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From YouTube: CQC Board Meeting 17 September 2014
Description
Agenda for the meeting of the Care Quality Commission Board held on Wednesday, 17 September 2014:
1. Apologies and declarations of interest 0:01
2. Minutes of the meeting held on 30 July 2014 0:14
3. Matters arising and action log 0:18
4. Chief Executive's report 0:39
5. Provider handbooks: Consultation results and key policy changes 1:19:54
6. CQC values and behaviours 2:24:22
7. National Information Governance Committee 2:34:28
8. National Survey Programme 2:38:03
9. Any other business 2:43:50
10. Questions from the floor 2:43:50
Read more about CQC's Board Meetings at
http://www.cqc.org.uk/public/about-us/our-people/board-members/board-meetings
A
Matters
arise,
we've
got
two
items
that
have
been
deferred
till
later.
The
the
report
on
covert
and
over
surveillance
will
come
back
in
october
and
on
experts.
Exp
by
experience
will
come
back
in
november.
I
think
paul,
that's
right
and
then
yeah
any
any
declarations
of
interest.
Nope
david,
your
report.
B
So
this
is
the
standard
report
which
is
updating
colleagues
on
progress.
A
number
of
these
items
are
regular
reporting
items
and
some
are
what
the
board
have
asked
for
in
previous
meetings,
the
july
meeting,
so
I'll
whiz
through
them
at
speed
david
and
if
colleagues
want
to
stop
me
as
I
go
through
then
happy
to
do
so.
B
B
B
If
you
to
just
look
at
each
of
the
annexes,
what
you'll
see
against
each
of
those
three
curricular
headings
in
the
original
slide
is
what
areas
are
covered
in
each
of
those
curricula
and
then
going
in
to
each
each
one
and
the
core
correctly.
You
can
see
what
the
course
titles
are
the
way
it's
delivered,
the
duration
in
days
and
hours
and
a
broad
time
table,
and
that
then
repeats
for
the
role
specific.
B
This
is
obviously
the
longer
list
is
a
mixture
of
instruction
led
and
e-learning
and
you've
got
again
a
sense
of
the
dates
and
the
timetable
for
the
activity.
And,
finally,
the
developmental
work
on
leadership,
which
is
a
combination
of
those
leadership
programs
which
have
been
delivered
previously
and
new
ones
which
are
being
added,
and
then
the
final
slide
is
the
distribution
of
the
budget
for
the
development
of
our
staff.
B
The
budget
that
the
academy
is
using
to
provide
those
courses,
tracy
forrester
who's,
led
this
work
for
us.
Eileen
and
myself
will
be
very
happy
to
meet
with
any
board
member
to
go
through
in
any
detail.
If
you
want
more
information
than
is
provided
here
and
that
we
can
walk
you
through
and
get
a
sense
of
what
is
actually
out
there
being
delivered,
andrea
was
saying
on
monday
that
her
inspectors
have
begun
the
programme
of
the
adult
social
care
rule
specific
development
on
monday.
So
this
is
now
underway
and
being
rolled
out.
B
I
think
this
is
a
key
issue
for
the
organization.
We're
often
told
risk
registers
need
to
be
about
what
makes
you
waking
up
early
well,
this
is
the
one
for
me.
This
is
really
the
one
about
whether
the
staff
we've
got
have
the
skills
to
do
the
job.
We're
asking
them
to
do,
and
this
is
why
this
is
absolutely
central
to
the
delivery
of
the
transformation
program
that
we're
taking
forward.
C
Okay,
I
mean
it
looks
very
comprehensive
and
I
presume
we'll
be
getting
feedback
from
from
staff
on
the
sort
of
offer
to
go
through
it
in
more
detail.
Because
what
I
didn't
see
on
here-
and
I
know
it's
happening
to
some
extent-
is
how
much
kind
of
patient
user
citizen
involvement
we've
got
in
in
you
know
in
the
training
program
you
know.
Obviously,
patient
stories
is
one
aspect,
but
there's
also
sorts
of
things
that
could
potentially
contribute.
B
I
think
paul
might
be
coming
on
one
of
these
shortly,
but
the
corporate
induction
there's
a
general
introduction,
given.
I
then
do
an
introduction
to
the
organisation,
and
then
one
of
the
et
colleagues
will
then
do
a
more
detailed
structure
and
then
immediately
after
that,
it's
a
user
of
services
story
and
that's
either
emma
pullen
who's.
Now
working
for
the
academy
who's
whose
brother
was
abused
in
winterbourne
telling
her
story.
So
it's
either
a
live
person
in
that
sense
or
there'll,
be
a
story
through
a
dvd.
That's
played
in.
D
And
just
to
give
further
reassurance,
we're
specifically
working
with
the
national
co-production
advisory
group
and
think
local
act
personal
to
ensure
that
the
kind
of
those
voices
are
included
in
the
work
we're
doing
on
personalization.
So
some
of
the
people
that
you
would
be
familiar
with
ko
are
involved
in
that
directly.
A
E
That's
one
question
david:
on
the
the
academy:
real
specific
curriculum,
the
difference
between
the
minimum
durations
and
the
maximum
durations.
Were
you
know
quite
sizable.
I
didn't
really
understand
you
know:
role
specific
induction
for
inspectors,
minimum
duration,
one
day,
maximum
duration,
23
days.
You
know
what
you
know,
that's
a
huge
difference
and
I
just
I
wasn't
quite
sure
what
to
take
from
that
really.
So
it's
more
a
question
not
another
point.
B
Can
I
need
help
on
this?
Michael
is
at
the
end
of
this
process.
Inspectors
will
have
up
to
23
days
development.
It's
not
saying
they'll
get
that
all
at
once,
but
the
way
we've
conceived
the
curriculum
for
inspectors
and
the
content
that's
there
in
order
to
get
through.
All
of
that
course,
which
is
what
we
think
is
the
core
that
people
need
to
do,
that
we
think
each
inspector
will
be
taking
up
to
23
days
to
actually
go
through
all
of
that
curriculum.
E
B
Perhaps
it's
not
the
most
helpful
way
to
have
presented.
It's
saying,
there's
a
minimum
that
we
expect.
We
do
expect
everybody
to
go
through
23
days
and
perhaps
what
we
shouldn't
have
done
is
put
the
minimum
and
maximum.
I
think
it
works
where
you've
got
blended
courses
where
you
can
actually
see
what
components
of
the
blended
course
are.
Perhaps
on
that
particular
one.
It's
not
a
logical
extension
of
what
we're
trying
to
say
to
present
it
in
that
way.
D
Yes,
I
think
that
you,
what
what
the
what
the
page
is
giving
us
is
kind
of
the
whole
picture,
and-
and
so
it
is
different
in
different
respects,
so
we've
got
new
people
coming
in
who
are
having
very
specific
inductions
and
support
and
then
development
with
their
teams
exactly
as
david
says,
which
is
extending
that
and
in
terms
of
the
new
inspection
methodology.
That's
building
up,
depending
on
what
original
training
people
have
had
so
in
adult
social
care.
D
For
example,
if
people
have
done
wave
one
and
wave
two
training
already
then
they're
getting
a
day's
worth
of
refreshment
for
the
new
approach
rollout,
but
if
they
haven't
done
any
of
that,
then
they're
getting
a
full
two
days.
So
so
it's
it's
kind
of
titrated,
really
in
terms
in
responding
trying
to
be
person-centred
about
the
needs
of
the
individuals
and
that
we're
training
as
well
as
as
what
we
need
to
see
from
the
organization's
point
of
view.
F
G
Yeah,
I
think
so
I
mean
these
are
always
presentational
issues
when
you
talk
about
education
and
training,
so
there's
a
certain
amount
of
training
you
need
for
any
job,
but
it's
the
culture
and
the
way
beyond
the
job,
learning
and
experiences
with
the
feedback
loop,
which
is
important.
So,
for
example,
on
friday,
we
have
a
number
of
inspectors
coming
into
our
gp
surgery,
just
to
get
a
feel
for
what
it's
like
in
general
practice
with
the
financial
squeeze
which
has
been
on
for
some
time
in
a
deprived
area
where
demand
is
increasing.
G
Most
of
our
inspectors
have
not
worked
in
general
practice
and
therefore
that
will
be
ongoing
through
the
year
and
I've
just
done
two
inspections
in
cambridge,
where
we
had
local
medical
committees
coming
in
as
well
on
our
inspections
for
them
to
learn.
So
it's
about
learning
and
culture
rather
than
training.
I
think
michael.
E
I
think
that's
an
excellent,
absolutely
excellent
point.
We
actually
we
discussed
yesterday.
You
know
the
regulatory
governance
committee,
whether
I
don't
think
we
want
we
thought
about
making
it
mandatory,
but
that
certainly
everybody
in
this
building
and
perhaps
the
regional
officers
needed
to
go
on
inspection.
So
that
was
you
know
what
you
know
should
be
expected
of.
Colleagues,
as
opposed
to
you
know,.
E
Understanding,
what's
actually
actually
happening
in
the
field
or
the
real
challenges
faced
by
inspectors.
I
I
think
steve's
point
is
excellent.
It's
rather
like
I
gave
the
analogy
of
a
retailer
where
you
know
usually
on
fridays,
everybody's
expected
in
a
head
office
to
go
and
visit
stores,
and
I
you
know,
I
think
it's
something
sort
of
similar
and
it
is
a
cultural.
It's
absolutely
a
cultural
point,
the
people
you
know,
I
just
don't
know
how
many
people
in
this
building
have
not
been
on
an
inspection,
be
quite
interesting
to
know.
B
B
So
I
think
we've
been
encouraging
that
exactly
that.
Certainly
I
do
that.
Every
time
I
go
and
speak
to
a
group
of
staff
that
are
not
inspectors
that
this
is
the
way
we
need
to
connect
the
different
bits
of
the
business.
Similarly,
I
think
it
works
the
other
way
around
that
I
think,
there's
a
whole
bunch
of
inspectors
that
need
to
understand
analytics
so
that
when
they've
got
numbers
in
front
of
them,
so
I
think
it
that
that
transfusion
of
skill
across
the
organization
from
one
bit
to
the
other
is
absolutely
right.
B
I
think,
in
terms
of
this
report,
the
academy
has
gone
from
a
standing
start
to
where
we
are
now
in
less
than
nine
months,
and
the
priority
is
really
about
making
sure
that
the
inspectors
that
are
rolling
out
the
new
inspection
and
their
managers
are
good
to
go
on
that
and
but
I
think,
ultimately,
our
vision
for
the
inspection
one
for
the
academy
when
we've
discussed
it
is
that
this
is
a
service.
That's
available
to
all.
B
We've
already
got
staff
saying
what
is
the
academy
doing
for
me,
because
the
focus
is
on
preparing
inspectors
ready
to
go,
but
ultimately
I
do
see
that
as
being
an
essential
part
of
what
we,
what
we
do.
I
know
that
most
inspection
teams,
certainly
for
the
hospitals,
have
had
visitors
on
them
and
those
visitors
have
been
people
from
outside
the
organization
as
well
as
people
from
inside.
B
So
I
think
you're
absolutely
right.
It
is
a
culture
that
we
need
to
develop,
whether
it
you
know
the
the
the
tradition
of
fridays
being
a
day
out,
not
a
dress
down
there,
but
a
day
out
there
will
be
a
good
one
to
shift
we're.
Not
there
it's
the
day
out
there
looking
at
what
we
do,
but
I
think
that's
where
we
need
to
go
so
I
think
the
challenge
is
absolutely
right.
C
And
I
probably
just
want
to
sum
up
as
the
the
person
who,
with
david's
probably
been
closest
to
the
academy
through
it's
growth,
to
say
an
echo,
absolutely
what
andrea
has
set
out
in
the
way
the
academy
offer
it
has
to
be
capable
of
calibration
across
different
staff
groupings.
23
days
for
an
inspector
who
is
already
in
post
is
the
core
offer?
It's
not
a
maximum.
It's
a
call
and
one
of
the
other
things
to
pick
up
on
what
steve's
talking
about
and
that
we
need
to
ensure.
C
They've
had
to
engage
in
planning
the
learning
opportunities
they'd
like
to
have-
and
that's
going
to
be
absolutely
key
to
us
as
an
organisation
to
actually
build
this
culture
of
having
something
that
people
can
draw
upon,
but
also
add
to
and
which
is
underpinned
by
view
about
the
improving
the
performance
of
the
organization.
So
that's
really
what
the
academy
is
about,
and
that's
why
it's
so
pleasing
to
see
it
moving
forward
now
to
to
move
from
idea
into
execution.
H
Very,
very
quick
one
I
mean,
I
think,
it's
terrific,
that
you've
managed
to
get
so
much
up
and
running
in
such
a
short
period
of
time.
It's
quite
it's
very
impressive.
I
think
the
question
would
be
around
how
effective
it
is
as
we
as
we
go
forward
in
terms
of
the
the
the
assessment
that
the
people
who
go
on
the
courses
have
of
the
learning
processes
and
also
of
of
how
well
they
do
in
terms
of
actually
absorbing
the
learning
and
and
what
that,
how
they
advance.
B
Baby
we'll
carry
on,
I
think,
paul's,
absolutely
right
and
that's
a
key
component
of
what
we
need
to
do.
I
think
it
ties
in
with
cair's
point
at
the
beginning
about
feedback
from
staff
about
is
this
making
a
difference.
Part
of
the
game
is
confidence.
Does
this
make
them
more
confident
to
do
the
job?
B
The
next
two
paragraphs,
two
and
three
david-
are
part
of
the
regular
updates
in
two
I'm
just
updating
you
on
the
floof
through
of
the
new
regulations,
so
these
are
being
led
before
the
fit
and
proper
people
and
the
duty
of
condo
regs
are
being
laid
in
october
and
in
the
lords
there's
then
a
21-day
gap.
There's
a
a
do
missing
from
that
last
sentence.
In
the
first
paragraph,
my
apologies
and
though
we
don't
anticipate
them
being
in
until
the
end
of
november.
B
B
People
have
expressed
the
view
that
it
won't
and
therefore
will
proceed
as
it
to
be
implemented,
but
it
needs
to
be
born
in
mind
that
that
could
result
in
their
annoyment
and
and
then
lastly,
is
the
move
by
the
department
to
introduce
a
display,
a
requirement
to
display
the
outcome
of
the
regulation
of
the
most
recent
rating
in
a
prominent
position.
Those
regulations
will
need
to
be
consulted
upon
and,
if
they're,
to
come
into
force,
they'll
come
into
force
from
the
1st
of
april
2015..
B
B
B
An
item
for
the
budget.
You
asked
at
the
last
meeting
for
an
update
in
relation
to
the
forecasting
of
the
budget,
and
the
annex
to
this
report
is
a
detailed
schedule
of
our
commitments
to
date
and
the
forecast
towards
the
end
of
the
year.
The
remainder
of
this
paragraph
spells
that
out.
So
that's
at
the
31st
of
july,
we
were
underspent
on
our
total
budget
by
4.3
million
that
run
rate
extended
to
the
end
of
the
year
would
result
in
an
underspend
of
14.2
million
pounds.
B
However,
you'll
also
see
in
the
annex
commitments
to
spend
11.7
million
pounds,
which
will
actually
identify
and
underspend
at
the
end
of
the
current
financially
of
2.5
million
pounds,
just
to
emphasize
that
the
size
of
the
underspend
will
be
dependent
on
the
ability
to
commit
that
11.7
million
pounds
worth
of
resources.
The
detail
of
those
is
set
out
on
the
last
sheet
of
the
annex
of
financial
commitments.
B
I
So
it's
slightly.
It
pains
me
to
say
that
I
think
it's
our
job
as
a
board
to
also
be
planning
the
next
phase
of
the
development
of
our
methods
as
a
strategic
exercise,
and
I
just
want
some
assurance
that
that
is
what
we
are
now
playing.
So
if
you
take
what
we've
done
so
far,
we
have
a
reliance
on
information,
as
collected
mainly
by
the
nhs
which
we
all
know
is
rather
flawed
and
which
needs
to
be
transformed
and
stepped
up
a
level.
I
We
have
an
inspection
method
that
relies
on
a
sort
of
mass
visit
which
kieran
walsh
in
his
review
said,
was
working
well,
but
actually
that
bit
of
it
may
be
the
bit
that
we
should
reconsider
the
mass
visit
and
we
haven't
yet.
I
think
got
to
the
point
where
we
understand
how
to
use
patient
experience
and
carer
experience
in
care
homes.
I
I
F
Yeah,
I
would
give
you
that
assurance,
so
we
we're
locked
down
when
it
comes
to
the
next
agenda
item
the
assessment
framework.
So
all
providers
know
how
we
will
judge
quality
of
care,
but
that
doesn't
mean
that
we
lock
down
and
forget
about
what
they
certainly
would
how
we
then
do
all
those
the
details
so
on
each
of
your
examples.
Yeah
absolutely
continue
to
develop,
and
the
best
example
is
the
knowledge
and
information
strategy
that
came
to
the
board
a
while
ago
in
outline.
F
But
the
whole
point
of
that
is:
how
do
you
get
to
be
more
intelligence,
driven,
we've
recruited,
a
new
head
of
function,
to
look
specifically
at
the
qualitative
side
of
that,
for
example,
because
we
know
that
even
in
the
nhs,
although
we
have
a
decent
amount
of
quantitative
data,
we're
in
much
poorer
shape
when
it
comes
to
the
qualitative
side,
and
what
people
are
saying
informally
goes
to
your
your
app,
and
we
know
that
right
across
adult
social
care.
We
have
to
improve
the
quality
of
data.
A
How
you
quite
got
that
from
the
budget
lewis,
but
transformation,
okay
anyway,
the
point
is
absolutely
no.
You
know
we
have
not
got
the
per.
We
have
not
got
the
perfect
way
of
doing
this
yet,
and
we
need
to
come
back
to
this.
So
can
we
note
it
now
and
not
otherwise,
we'll
spend
the
whole
morning
on
on
that
issue,
but
so
can
paul
we'll
we'll
bring
this
back
for
a
longer
discussion
at
a
future
board
meeting.
If
we
can.
J
Sorry,
dude
on
on
the
budget
and
particularly
on
on
the
financial
commitments,
page
two
financial
commitments,
and
I
I
mean
I-
I
I'm
not
quite
honestly,
not
quite
sure
how
to
frame
this
question.
But
I
suppose
a
cynic
might
say
that
we've
got
a
budget
underspend
and
then
we've
got
a
list
of
things
that
we
now
want
to
do
to
address
it.
J
And
if
I
look
at-
and
I
just
want
to
sort
of
test
that-
because
I
think
that's
our
role
is
to
test
that
about
sort
of
how
we're
planning
to
spend
the
budget.
So
it
seems
to
me
that
looking
at
this
list
of
things,
the
first
item,
the
hr
recruitment
campaign
and
the
last
three
items
which
together
add
up
to
about
5.2
million
so
about
half
of
this
11.7.
J
That
we
plan
to
spend
in
the
rest
of
the
year
are
related
directly
to
the
fact
that
we
haven't
managed
to
recruit
in
the
way
that
we
hope
to
recruit
and
we're
going
and
we're
redressing
it.
And
I
take
that
that's
a
kind
of
a
corrective
mechanism
for
an
issue
which
has
caused
partly
the
under
the
the
projected
underspend.
J
J
J
Would
these
be
the
things
that
we
wanted
to
spend
it
on
and-
and
I
I
kind
of
think-
that's
a
that's-
that's
a
question
that
that
we
need
to
be
asking
ourselves
is
as
well
as
the
question
which
I
I
take
it
you
as
an
et
have
been
asking
yourselves,
which
is
what
what
do
we
need
to
do
in
order
to
be
able
to
operationalize
the
the
business
plan
which
wasn't
previously
foreseen,
because
these
are
new
items.
If
I
understand
it,
rightly
rather
than
existing
items.
J
So
I,
as
I
said,
I'm
not
quite
sure
how
to
phrase
this
question,
but
I
just
I
see
a
long
list
of
of
of
of
relatively
small
items
of
expenditure
which,
together
put
us
in
a
position
where
our
forecast
under
spend
is
significantly
lower
than
it
would
have
been.
But
that,
for
me
begs
the
question
of
how
would
we
want
to
spend
a
full
cut?
How
would
we
want
to
spend
a
forecast
under
spend
to
deliver
the
best
outcome
for
the
organization.
B
I'm
very
good,
I
thought
you
framed
the
question
absolutely
as
it
should
be
framed,
so
we
don't
have
any,
and
I
personally
don't
have
any
problem
with
that.
Just
going
back
to
lewis's
question
and
paul's
answer,
the
other
thing
we've
done
is:
we've
grown
a
strategy
capacity
within
the
organization
when
we
did
that
people
said.
Why
are
you
doing
that?
We've
done
that
exactly
so
that
we
haven't
got
everybody
drawn
into
managing
today,
so
somebody
is
there
to
look
at
tomorrow.
B
The
reason
I
want
to
make
that
link
is
I'd,
argue
that
working
strategy
and
policy
to
support
market
oversight,
increased
stepping
costs
within
strategy
and
policy
are
as
a
direct
consequence
of
because
everybody
in
paul's
area
has
been
all
hands
to
the
pump
to
get
the
next
item
on
the
agenda.
The
handbook's
out,
literally
everybody
hands
to
the
pump
got
in
the
lift
with
somebody
today,
who's
in
paul
said.
How
are
you
when's
the
baby
due?
How
are
you
and
she
took?
How
are
you
to
me?
B
Have
we
got
the
handbooks
out
the
door?
Not?
How
is
she,
in
terms
of
the
confinement
just
to
give
you
a
sense
of
how?
How
are
you
is
being
interpreted
by
people
at
the
minute,
so
those
investments
are
about
making
sure
we've
got
the
capacity
to
do
today
and
just
keep
a
bit
back
in
terms
of
the
questions
about
where
next
and
at
the
dinner
last
night
we
talked
about
raising
the
bar
when
we
got
to
a
given
standard
they're,
all
part
of
what's
the
next
move
in
relation
to
some
are
tactical.
B
B
The
underspending
budget
is
a
direct
response
of
not
being
able
to
recruit.
We've
had
this
conversation
before
we've
held
a
line
on
the
standard
that
we
want
to
recruit
for,
and
the
easiest
thing
would
have
been
to
blink
and
not
hold
that
line
and
just
spend
the
money.
It
would
have
been
a
much
easier
way
to
have
this
conversation.
We've
not
done
that
and
we're
going
to
stand
by
that
unless
the
board
challenges
to
do
something
different,
but
we'll
stand
by
that.
B
So
I
think
there
are
some
things
and
you're
right.
You
flagged
them
the
recruitment,
the
support
of
bank
staff,
where
we
had
anticipated
running
bank
staff
down
in
the
autumn
of
this
year,
not
keeping
them
to
allow
us
to
have
that
additional
capacity
to
run
through.
I
think
we've
probably
got
to
rethink
how
much
bank
capability
we
need
moving
forward,
not
whether
we
can
actually
run
them
right
out
in
the
form
of
time.
B
B
E
B
A
E
But
and
it's
I
think
it
would
be
a
large
sum
of
money.
I
believe
that
the
cqc's
website
is
not
fit
for
purpose
and
obviously
one
of
its
main
purposes
is
to
allow
prospective
patients
or
care
home
users
or
patients.
You
know
deciding
on
which
gp
practice
to
use.
I
think
it
is
very
clumsy
old-fashioned.
E
A
F
Paul,
yes,
it's
not
doing
what
it
needs
to
do.
It's
worth
it.
We
can't
just
spend
the
money
we
have
a
categoric
from
the
cabinet
office.
You
can't
just
make
a
new
website,
so
it's
one
of
the
many
controls
that
we
have
in
place
government
has
in
place
over
us.
So
I
know
that
chris
day's
been
in
a
lot
of
negotiation
to
try
and
secure
us
the
money
to
do
a
whole
series
of
upgrades,
we're
doing
an
upgrade
program
in
the
background
to
try
and
make
it
incrementally
better.
F
A
C
C
A
A
B
Anything
that's
moving
by.
I
think
it
was
three
percentage
points
when
jsk
did.
The
analysis
back
to
us
is
not
significant.
Anything
that's
bigger
than
three
percentage
points
is
significant,
so
the
overall
engagement
index,
moving
from
63
to
64,
is
not
significant.
It's
effectively.
Staying
the
same,
so
that
is
saying
our
engagement
of
staff
is
reasonably
good
compared
to
the
public
sector.
I
think
the
private
sector
benchmark
is
74..
B
B
What
you've
got
is
a
high
level
summary
of
what's
up
what's
down
in
terms
of
numbers.
Robert
francis
in
some
written
comments,
said
it
would
be
helpful
to
know
what
the
top
and
bottom
areas
were.
So
the
top
scoring
areas
in
the
survey
were
related
to
teamwork.
The
top
ones
were
related
to
teamwork.
My
team
is
committed
to
producing
quality
work
came
in
at
90
percent.
I
can
rely
on
my
team.
I
believe
that
cqc
monitors
inspects
and
regulates
the
standards,
my
team
respects
and
values
each
other.
B
The
team
I
work
in
produces
effective
outcomes,
so
very,
very
high
scores
in
relation
to
those
the
development
areas
were
mainly
to
do
with
morale
compared
the
bottom.
Five
were
in
this
order
compared
to
other
people.
I
I
think
I'm
rewarded,
fairly
training
and
development
I
received
is
effective,
was
38
the
academy
debate.
I
believe
that
changes
are
effectively
implemented
was
34.
B
B
B
There
are
differences
between
directorates
and
and
therefore
the
actions
that
may
well
follow
from
that
are
likely
to
reflect
some
of
those
differences
in
the
way
they
move
forward
as
an
executive
team,
and
certainly
I
have
asked
that
we
focus
on
the
answer
to
the
question
in
the
survey
which
said
what
were
the
top
three
things
which
would
do
most
to
affect
morale
and
those
three
things
were
identified
as
effective
systems,
tools
and
processes,
learning
and
development
and
staffing
sourcing.
So
our
view.
B
Board
might
have
a
view
on
this
as
well.
Is
that
the
the
top
three
issues
that
we
need
to
attack
and
make
sure
that
we
do
that?
So
I'm
not
looking
for
broad
action
plans
which
are
attempting
to
do
lots
of
things,
but
very
specific
action
plans
which
are
designed
to
attack
those
three
areas
of
concern
which
are
expressed
in
the
survey.
C
And,
of
course,
staff
will
have
access
to
it
on
the
these
three
main
areas,
I
mean
it
would
be
useful
to
have
a
sort
of
mid-year
update
to
see
how
how
we're
doing
on
these,
because
you
know
we
we've
had
85
percent
of
our
staff
respond
to
the
survey,
which
is
is
great.
You
know-
and
I
know
that
staff
do
feel
listened
to,
but
these
are
really
quite
important
issues
for
them
and
for
us,
so
it
would
be.
You
know,
I'd
certainly
appreciate
it.
C
A
E
E
That
is
just
a
very
low
rating,
and
you
know-
and
it
is
was
it
slightly
depends
on
and
that
I
you
know.
I
understand
that
when
you
one
of
the
questions
that
there
is
a
difference
between
people's
individual
morale
and
what
they
feel
about
the
organization's
morale
and
their
individual
round
is
higher,
but
even
that,
I
think,
is
only
46
percent
talks.
I
mean
andrea
mentioned
it
in
one
of
that.
D
E
D
B
Sorry,
michael,
I
just
can't
find
it
quickly,
but
it
is
in
there
I'll
not
present
these
in
any
detail.
They
relate
to
mike
and
steve's
work
and
they
just
update
you
on
activity
and
progress
which
is
being
made
across
both
the
hospitals
directorate
and
across
primary
medical
services
and
integration.
Work.
B
K
K
So
actually
it's
quite
useful
to
have
a
pilot
of
our
appeal
or
review
process.
So
this
is
the
one
that's
that
it's
being
done
with,
and
there
is
a
completely
separate
team
reviewing
the
report
from
the
one
that
did
the
original
national
quality
assurance
group.
In
order
that
we
can
say
that
this
is
independent
and
we
will
then
hear
the
report
back
from
them
on
any
changes
that
they
feel
might
be
appropriate
for
us
to
make.
K
H
K
K
That
was
the
ramp
up
plan
according
to
to
the
model,
and
we
are
looking
to
ramp
up
to
just
over
300
by
march
of
next
year.
Now
I
think
we
can
look
at
that
as
clearly
it's,
so
it's
a
gap
of
about
200
that
we
need
to
fill
before
march.
We
can
say
that,
as
my
god,
that's
huge
in
comparison
with
the
number
we've
got
at
the
moment.
K
Actually,
it's
no
larger
than
the
number
that
some
individual
trusts
are
trying
to
recruit
in
terms
of
nurses.
After
all,
we
are
recruiting
from
across
the
whole
country
if
we
got
one
secondment
from
each
acute
trust
and
mental
health
trust
that
would
completely
fill
our
our
vacancies.
We
are
doing
a
targeted
approach
in
mental
health
and
no
doubt
at
all
that
the
expressions
of
interest
in
that
have
been
very
high,
we're
going
through
the
sifting
process
and
the
interviewing
process
at
the
moment.
K
A
H
I
I
know-
and
I
just
wonder
whether,
because
obviously
the
overall
figures
that
we
had
david
were
were
really
positive,
I
mean
you
had
we
had
a
lot
of
applications,
we
had
a
lot
of
interest
and
I'm
just
wondering
if
you
can
just
remind
across
the
piece
I
mean
mike.
You
know
you
sound
like
you're,
saying,
there's,
there's
a
lot
of
interest
and
it's
more
a
question
of
process,
but
then
there's
also
an
issue
about.
Are
we
targeting
the
rights?
Sorry
I
just
want
to
know,
is
it?
Is
it
sort
of?
Do
you
think?
H
K
I
think,
to
begin
with,
we
went
for
rather
a
generic
approach
to
recruitment.
I
think
we're
now
doing
it
in
a
much
more
targeted
way
and
I
think
the
early
results
from
and
what
the
early
results
from
two
things:
the
first
of
all
the
targeted
mental
health
approach
and
secondly,
this
idea
of
trying
to
attract
people
on
secondment
from
the
nhs
to
the
hospital
sector
still
early
days.
But
I
I
am
very
hopeful
that
those
that
will
actually
plug
a
lot
of
this
gap.
B
There's
also
a
need
for
geographical
targeting
as
well
camilla,
so
I
think
we're
now
at
a
stage
where
generic
adverts
for
inspectors
need
to
be
much
more
specific.
So
if
we
need
a
pms
inspector
for
leicester,
we
need
to
go
for
a
pms
inspector
for
leicester,
not
a
generic.
We
would
need
to
recruit
inspectors.
B
So
I
think
it's
probably
a
natural
evolution
for
this,
but
we're
much
more
targeted,
there's
some
places
where
we've
had
more
re
sponsor.
We
have
vacancies
and
other
places
where
we've
got
more
vacancies
and
we've
had
people,
so
I
think,
being
much
more
targeted
and
that's
what
we've
been
doing
in
relation
to
mental
health
and
people
from
hospitals-
and
I
say
offering
a
different,
a
much
more
flexible
way
to
recruit
people.
B
K
Well,
we
spend
quite
a
lot
of
time
working
with
the
royal
colleges
with
professional
societies.
I
talked
at
the
british
orthopedic
association's
annual
conference
on
friday,
for
example,
doing
those
sorts
of
meetings
on
a
regular
basis,
and
I
and
I
feel
very
disappointed
if
I
come
away
from
one
of
those
meetings
without
getting
some
people
signing
up
either
as
inspection
chairs
or
as
say,
consultants
to
come
on
on
the
session.
B
Colleagues
have
that
report
in
terms
of
its
content,
so
you'll
see
some
of
the
important
messages
that
we
intend
to
publish
there,
the
transfer
of
safety
functions.
This
really
follows
simon
stevens,
when
he
arrived
at
nhs
england,
making
a
request
to
us
that
the
safety
functions
which
are
currently
vested
with
nhs
england
come
to
us.
B
What
this
paragraph
is
attempting
to
say
is
that
that
work
is
ongoing,
I'm
not
being
deliberately
opaque
in
the
way
that
this
is
set
out,
but
there
is
now
a
working
group
process
been
introduced
in
this
by
the
departments
of
health
and
we'll
participate
in
that,
I
think
by
necessity.
That
means
that
this
decision
won't
be
arrived,
that
quickly
there
will
be
due
diligence
which
will
be
applied
to
this
decision.
B
So
what
we'll
continue
to
do
david
is
update
the
board
through
this
report,
and
then
you
can
track
progress
and
again
I'll,
be
very
happy
to
answer
any
questions
either
now
or
outside
of
this
meeting.
I
think
the
issues
which
are
also
causing
delay
are
simon's
requests
that
nhs
england
are
not
responsible
for
medical
revalidation.
B
That
said,
there
are
some
ideological
issues
that
people
hold
very
firmly
about
whether
the
regulator
should
be
the
organization
to
which
reports
are
made
and,
as
I
say
that
the
ideological
bit
here
is,
if
they're
reported
to
the
regulator
that
will
discourage
not
encourage
people
to
report.
It's
an
interesting
proposition
as
to
say
it's
ideological.
B
B
Item
11
is
amendment
to
the
schema
delegation.
These
are
all
consequential
on
the
2010
act
now
having
received
royal
assent
being
enacted,
and
I
ask
the
board
to
agree
to
these
changes.
I
hope
the
self-explanatory
briefly
stated
and
just
to
correct
my
report.
It's
to
ask
you
to
agree
item
11
rather
than
item
10.,
the
two
additional
items
david.
If
I
may
just
say,.
A
B
The
additional
item
to
report
is
that,
on
thursday
of
this
week,
we'll
publish
the
results
of
the
mental
health
survey.
This
is
a
regular
survey,
that's
carried
out,
and
these
are
treated
like
reports
from
the
national
statistics
office,
so
they
curse
closely
guarded
across
two
or
three
people
that
have
been
engaged
in
their
generation
production
and
finalization
and
will
be
published
on
thursday.
B
B
This
is
a
family
that
I
know
kaye
has
raised
previously,
and
james
chickamay
national
safety
advisor
has
been
heavily
involved
in
discussions
both
with
the
family
and
and
with
others.
It's
a
case
where
I
think
it's
first
to
say
david,
that
we've
got
huge
sympathy
with
the
family.
This
is
a
family
who
lost
their
daughter
over
10
years
ago
now
they've
raised
questions
about
the
care
and
treatment
their
daughter
received
and
how
that
care
and
treatment
has
contributed,
perhaps
contributed
to
the
death
of
their
daughter.
B
What
that
then
raise
is
an
issue
of
whether
we've
got
the
power
to
carry
out
an
investigation,
and
if
we
do
have
that
power,
what
is
the
nature
of
any
investigation
that
we
can
carry
out
well?
Section
48
of
the
2008
act
allows
us
to
carry
out
reviews
and
investigations.
That's
the
language
that
is
used
into
the
way,
and
there
are
four
or
five
clauses
to
this
particular
paragraph
and
one
of
the
clauses
which
is
generally
and
broadly
not
specifically
related
to
individual
cases
how
care
services
were
delivered.
B
That
continues
to
be
our
offer
in
relation
to
him.
I
think
the
family
are
probably
concerned
with
that.
They
want
more
than
that
they
want
more
than
we're
able
to
offer.
I
think
they
would
like
a
much
fuller
investigation
which
would
hold
people
to
account
if
they've
been
failures,
we're
not
able
to
carry
out
that
kind
of
investigation.
B
B
B
I
think
the
issue
that
the
family
are
raising
is
that
the
failure
wasn't
about
one
service
in
one
institution.
It
was
about
a
combination
of
services
and
institutions,
there's
probably
three
services
that
are
of
concern
here
so
actually
looking
more
broadly
across
people's
experience
of
services,
rather
than
the
specific
service
in
fairness
to
friendly
park,
they
have
carried
out
an
investigation
and
raised
some
issues,
and
one
could
say
that
they've
acted
entirely
appropriately
by
attempting
to
understand
what
happened
historically
in
relation
to
this
case.
B
But
nevertheless,
I
think
what
this
case
clearly
identifies
is
a
gap
in
the
system.
I
think
robert
francis
family
have
corresponded
with
robert
and
robert
wrote
to
me
prior
to
the
last
meeting.
I
suspect
david,
if
robertson
had
been
here
today
may
well
have
raised,
raises
raise
the
case
of
the
dixons
robert
has
also
identified
as
a
gap
in
the
system.
B
He's
been
asked
by
the
secretary
of
state
to
look
at
historic,
whistleblowing
cases
in
very
much
that
same
vein
as
there's
a
gap
in
the
system
and,
I
suspect,
there's
a
similar
piece
of
work
required
in
relation
to
a
gap
in
the
system
for
historic
complaints
like
like
the
one
that
the
dixon
family
are
raising
so
my
purpose
in
raising
it.
This
has
been
a
conversation
which
has
been
taking
place,
certainly
eileen
rebecca
james,
and
I
have
been
involved
in
conversation
in
relation
to.
B
How
can
we
demonstrate
our
sympathy
to
the
family
by
what
we
can
do
whilst-
and
I
hope
this
isn't-
a
bureaucratic
comment
remaining
within
the
powers
that
we've
got
for
a
variety
of
reasons
remaining
in
the
powers
that
we've
got
and
actually
working
with
the
family,
but
nevertheless,
I
think
it
does
identify
a
gap.
So
the
reason
in
raising
this
issue
today
is
just
to
again
to
use
one
of
the
phrases
that
paul
used
earlier.
B
C
Yeah
I
mean
thanks.
I
mean
that
was
my
understanding.
I
mean
there
are
kind
of
two
issues.
One
is
how
the
system,
not
necessarily
us,
but
the
system,
addresses
these
gaps
and
I'm
not
quite
sure
how
you
know
where
we
are
with
that,
because
you
know
there's
a
real
issue
about
how
in
investigations
independent
investigations
are
or
are
not
carried
out,
the
quality
of
them
commissions
them,
and
you
know,
thinking
ahead.
This
is
something
that
we
kind
of
need
to
need
to
sort
out.
C
You
know
I
mean,
is
I'm
not
sure
it's
the
role
of
cqc
to
investigate
these
individual
failures
of
care,
but
it
could
be
a
role,
for
example,
in
overseeing
how
a
provider
investigates.
This
kind
of
you
know
catastrophic
failure,
you
know
standards
or
something
and
we
kind
of
hold
them
to
account
for
doing
it
in
a
way,
that's
open,
transparent,
robust.
C
You
know,
so
you
know,
I
think
you
know,
there's
been
a
lot
said
on
this,
but
but
I'm
still
not
very
clear
about
you
know
we
all
agree,
there's
a
gap,
but
I'm
not
clear.
You
know
what
the
trajectory
is.
You
know
what
are
we
actually
going
to
get
to
a
point
where
we've
kind
of
resolved
this
issue,
and
I
I
I
don't
think
it's
the
cqc
to
investigate
all
these
cases.
Personally,
that's
my
personal
view.
C
Then.
The
other
issue
is
this.
Is
this?
Is
the
family
really
and
there
are
other
families
as
well?
You
know,
and
it's
it's
difficult
to
think
and
it's
the
same
for
whistleblowers
as
well
of
a
mechanism
that
could
actually
get
some
closure
answers
justice
for
for
for
these
people,
I
mean
they're,
quite
a
lot
of
them
and
I
just
think
is
it
actually
possible
and
I'm
not
so
sure
it
is
because
what
we
offer
is,
we
will
listen
and
we
will
learn-
and
I
think
you
know
we
are
actually
doing
that
quite
well.
C
J
J
So
that's
not
a
commitment,
because
I
couldn't
possibly
make
that
without
conversation
with
the
the
the
staff
and
the
committee
at
health
watching
them.
But
it's
to
say
it
is
emerging
for
us
too,
and
I
think
it
is
a
so
I
think
we
should
be
cautious
here
at
the
cqc
board
and
cqc
about
taking
it
on,
because
I
think
it's
bigger
than
than
us
and
outside
our
our
purview.
But
I
do
think
it's
important
that
someone
addresses
it
and
it
may
be
that
there's
something
we
could
usefully
do
at
healthwatch
england.
J
H
Just
two
brief
points:
my
own
brief
conversation
with
the
family
made
it
very
clear
that
they
were
very
disappointed
that
nhs
england
appeared
to
have
offered
something.
It
then
withdrew
and
I
think,
he's
absolutely
right
about
raising
expectations,
but
I
I
I'm
interested
to
know
how
that
happened,
because
I
think
that
was
really
very
unfortunate
indeed,
and
I
think
nhs
england
also
misled
the
cqc
into
what
it
was
proposing,
and
it
may
be
that
that's
it's
not
in
its
remit,
but
I
don't
quite
understand
how
it
got
itself
into
that
position.
H
H
Are
we
going
to
use
cases
like
that
to
have
the
conversation
with
the
chief
executive?
Even
if
they
weren't
the
person
imposed?
Are
we
having
those
confidence?
Are
we
actually
going
into
the
room
and
saying
well
on
our
shopping
list
happens
to
be.
You
know
these
three
cases
that
your
organization
failed
to
properly
investigate,
and
I
just
wonder
is
that
going
to
be
it's?
J
So
in
in
relation
to
at
least
one
of
the
cases
that
that
I
I'm
very
aware
of,
has
come
to
us
actually
a
very
similar
thing
where
nhsc
undertook
to
do
an
investigation
and
then
change
the
terms
of
that
investigation,
which
made
it
less
satisfactory.
So
I
mean
not
to
make
them
wholly
responsible
for
all
of
this,
but
I
mean
it's
just
a
point
to
the
fact
that
this
we
are
not
collectively
managing
this
very,
very
well.
B
So
two
or
three
things
I
think
joanna
and
kay.
I
think
what
robert
has
been
asked
to
do
in
relation
to
historic
whistleblowers
is
really
helpful,
because
it's
a
kind
of
let's
pause
and
think
this
through
and
think
it
through
in
the
round,
rather
than
the
difficulty
of
this,
is
people
reach
for
an
immediate
solution
and
say
what
we
need
to
do
is
this
and
it
needs
to
be
thought
through
in
the
round.
I
know
your
analysis
that
different
people
can
actually
play
different
contributions
to
this.
B
So
there
are
different
bits
of
the
system.
The
coroner's
court
can
reopen
inquiries,
the
standard
and
the
threshold
for
it
is
quite
high,
but
if
there's
new
and
different
information,
then
that
can
be
triggered
so
they're
all
different
ways,
but
none
of
themselves
are
perfect
in.
I
think
what
you've
been
referring
to,
which
is
often
what
a
lot
of
families
want,
and
I
think
a
lot
of
the
families
want
somebody
to
be
accountable
for
what
happened.
B
So
I
think
they've
gone
beyond
understanding.
What
happened?
They've
gone
beyond
an
apology
being
an
acceptable
resolution
to
it.
They
actually
want
somebody
to
be
held
to
account,
and
there
probably
is
a
relationship
between
the
longer.
This
has
gone
on
the
more
that
people
are
into
wanting
an
accountability
outcome
from
this,
rather
than
an
understanding,
but
that
needs
thinking
through
and
conversations
need
to
be
had.
I
do
think
the
duty
of
cando,
although
it
won't
be
retrospective,
will
actually
change
this
dynamic,
very,
very
powerfully.
B
So
I
think
careful
thoughts
and
thinking
it
through
and
healthwatch
playing
a
role
in
that
and
I'm
I'm
sure,
he's
right
for
all
the
cases
we
get
to
know
about.
I'm
sure
there
are
lots
that
we
don't
get
to
know
about
as
well,
because
people
are
with
solicitors
or
battling
it
through
by
themselves
and
raising
it
in
all
kind
of
different
ways.
B
B
B
Us
working
by
ourselves
meant
that
one
of
the
phrases
I've
used
is
we
were
the
last
person
standing
in
relation
to
the
offer.
I
don't
want
us
to
withdraw
that
offer,
but
I'm
also
aware
that
the
family
probably
won't
be
satisfied
with
the
offer
that
we're
making
and
that's
the
gap.
So
that's
that's
what
happened.
B
And
I
think
the
way
this
has
been
reported
subsequently,
I
think
that
story
is
out
because
the
family
have
told
the
story.
I
think
they
know,
because
my
colleagues,
eileen
and
colleagues
that
we're
dealing
with
the
family
have
been
quite
open
with
them
about
where
we
were
at,
and
this
decision
was
taken
on
the
friday
before
the
family
were
coming
in
for
a
meeting
on
the
monday.
So
by
that
time
it
had
been
explained
to
them
why
they
were
coming
in
for
a
meeting
and
what
the
purpose
of
the
meeting
was.
B
So
the
the
expectations
have
been
being
raised.
The
cruelty
of
this
there
isn't
another
way,
I'm
with
k
on
this,
while
expectations
were
raised
to
be
to
be
taken
away.
So
this
is
really
what's
behind
the
phrase
we
we
do
have
sympathy
for
this
family
relation
to
the
well-led
bit.
My
mike
will
say
about
what
we're
doing
now.
The
trickiness
about
a
case
which
goes
back
over
10
years
is
it
doesn't
raise
immediate
issues
of
safety
and
indeed,
we've
been
into
friendly
part,
which
is
the
hospital
we've
not
yet
announced
that.
B
B
If
this
was
a
recent
case
where
the
current
management
or
board
of
the
hospital
were
the
same
as
when
the
incident
occurred
now,
then
I
think
legitimately
we
would
say
there
is
no
doubt
that
we've
got
a
role
to
play
in
this,
and
this
case
raises
an
issue
about
leadership,
the
culture
of
safety
and
quality,
but
because
it's
a
historic
case
over
10
years,
it
does
raise
separate,
separate
issues.
So
there
are
other
families
have
raised
their
concerns
about
where
they've
been
dealt
with,
which
are
more
contemporary.
B
Where
we
are
able
to
say
we
will
look
at
this
specifically
in
the
next
inspection.
I
think
we've
mike
and
myself
have
talked
about
meeting
families
in
bristol
who
have
raised
their
concerns
around
pediatric
cardiac
surgery.
We
can
actually
take
that
is
live
information
which
does
raise
questions
that
we
think
we
need
to
explore
when
we
carry
out
the
inspection.
Is
this
it's
this
historic
cases
and
there
is
a
case
about
how
old
do
they
have
to
be.
B
I
I
personally
think
this
is
a
danger
of
making
personal
statements,
which
is
why
it
needs
thinking
through
about
five
years
ago.
I
think
there
would
have
been
a
different
response
to
this.
Is
time
expired
and
I
think
hillsborough
rochdale
stuff
in
south
yorkshire
means
I
don't
think
he
can.
I
don't
think
there's
any
currency
in
saying
something's
time
expired.
B
I
think
that
argument
is
now
gone
in
public
services.
I
think
we've
got
to
say
this
happened.
People
are
aggrieved
by
it.
There
needs
to
be
some
form,
some
mechanism,
that
people
can
get
some
way
of
achieving
satisfaction
in
relation
to
that.
So
those
of
us
that
say,
I'm
sorry,
we've
got
it's
three
years.
It's
time
expired.
I
don't
think
that
works
now.
I
think
the
whole
nature
of
this
debate
has
changed,
which
is
why
I
think
this
issue
about
thinking
it
through
carefully
needs
to
be
taken
forward.
C
So
sorry,
this
is
just
a
quick
point,
it's
about
where
there
are
concurrent
issues
raised,
and
I
I'm
still
slightly
young.
This
is
a
slightly
separate
question,
but
where
we
say
okay,
we
will
scoop
up
this
intelligence
and
when
we
next
inspect,
we
will
then
look
for
this
or
the
issue
or
where
we
say.
Actually
it
could
be
that
our
inspection
simply
is
not
the
right
lens
to
look
at
this
particular
issue.
C
That's
raised,
therefore,
we
will
have
a
special
investigation
of
what
sort
I
just
I
I
kind
of
I
don't
feel
totally,
because
we
kind
of
have
had
discussions
about
special
investigations
and
I
just
wonder
where
we
are
on
the
criteria
for
those
and
precisely
what
have
we
have?
We
bottomed
out
our
thinking
in
that
area.
This
is
on
contemporary
issues,
but
actually
you
could
also
say
in
the
light
of
this
conversation,
that
the
special
investigation
could
respond
to
a
historic
problem
where
there's
more
than
one
incidence
there's
a
pattern
of.
K
Just
to
respond
to
that
at
the
moment,
we
we
do
it
on
a
case-by-case
basis
and
there
are
at
least
a
couple
of
focused
inspections
that
I
can
think
of
that
have
been
triggered,
particularly
in
those
cases
by
whistleblowing
where
we
would
then
looked
at
a
specific
aspect
of
care
delivered
in
the
trust.
But
then
we've
used
what
comes
out
of
that
focused
inspection
to
inform
our
comprehensive
inspection
which,
in
both
cases,
took
place
within
about
six
months
of
the
of
the
focused
in
inspection.
C
It's
only
the
I
mean
this
is
difficult,
because
the
problems
have
so
many
facets,
but
I'm
just
wondering
whether
we
have
clarity
in
order
for
consistency
in
our
judgment
as
to
what
is
a
special
investigation
and
what
can
wait
until
that's
that's
all
it's
the
threshold
is
to
make
it
in
surfacing
it.
It
might
be
useful
to
protect
us
in
a
sense
and
to
protect
families.
B
B
So
I
think
we
have
done
the
work
that
we've
referred
to
on.
Where
do
we
carry
out
investigations?
What
are
the
thresholds
by
we've
gone
through
the
thematic
studies
etc?
But
I
think
in
truth,
jennifer
we're
still
working
that
out.
Each
individual
case
on
its
merits
is
where
we
are,
as
mike
said,
we
will
bring
forward
action,
we'll
get
complaints
that
mean
that
we'll
go
in
straight
away
and
look
at
what's
been
referred
to
us
and
there'll,
be
others
we'll
say
well.
Actually
we
do
know
about
this.
B
B
Our
plans
will
do
exactly
that
in
relation
to
primary
medical
services
and
adult
social
care,
as
well
in
in
truth,
but
I
think
this
is
something
we
continue
to
work
at
without
stealing
into
the
next
debate
david.
But
it
seems
to
me
that
my
reference
to
the
duty
of
canada
is,
I
think
we
may
well
get
more
individual
cases
referred
to
us
where
people
feel
that
they've
not
been
told,
in
inverted
commas,
the
truth
in
relation
to
an
incident
that
has
happened
to
them.
B
I
wouldn't
want
to
say
that
we've
actually
resolved
this
and
to
use
your
phrase
bottomed
it.
I
think
it
is
something
that
we
continue
to
work
on,
because
it
is
inherently
difficult.
When
does
an
individual
case
flag,
something
about
the
safety
of
the
way
an
organization
is,
should
we
be
looking
for
the
patterns?
Well,
I
think
we
are
clear
on
that.
Yes,
we
do
need
to
look
for
the
patterns,
but
on
these
individual
cases,
what
what
weight
do
we
give
that
so
at
the
minute
we
are
considering
each
one
and
they
do
get
weighed.
A
I
suggest
that
on
the
historic
cases
like
this
tragic
case
of
the
dixons
that
we
have
accomplished
with
robert
francis
outside
this
meeting
and
kick
it
and
just
think
it
through
a
little
bit
more
and
maybe
bring
it
back
into
the
next
meeting,
we'll
get
a
chance
to
do
that.
That'd
be
all
right,
because
I
do
think
there
are
so
many
analogies
with
the
work
he's
doing
on
on
the
old
whistleblowing
cases
as
well.
There
may
be
a
way
of
tying
this
into
into
that
in
into
that
investigation.
He's
doing
on
that.
A
F
So
this
is
the
item
about
the
provider
handbooks
and
links
to
lewis's.
Earlier
comment.
By
way
of
context,
we've
been
through
a
significant
process
of
consultation
since
we
released
the
draft
provider.
Handbooks
back
in
april
board
will
remember
that
we
do
handbooks
for
a
number
of
the
different
sectors
in
line
with
our
sector-specific
regulations.
So,
for
example,
domiciliary
care
is
separate
to
residential
care
in
andrea's
sectors
and
separate
again
to
hospice
care
in
mic
sectors.
We
have
separate
handbooks
for
mental
health,
for
community
health
services
and
for
acute
trusts.
F
In
terms
of
when
we
would
plan
to
publish
subject
to
boards
views
today,
we
plan
publication
in
three
tranches,
so
on
the
25th
so
week
on
thursday
week
tomorrow
we
would
pla,
we
would
publish
the
handbooks
for
mike
sectors
and
also
the
appendices
which
set
out
the
detail,
key
lines
of
inquiries
and
characteristics
of
good
and
other
ratings
levels
for
adult
social
care.
That's
to
give
people
the
maximum
providers
the
maximum
time
to
understand
what
we
will
be
assessing
from
october
onwards.
F
F
I
mean
that's
an
important
principle
so
that
we're
not
forever
changing
how
people
are
assessed.
There's
a
there's,
a
consistent
baseline
that
doesn't
mean
that
every
aspect
of
the
detail,
of
what
precise
questions
or
the
way
in
which
information
might
be
elicited
is
locked
for
two
years
and
that'd
be
a
big
mistake,
because
we
will
learn
as
we
go.
But
the
key
point
is
the
framework
against
which
we're
judging
is
locked.
J
I
I
just
want
to
test
it,
if
that's
okay,
so
to
make
sure
I
understand
it
and
and
feel
comfortable
with
it.
So
so
one
of
the
things
that
we're
doing
alongside
the
inspections
is
the
thematic
work
and
one
of
the
important
elements
of
the
thematic
work
is
that
it
tells
us
something
about
the
boundaries
between
different
sectors,
and
we
know
that
at
the
moment,
our
our
key
lines
of
inquiry
don't
take
probably
proper
account
of
that
integrated
pathway
as
opposed
to
the
sexual
issues.
J
Because
that's
why
we're
doing
the
thematic
studies,
because
we
want
to
understand
more
about
the
passing
across
between
different
different
sectors.
So
we've
we,
you
mentioned
in
your
report,
the
thematic
report
on
on
dementia,
and
that
that
indicates
that
there
are
indeed
some
issues
about
exactly
those
boundary
questions.
So
I
would
want
us
to
be
able,
as
we
look
at
that,
that
report
and
others
of
that
sort
to
build
into
our
inspections.
J
F
So
I
might
do
this
by
way
of
an
example
and
use
dementia
if
it's
helpful,
the
handbooks
are
deliberately
provider
specific,
so
by
definition,
they're
not
going
to
start
from
the
perspective
of
a
patient's
care
right
throughout
their
journey.
So
there's
a
limitation
and
it's
acknowledged,
and
they
don't
try
to
solve
that
entirely.
F
So
we
might
take
them
as
a
case
example,
and
we've
talked
about
that
in
the
past,
for
people
with
dementia
people
with
diabetes
with
a
learning
disability
or
a
mental
health
condition.
All
of
that
would
be
totally
reasonable
to
look
at
and
and
change
as
we
go
through
the
the
years
ahead
of
the
months
ahead.
But
what
we
wouldn't
do
is
fundamentally
change
how
we
would
judge
good
for
a
provider
against
the
key
against
the
individual
ratings
core
services
and
the
key
lines
of
inquiry.
J
So,
just
to
continue,
because
I
think
it's
impor
important
to
know
how
much
flexibility
we've
got
or
not.
So
if,
if
we
established
in
again
I'm
using
that
example,
because
because
it's
kind
of
current
at
present
in
our
minds
that
actually
the
key
lines
of
the
the
way
we
phrased,
the
key
line
of
inquiry
in
relation
to
discharge
was
not
fit
for
purpose.
Because
having
done
the
dementia
review,
we
had
established.
Actually
we
needed
to
be
asking
the
question
in
a
different
way
or
a
different
set
of
questions.
F
That
is
right
and
if
there
was
an
overwhelming
reason,
I
think
there's
a
reasonableness
test
if
we
found,
for
whatever
reason,
perhaps
that
the
way
in
which
care
was
being
delivered
fundamentally
changed.
Of
course
we
would
update
it,
but
the
principle
is
that
that
the
key
lance
inquiry
wouldn't
change.
The
prompts,
however,
could
change,
and
we
could,
for
example,
on
dementia,
one
or
four
people
in
a
hospital
bed
like
to
have
dementia.
F
J
So
can
I
just
one
one
one
more
so
so
so
a
couple
of
questions,
then?
How
long
are
we
locking
it
down
for?
What's
the
cycle
and-
and
I
suspect
it's
probably
different
in
the
different
sectors,
but
what's
how?
How
long
are
we
locking
it
down
for
and
what
would
a
reasonable
test?
Look
like,
because
my
I
suppose
my
my
concern
in
respect
of
this
specific
is
that
we
have,
quite
rightly,
and
understandably-
and
you
know,
knowingly
decided
to
build
our
inspection
regimes
around
sectors.
F
I
know
andrea
wants
to
come
in
on
this
as
well.
Two
years
is
the
proposal,
but
I
think
the
specific
of
that
is
until
we've
got
round
to
everybody
once
on
rating
on
a
sector.
So
in
some
cases
our
current
commitments
are
shorter
than
the
two-year
time
scale.
But
two
years
is
our:
you
know
our
mental
model,
but
the
the
principle
is
so
that
we've
rated
everybody
in
that
sector.
F
What
would
the
reasonableness
test
be?
Well,
I
think
we
would
need
to
do
it
on
that
case
by
case,
but
I
think
we
would
set
the
bar
very
high,
otherwise
everything
will
be
well.
We
could
do
it.
We
could
tweak
that,
but
what
I
would
say
is
the
key
lines.
Inquiry
are
high
level
to
take
the
safety
key
lines
inquiry
the
the
first
one
is:
what
is
the
record
on
past
harm?
F
That's
a
very
broad
set
question
under
which
there
are
a
whole
series
of
prompts,
and
we
may
well
want
to
change
the
process
if
we
find
to
take
an
example,
another
thematic,
if
we
would
define
that
it
turns
out
the
urine
tract
infections
are
skyrocketing
in
an
area.
We
would
absolutely
want
to
encourage
our
inspectors
to
ask
more
questions
about
the
wear,
uti
management
and
hydration,
but
that
wouldn't
be
about
changing
the
key
line
of
inquiry.
D
So
it
was
just
to
to
reinforce
some
of
the
things
that
that
paul
has
said,
but
to
give
hopefully
additional
assurance
for
anna
and
the
board.
I
mean
the
critical
reason
why
we
we
need
to
do
this.
Is
that
issue?
That's
constantly
raised
with
us
about
consistency
in
terms
of
the
judgments
that
we're
making
and
ensuring
that,
when
we're
publishing
the
assessments
that
we're
making
that
people
can
see
that
that's
comparable
from
you
know,
northumberland,
to
nether
wallop.
D
So
there's
a
there's,
a
really
good
reason
for
it
behind
it,
and
also
a
really
important
thing
in
terms
of
ensuring
that,
across
all
of
our
three
inspection
directorates,
we're
training
our
staff
so
that
they
understand
and
know
what
it
is
that
they
should
be
looking
at.
And
how
and
we're
not
constantly
changing
the
goal
posts
for
them
either,
because
that
that
you,
in
the
period
of
time
that
we've
had
in
adult
social
care
of
doing
two
ways
of
inspection
and
then
preparing
for
full
rollout.
D
We
have
been
changing
things
and
that
has
been
very,
very
stressful
for
people
to
cope
with,
but
paul's
right.
The
key
lines
of
inquiry
are,
at
a,
I
think,
a
sufficiently
high
level
for
us
to
be
able
to
inform
them
with
the
better
understanding
of
what
good
looks
like
in
certain
services,
and
that
certainly
knew
taking
dementia
as
an
example.
D
That's
certainly
one
of
the
things
that
we'd
be
wanting
to
do
in
in
adult
social
care
is
ensure
that
we
we
ask
people
to
to
look
at
the
environment
and
ensure
that
it's
effective
and
responsive
to
people's
needs.
Well,
if
something
comes
out
that
says
this
is
the
blinding
the
obvious
thing
that
you
should
be
doing
about
the
environment.
D
That
would
be
making
sure
that
that
people
knew
that
and
the
last,
but
not
leastly
point
is
the
the
bit
that
kind
of
prompted
you
to
get
into
this
anna
was
the
the
link
across.
So
you
know,
we
are
regulating
locations
and
services,
we're
not
regulating
the
pathway
of
care,
but
in
the
questions
that
we
are
asking
about,
whether
a
service
is
well
led.
D
One
of
the
absolutely
critical
aspects
of
that
is
how
well
are
the
services
working
with
others
to
support
the
needs
of
the
people
who
are
using
that
service
and
again.
I
think
that
helps
us
to
get
into
some
of
the
things
that
the
dementia
themed
work
was
exposing
which,
for
example,
is
the
transfer
of
information
from
care
home
to
hospital
from
hospital
to
care
home.
I
Thanks
well
broadly,
I'm
in
favor
of
the
having
a
period
of
stability.
I
think
it's
only
fair
to
the
people.
We
rate
to
say
that
for
a
period
of
time,
we're
not
going
to
make
major
changes,
but
there
is
a
a
broader
issue
here,
I
think,
than
the
thematic
review.
I
agree
with
you
the
thrust
of
your
question
anna,
but
it
is
also
about
the
other
areas
of
information
that
we
take
in
in
making
a
judgment.
At
the
moment
we
have
a
system
where
we
have.
I
There
are
several
components
of
how
we're
judging,
but
in
the
end,
we
have
an
inspection
based
rating,
and
so,
if
you
find
something
which
I
think,
if
I
understood
your
last
answer,
that
has
come
out
of
a
thematic
review,
then
what
that
will
do
is
influence.
How
you
then
approach
the
inspection.
What
how
you
ask
ask
the
questions
and
how
far
you
go
in
exploring?
What's
what's
come
through
the
thematic
approach,
but
it
might
be
more
than
that.
I
It
might
be
that
we
get
a
point
where
the
our
ability
to
collect
better
patient
information,
our
ability
to
use
statistical
data
reaches
the
point
where
it
isn't
enough
to
allow
the
inspection
process
to
be
a
filter
through
which
that
information
is
then
reassessed
that,
if
you've
got
enough
data
from
the
statistics
to
say
that
that's
rating
should
be
requires
improvement.
That
should
be
the
rating
and
the
inspection
can't
in
the
end.
I
No,
no
the
inspection
can't
it
when
we
get
to
that
point
that
that
we
can't
then
have
the
inspection
trumping
all
other
sources
of
information.
The
inspection
is
a
is
a
potentially
flawed
way
of
judging
because
it's
time
limited,
it's
a
snapshot,
and
it's
up
to
us.
This
is
I'm
afraid
why
my
strategic
question
does
need
an
answer.
I
The
we
have
to
be
looking
to
to
enhance
the
impact
of
the
statistical
data,
the
patient
data,
the
complaint
data
and
and
the
way
that
trusts
respond
to
what
they're
told
and
that
will
reset
the
balance
of
what
the
inspections
are
for.
They're,
not
really
just
to
filter
anything
else.
We
get
to
see
if
it's
true,
they
are
there
to
offer
a
different,
a
a
in
the
end,
a
component
of
how
we
assess
the
trusts,
and
so
I
I
agree
with
the
two
years,
but
it
is
more
than
just
a
period
of
stability.
I
F
Yeah
so
because
of
com,
we
agree
with
at
this
point
lewis
we
set
out
very
clearly
in
the
handbooks,
both
in
the
consultation
version
and
the
final
versions,
subject
to
what
we
discussed
today,
that
there
are
that
inspection
does
not
equal
judgment.
There
are
four
components:
we
have
a
little
jigsaw
picture
of
which
inspection
is
just
one
for
people's
edification,
the
the
four
are
the
ongoing
relationship
with
the
provider
and
all
the
information
we
get
from
them
in
the
run-up,
but
also
throughout
the
year.
F
Secondly,
all
the
intelligent
monitoring,
whatever
source
that
comes
from
that's,
not
just
the
quantitative
data,
but
to
the
earlier
discussion.
We
need
to
build
up
that
qualitative
side.
The
third
is
in
the
up
to
20
week
period,
pre-inspection
all
the
work,
that's
made
that
the
data
was
made
available
to
us
that
we
wouldn't
otherwise
get.
Of
course
that
has
a
heavy
emphasis
on
listening
to
people's
concerns
and
staff
concerns
in
that
pre-inspection
period
and
then
there's
the
inspection
itself.
F
Now,
let's
not
pretend,
though,
that
inspection
is
a
very
significant
element
of
it
and
can
suddenly
be
seen
as
the
dominant
element.
I
think
kieran's
report
shows
and
the
data
in
the
way
our
inspectors
see
what's
the
most
relative
levels
of
importance
and
they
clearly
see
the
act
of
the
inspection
as
the
most
important
currently.
F
So
I
think
your
your
point
that
that
we
should
challenge
whether
that
is
the
right
place
to
to
stay
is
well
taken
and
we
are
doing
that
through
the
intelligence
driven
work,
but
equally
we
have
no
plans
to
set
out.
Someone
said
at
the
moment:
it's
inspection
that
is
it
equals
regulation.
It
must
stay
as
those
four
components.
F
K
I'm
can
I
just
come
in
on
this,
but
because
actually
we're
already
doing
it
lewis.
If
you
come
to
the
acute
inspections,
you
will
find
that
it
is
a
balance.
It
is
a
blend
of
the
data
and
what
we
see
on
inspection
and
in
some
domains.
It
is
much
more
strongly
data
than
it
is
inspection.
You
cannot
in
an
acute
hospital
judge.
K
I
But
that's
fine,
I
don't
think
that's
enough!
The
because
the
we,
the
good
the
good
information.
Of
course
it
would
be
appalling
if
we
were
saying
we
weren't
taking
account
of
good
information,
but
a
lot
of
the
information
isn't
any
good,
that's
the
problem
and
as
that
gets
better,
as
that
gets
better.
The
balance
of
how
that
information
is
influences
ratings
has
to
change.
I
Now
that
will
affect
what
we've
just
said
about
locking
things
down
for
for
two
years,
it's
bound
to
effect.
Well,
I
can't
see
how
it
can
and
and
so
as
an
inspection
in
some
ways.
If
we
had
really
good
data
the
inspection,
the
role
of
inspection
could
be
more
targeted,
it
could
be
less
subjective
and
it
could
improve
so
it.
I
I
don't
think
it
necessarily
does
your
other
job
mike,
but
it
does
change
the
nature
of
our
reliance
on
different
bits
of
an
evaluation
system,
and
so
my
point
is
that
I
agree
with
the
two
years.
I
agree
with
the
composite
approach
to
ratings,
but
it
will
change
and
and
if
it
it
has
to
and
and
that
change
is
partly
based
on
having
more
reliable
data
which
inspections
struggle
to
provide.
I
would
say.
D
Sorry
could
I
could
I
just
say
I
don't
want
to
prolong
the
discussion,
but,
yes,
we
need
better
data,
but
we
will
be
looking
at
things
across
adult
social
care
and
primary
medical
services
and
hospitals,
mental
health
and
all
the
rest
of
it,
and
it
will
be
slightly
different
in
all
of
those
areas.
So
when
we
have
the
discussion
in
the
future
about
how
we're
influencing
what
we're
doing,
we
have
to
understand
that
we're
in
different
places
in
terms
of
the
both
the
quality
and
quantity
of
the
data
that
we've
got
available
to
us.
A
I
think
paul,
I
think,
where
we
are,
is
that
there's
a
general
agreement
for
the
sake
of
consistency.
We
need
to
have
some
lockdown,
but
there
does
need
to
be
a
reasonable
override.
On
that
I
mean
if
something
fundamentally
changed
the
data
of
the
next
two
years,
for
example,
the
balance
between
looking
at
objective
data
and
inspections
changed
or
on
anna's
point
in
terms
of
the
integrated
care
pathways
accountable
care
organizations.
The
like
you
know,
we
need
to
have
some
flexibility
around
those
sort
of
big
issues
if
they
change.
F
I
I
hear
that,
on
the
reasons
we
can
also
take
to
where,
if
it's
helpful,
to
sort
of
to
set
criteria,
we
can
certainly
think
it
through,
but
I
want
to
be
really
clear
that
you
would
have
an
enormous
swing
in
the
quality
of
data
in
a
sector,
for
example,
take
the
past
times.
Example
on
the
first
key
line
of
acquiring
safety.
F
F
A
Say
this,
I
don't
hate
you
to
think
I
was
being
dismissive
of
your
point
because
I
think
it
is
a
hugely
important
one
and
so
and
we
definitely
need
to
keep
coming
back
to
it.
Actually,
this
balance
between
objective
data,
good
data
and
inspection-
I
mean
it
is
extremely
important,
so
I
mean
keep
banging
away
at
it.
I
think,
is
the
message,
because
it
is
very
important,
michael.
E
Yeah.
Apologies
if
I
was
out
of
the
room
when
this
was
discussed,
but
it
does
link
to
lewis's
point,
which
I
completely
agree
with.
I.
I
am
not
entirely
sure
about
the
idea,
and
so
I'm
not
sure
whether
you
got
to
this
or
about
to
get
to
this
of
ditching
the
characteristics
of
good
against
each
of
the
key
lines
of
inquiries,
because
I
actually
thought
the
characteristics
of
good
was
probably
the
strongest
part
of
the
the
key
lines
of
inquiry.
E
For
example,
you
know
one
of
the
safety
in
acute
hospitals,
there's
a
safety
key
line
of
inquiry.
S2
has
the
provider
learned
when
things
go
wrong
and
improve
safety
standards
as
a
result
and
one
of
the
characteristics
of
good
is
the
provider
investigates
when
things
goes
wrong,
using
robust
approaches,
including
root,
cause
analysis
and
so
on?
E
You
know
which
are
used
for
answering
the
key
question.
I
mean
the
you
know:
what
were
the
five
domains
now
the
five
key
questions,
but
as
you
go
through
these
characteristics
as
a
good,
numerous
parts
of
them,
I
think,
are
open
to
being
able
to
ask
the
you
know,
in
this
case
the
hospital
or
the
trust
beforehand,
as
opposed
to
trying
to
answer
this
question
during
the
inspection
itself,.
K
K
So
that's
very
much
the
direction
of
travel.
How
far
are
they
down
the
line
towards
providing
seven-day
services?
Well,
if
we
have
a
questionnaire
that
asks
about
what's
going
on
in
gastroenterology
and
respiratory
medicine
and
intensification
whatever
it
may
be,
we
we
can
get
that
information
and
it
will
make
our
time
on
site
much
much
more
effective
and
could
potentially
even
affect
the
size
of
our
teams.
I'm
not
saying
it
will.
E
E
I
don't
know
if
we've
got
powers
to
do
it
or
powers
to
compel
answers
to
it
or
whatever,
but
you
know,
perhaps
we
should
be
sending
this
every
six
months
or
some
version
of
it
as
opposed
to
every
two
years
in
the
oh,
I
think
camilla
is
thinking.
This
is
a
huge
burden
on
hospitals,
but
it's
you
know
if
these
are
really
important
questions
and
to
take
lewis's
point
make
you
know
these
these
difficult
judgments
more
susceptible
to
you
know,
rigorous
analysis
or
statistical
analysis.
I
think
that
would
be
helpful.
K
I
think
at
this
stage
we're
very
keen
for
the
trusts
to
to
report,
but
the
assessment
remains
in
our
hands
and-
and
that's
certainly
my
experience
from
previous
roles-
that
actually
you
can
get
facts
and
figures
out
of
organizations,
but
we
still
need
to
be
in
charge
of
deciding
what,
whether
that's
good.
But
I
you
know,
I
think
we
are
still
developing
the
model
pre-inspection
questionnaire,
but
that
won't
be
stopped
by
a
lockdown
that
you
know
that
that
that
that
can
go
on
and
we
will
get
get
better
and
better
at
that.
F
Yeah,
so
this
was
partly
a
conversation
that
started
at
the
regulatory
governance
and
values
committee
yesterday,
this
this
sense
of
what
information
we
can
ask
and
how
we
can
ask
it
in
a
more
structured
way,
and
it's
sparked
an
internal
conversation
with
david
and
michael
myself
on
the
hospital
side
subject
to
our
policy.
Colleagues,
in
my
era,
look
at
the
fine
detail
of
it.
I
think
we
would
want
to
give
quite
a
strong
statement
about
this
being
the
way
we
will
do
things
that
may
well.
F
That
would,
I
think,
stop
short
of
self-assessment,
but
we
would
expect
a
clear
and
open
statement
from
our
providers
in
the
hospital
sector,
certainly
as
to
what
you
know
they
saw
their
quality
being
we
have
now
that
we
have
an
assessment
framework.
I
think
it
will
also
put
to
rest
some
of
the
things
that
are
reported
about
how
we
just
turn
up
and
tell
people
what
they
already
know.
Let's
find
out,
shall
we,
it
was
really
the
latter.
E
Point
which
led
to
the
discussion
yesterday,
which
is
that
it's
probably
not
true
when
trusts,
say
that
we
knew
about
all
of
this
already,
but
at
the
moment
we've
got
no
ability
to
counter
that
argument,
and
you
know
we
all
said
you
know.
Paul
is
a
you
know,
a
former
partner,
pwc
and
myself.
You
know
we're
used
to
client
and
saying
well.
We
knew
this
you're
just
telling
us
what
we
already
knew.
So,
therefore,
if
part
of
the
20
weeks
was
actually
asking
the
provider,
you
know
what
do
you?
E
D
A
Can
we
go
back
to
the
question
which
was
locking
it
down
for
two
years?
I
think
in
the
interest
of
consistency,
the
argument
for
locking
it
down
is
is
accepted,
but
there
are
some
caveats
I
mean
it's
clearly
there's
a
major
change,
then
bringing
back
to
the
bald
pool,
but
in
principle
I
think
we'll
agree
with
the
two
years.
Is
that
all
right?
A
F
F
So
that's
one
way
to
do
it
and
the
team
is
just
looking
through
that
we
have
a
series
of
proposals
which
are
in
the
information
section
about
getting
better
at
the
recording
of
how
each
key
line
of
inquiry
was
closed
and
the
evidence
for
that,
and
we
will
invest
in
systems
to
make
sure
that's
that
happens.
That
was
a
particular
recommendation
for
national
information
governance
committee,
as
you
see
in
the
later
paper.
F
So
as
this
was
based
on
quite
strong
feedback
from
the
consultation,
including
from
our
inspectors
on
how
it
was
best
to
to
inspect
and
regulate,
and
they
were
worried,
I
was
worried
that
we
would
move
to
a
tick
box
culture
if
we
just
said,
if
you
see
these
good
things
at
the
key
line
of
inquiry
level,
then
away
you
go,
we
think
this
is
the
right
thing
to
do.
We
also
think
it's
the
right
thing
to
do
to
put
safeguards
in
place,
so
we
don't
lose
the
valuable
information
that
was
there.
F
Okay,
two
additional
key
lines
of
inquiry
that
we
would
want
to
include
that's
one
on
consent
and
bringing
consent
key
line
and
requiring
the
mental
capacity
act
quinoa
into
into
a
single
chloe
and
the
other
is
for
the
health
providers.
So
that's
the
providers
covered
by
steve
and
mike's
areas,
for
the
avoidance
of
doubt
to
have
a
specific
key
line
of
inquiry
about
the
qual.
F
The
way
in
which
information
is
used
to
give
good
care,
and
by
that
I
mean
at
the
moment,
in
the
draft
reports,
we
have
a
number
of
prompts
buried
in
different
key
lines:
inquiry
that
look
at
different
levels
of
information,
information,
governance,
but
again,
as
the
national
information
governance
committee
advised
us
and
I
think
internal
discussions
as
well.
We
weren't
putting
due
emphasis
on
if
you
are
a
doctor
with
a
looking
or
treating
an
individual
patient.
Do
you
have
the
information
you
need
to
make
the
right
diagnosis
care
plan
treatment?
F
Do
you
have
the
scans
the
path
tests,
the
case
history
and
so
forth?
And
we
wanted
to
elevate
that
to
a
key
line
of
inquiry
and
then
record
the
evidence
as
to
whether
or
not
that
that
line
macquarie
was
closed
with
the
provider
was
doing
the
right
job
on
that.
So
those
are
the
two
key
lines
and
cry.
We
would
want
to
add.
C
A
very
quick
question:
you
know
the
consent,
one
it
says,
consent
and
the
mental
capacity
act.
Is
it
consent,
including
the
mental
capacity
act,
or
is
it
more
about
the
mental
capacity
act,
because
obviously
a
lot
of
people
are
actually
consenting
or
could
consent?
And
you
know
so:
it's
not
just
about
the
mental
capacity
act
and
it's
quite
a
big
issue.
I
think
yes
clarify
it's
both
or
not.
F
F
On
the
ratings
principles
and
you'll
see,
there's
quite
a
lot
of
detail
on
this.
Before
we
get
the
recommendations
on
page
five,
we've
had
a
number
of
broad
discussions
about
how
we
set
the
those
aggregation
principles.
In
particular,
one
of
the
questions
that
was
raised
in
the
consultation
was
were
we
being
too
generous
on
outstanding.
F
That
was
applying
at
the
level
of
the
overall
provider,
which
is
the
level
in
adult
social
care
that
we
go
to.
We
just
have
the
five
core
questions
and
the
overall
rating,
but
for
prior
medical
services
and
then
in
the
hospital
sector.
We
also
break
down
that
ratings
grid
into
other
core
services
or
population
groups,
and
so
that
principle
was
applying
at,
for
example,
maternity.
F
F
And,
secondly,
we
would
like
the
opportunity
as
time
progresses
to
after
the
lockdown
period
ends
to
to
raise
the
bar
and
one
way
we
can
raise.
The
bar
is
at
that
stage
to
look
at
going
to
three
outstandings,
but
we
do
think
that
at
this
stage
two
outstandings
is
the
is
the
appropriate
principle
and
I'll
pause
on
that
one,
because
it's
important
to
people.
H
F
A
H
If
we're
kind
of
pushing
people
into
the
out
outstanding
by
lowering
the
standard
there?
I
don't
quite
or
if
I
got
the
wrong
end
of
the
stick
there,
because
that
that,
but
by
dropping
it
down
in
order
to
make
sure
we
get
people
into
the
outstanding
are
we
are
we
being
disingenuous
in
some
reason?
Well,
I
would
argue:
we've
got
some
somewhere
where
you
should
have
the
same
standard
across
the
whole
lot,
rather
than
trying
to
push
people
up
into
now
standing
if
it's
not
outstanding.
F
So,
to
be
absolute,
that
this,
this
principle
would
apply
to
every
one
of
our
sectors,
so
it'd
either
be
two
outstandings
equals
overall
outstanding
across
the
board
or
three
across
the
board.
There'd
be
no
attempt
to
be,
in
inverted
commas,
easier
in
adult
social
care
or
in
hospitals
than
it
would
be
in
any
other
sector.
G
Thanks
david,
the
I'd
echo,
what
andrea
is
saying
for
primary
care
and
we've
been
shadow
rating,
and
it's
quite
interesting
that
you
can
see
in
a
in
a
number
of
gp
practices.
Paul
that
there
are
is
outstanding
care,
but
and
the
grid
we
will
have
just
like
the
one
you've
seen
for
the
hospital
inspections.
G
But
it's
that
dichotomy
in
general
medical
practice
where
some
of
the
basic
systems
aren't
working,
which
is
my
worry.
It's
also
in
our
discussions
with
the
bma
on
ratings.
One
of
the
issues
they've
been
rising,
raising
about
the
global
overall
rating
of
a
practice
and
how
they're
more
comfortable
with
the
granular
ratings
in
those
particular
cells,
and
I
think
we
personally,
I
think
we
need
both,
but
it
does
demonstrate
to
the
patients
the
differences
sometimes
and
it
will
allow
one
of
our
key
things
is
about
quality
improvement,
encouraging
quality
improvement.
G
G
I
On
the
other
hand,
for
the
purpose
of
developing
the
sophistication
of
the
ratings,
we
have
to
be
able
to
use
the
full
spectrum
enough
and
we
have
to
make
people
feel
that
they
can
get
there
now.
I
suppose,
partly
because
it's
a
paper
about
how
the
ratings
fit
together,
it
looks
slightly
like
the
the
task
is
to
get
the
right
grid
structure,
but
are
we
saying
somewhere?
I
In
other
words,
you
have
to
get
the
right
combination
and
that's
how
you
get
outstanding,
but
have
we
said
somewhere
how?
What
outstanding
would
be
based
on
so
that?
Sometimes,
when
we
talk
about
outstanding
services,
we
talk
about
what
they
do
and
then
there's
something
inspirational
about
something
we
see,
but
that's
quite
difficult
to
specify
and
to
define
and
and
the
key
will
be
it's
just
at
the
moment
it
looks
slightly
sort
of
mechanical.
I
You
know
you
get
one
of
this
and
two
of
that
and
you're
outstanding,
partly
because
it's
a
paper
not
a
not
the
it's
not
the
thing
in
practice,
but
the
key
will
be
to
making
sure
people
understand
what
three
things
they
will
have
to
do
to
improve
their
practice
enough.
Otherwise
they
will
all
settle
for
good
on
the
grounds.
That's
that
tactically,
that's
the
that's
the
most
efficient
thing
to
do.
F
So,
yes,
we
did.
We
we
set
out
what
the
characters,
for
example
outstanding,
are
for
each
of
the
five
key
questions,
and
it
is
things
like
the
level
of
innovation
but
entertaining
in
leadership,
particularly
the
way
in
which
the
culture
and
safety
isn't
just
something.
That's
done,
because
it
has
to
be
done,
but
it
really
lies
at
the
heart
of
the
way
the
practice
is
performed.
We
have
a
conversation
about
there's
a
tesla.
K
Usually
it's
a
member
of
paul's
team
who's
on
the
quality
assurance
group
will
have
those
rating
descriptors
and
we
will
ask
them
to
just
remind
us
exactly
what
the
wording
is.
Does
that
fit
that
characteristic
while
we're
on
the
inspections
it?
It
is
this
business
of
of
reminding
teams
that
even
to
be
good
you,
you
can
have
some
areas
that
require
improvement
and
reminding
people
about
that
and
saying
actually,
would
you
be
happy
to
be
treated
here
and
that's
a
pretty
good
metric
for
for
good,
but
outstanding
is
something
beyond
that.
K
Is
there
something
that
others
could
learn
from
this
place
is?
Is
there
something
that
this
can
demonstrate
when
we
compile
all
our
outstandings,
which
we
can
and
will
do
in
due
course,
when
we've
got
a
few
more
of
them,
then
you
know
it's
got
to
mean
something
to
people
in
the
outside
world.
Yes,
my
goodness,
that's
something
that
we're
not
doing
and
having
we've
got
some
examples
that
are
coming
through.
Where
you
know
when
people
have
read
the
reports,
they've
said
my
god.
Is
that
really
happening?
K
I
Understand,
though,
if
you
might
just
a
very
quick
comment:
dude,
that's
okay.
I
think
it's
good
when
we're
giving
people
examples
and
using
words
which
mean
something
like
innovation.
At
least
that
means
that's
a
sort
of
partial
meaning
word.
I
don't
think
it's
enough
to
be
honest,
I
I,
if
you
say,
would
you
travel
100
miles
to
see
it?
What
does
that
mean?
I
If
you
say,
would
your
friends
and
family
use
it?
Would
you
what
does
that
mean?
I
I
don't
think
those
are
reliable
bases
on
which
we
should
be
basing
our
inspection.
We
should
be.
Those
are
impressionistic
colloquialisms
that
they're
not
they're,
not
they're,
not
the
basis
of
a
serious
judgment
of
a
service
and
I'm
sorry
to
be
a
bit
negative
today,
but
but
we've
got
it,
we've
got
to
move
to
something:
that's
rigorous,
properly
defined
and
asking
people
their
impressions,
whether
they
would
travel
100
miles.
Well,
that
might
depend
on
whether
there
was
a
bus.
F
It's
happy
category,
it
doesn't
say
in
the
hamburg
50
miles
good
100.
That
was
for
the
purposes
of
exemplifying
the
the
point,
the
whole
friends
and
family
test.
Okay,
that
all
right
well,
we're
definitely
not
designing
the
friends
of
family,
but
the
there
are
rigorous
standards.
If
you
like,
set
out
for
what
outstanding
is
at
the
level
of
each
key
element
of
each
key
question,.
A
F
The
point
I
just
wanted
to
draw
out
there
was
that
we
we've
long
had
the
principle
which
one
to
hold
to
that
two
requires
improvements
in
a
key
question
would
limit
the
overall
rating
to
to
requires
improvement,
but,
as
we
always
have
to
once,
we
take
those
principles.
We
then
have
to
say
well
how
does
that
play
out
if
it
isn't
for
whatever
we're,
not
judging
across
the
key
questions,
we're
judging
across
the
core
services
or
population
groups?
F
So
what
would
it
mean
if
you
didn't
weren't
looking
at
two
from
five
you're,
looking
at
two
from
eight
or
two
from
four,
so
to
take
the
community
services
example
on
page
four,
what
we
were
finding
was
that,
because
we
had
said
well,
if,
if
we've
got
two
from
five
that
requires
improvement,
we
think
that
when
you've
got
four
or
fewer
in
this
case,
rows
for
the
four
core
services
and
community
health
services,
we
should
have
a
principle
if
you've
got
one
requires
improvement.
That
would
limit
it
to
requires
improvement.
F
Two
out
of
20
cell
levels
is
just
too
hard
a
test,
so
on
that
basis
we
want
to
change
the
the
number
of
underlying
ratings
I
set
out
at
the
top
of
page
five,
so
that
it
will
be
one
or
more
requires
improvement
required.
If
there
were
one
to
three
core
services,
four
to
eight
would
be
two
or
more
and
nine
plus
three
or
more
nine
plus
is
important,
because
in
mental
health
services
we
have
eleven
core
services
and
in
some
combined
providers
we
can
have
even
more.
A
H
H
I
So
I'm
this
is
a
different
point.
I
I
do
apologize,
but
it
was
it's
really
about
the
outstanding.
It's
a
it's,
a
very
important
thing
that
we
talked
about
at
previous
meetings,
and
that
is
the
place
for
of
care
for
people
with
dementia
and
learning
disability
and,
just
to
briefly
remind
you
of
the
history,
I
was
very
keen
that
we
that
you
as
an
acute
trust.
So
this
is
not
a
mental
health
as
an
acute
trust.
You
could
not
get
an
outstanding
rating
unless
you
could
demonstrate
that
you
had
done,
you
would
provide
satisfactory.
I
So
people
with
learning
disability
people
with
dementia,
so
you
had
to
be
you'd,
have
to
be
able
to
show
how
you
made
sure
their
care,
their
access
to
acute
physical
health
care
was
as
good
as
for
other
people,
and
I
think
at
a
previous
discussion
we
slightly
to
my
disappointment,
decided
that
would
not
be
in
the
system,
but
it
was
a
question
of
that
kind
was
then
included
in
the
handbook.
Consultation
now
it
doesn't
appear.
I
So
you
get
end
up
with
an
accurate
picture
or
whether
we're
not
just
trying
to
get
accuracy
here,
but
to
drive
improvement
in
the
system
and
to
drive
a
set
of
values
which
will
change
healthcare
and
that's
the
kind
of
question.
It
seems
to
me
about
people
with
dementia
people
with
learning
disability
that
drive
improvement
and
make
an
acute
trust.
Think
well,
yes,
what
we
do
may
be
good.
I
It
may
even
be
outstanding,
but
actually
here's
an
area
which
represents
a
set
of
values
for
the
healthcare
system,
which
we
are
not
very
good
on,
and
that
would
make
something
concrete
of
it.
Now
you
haven't
mentioned
it,
but
I
mean
is
this?
Is
it
somewhere
in
the
system
that
what
happens
on
that
point.
F
I'm
sorry,
I
can
think
of
at
least
two
places
in
the
handbook
that
it
that
does
come
up
so
in
the
responsive,
key
lines
of
inquiry.
One
of
the
the
chloe's
is
about
responsiveness
to
groups
with
different
needs,
so
there's
an
expectation
that
people
would
look
at.
Therefore.
Well,
I
hope
I
won't
go
through
them.
Obviously
different
different
groups
who
go
through
a
hospital
and
the
other
part
is
that
we
say
that
in
the
course
of
our
inspections
we
may
well
look
at.
F
I
think
we
do
phrase
in
terms
of
may
well,
rather
than
categorically
say
we
will
particular
groups,
those
with
learning
disability,
those
with
dementia.
Those
are
diabetes
and
those
are
mental
health
conditions,
and
I
think
that
was
in
line
with
the
board
discussion.
So
we
we,
as
you
said,
we
don't
go
as
fast
to
say
this
will
categorically
form
part
of
the
ratings
judgment
in
terms
of
a
key
line
of
query
or
above,
but
we
do
say
we
will
take
it
into
account.
K
There
was
information
on
dementia
by
the
way
in
that
same
report,
and
so
we
are
by
the
time
the
report
goes
out.
We
will
have
evidence
about
both
learning
disabilities
and
dementia.
What
I
don't
we're
asking
that
at
the
core
service
level
within
the
responsive
domain,
I
don't
think
we
are
yet
aggregating
that
to
trust
level
well
enough.
G
Thanks
just
just
to
add
one
in
primary
in
general
practice.
As
you
know,
lewis,
I've
been
an
advocate
with
sheila,
hollins
and
others
for
years
about
people
with
learning
disabilities
and
there's
the
marker
for
for
good
care
and
how
these
people,
who
are
equally
as
human
as
I
am,
how
they
get
care
in
general
practice
and
that
have
been
at
odds
with
people
over
the
years
in
promoting
that,
and
so
what
we've
done
for
our
vulnerable
group
section,
which
includes
people
with
learning
disabilities.
G
For
that
reason,
we
will,
in
every
practice
ask
them
to
demonstrate
that
they
have
a
register
of
people
with
learning
disabilities
and
also
the
care
that
they're,
providing
so
as
a
positive
set
of
prompts
and
also
we've
added
dementia
to
the
population
group
of
people
with
mental
health
issues.
So
it
doesn't
get
lost
in
just
the
elderly
care
area
that
we
specifically
focus
on
those
two
groups
of
people
in
primary
care.
A
F
Given
the
relative
paucity
of
data
in
that
sector,
the
paragraph
three
at
the
top
of
page
six
and
then
lays
out
how
that
would
break
down
according
to
the
ratings
judgments
as
we
go
around
them.
Obviously,
we
would
wish
to
be
back
sooner
for
a
care
home
provider
that
was
inadequate
rather
than
dom
silica
provider
that
was
seen
as
outstanding
and
that
we
will
also
do
a
number
of
random
inspections
each
year
of
good
and
outstanding
services
for
the
other
sectors.
F
F
A
E
E
You
know
that
it's
the
risk
of
degradation
in
the
quality
provided
is
you
know,
is
not
such
that
the
life
of
the
rating
is
less
or
significantly
less
than
the
frequency
of
inspection,
and
I
just
don't
know
whether
there's
evidence.
For
that
I
mean
it
would
just
be
very
helpful
to
know
that
you
know
we
can
only
inspect
every
two
years
or
three
years,
because
somebody's
outstanding,
you
know
90
of
the
time,
stays
outstanding
for
that
period
of
time,
but
you
know
so.
This
is
a
question
of.
Is
there
any.
E
Proof
one
way
or
the
other,
because
I
think
that
is
probably
the
you
know
should
be
the
key
determinant
of
frequency
is
the
you
know,
time
in
which
providers
maintain
quality
at
whatever
I
mean.
Obviously,
this
is
different
for
requires
improvement
or
inadequate,
but
for
people
we
rate
as
good
or
outstanding,
you
know.
Is
it
the
case
that
we
can
expect
them
to
be
good
or
outstanding
for
the
next
two
years?.
F
So
I
think
this
is
why
lewis's
first
comment
was
so
important
about:
we've
got
to
keep
on
going
and
do
australia.
Nobody
knows
the
answer
to
that
question
because
nobody's
ever
done
a
comprehensive
assessment
to
know
who's
outstanding
or
who
isn't
sector
by
sector.
But
we
are.
We
will
absolutely
then
build
up
that
knowledge
and,
as
we
see
variation
or
degradation,
then
we
can
change
our
frequency.
F
The
other
point
I
think
is
important
is
the
we
will
get
information
on
an
ongoing
basis,
particularly
if
there
are
concerns
we
build
up
this
intelligence
driven
approach.
So,
if
we
find
can
we
hear
concerns
that
weren't
a
focus
in
inspection?
We
absolutely
won't
wait
for
the
three
years
to
become
expired
or
go
in.
D
D
Death
notifications
and
both
of
those
things
come
through
to
us
and
one
of
the
things
that
we
absolutely
learned
from
the
orcid
view
review
was
not
to
allow
the
halo
effect
of
a
good
or
outstanding
assessment
of
a
service
or,
as
we
previously
described
it
in
the
old
regime
to
to
to
our
people.
Think,
oh
well,
it's
an
outstanding
service
and
actually
those
things
have
happened
and
it's
all
right.
Actually,
I
think
we
are
much
more
attuned
to
picking
up
on
those
risks.
So
it's
it's
something
that
we
will
build
up
over
time.
A
Okay,
thank
you
very
much
paul.
Could
you
thank
your
team
for
the
work
they've
done
these
provider
handbooks
with
the
key.
You
know,
they've
done
a
really
remarkably
good
job.
So
would
you
thank
them
very
much
and
stimulated
a
a
long
discussion?
I
I
think
we've
finished
the
paper.
Haven't
we
really
the
rest
of
it
is
for
noting
the.
A
B
B
B
So
there's
been
a
mixture
if
I
can
use
this
rather
reductionist
language
of
bottom-up
and
top-down
engagement
with
this
approach.
So
what
you've
got
in
front
of
you?
At
the
last
meeting,
you
asked
the
executive
team.
You
asked
me
to
go
away
and
bring
back
a
report
which
made
recommendations
to
you
about
what
the
values
of
the
organisation
should
be.
B
We've
then
gone
to
layout,
and
this
was
the
next
slide-
is
a
four
box
grid
about
the
values
what's
important
to
us.
The
purpose
of
this
particular
slide
was
to
go
beyond
the
thing
that
your
challenge
was
on
last
time,
which
is
to
move
away
from
one
word
statements
of
values,
and
what
we
propose
is
that
the
approach
that
we
take
is
to
use
this
grid
as
a
way
of
stating
our
values.
B
Is
we've
taken
the
30,
odd
words
which
continued
to
repeat
through
the
consultations
through
the
conversations
and
assemble
them
in
a
word
cloud
to
actually
link
and
demonstrate
what
is
subsumed
under
the
use
of
the
word
excellence
and
then
the
words
that
follow
in
that
narrative
in
the
four
box
quadrant?
What
is
important
to
us?
So,
in
a
sense
if
this
was
the,
I
did
all
level
maths
and
when
you
did
that
you
got
to
submit
your
workings
out
as
well
as
your
answer.
B
B
So.
The
three
key
slides
here,
david
and
colleagues,
is
the
statement
of
purpose,
the
slider
values.
What
is
important
to
us,
a
four
box
grid
and
then
the
values
brought
to
life.
These
are
the
these.
Are
the
documents
we'd
prep
propose
that
we
use
and
begin
to
pass
into
the
way
we
take
them
forward?
The
cover
report,
I
think,
flags
how
we
intend
to
use
them
in
terms
of
our
recruitment,
literature,
some
of
our
training
and
development
courses,
etc.
B
B
B
I
know
that,
since
these
papers
went
out,
some
colleagues
have
made
suggestions
around
this.
Certainly
robert
has
sent
robert
francis
sent
some
comments
in,
and
one
of
his
reflections
is
whether
the
word
independence
features
sufficiently
well.
So
I
think,
there's
just
the
last
bit
of
finessing
to
do
with
these
to
make
sure
that
these
are
aligned
with
previous
publications
and
the
approach
that
we're
taking
so
they're
presented
in
that
spirit
david.
This
is
a
an
extensive
piece
of
work.
B
They're
presented
to
ask
you
for
agreement
with
the
notion
that,
as
we
just
take
this
finalization,
we
may
polish
the
odd
phrase
to
make
sure
that
they're
fully
aligned
with
what
we
want
to
take
forward.
But
I
hope
that
gives
you
a
sense
of
why
it's
here
the
journey
it's
been
on
and
what
we're
asking
you
to
agree.
C
Thanks
david
and
for
talking
around
it
I
mean
I
actually.
I
think
this
is
really
really
good.
I
think
it's
fab.
I
think
it's
it's
good
in
the
sense
of
what
the
end
product,
but
also
how
we've
got
to
the
end
product.
Yes,
there
might
be
some
finesse,
but
I
think
that
it
reflects
really
well
on
the
organization.
C
As
I
say
it's
how
we've
got
to
the
point
as
well
as
the
the
end
product,
and
my
other
point
is
as
a
challenge
actually
to
david
as
chair
to
make
sure
that
we
as
a
board,
live
and
embody
these
values.
So
we've
got
to
sort
of
lead
by
example
and
demonstrate
I'm
sure
we
can
do
it.
But
that's
my
challenge
to
you.
A
Anyone
else
like
to
make
any
comments.
Well,
look
it's!
It
has
been.
A
lot
of
people
have
been
involved
in
this
process
david.
I
think,
there's
a
big
commitment
to
these
values
in
terms
of
how
you
present
them-
and
there
may
be
a
little
bit
of
finessing
to
do
around
that,
but
I
think
I
think
the
board
absolutely
endorses
these
fundamental
values
and
I
think,
actually
in
in
part,
answer
to
kay's
question.
A
I
think
that
the
way
david
leads
this
organization
I
mean
he
is
regarded
very
much
as
an
authentic
leader
of
this
organization
and
does
embody
all
these
values.
I
think-
and
I
think
the
weekly
note
that
goes
out
to
all
staff
is
he's
part
of
that.
So
and
then
we
had
a
good
discussion,
the
board
last
time
on
this
as
well.
So
I
think
we're
all
very
much
in
favor
david,
so
well
done.
Thank.
F
One,
I
think
I
think,
that's
right,
so
the
national
information
governance
committee
is
a
statutory
requirement
on
for
cqc,
as
is
set
out
in
the
paper.
It's
been
in
operation
for
a
little
over
a
year
now
and
we'll
be
carrying
on
at
least
from
march
2015,
just
to
give
a
sense
of
it.
I
share
that
now
that
steve
has
left
the
board
and
the
with,
with
sort
of
between
gratitude
to
the
to
all
the
members
of
that
committee.
F
Those
are
the
overriding
recommendations,
there's
also
an
analysis
from
a
small
selection
of
hospitals,
community
health
services,
mental
health
and
out
of
hours
reports,
which
is
mentioned
on
page
three
of
the
of
the
report,
which
shows
what
we
know
so
far
about
the
quality
of
information
governance
in
across
our
provider
sectors.
But
it
comes
with
a
heavy
caveat,
those
who
were
just
testing
most
of
our
assessments
at
that
stage
and
there's
a
limit
to
how
much
insight
can
be
drawn
from
them.
F
H
Sorry,
I
very
quick
question:
maybe
I
haven't
understood
this
properly.
Are
we
clear
that
we're
when
we're
asking
for
information
we're
asking
for
meaningful
information
just
because
we
don't
want
to
create
a
counterproductive
situation
where
people
are
rushing
around
and
creating
information?
See
what
I
mean
I'm
slightly
concerned
about.
I
mean
I'm
always
concerned
about
the
burden
we
put
on
provides
anywhere,
but
we
don't
want
mountains
of
meaningless
information.
F
So
so
this
this
came
out
thinking
kieran's
report
as
well.
This
sort
of
sense
that
when
we
started
out
in
our
desire
to
want
to
know
we'd
ask
for
a
lot
of
stuff,
I
think
there
was
about
500
documents
and
now,
for
example,
in
the
handbook,
we're
going
to
be
much
clearer,
that
we
want
specific
information
and
turning
that
round,
as
michael
drew
out
into
you,
tell
us
about
the
quality
of
care
is
exactly
where
we
want
to
go.
We
do
reserve
the
right
to
answer
information.
F
A
F
F
So
we
don't
want
to
be
high
bound
by
a
a
rigid
procurement.
That
only
means
we
can
do
certain
things,
so
the
proposal
has
been
to
is
to
procure
the
survey
program
for
the
next
three
years,
but
to
do
so
in
a
way
that
maintains
what
the
maximum
flexibility
and,
rather
than
that,
just
being
something
which
we
look
at
in
isolation.
F
What
would
we
sort
of
like
to
do
on
surveys
to
embed
that
in
the
work
of
the
knowledge
and
information
strategy,
so
that
it's
looking
at?
Why
would
we
want
surveys
versus
a
friends
and
family
test
or
any
other
form
of
feedback
that
we
might
receive
and
to
particularly
fill
the
gaps
in
the
knowledge
that
we
have
and,
of
course,
the
gaps
are
particularly
severe
in
the
adult
social
care
world?
F
So
that's
a
proposal.
It's
for
2.5
million,
pre
v8,
3
million
after
v80.
That's
a
small
uplift
on
the
2.2
million
preview
80
for
the
last
three
years,
and
that
reflects
that
we're
doing
more
surveys
than
we
were.
The
only
thing
I
would
mention
is
that
nhs
england
also
have
their
run.
Some
other
surveys,
like
the
general
practice
patient
server,
which
is
a
bigger
single
survey,
and
we
are
in
discussion
with
them
about
what
their
forward
program
of
work
is
like.
A
H
H
H
No,
I
thought
you
were
implying,
rightly,
that
it
was
important
for
us
to
understand
what
their
program
of
work
was,
so
that
it's
coordinated
I
mean
I'd
rather
have
one
organization
doing
it
all,
but
as
somebody
recommended
our
currently,
it
was,
but
I
mean,
if
not,
then
we
just
need
to
yeah
it's
just
it's
just
if
it's
just
an
efficiency
point.
You
know.
I
Is
this
a
chance
to
reconsider
how
some
of
the
surveys
are
carried
out
to
make
sure
that
they're,
it's
it's
more
than
a
real
procurement?
It's
a
rethink
of
what
their
place
is
in
the
system,
how
we
conduct
them
the
ones
I
know
best
are
the
ones
in
mental
health
and
they're,
not
bad,
but
sometimes
the
questions
have
been
have
seemed
a
little
sort
of
crude
and
the
way
that
the
answers
have
been
dealt
with
have
also
seemed.
I
You
know
open
to
challenge
the
way
that
people
answering
questions
in
different
ways
then
have
their
answers
lumped
together
so
that
they
become
the
same
way
and
that
doesn't
that
really
is
an
insensitive
way
of
going
about
it.
I
mean,
if
you're
going
to
do
that,
then
don't
ask
you,
don't
offer
people
options,
but
you
then
just
combine.
F
Yeah
really
important
that
we
we
do
do
it
in
that
way,
I
mean
the
one
big
question
is:
is
three
years
actually
a
valid
cycle
time
because
things
we
sell
out
of
date
by
year?
Three,
so
we'll
be
looking
at
the
frequency
we're
also
looking
at
the
questions.
Obviously,
we
want
to
have
some
consistency
over
years
and
we
will
need
to
go
through
the
costs
implications
of
changing
frequency,
but.
I
I
I
mean
that's
one
of
the
things
people
say
about
services,
you
do
them
every
two
years
or
whatever
it
is,
and
they
just
show
the
same
thing
again
now
you
could
say
that's
because
the
system
isn't
responding
very
well,
but
it
may
be
that
the
questionnaires
are
not
very
sensitive
to
what
people
actually
think.
So
it's
just
a
a
question
about
rethinking
what,
in
a
more
comprehensive
way.
K
I
completely
go
along
with
that
lewis,
and
certainly
I
know
it's
my
area
that
at
the
moment
is
the
main
beneficiary
of
this,
the
these
surveys,
whether
it's
the
community
mental
health
survey
or
whether
it's
the
ones
that
apply
to
the
acute
sector.
But
I
think
this
this
point
about
the
frequency
is
a
very
important
one,
because,
frankly,
if
an
ane
survey
was
done
in
2011,
it
really
isn't
a
germain
to
our
inspections
now.
K
So
I
think,
looking
at
what
is
the
interval
that
we
can
still
reliably
say
that
that
should
inform
our
judgment
is
an
important
one,
whereas
the
maternity
survey,
which
has
been
only
published
a
few
months
back,
it
clearly
is
informing
our
judgments
on
maternity
as
a
core
service.
So
I
think
it's
about
how
we
do
it,
but
how
often
we
do
it.
What
matters.
H
David
hogar,
I
went
down
to
penzance
for
my
holiday
and
I
started
reading
the
guidance,
this
enormous
document,
the
guidance
for
providers
on
meeting
the
fundamental
standards
at
paddington.
I
was
still
reading
when
I
crossed
the
tamar
bridge
and
I
I
must
have-
I
felt
a
little
sense
of
well.
I
think
I
thank
god.
I
wasn't
a
provider
myself.
H
That
seems
to
be
absolutely
crucial
thing
and
that
all
the
other
things
will
some
extent
fall
in
your
lap,
because
if
they
want
to
make
the
things
happen,
then
they
will
care
about
being
safe.
Then
they
will
care
about
being
stimulating.
Then
they
will
care
about
everything
else
and
you
will
be
more
friendly
advisors
than
inspectors.
So
that
was
why
one
thought
I
was
also
slightly
influenced
by
having
read
this
report,
which
I
expect
camilla
will
know.
Well
the
roundtree
report
on
excessive
paperwork
undermining.
H
I
just
finally
like
to
say
that
about
the
provider
and
books,
a
small
voice
saying:
do
you
really
want
so
much
consistency,
because
the
more
inconsistency
that
you
have
the
more
worried
the
providers
will
be
and
more
effective?
Your
inspection
will
be
the
better.
The
quality
will
be
at
the
end
of
it
all,
and
I
finally
like
to
say
thank,
I
always
feel,
certainly
as
a
gate
crasher
coming
to
these
meetings.
Although
I've
been
coming
for
a
year
and
a
half,
I
feel
that
you
know
some.
A
F
So
very
good
just
to
people
know
that
that's
the
draft
out
for
consultation
on
the
enforcement
policy
and
the
guidance
about
registration
regulations.
The
consultation
is
live
at
the
moment
david.
So
we
need
to
hear
back
from
what
everybody
says.
What
I
would
say
is
that
at
least
some
providers-
I'm
here
I'll
say,
is
this
enough,
because
they
want
to
know
what
they
want
to
do.
F
So,
I'm
sure
we'll
have
a
series
of
different
views,
and
I
take
your
point
about
making
people
happy,
but
because
the
guidance
is
specifically
about
the
fundamental
standards,
the
legal
requirements,
I
think
we
do
need
to
set
out
we're
required
to
by
law
the
detail
of
them
of
what's
in
them
and
the
implications
for
providers
in
in
terms
of
the
burdens.
I
know
the
single
biggest
thing
we
can
do
is
move
more
things
online.
F
F
A
D
You
and,
and
just
one
thing
to
say,
one
of
the
things
that
we've
been
doing
from
an
adult
social
care
point
of
view
with
the
provider.
Information
return
is
actually
to
try
and
reduce
the
burden,
although
it's
the
kind
of
return
that
we're
asking
for
it
actually
sort
of
helps
to
bring
things
all
together
in
one
place
at
one
time
and
stops
this
kind
of
you
know
two
in
and
throwing
that
sometimes
happens
between
inspectors
and
providers.
H
Hi,
my
name
is
noel
finn:
I'm
a
whistleblower,
I'm
a
carer,
I'm
also
a
service
user
in
the
nhs
and
private
sector,
and
the
question
for
michael,
please
in
relation
to
the
relationship
between
her
majesty's
inspectors
of
prisons
and
also
the
cqc,
seems
to
be
a
huge
gap
and
also
the
services
that
are
available
within
the
detention.
Centers
and
the
prison
services
seem
to
be
lacking
regards
to
care
and
quality.
G
It's
led
by
one
of
my
deputies,
sue,
mcmillan
and
we've
had
a
succession
of
meetings
with
her
majesty's
inspectorates
of
prisons,
probation,
etc,
as
well
as
ofsted.
Looking
at
some
of
the
child
safeguarding
areas,
we
have
in
draft
form
a
signposting
document
for
I'd
use
the
word
revolutionizing,
but
you
know
you
know
it's
probably
inappropriate,
improving
dramatically
the
inspection,
which
includes
the
intelligent
monitoring
of
secure
environments,
which
includes
prisons,
but
places
like
yale's
wood
as
well,
which
I
know,
I
think,
from
your
point
of
view,
is
a
particular
issue.
G
G
The
thoughts
at
the
moment
include
taking
the
mental
health
issues
very
seriously,
as
well
as
the
general
medical
services
provided
in
those
institutions
and
looking
at
how
we're
doing
gp
inspections
and
including,
for
example,
gps
on
all
of
those
inspections
and
other
relevant
specialists,
which
includes
working
very
closely
with
mike's
mental
health
team
led
by
paul
elliot
the
time
scale.
Is
that
the
you
know
I
have
a
draft
here
on
my
ipad.
G
H
H
With
cqc
I
mean
I
had
a
meeting
previous
two
meetings
with
our
two
members
from
cqc,
and
one
of
the
questions
came
out
of.
That
was
that
you
need
special
clearance
to
go
into
detention
centers.
I
just
want
some
clarity
on
that.
Do
you
need
special
clearance
from
the
cqc
to
do
an
assessment
in
detention,
centers.
G
G
H
H
I
would
disagree,
I
think,
there's
a
slight
there's,
a
slight
detachment
between
the
home
office
and
the
cq
in
regards
to
ensuring
quality
of
care
within
detention,
centers
and
prison
services-
and
I
know
you're
going
to
work
on
that,
but
we
are
have
got
people
in
detention,
centers
and
prisons
they're-
actually
very
vulnerable
at
this
time
that
we
speak
and
they're
subject
to
self-harming
suicide
litigation.
So
I
understand
there's
a
time
frame
to
that
and
I
accept
that.
But
it's
something
that
needs
to
be
taken
on
board
in
your
discussions.
Can
I
just.
G
G
They
of
course,
have
their
own
relationship
issues
as
we
do
with
our
department
of
health
they
do
with
their
home
office.
Colleagues,
that's
the
statement
of
fact.
I
won't
make
any
pejorative
statement
on
how
well
or
badly
or
challenging
these
are
relationships,
and
what
we
want
is
a
joint
model
from
april,
and
the
indications
are
so
far
that
we've
got
absolute
complete
cooperation
and
support,
and
it's
enhancing
what
we're
doing,
rather
than
anything
else,.
H
H
The
point
that
you
made
earlier
on
about
reinforcing
your
your
analysis
and
expertise
and
doing
your
assessments,
your
suggestion
was,
the
staff
can
be
seconded
over
from
the
nhs.
What
I'm
concerned
about
is
there's
already
a
leaking
staffing
issue
in
the
nhs,
if
you're
bringing
them
over
to
cqc
you're
going
to
have
further
problems
in
the
nhs.
K
Shall
I
tell
that
one?
Thank
you.
I
think
we
do
have
to
remember
the
1.3
million
people
working
in
the
nhs
and,
as
I
said,
we're
looking
in
the
first
instance
for
perhaps
200
people
now
I've
realized
that
we're
looking
for
200
very
specific
people.
I
do
also
believe
that
in
the
medium
term,
this
is
highly
to
the
advantage
of
driving
up
quality
in
the
nhs.
I
think,
if
people
as
a
mid-career
step
come
to
us
for
let's
say
two
years,
they
will
get
the
experience
of
how
we
assess
quality
and
safety.
K
They
will
see
a
large
number
of
different
hospitals
and
how
they're
doing
it.
I
think
that
will
be
extremely
valuable
to
them.
I
I
in
in
going
back
in
if
they
want,
for
example,
if
they've
been
awards
history
and
they're
wanting
to
move
up
a
managerial
letter,
I
believe
that
will
be
an
enormously
beneficial,
so,
yes,
in
a
very
small
sense,
considering
the
numbers
that
are
being
recruited
to
the
the
nhs
overall.
K
I
think
this
is
this
is
small,
but
we're
not
only
looking
for
that
group
and
david
mentioned
earlier
on,
the
the
prospect
is
of
us.
Looking
for
people
who
want
to
work
term
time
only
now
that
may
be
a
group
of
people
who
have
moved
out
of
the
the
nhs
and
who
would
like
to
come
and
work
in
an
area
where
that
term
time
work
only
is
possible.
So
we
might
be
not
actually
depleting
the
nhs
at
all,
but
getting
people
back
into
the
workforce
who
are
not
currently
working.
H
The
last
last
question
is
regards
to
france's
review
and
just
the
francis
cq
review,
just
to
make
it
clear:
it's
just
a
review,
and
so
it's
not
going
to
be
there's
not
going
to
be
bite.
Anybody
coming
from
that
review,
there'll
be
just
a
lot
of
talking
and
a
suggestion
of
a
public
inquiry
has
got
a
bit
more
buy
to
it
in
regards
to
ensuring
about
whistleblowing
and
safety
within
the
health
sector.
H
Thank
you.
I
would
like
to
endorse
what
david
said
to
begin
with
about
the
helpful
way
in
which
the
board
does
accept
questions
from
members
of
the
public.
I
have
two
questions
briefly.
One
relates
to
an
innovation
which
I
think
is
taking
place,
probably
at
the
level
of
ccgs
who
are
procuring
services
locally.
H
G
It
really
depends
on
what
sort
of
service
it
is
and
where
the
registration
is
for
that
service.
If
it's
outreach
at
the
moment,
we
are
doing
a
review
of
registration
at
the
moment
and
it's
a
very,
very
good
question,
because
in
other
areas
there
are
new
entities
being
formed
to
look
at
integrated
care
provision.
G
H
A
We
have
had
a
number
of
meetings
with
ofsted
over
the
last
year
and
they've
been
very
useful,
actually
because
there's
a
lot
of
similarities
between
what
often
are
doing
what
we're
doing
so
there
is.
There
is
a
good,
close
working
relationship
there
excellent
well.
Thank
you
all
very
much.
I
think
we'll
break
the
coffee
now.
Thank.