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From YouTube: CQC board meeting - June 2021
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A
Right
good
morning
and
welcome
to
the
june-born
meeting
of
the
cqc,
we
had,
of
course,
hope
to
be
meeting
in
person,
but
because
of
the
extension
of
the
restrictions
we
are
meeting
yet
again
of
our
teams.
A
Rebecca
lloyd
jones
is
not
with
us
today,
but
we
are
very
pleased
to
welcome
blessing.
Who
is
the
gender
equality
network
co-chair?
You
are
extremely
welcome
here
today.
Does
anybody
have
any
declaration
of
interest
they?
They
wish
to
make
very
good,
and
I
think
that
takes
us
straight
then
to
the
minutes
of
our
meeting
of
the
19th
of
may.
Are
they
a
true
and
accurate
record
of
all
we
discussed?
A
Thank
you.
Thank
you
very
much
indeed,
there's
nothing
outstanding
on
our
action
log.
Is
there
anything
arising?
It's
not
otherwise,
on
the
agenda.
Anybody
wanted
to
raise
good
fine.
Well
then,
we
move
swiftly
on
to
our
report
from
the
executive
team
in.
B
Thanks
peter
and
good
morning,
everybody
a
few
a
few
items
to
report
this
month.
I
think
the
first
thing
to
report
is
the
successful
launch
of
our
strategy.
You'll
recall
that
we
launched
our
new
strategy
at
the
end
of
may.
There
was
a
strategy
which
had
had
widespread
consultation,
and
I
was
really
pleased
about
the
way
that
it
continues
to
be
widely
welcomed
and
seen
as
a
an
innovative
and
ambitious
new
strategy.
B
We
just
need
to
to
go
away
and
deliver
it
now,
which,
of
course,
is
is
what
we
are
embarked
upon.
Just
picking
up
on
your
point
at
the
top
of
the
meeting
peter
around
the
prime
minister's
announcement
recently
that
stage
four
of
the
covid
road
map
is
has
been
has
been
postponed.
B
B
Four
will
continue
to
do
that
in
the
way
that
we
have
been
with
a
big
focus
on
higher
risk
services
in
in
all
across
all
of
the
directorates
that
that
we
operate
on
and
again
we
we're
not
return,
as
with
many
employers,
we're
not
formally
returning
to
offices
until
government
guidance
allows,
and
that,
of
course,
just
creates
some
some
practical
difficulties
for
us.
B
But
of
course,
we've
been
working
with
those
for
the
last
15
or
16
months
anyway,
and
in
terms
of
work
we've
been
doing
with
parliamentarians
peter,
and
I
attended
the
all
party
parliamentary
group
on
whistleblowing
to
support
them
in
their
work.
Looking
at
at
a
whistleblowing
within
health
and
social
care.
B
I'm
also
really
pleased
to
announce
that
professor
professor
ursula
gallagher,
one
of
our
recently
retired
deputy
chief
inspectors
from
the
primary
medical
services
group,
was
awarded
an
mba
in
the
queen's
birthday
honours
list
recently
and
that
that
mba
was
awarded
for
services
to
healthcare
and
and
patient
safety.
Many
of
you
will
will
know
actually
well.
B
She
made
numerous
appearances
at
this
board
presenting
on
on
a
range
of
topics,
and
I
think
it
would
be
fair
to
say
that
ursula's
leadership
and
and
passion
frankly
for
for
patient
safety
around
in
areas
like
clinical
nursing
practice,
the
operation
of
the
primary
medical
services,
directors,
outcomes
for
children,
children
and
detained
people.
B
It
really
did
raise
the
bar
in
terms
of
the
work
that
we
do
and
and
excellence
in
healthcare,
and
I
think
a
number
of
people
will
will
have
gained
very
directly
from
from
from
working
alongside
us
as
mentors,
but
but
also
people
who
use
healthcare
will
have
gained
from
the
work
that
did
so.
I
think
we've
been
we're
all
really
pleased
to
that.
Ursula
has
been
honored
in
this
in
this
way.
B
In
terms
of
upcoming
events,
we
have
been
invited
to
speak
to
the
all
party
parliamentary
group
on
learning
disability,
so
I
will
be
I've
been
invited
alongside
debbie
ivanova,
one
of
our
our
deputy
chief
inspectors,
who,
who
leads
on
learning
disabilities
and
and
autism
for
us,
we'll
be
going
later
this
month
as
they
reflect
as
a
group
of
parliamentarians
on
the
fact
that
it's
been
10
years
since
since
winterbourne
view.
B
Another
panelists
will
include
the
minister
of
state
for
care
representatives
from
nhs,
england
and,
of
course,
relatives
of
people
who
are
receiving
care
peter.
That's
all
I
I
wanted
to
say
before
handing
on
to
kate.
But
how
was
he
happy
to
take
any
questions.
C
And
good
morning,
all
so
what
I'm
gonna
update
you
on
follows
on
nicely
from
ian's
comments
about
the
up
and
coming
appearance
at
the
all
party
parliamentary
group.
So
I
want
to
update
you
on
our
work,
around
close
cultures
and
our
transformation
of
how
we
inspect
services
for
people
with
learning
disabilities
and
autistic
people.
C
So,
first
of
all,
on
the
close
cultures
front
and
board
will
be
aware
that
we
have
been
busily
developing
improved
tools
to
enable
us
to
get
under
the
skin
of
a
service
and
to
really
understand
what
it
feels
like
as
best
as
we
can
for
someone
to
be
in
receipt
of
that
care.
So
that
work
has
happened.
We've
developed
a
new
tool
called
our
quality
of
life
tool
that
is
now
being
piloted
on
hospital
inspections
and
it's
delivering
some
good
results
that
will
in
time
be
evaluated.
C
So
I'm
so
good
progress
on
the
development
and
training
of
that
tall
in
closed
cultures
and
then
just
moving
on
to
learning,
disability
and
autism
so
and
as
ian
mentioned,
debbie
ivanova
is
our
lead
chief
inspector
on
this
agenda
for
the
next
12
months
and
she's,
focusing
on
three
areas
of
work,
she's,
focusing
on
how
we
can
assure
that
we
consistently
only
register
services
that
deliver
the
model
of
best
practice
that
we
make
sure
that
we
support
services
to
improve,
but
where
services
aren't
able
to
improve
and
people
are
getting
poor
quality
care
that
we
take
robust
action
and
her
third
area
of
work
is
looking
at
how
people
access
health,
health
and
social
care
in
a
timely
way
and
look
at
that
kind
of
pathway
through
health
and
care.
C
So
debbie
has
been
doing
responsive,
risk-based
inspections
going
out
into
inpatient
hospitals
where
we
had
information
of
concern,
or
possibly
it
was
a
service
rated
previously,
as
poor
we've
been
using
our
new
tool
and
in
each
of
those
risk-based
inspections
that
we've
done,
we've
been
taking
some
form
of
enforcement
activity.
So
that
is
telling
me
that
we
are
going
out
to
the
right
sorts
of
services
and
we
are
using
all
the
tools
at
our
disposal
to
make
sure
that
we
are
taking
action
to
ensure
that
people
are
getting
improved
outcomes.
C
D
D
Thank
you.
Thank
you,
kate.
Thank
you
peter
good
morning,
everyone.
So
over
the
last
month,
we
have
started
in
hospitals
using
a
more
a
streamlined,
a
more
flexible
approach
to
inspection,
to
revisit
some
of
the
organizations.
The
providers
we've
had
long-term
concerns
about
such
as
those
in
special
measures
or
those
who
are
under
a
special
observation.
D
One
of
the
I
think,
really
encouraging
things
we've
found
is
that
we
are
finding
that
has
been
improvement
in
some
of
those
services.
Despite
the
fact
they've
just
come
through
a
pandemic,
and
I
think
I
want
to
start
off
just
by
paying
tribute
to
the
way
that
services
have
been
led
during
this
pandemic.
There's
a
lot
of
very
good
work
going
on
and,
as
I
say,
it's
not
just
dealing
with
a
pandemic,
but
some
underlying
issues
have
been
addressed.
D
D
But
having
said
that,
there
are
still
significant
problems
in
the
system
in
the
aftermath
of
the
pandemic,
which
I
reported
on
this
board
last
month,
and
I
have
to
say
since
then
the
situation
has
it.
D
Just
on
urgent
emergency
care
have
been
really
very
severe
and
they
continue
to
be
severe,
and
that
is
the
time
of
the
year
when
you
expect
in
a
normal
year
for
them
to
be
lessened.
So
the
summer
is
really
fitting
for
many
services
very
much
like
the
winter
pressures
and
equally,
the
the
waiting
list
for
people
for
planned
care
has
continued
to
increase.
D
Despite
the
fact
and
I've
seen
this
myself
on
visits
to
hospitals,
the
staff
are
very
focused
are
on
the
tackling
the
backlog
in
planned
care,
but
but
there
is
because
of
the
pandemic,
a
lot
of
unmet
need.
That
needs
to
be
addressed,
and-
and
I
think
I
would
summarize
this
as
there
are
enormous
pressures
on
the
system
at
the
moment
and-
and
we
know,
working
with
staff
that
they're
doing
a
lot
to
address
those
pressures.
For
instance,
we
had
a
a
workshop
with
frontline
clinicians
from
emergency
departments
all
over
the
country.
D
D
The
pandemic
has
made
very
much
very,
very
much
more
more
clearer
as
an
issue,
and
I
think,
while
the
services
need
to
respond
to
the
immediate
problem,
we
also
need,
and
the
services
need
to
look
forward
to
actually
changing
the
way
they
provide
care.
So
they
can
better
meet
the
needs
of
the
population.
I
think
the
the
the
changes
in
terms
of
the
integrated
care
systems
next
year
is
an
opportunity
to
really
address
some
of
the
models
of
care
that
need
to
meet
the
needs
of
of
the
populations
they
serve.
D
Can
I
just
mention
maternity
services.
We
are
continuing
our
program
of
responsive,
risk-based
reviews
of
maternity
services.
Now
these
reviews
we're
doing
at
the
moment,
are
very
much
based
on
culture
and
leadership
and
we're
looking
at
very
much
aligned
with
with
our
strategy
going
forward,
and
I
think
we
are
continuing
to
find
some
issues
in
some
services
where
culture
and
leadership
is
not
driving
the
safety
in
the
way
we
want
and
we've
been
reporting
on
those
as
we've
done.
The
individual
reports
we'll
produce
a
summary
report
later
in
the
year.
D
Having
said
that,
we
are
finding
some
good
progress
in
some
in
some
maternity
services
and
I'm
very
glad
to
say
that
the
investment
is
going
in
from
nhs
england
to
increase
the
staffing
and
maternity
services,
because
one
of
the
ongoing
issues
we
see
day
in
day
out
is
our
shortages
of
staff
in
midwifery
and
obstetrics.
So
a
lot
of
work
is
going
on
in
terms
of
that
nationally
and
we
working
with
stakeholders
to
drive
that
forward,
and
we
will
input
into
that
when
we
produce
our
report
on
maternity
services
later
in
the
year.
D
That's
all
I
wanted
to
say
at
this
stage
peter
I'll,
take
any
questions,
if
not
I'll
hand
over
to
rosie.
It's
not
a.
A
Question
teddy,
but
it
is
just
a
sort
of
comment
to
reinforce
what
you
were
saying
at
the
at
the
start
of
your
your
report.
You
know
the
pandemic
may
be
beating,
but
it,
but
it
hasn't,
ended
and
probably
isn't
going
to
end
quite
a
considerable
time.
People
are
now
very
worried
about
flu
next
winter.
A
The
backlog
you've
referred
to
is
is
considerable,
and
I
suspect
that
many
people
on
that
backlog
will
be
sicker
and
require
greater
care
than
they
would
have
done
if
they
presented
earlier.
So
your
point
about
services
having
to
think
very
differently,
it's
just
so
important.
Isn't
it
because
the
pressures
are
just
greater
and
will
get
greater
still?
I
suspect.
D
I
think
there's
a
lot
of
concern
about
resurgence
of
other
respiratory
viruses
flu
rsv
during
during
the
next
winter
they
may
come
earlier.
They
may
be
greater
in
number.
I
mean
we
can't
be
certain,
but
there
is
a
real
concern
about
that
and,
of
course,
that
will
set
things
back
again,
applying
more
pressure
on
issues,
emergency
care
and
also
cause
further
problems
with
elective
care.
A
And
and
rosie,
obviously,
primary
care
is
going
to
be
under
huge
pressure
as
well.
E
Yes,
we're
seeing
enormous
pressure
in
primary
care,
and
certainly
in
general
practice
at
the
moment
and
gp
colleagues
are
telling
me
that
the
demand
going
into
services
is,
unlike
anything,
they've
seen
before
in
some
cases,
and
so
I
I
share
ted's
concerns
about
the
coming
months,
because
I
think
that's
at
a
time
where
people
are
already
feeling
exhausted
and
tired.
After
all,
we've
had
to
manage
over
the
last
few
months.
E
But
having
said
that,
as
ted
said,
we
are
seeing
significant
improvement
in
some
services,
which
is
great
despite
all
of
those
pressures,
and
what
the
first
aspect
of
my
report
is
that
we've
been
looking
at
our
special
measures,
practices
and
we've.
We've
undertaken
a
program
of
re-inspection
of
special
special
measures
practices
over
the
last
few
months
and
it's
fantastic
to
see.
E
Many
of
those
practices
have
actually
come
out
of
out
of
special
measures,
and
one
of
the
pieces
of
work
we're
doing
at
the
moment
is
looking
actually
the
correlation
between
the
length
of
time
between
re-inspection
of
those
practices
and
the
improvements
that
have
been
made
and
because
of
the
pandemic
and
various
other
reasons.
Some
in
some
cases,
during
covert,
we
had
to
leave
those
reinspections
slightly
longer
than
we
would
have
previously
with
the
six
months
reinspection,
and
we
found
significantly
more
improvements
if
people
had
a
bit
more
time.
E
So
we
want
to
feed
this
into
our
learning
into
our
future
approach
and
develop
a
much
more
flexible
approach
to
allow
for
those
improvements
to
be
made.
But
I
just
would
like
to
say
thank
you
to
all
of
those
practices
who
have
spent
the
time
improving
their
services
for
people,
despite
all
of
the
challenges
that
they
have
had
to
encounter,
we
do
continue.
E
We
are
continuing
with
our
risk-based
approach
and
we
are,
with
all
of
our
inspections,
featuring
a
a
an
aspect
of
a
look
at
access,
and
we
will
be
looking
at
pulling
together
all
of
the
learning
from
the
access
work
into
an
insight
report
and
then
into
the
state
of
care
report
later
on
in
the
year.
E
The
other
two
areas,
just
to
briefly
mention,
is
we're
working
very
closely
with
health,
education,
england
and
nhs
england
around
the
additional
roles
reimbursement
scheme,
as
the
board
is
aware,
there
are,
there
is
primary
care
networks.
Are
looking
to
recruit
an
additional
26
000
people
into
primary
care
from
a
whole
range
of
backgrounds,
and
actually
I
really
welcome
this.
I
think
that
we
need
a
really
strong,
diverse
workforce
in
primary
care.
E
I
think
the
different
skill
mix
that
this
will
experience
and
really
add
to
to
outcomes
for
people.
I
think,
however,
we
we're
very
keen
that
we
make
sure
that
people
coming
into
primary
care
networks
from
a
whole
range
of
different
backgrounds
have
the
support,
the
supervision,
the
training
that
they
need
to
be
able
to
deliver
their
job.
E
That
governance
is
thought
through
that
there
is
clear
accountability,
especially
if
someone
is
working,
for
example,
a
pharmacist
working
between
many
different
practices
to
make
sure
that
patient
care
is
safe
and
that
there
is
no
no
concern
from
that
point
of
view,
so
we're
working
very
closely
with
stakeholders
to
look
at.
How
do
we
make
sure
that
that
happens?
E
And
the
final
thing
just
to
mention
in
the
report
is
an
update
on
provided
collaboration
reviews
and
it's
we're
currently
undertaking
the
mental
health
provider.
Collaboration
review,
which
is,
as
we've
previously
said,
has
a
focus
on
children
and
young
people,
and
we
are
looking
to
bring
back
the
learning,
disability
and
cancer
reviews
in
the
next
board.
A
Thank
you,
rosie
rosie,
going
back
to
your
your
first
point
about
practices
in
special
measures
extended
period
for
some
between
inspections,
but
presumably
there
is
ongoing
monitoring
during
that
period.
F
I'll
win
the
prize
for
that
one
today.
So
yes,
thank
you.
Just
just
a
couple
of
things
from
me
today,
I'm
just
going
to
update
you
on
the
people
plan
and
then
hand
over
to
chris
who's,
going
to
pick
up
the
performance
report.
So
just
on
the
people
plan,
I
think
we're
making
continue
to
make
some
good
progress
around
that
just
a
couple
of
areas
to
highlight.
F
Last
year
we
ran
our
all
staff
conference
virtually
and
it
was
a
real
opportunity
to
get
everybody
in
the
organization
together
for
a
conference,
we
are
planning
on
doing
the
same
again.
The
feedback
has
been
incredibly
was
incredibly
positive
from
from.
F
Again,
using
the
same
form
and
we'll
be
running
at
the
end,
this
will
give
us
some
further
opportunities
for
some
bite-sized
learning
around
some
key
key
areas
for
us
and
also
to
have
some
good
conversations
around
our
strategy
and
transformation
program.
F
I'm
also
really
pleased
to
say
that
for
the
first
in
mineworkforce
well-being
indexed
this
year
for
the
first
time
and
we
were
awarded
a
silver
award-
which
I
think
is
a
really
really
good
achievement,
given
it
was
our
first
go
at
this.
We
were
43rd.
F
Organizations
that
participated
and
has
given
us
a
really
solid
benchmark
now
from
which
to
move
forward.
So
I
think
well
done
to
the
team
who've
been
involved
in
that
and
actually
our
next
pulse
survey
is
going
to
be
focused
around
well-being
as
well,
just
to
add
further
into
that
one
there's
a
few
other
bits
in
the
report,
but
I'm
not
going
to
pick
up
on
those
just
hand
over
to
chris
now.
G
F
G
About
performance
so
before
we
just
move
to
chris,
can
I
just
bring
mark
saxton
in
please.
H
Certainly
thanks
chairman
and
kirsty
thanks
a
lot
really
good
people
report
to
really
encouraging
around
inclusion,
leadership,
the
mind
well-being
award
and
development
and
line
management
capability.
But
could
I
ask
you
a
question
please
about
people,
it's
kind
of
linked
to
the
green
plan,
which
I
know
is
later
in
the
agenda.
H
It's
you
know
about
office
working
and
I
know
we've
articulated
an
office
working
strategy
at
the
moment
based
on
business
and
personal
well-being
needs.
But
to
what
extent
are
we
developing
a
new
way
of
using
offices
based
on
our
learnings
from
the
pandemic?
I
just
wonder
if
you
could
ask
any
information
on
that.
Please.
F
Yes,
we
now
have
80
of
our
workforce
that
have
elected
to
be
permanently
home
based.
It
was
60
before
the
pandemic
and
we've
we
we've
given
people
the
option
to
choose
whether
they
want
to
be
home
based
or
have
flexible,
working
going
forward
and
say:
we'd,
never
80.
What
we've
done
to
support
that
is.
We've
set
out
some
guidance
on
how
we
want
to
work
going
forward
in
terms
of
when
will
people
will
be
coming
into
offices?
F
What
we've
said
is
we
don't
if
people
have
got
quiet,
work
to
do
or
meetings
are
best
conducted
over
teams
and
they
should
be
working
from
home,
they
should
and
if
they
do
come
in
it's
more
for
set
piece
meetings
like
like
the
board
or
our
executive
team
meetings
or
other
other
meetings,
and
I
think
it's
really
important
that
we
as
a
leadership
group,
set
an
example
and
don't
just
keep
saying
to
people.
F
F
That
down
is
the
policy
we
are
reviewing
our
estate
strategy,
we're
quite
clear
that
we
want
to
keep
the
two
key
offices
in
in
stratford
in
london
and
in
in
newcastle,
and
then
some
client
offices
that
we've
currently
got
and
we
are
keeping
we'll
be
monitoring
the
usage
of
those
over
the
next
few
few
years
to
see
how
how
our
estates
plan
is
working.
F
The
key
thing
we
want
to
do
is
put
some
metrics
in
around
how
we
are
to
continue
to
keep
a
view
of
whether
the
estate
is
the
right
size
and
structure
for
us
and
we'll
be
reporting
back
on
that
on
a
quarterly
basis
to
see
once
we
get
back
out
of
the
pandemic,
how
people
are
actually
using
that
estate
and
we'll
keep
it
under
review,
and
if
it
does
look
like
we've
got
a
live
master's
capacity,
then
we
will.
We
will
adjust
accordingly
or
vice
versa.
F
So
it's
I
think,
we've
got
a
good,
a
good
plan
and
now
we'll
just
see
how
it
pans
out.
Once
we
get
back
into
some
sort
of
traveling
and
use
of
use
of
this
state.
A
But
it
seems
to
me
kirsty.
The
whole
world
is
on
learning
our
new
model
of
working.
So
I
would
imagine
that
we
will
learn
from
the
general
experiences
tomorrow
and
adjust
over
the
next
year
or
two.
H
Yeah
this
blend
and
blending
that
we
will
learn
we'll
learn
from
others,
but
so
hear
from
our
people
as
to
what
was
for
them,
but
thanks
kirstie.
It's
encouraging
to
hear
thank
you.
A
Right
good
so,
chris
over
to
you.
I
Sir,
yes,
so
it
is
april's
performance,
so
obviously
quite
early
in
the
year.
So
just
a
few
headlines
for
me.
So
in
terms
of
registration
applications,
simple
applications
have
taken
28.4
days
to
process
complex
applications,
134.6
there's
a
close
focus
on
this
internally
present,
just
to
ensure
we've
seen
improvement
over
the
course
this
year.
This
is
already
showing
the
volume
of
application
the
system
is
coming
down
in
a
fatty.
I
I
I
It's
been
discussed
with
each
director
who
are
reviewing
reviewing
that
position
in
terms
of
regulatory
action,
something
we
continue
to
to
track
in
april,
2020,
right
up
to
the
10th
of
june
this
month,
52
of
locations
about
regulatory
activity
be
an
inspection
or
a
call
to
the
provider
and
in
regards
to
enforcement,
four
percent
of
asian
enforcement
was
between
three
days
in
terms
of
hr.
A
couple
of
metrics
there's
turnover
is,
it's
remained
stable
at
just
unders,
just
under
8
was
sickness
currently
at
3.19
with
regards
to
money.
I
At
the
end
of
april,
revenue
budget
was
underspent
by
1.1
million.
This
cross
pay
and
non-pin
reflects
the
combination
of
ongoing
reduced
travel
and
the
time
and
delivery
of
activity.
This
this
stage
we're
assuming
we
will
be
on
budget
for
the
year,
but
forecast
ban
being
established
and
on
a
capital
of
april
we
were
half
a
million.
I
understand
that
is
actually
due
to
time
of
activity
with
the
expectation
that
we'll
be
on
budget
for
the
year
and
they'll
be
fully
utilized.
A
Chris,
I
I
appreciate
you're
the
the
scorekeeper
in
one
regard,
not
not
a
not
a
batsman,
but
I'm
a
bit
concerned
about
the
the
safeguarding
whistleblowing
performance
where
we
have
missed
targets.
Can
you,
or,
or
or
chief
inspector
colleagues,
give
us
some
reassurance
on
this.
C
Like
I
started
is
that
all
right
chris,
so
so,
just
to
put
this
into
context,
the
numbers
of
safeguarding
referrals
that
came
in
in
april
were
small,
so
we're
talking
about
less
than
60
and
it's
a
handful
when
the
kpi
was
missed
and
each
one
of
those
cases
we
followed
up
and
we've
been
assured
that
appropriate
action
has
been
taken.
So
the
right
thing
has
happened
in
each
of
those
cases.
C
What
we're
now
doing
is
in
that
very
small
number
of
cases,
I'm
picking
why
we
weren't
able
to
hit
the
kpi
so
so
with
regard
to
safety,
the
numbers
are
small
and
action.
That's
being
taken.
Chris
talked
about
our
our
new
way
of
capturing
our
whistle
blowing.
So
so
previously
inspectors
were
in
the
routine
of
recording
an
action
at
the
end
of
an
outcome
at
the
end
of
investigation.
That
meant
that,
for
us,
it
was
sometimes
hard
to
have
whistle.
Blowings
were
being
dealt
with
in
that
kind
of
interval,
so
we
said.
C
C
What
they've
done
to
mitigate
their
risk
that
risk?
And
I
think
it's
something
where
we
just
need
to
do
a
bit
of
reinforcing
the
message
to
the
organization
so
that
we
can
get
inspectors
capturing
what
they
need
to
invite
up.
Our
new
our
new
environment
really
focus
more
on
outcomes
and
to
give
us
that
that
better
visibility
and
then
the
final
thing
is
the
delivery
coordination
group
that
ted
rosie
and
my
deputy
chief
inspector
sit
on
along
with
many
other.
C
You
know,
reps
from
other
parts
of
the
organization,
and
that
group,
along
with
the
safeguarding
committee,
are
kind
of
crawling
all
over
these
figures
on
a
kind
of
weekly
weekly
basis
as
well.
I
don't
tend
to
raise
if
I
captured
our
collective
position.
I
don't
know
whether
you
want
to
come
in.
D
J
A
A
K
Advisory
group-
that
is
a
group
that
is
an
important
forum
for
us.
It
brings
together
representatives
from
people,
use
services,
providers
and
wider
stakeholders
to
help
shape
some
of
our
collective
thinking
and
elements
of
our
strategic
development.
We
brought
three
issues
to
the
group
which
want
to
report
back
on
some
of
the
conversations
that
we
were
having.
The
first
was
our
update
on
the
development
of
our
approach
to
integrated
care
systems.
K
K
The
importance
of
ensuring
that
ics
is
themselves
and
that
our
oversight
of
them
just
doesn't
just
focus
on
health
provision
and
nhs
outcomes,
but
the
wider
health
and
care
and
the
the
importance
of
linking
social
penny
to
be
an
integral
part
of
our
assessment
of
an
ics.
K
K
Working
with
other
national
organizations
in
terms
of
the
oversight
of
local
authority
assurance
the
second
issue
that
we
brought
to
them,
there
was
a
issues
they
were
raising
around
needing
to
be
able
to
share
good
practice,
focus
on
how
services
were
performing,
but
also
sharing
good
practice
between
systems
and
areas.
K
Local
leaders,
providers
and
people
who
use
services
collectively
to
develop
a
joint
view
of
oversight,
and
I
think
that
was
both
true
of
ics's
and
local
authority
assurance
and
finally,
on
wider
regulation.
There
was
an
interest
in
how
ckc
divide
defines
quality
in
a
system
in
an
area
and
how
that
might
look
different
from
the
provider
level
assessment
that
we
make,
and
it
also
raised
some
ongoing
issues
around
whether
system
should
be
rated
and
what
it
would
mean
to
rate
a
system.
K
The
stakeholders
generally
welcomed
a
single
approach
to
our
our
processes
and
in
in
to
ensure
safe
care,
and
there
was
there
was
an
important
note
for
us
that,
in
our
future
model
focusing
on
mitigating
risk,
it's
important.
We
can
look
just
at
the
provision,
the
provider
risk
and
also
the
system
risk
in
an
area.
And
finally,
an
important
message
about
the
understanding
of
quality
and
risk
is
is
as
much
about
continuing
to
hear
the
voice
of
people
use,
services
and
continuing
to
cross
threshold
alongside
the
use
of
data
and
intelligence
information.
K
A
strong
support
for
it,
but
just
to
sort
of
to
reiterate
that
that
theme.
So,
to
sum
up,
there's
a
a
good,
strong
support
for
our
role
in
systems,
regulation
more
generally,
and
also
our
role,
maintaining
our
role
in
improvement
systems
and
the
messages
about
working
well
with
providers
and
public
groups
to
create
that
unified
view
of
quality
came
across
loud
and
clear.
That
was
it
for
me,
peter.
A
Thanks
chris,
it's
probably
quite
a
good
opportunity
just
to
to
thank
members
of
the
group
publicly
because
they
do
provide
a
really
useful
input
to
our
thinking.
Don't
they
so
we
should
thank
them.
K
They
do,
and
they
are,
they
are
all
very
busy
people
that
come
from
a
variety
of
backgrounds
across
health
care,
primary
care,
people
use
services
and
they
they
contribute
their
their
thinking
to
us
on
a
regular
basis.
Eastside
is
one
sort
of
visible
sign
of
it,
but
there
are
many
others
as
well,
so
you're,
absolutely
right
peter
they
are.
They
are
invaluable
in
help
shape,
helping
to
shape
our
our
thinking
around
the
strategy
and
also
how
we
respond
to
to
other
issues
that
are
out
there.
A
Are
we
happy
to
move
on
right
chris?
I
think
that
takes
us
on
to
to
the
green
plan,
and
I
know
you're
joined
by
by
tim,
ballard
and
and
max
hood
of
very
welcome.
But
chris
you
start.
I
Can't
you
peter
yeah,
so
this
update
provides
board
with
an
update
on
ckc
green
plan
and
the
main
actions
set
out
over
the
next
five
years.
The
plan
aims
to
direct
cqc's
activities
on
improving
our
environmental
sustainability
performance,
both
as
an
organization
in
our
own
right
and
as
a
regulator.
I
The
the
main
areas
of
focus
covered
are
changing,
how
we
work
smarter
working,
including
less
travel
and
incentivizing
sustainable
behaviors
having
a
smaller
estate
recycling
and
using
less
paper
better
use
of
technology
and
ensuring
we
procure
in
a
sustainable
way
and
to
support
the
wider
health
and
social
care
system.
The
plan
also
commits
to
us,
using
our
role
as
a
regulator,
to
encourage
and
promote
sustainability
and
providers
in
order
to
do
the
cqc
needs
to
be
leading
by
example,
and
this
plan
sets
us
out
on
that
journey.
I
It's
probably
worth
noting
in
quite
a
few
areas,
for
example,
travel
we're
aiming
to
establish
a
new
baseline,
given
the
highly
unusual
times
we've
just
experienced.
It's
probably
also
worth
saying.
The
plan
is
being
developed
by
max
hood,
who
is
on
the
call
and
sport
by
tim,
ballard
who's,
our
national
clinical
advisor
in
primary
medical
services
and
he's
been
working
on
the
regulation
side
of
the
plan.
We
also
have
mark
chambers,
who
is
the
board,
lead
on
sustainability?
I
A
Tim,
I
think
you
you,
you
first
bent
my
ear
on
this,
probably
three
or
four
years
ago.
So
sorry,
it's
taken
a
long
time,
but
we
are
now
we
are
now
properly
on
the
road.
I
think
steve
stephen.
You
want
to
come
in.
L
Great,
thank
you,
peter,
and,
and
thank
you
chris
and
colleagues
for
for
this
very
interesting
report.
Couple
of
questions.
If
I
could
the
nature
of
cqc's
business,
even
post
lockdown
means
that
the
you
know,
staff
inspectors
need
to
do
quite
a
lot
of
travel.
L
L
Do
you
see
this
only
in
terms
of
carbon
or
could
we
should
we
broaden
out
to
the
wider
set
of
sustainable
development
goals,
because
there's
a
lot
that
cqc
does
and
a
lot
that
you
could
say
that
actually
contributes
to
a
number
of
the
of
the
sdg
goals
going
way
beyond
carbon
zero
policies,
so
just
interested
to
understand
how
how
your
thinking
is
moving
in
those
areas?
Thanks
do
you
want
to
take
the
targets
first,
max.
M
Yes,
I
mean,
I
think,
you're,
it's
a
very
good
point
and
I
think
we
do
probably
need
to
broaden
that
beyond
beyond
carbon
in
terms
of
the
target
for
a
reduction
in
inspectors
travel,
I
think
part
of
it
is
just
changing
the
way
we
work,
but
you're
absolutely
right
inspectors
will
need
to
travel
and
what
we're
also
looking
at
is
trying
to
encourage
sort
of
greener
means
of
transport.
So
electric
vehicles,
those
sorts
of
things
through
our
through
our
expenses
and
other
other
processes,
is
zero.
M
We
haven't
set
it
as
a
target,
but
it
that
certainly
should
be
an
aspirational
target.
I
think,
but
it's
just
how
we
sort
of
like
other
organizations,
trade
off
one
impact
with
a
sort
of
reduction
or
or
an
activity
in
another
area,
but
I
think
I
think
that's
a
good
challenge
and
I
think
something
we
need
to
think
about.
M
N
And
just
to
add
to
that,
the
in
the
pms
directorate,
with
which
I'm
obviously
more
familiar,
we've
embarked
on
a
whole
series
of
equipping
inspectors
and
gp
special
advice,
specialist
advisors,
with
the
ability
to
be
able
to
carry
out
remote
assessments,
so
I've
been
involved
with
three
over
the
last
10
days
or
so,
and
it
allows
me
not
to
move
from
my
own
home
but
have
access
to
clinical
systems
in
the
same
way
as
a
if
I'd
driven,
100
miles
to
do
it.
N
So
so
I
think
that
will
be
part
of
the
pattern
as
we
go
for
what
it
won't
be.
The
only
way
that
we
do
it,
but
it
will
be
open
to
us
to
actually
deploy
in
relation
to
wider
goals
in
relation
to
our
regulatory
function.
I
agree
completely.
I
I
think
that
carbon
is
is
a
useful
metric,
but
it
only
goes
so
far.
I
think
that,
especially
as
with
the
new
strategy,
we
move
into
the
space
of
looking
at
how
whole
systems
actually
work
across
health
and
social
care.
N
L
Actually
we
have
a
really
really
powerful
contribution
we
can
make
to
many
of
the
core
sustainable
development
goals,
and-
and
so
actually
I
think
it's
it's
valuable
and
important-
that
we
kind
of
broaden
this
agenda,
because
it's
a
it's
an
important
and
positive
one
for
for
the
organization
and
in
the
run-up
to
sort
of
cop
26
in
november
that
there
should
be
lots
of
opportunity
to
sort
of
work
with
others
and
and
set
out
the
stall
in
terms
of
of
what
we're
doing
so,
I
think
there's
a
big
opportunity
here.
Peter
could
I.
N
Just
add
one
more
thing
to
that:
oh,
do
you
want
me
to
take
the
next
question
I'll?
Take
the
next
one,
it's
just
to
say
that
I
think
in
the
in
the
early
phase
of
how
we
respond
as
a
regulator
to
this
you'll
be
aware
that
the
climate
change
committee
published
a
report
only
in
the
last
10
days
or
so
where
they
describe
the
uk.
N
Why
do
societies
shockingly
unprepared
in
relation
to
adaptation
to
climate
change,
and
I
think
that
fits
in
very
much
well
fits
in
very
easily,
with
our
with
our
current
accepted
methodology
about
business
continuity
and
safe
environments
for
people?
But
again,
I
think
this
is
an
opportunity
for
us
to
take
that
wider
and
think
about
how
we
work
with
systems
to
keep
people
safe
in
their
own
homes
during
heat
waves,
so
that
it's
not
just
about
the
fabric
of
hospitals
and
care
homes.
D
Ted
yeah
thanks
peter,
just
a
big
thank
you
to
tim,
maxx
and
colleagues
for
all
the
work
they
put
into
this.
I
think
it
really
is
important,
and
this
is
just
where
kind
of
area
where
so
you
see
as
a
regulation
needs
to
show
leadership,
and
I
think
you
know
getting
our
own
house
in
order
is
clearly
an
important
part
of
that,
but
also
making
sure
that
we
see
sustainability
as
a
key
element
of
a
well
well-run
organization.
D
The
nhs
is
a
is
a
major
emitter
of
carbon
and
it
set
itself
a
net
zero
goal
by
2040,
and
I
think,
as
we
go
forward
and
look
at
the
well-led,
you
know
just
trusts
and
this
presumably
apply
to
other
providers
as
well.
We
need
to.
We
need
them
to
demonstrate
to
us
how
they're
contributing
to
that
and
how
they're
going
to
achieve
that.
So
so,
and
it
isn't
just
important
in
its
own
right.
It
is,
as
I
say,
another
element
to
show.
This
is
a
well-run
organization.
D
Long-Term
measures,
but
also,
as
you
said,
tim
the
effects
of
sustainability
on
improving
the
health
of
the
communities
they
serve
and
very
much
fits
with
our
health
inequalities
theme
in
our
strategy.
So
I
think
it's
really
a
very
important
initiative
and
I
I
do
think
we
need
to
build
it
strongly
into
our
well-lit
framework.
Yeah
thanks
very
much.
I
I.
A
I
totally
agree
tim
and
max
you're,
leading
by
example,
by
by
cycling
miles.
I
know
I
am
yes.
Thank
you
any
any
other
comments
about.
This
is
really
important,
but
but
a
really
good
report
to
get
us
on
the
way
sally.
J
J
But
if
you
look
at
primary
care,
for
example,
where
the
organizations
are
much
much
smaller
and
adult
social
care
as
well,
there
won't
be
an
infrastructure
in
place
to
help
those
organizations.
Will
there
deliver
their
bit
of
sustainability?
So
I
don't
have
an
answer
for
now.
I
think
it's
just
a
thought
about
whether
we
max
and
tim
and
the
team
do
a
bit
of
differentiated
work,
because
you
know
in
trust
there's
already.
N
Yeah
thanks
so
so,
just
to
the
border
are
aware.
We've
we've
done
some
collaborative
work
with
the
greener
practice
programme,
where
the
lead
for
that
is
one
of
the
ex-presidents
of
the
rcgb
terry
kemple,
and
we're
working
with
them
in
the
pms
directorate
to
try
and
understand
what
the
opportunities
are
there
and
to
actually
develop
our
approach
across
all
of
our
directorates.
N
N
A
Good
so
board
we're
we're
asked
to
both
note
the
report,
but
in
in
in
sorry
I
can't
speak
endorse
the
action.
That's
already
underway,
I'll,
be
happy
to
to
endorse
the
action
yep
good
so
max
and
tim
and
colleagues.
Thank
you
very
much
again
for
all
you're
doing
and
no
doubt
you
will
be
back
at
the
board
periodically
to.
I
sincerely
hope.
Thank
you.
A
Thank
you
very
much
great
thanks
a
lot
good.
So
chris
stay
now
insight.
K
Great
thank
you.
Thank
you
peter,
so
for
this
insight
report.
The
the
penultimate
report
in
its
current
form,
there's
an
opportunity
to
look
ahead
to
the
full
length
of
the
learn.
Disability
report
should
be
out
next
month.
We
wanted
to
share
some
of
the
early
thinking,
focusing
on
the
support
for
people
with
learning
disabilities,
alongside
our
regular
update
on
data.
K
We've
also
know
that
there
is
good
care
and
good
practice
out
there
provided
clubs.
Reviews
have
aimed
to
show
the
best
of
innovation
across
the
system
alongside
some
of
the
areas
that
we
no
need
to
change.
What
we've
that
the
latest
review
has
sought
to
find
out
a
bit
a
bit
more
about
people
with
disabilities
who
live
in
the
community
and
what
impact
covid
the
kobe
pandemic
has
had
on
them
and
their
services
they
receive,
and
to
do
that,
we
looked
at
whether
people
who
would
learn.
K
It
includes
how
organizations
collaborate
to
keep
people
safe,
and
we
also
look
at
the
the
impact
of
the
pandemic
on
people
living
independently
in
the
community
and
also
how
we
provide
how
the
providers
balance
the
needs
of
staff
to
keep
them
safe
and
continue
to
provide
the
right
support
for
people
and
and
finally,
how
digital
technology
is
supporting
and
preventing
services
from
being
able
to
well
so
enabling
people
to
provide
the
right
care
at
the
right
time.
So
what
do
we
know
so
far?
K
I
think
it's
fair
to
say
that
the
pandemic
has
shown
a
light
on
the
pre-existing
challenges
and
the
gaps
and
the
poor
quality
in
poor
quality
care.
There
have
been,
and
continue
to
be,
some
clear
signals
that
there
is
no.
There
should
be
no
one-size-fits-all
care
for
people
with
a
learning
disability,
because
by
nature
the
services
should
be
tailored
to
the
individual.
O
K
Enabling
and
support
can
really
make
a
difference
to
the
way
care
is
provided
so
giving
people
a
choice
of
control
to
be
independent.
This
includes
support
them
to
live.
K
But
also
being
cared
for
close
to
family
and
friends,
access
to
the
right
care
sport
at
the
right
time,
including
access
to
the
right
health
care
and
also
how
to
deal
with
emergencies
and
crises,
and,
crucially,
collaboration
between
services
with
a
person
and
their
and
their
families.
So
the
appropriate
sharing
of
information
between
different
agencies,
their
likes,
their
dislikes
their
interests.
Their
preferences
can
help
build
a
service
that
helps
keep
people
living
well
in
the
community.
K
Don't
always
join
up
to
deliver
the
right
care
for
for
for
people,
and
the
full
report
will
look
at
some
of
the
the
real
areas
of
concern
that
we
have
around
some
of
the
models
that
still
it's
also
clear
that
the
pandemic
has
introduced
some
new
challenges,
for
example,
how,
during
lockdown
and
social
distancing,
has
affect
the
ability
of
people
to
access
services,
including
gps,
dentists,
daycare
and
rest
by
care,
and
how
people
have
continued
to
be
supported,
what
the
impact
has
been
on
their
health
and
well-being.
K
During
this
time
there's
been,
we
know,
there's
been
a
sudden
shift
in
technology.
Just
talked
about
it
in
terms
of
the
the
the
previous
paper,
but
that
that
shift
in
technology
can
itself
have
a
have
a
negative
impact
on
on
some
people
with
a
learning
disability.
So
we're
looking
more
at
that.
K
This
report
isn't
just
about
what
others
need
to
do
and
change
is
also
about
what
we,
as
an
organization,
need
to
do
and
the
from
our
perspective,
registering
services
in
the
right
way
to
make
sure
that
they
can.
They
are
services
that
will
deliver
support
for
people,
supporting
providers
to
improve
and
influencing,
and
the
improvements
in
the
care
pathway
and
ensuring
that
commissioners
take
the
right
action.
These
are
all
things
that
we've
talked
about
and
we're
all
all
things
that
we're
we're
doing
as
a
part
of
this.
K
As
I
said,
the
full
report
will
be
out
in
the
july
board,
but
we
wanted
to
give
this
opportunity
just
to
cite
some
of
the
good
practice
and
also
some
of
the
developing
our
developing
themes
before
the
main
report
is
out.
Rosie.
Then,
if
you
wanted
to
say
anything
more
about
that.
E
Just
to
say
thank
you
to
the
teams
that
have
been
involved
in
this
piece
of
work.
It
has
been
a
fantastic
piece
of
work
and
what
we've
tried
to
do
is
really
look
from
the
the
person
using
services,
viewpoint
and
you'll
see
in
the
report.
E
As
it
comes
out,
we've
we've
based
all
the
themes
on
what
we've
actually
we've
been
following
people's
stories
through
different
parts
of
the
system,
and
that
will
that
will
shine
through
in
the
report
and
and
the
experiences
that
they've
had,
and
that
leads
on
to
the
themes
as
presented
here.
So
looking
forward
to
bringing
back
that
report
in
july
to
you.
K
And
just
to
say
that
alongside
that
report
will
also
be
a
further
update
on
our
cancer
pcr
and
also
an
update
on
the
information
around
death
in
adult
social
care.
So
all
that
will
come
through
to
the
the
july
july
board
happy
to
take
any
questions
or
comments.
Peter.
A
Thank
you
chris
and
and
rosie
as
well
questions
or
comments.
Colleagues.
A
A
So,
chris,
I
think
it's
a
another
really
good
and
very
insightful
if
you're,
apart
from
the
plan,
a
very
insightful
report,
so
grateful
to
you,
but
I
I
know
a
lot
of
work
goes
in
behind
the
scenes
term
to
actually
pull
these
reports
together.
So
thanks
to
a
rather
wider
group
as
well,
I
think.
K
Great,
it's
a
very
good
cross
team.
I
think
I
think
you
might
be
on
the
call,
but
there's
a
crossteam
effort
that
goes
into
making
these
things
possible.
So
it's
a
really
yeah.
It's
a
good
example
of
collaboration
across
across
the
organization.
Thank
you.
Rosie.
E
Just
to
add,
more
generally
about
the
provider
collaboration
review
work
because
there's
been
a
huge
amount
of
learning.
That's
come
out
of
these
provider
collaboration
reviews
and
we're
now
working
with
the
team
to
say.
Actually
how
do
we
get
these
messages
out
so
that
they
can
have
the
maximum
impact?
I
would
encourage
anyone
working
in
systems
to
read
these
reports
and
we
will
be
putting
out
I'm
keen
to
explore
how
we
get
some
of
that
that
learning
further
into
systems
so
that
we
can
really
enable
the
learning
from
this
to
to
deliver
change.
K
A
really
good
point,
rosie
that
we've
been
already
been
talking
to
nhs
providers
nhse
and
the
groups
that
support
local
authorities
around
how
we
can
position
the
messages.
Well,
we're
going
to
have
further
conversations
with
other
colleagues
as
part
of
that
esac
group
that
I
spoke
of
earlier.
K
So
we
can
make
sure
that
messages
don't
just
come
out
today
at
a
particular
time,
but
their
ongoing
conversations
about
how
they're
integrated
into
the
support
one
of
the
things
that
the
the
esa
group
talked
about
was
how
useful
the
the
conversations
were
around
these
reports
to
help
stimulate
debate
locally,
and
hopefully
that
will
do
we'll.
Do
this
exactly
the
same
with
the
next
two
pcrs
on
learn:
disabilities
in
cancer.
J
Thank
you
peter,
and
to
chris
and
your
team
for
their
report.
I
find
these
really
helpful,
read
to
try
and
give
us
a
sense
of
what's
actually
going
on
in
settings
where
people
receive
care,
and
I
suppose
I
just
wanted
to
say-
we've
had
a
bit
of
a
debate,
haven't
we
about
our
role
in
tackling
inequalities,
a
cqc
and
the
fact
that
we
can't
really
do
it
on
our
own.
But
I
think
this
is
a
really
good
example
of
highlighting,
particularly
for
people
who
are
vulnerable
or
where
there
are
any
qualities.
J
The
data
that
we
have
that
can
be
used
by
the
wider
system
to
complement
both
the
work
that
we're
doing
that
we
heard
about
before
from
debbie
and
mary
on
supporting
people
with
a
learning
disability
or
who
were
autistic,
but
it
it.
Whilst
we
can't
tackle
any
qualities,
I
think
it's
a
really
good
pointer
for
the
people
to
use.
So
thank
you.
K
A
Good,
so
I'm
going
to
suggest
because
we're
running
slightly
ahead
of
time
that
to
give
inaudible
a
chance
to
to
to
get
here
sally
if
you're
happy,
oh
right,
okay,
in
that
case,
we
we
will
stick
to
the
order
of
the
agenda.
I
I
am
elder
you're
very
welcome.
You
didn't
pop
up
on
my
screen,
so
I
didn't
know
you
were
here,
but
you're
extremely
welcome
and
robert's
extremely
relieved
you're
here
so.
M
Not
wishing,
of
course,
to
steal
imelda's
thunder,
but
you
you
have
our
report
and
I'd
just
like
to
highlight
four
things
very
briefly:
one
is
to
pay
tribute
to
imelda
and
her
team
for
the
amazing
work
they've
done
about
the
impact
of
kovid
in
various
ways
during
the
last
year
in
collecting
people's
experiences,
and
not
only
just
doing
that,
but
actually
transforming
that
into
responsive
action
in
relevant
courses,
and
I
think
that
shows
the
real
value
of
health
work.
M
M
We've
been
continuing
to
have
very
constructive
conversations
with
the
department
of
nhs
england
about
about
that,
and
I
think
in
general
there's
it's
accepted
that
healthwatch
is
at
least
a
if
not
the
principal
vehicle
through
which
ics
should
receive
and
communicate
to
people
who
use
services
about
their
needs
and
be
responsive
to
them,
because
it's
not
the
only
channel,
but
it
is
clearly
a
very
valuable
one,
but
obviously
to
do
that.
We
need
resources
to
do
it,
and
that
is
a
matter
that's
still
under
understandably
under
discussion.
M
Which
brings
me
to
the
third
point,
which
is
about
the
level
of
support
available
to
local
health
watch
and
as
you'll
see.
We
continue
to
have
concerns
about
this
and
we
don't
actually
see
this
improving
very
much
in
the
near
future,
but
in
a
world
in
which
not
only
our
strategy,
but
it
would
seem.
The
nhs
strategy
is
to
be
listening
to
those
whom
the
service
served
in
relation
to
their
needs
and
being
responsive.
M
To
that
we
we
do
think
that
to
make
that
real,
there
has
to
be
proper
support
given
to
local
health
watch,
and
we
will
be
keeping
our
eye
on
that.
M
Finally,
I
draw
attention
to
work
that
I
think
see,
if
I
must
say,
cqc
generally
can
benefit
from
which
is
our
report
that
recently
produced
on
the
attitude
towards
vaccines
among
certain
minority
communities
or
not
so
much
their
attitude,
but
also
the
way
in
which
communications
about
that
is
are
received,
and
I
think
there
are
lessons
to
be
learned
on
a
rather
wider
field
in
relation
to
how
we
gather
and
respond
to
people's
experiences
and
not
make
assumptions
that,
just
because
an
announcement
is
made
whether
by
us
or
government
or
a
health
service,
that
it
will
be
received
in
the
way
that
it's
intended
and
that
actually
people
like
making
decisions
for
themselves
and
they
like
getting
the
information
upon
which
the
recommendations
are
made
and
in
particular
that
they
like
getting
that
information
and
advice
from
people
they
know
and
trust
and
the
nearer
to
them.
M
Those
people
are
the
more
likely
they
are
to
trust
them,
and
trust
is
really
what
makes
healthcare
healthcare
generally
work.
So
I
would
commend
that
report
because
I
think
it's
not
only
about
fits
in
very
well
with
us
new
strategy
in
relation
to
listening
to
people,
but
I
also
think
it's
a
very
valuable
tool
in
relation
to
furthering
the
inequalities
of
gender
that
we,
we
quite
rightly
focus
on.
So
that's
all
I
want
to
say-
and
I
will
obviously
leave
about
to
tell
you
more
in
her
own
words
about
the
detail.
E
Sorry,
I
can
wait
for
melda.
I
just
wanted
to
say
thank
you
to
the
healthwatch
team,
because
I
think
the
collaborative
work
on
a
whole
range
of
areas
with
dna
cpr
with
gp
access
with
dentistry
in
pms,
has
been
absolutely
brilliant
over
the
last
few
months.
So
I
just
wanted
to
say
thank
you
to
robert
imelda
and
the
team
for
all
their
joint
work
with
us.
J
J
The
first
thing,
I
should
say
is
apologies
for
the
length
of
the
reporter.
This
was
written
for
our
committee
last
week
and
I'm
afraid
I
just
didn't
have
time
to
to
squash
out
the
stuff
that
you
don't
need
to
hear
from
us,
but
but
I'm
sure
you
could
skim
over
it
or
or
ignore
it.
J
I
just
there
are
a
few
things
I
wanted
to
pull
out
and
I
will
go
back
to
the
piece
that
robert
talked
about,
which
was
the
research
that
we
did
on
vaccination
hesitancy
and
it
was
amongst
particularly
the
african,
bengali,
caribbean
and
pakistani
people
very
concentrated,
purposefully,
just
picking
those
groups
because
they're
the
groups
that
were
further
away
from
vaccination,
but
the
learning
from
it
as
robert
says,
is
much
greater
than
just
for
the
vaccination
program
and
and
and
was
really
very
useful.
J
Just
this
morning,
when
we
were
having
conversations
with
nhsx
about
their
new
data
strategy
and
getting
public
buy-in
and
getting
the
public
to
understand
it,
and
one
of
the
first
learning
things
from
it
is
that
people
do
not
want
us
to
skate
over
ambiguity.
J
They
don't
want
us
to
pretend
it's
okay
and
I
think
there's
been
too
much
of
that.
You
know.
We
know
trust
us
just
get
behind
us
because
we're
politicians-
or
you
know,
and
the
public
just
saying.
No,
we
don't
want
that.
We
want
the
ambiguity
to
be
raised
so
that
we
make
our
own
decisions.
J
We
want
to
see
the
evidence
that
you
make
your
decisions
on,
so
we
want
the
link
to
the
papers
that
you're
saying
that
that
you
have
made
your
decisions
on
and
even
if
we
don't
read
them,
we
want
to
know
that
we
could
access
them
if
we
want
to
so
so.
What
the
public
are
asking
for
is
much
greater
depth
of
exposure
to
ideas
and
information.
J
The
the
other
thing
I
just
want
to
highlight
quickly
is
the
because
we
all
care
campaign
which
we've
run
together
with
you,
and
I
think
that
has
been
really
interesting
piece
of
work.
I
I
think,
as
I
understand
it,
about
54
000
people
have
shared
their
their
information
with
us.
J
A
great
source
of
data
we've
been
using
it
to
help
with
our
ins,
our
regular
insights
that
we
do
to
you
know,
what's
happening
with
people
during
covid,
so
we're
able
to
do
a
sort
of
real
highlight
on
what's
happening
with
carers
and
so
on,
and
that
data
will
continue
to
be
really
useful.
So
thank
you
for
that,
and
I
see
chris
has
got
his
hand
up
so.
K
It
was
only
to
say
I
was
another.
Thank
you
really
to
say
that
I
think
that
that
came.
The
success
of
that
campaign
was
was
more
so
because
of
the
partnership
that
we
had,
and
I
think
that
that's
just
one
of
the
examples
of
how
we've
collaborated
this
year,
to
which
has
been
a
very
important
at
a
time
when
the
pandemic
has
thrown
many
other
things
off.
I
think
the
ability
to
reach
to
reach
out
to
people
who
use
services
collectively
has
had
a
real
impact
in
our
ability.
K
J
Now
I
I
I
would
agree
it's
been.
It's
been
incredibly
useful
insight
that,
during
a
pandemic,
when
we're
not
out
meeting
people
like
we
would
do
enough,
you
know
other
circumstances.
It's
it's
been
fantastic.
Just
briefly,
also
on
hospital
discharge,
you'll
remember
a
couple
of
months
ago
we
did
an
in-depth
piece
of
work
with
people
who
had
been
on
the
receiving
end
of
the
rapid
hospital
discharge.
J
You
know
the
discharge
to
assess
process
and-
and
we
did
it
both
from
the
the
perspective
of
people
who
were
out
of
hospital
quickly,
the
perspective
of
their
families
or
their
carers
and
the
perspective
of
the
the
workers,
the
staff
who
were
making
those
decisions,
either
social
workers
or
people
working
in
the
community,
and
that
that
that
gave
us
quite
lots
of
information
that
we
were
able
to
feed
into
nhs
england
and
help
them
with
their
discharge
policies.
J
We
continue
to
work
on
them,
because
what
we've
identified
is
there
are
still
a
large
group
of
people
who
are
falling
through
the
net,
who
are
identified
as
not
needing
any
support
when
they
leave
hospital,
but
actually
they're
pretty
frail,
and
that
quick,
rapid
turnaround
of
a
few
hours
is
not
always
helping
them.
So
that
work
continues
to
see
about
how
we
put
a
safety
net
in
which
is
not
very
costly
to
do,
but
just
as
a
follow-up,
so
that
people
feel
that
they
they
are
better
supported
as
they
leave.
J
As
robert
said,
we
are
we're
really
looking
for
how
we
respond
to
the
the
establishment
of
ics's
on
a
statutory
footing
and
what
we
we
understand
very
clearly.
What
health
role
watch
role
should
be?
J
What
we're
looking
for
now
is
is
how
do
we
get
the
resources
to
make
sure
that
we
have
that
infrastructure
to
provide
that
insight
at
an
ics
level
and
at
a
very
local
level
at
the
moment,
we're
very
strong
at
a
local
level
and
at
a
national
level,
but
it
leaves
that
that
gap
where
I
think
we
can
do
a
really
good
job.
On
that.
J
The
we're
doing
we've
done
quite
a
lot
of
work
on
on
nhs,
one
one
one
first,
so
rather
than
people
going
to
a
e
using
1-1-1
and
trying
to
make
appointments
and
trying
to
make
sure
they're
diverted
to
the
right
place
and
we'll
continue
to
to
monitor
that
and
because
I
think
I
think
it
isn't
in
the
public's
mind.
Yet
there's
a
lot
of
work
to
be
done
before
people
understand
that
that
there
is
a
better
approach
to
to
accessing
a
e.
J
Now
our
work
on
dentistry,
which
we
shared
with
you
all
along,
I
think,
has
really
resonated
with
the
public
and
has
had
a
huge
amount
of
coverage
in
the
press
and
we're
now
talking
properly
to
the
parts
of
nhs,
england
and
the
department
of
health
that
are
responsible
for
dentistry
problems.
J
We
also
did
published
a
report
which
was
on
access
to
gps
and
to
primary
care
services
through
gp
surgeries,
and
that
was
based
on
the
experience
of
over
200
000
people
and
you'll.
You,
you
all
know,
and
have
rehearsed
the
difficulties
that
there
are
for
for
our
current
primary
care
services
to
respond
to
the
demand,
that's
out
there,
and
we
hope.
J
We
hope
that
the
piece
of
work
that
we've
done
will
help
add
to
the
to
the
knowledge
so
that
we
get
change,
that's
needed
both
for
for
primary
care
and
for
the
public
trying
to
access
it.
J
We've
really
worked
hard
over
the
last
quarter
on
our
parliamentary
engagement
as
well
and
to
have
and
have
had
some
success
there
and
and
far
more
than
we
would
have
done
in
the
past,
and
I
suppose
finally,
I
just
want
to
because
it's
a
sort
of
a
newer
thing
for
us:
we're
also
working
hard
on
building
our
academic
partners
and
and
so
far
we've
been
doing
some
work
with
the
lse
with
sheffield
university,
northumberland
and
king's
college.
So
we're
beginning
to
build
that.
J
I
think
it's
a
crucial
part
of
our
of
our
strategy
that
we
are
also
anchored
into
good
and
relevant
academic
institutions.
So
I
think
I'll
leave
it
there
and
I'm
more
than
happy
to
take
questions
or
comments.
A
So
just
a
comment
from
me,
imelda
and
just
to
say
I
I
this
is
just
fantastic
and
one
of
the
problems
that
we
have
not
just
in
healthcare
but
but
in
society
generally,
is
you.
You
have
lots
of
anecdotal
information
which
is
usually
based
on
one
or
two
people's
prejudices,
and
what
you're
doing
in
healthwatch
is
actually
getting
really
quite
a
substantial
number.
C
A
Of
those
anecdotes,
so
200
000
was
one
you
mentioned
in
relation
to
access
to
primary
care.
So
that
goes
beyond
that's
the
odd
person
and
I
think
it's
really
it's
really
it.
It's
really
a
weighty
evidence,
I'm
really
valuable.
So
just
to
say
thank
you
for
that
and
to
encourage
more
mark.
H
Saxton
thanks
chairman
and
imalda,
just
to
echo
the
chairman's
thanks
to
you
because
don't
apologize
for
the
length
of
this
report,
it's
a
fantastic
read.
So
thanks
for
supplying
it,
what
I
really
love
about
your
report,
is
you
really
focus
on
needs?
H
So
you
know
great
work
of
around
gp
access,
great
work
around
dentistry
nhs,
111
first
and
your
inequalities
study
and
your
vaccine
study
and
what
I?
Secondly,
what
I
really
like
about
the
report
is
your
profile
buildings,
so
you
are
getting
two
influencers
and
decision
makers,
and
so
they
can
hear
what's
happening
on
the
front
line
and
your
brand
development
work
is
is
great.
H
But
can
I
just
ask
one
question
please
around
dealing
with
the
backlog
of
care,
I
wondered
if
you're
going
to
do
some
specific
research
on
this
on
people's
experiences
of
of
treatment
delays
and
the
the
running
down
of
the
waiting
lists
that
exist
post
this
pandemic.
J
Yes,
mark
we
we
are,
we
are
beginning
to
hear
more
than
we
were
in
the
during
the
the
height
of
the
pandemic.
We
weren't
hearing
much
from
people
who
were
having
delays.
J
And
have
been
now
for
for
several
months,
we're
working
with
nhs
england
on
feeding
that
insight
in
so
rather
than
doing
it
sometimes
sometimes
it's
better
just
to
do
the
insight
and
hand
it
over
and
work
with
people,
rather
than
do
a
more
public-facing
piece
of
work,
because
you
don't
particularly
want
to
stir
up
lots
of
anger
and
anxiety
amongst
the
public.
J
So
we're
feeding
that
insight
in
regularly
into
the
work
which
is
about
the
return
to
elective
care
and
the
return
to
other
care
and
I'll
I'll,
have
a
look
and
see
whether
there's
more.
We
should
do
on
that.
Actually,
because
we've
been
doing
it
gradually
for
a
few
months
now
so
I'll
go
back
and
have
a
look
at
that.
Actually.
J
Thanks
imelda
and
to
robert,
I
love
all
my
cqc
board
papers.
Obviously,
but
this
was
one
of
the
highlights
for
me
this
month.
I
just
really
love
reading
about
all
the
excellent
work
you've
done.
So
thank
you.
J
Just
had
two
or
three
separate
things
that
I
wanted
to
ask:
if
that's
okay,
one,
I'm
quite
interested
in
the
fact
that
you've
been
able
to
make
better
use
of
both
traditional
media
and
social
media,
and
I
just
wondered
how
that
fitted
with
you
know
hard
to
reach
groups
or
vulnerable
groups
and
whether
there's
any
tension
in
getting
people's
opinions.
I
guess
that's!
That's
the
first
thing.
J
Secondly,
you
have
talked
about
threats
to
your
funding
or
potentially
difficult
tenders
on
the
horizon,
and
I
just
wondered
whether
you
could
comment
on
that
and
link
to
that.
Robert
might
have
something
to
say
anyway,
but
you've
been
really
complimentary
about
the
partnership
with
cqc,
which
is
really
nice
to
hear,
but
I
wonder
whether
there's
anything
else
that
we
could
help
you
with.
J
Thank
you,
the
media,
the
media.
One
is
quite
interesting
because
I
think
we've
had
a
low
media
profile
for
too
long
and
and
this
year
we've
invested
more
in
in
having
the
right
staff
in
place,
and
I
think
we're
also
much
better
at
focusing
on
impact
and
outcomes
than
we
were
and
and
so,
if
you,
if
you
get
that
right
and
and
for
us
it
means
getting
151
organizations
also
doing
the
same
drum
beat
and
sending
things
in
a
way
that
makes
it
into
an
interesting
thing.
J
So
we
have
a
story
to
tell
much
more
than
we
used
to.
I
think,
and
that
story
then,
is
newsworthy,
so
so
that's
part
of
it
and
and
our
social
media
profile,
I
think,
is
based
around
that,
because
we've
got
interesting
things
to
ask
people
and
tell
people.
So
that's
that's
going
up.
The
other
thing
we
did
was
massively
increase
the
information
to
the
public
over
recent
years
and
that's
really
paying
dividends.
J
You
know
we
weren't,
particularly
an
information
provider.
We've
moved
into
being.
It
is
within
our
within
our
statutory
remit
to
provide
information,
but
it
had
been
interpreted
in
the
early
days
as
a
sign
posting
role,
and
actually
we
provide
information
now
to
the
public
a
lot,
and
that
brings
people
to
you
you,
it's
not
you're,
not
just
asking
them
for
something
you're,
giving
them
something,
and
that
then
develops
relationships.
J
We're
we're
look.
We
are
thinking
long
and
hard
about
how
we
target
that
media
that
work
on
people's,
whose
voices
are
not
heard,
and
so
we
are
working
really
hard
at
the
moment
on
designing
a
campaign
that
will
happen
in
quarter
four.
That
will
be
about
really
targeting
people
whose
voices
do
not
do
not
come
through.
It's
going
to
be
it's
hard
and
you
get
lower
numbers.
J
So
what
we're
looking
at
is
trying
to
get
that
balance
of
the
big
numbers
on
the
big
generic
stuff
and
smaller
numbers
on
stuff,
where
we
want
deeper
insight.
So
the
vaccination
report
was
only
around
90
people,
but
it
was
in
depth.
We
spent
more
time
doing
that
work
so
so
we're
in
the
beginning
of
that
journey.
I'd
say
of
really
targeting
our
messaging
and
our
media
work
to
to
people
who
are
further
away
from
being
heard,
and
it's
a
it's
going
to
be
a
journey
this
year.
J
I
think
because
I
don't
think
it's
good
enough
yet
and
to
do
that.
There's
masses
of
change
management
that
has
to
happen
behind
seeds
and
we
have
to
do
a
whole
digital,
new
digital
approach
to
it
we
have
to
have
a
whole
new
taxonomy.
We
have
to
get
151
organizations
buying
into
all
of
that.
So
there's
a
big
there's,
a
big
drive
that
goes
behind
trying
to
do
that
that
right,
it's
it's
hard
and
complex,
but
but
it
is
our
plan
to
do
it.
J
Yes
and
threats
to
funding.
Yes,
it's
a
continuous
worry.
I
mean
it's
our
biggest
risk.
Without
a
doubt,
our
funding
funding
for
the
healthwatch
at
a
local
level
comes
through
local
government.
Local
government,
as
we
all
know,
is
squeezed
beyond
belief.
You
know
the
the
adas
talking
about
how
difficult
it
is,
I
think,
there's
only
four
percent.
J
In
their
recent
survey,
four
percent
of
local
authorities
thought
that
they'd
be
able
to
meet
their
statutory
duties
and
when
local
authorities
are
under
that
level
of
pressure,
they
look
to
see
where
they
can
squeeze
it,
so
even
where
they
have
really
high
performing
health
watch
and
they
really
value
them.
J
Cuts
are
still
coming
so
we're
doing
all
that
we
can
to
mitigate
that
in
terms
of
we've
got
a
big
program
of
work
with
commissioners.
We've
got
a
quality
framework,
a
quality
framework
to
commission,
so
that
we
so
that
we
really
understand
what
high
quality
health
watch
is.
We're
also
talking
to
the
department
of
health
we've
just
written
our
annual
letter
to
the
secretary
of
state,
saying
you
know
this,
you
have
this.
You
have
this
statutory
responsibility
to
deliver
this.
This
is
what's
happening
on
you
know
in
your
patch.
J
Yes,
it
might
be
happening
through
the
department
with
the
ministry
for
housing,
communities
and
local
government,
but
nevertheless
the
statutory
responsibilities
remain
with
the
department
of
health
and
social
care.
So
we're
asking
for
a
meeting
about
that
and
we're
also
asking
for
more
work
to
be
done
across
government
to
to
sort
it.
It's
really
complex,
because
the
funding
isn't
ring
fenced
into
local
government
and
government
policy
is
not
to
ring
fence
and
it
hasn't.
You
know
that
that
has
been
government
policy
for
a
very
long
time.
M
Yeah,
could
I
just
echo
that
in
a
certain
report,
because
he's
now
over
10
more
10
years
ago,
nearly
I
made-
I
expressed
this
concern
and
I
think
we
will
have
this
concern
as
long
as
financing
of
local
health
watch
goes
through
this
circuitous
and
not
hugely
transparent
route,
and
it's
something
the
national
audit
office
has
commented
on,
but
that
we
we
have
to
deal
with
life
as
it
is
on
the
sally's
partnership.
M
Point
we've
come
a
long
way
over
a
few
years
in
improving
the
working
partnership
between
cqc
and
healthwatch
and
clearly,
there's
always
more.
M
We
can
do,
but
I
think
we
there
isn't
that
we
now
have
a
much
better
way
of
working
as
a
small
and
independent,
mostly
semi-independent
organization,
within
a
bigger
one,
because
the
needs
are
quite
different
and
there
have
been
times
in
the
past
where
there's
been
frustration
about
procurement,
for
instance,
which
is
designed
for
a
huge,
complex
organization
being
applied
to
a
tiny
one
which
has
wants
to
make
quick
decisions
but
happy,
and
I'm
very
happy
to
pay
tribute
to
chris
ashraf
about
this.
M
I
think
there
is
much
more
in
terms
of
potential
that
we
can
do
and
I
think
we've
been
beginning
to
demonstrate
this
both
and
chris
day's
efforts
as
well
in,
firstly,
the
use
of
healthwatch
information
by
cqc,
and
you,
I
think,
we're
seeing
much
more
of
that
and
also,
I
think,
the
other
way,
actually
the
the
ability
of
cqc
to
reach
out
to
healthwatch
a
bit
and
maybe
there's
an
exchange
of
information
and
work
that
we
could
have
more
of,
and
I
mean
there
are
all
sorts
of
things
one
one
could
talk
about,
but
I
think
we
now
because
the
conversations
we
have
we
are
much
more
likely
to
be
working
in
the
same
direction.
M
Our
strategies
are
pretty
well
aligned
and
obviously
we
will
both
share
a
focus
in
relation
to
health
inequalities,
albeit
approaching
them
perhaps
from
a
slightly
different
angle,
but
I
think
actually
we're
on
continuing
on
on
the
right
path.
With
regards
to
that
and
equally
we
don't
want
to
get
so
close.
We
are
the
same
because
actually
we
are
doing
different
things
and
healthwatch.
M
The
value
of
healthwatch
is
that
it's
unique
in
being
statutory,
funded,
but
also
independent
and
long
may
that
last.
A
Any
any
other
comments
from,
or
questions
from
anybody,
so
just
again,
amelda
and
robert
personally,
I
think
it's
a
great
report.
I
think
you've
heard
from
a
large
number
of
board
members
that
have
have
echoed
that,
so
I
think
our
collective
thanks
to
you
both
and
and
imelda
to
your
your
team
and
the
the
wider
health
watchers
around
the
country.
So
thank
you
very
much
indeed.
Thank.
J
A
P
Hi
yeah,
it
is
for
you
imelda.
I
just
wanted
to
ask
about
your
campaign
design
going
forward
if
you
had
plans
within
that
to
kind
of
put
the
spotlight
on
inequalities
as
a
result
of
socio-economic
factors
and
also
digital
poverty,
because
with
reference
to
some
of
the
progress
we've
seen
on
vaccination
in
minority
communities,
I
think
we
may
have
some
answers
in
in
this
area
as
well.
P
With
regards
to
some
of
the
pushback
that
we're
having
among
the
social
care
workforce,
who,
I
think,
make
up
quite
a
bit
of
this
area.
J
You
raise
a
really
good
point
blessing.
We
we've
just
launched
last
week
a
piece
of
work
on
on
the
the
move
to
the
digitalisation
of
health
and
social
care,
and
we've
been
working
with
an
organization.
I
think
it's
going
to
be
an
ongoing
piece
of
work.
So
we've
done
with
you
know:
we've
we've.
We
we
did
a
shorter
piece
of
work,
which
was
called
the
doctor
will
zoom
you
now,
which
is
about
people's
experience
of
using
digital.
J
I
think
the
next
piece
of
work
is
really
very
much
about
who's
it
who's
in
and
who's
who's
out,
and
so
we've
been
working
with
the
I
don't
know
if
you've
come
across
the
good
things
primarily
around
people
from
poorer
communities
accessing
the
digital
world,
because
it
is
a
quite
you
know,
it's
quite
quite
privileged
people
have
access
to
the
internet
in
their
house
to
laptops
to
smartphones
and-
and
I
think
it
isn't
so
we
so
often
in
health
people
will
talk
about
digital
work
is
not
very
good.
J
For
I
don't
know,
people
who
who
have
autism
or
learning
disabilities
or
or
elderly,
but
actually
that
socio-economic
exclusion
is
massive
as
well
and-
and
I
think
we've
got
to
really
work
hard
to
make
sure
that
those
people
are
not
left
behind.
I
think
you
raise
an
excellent
point.
We'll
continue
that
work
on
it.
We'll
talk
to
you
about
it,
as
we
do
good.
A
Now,
I
really
don't
think
anybody
else
has
got
their
hand
up
so
once
again,
I'm
older
robert,
thank
you
very
much
indeed,
and
we
will
move
on
sally
to
the
acgc
report
minutes.
Please.
J
J
The
internal
audit
program
for
20,
20
21
is
complete
and
so
credit
to
both
our
auditors,
but
also
our
exec
and
our
internal
management
team
for
delivering
that
through
a
pandemic
is
the
first
thing.
There
is
one
report
around
closed
cultures
still.
J
We
are
in
our
annual
report
and
account
cycle,
and
we've
had
a
couple
of
really
good
meetings,
one
which
we
had
with
our
non-execs
and
audit
committee
members
together,
where
we
provided
the
feedback
that
we
had
from
different
points
of
view
into
the
draft
of
the
annual
reporting
accounts,
and
I
think
everybody
thought
that
was
a
useful
meeting.
J
There
are
some
final
amendments
to
be
made
from
our
meeting
a
couple
of
weeks
ago,
but
we
agreed
to
recommend
that
the
annual
reporting
accounts
come
to
the
july
board,
which
is
where
you
will
see
it.
There
is
one
issue
potentially
around
the
annual
report
accounts,
which
is
the
same
one
as
last
year.
J
There
is
a
delay
in
the
auditing
of
local
government
pension
schemes,
which
will
impact
our
timeline
and
we
are
in
the
same
boat
as
many
other
people,
so
just
to
note
that
really
and
we'll
discuss
it
more
in
july
just
going
forward.
We
have
an
internal
audit
plan
for
2021-22,
which
we
also
broadly
agreed
in
terms
of
work
packages.
J
What
we
want
to
focus
on
are
things
that
we
consider
to
be
high
risk,
naturally,
but
also
a
slight
change
in
emphasis
to
support
the
delivery
of
our
new
strategy,
which
has
been
so
well
received.
So
with
a
few
tweaks
to
that
plan.
That
work
has
started,
and
I
just
wanted
to
say
thanks
to
all
of
our
staff,
the
people
behind
the
scenes
as
well
in
kirsty's
directorate,
and
he
work
in
chris's
team
for
all
the
work
they've
done
on
the
annual
report
and
accounts
so
far.
J
The
work
that's
still
to
be
done,
but
also
the
fact
that
they're
very
happy
to
look
forward
and
shape
the
new
internal
audit
plan.
Thanks
happy
to
take
comments.
A
Sally
you
know,
there's
nobody
more
excited
or
enthusiastic
than
me
when
it
comes
to
annual
report
and
accounts,
but
I
think
the
reality
is
that,
because
these
have
to
be
laid
in
parliament,
it
won't
be
july
that
the
the
the
public
board
sees
the
that
the
accounts
isn't
that
right,
ian
it'll
be
only
when
they're
in
a
position
to
be
laid
in
in
parliament.
A
So
just
just
want
everybody
in
the
public
who
might
be
getting
as
excited
as
I
am
about
seeing
the
accounts
just
just
to
warn
them
that
they
that
that's
a
pleasure
that
may
be
delayed,
but
we'll
see
what
happens
any
any.
A
That's
right,
yep,
unfortunately,
okay,
any
other
comments
from
anybody
right.
Thank
you
sally
for
for
that
I
am
struggling
to
see,
is,
is
henrietta
with
us.
You
hear
henrietta
or
not
yet,
because
we
are
miraculously.
B
I
don't
think
she
is,
but
I've
just
caught.
I've
just
called
her
into
the
meeting,
so
I
will
we'll
see
if
she,
if
she
responds.
A
So,
let's,
let's,
let's,
let's
just
pause
the
meeting
have
a
have
a
a
short
stretch
break
and,
let's
start
again
at.
A
A
A
Excellent
so
after
that
short
stretch,
break
we're
we're
back,
and
I'm
really
really
pleased
to
welcome
henrietta
hughes,
our
our
national
guardian
and
henrietta
you've
got
a
report
to
deliver.
So
let
me
hand
over
to
you.
Q
Well,
thank
you
so
much
and
I
want
to
say
how
grateful
I
am
that
you've
invited
me
to
come
to
the
board
on
it
could
be
really
more
appropriate
over
the
last
quarter.
There's
been
quite
a
lot
of
activity
in
my
team,
and
I
just
wanted
to
draw
your
attention
to
a
few
things
in
the
update
that
I've
sent
in
the
first
one
is
our
website
having
started
with
a
few
web
pages
on
the
cqc
website
and
then
had
our
own
independent
website.
Q
We've
relaunched
the
website
now,
and
it
has
more
user-friendly
functions.
In
particular,
one
called
find
my
guardian,
and
this
means
that
you
can
put
your
the
details
of
your
employer
or
the
details
of
whereabouts.
You
work
and
it
comes
up
with
the
list
of
guardians
that
are
relevant
for
you,
and
I
think
this
is
a
really
positive
step
forward.
Compared
to
previously,
we
had
a
very
long
pdf,
which
was
quite
unwieldy
and
we've
also
got
other
search
functions
and
just
makes
it
much
more
user-friendly.
Q
Q
The
other
thing
I
wanted
to
talk
about
was
the
introduction
of
freedom
to
speak
up
in
primary
care
settings,
and
this
was
a
piece
of
work
that
we
were
commissioned
to
do
by
nhs
england
improvement
a
two-year
project
to
look
at
how
freedom
to
speak
up
could
be
integrated
into
primary
care.
Now
primary
care
is
so
complex,
with
tens
of
thousands
of
organizations
across
gp,
dentistry,
optometry
and
pharmacy,
and
members
of
my
team,
through
hundreds
of
conversations,
have
come
to
the
conclusion
that
it's
possible
to
engage
with
primary
care
in
two
different
ways.
Q
So
I
just
really
wanted
to
just
highlight
that,
because
I
think
it's
a
really
interesting
and
important
piece
of
work
and
then,
finally,
there
are
some
other
areas
that
I've
been
involved
with,
including
the
ministerial
oversight
group
for
the
recommendation
from
the
dna
cpr
report.
Your
report
protect
connect
and
respect,
and
I've
also
been
invited
to
take
part
in
the
maternity
safety,
culture,
working
group
and
steering
group.
Q
Following
on
from
the
ochenton
report,
I
will
be
soon
publishing
our
strategy,
which
sets
out
the
aims
for
the
next
five
years,
related
to
the
needs
of
workers.
Freedom
to
speak
up.
Guardians
leadership
and
the
system
as
a
whole,
but
I
also
wanted
to
say
that
this
is
my
last
board
meeting
for
presenting
to
cqc,
as
I'm
going
to
be
leaving
to
chair
a
children's
charity.
The
institute
of
systemic
therapy
childhood
first
from
september.
Q
So
I
wanted
to
just
say
thank
you
so
much
to
you
particularly
chair,
but
also
all
the
board
members
for
all
your
incredible
support
and
encouragement,
and
I
feel
very
confident
that
handing
the
baton
on
to
the
next
national
guardian
that
you'll
continue
to
provide
all
of
the
the
support
and
actions
needed
so
that
speaking
up
does
become
business.
As
usual.
A
So
so
you
beat
me
to
it:
henrietta,
you
will
not
be
surprised.
I
was
going
to
again
thank
you,
but
it
is
quite
incredible
when
you
think
that
when
you
started
there
really
wasn't
anything
was
there,
I
mean
this
was
a
a
a
new,
a
new
office
that
you
have
built
up
and
it's
now
you
know
a
fundamental
part
of
the
system
and
I
think
huge,
huge
credit
to
you
and
and
all
you've
achieved
in
the
role,
and
I
don't
think
we
can.
A
Thank
you
enough
for
what
you've
done,
and
I
wish
you
huge
success
in
the
future.
I'm
sure
I
very
much
hope.
Anyway,
our
paths
will
continue
to
cross
and
you
know
on
a
personal
level,
but
a
huge
thanks
again
robert
you
were
you,
you
were
really
responsible
for
all
of
this.
I
think
so.
M
You
don't
blame
me
for
everything.
No,
no!
No.
This
is,
if
I
may
say,
says
the
an
area.
I
I'm
really
so
grateful
to
henrietta
for
turning
what
was
a
vision
on
a
piece
of
paper
into
a
reality
across
the
service
in
very
difficult
circumstances.
This
was
not
easy
to
land,
because
this
is
not
a
a
way
forward
that
met
with
universal
approval.
M
If
I
can
put
that
gently
and
yet
henrietta
through
her
advocacy
through
her
passion
and
her
commitment
has
turned
that
into
something
that
is
present
throughout
the
nhs
in
a
way,
which
is
a
piece
says,
I
don't
think
could
be
reversed,
but
that's
not
to
say,
there's
a
need
for
complacency
because
or
justification
for
it,
because
this
is
an
area
where,
if
you're
not
pushing
forwards,
someone
will
be
pushing
backwards
and,
but
I
think,
henrietta's
laid
more
than
a
foundation.
M
She's
laid
a
real
structure
and
I
think
the
now
now
whoever
takes
over
will
have
a
fantastic
opportunity
to
take
forward
something
to
the
next
level.
So
I'd
like
to
thank
her
personally
I'd
like
to
like
seek
her
as
a
real
friend
too
and
she's.
Certainly
a
person
to
turn
to
in
a
time
of
need
both
as
a
general
practitioner,
but
also
as
a
national
guardian.
So
thank
you
very
much.
A
Are
there
are
there
any
questions
for
henrietta
on
the
the
report.
A
I
mean
it
just
just
just
following
on
from
what
robert
was
saying:
henrietta
I
mean
it
does
seem
to
me
that
that,
whilst
this
is
firmly
established,
if
we
aren't
careful
to
keep
the
pressure
on
it
can
wither
on
the
vine,
you
know
that's
the
last
thing
you
want
to
see
happen,
so
it
is
important.
Isn't
it
for
the
office
to
keep
keep
the
pressure
on
everybody,
including
us.
Q
Well,
I
think
you're
right,
there's
no
complacency,
because
it's
it's
a
mindset
shift,
and
that
requires
information,
data
and
stories
to
remind
people
why
this
is
so
important,
and
you
know
the
other
thing
that
I
was
going
to
say
is
that
every
making
out
like
I've
done
this
by
myself,
it's
impossible.
You
can't
do
anything
by
yourself.
You
can
only
work
in
partnership
and
I
think
the
work
of
the
my
office,
the
team,
the
freedom
to
speak
up
guardians
of
over
700
guardians
now
and
they've
dealt
with
50
000
cases.
Q
So
just
in
thinking
about
the
scale
of
it,
that's
50
000
people,
50
000
cases
that
have
had
productive
solutions.
So
I
do
think
it
does
require
that
onward
momentum
and
but
there's
a
lot
of
allies
around
the
system
who
are
really
keen
and
see
the
benefits
of
this
in
their
organizations.
A
Yeah
but
led
by
you
right,
no
other
questions
or
comments
for
henrietta
stephen's
got
his
hand
up.
Please
oh
right.
L
Henrietta,
could
I
just
add
my
thanks.
I
mean
amazing
work
that
you
and
your
colleagues
have
done.
It's
it's
really
brilliant
and,
and
what
it
creates
is
a
is
a
fantastically
important
and
rich
picture
about
the
cultures
going
on
in
different
organizations.
So
my
my
question,
which
may
be
as
much
for
mark
sutton
as
it
is
for
yourself
how?
How
well
are
we
actually
using
what
you're
telling
us
do?
Do
you
feel
that
kind
of
the
feed
of
your
information
into
cqc's
understanding
of
different
providers
is?
Is
there
it's
fully
integrated?
Q
Well,
I
think
there
are
two
areas
that
I
wanted
to
focus
on.
One
was
in
terms
of
the
data-driven
approach
of
zqc
that
the
freedom
to
speak
up
information
is
now
part
of
that.
Q
So
the
the
analytics
department
include
the
information
there
and
the
second
thing
is
about
the
inspectors
and
I
had
the
absolute
pleasure
and
privilege
of
training
hospital
inspectors,
and
my
experience
was
that
the
more
that
the
inspectors
understand
and
and
recognize
the
impact
of
a
positive
or
negative
speaking
up
culture,
the
more
enthusiastic
they
are
about
incorporating
it
into
their
well-led
inspection.
Q
Q
If
you
don't
have
a
positive
speak
up
culture
now,
there's
no
one
way
of
measuring
that
there
are
multiple
ways
of
measuring
that,
but
I
think
what
we
can
see
is
that
organizations
who've
really
their
ratings,
have
reduced
over
a
short
earth
interval.
It's
not
unusual
that
that's
related
to
problems
in
terms
of
the
way
that
the
leadership
have
responded
to
the
speaking
up
from
their
workforce.
So
I'm
not
saying
that
you
know
you
were
required
to
have
it.
Q
This
is
a
rate
limiter,
but
there
is
something
about
that
and
I
know
ted's
got
his
hand
up,
because
this
is
the
conversation
that
we've
had
many
times
over
the
last
few
years.
D
Well,
you've
caught
up
with
me
on
rating
limiters
henrietta,
but
but
before
I
get
on
to
that,
can
I
just
say
that
the
weight
you've
done
over
the
last
five
years
has
made
a
real
difference.
You
talking
about
that
training
of
our
inspectors.
It's
had
a
big
impact
on
them
and
their
ability
to
assess
well-led,
and
it
has
a
really
major
impact
on
our
well
at
assessments,
and
I
think
it
will
be
central
as
we
go
forward
and
develop
well-led.
D
We
we're
talking
about
you
know
focusing
on
the
leadership
culture,
organizations
much
more
and
and
the
freedom
to
speak
up.
Culture
is
absolutely
crisp.
Absolutely
central
for
that,
and
certainly
my
visits
to
hospitals.
You
can
feel
a
real
difference
in
in
on
the
front
line
in
terms
of
people,
people's
willingness
to
speak
up
if
you
compare
it
to
where
we
were
a
few
years
ago.
D
So
so
I
think
it's
had
a
big
impact
both
on
on
the
culture
but
of
course,
then,
on
the
cu
on
the
quality
of
care
that
patients
are
receiving
to
come
back
to
rating
limiters,
because
you,
you
asked
me
about
that.
It's
very
difficult
because
if
you
have
rating
limiters,
then
you
end
up
boxing
yourself
in
and
you'll
never
have
any
outstanding
organizations,
because
no
organization
is
perfect.
What
we're
looking
for
in
organizations
is
not
perfection,
but
it
is
a
desire
to
continuously
improve.
D
So
so
you
know,
freedom
speak
up.
Measures
are
free
to
speak
up.
Cultures
are
going
to
be
really
important,
but
I'm
very
worried
about
having
rating
limiters
a
few.
If
you
before
you
joined
us,
we're
talking
about
sustainability
and
the
importance
of
that
and
that's
really
vitally
important,
we
could
make
that
a
rating
limiter.
We
could
end
up
with
a
whole
series
of
rating
limiters
that
would
it
wouldn't
effectively
stop
us
ever
awarding
outstanding
to
any
trust,
and
I'm
very
wary
about
doing
that.
So
so
it
is
really
important.
R
Thank
you
and
I
mean
henrietta,
I'm
I'm
in
award
of
what
has
been
achieved.
You
know
I
spent
wearing
one
of
my
other
hats
spent
quite
a
bit
of
time,
trying
to
help
businesses
build
ethical
cultures
and
it
it's
it's
hard,
even
with
the
clearest
possible
leadership
from
the
from
from
the
top
in
simple
all
in
in
simple
organizations.
R
So
you
know
how
you've
built
support.
How
you've
mobilized
resource
is
is
astonishing,
and
I
think
you
have
built
something
which
is
a
really
solid
foundation
for
very
good
cultural
things
to
be
happening.
I
I,
I
think,
a
speak
up.
Culture
where
people
feel
free
to
to
to
call
things
out
which
don't
feel
right
is
a
is
a
really
vital
part
of
a
healthy
culture.
R
It
may
not
be
a
a
rating
limiter,
but
it
ought
to
be
a
red
flag
if
it's
not
there
and
and
an
organization
should
want
to
do
this.
I
mean
this.
Is
this
really?
You
know
this
really
tells
you
what's
going
on
in
an
organization
and
it's
an
incredibly
useful
early
warning
of
things
going
wrong
if
you,
if
leadership
is
really
bought
into
this.
I
think
these
you
know
these
disparities
are
deeply
worrying.
R
You
know,
cultures,
don't
sort
of
exist
in
in
in
a
vacuum
and
microcultures
are,
you
know,
are
an
area
that
we
really
worry
about.
You
know
they
correlate
they're
going
to
correlate
in
our
world
for
increased
risk
risk
of
harm,
so
where
we,
where
we
do
have
an
indicator,
an
indication
that
people
are
not
comfortable.
Speaking
up
that
issues
are
not
being
raised.
R
I
think
that's
a
that's
a
vital
warning
for
us
as
part
of
our
assessment
of
risk
across
this
across
the
system,
but
I
think,
what's
been
achieved
is
is
amazing
and
I
think
it's
a
lasting
foundation
for
for
good.
So
thank
you.
A
So
if
we
were
meeting
as
we
had
originally
planned
in
person
henrietta,
we
would
now
entertain
you
to
our
usual
lavish
board.
Lunch
as
it
is
you'll
probably
have
a
much
better
lunch
wherever
you
are,
but
without
our
company
and
just
once
again
on
behalf
of
everybody.
Thank
you
for
everything
you've
done
for
for
us
and
for
health
and
social
care
generally
and
wish
you
every
success
in
the
future.
A
And
that
just
leaves
us
with
any
other
business.
If
anybody
has
any
other
business
for
the
board,
none
has
been
notified.
So
we'll
assume
there
is
no
other
business.
So
that
is
the
end
of
the
formal
meeting,
but
I
do
have
two
questions
both
from
robin
pike.
The
first
is
hospitals,
gather,
intelligence,
about
outpatient
experiences
of
our
tech
surveys
and
gp
surgeries
do
the
same
for
our
friends
and
family
tests.
How
is
this
intelligence
shared
with
the
cqc.
O
Able
to
answer
that,
I
I
will
indeed
and
also
touch-
and
I
think
a
little
bit
about
the
the
previous
conversation
as
the
point
that
stephen
wright
is
there
about
sharing
of
national
guardian
office
information
with
us.
So
I
I
think
it's
a
very
important
question
and
it's
important
because
the
information
that
is
about
people's
experience
is
really
important
for
our
regulatory
work.
O
O
So
we're
able
to
get
access
to
that
important
information
again
and
in
general
practice.
They
are
actually
developing
a
new
method
for
real-time
patient
feedback
and
we're
awaiting
more
details
on
those
developments
and
how
we
can
get
access
to
that
that
rich
information
and
there's
also
worth
noticing
that
that
isn't
the
only
source
of
information
that
we
have
on
people's
experiences.
There's
a
rich
range
of
information.
We
use
nhs
and
gp
patient
surveys,
comments
left
on
nhs.
O
We
can
review
information
from
local
healthwatch
as
we
talked
on
the
in
the
previous
conversation,
the
national
guardians
office,
feedback
from
individuals
for
our
contact
center
and
our
relatively
new
give
feedback
on
care
digital
service
by
which
people
can
provide
feedback
on
health
and
care
services,
and
that
partnerships
with
organizations
like
the
patients
association
and
finally,
as
an
important
part
of
our
transformation
work,
we'll
focus
on
improving
how
we
access
analyze
and
use
people's
experience
throughout
their
regulatory
model.
To
achieve
the
ambitions
that
we
set
out
within
our
new
strategy.
A
Thanks
mark
and
then
the
second
question
I
think
rosie,
this
will
be
one
for
you.
When
will
the
arrangements
for
inspecting
dental
services
be
reviewed?
Dental
surgeries
are
currently
not
rated
rosie.
E
Yes,
thank
you
peter.
So
in
line
with
the
cqc
strategy
launch,
we
have
started
to
review
the
way
related.
We
worked
with
many
of
the
dental
stakeholders
during
the
development
of
the
strategy
and
are
continuing
to
work
with
dental
stakeholders
through
a
regular
dental
reference
group
that
we
hold.
We
have.
We've
had
introduced
smarter
regulation
with
the
dental
sector
and
the
the
work
we've
been
doing.
E
Introducing
the
monitoring
approach
with
the
tma
and
and
other
monitoring
approaches
have
been
very
much
welcomed
by
the
sector
and
and
we've
been
encouraged
to
build
on
that
work
by
the
sector.
So
we
are
starting
to
look
at
the
data.
That's
required
to
really
drive
an
intelligent,
led
assessment
in
our
dental
providers
and
we
will
be
continuing
to
review
how
we
monitor
and
what
a
streamlined,
smarter
inspection
would
look
like.
A
Thank
you
rosie,
and
there
are
no
other
questions
from
members.
A
And
I
suggest
that
we've
caught
up
a
bit
of
the
time.
So
if
we,
if
we
start,
we
would
you
start
again
at
two
o'clock
if
we
started
at
1
50,
that
gives
us
a
pretty
decent
lunch
break
and
we
should
be
able
to
knock
off
the
acgc
and
rgc
reports,
which
I
think
the
only
two
things
that
are
that
are
outstanding.
Does
that
is
that,
okay.
R
A
Report
that
okay,
okay
and
and
sally's,
given
most
of
the
private
report
in
the
public
one
so
anyway,
let's
start
again
at
10,
2
and
we'll
just
formally
knock
those
items
off
for
the
minutes
and
then
we'll
be
in
good
shape.
So
is
that
okay,
ten
to
two.