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From YouTube: CQC Board Meeting – June 2016 (with subtitles)
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A
A
Right
good
morning,
everybody
as
I
think
probably
anybody
who
reads
newspaper
or
listens
to
the
television
or
radio
will
know
that
today
would
have
been
the
42nd
birthday
of
joe
cox,
who
was
murdered
so
cruelly
last
week,
and
I
just
invite
everybody
to
stand
with
me
for
a
minute
in
silence.
In
memory
of
joe
cox.
A
A
The
board
meeting
so
I'm
not
guaranteeing
there
will
be
a
lot
of
time
for
questions,
but
we'll
try
and
fit
some
questions
in
if
we
can
can
I,
also
just
to
reiterate
that
the
that
the
purpose
of
questions
or
comments
from
front
from
members
of
the
public
is
around
areas
of
public
concern
and
public
interest,
and
what
we
can't
do
in
these
sessions
for
kinds
of
different
reasons
is
go
into
individual
cases.
There
are
other
places
for
doing
that
not
trying
to
for
one
minute,
stop
those
discussions,
but
this
in
a
public.
A
A
A
And
that
then
takes
us
to
the
the
action
log
good
if
I
could
find
it
everything
there
seems
to
be
sort
of
in
order,
but
II
want
to
raise
anything
or
is
anything
else,
that's
arising
from
the
minutes
that
isn't
otherwise
on
this
agenda
good.
So
in
that
case,
let's
please.
B
B
Good
morning
everybody
thank
you
Peter,
so
I'll
technisat
term
some
speed.
It
is
an
updating
report
rather
than
a
report
which
is
asking
for
any
significant
decisions,
and
when
I
get
to
item
11
I
think
Robert
will
also
updated
on
the
progress
in
relation
to
the
National
Guardian
role
as
well,
which
it
isn't
in
my
paper.
But
the
senior
appointments
paragraph
allows
that
opportunity
for
Robert
to
just
update
us
so
starting
at
the
top.
As
they
say,
the
performance
report
is
attacks.
B
This
is
a
new
style
performance
reports
which
a
lot
of
work
has
been
undertaken
on
this
and
I
hope
people
find
it
accessible.
It
contains
much
of
the
information
that
you've,
historically
and
traditionally
been
used
to,
but
it's
presented
in
a
different
way
and
as
an
alignment
with
the
chief
inspectors
reporting
arrangements
that
they
use
on
a
an
ongoing
basis
week
later
and
then
into
monthly
meetings
as
well.
So,
in
summary,
there's
this
is
the
report
for
April.
B
Good
progress
is
being
made
on
the
operational
indicators,
spend
against
butcher,
as
in
line
with
expectations,
and
the
numbers
of
people
that
we
employ
continues
to
hold
up.
It's
just
over
1,200
inspectors,
I
think
with
about
1100
actually
inspecting,
as
opposed
to
being
prepared,
etc
so
and
productivity
rates
of
tech
and
a
site
step
back
from
the
progress
that
has
been
made.
B
If
there's
questions
you
laughs,
timeliness
of
reports
continues
to
show
improvements
in
both
adult
social
care
and
primary
medical
services
as
well,
and
there
is
work
that
Mike
and
Paul
have
been
doing
in
relation
to
the
timeliness
of
reports
in
hospitals,
with
some
piloting
being
done
over
this
next
quarter.
With
a
view
to
the
third
quarter,
a
new
model
for
report
as
much
more
of
the
observations
and
conclusions
upfront
with
the
evidence
sitting
behind
the
report,
which
is
the
mechanism
by
which
will
have
sure
to
report
some
of
the
evidence,
that's
use.
B
Some
good
news
in
relation
to
the
use
of
our
new
powers.
We
were
given
new
powers
in
a
couple
of
years
ago
in
relation
to
a
transfer
of
responsibility
from
the
Health
and
Safety
Executive,
protecting
prosecution's
and
the
that
legislation
and
last
week
the
first
prosecution
in
the
lesson
to
health
and
safety
was
taken
successfully
against
sentence.
Community
services
following
the
death
of
an
individual
in
that
service
prosecution
took
place
at
Dartford,
magistrate's
court
sentence
pleaded
guilty
to
that,
and
the
fine
of
under
the
90,000
and
costs
were
awarded
against
interns.
B
As
a
consequence
of
that,
one
of
the
tests
were
given,
particularly
by
the
care
services
minister,
at
the
time
Norman
lamb
was
about
whether
we
would
use
these
powers
and
I
think
this
is
the
evidence
that
these
powers
are
indeed
being
used
and
I
think
the
other
not
will
fact
from
this
I
want
to
Rebecca's
staff.
He
was
joined
us
to
take
over
responsibility
for
this.
This
was
an
in-house
prosecution,
so
this
wasn't
put
outside
of
CQC.
This
was
something
that
I'm
a
member
of
Rebecca's
team
took
forward.
B
So
a
significant
development
Steve's
update
is
really
wrapped
into
the
one
on
southwestern
ambulance
service,
which
follows
the
publicity
last
week
about
our
assessment
and
rating
of
the
111
service
in
the
southwest
were
following
the
inspection.
We
observed
a
number
of
concerns
in
relation
to
this
and
issued
a
warning
notice
against
the
trust.
We're
also
due
to
take
a
comprehensive
inspection
of
the
trust
imminently.
B
There
is
a
general
issue,
I
think
about
the
effectiveness
of
111
services,
which
is
coming
out
from
our
inspections
and
I.
Think
this
pattern
is
going
to
be
repeated
as
we
do
undertake
more
warm
warm
one.
Inspections
has
been
recent
publicity
about
the
north,
middlesex
hospital
trust
and
the
emergency
department
in
relation
to
this,
where
again
with
issued
warning
notices
and
continue
to
work
closer
with
health,
education,
England
and
the
GMC
and
mike's
up
to
date.
B
On
that
and
as
I've
meetings
this
week
Peter,
you
asked
for
some
feedback
in
relation
to
the
strategy
following
its
publication
on
the
24th
Amir,
just
after
our
last
board
meeting,
and
if
you
remember
this
was
a
soft
launch,
we
didn't
really
go
for
a
big
razzamatazz.
The
tread
press
covered
this,
the
health
service
journal
covered
it
on
and
three
separate
articles.
What
we
felt
was
a
fair,
balanced
and
accurate
reflection
of
the
contents
of
it.
National
and
trade
media
also
covered
it.
B
They
tended
to
focus
on
the
use
of
unannounced
inspections
and
the
use
of
intelligence.
Whilst
one
or
two
made
more
of
the
budget
reductions,
we
were
making
since
remember.
That's
how
the
Guardian
led
with
it
stakeholders
have
been
positive:
NHS
providers,
UK,
Home,
Care,
Association,
the
outsiders
society.
All
issued
positive
comments
where
reaction
was
less
positive,
was
on
a
perception
that
inspection
activity
was
being
reduced
due
to
budget
cuts.
B
Where
elements
of
the
strategy
was
welcomed,
it
was
about
making
better
use
of
information
from
members
of
the
public
and
providers,
the
sharing
of
data
and,
critically,
the
aligning
of
requests
to
reduce
duplication,
the
aligning
of
requests
from
CQC
NHS
improvement,
NHS
England
to
reduce
duplication
on
those
providing
the
information,
which
is
largely
trust,
private
sector
provided
CCGs,
etc,
and
it
was
also
a
welcome
for
the
focus
on
population
groups
and
local
areas.
These
are
the
reports
within
north
linkage
resulted
in
terms
that
indeed,
I
think
one
of
Paul's.
C
B
Was
up
presenting
the
soul,
food
report
to
Salford
health
and
well-being
board
yesterday
by
way
of
feedback
to
them,
so
so
I
think
a
lot
in
there
Peter
to
reflect
on
and
yesterday
the
executive
team.
With
the
median
turn
strategy
group
spent
an
hour
and
a
half
looking
at
what
is
required
to
translate
the
policy
ambitions
in
the
strategy
into
delivery,
both
this
year
and
next
year.
So
we'll
begin
to
bring
forward
the
detail
of
those
plans
as
we
go
forward.
B
B
These
were
largely
questions
around
the
number
of
stuff
that
we've
got
on
the
progress
in
relation
to
conduct
in
the
inspections
that
we'd
set
out
in
our
last
year's
business
plan,
so
that
work
is
in
preparation
and
once
that
letters
in
a
reasonable
state,
I'll
circulate
that
the
non-executive
directors
in
the
board
to
ensure
they
can
see
that
before.
That
goes
before
Parliament
recesses
for
the
summer,
which
I
think
is
the
22nd
of
July.
So
and
that's
our
ambition
to
get
that
letter
there,
the
work
has
been
done
and
it's
just
being
ashamed.
B
Some
more
matted
we're
also
taking
the
opportunity
in
the
report
just
to
update
on
integration
pathways
in
place.
This
is
one
of
the
themes
that
came
from
that
positive
feedback
from
the
strategy
and
this
three
bullet
points
which
describes
the
foot
of
the
work
we're
doing
by
working
with
the
five
year
old
view
and
the
STP
areas.
B
We've
got
deputy
chief
inspectors
link
to
the
STP
areas,
we're
also
looking
at
the
new
care
model,
such
as
a
van
guides,
and
what
it
is
that
we
need
to
do
to
reflect
the
changes
in
the
way
that
services
are
provided
in
the
way
that
we
both
register
and
then
subsequently
inspect,
and
we
are
creating
some
capability.
That's
coordinate
and
consolidate
the
learning
we're
taking
from
this
there's
now
an
awful
lot
of
activity
going
on
across
the
country
and
therefore
it's
impossible
I
think
for
any.
B
It
was
essentially
to
keep
track
of
the
developments
taking
place
so
we're
trying
to
work
out
what
so
much
more
distributed
way,
I've,
actually
keeping
in
touch
with
these
projects.
The
risk
is
that
any
innovations
are
met
with
you
can't
possibly
do
that
response
is
distinct
from
how
can
we
capture
the
responses
have
come
in
and
then
actually
take
a
consistent
view.
Otherwise
we
might
be
saying
in
one
place.
B
As
I
say,
we
continue
to
work
closely
with
the
NHS
England
NHS
improvement
in
identifying
themes
for
changing
the
regulations
and
my
personal
view
is
it's
not
just
what
we
do
it.
People
are
looking
for
systems
approaches
to
this.
This
is
critically
as
much
as
what
NHS
England
are
in
relation
to
those
ccg
assessment
and
oversight
framework,
because
it
is
about
what
we
do
is
as
a
regulator
for
the
provider
side
and
in
addition
to
that,
will
continue
to
develop
our
own
work
on
integration
policy.
B
Steve
takes
a
lead
on
this
for
us
and
working
alongside
poles,
people
and
as
I
say.
The
big
issue
at
the
minute
is
how
we
align
with
the
stps
they're
all
due
to
send
in
their
plans
to
NHS
England
in
its
improvements
at
the
end
of
this
month
and
then
there's
a
sequence
of
meetings
with
the
stp
areas.
B
I
think
it's
about
10
meetings
which,
for
the
chief
execs
at
a
five-year
forward
view
I,
think
I'm
down
so
get
to
about
six
or
seven
of
those
alongside
people
like
Simon,
Stephens
and
Jim
Mackay
over
this
period
of
time,
so
important
work,
Michael
in
chair
in
the
SE
GC
yesterday,
touchstones
primary
medical
services
activity
and
one
of
the
issues
touched
on
was
the
work
around
health
and
justice.
I
think
this
was
referred
to
by
colleagues
that
were
at
that
meeting
the
prison
radio
campaign.
B
There
is
a
national
prison
radio
service
and
to
advertise
the
work
that
we
undertake
alongside
a
Majesty's
Inspectorate
of
prisons,
where
we
do
inspect
the
healthcare
provision
in
prisons,
there's
going
to
be
adverts
on
on
national
prison
radio
to
raise
awareness
about
CQC
and
encourage
feedback
from
prisoners
about
their
experience
of
Health
and
Care
Services,
say
they've
got
a
captive.
Audience
is
an
understatement.
So
we
are.
We
are
told.
D
Just
also
very
good
question
on
that,
and
obviously
it's
good
we're
advertising
the
role
of
CQC.
But
what
are
the
arrangements
as
prisoners
feeding
back
I
mean?
Is
it?
Can
it
be
totally
confidential,
because
I
mean
people
at
the
best
of
times
can
be
a
bit
worried
about
feeding
back
and
how
it
impacts
on
their
care?
I
just
wondered
if
you
know
within
a
prison,
it
could
be
even
more
so
and
I
just
wondered
to
whether
we've
considered
that
that
part
of
it
that
they
can
give
feedback
without
any
fear
of
retribution.
B
E
There
is
opportunity
for
them
to
talk
when
we
go
into
the
prisons.
In
fact,
the
hair
inspectors
have
keys
to
go
wherever
they
want
to
in
the
prison
as
well
so
on
the
last
inspection
I
went
on.
I
certainly
got
the
opportunity
to
speak
to
prisons
on
their
own
there's,
obviously,
security
for
some
prisoners,
but
you
know
you
have
to
be
sensible,
but
this
is
it's.
It's
advert,
but
we've
done
interviews
on
the
radio
station
as
well
and
we
think
over
eighty
percent
of
prisoners
actually
actively
listen
to
the
prison
radio
service.
B
If
it
could
paragraph
nine
just
plug
the
workforce
race,
he
called
his
standard.
This
was
published
and
their
report,
so
their
inaugural
report
was
published.
There
was
a
conference
earlier
this
week.
I
think
it
was
on.
Monday
Mike
spoke
at
the
top
of
the
agenda
and,
importantly,
what
we're
doing
is
building
into
our
inspection,
particularly
around
how
well
leaded
trustees
assessment.
How
well
organizations
are
checking
for
the
workforce
race,
equality
standard
which
gives
our
support
to
this
work
and
certainly
a
very
well
attended
conference
on
Monday.
B
This
was
seen
as
a
significant
aspect
to
support
the
agenda
around
inclusivity
and
supporting
staff
on
experts
by
experience
in
a
private
session
of
the
board.
Does
a
report
on
that
will
discuss
in
more
detail
but
said
to
say
that
I'm
now
met
with
the
chief
executive
and
chief
operating
officer
of
R
employ
in
relation
to
the
contract
and
gone
through
that
with
them?
F
Well
well,
I
want
to
say
with
two
things
really:
firstly,
that
the
recruitment
process
for
a
new
national
guardian,
it
is,
is
ongoing.
We
will
be
in
jail
a
short
list
later
this
month
and
therefore
we
expect
to
be
in
a
position
to
make
an
appointment,
not
too
long
after
that.
In
the
meantime,
the
office
of
the
National
Guardian
has
been
continuing
its
work
in
setting
up
something
for
the
National
Guardian
to
take
over
and
I'd
like
to
pay
tribute
to
the
work
done
by
lucia
Dennett
and
her
team.
Just
a
quick
word
about
it.
F
They
they
have
prior
a
list
of
priorities,
the
first
of
which
is
to
deliver
a
program
of
training
events.
What
to
which
I'm
going
to
be
participating
in
these
are
in
order
to
support
national,
not
Ned,
non-executive
directors
and
other
trust
leaders
in
the
role
of
it
ft
Guardians.
The
reason
being
our
priority
is
that
clearly,
a
lot
of
trusts
have
yet
to
appoint
Guardians
I,
think
some
45
47.
F
60
Guardians,
but
now
some
trusts
have
looked
more
than
150
good
reason.
We've.
We
are
collecting
information
about
this
and
there
appears
to
be
quite
a
wide
variation
in
the
approach
of
trusts
to
this,
some
of
which
perhaps
are
more
in
line
with
what
my
vision
might
have
been
than
others,
but
we'll
see
how
their
pans
out.
We're
also
will
the
opposite
of
setting
up
a
network
of
guardians
so
that
they
can
support
each
other.
This
is
challenging
work
and
they
will
need
to
be
able
to
refer
to
other
people.
F
You
know
what's
going
on
to
help
them.
The
office
is
also
has
a
lot
of
queries
coming
in
not
only
from
directors,
HR
staff
and
so
on,
but
also
NHS
staff.
You
want
guidance
and
well,
we
do
our
best
in
relation
to
that
I
think
it's
necessary
to
emphasize.
The
office
cannot
review
it
the
local
hand,
individual
cases
at
the
moment
and
really
how,
if
at
all
that
will
be
done,
it
will
be
a
matter
for
the
national
guardian,
but
it's
I
just
like
to
assure
the
border
from
what
I
can
see.
F
B
Thanks
Robert
on
the
theme
of
senior
appointments,
just
to
announce
that
Ruth
Bailey
has
been
appointed
as
a
director
of
people
to
succeed.
Tracy
Dennison
Ruth
is
due
to
start
with
us
in
September
and
Steve
last
week
internally.
So
this
is
the
first
time
we've
announces
externally.
I
think
we
appointed
Alison
holborn
who's.
Currently,
the
chief
executive
of
the
GP
led
social
enterprise,
warrington
Health
Plus,
so
Allison
will
succeed.
B
B
The
past
I'll,
certainly
during
my
time
here,
but
I
think
she
was
also
quite
a
significant
contributor
to
the
Mental
Health
Act
Commission
work,
I
think,
come
care
and
I
think,
was
one
of
the
people
that
was
provided
some
stability
for
many
many
staff
that
works
in
the
organization
from
2010
onwards,
and
she
goes
with
our
very
best
wishes
and
I'm.
Sure
Allison
will
be
a
very
valuable
addition
to
to
CQC
senior
team
and
then
the
last
item
is
in
relation
to
board
members.
B
B
Paul's
been
with
with
CQC
since
2013
and
I
think
performed
a
fabulous
role
for
for
us
over
those
three
years,
I'm
personally,
incredibly
grateful
to
him
for
his
contribution
over
that
period
of
time.
I
know
he's
added
real
value
to
the
Commission
and
he
will
be
missed
so-called.
Thank
you
for
that,
and
also
paying
tribute,
I
think
it's
Jennifer's
last
meeting
as
well
and
equally
I'd
like
to
pay
tribute
to
Jennifer
for
the
work
that
you've
done.
B
You've
provided
real
sagacity
and
wisdom
on
a
range
of
issues
that
has
added
real
value
time
and
time
again,
both
in
meetings
and,
quite
importantly,
outside
of
meetings,
so
Peter
I'm
sure
I
speak
for
the
or
board
in
thanking
both
Jennifer
and
Paul
for
everything
that
they've
contributed,
and
it
would
have
been
wrong
really
just
to
let
the
meeting
go
without
acknowledging
both
contribution
so
Jennifer.
Thank
you
very
much
Paul.
Thank
you.
A
C
A
H
Thanks
very
much
and
just
couple,
questions
and
first
of
all,
David
is
very
helpful
to
hear
what
you
had
to
say
about
the
the
next
stage
of
the
strategy
development
and
it
does
feel
a
little
bit
a
zip
raas
s
out.
There
is
quite
unformed
at
the
moment.
There's
a
lot
is
happening
in
the
in
the
configuration
of
the
local
NHS,
the
integration
of
social
care
and
the
st
p's
and
so
on,
and
I
just
want
to
make
sure
that
we've
got
our
alignment
right.
H
At
all
admit,
it
had
been
a
call
once
in
a
while
and
and
I
noticed
that
in
the
item
on
this,
we
use
the
phrase
working
closely
with
five
times
so
I'm
just
raising
the
question
of
whether
we're
able
to
keep
track.
There's
not
a
criticism
of
our
work,
but
just
whether
we're
able
to
keep
track
of
what's
happening
in
quite
a
turbulent
period
for
the
NHS
and
I.
H
Suppose
the
paradox
for
us-
and
the
thing
we
have
to
get
right
is
that
we
spend
quite
a
lot
of
time
time
to
track
the
NHS,
and
this
isn't
a
good
time
to
do
that.
But
it's
what
we
often
do
because
of
the
way
in
which
we
carry
out
our
roll
and
but
in
the
end
our
primary
responsibility
is
to
the
people
who
use
the
NHS,
and
mostly
they
don't
really
care
about
the
structure
of
the
NHS
they're
interested
in
their
direct
experience
of
care.
H
And
so
when
we,
when
we
put
a
lot
of
time
into
this
tracking
of
structure,
can
we
remember
that
our
fallback
position,
perhaps
our
most
important
position-
and
perhaps
it
helps
us
through
the
turmoil-
is
that
we
want
to
reflect
the
the
experience
of
care.
Maybe
it'll
make
it
make
a
little
bit
easier
to
cut
our
way
through
this
period
of
change.
C
H
A
couple
other
points
as
well:
that's,
okay,
Peter
and,
and
what
is
about
the
report?
The
report,
this
month's
report
I,
was
like
I'm
slightly
unsure
about
how
to
interpret
this.
The
risk
element
of
the
report
with
which
I've
had
a
slightly
closing
down
an
inverter
thanks,
I,
so
the
so
the
the
element
which
is
about
strategic
and
operational
risk
just
want
to
get
some
understanding
of
it.
Some
of
the
risks
are
new.
H
Some
of
them
are
I,
suppose
you'd
have
to
so
slightly
generally
expressed,
and
yet
10
of
the
16
items
are
registered
as
high
risk
for
us
and
then
luckily,
there's
a
column
at
the
end
called
mitigation
where
all
of
the
high
risks
become
medium
risk.
I
try
to
get
understand
what
what
the
processes
of
mitigation
which
allows
that
to
happen,
because
otherwise
we've
got
a
lot
of
risk
in
our
system
and
one
quick
final
point
on
the
race
equality
standard.
H
When
we
met
with
some
of
the
people
who
were
behind
Roger
Cline
who
behind
a
race
equality
standard
and
who
wrote
the
report,
the
snowy
white
Peaks
to
the
NHS-
and
we
committed
at
that
time
to
make
sure
that
the
CQC
itself
applied
that
principle
I
just
wanted
to
know
how
that
was
going.
Just
glancing
around
the
snow
white
Peaks
of
CQC
in
this
room,
you
might
be
excused
to
think
you
hadn't
made
too
much
progress
on
that.
So
far,.
B
C
B
But
anyway,
and
so,
and
can
we
give
you
reassurance?
Yes,
we
can
can
I
give
you
a
reassurance.
This
is
nailed
to
with
an
inch
of
its
project
management
life.
No
I
can't
just
to
pick
away
through
that.
So
some
examples
of
where
I've
got
absolute
confidence
that
were
aligned
with
this.
There
are
four
deputy
chief
inspectors
or
we
were
aligned
with
the
four
regional
directors
of
NHS
England.
They
were
obviously
in
the
stp
process,
though
named
people
who
go
to
the
meetings
that
have
been
reviewing
the
literature.
B
There
are
actual
people
that
are
doing
that.
So
that's
one
example
of
that
I
was
at
the
five-year
for
do
chief
executives,
meeting
on
Monday.
In
fact,
I
shared
it
and
I
will
go
to.
As
I've
said.
Seven
out
of
the
tennis
or
five
year
forward
view
reviews
of
the
stp
processes
being
clear.
What
our
role
is
to
go
back
to
your
points
about
I'm,
not
there
to
agreed
them,
but
we
do
need
to
have
real-time
intelligence
about
the
way
that
this
is
developing.
B
So
a
national
level
I
think
we've
got
engagement
with
some
of
those
things.
On
that
theme,
Paul's
been
our
representative
on
the
new
models
of
care
board.
The
detailed
programs
and
projects
that
are
coming
through
from
that
are
new
models
of
care
are
real
and
significant.
The
vast
majority
of
those
new
models
of
care
of
a
link,
inspector
or
inspection
manager.
So
one
of
the
things
that's
been
reflected
back
to
me,
some
discussion
on
the
Isle
of
Wight,
for
instance,
or
Debbie
Evan
over
who's,
the
now
the
Deputy
Chief
Inspector.
B
She
was
the
head
of
inspection
for
adult
social
care
on
the
other
white,
went
to
see
the
lead
officer
for
the
new
models
are
carry
on
the
other
whites
who
have
specific
discussions
about
what
they
wanted
to
do,
and
she
did
that
back
in
the
last
year
beginning
of
this
year.
So
this
isn't
something
that
we're
just
doing
now.
I
was
in
the
Preston
office
a
couple
of
weeks
ago,
I
wand,
it
up
to
somebody
and
said
hi,
I'm
David
being
who
are
you?
They
taught
me
anywhere.
B
I
said
what
are
you
working
on
and
she
was
working
on
the
new
insight
model
for
adult
social
care.
That's
what
she
was
Saturday
desk.
Doing
so,
I
strutted
he
talks
about
the
importance
of
insight
as
a
chill
to
direct
and
just
spontaneous
conversation.
That's
what
this
person
was
working
on.
I
asked
her
to
set
me
through
what
she
was
doing.
I
thought
actually
I
thought
this
is
really
good,
so
I
think
there
are
people
that
have
work.
Plans
are
working
on
delivering
this
now
we're
unless
clear
its
upon
I
touched
on
in
my
report.
B
I
think
this
was
one
of
your
points
yesterday
evening
at
the
ICGC
about
some
people
just
coming
together
as
a
way
of
planning
and
huddling
together
for
the
way
some
people
are
coming
together
to
tip
and
compete,
the
contracts
that
are
being
offered.
So
we
need
to
think
through
what
they
are.
There's
people
I,
don't
think,
there's
an
acute
hospital,
that's
not
having
some
kind
of
conversation
about
accountable
care,
either
becoming
an
accountable
care
organization
or
becoming
an
accountable
care
system.
B
B
Now
that
some
place
is
going
to
look
pretty
much
the
same
as
you
look
now,
because
they've
just
not
got
the
maturity
of
relationships
to
make
the
kind
of
progress
that
needs
to
demand
so
how
we
track
that,
and
now
we
can
be
connected
with
what
is
a
very
different.
A
different
feel
I
think
he's
is
one
of
the
challenges
we've
got
and
that's
the
point
that
was
trying
to
draw
out
in
that
report
we're
still
working
at
I.
B
From
being
brutally
honest,
how
do
we
ensure
that
all
the
people
we've
got
in
contact
with
new
models
of
care
is
speaking
in
a
consistent
way,
so
we're
putting
in
this
coordinating
mechanism
to
make
sure
that
we
can
both
listen
and
learn
from
what
people
are
picking
up,
but
also
where
we
need
to
take
a
consistent
approach,
because
we
have
learned
to
want
to
do
something
different?
We
need
to
make
sure
that
everybody
that's
in
contact
with
this
is
that
I
mean
I
was
out
on
Monday.
B
There
is
still
a
view
that
the
obstacle
to
what
some
people
can
do
at
a
local
level
is
CQC,
and
you
know
whether
it's
right
or
wrong.
That
view
is
there
there's
a
significant
view.
However,
though,
if
you're
looking
at
a
system
so
care
pathways
for
people
with
long-term
conditions
I'm
as
interested
in
how
that's
being
commissioned
as
well
as
how
do
we
regulate
that?
If
you're
going
to
have
a
true
the
systems,
you?
What
are
the
CCGs
doing?
What
is
the
oversight
arrangement
to
that?
B
So
what
we're
working
on
there
is
to
come
back
is
we
have
no
formal
agreement
with
NHS
England
about
how
a
single
view
of
quality
for
a
system
policy
ambition
in
our
strategy
relates
to
what
they're
doing
about
CCGs
my
my
ambition
would
be.
Are
we
collecting
dirty
in
the
same
where
the
CCGs
are
collecting
data?
So
we've
got
a
single
data
set.
That's
what
we
said
in
the
strategy
in
a
consistent
way
to
NHS
England
I.
Don't
think!
We've
got
that
as
an
agreement.
B
I
got
a
memorandum
of
understanding
that
sets
that,
but
that's
the
implication
of
the
policy,
so
I
think
we've
got
some
things
which
are
very
hard
work
on
insight,
new
models
of
care
on
the
program
boards
and
we've
got
some
areas
which
are
in
development,
and
what
we'll
do
in
the
report
to
July
we'll
try
and
capture
that
which
is
there
and
it's
hard
and
that
which
is
still
evolving
I.
Think
working
closely
with
is
not
me
having
swallowed
a
man
during
diary
at
dictionary,
it
is
actually
we
are
still
doing
this
work.
B
That
work
is
quite
advanced
now
so
previously,
when
we've
reported,
we've
talked
about
work
that
we're
putting
in
place
that
is
now
product
which
is
emerging
and
I.
Think
they've
been
meetings
over
the
past
four
weeks,
since
we
last
met
which
have
accelerated
that
quite
a
long
way.
So
it's
not
finished
yet
it's
not
signed
off
yet,
but
as
I
advanced
quite
a
significant
part,
as
NHS
improvement
have
put
their
capability
and
capacity
in
place
that
this,
alongside
the
people
that
we've
had
working
on
this,
both
poor
predominately
pulls
people.
B
So
I
do
think
this
is
a
developing
picture,
but
I
wouldn't
picture
on
those
council
perfection
on
this.
It
is
hard
work,
realigning
the
cells
with
with
what's
going
on
in
the
speed.
This
is
going
because
there
are
literally
thousands
of
conversations
going
on
about
what
this
means
for
local
health
and
care
systems
and
they're
happening
in
real
time.
B
But
are
we
clear
about
this
and
are
we
working
towards
getting
on
top
of
it?
I
think
we
are
on
your
point
about,
but
I
think
there's
also
an
issue
about
was
not
not
being
overly
worried
about
how
that
is
going
to
go.
So
we
need
real-time
information,
but
we
need
to
concentrate
on
what
we're
doing
our
big
ambition-
and
this
was
the
strapline
in
the
strategy-
was
we're
going
to
go
for
a
more
risk-based
and
proportionate
approach
to
inspection.
So
what
does
that
mean
for
what
we
need
to
do?
B
What
does
that
mean
when
we've
rested?
Eighty-Five
percent
of
GPS
good
and
outstanding
now
we're
going
to
check
that
forward.
We
set
out
in
the
document
that
we
would
inspect
trust
looking
at
well
LED
and
a
core
service
once
a
year.
What
is
how
are
we
going
to
assess
the
core
service
will
look
at
what
is
the
strategy?
We've
got
that?
How
do
we
risk
profile
that
what's
the
approach
that
we're
going
out
to
re-rate
interest,
where
those
are
the
inspections
are
all
things
for
us
not
for
what's
happening
out
there?
B
So
I
think
we
need
to
strike
a
balance
between
what
it
is
that
we
need
to
do
and
what
it
is
that
we
need
to
respond
to
out
of
there.
Sorry
out
there
and
striking
that
balance.
I
think
it's
what
we're
looking
to
do
so.
I,
wouldn't
council
perfection
Lewis,
but
I
think
we
are
endeavouring
to
do
this,
and
these
are
real-time
conversations
in
the
organization
in
terms
of
risk
if
I'm
right,
this
is
the
a
very
dramatic
reduction
of
the
risk
profiles
that
go
to
a
CGC.
C
On
cinema,
thank
you
I'm,
yes,
I
think
Ivan
goes
juicy
and
also
it
came
to
the
board.
I
think
that
the
last
session
we
had
quite
a
long
conversation,
which
is
resulted
in
some
changes,
not
least
in
the
ordering
just
make
sure
we're
absolutely
clear
that
the
most
important
thing
is
impact
for
people
using
services.
You
see
at
the
right
of
the
top
there,
but
I
think
the
point
in
making
about
the
two
columns.
C
So
the
what
we're
highlighting
there
is
an
organization
which
is
complex
as
important
role
like
we
do,
and
there
are
a
number
which
are
just
very
high
risk.
If
we
don't
take
any
action
and
we've
try
to
assess
those,
that's
what
and
we're
saying
pre-action
what
we're
saying
is
for
each
of
those
we've
gone
through
them
and
validate
them
and
having
the
conversations
within
the
executive
and
with
the
wider
board
and-
and
we
think,
we're
at
the
level
where
it's
reasonable
to.
C
We
mitigated
the
risk
down
to
the
level
of
medium,
not
down
to
the
level
of
it.
If
it
being
green
or
wait,
we
don't
have
to
keep
a
very
careful
watching
eye
on
it.
But
in
each
of
those
cases
they
and
we're
down
at
the
level
which
is
significantly
better
and
when
we
combine
likelihood
and
impact
than
we
would
otherwise
be
and
the
longer
risk
register
sets
out.
All
the
mitigating
actions
were
taking
that
are
taking
place
in
order
to
go
from
a
high
to
a
medium.
B
Ctc
itself
in
the
rest,
call
T
strategy
you're
right.
We
are
a
predominately
white
organization
at
a
senior
level
and
we
will
work
actively
to
address
that.
I
think
there
are
opportunities
that
we
need
to
take
over
the
period,
but
we're
a
consciously
aware
that,
if
we're
holding
others
to
account
for
their
performance,
we
can't
ignore
that
in
the
way
that
we
make
our
appointments
and
that
that
challenge
will
not
just
come
from
your
self
Lewis,
it
will
come
from
people
outside
of
the
organization
and
quite
properly
it
will
come
from
them.
B
So
I've
often
said
that
will
be
judged
on
what
we
do
not
on
what
we
say
and
we've
I
think
got
good
values
and
good
principles
around
equality
and
diversity.
But
we
need
to
do
more
in
relation
to
I,
think
we've
got
a
vibrant
risk
quality
network
and
they
continue
to
work
constructively
and
productively.
I
think
we've
got
mentoring
arrangements
within
the
organization
to
champion
those
black
staff
that
we've
got
in
the
organization
to
support
them,
so
they
can
advance
their
careers.
B
So
there
are
actions
that
we've
got
in
place
where
we're
attempting
to
address
that
issue
of
our
own
snowy
white
peeps.
But
it's
true.
We
have
snowy
white
Peaks.
That
said
both
Roger
Cline
and
Yvonne
kogo
are
incredibly
incredibly
complimentary
about
the
work
that
we've
been
doing
in
CQC
and
take
every
opportunity
when
they're
on
public
platforms
to
serve
out
as
well.
I
was
at
a
session
yesterday
talking
about
the
work
that
we
do
responding
to
feedback
and
spontaneously.
One
of
the
questions
I
was
what
it
was
a
statement.
A
So
can
I
can
I
just
add
a
couple
of
comments
to
that.
Then
Robert
wanted
to
raise
something
and
then
Jennifer,
so
just
just
on
that
last
point:
Louis
I'm,
also
very
conscious
that
the
board
is
white.
As
you
pointed
out,
we
have
three
appointments
to
make
to
the
board
and
a
fourth
they
in
the
when,
when
case
turn
comes
to
an
end,
the
process
is
already
starting
and
we
will
gain
to
advert
in
about
three
weeks
time.
I
really
believe
in
diversity,
but
diversity
is,
is
multifaceted.
A
A
I
look
round
the
board,
the
one
thing
I'm,
absolutely
confident
knowing
you're
very
well
is
we
don't
have
groups
groupthink
looking
at
you
Louis
that
bad
others
as
well
uh-huh
but
yeah
we
just
we
just.
Let
me
really
need
to
make
sure
that
that
back
continues.
Cuz
I
think
that's
really
important
they're,
actually
some
very
specific
skills
that
we
need.
We've
discussed.
Those
will
be
clear
from
the
advert
when,
when
that
comes
out,
whether
we
can
achieve
all
of
that
and
at
the
same
time
gets
that
gets
embrace
diversity.
A
I
just
don't
know,
I
hope
so,
but
you
know
it's
quite
a
complex
matrix,
oh
I.
Just
think
we
need
to
be
clear
about
that.
Can
I
just
also
go
back
to
your
first
point:
I'm,
not
a
hundred
percent
agree
with
you.
You
know
we
are
ultimately
first
and
foremost
here
for
patients.
That's
our
that's
our
mission,
but
as
the
NHS
goes
through
really
a
very
complex
set
of
organizational
and
structural
changes.
I
think
it's
really
important
organization
isn't
a
spanner
in
the
works
of
that,
because
that
actually
would
damage
patients.
A
So
I
do
think
it's
important
that
we
both
understand
what's
going
on
and
then
work
closely,
both
with
providers
and
with
all
the
other
organizations
that
they
have
to
work
with,
as
I
say,
to
make
sure
that,
even
if
we're
not
promoting
check,
we
are
at
least
not
a
barrier
to
change.
I
just
think.
That's
that's
really
important.
That
was
all
I
wanted
to
say.
Robert.
You
wanted
to
ask
question.
Well.
F
F
Firstly,
it
seems
to
me
it's
not
our
role,
so
I
never
say
a
particular
way
of
doing
things
is
good
or
bad
and
I
would
not
like
us
to
see
us
being
in
the
position
where
we're
sore
to
signed
up
to
that
and
people
turn
around
when
we
criticize
the
care.
That's
because
well,
you
said
that
was
all
all
right,
because
that's
not
our
role,
but
throughout
this
process
we
need
I
would
suggest
to
make
sure
that
these
organizations
we
regulate
are
able
and
do
continue
to
do
this
business
as
usual.
F
One
of
this
process
takes
place
and
that
of
course,
is
very,
very
challenging,
because
chief
executives
everywhere
is
David,
opposite
leg,
evidently
one
of
them
in
any
organization,
and
they
only
have
so
much
time
to
debate
two
things,
but
actually
the
business
is
usual
part
is
what
patients
and
service
uses
need.
So
I
would
urge
that
we
don't
forget
that,
while
at
the
same
time
not
we
getting
either
way
of
checked
and
they
don't
see
why
we
have
two.
G
A
similar
point,
I
was
trapped
by
Simon
Stephens
speech
at
the
confeds
last
week,
where
he
talked
about
quite
reset
the
money
and
quite
what
that
means
is
in
precise,
except
it's
going
to
mean
I
think
because
of
the
over
spend
a
lot
more
toughness,
particularly
in
the
hospital
sector,
so
I
think
for
us.
There
is
an
issue
for
us
where
all
the
discussion
is
money.
G
If
you
like
too
many
trusts-
and
we
really
want
to
keep
that
in
our
gimlet
sites,
and
the
other
issue
on
quality
is
of
course,
access,
which
is
the
other
thing
that
can
go
south
in
this
kind
of
environment.
And
it's
not
really
for
us
in
many
respects.
Is
it
because
we
look
at
care
once
it's
being
given,
but
there
is
an
issue
now
an
opportunity
with
the
place
based
focus
to
to
really
try
and
get
insert
issues
on
access
into
that
agenda.
More
than
the
usual
referral
to
treat
times,
I.
A
Think
we're
all
in
violence,
green
or
Mike.
On
your
coming
and
just
say,
we
are
obviously
very
aware
of
that,
but
we
are
now
in
a
much
better
position
than
we
were
three
years
ago,
because
we
now
do
have
a
baseline
of
quality
for
all
or
virtually
all
NHS
trusts
acute
community
ambulance
and
mental
health.
A
The
services
by
the
end
of
this
month,
we
will
have
completed
that
first
round,
so
I
think
we
will
have
the
baseline
against,
which
will
be
able
to
see
whether
trusts
are
improving
or
indeed
whether
any
are
deteriorating,
and
we
will
be
watching
them
very.
Very
closely
include
staffing
is
absolutely
part
of
that,
because
that's
a
major
contributor
to
our
assessment
of
safety.
A
So,
just
just
to
be
absolutely
clear,
lots
of
changes
are
taking
place.
We
need
to
understand
what
those
changes
are
for
a
number
of
reasons.
Any
suggestion
that,
because
of
we're
looking
and
make
sure,
we
understand
that
somehow
we're
going
to
relax
are
our
core
function
is
absolutely
not
not
the
case.
Yes,.
G
A
I
don't
mind
being
perceived
the
problem
if,
if
people
are
saying
you
know,
you've
got
focus
on
quality
and
that's
a
problem
and
I'm
really
comfortable
about
that.
I
wouldn't
be
comfortable
if
we
were
seen
as
being
the
problem
in
terms
of
new
models
of
care
being
developed
and
so
on,
because
actually
I
do
think.
Let's
come
back
to
your
point.
This.
These
new
models
will
be
if
the
well
done
will
actually
very
much
be
impatient.
A
Sinteres
services
at
the
moment
need
to
be
better
aligned
and
it's
all
and
so
on,
but
that's
that's
not
a
judgment
that
for
us
to
make,
but
I
certainly
wouldn't
want
us
to
be
seen
as
the
barrier
to
change.
But
you
know
we
are
we.
We
will
be
accused
by
some
people,
no
doubt
of
being
a
problem
because
of
our
insistence
on
quality
and
certainly
I
go
around
the
country
and
people
say
to
me.
You
know
you're
around
helpful
when
you
rate
something
as
requiring
improvement
and
morale
goes
down.
A
B
No
just
to
give
and
hope
some
reassurance
on
this
to
build
on
your
on
the
point
that
you're
making
I
do
think.
We've
got
that
four,
because
I
will
frequently
sale
when
I
go
to
see
any
meetings.
I'm
sure
Mike
and
Paul
will
do
the
same.
We
are
here
to
make
a
contribution
that
we've
got
a
responsibility
to
discharge
and
we
can't
be
compromising
the
discharger
that
I
think
I've
brought
papers
here
before
just
to
expose
that
to
make
sure
that
that
balance
cut
is
constantly,
there
I
think
some
of
the
new
models
of
care.
B
I
saw
some
data
last
week,
which
is
showing
that
the
GP
care
home
new
models
of
care
are
really
generating
reductions
in
admissions
to
any
of
people
from
care
homes
reduction
in
things
like
pressure
sores,
as
a
consequence
of
that,
so
I
think
there
are
some
new
models
work
out
where
quality
is
going
to
improve.
I,
think
the
issue
that
challenges
me
and
people
might
have
seen:
David
Dalton's,
interviewing
Health
Service
journal.
B
So
I
think
this
is
a
really
difficult
balance
to
strike,
but
it
is
the
balance
that
we've
been
asked
to
strike
and
I
think
as
you've
said,
Peter,
that's
what
we're
trying
to
do
and
I
think
we
are
in
agreement
to
that.
I
think
what
we
and
the
executive
team
need
to
do
is
through
the
reports
would
bring
to
the
board.
B
Taking
over
one
that
isn't
as
good
so
I
just
think,
we
need
to
go
into
this
because
I
think
there's
going
to
be
lots
of
mergers
and
acquisitions
over
this
period
and
our
focus
will
be
on.
This
is
why,
when
we
get
asked
for
inspection
holder
as
my
response,
this
is
actually
we
are
here
to
ensure
that
people
get
access
to
a
good
quality
service.
So
they
can't
be
a
holiday.
B
C
Peter
I'm
so
on,
say
three
things.
What
one
was
the
who
we
go
back
to
our
legislation.
We
discuss
is
quite
a
lot,
an
appointed
that
we
have
the
three
three
functions
that
we're
trying
to
perform:
the
improvement
in
quality
function,
the
making
sure
the
services
provided
are
based
around
the
needs
and
experiences
of
people
using
them
and
the
efficient,
effective
use
resources.
C
Really
that's
important,
as
it
always
gives
us
the
mandate
in
any
meeting
to
be
raising
those
issues
and
make
sure
that
quality
is
always
center
stage,
without
it
being
the
case
into
somehow
week
ever
be
ignored
or
sidelined,
because
we
don't
get
the
reality.
That
is
part
of
our
reality.
It's
also
why
we
will
be
doing
use
of
resources
and
assessments
of
trusts
and
ratings
of
trusts
I'm.
C
It's
also
why
we're
focusing
on
a
single
shared
view
of
quality
in
the
strategy,
because
one
of
the
ways
I
think
mid
staffordshire
proved
this
and
is
that
when
there
are
multiple
definitions
of
quality
and
people
can
take
false
assurance-
and
that
is
one
of
the
many
ways
in
which
a
quality
can
be
underplayed
in
pursuit
of
other
aims.
But
by
having
a
single
shared
view
of
quality,
that
providers
can
sign
up
to
income
benchmark
against
all
the
different
bodies
in
the
oversight
system.
The
David
was
mentioning
and
are
aligned
around.
C
People
who
had
attained
I'm
just
worth
saying
that
the
medicines
better
of
Prisons
has
had
a
protocol
in
place
for
some
time
with
the
Ombudsman
and
independent
monitoring
boards,
because,
although
we
look
at
it
from
a
health
perspective
course
they're
looking
at
it
from
the
perspective
of
all
issues
that
detail,
you
might
register,
I'm
I
am
with
them.
So
that
I
think
that's
quite
well
established
and
we
work
to
that
protocol.
A
Thank
you,
Paul
Mike,
I
think
just
one
point
where
Don
mergers
and
acquisitions
again,
because
we
have
now
completed
the
first
round.
We
do
know
whether
the
organization,
if
it's
an
NHS
organization
that
is
proposing
to
acquire
another
organization,
is
well
let
and
you
know
I
I,
think
in
the
past.
What
has
often
happened
is
the
two
not
well
led.
Our
organizations
have
been
sort
of
encouraged
to
merging,
with
the
assumption
that
that
would
make
one
well
led
organization
and
but
I
think
we
can
now
say
yes,
this.
A
We
do
at
least
know
that
this
acquisition
is
being
undertaken
by
a
welded
organization.
Thank
you.
Any
other
questions
comments
or
anything
else
on
David's
report,
great
David.
Thank
you
very
much
good,
very
good
discussion
and
Paul
your
report.
Only
the
the
audit
and
Corporate
Governance
Committee
and
you
might
while
introduced
now.
If
you
want
to
say
anything
on
on
risk,
going
back
to
Louis's
first
question:
please
do.
F
Thank
you,
Peter
I,
think
I'm
Luis,
first
question
I
think
Paul
answer,
especially,
which
is
that
the
columns
are
not
actually
headed
up,
rightly
I.
Think
the
first
column
is
this
is
where
the
risk
is
without
any
mitigation
in
prosser
in
in
place,
and
then
the
second
column
is
having
looked
at
all
the
mitigation
actions
which
are
intended
to
be
taken
or
are
being
taken.
That
is
where
we
believe
the
risk
will
get
down
to
in
a
targeted
level
of
time.
So
I
think
I
think
that
that's
what
it's
been
you're
quite
right.
F
There
are
an
awful
lot
of
risks
in
there.
They
have.
Some
of
them
have
been
adjusted
since
the
last
board
meeting
and
Casey
GC
before
that
that
looked
at
the
risk
and
the
HGC
will
be
looking
at
those
risks
again
at
the
next
meeting,
I
think
so
they
will
keep
it
under
review,
but
you're
right.
There
are
a
lot
of
risks
around
the.
F
If
I
just
go
back
to
the
meeting
that
we've
paper
has
been
produced,
on
which
some
twenty
fifth
of
may
a
large
chunk
of
that
meeting,
as
going
through
there
will
recall,
was
devoted
to
the
the
scrutiny
of
the
annual
report.
Matt
counts,
which
will
be
emerging
in
the
not-too-distant
future,
and
we
will
have
a
session
I
think
in
the
private
boards.
There's
not
the
draft
of
that
of
the
ARA
I
think
headlines
that
it
does
what's
happened,
has
events
or
I'll
developing
since
the
25th
may.
F
We
are
told
that
the
nao
are
likely
to
be
in
a
position
to
give
her
a
clean
opinion
on
the
financial
statements
and
on
to
the
other
parts
of
the
ARA
which
they're
voting,
which
is
good
what
we
would
hope
for
and
expect
actually,
and
we
are
believe
that
the
head
of
internal
audits
opinion
will
show
good
progress
from
last
year
as
well,
and
indeed
we
spent
a
lot
of
time
in
the
meeting
on
on
that.
But
we'll
come
back
to
that.
Perhaps
so.
Well,
I.
F
F
In
fact,
we
know
it
wasn't
designed
if
that's
where
it's
being
used,
it's
been
adapted
and
adopted
into
into.
It
won't
be
easy,
but
it's
not
a
very
efficient
system
for
doing
that,
and
that
brings
up
a
number
of
questions,
but
particularly
questions
around
our
ability.
Efficiency
abilities,
because
it's
not
a
good
working
system
for
inspectors
to
be
able
to
do
their
work
easily
and
quickly
and
move
on.
So
in
terms
of
productivity.
F
It's
an
issue
in
terms
of
handoffs
between
registration
and
inspection
is
a
bit
of
an
issue
as
well
and
in
terms
of
some
of
the
evidencing
of
the
work
we
do,
which
is
becomes
more
cumbersome,
more
convoluted,
etc
as
well.
So
I
think
the
committee
are
concerned
and
statement
its
spend
some
time
discussing
this
as
to
what
our
plans
will
be
around
either.
Enhancing
that
crm
system
or
replacing
it
and
I
know
that's
something
which
the
board
is
going
to
come
back
to.
F
F
F
Some
of
those
which
were
limited
assurance
ratings
in
there
around
business
continuity,
the
expensive
system
and
flexible
workforce
office
now
I
think
in
each
case
those
will
follow
up
audits,
two
things
that
should
be
done
previously.
There
had
been
progress,
but
has
not
been
sufficient
to
actually
get
them
up
engraved.
If
you
like,
with
in
there,
there
is
action,
that's
going
to
be
taken
and
we'll
be
coming
back
to
those
to
see
those
actions
aren't
taken
around
this
one's,
but
overall
for
the
year.
F
I
think
the
out
of
if
I've
got
the
numbers
right,
24
reports
during
the
year
15
were
rated
as
moderate
assurance.
Seven
were
rated
as
limited
assurance
and
I
think
two
were
not
subject
to
a
wooden
with
appropriate
at
ratings
around,
which
is
a
much
better
proportion
that
we've
had
in
previous
years.
So
I
think
that's
a
that's
encouraging
it's
not
enough,
and
I
know
that
Dave
them
team
recognize
that
as
well
so
yeah
there
is
good
directionally
there's
more
to
be
done,
but
we
are
at
least
heading
in
the
right
direction.
F
C
Yeah,
pork,
sorry
it
was
open
the
CRM
point
and
Eileen
and
I
could
share
the
young
face
management
technology
group
forum
within
CQC,
and
the
Ashley
cool
thing
here
is
that
historically
and
to
say
when
it
came
to
IT.
If
the
answer
was
CRM,
and
then
you
something
you
worked
out
what
the
question
was
and
whereas
we're
much
more
now
developing
what
what
are
the
applications?
Rural
that
we
need
to
support
our
frontline
staff
to
do
the
very
best
job
they
can
so
I
we're
bringing
in
the
National
Resource
Planning
tool.
C
We
board
procure
from
the
csci
in
that
goes,
live
in
early
September
and
will
bring
an
enterprise
content
management
will
bring
in
them
as
part
of
that,
the
document,
a
records
management
and
we'll
get
the
digital
register.
Some
of
that
will
be
carried
out
by
an
biologists
in
CRM
product
by
the
Oracle
product
and
lots
won't
be
will
bring
to.
C
The
board
would
like
to
bring
to
the
board
I'm
our
expectations
in
July
and
the
the
emerging
strategy
and
there's
some
work
still
to
be
done
on
that,
not
least
and
the
finances
part
of
the
elements
as
well.
By
the
report,
link
back
to
is
understanding
what
our
frontline
staff
needs
and
the
business
processes
and
run
rules
that
run
behind
that
and
what
the
information
flows
need
to
be
in
the
business.
That's
what
drives
the
right
applications
and
then
the
right
infrastructure
other
than
it's
been
that
precision
of
thought
and
throughout
the
organization.
G
Out
stream
right,
there
is
just
one
other
element
which
you
mustn't
lose
sight
of,
because
then
you
know
almost
the
IO.
If,
if
the
answer
is
crm,
as
Paul
says,
the
question
is
what's
the
problem,
it
kind
of
cannot
be
the
answer
to
everything
and
one
of
the
things
that
staff
do
tell
us
is
that
actually,
its
processes
we've
built
round
our
technology
that
actually
served
to
hold
them
up.
G
G
A
A
That
board
actually
needs
to
spend
time
immediately
on,
in
which
case
it
won't
be
a
short
or
all
updates
via
a
longer
discussion,
and
then
the
that
the
minutes
of
the
meeting
will
come
to
the
following
board
meeting
and
then
an
opportunity
for
discussion.
We'd
got
into
a
slight
sort
of
repetitious
behavior,
which
was
not
the
best
use
of
time,
so
that
that's
that
the
agreed
way
forward
see
how
it
works
so
Michael.
Your
brief
oral
update.
E
E
The
the
main
the
main
themes
was
that
Steve
gave
an
excellent
review
of
how
primary
medical
services
director
was
operating.
We
had
a
deep
dive
into
health
and
the
criminal
justice
system
which
sue
took
us
through,
and
we
then
talked
a
lot
about
three
major
themes,
and
this
is
the
bit
that
we
can't
shouldn't
discuss
now,
but
maybe
at
our
next
meeting
that
are
affecting
primary
medical
services.
E
First,
the
increasing
prevalence
of
Federation,
some
of
which
in
a
way,
are
harder,
Federation's
like
modality,
which
steve
is
a
member
of
indeed,
a
shareholder,
of
loose
ephedra
shins,
which
claimed
for
the
Federation's,
but
are
really
not
so
an
organization
challenge
to
us
and
David
put
it
I.
Think
very
well,
which
is:
do
we
start
looking
at
as
it
were
the
controlling
mind
of
these
organizations,
or
do
we
continue
with
a
completely
ground
up
or
bottoms
up
look,
and
this
of
course
covers
other
aspects
of
our
work
like
in
adult
social
care.
E
Should
we
be
looking
at
the
way
that
the
Corporate
Center
at
four
seasons,
or
or
indeed
in
hospitals
or
mental
health,
the
corporate
center
of
Priory?
What's
the
balance
be
between
corporate
center
and
individual
locations?
David
Orton's
argument,
of
course,
that
David
David
mentioned
was
that
we
should
only
be
looking
or
certainly
in
the
case
of
his
chain,
only
be
looking
at
individual
locations,
which
I
think
the
rgc
felt
was
the
wrong
way
to
go.
But
this
is
an
issue
for
the
future.
E
Like
Babylon,
for
example,
where
the
public
now
has
accessed
directly
to
gps
and
and
pay
for
it
or
the
technology
that
doctors
themselves
use
either
in
their
in
their
consultation
rooms
all
to
track
pace
and
help
when
they're
at
home,
so
technology
is
going
to
be
important
going
forward.
The
final
point
that
Steve
made
and
I
think
the
whole
committee
thought
it
was
an
excellent
point,
which
is
that
in
a
world
of
new
models
of
care
and
your
integration,
how
should
the
CQC's
own
organization
be
modified
so
that
we
we're
not
no
longer?
E
We
recognize
that
there
aren't
three
distinct
parts
of
Health
and
Social
Care,
which
are
unconnected
that
we
have
to
become
more
connected
as
the
system
becomes.
What
connected
that
was
the
last
thought
that
was
raised
at
the
meeting,
so
we
had
a
very
good
meeting
and
I
think
when
we
come
to
discuss
these.
You
know
we.
Maybe
we
can
discuss
these
topics
when
the
full
minutes
are
tabled
at
our
next
board
meeting.
H
Briefly,
I
know
you
don't
want
to
have
a
full
discussion
of
what
happened
yesterday.
I
think
it
is
just
worth
emphasizing
the
health
and
justice
discussion,
because
we
don't
very
often
return
to
that
in
detail.
It
was
an
opportunity
to
discuss
it
and
it
was
very
encouraging
to
see
how
much
work
was
taking
place
in
the
health
and
justice
as
he
went
through
stephen
has
his
colleague,
sue
McMillan,
who
came
I,
think
there's
one
very
important
point
there.
H
It's
shown
about
that
that
our
role
in
inspecting
prisons,
of
course,
is
confined
to
the
health
care,
the
health
center,
for
other
words,
the
health
provision,
whereas
in
fact
the
health
of
prisoners
is
also
very
much
determined
by
the
prison
environment
itself.
So
healthy
prison
is
also
a
whole
prison,
not
just
about
the
health
care
that
you
get
if
you
go
to
the
good
center
and
that's
a
very
important
thing
for
us
to
have
in
mind
and
the
way
that
that's
handled
is
to
do
inspections
with
the
cheat
the
spectra
of
prisons.
H
H
General
prison
environment
and
therefore
is
sort
of
out
of
our
scope,
and
it
would
be
very
important
that
we
don't
lose
sight
of
what's
going
on
in
prisons,
gently
and
our
route
into,
that
is
by
joint
inspection
and
by
working
with
the
prison's
Inspectorate,
so
that
they
can
raise
matters
of
general
concern.
For
example,
prisons
be
expending
a
lot
of
time
in
lockup
their
withdrawal
of
privileges,
all
the
other
things
that
acts
against
stress
prisoners
and
put
their
put
them
at
risk
outside
our
strict
remit,
but
certainly
not
outside
the
realm
of
prisoners.
Health.
H
One
important
distinction,
which
is
the
prison's
Inspectorate,
doesn't
have
any
rights
in
a
way.
They
have
a
right
to
get
into
prisons
and
they
can
write
reports.
But,
unlike
us,
they
can't
take
any
kind
of
enforcement
action,
and
so
it
is
very
important
that,
through
a
combination
of
fortunately
with
the
inspector,
we
can
get
the
health
of
Prisons
improved.
H
A
I
Thank
you
very
much
for
giving
us
this
opportunity
just
to
come
and
give
you
a
brief
update
on
where
we
are
with
the
transition
project
for
HealthWatch
England,
for
which
I've
been
acting
as
the
SL
row
following
conversations
with
David,
and
we
very
much
thought
that
what
we
needed
to
do
first
in
this
paper,
briefly,
summarizes
is
put
in
place.
The
enabling
actions,
the
practical
logistics,
including
things
like
the
move
on
to
this
site.
I
G
This
is
one
of
those
things
that
could
have
gone
horribly
wrong
and
in
a
trap,
it's
gone
horribly
right,
wonderfully
right,
Susan
and
I
sat
down
together
properties
of
very
early
January
and
decided
that
we
can
do
this.
We
can
make
this
work
and
actually
can
really
really
make
it
work.
So
we
have,
as
somebody's
already
said
today,
we
have
the
same
clients:
CQC
works
through
regulation,
HealthWatch
works
through
gathering
evidence
and
together
we
can
really
really
do
something
useful.
G
There
was
a
moment
in
early
in
January,
where
we
were
expecting
floods
of
letters
from
local
HealthWatch
about
the
independence
question
and
what
did
it
mean
in
an
actual
fat
and
I
think
through
Susan's,
share
leadership
and
determination
and
working
with
colleagues?
Here
we
had
only
one
or
two
and
now
what
I'm
here
and
we
have
a
conference
two
weeks
ago-
is
colleagues
saying
I
really
enjoyed
this.
Having
health,
CQC
I
can
go
in
and
say,
look
like
f
do.
They
feel
they've
got
more
they're
part
of
a
larger
organization
and
it
really
works.
G
There
are
a
few
who
might
still
think
CQC,
but
it's
not
as
not,
as
you
might
think.
Oh
dear
you're
CQC,
taking
away
our
independence,
it's
more
about
CQC.
Please
work
with
us
because
we've
got
something
evidence
to
give
to
you
so
all
in
all,
very
good
and
useful
picture
in
terms
of
HealthWatch
itself.
A
very
quick
update,
if
you
like,
and
up
really
quick
update
I,
do
think
we
have
proof
of
concept.
Now
this
particular
iteration
and
I
know
community
health
councils,
pals
links
has
been
several
others.
This
one
does
seem
to
really
work.
G
We
have
over
the
first
four
years.
I
think
we
sort
of
focus
particularly
on
those
are
major
pinch
points
access
getting
into
the
system
discharge
coming
out
of
the
system,
but
we
are
very
much
as
I
think
Lewis
was
saying
earlier
on.
We
are
very
trying
to
play
our
part
in
the
interesting
change
initiatives
in
the
world
of
Health
and
Social
Care,
and
we
found
that
our
role
very
much
starting
and
ending
and
staying
with
the
the
public.
Our
role
has
been
one
of
honest
broker.
G
Genet
Jennifer
was
talking
about
the
money
just
now
that
a
lot
of
our
evidence
is
about
NHS
or
social
care,
not
getting
it
right
first
time.
So,
there's
a
story.
I
I,
often
tell
about
some
young
woman
who
took
an
overdose,
was
bounced
around
the
system
without
getting
looked
after.
She
virtually
had
to
take
a
second
overdose
to
get
back
into
a
and
E
and
get
sorted
out.
So
there's
a
real
there's,
a
lot
of
what
I
think
we
can
help
a
government
and
a
system.
That's
really
focused
on
the
money.
G
G
We
I
suppose
the
thing
that
keeps
me
on
the
edge
of
my
seat
is
is:
are
we
are
we?
We
know
there
will
be
a
tragedy
out
there.
We
have
mid
staffordshire,
we
had
Winterbourne
view.
We
know
there
will
be
a
tragedy
out
there
at
some
point
and
are
we
helping
it's?
Not
our
job
did
just
always
spotless.
Are
we
helping
the
system
to
spot
those?
G
G
Think.
Looking
ahead,
we
are
a
small
organization.
We've
got
a
bit
smaller
recently
and
my
concern
is:
we
are
getting
more
and
more
invitations
to
join
oversight.
Boards
to
do
this
to
get
involved
and
we
all
need
to
be
very
focused
indeed
to
make
sure
we
can
deliver
that.
But
what
is
happening
wonderfully
is
it
was
it's
not
just
HealthWatch
England
there
are
148
local
HealthWatch
out
there.
They
are
very
good,
I
mean
there's
a
mixer,
obviously,
but
there
are
some
real
talent
out
there,
some
real
energy
and
so
under
Susan's
leadership.
G
J
I,
don't
want
to
be
repetitious,
but
I
just
wanted
to
say
a
few
things
about
our
priorities
and
her
business
plan
is
is
progressing
and
the
first
of
our
priorities
this
year
was
to
make
sure
that
we
put
good
focus
on
the
network
and
the
development
of
the
network
and
I'm
pleased
to
report.
As
Gina
said,
we
had
our
most
successful
ever
conference
this
year.
J
But
it's
a
difficult
conversation
that
that
we
have
known
again-
and
I
think
this
learning
together
has
enabled
to
prepare
us
to
break
down
some
of
the
barriers,
help
them
work
collaboratively,
which
is
the
way
that
they
need
to
behave
when
they're
participating
in
activities
around
the
five-year
forward
view
and
getting
involved
in
things
like
the
sustainable
transformation
plans,
which
are
things
that
are
exercising
them
at
the
moment.
So
we
are
giving
them
as
much
support
as
we
can
to
get
involved
in
an
appropriate
way.
J
Our
second
priority,
as
is
the
development
of
a
good
strategy,
to
use
our
information
and
intelligence
effectively
because
local
HealthWatch
are
developing
and
they
are
becoming
more
and
more
sophisticated
in
the
way
that
they
are
engaging
with
their
communities.
The
information
that
is
coming
through
em
it
gets
stronger
and
we
need
to
make
sure
that
we
are
making
good
robust
use
of
that,
so
that
we
can
influence
in
a
way
that
make
sure
that
we
are
talking
to
the
right
people
at
the
right
time
about
the
right
things.
J
So
that's
the
big
piece
of
development
work
that
we're
doing
at
the
moment
and
then.
Thirdly,
the
final
priority
was
to
make
sure
that
we
are
fit
for
purpose,
and
that
has
probably
been
my
biggest
challenge
in
the
last
six
months
and
what
we're
facing,
as
Jane
has
alluded
to,
is
a
reduction
of
budget,
but
I
also
just
want
to
reiterate
my
thank
you
at
this
point
to
particularly
David
and
Ursula,
who
have
given
us
the
most
phenomenal
amount
of
support
and
welcomed
us
very
warmly
into
CQC.
J
What
we
have
to
do
now
is
is
look
at
a
refreshed
operating
model
and
following
that
will
be
of
a
fresh
structure.
So
that's
going
to
be
the
focus
of
my
work
in
the
coming
few
months
so
that
we
have
an
organization
that
is
fit
for
purpose
to
pass
on
to
the
new
leadership
that
will
be
hoping
to
recruit.
Thank
you
can.
A
D
Thank
you
for
the
report
and
your
verbal
updates,
and
it's
good
that
the
transition
has
gone
well
and
I.
Think
you
know
I
know
your
budget
has
been
reduced,
but
I
think
there
are
some
real
opportunities
here
for
HealthWatch
and
CQC
to
work
together
much
more
effectively.
You
know
that
together
we'll
be
stronger
than
the
sum
of
the
parts
I
think
there
are
some
real
opportunities
there
and
I
do
think
it's
the
CQC
to
really
embrace
it
at
all
levels.
D
I
mean
I'm
sure
that
David
will
will
champion
it,
as
others
will,
but
there
are
certainly
parts
of
the
organization
that
are
really
not
sure
what
HealthWatch
does
or
how
to
make
use
of
them.
So
there's
been
me
a
sort
of
a
need
to
sort
of
develop
and
grow
site
by
side
over
there
sort
of
coming
months
and
I.
Guess
that
will
take
off
when
the
permanent
director
and
chair
are
in
impost,
so
I
mean
it's.
D
You
know,
you've
come
through
a
difficult
time,
but
I
think
there's
some
real
opportunities
and
reason
for
sort
of
optimism
about
the
future.
I
had
a
specific
question
because
it
in
the
paper
it
says
that
a
common
statement
of
intent
has
been
submitted
to
the
CQC
board.
Have
we
got
that?
Have
we
had
it?
It
doesn't
seem
to
be
here.
It
was
supposed
to
be
reviewing
it
endorsing
it
today.
So
it
says
in
the
paper.
I
J
A
F
Everything
I
read
here
is
obviously
very
encouraging
in
grants
relations
to
all
concerned
the
question
I
have
this
really
about
what
we
know
about
local
healthwatches
and
the
challenges
they
face
and
what
we
or
rather
HealthWatch,
can
do
about
it
in
relation
to
funding
own
York,
we
know
Lisa
I,
believe
funding
of
local
healthwatches
through
local
authorities.
It's
not
transparent.
G
So
I
start
yes
and
we
do
monitor
constantly
the
funding
for
local
HealthWatch
on
you're.
Quite
right,
it
goes
through
local
sort.
It
comes
from
Department
health,
it
filters
through
local
authorities
and
there
what
comes
through
after
that
is
sometimes
quite
interesting.
I
think
I'm
right
in
saying
that
overall,
there's
been
about
a
ten
percent
cut
10
to
50
I'll.
H
G
Susan
give
you
the
correct
figures,
but,
but
I
have
to
say
almost
the
first
question
when
I
no
longer,
but
when
I
was
meeting
with
John
rouse
at
the
Department
of
Health.
Almost
the
first
question.
He
would
ask
me,
as
you
are
there,
any
health
watch
out
there
who
are
seriously
struggling
in
terms
of
their
financial
allocation,
and
you
tell
me
about
it.
What
can
we
do
about
it?
So
I'm
going
to
hand
over
to
Susan
now
for
more
euros
or
grounded
reply?
G
J
Independence
is
something
we
talk
about
a
lot
and
sometimes
that
almost
gets
in
the
way,
but
we
have
to
have
those
conversations
and-
and
the
other
thing
we
are
doing
is
we
are
talking
water
commissioners,
because
the
more
that
commissioners
understand
the
purpose
and
the
value
of
local
HealthWatch.
We
believe
the
more
em
they'll
be
able
to
support
them
locally
and
make
sure
that
the
monies
is
is
there.
But
we
understand
that
the
financial
position
is
very
difficult,
but
I
think
we're
actually
doing
as
much
as
we
can.
A
Okay,
just
one
final
comment
from
ek:
you
said
you
thought
that
things
would
take
off
when
the
permanent
appointments
are
made.
I
think
they've
taken
off
so.
C
A
Just
once
again,
well
the
thank
all
three
of
you
for
what
you've
done
is
been
a
fantastic
performance
over
the
last
few
months
and
I'm
sure
it
will.
It
will
continue.
Is
there
any
other
business
anybody
on
the
board
wants
to
raise?
Okay,
I'm,
very
sorry.
We
ran
out
of
time
for
public
questions.
As
I
said
at
the
start,
we've
got
a
very
full
set
of
meetings
following
this
meeting
so
Freight
on
I'm.
Very
sorry,
I've
just
said
we're
at
what
we've
run
out
of
time.