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From YouTube: CQC board meeting – November 2019
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A
Good
morning
everybody
welcome
to
the
November
CQC
public
board
meeting
I,
don't
think
we
have
any
apologies.
Do
we
have
anything?
Anybody
needs
to
declare
any
interest.
We
need
to
declare.
Okay,
that's
good.
As
you
know,
we
have
a
representative
from
one
of
our
equality
networks
at
every
meeting.
Paradism
Barrett,
who
is
the
co-chair
of
our
race
equality
network,
is
here
today.
Farrow
you've
been
before
so
you're
you're.
Welcome,
again
nice
to
see
you
here.
Thank
you
for
coming.
I.
A
Think
that
take
deals
with
the
preliminaries
takes
us
straight
into
the
minutes
of
the
meeting
of
the
16th
of
October.
Are
they
true
and
accurate
record
of
everything
we
discussed
good,
so
they
are
approved
in
the
action
log?
There
are
a
number
of
items
that
are
are
not
yet
do
so.
We
just
need
that
there
there
there
that's
fine
in.
B
Peters
election.
At
the
last
board
meeting,
we
received
a
letter
from
David
Noble
in
relation
to
an
independent
review
that
he's
doing
into
our
2015
review
at
Walton
Hall.
The
expectation
was
that
he
would
present
his
report
to
the
board
at
this
meeting.
However,
due
to
the
pre-election
period,
we
we
are
unable
to
take
the
report
about
this
at
this
meeting,
because
there
are
restrictions
on
all
public
bodies,
as
as,
as
you
will
appreciate,
on
on
the
the
types
of
material
that
can
be
presented
in
public,
so
David's.
A
Thanks,
how
many
it's
worth
saying
that
it's
extremely
disappointing
that
we're
in
this
position,
but
it
is
as
as
you
say
and
I
think
just
worth
also
saying
that
we
set
dates
for
December
and
January
board
meetings
every
year,
because
you
don't
know
what
business
there
will
be,
but
we
normally
aim
to
cancel
the
January
meeting,
because
the
working
time
elapsed
between
December
and
January
isn't
that
great
this
year,
we're
reversing
it.
So
there
isn't
a
meeting
in
December,
but
there
will
be
a
bit.
A
A
B
Thanks
Peter
I
think
that
one
of
the
main
things
that
we
did
that
I
did
this
month
was
that
I
joined
a
number
of
colleagues
in
Parliament
and
we
presented
to
parliamentarians
and
to
members
of
the
House
of
Lords
on
our
state
of
care
report.
As
you
know,
our
state
of
care
report
is
our
annual
review
of
what
we
believe
the
state
of
care
in
Health
and
Social
Care
is
I
think
that
was
a
successful
event,
as
always
lots
of
lots
of
interest
from
from
those
present.
B
C
D
Thank
you
so
just
update
on
in
my
report
on
at
the
work
we're
doing
on
regulation
of
carrying
closed
environments
following
Wharton
Hall
and
our
interim
report
on
our
Aris,
the
RSS
restrictive
practices
report.
So
it's
since
last
board
meeting
we
have
published
our
guidance
on
inspecting
closed
environments.
That's
been
well
received
by
inspectors
and
is
being
used
on
the
grounds.
D
That's
that
guidance
emphasized
the
importance
of
a
human
rights
approach
and,
of
course,
that
was
reinforced
with
the
report
that
came
out
from
the
Joint
Committee
on
Human
Rights,
which
drew
heavily
on
our
interim
report
and
came
forward
with
some
further
suggestions
of
how
we
can
tighten
up
our
inspection
protocols.
We
will
obviously
be
looking
at
that
going
forward
in
the
work
we're
doing
building
on
what
we've
learned
so
far,
but
also
the
the
findings
and
recommendations
of
the
two
independent
reports
that
are
in
progress.
D
We've
just
discussed
one
of
them
and
we
clearly
would
incorporate
that
into
the
work
we're
doing.
Last
week.
There
was
the
second
of
the
expert
stakeholder
summits
from
the
RSS
review
in
Bristol,
which
was
organized
by
British
Institute
of
learning
disabilities
and
that
really
was
well
attended
and
I
thought
very,
very
interesting
it.
Some
of
the
suggestions
coming
forward
will
be
building
that
and
the
advice
of
my
expert
advisor
report
into
the
report
that
we'll
be
publishing
the
final
importance
of
publishing
in
March
of
next
year.
D
I
think
I
take
away
from
that
the
importance
and
what
I
said
at
the
event,
a
strong
commitment
to
the
people
there.
That
is
it
important
that
this
report,
when
it
comes
out,
is
not
just
another
report
that
says
that
describes
the
very
unsatisfactory
care
project
in
some
of
these
environments,
but
a
report
that
is
really
going
to
make
a
difference
and,
as
we
come
to
looking
at
the
recommendations,
we're
going
to
make
in
that
report,
I
think
is
very
important.
We
focus
on
what
recommendations
are
really
going
to
change.
D
This
theme
did
the
circumstances
that
leads
to
these
restrictive
practices
and
the
what
we've
seen
in
these
various
reports
can
I
also
highlight
that
we'll
be
publishing
shortly.
The
survey
on
the
community
of
patients
experiencing
community
mental
health
services-
that's
something
we
publish
on
a
regular
basis
and
they're
interesting
findings
this
year
that
will
be
published
in
the
next
couple
of
weeks.
Time.
E
Thank
you
and
yeah
I
just
wanted
to
welcome
both
the
revised
guidance
and
the
process.
That's
ongoing,
including
the
event
that
was
the
summit
hosted
by
the
British
Institute
for
learning
disabilities
and
really
to
support
what
I
just
said
about
the
importance
of
our
recommendations,
being
quite
specific,
for
particular,
who
exactly
needs
to
do
what
exactly
to
make
sure
that
action
really
happens
and
that
it's
tracked
and
that
there's
accountability,
because
at
the
moment
the
you
know
there
are
a
number
of
people
raising
huge
concerns
about
these.
E
These
issues
for
people
and
people's
human
rights,
and
so
that
there's
an
alignment
there
there's
an
opportunity
for
some
real
change
to
happen
and
I
think
we
need
to
really
sort
of
seize
that
opportunity.
I've
just
got
one
question
if
I
may,
which
is
our
our
review
into
restrictive
practices,
does
touch
on
the
experience
of
people
with
mental
health
conditions
as
well
as
people
with
learning
disabilities
and
autism
and
I
just
wondered
whether
what
process
we
will
have
for
looking
at
the
recommendations,
kind
of
the
big
focus
on
people
learning
disabilities.
E
D
You
Liz
and
I'm
grateful
for
your
support.
I
think
it's
important
that
we
do
make.
This
report
really
count
to
make
a
difference,
not
just
for
people
with
learning
disabilities.
Autism
I
mean
they've,
been
a
strong
focus,
but
for
all
all
people
who
are
careful
in
closed
environments
where
restrictive
practices
are
used
to
make
sure
that
they're
not
used
in
a
fair
and
focusing
on
the
human
rights
of
people
involved.
So,
yes,
the
report
must
cover
all
that.
D
Certainly,
if
issues
are
raised
with
us,
then
even
if
they're
raised
by
someone
in
calm
or
we
can
take
it
up
with
our
team
in
say
the
north
of
England,
where,
where
the
the
individual
may
actually
be
so
I,
think
that's
an
issue.
But
there
are
clearly
is
an
issue
around
commissioning
of
these
services.
Not
often
the
commissioners
are
a
long
way
away
from
these
services
and
I.
D
Think
one
of
the
characteristics
of
these
environments
often
is
that
the
people
in
in
in
in
the
service
are
often
commissioned
by
lots
of
different
commissioners,
and
so
there's
no
one
oversight,
commissioning
and
I.
Think
that's
something
we
will
want
to
look
at
in
our
in
our
report.
How
do
we
bring
that
together?
So
the
oversight
not
just
for
us
as
the
regulator
on
the
daily
basis
from
the
commissioners
and
other
people
involved
in
the
care
of
these
patients
is
sufficient
to
focus
on
the
overall
picture
of
care
in
that
in
that
organization.
A
Anything
else
on
report
shall
we
move
on
to
the
performance
report.
Chris
I'm,
not
sure
whether
this
has
been
communicated
to
you
but
Kirsty
and
I
agreed
that
we'd
start
with
you
and
then
then
what
I
heard
I
finally
awkwardly
just
getting
ready
and
then
then
obviously
Kirsty,
but
what
I
suggest
that
we
do
is
aboard
when
we've
had
any
introductory
remarks
from
Chris
and
Kirsty
he's
actually
just
turned
the
pages
of
the
slides
one
by
one
and
the
reason
I
want
to
do.
A
G
G
G
And
inspections
in
in
PMS
and
hospitals
continue
deliver
commitments
overnight.
Percent
of
inspections
within
KPI
requires
improvements.
Fashion
PMS
is
dropped
to
79
percent
in
month
of
September
in
ASC
continue
deliver
an
article
in
requires
improvements.
Inspections
within
KPI
and
Bob
returned
to
good
and
outstanding
drop
below
KPI
this
month.
G
G
Reports,
eighty
nine
percent
report
has
been
published
with
a
KPI
near
in
total
nine
percent
air
saying
PMS
continued
performed
above
target
hospital
performance,
increased
improved
steadily
throughout
q2,
but
fifty-six
reports
published
in
KPI
on
September
second
highest
this
year
on
Finance
I'll,
say
few
words
on
Finance.
So
it
concerns
early
in
the
about
financial
position.
G
We
had
an
overspend
and
when
were
projecting
novice
phone
for
the
end
of
year,
we're
currently
under
spent.
Now
following
action
with
tick
and
in
our
executive
team,
we
have
2.7
billion
under
spend
and
protecting
it.
Nor
point
two
million
variants
at
the
end
of
the
year,
they're,
probably
the
highlights
to
pull
out
and
to
pass
it
over
to
others
to
talk.
A
So,
just
on
the
finance
I
think
it's
not
quite
at
the
end
of
the
year,
yet
so,
but
but
I
think
it's
a
really
good
example
of
knowing
where
we
were
taking
taking
the
early
action
and
and
if
you
are
within
a
couple
of
hundred
thousand
at
the
end
of
the
year,
a
plus
or
minus,
on
a
on
a
budget
north
of
a
hundred
million.
You
know,
that's
that
that's
a
that's
a
really
good
achievement.
So
congratulations
to
you,
Chris
for
driving
the
team
to
take
the
necessary
action
to
get
back
on
on
the
track.
A
Let's
because
anything
you
want
to
add
at
the
station,
we
are
yeah,
we
are
so
if
we
get
it,
if
we
get
a
slide
four,
which
is
the
the
first
one
I
think
where
we're
talking
about
registration
and
and
a
notice
is
a
huge
amount
of
working
on
a
registration.
But
but
we
are,
we
are
behind
performance
or
on
every
level.
H
I
A
registration
there
is
an
awful
lot
of
work
going
on
what
we
have
done
in
registration
is.
We
have
changed
our
operating
model
slightly
in
that
we
have
split
out
operations
and
Quality
Assurance
under
two
separate
teams.
So
in
terms
of
the
operations
piece
now
we
are
starting
to
look
at
this
end
to
end.
I
We've
got
a
big
piece
of
work
that
we're
doing
to
understand
what
our
back
dog
is
and
registration
and
what
we're
doing
now
is
focusing
on
clearing
down
some
older,
older
applications,
which
is
meaning
that
our
performance
is
taking
a
dip
because
we're
trying
to
get
on
top
of
that
backlog
that
has
built
up.
We
are
so
reorganizing
ourselves
and
managing
work
now,
according
to
risk,
and
also
trying
to
get
this
backlog
down,
which
which,
which
will
mean
over
between
now
and
and
the
end,
the
last
quarter
of
this
year.
I
We
expect
to
see
performance
dip
slightly
as
we
as
we
start
to
address
this.
We
are
looking
at
developing
some
new
new
kpi's
so
that
we
can
start
to
separate
out
the
complexity
around
registration.
At
the
moment,
one
KPI
is
covering
all
activity
that
doesn't
set
distinguish
between
the
more
complex
ones
that
take
longer
and
their
shorter
ones
that
we
can
do
quickly.
I
So
we
are
starting
to
look
at
that
and
from
next
from
I'm,
very
confident
than
from
April
under
the
knee
kpi's
will
see
a
real
improvement
in
performance,
so
I
think
if
I
could
just
ask
people
to
bear
with
us.
Whilst
we
address
some
of
these
issues
that
we
are,
we
are,
we
had
discovered
in
our
servicing
and
addressing
you
know,
really
consistent
its
rayona
in
a
concentrated
and
a
consistent
way
to
really
drive
up
performance
for
the
longer
term.
He.
A
C
Thank
You
Kirsty,
when
we've
looked
at
these
previously
I,
was
reassured
that
the
refusal
rate
was
coming
down,
which
was
consistent
with
the
new
way
of
working
and
doing
things
differently,
and
ultimately
the
others
figures
would
start
to
follow.
What
disconcerts
me
about
this
set
of
figures
is
the
rise
in
the
refusal
rate,
which
seems
to
indicate
that
the
attempts
to
have
people
will
do
the
forms
in
advance,
properly,
etc,
etc.
May
not
be
quite
them
quite
working
to
plans
so.
I
I
think
that
this
is
another
one
of
the
issues
with
these
set
of
slices.
Is
that
they're
not
terribly
clear
so
the
refusal
rate,
the
yellow
line
at
the
bottom,
is
actually
how
long
it
takes
us
to
progress
to
to
demand
to
deliver
food.
Not
a
number
of
refusal
so
actually
on
that
slide
is
getting
better,
but
what
we,
what
we,
if
you
look
at
the
refusal
rate
on
the
sides,
much
as
we've
got
them
on
here,
but
you'll
see
that
we
have
made
massive
improvement
on
our
refusal
rates.
I
We've
gone
from
I
think
off
the
top
of
my
head.
They
were
about
about
34
percent
on
average
in
terms
of
applications
were
refused.
We've
now
got
that
down
to
think
off
the
top.
My
head,
it's
around
18%
I'll,
look
at
it
and
confirm
in
a
minute,
so
we've
made
him
read:
we've
done
a
big
Qi
program
around
refuses
and
we
have
made
real
that.
B
Okay,
so
yeah
just
do
it
just
right.
I
think
what
quezon
I've
been
talking
about
is
how
to
create
a
set
of
measures
for
the
board
that
do
reflect
that
much
more
nuanced
position.
That
Kirsty
was
describing
cuz
I
I
did
I
think
actually,
the
this
this
graph
probably
doesn't
reflect
the
experience
of
people
who
are
trying
to
be
registered,
whereas
there's
a
set
of
numbers
that
Kirstin
the
team
are
working
on,
which
I
think
will
give
us
a
much
more
sensible
view
and
we'll
be
able
to
answer
the
sorts
of
questions
from
from
this.
A
J
We've
had
some
issues
that
have
identified
that
some
locations
have
ceased
trading
and
providing
regulated
activities
because
we've
taken
action.
But
then
the
registration
processes
haven't
been
completed.
So
another
data
issue,
we've
identified
that
some
of
the
teams
were
not
clear
about
the
the
rules
around
returning
to
requires
improvement
with
one
inadequate
within
six
months,
and
we've
dealt
with
that.
We've
sent
our
communications
around
that
and
there
was
also
some
an
issue
about
the
the
impact
of
enforcement
and
how
that
works
with
returns.
J
So
all
of
those
issues
that
we've
identified
are
being
worked
through,
we're
putting
in
plans
in
place
to
deal
with
those,
and
the
teams
are
working
on
that
at
the
moment.
I
guess.
The
other
thing
that
we
need
to
mention
here
is
that
some
of
the
factors
related
to
this
they're
external
factors.
So
we
working
hand-in-hand
with
our
local
CCG
partners
and
in
some
cases
the
CCG
might
say
to
us,
can
you
leave?
Can
you
leave
an
inspection
for
for
a
month
or
so
before?
J
We
you
come
in,
because
there
are
various
factors
and
we
work
with
our
partners
to
work
out
what
the
best
time
is
to
go
back
in.
So
that
does
have
an
impact
as
well,
and
we
we
anticipate
at
you
that
this
these
are
very,
very
small
numbers
and
we
anticipate,
for
example,
in
in
January.
There
will
be
a
specific
it's
like
dip,
because
we've
been
asked
related
to
a
complex
provider
where
some
of
our
inadequate
practices
are
related
to
another
provider.
A
A
F
You
can
I
ask
some
related
questions,
the
slide,
which
is
when
you
look
at
the
outstanding
and
good
and
the
good
ones
in
particular,
I
guess,
because
we've
done
320
inspections
of
the
results
of
those
inspections.
Do
you
do
we
in
terms
of
maintaining
the
ratings?
Do
we
know
what
that
shows
in
terms
of
there's
any
sort
of
decline?
Overall,
yes,.
J
Listen
we're
seeing
a
huge
movement
actually
in
the
ratings
across
primary
medical
services
and
in
our
good
and
outstanding
practices.
We
are
seeing
about
17%
deterioration
in
those
good
and
outstanding
practices
to
requires
improvement
or
inadequate.
So
there
is
quite
a
movement
we're
seeing
movement.
The
other
way
so
I
know
adequate
and
and
requires
improvement
practices
are
improving
and
there's
a
there's,
a
whole
range
of
reasons
for
that
I
think.
Firstly,
we
know
which
we
outlined
in
the
state
of
care
report.
J
We
know
that
there's
a
huge
increase
in
demand
and
a
huge
capacity
issues
across
general
practice.
At
the
moment.
We
know
that
there's
workforce
shortages
and
pressures
from
that
point
of
view,
and
we
also
know
that
there's
there's
a
lot
of
changes,
because
in
the
in
the
primary
care
landscape,
perhaps
there's
a
emerging,
some
perhapses
are
taking
over
failing
practices
and
that
can
have
a
short-term
impact
on
my
ratings.
F
A
K
However,
performance
has
improved,
notably
during
October,
so
we
were
down
to
about
seventy
percent
within
KP
I've
returned
to
good
in
September,
we're
up
to
eighty
nine
percent
in
October
and
drilling
down
into
that
three
of
my
regions.
So
South
are
so
London,
Central
and
North
are
well
into
the
90s.
We
have
some
particular
challenges
in
the
South
Region,
so
they're
about
77%
of
return
to
good
ratings,
and
this
translates
to
some
real
challenges
around
recruitment
and
retention
within
within
the
patch.
K
So
we
currently
have
eleven
inspector
vacancies
in
the
South,
six
of
which
we've
recruited
two,
but
they
haven't
started
yet
and
when
we
get
to
a
conversation
about
turnover,
I
also
have
notably
higher
turnover
rates
within
the
South
Region
as
well.
This
has
been
recognized
and
the
piece
of
work
that
your
Nicholson's
lead
you
and
around
are
people
thinking
about
our
kind
of
people
strategy.
K
The
the
issue
that
I
think
a
number
of
us
across
the
directorate's
experience
around
recruitment
and
retention,
particularly
in
the
southeast,
will
be,
will
be
focused
on,
but
returning
to
this,
yes
there's
improved
performance
with
in
October
with
a
risk-based
approach
to
which
inspections
we
are
bringing
forward
to
make
sure
we
are.
We
are
targeting
our
efforts,
effective,
easy.
D
This
is
in
the
context
of
the
tight
financial
planning
that
we've
had
that
we
discuss
where
we've
achieved
financial
targets
as
well,
so
I
think,
if
I
doubly
proud
of
what
the
work
they've
done
there
I'd,
but
just
just
behind
this,
just
just
to
focus
that
that
I
suppose
moving
forward
it's
a
new
financial
year
I
would
like
a
bit
more
Headroom
in
the
inspection
teams,
to
focus
more
on
risk
to
be
more
reactive
rather
than
to
be
just
tan,
tabled
in
and
I.
Think.
D
One
of
the
things
we
need
to
move
forward
from
is
a
is
very
timetabled
approaches
we
go
back
after
so
many
times,
depending
on
the
rate,
the
rating
to
one
where
we
can
be
more
responsive.
In
truth,
at
the
moment
we
are
doing
more
responsive
inspections
and
previously-
and
that's
been
Minh
in
this-
which
I
think
is
encouraging,
but
I
think
we
need
to
be
more
flee
to
force.
And
you
know
one
of
the
recommendations
of
the
JCAHO
report
was.
We
need
to
be
more
fleet
of
foot.
A
E
A
A
L
I
think
probably
where
you
have
things
outside
kpi,
it
will
be
because
an
issue
arises
which
is
at
the
margin
of
the
statutory
risk
of
harm
test,
and
it
requires
a
longer
process
to
establish
baseball,
basically,
the
level
of
urgency
so
sometimes
I
think
these
cases
are
clear-cut,
but
sometimes
they're
not
and
we
we
may
have
to
have
more
than
one
visit.
For
example,
you
know
so
it
may
reflect
an
inspection,
but
then
we've
had
a
timetable
in
going
back
to
gather
further
evidence.
Meishan
I
think
that's
probably
what
the
picture
shows
and
I.
A
L
A
L
And
I
think
also
because
these
show
outcomes
they
don't
show
when
the
issue
started.
So
you
have
some
cases
where,
if
we're
not
taking
action,
that's
version
action.
You'll
have
some
cases
where
you
start
a
case,
but
it
hasn't
finished.
So
if
you
look
to
September
and
you've
got
that
figure
54
those
those
might
be
cases
which,
if
we
come
to
November
December,
actually
they
would
be
concluded
and
the
figure
would
look
different.
But
some
are
so.
L
A
C
John
Rebecca,
if
I,
could
just
go
back
to
the
enforcement
action
on
the
tank
within
three
days
version:
two
enforcement
under
32
percent
that
are
outside
Keith,
KPI
and
you've.
Given
us
an
impression
of
why
I
think
that
is
the
case,
I
mean
in
reality,
that's
hundreds
of
people
who
are
in
places.
We
don't
think
they
should
be
in
or
receiving
care
that
we
don't
think
they
should
be
receiving.
K
If
I
can
endeavor
to
answer
this,
but
I
might
just
come
back
to
kind
of
make
this
a
bit
more
concrete,
so
I
think
I
think
this
is
about.
Our
inspectors
are
taking
action
in
a
timely
way,
but
what
they
are
doing
is
they
are
not
going
through
the
process
that
we've
established
for
them.
So
my
understanding
is
when
there's
a
need
to
take
enforcement
action.
K
There's
a
process
by
which
the
NCSC,
the
national
contact
center
actions,
something
on
the
inspectors
behalf
the
inspectors
aren't
going
through
that
route
and
efforts
not
being
recorded
and
hitting
kpi.
What
they're
doing
is
it
might
be
a
Friday
evening.
They
want
them
to
take
action
and
then
form
the
provider
there
and
then
and
they're
going
the
direct
route,
which
is
telling
the
provider
directly
so
I.
K
I
I
can
agree.
I
can
support
that
assumption
that
we
are
doing
some
works
that
are
kept.
That
sort
of
the
coward
closed
these
out,
to
make
sure
that
our
data
caches
with
the
actions
that
we've
currently
got
and
there's
a
bit
of
a
project,
look
at
how
we,
how
we
recall
better
and
whether,
if
whether
we
do
need
to
use
ncsc
in
this
space
or
we
can
actually
look
at
whether
it
can
just
be
done
by
inspectors.
I
E
Yes,
thanks,
I
mean
I
think
it
would
be
useful
to
keep
an
eye
on
this
in
in
the
board,
but
also
just
to
say
that
in
the
regulatory
Governance
Committee
we
have
got
in
our
forward
plan,
timetabled,
a
more
in-depth,
deep
dive
and
looking
at
enforcement
overall
I
think
from
memory,
that's
in
not
till
March.
So
we
need
to
keep
an
eye
on
this
at
before
that,
but
we
can
certainly,
after
that
report
back
to
the
board
as
well
or
lately,
overall
position
on
enforcement.
Thank.
A
C
Not
willingly,
but
the
run,
chart
and
I
haven't
got
it
in
big
enough
scale
to
be
absolutely
certain
about
this,
so
I'm
deferring
to
Rosie's
analysis.
But
it
looks
to
me
as
though
there
has
been
a
slight
system
worsening
over
the
past
few
months,
rather
than
just
not
some
month,
variation
and
I.
Wonder
if
you
could
just
comment
whether
I'm,
right
or
on.
J
And
it's
it's
very
astute
because
actually,
when
we
see
the
report
next
month,
actually
it's
we
have
got
a
dip
in
the
October
performance.
There
is
a
dip,
sadly
under
KPI
to
88%,
with
our
report
timescales.
I
think
this
is
probably
multifactorial.
So,
firstly,
our
teams
have
been
under
huge
pressure
this
year,
but
for
a
variety
of
reasons,
one
being
the
introduction
of
the
annual
regulatory
review
process,
which
is
a
good
process
to
have
a
more
regular
review
of
what's
happening
within
practices,
but
initially
that
certainly
was
triggering
more
inspections
than
we
anticipated.
A
John,
it
was
you
that
was
pushing
us
to
have
this
rum
rate
trend
data.
So
thank
you
on
to
hospitals,
I
mean
good
progress.
Ted
it
just
occurred
to
me
would
be
would
be
helpful
to
start
having
some
some
data
around
the
letters
because,
though,
that's
a
really
important
initiative
in
hospitals
and
it's
not
actually
in
our
data
yeah.
D
No,
we
don't
report
here
on
the
letters
but
but,
as
you
know,
in
order
to
make
sure
that
issues
are
raised
in
a
timely
way,
we
do
write
out.
We
do
write
feedback
letters
to
trust
and
ask
them
to
discuss
them
at
their
public
boards
so
that
they
are
in
the
public
domain
that
we
have
made
some
progress
here,
but
it's
month-on-month
progress,
I,
think
John's.
Looking
at
me
and
now
she'll
say
straight
away.
D
If
you
look
at
the
run
chart
I
am
Not
sure
we've
changed
the
game
yet
so
so
so
I'm
not
going
to
claim
that
we've
turned
the
corner
on
this.
We
are.
There
is
a
now
well-established
Quality,
Improvement
Program,
looking
at
this
work
and
there's
a
lot
of
things
that
it
is
doing.
First
of
all,
learning
from
some
of
my
colleagues
and
the
other
directorates.
It
is
about
simplifying
the
report
structure,
because
I
think
our
reports
are
unnecessarily
complex
and
people.
People
will
say
that
they
are
very
repetitive
and
I.
Think
that's
a
fair
comment.
D
In
many
ways
we
tried
to
make
more
things
to
all
people
and
I
think
we
just
need
to
simplify
them.
The
other
thing
that
they're
looking
at
is
is
through
the
evidence
appendix
because,
as
those
of
you
who've
seen,
our
reports
will
know
that
they
there's
a
summary
report
with
a
which
is
relatively
short,
not
very
short,
but
as
if
they're
short
and
often
a
very
long
evidence
appendix
which
has
all
the
evidence
behind
the
report
in
it,
and
we
feel
we
can
simplify
the
evidence
appendix
we
need
their
evidence
to
back
up
our
report.
D
But
we
don't
need
necessary
to
publish
in
a
narrative
form
in
the
way
we
do
at
the
moment.
We're
also
looking
at
the
quality
assurance
arrangements
to
make
it
make
sure
they're
effective,
but
not
over
ever
time-consuming
and
I.
Think
that's
where
to
do
on
that
and
just
come
back
to
something
Rosie
was
talking
about
in
terms
of
the
digital
publisher.
D
We
didn't
work
on
that
as
well,
because
there
are
sometimes
delays
caused
by
problems
with
digital
publisher
right
at
the
time
we
publish,
which
sometimes
can
take
at
a
few
days
or
week
or
so
to
the
the
report.
Timeliness
so
I
think
there's
a
whole
series
of
things.
We're
focusing
on
at
the
moment.
I
am
confident
they
will
make
a
big
difference
and
that
work
is
progressing
quite
at
quite
a
pace.
So.
A
Just
on
the
on
the
letters
I
mean
III
would
like
to
know.
Firstly
that
we
are.
We
are
hitting
the
target
of
getting
letters
out
within
two
weeks.
Well,
then.
Secondly,
though,
that
we
get
confirmation
that
the
next
available
public
board
meeting,
the
trust
has
made
made
it
available,
because,
fundamentally,
that
letter
is
for
the
public
and
if
it's
not
made
available
to
the
minutes,
is
it
some
lost
its
purpose?
We.
C
Okay,
thank
you
for
making
the
point
that
I
was
going
to
make
to
you,
but
as
as
you,
as
you
know,
we
raised
this
issue
since
I've
been
on
the
board,
and
this
is
becoming
a
bit
like
the
waiting
for
god,
o
charts,
if
I'm
being
a
little
unkind
that
when
we
talked
previously
in
the
oh,
he
gave
us
a
date
of
July
that
things
would
start
to
pick
up.
So
what
is
the
new
date
that
you
expect?
The
work
which
I
know
is
going
on
will
actually
make
us
see
a
system
change.
D
Well,
you're
right,
John
that
that
we
were
hoping
to
turn
it
around
earlier
on.
Then
we
made
some
progress,
but
that
was
not
sustained
I
think
with
the
weight
of
work
which
I
have
reported
earlier
on.
I
think
the
work
going
at
the
moment
will
make
a
difference
because
we
are
taking
a
much
more
systematic
quality.
Privat
approach
to
it.
I
am
cautious
about
giving
you
a
time
scale.
D
A
A
K
K
The
average
of
our
reports
are
published
within
26
days
and
there
was
a
real
focus
on
reports
that
are
outside
of
that
kind
of
median
range
too.
For
us
to
be
assured
that
there's
a
clear
rush
now
and
often
it's
a
discussion
with
the
provider
around
factual
accuracy
and
and
that
kind
of
piece
away.
But
we
are,
we
are
holding
steady
at
KPI
at
the
moment
on
this
I.
A
M
We
we've
had
a
recent
uptick
in
time
loss
to
IT
issues
due
to
a
couple
of
teething
issues
that
we've
had
one
one.
One
large
one
was
with
the
migration
of
air
about
SharePoint
about
the
files
from
an
old
file
server
into
SharePoint,
with
with
all
the
regeneration
work
that
we're
doing
around
digital
foundations,
etc.
We
anticipate
that
this
will
will
be
significantly
improved,
although
that
work
is
is
happening
between
now
over
the
next
six
months.
So,
but
would
it
would
expect
with
it
with
the
work?
A
B
4,000
email,
accounts
onto
Microsoft,
Office,
365
I,
think
was
something
like
40
million
files
were
migrated
over
the
course
of
a
weekend,
and
that
was
the
consequence,
so
I
think
then,
given
what
we've
achieved
over
the
last
really
over
that
over
the
last
six
weeks
or
so
I
believe
one
would
normally
have
expected
a
much
greater
disruption
than
it's
been
as
evident
here
and
actually,
in
a
number
of
these
cases,
we
were
able
to
continue
to
work
this.
This
was
not
necessarily
about
the
whole
organization,
stopping
so
so
I
think
I.
B
Think
if
you
take
this
in
the
round,
I
think
what
this
represents
is
a
significant
improvement
in
our
in
our
capability
from
a
technology
point
of
view
and
I
think
you,
as
mark
describes
what
you
will
see
over
the
course
of
time
is.
That
is
this.
Is
this
really
significantly
reducing?
If
you
recall
this,
this
chart
was
put
in
some
years
ago
because
of
consistent
outages
across
the
infrastructure,
consistent
inability
of
inspectors
to
get
into
infrastructure
over
over
an
extended
period
of
time
and
and
I.
Don't
think
this
really
reflects
that
at
all.
E
A
I
I
Our
vacancy
factor
is
around
where
we
would.
We
said
it
would
be
less
and
5%.
We
use
that
to
help
manage
budget
variances
within
within
here
and
that's
about
where
we
would
expect
it
to
be.
There's
nothing
I'm
particularly
worried
around
there,
and
if
you
look
at
our
sickness
by
sickness,
still
is
around
our
target
with
3.7
percent
sickness
across
the
piece
which
I
think
is
it's
pretty
good.
I
To
be
honest,
I
expect
next
balance
the
month
after
we
also
see
a
slight
peak
with
seasonal,
seasonal
flu,
and
things
like
that,
but
at
the
main
sickness
is
where
we'd
expect
it
to
be
people
in
learning.
That's
justice
of
showing
this
is
a
combination
of
mandatory
training
or
annual
training,
and
also
some
mandatory
training
that
people
have
to
just
do
once
across
the
piece
and
again,
I
think
we're
the
key
ones
we
want
to
keep
an
eye
on
in.
Here
is
all
the
training
around.
I
Afraid's
good
the
work
around
our
values
in
terms
of
information
security,
and
we
keep
a
track
on
that
to
make
sure
that
that
that
happened,
we
get
it
that
done
and
we
get
the
levels
that
we
need
to
get
not
to
provide
the
assurance,
the
Information
Commissioner,
and
we
will
that
has
to
be
completed
by
April
next
year.
So
that's
on
track.
That's
all
I
wanted
to
say
on
that.
Thanks.
C
Does
anybody
want
to
John?
Thank
you
very
much.
Yeah
I'm,
just
looking
at
the
turnover
range
and
I
always
regard
turnover
as
a
bit
like
the
visible
bit
of
the
iceberg,
and
whilst
it
is
within
range,
I
also
think
there
may
be
a
rising
trend
amongst
the
operational
directorates
in
turnover
and
I.
Just
think
it's
worth
as
just
noting
and
and
cautioning,
and
keeping
an
eye
on
that
in
order
that
it
doesn't
go
and
in
a
sense,
vaguely,
related
and
and
Alaska.
C
I
The
staff
survey
is
open
at
the
moment
and
is
currently
running
until
I
think
mid
December,
and
we
anticipate
we'll
get
early
results
in
January.
So
I'm
not
entirely
sure
once
that,
when
that
full
analysis
will
have
been
done,
it
will
come
to
the
board,
but
I
anticipate.
It
will
be
back
last
backend
quarter
of
this
financial
year,
I
mean.
A
A
J
Just
to
let
you
know
that
we've
been
doing
a
dig
dive
with
deep
dive
into
our
turnover
because
of
the
rising
trend
in
the
PMS
Directorate.
Quite
a
significant
proportion
of
that
is
related
to
retirement,
and
we
are
monitoring
that
so
but
and
I
think
also
it's
probably
a
reflection
that
we've
been
running
the
program
now
for
five
years
or
so,
and
sometimes
that's
a
point
where
people
want
to
change
though,
but
we
are,
we
are
monitoring
on
a
regular
basis.
I'm.
N
Sorry
I
know
Marcus
you're,
a
different
point:
okay
mark
on
I'm
chairman,
just
building
on
John's
point
I,
just
wonder
whether
it
wouldn't
be
helpful
for
us
to
see
once
a
quarter
or
some
regular
period
turnover
for
service
of
less
than
two
years.
I
mean
that's,
usually
has
some
big
spikes
in
it
and
it
would
just
be
I
know
we
tracked
this
in
new
organization,
we're
good
for
the
board
just
just
to
see
that
I
do
have
another
point
and
just
in
terms
of
the
reducing
the
vacancy
factor
can
I.
N
I
N
I
So
we
do,
we
do
track
separately
portfolio
posts
and
we
track
the
length
of
time
to
to
fill
those
posts.
So
we
can
see
whether
we're
getting
better
or
it's
taking
longer
to
feel
particularly
hard
to
fill
posts.
I
haven't
got
details
in
front
of
me,
but
I
know
we
are
making
real
improvements
around
how
quickly
we're
taking
to
get
people
into
those
roles.
I
N
K
K
So
so
for
me,
there's
something
about
when
we,
when
we
think
about
our
people,
play
enough
people
strategy
landing,
that
we
understand
that
regional
variation,
but
also
to
give
board
assurance
around
exit
interviews
and
how
we
are
compiling
that
information,
so
that
we're
learning.
So
it
might
be
that
there
will
be
a
proportion
of
people
that
are
leaving
because
of
retirement.
I
know
when
I've
spoken
to
some
inspectors.
K
They
talked
about
I'm,
going
to
work
with
providers
and
being
able
taking
on
that
kind
of
quality
role,
so
I
think
for
me,
it
might
be
helpful
for
us
to
discuss
at
board
how
we're
using
that
data.
When
people
leave
the
organization
to
help
us
think
about,
do,
we
need
to
be
doing
anything
different
than
how
we
how
we
manage
our
star.
A
B
B
On
behalf
of
on
behalf
of
the
people
that
use
services,
change
and
improvement,
that's
really
an
issue
which
we've
largely
touched
on
earlier
in
the
meeting
around
around
resourcing
change,
the
change
programs
and
the
fact
that
we
have
got
a
significant
and
fairly
sophisticated
program
of
change
with
a
number
of
moving
parts
and
a
number
of
interdependencies
within
those
moving
parts.
So
clearly
that
is
a
the
risk
of
one
part.
One
part
falling
behind
and
then
impacting
on.
B
The
rest
of
the
program
is
also
obviously
significant
and,
finally,
the
general
election
I
think
this
is
just.
This
is
recognition
that
again,
because
a
number
of
our
decisions
have
to
be
played
through
the
Department
of
Health
and
Social
Care
and
through
and
through
wider
government.
Things
like
sign
offs
for
business
cases
for
investments
when
that,
when
there's
when
there
isn't
when
when
when
government
is
in
transition,
as
it
is
at
the
moment
that
that
can
sometimes
lead
to
delays
in
some
of
the
the
programs
have
changed.
B
A
A
A
L
B
So
if
I
just
say
a
few
words
on
each
of
those
topics,
and
then
then
perhaps
we
can.
We
can
discuss
them
if
necessary,
but
I
think
if
I
look
at
slide,
six
I
think
what
the
first,
what
the
first
slide
does
in
relation
to
whistle
blows.
It
shows
a
substantial
year-on-year
increase
in
in
in
people
contacting
us
with
information.
That's
fourteen
and
a
half
percent
increase
on
last
year,
which
is
an
increase
which
we
didn't
of
itself
was
about
a
ten
percent
increase
on
the
previous
year.
B
There
are
a
number
of
factors
that
we
think
might
contribute
to
that.
One
of
them
is
the
fact
that
the
more
action
we
take
and
the
more
public
action
that
we
take
on
them
as
a
result
of
whistleblowing
the
more
people
that
ring
and
talk
to
us,
because
they
believe
that
when
they
do
ring
us,
then
action
will
be
taken.
So
there's
there's
a
sort
of
that
the
pump
is
priming
itself.
B
If
you
will
I
think
also,
we
we've
we've
launched
a
give
feedback
on
care
service
this
year,
which
is
a
completely
revised
version
of
our
online
feedback
and
when
we
do
believe
from
from
from
the
early
early
results
that
we've
seen,
that
has
made
a
very
significant
improvements
on
on
the
what's
called
the
completion
rate.
So
under
the
old
system
about
ten
percent
of
people
that
began,
the
transaction
actually
completed
it.
B
So,
in
other
words,
we
we
know
we
heard
we
hear
something
today
and
we
are
going
through
and
and
re
inspecting
tomorrow
and
that's
the
large
extent,
because
an
awful
lot
of
what
we
receive
is
anonymous
or
it's
partial
information.
So
it's
quite
difficult
sometimes
to
get
to
the
bottom
of
exactly
what's
what's
required,
so
we
may
need
to
go
back
and
understand.
B
So
so,
if
you,
if
you
go
to
assistance,
advice
bureau-
and
we
talk
about
concern
around
health
and
it's
appropriate
for
us
to
to
get
that
information
to
come
to
us,
they
will
feed
that
to
us
and
I.
Think
colleagues
in
HealthWatch
as
Robert
will
know
very
well,
do
exactly
the
same,
so
so.
I
think
that
relationship
with
other
other
organisations
is
an
important
part
of
this
story.
B
As
well,
we
know
that
we
do
need
to
improve
what
we
do
so
there's
again
in
the
slide
deck
there's
a
number
of
actions
that
were
taking
around
how
we
improve
the
overall
experience
of
somebody
that
comes
to
talk
to
us.
So
at
the
moment
we
in
order
to
try
and
preserve
people's
anonymity.
We
tend
to
not
go
back
and
build
a
relation
with
them
over
the
long
term
and
I
think
on
balance,
that's
probably
not
not
the
best
situation,
so
I
think
what
we
would
sit.
B
What
we
don't
expect
to
see
is
that
when
you
do
give
us
information,
there's
much
more
of
a
closed
feedback
loop,
so
you
understand
exactly
what's
happened
and
we
can
start
it
start
to
encourage
you
to
give
us
a
level
of
detail
which
enables
us
to
act
more
more
effectively.
So
I
think
I.
Think
I'm,
just
gonna
pause
there
in
relation
to
the
whistleblowing
and
ask
for
questions
Peter
and
then
I'll
say
a
couple
of
words
around
enforcement
before
we
finish
so.
A
On
slide
7,
it
doesn't
add
up
to
a
hundred
percent.
It
adds
up
to
just
over
80
percent.
Do
we
know
is
the
20
percent
that
were
where
we
appear
not
to
taking
any
action.
Is
that
because
what
we
were,
what
we
were
given
was
so
imprecise
that
he
couldn't
take
action
or
or
is
it
that
actually
the
multiple
whistleblowers
for
certain
things?
A
So
the
fact
that
it's
led
to
a
responsive
inspection
might
not
have
been
just
the
tube
might
have
been
rather
more
than
the
individual
number
of
a
sergeant,
but
that
very
well,
but
I
I
couldn't
make
sense
for
the
slide,
because
there's
20
percent,
missing
and
I
should
have
given
you
notice
of
the
question.
I
follow,
judge
and.
O
I
I
don't
know,
Chris
Chris
may
help
I.
Think
part
of
it
is
they're,
not
necessarily
authority
of
the
answer.
The
18.5
sentence.
That's
not
there.
In
the
past
we've,
where
the
primary
information
is
already
known,
we
haven't
been
assigned
it
to
the
new
information
we've
received.
So
I
wonder
if
part
of
the
answer
is,
if
it's
a
known
issue,
I
either
were
suppose
you've
heard
something
that's
already
known
and
already
been
acted
upon.
O
A
Said
if
we
could
look
into
it,
because
my
concern
wasn't
that
we
hadn't
acted
on
it
because
we
just
failed,
my
concern
was:
are
we
getting
whistleblowing
information
that
is,
is
so
in
imprecise?
We
didn't
even
work
out
which,
which
provider
it
refers
to
when
I've
sat
in
on
some
calls.
You
know
where
we're.
Actually
we
really
struggled
to
or
the
call
handlers
really
struggle
to
identify
what
the
call
is
actually
phoning
about
so
I
just
I
think
we
just
be
good
to
know
cuz
it.
A
D
A
E
Is
I
just
wondered
whether,
in
terms
of
the
threshold
for
when
we
take
action,
I
just
wondered
whether
it's
consistent
across
all
types
of
service
or
whether
amendment
earlier
we
were
talking
about
closed
institutions
and
I,
was
wondering
whether
you
know
a
single
alert
about
a
closed
institution
might
be
more
likely
to
trigger
action
than
say
a
single.
You
know
if
you've
only
got
one
person
raising
a
concern
about
a
wider
kind
of
service
that
might
not
be
of
such
immediate
concern.
I'm,
not
sure
I
just
wondered
if
that
plays
into
how
we
think.
B
So
there's
a
there's,
a
pretty
sophisticated
triaging
process
to
look
at
the
that's
exactly
what
we're
being
told
and
sometimes
people
will
will
give
us
part
of
the
information
we
need
to
go
back
and
other
times
were
not
able
to
go
back,
but
but
two
pieces
of
anonymous
information
that
give
us
part
of
a
story
added
to
something
else
may
may
lead
to
trigger.
So
there's
a
there
was
an
algorithm
that
that
the
court
handlers
and
and
the
people
in
there
in
the
service
center
use
to
do
this.
F
Okay,
oh,
oh
I'm,
sorry
Robert,
a
big
apology,
I'm
just
firstly
to
welcome
Jason
to
have
this
coherent
level
of
information
in
public
domain.
I
think
is
very
encouraging,
as
is
the
fact
that
people
are
in
appears
to
be
increasingly
coming
to
us,
which
is
it's
a
good
thing
of
bouncing
I.
Also
welcome.
You
know
that
we
need
to
think
more
about
our
relationship
with
the
people.
You
talk
to
what
I'm
not
sure
I
see
here,
but
it
may
be
implicit
but
I,
like
your
confirmation
as
to
what
we
do
about.
F
It
is
obviously
some
whistleblowers
don't
mind
not
being,
and
all
of
us
sorry
have
been
identified
and
others
inevitably
and
some
of
those,
maybe
a
lot
of
them,
would
feel
then
quite
exposed
in
relation
possibly
to
a
bad
cultural
from
the
place.
They're
coming
from
and
well
I
absolutely
understand
it's
in.
If
it's
sense,
not
our
legal
duty
to
ensure
protection
that's
their
employ.
Sometimes
the
employer
is
unable
to
do
that
and
I.
F
B
Think
that's
exactly
the
piece
of
what
we're
doing
at
the
moment.
Are
they
I
think
what
we've
recognized
is
that
some
people
will
wish
to
remain
anonymous
because
of
the
fear
of
all
the
things
you've
just
described.
The
problem
that
presents
to
us
is
sometimes
people
goes
with.
That
with
that
wish,
for
anonymity
is,
is
a
a
slight
obfuscation
of
the
information
they
give
us.
B
But
I
don't
think
we
can
give
people
an
absolute
undertaking
that
we
won't
expose
them
indirectly.
So
there's
a
number
of
spin
of
pass
to
this
I
think
about,
but
I
think
the
the
message
I
hope
that
as
a
board,
your
your
hearing
is
this.
This
is
a
topic
that
we're
taking
very
seriously
and
there
are
a
number
of
pieces
of
work
to
try
and
address
all
of
these.
B
These
multiple
questions,
because
I
think
we've
had
a
fairly
simple
approach
to
this
and
thus
far
and
I
want
to
make
one
to
make
it
to
be
a
more
sophisticated
approach.
I
think
that
the
thing
we
need
to
be
very
cautious
of
is
is
at
the
point
at
which
we
are
building
a
relationship
which
takes
that
individual
into
a
place
where
they
become,
where
they're,
giving
us
information
on
ongoing
basis.
And
we
are
targeting
that
information.
B
We
need
to
be
cognizant
of
the
regulatory
Investigatory,
Powers,
Act
and
and
all
the
obligations
that
that
brings
with
it.
So
we
need
to
make
sure
that
we
don't
accidentally
start
to
start
to
create
a
group
of
people
who
are
effectively
covert
human
intelligence
sources
to
use
them.
You
use
the
job
so.
A
I
think
Robert,
your
your
your
point
was
that
having
been
exposed
by
you
know
because
it's
obvious
it
was
then
some
people
are
either
actually
are,
or
certainly
feel,
that
they're
victimized
and
how
can
they
be
support
and
I
I
suspect
we
need
to
I
was
going
to
say
temperature
to
me
a
better
answer.
I
would
say:
I
think
we
just
need
to
think
very
carefully
about
how
they
are.
A
F
Is
I
agree
with
everything
everyone
has
said
that
the
more
that
those
who
maybe
was
responsible
for
a
toxic
talk
for
one,
which
is
thought
to
be
wrong,
believe
that
we're
keeping
an
eye
on
the
situation
that's
different
from
taking
responsibility
of
an
individual,
the
more
the
individual
themselves
will
actually
feel
protected.
Okay,.
B
And
just
just
a
couple
of
quick
things
on
on
enforcement.
Again,
this
is
a
topic
which
is
which
is
probably
more
complicated
than
it
may
first
appear.
We
covered
a
number
of
these.
These
points
earlier
on
with
with
Rebecca,
but
I.
Think
the
general
point
that
I
wanted
to
make
was
hello.
There's
been
an
overall
rise
in
prosecutions
over
the
last
year,
I
I
think
we
do
need
to
recognize.
The
prosecution's
can
often
often
investigations
followed
by
prosecutions
can
take.
B
It
can
take
more
than
a
year
and
cross
her
across
an
annual
boundary,
so
so
seeing
that
the
seeing
an
increase
doesn't
necessarily
suggest
that
this
is
a
material
and
material
change
in
policy
or
so
I
had
caution
against
seeing
any
rise
in
one
year
as
being
as
being
significant
in
the
long
term.
I
think
we
try
and
do
in
terms
of
enforcement
policies
make
sure
that
when
we
take
enforce
production,
it's
proportionate
in
terms
of
its
impact
and
and
the
risk
that
that
that
we
are
taking
enforcement
action
against.
B
It
has
taken
two
to
two-and-a-half
years
to
to
carry
out
their
investigation.
We
have
a
maximum
time
period
of
three
years
to
to
to
to
take
enforcement
action.
So
we
may
very
well
find
that
a
lower
case
may
have
may
relate
to
an
incident
that
occurred
three
years
ago.
Actually,
we,
we
have
only
had
a
relatively
short
period
of
time
to
act
on
it,
which
may
sometimes
appear
that
when
we
see
enforcement
cases
where
the
event
took
place
some
time
ago,
it's
because
it's
been
to
another
agency
first
to
be
investigated.
B
G
A
I
You
Peter
so
I
will
pick
out
some
highlights
from
our
change
and
improvement
report.
I
will
I
will
pick
it
up
with
and
then
I'll
hand
over
tomorrow
talk
around
the
digital
and
digital
bits,
and
then
I'll
I'll
come
back
to
Jill
to
talk
about
people,
if
that's
okay,
so
just
in
terms
of
progress
over
the
last
quarter,
we
have
been
working
quite
closely
with
our
on
our
transformation,
engagement
and
strategy
and
vision,
piece
and
we're
now,
starting
to
socialize
that
with
internal
and
external
stakeholders
over
the
next
month.
I
To
finalize
that,
we
have
made
some
really
strong
progress
on
a
number
of
programs
and
projects
and
I'll
come
through
a
common
basis
and
then
shortly
and
we've
also
made
some
really
good
progress
on
acquiring
the
skills
that
we
need
to
deliver
on
our
transformation
program
over
the
last
month
or
so
so.
In
terms
of
some
of
the
projects
that
were
programs
that
we
have
in
place.
We
have
a
new
project
called
transforming
our
organization,
we're
starting
to
scope
that
one
out
this
project
is
to
support
the
development.
I
The
implementation
of
asked
new
strategy
as
we
work
forward
and
we're
just
trying
to
we're
just
in
the
process
of
scoping
that
out
bringing
resources
together
to
to
start
to
have
that
in
place
so
that
it
can
start
to
work
alongside
the
work
that
we're
doing
on
developing
our
strategy
regulatory
platform.
This
is
a
piece
of
work
to
replace
our
current
CRM.
I
This
one
is:
has
a
large
digital
contingent
and
mark
I'm
sure
we'll
talk
a
little
bit
more
about
that,
but
we
are
seeing
this
really
as
a
business
change
program
with
a
digital
enablement
capability
around
that,
and
this
piece
of
work
is
now
currently
going
through
our
external
approvals
we
and
on
through
the
Department
of
the
Department
of
Health
and
Social
Care,
and
this
we
are
now
starting
to
pull
together
the
resources
and
the
teams
to
start
to
move.
This
really
important
piece
of
work
forward.
I
Our
registration
transformation
program
is
a
multi-faceted
program
with
sales
design
element,
some
leaning
and
Qi
work
in
there,
as
well
as
some
wider
work
on
operational
improvement.
We
are
continuing
to
build
our
new
digital
service.
The
first
one
of
this
is
community
care
providers
and
new
registrations.
We're
making
really
good
progress
with
this,
we've
developed
a
new
model
office
to
really
test
out
the
work
that
we're
doing
on
this
area,
and
we
hope
this
will
be
alive
into
private
beta
early
in
the
new
year.
I
Improving
regulation
today
is
a
program
of
work
which
is
supporting
the
delivery
of
our
current
strategy
and
looking
at
how
we
can
improve
and
target
our
regulatory
interventions
as
we
need
to.
We
have
two
key
areas
of
work
in
this
space.
One
is
looking
at
implementing
the
Mental
Capacity
Liberty
protection
safeguards,
Act,
that's
coming
forwards
and
we're
in
the
process
of
scoping
that
to
really
understand
what
that
means
for
how
we
operate
and
how
we
work
in
our
organization
and
the
other.
One
is
some
work
that
we're
doing.
I
We
have
three
sandboxing
pilots,
regulatory
sandbox
and
pilots
in
place
to
look
at
how
we
regulate
new
innovations
in
digital
technology,
and
we
have
three
sandboxes
where
we're
working
with
providers,
one
on
clinical,
digital
triage,
one
on
machine
learning
and
Dynex
diagnostic
screening
and
the
other
on
providing
personal
care.
The
other
area
of
work,
we
have
a
number
of
stand-alone
projects
in
our
portfolio,
but
a
really
positive
piece
of
work
that
we've
been
doing
is
around
giving
feedback
on
care.
I
So
this
is
a
new
digital
service
to
enable
people
to
tell
us
about
the
care
that
they
experience.
We
have
been
through
the
GDS
process
with
this
government
digital
services
and
had
really
positive
feedback
on
the
work
that
we've
done.
This
one
is
currently
in
private
beta
and
we
are
about
to
move
in
the
new
year
to
a
public
beta,
which
means
that
we
will
open
that
service
to
all
users,
which
means
more
people
will
be
able
to
tell
us
about
their
care
using
various
different
digital
platforms.
I
This
has
a
positive
positive
benefit,
as
it
will
enable
us
to
manage
the
information
there
much
more
efficiently
in
our
national
customer
service
center,
but
also
really
enable
us
to
support
our
intelligence-gathering
process
and
the
data
will
come
into
in
an
easier
way
for
us
to
feed
that
into
our
analytics
platform.
Our
quality
improvement
program
is
starting
to
really
gain
traction.
Now
we
have
14
people
currently
going
through
our
gold
training
program
to
support
support
the
implementation
of
quality
improvement
across
the
organization.
I
Alongside
that
training,
we
have
14
quality
improvement
projects
that
are
starting
to
take
place
and
they
they
will
really
start
to,
hopefully
drive
out
some
improvements
in
our
prices
and
systems
and
really
deliver
benefits
quickly.
We
are
also
looking
at
starting
to
roll
out
our
silver
training
program,
which
is
a
program
to
upskill,
people
across
the
organization
to
really
start
to
be
able
to
take
quality
improvement
projects
forwards
at
a
local
and
directorate
level,
to
really
start
to
drive
that
quality
improvement,
culture
and
drive
out
some
improvements
and
efficiencies
at
a
local
level.
I
M
Kirsty
mentioned,
and
this
program
is
very
much
aligned
and
working
in
partnership
with
the
transforming
our
organisation
program,
and
it
will
allow
us
to
support
business
change
effectiveness
and
deliver
really
significant
system
improvements
for
all
their
colleagues
on
the
intelligence-driven
enablers
program,
and
this
this
will
complement
the
regulatory
platform
and
design
allow
us
to
design
future
data
structures
that
support
our
ambition
to
become
truly
intelligence
driven,
and
this
program
has
got
several
components.
A
lot
of
those
are
largely
in
the
discovery
phase,
and
some
of
those
elements
are
in
this.
M
In
the
early
proof
of
concept
phase
on
our
digital
foundations
program,
we've
completed
the
rollout
of
our
office
365
and
teams
implementation
across
the
whole
organization,
which
really
gives
a
significant
new
mobile
collaborative
and
productivity
platform
for
all
of
our
colleagues,
and
we've
already
received
really
great
feedback
across
the
organization
about
how
that's
working
for
people
we
are.
We
surely
be
extending
that
functionality
to
allow
us
to
work
with
external
parties
as
well,
which
will
dramatically
improve
our
ability
to
work
with
others
around
inspections.
M
We've
also
completed
a
new
corporate
Wi-Fi
implementation
across
the
all
CQC
offices,
which
really
helps
our
workers
work,
be
able
to
work
in
a
more
agile
way
throughout
throughout
the
office
environment
and
on
our
procurements
for
new
service
desk
application
management
and
security
services.
Those
are
all
progressing
very
well
as
well.
That's
it
for
me.
Thank.
P
This
doesn't
obviously
cover
off
the
business-as-usual
activity
that
is
underway
across
my
director
and
and
across
the
organization
in
terms
of
the
people
agenda
and
I
alluded
last
month
when
I
was
here
talking
about
the
pulse
survey
that
I
was
pulling
together
at
people
plan.
Work
progresses
continues
to
progress
on
that
and
I.
P
But
we
are
doing
our
very
best
to
think
about
the
entirety
of
our
attraction
strategy
as
we're
going
out
to
market
and
hoping
to
think
quite
even
innovatively
around
how
we
can
actually
bring
the
right
people
in
with
the
right
skills
and
to
help
us
deliver
the
agenda
that
we've
just
heard
of,
and
the
employee
engagement
agenda
is
awfully
important
part
of
how
we
create
a
great
place
to
work.
How
we
are
perceived
to
be
listening
to
our
staff
and
their
feedback
is
vital
to
how
we
continue
to
build
that.
P
We
talked
about
our
pulse
over
at
the
last
board
session.
So
it
rehearsed
that
again
annual
people
survey,
the
full
survey
is
live
at
the
moment.
We've
got
a
reasonable
response
rate
and
just
under
a
week
to
go
so
I'd
expect,
as
is
normal
within
all
organizations
that
will
have
a
bit
of
a
peak
of
activity.
At
the
end,
at
the
final
period
and
I
know,
leaders
around
the
table
and
in
the
organization
are
really
encouraging
staff
to
have
their
say.
P
We
have
a
session
later
on
diversity,
inclusion
and
and
I
do
think.
It
is
time
that
we
frame
this
in
an
organization-wide
strategy
which
actually
identifies
and
a
handful
of
things
that
we
do
really
really
well
and
build
on
so,
and
we've
been
working
quite
closely
with
the
networks
on
this
and
and
building
on
their
experiences
and
successes
to
date,
but
I
think
pulling
things
together
is
going
to
be
really
important
to
actually
start
to
make
a
difference
and
setting
ourselves
some
quite
aspirational
and
and
therefore
quite
difficult
targets
and
measuring
our
progress
against
those.
P
The
work
we've
been
doing
on
well-being,
I'm
seeking
to
embed
into
business
as
usual.
This
is
just
an
integral
part
of
how
people
experience
a
great
day
at
work
and
offers
some
tools
and
techniques
for
people
to
understand
how
they
can
give
up
their
best
and
and
search
for
those
where
they
are,
having
particular
difficulties
and
and
I've
highlighted
very
quickly,
three
of
a
number
of
capability
building
and
development
interventions
that
we're
focusing
on
at
the
moment.
P
Firstly,
around
professionalizing
sort
of
some
of
our
our
regulatory
skills
and
which
is
a
significant
piece
of
work,
and
it
shifts
us
forward,
gives
people
an
accreditation
which
we've
never
had
before
so
sort
of
rolling
that
out
and
then
considering
how
we
might
embed
that
further
equipping
some
of
our
line,
leaders
and
managers
in
coaching
skills
to
enhance
the
performance
management.
Conversations
that
are
happening
throughout
the
organisation
feels
really
important.
They
will
be
capitalizing
on
on
the
success
of
that
and
really
sort
of
targeting
a
sort
of
the
early.
P
The
bottom
end
of
our
pie,
of
our
talent
pipeline
to
identify
those
those
colleagues
that
we
have
that
are
our
future
leaders
and
such
demonstrating.
How
we
can
both
identify
them,
develop
them
and
then
I
think
the
critical
next
step
in
terms
of
our
talent,
gender,
is
how
we
then
deploy
them
across
the
organization
so
that
they
get
stretched,
but
also
we
get
the
benefit
of
them.
Having
really
high
potential
and
and
a
development
that
we've
invested
in
and
just
finally,
we've
got
some
exciting
stuff
going
on
in
the
future.
A
So
not
much
going
on
then
Kirsty,
okay
seriously,
before
opening
it
I
just
would
congratulate
you
and
your
teams
for
the
energy
and
the
drive
that's
going
into
all
of
this,
and
and
some
quite
considerable
successes
mark
I,
think
the
the
office
365
rollouts
been
particularly
good.
And/Or
both
enhance
people's
experience
at
work,
but
also
improve
our
productivity.
So
it's
a
win-win
and
lots
of
good
stuff
going
on
everywhere.
So
well
done
everybody
now
I'll
open
it
up
and
you'll
get.
No
doubt
questions
and
comments
mark.
You
want
to
kick
off
Thank.
N
Looking
at
the
people
plan,
I
tried
to
compare
this
to
our
old
HR
strategy
and
I
must
say,
I
think
what
you've
produced
as
a
framework
is
strategically
much
more
aligned,
much
tighter
and
and
really
looks
good
I
think
the
move
to
change
resourcing
is
it's
a
critical
move
for
us.
I've
already
mentioned
it
before
as
to
how
we
bring
these
difficult
roles
to
recruit
on
board.
N
It's
very
good
to
see
diversity
and
inclusion
and
well-being
being
maintained
and
at
the
forefront
of
the
people
plan
seems
to
me
you've
moved
from
workforce
strategy
and
learning
organization
to
building
capability
and
think
that's
you
know
much
better
focus
but
with
Pharaoh
here,
especially
I.
Think
it's
important
that
that
building
capability
is
for
all
of
our
people
across
the
organization,
but
so
I
think
it's.
You
know,
I'm
really
good.
N
From
a
strategic
point
of
view,
just
a
couple
of
observatory,
an
observation
and
and
a
question
I
think
the
framework
the
plan
will
get
much
more
traction
once
we
have
some
very
specific
kpi's
attached
to
it.
So
I
know
we've
discussed
that
before
and
I
look
forward
to
the
development
of
that.
Just
in
terms
of
within
the
presentation,
the
building
capability
talking
about
the
coaches
and
the
work
they've
been
doing
and
I
noticed
that
we
make
the
point
there
that
the
coach's
program
has
been
in
place
for
quite
some
time
now.
N
Sort
of
halfway
through
I
met
some
of
the
coaches.
When
I
was
up
in
you
guys,
I
was
really
impressed
with
them,
but
I
wonder
if
we're
tracking
any
potential
productivity
gains.
You
know
out
of
that.
So
I'm
thinking
things
like
reduced
turnover,
greater
job
satisfaction
and
engagement,
quicker
issue
resolution,
more
effective
team
working
fewer
grievances,
I.
Just
wonder
if
we
we've
got
any
way
that
we're
tracking
that
investment
that
we're
making
in
coaches.
Thank.
P
Mark
and
I
look
forward
to
continuing
our
conversation
around
KPIs
and
so
I.
Think,
though,
I
think
you're
absolutely
right.
Once
we
get
a
plan
that
sits
underneath
this
framework,
which
is
a
delivery
plan
and
with
some
hard
measures
in
there
and
some
milestones
that
that's
my
next
stage
and
that's
kind
of
what
I
want
to
take
through
to
the
executive
team
shortly
and
on
the
point
about
track.
P
The
impact
of
our
coaches
so
I
think
there's
a
sort
of
does
that
make
them
as
individual
employees
more
efficient
and
effective,
but
also
the
impact
of
their
coaching.
So
in
part,
I
think
it's
a
little
difficult
to
track
all
of
it,
because
some
of
it
will
be
very
confidential
and
they
are
still
coming
to
the
end
of
their
program.
But
I
can
certainly
take
away
and
worth
a
look
at
and
I'd
expect
for
those
coaches
who
are
line
managers.
C
Q
Thanks
very
much
Joe
and
from
a
network
perspective,
we
really
welcome
diversity
and
inclusion
framework
at
CTC
and,
seeing
this
and
the
well
being
specially
right
at
the
heart
of
the
people
and
the
strategy
is
the
people
plan,
I
should
say,
is
really
good
to
see
for
others.
I
think
that
the
word
ambition
there
and
being
ambitious
is
really
important,
and
we
we
want
to
know
more
about
what
aspirational
targets
mean.
I
mean
what
we
hope
to
see
a
real,
tangible
change
over
time.
Q
Q
A
E
We,
we
gave
a
steer
I
think
to
the
effects
that
it
would
be
good
to
think
more
explicitly
about
how
we
use
these
different
levers
in
terms
of
how
we
prioritize
our
activities,
both
in
next
years.
In
the
coming
business
plan
and
in
the
strategic
plan
going
forwards,
we
took
a
deeper
look
at
relational
impact.
That's
the
relationship
between
CQC
and
providers,
which
can
be
very
significant
in
encouraging
improvements
and
the
steer
we
gave.
E
There
was
really
that
that
it
may
be
worth
doing
some
more
work
on
the
framework
and
the
training
that
underpin
the
activities
of
our
colleagues,
so
that
they
can
use
the
full
range
of
different
approaches
to
the
relationship
that
are
most
effective.
In
that
circumstances,
we
also
looked
at
our
content
and
our
products
and
the
impact
that
those
can
have,
including
through
partnerships
and
third
parties,
where,
for
example,
our
content
might
then
be
tailored
by
somebody
else
for
a
particular
audience
in
order
for
it
to
make
most
difference
on
the
ground
to
them.
E
We
looked
a
bit
also
at
the
conditions
in
which
we
have
impact
and
how
we
can
use
our
independent
voice,
for
example,
to
encourage
changes
amongst
other
players
in
the
system
that
might
make
it
easier
for
our
impact
and
so
that
all
that
steer
went
through
into
the
people,
preparing
the
strategic
plan
and
indeed
business
planning.
We
also
looked
at
the
risk
register
and
we've
now
agreed
with
the
ACDC
that
we
in
the
regulatory
Governance
Committee
will
own,
so
to
speak,
a
subset
of
the
risks,
those
that
are
most
concerned
with
regulatory
risk.
E
So
we
looked
at
those
and
we
identified
a
number
of
issues
that
we
want
to
do
a
deeper
dive
on
in
future
meetings
and
we've
got
some
drive
issues
coming
up,
including
in
primary
medical
services
area
and
all
the
risks
that
we
looked
at
yesterday
in
that
area.
Where
am
varam,
we've
already
looked
at
the
register
so.
A
A
If
not
that's
the
end
of
the
meeting
that
takes
us,
though,
to
questions
from
the
public
and
I've
been
notified
of
for
people
who
want
to
ask
questions.
We've
got
about
ten
minutes.
So
if
I
could
ask
people
asking
the
questions
to
be
fairly
concise
and
if
I
could
then
ask
my
colleagues
to
try
and
be
fairly
concise
and
their
response
will
get
through
all
four
questions
taking
in
the
order
in
which
they,
they
came
to
me,
Robin
I
think
you're
you're.
First,
please.
R
Thank
You
German
Robin
pike
are
now
an
independent
member
of
the
public
I'd
like
to
ask
what
plans
there
are
to
upgrade
the
CQC
website
and
I'm
asking
the
question
within
the
context
of
Anna
a
search
which
I
did
yesterday.
Four
key
lines
of
inquiry
which
yielded
4029
results.
The
first
of
these
was
nigel
surgery.
68
areas
looked
at
on
inspection
brackets
key
lines
of
inquiry.
I
did
ask
chairman
a
similar
question
about
a
year
ago
and
I
had
very
similar
response
from
the
search
I
think.
O
The
thing
I
wanted
to
improve
the
fastest
girls,
getting
the
most
feedback
from
cause
at
HealthWatch,
but
also
colleagues,
some
other
organizations,
isn't
that
is
a
major
barrier
to
people
engaging
with
us,
so
that
was
the.
That
was
the
important
first
step
that
we
wanted
to
take.
The
next
area,
which
sort
of
speaks
as
part
of
your
question,
is
the
guidance
that
we
provide
for
providers
and
actually
for
other
people
as
well.
There
is
too
much
guidance
at
the
moment
and
it
is
duplicated.
O
So
what
we're
trying
to
do
by
sector
is
to
have
a
review
of
that
guidance
to
streamline
that
guidance
and
also
to
change
the
nature
of
the
guidance.
So
it's
written
in.
If
you,
if
you
see
some
of
the
guidance
it
can
be
written
in
quite
a
sort
of
hard
to
understand
tone.
What
we're
trying
to
do
is
to
is
to
make
it
more
accessible
to
everybody,
for
people
use
services
and
for
those
providing
them,
but
fundamentally
to
to
reduce
the
amount
of
that
guidance.
My
ambition
is
to
that.
O
You
can
type
into
the
page
where
it's
about
where
it's
about
guidance
is
it's
for
providers
and
you
can
type
in
a
keyword
and
it
will
pull
up
the
guidance
that
we
have
that
relates
to
it
and
also
the
best
practice.
So
ambition
is
isn't
to
replace
the
website
like
for
like,
but
actually
to
build
services
for
providers
to
build
services
for
the
public.
The
share
experts
have
to
give
you
some
comfort.
The
sharing
experience,
one
is
probably
was
seen
as
an
exemplar
by
I.
O
A
S
So
the
questions
are
in
four
parts,
mr.
chairman,
and
if
we
can't
answer
them
all
today,
I'm
happy
to
receive
a
written
response.
How
does
the
Care
Quality
Commission
monitor
the
practice
of
clipping?
What
percentage
of
at
home
care
providers
use
digital
systems
which
is
clocking
on
and
off,
which
may
prevent
clipping
versus
manual
systems
which
are
inevitably
more
open
to
fraud?
S
What
plans
does
the
Care
Quality
Commission
have
to
insist
that
all
at-home
care
providers
use
digital
students
and
also
to
mandate
that
carers
stay
for
their
contracted
hours
and
finally,
in
the
CQC's
experience,
how
many
councils
have
successfully
prosecuted
care
providers
for
clipping
following
inspections
or
interventions?
Thank
you
very
much.
Thank.
K
Thank
you
so
much
for
your
question
and
so
I
suppose
I
just
want
to
start
off
with
what
our
dream.
It
is
and
then
note
that
there
are
other
parties
that
have
responsibility
with
this
as
well,
so
so
our
job
is
to
ensure
that
people
are
receiving
high-quality,
person-centered
care.
When
we
go
out
and
inspect
individuals,
we
have
conversations
with
them
as
to
our
experts,
by
experience
about
how
they're
receiving
that
care
is,
it
are
they're
being
supported
by
people
who
know
how
they
need
their
care
delivered.
Are
they
not
rushed?
K
Are
they
given
the
time
that
that's
required
to
ensure
that
they
have
their
needs
met?
We
also
have
conversations
with
staff,
so
we
would
have
conversations
with
care
workers
on
their
own,
so
not
not
necessarily
in
their
place,
where
their
managers
might
be
there
again
to
ask
about
what
their
arrangements
are
to
ensure
that
they
have
the
time
they
need
to
deliver
the
care
that
they
are
being
commissioned
to
do
so.
So
that
is
our
job
very
simply
about
ensuring
that
people
are
getting
the
care
that
they
need.
K
There's
a
couple
of
other
pieces
of
it,
and
one
component
is
how
this
care
has
been
commissioned.
So
it's
not
application
in
the
way
that
you've
just
described
it,
but
we
know
that
nice
issued
guidance
a
little
while
ago,
that
talked
about
personal
care
visits
not
being
less
than
30
minutes.
So
there
there
are
some
guidance
out
there
available
to
commissioners
to
make
sure
that
they
are
buying
units
of
care
that
are
sufficiently
long
for
people
to
get
a
good
person
center
care
and
then
there's
responsibilities
of
providers.
K
So,
in
the
case
you
describe,
commissioners
are
doing
their
job,
so
they're
buying
suitably
length
periods
of
care
for
the
people
to
have
their
needs
met.
But
if
providers
are
not
delivering
that,
then
it
becomes
a
contractual
issue
and,
as
you
say,
a
potential
safeguarding
if
people
aren't
having
having
their
needs
met.
So
just
on
a
couple
other
things.
So
it
is
not
our
job
to
be
prescriptive
about
how
providers
to
deliver
their
care.
K
K
T
T
There's
a
great
deal
of
a
lot
of
a
lot
of
people.
I
visit,
I
I
deal
with
a
foreigners
and
they're,
sometimes
amazed
at
how
little
children
have
to
do
with
their
families.
I
think.
One
of
the
reasons
for
this
is
that
in
this
country
there
are
great
distances,
sometimes
between
families
and
they,
their
parents
and
a
great
distance
doesn't
mean
that
you
already
had
one
is
in
Edinburgh
and
the
other
is
in
London.
A
David
were
in
violent
agreement
that
technology
has
a
really
big
part
to
play
in
keeping
people
in
contact
with
their
friends
and
family,
and
it's
really
important
just
to
remind
you.
You
know
this.
The
CQC's
agreement
does
not
extend
to
people
who
are
living
independently,
not
receiving
care,
so
a
very
large
number
of
people
are
talking
about
would
just
be
outside
of
our
remit,
so
we
can
talk
more
generally,
but
it
falls
outside.
A
K
You
so
after
I
responded
to
the
other
person
earlier.
I
think
we
have
an
important
job
about
shining,
a
spotlight
on
where
this
is
working.
Well,
I
think
our
trade
associations
have
a
big
role
to
play
in
this.
So
as
many
of
our
colleagues,
we
I
often
go
out
and
visit
services
and
I
visited
a
service
where
they
were
using
electronic
care
planning
on
the
mobile
device.
So
as
a
care
worker
was
delivering
support,
they
were
updating
the
care
record,
but
those
residents
had
also
given
permission
for
their
family
to
access
the
app.
K
So
there
are
examples
where
a
family
member
on
an
hour-by-hour
basis
can
see
on
one's,
got
up
and
be
washed
almost
now
doing
an
activity
with
her
friends
in
the
dining
room,
so
there
is
and
what
they
describe
is
they
described
improved
relationships
between
the
provider
and
family.
They
described
a
reduction
in
complaints
because
the
family
had
a
better
idea
about
the
support
that
they
were
getting,
and
so
there
are
a
whole
host
of
benefits
that
come
from
that.
That
I
think
are
providers.
H
Peter,
you
know,
that's
not
true.
The
last
word
always
goes
to
you
really,
but
I
take
your
point
really
very
quickly.
Really
Peter
thanks
the
way
you
chair
this
and
also
that's
about
for
me,
demonstrating
values,
cultures
etc.
Really,
so
let
me
start
by
saying
that
really
one
or
two
points
really,
first
and
foremost,
can
we
look
to
intense
by
how
we
promote
their
alerts
that
we
sent
out
about
reports
that
are
published
all
that.
H
H
You
know:
I
lost
count
Reed
after
about
double
figures,
the
amount
of
acronyms
that
has
spoken
at
the
board.
We
really
do
need
to
know
and
listen
to
that
really,
because
that
is
a
powerful
turn-off
and
also
a
powerful
turn
off
as
well.
Really
we
need
to
have
a
look
at
how
we
proof
are
occurring
profile
reports
before
they
go
forward,
and
also
we
need
to
look
at
the
language,
because
again,
this
has
been
put
out
for
multiple
audience
to
read
and
acronyms
can
be
actually
a
barrier
to
actually
understanding.
A
O
Some
of
what
yeah,
first
of
all,
Brent
thanks
for
your
comments
and
they're,
really
well
made
around
our
our
reports
that
the
part
of
the
value
of
the
report
is
making
sure
people
are
aware
of
for
them
and
know
about
them.
There
are
a
couple
of
services
you
mentioned
one,
which
is
where
you
can
some.
If
you
go
on
to
a
page
that
website,
you
can
sign
up
to
the
reports
for
that
individual
organization,
I
think
there's
as
well.
O
It's
important
we
can
talk
to
people
locally,
so
group,
so
we
work
we
work
with
colleagues
in
HealthWatch.
We
work
with
colleagues
and
other
organizations
to
share
both.
What's
happened,
also,
what
is
happening?
I
think,
there's
more.
We
can
do
in
that
space
absolutely
to
encourage
more
people
to
engage
with
the
reports.
We're
also
doing
some
work
to
improve
the
quality
of
the
reports
and
I
think
Ted
mentioned
it
earlier.
There
are.
O
There
are
parts
of
this
which
is
a
narrative
description
of
what
we
found
and
there's
some
data
evidence
and
our
attack
rooms
that
sit
behind.
That
I
think
it's
important.
We
can
get
the
right
message
about
what
we
think
about
an
organization
on
on
to
a
few
pages,
so
some
work
that
we're
doing
there.
One
of
the
things
that's
important-
and
we
mentioned
it
earlier
on
in
the
conversation
particularly
for
reports
where
we've
got
concerns-
is
how
we
advise
the
public
and
people
use
services
earlier.
O
So
the
work
Pettine
hospitals
around
the
letter,
which
comes
out
to
an
organization,
it's
important,
we
can
make
that
available
to.
We
do
make
it
available
to
people
but
I
think
there's
more.
We
can
do
in
this
space
and
I.
Think
some
of
the
work
we
want
to
encourage
around
local
systems
means
that
people
can
see
not
just
one
service
but
then
what's
what's
happened
in
their
local
area
and
I.
Think
that's!
What's
one
of
the
pieces
of
work
that
we're
looking
to
put
in
place
as
part
of
the
website
redevelopment,
but.