►
From YouTube: CQC Board Meeting 18 December 2013
Description
Agenda for the meeting of the Care Quality Commission on 18 December 2013:
1 Chief Executive's report 0:00:01
2 Chief Inspector of Hospitals update 0:37:10
3 Chief Inspector of Adult Social Care update 0:57:49
4 Chief Inspector of General Practice update 1:15:25
5 Performance, finance and risk report 1:32:33
6 National Information Governance Committee update 1:41:04
7 Q & A 1:44:04
Read more about CQC's Board Meetings at
http://www.cqc.org.uk/public/about-us/our-people/board-members/board-meetings
B
Thanks
sure
and
we've
got
a
meeting
with
colleagues
in
the
senior
level
on
friday
on
planning
for
the
state
of
care
report
for
next
year,
just
to
pick
up
on
that
point.
So
so
my
report
chair,
so
this
is
an
update
report
on
work
that
has
been
going
on
over
the
four
weeks
since
our
last
meeting,
I
draw
attention
to
the
sign
posting
documents:
progress
on
the
inspection
program
on
the
kerbal.
I
don't
intend
to
dwell
on
those
david.
B
I
will
spend
most
of
my
time
on
the
fit
and
proper
person
test
and
the
duty
of
candor
so
a
fit
and
proper
person
test.
These
are
proposals
which
will
allow
us
to
carry
out
well
will
require
a
fit
and
proper
person
test
to
be
carried
out
as
part
of
the
recruitment
and
appointment
process
for
directors
of
organizations
that
are
registered
with
us.
B
The
proposal
is
that
any
organization
undertakes
a
fit
and
proper
person
test
for
people
who
they're
taking
on
to
their
board,
so
it
is
part
of,
and
they
will
then
make
a
legal
declaration
that
the
organization
have
got
to
sign
when
they
apply
to
cqc.
That
they've
carried
out
that
fit
and
proper
person
test.
B
B
C
D
Of
the
things
that
I
think
that
that
slightly
exasperates
the
public
is
that
when
a
a
trust
or
an
organization
is
found
to
have
failed
in
some
way
and
there's
an
investigation
by
the
time
that
investigation
reports,
a
lot
of
the
people
who
might
have
been
culpable
have
already
moved
and
the
response
of
the
organization
is
often
to
say.
Well,
you
know
this
particular
person
who
are
identified
in
the
report.
B
So,
where
people
have
found
not
to
be
fit
and
proper,
that
will
go
on
the
record
and
that
will
allow
us
to
actually
be
clear
so
that
will
go
to
people.
So
that's
exactly
the
purpose
of
having
a
fit
and
proper
person
testing
allowing
us
to
take
action
against
it
and
because
we'll
take
that
action
and
when
we
confirm
that
action
that
will
be
public,
it
will
then
be
a
matter
of
public
record
that
somebody's
found
not
to
be
pre
fit
and
proper,
and
that
will
in
a
sense,
be
with
them.
B
But
it's
exactly
the
issue
about
how
that
will
operate.
That
needs
to
be
teased
out
amongst
some
of
the
other
practical
arrangements,
but
it
the
practitioner
staff,
there's
the
boring
system
that
exists,
which
acts
as
a
record
that
can
run
and
and
in
effect,
follow
people
where
if
people
are
disqualified,
then
there
is
a
record
of
that.
B
We
need
to
work
through
this,
so
we
can
actually
get
into
this
position
of
ensuring
that
people
are
not
moving
around
the
system
as
you've
identified.
That
is
the
case
hitherto,
and
this
is
a
move
to
actually
prevent
that
happening.
There
is
an
issue
about
whether
there
will
be
a
register
of
people
who
are
fit
and
proper,
and
that's
one
of
the
issues
that
needs
to
be
teased
out
and
the
legal
issues
that
surround
that
are
occupying
a
lot
of
the
conversations
in
that.
B
B
B
In
effect,
negligence
that
they
allow
that
to
happen
when
they
were
responsible
for
quality,
so
this
is
trying
to
introduce
a
system
that
allows
where
people
have
been
in
supervisory
positions
where
those
kind
of
offenses
have
taken
place.
There
is
a
way
of
holding
them
to
account
and
ensuring
that
they
don't
do.
As
you
said,
lewis
turn
up
somewhere
else.
D
The
point
is
the
retrospective
nature,
I
suppose
as
well.
That's
the
we
don't
need
to
respond
to
that,
but
if
the
details
are
still
too
worked
out
that
that
ability
to
to
learn
from
an
investigation
where
something
has
gone
wrong
but
then
apply
it
fairly,
even
though
the
system
might
have
helped
people
who
are
culpable
to
have
moved
elsewhere
already
and
therefore
to
escape
the
the
consequences
of
the
test.
B
Typically,
what
happens
in
relation
to
this
is
there
are
checks
whether
people
in
director
positions
have
been
bankrupt
before
and
that
runs
through
companies,
house,
etc.
There's
no
way
of
actually
running
a
check
about
whether
people
have
been
in
organizations
where
there's
been
repeatedly
poor
quality
of
care.
We
can
do
something
about
registered
managers
and
not
approving
registered
managers,
but
those
that
sit
above
registered
managers
there's
a
lacunae
at
the
minute
in
terms
of
any
reach
that
we've
got
to
stop
people
just
closing
down
one
organization
moving
into
another
and
then
repeating
those.
B
So,
yes,
it
is
post
hoc,
but
it
isn't
always
retrospective.
This
can
be
a
preventative
measure
of
stopping
people
have
been
identified
as
being
less
than
suitable,
not
fit
and
proper
people
from
cropping
up
again
in
organizations
in
the
future.
But
it's
this
issue
about
whether
there's
a
registry,
not
a
register.
That
needs
to
be
teased
out
and
that's
a
how-to
question.
C
E
Sorry
so
there's
a
big
job
of
work
to
be
done
there
in
terms
of
what
working
it
through.
Let's
assume
that
well
you'll
end
up
with
a
version
of
what
what
it
looks
like
and
how
how
one
can
track
people
to
make
sure
that
they've
been
identified,
but
once
we've
reached
that
stage,
is
it
the
assumption
that
this
new
regime
will
then
be
applied
only
going
forward?
F
So
I
think
there
are
two
parts
there,
so
there's
the
the
future
looking
better,
and
so
once
the
regulation
so
forth
is
in
place.
Systematically
chairs
will
have
to
tell
us
that
they're
comfortable
as
david's
outlined,
but
that
doesn't
stop
us
at
all
from
being
retrospective
as
well.
If
there
are
particular
care
failings
that
we,
in
whatever
judgment
threshold
we
put
in
place,
say
that's
something.
So
bad
that's
happened
in
the
past.
If
there
are
any
directors
in
the
system
running
different
providers
we
want.
F
E
B
So
let
us
work
out
how
the
spirit
of
what
you've
said
can
be
built
into
the
plans
moving
forward
and
the
way
the
regulations
are
going
to
be
drafted.
That
will
give
us
the
power
to
do
this,
and
this
is
work
in
progress.
So
the
difficulty
in
answering
the
detailed
questions
is,
it
really
is
live
work
and
I
think
other
issues
from
the
francis
stuff
have
dominated
the
agenda,
and
this
is
now
something
that
needs
to
be
worked
through.
C
A
G
G
A
Yeah
thanks,
I
don't
think
it
is
about
health
at
all.
You
talk
about
physical
or
mental
health.
Are
you
either?
I
don't
think
it's
about
that.
I
think
it's
about
whether
they're
proper,
morally
proper
people
and
qualified
people
and
that's
correct.
No
david
yeah,
it's
integrity,
it's
integrity,
yeah,
okay,.
B
Yeah,
so
the
second
related
issue
is
in
relation
to
the
duty
of
candor.
This
is
an
issue
which
has
arisen
as
a
direct
consequence
of
robert
francis's
inquiry
into
mid
staffs,
and
it's
a
key
and
significant
part
of
the
care
bill
which
was
introduced
into
the
commons
for
its
second
reading
on
monday
of
this
week,
and
the
objective
is
in
addition
to
the
already
existing
contractual
duty
to
promote
a
more
open
culture
with
patients
and
others
where
mistakes
have
been
made
that
have
affected
the
safety
of
those
receiving
care.
B
B
Robert
francis,
in
his
recommendations,
talked
about
death
and
serious
harm.
The
distinction
here
is
the
difference
between
severe
and
serious
and,
and
that
potentially
includes
those
incidents
which
are
classified
as
moderate
harm
and
that
could,
on
estimations,
go
to
about
a
hundred
thousand
incidents
per
year.
B
B
One
of
the
reasons
for
that
is
that
there's
a
considerable
under-reporting
of
these
incidents
and
I
think
the
last
sentence
in
the
paragraph.
The
third
paragraph
in
my
report-
is
probably
not
entirely
accurate.
It's
not
that
will
be
an
increase
in
responsibility.
But
if
there's
to
be
an
increase
in
reporting,
then
that
will
be
an
increase
in
activity
that
the
trust
will
undertake
rather
than
responsibility.
B
It
takes
us
into
a
situation
where
I
think
we
should
be
looking
at
moderate
harm
and
going
for
that
larger
definition,
which
is
consistent
with
sirius
and
not
sticking
in
that
severe.
The
very
last
paragraph
in
this
section
says
it
would
be
presumptive
of
cqc,
david
and
himself
were
talking
before
the
meeting.
I've
certainly
had
email
correspondence
since
these
papers
went
on
to
the
public
agenda
with
peter
walsh,
who's
saying
you
need
to
say
what
you
think.
A
B
H
Really
just
to
give
a
few
comments
from
the
perspective
of
what
we've
already
seen.
As
we've
been
around
the
the
first
eight
interesting,
we
have
seen,
first
of
all,
a
huge
variation
in
reporting.
Now
it
is
always
possible
that
there
are
more
incidents
of
one
trust
than
another,
but
even
when
you
take
account
of
the
size
of
the
trust,
it's
most
improbable
that
that
is
actually
right
and
in
fact
one
of
the
trusts
where
we've
had
greatest
concerns
has
been
at
the
lower
end
of
reporting.
H
H
I
think
we
need
to
look
at
what
the
barriers
and
incentives
are
just
to
give
a
very
practical
one,
which
I
mentioned
actually
to
norman
williams
yesterday
on
some
hospitals
reporting
systems.
If
you
get
halfway
through
reporting
and
you're
called
off,
because
you're
you're
called
to
an
urgent
case,
it
disappears
again
so,
and
you
can't
save
it
until
you've
completed
it.
Now.
That
is
a
strong
disincentive
to
reporting
now,
so
we
we
need
to
find
ways
of
getting
getting
around
that
equally.
H
I
have
heard
in
some
trust
that
people
are
more
in
favor
of
reporting
when
they
can
see
that
it's
a
system
failure
than
when
they
see
it
as
an
individual
failure,
but
we
need
to
know
both
if
we're
going
to
learn
from
them.
So
I
do
think
we
need
to
to
learn
from
particularly
junior
doctors,
who
are
doing
a
lot
of
the
reporting
and
from
and
from
nurses
as
well
about
what
are
the
barriers
and
incentives.
G
I
mean
I
agree
with
david.
I
think
that
you
know
we
should
look
at
having
a
statutory
duty
to
report
moderate
concerns.
I
mean
I,
I
wonder
if
we
also
had
a
role
in
as
well
as
looking
at,
why
people
do
or
don't
report,
but
actually
build
that
into
how
we
inspect
you
know,
because
if
we're,
if
there
are
trusts
that
are
under
reporting,
that
potentially
should
count
against
them.
G
You
know,
and
we
could
also
link
it
into
this
holy
grail
of
the
sort
of
just
culture
where
we
kind
of
praise
people.
We
should
be
sort
of
praising
people
who
report
incidents
you
know
and
and
being
harder
on
people
who
who
don't
report
I
mean,
I
think
it
will
take
a
while
to
get
there,
but
I
think
you
know
we
have
a
good
opportunity
now
to
to
at
least
try
to
put
in
some
kind
of
building
blocks
and
show
a
bit
of
leadership
around
this
yep.
E
What's
right
for
for
for
patients
and
users
of
service
and
then
think
about,
and
then
how
do
we
manage
that
in
terms
of
the
work
that
we
need
to
do
and-
and
I
don't
think
there
can
be
any
argument
really
that
given
what's
happened
over
the
recent
past,
what's
become
evident
over
the
recent
past,
that
what's
right
for
the
users
of
service
is
that
they
are
owed
a
duty
of
candor
and
it
can't
just
apply
to
situations
in
which
there's
a
death.
It
must
apply
in
situations
to
which
in
which
there's
serious
harm.
E
E
What's
happened
in
an
honest
and
and
undefensive
manner,
and
that's
that's
that's
the
primary
purpose
of
of
of
this
as
francis
devised
it
and-
and
I
think
we
have
to
kind
of
keep
that
very
much
in
our
minds
and
it's
very
difficult
to
gain
say
that
what
I
recognize,
however,
is
that
that
then
creates
the
conditions
in
which
there's
a
huge
amount,
more
that
gets
both
reported
and
then
there's
a
big
dilemma
about.
What
do
we
do
with
it
all,
and
you
know
we
have
certainly
discussed
amongst
ourselves.
E
I
think
in
in
other
situations.
You
know
whether,
whether
we,
for
instance,
investigate
these,
the
these
reports
and
and
if
so,
which
ones
we
report
and
it
seems
to
me
it's
perfect.
We
investigate
it
seems
to
me
it's
perfectly
acceptable
for
us
to
make
some
different
decisions
about
which
we
investigate
and
how
we
manage
all
of
these.
E
I
That
is,
is
longer
than
having
the
error
in
the
first
place,
and
because
actually
the
public
lose
complete
trust
in
everything.
So
the
active
cover-up
I
think,
is,
but
then
I
think
that
you
know
a
passive
cover-up
is
we
we
didn't
know.
We
had
to
do
anything
to
report
this
and
I
think
that's
where
we're
moving
into
changing
a
culture,
and
that
is
a
much
longer
term
thing,
but
as
important
where
people
where
the
sorts
of
discussions
we've
had
around
this.
I
Are
you
know,
some
parts
of
the
profession
are
surprised
that
they
have
to
do
this
rather
than
actually
seeing
it
as
a
normal
part
of
what
they
do.
So
I
actually
think
in.
In
short,
in
a
short
term,
the
public
need
to
know
that
we
are
going
to
we
and
the
and
everybody
is
going
to
be
tough
around
people
who
actively
cover
up
and
that
that
is
going
to
be
part
of
a
cultural
change
which
says
it's
it's
normal
to
actually
investigate
your
own
mistakes
and
to
and
and
to
change
the
culture.
D
D
Surely
there
are
some
incidents
that
need
to
be
reported,
others
that
need
to
be
recorded
internally
that
then
there
is
the
requirement
when
somebody
asks
a
question
to
be
fully
open,
but
maybe
the
harm
was
of
a
relatively
minor
kind,
so
that
takes
us
below
the
threshold
that
we're
talking
about.
Of
course,
the
candor,
the
requirement
to
be
for
candor
is
still
there,
but
the
flexibility
means
that
the
response
of
the
organization
is
slightly
slightly
different.
It's
a
more
responsive
one
to
the
individuals
who's
asking
questions.
D
I
don't
instantly
think
it's
sustainable
to
have
a
different
requirement
on
individuals
from
the
one
that
you
have
on
the
organization
as
a
whole
because
they
are
working
in
the
organization
and
on
speaking
on
behalf
of
the
care
of
that
was
provided
by
it.
So
I
just
cannot
see
that
that
can
work.
So
my
suggestion
is
that
we,
the
duty
of
canada,
is
universal,
but
there
is
significant
flexibility
in
how
that
plays
out
according
to
the
severity
of
the
of
the
incident,
whether
that
from
severe
and
death
right
down
to
the
more
minor
incidents.
J
Sorry,
just
a
quick
question
in
the
case
of
primary
care
is
the
duty
of
canada
applying
to
the
organization
the
practice
or
is
it
just
applying
to
the
is?
Are
we
going
down
the
professional
route
for
general
practitioners,
and
second
point
is
that
I
just
noticed-
I
mean
all
of
this
is
very
acute
oriented,
isn't
it
with
david
dalton
and
surgeons
and
all
the
rest.
I
noticed
that,
and
I
noticed
that
nhs
england
recently
published
a
serious
incident
by
acute
trust,
mostly
wrong
sight
surgery
or
retained
foreign
body
post
surgery.
J
K
A
Good
thanks
very
much.
I
think,
we're
very
clear,
then
david,
that
the
that
we
support
robert,
france's
recommendations
on
this.
How
we
use
this
information
is
is
the
next
issue,
and
I
think
that
the
point
that
paul
makes,
but
under
reporting
or
covering
up,
is
often
more
important
than
the
than
the
original
arabs.
A
H
B
B
Women
who
have
terminations
of
pregnancies
about
the
guidelines
that
need
to
be
followed
and
as
a
consequence
of
that
is
we're
reviewing
our
guidance
in
relation
to
that
and
that
follows
an
earlier
piece
of
work.
That
cqc
was
asked
to
undertake
in
the
early
part
of
2012
on
looking
at
termination
of
pregnancy.
So
we
just
wanted
to
flag
that
this
was
important
work.
Coming.
B
The
remainder
of
the
report,
dr
bill
kirkup's
investigation
into
university
hospital,
more
convey
has
now
begun,
he's
begun
to
take
evidence
from
families
and
in
seven
I'm
just
providing
an
update
linked
to
that.
The
parliamentary
and
health
ombudsman
published
a
report
last
week
into
the
circumstances
of
three
families
who
had
complained
following
the
services
that
they
received
at
morecambe
and,
as
a
consequence
of
that,
drew
that
dem
julie,
millers
is
recommending
that
there's
a
separation
between
the
supervisory
oversight
of
midwives
and
the
professional
regulation
of
midwives.
B
Those
two
things
to
date
have
been
actually
being
conflated
together
at
a
regional
level
in
the
shas
and
what
she's
saying
is
that
there's
a
clear
conflict
here
and
he's
recommending
that
that's
separated
out
in
nine
I'm
just
drawing
the
board's
attention
to
some
work
which
colleagues
have
been
undertaking
working
with
a
range
of
organizations
and
the
department
of
health
on
a
concorde
around
supporting
crisis
care
in
mental
health.
This
is
largely
led
by
norman
lam,
the
minister
for
care
services.
B
We've
been
asked
to
carry
out
a
thematic
study
and
that's
now
in
our
plan
on
looking
at
emergency
and
urgent
care
in
mental
health,
and
that
will
be
taken
forward
over
the
next
year,
which
will
be
our
contribution
to
this
concord
act.
But
it
really
is
an
agreement
across
a
range
of
agencies
to
work
to
improve
the
quality
of
crisis
care
for
people
with
mental
health
problems
at
10.
B
You've
already
referred
to
this
david,
we
agreed
to
write
to
stephen
dorrell
as
chair
of
the
health
select
committee
in
relation
to
the
circumstances
where
we've
got
compromise
agreements
and
non-disparagement
provision
reinforcing
to
where
those
agreements
exist.
That
there's
no
way
that
we
want
to
prevent
anybody
from
raising
legitimate
concerns
that
they
believe
to
be
in
the
public
interest.
B
Not
all
the
individuals
have
told
their
employers
that
they've
been
offered
under
accepting
a
job.
So
in
public
session
it
wouldn't
be
appropriate
for
me
to
say
anything,
but
that's
in
progress
we'll
complete
the
due
diligence
this
side
of
christmas,
but
I
think
it's
probably
the
other
side
of
the
christmas
new
year
holiday
before
we'll
make
any
public
announcements
on
that
just
so
we
can
sequence
this
with
the
individuals
affected
and
their
organizations.
B
So
I
think
we
were
delighted
with
the
candidacies
that
we
were
able
to
consider
and
I
think
we're
very
very
pleased
with
the
offers
that
we've
been
able
to
make
to
people
as
we
go
forward.
I
think
both
steve
and
andrea,
when
they
do
their
updates,
will
update
more
generally
about
where
we
are
on
appointments
on
chief
inspectors
davidson.
H
H
H
We've
held
quality
summits
for
the
first
eight
of
those
18
and
four
of
the
reports
are
already
in
the
public
domain.
The
next
four
will
be
in
the
public
domain
from
this
afternoon,
so
I
can't
formally
talk
about
about
them
as
specifically
at
this
stage,
but
I
can
give
some
general
comments
on
all
18
without
naming
names.
H
As
everybody
knows,
it's
been
a
three-phase
program,
the
pre-inspectional
preparation
phase
in
the
inspection
phase
and
then
the
report
writing
and
quality
summit.
It
was
based
on
a
combination
of
what
we
have
been
doing
here
previously
at
cqc
and
what
bruce
keough
had
been
doing
for
his
review
of
high
mortality
trusts.
H
What
I
would
say
is
that
we
have
been
making
modifications
to
the
process
as
we've
gone
along:
we've
done
them
in
groups
of
four
or
five
and
after
each
group
we've
taken
the
time
to
try
and
improve
the
process,
and
then
there
will
be
further
significant
improvements
between
this
wave
and
the
next
wave,
which
is
in
january.
So
just
give
examples.
H
We
we
now
ask
the
chief
executive
of
the
provider
trust
to
give
us
a
presentation,
but
we
do
that
during
our
training
day,
because
it
starts
getting
the
team
really
familiarized,
with
the
trust
that
they're
going
to
be
inspecting.
It
also
gives
us
the
opportunity
what
gives
the
trust
the
opportunity
to
say
what
the
context
is,
what
they
think
they're
doing
well,
but
also
what
challenges
they
face
and
obviously
we
want
to
see
if
they
know
about
the
challenges
they
face
alongside
what
we
then
find.
H
And
I
think
a
very
important
part
of
this
is
that
we
are
trying
to
get
people
to
identify
both
the
positive
and
the
negative
factors,
and
I
think
this
is
quite
a
change
in
the
way
that
we're
doing
things
emphasizing
what
is
good
as
well
as,
what's
not
so
good,
we're
still
learning
we're
still
working
with
the
kings
fund,
for
example,
on
how
we
measure
the
well-led
domain.
But
I
think
we've
already
made
good
progress
on
that
and,
I
think
also
to
say
in
these
18
trusts.
H
We've
had
some
very,
very
large
trusts,
bart's
health,
heart
of
england
foundation,
trust,
nottingham,
university,
hospitals,
trust,
and
so
these
are,
I
don't
think,
inspections
of
this
size
and
complexity
have
been
done
before,
because
all
of
the
keo
trusts
happen
to
be
rather
smaller
and
again
we
are
learning
how
best
to
do
that.
What
we
have
shown,
I
think,
is
that
the
the
process
is
deliverable
and,
despite
very
tight
time
skills,
we
have
recruited
the
people.
H
We
need
the
very
senior
figures
to
be
the
chairs,
the
team
leaders,
the
clinicians,
the
experts
by
experience
and
the
cqc
inspectors.
That's
has
been
tight
simply
because
of
the
pace
that
we've
been
doing
it
at.
I
think
in
future,
if
we
can
give
ourselves
a
longer
interval
between
identifying
the
trust
that
we're
going
to
go
into
and
the
actual
site
visit
that
will
get
considerably
easier.
H
I
think
in
terms
of
what
we
have
found.
First
of
all,
I
think
it
is
very
important
to
say
we
have
found
a
lot
of
very,
very
good
care
and
really
compassionate
care
being
delivered
by
staff.
Actually
in
every
single
one
of
the
18
trusts,
we've
been
into
that's
been
reported
by
the
inspection
teams,
and
I've
witnessed
it
myself.
H
We
have
seen
some
trusts
that
are
really
delivering
excellent
care
across
a
whole
range
of
of
services
and
under
and
across
all
the
core
services
that
we
are
looking
at.
That
also
means
that
we've
seen
some
that
are
not
doing
that,
but
I
think
what
that
does
tell
us
is
that
our
inspection
program
really
can
tell
the
difference
between
the
different
levels
of
quality
and
the
different
outcomes,
but
possibly
just
as
important
as
that
is
that
within
an
individual
trust,
we
can
detect
variation.
H
I
think,
a
third
level
of
specificity
if
you
like.
We
have
also
seen
that
there
are
some
individual
services,
and
this
particularly,
I
think,
applies
to
to
the
medical
care
where
across
10
15
wards
in
a
in
the
trust.
Most
of
them
may
actually
be
delivering
good
care,
but
there
may
be
one
or
two
wards
that
are
really
off
the
pace
now.
Clearly,
what
one
of
the
things
that
matters
here
is?
Does
the
trust
know
that
in
advance
and
what
are
they
doing
about
it?
H
H
We
will
be
bringing
in
more
information
from
national
clinical
audits,
because
actually
they
are
one
of
the
best
ways
of
deciding
how
effective
the
care
is
and
how
that
compares
with
other
trusts.
We're
also
looking
at
whether
we
can
vary
the
the
time
and
location
of
patient
listening
events.
Is
it
always
best
to
do
these
in
the
evening,
or
should
we
be
doing
some
of
them
in
during
the
day
time
so
and
under
report?
Writing
we're
still
at
quite
an
early
phase
of
the
report.
H
Writing,
if
I'm,
if
I'm
honest,
we
are
learning
with
each
report
that
we
write
and
the
more
that
we
can
have
a
standardized
template
and
actually
that
we
can
populate
the
the
reports
from
the
data
packs
that
will
make
things
easier.
We've
established
an
acute
advisory
group.
Now
it's
had
its
first
meeting.
That's
been
very
valuable:
getting
feedback
from
royal
colleges
from
other
partner
agencies
healthwatch,
so
that
we
can
really
make
sure
that
we
are
doing
this
with
support
of
all
those
those
agencies.
H
We
will
be
publishing
a
handbook
in
january,
which
will
give
guidance
to
providers
about
what
we're
expecting,
and
it
should
be
helpful
for
them
and
also
at
the
end
of
the
the
process
for
wave
one
which,
by
the
time
we
get
to
all
the
reports,
is
at
the
end
of
january
or
early
february.
We
will
then
be
reporting
on
the
first
three
shadow
ratings,
and
so
I
think
all
of
that
is
pointing
in
the
right
direction.
H
H
A
A
A
A
I
We
are
looking
going
back
on
every
to
everybody.
You
know,
if
not
physically
going
back.
You
know
everybody's
under
review,
because
the
importance
of
improvement
and
generally
over
the
last
three
months
it
was
about
three
months
ago
after
the
kia
reviews,
when
when
the
first
hospitals
were
put
into
special
measures
and
no
one
knew
what
it
was
for
the
day,
it
happened.
No
one
knew
it
was,
and
actually
the
interesting
thing
is
now.
I
think
they
do.
I
I
actually
think
within
three
months
people
have
recognized
that
actually,
you
can
have
a
very
bad
report
and
be
left
in
charge
of
the
outcome
or
have
a
very
bad
report
and
lose
your
autonomy,
because
you
actually
have
special
measures
and
I
think
so.
I
actually
think
there
is
a
there's,
a
recognition
of
a
differentiated
set
of
outcomes.
Now
what
happens
then,
after
that?
I
you
know
it's
early
days
on
that,
but
so
I
think
the
categories
that
you
end
up
in
are
beginning
to
mean
something
in
in
the
in
the
service.
D
So
people
with
dementia
or
learning
disability
it
might
be
because
of
settings
which
are
historically
rather
poor,
such
as
the
the
way
emergency
departments
provide
for
people,
who've
self-harmed,
for
example,
or
it
might
be
people
who
are
socially
on
the
margins
homeless,
people
people
from
certain
ethnic
minorities,
people
whose
first
language
is
not
english
but
there's
a
whole
set
of
people
who
who
sometimes
don't
get
the
best
that
the
health
service
can
generally
provide.
And
we
want
that
to
be
reflected.
H
So,
for
example,
on
the
medical
wards,
we
will
always
look
at
the
care
of
the
elderly,
which
always
includes
people
with
dementia,
and
we
will
ask
specific
questions
there.
I
think
we
are
in
the
in
the
a
e
department
we're
clearly
going
to
be
asking
about
what
mental
health
support
there
is
in
the
a
e
department.
Are
we
doing
it
as
well
as
we
could
and
as
systematically
as
we
could?
Yet?
J
We've
in
our
inspections,
we
have
to
set
priorities
about
where
to
go
and
look
and
what
to
probe
and
that's
based
on
a
whole
set
of
information
that
we've
got
in
advance
under
so
understood
that,
but
where
we,
because
we
can't
be
everywhere
all
the
time
in
these
hospitals
and
where
we
have
in
a
sense
deprioritized
some
areas
because
we're
not
so
worried
about
them.
Perhaps
how
confident
are
we
that
if
we
haven't
been
to
look
at
those
areas
that
actually
they're
okay,
have
we
done
any
testing
to
just
check
that.
H
I
think
the
second
half
for
your
question
probably
have
we
done
any
testing.
The
answer
is
no.
I
think
that
the
process
does
allow
for
us
to
hear
from
a
lot
of
different
angles.
That
would
point
us
towards
different
services,
so
in
one
of
the
hospitals
we've
been
into,
we
did
pick
up
concerns
about
the
off
salmonology
outpatient
department,
and
so
we
went
and
looked
at
that
ophthalmology
outpatient
department
that
came
through
complaints.
The
trust
knew
about
it
themselves.
We
heard
about
it
from
staff,
so
I
think,
because
we
look
from
multiple
angles.
H
We
will
pick
up
a
lot
of
those
things
and
equally
at
the
the
listening
event,
I
think
in
what
one
place
we
heard
concerns
about
vascular
services,
so
we
went
and
looked
at
vascular
services.
I
don't
think
unless
we
go
to
every
single
department
of
every
single
hospital,
I
can
ever
give
assurance
that
we
won't
miss
things.
I
think
our
process
minimizes
the
risk
of
that
but
does
not
eliminate
it.
G
Yeah
I
mean
thanks
for
the
report.
I
mean
one
thing
that
I
would
like
to
be
able
to
sort
of
say
eventually
is
to
sort
of
answer
the
question
about.
You
know
what
what
what
difference
have
we
made,
and
I
think
particularly
you
know
over
time.
You
know
we
we
can
maybe
look
at.
You
know,
sort
of
tangible
improvements.
G
You
know
based
on
the
inspection
and,
obviously
that's
very
good
sort
of
evidence
of
the
the
sort
of
impact
we've
had
so
it'll
be
useful
to
know
that,
but
also
sort
of
over
over
time
I
mean
there
inevitably
will
be,
for
example,
unintended
consequences,
that's
sort
of
inevitable
and
and
also
the
sort
of
also
the
value
for
money
element
which
we
will
at
some
point
be
challenged
with
so
yeah.
What
what
it's?
H
And
so
will
I
undoubtedly,
I
think
we
will
probably,
within
a
few
months,
get
some
steers
about
if
you
like,
the
quick
wins
that
we've
had.
I
there
are
things
that
people
have
put
right
already.
I
can't
give
you
a
list
of
those
yet,
but
I
think
we
should.
We
should
try
and
compile
a
list
of
of
the
things
where,
where
trusts
have
said
yep
in
response
to
that
within
a
month
within
two
months,
we
we
did
the
following
things,
because
I
think
that
would
be
would
be
valuable.
H
A
Thanks
very
much
mike
just
kind
of
just
finished
with
just
two
points:
some
inspections
are
better
than
others.
Inevitably,
because
the
people
on
the
team
will
be
better
they'll
handle
it
better
in
terms
of
training
up
inspectors.
Is
that
that's
something
I
just
would
like
to
think
that
we're
doing.
A
A
H
No
undoubtedly,
we
need
more
training
and
better
training
for
for
people
going
on
these
inspections.
Again,
it's
partly
been
the
the
pace
that
we've
been
working
at.
That
has
not
meant
that
that's
ideal,
but
equally,
we
now
know
more
about
the
process
ourselves
and
we
we
know
what
we
really
want
to
the
training
to
include
and-
and
I
think
a
key
group
are
our
own
staff-
that
this
is
a
very
different
process.
We
are
expecting
different
things
of
of
them.
H
We
particularly
want
them
to
look
at
what
is
good
in
this,
and
so
we
need
to
give
them
the
training
in
what
to
look
at
is
what
is
good
so
that
that
is
something
that
we
are
put.
We
have
put
in
place
a
one-day
training
program
for
the
people
who
will
be
inspectors
in
the
next
wave
that
will
starts
in
early
january,
so
we're
taking
that
seriously.
Will
that
be
enough?
H
No,
it
won't,
but
it
will
be
a
good
starting
point
and
in
terms
of
the
external
people
we
have
already
selected,
because
we
didn't
have
time
to
do
more
training.
We
have
selected
people
who
have
done
similar,
peer-review
inspections
for
other
organizations
and
but
we
do
build
in
some
training
to
the
so-called
day
naught
of
our
program,
in
other
words,
when
they're
on
site,
but
before
they
go
and
inspect
the
hospital.
But
we
can
do
bit
more
and
we
do
better.
A
L
So
it's
a
challenging
task
to
try
and
make
sure
that
we
can
have
a
good
line
of
inquiry
which
is
supportive
to
the
inspections
that
we're
going
to
undertake.
But
it's
not
war
and
peace
in
terms
of
burdening
our
inspectors
and
our
experts
by
experience
with
with
so
much
guidance
that
they
can't
get
through
it.
L
Developing
the
rating
system
obviously
comes
out
of
that
and
and
it'd
be
you.
It's
going
to
be
very
useful
to
take
the
experience
that
mike
has
already
had
of
looking
at
how
the
the
assessments
that
the
inspections
teams
will
make,
how
that
will
apply
in
adult
social
care,
which
again
is
different
in
terms
of
the
complexity.
L
But
we
also
need
to
be
thinking
about
how
we,
how
we
look
at
this
from
a
corporate
provider's
point
of
view
to
a
very
small
domiciliary
care
agency,
point
of
view
ensuring
that
we're
still
consistent
across
the
board,
so
that
people
can
have
confidence
in
that.
But
that
we're
recognizing
and
acknowledging
the
different
sources
of
data
that
we've
got
there.
L
L
So
we
are
being
able
to
involve
inspectors
and
people
in
some
of
the
supporting
teams
in
the
development
of
the
new
approach,
so
that
actually
we're
kind
of
building
up
the
learning
from
within,
as
well
as
in
the
future,
and
putting
that
into
the
training
that
we'll
take
through
the
academy
once
we're
clear
about
what
what
training
needs.
There
are,
and
we've
got
an
internal
co-production
group
which
met
last
week
and
which
is
going
through
the
key
lines
of
the
lines
of
inquiry
and
and
how
he
would
take
that
forward.
L
L
D
D
The
risks
that
people
could
be
could
be
under
and
the
winterbourne
view
work
is
reaching
a
sort
of
conclusion.
I
suppose,
over
the
next
few
months.
As
I
understand
it,
and
so
I
I
am
wondering
whether
there
is
an
equivalent
piece
of
work
which
might
apply
more
broadly,
not
just
to
the
learning
disability
people
who
are
the
the
subject
of
the
winterbourne
view
post
winter.
One
view
work,
but
talking
now
about
more
broadly
about
residents
of
care
homes
who
might
be
equivalently
vulnerable.
L
Thank
you
very
much
lewis,
and
and
thank
you
very
much
for
raising
it
in
between
the
meeting
with
me
as
well.
I
think
the
the
reassurance
that
I
can
give
you
is
that
this
is
a
critical
part
of
what
we're
doing
in
the
development
of
the
new
regulatory
approach
on
on
two
levels.
I
think
which
are
really
important.
The
first
is,
what's
the
in
what
is
intelligent
monitoring
for
adult
social
care?
Where
do
we
get
the
information
and
the
insight
to
identify
the
risks?
L
That
would
determine
our
inspection
practice,
and
I
think
that
we
do
not
have
in
in
adult
social
care
the
breadth
and
the
depth
of
the
data
that
is
available
in
an
acute
hospital,
so
the
risk
rating
that
mike
was
able
to
produce
a
few
weeks
ago,
150
data
items
behind
each
of
those
hospitals.
We
are
unlikely
ever
to
have
that
amount
of
information
consistently
collected
across
the
24,
odd
thousand
locations
that
we're
regulating
in
adult
social
care.
L
So
we
need
to
be
thinking
about
how
do
we
actually
get
insight
in
different
ways?
So
that's
looking
at
what
some
of
the
corporate
providers
are
already
doing,
because
they
are
actually
interested
in
this
as
well
in
creating
their
own
quality
assurance
mechanisms.
So
how
do
we?
How
do
we
make
sure
that
we're
sharing
data
and
information
appropriately
there?
L
So
that's
one
aspect
of
it.
The
second
aspect
of
it,
then,
is
what
are
we
doing
around
our
inspection
practice
and
looking
at
those
things
that
actually,
as
you
quite
rightly
say,
would
be
warning
signals
in
terms
of
the
potential
for
abuse
and-
and
here
I,
I
think,
we're
helped
by
something
that
I
was
involved
in
last
week,
which
was
the
launch
of
a
summary
report
which
had
been
commissioned
by
comic
relief
and
the
department
of
health
looking
at
the
prevention
of
abuse
and
neglect
of
older
people
in
institutional
settings.
L
L
How
do
we
ensure
that
they've
got
much
as
we
were
talking
about
fit
and
proper
persons
at
a
directorate
level?
How
do
we
make
sure
that
we're
recruiting
people
who
got
the
values
and
displayed
the
behaviors
that
we
need
to
have
in
the
services
that
we're
regulating?
How
are
they
trained
and
how
are
they
appropriately
supported?
L
And
then
I
think
the
other
things
that
we
can
do
to
help
around
this
is
identify
the
areas
of
good
practice
because
they
do
exist,
and
so
our
ability
to
rate
on
this
basis
in
the
future,
I
think,
will
give
us
greater
confidence
in
being
able
to
share
good
practice
and
also
to
point
people
to
the
resources
that
are
available
to
them
to
improve
practice.
So
things
like
the
adult
social
adult
safeguarding
resources
that
social
care
institute
for
excellence
launched
earlier
this
year
as
an
example.
G
I
mean
I
obviously
agree
that
we
should
be
looking
at
prevention,
but
I
think
he
probably
needs
more
more
than
that.
That's
just
one
one
element
of
it,
and
I
think
you
know
this.
This
sort
of
abuse
has
been
going
on
for
years
and
years
and
we're
just
sort
of
more
aware
of
it
now,
and
it
probably
will
you
know,
because
people
are
potentially
vulnerable,
for
example,
if
they
have
sort
of
dementia
or
learning
disability,
it
does
add
to
their
risk.
G
If
you
like,
of
abuse
and-
and
I
think
I'm
I'm
right
in
saying
that
when
we
have
people
that
contact
us
with
concerns,
it's
more
often
than
not
from
a
social
care
setting-
and
I
just
wondered
you
know
going
forward
the
extent
to
which
we
should
either
continue
or
encourage
people
to
come
to
us
with
concerns
whistleblowing
concerns,
because
it
seems
that
that
that
is
a
really
important.
It's
at
the
moment.
It's
still
a
really
important
way
of
of
getting
getting
to
concerns.
G
You
know
if,
if
we
need,
for
example,
a
relative
or
a
staff,
a
member
of
staff
to
actually
say
look
abuse
is,
is
is
happening.
You
know
that's
in
a
way
a
really
important
way
of
identifying
it,
and
I
just
wondered
if
we
are
going
to
sort
of
continue
to
promote
that.
You
know
to
encourage
people
to
to
contact
us
with
concern.
L
The
short
answer
given
that
I
gave
such
a
long
answer
to
the
last
question
is:
is
yes
and
and
you're
absolutely
right.
We
get
information
in
a
variety
of
different
ways,
both
from
relatives
but
also
from
other
professionals
who
are
visiting
services
or
visiting
people
at
home
and
picking
up
on
on
those
signs,
and
we
do
need
to
take
those
into
consideration
and
that's
part
and
parcel.
J
It's
just
a
quick
question.
The
wave
one
of
inspections
for
social
care
and
indeed
for
primary
care,
is
the
principle
going
to
be
the
similar
to
the
acute
sector
that
there
will
be
high
risk,
medium
risk,
low
risk
or
at
least
perceived
higher
and
medium
lowest,
and
that's
going
to
be
part
of
wave.
One.
L
L
So
so
I
think
that
what
we're
looking
at
in
terms
of
trying
to
work
out,
what
are
the
places
that
we
should
be
going
into
in
wave
one,
is
the
different
types
of
service
and
the
different
nature
of
those
services,
because,
actually
that
the
risk
is
really
well
spread
out,
I
mean
k
is
absolutely
right.
An
awful
lot
of
the
people
that
we're
providing
service
to
and
adult
social
care
are
vulnerable
are
at
risk
and
because
of
the
nature
of
the
situation
that
they're
living
in.
L
L
Yes,
we
do
and
that's
something
that,
as
you
know,
we're
tackling
at
the
moment
in
terms
of,
and
actually
it's
one
of
those
things.
The
question
that
we
were
asking
earlier
is
that
are
we
making
a
difference?
And
we
certainly
know
that
in
encouraging
people
or
letting
people
know
that
we
were
going
to
be
taking
forward
our
ability
to
issue
fixed
penalty
notices
around
registered
managers?
People
are
pretty
rapidly
getting
that
sorted
out,
but
yes,
you're
right.
A
Well,
thank
andrew.
Thank
you
very
much,
I
think,
maybe
paul.
We
could
ask
you
and
andrew
to
come
back
to
the
board
with
what
we
do
have
when
it
comes
to
intelligent
monitoring
about
social
care
at
a
future
meeting
we'll
be
all
right.
I
think
we
should
move
on
to
steve
steve
has
had
you
had
a
tough
week
steve.
A
K
K
K
So
one
of
the
difficulties
we're
going
to
have,
I
think,
social
care.
It
also
goes
very
similar
and
if
you
have
very
small
practices,
many
patients
feel
vulnerable
about
complaining,
because
in
some
areas
that's
the
only
gp
they
have
access
to
and
they
feel
that
their
future
care
will
be
compromised
if
they
were
identified.
K
The
same
for
for
members
of
staff
and
therefore
one
of
the
things
I
have
to
do
is
protect
the
sources
that
we
are
getting
that
information
from
which
at
times
makes
my
job
more
difficult.
But
that's
what
we
will
do.
I
was
delighted
by
the
collective
effort
of
staff
in
cqc,
helping
us
produce
the
signposting
document
and
also
to
reflect
back
on
to
the
last
board
meeting
which
challenging
in
a
really
constructive
way.
For
example,
positing
a
question
about
whether
we
should
rate
general
medical
practices
against
the
patient
groups.
K
Unfortunately,
when
you
talk
about
a
system
that
I've
inherited,
it
does
focus
on
inadequate
practices
and
compliance
with
regulations,
rather
than
looking
at
the
good
and
outstanding.
So
one
of
the
things
that
will
happen,
as
we
begin
wave
one
and
onwards
from
april-
is
that
when
we
start
to
rate
practices,
we
will
be
able
to
celebrate
good
and
outstanding
practice.
K
How?
How
really
good
and
keen
people
are
to
get
involved,
but
we
will
need
to
recruit
from
the
outside
and
we're
having
many
meetings
with
stakeholders,
including
people
like
senior
examiners
from
the
college
senior
educators.
Who've
been
involved
in
inspections,
who
want
to
be
part
of
this
journey.
K
K
We'll
then
start
to
take
out
of
hours
in
as
part
of
when
we
go
into
the
localities,
and
we
can
also
then,
through
our
integrated
approach
and
team
review,
start
to
look
at
how
urgent
care
is
provided
because
it's
the
handoffs
between
services,
where,
where
patients
are
at
risk.
That's
all.
I
actually
wanted
to
say,
because
those
are
the
two
main
areas
of
work.
Although
you'll
see
in
the
report
that
we've
also
started
to
work
with
with
dentists
and
others.
Thank
you.
J
I
It
was
interesting
to
to
to
see,
as
this
is
the
first
time
as
steve
said,
the
gp's
been
regulated
that
the
interest
in
it
first
of
all
the
recognition
again
that
there's
variation
and
that
this
was
an
important
issue
and
then
disappointingly
that
the
world
college
didn't
say
there
was
variation,
and
this
looks
remarkably
like
the
nut
in
93.,
and
I
just
like
to
say
that
sooner
or
later
they
will
say
there
is,
as
spring
becomes
summer
and
more
more
reports
come
out.
They
will
then
agree.
I
There
is
variation
that,
in
the
end,
the
public
recognition
of
this
will
overcome
a
protective
stance
and
it
will
be
tricky
for
a
few
months
as
the
as
the
professional.
In
a
sense,
I
think,
acts
in
a
defensive
way,
but
I
think
the
evidence
will
the
evidence
will
be
there,
and
I
think
that's
that's
important
to
recognize
at
the
beginning
of
that
and
it
will
change.
I
The
second
thing
is
this
is
going
and
coming
back
to
my
thing
about
the
rhythm
of
of
a
of
a
report,
and
then
this
is
one
of
the
few
reports
that
actually
nhs
england
should
be
responding
to
because
it
says
they
hold
the
contracts
and
therefore
they'll
be
they'll,
be
the
improvement
agency.
The
practices
themselves
will
be
the
improving
nature,
but
then
energy
england
needs
to
take
responsibility
and
if,
in
the
fullness
of
time,
there
are
special
measures
for
practices,
then
actually
it's
energies,
england.
K
K
You
have
examples
of
of
support
development
and
not
tolerating
inadequate
practice
in
places
like
tower
hamlets
in
other
areas,
we're
picking
up
from
the
british
medical
association
and
others
that
practices
haven't
been
supported
and
in
one
area
specifically,
they
were
worried
about
whether
if
they
didn't
have
a
practice,
it
was
better
to
have
a
gp
that
they
were
worried
about
rather
than
no
gp
at
all,
and
I
think
what
we're
now
finding
is
that
we're
turning
up
the
heat
not
just
on
quality
within
practice.
I
hope
we
never
see
another
inadequate
practice.
K
K
So,
if
I,
if,
if
our
teams
go
into
practices
now
and
and
those
sort
of
things
are
exposed
again,
it
is
very,
very
sad,
but
also
we
do
need
nhs
england
to
support
the
practices
and
actually
monitor
the
contracts
as
well,
and
I
think
this
is
a
wake-up
call
to
everyone.
Unfortunately,
messengers
get
shot
occasionally
and
there
you
go.
D
Quickly,
well,
in
that
case
very
quickly,
I
I
actually
thought
you
did
a
really
good
job
steve.
Actually,
I
must
say
it
was
it
wasn't
an
easy
task,
because
there
was
much
less
interest
in
what
you
said
about
the
widespread
nature
of
good
practice,
and
even
though
you
kept
saying
it,
I
think
it
kept
being
ignored
and
you
were
brought
back
to
the
maggot
question,
which
I
think
we'll
all
remember
this
launch
for
the.
D
But
there
is
a
serious
point
here
about
the
clinical
credibility
of
this
process,
which
we
have
to
bear
in
mind.
There's
no
doubt
that
responsibility
to
patients
and
to
their
patients,
families
is
absolutely
the
criterion
by
which
the
success
of
these
inspections
will
be
measured.
But
behind.
But
next
in
importance
is
the
credibility
in
the
people
who,
with
with
people
who
are
delivering
the
service,
and
so
I
don't
encourage
you
to
keep
making
the
point
about
good
practice.
D
B
So
I
think,
behind
each
of
them
there
are
teams
that
are
working
on
this
to
produce
the
documents,
and
so
I
think
the
organization
as
a
whole
is
really
demonstrating
a
corporate
and
collaborative
approach
to
this.
I
think
all
of
them
has
referred
to
the
people
that
have
assisted
in
producing
the
reports,
etc.
So
the
other
side
of
this
internally
there's
a
real
team
effort
going
into
this.
The
organization's
running
very
hot
people
are
very
busy
and
we
need
to
attend
to
that.
B
But
the
fact
is
that
people
are
really
working
to
support
this.
I
think
the
other
thing-
and
I
think
this
is
a
space
that
lewis
was
just
in
really
as
well
as
our
own
staff.
Behind
this
david.
I
think
the
launch
we
had
this
morning
of
engagement
with
service
users
and
then
engagement
across
the
system
has
been
critical
to
helping
us,
not
just
in
terms
of
the
credibility
with
the
service.
I
think
your
point
paul
about
changing
perceptions
is,
I
think
we
are
at
that
edge
of
whether
people
think
regulation
is
good
or
bad.
B
So
it
feels
to
me
that
it's
coming
together,
I
think
jennifer's
questions
were
really
pertinent.
I
think
andrea's
point
was:
is
that
there's
more
date
on
which
we
can
do
the
surveillance
for
acute
healthcare,
but
I
think
we
need
to
not
to
emphasize
what
we've
not
got
in
terms
of
the
data
to
emphasize
what
we
have
got
and
say
what
we
can
do
about
that
surveillance,
and
I
think
these
points
about
we
do
know
something
about
registered
managers,
for
instance,
and
the
criticality,
and
that
can
flag
risk.
B
It's
a
smoke
alarm
and
similar
steve
will
have
them.
So
I
think
I
think
pushing
into
that
space
after
at
the
beginning
of
next
year.
David
and
bringing
a
report
forward
will
help
us
actually
talk
about
what
it
is.
We
can
do
and
expose
that
that
conversation
in
the
same
way
that
we
have
on
acute
healthcare,
because
that
surveillance
or
metrics
are
an
essential
part
of
our
new
operating
model
and
therefore
I
think
we
need
to
start
demonstrating
what
we
can
do
the
debate's
about.
B
F
All
right,
so
this
is
the
october
report,
combines
performance,
finance
and
risk.
If
I
just
do
the
headline
sense,
so
we're
at
98
of
our
plan
for
the
inspections
completed,
we've
discussed
many
times
that
activity
is
by
no
means
the
only
measure
and
we
will
look
to
or
we
are
changing
that
already,
but
as
far
as
it
is
an
important
measure,
it's
when
we
track
carefully,
which
means
we
remain
confident
that
we'll
complete
the
our
programme
of
inspections
in
good
time
for
the
year
end
of
the
end
of
march.
F
We
had
a
conversation,
I
think,
at
the
previous
board
meeting
about
the
underperformance
in
terms
of
the
metric
around
reporting
after
inspections
and
a
conversation
about
whether
it
was
appropriate
to
sort
of
effectively
performance
manage
that
and
the
dangers
of
cracking
the
whip
resulting
in
in
the
wrong
reports
or
reports
weren't
as
good
as
they
need
to
be.
I
think
I
gave
assurances
at
that
time
that
we
would.
We
would
do
that
thoughtfully
and
we
would
do
it
differentially
for
the
different
sets.
F
The
finances
remain
unchanged
in
terms
of
year-end
projections
compared
to
the
last
board
update.
That's
a
2.4
million
under
spend
on
the
revenue
side
and
7.1
million
projected
underspend
on
the
capital
side
and
we're
very
much
holding
to
the
line
that
we
will
spend
where
we
have
firm
plans
to
do
so.
But
what
we
absolutely
won't
do
is
commit
and
spend
money
if
we
don't
think
it's
good
value
for
money.
F
Looking
at
the
risk
side,
we
have
a
number
of
strategic
risks
that
doesn't
mean
that
we
don't
also
have
a
series
of
operational
risks
as
well,
but
in
terms
of
things
which
we
monitor
most
carefully
at
the
board,
we
have
five
that
are
in
the
high
risk
category.
We
think
we
have
the
right
medications
in
place.
I
think
it's
worth
pointing
out
that
they
are
high
risk
because
of
the
impact
if
they
did
occur,
rather
than
the
likelihood
of
them
occurring,
which
are
all
at
medium
I'll.
Stop.
There.
C
Chairman,
thank
you.
I
was
going
to
ask
some
questions
about
the
transformation
program,
but
I'd
like
to
do
that
under
item
six
in
the
next
part
of
our
agenda.
I
think
which
would
probably
fit
better
and
it
would
fit
with
your
time.
So
I
will
limit
myself
to
my
regular
query
about
the
budget
and
I
was
struck
very
much
last
night
sitting
next
to
matthew
swindell.
C
It's
still
where
it
was,
and
we
now
need
to
spend
more
in
the
last
five
months
of
this
year
than
we
did
in
the
first
seven
months
in
order
to
meet
our
target.
So
I
just
feel
that
at
the
next
meeting,
if
we're
still
saying
2.4
million,
then
probably
we're
not
as
forecasting
as
accurately
as
we
need
to.
B
So
no
routine
inspections,
just
because
it's
a
time
on
the
program
unless
there's
a
risk
that
is
presented
by
it,
and
that
will
give
some
easing
because
we're
going
to
dramatically
change
our
methodology
for
hospitals,
which
we
think
are
okay.
There's
no
point
in
applying
the
old
methodology
to
those
inspections.
I'm
going
to
invite
the
regional
directors
to
just
confirm
that
they'll
remove
those
from
the
plan,
and
that
will
then
give
more
time
back
to
some
of
the
planning
and
the
other
inspections
which
need
to
take
place.
G
Just
that
I
welcome
that
I'd
much.
Rather,
we
spent
our
time
on
where
we
think
there
are
problems.
Actually,
even
if
it
means
we
do
a
bit
less
inspections.
I'd
rather,
you
know
switch
more
to
quality
than
quantity.
So
I'm
you
know
really
really
pleased
you're
doing
that
also
I
mean
have
we
thought
ahead
about
our
you
know.
B
It's
a
really
good
question,
kate,
and
I
think
the
answer
to
this
is
why
the
early
conversation
about
the
surveillance
on
adult
social
care
and
primary
medical
services
is
so
important
because
we've
taken
our
decision
in
relation
to
the
choose.
One
of
pulse
rates
is
the
rhythm
of
our
inspection
year
next
year,
based
on
the
bandings
on
that
risk
surveillance.
Given
we've
not
got
that
what
we'll
be
doing
next
year
is
running
our
commitments,
thus
far
on
adult
social
care
have
been
willing
to
inspect
everything.
B
I
hope
this
meets
john's
metric
of
a
good
organisation.
That's
what
predominantly
paul's
team,
along
with
the
chief
inspectors
and
their
emergent
teams.
I
do
make
this
point
that
some
of
these
people
just
walked
through
the
door
a
couple
of
weeks
ago
to
do
this
work,
that's
effectively
what
they're
doing
just
to
get
that
and
the
same
on
primary
medical
services.
B
So
it's
absolutely
right,
but
that's
what
we're
trying
to
do
and
that's
what's
driving
the
numbers
that
we
think
we
need
to
do
the
inspections
next
year
and
also
trying
to
build
in
enough
time
for
enforcement.
But
this
issue
that
paul
made
brief
reference
to,
which
is
making
sure
that
we
don't
just
count
the
numbers
that
we've
done.
But
we've
got
some
view
about
the
quality
of
that
work,
which
is
being
done
as
well,
and
we've
been
doing
some
work
on
how
we
capture
quality,
not
just
overall
numbers,
yeah.
G
M
M
This
is
not
only
desirable
but
needs
to
be
done
smoothly,
and
I
think
I
want
to
pay
tribute
to
the
quality
of
the
members
of
the
committee,
who
are
all
experts
and
whenever
we've
had
presentations
from
cqc
staff,
about
what
they're
doing
which
you
can
see.
We
had
a
number
out
of
at
this
last
meeting.
They
have
gone
away
genuinely
impressed
by
the
quality
of
contributions
from
the
members
of
the
committee,
and
I
think
it
is
proving
very,
very
worthwhile.
M
M
A
Steve,
thank
you
very
much
and
just
take
this
opportunity
to
thank
you
very
much
because
actually,
everyone
knows
steve
is
standing
down
in
at
the
end
of
december,
going
to
be
the
chairman
of
the
whittington
trust,
willington
health
trust,
which
is
an
integrated
community,
an
acute
nhs
hospital
trust.
So
thank
you
very
much
for
what
you've
done
for
us,
steve
and
good
luck.
The
future
will
be
coming
around
to
inspect
you
in
due
course.
C
M
Yes,
all
right
very
much,
I
mean
I've
had
a
great
time.
We
actually
got
the
lowest
mortality
rate
of
any
acute
trust
in
the
country
at
the
moment,
but
so
I'm
moving
from
regulator
to
regulated,
but
I
had
a
great
time.
Thank
you
very
much
to
everybody,
I'm
sorry
to
be
leaving
before
my
period
of
offices
up,
but
I
suppose
the
next
thing
to
do
is
to
be
recruited
to
mike's
army.
Isn't
it
thank
you
very
much.
C
Thank
you
very
much.
Would
the
board
agree
that
that
the
quality
of
this
information
would
be
very
much
improved
if
the
secretary
of
state
would
allow
the
resumption
of
inspection
of
adult
social
services
department
which
have
come
to
an
end
recently,
not
the
old
whitewashing
ones
which
we
saw
in
the
past,
but
the
new,
demanding
and
probing
kind
of
inspection
that
you're
doing
everywhere.
B
80
percent
of
people
who
are
commissioning
services
are
self-funders,
and
it's
currently
at
about
47
48
and
rising
of
nationally
people
who
are
self-funders.
A
significant
proportion
is
commissioned
by
ccgs
because
it's
nursing
care
or
the
nursing
element
of
adult
social
care.
So
in
a
sense
if
the
challenge
from
providers
is
about
who's,
assessing
and
holding
to
account
those
people
that
are
commissioning,
then
there's
a
bigger
discussion
that
needs
to
take
place
about
who's
commissioning.
And
why
and
how
so
that
that's
one
part
of
it.
B
The
kerber,
which
is
currently
going
through,
will
give
secretaries
of
state
for
health
and
communities
and
local
government
the
ability
to
ask
us
to
review
local
authorities,
and
we
can,
under
the
current
legislation
under
section
48.
I
think
it
is
carry
out
a
special
review
which
gives
us
a
based
power.
The
board
have
previously
considered
the
report
from
deloitte.
That
said,
you've
got
this
power
use
it
strategically.
B
B
Yeah,
yes,
I
think
that's
the
fact
that
we've
put
that
on
the
record
in
a
public
meeting.
That's
the
reason
I
went
further
than
the
words
in
the
report
and
it's
uploaded
on
youtube
as
evidence
for
anybody
to
hit
on
and
watch.
So
I
think
I
hope
it's
unambiguously
clear
and
we'll
make
sure
that
colleagues
like
peter
walsh,
who
were
anxious
that
we
did
adopt
a
clear
position.
We
make
contact
with
them
after
this
meeting
so
that
anna
can
do
health
watch
we'll
do
peter
and
those
other
organizations
so
they're,
clear.
N
Thank
you
chairman.
Can
I
ask
general
question,
then
very
quickly,
a
specific
question:
is
there
any
structured
link
between
the
inspections
within
cqc
and
those
within
ofsted,
and
I
should
perhaps
declare
an
interest
in
that
I
have
in
the
past
qualified
as
an
ofsted
inspector,
and
I
had,
I
think,
four
residential
weekends
of
training
followed
by.
N
As
a
general
question,
specific
question
is
in
inspecting
primary
care
and
general
practice.
Can
I
be
assured
that,
when
patients
carers,
families
are
met,
that
there
will
be
some
comparability
between
the
listening
event
within
hospitals
and
that
in
general
practice
in
that
patient's
patients,
carers,
etc?
Can
come
forward
and
speak
freely
to
the
inspecting
team?.
B
If
I
do,
the
general
one
and
steve
will
do
the
specific
one
so,
on
the
general
one,
there's
been
number
of
contacts
between
senior
staff
at
a
senior
level
and
seeing
his
staff
in
ofsted
on
exactly
these
questions.
Those.
How
do
you
do
these
questions?
What
have
you
learned
over
the
years
that
you've
been
doing
it?
I
know
that
david
has
invited
the
chair
of
ofsted
into
a
dinner
and
there's
been
exchanges
at
the
highest
level,
so
it's
a
relationship
that
we
continue
to
maintain
and
then
on
some
quite
detailed
work
about
inspecting
children's
services.
B
We
were
in
meetings
with
ofsted
as
recently
as
last
week,
so
it's
operating
at
the
very
strategic
level
of
governance
at
what
we
can
learn
from
them
about
how
they've
done
some
of
this
stuff
in
the
past
and
training
of
inspectors
is
one
and
then
there's
some
just
practical
things
that
we
must
do
with
them
about
how
we
inspect
and
some
of
our
inspections
are
joint
with
offstead.
So
it
operates
at
those
three
levels.
K
Thank
you
just
on
offstead,
one
of
the
things
that
I
that
I
really
like
is
the
way
they
write
to
pupils
and
in
a
language
that
even
junior
school
pupils
can
understand,
and
so
one
of
the
things
certainly
for
for
primary
medical
services
that
we'll
do
is
write
an
open
letter
for
the
patients
of
a
practice
explaining,
as
well
as
them
having
the
ratings
in
their
waiting
room
clear
for
everybody
to
see.
That's
part
of
the
new
gp
contract
discussion
negotiations.
K
K
The
model
for
for
us
is
that
we'll
be
going
into
each
ccg
area
and
ccgs
aggregate
up
to
local
authority
areas.
Every
six
months
and
we're
we've
spoken
this
week
had
a
really
interesting
meeting
very
helpful
with
healthwatch
england
and
we're
talking
to
our
own
engagement
groups
about
when
we
go
in,
as
this
rolls
forward
year
on
year,
we'll
be
meeting
with
patients
from
all
sorts
of
different
groups
as
well
as
clinicians.
K
I
think
we
need
to
learn
lessons
and
we
communicate
all
the
time
and
we
need
systems
in
place
so
that
we
pick
up
concerns,
and
we
also
pick
up
great
practice
so
that,
if
there's
a
really
fantastic
piece
of
practice
between
adult
social
care
and
general
medical
practice,
perhaps
on
care
homes,
we
need
to
pick
that
up
quickly
and
disseminate
it
so
that
people
can
learn.
So
it
works.
Both
ways
really
good
question.
C
Thank
you
just
hopefully
a
quick
question
to
andrea,
and
this
is
about
the
pilot
phase
of
introducing
the
new
inspection
methodology
for
adult
social
care
from
april
till
october.
I
think
it's
brilliant
that
those
five
questions
are
going
to
be
asked
of
this
sector.
I
think
the
general
public
will
understand
what
the
questions
are,
why
they've
been
asked
and
what
it
means
for
the
services.
L
Great
question:
thank
you.
That's
one
of
the
reasons
why
we're
developing
the
the
the
questions
that
we're
going
to
ask
in
co-production
with
people
who
are
using
services
and
their
carers,
but
also
people
who
are
providing
services
so
that
we
can.
We
can
kind
of
balance
that
and
look
at
that
we're
certainly
looking
at
the
difference
between
residential
care
and
domiciliary
care.