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From YouTube: CQC board meeting – April 2018
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A
Right
good
morning,
everybody
welcome
to
our
April
board
meeting
I.
Don't
think
we
have
any
apologies
for
absence.
Does
anybody
have
any
interest
they
need
to
declare
excellent,
so
that
takes
us
to
the
minutes
of
our
March
meeting
as
everybody
content.
They
are
a
true
and
accurate
record
of
what
we
discussed
and
agreed
good.
Thank
you
very
much.
Take
that
as
approved,
miraculously
there
is
nothing
outstanding
on
our
action
log,
which
is
great
achievement.
Is
there
anything
else
that
anybody
wanted
to
raise
as
a
matter
or
arising?
That's
not
otherwise,
on
our
agenda.
B
B
Safeguarding
alerts
after
a
dipper
back
to
where
they
need
to
be
in
terms
of
volumes
of
inspection
were
performing
strongly,
but
those
key
issues
related
to
recruitment
and
that
recruitment
pipeline
has
begun
beginning
to
work.
The
perennial
challenge
around
the
inspection
reports
and
the
time
again
you've
got
the
up
to
date.
Data
as
we
continue
and
colleagues
continue
to
work
on
that
and.
B
Whistle
blowing
data
is
in
here
and
we've
tried
to
separate
this
out
into
a
priority
one
and
two
three
and
four
to
give
you
a
sense
of
the
priority.
That's
given
to
that
information
when
it
comes
in
like
every,
and
this
is
a
monthly
performance
report.
So
this
is
a
reduced
performance
report,
given
the
one
that
you
get
quarterly,
but
the
annex
is
attached
to
the
report,
which
has
the
more
detailed
analysis
in
that
informs
the
covering
report.
B
C
B
B
It's
broken
down
even
further,
so
I
think
it
now
goes
down.
So
each
inspection
team
in
the
inspection
Directorate.
So
we
keep
this
information
in
quite
a
granular
fashion,
and
that
goes
back
to
managers
at
different
levels
through
the
organisation.
So
if
there
are
spikes
long-term
illnesses,
we've
got
an
older
workforce.
A
predominately
female
workforce
will
generate
a
particular
kind
of
long
term
sickness
issues
that
we've
we've
got.
B
We
do
get
musculoskeletal
issues
you'll
see
a
lot
of
inspectors
who
were
working
aware
will
now
carry
briefcases
which
are
on
wheels
because
of
the
amount
of
just
the
computers,
the
weight
of
the
computers,
people
that
have
been
doing
the
locals.
Cg
reviews
will
have
quite
a
bit
a
dare
to
with
them
that
will
be
carrying
so
musculoskeletal
stuff
is
there,
but
if
you
wanted
more
information,
Markham
I'm
sure,
Ruth
barriers
and
director
people
would
make
that
available
to
you
and
get
into
that.
B
It's
in
the
question
on
turnover
turnovers
has
been
a
tricky
one,
because
we've
gone
through
a
period
where
we
have
been
expanding.
We
have
been
taking
on
more
people,
and
but
one
of
the
issues
with
hard
is
people
have
been
in
in
the
organization
for
a
long
time.
It
will
felt
that
the
changes
we've
made
in
not
for
them,
so
we've
had
a
number
of
people
leaving
because
they
don't
feel
comfortable
with
the
changes
we've
introduced.
B
These
are
ins,
people
that
have
been
regulating
for
10
15
in
some
cases,
20
years,
going
back
through
our
predecessor,
bodies,
who
are
in
terms
of
some
of
our
new
methodologies
that
felt
this
is
not
for
them.
One
of
the
issues,
for
instance,
will
be
about
report.
Writing.
One
of
the
things
inspectors
would
say
is
this
job
of
the
fine.
B
If
I
didn't
have
to
write
the
report
and
actually
the
report,
writing
is
inherent
an
integral
part
of
the
job
that
we
have
to
do
so
so
I
think
there
have
been
people
leaving
because
it
felt
the
job
isn't
for
them.
Interestingly,
your
point
about
turnover
in
terms
of
the
length
of
time
people
have
worked
for
us
and
actually
being
alert
to
that
as
an
executive
team.
B
We
have
had
that
report
and
monitored
that
through
a
period
of
time,
this
is
a
high-level
report
that
we've
not
been
through
and
again
it
is
something
that
we
look
at,
because
that
allows
us
to
reflect
on.
Have
we
got
the
recruitment
decisions
right?
Are
we
in
ducting
and
supporting
people
prior
to
then
beginning
to
take
up
the
heavy
lifting
of
the
job
that
they've
come
here
to?
There
is
a
key
issue,
so
we
are
alert.
I
can't
remember
what
the
figure
is
off.
B
B
It's
certainly
something
that
I
think
has
informed
the
policy
position
we've
now
got
to,
which
is
for
inspection
staff
in
particular
to
run
and
always
on
recruitment,
so
instead
of
having
recruitment
campaigns
which
begin
and
end
with
adopted
approach,
which
is
always
always
on,
and
that
I
think
has
been
informed
by
the
position
that
we've
had
about
recruitment.
We've
also
got
variation
in
recruitment,
so
there's
been
some
particularly
hot
or
cold
spots,
depending
on
how
you
want
to
refer
this
so
recruiting
adult
social
care
inspectors,
I
think
in
the
southeast
has
been
particularly
challenging.
B
A
lot
of
effort
has
gone
into
that
and
I
think
those
teams
now
in
the
South
East,
coming
up
pretty
much
up
to
full
strength.
But
one
of
the
reasons
our
performance
on
producing
reports
on
time
and
in
doing
the
inspection
program
that
we've
flagged
in
that
southeast
corner
has
been
down
to
work.
Force.
B
I've
visited
teams
more
recently
where
there
should
be
eight
inspectors
and
the
operating
with
three
they're
now
up
to
strength,
and
so
I
think,
probably
last
month
saw
them
start
with
eighty
inspectors
in
the
team
that
should
have
had
eighteen
specters
for
the
first
time.
So
I
think
we
are
taking
a
taking
action
in
relation
to
this.
But.
B
C
A
F
F
Which
talked
about
before,
but
this
is
relates
to
the
report
data
and
it's
the
page,
23
I,
think
of
the
report.
Information
of
us
yeah.
B
A
H
F
But
the
question
is
not
what
page
are
we
on,
but
the
the
issue
of
improvement
because
I,
it
may
be
the
time
I've
missed
this
before,
but
it
just
looks
like
we're
getting
an
increasing
divergence
between
sectors
on
how
how
much
improvement
is
occurring
on
re-inspection
and
now,
obviously,
there's
the
question
Hammond
how
many
inspections
this
is
based
on
and
so
on.
But
if
you
look
at
the
the
the
third
slide,
the
third
graph
there
that's
see.
F
Ratings
change
for
previous
requires
improvement
and
say:
compare
the
Mental
Health
Trust
with
the
acute
trust,
so
the
mental
health
trusts
and
look
like
they
respond
on
re-inspection
quite
likely
to
get
a
rating
of
good,
whereas
the
acute
trust-
that's
not
true
and
I-
think
that's
probably
always
been
true
in
primary
in
PNAS
and
but
it
just
looks
like
the
acute
trusts
are
being
slightly
left
behind.
So
good
good
for
Mental,
Health,
Trust
they're
doing
doing
very
well.
F
It
looks
like
they're
improving
on
our
inspection
and
a
question
over
acute
trusts
and
when
we,
when
we
look
at
these
things,
we
tend
to
say
well,
that's
partly
because
of
the
complexity
of
acute
trusts.
Overall
ratings,
they're
aggregates
they're,
based
on
a
number
of
locations
and
because
there's
so
many
locations
in
an
acute
trust
that
slightly
counts
against
an
upgrade
in
in
overall
ratings.
But
that's
not
really
true
here,
because
the
the
locations
figure,
which
is
on
the
same
graph,
is
more
or
less
the
same
as
their
overall
grading
figure.
So
it
does.
F
And
if
you
then
look
at
how
that
what
impact
that
has
on
graph
a
you
can
see
that
we've
now
got
quite
a
disparity
between
sectors
on
how
likely
you
are
to
be
served
by
a
a
good
or
a
requires
improvement,
trust
locally,
and
the
acute
sector
is
the
only
part
of
the
system.
Now,
where
you're
more
likely
locally
to
have
a
trust
with
a
rating
which
is
which
is
below
good
as
the
only
sector
and
so
mental
health
has
improved.
F
D
Yes,
well,
I'm
I
think
it's
real.
Those
I
think
we
are
seeing
improvement
in
all
sectors,
we're
seeing
more
rapid
improvement
in
Mental
Health
Trust
than
we
are
in
acute
trusts
and
I.
Think
that
is
a
real
finding.
I
should
say
that
that
we
need
to
recognize
the
pressure
the
acute
sector
is
under
at
the
moment
and
has
been
for
a
while.
D
D
That
I
think
some
trust
felt
comfortable
in
that
in
that
space,
and
it's
very
clear
that
some
trusts
have
risen
to
the
challenge
of
improving
their
services,
despite
the
pressures
other
trusts
have,
if
you
like,
focus
too
much
on
the
operational
pressures
and
failed
to
see
the
necessary
necessity
of
improving
services
overall
and
we'll
be
challenging
those
trusts
and
we're
increasingly
challenging
those
trusts
as
a
stuck-at
RI.
To
follow
the
example
of
those
that
have
improved
so
I
think
different
sectors
are
moving
at
different
speeds,
but
they
are
all
improving
I.
B
Thanks
so
I'll
do
this
next
bit
quite
quickly,
so
just
wanted
to
draw
attention
to
the
to
the
board
in
public
session
that
we
submitted
evidence
to
the
housing
communities,
local
government,
joint
Health
and
Social
Care
Select
Committee,
where
they
were
asking
for
evidence
on
the
inquiry
into
the
funding
of
long-term
funding
of
adult
social
care.
We
drafted
a
paper
that's
been
submitted
as
evidence
that
went
upon
the
website
and
is
now
on
CQC's
website
and
next
week.
B
Andrea
will
go
and
present
evidence
to
the
committee
and
the
published
paper
will
we'll
ship
and
inform
the
evidence
and
I'm
sure
there'll
be
a
healthy
discussion
at
the
Commission.
That
Andrea
will
be
able
to
contribute
to
we've
also
published
a
response
to
health,
education,
England's
consultation
on
the
draft
Health
and
Social
Care
workforce,
which
is
a
pretty
important
document
that
is
being
developed
and
drafted
and
again.
That
response
is
appended
to
the
report
and
I.
B
This
is
I,
think
the
third
of
those
years
going
through,
but
members
of
this
sector
were
concerned
about
the
significance
of
the
fee
increase,
we'll
continue
to
work
with
them
and
Andrea
Pizza
will
meet
further
with
UK
HCA
later
this
year
and
we'll
need
further
discussions
as
we
go
through
the
year
with
them.
So
I
don't
think
this
is
a
one-off,
but
we
just
wanted
to
mark
both
the
decision
by
the
Secretary
of
State
and
the
concerns
that
were
voiced
by
UK
yeah,
just
on
updates.
B
They
work
on
the
thematic
review
on
every
events
has
begun
and
the
teams
here
and
led
by
Ted
and
I
think
Robert
I
think
you're.
The
non-executive
sponsor
for
this
so
have
begun.
This
work,
anticipating
an
interim
report
in
the
summer
and
the
final
report
in
October,
just
also
wanted
to
acknowledge
the
announcement
by
NHS
improvement
and
NHS
England
of
their
move
towards
making
joint
appointments,
particularly
at
a
regional
level,
and
will
continue
to
work
with
both
organisations.
In
relation
to
that
work.
B
We've
got
a
strong
basis
from
the
local
systems
reviews
on
which
to
build,
but
it
does
allow
us
to
work
in
real
time
to
develop
our
thinking.
The
other
advantage
of
linking
people
and
working
in
two
areas
is
that
that
becomes
something
that's
not
just
done
at
a
senior
level,
it's
actually
done
by
managers
and
practitioners
in
the
auga
ie
inspectors,
analysts,
etc.
So
we've
got
some
real
time:
development
following
the
sales
buri
incidents
and
the
issues
around
cybersecurity.
Our
guess
has
been
development.
B
Since,
since
this
letter
came
from
the
Department
of
Health,
we've
been
asked
to
again
review
our
security
procedures
in
relation
to
cyber
attacks,
etc.
I
think
they've
Bing
warnings
as
recently
as
this
week
as
well
in
relation
to
this,
and
just
wanted
to
provide
some
assurance
to
the
board
that
we
again
continue
to
pay
attention
to
this
area
because
of
the
importance
of
the
security
of
our
systems
and
needing
to
attend
to
that,
because
we
have
external
providers
of
a
lot
of
our
systems.
B
Now
I'm
not
going
to
dwell
on
these
Pizza
we're
just
flagging
publications
that
we've
made
approved
mental
health
professionals,
the
state
of
independent
healthcare,
driving
improvement
in
mental
health
trusts
and
shirt
view
of
Mental
Health.
Sorry
a
shared
view
of
quality
and
general
practice,
and
would
you
to
publish,
before
our
next
board
meeting
a
report
on
driving
improvements
in
GP
practices
which
player
to
this
point
about
what
contribution
we
make
in
to
improvement,
not
just
at
an
organizational
level
but
a
system-wide
level
which
place
to
the
conversation
we've
just
heard
about
the
research
paper.
B
A
F
You
very
much
class
about
the
never
events
review
the
never
events
after
declare
an
interest
here,
because
there
is
only
one,
never
event
in
mental
health
as
I
understand
it,
and
that's
comes
from
my
research
which
I
did
about
15
years
ago.
So
that
tells
the
story
here.
We
we
haven't
been
very
good
in
in
mental
health,
but
being
able
to
develop
a
sort
of
more
up-to-date
and
rap
practice.
F
That's
quite
a
difficult
thing
to
say:
because
is
there
something
you
can
an
intervention
you
can
apply
and
then
a
tragedy
will
never
happen
at
all,
very
difficult
and
so
I
hope
that
and
that's
played
out
in
quite
an
important
way
recently,
because
you
may
know
that
earlier
this
year
about
two
months
ago,
there
was
an
announcement
by
effective
state
about
suicide
on
inpatient
wards
in
which
there
was
there's
a
drive.
Now,
at
the
moment,
there
was
something
like
85
to
90
deaths
by
suicide
of
mental
health
in
patients
every
year.
D
Well,
it's
too
early
to
draw
any
conclusions
about
what
our
recommendation
is
again
to
be,
but
I
think
it's
important
to
emphasize
that
the
reason
we're
doing
this
review
is
that
never
events
have
bow
being
I,
think
five
years
in
actual
and
and
and
the
number
of
never
events
has
not
fallen,
so
that
there's
a
stop
that
there
was
a
kind
of
assumption
at
the
start
that
these
events
were
preventable
and
if
everyone
did,
as
they
were
told
they
wouldn't
happen.
Well,
patient
safety.
Isn't
that
simple?
D
It's
much
more
complex
than
that
and
we
try
to
understand
what
are
the
barriers
that
stop
these
apparently
preventable
events
from
being
prevented
and
that's
fundamentally
what
we're
trying
to
do
and
understand
that
if
you
like
that
dynamic
and
that
is
really
fundamentally
at
the
heart
of
patient
safety,
because
it
won't
just
be
about
never
event,
it
would
be
about
other
safety
gardeners
as
well
such
as
well
as
the
issues
you're
talking
about.
So
so
whether
we
should
extend
never
events.
D
Think
that
is
the
fundamental
question
we're
trying
to
challenge
here
and
it
is
a
fundamental
question
about
safety
and
it
relates
back
to
the
work
we
did
last
year
on
learning
from
deaths,
for
instance,
where
there's
a
front,
a
similar
question
asked:
how
can
we
learn
from
things
going
wrong
to
to
improve
safety
going
forward?
I
think
that's
a
fundamental
challenge
in
the
health
care
system
across
the
board.
It's.
F
Very
bright,
and
thank
you
very
much
that
said
the
the
time.
The
time
scale
looks
quite
as
time
scale
is
always
are
tight.
So
an
interim
report
in
the
summer,
a
final
report
in
October
that
sounds
like
some
big
questions
have
to
be
addressed
between
now
and
then
could
I
just
ask
her
that
that
would
come
back
in
some
way
to
the
board,
because
it's
quite
a
an
area
that
we
should
all
take.
Quite
a
strong
interest.
D
In
I
think
I
think
I
think
it's
very
important
area.
We
are
on
site
at
the
moment
inspecting
hospitals,
it's
part
of
our
routine
inspections,
looking
at
how
they're
implementing,
never
events
learning
from
what
works
for
them
and
what
doesn't
work
for
them
and
we
are
consulting
on
a
wide
spectrum
of
experts
from
across
safety
field,
not
just
in
healthcare
but
across
many
other
industries
as
well
to
understand.
What's
worked
in
other
industries,
so
at
this
stage
I
think
is
towards
jetty.
D
A
Thought
I'd
done
it.
Sorry,
thank
you.
So,
yes,
I
think
it
will
come
back
to
the
to
the
board.
I
think
there
will
be
an
interesting
set
of
learnings
that
will
come
out
of
it,
so
I'm
not
quite
sure
which
month
I've
got
my
mind
around
that
yet
well
now
I
think
he
comes
back
after
the
report.
Rather
that
was
what
I
was
thinking.
Yeah.
D
B
On
the
process,
pouring
all
of
us
in
artic
reviews
I
think
have
been
sent
out
to
the
board
and
allowed
comment
before
it,
because
we
otherwise
get
into
this
you're,
either
resting
to
get
it
for
a
board
me
to
be
you
slowing
it
down,
but
I
think
the
delegation
said
that
I
signed
them
off
occasionally
with
Peter,
but
I.
Think.
B
On
the
last
view,
the
cams
report
came
to
the
board
I'm
looking
at
K
etcetera,
and
you
all
got
the
opportunity
to
comment
whether
it
comes
to
a
meeting
where
there's
a
discussion
in
our
is
another
issue.
But
given
your
experience
and
what
you've
said,
I've
got
huge
sympathy
with
the
point
you're
making
Louis
about
suicides
I'm
absolutely
with
you
on
that
I
think
we
should
get.
B
We
should
work
out
how
we're
going
to
get
that
in
the
way
that
we
have
done
with
the
other
thematic,
which
is
draft
report,
letting
you
have
some
sides
of
it
rather
than
we're
then
trying
to
launch
things
based
on
an
agenda.
The
October
one
will
be
a
lot
easier
to
manage
than
this
summer.
One
I
suspect,
but
we'll
make
sure
it
happen.
Robert.
I
I
I
depend
before
this
review
is
that
never
events
are
a
very
peculiar
variety
of
things
to
which
different
responses
might
be
required,
and
certainly
with
the
time
of
did
staffs,
it
was
a
the
alert
system
was
to
burek
was
bureaucratically
reacted
to
with
the
result
that
the
alerts
never
seem
to
get
through
to
the
people
who
actually
needed
to
do
something,
and
if
this
review
has
at
least
changes
that
that
would
be
an
encouraging
thing.
Good.
A
G
Thank
you,
sorry
yeah.
It
was
interested
to
see
our
response
to
the
health,
education,
England's
draft
health
and
care
workforce
strategy,
and
particularly
drawing
on
our
learning
from
new
models
of
care
and
not
having
an
overemphasis
purely
on
hospitals
and
the
role
of
social
cats
that
draw
very
good
stuff,
I
thought
and
it
mentions
in
there.
The
potential
of
new
pools
of
labour
and
the
importance
of
looking
at
new
pools
of
labour
and
I
just
wondered
whether
we've
done
anything
to
sort
of
join
up
that
thought.
G
With
some
of
the
work
we
do
in
another
sense
which
Fritz
for
in
relation
to
some
of
our
work.
We
do
look
at
employment
outcomes,
for
example,
looking
at
recovery
focused
practice
in
mental
health,
employment
outcomes
or
one
of
the
things
that
we
do
look
for
in
inspections
and
are
looking
at
mental
health
services.
B
A
Hundred
you
want
to
hear
that
no,
no,
no,
so
to
respond,
damages
two-digit
year
to
hear
what
what
what
what
Liz
was
saying.
I
was
gonna,
make
a
different
point
on
this,
which
is
and
I
think
our
response
almost
almost
gets
there,
but
there's
if
you,
if
you're,
trying
to
work
out
what
what
what
workforce
needs
you're
going
to
have
over
the
next
10
15
20
years,
it's
impossible,
because
there
are
that
we
don't
understand
and
can't
understand
at
the
moment
the
the
the
impact
that
technology
is
going
to
have
and
what
skills.
A
Therefore,
we
will
need
from
from
from
our
workforce
in
the
future,
and
it
seems
to
me
anyway
that
the
very
big
part
of
what
needs
to
be
thought
through
is
how
do
we
acquit
the
workforce
right
from
right
across
the
spectrum
with
with
skills
that
are
are
transferable
so
that,
as
the
as
technology
takes
away,
some
of
the
existing
jobs
and
new
new
new
jobs
are
are
needed.
In
response,
we've
got
that
flexible
work,
force
and
I
I
didn't
think
that
our
we
almost
get
there.
We
talked
about
that
you
know.
A
Are
we
going
to
have
a
need
for
more
general
physicians
rather
than
specialists,
but
I
think
it's
much
wider
than
that
I
think
it's
across
the
entire
workforce,
I
and
I.
It's
not
the
same
point
you're
making
this
at
all,
but
it
was
the
point
I
was
I
was
going
to
make
and
it
seems
to
me
if
I
was
trying
to
design
a
workforce
strategy
apart
from
panicking
at
the
thought
of
it.
That
would
be
the
thing
that
would
be
most
in
my
mind
and
I'm.
Just
on
that.
J
G
J
Is
just
very
odd,
given
the
nature
of
the
needs?
They'll
be
there
in
12
years
time,
so
we
have
an
incredibly
inflexible
training
system,
for
what
is
everybody,
intellectually
knows
got
to
be
an
incredibly
flexible
workforce
and
seems
like
no
one's
doing
anything
about
that,
though
every
year
that
continues
and
probably
expands.
So
when
we
talk
about
expanding
for
the
future,
workforce
will
primarily
end
up
expanding
in
flexibility
in
when
we,
when
everyone
knows,
we
need
more
flexibility,
but
I
think
there's
a
there's
a
there's.
Another
really
important,
quite
important
point.
J
This
is
one
of
the
biggest
industries
in
the
country,
maybe
the
biggest
interests
in
the
country,
health
and
social
care,
and
everybody
goes
around
saying.
There
is
a
shortage
of
Labor
and
everybody
by
and
large
when
they
say
this
sort
of
labor
is
looking
away
from
where
labor
is
and
looking
in
directions
where
labor
isn't,
and
so.
Actually
there
are
lots
and
lots
of
people
engaged
with
health
and
social
care.
J
Who
would
love
there
to
be
a
ladder
of
opportunity
and
the
ladder
exists
has
several
rungs
not
in
it,
including
where
it
reaches
down
into
and
so
that
there
needs
to
be
something
beyond
exactly
as
Liz
was
saying,
the
way
in
which
we
are.
We
continue
to
replan
and
re
plan
and
re
plan.
As
you
said,
a
mug's
game,
given
we
can
never
know,
what's
going
to
happen
and
actually
start
saying,
what
are
we
got
in
our
society?
Where
do
people
want
to
work?
J
B
Well,
why
don't
we
just
set
them
this
conversation
and
capture
that
and
then
set
out
a
supplementary
letter
back
that
captures
the
points,
in
addition,
so
I
think
some
of
the
points
about
the
difficulty
of
forecasting
etc.
I,
don't
think
we
made
that
point
Liz,
but
is
it
connected
intellectually
I
think
it
is
practically
who's
doing?
What
in
relation
to
that
I
think
is
a
different
question.
I'm
sure,
there's
examples
where
people
are
doing
that
I,
don't
know,
that's
the
norm,
I
think
that's
what
you
and
Paul
is
also
so.
B
I
I
There
was
a
recent
survey,
a
ton
of
trainees,
of
the
Royal
College
of
anaesthetists,
which
indicated
very
high
levels
of
of
concern
about
lack
of
facilities,
of
really
basic
facilities
in
which
to
work
like
places
to
eat
places
to
rest
all
those
sort
of
things
which,
if
they
persist,
particularly
in
an
area
of
financial
shortage
and
staff
shortage,
will
lead
to
people
leaving,
and
there
is
evidence
of
both
doctors
and
nurses,
leaving
after
pretty
expensive
training.
Now
it
seems
to
be
that
work,
health,
education,
England
that
it
has
a
role
in
this.
I
We,
as
instead
of
the
Inspectorate,
also
have
a
role
in
when
we're
looking
at
whether
a
place
is
well
laid
in
whether
their
staff
are
being
looked
after
and
I.
Just
wonder
whether
that's
something
we
could
consider
I'm,
not
saying
we
don't
consider
it,
but
whether
we
should
consider
it
more
overtly
leave.
K
Them
thanks.
So
the
local
system
review
summit
meetings,
the
feedback
meetings.
We
have
it's
the
single
most
common
question
that
I'm
asked
and
the
most
common
assertion
is
about
workforce
issues
in
whichever
area,
and
it's
usually
about
nursing
and
people
working
at
the
lowest
levels
financially
in
the
health
and
social
care
system.
Those
who
are
giving
care
in
care
homes,
nursing
homes,
domiciliary
care
are
often
paid
or
usually
paid.
The
worst
of
any
care
worker
and
the
problems,
for
example
in
Oxford,
were
around.
K
How
do
you
recruit
people
when
you've
got
London
prices
without
London
waiting
within
inadequate
supply
of
housing
through
to
Trafford,
where
we
were,
where
you've
got
a
massive
retail
Park
and
as
soon
as
a
supermarket
opens
or
a
new
shop
opens?
Who
pay
more
for
less
responsibility?
Why
wouldn't
you
move
or
about
attraction?
And-
and
so
we
talk
a
lot
about
that
and
I
think
if
you
read
our
reports
in
most
of
the
reports,
those
who
are
not
doing
very
well
from
a
delayed
transfers
of
care
and
care
the
over
65s.
K
You
know
in
a
very
difficult
area
and
what
they
said.
I
went
into
the
room
with
the
management
staff
and
talked
to
them
and
I
just
asked
why
they
wanted
to
work
in
this
sort
of
surgery,
and
they
said
well,
it's
rated
outstanding
and
that's
really
important
and
we
looked
for
their
rating
and
I
said
well.
What
was
your
background
and
the
first
person
said
well,
I
was
a
hairdressing
college
and
now
I
said
to
her
the
person
next
to
her.
K
What
was
your
vigor
I
was
a
hairdressing
college
and
I
turn
round
to
the
third
person,
who
is
much
older
and
said:
oh
well,
you're,
not
a
hairdresser
as
well.
Are
you
interested
well?
Actually,
I
was,
and
it's
an
important
thing,
because
the
aspirations
of
some
people
in
this
country
at
school
are
for
those
sort
of
careers
because
they
have
more
contact
with
them
and
they're
they're
perceived
to
be
stable
and
the
income
is
often
better
than
the
care
workers
where
they
have
no
access
to,
and
they
don't
know
what
the
careers
are.
K
And
so
the
sort
of
thing
I
was
feeding
back.
It's
places
like
heart,
Hartlepool
was,
if
you're
going
to
do
a
workforce
strategy,
you
need
to
look
at
the
whole
thing
from
junior
school
onwards
and
C
health
and
social
care
as
a
career
to
aspire
to
and
I
think
we
have
a
responsibility
of
a
regulator
to
do
that.
But
the
good
news
was
the
rating
of
outstanding
in
the
practice.
K
Helped
the
lower
end
of
the
workforce
look
to
aspire
to
work
there,
and
we
have
other
examples
where
they
have
succeeded
in
recruiting
doctors
and
nurses
when
before
they
were
rated
outstanding,
they
couldn't
so
that
is
a
positive
impact.
Given
the
theme
of
today
is
what's
the
impact
of
CQC
thanks
Steve
Andrea
and.
H
Thank
you,
Peter,
and
just
to
respond
to
Roberts
point
about
the
questions
that
we
ask
on
inspection
about
well-led
and
how
staff
are
supported,
and
that
absolutely
is
one
of
the
key
lines
of
inquiry
both
in
terms
of
whether
staff
are
safely
recruited.
Do
we
have
enough
of
them
whether
recruited
properly
and
do
they
have
the
training
and
development
to
allow
them
to
have
the
capability
and
confidence
to
do
the
job
that
they
need
to
do
in
the
circumstances
that
they're
working
in
and
secondly,
what
is
the
culture?
Is
it
inclusive?
Is
it
open?
H
Is
it's
supportive
to
members
of
staff
so
that
they
feel
engaged
in
the
development
of
the
service
and
feel
aligned
to
it
in
a
way
that
actually
makes
them
want
to
kind
of
give
give
more
of
themselves
to
it,
and
it
helps
to
support
retention
as
well?
So
they
are
key
questions
and
they
are
some
of
the
areas
that
we
find
difficulties
when
we
go
into
services,
and
it
is
something
that
we
have
highlighted
both
in
response
to
the
questions,
if
the
service
safe
and
is
the
service
well
that
so
I
think
it
may
be.
H
One
of
those
things
that,
as
we
go
forward-
and
we
could
be-
we've
talked
today
about
some
of
the
thematic
publications
that
we've
done-
I'm
sure,
there's
probably
quite
a
lot
of
evidence
within
the
depth.
Our
report
that
identifies
some
of
the
good
things
that
providers
have
been
doing
and
some
of
the
things
that
providers
should
avoid,
and
maybe
one
of
the
things
that
we
can
think
about
is
whether
using
our
independent
voice.
That's
something
that
we
might
want
to
exemplify
more
in
a
more
thematic
way
and.
A
Just
to
support
that
I
mean
just
in
my
my
casual
visits
to
providers
right
across
the
spectrum,
I've
seen
some
fantastic
examples
of
how
staff
have
been
supported
in
in
lots
of
different
ways
and
I've
seen
some
examples
where
there's
little
evidence
there
being
supported
at
all.
So
you
know
it's
a
really
big
point
John.
In
wanting
to
say
it's.
L
A
very
quick
point,
and
what
hasn't
been
brought
out
here,
is
that
the
sustainability
of
health
and
care
systems
will
struggle
unless
we
embrace
the
users
of
the
system
as
part
of
it.
They
have
the
maximum
amount
of
time.
They
have
to
look
after
their
own
conditions,
and
for
that
you
need
the
workforce
to
be
systematically
trained
in
how
to
do
co-production
and
co-manage
ins.
We
currently,
they
aren't
and
I
wonder
if
you
consider
adding
that
to
the
supplementary.
A
M
Thank
you
and
thank
you
for
the
opportunity
to
provide
a
verbal
report
ahead
of
my
presentation
of
the
annual
report,
which
will
happen
in
June.
I
am
the
CQC
freedom
to
speak
up
Guardian
and
also
the
day
job
as
a
head
of
hospital
inspection,
currently
covering
Southwest
and
south-central
on
the
acute
side,
I'd
like
to
cover
three
areas
and
then
I'm
very
happy
to
take
questions.
M
I'd
like
to
give
you
a
brief
update
on
our
arrangements,
I'd
like
to
tell
you
about
the
recruitment
and
training
of
Speak
Up
ambassadors,
and
also
touch
on
my
membership
of
a
cooperative
inquiry
group.
A
group
of
folk
I
happened
upon
via
average
and
involving
tutors
of
Master
in
the
NHS
Leadership
Academy.
So
the
arrangements
I
was
appointed
after
open
competition
within
the
leadership
group
at
CQC
and
I've
had
great
support
and
encouragement
from
the
hospital's
Directorate
to
fulfill
the
role
and
also
HR
and
in
the
Engagement.
M
We
take
into
account
Henrietta's
recommendations
on
the
back
of
her
annual
reports
and
surveys
and
so
on,
and
we
check
out
a
lot
of
the
work
that
we're
that
we're
doing
with
them
in
the
day
job
as
a
head
of
hospital
inspection,
I
encounter
Guardians
on
inspection,
and
it's
always
my
pleasure
to
interview
them
and
we're
also
seeing
Guardians
as
part
of
our
regular,
12-month
engagement
with
trusts
and
it's
a
great
source
of
support
and
inspiration.
Meeting
people
doing
the
same
thing
in
a
different
environment.
M
We
have
revised
our
policy
in
line
with
the
national
guidance
that
came
out
from
NHS
improvement
and
England,
and
we've
also
taken
account
of
the
best
practice
in
trusts
and
were
pointed
by
the
Guardians
office
towards
a
mental
health
trust
in
London
as
having
what
they
regarded
as
the
best
of
the
policies.
It's
been
a
key
thrust
to
get
those
policies
out
of
the
HR
space
if
I
might
describe
it
as
such
and
much
more
as
a
sort
of
open
way
of
being,
as
opposed
to
set
prescribed
procedures.
M
Our
advise
policy
awaiting
sign-off
I've
set
up
a
reference
group.
I
didn't
like
to
fly
completely
solo
on
this.
So
I
have
a
group
of
people
from
across
CQC
to
support
and
challenge
me.
We
devised
a
work
programme
together.
They
hold
me
to
account
and
I'm
pleased
to
say
all
the
Equality
networks
are
represented
on
that
on
that
group
and
we
have
a
spread
across
the
organisation
the
National
Guardians
office
has
has
presented
their
report
to
you
in
the
past
and
described
the
series
of
recommendations
they've
made
for
Guardians.
M
We've
undertaken
a
analysis
against
that
I'm
police
reporter
in
a
good
place
and
they'll
be
more
detail
in
my
annual
report
about
it.
We
have,
as
you
would
expect
intranet
pages
in
a
communications
plan,
and
we've
run
a
number
of
campaigns
to
raise
awareness
of
speaking
up.
It
is
not
my
ambition
that
everyone
comes
to
Mary
courage
to
speak
up.
M
It
is
my
ambition
that
we
are
a
place
where
speaking
up
is
a
way
of
life
where
staff
are
encouraged
and
supported
to
speak
up
well
and
when
they
do
that,
managers
and
colleagues
respond
well,
and
therein
lies
some
of
the
challenge.
We've
mentioned
campaigns.
We
worked
around
the
national
anti-bullying
campaign.
M
I've
had
a
number
of
cases
and
contacts
with
staff
and
ahead
of
providing
you
with
the
figures
and
themes
in
the
annual
report.
I'll
say
that
they
broadly
affect
the
experience
of
guardians
in
NHS
trusts.
Although
there
are
safety
issues
that
do
come
forward
and
things
that
you
know
are
surprising,
the
vast
majority
are
around
behavior
and
how
atmosphere
in
teams
and
groups.
M
We
have
had
a
couple
of
cases
that
have
gone
all
the
way
by
which
I
mean
to
formal
investigation,
but
that
those
are
a
rarity
as
they
are
in
the
NHS
and
success
for
me
is
when,
on
the
back
of
a
conversation,
someone
goes
away
and
speaks
up
themselves
and
gets
a
good
response,
and
when
you
see
the
detail
in
June
there
being
some
quite
inspiring
examples
of
that.
I've
referred
to
ambassadors.
I
couldn't
possibly
do
this
alone,
and
we
have
them
all
levels
in
the
organization,
including
one
round
this
table.
M
So
we
have
inspectors
managers
we
have
personal
assistants
and
executive.
As
I
say
we
have
ambassadors
from
everywhere
strategy,
intelligence,
all
the
inspecting
directorates
and
the
corporate
functions
and
I'll
come
on
to
say
a
bit
about
that
training
in
more
detail.
The
whole
purpose
of
them
is
to
provide
confidential
advice
and
support,
to
be
approachable,
to
listen
well
and
to
role
model.
M
Our
dignity
at
work,
advisors
have
all
signed
up
to
be
ambassadors
and,
in
the
longer
term,
will
be
considering
whether
we
merge
those
roles
as
well.
The
training
we
train
38
staff
last
week
in
London
and
Leeds.
This
was
delivered
in
partnership
with
the
Academy
and
the
National
Guardians
office,
and
we
reflected
on
some
of
the
sayings
of
Michel
West
around
civility
warmth,
positivity
and
kindness
having
a
place
in
our
culture
and
in
how
we
deal
with
each
other.
Every
day
we
reflected
on
what
a
great
fit.
This
all
is
with
our
CQC
values.
M
We
also
reflected
on
it's
hard
to
do.
If
it
was
easy,
we
wouldn't
be.
Even
bothering
would
we
but
it
isn't.
We
looked
at
the
barriers
there
are
to
speaking
up.
We
understood
the
background.
We
had
a
very
moving
film
in
futuring,
Hellena,
Donnelly
and
dr.
Nick,
Harper
I,
think
you
will
all
have
met
at
one
stage.
We
considered
our
role
and
activities.
N
Thank
you
very
much.
Well,
the
one
thing
you
haven't
said
that
we
did
during
the
training
and,
as
you
said,
was
really
young.
Colleagues
from
all
parts
of
the
organisation
in
all
levels,
which
was
very
exciting,
was
first
of
all
how
how
much
interest
in
enthusiasm
there
is
from
from
our
staff
to
take
on
this
role
and
to
a
role
model.
N
This
is
also
about
speaking
much
more
openly
where
we
things
can
be
done
better
and,
as
you
say,
if
that
turns
into
a
social
movement,
then
there
might
be
a
future
where
actually
as
ambassadors
and
as
Guardians,
we
don't
have
a
lot
to
do,
but
that
is
because
everything
else
is
working
in
the
way
we
want
that
supports.
I'm,
really
proud
to
be
part
of
it
and
you're
doing
a
great
role
in
supporting
that.
Thank
you.
M
But
at
the
moment
we
are
talking
about
speaking
up
about
the
barriers
to
it
and
about
the
examples
of
where
it's
done
being
done
really
well.
I
was
signposted
to
Professor
Megan
Reese,
who
is
one
of
the
tutors
at
Ridge,
and
she
has
a
group
there
about
six
of
us.
We
meet
every
quarter
and
explore
this
Megan
published
some
research
last
March
being
silenced
and
silencing
others,
developing
the
capacity
to
speak
truth
to
power,
the
key
finding
of
which-
and
this
was
research-based
international
research
in
both
the
public
and
private
sectors.
M
The
key
barrier
is
how
leaders
vastly
overestimates
how
approachable
they
are.
The
workplace
is
very
different.
Now
from
when
I
started
to
work
started
my
first
job
people
on
first-name
terms,
people
communicate
very
well
with
each
other
dress
code
doesn't
usually
distinguish
either,
and
it
can
be
really
difficult
to
tell
from
watching
an
interaction.
Just
who's
got
the
power,
but
the
people
in
that
reaction
understand
who
has
it
and
who
doesn't
and
being
more
aware
of
situational
and
positional
power
is
really
important.
M
So
my
longer-term
plans
include
training
for
all
members
of
CQC
and
particularly
managers
and
first-line
managers
in
terms
of
encouraging
people
to
speak
up
and
then
how
to
react
well
when
they
do
as
I
say.
That's
a
sort
of
brief
brief
cancer
through
what
I've
been
up
to
and
there'll
be
a
formal
and
fuller
reports
in
June.
So.
A
Mary
I
look
forward
to
the
full
of
report,
but
can
I
just
say
thank
you
not
just
for
the
presentation
just
now,
but
for
what
you've
been
doing
so
I
know,
you've
put
in
a
huge
amount
of
energy,
I
daresay
a
huge
amount
of
your
personal
time
as
well
and
I
think
the
whole
organization
is
the
better
for
it.
So
thank
you
very
much
what
you've
been
doing.
Anybody
want
to
raise
anything
with
Mary.
I
O
M
A
Okay
Mary.
Thank
you
very
much
again.
Oh,
it's
really
great!
So
from
the
board.
Is
there
any
other
business
that
anybody
needs
to
raise?
So
we've
got
about
four
minutes
for
questions
from
public.
You
were
here,
I
know:
Robin,
you've,
you
you
you've,
given
notice
of
a
question.
Can
I
just
ask?
Is
anybody
else
got
a
burning
question
that
they,
mr.
Hogarth,
how
surprising
and
nice
to
see
anybody
else?
So
we
just
have
the
to
do.
You
want
to
go
first
Robin,
since
you
gave
us
notice
of
your
question.
P
Thank
You
chairman
Robin
Pike,
a
HealthWatch
hartfordshire,
it's
a
question
relating
to
hospital
inspections
and
to
ask
really
how
certain
types
of
patient
experiences
which
cross
over
all
core
services
are
noted
in
the
course
of
an
inspection.
I
have
in
mind,
particularly
the
pharmacy
services,
most
of
which
are
out
sourced,
many
of
which
are
out
sourced
in
hospitals,
and
this
can
involve
quite
a
task
really
for
the
patient.
Who's
generally
handed
a
blue
copy
and
a
pink
copy
of
the
prescription.
P
The
doctor
having
may
help
the
white
copy,
the
patient,
then
queues
at
a
desk
at
the
pharmacy
in
order
to
hand
in
there
and
two
copies
and
takes
a
ticket.
The
ticket
is
numbered
so
that
the
patient
then
waits
for
a
period
frequently
an
hour
in
order
to
obtain
that
the
medication
I
understand
that
in
primary
medical
services,
many
prescriptions
are
electronic.
P
There
other
experiences
relating
to
the
reception
in
a
clinic
where,
in
some
hospitals,
the
patient
can
register
electronically
on
a
pad
in
other
hospitals.
The
patient
will
queue
in
a
corridor
in
order
to
see
a
Harris
receptionist
who
is
looking
from
their
file,
and
that
can
be
sometimes
a
lengthy
wait
and
finally,
a
mention
of
secretarial
services
to
doctors
in
a
hospital
where,
in
some
cases,
the
secretary
doesn't
have
their
own
desk
or
their
own
telephone,
because
the
secretarial
services
are
hot
desk
and
consequently,
it's
very
difficult
for
a
patient
to
contact
a
doctor's
secretary.
D
You
described
my
last
experience
when
I
picked
up
a
prescription
in
the
hospital
exactly
almost
exactly
and
I.
Think
we're
very
well
aware
that
some
of
these
interactions
at
the
front
desk
are
very
important
for
patients
in
terms
of
their
experience
of
care.
We
certainly
do
look
at
these
areas
when
we
inspect
I
think
it's
a
real
challenge
from
you
that
are
we
giving
them
enough
priority
and
I
think
that
that's
something
I
accept
and
take
away.
We
have
pharmacists
who
go
where
and
with
us
and
inspections.
They
look
at
medicine
management.
D
They
also
look
at
the
process
and
one
area
you
haven't
mentioned,
which
I
think
is
particularly
concerned
to
us,
is
the
delay
in
getting
medicines
for
patients
being
discharged
from
hospital,
because
that
needs
that
weight,
but
often
it
delays
their
discharge.
Sometimes
those
days
just
charge
overnight
and
I
think
there
are
it's,
sometimes
the
enormous
delays
and
getting
descriptions
for
patients
to
take
home
and
that's
something
we've
focused
on
and
we
have
challenged
across
the
bat.
D
But
the
outpatient
experience
a
little
more
difficult
to
follow
up,
because
we
do
sitting
out
patients
who
do
watch
what's
going
on.
We
watch
on
the
interactions
between
receptionists
and
and
patients
and
because
we
talk
to
patients
about
it,
and
we
talk
to
self
about
it
and
staff
sometimes
express
great
frustrations
about
about
those
interactions,
and
we
do
reflect
that,
where
necessary
in
our
reports,
both
under
the
key
question
of
caring
and
also
the
key
equation
responsiveness.
D
But
do
we
capture
it
as
well
as
we
cook,
we
could
I
think
that's
a
challenge
you're,
giving
us
and
I
think
it's
a
challenge
and
quite
happy
to
store
a
takeaway
I.
Think
secretarial
services
are
very
important
and
anyone
who's
worked
in
hospital
knows
and
thought
they
are
in
terms
of
the
patient,
experience
and
I.
Think.
D
Sometimes
we
have
challenged
hospitals
that,
if
you
like,
have
downgraded
the
secretary
of
services
and
don't
understand
how
important
they
are
to
patients
in
terms
of
their
contact
with
the
system,
and
sometimes
it's
the
doctors
who
raise
that
with
us
and
point
out
that
actually,
the
patient's
experience
is
downgraded
because
of
secretarial
services,
because
the
patient
often
doesn't
understand
why
their
experiences
is
less
than
satisfactory
because
they
don't
understand
the
internal
hospital
systems.
And
again
we
have
challenged
that
on
occasion
help
you
focus
on
enough.
I'll.
Take
that
away
as
a
charge.
Good.
C
Jones
would
and
made
a
veil.
My
question
goes
back
to
what
Lewis
was
saying
under
the
performance
when
we're
talking
about
performance
and
about
how
it's
more
likely
that
a
mental
health
institution
will
go
up
from
requires
improvement
to
good
acute
trust.
Of
course,
these
sort
of
comparisons
are
important,
or
only
as
important
as
the
validity
of
the
judgments
the
CQC
has
made,
and
I
really
wanted
to
ask
Louis
how
satisfied
he
is.
The
judgments
in
mental
health
area
of
the
CQC
of
making
are
really.
A
Question
by
saying
that
we
put
in
a
lot
of
time
and
effort
in
reviewing
and
understanding
the
judgments
that
were
making
and
there's
a
whole
Quality
Assurance
process,
because
the
central
point
is
not
whether
where
the
services
are
improving
or
not,
but
absolutely
the
point
you're
making
it
is,
can
we
have
confidence
in
the
judgments
and
findings
that
that
we
makes
across
all
all
the
directorates?
This
is
an
important
area.
I,
don't
think
we've
got
perfection
in
this
area,
yet
I
think
strange
enough.
A
I
think
some
of
the
technology
that
we
will
be
adopting
in
the
future
will
will
help
us
further.
So
it's
a
really
important
issue
were
on
the
case.
I,
don't
know
whether
any
of
my
colleagues
want
at
I'm
looking
at
the
chief
inspectors
want
to
add
anything
or
whether
that's
a
brief
summary
of
where
we're
at
techie.
A
D
To
show
you,
there
is
a
very
rigorous
process
to
make
sure
the
ratings
are
consistent
between
one
inspection
and
another.
So
I
think
when
we
demonstrate
that
a
trust
has
changed.
The
rating
I
think
that
is
actually
quite
a
significant
finding
so
and
we
have
a
framework
to
make
sure
that
we
make
these
similar
judgments
in
different
sectors.
So
we
have
we're
very
aware
of
those
issues
and
we
have
a
process
in
place
to
control
a
I'm
sure
Peters
right
that
we're
not
perfect
in
this
regard.
F
B
So
Debbie
could
kind
of
just
say:
I'm
a
published
should
have
said
this
when
Lewis
spoke
I'm
just
trying
to
not
speak
on
every
item.
I
think
there
is
this
challenge
this
morning
and
your
question
is
absolutely
legitimate.
It's
a
question,
I
ask
and
ask
of
myself
continually
about
how
far
is
the
performance
report
would
present
and
the
dirty
and
a
reflection
of
what
we're
finding
or
a
reflection
of
how
were
behaving,
and
how
do
we
begin
to
understand
that
in
a
different
way?
B
So
I
don't
think
this
is
something
we
can
give
a
ready-made
answer
to,
but
our
hope
as
well
as
the
answer
ted
has
given
about
the
quality
assurance.
How
confident
are
we
when
we
say
this
is
good?
It
actually
is
good
based
on
our
methodologies.
I
think
we've
got
stronger
and
better
and
more
effective
at
doing
that
over
the
years,
but
I
think
the
question
that
Luis
asses
earlier
today
that
you're
repeating
and
just
on
Peters
lead.
Let
me
take
it
away
from
individuals,
I
think
it's
a
question.
B
Earlier
today
we
had
a
conversation
in
private
session
about
how
we
evaluate
the
work
that
we
do
are
now
confident
we
can
be
of
what
we
found
and
what
what
I'd
like
to
do
is
not
give
any
kind
of
conclusions
from
that
word,
but
actually
say
it's
a
hugely
important
part
of
our
worth,
going
forward
to
make
sure
that
we
are
a
poor
transfer.
Those
questions,
because
it's
not
just
you
David
that
are
raised
in
the
Melua,
so
I
think
these
are
questions
that
our
stakeholders
ask
as
well
about
consistency,
etc.
B
So
it
good
it's
a
question
that
goes
right
to
the
heart
of
our
credibility
as
a
regulator.
I
think,
do
we
understand
what's
behind
our
numbers
and
what
will
reflection
bike
so
I
hope
it
provides
some
reassurance
Peter.
It's
a
hugely
important
issue.
I
wouldn't
like
to
answer
the
question
you
just
asked
Lewis
about
you
know,
but
I
think
it's
right
that
that
question
and
he's
asked-
and
we
continue
to
work
at
understand
it.
So.