change
people's
experiences
of
how
they're
receiving
care
and
those
sorts
of
crisis
crisis
windows.
A
Thanks
kate
it'll
be
really
really
important
subject,
and
I'm
really
impressed
with
the
with
the
work
that
you
and
colleagues
are
doing
to
to
try
and
get
on
top
of
this.
Does
anybody
want
to
come
in.
F
No,
in
which
case
ted
will
move
on
to
you.
Okay,
thank
you,
peter
just
to
reflect
again
there.
What
what
ian
was
talking
about
earlier
on
how
much
our
approach
to
regulations
change
because
of
the
kovid
pandemic
and-
and
I
think
it
is-
I
want
to
pay
real
tribute
to
colleagues
across
the
cqc
who've
adapted
so
well.
In
these
difficult
circumstances,
I
think
there's
been
a
really
enormous
effort
to
focus
on
the
safety
and
quality
of
care.
F
Despite
the
fact
we're
approaching
our
regulatory
process
in
a
different
in
a
different
way,
reflecting
the
the
risks
of
the
coping
pandemic,
and
I
think,
and
I'm
really
proud
of
what
they've
achieved
and
I
think,
there's
a
lot
we
can
build
on
and
when
we
talk
later
about
the
transitional
regulatory
approach,
it
is
building
on
what
we've
learned
over
the
last
six
months,
which
I
think
has
been
extremely
important.
F
F
Such
as
whistleblowing
user
feedback,
serious
incidents,
safeguarding
concerns,
etc,
and
that
is
enabling
us
to
identify
whether
where
there
may
be
risk
in
providers,
some
of
that
may
be
covered
related,
but
a
lot
of
it
is
is
risk
that
we've
seen
before
in
providers
that
is
still
present
and
where
we
find
that
we
are
taking
action
and
we
are
continuing
inspections.
Risk-Based
targeted
inspections,
there's
some
detail
of
that
in
the
report.
F
The
numbers
now
are
66,
so
it's
increased
since
the
the
paper
was
produced,
and
I
think
where
we
find
concerns,
we
are
still
taking
enforcement
action
and
we're
still
taking
a
full
full
spectrum
of
enforcement
action
where
we're
finding
concerns
in
services,
and
it's
important
to
emphasize
that
that
is
still
going
on
and
has
been
going
on
throughout
the
pandemic,
and
we
will
continue
that
going
forward,
but
also
a
part
of
not
only
looking
at
specific
risks.
F
Individual
providers
we're
looking
at
system
risk,
and
this
comes
back
to
the
infection
control
issue
that
kate
was
talking
about
in
social
care.
We
identified
early
on
in
the
pandemic
the
importance
of
good
infection
control
across
hospital
providers
to
make
sure
that
patients
who
did
not
have
covid
could
be
treated
safely
and
working
with
partners
such
as
nhs
improvement
in
nhs.
F
England
guidance
was
produced
for
for
providers
across
the
board
to
ensure
that
they
had
the
best
possible
standard
and
an
assurance
tool
was
produced
at
our
request,
which
we,
which
we
sent
out
to
all
providers
and
asked
them
to
use
to
ensure
they
were
compliant
with
the
best
quality
infection
control
standards,
and,
I
have
to
say,
the
feedback
from
fraudulent
has
been
very
positive.
They
found
the
tool
really
helpful,
and
now
we
have
contacted
and
again
the
data
to
update
the
data.
F
We've
contacted
all
nhs
trusts
and
many
independent
healthcare
providers
with
continuing
that
work
to
discuss
with
them.
How
they've
got
assurance
around
the
infection
control
practice
and
some
of
the
outcome
of
that
is
reported
inside
report
which
we're
coming
to
later,
but
but
essentially
again
as
caters,
has
described.
We've
seen
a
lot
of
very
good
practice
and
I
want
to
pay
tribute
to
the
standards
of
infection
control.
F
We
found
in
many
trusts,
and
I
think
that
is
excellent
and
it
is
ensuring
that
trust
can
reinstate
non-coveted
services
safely
for
patients,
which
of
course,
is
increasingly
important
as
we
come
as
we
move
forward.
Having
said
that,
where
we
found
some
trust
that
don't
have
assurance,
we've
challenged
them
and
sometimes
we'd
be
able
to
challenge
them
to
change.
Sometimes,
we've
brought
in
support
from
the
nhs
improvement
team
that
is
leading
on
this
nationally
and
working
very
closely
with
nhs
improvement.
F
We've
done
inspections
around
infection
control
and
we
have
taken
enforced
protection
against
a
small
number
of
providers
where
we
found
that
there'd
been
problems
with
their
infection
control
standards,
and
so
we
are
again
focused
on
taking
action
where
necessary,
but
equally
driving
improvement
and
supporting
trust
to
drop
to
to
to
to
to
deliver
high
standards
in
fashion
control
generally
and,
as
I
say,
we've
seen
a
lot
of
that
going
delivered
and
we'll
come
back
to
that
in
this
inside
report.
F
In
a
moment,
just
just
one
other
area
I
want
to
cover
yeah
chris
is
going
to
talk
about
it
later
in
the
in
his
section,
but
we
I
expressed
after
last
winter
real
concern
about
how
the
nhs
was
able
to
cope
with
winter
pressures
in
emergency
departments,
and
we,
the
board,
will
remember,
we
inspected
a
number
of
emergency
parts
over
winter
and
had
concerns
about
how
they
were
coping.
F
I
I
I
said
to
the
board
and
also
publicly
that
I
thought
that
we
as
we
go
into
the
next
winter
we've
got
to
be
better
prepared
and,
of
course,
that
was
before
the
coveted
pandemic
came
and
the
kobe
pandemic
has
created
extra
pressure
on
emergency
departments
during
the
height
of
the
pandemic.
Of
course,
fewer
people
went
to
emergency
departments
and
the
figures
superficially
improved,
but
talking
to
emergency
departments
across
england.
F
Now
it
is
clear
now
the
number
of
people
attending
is
going
steadily
up
and
pressures
are
building
up
again
and
we're
not
yet
into
winter,
and
when
covid
comes
back,
if
it
does
or
other
respiratory
viruses
which
are
bound
to
come
back
and
that
that
is
going
to
create
extra
pressure
for
emergency
departments,
and
it
is
really
important
that
those
departments,
but
also
the
trusts
that
that
house,
those
departments
and
the
systems
they
work
in
are
well
prepared
for
winter,
because
this
could
be
a
very
difficult
winter
for
emergency
services
going
forward
and
what
we've
been
doing
over
the
summer
is
working
with
our
specialist
advisors,
from
emergency
departments
across
england
to
ensure
that
we
have
the
best
possible
clinical
advice
about
how
emergency
departments
can
be
kept
safe
and
we'll
be
putting
that
guidance
out
shortly
and
again,
we'll
be
asking
trusts
how
they
are
complying
with
that
guidance
going
into
winter
and
when
necessary,
we
will
be
inspecting
against
that
guidance
to
ensure
people
are
delivering
the
right
standards.
F
A
Ted
can
I
can.
I
just
ask
a
question
and
it
kind
of
links
the
two
points
you
were
making
as
we
go
into
what
is
undoubtedly
going
to
be
a
very
difficult
winter.
Whatever
happens,
is
there
a
risk
that
the
better
quality
infection,
prevention
and
control
that
you're
now
seeing
in
trusts
starts
to
slip
back
just
because
of
the
pressures
they're
under
and
and
if
there
is
that
risk?
Is
there
anything
that
we
should
or
could
be
doing
now,
to
try
and
minimize
that
risk.
F
Well,
as
I
say
peter,
I
think
the
fact
that
trusts
have
assured
themselves
against
a
high
standard
of
infection
control
over
the
last
six
weeks
or
so
is
really
good
start.
But
of
course,
they've
got
to
maintain
that
going
into
india
and
as
the
work
increases,
that's
important
and
part
of
our
advice.
Part
of
the
guidance
we're
producing
for
emergency
departments
is
around.
How
do
you
main
maintain
good
infection
control
under
pressure
and
that's
one
of
the
key
elements
of
it
and
the
two
there
are
two
aspects
of
that.
F
One
is
you've
got
to
protect
people
against
the
the
the
cross
infection,
but
equally
the
fact
you're,
maintaining
social,
distancing,
etcetera.
It
reduces
the
capacity
of
the
emergency
department,
but
also
in
patient
beds
and
inpatient
beds
in
many
hospitals,
because
of
this
social
distancing
and
the
other
infection
control
are
have
been
reduced
in
capacity
by
20
30
in
some
cases.
So
clearly
that
is
having
an
impact
on
the
ability
to
get
patients
into
the
hospital
and
maintain
flow
through
the
hospital,
which
is
the
key
element
in
keeping
emergency
departments
safe.
F
So
it
is
absolutely
important
that,
while
they
may,
the
hospitals
maintain
the
highest
standards
of
infection
control.
They
take
into
account
the
the
the
the
pressures
that
causes
for
the
emergency
pathway
and
they've
got
to
balance
both
and
as
we
go
into
winter.
As
I
say,
we're
going
to
be
inspecting
against
this.
F
This
this
guidance
where
necessary-
and
I
mean
generally-
I
think
we-
we
want
to
approach
this
in
a
supportive
way,
but
where
necessary,
will
inspect
against
it,
and
we
will
be
looking
very
clearly
at
the
level
of
infection
control
that
they
they
achieve.
A
G
Thank
you
peter.
So,
as
with
ted
and
kate,
we,
our
teams
have
been
doing
a
lot
of
work
in
terms
of
monitoring
services
and
that's
involved.
Looking
at
the
data,
that's
involved
lots
of
stakeholder
engagement,
particularly
with
clinical
commissioning
groups
and
with
local
healthwatch,
to
identify
where
there
are
any
concerns
and
we've
also
been
undertaking.
G
Emergency
support
framework
calls
and
ipc
calls,
which
are
the
ipc
information
is
in
the
insight
report.
G
Alongside
that,
we
have
been
doing
inspections
where
we
have
under
seen
risk
and
we've
also
been
piloting
a
new
methodology
which
enables
us
to
access
many
of
the
systems
in
a
gp
practice
without
being
on
site,
and
this
is
hugely
valuable,
so
we
can
respond
to
immediate
risk
without
actually
having
to
cross
the
threshold,
and
we
we
are
piloting
that
and
evaluating
that
at
the
moment
and
that's
sitting
with
the
transitional
methodology
which
ted
will
mention
later
on.
G
G
With
significant
breaches,
so
that's
there's
a
lot
of
work
going
on
along
with
that,
we're
also
working
across
all
of
the
other
sectors
in
pms
to
look
at
how
we
make
sure
that
that
we're
working
with
other
regulators,
such
as
the
work
we're
doing
with
hmip
in
health
and
justice,
the
work
we're
doing
with
ofsted
around
send
services
to
look
at
how
we're
making
sure
that
all
all
the
populations
that
we
look
at
within
the
pms
portfolio
are
monitored
carefully.
G
I
just
want
to
mention
some
concerns
that
we
are
particularly
worried
about
and
working
on
at
the
moment,
and
this
is
about
access
and
it's,
I
think,
if,
if
we
talk
about
accessing
all
services,
I
think
there
are
concerns,
but
particularly
just
want
to
mention
general
practice
access,
because
there
has
been
a
lot
in
the
media
and
on
social
media
about
this
and-
and
we
are
hearing
a
lot
of
anecdotes
from
members
of
the
public
and
also
from
people
like
a
e
consultants
who
are
saying
their
needs
and
they're
not
able
to
access
appointments
or
they're.
G
Not
their
needs
are
not
being
met
when
they
access
a
digital
appointment
and
turning
up
in
a
as
a
result
of
that,
we
can't
quantify
this
at
the
moment,
and
I
suspect
it's
probably
a
minority
rather
than
the
majority.
We
know
that
gps
are
working
and
their
teams
are
working
very
hard
and
have
adapted
hugely
over
the
last
few
months
to
make
sure
patients
get
the
care
they
need.
G
And
we
wonder
if
some
of
it
is
actually
around
communication
to
patients
and
and
commune
how
a
practice
has
actually
communicated
what
how
they're
working
in
the
new
ways
of
working
to
their
patients
and
engage
with
patients
around
that
and-
and
certainly
I
would.
We
are
encouraging
practices
to
to
make
sure
that
those
lines
of
communication
act
practices
are
released
out.
Patients
who
use
services
are
really
strong
and
people
can
understand
how
to
access
the
services
they
need,
and
we
are,
we've
got
a
working
group.
G
Looking
at
this
looking
at
the
data,
we
have
available
working
with
our
hospital
colleagues
to
understand,
what's
happening
in
the
local,
a
e
departments
and
and
seeing
making
sure
that
there
isn't
any
increase
as
a
result
of
access
to
general
practice.
G
We
would
like
very
much
public
feedback
if,
if
they
are
having
any
problems
around
this-
and
we
are
also
working
with
healthwatch
through
our
primary
care
quality
board
and,
for
example,
I
think
yesterday
we
heard
from
healthwatch
how
they'd
heard
of
one
practice
that
had
a
blanket
policy
of
not
seeing
anyone
between
the
age
of
15
and
60
face-to-face
or
actually,
I
think
it
was
16
to
50.
G
But
I
think
what
we
would
say
is
absolutely
it's
not
acceptable
to
have
blanket
policies
about
virtually
everything
I
think
in
this
situation,
but
we
if
people
do
need
to
be
seen,
face
to
face,
and
that
might
be
for
a
clinical
reason,
but
it
might
be
for
another
reason,
such
as
they're
an
abusive
relationship
at
home,
and
they
they
don't
want
to
talk
about
their
problems
in
front
of
their
their
abusive
partner
or
they.
They
need
to
actually
explain
something
that
they
can't
do
that
on
the
phone.
G
So
we
we
very
much
need
to
make
sure
that
people
are
getting
the
appropriate
access
that
they
need
going
forward.
So
I'll
stop
there
for
any
questions.
H
Thanks
very
much
rosie
I
just
wanted
to
pick
up.
You
mentioned
the
joint
work
with
ofsted
in
relation
to
disabled
children,
children
with
complex
health
needs,
etc,
and-
and
I
just
want-
I
mean
there-
have
been
some
reports
elsewhere-
of
disabled
children,
children
with
health
conditions,
kind
of
getting
quite
isolated
and
families
being
under
some
pressure.
It's
been
in
the
media
as
well,
where,
for
example,
educational
schools
haven't
been
able
to
cater
for
people
in
the
usual
way
and
support.
There
have
been
constraints
on
the
support
that
children
and
their
families
need.
G
Yeah,
certainly
it
is
something
that
the
teams
are
very
much
following
up
if
they're
hearing
any
concerns
and
ofsted
and
the
cqc
have
developed
a
joint
new
joint
methodology,
a
transitional
methodology
to
to
go
into
local
areas
where
there
are
concerns.
So
we
can
specifically
look
at
how
their
how
local
areas
are
responding
to
people's
needs
and
looking
at,
for
example,
their
their
ehcps,
their
education,
health
and
care
plans
and
making
sure
that
they're
fit
for
purpose
and
and
following
a
person's
journey
through
the
system.
G
So
I
think
it
is
something
that
we're
very
alive
to
and
very
much
following
up
where
there
are
any.
A
Issues
thanks
rosie
very
much
and
the
the
the
the
issue
of
access
is
a
a
a
long-standing
problem.
Isn't
it
and
getting
the
balance
right
between
what
you
can
do
digitally
and
what
you
can't
is
is
is
so
important
right.
Nobody
else
wants
to
come
in
liz.
Do
you
want
to
put
your
hand
down?
Otherwise,
I
might
think
you
want
to
come
back.
A
I
Sorry,
most
of
what
I
was
going
to
say
is
covered
off
in
the
update,
so
I
can
pick
it
up
then.
If
that's,
if
that's
easier,.
A
Okay,
that's
that
that's
that's
fine
mark
anything
you
need
to
to
raise
on
cyber.
C
J
Will
they
have
good
conversations
between
october
and
december,
with
a
view
that
we
put,
we
publish
a
consultation
document,
a
formal
conversation
in
january.
That
is
not
only
a
good,
a
good
summation
of
what
we
want
and
what
we
know.
People
use,
services
providers
and
others
want,
but
also
his
effectively
is
able
to
be
effectively
implemented.
J
J
J
Colleagues-
and
we
will,
this
will
probably
be
followed
up
with
a
formal,
a
request
for
information
which
will
which
we'll
put
some
colleagues
up
for
in
the
coming
weeks.
Ian
and
peter
continue
to
meet
with
members
of
the
house
health
select
committee
and
again
we
will
talk
a
bit
about
our
future
direction,
a
bit
about
our
response
to
covid.
I
also
wanted
to
bring
to
the
board's
attention
the
fact
we've
recently
launched
a
new
campaign
for
give
feedback
on
care.
J
It's
a
year-long
campaign,
but
it's
been
supported
by
a
number
of
organizations
and
particularly
as
as
robert
say,
I'd
like
to
thank
healthwatch
england,
also
local
health
watchers,
for
their
support
at
the
launch
on
the
ongoing
support
throughout
this
year.
J
J
This
is
not
just
to
give
feedback
on
care
itself,
but
also
information
that
people
feel
confident
to
give
us
around
whistleblowing
and
around
safeguarding,
and
that
in
turn,
has
been
able
to
improve
the
way
we
are
able
to
responsively
go
out
and
inspect
and
take
forward
that
information
you'll
see
later
in
the
performance
report,
how
we've
used
that
information
to
guide
our
inspection
activity
and,
as
colleagues
have
already
mentioned,
the
probabilities
we're
really
slightly
late.
J
We've
got
10
significant
reports
coming
out
in
the
next
eight
weeks,
designed
to
drive
change
and
improvement
across
the
sectors
that
we
regulate.
I
won't
go
back
over
some
of
the
information,
but
I
just
think
there's
some
there's
some
really
important
information
in
the
inside
report,
which
I'll
talk
about
later,
but
also
in
the
in
in
ted,
talked
about
the
outstanding
ed
report.
J
I
think
the
critical
thing
for
me
about
that
report
is
it
gives
really
practical
information
about
how
people
who
are
working
in
emergency
departments
can
think
about
their
their
operation
as
they
approach
winter,
not
just
for
themselves,
not
just
for
the
hospital,
but
also
about
their
interactions,
with
primary
care
and
with
adult
social
care.
As
kate's
already
talked
about,
there's
some
important
information
on
the
restraints
and
segregation
report.
We
had
initial
findings
in
may
last
year.
J
This
is
really
to
try
and
nail
what
has
to
happen.
Who
has
to
deliver
what
in
the
coming
weeks
and
months,
and
I
think
it's
important
that
we've
got
actions
that
are
supported
by
people
use
services
and
also
by
sector
partners.
So
that's
the
conversations
we'll
be
having
over
the
coming
weeks
with
an
aim
to
launching
that
that
report
in
late
october
and
finally,
for
me,
the
the
16th
of
october
marks
the
publication
of
our
annual
assessment
of
quality
in
state
of
care.
J
Again,
as
a
this
report
would
not
be
possible
without
all
the
work
that
goes
on
across
each
of
the
inspecting
directorates.
All
the
information
that
we
gather
from
our
inspection
activity
and
our
monitoring
activity
and
intelligence
gives
us
the
ability
to
have
an
authority
view
about
how
services
are
performing.
J
We've
got
some
key
issues
that
we
want
to
talk
through
when
that
report
comes
out
on
the
16th
of
october,
and
it
will
be
an
assessment
of
the
time
before
covid.
If
you
can
remember
that
time
and
also
the
time
since
that,
since
the
kermit
outbreak,
that's
it
for
me,
peter.
A
Thank
you,
chris
very
much.
Is
there
anything
anybody
else
wants
to
raise
under
the
et
report,
in
which
case,
let's
move
on
kirsty
and
chris
the
performance
update.
Please.
I
Thank
you
peter
chris
is
going
to
take
the
lead
on
this
one
yeah.
K
I'll
pick
that
up
thanks
and
just
just
to
help
colleagues,
this
is
this
starts
from
page
53
on
diligent,
so
just
to
say,
we've
we
obviously
review
performance
each
month.
However,
this
is
the
the
quarterly
update,
including
july,
so
it
allows
us
for
a
first
view
of
the
full
dashboard
pack,
the
first
time
this
financial
year.
I
hope
in
the
pack
demonstrates
three
things
in
in
terms
of
our
performance
so
far
this
year,
one
of
which
is
that
we've
kept
operating
during
covers
we've
still
carried
out.
K
A
monitoring
activity
responded
to
risk
enforcement
activity.
The
second
is
that
we've
adapted
our
approach,
both
during
corvid
for
the
new
normal,
have
introduced
the
esf
and
ipc
frameworks
that
we've
we've
talked
about
already.
K
We're
also
focusing
on
our
transitional
and
future
strategic
approach,
and
the
third
one
is
that
we've
been
working
hard
to
improve
existing
processes,
for
example,
registration,
the
availability
of
our
systems
and
also
how
we
support
our
people,
I'm
going
to
pull
out
four
areas
that
I
think
hopefully
demonstrate
this
and
then
happy
to
open
it
up
for
questions
about
anything
in
the
pack
and
sorry,
I
should
have
said
also:
we've
got
steph
tarrant
joined
us
for
this
for
this
bit
who's
who
works
in
my
team,
and
he
pulls
all
this
pack
together
as
well.
K
So
the
first
area,
just
just
to
pull
out
is,
is
registration.
This
is
slide
five
page
57
and
diligent,
so
hopefully
an
example
about
how
we've
been
working
hard
to
improve
existing
processes.
K
We've
talked
about
this
previously
about
how
we're
leaning,
leaning
out
our
processing
here,
we've
split
our
work
into
simple,
normal
and
complex
applications
and
we're
really
aiming
to
just
improve
the
average
days
of
the
end-to-end
process.
K
You
can
now
see
the
graphic
around
that
which
shows
that
simple
and
normal
processors
are
improving.
Complex
is
still
settling
down.
It's
still
it's
still
moving
around,
but
it's
worth
noting
the
the
really
low
volumes
for
for
complex
cases.
K
A
second
area
to
to
pull
out
and
focus
on
is
in
terms
of
our
regulator
reaction
so
slide,
seven,
which
is
which
is
page
59.
This
shows
how
we've
kept
operating
during
covert
we've
carried
out
228
inspections
with
the
site
visits
since
april,
and
90
of
these
are
based
on
intelligence
and
information
we've
received.
K
K
K
In
addition
to
that,
eighty
six
percent
of
two
hundred
and
twenty,
so
eight
percent
of
226
applicable
registered
services,
have
received
an
ipc
call
and
then
the
last
the
last
the
last
one
to
pull
out
for
me
would
be
slide.
10,
which
is
page
62.,
another
example
of
how
we've
kept
operating
volume
of
whistleblowing
cases
is,
is
increased
by
nearly
20
percent
compared
to
last
year.
K
Likely
contributed
to
this
is
the
the
launch
of
the
give
feedback
on
care,
so
those
those
volumes
have
increased
and
keep
coming
in
a
final
bit
for
me,
just
before
I
open
it
up
would
just
be
around
our
money,
our
revenue
budget.
So
in
the
start
of
the
year,
in
order
to
prudently
plan
for
a
delivery
of
a
change
program,
we
intentionally
set
a
five
million
deficit
budget
for
the
financial
year.
K
Current
financial
projections
mean
it's
likely
we'll
be
able
to
deliver
within
our
funding
envelope,
excluding
the
deficit
budget,
so
that
would
result
in
circa
two
to
three
million
net
underspend
on
a
revenue
budget
which
incorporates
potential
1.8
million
shortfall
on
income
from
from
providers
that
we
were
monitoring
in
terms
of
the
capital
budget.
As
we've
we've
currently
projected
a
three
million
overspend
on
that
due
to
which
is,
which
is
something
that
we're
aiming
to
manage
down
in
in
the
in
the
year.
K
A
Our
colleagues
have
been
incredibly
good
during
the
the
last
few
months
in
in
adapting
rapidly
to
new
ways
of
working.
That
has,
you
know,
as
chris
has
just
been
saying,
really
kept
the
show
on
the
road.
I
I'd
really
like
just
to
thank
everybody
and
congratulate
them
on
on
what
they've,
what
they've
achieved.
M
It
may
be
for
you
chris,
so
it
may
be
for
you,
kirsty
and
mark.
I
just
wanted
as
we're
seeing
sort
of
the
changes
over
time
that
are
happening
in
the
information
pack
that
you
just
shared
and
the
initiatives
that
we're
doing
is
there
a
way
of
sort
of
seeing
the
impact
of
the
initiatives
that
kirsty
through
you
know,
improved
qri
or
improved
digital
sort
of
technology
solutions?
M
Is
there
a
way
that
we
would
sort
of
overlay
we're
expecting
to
see
improvements,
because
that
is
what
the
business
cases
are
based
on
and
as
I
look
at
it
and
I'm
sort
of
a
far
it,
I
it's
difficult
to
connect
the
two.
I
Yes,
so
that's
all
around
our
benefits,
realization
piece
of
work
that
we
are
doing
at
the
moment.
So
we
are.
We
are
currently
mapping
out
what
the
benefits
are,
both
in
terms
of
financial
benefits
and
non-financial
benefits.
So
I
think
we've
obviously
started
to
realize
some
benefits
through
the
program
now,
for
instance,
digital
foundations
program
has
has
delivered
on
time
under
budget
and
is
now
starting
to
realize
savings
going
forward.
So
we're
mapping
those
plus
we're
also
looking
at
what
the
non-cachable
benefits
are.
I
The
sort
of
quality
quality
quality
type
benefits
as
well
that
that
work
is
happening
in
the
pmo.
At
the
moment,
we've
just
had
a
couple
of
keep
people
off
sick
for
a
while,
which
is
sort
of
slightly
giving
us
a
bit
of
delay,
but
I'm
hoping
we'll
be
able
to
start
to
put
that
into
the
pack
as
a
regular
as
a
regular
reporting.
So
you
can
see
how
the
benefits
are
tracking,
and
if
you
look
at
the
change
pack,
you
can
see.
I
There's
the
benefits
are,
are
rag
rated
as
well,
but
we
want
to
bring
that
a
bit
more
to
life
rather
than
just
a
red
amber
and
green
a
square
on
a
page,
but
we'll
we'll
just
hopefully
start
to
see
that
coming
through
in
the
next
few
months.
M
I
Just
on
that,
one
in
terms
of
kpis
we've
not
set
we've
we're
wanting
to
set
percentage
improvement
targets
so
that,
because
what
I
don't
want
to
do
is
set
a
target
that
everyone
goes
to
and
then
they
relax
and
get
off
because
we've
hit
that
and
then
it's
just
constantly
driving
that
that
improvement.
So
the
other
piece
on
registration
is
we're
starting
to
track
the
the
actual
financial
benefits
involved
in
the
sa
in
the
time.
I
Savings
that
we're
making
through
the
new
services
and
those
are
those
are
being
those
are
being
captured
and
are
fed
into
this
rag
ratings.
But
we
can.
We
can
certainly
look
to
bring
those
forward
in
a
bit
more
detail,
certainly
in
future
reports.
Thank
you.
M
L
J
Put
my
hand
down
mute
yeah.
Sorry,
I'm
back
on
that,
just
to
make
a
practical
example
of
what
kersey
was
saying:
jorah
without
the
changes
that
we
made
to
give
feedback
and
care
in
a
technical
sense,
without
improving
the
way
that
that
form
operate.
We
have
and
the
campaign
that
we
run.
We
would
not
have
seen
a
60
increase
in
the
gift
feedback
on
care,
or
indeed
the
increase
in
safeguarding
whistleblown.
J
In
my
opinion,
and
without
those
we
would
not
have
seen
the
300
or
so
responsive
inspections
that
we've
done,
because
that
is
that
information
that
has
driven
those
responsive
inspections.
So
I
appreciate
that.
That's
not
a
that's,
not
a
stats
answer,
but
that's
a
very
practical
example
of
a
change
to
our
systems
and
an
improvement
in
a
campaign.
That's
led
to
an
increasing
feedback,
that's
led
to
an
increase
in
responsive
inspections
and
I
think
that's
a
critical
path
of
things
that
we've
done
as
a
result
of
which
started
with
the
technology,
change
and
improvement.
A
Thanks
chris
mark
and
then
liz.
N
N
You
know
it
seems
to
me
in
the
month
where
we've
been
told
in
the
change
report
that
there's
a
new
people
and
analytics
data
hub
that
we
could
provide
some
richer
information
in
terms
of
how
we
are
performing
against,
managing
and
equipping
our
people
for
the
future,
especially
around
training
or
progression,
and
I
wonder
whether
it's
also
an
opportunity
for
us
to
also
highlight
at
board
level
our
performance
and
focus
on
some
of
our
res
standards.
I
So
yes
mark
we,
we
do
have
a
a
much
bigger
wealth
of
data.
Now
around
our
people
performance.
These
were
the
metrics.
I
think
that
we
I'm
just
looking
at
the
start
that
we
put
into
the
to
the
timetable
at
the
front,
but
we
certainly
have
a
bigger
pack
of
information
that
we
share,
that
the
managers
now
use
that
we
they
can.
They
can
use
to
manage
their
their
performance
and
their
management
capability
more
closely.
I
I
think,
there's
a
there's,
a
balance.
Isn't
there
between
how
much
information
we
we
we
share.
I
don't
wanna,
we
were
happy
to
share
everything,
but
there's
there's
a
balance
between
what's
sensible
at
a
board
level
and
then
what
what
the
managers
need
to
manage
their
business
on
a
day-to-day
basis.
So
perhaps
we
could
take
it
offline
and
you-
and
I
could
have
a
have,
a
look
through
our
data
and
then
we
could
say
which
ones
we
think
we
might
want
to
report
on
more
regularly
to
the
board.
B
It
was,
it
was
to
come
back
on.
Excuse
me,
jurors,
benefits
points
just
again,
as
kirsty
described,
we're
doing
a
very
sophisticated
piece
of
work,
around
benefits,
realization
in
sort
of
cash
and
non-cash
terms,
but
I
think
another
stat,
which
we've
we've
looked
at
during
this
time
period,
is
between
the
1st
of
april
and
the
15th
of
september.
Last
year
we
did
just
less
than
about
8
000
inspections.
B
If
we
look
at
exactly
the
same
time
period
this
year,
you
know
almost
entirely.
During
the
covered
period,
we've
done
19,
000
visits
and
and
and
regulatory
contact.
So
you
know,
I
think
I
think
that
the
shifts
that
we've
made
has
meant
that
our
reach
into
more
providers
has
been
greater
despite
the
the
code,
the
kobe
situation.
So
I
think,
as
we
as
we
start
to
develop
our
methodology,
then
we'll
start
to
see
you
know
what
works
and
what
doesn't
work
and
we
do
need
to
do
more
and
less
off.
B
But
but
you
know,
we've
done
more
than
double
the
number
of
regulatory
contacts
this
year
than
than
last,
albeit
in
a
different
context.
Thank
you.
H
Yes,
thanks
very
much
chair,
I,
I
was
very
interested
in
the
regulatory
action
response
to
risk
slide
that
you
highlighted
chris
and
what
looks
like
a
very
interesting
example
of
how
we're
using
our
inspection
tool
in
response
to
very
live
information.
Intelligence.
That's
coming
in
less
less
constrained
by
the
sort
of
you
know.
We
do
we
do
inspections
on
a
particular
level
of
regularity
depending
on
ratings,
etc.
So
I'm
sure
there's
a
lot
of.
H
I
imagine,
there's
a
lot
of
learning
from
that
for
our
future
approaches,
but
what
I
wondered:
we've
categorized
the
information
here
in
terms
of
how
it
comes
in
safeguarding
whistleblowing
and
so
on.
Do
we
have
other
ways
of
categorizing
this
intelligence,
I'm
thinking
both
of
theme
and
also
who's
giving
it.
We
had
a
very
interesting
discussion
yesterday
in
the
regulatory
governance
committee
about
the
triangulation
of
our
intelligence.
H
So
you
know
it
might
be
that
some
is
coming
from
whistleblowers
members
of
staff,
some
is
coming
from
people
using
a
service
or
their
relatives
or
other
people.
I
just
wondered:
I
just
wonder
whether,
as
we
go
into
this,
you
know
really
further
developing
our
intelligence-driven
approach,
whether
we
do
or
will
have
other
ways
of
categorizing
as
well
as
this,
which
is
very
useful.
K
Yes,
we
do
is
the
short
answer,
so
we
can.
We
can
identify
themes
of
who
they've
come
from
and
also
the
themes
of
what.
So
we
can
look
at
how
we
we
bring
that
into
a
report
and
if
that
would
be
helpful.
H
A
Anybody
else
want
to
come
in
on
the
performance
report,
so
it
strikes
me
that
we
we
had
a
coffee
break
just
over
an
hour
ago,
and
we
probably
need
a
comfort
break
now
about
halfway
through
the
the
agenda.
So
shall
we
give
ourselves
literally
just
five
minutes
and
then
come
back
and
we'll
get
into
the
change
report.
A
I
Thank
you
peter.
So
this
is
our
quarterly
change
update
in
terms
of
just
an
update
on
what
we've
been
doing
through
the
transformation
program
and
I'll
I'll
cover
off
most
bits
and
then
I'll
hand
over
to
mark
to
pick
up
some
of
the
digital
aspects
as
well.
So
we
have
continued
to
make
really
good
progress
across
the
portfolio
as
a
whole.
I
We
have
seen
some
small
variation
within
programmes,
but
generally,
I
think
we're
making
some
really
really
good
progress
across
the
breadth
and
complexity
of
our
portfolio,
whilst
covert
19
has
proved
to
be
a
bit
of
a
bit
of
a
challenge,
to
put
it
mildly,
over
the
last
quarter,
or
so.
It's
also
presented
some
real
opportunities
for
us
to
learn
and
adapt
and
evolve
and
to
work
in
a
different
way
and,
and
the
organization
in
in
the
change
space
has
really
responded.
I
I
think
one
of
the
things
we've
really
really
been
able
to
do
is
to
look
at
how
we
we
implement
and
how
we
work
across
the
organization
in
multidisciplinary
teams.
How
we've
approached
the
the
concept
of
testing
putting
stuff
out
there
and
then
adapting
it
and
iterating
as
we've
gone,
so
that
we
learn
as
we
go,
and
I
think
that's
been
a
really
helpful
lesson
for
us
and
one
that
we
want
to
continue
to
build
on
going
forwards.
I
So
some
highlights
from
the
last
quarter.
Our
transitional
regulatory
approach
is
is
on
the
on
the
agenda
later
and
ted
will
talk
a
little
bit
more
about
that,
but
this
really
does
exemplify
our
new
ways
of
working.
I
How
we
have
taken
an
idea
through
from
the
original
concept
of
the
emergency
support
framework,
how
we've
been
able
to
build
on
that
digital
platform
working
really
collaboratively
across
the
organization
to
put
in
new
ways
of
working
into
practice
at
pace
to
really
adapt
to
the
changing
environment
which
we
find
out
there
in
in
the
world
in
which
we
regulate.
I
won't
say
any
more
than
that,
because
I
don't
want
to
steal
ted's
thunder,
but
a
really
really
positive
story.
I
We
have
been
working
really
hard
on
on
this
over
the
last
quarter
or
so,
and
the
team
have
now
moved
into
a
detailed
design
phase
which
will
culminate
in
about
towards
the
end
of
september.
I
With
a
new
blueprint,
this
blueprint
will
sort
of
set
out
how
the
operational
model
the
target
operating
model
will
work
into
practice
and
how
it
will
actually
support
the
realization
of
our
strategy
and
continue
and
support
us
to
deliver
benefits
to
to
service
users
and
out
into
providers
providing
a
how
we
can
really
help
us
provide
that
really
good
regulatory
experience
where
we
we're
able
to
provide
right
touch
style
of
regulation,
the
regulatory
platform
piece
of
work.
Sorry,
the
regulatory
platform
piece
of
work
is
a
core
tech
core
enabling
technology.
I
This
is
replacing
our
legacy
crm
system
we
are.
We
have
been
building
on
this.
It's
a
key
key
underpinning
piece
of
capability
for
us
for
the
future
and
we
are
making
good
progress
on
that
in
terms
of
bringing
in
our
delivery
partner
and
developing
a
delivery
roadmap
to
set
out
the
the
progress
that
we're
going
to
make
at
the
the
releases
that
we
are
going
to
make
in
order
to
bring
forward
benefits
at
the
earliest
opportunity.
I
There's
a
huge
digital
component
to
that
and
I'll.
Let
mark
talk
a
little
bit
more
about
the
process
that
is
going
on
with
that
program
shortly.
The
intelligence
driven
enablers
again
is
another
critical
program
to
support
our
ambition
to
be
intelligence
driven.
I
I'm
pleased
to
announce
we
had
a
major
success
with
our
digital
foundations
program.
We
had
a
major
milestone
achieved
with
this
program,
in
that
it
delivered
on
time
and
to
budget,
and
we've
been
able
to
close
out
that
program
on
the
28th
of
august.
I
This
is
a
huge
piece
of
work
that
we
have
done:
transforming
trans,
transferring
all
of
our
I.t
provision
from
our
legacy
provider
into
a
new
service
and
new
ways
of
working,
and
I
think
I
must
want
to
say
to
mark
and
his
team
that
they
have
done
a
fantastic
job
in
enabling
this
to
happen.
It
is
a
very,
very
complex
piece
of
work
and
to
deliver
it
on
time
and
on
to
budget.
For
such
a
big
digital
piece
of
work
is,
is,
is
a
serious,
a
serious
achievement
to
be
fairly
honest.
I
I
We
have
developed
a
new,
a
new
digital
service
called
register
with
cqc,
and
this
has
gone
live
in
this
one
live
back
in
the
summer
for
the
first,
a
minimum,
viable
product.
I
We
have
now
scaled
that
out
to
incorporate
both
community-based
adults,
social
care
partners
and
sole
traders.
That's
happened
on
schedule
and
we
have
received
really
positive
feedback
from
providers
saying
that
this
is
actually
a
really
simple
easy
to
use
system.
It's
saving
them
a
lot
of
time
and
effort
in
being
able
to
do
that
which
is
really
positive.
I
It's
also
has
some
real
benefits
in
terms
of
our
internal
workings,
and
we've
noticed
that
we've
been
able
to
save
significant
amounts
of
time
in,
in
that
in
in
terms
of
our
back
office
processing
for
that
service,
we're
now
looking
to
expand
that
service
over
the
over
the
coming
months
and
rolling
out
that
into
public
beta,
which
is
again
a
positive
story.
I
Improving
regulation
today
is
is
a
complex
collection
of
programs
and
projects
which
improve
how
we
regulate
today.
It
brings
all
brings
all
those
together
in
into
a
program
of
work,
so
we
can
keep
keeper
can
manage
it
in
so
in
a
in
a
coordinated
way.
I
We've
also
got
a
huge
amount
of
work
in
there
on
other
areas,
such
as
safeguarding
and
whistleblowing,
and
what
we're
doing
with
that
program
of
work
is
it's
prioritizing
things
bringing
them
forwards
on
a
sort
of
on
a
backlog
of
conveyor
belt
if
you
like,
as
we
work
through
them,
making
sure
that
we
resource
these
are
properly
to
deliver
on
these
important
areas
in
a
timely
fashion.
I
I
We've
delivered
a
range
of
training
programs
to
upskill,
our
colleagues
across
the
organization
ranging
from
experts
to
gold
gold
standard
to
the
practitioner
level
and
brought
abroad
sort
of
baseline
knowledge
for
the
organisation.
I
I
We
are
continuing
to
build
our
maturity
in
this
area,
continuing
to
roll
out
training
and
bringing
forward
projects
and
we're
now
starting
to
see
some
of
those
benefits
starting
to
be
realized
across
the
business
and
as
we
do
that
it
starts
to
reinforce
the
value
and
the
the
benefits
of
working
in
this
qi
way
and
we're
starting
to
really
see
that
that
cultural
change
taking
taking
effect
throughout
the
organization
more
work
to
do,
but
a
really
really
solid
start.
I
C
Thanks
kirsty,
so
just
adding
to
that
a
few.
C
Of
extra
of
extra
color
here
accommodations
program-
that's
cursed,
he
was
talking
about,
is
now
complete.
Let
me
use
this
shared
services
in
the
ims:
three
department
distribution,
that
city
owns
map
and
it
administrates
itself,
and
that
includes
a
new
service
city,
opera
center
and
a
new
internal
capabilities.
We've
successfully
separated
completed
the.
C
Exit
that
you
know
and
and
now
we're
focusing
on
him,
barely
it's
improvement.
I'd
really
like
to
thank
and
his
team
and
all
of
our
technologies,
his
significant
piece
of
work
and
the
transition
of
success.
I
I
C
Can
you
hear
me
okay
great?
So
actually,
so
let
me
cover
that.
Okay,
in
case
you
didn't
get
it
all
so
digital
and
that's
and
we've
exited
from
our
previous
ims3
shared
services.
L
A
I
Will
do
okay
so
again
a
pretty
packed
agenda
around
the
work
we're
doing
around
our
supporting
of
our
people.
Development
across
the
organization.
I
So,
in
order
to
facilitate
that,
we've
been
running
a
whole
range,
a
whole
range
of
cross-organizational
workshops
where
we've
been
gathering
people
together
to
understand
both
their
their
their
get
their
views,
their
ideas,
their
frustrations,
so
that
we
can
get
collate,
pull
that
information
together
to
help
us
inform
our
detailed
design.
I
Those
have
been
really
positive.
Workshops
have
been
really
well
attended,
been
very
vibrant
lots
of
lots
of
conversation
and
discussion,
great
ideas
coming
forward
from
there,
and
we
want
to
contain
continue
with
that
as
we
go
forward.
But
I
think
that
that
first,
that
those
first
tranches
of
workshops
have
been
really
helpful
in
terms
of
helping
us
with
our
with
our
thinking
and,
I
think,
have
been
really
well
received.
I
Other
areas
of
work.
We
we
have
a
a
detailed
people
plan
and
one
of
the
areas
we've
been
looking
at
is
building
leadership
and
management
capability.
I
This
success
profiles,
I
think
in
in
previous
year,
previous
iterations
or
previous
years,
were
called
competency
frameworks,
but
I
think
success
profiles
sounds
sounds
better.
We
have
been
building
we've
been,
we've
been
doing.
This
work
to
really
start
to
codify
the
behavioral
excellence,
the
expectations
of
behavioral
excellence
and
the
capabilities
we
want
to
see
at
each
grade
in
the
organization
right
through
from
the
most
junior
grades
to
the
most
senior
senior
grades.
Those
have
been
pulled
together
through
again
through
collaborative
workshops
where
people
have
really
talked
about.
I
What's
what
good
looks
like
in
their
jobs
and
we've
been
able
to
translate
that
into
a
framework
that
will
be
launched
across
the
organization
in
november,
and
it
will
provide
that
framework
now
to
support
our
leadership
development
moving
forward
and
a
whole
host
of
other
hr
and
people
type
policies
that
we
want
to.
We
want
to
bring
in
a
key
one
of
those
is
our
line
management
capability
building
program
that
will
be
based
on
the
the
on
the
success
profiles
and
what
we've
been
doing.
I
There
is
looking
at
developing
pathways
development
pathways
for
for
line
managers
to
align
to
the
success
profiles
and
give
them
equip
them
with
a
really
solid
range
of
practical
skills
of
management,
skills
that
each
at
the
right
for
the
right
level
of
the
their
job
and
in
the
organization
and
also
a
pathway.
So
they
can
see
what
they
need
to
do
to
build
capability
to
progress
through
to
the
next
levels.
I
What
we've
done
to
do
that
is
we've.
We
have
skill
trained
up
some
of
our
hr
experts
within
the
academy
to
deliver
some
of
these.
Some
of
these
training.
I
Through
through
through
so
that
we're
able
to
to
to
tailor
them
to
support
cqc
and
we're
able
to
flex
them
as
well.
We
like
that's
about
to
be
being
launched
as
well
to
start
to
drive
those
those
skills.
We've
run
a
few
pilots.
Those
have
been
really
well
received
in
terms
of
that
real
practical
type
of
training
that
people
can
use
lots
of
things
like
role
playing
and
things
they
actually
get
to
to
to
learn
to
do
difficult.
I
In
a
real
life
situation,
rather
than
just
being
dry
training
through
certain
textbooks
and
things
like
that,
we're
also
continuing
our
refresh
of
our
people
policies.
Those
are
on
track
to
complete
by
the
end
of
2021.
I
These
are
the
policies
that
we
that
govern
our
our
our
leadership
management
and
how
we
we
work
as
an
organization
with
regards
to
our
people.
I
What
we
want
to
do
with
these
is
we're
updating
them,
so
they
reflect
a
a
modern
working
environment,
but
what
we
also
want
to
do
is
to
bring
forward
these
into
an
app
enabled
capability
so
that
they
really
provide
that
that
support
and
guidance
to
to
managers,
so
they
are
able
to
do
the
right
thing
in
the
right
way
in
a
timely
fashion
with
that
with
those
apps
which
will
sort
of
guide
them
through
in
a
really
helpful
way,
inclusion
inclusion,
we
have,
we
have
something.
I
On
the
agenda
later,
but
we
are
continuing
to
focus
quite
heavily
on
this.
We
have
a
big
piece
of
work
around
around
increasing
in
around
inclusion,
which
is
based
around
our
dni
strategy.
I
We
have
been
focusing
recently
more
on
our
recruitment
process
and
practice
to
ensure
that
our
recruitment
process
practices
are
fair
and
fair
and
open,
and
that
everybody,
regardless
of
their
background
or
their
protective
characteristics,
has
a
fair
shot
at
getting
through
the
process
as
well
as
doing
that.
We
are
also
looking
at
develop
our
development
program
for
leaders,
including
a
big
program
around
cultural
awareness
and
also
formalizing,
reverse
mentoring
for
our
senior
leaders
to
really
help
both
encourage
understanding,
but
also
really
raise
awareness
of
the
importance
of
this
issue.
I
We
also
following
the
black
lives
matter,
protests
and
the
the
response
to
that.
We
held
a
number
of
listening
events,
and
as
a
result
of
that,
we
had
some
some
really
powerful
stories.
As
a
result
of
that,
we've
pulled
together
a
a
new
race
equality
action
group
which
are
going
to
address
some
of
these
concerns
and
really
ensure
that
we
are
driving
through
significant
improvement
in
a
timely
way
in
these
important
areas
and
then,
finally,
on
the
people
front
we
are
we
are.
I
We
have
been
planning
to
run
a
series
of
pulse
surveys
to
take
temperature
check
of
our
organization
on
a
regular
basis.
We
are
planning
running
the
next
one
of
those
in
autumn,
which
again
gives
people
an
opportunity
to
feedback
what
they're
feeling.
I
think
this
one
will
be
particularly
important,
as
this
will
be
the
first
one.
I
We've
run
since
a
lot
since
the
second
one
since
lockdown,
but
I
think
we
really
want
to
focus
this
one
on
well-being
and
seeing
how
people
have
are
coping
and
responding
to
to
the
change
changing
ways
of
working
through
covid,
so
that
we
can
make
sure
we're
tailoring
our
policies
and
the
ways
of
working
to
support
people
in
in
these
new
and
interesting
times.
A
H
Thanks
peter
yes,
I
just
wanted
to
touch
on
the
the
new
race
equality
action
group
and
very
much
to
welcome
it
and
welcome
what
what
I've
heard
about
its
focus
on
action
and
on
really
solid
engagement
with
colleagues
from
across
the
organization
and
I've.
I've
agreed
to
be
a
a
link
to
the
non-exec
link
to
that
group,
so
I'll
be
able
to
hopefully
update
the
board
in
in
future
on
issues
coming
up.
H
I
just
wanted
to
ask
immediately
what's
the
sort
of
join
up
between
some
of
these
different
strands
of
work
in
the
people's
strategy,
so,
for
example,
line
management
capability.
I
know
that
a
number
of
organizations
on
race
equality
have
found,
there's
really
strong.
You
know
really
strong
strategic
intent,
strong
leadership,
backing
for
good
practice
on
race
equality,
but
it
can
get
lost
in
parts
of
the
organization
just
in
the
busy
day-to-day.
H
You
know
the
huge
numbers
of
priorities
that
managers
are
dealing
with,
and
I
just
wondered
whether
the
inclusion
strategy
is
threading
into
the
line
management
capability
work
or
if
it
will
be
yes,.
I
Yes,
so
the
the
success
profiles
have
a
very
strong
element
of
inclusion
woven
through
them,
so
that,
if
you
think
about
the
success
provides
being
the
building
block
for
us
in
terms
of
all
the
other
things.
So
that
will
be
a
a
core
competency,
if
not
com
or
a
key
expectation
of
the
behaviors
and
things
that
we
want
to
see.
So
inclusion
will
be
picked
up
through
through
performance
management
and
all
those
sort
of
areas,
because
it
is
absolutely
critical
to
to
the
organization
going
forward.
I
We
want
to
be
a
truly
inclusive
organization,
and
that
has
to
start
right
at
the
the
basics
in
terms
of
how
we
manage
people
day-to-day,
how
we
assess
people
in
terms
of
their
progress
and
their
performance.
So
it
has
been
absolutely
hardwired
into
sort
of
our
day-to-day
activity.
If
you
like
thanks.
N
Yeah,
thank
you
peter.
Thank
you,
chairman
echo,
liz's
comments
and
very
pleased
to
to
hear
that
this
is
a
link
for
us
to
the
race
equality
action
group.
I
think
that's
going
to
be
very
positive
for
us
as
a
board,
kirsty
very,
very
busy,
and
you
know
super
rapport
around
people.
N
Could
I
just
ask
in
terms
of
transforming
our
organization
there's
quite
a
few
comments
and
you've
referred
to
it
as
well
today
in
your
verbal
report,
around
the
emphasis
on
communications
and
opportunities
to
contribute
to
the
transforming
our
our
organization,
and
I
just
wonder
whether,
in
terms
of
the
pulse
survey,
I
totally
support
the
focus
on
well-being
after
this
major
transformation
in
working
practices.
I
So
absolutely
mark,
so
I
think,
if
you
remember
back
to
previous
conversations
on
our
our
pulse
survey,
we
have
a
thread.
We
will
have
a
common
thread
of
questions
that
we
ask
every
time
so
that
we
can
always
we
can
benchmark
where
we
are
and
our
our
ability
to
communicate
around
change
is
is
one
of
those
areas,
so
we
can
just
keep
track
of
it,
and
it's
really
important
that
we're
able
to
do
that
during
as
we
go
through
this.
A
Great,
thank
you
so
chris
did
you
want
just
to
follow
up
on
that
and
then
paul
rue
to
come
in
please
yeah.
I.
J
Think
that's
a
really
important
point.
Important
point
mark.
I
think
the
key
thing
for
me
is
the
relationship
between
the
to
and
the
strategy,
so
that
we're
having
a
single
conversation
with
our
colleagues
with
providers
with
people
who
use
services
about
what
our
intent
is
during
this
transformation
and
what
our,
what
our
longer
term
intent,
is
as
we
move
towards
the
next
strategy.
So
it
isn't
just
about
the
acts
of
engaging
on
on
transforming
an
organization.
J
It's
a
link
between
that
and
our
wider
strategy
that
I
want
to
make
sure
we
do
and
what
we're
trying
to
do
with
each
of
the
people
who
lead
in
the
work
stream
of
working
and
transforming
our
organization
space
is
to
agree
with
our
team.
What
are
the
opportunities
to
engage?
What
are
the
messages
and,
importantly,
how
will
the
feedback
be
used
to
drive
each
of
the
strands
of
work
in
the
transformational
organization,
space.
E
Yeah
thanks
peter,
I
have
to
say
I
think
this
is
an
amazing
amount
of
work.
That's
been
going
on
over
the
period,
it's
a
quite
a
phenomenal
program
that
is
being
managed
through
the
business
in
in.
C
E
E
I
think,
maybe
on
or
even
under
budget
and
successfully
implemented
off
the
other
systems
that
that
really
is
a
a
sign
of
an
I.t
function.
I
think
which
is
is
is
performing
well
the
comments
that
I
had.
One
question,
though,
which
was
around
covid
and
the
pandemic
and
the
impact
upon
what
they're
doing
it
has
it.
Has
it
been
a
help
to
have
the
pandemic
to
for
this
program?
E
In
that
it
I
I
guess
it
has
driven
some
things
around
being
agile
and
moving
fast
to
get
some
some
things
that
really
had
to
be
done
done,
but
has
been
a
help,
because
we've
had
people
who
might
otherwise
have
been
out
doing
inspections
on
the
ground,
able
to
actually
act
as
smes
and
so
on
and
bring
into
the
system,
or
has
it
been
a
hindrance?
E
That
was
one
question,
and
the
second
question
was
around
the
linkages
between
all
the
different
strands.
As
we
go
forward,
are
those
interdependencies
going
to
become
more
important
and
more
limiting
so
as
as
we
start
to
get
things
coming
to
when
they
should
be
completed?
E
If
one
thing
depends
upon
another,
are
there
risks
that
we're
going
to
be
finding
problems
around
around
that
or
have
we
got
that
that
really
mapped
out
out
well
and
and
clear
and
taken
on
top
of
it,
and
I
think
the
third
things
I'd
echo,
what
what
mark
was
saying
about
bringing
in
the
into
the
pulse
survey
around
this,
but
I
think
particularly,
is
not
only
to
people
what
how
do
they
contribute
to
the
transforming
the
organization
and
the
strategy,
but
also
do
they
understand
what's
going
on
here?
E
Do
they
feel
that
that,
because
there's
so
much
going
on,
how
do
we?
How
do
we
communicate
in
a
way
which
helps
them
understand
what
they
feel
they
need
to
understand
around
it?
Those
are
the
three
questions.
Okay,.
A
I
Technically,
if
that
helps,
and
then
like,
I
just
knock
off
some
of
the
technical
ones.
If
that
helps
around
the
interdependency
piece,
yeah
yeah,
I
think
the
interdependencies
is,
is
if
there's
so.
If
there's
one
bit
that
keeps
me
awake
at
night,
it's
bad
because
there
is.
There
is
a
lot
of
moving
parts
to
this
program,
and
there
are,
there
are,
if
you
start
to
unpick
it,
it
looks
like
a
spider's
web
of
dependencies.
I
The
key
thing
that
we
need
to
land
is
a
blueprint
for
the
tom,
and
once
we've
got
that
landed
at
the
end
of
september.
That
then
starts
to
say
where
what
are
the?
What
are
the?
What,
in
terms
of
that
holistic
program
of
activity,
have
we
got
everything
we
need
in
order
in
place
to
deliver
against
this?
To
make
sure
we
realize
the
strategy
and
what's
the
timing
of
these
things,
what
are
the?
Where
do
which
what
things
need
to
go
first,
and
is
that
in
the
current?
I
So
the
team
are
on
on
with
this
at
the
moment,
but
we're
still
waiting
for
that
final
blueprint
to
just
absolutely
nail
this
down,
but
it
is
something
that
we
are
talking
about
regularly
day
in
day
out,
because
I
think
it
is
really
important,
but
we
just
need
that
that
final
that
blueprint,
which
is,
I
suppose,
the
key.
The
key
to
all
this
to
then
enable
us
to
put
all
those
moving
parts,
absolutely
in
the
right
order
and
then
really
map
and
do
some
scenario
planning
about
what
happens.
B
Thanks
peter
I
can
I
just
I
think
paul
makes
answers
asks
a
great
question
if
I
could,
if
I
could
link
that
to
the
the
other
point
about
digital
fundamentals
in
in
general,
I
think
the
digital
fundamentals
program
has
done
two
things
hey.
It
is
a
sort
of
rip
and
replace
which
I
know
marco
and
thank
me
for
saying
around
some
of
the
core
things
that
we
already
had
like,
like
an
email
system
and
a
file
storage
system
and
so
forth.
B
So
in
many
senses
for
the
average
average
colleague,
they'll
look
and
just
go
well,
I've
got
an
email
system,
looks
very
similar
to
the
way
I
did
yesterday.
The
fact
that
some
of
the
plumbing
has
been
changed
is
of
no
import
to
them,
but
what
it
has
done
is
it
gave
us
a
set
of
digital
capabilities,
particularly
the
ability
to
use
video
conferencing
and
mass
broadcast
technology
within
teams
to
to
talk
to
the
whole
organization
in
one
go
and
we've.
So
what
I
do
is
I
talk
to.
B
I
talk
to
the
whole
organization
twice
a
week,
so
I
got
a
routine.
I've
got
an
audience
of
around
2000,
regular
people
that
I
am
you
know.
I
try
regularly
rather
talk
to
2
000
people
every
week
with
a
set
of
messages.
They
hear
them
directly
from
me.
Colleagues
on
it
on
the
exact
team
taking
in
turns
to
run
leadership
calls
which
are
once
every
week
to
two
weeks.
I
know
individual
exec
team
leaders
will
be
talking
to
their
own
directorates
on
on
on
talk
calls
as
well.
B
So
we
were,
we've
been
able
to
blend
written
material
with
the
the
voices
of
leaders
directly
delivering
that
material
we've
been
able
to
jump
on
the
misconceptions
that
often
run
around
an
organization
and
deal
with
them
in
real
time.
Sometimes
on
my
calls
I'll
get
people
putting
something
in
the
chat
and
I'm
able
to
deal
with
it
straight
away
was
in
the
in
the
old
world.
You
know
it
would
have
taken
weeks
before
we'd
realized
that
people
had
got
the
wrong
end
of
the
stick
on
something.
B
So
I
I
think
kovit
has
helped,
because
in
my
in
my
old
way
of
thinking
I
would
have
to
say
I'm
pretty
guilty
of
saying
I
I
disliked
digital
communications
because
I
didn't
think
it
was
authentic.
I
would
far
rather
stand
in
front
of
a
group
of
people
and
talk
to
them
directly,
and
I
think
we
probably
have
all
been
brought
up
in
a
leadership.
Culture
that
said
face
to
face
is
always
better
and
I
think
what
kovid
has
done
is
it
stopped?
B
It
forced
us
to
stop
doing
that
and
forced
us
to
really
give
digital
a
go,
and
in
doing
that,
we've
also
had
a
great
digital
platform
off
which
to
do
it.
So
I
think
those
two
things
coming
together
has
been
a
real
positive
and
I've
certainly
learned
the
lesson
that
that
I
don't
think
any
exclusively
digital
communication
setup
is
is,
is
completely
the
right
thing
to
do,
but
it's
probably
far
more
important
than
I
ever
realized,
and
I
know
I
know
other
colleagues
feel
the
same
way.
B
I
think
that
the
the
the
big
downside
of
covert
for
me
is,
we
may
have
people
potentially
more
available
because
they're
not
traveling,
so
much
and
they're
able
to
jump
on
calls
quickly,
but
the
the
depth
of
creativity
that
we
get
digitally
is
probably
not
necessarily
as
good
as
it
would
be
if
we've
got
those
same
people
in
a
room,
but
there's
a
there's
a
trade-off
there,
and
I
think
that
that
the
breadth
of
access,
the
number
of
voices
we've
been
able
to
pull
into
conversations
is
a
real
positive.
B
I
think
the
thing
we
don't
know
is
what
the
negative
of
that
of
that
creativity
thing
is
and
whether,
in
the
long
term,
there's
a
creativity
deficit,
if
you
will-
and
I
think
I
think
most
organizations
are
feeling
the
same
way-
is
that
you
know
if
they're
doing
work,
which
is
new
and
different
and
spontaneous.
B
D
Just
very
briefly
so
feedback
from
inspectors,
I
don't
think
they've
ever
felt
as
plugged
in
or
able
to
contribute
to
something.
So
you
know
if
you're
an
inspector
in
stoke
or
a
newcastle,
the
ability
to
hop
onto
a
workshop
to
talk
about
the
way
our
workforce
should,
you
know,
deliver
the
ambition
and
the
feedback
from
inspectors.
I've
heard
is
loud
and
clear
that
the
tech,
the
tech,
a
solution
to
enable
them
to
engage
in
these
discussions
in
a
really
timely
way
is,
is
brilliant.
D
I
think
our
staff
feel
highly
engaged
pretty
optimistic.
I
think
we
sometimes
get
the
challenge
of
sharing
stuff
and
trying
to
co-produce
stuff
at
such
an
early
day.
At
such
an
early
stage
means
often
we
and
leaders
and
managers
don't
have
the
answers,
but
that
is
the
kind
of
pros
and
cons
of
doing
that.
D
People
have
the
chance
to
really
shape
what
something
looks
like,
but
you
can't
look
to
the
manager
to
to
respond
to
to
have
every
answer
up
their
sleeve,
but
generally,
I
think
you
know
we
would
absolutely
want
to
retain
what
tech
has
given
us
in
terms
of
inspectors
based
throughout
the
country.
Being
able
to
plug
in
and
engage
to
these
conversation
stations
in
a
really
timely
way,.
A
So
chris
day
and
then
unless
anybody's
got
anything
more
on
on
this
subject,
we'll
go
back
to
mark
and
hopefully
his
broadband
is
working.
Chris.
J
Just
one
thing
to
finally
to
say
on,
I
agree
the
thing
that
colleagues
have
said.
I
think
the
really
important
bit
for
people
both
internally
and
externally
is
to
link
our
ambition
to
a
to
a
simple
to
understand
outcome.
I
think
paul
asks
questions.
Do
people
understand
what
they're
doing?
J
I
think
if
you,
we
often
use
a
language
in
in
business
or
a
programme
language
which
is
useful
for
us,
but
when
we're
describing
things
that
are
meaningful
to
our
colleagues,
meaningful
supervisors
in
terms
of
to
the
public,
I
think
the
ambition
of
the
outcome
that
we're
seeking
is
the
most
important
thing,
the
most
important
language
that
we
can
use
in
that
communication
and
for
me
I
think
the
there's
a
thing
to
describe
as
a
squeeze
middle.
So
those
are
managers
that
have
to
have
frontline
interactions
with
with
with
staff.
J
It's
really
really
important
that
they
understand
the
reasons
why
we're
making
the
change
that
we're
making
and
if
they
understand
the
outcome
and
the
outcome
benefit.
They
are
better
able
to
describe
to
somebody
what
that
means
for
them.
So,
rather
than
trying
to
have
a
generic
communication
that
tries
to
talk
to
everybody,
trying
to
be
clear
about
the
outcomes
and
giving
those
those
managers
the
opportunity,
having
good
conversations
with
their
team
about
what
the
outcome
has
been
for
how
they
work
those
two
things
that
are
key
to
me
outside
what
the
digital
impact.
A
Thanks
chris
right
mark
is
your:
is
your
broadband
back
on.
C
I
hope
so
I've
switched
to
another
provider,
so
I
I
hope
you
can
hear
and
hear
me:
okay,
loud
and
clear,
fantastic,
okay.
So
so,
very
briefly,
we
we
talked
briefly
there
about
digital
foundations.
We
would
describe
that
program
now
as
being
complete.
We've
exited
from
the
previous
ims.
Three
shared
service
contract
and
we've
established
our
own,
our
own
managed
within
with
a
new
internal
capability
model
of
service
provision.
C
So
we
are.
We
are
now
masters
of
our
own
digital
destiny.
We
have
a
new
service
desk,
we
have
new
security
operations
center
and
and
as
of
the
end
of
august,
we
we've
kind
of
cut
our
network
ties
with
with
atos,
and
we
are
now
successfully
on
our
own.
Our
focus
now
is
on
on
embedding
and
on
on
continuous
improvement,
making
sure
that
we
can.
C
We
can
leverage
the
the
benefits
that
we've
we've
got
from
this
investment,
but
I'd
really
like
to
thank
ian
lovett
and
his
team
and
all
of
our
technology
suppliers,
including
atos,
who
made
this
really
significant,
transitioner
a
success,
and
I
think
to
paul's
point
earlier
on
about.
C
Whether
working
from
home
may
have
made
this
more
challenging
or
not.
I
think
it
was
a
challenge,
certainly
in
terms
of
this
specific
program,
but
I'm
you
know,
I'm
really
grateful
for
the
team.
I
think
we've
worked
incredibly
hard
to
make
this
happen
and
I
think
it's
the
commitment
of
the
of
the
extended
team
and
of
cqc
colleagues
that
have
really
made
this
a
success.
C
The
regulatory
platform
is
is
now
working
with
our
we've
got
a
new
supplier
on
board
to
help
us
with
the
implementation
we're
in
a
design
phase
of
that
at
the
moment,
which
is
going
to
complete
next
month
and
then
we'll
start
the
foundational
build
of
our
dynamics,
365
system,
which
will
support
all
of
our
new
or
all
of
our
regulatory
activities
with
new
applications.
C
C
The
thing
that's
underpinned
all
of
our
very
quick
work
that
we've
done
in
response
to
the
to
the
covid
pandemic
and
is
currently
supporting
our
transition
activities,
such
as
the
emergency
support
framework
and
now
the
new
transition
monitoring
app
and
we'll
be
we'll
be
we'll
be
building
out
our
our
future
foundational
components,
which
includes
things
like
security
and
authentication
and
new
data
model
and
integration
with
existing
systems,
which
will
allow
us
to
continue
in
this,
this
very
agile
way
of
working
and
that
allows
us
to
build
out
functionality
and
deliver
functionality
and
deliver
that
benefit
to
the
organization.
C
In
a
way
that
is
very
quick
to
enable
us
to
to
to
get
the
benefit
in
that
early.
C
We're
also
building
out
now
and
a
new
intelligence
data
platform,
and
that
architectural
design
work
is
now
complete
and
has
been
validated
externally,
and
we're
going
to
start
to
build
that
out.
Now,
working
with
work,
work
working
with
the
teams
internally
and
externally,
to
build
out
two
or
three
use
cases
of
how
that
technology
can
can
underpin
our
our
our
intelligence
and
and
data
business
use
cases.
C
We've
also
very
recently,
successfully
implemented
a
new
underpinning
technology
for
our
contact
center,
which
is
a
significant
milestone
for
us,
and
that's
that
launch
will
continue
to
support
an
evolution
of
our
ability
to
to
offer
different
ways
that
people
will
be
able
to
contact
contact
cqc
above
and
beyond
the
the
current
methods
that
we
have,
and
I
you
know
just
like
to
kind
of
reiterate
the
point
earlier
on
this.
It's
been
a
really
successful
quarter
of
delivery
under
under
some.
C
You
know
unusual
circumstances
and
some
really
notable
achievements
and
that's
been
that's
been
successful
because
of
the
hard
work
of
people
within
cqc,
but
also
our
technology
partners.
Who've
carried
on
carried
on
working
under
these.
Under
these
circumstances
of
working
remotely.
A
Well,
it
seems
to
me
that
we
are,
we
are
already
in
a
a
better
place
and
doing
our
our
job
better
than
we
were
able
to
in
many
many
respects,
pre-covered
and
as
and
when
we're
able
to
get
back
out
again
we're
we're
just
going
to
be
in
such
a
good
place,
and
I
really
again
congratulate
you
mark
and
indeed
everybody
for
for
what's
been
achieved.
A
J
Sorry,
this
insight
report
has
two
main
themes
alongside
the
regular
information
that
we
that
we
published
as
part
of
our
insight
report,
we
wanted
to
look
in
particular
at
some
of
our
early
findings
on
the
provided
clarity,
reviews
and
also
some
of
our
what
we
learned
from
our
infection
prevention
control.
So
if
I
hand
over
to
rosie
just
to
go
through
some
of
the
pcr
work.
First
is
that
okay,
rosie.
G
Yeah,
certainly
thank
you
chris
and,
as
we've
discussed
many
times
on
the
board,
we
think
the
quality
of
care
that
people
receive
partly
depends
on
the
care
they
received
within
a
provider,
but
actually
also
depends
on
the
care
they
receive
as
they
they
transfer
from
provider
to
provider
or
how
providers
work
to
really
make
sure
that
the
person
and
the
population
needs
are
met.
G
So
there's
two
aspects
to
provide
a
collaboration
reviews
I'm
just
going
to
ask
charles
to
just
briefly
remind
the
board
about
what
we
did
and
carolyn
is
going
to
feed
in
the
high-level
results
of
the
report
from
the
provider,
collaboration
reviews
with
a
view
that
much
more
detail
will
be
in
the
next.
The
state
of
care
report
in
october
and
there's
going
to
be
a
whole
chapter
dedicated
to
the
findings
from
the
provider.
G
Collaboration
reviews,
the
next
agenda
item
which
victoria
is
here
for
we
will
be
discussing
the
next
step
in
the
provider,
collaboration
reviews,
but
that
will
be
after
the
insight
report.
So
if
I
could
just
briefly
hand
over
to
charles
and
carolyn.
O
Thanks
rosie,
so
I
was
just
going
to
cover
off
the
methodology
again
for
the
for
the
provider.
Collaboration
views,
so
methodology
for
the
first
phase
of
the
reviews
is
focused
on
the
interface
of
health
and
social
care,
for
people
age
65
over
and
over,
and
has
looked
at
how
providers
in
the
system
have
worked
together
to
ensure
there's
high
quality
services
for
those
for
those
people.
O
In
between
july
and
august,
we've
looked
at
11,
integrated
care
systems
and
stps,
and
in
each
system
we
had
a
small
team
of
inspectors
working
remotely.
Each
team
was
supplied
with
a
range
of
data.
Firstly,
it
was
around
system
indicators
based
on
the
experience
of
over
65s
moving
through
the
system,
and
that
data
was
based
on
the
data
packs
which
we
developed.
O
When
we
did
the
local
system
reviews,
they
also
had
a
range
of
demographic
data
around
deprivation,
population,
age,
ethnicity
and
then
also
some
data
on
covert
19
outcomes
and
for
each
system.
We
also
had
the
local
inspector
information,
so
we
got
intelligence
from
the
local
inspection
teams
for
each
area.
O
We
did
a
deep
dive
review
into
one
or
two
local
authority
areas,
and
then
we
interviewed
a
range
of
organizations
in
that
areas
from,
for
example,
primary
care,
net
networks,
nhs
trusts,
acute
ambulance
services
and
adult
social
care
providers,
and
for
each
area
we
asked
around
basically
work
around
four
key
lines
of
inquiry,
so
the
first
one
was
around
ensuring
that
people
at
the
center,
so
how
providers
have
worked
together
in
responding
to
kovid
19
around
ensuring
that
people
move
through
health
and
cost
health
and
social
care
systems
safely,
and
we're
in
the
right
place
at
the
right
time,
careful
by
people
with
the
right
skills,
etc.
O
The
second
one
was
around
system
leadership,
so
it
was
looking
around
was
a
shared
plan,
shared
plans
across
systems,
and
we
looked
at
governance
arrangements
and
leadership
during
the
covert
period
and
how
they
were
coming
out
of
the
covid,
the
initial
kobe
period,
the
third
one.
We
looked
at
workforce
capacity
and
capabilities.
O
We
looked
at
how
workforce
has
been
deployed
across
systems
and
how
providers
had
worked
together
to
deploy
workforce
and,
secondly,
how
providers
had
worked
together
to
ensure
that
staff
were
kept
safe
and
the
fourth
glory
is
around
digital
solutions
and
technology.
So
it's
looking
at
what
impacts
of
digital
solutions
and
technology
had
on
providers,
providers
collaborating
and
the
services
they
provide
and
and
how
those
services
have
been
accelerated
and
once
we've
done,
the
reviews.
O
Findings
were
fed
back
locally
via
high
level
presentations,
and
then
all
those
findings
have
been
pulled
together
to
bring
out
the
the
detailed
findings
in
the
care
as
stead.
Care
report
which
which
rosie
has
has
just
discussed
so
I'll,
just
hand
you
over
to
carolyn
to
go
through
some
of
the
high
level
findings.
P
Thanks,
charles
so
I'm
carolyn
and
I'm
one
of
the
heads
of
inspection
and
I'm
leading
the
pcrs
and-
and
we
know
that
there's
lots
of
emerging
high-level
messages
coming
out
of
this
and
we'll
we'll
go
into
a
lot
more
detail
in
the
state
of
care
report.
But
just
some
of
those
clear
messages
at
the
moment
are
around
understanding
of
local
populations,
so
where
a
system
really
understands
the
cultural
differences
within
their
population
that
that
was
really
important.
P
We
found
the
quality
of
existing
relationships
between
local
providers,
played
a
major
role
in
the
coordination
and
delivery
of
joined
up
health
and
social
care
services,
and
that
was
without
a
doubt.
We
found
that
there
was
an
increased
focus
on
shared
planning
and
system-wide
governance
and
but
the
pre-existing
plans
that
were
already
in
place.
You
know
those
plans
to
deal
with
a
major
incident
and
deal
with
a
pandemic
even
and
they
weren't
really
fit
for
purpose
to
cope
with
covid19.
P
P
You
know
committed
staff
that
really
committed
to
supporting
everybody
in
their
care,
but
equally
we
also
heard
a
lot
of
initiatives
and
by
providers
themselves
to
you
know
to
care
about
their
staff
as
well
and
to
look
at
the
well-being
of
their
staff,
and
that
was
really
refreshing
to
hear
about
and
then,
from
a
digital
point
of
view.
We
heard
about
the
move,
to
enhance
and
and
to
accelerate
digital
solutions.
P
You
know
we're
a
really
big
part
of
the
period,
but
we
also
heard
about
that.
How
that
had
impacted
on
access
to
services
as
well.
So
we
heard
the
positives
and
negatives
of
the
digital
scenarios,
and
but
we
we
certainly
heard
about
digital
solutions
and
supported
data
and
how
data
was
shared
across
health
and
social
care.
P
But
I
think
we've
got
some
a
bit
of
time
to
answer
any
questions.
If
anyone's
got
any.
G
Thank
you,
carolyn,
and
can
I
just
add
to
charles
and
caroline,
because
I
think
that
all
the
teams
involved
the
intelligence
team,
all
of
the
policy
team.
The
inspectors
have
worked
tirelessly
to
pull
this
off,
and
so
I
just
want
to
say
a
very
big
thank
you
in
public
for
them,
but
really
useful
learning
coming
out
that,
hopefully
the
systems
will
listen
to
and
start
to
think
about
how
they
can
embed.
So
back
to
you.
A
J
I
think
the
the
point
of
these
and
and
it's
great
that
people
are
doing
such
speed,
because
we
want
other
systems
to
learn
from
this
work
and
to
learn
from
what
others
have
done
well
and
also
where
they
haven't,
and
if
I
just
move
on
to
the
other
theme,
which
is
in
infection
credit
control,
you
you've
heard
kate
talk
about
this
a
bit
earlier.
We
wanted
to
the
reason
why
to
talk
about
infectious
momentum,
control
was
partly
about
sharing
reflection.
J
What
has
gone
well
understand
and
learn
from
what
happened
and
help
all
health
and
care
systems
prepare
for
the
future
of
the
next
few
months.
What
we
did
see
we,
we
did
see
some
some
of
this
work.
Some
really
good
triaging
systems
to
help
people
get
the
right
service
early
and
when
we
saw
teams
come
together
to
assess
risk,
to
communicate
well
to
make
sure
that
every
everybody
in
different
roles
in
an
organization
knew
their
responsibility.
J
There
was
good
audits
carried
out
to
make
sure
things
were
happening
in
the
right
way
and
obviously
good
training.
Good
cleaning,
both
in
terms
of
staff
and
also
contractors
where
we
saw
where
we
had
some
concerns,
were
mainly
around
training
of
staff
in
the
use
of
ppe
and
also
in
having
some
of
those
procedures
and
some
of
those
audits
regularly
carried
out.
J
But
we've
published
the
information
that
goes
into
the
covered
insight
report
as
kate,
as
kate
said,
this
is
primarily
about
helping
organizations
prepare
for
the
future,
but
also
if
we
do
see
any
issues
that
that
concern
us
as
part
of
these
audits,
we've
got
don't
hesitate
and
taking
of
the
appropriate
regulatory
action
to
make
sure
people
and
services
are
safe,
but
that
we
from
what
both
kate
and
and
ted
and,
in
fact,
rosie
said,
there's
a
lot
of
good
practices
going
on
locally
in
organizations.
J
You
want
other
organizations
to
learn,
but
we
will
continue
to
take
action
ourselves
if
we
feel
that
there
are
some
concerns,
I'm
conscious
of
time.
So
I
wanted
to
give
you
a
sort
of
a
brief
overview
of
those
things.
Obviously
it's
in
the
covered
inside
report,
we'll,
as
we
always
do
with
the
code
insight
report,
we'll
seek
stake
all
the
feedback
after
it's
out
to
make
sure
people
can
understand
and
hear
the
message
and
we'll
continue
to
promote
them
over
the
coming
weeks.
J
A
F
I
I
just
wanted
to
say
that
I
mean
the
work
that
all
three
sectors
have
done
on
infection
control,
I
think,
is
really
very
important
and
it
gives
oversight
of
the
the
levels
of
infection,
control,
affection,
professional
control
across
the
whole
of
health
and
social
care,
and
I
think
this
is
unique
insight
into
it.
So
I
think
that
this
aspect
of
the
report
is
really
very
important.
A
Thanks,
so
what
what
I'm
going
to
suggest,
unless
you
all
think
something
better,
is
that
we
take
the
next
item
which
is
rosie
and
update
on
on
pcrs
and
then
have
a
short
break
for
lunch,
because
we've
got
about
another
hour
of
the
board
to
go
the
public
board
to
go.
A
If
we
stick
roughly
to
the
time
we've
allotted
and
that's
going
to
take
us
way
past
two
o'clock,
if
we
carry
on,
does
that.
Does
that
sound
like
a
good
plan,
lots
of
noddings
of
heads
right?
So,
let's,
let's
deal
with
pcrs,
because
they're
really
really
important.
So
I
don't
want
to
rush
it
rosie,
but
at
the
end
of
it,
there's
a
break.
G
Thank
you
peter,
so
I
would
like
to
welcome
victoria
watkins
who's,
the
deputy
chief
inspector
in
pms,
to
talk
through
the
paper
in
front
of
you,
but
before
I
hand
over
to
victoria
just
to
say,
I
think
this
is
a
really
important
stepping
stone
in
terms
of
how
we
move
from
where
we've
been
in
terms
of
our
provider
regulation
to
our
our
thoughts
and
and
kind
of
hopes
for
system
regulation,
and
I
think
this
is
going
to
give
us.
G
Firstly,
a
huge
amount
of
learning
in
terms
of
how
we
can
really
support
systems
to
work
effectively
together
to
deliver
really
good
joined
up
person-centered
care
going
forward,
but
also
much
more
immediately
help
support
systems
as
they're
going
through
the
next
few
months,
to
really
learn
about
how
they're
working
and
also
how
how
they
can
learn
from
other
parts
of
the
country.
So
so
victoria.
Do
you
want
to
take
us
through
the
paper.
Q
Thanks
rosie
afternoon,
everybody
victoria
watkins
dci
really
pleased
to
be
here
about
the
pcrs.
I'm
going
to
keep
it
brief.
If
that's
all
right
in
terms
of
the
overview
recognizing
everybody
will
have
had
access
to
the
paper,
and
so
it's
really
focused
on
what
comes
next
for
pcrs,
particularly
2021
and
beyond
so
the
2021
first.
So
we're
going
to
and
we've
agreed,
we
will
review
all
system
areas
using
a
variety
of
topic
modules
and
we've
agreed
those
as
urgent
and
emergency
care.
Q
Cancer
learning
disabilities
and
autism,
followed
by
mental
health,
important
to
flag
that
each
and
every
one
of
those
reviews
will
shine
a
spotlight
in
terms
of
inequalities,
particularly
for
bame
population
groups.
Each
one
of
those
topic
modules
will
report
nationally
in
a
similar
way
to
what
we've
heard
for
phase
one.
So,
firstly
through
insight
as
a
headline
summary
and
followed
by
a
full
topic
report.
Afterwards,
the
difference
for
phase
two
onwards
comes
in
the
publication
of
the
local
level.
Summary
of
findings.
Q
So
for
each
review
we
will
continue
to
feed
back
the
summary
findings
to
the
system,
and
then
we
will
publish
the
entire
set
of
those
summaries
at
the
same
time
as
that,
full
national
report
we're
going
to
focus
on
hearing
the
experiences
of
those
accessing
care
through
the
reviews
and
we're
going
to
continue
to
use
our
section
58
powers
in
terms
of
the
pcr
approach.
So
that's
2021,
a
summary
of
in
terms
of
the
beyond.
Q
By
then
we'll
have
a
topic
of
a
range
of
the
topic
methodologies,
so
the
regions
will
be
able
to
tailor
the
best
fit
pcr
program
based
on
the
regional
risks,
issues
and
opportunities
for
learning,
and
so
I
think
I
think
I'll
probably
leave
it
there.
That's
a
very
brief
summary,
but
but
realize
we
want
to
focus
on
discussion.
A
So
could
I
ask
in
the
pcrs
that
you've
done
so
far
what
what
was
the
the
quality
of
the
feedback?
How
did
how
did
those
sessions
work?
I
mean
I've,
read
the
reviews
and
they
look
really
good,
but
what
what
how?
How
did
it?
How
did
it
work
when
you
went
back
to
the
providers.
G
Shall
I
start
with
that
and
then
carolyn
and
and
charles
and
victoria
might
want
to
chip
in.
So
I
I
sat
in
on
several
of
the
feedback
sessions
and
they
were
very
well
received
by
the
systems
that
I
sat
in
there.
I
think
they'd
found
the
process
very
useful
in
terms
of
giving
that
opportunity
to
reflect
on
what
they
had
done
and
what
their
areas
of
development
and
learning
were.
G
I
think
that
I
think
the
fact
that
we
were
able
to
have
such
a
broad
view
of
what
was
happening
in
their
local
systems,
including
looking
at
what
was
happening
in
pharmacies,
including
what
was
in
medicines,
including
what
was
happening
in
the
local
hospices
and
the
dental
provision
and
as
well
as
the
the
other
parts
of
the
local
system,
really
gave
a
very
comprehensive
overview
that
actually
some
of
the
system
leaders
said
well.
G
Actually
we
we
hadn't
considered
this
about
the
dental
provision
or
we
hadn't
considered
this
about
hospices
and
things,
and-
and
so
so,
I
think,
because
we
have
that
very
clear
overview
of
all
parts
of
the
system.
We
were
able
to
feedback
some
of
the
areas
that
aren't
necessarily
as
visible
in
in
the
kind
of
day-to-day
discussions
but
I'll
hand
over
to
victoria
and
carolyn
and
charles.
If
they
want
to
add
to
that.
P
I
I
could
just
add
to
that
is
carolyn.
There
is
something
about
perceptions.
We
were
able
to
play
back
perceptions.
P
You
know
in
terms
of
that,
the
system
might
have
felt
the
leaders
might
have
felt
that
communication
was
really
good
with
with
providers
and
but
actually
you
know,
we
we
might
have
heard
slightly
different
stories,
so
we
were
able
to
share
some
of
that
richness
and
about
those
perceptions
that
were
out
there,
which
is
is
useful
because
perceptions,
whether
they're,
based
on
reality
or
or
fact
or
whatever
they're
they're,
still
important.
Aren't
they.
A
So
carrick,
what's
the
reaction
from
the
the
system
providers,
you
know
one
that
this
has
been
a
useful
thing
and
we're
going
to
take
away
and
we're
going
to
do
things
differently
or
or
were
they
just
sort
of
nodding
and
did
you
leave
with
the
feeling.
C
P
I
got
the
feeling
that
they
would
make
huge
changes
based
on
what
we
said,
but
there
were
some
that
were
more
open
to
things
than
others,
and
you
know
I
think
it
will
vary
how
it
you
know
that
you
we
can.
We
know
we've
seen
a
difference
in
how
each
the
different
systems
have
responded
to
us.
Definitely,
and
you
can
see
a
level
of
maturity
among
systems
and
it
varies.
A
So
we're
going
to
have
to
find
a
a
sort
of
loopback
mechanism.
Aren't
we,
whether
that's
through
our
individual
provider,
inspections
and
and
dialogue,
or
back
through
the
the
system,
because
this
is
pointless
unless
it
drives
change
and
improvement.
Q
One
of
the
one
of
the
consistent
bits
of
feedback
from
most-
I
want
to
say
most
of
the
systems
for
these
first
11
was
around
actually
how
useful
it
had
been
for
this
opportunity
to
be
driven
via
the
pcr
for
them
to
get
together.
Q
To
covet
and
the
pace
of
some
of
that
work
had
not
allowed
that
opportunity
to
reflect
and
pull
together
the
story
that
highlights
the
challenges,
the
learnings
all
of
it
in
one
resoundingly.
That
was
a
consistent
message
about
that.
P
And
one
one
of
the
systems,
we
have
got
another
follow-up
session
with
them.
So
they've
come
back
to
us
and
said:
actually
can
we
have
another
session
with
you
and
talk
about
it?
A
bit
more
once
they've
had
chance
to.
You
know
digest
that
verbal
feedback
that
we've
given
them.
So
you
know
that
that's
positive
and
it
it's
new
for
them.
Isn't
it
as
well
so.
A
Yeah
that
that
does
sound
positive,
let
me
bring,
let
me
bring
liz
in
who
wants
to
raise
something
and
then
paul.
H
Thanks
very
much,
I
I
just
wanted
to
look
to
the
future
and
they
sound
like
a
really
useful
and
important
set
of
future
modules,
and
I
was
thinking
that
in
the
regulatory
governance
committee,
we've
had
a
number
of
discussions
about
cross-cutting
issues.
So,
for
instance,
if
you
take
people
learning
disabilities
and
autistic
people,
what
I
mean,
obviously,
what
matters
to
people
is
not
only
the
specialist
service,
they
might
get
from
say
adult
social
care,
but
also
what
happens
in
primary
care.
H
What
happens
if
you're
admitted
to
an
acute
hospital
board,
etc,
and,
and
at
that
time
this
is
going
back
a
while
when
we
had
those
discussions
it
it
flushed
out
the
issues
of
how
we
as
an
organization,
work
across
those
boundaries
as
well,
and
I
just
wondered
whether
there's
any
learning
coming
out
of
this
or
whether
you
think
there
may
be
for
how
we
work
across
to
think
about
the
people
and
their
experience
of
the
whole
system.
H
G
So
I've
I've
had
a
huge
amount
of
feedback
from
inspectors
that
actually
it's
been
fantastic
because
they've
got
to
know
people
in
other
directorates
and,
firstly,
it's
really
started
to-
I
guess
open
their
eyes
in
terms
of
what
happens
in
other
sectors
and
really
understand
some
of
the
issues
in
those
sectors
and
understand
the
importance
of
those
both
us
working
together
internally,
but
also
how
important
it
is
for
those
providers
to
work
externally
together
as
well.
G
So
that's
been
certainly
a
very
strong,
strong
message
from
me
and
also,
I
think
that
the
teams
have
found
the
data
packs
really
useful.
So
this
very
rich
data
pack,
and
and
thank
you
to
the
intelligence
team
because
they
are
really
fantastic
and
the
amount
of
information
is,
is
immense
in
them
and
that
ability
to
help
understand
that
local
picture
across
all
of
all
of
the
sectors
has
been
something
that's
very
been
well
received
by
the
local
teams.
So
does
anyone
want
to
add
to
that.
Q
Q
P
A
It
certainly
does
tells
a
good
story
paul
you
wanted
to
ask
something
or
raise
something
yeah.
It
was
a
very.
E
Quick
question
actually
peter:
I
noticed
that
you
know
what
we
focus
on
in
the
in
the
insight
report
is
the
good
practice.
We
don't
say
anything
about
poor
practice
and
I'm
just
just
really
just
wondering
just
a
confirmation
that
we
are
going
to
bring
out
poor
practice
somewhere
and
a
report
on
that.
J
J
We
always
do
focus
on
what's
working
well
and
what
isn't
and
we'll
do
that
in
state
of
care
and
in
the
final
and
in
the
next
wave
of
these
reports
as
they
as
they
come
forward,
but
I
want
we
wanted
to
give
people
a
sense
of
what
do
they
have
to
do
between
now
and
as
we
move
into
a
sort
of
a
winter
period
around
their
system.
Collaboration.
That's
why
that's
why?
The
focus
is
as
it
is
in
this.
In
this
insight
report,
yeah.
Q
And
sorry,
I
might
just
add
so-
for
phase
two
onwards
as
well.
Just
building
on
that
thing.
The
the
local
system,
summary
feedback
and
details
that
go
to
the
system.
We
will
invite
responses
to
those,
including
any
intended
actions
and,
and
that
will
kind
of
enable
us
to
continue
that
oversight
and
work
with
the
system.
So
so
we
are
very
definitely
future
proofing
in
the
sense
of
so
so
once
we've
got
the
findings
once
we
know
that
what's
gone
well,
but
also
the
areas
for
future
focus.
N
Thank
you,
chairman,
yeah,
really
interesting
report.
I
just
sort
of
focusing
on
the
word
collaboration
and
wondering
whether,
in
your
experience,
you're
seeing
a
different
type
or
a
different,
a
need
for
a
different
type
of
collaboration
when
you
apply
that
word
to
a
broader
geography,
so
distance,
for
instance,
making
it
a
bigger
challenge
to
collaboration
than
perhaps
in
an
stp
area.
That's
much
closer!
N
So
you
know
my
experience
of
working
in
an
stp
that
had
great
problems,
collaborating
over
40
miles
and
I'm
currently
sitting
in
a
county
where,
from
beric
to
morpheth,
is
being
covered
by
one.
You
know
one
stp,
so
I
just
wonder
whether
you're
you
know
whether
there
isn't
a
an
approach
that
needs
to
acknowledge
the
challenges
of
that
distance
and
geography.
G
So
really
interesting,
point
mark
and
part
of
what
we've
done
through
this
process
is
identify
different
areas
with
different
demographic
makeup
and
areas
with
different
challenges
such
as
rural
and
urban
areas,
and
one
of
the
things
we've
consistently
heard
actually
through
the
through
the
work
and
the
pandemic
is
how
much
technology
has
been
able
to
transform
that
collaboration.
G
So
those
distances
have
become
in
some
ways
with
those
discussions
that
need
to
happen
across
those
providers
have
become
a
lot
easier
because
of
the
use
of
technology
and
multi-disciplinary
team
working
across
bigger
geographies
because
of
the
because
the
technology
used.
I
don't
know
if
the
team
have
got
any
other
insights
into
that.
I
think
it's
certainly
something
that
we
will
be
looking
as
we
go
forward
and
making
sure
that
we
capture
those
differences
between
the
different
geographical
places
that
we
we
attend.
P
Yeah,
I
think
we
we've
certainly
heard
from
some
of
the
systems
that
there
is
maybe
a
feeling
that
some
of
them
are
too
big.
P
There's
such
a
variety
across
the
country
and
the
size
of
them,
and-
and
I've
heard
I've
heard
our
teams
comment
on
that.
They
think
that
those
some
of
the
systems
would
just
cover
too
big
an
area
for
them
to
be
truly
meaningful
enough
in
terms
of
really
understanding
their
populations.
Q
I
mean,
I
think
it
plays
back
to
the
maturity
point
again,
where
we've,
where
we've
included
and
heard
from
those
systems
where
they
are
more
more
mature
than
others.
We've
certainly
felt
that
represented
in
who
is
kind
of
coming
along
who's
representing
the
system.
Are
we
getting
voices
from
every
corner
of
the
sectors,
for
example?
So
so
I
would
think
that
it's
about
the
the
evolution
of
and
the
current
status
of,
some
of
the
systems
that
we've
visited
as
well.
A
E
Thank
you.
Firstly,
this
is
a
fantastic
looking
project.
The
question
I
wanted
to
ask,
perhaps,
not
surprisingly,
is
about
engagement
with
the
people
who
use
services
with
which
you
identify.
E
There
have
been
problems,
and
I
wondered
I
mean
I
can
see
why
that
would
be
difficult
moving
in,
from
our
point
of
view,
to
immediately
find
out
what
people
are
saying,
but
can
we
have
some
expectation
that
the
in
their
collaboration,
the
providers
actually
are
seeking
the
feedback
themselves?
Point
one
and
point
two
has
helped
what
local
health
watch
had
any
role
to
play
so
far
in
what
you've
been
doing.
G
Q
Have
connected
with
healthwatch
in
each
of
the
11
areas,
but
but
what
we've
heard
through
those
connection
points
has
varied
in
terms
of
the
detail
and
the
quality
of
the
information
coming
through.
I
mean
charles
can
come
in
if
you
want
full
detail,
but
we
have
made
significant
efforts,
it's
fair
to
say
for
phase
two
onwards,
thinking
about
how
we
can
connect,
particularly
through
experts,
by
experience
as
well
and
connect
to
patient
forums
and
user
user
groups.
Q
O
Suppose
is
is
quite
good
to
sign
post
one
of
the
good
practice
examples
about
how
local
health
watching
worked
in
brighton
hove
and
the
contribution
they'd
made
to
supporting
the
whole
system,
and,
secondly,
yeah
we're
doing
a
lot
of
work
with
how
we
can
work
with
x
by
x's
for
the
next
reviews
and
and
we've
got.
O
We've
got
a
quite
a
few,
quite
substantial
plans
of
how
that
will
work
better
in
in
the
next
few
years,
as
well
as
working
with
local
health
watchers
and
as
well
as
engaging
with
local
scrutiny,
committees
and
others
like
that.
E
Thank
you.
Can
I
just
to
make
an
offer
if
him
else
is
listening
to
this?
I'm
sure
she
won't
thank
me,
but
we
obviously
have
a
direct
communication
with
all
local
health
watchers
and
if
there's
anything,
you
want
us
to
push
out
in
advance
to
them
of
your
reviews,
then
that
might
give
them
a
bit
of
time
to
think
about
it.
E
Not
all
of
them,
of
course,
are
in
a
position
stretched
as
they
are
so
suddenly
do
something
different,
what
they're
already
doing,
but
we
can
at
least
tell
them
what
you're
doing.
Q
And
we've
recently
had
site
of
the
healthwatch
surveys,
haven't
we
so
which
we
hadn't
for
phase
one
and
they
are
so
incredibly
informative.
The
quality
of
the
the
quantitative
and
qualitative
data
in
there
is
superb
and
will
definitely
feed
into
our
pcrs
yeah.
A
Great,
so
look
I'm
going
to
bring
this
this
this
to
an
end.
I
think
the
work
you
have
been
doing
has
been
superb
both
on
the
the
11
that
you've
done,
but
also
as
a
stepping
stone
for
what
we
might
do
in
the
longer
term,
in
looking
at
systems
as
well
as
individual
providers,
so
carolyn
victoria.
Charles.
A
Thank
you
very
much
indeed,
and
please
thank
everybody
else.
That's
been
involved
in
this
work,
so
I
I
there
was
a
bit
of
a
bidding
war
going
on
for
how
long
we
had
a
break
for,
but
I'm
going
to
start
again
at
a
quarter
to
two
and
if
you're,
not
here,
that's
up
to
you,
but
that's
what
I'm
going
to
start.
So,
let's
give
ourselves
a
quick
break.
Thank
you
very
much
indeed,.
A
And
ted
we
come
to
you
now
on
the
transitional
regulatory
approach.
Please.
F
Okay,
thank
you
peter.
So
the
transitional
regulatory
approach
is
an
umbrella
term
covering
the
work
we're
doing
between
now
and
the
future
regular
introduction
of
the
future
regulatory
platform
in
2021,
and
I'm
going
to
give
you
an
oversight,
an
overview
of
it
now
very
briefly,
there's
a
lot
of
detail
in
the
paper
that
that's
been
you've
got
in
front
of
you
and
then
have
an
opportunity
to
discuss
it
now.
F
Moving
away
from
the
our
previous
approach
of
a
timetable,
program,
inspections
to
a
risk-driven
approach
to
inspect
inspections,
and
we've
learned
an
awful
lot
about
that
over
the
last
six
months
and
we're
building
on
that
going
forward
in
the
transitional
regulatory
approach,
but
equally
we're
building
on
what
we've
learned
from
the
rollout
of
the
emergency
support
framework
during
the
pandemic.
And
how
and
we've
done
a
detailed
evaluation
of
that
which
we
built
into
our
learning
for
introducing
the
transitional
regulatory
approach.
F
But
we
are
still
bringing
in
the
best
from
our
previous
methodology.
So
we
haven't,
we
haven't
totally.
We
haven't
totally
stood
away
from
our
previous
methodology.
We
are
using
that,
but
we're
using
that
in
a
slightly
different
way.
As
I'm
trying
to
explain
now.
F
There
are
five
elements
related
to
the
transitional
regulatory
approach
right
at
the
center
of
it
is
enhancing
and
creating
a
structure
to
our
monitoring
of
risk
and
building
that
on
a
digital
platform,
as
we
did
with
the
esf,
and
that
is
the
work
that's
been
going
on
over
the
last
six
weeks
or
so
and
as
I
say,
that
is
the
work
we'll
be
rolling
out
in
october
and
we're
taking
very
much
a
continuous
improvement
approach
to
this.
So
what
we'll
run
out
in
october,
we
have
first
iteration
and
we
expect
to
develop
it
over
time.
F
The
the
the
monitoring
activity
ssa
is
built
on
a
digital
platform,
the
transitional
monitoring
app
that
that
mark
has
already
mentioned,
and
that
will
be
a
a
way
of
assessing
risk
in
a
structured
way.
F
Looking
looking
at
all
five
key
questions
from
our
current
assessment
framework,
focusing
particularly
on
safety
and
well-led,
but
incorporating
elements
of
all
five
key
questions
and
we'll
use
that
to
assess
risk
in
our
interactions
with
providers,
some
of
most
of
those
interactions
will
be
remote,
but
the
the
the
approach
can
be
used
for
on-site
visits
as
well,
and
we
envisage
that
and
occasionally
will
happen
as
we
go
forward
now,
depending
on
what
comes
out
of
that,
we
can
either
decide
that
that
no
further
regulatory
action
is
required
at
the
time
or
we
can
identify
risk
and
then
make
a
decision
about
whether
further
regulatory
action
is
required.
F
The
second
element
of
the
approach
is
risk-based
targeted
inspections.
Now
we've
already
discussed,
we
are
doing
those
at
the
moment
and
we
can
intend
to
continue
doing
those
driven
by
our
assessment
from
the
monitoring
activity
to
determine
where
we
need
to
target
those
inspections
going
forward
and
those
risk-based
inspections.
We
will
continue
throughout
this
process
so
where
we
identify
risk,
if
necessary,
having
considered
all
the
options.
If
we
need
to
do
an
on-site
inspection,
we
will
do
an
on-site
inspection
and
we'll
take
the
necessary
action
after
that.
F
F
For
me,
I
suppose
the
the
biggest
example
of
that
are
our
trust
in
special
measures,
where
we
need
to
need
to
make
a
decision
about
whether
they
stay
in
special
emotions
or
come
after
special
measures
or
trusts
that
might
need
to
go
into
special
measures
where
we
need
to
assess
them,
and
so
we
still
need
a
methodology
that
allows
us
to
do
ratings,
and
for
that
we'll
use
our
previous
methodology
streamlined,
so
be
streamlined
in
the
sense
of
we
will
minimize
the
amount
of
on-site
activity
streamlined
in
the
sense
of
we
will
only
ask
for
the
evidence
we.
F
Actually,
we
have
to
absolutely
to
identify
to
make
a
a
rigorous
rating
assessment
and
streamlined
in
the
sense
of
we'll
produce
streamlined,
simpler
reports
which
are
more
targeted
at
identifying
the
key
problems
and
informing
the
public
about
the
issues
we've
found
in
the
in
those
providers.
So
we'll
still
do
those
ratings
inspections,
but
they
will
not
be
a
large
part
of
what
we
do,
but
where
necessary,
we'll
have
the
means
of
doing
those.
F
F
We're
piloting
it
in
in
limited
areas
and
we
will
learn
from
those
pilots
and
we
may
well
over
the
transitional
period,
extend
into
other
areas
depending
on
our
learning
for
those
initial
pilots.
So
that
gives
us
the
scope
to
develop
as
we
go
forward
into
the
future
regulating
platform
and
approach
to
assessment
without
on-site
inspection.
But
but
that
is
still
very
much
early
days
and
we
need
to
learn
as
we
go
along
to
make
sure
we
can
maintain
the
rigor
and
quality
of
our
aspect
of
our
assessments
using
that
approach.
F
As
I
say,
this
is
a
continu
this
we
will
be
improving
this
over
the
over
the
next
six
months
or
so
so,
when
we
move
into
the
new
future
regulatory
platform,
we
will
have
learnt
a
lot
from
the
transitional
process
and
that
will
help
inform
us
going
forward
into
the
into
the
new
approach.
So
that's
a
summary
of
where
we
are
there's
a
lot
of
detail
in
the
paper,
I'll
open
it
up
to
any
questions
or
anything.
Anyone
wants
to
to
feedback.
A
That's
that's
really
good
kate.
D
Thanks
peter,
so
if
I
can
just
do
a
quick
minute
on
the
home
care
pilot
ted
reference,
because
I
think
rosie
covered
off
what
they're
doing
in
gps
earlier
on
in
the
session.
So
very
briefly,
in
partnership
with
the
trade
association
for
for
home
care,
we've
been
having
some
discussions
throughout
cloverd
about.
Actually
what
is
the
added
value
of
an
inspector
going
to
a
small
home
care
office
where
there's
no
one,
there
who's
receiving
care?
D
And
actually
might
we
want
to
work
together
in
partnership,
to
look
at
whether
we
can
spend
that
increased
time
not
traveling,
to
sit
in
an
office
but
actually
spend
more
time
speaking
to
members
of
staff
who
get
who
are
delivering
that
care
and
speaking
to
more
people
in
their
own
homes?
And
we
are
also
looking
at
the
role
of
experts
by
experience
to
have
those
conversations
with
people
in
receipt
of
care.
So
we
are
working
with
60
home
care
providers
who
have
volunteered
to
be
part
of
this.
L
L
H
H
What
have
our
stakeholders
had
to
say
about
this
in
as
far
as
we've
so
far
talked
to
them
about
it,
because,
obviously
it's
really
important
that
we
that
we
are
intending
to
that.
We
are
planning
to
take
robust
action
where
that
is
needed,
and
this
is
this
is
you
know,
and
people
need
to
be
very,
very
confident
about
that,
and
I
just
wanted
to
understand
what
kind
of
feedback
we've
had
and
how
we've
dealt
with
that.
If
people
have
raised
any
concerns.
F
Well,
can
I
talk
about
the
bigger
stakeholder
picture?
I
think
you
may
have
talked
about
particularly
kate,
but
can
I
just
talk
about
the
biggest
stakeholder
picture,
because
we
we
have
been
sharing
our
plans
with
stakeholders
and
received
positive
feedback
on
this.
I
think
stakeholders,
of
course,
are
still
working
under
the
pressures
of
kobe
19
and
are
looking
for
us
to
be
proportionate
and,
of
course,
we
are
keen
to
do
that.
And
of
course
we
are.
You
know
using
methodologies
that
minimize
the
risk
of
us
visiting
providers
on
a
regular
basis.
F
I
think
there
are
a
couple
of
things
that
that
are
really
important
for
us
going
forward,
and
that
is
capturing
the
user
voice
in
our
risk
assessment,
and
we've
been
talking
a
lot
about
that,
and
it's
absolutely
key
in
the
guidance
for
the
the
monitoring
activity
that
the
user
voice
is
actually
central
to
that.
If
we
don't
have
sufficient
feedback
from
users
of
services,
then
that
itself
is
a
risk
for
us
that
we
need
to
take
into
account.
F
H
I
suppose
I
suppose
I
was
thinking
particularly
about
the
non-provider
stakeholders.
I
mean
I
can
see
that
from
provider's
point
of
view.
Anything
that
simplifies
and
streamlines
is
going
to
be
welcome.
But,
but
I
was
thinking
about
the
public
confidence
point.
J
May
I
respond
to
that
peter
yes,
please,
chris
dude,
so
you're,
absolutely
right.
It
is
very
important.
I
I
was
in
a
conversation
with
choice,
support
who
are
our
experts
by
experience
partner
at
the
moment
and
they're
really
excited
about
their
salazar.
The
experts
by
experience
involved
with
it,
and
this
is
sort
of
similar
to
what
other
public
stakeholders
have
said.
J
And,
as
I
go
back
to
what
I
said
earlier,
without
sort
of
rerunning
the
same
that
they're
the
same
message.
If
you
look
at
what
we've
done
in
the
performance
support,
if
you
look
at
how
we've
used
the
voice
of
people
to
drive
our
inspection
activity,
I
think
that's
the
confidence
that
they
are
seeking,
but
certainly
choice.
Paul
was
saying
that
they're
excited
by
the
prospects
to
be
able
to
provide
the
information
on
a
more
regular
basis.
J
I
think
that
one
of
the
challenges
that
remains
is
how
we
present
this
information
alongside
our
inspection
report,
so
that
this
always
on
view
of
quality
is
meaningful
to
people
who
use
services.
I
think
that's
a
that's
a
challenge
that
we
have,
but
it's
a
good
challenge
to
have,
and
I
think
the
richness
of
the
information
that
we
get
as
people
begin
to
trust
us
more
will
help
us
in
our
regular
activity
and
will
help
us
provide
better
better
care
for
people
thanks
chris
ian.
B
B
It
means
we
are
interacting
with
providers
either
directly
on
site
or
or
off
site,
probably
more
frequently
than
has
ever
been
the
case
before
so
from
a
public
point
of
view,
they
may
not
necessarily
be
terribly
interested
in
the
in
in
the
details
of
all
of
this,
but
the
practical
reality
is
chris
was
describing.
Is
that
always
on
view
of
quality
becomes
becomes
a
reality?
B
And
if
we,
if
we
recognize
that
what
we've
current
the
information
we've
currently
got
is
largely
held
within
a
series
of
pdf
reports
and
a
lot
of
manual
work
has
to
go
on
before
so
we
can
derive
insight.
I
think
this
starts
to
give
us
an
opportunity
to
to
to
create
data
which
can
then
be
analyzed
and
interrogated
and
starts
to
give
us
unique
and
much
more
sophisticated
insight.
B
It's
one
of
the
themes
that's
come
up
again
and
again
in
the
meeting
is:
is
this
idea
of
of
defining
what
good
looks
like
around
around
around
a
particularly
good
culture
and
that
sort
of
thing
actually
that
that's
a
pretty
unsophisticated
activity
at
the
moment?
But
actually
with
this
with
this
approach
and
that
ability
to
analyze
data
and
turn
qualitative
information
into
quantitative
information?
This
could
get
really
interesting
in
terms
of
in
terms
of
our
ability
to
contribute
to
the
the
wider
conversation
around.
B
What
good
looks
like
on
things
like
a
safety
culture
in
a
in
a
hospital
or
a
you
know
all
those
sorts
of
things.
So
I
I
think,
there's
the
opportunities
here
are
just
just
enormous
and
I
think
what
what
this
current
covered
period
gives
us
is
an
opportunity.
It's
a
bit
of
space,
I
suppose
to
try
this
out
and
it
allows
us
to
accelerate
our
original
plans.
B
But
I
think
it
was
dura
said
a
few
meetings
ago
that
what
kogit
has
done
is
it's
taken
the
2022
strategic
plan
and
made
it
your
2020
delivery
plan,
and
I
think,
he's
you
know
it's
probably
spot
on.
Actually,
in
terms
of
it
in
terms
of
what
we're
doing
now
so
so
I
I
think,
you'd
take
taking
the
bigger
picture
view
of
this.
B
I
I
think
you
know
I
would
completely
agree
with
ted's
ted's
excitement
on
the
about
this,
because
it
genuinely
is
about
changing
the
way
we
regulate
and
I
think
providers
would
see
it
as
a
as
a
reduction
in
the
in
in
the
perceived
burden.
The
public,
though
I
think,
will
get
a
better
service
and
can
be
more
assured
as
a
consequence
of
this
thanks.
E
Thanks,
I,
I
don't
disagree
with
the
direction
of
travel
at
all
on
this
or
that
or
what's
been
proposed.
E
Applaud
the
enthusiasm
that
ian
referred
to,
I
have
a
question,
though,
which
is
if
we
are
really
basing
this
upon
risk,
and
so
we
select
those
those
providers
who
we
see
as
being
at
more
at
risk
in
order
to
go
and
flow
through
this
breaststroke.
F
F
The
priorities
are
driven
by
what
we
perceive
to
be
the
risks
in
different
providers,
but
equally,
some
of
that
is
about
providers
who
we
regard
as
low
risk
to
see
whether
the
the
system
works
for
them
as
well.
So
I
I
think
we
will
do
that.
I
mean
clearly
we
need
to
prioritize
risk,
so
we
can't
we
can't
go
out
and
look
at
low
risk
providers
and
spend
too
many
much
resources
in
that.
But
I.
F
Is
part
of
the
pattern,
I
think
one
of
the
things
that
the
old
system,
the
timetabled
approach
to
inspections,
gave
us
was
this
sense
that
we
were
going
out
and
inspecting
low-risk
providers
and
putting
our
resources
into
inspecting
low-risk
providers.
Well,
in
actual
fact,
we
needed
those
resources
for
the
for
the
higher
risk
providers.
D
I
was
just
going
to
write
briefly
flags,
so
obviously,
over
the
summer,
we've
been
prioritizing
crossing
the
threshold
for
high-risk
services,
but
we've
also
used
our
ipc
methodology
to
go
out
and
look
at
services
where
we
thought
we
would
find
good
stuff
which
we
did
and
the
benefit
of
being
able
to
test
that
our
methodology
works
in
both
scenarios,
but
also
the
added
value
of
being
able
to
describe
what
good
looks
like.
D
So
I
think
I
would
absolutely
support
ted's
comments
that
the
bulk
of
the
resources
need
to
be
responding
to
risk,
but
we
absolutely
need
a
methodology
methodology
that
works
across
all
all
kind
of
all
different
types
of
services,
with
different
levels
of
quality.
A
A
I
I
I
think
it's
all
for
discussion
as
we
as
we
go
along,
but
I
don't
think
we're
ever
going
to
be
in
a
position
where
we
can
be
so
confident
that
there
is
very
low
risk
in
those
that
we
think
are
low
risk
that
we
don't
even
need
need
to
go
at
all.
F
Well,
part
of
the
risk
assessment
will
be
what
the
last
rating
was
in
that
pride,
but
also
how
long
since
we
last
assessed
them.
So
as
a
provider,
it
is
not
assessed
for
an
extended
period.
Even
if
we
proceeding
to
be
low
risk,
our
risk
score
and
assessment
often
will
go
up.
So
so
what
we
don't
want
is
to
have
some
providers
that
perceive
to
be
low
risk
and
never.
C
F
A
Thank
you,
robert.
E
I'm
just
building
on
on
that
point.
I
I
think
that
there
could
be
there.
I
think
there
may
be
out
there
and
anxiety
that
we're
going
to
stop
inspect
looking
at
places
that
we
have
rated
as
as
good
and
that
I'm
reassured
that
that
is
not
necessarily
the
case,
but
also
to
point
out
that
the
rate
the
speed
at
which
places
can
change
or
deteriorate
varies
considerably
as
to
units
within
particular
organizations.
A
Thinking
but
a
combination
of
the
triggers
that
we
know
that
cause
that
that
rapid
deterioration,
change
of
manager
or
whatever
plus
you
know
all
the
the
alerts
that
we
get
from
from
service
users
ought
to
get
us
to
a
point
where
we,
where
we
are.
We
are
on
notice
that
there
might
be
a
change
and
therefore
we
need
to
go.
D
That's
that's
developing
in
their
service
with
the
inspector,
so
I
think
that
emphasis
on
us
having
that
more
week-to-week
view
of
what's
going
on
in
the
service,
plus
the
focus
on
understanding.
What's
going
on
in
the
system
as
well,
I
think
as
to
that
that
confidence
we
should
have
that
we
we
will
have
a
group
of
what's
going
on
in
those
services.
N
Good
mark,
thanks
chairman,
I
just
wanted
ted
to
ask
a
question
about
experience
of
service
users
and
the
use
of
experts
by
experience,
because
we
will
now
be
using
them
in
a
different
way.
I.E
remotely.
N
Is
there
going
to
be
some
training
to
the
expert
by
experience
to
be
able
to
glean
the
information
we
want,
but
through
instead
of
face
to
face
through
a
a
different
medium.
Chris.
J
Shall
I
take
that
so
absolutely
there's
a
there's,
a
really
important
project
going
on
at
the
moment,
with
choice,
support
around
what
people
need
not
just
to
have
direct
conversations
with
service
users
in
that
direct
assessment.
So
we
hear
you
know
firsthand
from
them
not
just
around
that,
but
also
around
how
they
might
bring
together
different
groups
virtually
or
actually
to
have
conversations
about
how
our
services
are
performing.
J
So
choice
support
been
working
really
well
with
them
with
our
team
to
understand
what
the
training
needs
of
each
individual
group
are,
and
it's
not
the
same
across
the
different
groups
of
experts
by
experience
and
providing
that
tailored
training
and,
as
kate
mentioned,
some
of
the
early
work
around
what
we've
been
doing
around
domiciliary
care
and
those
direct
conversations
with
service
users
has
taught
their
mandates
a
lot
about
what
training
and
support
we
need
to
provide
to
the
wider
group.
So
I
said
before
they're
really
excited
about
it.
J
N
J
Choice:
support
who
are
a
strong
leader
on
understanding
inequalities
in
different
types
of
health
and
care
situation
from
their
other
work,
have
been
working
closely
with
those
sexual
organizations
about
how
to
give
people
the
right,
the
right
information
and
the
right
support
to
do
that.
So
it
absolutely
does
include
a
look
at
inequalities
and
access.
It
includes
support
people
as
first
languages,
english.
It
also
supports
that
wider
conversation
about
why
and
how
they
access
services.
J
A
Great
ted,
I
think
this
is
and
colleagues
this
is
really
really
again
another
exciting
development
and
I
can
speak,
but
I
can
congratulate
you
all
on
on,
what's
been
achieved
so
far,
so
imelda
welcome
and
sorry
we
are
running
slightly
out
of
schedule,
but
you
won't
be
surprised
by
that
and
robert
can
I
come
to
you
on
the
healthwatch.
Yes,.
E
Thank
you.
Well,
I
I
won't
steal
imelda's
standard
too
much,
but
firstly,
I'd
like
to
pay
tribute
to
the
immense
work
she
and
her
team
have
done
under
quite
challenging
circumstances,
as
everyone
has
and
the
work
of
the
organization
really
has
gone
on
pretty
seamlessly.
Bearing
in
mind
that
fact,
I'd
just
like
to
draw
attention
to
perhaps
a
couple
of
things
which
I
I
think
directly
affect
the
cqc
you'll,
see
from
elder's
report
and
she
may
talk
about
the
detail.
A
bit.
E
We've
started
a
conversation
with
the
department
of
health
and
social
care
about
the
funding
of
local
health
watch,
which
is
byzantine,
to
say
the
least,
and
doesn't
really
enable
the
department
of
health
to
work
out
whether
it's
getting
value
for
money,
but
has
led
to
a
slow
erosion
of
the
money
that's
actually
getting
through
to
local
health
watch,
and
this
is
a
time
when
there
is
an
increasing
appreciation,
both
in
the
department
and
the
system
generally,
but
also
cqc.
E
I
would
say,
as
to
the
value
of
local
health
watch
in
terms
of
the
information
it
can
provide.
So
I'm
hoping
that
we
there
will
be
improvements.
It's
too
early
to
say,
because
the
conversations
are
at
an
early
stage,
but
this
is
something
I
think
that
could
directly
affect
cqc.
E
Secondly,
just
we,
as
a
committee
have
made
it
down
business,
I
think
to
ensure
that
the
equality,
diversity
and
inclusion
agenda
is
absolutely
integrated
into
everything
we
do
so.
We
are
now
asking
that
every
report
that
comes
to
us
in
relation
to
work
being
done
includes
the
impact
that
work
is
happening
in
that
particular
area,
both
internally
and
and
externally.
E
So
far
as
health
watch
england
is
concerned,
and
finally,
I'd
like
to
report
to
you
that
we
too,
like
cqc,
have
appointed
a
freedom
to
speak
up
guardian,
who
gave
an
illuminating
presentation
to
our
last
committee
meeting.
H
Thank
you
robert.
I
I
I
won't
go
into
too
much
detail
because
you've
got
a
written
report
there
and
I
can
see
that
you've
got
a
very
full
agenda
today
and
I'm
actually
quite
pleased
that
you've
overran,
because
I
got
to
hear
that
very
interesting
discussion,
and
so
thank
you
very
much
for
that.
H
There's
just
a
few
things
that
I
would
highlight.
We
continue
to
share
the
insight
that
we
receive
from
the
public
with
with
whole
parts
of
the
system,
and
last
week
published
our
latest
one.
It
won't
surprise
any
of
you
to
know
that
the
biggest
issue
that's
coming
up
is
it
from
the
public
is
about
the
reintroducing
different
types
of
treatment
and
surgery.
H
That's
that's
coming
through
very
strongly
with
anxiety
from
the
public,
the
poor
information,
access
to
treatment
and
we've
been
doing
some
work
with
chris
moran
at
the
nhs
england
who's
leading
on
the
elective
surgery.
Part
of
this
to
make
sure
that
we
get
the
messaging
right
and
I
think,
they're
doing
quite
an
impressive
piece
of
work
on
that.
H
The
another
piece
of
work
I'll
just
highlight
quickly,
for
you
is
a
piece
of
work
that
we've
been
doing
on
hospital
discharge
when
covert
hit.
We
got
the
rapid
hospital
discharge,
the
the
two
hour
turn
round,
and
so
we
wanted
to
find
out
what
what
that
was
like
for
people
and
and
what
was
good
about
it
and
what
could
be
improved
and
again
working
quite
closely
with
nhs
england
and
with
the
people
who
drew
up
that
guidance.
H
We've
we've
gone
out
through
107
local
health
watch,
so
107
parts
of
the
country
have
responded.
H
We've
done
a
combination
of
getting
information
back
from
people
who
are
directly
affected,
but
also
interviews
with
people
who
work
in
the
sector,
either
as
care
workers
in
care
homes,
social
workers
who
are
making
the
decisions.
The
people
who
are
who
are
dealing
with
the
rapid
hospital
discharge.
So
we've
got
quite
a
rounded
picture.
H
We're
just
doing
the
analysis
of
that
and
we'll
be
publishing
that
in
the
next
few
weeks,
again
working
really
closely
with
with
nhs
england,
so
that
we're
helping
understand
all
that
in
time
for
the
for
for
winter
and
the
demand
going
up
on
on
the
nhs
again,
just
just
also
a
piece
of
work,
I
think
you'll
be
interested
in.
We
published
a
report
which
was
about
people's
experience
of
the
rapid
change
towards
the
digital
access
to
primary
care
to
gps
in
particular.
H
The
report
is
called
the
doctor,
will
zoom
you
now
and
that's
laid
quite
a
good
foundation
for
us
in
understanding
what
people
really
like
about
it
and
what
needs
to
be
improved
and
we're
at
the
moment
scoping
to
do
a
piece
of
work
and
we're
talking
to
all
the
relevant
stakeholders
to
look
at
how
how
we
can
make
sure
that
no
one
is
left
behind
in
the
move
to
digital?
Who
are
the
people
likely
to
be
left
behind?
H
How
can
we
make
sure
that
we
we
we
work
with
them
to
make
sure
that
they
get
full
access
to
care?
So
I
think
I
think
that's
it.
The
only
thing
I
just
a
final
thing
is
that
our
work
with
the
network
is
incredibly
vibrant.
I
mean
it's
been
growing
over
recent
years,
but
during
during
the
covid
pandemic,
it's
been
really
interesting.
The
engagement
has
been
fantastic.
H
We
couldn't
ask
for
better
there's
a
real
lively
debate,
all
the
time
across
the
organization's
real,
proper
sharing
of
information,
which
I
don't
think
we
had
that
sense
of
community.
It
takes
years
to
build
real
community,
but
I
really
feel
it's
building,
so
I'm
very
very
pleased
about
that
and
we're
we're
in
the
middle
of
planning
for
our
our
annual
conference,
which
we've
moved
online.
The
main
theme
of
that
will
be
around
equalities
and
how
on
what
role
health
watch
across
the
country
can
play
in
reducing
inequalities.
H
So
far,
we
know
that
we've
got
the
secretary
of
state
is
going
to
open
it
and
sir
michael
marmot
will
be
doing
the
opening
speech.
So
we've
got.
We've
got
quite
an
interesting
four
day,
long
online
conference,
so
you
might
have
to
pick
me
up
at
the
end
at
the
end
of
those
those
four
intense
days
and
then
finally,
we're
working
very
closely
with
the
committee
and
and
staff
and
on
refreshing
our
strategy,
which
is
now
halfway
through
the
one
that
was
set
two
and
a
half
years
ago.
H
A
Thanks
to
welder,
I'm
just
trying
to
get
my
mind
around
a
four
days
conference
on
video,
I'm
struggling
with
a
one-day
board
meeting.
I
think.
H
A
Does
anybody
want
to
write?
I
was
a
brilliant
written
report
as
well,
so
you
have
covered
a
lot
of
ground.
Does
anything
anybody
wants
to
to
raise
mark
you've
got
your
hand
up,
but
I
think
that's
from
a
previous
thing,
ted.
F
Yes,
imelda
thanks
thanks
for
thanks
for
the
report,
it's
really
really
fascinating
to
hear,
but
the
I
the
doctor
will
zoom
you
now
is
is
is,
as
rosie
said,
a
great
report.
I
suppose
my
concern
is
that
an
awful
lot
of
virtual
consultations
are
actually
phone
calls
they're,
not
they're,
not
digital.
F
I
mean
everyone
says
it's
digital
and
virtual
technology,
but
in
truth,
an
awful
lot
of
outpatient
clinics
being
done
on
the
phone
these
days
and-
and
I
I
suspect
in
in
in
primary
medical
services
as
well,
it's
on
the
phone-
and
I
just
wonder
whether
we
should
be
you
know
not
kind
of
including
all
virtual
consultations
as
one
and
and
whether
you've
got
any
sense
about
people's
perception
of
that.
H
H
So
we
had
decided
to
do
this
as
part
of
our
work
plan,
but
then,
with
that
rapid
move
to
to
on
to
online
and
on
phone
initial
triage,
we
we
thought
we'd
step
it
up
and
what
we're
really
interested
in
is
if
there
is,
if
it's
causing
widening
inequalities
in
any
part,
that's
our
focus
and
yes,
it
will
cover
phone,
video
and
and
and
all
those
methods.
A
N
Mark
yeah,
I
did
want
to
ask
another
question
chairman,
I'm
on
a
great
report.
As
always-
and
I
I
I
zoomed
in
on
the
doctor-
will
zoom
you
now.
I
just
thinking
that
this
report
that
you're
going
to
bring
out
on
the
potentially
excluded
groups.
If
we
look
at
the
previous
reports,
you've
produced,
such
as
maternity
and
mental
health
and-
and
I
always
remember
the
transport
report
with
just
these
incredible
patient
stories,
embedded
into
the
report
that
actually
created
some
traction
with
the
with
nhse.
N
So
I
would
really
hope
that
the
report
that
that
on
the
potentially
excluded
groups
will
have
that
richness,
because
I
certainly
can
relate
to
some
of
the
frustrations
of
the
the
zoom
process
that
you're
alluding
to
in
your
report.
So
I
really
look
forward
to
that.
H
Thank
you,
and,
and
yes,
it
will
in
fact,
we've
seconded
somebody
in
from
the
network
to
do
some
in-depth
work
on
on
on
working
through
local
health
watch,
two
very
excluded
groups,
so
that
we
can
get
some
real
insight
and
people's
stories
because
I
think
you're
right.
That's
that's
what
changes
your
heart
and
mind
yeah!
G
Could
I
just
add
to
that
particular
point
peter
if
that's
okay,
because
I
I
just
wanted
to
say
thank
you
to
imelda,
because
jacob
land
joins
our
primary
care,
quality
board
meetings
and
has
been
really
helpful,
and
we
discussed
this
yesterday
because
and
we're
going
to
be
doing
some
specific
work
with
jacob
as
to
how
we
can
pull
together
what
we're
doing
around
making
sure
that
people
get.
G
This
is
particularly
around
accessing
primary
care
and
pulling
in
those
local
stories
and
local
knowledge
that
that
you
have
so
we
can
make
sure
that
we
can.
We
can
address
it
as
as
appropriate.
Oh
that's
great!
Yes,.
A
Great
and
alder
thank
you
very
much
seriously,
really
really
good
written
report,
which
I
think
we
all
enjoyed
reading
a
good,
quick
presentation
now
wish
you
every
success
with
your
four
and
a
half
days
and
rapidly
counting
conference,
but
thank
you.
You're.
A
And
and
just
do
stay
with
us
for
the
rest
of
the
board
meeting,
if
you
want
to
we
move
on
now
to
the
response
in
the
independent
medicines
and
medical
devices
safety
review,
I
think
matthew
tate's
joining
us
matt
you're
welcome
but
ted.
Do
you
want
to
start.
F
Yes,
so
thank
you
for
this.
This
was
an
important
report
that
came
out
in
july
of
this
year
and
I,
I
think,
the
what
we
want
to
present
to
the
board.
Now
it
is
really
some
assurance
that
we're
dealing
with
the
immediate
issues
that
were
raised
in
the
report,
the
recommendations
for
the
cqc,
but
also
a
recognition
that
the
underlying
issues
in
this
report
reflect
similar
under
eyeing
issues
from
previous
reports
and
that
the
challenge
is
not
just
to
deal
with
the
immediate
recommendations
but
to
tackle
some
of
the
underlying
issues.
F
So,
in
a
sense,
there's
a
temptation
just
to
deal
with
the
symptoms
of
the
problem
rather
than
the
underlying
causes,
and
I
think
the
challenge
is
the
underlying
causes
and
what
what
matt
and
his
team
have
done
is
brought
is
drawn
out
some
of
the
underlying
themes
from
this
report
and
from
the
paterson
report
and
the
gospel
report,
all
of
which
have
occurred
recently.
But
I,
I
suspect,
if
we
look
back
for
previous
reports,
including
robert's
report
on
mid
staffs,
we
would
have
similar
underlying
themes
in
all
of
them.
F
Quite
honestly-
and
I
suppose
the
the
real
message
here
is
the
system
as
a
whole,
including
us
as
cqc,
have
not
tackled
sufficiently
the
underlying
themes,
with
the
result
that
individual
failures
occur
and
we
keep
coming
back
to
just
dealing
with
the
process
of
the
immediate
process
of
the
failure
and
don't
address
the
underlying
issues,
and
the
underlying
issues
is
to
be
identified
that
we've
identified
here
and
clearly
this
is,
is
the
analysis
we've
come
to.
F
Is
it
are
kind
of
outlined
at
the
start
of
this
paper,
where
there's
a
sense
of
the
system?
Doesn't
that
involve
patients
effectively
as
equals
in
their
care,
and
when
things
go
wrong,
patients
find
it
very
difficult
to
be
listened
to,
and
we
don't
listen
to.
Patients
concerns
when
things
do
go
wrong.
The
system
tends
to
act
defensively
and
it
gets
into
a
mindset
of
blame
and
trying
to
find
fault
and
then
that
that
moves
to
an
issue
of
just
identifying.
F
You
know
individuals
to
blame
for
indiv
for
particular
problems,
rather
than
looking
at
the
system
issues
beyond
it
that
there's
an
ability
in
the
system
to
to
to
monitor
concerns.
So
in
all
these
cases
there
was
a
sense
of
the
evidence
was
there.
Why
did
we
not
pick
it
up?
F
Why
do
we
wait
for
the
patients
to
to
form
lobby
groups
and
and
to
actually
have
to
fight
very
hard
to
listen
to
before
we
recognize
the
problem
and
then
there's
there's
another
issue
that
comes
out
of
all
these
reports,
and
that
is
that
that
the
regulatory
framework
is
enormously
complex
in
healthcare,
and
we've
discussed
this
previously
as
a
board
and
there's
a
sense
of.
F
Does
it
act
in
a
coordinated
way
to
deal
with
problems
or
is
it
to
still
too
uncoordinated,
and
is
there
all
for
us
to
seek
you
see
to
to
to
bring
bring
the
regulators
together,
so
we
can
act
in
the
much
more
coordinated
way
when
things
are
problematic.
So
that's.
That's
briefly.
All
I
wanted
to
say
about
this
about
these
underlying
issues
I
mean.
Clearly,
we
need
to
consider
these
when
we
come
to
consider
our
strategy
going
forward.
F
I
think
we've
touched
on
some
of
these
already,
but
I
think
there's
an
opportunity,
perhaps
to
address
it
again
on
the
basis
of
this
this.
This
summer's
report,
I
think,
in
terms
of
the
detail,
recommendations
that
involved
us
in
the
report
they're
outlined
in
the
annex,
and
we
will
be
producing
a
summary
of
our
actions
in
response
to
those
in
due
course
and
bring
them
back
to
the
board.
F
That's
all
I
want
to
say
matt.
Is
there
anything
else
you
wanted
to
add.
A
So
I
guess
the
the
the
other
way
of
looking
at
this
through
the
other
end
of
the
telescope.
Is
that
as
we've
developed
the
strategy
and
and
all
the
other
things
we've
been
talking
about
throughout
this
meeting,
do
we
think
we
have
reduced
the
chance
of
just
history
constantly
repeating
itself
with
things
going
wrong
all
the
time
that
have
gone
wrong
in
the
past?
So
we
need
to
probably
come
back
and
look
at
it
from
that
end
of
the
telescope?
Don't
we
ted.
F
I
think
that's
right
and
I
think
it's
a
big
challenge,
peter.
I
don't
think
any
of
this
is
easy,
and-
and
so
I
do
think,
we
need
to
test
ourselves
about
whether
we
working
with
others,
because
we
can't
do
this
by
ourselves,
but
but
but
working
with
others
can
address
some
of
these
fundamental
issues,
because
if
we
don't,
if
there's
going
to
be
another
report
in
another
couple
of
years
about
something
else
that
we
haven't
spotted
yet
gone
wrong,
and
that's
that's
my
concern.
A
Okay,
we'll
move
on
then
thank
you,
matt
and
ted,
so
liz
the
rgc
meeting
last
night.
I'm
sorry,
I
couldn't
be
there.
I
was
interviewing
as
you
know,
but
you
want
us
to
give
us
a
quick
readout
from
what
you
discussed.
H
Yes,
definitely
thanks
very
much
so
we
discussed
two
substantive
items.
The
first
one
was
touched
on
by
ted
earlier,
and
that
was
about
the
the
work,
that's
in
progress
on
emergency
departments
and
the
improvement
agenda,
and
essentially,
whilst
there's
very
good
practice
in
many
emergency
departments,
there
are
some
that
haven't
really
improved
and
and
what
this
work
is
about
is
really
working
with
the
clinical
leaders,
the
country
to
including
those
from
outstanding
trusts
who
are
really
doing
this
well
to
identify.
H
What
does
good
look
like
and
then
draw
on
that
for
guidance,
which
then
I
think
people
are
really
waiting
for
in
anticipation
to
see
what
this
guidance
looks
like
and
then
coming
back
to
that
in
terms
of
this
is
what
we're
expecting-
and
this
is
you
know
it's
a
framework
and-
and
I
think
we
had
a
good
discussion
about
the
importance
of
that
sort
of
positive,
proactive
work
that
is
positively
motivating,
alongside,
of
course,
using
enforcement
powers
where
that's
necessary.
H
But
enforcement
is
always
kind
of
after
the
event
and
sometimes,
as
a
has
a
less
systemic
impact,
and
we
had.
I
think
that
the
committee's
view
was
that
was
very
supportive
of
this
work
and
supportive
of
the
intention
to
to
address
not
only
the
leaders
within
emergency
departments,
but
also
the
the
system
leaders
who,
because
a
lot
of
what
goes
on,
of
course,
is
you
know
the
flow
of
people,
whether
they
can
leave,
whether
when
they
need
to
go
to
a
in
the
first
place,
but
also
how
they
move
through
the
system.
H
So
that
was
a
very
positive
discussion.
We
then
had
a
discussion
about
both
experts
by
experience
and
wider
question
about
how
people's
voices
and
views
and
engagement
are
part
of
our
methodology
and
our
future
plans,
and
we
talked
about
how
ex
the
plans
for
experts
by
experience
to
be
deployed
in
different
ways,
because
there's
less
use
in
inspections,
because
we're
not
doing
so
many
inspections
at
the
moment,
for
example,
supporting
securing
user
voice
in
different
kind
of
the
sort
of
pilots.
H
But
we
also
sort
of
talked
more
broadly
about
the
huge
significance
of
being
able
to
bring
together
and
analyze
all
the
different
kinds
of
evident
personal
evidence
and
information
and
views
that
come
in
through
lots
of
different,
sometimes
fragmented
routes
into
cqc,
but
being
able
to
turn
that
both
the
sort
of
qualitative
and
quantitative
material
in
that
into
a
dashboard
that
can
be
easily
used
as
part
of
our
future
methodology
and
also,
of
course,
more
proactively
working
with
people
with
lived
experience
in
a
kind
of
mode
of
co-production
when
we're
developing
regulatory
approaches
and
going
out
proactively
when
we're
looking
at
particular
places
or
particular
types
of
service
etc.
H
So
it
was
a
good
discussion
that
I
think
said.
The
voice
of
service
users
and
families
is
a
core
part
of
the
intelligence
that
we
need
to
be
properly
intelligence
driven.
It
enables
us
to
triangulate
what
the
different
players
in
the
system
are
saying
and
it
and
it's
important
to
give
weight
to
that
experience
of
service
users
alongside
the
weight
of
providers
or
other
people
in
the
system
and-
and
I
think
it
was
a
it-
was
a
rounded
and
and
very
lively
and
good
discussion.
I
think
so.
A
Good,
thank
you
right.
So
is
there
any
other
business?
A
So,
in
the
absence
of
any
other
business,
it
takes
us
on
to
questions
from
members
of
public,
and
you
may
remember,
at
the
end
of
the
july
board,
we
were
asked
whether
there
was
a
way
through
a
different
use
of
teams,
perhaps
that
we
could
improve
the
experience
for
people
wanting
to
watch
the
public
board
meeting
while
we're
not
able
to
meet
in
in
person
with
with
them
in
the
room,
and
I
just
wanted
to
say
to
anybody-
that's
interested
in
this-
that
I
don't
have
an
answer
at
the
moment,
but
we
are
looking
at
a
a
a
couple
of
options
and
we'll
come
back,
hopefully
by
the
next
board
meeting
to
say
what
we
think
we
can
do
if
anything
in
the
in
in
this
space,
but
it's
certainly
not
forgotten.
A
We
then
had
we've
got
two
questions
from
robin
pike
that
are
new
to
this
meeting.
The
first
is:
how
does
cqc
explore
patient
experiences
in
making
formal
complaints
to
nhs
nhs
hospital
trusts?
Patient
patients
seem
to
find
that
it
takes
at
least
nine
weeks
to
get
a
response
and
is
generally
difficult
and
a
ted.
I
don't
know
if
you
could
answer
that.
One.
F
Yes,
thank
you
peter.
So
response
to
complaints
is
a
feature
of
our
responsive,
key
question
and
their
key
lines
are
inquiry
that
addressed
that
and,
as
part
of
our
inspections,
we
would
always
look
at
the
a
services
response
to
complaints
to
make
sure
they
are
responding
effectively
and
where
we
find
problems
with
that,
we
will.
We
will
ask
for
improvement
in
the
in,
in.
F
C
F
Learning
that
comes
from
complaints,
so
we
also
look
at
well
led
to
make
sure
that
the
process
for
managing
complaints
is
satisfactory
and,
as
part
of
every
inspection,
every
comprehensive
inspection.
We
would
look
at
a
sample
of
complaints
and
just
picked
at
random,
so
they're
not
selected
in
any
way
and
just
to
see
how
the
how
effective
the
response
is
in
terms
of
the
quality
of
the
response,
but
also
how
well
the
process
has
been
managed
by
the
trust
and
again,
if
it's
not
been
managed
well,
we
would.
F
We
would
include
that
in
the
improvements
we
asked
the
trust
to
make.
So
we
do
look
at
complaints
routinely
as
part
of
our
inspections,
and
this
is,
it
is
quite
honestly
offer
it's
quite
a
frequent
area
where
we
have
to
ask
for
improvement.
So
I
think
that
reflects
robin's
concerns
about
this,
and
I
think
it's
scenario
we
need
to
keep
focused
on
going
forward.
G
Yeah,
certainly
peter,
so
our
inspectors
always
check
the
current
ratings
are
displayed
in
gp
practices
through
both
their
monitoring
and
their
inspection
activity,
usually
for
gp
practices.
We
would
expect
that
this
includes
the
display
of
ratings
on
the
practice
website,
practices
who
failed
to
display
their
meetings
would
be
reminded
to
do
so
before
we
took
any
formal
action
we
can
and
we
have
issue
penalty
notices
to
those
who
persistently
fail
to
display
ratings,
but
this
is
rare.
D
Yes,
so
nothing
particularly
the
same
approach
in
adult
social
care.
A
Great
well
we're
only
we're
only
running
about
an
hour
behind
where
we
should
have
been,
but
that
is
the
end
of
the
public
board
meeting.
Thank
you
all
very
much
indeed.
A
Do
we
want
a
five-minute
break
or
do
we
want
to
go
straight
on
a
couple
of
nod,
so
look
we're
literally
five
minutes
and
then
we
are
going
to
go
through
the
rest
of
the
agenda
without
any
breaks,
even
if
we're
still
here
at
midnight
so
just
to
concentrate
your
minds.
But
five
minutes
now
we're
starting
at
14
40.