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From YouTube: CQC board meeting - July 2021
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A
Good
good
morning,
everybody
welcome
to
the
july
meeting
of
the
cqc
board.
We
have
an
apology
from
kirsty
shaw,
who
has
to
be
elsewhere
today.
A
We
have,
I
think,
no
declarations
of
interest.
Can
I
just
just
check
nobody
has
anything
they
need
to
add
that
takes
us
to
the
minutes
of
the
public
board
meeting
on
the
23rd
of
june.
Are
they
through
an
accurate
record
of
everything
we
discussed,
then
thank
you
I'll
I'll.
Take
that
as
approval.
A
There
is
nothing
outstanding
on
our
action
log.
Is
there
anything
arising?
Anybody
wants
to
raise.
That's
not
otherwise
on
the
agenda.
B
B
We
we've
we've
first
had
meetings
with
a
number
of
new
faces
in
the
health
and
social
care
world
not,
and
we
have
written
our
letter
of
welcome
to
the
new
secretary
of
state
peter,
and
I
are
looking
forward
to
meeting
the
secretary
of
state
in
person
when,
when
we're
able
to
which
we're
hoping
will
be
will
be
reasonably
soon,
there's
also
been
new
faces
at
nhs,
digital
and
and
the
nhs
confederation
and
again
we
have
I
I've
met.
B
I've
met
the
new
chief
execs
of
both
of
those
organizations
and
had
positive
meetings,
and
I
think
it's
just
a
I.
I've
certainly
felt
that
you
know
post
covered.
A
number
of
our
relationships,
have
deepened
and
strengthened
with
with
our
partners
because
of
the
work
we've
done
together
and
I'm
hoping
we
can
capitalize
on
that
in
the
months
and
years
ahead.
Moving
on
to
the
all-party
parliamentary
group
on
learning
disabilities,
debbie
ivanova
and
I
attended
the
the
meeting
recently
that
was
was
held
by
the
group
to
reflect
on
10
years.
B
B
I
think,
and
I
think
it
was
an
opportunity
for
us
to
talk
to
the
group
about
the
the
work
that
that's
being
led
by
debbie
and
the
work
we
as
an
organization
have
done
for
people
who
were
in
acute
services
who
are
being
looked
after
with
people
with
learning
disabilities
and
autistic
people,
and
I
think
it
was
also.
B
There
was
a
good
discussion
by
those
and
the
meeting
around
the
the
important
point
about
needing
to
have
a
greater
focus
on
community
services,
for
people
with
learning
disabilities
and
and
autistic
people,
and
the
fact
that
that
progress
needs
to
be
accelerated
because,
as
we
are
doing
our
work,
what
we're
finding
is
is
poor
practice.
That's
translating
into
into
into
hospital
hospitals
being
closed,
and
that
translates
into
a
need
to
to
find
alternative
support
for
for
some
very
vulnerable
people.
B
Ideally
we'd
like
to
see
that
in
the
community
and
we've
been
very
vocal
on
that
in
the
past.
So
again
it
was
an
opportunity
just
to
reflect
on
on
the
last
few
years,
what
we've
done
and
what
other
other
partners
have
do
are
doing
and
and
the
progress
that's
been
made,
I
want
to
move
on
and
talk
about
about.
Peter
peters,
sadly,
is
coming
to
the
end
of
his
six
year
term,
and
that
means
that
the
the
opportunity
to
take
over
as
chair
of
cqc
is
open.
B
The
advert
is
live
on
the
public
appointments
website
and
we'll
be
we'll
be
live
until
the
second
of
august.
So
we're
we're
very,
very
optimistic
of
of
a
large
and
diverse
field
of
people
putting
themselves
forward
to
fulfill
what
I
think
we'd
all
agree
are
very
big
shoes,
I'm
sure
we'll
all
pay
tribute
to
peter
at
the
appropriate
time.
But
but
certainly
it's
a
it's
a
sad
time
in
many
respects.
For
us.
B
Gone
yet
I
won't
embarrass
you
further
and
I
will
move
on.
So
I
talk
really
talking
about
our
developing
our
developing
our
monitoring
approach.
I've
spoken
a
few
times
over
the
last
few
months
on
on
the
way
in
which
we
are
moving
out
of
covid
and
and
what
we're
doing
in
terms
of
of
our
of
our
approach
to
regulation.
B
In
this
time
period,
that's
still
incovered,
but
but
things
are
in
some
respects.
Improving.
I've
said
again
repeatedly
that
in
march
2020
we
suspended
our
routine
inspection
program
and
moved
to
a
space
approach,
and
that's
still
our
core
our
core
position,
we're
not
doing
any
routine
inspections.
We
are.
We
are
inspecting
based
on
on
our
perception
of
risk.
B
It
does
mean,
though,
that
we've
evolved
our
approach
so
that
it
means
that
during
covid
we've
we've
been
trying
to
strike
this
really
important
balance
between
discharging
our
duty
to
the
public
to
give
them
assurance
around
the
care
services
that
they're
using,
whilst
at
the
same
time
recognizing
the
enormous
pressure,
the
the
providers
we
regulate
and
the
people
that
work
in
those
providers
were
under
and
and
indeed
continue
to
be
under,
and
I
think
we
said
again
and
again
that
what
we
have
seen
as
we've
spoken
to
providers
and
as
we've
been
out
and
done,
inspections
is
truly
remarkable
efforts
that
have
saved
many
many
lives
over
the
last
over
the
last
year,
or
so.
B
That
said,
of
course,
concerns
continue
to
be
raised
with
us,
either
from
from
the
public
or
from
people
that
are
working
services
and,
of
course,
we
have
to
respond
appropriately
to
those
to
those
concerns,
and
in
some
cases
that's
that's
a
conversation
with
the
provider.
In
some
cases,
that's
a
face-to-face
visit.
In
other
cases,
it
may
be
a
full
inspection
which
may
ultimately
lead
to
the
re-rating
of
a
service.
B
We've
launched
the
the
next.
The
next
phase
of
our
work,
where
we
are,
we
are
improving
the
the
way
we're
approaching
the
analysis
of
risk,
but
also
we're
now
being
much
more
open
with
the
public
about
doing
that.
So
we've
introduced
introduced
statements
on
every
provider's
website.
B
Now
that
says,
if
we
are
satisfied
and
content
that
that
that
provider
doesn't
need
an
immediate
inspection
and
that
we're
we're
again
reinforcing
the
point
that
if,
if,
if
somebody
reading
that
information
disagrees
with
our
assessment
of
of
a
provider,
then
we
are
flagging
to
them
that
they
can
talk
to
us
through
our
give
feedback
on
care
service
and
that
that's
that
that's
that's
on
on
a
number
of
providers
websites.
Of
course,
we
still
reserve
the
right
to
to
go
out
and
inspect,
and
we
will.
We
will
continue
to
do
that.
B
We're
upgrading
this
material
on
on
on
a
very
frequent
basis,
no
less
than
the
monthly
and
it'll
be
clear
on
the
website.
Exactly
when
the
last
time
we
looked
at
the
information
in
relation
to
that
provider
was
based
on
the
information
that
we
get
from
the
public
and
from
the
people
that
work
within
services.
We
may
do
a
video
conference
follow-up
with
with
the
provider.
B
We
may,
of
course,
cross
the
threshold
and
do
and
do
do
a
visit,
or
we
may
do
a
full
inspection
and
we
obviously
deserve
the
right
to
do
any
any
any
one
of
those
things.
But,
of
course,
as
ever,
we're
trying
to
try
to
strike
this
balance
around
doing
the
best
job
we
can
for
the
public,
whilst
at
the
same
time
recognizing
the
position
that
the
providers
are
in,
and
I
expect
we'll
continue
to
be
evolving.
B
Our
approach
during
the
during
the
the
latter
half
of
this
calendar
year
as
we
build
our
new
regulatory
platform
and
our
new
regulatory
approach,
we'll
be
doing
we'll,
be
piloting
things
with
with
small
groups
of
providers
and
then
deciding
if
we're
going
to
go
ahead
with
them
and,
of
course,
communicating
that
to
providers
we're
doing
that
through
through
routine
bulletins,
as
well
as
things
like
round,
table
events,
conferences
and
and
so
forth.
B
So
I
just
thought:
I'd
just
just
just
flagged
to
board
members
that
that
again
we're
taking
another
another
step
in
terms
of
evolving
our
approach.
But
but
we
are
an
awfully
long
way
from
routine
inspections,
and
I
just
wanted
to
just
to
highlight
that
to
everybody.
That's
it
from
me,
peter
and
I
hand
over
to
kate.
If
there's
no
questions
from
my
section
thanks
ian
kate.
Thank.
D
You
thank
you
good
morning,
everyone,
so
I'm
going
to
update
on
two
things
today.
Firstly,
about
closed
cultures
and
our
work
on
that
agenda,
and
then,
secondly,
I'm
just
going
to
say
a
few
words
around
visiting
in
care
homes,
so,
firstly,
on
close
cultures,
work
lots.
Lots
of
work,
continues
to
progress,
we're
currently
consulting
and
engaging
on
our
role
in
assessing
providers,
use
of
surveillance
and
very
much
looking
at
that
through
a
human
rights
lens.
D
As
board
knows,
we've
developed
a
new
quality
of
life
tool,
which
we
are
looking
at
really
using
to
understand
what
it
feels
like
from
a
person's
perspective.
Who
draws
on
care
as
to
what
it
feels
like
to
receive
that
care
in
that
setting.
So
we're
using
our
quality
of
life
and
tall
out
on
our
inspections
in
some
inpatient
services,
but
also
in
some
adult
social
care
inspections
and
we've
got
groups
of
people
helping
us
evaluate
the
effectiveness
of
that
tool
and
really
reflecting
what
it
feels
like
to
receive
that
care.
D
We're
looking
at
some
case,
studies
to
to
keep
on
testing
out
where
there
are
new
methods
for
identifying
places
at
risk
of
close
cultures
and
regulating
them
with
our
different
tools
to
ensure
that
they
are
as
effective
as
possible.
We're
working
up
a
research
proposal
as
board
is
aware
to
look
at
what
the
ingredients
are,
that
tips
are
kind
of
poor
culture
into
an
abusive
culture.
And
finally,
our
colleagues
at
our
intelligence
are
making
a
progress
around
kind
of
prototyping
a
dashboard.
D
That's
going
to
support
our
inspectors
to
understand
services
that
may
be
at
risk
of
close
culture,
so
lots
of
work
going
on
on
that
front
if
I'm
just
going
to
briefly
turn
to
talk
about
visiting
in
care
homes.
So
a
really
important
topic
that
we
focus
on
over
the
last
year.
We
really
welcome
the
removal
of
the
cat
put
visitors
into
care
homes.
D
We
know
this
is
something
that
care
home
residents
and
families
have
been
desperate
to
see
happen
in
over
the
period
of
the
pandemic,
and
we
know
that
visiting
has
a
kind
of
key
contributor
to
people's
well-being
and
and
general
quality
of
life.
D
So
we're
really
clear
that
care
home
should
be
making
this
happen
wherever
it's
abs,
it's
safe
safe
to
do
so,
we
want
to
recognize
separate
care
homes
for
registered
managers,
so
they
will
also
be
no
doubt
delighted
that
that
more
of
their
residents
will
see
family
members
more
regularly.
Just
conscious
that
register
managers
continue
to
have
that
challenge
of
thinking
about
how
they
make
this
a
reality.
D
D
We
absolutely
want
to
see
visiting
happen
and
really
welcome
the
lifting
of
of
the
cap
just
conscious
as
well
that
the
pressure
this
will
put
on
registered
managers
to
make
this
a
reality
for
lots
of
people
who
have
lots
of
expectations
following
this
announcement,
we're
continuing
to
look
at
visiting
on
all
of
our
care
home
inspections.
D
So,
since
the
beginning
of
march,
since
the
8th
of
8th
of
march,
we've
done
1763
care
home
inspections,
where
we've
looked
at
a
variety
of
things,
including
infection
prevention
control
and
visiting
over
97
of
those
inspections
confirmed.
That
visiting
was
happening
in
the
small
number.
Where
we
had
questions,
we
then
took
action
to
get
confidence
that
that
cairns
were
doing
what
they
needed
to
do
to
ensure
that
people
were
able
to
see
their
loved
ones.
D
So,
just
a
brief
update
from
me
on
how
we
continue
to
focus
on
ensuring
that
visiting
is
happening
and,
as
I've
said
on
many
occasions
before,
if
we
have
any
concerns
about
a
blanket
approach
to
visiting
not
taking
place,
that
is
absolutely
something
we
would
actually
look
to
be
assured
that
that
was
not
what
was
going
on
in
those
care
homes
thanks
peter.
A
Nobody
wants
to
come
in,
okay,
good,
so
I
think
we'll
move
on
ted
to
you.
Please.
E
Thank
you
peter,
as
I
have
outlined
in
the
report.
The
written
report
to
the
board
hospital
services
remain
under
tremendous
pressure
at
the
moment
and
they
they
face.
A
combination
of
three
exceptional
demands.
E
First
of
all,
the
rising
tide
of
covid
patients
during
the
current
resurgence
which
they
are
seeing,
is
different,
different
spectrum
of
patients
from
previous
coping
episodes,
but
but
still
causing
a
lot
of
pressure,
and
I
think,
there's
uncertainty
about
how
high
the
number
of
admissions
will
rise
over
the
next
few
weeks
and
that
uncertainty
itself
is
causing
a
lot
of
concern.
E
There's
also
importantly,
a
record
level
of
emergency
patients
seeking
emergency
care
both
in
hospitals
and,
as
I
come
to
at
the
moment
in
amber
for
ambulances
as
well,
and
these
are
some
of
them
are
coveted
patients.
E
But
many
in
fact
the
majority
are
non-covered
patients
and
we
are
seeing
a
very
high
level
of
emergency
demand
this
summer,
which
is
which
is
exceptional
compared
to
previous
summers
and
really
reflects
the
level
of
activity
that
most
of
these
services
see
in
winters
and
again,
there's
a
great
deal
of
uncertainty,
of
how
the
emergency
pressure
will
continue
through
the
rest
of
the
summer
and
into
next
winter.
And
of
course,
on
top
of
that,
the
third
element
they're
facing
is
a
backlog
of
planned
care
which
they
are
working
very
hard
to
tackle.
E
I've
just
mentioned
to
you
and
these
these
factors
combining
together,
are
having
a
big
impact
on
their
ability
to
provide
patient
care,
as
well
as
they'd
like,
but
also
have
a
big
impact
on
staff,
many
of
whom
have
been
working
in
a
highly
pressurized
environment
now
for
well
over
a
year,
and
I
think
we
need
to
recognize
the
the
impact
this
is
having
on
services
in
the
long
term
and
the
fact
that
the,
if
you
like
the
normal
summer,
quiet
period
for
emergency
services,
it
would
is
not
being
seen
this
year.
E
Yesterday,
I
had
a
meeting
with
some
chief
executives
from
ambulance
trusts
in
the
country
and
they
reported
they
are
two
facing
record.
Demar
record
demands
for
care,
the
ambulance,
trust
several
of
them
are
reporting
their
busiest
days
ever
in
the
last
week
or
so-
and
this
is
extraordinary
for
for
summer
time,
and-
and
I
think
this
inevitably
is
having
an
impact
on
their
ability
to
provide
care
in
their
way
they
want
to.
E
E
We
also
need
to
deal
with
the
underlying
problems
with
the
models
of
care,
and
that
and
the
pandemic
has
really
emphasized
that
if
we
are
going
to
provide
pet
care
for
patients
in
the
way
they
need
at
the
time
they
need.
The
whole
systems
need
to
work
together
around
new
models
of
care,
and
if
we
don't
do
that,
patients
will
not
be
able
to
receive
the
care
that
we
want
them
to,
and
the
pressure
on
staff
to
provide
care
under
these
difficult
circumstances
will
continue.
E
F
Thank
you
chairman
and
thank
you
ted.
It's.
It's
always
great
to
hear
how
you
and
your
team
in
the
hospital
directorate
are
working
with
providers,
especially
in
these
difficult
times,
and
and
always
you
talk
about
being
patient
care
and
patient
focus.
So
I
you
know
I
thank
you
very
much
and
and
your
team
for
that.
No
sorry,
I
had
a
slightly
slow
finger
before
because
I
want
to
go
back
to
kate
and
to
ian.
F
D
Thank
you
shall
I
go
first
and
then
I
don't
know
whether
mark
or
ian
will
want
to
so
so
mark.
At
the
moment,
we
are
working
on
a
dashboard
that
provides
that
information
for
inspectors,
and
already
we
are
bringing
together
much
more
intelligence
into
one
place
for
inspectors
than
they've
ever
had
before,
with
a
real
focus
on
what
are
the
key
things
that
may
trigger
an
inspector
wanting
to
go
out
and
just
go
and
observe
the
care
being
delivered
within
a
place.
D
So
so
we
are
much
further
ahead
now
than
we've
ever
been
our
intention
with
our
kind
of
transformation
work
that
we
will
be
that
we've
been
talking
about
is
that
any
requirements
that
we
want
to
embed
in
our
new
system
and
our
new
regulatory
platform
has
closed
cultures
woven
through
it.
D
So
we
we
are
pulling
together
data
and
intelligence
in
a
much
more
effective
way
now
than
we
ever
have
been,
and
we
are
going
to
be
locking
those
requirements
in
as
we
continue
our
developments
around
our
our
regulatory
design,
work
and
and
our
regulatory
platform
as
well.
Can
I
just
check
my
if
I
describe
that
quickly?
Is
anything
you
want
to
add.
G
I've
very
little
to
add
to
that.
Okay.
That
was
perfect.
I
think
what
what
what
our
the
development
of
our
new
data
and
insight
capabilities
and
the
regulatory
platform
will
give
us
is
this
opportunity,
as
kate
said,
to
weave
in
the
the
powerful
insights
that
we
we
we
will
we
are
now
we
will
continue
to
improve
upon
developing
into
the
into
the
hands
of
inspectors
at
the
moment
that
they
need
it.
G
So
not
just
close
cultures,
but
all
sorts
of
other
indicators
of
of
risk,
as
well
will
will
be
will
be
brought
into
their
into
their
portfolio
of
of
insight
and
the
close
cultures
work
that
we
have
is
is
is
one
of
the
first
opportunities
we
have
to
bring
that
in.
B
Right
and
finally,
peter
just
one
quick
thing
for
me:
mark
we're
hoping
to
come
back
in
september
to
give
the
board
a
flight
out
a
more
detailed
flavor
of
what
I
was
referring
to
around
what
the
new
method
will
look
like
to
try
and
bring
to
life
some
of
the
things
that
kate
was
just
mentioning
there.
Thank
you.
Okay.
Thank.
H
Thank
you.
My
question
was
to
ted
and
it
was
about
reference
to
the
system,
oversight,
framework
of
nhsei
and
the
recovery
support
program.
I've
read
bits
of
that,
but
could
you
just
outline
in
a
couple
of
sentences
how
that
differs
from
special
measures.
E
Special
measures
was
an
intervention
for
an
individual
provider
robert
where
the
provider
was
provided
with
in
nhs
trust
terms,
at
least
was
provided
with
extra
support
from
nhs
improvement
to
help
them
drive
the
improvements
that
we'd
identified.
In
our
inspections.
E
So
there's
no
kind
of
generalized
approach,
but
this
is,
if
you
like,
a
more
system
based
view
of
of
this,
and
it
is
meant
to
be
more
clearly
supportive.
There
was
a
there
was
a
problem
that
special
measures
were
seen
by
many
to
be.
If
you
like
punitive,
it
was
seen
to
be
a
a
kind
of
badge
of
shame
for
trust
that
when
we
found
problems,
we
we
recognize
that
trusts
are
in
difficult
circumstances.
E
I
just
talked
about
that
a
few
minutes
ago,
and
really
we
should
be
looking
at
support
for
trust
as
something
that
that
they
welcome,
rather
than
something
that
they
see
as
a
negative.
And
so
not
only
is
this
more
system
focused.
It
is
more
bespoke
for
individual
organizations
and
systems,
but
also,
I
hope
it
will
be
seen
as
more
supportive
and
less
critical
of
organizations.
H
That's
very
welcome,
given
we
will
unfortunately,
still
find
trust
we
raise
inadequate
and
therefore,
under
the
current
regime,
qualify
for
special
measures.
How
do
we
keep
our
line
of
sight
on
progress,
bearing
in
mind
the
intervention
of
systems
in
this,
and
does
that
complicate
the
work?
We're
asking
our
inspectors
to
do?
No.
E
I
I
don't
think
so,
robert
I
we
will
keep.
We
will
continue
our
approach
in
terms
of
recommending
the
the
recovery
support
package
and
the
the
support
that
goes
with
that
when
we
find
inadequate
care
equally,
we
will
continue
our
monitoring
of
that
and
our
repeat,
inspection
and
we've
agreed
with
nhs
nhsei
that
the
organizations
will
not
have
that
support
taken
away
until
we've
seen
the
improvement,
we
need
to
see
going
forward.
E
A
Thanks
robert
stephen.
C
C
E
E
But
I'm
sure
rosie
will
say
that
gps
feel
the
same
that
that
they
are
at
a
default
place
for
for
people
who
need
urges
emotions
to
get
to
go,
and
actually
we
need
to
reflect
on
this
and
see
that
we're
not
providing
care
in
the
way
that
patients
need
or
want
it
to
be
provided.
And
we
need
to
address
that.
E
We
need
to
build
care
around
the
needs
of
patients,
not
about
the
needs
of
providers,
and
a
lot
of
the
debate
at
the
moment
is
focused
on
the
needs
of
providers
and
we
need
to
focus
on
these
patients,
so
the
models
of
care
have
to
change,
and
we've
seen
that
in
winter
after
winter
after
winter.
This
is
not
new
to
the
pandemic.
I
I
think
we
are
seeing
some
interesting
models
of
care,
but
they
tend
to
be
very
often
small
scale
and
not
not
rolled
out
fully
and
sometimes
also
they
are
not
accelerating
and
not
being
delivered
at
pace
the
pace
we
need
to
see
so
so
lots
of
great
examples
of
innovation
and
what
people
are
trying
and
we've
tried
to
highlight
that
in
our
provider,
collaboration
reviews
which
we're
coming
on
to
later-
and
I
would
encourage
systems
to
be
looking
at
those
provider,
collaboration
reviews
to
look
at
what
other
systems
are
doing,
learning
from
each
other
and
really
starting
to
to
kind
of
roll
those
out
at
pace.
I
I
just
want
to
completely
echo
what
ted
is
saying:
we
need
a
new
model
of
care
right
across
the
system,
I'm
very,
very
worried
about
what's
happening
in
general
practice.
At
the
moment,
I've
visited
several
practices
over
the
last
month
and
I've
spoken
to
gps
from
across
the
country
and
the
themes
that
we're
seeing
are
repeated
right
across
the
country.
I
The
themes
that
we
are
hearing
about
are,
firstly,
the
very,
very
high
demand,
I'm
speaking
to
gps,
who've
been
gps
for
35
years
and
they've
said
they've,
never
known
demand
like
it
is,
and
then
in
july
that's
you
know,
which
is
often
slightly
quieter
in
historic
years.
That
is,
is
highly
unusual
and
they're,
saying
that
that
demand
is
driven
by
a
variety
of
things.
One
is
thing
there
is
a
growing
amount
of
covid.
I
Secondly,
people
worried
that
they've
got
covered
and
the
symptoms
related
worried
about
covert
vaccination
side
effects,
and
sometimes
the
vaccination
program,
as
we
know,
has
been
a
huge
success,
but
sometimes
people
get
some
side
effects.
That's
driving
lots
of
people
to
contact
their
practices,
they're
still
seeing
late
presentations
of
a
whole
variety
of
illnesses,
that
for
people
who
didn't
present
during
the
time
of
the
pandemic
and
a
growing
number
of
people
with
mental
health
type
problems
and
anxiety
and
and
other
symptoms,
so
lots
of
demand.
I
On
top
of
that,
I
think
we've
got
a
very
exhausted
workforce.
Morale
many
gps
are
reporting
to
me
is
the
worst.
It's
ever
been
they're
working
very,
very
long
hours.
I
I've
spoken
to
gps,
who
said
they're,
not
sleeping
because
of
the
stress,
and
also
the
impact
of
isolating
the
workforce
isolating
when
they
they
need
to
they're,
also
adding
on
to
that
the
vaccination
and
and
the
additional
hours
that
they're
working
to
to
make
sure
the
vaccination
programs
have
been
the
success
that
they
have
been,
and
I
think
the
other
theme
that
we're
consistently
hearing
is
because
of
the
backlog
of
elective
care
and
the
backlog
in
other
parts
of
the
system
and
the
pressure
on
other
parts
of
the
system
which
work
very
closely
with
primary
care.
I
So
community
nurses,
mental
health
teams,
for
example,
and
and
the
acute
trusts
that
means
that
gps
are
holding
clinical
a
lot
of
a
lot
more
clinical
risk
in
the
community,
while
people
are
waiting
for
procedures
and
so
for
everyone
who's
on
a
waiting
list,
they're
getting
a
lot
more
people
coming
in
saying,
can
you
write
and
hurry
up
my
appointment?
Can
you
give
me
extra
painkillers?
I
need
to
be
off
work
longer.
I
Those
type
of
things
which
adds
to
the
workload
as
well,
and
that
is
that
kind
of
extra
clinical
risk
they're
holding
within
primary
care
is,
is
certainly
a
factor
so
in
terms
of
what
we're
doing
we're
very
conscious.
Firstly,
to
make
sure
that
we
continue
to
develop
our
approach
as
ian
was
saying
earlier,
to
make
sure
that
we
focus
on
those
those
areas
of
risk.
I
We're
not
doing
routine
inspections,
as
ian
ian
has
said,
and
absolutely
just
to
reinforce
that
message,
and
we
are
very
much
looking
at
how
we
can
support
primary
care,
and
my
teams
are
working
through
a
whole
series
of
actions
to
see
what
more
can
we
do
to
support
a
very
fragile
system
at
the
moment,
I'm
also
meeting
with
senior
stakeholders
next
week
from
nhs
england
from
the
rcgp
and
the
bma,
and
have
a
further
discussion,
but
I
just
wanted
to
flag
that,
as
ted
has
said,
the
system
is
under
huge
pressure
at
the
moment.
E
Can
I
just
come
back
on
just
one
aspect
of
what
rosie
said?
I
I
think
it
it.
It
is
important
to
understand
that
the
fact
the
model
of
care
is
does
not
deliver
the
care
that
patients
need
has
an
impact
on
patient,
but
it
also
has
a
profound
impact
on
staff,
because
the
only
way
they
can
make
it
work
is
often
by
working
extraordinarily
hard
to
to
actually
sustain
the
service.
And
if
we
are
going
to
take
some
of
the
pressure
off
staff,
we
have
to
give
them
a
model
care
that
works
for
patients.
A
The
the
slightly
frustrating
thing
in
this
conversation
is
that
that
we
would
have
had
much
the
same
conversation
before
the
pandemic.
I
mean,
obviously,
the
pantomic
is
vastly
accentuated
all
these
issues,
but
but
they
were,
they
were
there
beforehand
and
and
and
what
we
have
seen
I
mean
absolutely
to
your
point,
ted
is:
is
the
response
has
been
work
harder,
not
not
not
to
find
different
ways
of
working
to
work,
smarter
and
somehow
we
have
to
help
the
system
to
to
to
move
more
quickly
to
to
to
help
itself.
A
C
C
C
C
B
I
mean
essentially,
what
I
was
gonna
say
was.
I
think
I
think
what
we
bring
to
the
table.
That's
unique
as
the
regulator
is
that
perspective
across
primary,
secondary
and
and
social
care,
both
in
terms
of
seeing
seeing
the
outcomes
for
people
around
safety
and
quality,
but
also,
I
think,
a
glimpse
into
into
the
commercial
drivers
to
some
of
the
decisions
that
are
that
are
made
and
they're,
particularly
cute
in
in
in
and
around
general
practice,
and
particularly
particularly
acute
in
in
social
care.
B
So
I
think
we
bring
that
perspective
to
the
table,
but
I
think
the
power
that
we've
got
is
the
convening
power
in
the
sense
that
you
know
if
we
bring
a
group
of
people
together
and
and
ted
you
know,
ted
was
talking
about
this
earlier
on
around
the
work
we've
done
with
emergency
physicians,
for
example,
the
work
that
ted
ted
personally
and
colleagues
are
doing
around
maternity,
we're
taking
a
a
topic
worked
with.
You
know:
gmc
nmc,
royal
colleges
and
others
on
a
range
of
different
potential
interventions.
B
But
I
think
for
me
there
is
this,
this
classic
sort
of
strategic
question,
which
is,
if
you
look
at
what's
going
on
at
the
moment
in
and
around
health
and
social
care,
there's
there's
good,
solid
plans
around
ics's
and
and
the
legislation's
on
track
and
all
of
those
good
things,
but
realistically
ics's
will
not
be
up
and
running
for
18
months,
two
years
before
they're,
starting
to
make
a
difference,
looking
sort
of
very
very
far
ahead.
B
People
talk
talk
very
eloquently
about
things
like
genomics
people
talk
about
about
about
people
changing
their
behaviors
and
public
health
and
people
owning
their
own
health.
That's
sort
of
long
long,
long,
one
way
in
the
future.
The
issue,
frankly,
is
is
what
we
do
in
the
next.
What
what
does
the
system
and
what
do
we
contribute
to
the
next
six
months
and
that
that's
the
bit
that
feels
to
me
at
the
moment,
which
is
to
ted's
point
just
just
paddle
faster
rather
than
actually?
What
can
we
do?
B
So
for
me
that
the
the
real
focus
is
what
are
we
seeing
on
the
ground
that
we
can
sort
of
recycle
in
a
really
tactical
way,
to
make
a
short-term
difference?
That
feels
like
the
space
that
that's
the
here
and
now
and
of
course,
support,
ics's
and
and
things
in
the
long
term.
But
that's
that's
my
worry
at
the
moment
that
feels
like
the
gap
at
the
moment.
So
thanks
peter.
I
Just
to
say
we
we
are
we're
absolutely
trying
to
do
that,
stephen,
where,
where
we
can
we,
we
are
absolutely
delivering
on
our
purpose
on
looking
at
where
we
find
concerns
and-
and
you
know,
making
sure
that
the
public,
when
we've
identified
those
concerns
that
that
they're
actioned
and
dealt
with
so
that
actually
the
qualitative
care
improves.
I
But
we
are
working
with
all
of
our
stakeholder
external
stakeholders
to
look
at
actually,
when
we're
identifying
themes.
When
we're
identifying
ideas
that
we
hear
from
practices,
we
can
actually
flag
those
we
can
raise
them.
We
can
see
what
we
can
do
within
our
assessment
frameworks
and
our
regulation
to
be
able
to
support
the
right
things
to
happen
and
we're
also
trying
to
share
best
practice
where
we
can
and-
and,
as
I
said
earlier,
the
provider
collaboration
reviews
is
one
way
of
doing
that.
I
We
also
meet
regularly
with
local
clinical
commissioning
groups.
Our
teams
do
across
the
country
and
talk
about
what
we're
finding
and
and
and
raise
any
concerns
with
them.
So
so
we're
trying
a
whole
variety
of
ways
to
support
in
whatever
way
we
can
at
the
moment.
A
Thanks,
rosie
and
and
oh
dora,
you
wanted
to
come
in
jorah.
J
How
would
we
then
assess
that
sort
of
integrated
okay?
What
sort
of
should
we
be?
Are
we
working
on
a
methodology
already
and
and
and
how
we're
progressing,
because
18
months
hasn't
seen
a
long
way
away?
And
I
don't
know
if
we're
going
to
be
averaging
out
all
the
providers
in
that
or
what
the
algorithm
is
going
to
be
interested.
I
Oh
sorry,
I
thought
you
finished
your
question.
Apologies
so
just
just
to
confirm
we
are
working
on
that
methodology.
We
are
looking
building
on
the
work
that
we've
done
with
local
system
reviews
with
the
recent
provider,
collaboration
reviews.
We
are
looking
and
working
with
the
department
of
health
and
social
care
and
nhs
england
on
what
systems
regulation
could
look
like
and
how
we
absolutely
look
at
that
from
a
person's
perspective
using
services,
hopefully
we'll
be
able
to
share
more
detail
with
that
as
we
go
forward.
A
A
We
have
unearthed
and
you're
also
some
really
good
learnings
for
for
where
things
have
worked
well,
and
I
think
that's
that's,
that's
the
the
benefit
of
being
able
to
look
at
the
systems,
but
whether
it's
looking
at
systems
or
individual
providers,
you
could
you
can
point
people
to
good
ideas,
but
it's
you
know
leading
horses
to
water
and
all
of
that
they
have
not
always
been
terribly
good
at
following
up
on
things
that
haven't
been
invented
here
and
that's
a
challenge
I
think
rosie
was
there
anything
else
you
wanted
to
to
to
say
in
your
your
your
section
or
are
we?
A
B
Yes,
thanks
peter,
so
just
a
few
updates
from
from
in
in
kirsty's
absence
and
from
the
people
directed
so
in
terms
of
mental
health
and
well-being.
We've
currently
got
a
pulse
survey
open
at
present,
which
is
focusing
on
mental
health
and
well-being
that
that
shuts
tomorrow,
it's
been
open
for
two
weeks
that
will
that'll
help
provide
vital
feedback
to
ensure
we're
harnessing
a
healthy
workplace
in
terms
of
culture
and
change.
We're
working
to
ensure
our
approach
on
culture
is
embedded
into
our
transformation
programme.
B
This
has
started
with
a
module
that
is
currently
running
on
embracing
change
in
terms
of
diversity
inclusion.
We
created
a
voluntary
dni
coordinator
role,
which
will
work
closely
with
our
dni
manager,
role,
which
is
already
in
the
organization,
hopefully
aimed
at
helping
to
provide
visible
leadership
and
promote
good
dna
practices
and
and
finally,
in
terms
of
talent
resource.
B
B
A
K
Thanks
and
I
I
it
it's
great
to
see
the
the
the
emphasis
on
leadership,
programs
and
apprentice
programs
to
build
up
our
pipeline
of
talent
and
that's
essential
thing
about
being
an
employer
of
choice,
but
it's
also,
you
know
these
are
also
sort
of
key
tools
in
helping
us
build
increasing
diversity
at
a
senior
level
within
within
the
organization.
K
You
know
what
what
are
we
doing
in
relation
to
these,
these
programs
to
ensure
that
they
are
as
inclusive
as
possible
and
that
we
and
that
we,
you
know,
we
generate
expressions
of
of
interest
from
you
know
as
widely
as
possible
within
the
organization.
B
I'll
attempt
to
respond
to
that
mark.
Well,
I
think
it's
around
it's
around
publicizing
these
and
around
how
we
promote
them
internally
in
the
organization
and
ensure
we're
connected
in
with
the
networks
which
we
are
to
make
sure
that
everybody
is
aware
of
the
opportunities
and
everyone
has
the
same
opportunity
to
to
apply
as
everyone
else.
A
I
don't
think
jill
will
allow
us
to
miss
any
any
opportunities
here
in.
B
Just
to
build
on
that
a
little
bit,
I
think
what
we,
what
we're
all
we've
got:
a
series
of
of
specific
intervention,
specific
training,
specific
opportunities,
but
the
dna
coordinator
role,
I
think,
is
really
important,
because
it's
that
that's
that's
a
person
who's,
a
a
local
advocate
who
can
draw
to
people's
attention
some
of
the
the
roles,
because
I
think
my
reflection
of
some
of
the
some
of
the
challenges
that
we've
had
and
not
that
we
haven't
got
the
right
pieces
in
place.
B
It's
just
sometimes
people
don't
know
about
them
or
they're
reluctant
to
apply,
and
so
the
dna
coordinators
are
really
there
as
sort
of
little
local
coaches.
I
suppose
they
have
a
multiplicity
of
roles
but
they're
to
coach
people
into
applying
pushing
themselves
forward
for
things,
people
expressing
interest
for
things
that
perhaps
they
wouldn't
otherwise
have
done
without
a
a
little
bit
of
a
gentle
shelf,
so
that
that
I
think
is
a
is
an
important
part
of
this,
but
I
think
it
just
it.
B
Just
from
my
point
of
view,
it
is
making
sure
that
we
do
lots
of
small
things
consistently
well,
rather
than
sort
of
two
or
three
big
things,
because
that
that
everyone
does
the
two
or
three
big
things.
But
it's
the
lots
of
small
things
done
really
well.
That
I
think
are
is
going
to
make
the
difference.
B
Yeah,
so
just
a
fairly
short
update
this
month,
we'll
do
a
fuller
one
next
month,
which
is
the
quarter
quarterly
update.
So
this
is
this
is
may's
update,
so
in
terms
of
registration,
the
end
of
may
similar
applications
are
taken
27.7
days
to
process.
That's
an
improvement
trend.
We
are
seeing
seeing
some
real
progress
in
that
area.
Complex
applications
has
taken
128
days,
which
is
which
has
been
monitored
closely:
the
lower
volumes
and
the
the
the
simple
ones.
B
B
B
Our
current
data
up
right
up
to
now
shows
this
is
an
improving
trend.
However,
to
understand
that
that
early
findings,
further
a
review
was
carried
out
of
all
the
cases
outside
of
five
days
to
ensure
appropriate
action
has
been
taken.
That
found
no
concerns
on
our
action,
but
highlighted
where
additional
training
and
communication
was
required.
B
Finally,
for
me
on
our
money
at
the
end
of
may,
our
revenue
budget
is
underspent
by
3.1
million.
This
is
across
pay
and
non-pay
and
reflects
a
combination
of
ongoing,
reduced
travel
and
timing
of
delivery
of
our
activity.
We're
still
working
up
our
forecast
plans
where
we'll
see
where
we'll
anticipate
we'll
end
the
year
out
and
report
that
to
board
next
month
on
the
capital
side,
you
underspend
at
the
end
of
may
is
1.2
million.
B
I
think
this
is
largely
down
to
time
and
we
we're
still
on
the
we're
consumption
that
our
budget
will
be
fully
utilized
this
year.
B
Absolutely
absolutely
peter,
I
think
I
think
the
the
what
we,
what
the
individual
chief
inspectors
have
done,
is
they've
done
a
deep
dive
on
on
the
individual
cases
in
their
areas,
because
I
think
when
we,
when
we
first
saw
this,
we
it
obviously
caused
concern.
But
it's
a
new
measure
that
was
introduced
in
april.
B
B
So
there
was
a
an
issue
of
recording,
even
though
the
work
itself
had
been
done,
but
secondly,
there
was
also
I
there
was
also
there
were
also
issues
around
when
they
found
safeguarding
issues
whilst
out
inspection
they
they
were
just
dealing
with
them
straight
away
and
weren't
raising
separate
safeguarding
queries,
which
again
is
exactly
the
right
thing
to
do
in
terms
of
the
people
using
the
service
but
from
our
recording
point
of
view,
is
causing
causing
some
challenges.
B
So
so,
there's
a
couple
of
things
that
we're
we're
just
working
through
around
around
recording,
but
this
is
relatively
low
numbers
to
the
point
where
we
have.
We
have
gone
back
to
every
case
and
checked
that
the
right,
the
right
things
were
done
in
in
the
right
way,
and
you
know
it
is
a
topic
that
we
have
done
a
lot
of
work
on
in
the
past
and
continues
to
be
seen
as
really
important
work
by
by
all
of
our
inspectors.
B
A
Good,
thank
you
robert.
You
had
a
question.
H
Oh,
yes,
surprisingly,
not
about
that
at
the
my
customers
about
staff
turnover,
and
I
noted
the
figure
for
turnover
for
those
under
two-year
service,
which
is
clearly
significantly
higher
than
the
overall
turnover
rate.
And
I
wonder
how
that
benchmarks
against
other
organizations.
Is
that
good,
bad
or
concerning.
B
A
I
I
was
only
going
to
remind
you,
robert,
because
you
and
I
been
on
this
board
a
long
time
that
it
was
a
major
concern
several
years
ago,
where
it
was
very
high
and
was
definitely
suggesting
we,
we
needed
to
change
the
recruitment
process
to
make
sure
that
people
who
thought
that
working
from
home
was
going
to
suit
their
lifestyle
and
everything
else
really
really
understood
the
the
cons
as
well
as
the
pros.
So
I
was
actually
quite
pleased
that
it
it
it.
A
It
had
come
down
from
the
very
high
levels
of
a
few
years
ago,
but
ian
you
were
gonna
answer.
Robert
was
questioning.
B
I
I
was,
I
would
like
something
was
gonna
part
answer.
I
think
I
think
a
couple
of
things
I
think
recruitment
and
people
movement
at
the
moment
just
doesn't
benchmark
at
the
moment.
I
think
I
think
coming
out
of
covet.
I
think
what
we're
seeing
is
is
all
sorts
of
a
very
odd
patterns
of
of
things
going
on.
B
I
think
what
we
have
seen
is
there's
a
fair
amount
of
movement
over
the
last
few
months,
because
there's
a
perception
that
we're
coming
out
of
covid
people
have
have
decided
they
want
to
move
on
to
two
other
jobs.
B
Coincidentally,
I
was
with
the
the
engagement
performance
policy
and
strategy
leadership
group
yesterday,
and
we
were
talking
about
this
for
that
cohorts
of
people
and
one
of
the
things
that
became
very
obvious
was
that
there's
a
lot
of
people
going
out
on
promotion,
which
is
which
is
good
a
lot
of
younger
people
leaving
because
they
they
see
they
see
that
they
want
to
take
their
career
in
a
different
in
a
different
direction.
B
A
lot
of
people
have
clearly
hung
on
as
well
waiting
till
covid
finishes
or
is
perceived
to
finish
before
they
before
they
make
a
move.
There's
a
whole
range.
I
think
of
reasons
that
that
the
people
have
got
for
leaving.
It
is
a
topic
that
we
look
at
very
carefully
because
I
think
I
think,
as
you
say,
people
leaving
after
a
relatively
short
period
of
service
isn't
necessarily
a
good
thing.
The
other
thing
that
that's
worth
remembering
is
that
we've
got
an
awful
lot
of
people
on
fixed
term
contracts.
At
the
moment.
B
As
part
of
the
change
work,
we
made
a
decision
to
keep
the
majority
of
new
starters
onto
fixed
term
contracts
and
again
for
some
people.
They
understandably
are
given
a
choice
between
staying
on
a
fixed
term
contract
versus
going
on
something
permanent.
They
may
move
so
there's
a
there's,
a
range
of
of
disrupting
factors
in
all
of
this,
so
I
I'm
sort
of
slightly
loathe
to
to
to
just
simply
give
an
answer
to
the
question,
but
it
just
to
be
reassured
it
is.
B
A
Yeah-
and
I
think
that
that
that
last
point
robert
goes
back
to
the
point
I
was
trying
to
make
with
the
work
that
was
done
a
couple
of
years
ago
and
probably
more
than
that
now
to
make
sure
that
we
were.
We
were
clear
when
we
hired
people
what
was
involved
and
we
were
hiring
the
right
people
for
the
right
reasons.
A
Okay,
good
mark,
I'm
hoping
that
you're
going
to
give
us
a
new
report.
Oh
sorry,
mark
saxton
wanted
to
come
in
sorry
before
I
come
on
to
to
tell
mark
mark
sexton.
F
I
think
I'd
be
more
worried
if
the
under
two-year
turnover
figure
hadn't
dropped
in
the
same
percentage
as
the
overall
recruitment
figure,
so
our
turnover
figure
you
know
because
we
have
seen
that
slide
backwards
during
this
process.
F
There's
a
lot
of
the
reasons
ian
has
said,
but
it's
it
is
a
theme
that
we
asked
to
look
at
a
couple
of
years
ago,
and
we
now
get
this
data
for
us
to
actually
have
these
ask
these
questions
and
to
see
the
exec
answering
them
and
and
doing
the
work
that
we
need
to
onboard
people
and
recruit
people
into
our
organization
effectively.
G
L
To
you,
and
so,
first
of
all,
let's
just
talk
a
bit
about
some
parliamentary
business.
We've
recently
contributed
to
an
inquiry
into
support
surrounding
people
with
an
autism
diagnosis
and
where
we
outlined
some
of
the
work
on
close
cultures
from
our
finding
from
the
restraints
occlusion
segregation
report.
Today,
in
fact,
actually,
just
a
few
hours
ago,
the
dhse
launched
a
five-year
strategy
developed
following
the
engagement
with
autistic
people,
but
also
following
the
findings
of
our
report.
L
Our
decision
who
cares
the
strategy
sets
out
some
commitments
around
providing
25
million
pounds
worth
of
funding
for
capacity
and
capability,
18
million
for
crisis
prevention
and
21
million
for
local
authorities
and
community
discharge
grants.
I
think
this
is
a
real,
tangible
example
of
how
ckcc's
independent
voice
leads
to
a
direct
improvement
in
the
way
services
are,
are
provided
and
offered.
L
There's
also
just
been,
as
I
said
earlier,
a
lot
of
interest
in
our
support
and
support
for
our
role
in
system
regulation
moving
forward
and
the
bill's
second
reading.
In
particular,
there
was
lots
of
support
from
mps
who
had
the
who
represented
the
views
of
both
providers
and
public
groups
around
the
idea
of
creating
a
common
framework
for
a
view
of
health
and
care
regulation
in
one
overseen
by
cqc.
L
So
that's
very
positive,
just
in
terms
of
publications,
we're
publishing
our
equality
objectives
which
help
bring
to
life
some
of
our
commitments
made
in
the
strategy.
The
engagement
on
those
objectives
has
been
significant.
There
have
been
a
number
of,
I
think
about.
L
A
thousand
people
have
been
involved
in
some
of
the
the
drafting
of
those
objectives
of
both
people
use
services
and
providers,
and
we've
also
had
over
100
ccc
staff
involved
in
workshops
around
them,
and
then
we've
identified
five
themes,
amplifying
the
voice
of
people
most
likely
to
receive
poor
care
or
having
an
equal
access.
L
Using
data
to
understand
the
response
to
equality
risks
working
with
others
to
improve
equality
outcomes,
use
our
independent
voice
to
reduce
inequalities
and
making
sure
that
we
ourselves
as
an
employer,
are
appropriately
understanding
inequality
in
our
own
environment.
L
L
We're
trying
to
go
on
to
the
to
the
inside
report.
A
A
The
the
the
support
and
gratitude
of
the
non-executive
directors,
including
myself,
for
our
executive
colleagues,
I
mean,
I
think
it's
been
an
exceptional,
exceptionally
difficult
period.
A
huge
amount
of
work
has
been
done,
some
of
it's
in
relatively
difficult
and
controversial
areas,
but
I
think
the
progress
that
everybody's
made
and
the
professionalism
they've
shown
has
been
exemplary
and
I
just
think
we
should
take
this
opportunity
to
put
that
on
record
and
I'm
pleased
to
see
my
non-executive
colleagues
all
nodding
and
clapping
and
all
the
rest
of
it.
A
L
So
there's
a
couple
of
topics
in
the
insight.
Paul
probably
the
most
significant
is
the
information
we
have
on
location
level
deaths.
So
ckc
is
today
publishing
our
information
on
showing
the
death
notifications
involved
in
kobe
19
received
from
individual
care
homes
between
april
last
year
and
march
this
year.
L
Obviously,
the
impact
of
the
pandemic
on
people
who
use
services
and
those
that
work
in
adult
adult
social
care
services
has
been
devastating
and,
despite
the
best
efforts
of
staff,
curving
19
has
led
to
an
increase
in
the
number
of
deaths
in
nursing
residential
homes
alongside
nhs
and
other
services
throughout
the
pandemic,
ccc
has
asked
care
providers
to
be
open
with
people
in
care
who
are
receiving
their
care
and
their
loved
ones
about
outbreaks,
and
cpc
has
worked
with
the
office
of
national
statistics
to
provide
weekly
information
on
how
code
is
affecting
care
homes.
L
The
data
the
data
itself
covers
residents
involved
involving
kerbin
19
under
the
care
of
a
particular
provider,
regardless
of
where
the
virus
was
contracted
or
the
death
occurred.
So
there's
a
legal
obligation
on
a
provider
to
give
us
the
information
following
a
a
a
patient.
Sorry,
a
service
user
that
might
go
in
to
use
use
other
services,
contract
covered
and
and
die
the
other
social
care
services
must
notify
us
of
these
deaths,
and
it
must,
even
if
the
individual
didn't
contract
covered
in
the
home
and
didn't
didn't
die
in
the
care
home.
L
It's
important
to
note,
then,
that
the
the
death
notification
themselves
do
not
indicate
poor
quality
care
in
an
individual
care
home,
particularly
given
what
I've
just
said
and
also
other
factors,
including
the
race
community
transmission
in
in
a
particular
organization.
We
publish
this
information
today
alongside
the
public
health
england
data
on
community
transmission,
and
that
appears
to
show
the
best.
The
best
link,
if
you
like,
between
those
two,
is
between
the
community
transmission
area
and
care
home
desk
in
an
area.
L
I
just
want
to
say
it's
very
clear
that
professionals
in
all
sectors
have
gone
to
extraordinary
lengths
to
try
to
contain
the
effects
of
the
virus,
and
our
report,
which
we
are
publishing,
is
around
prevention.
Controls
show
shows
that
today,
so
we'll
talk
a
bit
more
about
the
infection
control
in
hospitals,
in
particular.
So,
to
say
this,
just
this,
this
doesn't
represent
a
perspective
on
the
the
quality
of
care
that
an
individual
organization
has
given
has
given
what
you
can.
The
way
in
which
we
do
represent.
L
That
is
through
our
individual
inspection
reports
and
through
our
eight
ticks
of
assurance
and
that
information,
and
that
information
alone
is
guide
for
the
public,
on
the
quality
of
care
and
services,
to
support
that
we've
conducted
over
five
and
a
half
thousand
inspections
in
residential
and
and
other
social
care
services
since
april
last
year
and
those
inspections
and
that
information
is
what
should
be
a
good
judge
of
the
quality
in
individual
care
homes.
So,
death
notification
shouldn't
be
used
as
a
tool
to
understand
quality.
That's
not
what
they're
there
to
do.
L
They
are,
and
I
think
they
will
increasingly
give
us
a
view
on
on
how
people
move
between
different
elements
of
the
system
and
the
effect
that
that,
though
those
moves
might
have.
I
just
wanted
to
give
maybe
just
a
pause
there
and
perhaps
allow
particularly
kate
and
perhaps
other
chief
inspectors
to
come
in
and
offer
a
perspective
as
well.
D
Chris
thanks
so
we're
sharing
this
information
today.
This
has
been
a
long
time
in
the
coming,
so
we
have
thought
long
and
hard
and
have
given
serious
consideration
about.
When
is
the
right
time
to
share
this
information
we
are
obviously
you
know
it's
crucial
that
we
are
transparent
with
information
that
we
hold
we've
throughout.
This
not
wanted
to
do
it
at
the
height
of
the
pandemic,
for
fear
that
some
of
this
information
may
be
misunderstood
when
we,
when
we
share
it.
D
So
just
to
restate
you
know,
these
deaths
are
not
an
indicator
of
quality
of
care
within
the
service
death
notifications
help
inform
my
inspectors
about
when
they
might
want
to
go
out
and
do
an
inspection,
so
that
sits
alongside
things
such
as
whistleblowing
safeguarding
previous
ratings
etcetera,
and
when
we
have
information
of
concern,
we
go
out.
D
We
visit
a
service,
we
write
a
report
and
we
publish
that
on
our
website
and
back
in
august
we
developed
our
infection
prevention
control
inspection,
so
a
kind
of
focus
inspection
around
how
well
providers
were
to
different
good
infection
prevention
control
within
care
homes
and
a
large
majority
of
providers
were
absolutely
doing
what
they
needed
to
across
the
antics
of
assurance.
D
Lots
of
people
have
different
views
about
us
sharing
this
information
today,
family
groups,
people
who
have
sent
fois
to
us
over
the
last
year
have
been
really
keen
for
us
to
release
this
data.
We're
also
incredibly
mindful
of
the
impact
that
this
may
have
on
care
homes
and
the
sector,
and
we've
been
really
really
tuned
into
that.
D
So,
for
example,
I
was
aware
of
a
provider
the
other
day
who
proudly
talked
about
being
covered
free
throughout
the
pandemic,
and
yet
they
will
have
a
notification
against
their
name
because
one
of
their
residents
had
a
stroke
went
into
a
hospital
during
that
period
of
time
with
them
having
left
their
care
home,
developed,
covered
and
sadly,
died
of
covet.
D
So
this
is
hugely
sensitive,
but
if
there's
one
message
I
can
get
across
is
that
if
you
want
to
look
at
the
quality
of
care
delivered
within
a
care
home,
refer
to
our
inspection
reports
and
our
eight
ticks
of
assurance,
please
heed
the
parallels
of
increase
and
prevalence
in
the
community
and
likelihood
or
increased
likelihood
of
covert
within
a
care
home.
That's
that's
the
kind
of
predominant
relationship
that
you
will
note
when
you
look
at
the
the
information
and
care
homes
are
part
parts
of
communities.
So
so
you
would.
D
You
would
expect
that
and
the
majority
of
caregivers
that
we've
been
out
and
seen
and
actually
in
the
last
12
months,
it's
been
8,
000
inspections
that
we've
done
the
majority
of
our
care
workers
and
our
registered
managers
have
been
absolutely.
You
know
fantastic
at
doing
a
job
that
most
people
would
find
incredibly
hard
to
do
so
I
really
hope
this
lands
with
and
how
we
intend
it.
This
is
us
being
transparent,
but
also
real
clarity
that
you
know.
D
Many
of
these
notifications
against
care
homes
are
people
who
would
have
contracted
and
died
from
covered,
having
left
the
care
home,
but
care
home
providers
are
required
to
legally
require
to
inform
us
of
it.
Thanks
peter.
L
Right
so
we've
got
to
stay
after
the
public
board
and
we'll
make
it
available
to
to
colleagues
in
the
media
as
well,
and
we've
also
been
engaging
with
public
groups.
People
represent
people,
use
services
and
provider
organizations,
so
they're
all
aware
of
our
intention
to
publish
it
today
and
everyone
will
see
the
information
at
the
same
time.
A
And
I
can
only
support
what
you
and
kate
have
been
saying
and
hoping
and
urging
people
who
choose
to
comment
on
this
to
taken
and
on
board
everything
that
you've
both
been
saying
and
not
to
misrepresent
the
the
data
we
live.
L
In
hopes,
there
were
two
other
areas
of
the
inside
report
if
I
may
just
just
quickly.
One
of
them
relates
also
to
infection
prevention
control
in
the
nhs
and
we've
we've
had
a
number
of
focused
well-led
reviews
that
look
at
how
nhs
organizations
have
tackled
the
issues
of
good
infection
prevention
control
in
their
organizations.
L
There
is
some
really
good
practice.
The
key
factors
for
how
a
service
manages
around
leadership,
culture
and
communications,
having
a
plan
providing
right,
the
right
guidance,
risk
management
and
prioritization
monitoring
and
record
keeping
and
learning
and
improving
when
things
do
go
wrong.
How
fast
does
the
information
travel
around
the
rest
of
the
organization?
L
So
some
really
good
information
which
comes
out
from
that
and
the
ipc?
So
the
the
the
report
is
designed
to
give
both
information
to
providers
to
help
them
improve,
as
well
as
a
wider
understanding
of
stakeholders
about
how
infectious
prevention
controls
being
managed
in
hospital.
L
And
then
the
last
area
is
about
identifying
and
responding
to
close
cultures,
and
in
this
section
we
just
look
at
some
of
the
the
highlights
of
learning
so
far
about
how
risks
can
accumulate.
In
some
close
cultural
environments,
we
there's
a
sample
of
29
inspections,
of
independent
mental
health
and
other
social
care
services,
where
we
found
evidence
of
close
cultures
and
incidents
of
abuse
and
restrictive
practices
is
issues
of
staff,
confidence
and
training.
L
A
cover-up
culture,
lack
of
leadership,
poor
governance,
each
one
of
these
has
been
dealt
with
separately,
as
you
might
imagine,
through
our
regulation.
But
again
we
wanted
to
highlight
this,
partly
because
it
helps
both
providers
and
indeed,
commissioners,
understand
the
challenges
of
close
cultures
and
ensures
that
we
can
continue
to
apply
pressure
so
that
we
see
the
reform
such
as
the
reform
that
was
announced
today
through
the
dhse
and
those
are
the
three
main
areas
of
the
inside
report
have
to
take
any
any
other
questions.
E
Yeah,
yes,
thanks
can
I
just
comment
about
the
infection
control
report.
It
thanks
chris
and
your
team,
putting
it
together.
We
we
inspected
a
range
of
hospitals
where
we
had
concerns,
or
we
were
just
checking
on
the
level
of
infection
control.
We
contacted
all
hospitals
and
spoke
to
them
through
their
processes,
and
I
think
the
overarching
picture
of
vector
control
hospitals
is
really
positive.
E
That
staff
have
worked
incredibly
hard
to
maintain
really
high
standards
of
infection
control
and,
interestingly,
we
monitored
nosoco
infections
very
closely
and
and
the
biggest
predictor
of
nosoconal
infections
in
hospitals
is
the
community
rate
of
covid
and
just
as
kate
was
saying
a
moment
ago,
that
care
homes
are
part
of
the
communities
they
serve,
so
are
hospitals
and
so
are
other
services,
and
inevitably
they
are
affected
by
the
community
prevalence
of
covid
and
I
think
it
in
truth,
the
no
second
infection
rate
was
not
a
good
predictor
of
the
quality
of
infection
control
we
went
in.
E
We
did
find
some
infection
control
problems
and
took
enforcement
action,
but
it
was
generally
feedback
from
staff
or
patients
that
drew
our
attention
to
poor
practice
rather
than
there's
a
common
infection
which,
as
I
say,
generally
just
reflected
the
overarching
community
levels
of
infection.
A
Anything
from
anybody
else,
chris,
I
I
think
these
insight
reports
have
been
very
insightful.
I
may
say
so
and
I
think
they've
been
valuable
and
and
thanks
to
you
and
your
your
team
for
putting
them
together
over
the
last
year
or
so
robert.
H
I
just
wanted
to
voice
my
support
for
the
publication
of
these
figures
sobering.
No
doubt
they
will
be.
I
I
think
it's
really
important,
that
there
is
transparency
about
issues
of
this
nature,
so
there
can
be
open
discussion
about
them
and
there
are,
of
course,
challenges
in
in
under
in
communicating
your
proper
understanding
of
what
their
significance
is,
but
that
will
become
apparent.
I
very
much
hope
through
discussion,
and
it's
much
better
to
do
that
than
not
to
publish
these
things.
L
Yeah,
I
agree
absolutely
with
that
robert
that
he
does
prompt
good
conversations
about
how
we
look
at
and
manage
system
response
to
to
to
death
going
forward.
I
just
wanted
to
say
peter
that
this
is
a
I
represent
across
organizational
group
when
we
do
these
insight
reports
as
colleagues
and
rights
across
the
organization,
intelligence
and
and
digital
rocco,
and
obviously
the
the
inspecting
directorates
that
have
contributed
to
make
this
possible.
So
this
is
a
very
much
a
a
a
team
effort
from
across
cqc.
A
Thanks,
thank
you.
Well,
thanks
to
everybody,
then
seriously
they're
they're
very
good.
Can
we
move
on
then
to
provide
a
collaboration,
reviews
rosie,
you've
done
two
and
very
interesting
reading
over
to
you,
rosie.
I
Thank
you
very
much
peter,
so
so
I'm
really
pleased
today
to
be
able
to
present
these
two
reports,
one
looking
at
learning
disabilities
and
one
looking
at
cancer
just
to
remind
the
board
provider
collaboration
reviews
are
something
we
started
in
the
middle
of
last
year
and
the
aim
of
them
is
to
highlight
good
practice
and
and
pick
that
up
the
good
practice.
That's
happened
during
the
pandemic
and
also
shine
a
spotlight
on
some
of
the
things
that
we
feel
need
to
be
improved
across
the
systems
just
to
jura's
point
earlier.
I
We,
these
are
a
great
example
of
of
cross
directorate
working
across
the
cqc
colleagues
from
all
the
directorates
have
been
involved
in
this,
and
I
think
it
as
well
as
as
giving
some
really
good
insights
into
what's
happening
now.
It
does
also
help
us
to
understand
and
develop
our
regulation
of
systems
as
we
go
forward.
I
So
learning
disabilities
and
cancer
are
both
areas
which
require
the
whole
system
to
work
together
and
when
I'm
talking
about
the
system,
I'm
talking
about
hospitals,
community
work,
people
working
in
the
community,
mental
health
teams,
primary
care,
adult
social
care
and
and
very
often
the
voluntary
sector,
as
well
and
other
parts
of
the
system
that
really
have
an
impact
on
people
who
use
services
and
in
both
of
these
areas,
we
have
seen
some
really
great
innovation.
I
We've
seen
examples
of
how
people
have
worked
together
and
gone
above
and
beyond
to
deliver
care.
Despite
the
challenges,
we've
also
found
areas
that
we
feel
that
need
to
be
improved
and
many
of
the
areas
we've
highlighted
in
these
reports
are
actually
areas
that
predate
the
pandemic
but
have
been
exposed
or
made
more
visible
during
the
pandemic.
I
I'm
hoping
that
you'll
notice,
particularly
with
the
learning
disability
review
that
actually
we've
very
much
tried
to
strengthen
the
voice
of
people
using
services
in
this
report,
which
we
think
is
really
important,
and
actually
the
learning
disability
review
has
has
started
with
the
people
who
use
services
with
the
vignettes
and
the
stories
that
we've
heard.
I
As
part
of
these
reviews,
and
that's
something,
I
think
we
very
much
want
to
strengthen
as
we
go
forward
and
and
explore,
and
particularly
with
our
strategic
aim
of
of
regulating
services
through
the
eyes
of
people
who
use
services
in
terms
of
next
steps,
I
we
will
be
using
the
information
on
this
review
and
we
will
be
sharing
it
widely
working
with
the
engagement
team.
I
Looking
at
how
we
can
get
these
messages
out
to
local
systems,
how
we
can
share
the
learning
and
working
with
chris's
team
to
look
at
the
mechanisms
for
doing
that
and
we're
thinking
about
blogs
and
podcasts
and
potentially
meetings
with
ccgs
and
various
other
ways
to
share
the
learning
that
we
get
out
of
this,
because
I
think
it's
really
important
that
systems
learn
from
what
other
places
are
doing,
hear.
What's
been
working
and
look
at
adoption
as
quickly
as
possible
of
those
innovations
that
are
making
a
significant
difference.
I
I
want
to
just
thank
the
the
systems
that
have
worked
with
us
on
this.
We've
had
very
positive
response
from
from
the
systems
that
we've
worked
with
each
of
these
reviews
and
thank
you
for
taking
the
time
to
share
the
experiences
and
and
work
with
us
on
them,
and
I
I
think
before
that
my
only
final
thing
just
mentioned
for
any
of
the
public
watching
is,
as
you
will
see
in
the
cancer
report.
I
The
concerns
raised
about
early
diagnosis
and
people
still
not
always
seeking
help
early
when
they
experience
symptoms
because
of
the
fear
of
covid.
I
What
I
would
say
to
any
of
the
public
listening
here
is:
please:
if
you
have
any
worrying
persistent
symptoms,
please
go
and
get
them
checked
out,
because
we
want
to
make
sure
that
you
get
get
the
the
investigations
and
treatment
that
you
need
at
an
early
stage.
So
that's
all
I
was
going
to
say
peter,
but
very
happy
to
take
any
more
detailed
questions
about
either
of
the
reports.
A
F
Saxton,
sorry
chairman,
thank
you.
Rosie
thanks
for
super
reports
really
really
good.
Can
I
say
that
I
thought
that
the
case
studies
in
the
learning
disabilities
were
really
powerful
and
it
showed
that
for
james
dominic,
sarah
narinda
dennis
harry
stephen.
There
were
real
real
stories
of
real
issues
that
are
of
concern
to
us.
F
You
know
we
could
see
quite
clearly
from
that
report
that
communications
and
working
together
what
we
call
system
working
there
were
a
lot
of
challenges
there.
We
saw
the
issue
that
we've
talked
about
a
lot
before
this
transition
from
child
to
adult
services
being
a
challenge,
especially
during
the
pandemic,
and
we
saw
technology
being
both
an
enabler
but
also
underlining
inequality.
F
F
F
I
don't
get
a
sense
of
scale
of
how
the
service
and
the
support
for
people
with
learning
disabilities
is
getting
back
on
track
postcode
bits.
So
I
wondered
if
you
could
just
talk
to
that,
but
you
know
overall,
two
really
really
powerful
reports
and
thank
you.
I
Thank
you
mark,
and
can
I
just
take
this
moment
to
to
say
thank
you
to
debbie
even
over
for
her
leadership
on
the
learning
disability
report,
because
she
was
very
much
very
keen
to
use
those
those
people's
stories
and
we
are
on
a
very
much
a
learning
curve
and
I
think
that's
something
we
will
continue
to
develop
and
also
victoria
watkins
for
her
leadership
as
well
for
the
pcr
program
overall.
I
So,
in
terms
of
cancer,
we
have
been
working
closely
with
the
cancer
alliances
at
nhs
england.
I
I
think
we
have
our
intelligence
team
have
have
done
a
huge
amount
to
pull
the
intelligence
that
we
have
across
the
areas
that
we've
looked
at.
I
I
think
at
the
moment,
as
you
can
tell
from
the
the
report,
we've
only
looked
at
a
small
number
of
systems,
so
we
have
presented
the
information
that
we've
had
in
the
context
that
actually
this
is
in
the
the
systems
that
we've
actually
looked
at,
but
we
we
know
that
deferred
treatment
is,
is
an
issue
we
continue
to
to
work
with
nhs,
england
and
and
other
partners
to
look
at
how
we
can
raise
the
the
findings
from
this
report,
and
we
will
continue
to
share
the
findings.
I
We've
already
spent
some
time
with
the
systems
that
we've
been
in
to
share
those
findings,
work
with
them
around
the
improvements
that
we
feel
need
to
be
made
in
those
areas
and
ask
for
them
for
plans
of
action
as
a
result,
in
terms
of
learning
disabilities
again
and
kate
may
want
to
comment
about
this
and
ted
may
want
to
comment
more
about
the
cancer
again.
It
is.
I
We
have
looked
at
only
a
kind
of
snapshot
across
the
country,
but
to
what
I
was
saying
earlier
with
both
reports,
we
will
look
at
all
of
the
information
that
we've
got
and
continue
to
use
that
this
is
not
a
snapshot.
Although
it's
a
snapshot
of
what
we've
seen
the
messages
from
these
reports,
we
will
continue
to
use
in
our
discussions
both
nationally
and
locally,
and
we
will
be
using
a
lot
of
this
information
in
the
state
of
care
as
well,
which
we're
going
to
be
discussing
later
today.
I
So
so
kate,
do
you
want
to
add
anything
and
ted?
You
want
to
add
and
think
about
ld
and
cancer.
D
Thanks
rosie
thanks,
so
bordeaux
will
remember
two
or
three
months
ago
we
established
this
new,
12-month
role
for
debbie,
even
over
deputy
chief
inspector,
to
provide
some
cross-organizational
leadership
around
health
and
care
services
delivered
to
people
with
learning
disabilities
and
autistic
people
and
debbie
has
three
priority
areas
of
work,
and
one
of
those
is
around
how
people
with
learning
disabilities
and
autism
have
access
in
a
timely
way
to
the
right
health
services
and
how
they
are
supported
in
a
joined
up
way
as
we
go.
D
This
is
all
also
our
absolute
direction
of
travel,
so
we
know
our
collective
ambition
is
to
be
able
to
track
people's
experiences.
Maybe
during
a
crisis
or
trying
a
person
with
learning
disability
trying
to
get
access
to
their
annual
health
check
or
regular
dental
appointments,
or
maybe
a
stay
in
an
acute
hospital.
We
want
to
be
able
to
track
and
describe
people's
experiences
as
they
move
through,
and
I
think
our
provider
collaboration
reviews
is
a
flavor
of
more
and
more.
D
What
we
we
will
do
is
hopefully
part
of
our
kind
of
core
core
regulatory
business
as
well,
and
then
you
add
into
that,
are
developing
plans
around
being
able
to
look
at
local
authorities
and
the
way
that
they
commission
services
as
well,
and
our
you
know,
emerging
thinking
around
our
role
with
integrated
care
systems
and
soon
we
should
have
all
the
ingredients
in
place
that
we
need
to
be
able
to
say.
E
E
But
I
think
the
striking
thing
for
me
about
it
is,
if
you
look
at
the
data,
the
impact
that
the
pandemic
has
had
on
cancer,
diagnosis
and
timing,
a
presentation
and
there's
no
doubt
that
recovering
from
this
cancer
services
are
going
to
face
a
tremendous
burden
to
to
catch
up
with.
With
with
the
ground,
that's
been
lost
and
I
think,
as
we
go
forward
inspecting
cancer
services
and
regulating
them,
we
need
to
know
how
to
support
them
and
point
them
in
the
right
direction.
And
this
this
is
a
really
good
basis
for
that
going
forward.
E
But
I
think
we
are
going
to
have
to
develop
our
approach
to
cancer
services,
recognizing
the
fact
that
they
have
they
do
have
some
catching
up
to
do
in
in
terms
as
I
described
earlier
on
in
terms
of
the
backlog
of
care.
A
Thanks,
it's
not
something
we
we
we've
discussed,
but
I
suppose
there
is
something
we
need
to
think
about
whether
whether
and
when
we
repeat
these,
these
exercises
to
see
whether
things
have
got
better
or
worse,
you
know,
so
we
should
at
least
think
about
whether
we
do
pcr
or
maybe
a
slightly
different
methodology
in
a
year
or
or
two
years
time
to
see
how
we're
going,
but
no
commitment
now,
because
we
haven't
discussed
it
mark
chambers.
K
Repeating
some
of
what
mark
said,
I
did,
I
did
think
well.
Both
of
these
reports
are
fantastic
and
and
really
helpful.
I
I
did
find
the
the
learning
disability
one
and
the
addition
of
the
of
the
experience
information.
You
know
it
helped
accessibility
enormously
and
I
I
and
it
was
very
nicely
presented-
it's
contextual.
K
I
think
the
danger
of
these
things
is,
if
you
put
too
much
in
it,
becomes
anecdotal
and
I
think
you've
got
the
balance
absolutely
right,
and
I
think
that
report
would
be
a
useful
model
for
for
for
for
going
forward
and
then
the
second
thing
I
wanted
to
mention-
and
it's
it's
more
a
comment
really.
You
know
the
section
on
health
inequalities
in
relation
to
the
learning
disability
report.
K
You
know
it
is.
It
is
terrifying
and,
and
and
so,
and
and
and
sobering.
Average
life
expectancies
of
23
years
lower
for
those
with
the
learning
for
males
with
a
learning
disability
in
27
years.
Younger
for
females
with
with
a
learning
disability
shows
that
there's
a
vast
amount
of
required
to
be
done
at
a
system
level
in
in
relation
to
tackling
this,
and
it
was
not
particularly
encouraging
the
you
know
the
amount
of
system
work.
That's
been
done
on
that
so
far,
so
anything
that
we
can
do
in
relation
to
to
that
going
forward.
K
M
I
Because
I
think,
by
looking
at
things
across
system,
we
are
going
to
be
able
to
have
much
more
influence
on
what
happens
with
inequalities,
and
I
you
know,
I
think,
the
the
the
major
theme
we've
got
in
our
new
strategy.
Around
inequalities
and
systems
going
hand
in
hand
actually,
because
I
think
we
can
start
to
look
at
really
understanding
how
services
are
being
designed
and
developed
to
meet
their
population
needs
and
and
address
those
those
inequalities
that
we're
seeing
in
in
all
sorts
of
services.
At
the
moment,.
N
Yes,
thank
you
peter
and
others
who've
produced
the
reports.
I
echo
what
other
board
members
have
said
about
the
value
of
these.
I
think
there
are
very
few
organizations
across
health
and
social
care
who
try
to
join
things
up
in
this
way,
and
these
type
of
reports
are
a
really
good
example
of
those.
N
N
So
the
learning,
disability
and
autism
report
is
very
much
a
big
program
of
work
for
cqc,
something
that
we
are
taking
forward,
as
kate
said,
with
debbie
over
a
year,
so
we
have
access
to
an
awful
lot
of
information,
whereas
cancer
is
a
huge
piece
of
work
that
we
couldn't
possibly
get
our
arms
around
and,
as
you
said,
rosie
we've
looked
at
seven
or
eight
different
local
areas.
Really
you
can't
get
to
everyone.
N
So
it's
it's
partly
a
question
about.
N
Where
do
we
take
these,
and
how
do
we
approach
these
in
the
future
and
partly
peter's
comment
about
whether
we
repeat
them,
so
I'd
suggest
that
we
as
a
board,
perhaps
have
a
further
discussion
about
what
topics
should
be
in
pcrs,
what
the
kind
of
scope
of
them
or
to
be
what
we
think
the
biggest
needs
are
across
healthcare,
which
would
help
us
deliver
part
of
our
strategy,
an
improvement
and
also
when
we
should
revisit
so,
I
think,
really
good
piece
of
work,
some
questions
about
the
future
and
how
expansive
some
of
them
are.
I
And
could
I
could
I
just
respond
to
that
peter
if
that's
okay,
so,
firstly,
we
specifically
chose
these
topics
during
the
population
groups.
We've
looked
at
during
the
pcr
program
because
of
the
concerns
that
we
were
hearing
in
the
pandemic
and
the
fact
that,
actually
from
our
regional
escalation
groups,
we
were
hearing
concerns
around
all
of
the
different
areas
that
we've
actually
chosen
for
the
pcr,
so
that
led
to
the
the
topic
development.
I
I
we
are
tests
using
this
as
an
opportunity
to
test
new
ways
of
presenting
information
and
and
looking
at
information
in
light
of
our
future
role
with
a
potential
future
role
around
systems
regulation,
and
I
think
that
that
we've
certainly
learned
a
huge
amount.
We've
had
a
variety
of
wash
up
sessions
after
each
pcr
and
each
pcr
has
learnt
something
to
move
on,
and
I'm
hoping
that
you'll
have
noticed
as
we've
we've
presented
them
as
they've
gone
forward.
I
Those
improvements
in
in
how
we've
delivered
this
program
and
and
how
we've
how
we've
been
presenting
the
information
back
to
the
board
in
terms
of
going
forward
those
discussions.
I
I
would
very
much
welcome
a
a
session
with
the
board
at
some
stage
to
look
at
the
the
kind
of
the
thoughts
that
we're
developing
around
systems.
I
know
we've
discussed
it
on
several
times
before.
I
I
What
we
look
at
the
pathway
level
at
the
population
group
level
and
I
think,
those
discussions
we
absolutely
need
to
have
with
the
board
to
to
look
at
where
we
go
forward,
and
I
think
that
will
help
us
inform
as
well,
where
we
go
back
to
in
terms
of
what
we
look
at
in
terms
of
the
findings
we've
had
now
and
what
will
be
subsumed
into
our
future
regulatory
role
in
systems.
A
B
I
think
I
think
we've
had
we've
had
a
we've
talked
a
couple
of
times
during
the
course
of
this
meeting
in
sort
of
unconnected
ways,
but
on
essentially
the
same
point,
which
is
we
we,
we
essentially
do
work
at
the
moment
at
provider
level,
it's
just
it's
effectively
a
series
of
stove
pipes,
there's
40
000
stovepipes
that
we
that
we
look
at
and
we
capture
the
value
in
in
that
work
through
a
series
of
set-piece
reports
and
increasingly
overcovered.
We
we've
done
different
ways
of
doing
that.
B
With
the
new
methodology
and
the
the
conversation
we
had
earlier
on
around
change,
I
think
what
we,
what
we're
really
about
there
is,
is
to
create
a
set
of
technology
that
does
enable
us
to
do
the
sorts
of
pieces
of
work
where
we
can
very
quickly
look
across
and
say
in
particular
places
with
these
characteristics.
What
are
we
seeing
in
particular
pathways?
What
are
we
seeing?
That's
almost
like
a
pilot
piece
of
work.
B
I
think,
and
it
gives
us
an
opportunity
to
comment
in
ways
that
we
just
frankly
never
thought
possible
much
much
faster
about
a
broader
range
of
topics
than
we
could
ever
have
thought
of
so
hopefully,
as
we,
you
know,
as
we
bring
as
we
bring
back
versions
of
new
methodologies
and
so
forth
in
coming
months,
you'll
be
able
to
start
to
see
the
opportunity
to
answer
the
questions
that
you
know
that
you
ask
peter
and
sally.
Thank
you.
A
Oh,
thank
you.
Let
me
bring
chris
in
and
then
we'll
give
the
the
final
word
to
ted
chris.
L
You're
on
mute,
chris,
that's
happened
once
sorry
just
to
build
on
what
ian
was
saying
and
also
what
sally
said.
I
think
it's
really
important
that
we
can
use
these
both
nationally
and
also
regionally.
So,
as
we
begin
to
get
more
into
a
regional
perspective
on
how
ics
and
regional
areas
are
performing,
we
can
use
some
of
that
information
in
that
way.
L
So
I
have
a
regular
conversation
with
about
30
organizations
that
have
have
other
data
that
we
that
we
work
regularly
with
and
public
groups,
and
I
think
we'll
be
what
we're
trying
to
do
is
develop
a
sort
of
a
topics
of
interest
that
we
want
to
explore
over
the
coming
12
months
and
and
used
that
as
a
guide
for
where
we
might
want
to
have
thematic
presentations
of
data
or
develop
a
perspective
on
a
particular
theme,
as
we
have
done
with
learning
disabilities.
L
E
Yeah
thanks
peter
cancer
services
are
par
excellence.
The
kind
of
service
looking
at
it
on
a
provider
by
provider
basis
doesn't
work
because
cancer
care
is
provided
as
a
pathway
by
multiple
providers
working
together
and
so
before
the
pandemic.
We
were
looking
at
developing
a
thematic
approach
to
cancer
services,
so
we
could
look
at
it
if
you
like,
through
the
experience
of
patients
receiving
those
cares
rather
than
through
the
provider's
eyes,
which
is
it's
way.
E
We've
been
effectively
been
doing
it
before
the
pandemic
center
has
brought
that
to
the
fore
because,
as
I
said,
the
pandemic
has
exacerbated
problems,
we're
already
aware
of,
and
I
think
the
effect
on
the
cancer
services
as
as
this
pcr
report
demonstrates,
are
quite
profound,
so
there's
lots
of
good
good
care
going
on,
but
actually,
how
does
that
add
up
to
an
integrated
care
pathway
for
patients?
And
I
think
that's
the
question
we
need
to
ask.
A
A
good
point
to
leave
this
subject
on,
but
thanks
to
everybody,
rosia
who's
been
involved
in
producing
these
reports,
because
I
do
think
they
have
been
excellent.
A
So
I
think
that
then
takes
us
on
sally
to
the
annual
report
from
the
audit
committee.
Please.
N
Yes,
thanks
peter,
so
this
is
the
10th
annual
report
of
the
austin
corporate
governance
committee,
commonly
known
as
acgc
one
of
the
board
key
committees.
I've
only
been
there
for
less
than
a
year
and
we
have
some
new
members.
N
So
our
thanks
go
to
the
people
who
staffed
the
committee
before
we
joined
earlier
this
year
in
january.
N
N
There
is
a
report
in
the
papers,
but
I'm
just
going
to
pick
out
some
highlights.
If
that's
okay,
we
obviously
have
our
own
internal
systems
of
control,
risk
management
and
governance,
but
we
also
enlist
the
support
of
internal
auditors
who
report
on
different
parts
of
our
organization
or
the
ways
in
which
we
do
things
and
provide
their
opinions
and
recommendations
and
we're
also
externally
audited
by
the
national
audit
office,
who
work
on
our
annual
accounts
and
allow
us
allow
ian
to
sign
those
off
and
then
sign
them
off
themselves.
N
I
think
the
key
message
is
that,
given
all
of
the
challenges
of
the
pandemic,
we
feel
that
we're
in
a
good
place
and
that
our
systems
of
control
and
governance
are
reliable
and
do
have
integrity.
So
that's
the
positive
message
you
should
take.
I
think
there
have
been
two
challenges
over
last
year.
Clearly,
the
pandemic,
but
also
a
significant
change
programme
that
we
are
undertaking
within
cqc.
N
So
we
have
established
a
subcommittee
of
the
audit
committee,
which
is
looking
more
closely
at
some
of
those
business
cases
and
the
transformation
program
that
we
have
just
to
be
able
to
provide
an
extra
level
of
assurance,
and
our
internal
external
auditors
have
also
had
a
view
on
that
change
programme.
N
We've
also
looked
at
transformation
projects,
including
in
digital,
as
we
are
putting
together
a
new
operating
model
with
our
people
plan
and
also
the
way
that
cqc
regulates
and
has
had
to
adapt
over
the
last
12
to
18
months
as
the
pandemic
has
happened,
and
we've
also
done
some
work
around
improvement.
Naturally
we're
not
just
about
assurance
for
what's
happening.
Now.
We
are
about
improvement
into
the
future,
so
I
wanted
to
say
thank
you
to
to
chris
usher
on
the
team,
but
also
everybody
who's
contributed
to
the
work
of
acgc.
N
It
is
right
across
the
organisation
and
thanks
to
all
those
executive
board,
members
and
their
teams
who've
come
to
present
to
meetings.
We've
worked
well
with
our
internal
auditors,
I'd
like
to
say
thank
you
to
them.
There'll
be
more
detail
on
their
opinion
in
our
annual
reporting
accounts
when
it's
published
in
the
autumn
and
laid
before
parliament,
but
we
have
committed
to
delivering
and
working
with
them
on
all
their
recommendations
for
improvement,
in
particular
areas
of
our
business
and
our
external
auditors.
N
So
I
suppose
I'm
happy
to
take
questions,
but
just
wanted
to
reiterate
the
positive
message
at
the
start
that
the
assurance
that
our
systems
are
reliable
and
comprehensive
is
there
and
that
it
meets
the
needs
of
the
board
and
the
accounting
officer,
and
the
recommendation
is
that
you
note
the
report.
Thank
you.
A
Thank
you
sally
and
thank
thanks
actually
to
you
personally,
because
you
you
sort
of
got
parachuted
into
this
without
much
of
a
organized
handover
and
everything
else
and
they've
done
a
great
job
over
the
last
a
few
months.
So
thank
you
very
much
indeed
any
questions
or
comments
on
the
acgc
report.
A
In
which
case
we
will
we
will.
We
will
note
it
as
requested,
but
thanks
again
sally
and
thanks
to
everybody
on
on
the
committee,
is
there
any
other
business
the
board
wants
to
raise
this
morning,
in
which
case
that
that's
the
end
of
the
the
formal
part
of
the
meeting?
We
do
have
two
questions
from
a
member
of
the
public
robin
pike.
A
The
first
question
is
how
does
cqc
liaise
with
the
parliamentary
and
health
ombudsman
and
how
does
it
respond
to
its
decisions?
Probably
a
number
of
us
could
answer
that
question,
but
chris.
Why
don't
I
give
it
to
you?
Okay,.
L
So
ian
mate
meets
regularly
with
the
chief
executive
officer
and
the
deputy
ombudsman.
Usually
once
a
quarter
two
or
at
least
two
or
three
times
a
year.
Colleagues
also
meet
more
regularly
with
them,
with
with
the
phso
and
others
at
a
working
level
to
consult
on
particular
issues
that
affect
their
work
and
hours.
L
So
we
will
probably
hold
those
meetings
at
least
every
four
to
six
weeks
in
terms
of
our
work
where,
where
there
is
an
issue
where
they
are
investigating
the
competition,
cqc
they'll
regularly
have
a
conversation
with
the
national
complaints
team
and
ask
for
information,
and
the
companies
team
will
help
sort
of
share
that
information
and
shape
what
we
offer
back
to
the
phso
when
they
conduct
an
the
phd
will
investigation
their
decision,
an
issue
report
to
all
the
parties
that
are
concerned,
that,
if
there's
any
recommendations
for
us,
they'll,
usually
talk
to
us
well
in
advance
of
those.
A
E
Yes,
well,
thank
you
robin
for
the
question.
The
in
direct
directly
answering
your
question.
Over
the
last
three
years,
we've
had
965
whistleblower
concerns
raised
about
sites
where
we
know
that
patients
with
learning
disabilities
are
being
looked
after.
That's
about
20
percent
of
our
total
whistleblowing
for
hospitals.
E
The
I've
said
to
the
board
report
before
how
important
staff
raising
concerns
about
the
services
they
provide
is
so.
Can
I
again
express
my
thanks
to
all
staff
who
raised
concerns
for
us.
It
is
a
very
important
part
of
us
understanding
the
risks
in
the
system
and
during
the
pandemic.
That
has
been
particularly
true,
as
I'm
sure
we've
discussed
before
the
number
of
whistleblowing
concerns
raised
with
us
has
risen
over
the
last
year
and
that
that
is
something
that
has
really
helped
us
maintain
a
risk-based
focus
on
services.
E
A
Agreed,
thank
you
ted,
and
there
are
no
other
questions
from
the
public,
so
there
is
no
other
business,
so
that
is
the
end
of
our
public
board
meeting.
Thank
you
very
much
indeed,
and
miraculously
everybody
we.