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From YouTube: CQC Board Meeting – January 2016 (with subtitles)
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A
Right
good
morning,
everybody,
it's
nine
o'clock,
particular
welcome
to
Jane.
Your
first
meeting
particularly
welcome
to
me
at
my
first
meeting
as
well,
but
cannot
connect.
I
am
seriously
thank
everybody
around
the
table
for
the
warm
welcome
that
you
have
given
me
over
the
last
few
weeks.
It's
been
been
really
good.
Michael
I
know
that
the
last
meeting
David
thank
you
for
being
in
the
chair,
but
can
I.
Thank
you
also
for
holding
the
ring,
obviously
extremely
well.
Thank
you
for
that.
I.
Don't
think
we
have
any
apologies.
Do
we
have
any
interest?
A
Okay,
so
they're
approved,
there's
an
action.
Log
were
still
just
looking
up,
which
is
the
right
meeting,
I
think
to
have
in
Newcastle,
Paul,
I,
guess,
you're,
giving
ongoing
thinking
thought
to
the
performance
of
finance
report
and
the
staff
survey
is
scheduled
for
the
next
meeting.
So
that's
fine.
Is
there
anything
arising?
Anybody
wants
to
raise
that's
not
on
the
action
log
or
otherwise
on
them
on
the
agenda
perfect,
so
that
takes
us
to
the
regulatory
Governance,
Committee
and
Lewis
I.
Think
that's
for
you!
Please.
B
So
if
you
remember
that
the
the
issues
were
first
of
all,
the
need
to
take
urgent
action
when
closure
seems
immediate,
closure
of
a
care
home
seems
inappropriate
or
potentially
unsafe.
What
are
the
alternatives,
and
how
do
they
work
bear
in
mind
that
they
may
involve
organizations
which
have
had
some
degree
of
oversight
already
of
the
carom
and
therefore
haven't
necessarily
picked
up
on
the
urgency
themselves?
And
the
second
thing
is
that
is
about
ownership
by
proxy.
B
The
third
thing
was
about
the
how
we
inform
families.
This
is
particularly
in
care
homes,
but
it's
not
unique
to
count
when
there
is
when
there
are
serious
causes
for
concern.
How
do
we
ensure
that
the
people
who
who
are
using
that
cab
I'm,
not
just
the
residents
but
also
the
families
who
have
often
sought
out
a
care
home
and
made
that
choice
and
by
implication,
could
make
a
different
choice
if
they
had
other
information?
How
do
we
make
sure
that
they're
properly
informed?
B
We
do
place
a
certain
requirement
on
Carolina's
and
trusts
to
do
this,
and
but,
in
the
case
of
care
homes,
I
think
it's
debatable
whether
we're
doing
enough
to
ensure
that
families
are
properly
aware
of
what
we
find
and
then
the
fourth
of
the
useful
things
was
about
delays.
It
wasn't
specific
to
this
carom
and
but
there's
a
question
of
whether
providers
are
guilty
of
vexatious
challenge
to
our
reports
as
a
way
of,
and
essentially
wearing
us
down
to
the
point
where
we
water
down
the
strength
of
our
conclusions.
A
B
I
just
want.
My
question
is
partly
given
that
those
are
the
issues
and
we
had
a
very
good
response
around
rely
on
us
say
it
was
very
helpful
and
but
obviously
this
is
work
in
progress
on
several
of
these
issues
and
I
just
don't
want
to
lose
them
because
they
are
broader
than
just
this.
Particular
inspection.
C
Andrea
and
thank
you
very
much
so
what
we've
agreed
is
that
will
bring
a
report
back
to
the
regulatory
Governance
Committee
for
its
April
meeting,
so
that
we
can
update
on
the
various
aspects
of
the
of
the
work
that
Luis
is
outlined.
Some
of
that
subsidy,
not
just
within
adult
social
care,
has
broader
ramifications
and
broader
responsibilities.
So
it
kind
of
needs
to
link
into
the
work
that
we're
doing
on
our
policy
and
strategy
overall.
C
A
D
Thank
you,
Peter,
and
so
there's
quite
a
few
items
here.
Colleagues
and
the
sum
and
some
of
it
is
just
for
information
rather
than
from
for
raising
when
we
get
to
looking
at
hospitals
just
to
pick
up
on
last
meetings
minutes
we
said
that
we'd
consider
southern
health
in
open
session
and
Michael
at
that
point.
Come
in
and
Reza
Lewis
sedessa
for
that
clarification
earlier
and
that
sand.
D
Traditional
fashion
now
there
is
a
report
which
is
updating
on
our
performance
and
you've
got
attached
to
an
x1
to
this
report,
the
performance
report.
This
is
activity
reporting
up
to
the
end
of
november,
although
in
the
text
of
the
report
itself,
there's
some
further
updates
to
that
which
go
beyond
the
end
of
november
date.
So
we
are
able
to
report
those
improvements
in
performance
in
relation
to
the
inspections
being
completed.
But
I
think
the
report
is
clear
that
there's
still
improvements
to
be
made.
D
Although
there's
some
further
improvements
required
in
that
area,
particularly
as
the
November
performance
wasn't
quite
in
keeping
with
the
October
performance
in
relation
to
mandatory
reporting
in
relation
to
safeguard
in
incidents
notified
to
us.
That
said,
if
you
remember
about
12
months
ago,
we
looked
at
this
in
some
detail
and
the
significant
improvements
been
made
over
that
over
that
12-month
period
and
full
credit
to
Sally
Warren
who's
showed
the
safeguarding
committee
in
relation
to
the
work
that
she's
done.
E
F
Me
interested
question
about
the
inspections,
am
I
writing
interpreting
the
figures.
There's
anything
the
short
for,
particularly
in
that
out.
Social
Care
is
continuing
to
go
up
and
therefore
the
challenge,
which
seems
needs
getting
worse
rather
than
better
if
I'm.
Unless
I
misinterpreting
the
a
figure.
C
The
that
there
was
a
challenge-
I,
don't
don't
think
it
is
worsening.
We
are
improving
the
performance
with
in
adult
social
care
in
terms
of
the
number
of
inspections
that
we
expected
to
do.
Although
we
hadn't
had
anticipated
that
we
would
have
more
inspectors
in
place
now
to
be
able
to
do
inspections,
we
have
made,
as
David's
already
alluded,
to
significant
progress
on
recruitment,
but
obviously
some
of
those
people
are
still
an
induction,
still
kind
of
doing
the
training
to
enable
them
to
do
the
inspection.
C
Because
you-
and
we
know
that
that
takes
and
considerable
time
tickly
of
people
are
making
taking
things
and
to
court?
Then
the
team
kind
of
pitches
in
and
helps
to
balance
out
the
workload
so
that
other
inspections
do
continue
to
happen.
So
there's
been
a
huge
amount
of
effort
on
looking
at
providing
good
information
to
inspection
managers
so
that
they
can
manage
that
process.
So
I
don't
think
it's
getting
worse.
It's
not
getting
better
as
quickly
as
I
would
like
it
to
get
better,
but
that's
not
new.
C
Notwithstanding
that
staff
are
working
very,
very
hard,
we
will
see
a
dip
in
cember
because
of
the
loss
of
time
because
of
christmas
and
new
year,
because
of
course,
obviously
people
have
taken
time
during
that
during
that
period,
and
so
so
that
will
kind
of
take
us
down
and
one
of
the
things
that
we're
doing
in
the
planning
for
next
year.
It's
been
a
lot
more
mindful
about
what
it
is
that
we
can
expect
people
to
do
at
those
high
holiday
periods
so
that
we're
not
anticipating
a
level
of
activity
that
actually
won't
manifest
itself.
F
What
just
worries
me
slightly
on
the
path?
/
half
the
staff,
but
we
see
we
are
doing
more
more
inspections,
but
they've
sought
keyword,
ative
shortfall
on
your
table
keeps
on
going
up
and
I.
Just
wonder
whether
they're
for
the,
even
if
the
recruitment
is
planned
on
the
basis
of
doing
a
certain
number
amount,
whether
in
fact
we
will
do
actually
catch
up
but
I'm
full.
Your
you've
got
nothing
here.
F
D
That's
not
to
keep
it
public,
but
that's
still
at
the
level
of
planning
and
anticipation,
and
also
we
not
yet
had
confirmation
what
our
budget
is
for
next
year's,
so
we're
making
assumptions
about
what
it
is.
I
think
we
should
be
confident
about
those
assumptions
and
I.
Don't
think
we
should
deliver
from
that,
but
we
are
waiting
to
bring
all
those
elements
together
in
the
business
plan
which
would
anticipate
bring
it
up.
I
think
it's!
The
februari
meeting
I
think
it's
nepal
in
terms
of
draft,
so
you've
got
the
information
here.
D
H
You
it's
really
good
to
see
that
the
timeliness
of
reports
as
improved
across
the
board,
which
is
fantastic
and
I,
just
wondered,
given
productivity
is
more
less
than
the
same.
What's
made
the
difference
there
and
why
is
it
suddenly?
Why
is
it
improving
and
secondly,
it's
just
a
point
to
poor,
which
is
about
the
analysts
gap
in?
Can
you
just
give
us
a
flavor
about
the
proportion
of
the
lack?
Is
it
really
material
or
is
it?
Is
it
a
small
rump
that
we
can't
fill
Thank
You
Andrea.
E
C
Thank
you
very
much.
Jennifer
on
the
reports.
I
think
there
were
a
number
of
things
that
we've
done,
that
the
first
was
that
in
each
of
the
regions,
we've
really
concentrated
on
proclaiming
the
backlog.
So
there
will
continue
to
be
some
reports
coming
through,
which
will
have
an
extended
period
of
time
on
them
and
which
is
not
acceptable,
and
there
were
variety
of
different
reasons.
C
C
So
when
a
drafters
and
by
and
when,
when
it's
been
peer,
reviewed
and
all
of
those
kind
of
things,
so
that
they
can
keep
up
on
the
progress
of
that
as
the
proto
as
the
reports
are
going
through,
not
just
picking
it
up
at
the
end.
The
third
thing
is
that
we
are
also
looking
at
what
ways
can
we
take
some
of
the
time
in
that
period
of
50
days
down
to
its
minimum?
So,
for
example,
providers
have
the
opportunity
to
check
reports
for
factual
accuracy.
C
We
could
have
pressed
the
button
on
day
two
of
the
factual
accuracy
period,
so
we're
kind
of
exploring
with
the
team
how
we
can
make
sure
that
we're
encouraging
providers
to
compact
was
to
let
us
know
that
they're
actually
happy
with
reports
so
that
we
can
progress
so
that
the
inspectors
can
concentrate
on
those
areas
where
there
are
potentially
problems
as
opposed
to
the
ones
that
were
worried
about.
But
the
critical
thing
for
us
is
just
making
sure
that
you
know
we
we
don't
do
a
pendulum
swing
between.
C
G
So,
on
the
intelligence
analysis
in
particular-
and
we
are
currently
in
broad
numbers
around
230
240
stuff
within
the
intelligence
which
leaves
about
50
or
60
short
in
broad
numbers
and
and
as
ever
in
a
big
unit
like
that,
there
are
some
teams
which
are
pretty
close
to
their
their
full
capacity.
Your
compliments
and
others
that
are
further
off.
So
in
some
of
the
areas
of
supporting
and
provider
analytics
product
to
the
m
the
inspector
of
functions.
So
particularly
in
Mike's
area.
G
Different
ways
of
tracking
people
and
I
will
have
a
graduate
analyst
program
to
grow
up,
grow
our
own,
proving
quite
successful
into
our
second
cohort
of
that
now
and
and
where
appropriate,
we're
looking
at
whether
it
would
be
better
to
have
a
slightly
smaller
number
of
people,
but
of
a
slightly
higher
grade,
as
we
can
make
sure
that
the
word
people
are
doing
is
the
most
value.
Adding
work
now
big
challenge
for
us.
G
D
Former
a
trust-
and
we
saw
that
level
of
performance
on
a
mandatory
performance,
a
mandatory
expectation,
we'd,
be
saying
something
pretty
severe,
and
that
may
well
also
be
contributing
to
any
enforcement
action.
We
take.
So
I
think
this
comes
to
exactly
the
point
of.
Can
we
hold
others
to
account
for
how
they're,
before
long,
training
and
development
of
their
staff
and
utter
figures
which
I
have
to
say
a
disappointing?
D
D
D
B
F
D
These
are
e-learning
courses,
so
I've
done
some
of
these
myself,
but
the
reasons
will
be
given
will
be
multiple,
but
often
is
people
would
say
they
haven't
got
time
because
they're
doing
the
inspection
program,
we're
in
a
vicious
cycle
in
relation
to
this
I
think.
The
paradox
of
this,
though,
is,
can
you
be
too
busy
for
development
I?
D
Personally,
I,
don't
think
we
can
maintain
that
we've
deliberately
created
the
Academy
to
create
the
space
and
the
opportunity
for
people
to
get
access
to
the
development
opportunities
which
are
critical
to
the
capability
of
individuals
in
the
organization.
What
gives
the
organization
its
capability
to
do?
This
I
think
you'll
see
differential
performance
across
the
organisation
with
some
teams
that
are
able
to
do
this
and
other
teams
where
the
level
of
performance
I
think
that
what
that
signifies
is
how
far
those
team
leaders
are
prioritized.
D
A
C
No
just
going
to
say
that
I
mean
I,
agree
totally,
but
I
think
we
also
need
to
realize
that
we've
developed
at
a
huge
speed
and
that
it's
the
pressure
to
get
the
inspections
done.
That's
probably
meant
that
the
learning
hasn't
been
completed.
So
my
point
is
that
it's
absolutely
crucial
that
when
we
go
forward
in
our
business
plan
and
what
we
commit,
we
do
actually
make
sure
that
we
factor
in
things
are
fed
with
regards
to
staff
development.
C
D
So
none,
sir
ian
roberts
questions
about
business
plans.
Paragraph
2
on
page
4
is
just
setting
out
the
time
table
will
bring
a
draft
to
the
februari
board
and
then
bring
a
final
version
to
the
March
public
board,
hopefully
for
agreement
and
sign
off,
and
a
number
of
the
questions
have
just
been
asked
should
come
together
in
those
februari
and
March
reports.
We
update
on
registration.
D
I.
Think
many
of
as
we'll
have
that
feedback
from
providers
about
how
cumbersome
and
difficult
simple
variations
to
registration
will
be.
So
there
are
some
of
the
examples
of
the
efficiencies
that
are
being
secured
and
then,
finally,
we
look
at
some
of
the
quick
wins,
one
of
which
is
specializing
amongst
registration
inspectors.
So
people
are
developing
a
repertoire
in
one
sector
rather
than
attempting
to
cover
all
three
sectors
in
the
way
that
they
operate
and
that
should
build
up.
D
Updates
then,
from
the
directorate's,
paying
particular
attention
to
the
recent
floods
in
the
in
the
north
of
England,
which
had
a
pretty
significant
impact
on
the
provision
of
health
and
care
services,
but
particularly
in
some
areas,
rochdale
I,
think
being
one
of
them
in
terms
of
the
car
horn
population.
But
it
also
impacted
on
our
staff
as
well.
We've
got
one
member
of
staff
who
had
to
leave
her
home
because
of
flooding
and
is
going
through
what
many
people
in
the
north
of
England
about
to
experience.
D
In
terms
of
all
that
dislocation
and
our
suspect,
anxiety
and
stress
to
her
credit,
she's
continued
to
work
and
perform
term
just
wanted
to
acknowledge
that
unprecedented
was
a
word
that
got
debated
about
the
floods.
The
murder
at
Del,
Mar
house
of
a
Christmas
with
the
shooting
I
think,
does
desert
the
word.
D
So
I
expect
that
to
be
a
difficult
and
tense
period
over
the
30th
of
January
I've
arranged
to
meet
both
Maureen
baker
and
chan.
Negra
pallu
chose
a
general
practitioner
committee
in
February
Maureen
to
invite
a
sick.
You
see
to
a
round
table
to
discuss
our
future
strategy,
which
gives
us
a
way
of
having
an
advancement
conversation
about.
So
what
are
we
going
to
do
about
this
I'm,
not
entirely
confident
I
understand?
D
Where
will
land
on
the
thirty-first
of
January
in
relation
to
the
general
practitioners
committed,
though
we
did
agree
yesterday
with
Chan
negra
Paul,
but
I
would
meet
him
in
the
second
or
third
week
in
February
to
actually
again
a
van
advancement
conversation.
Everything
I've
ever
learnt
about
industrial
relations
is
keep
talking
and
I.
Think
that's
what
we're
aiming
to
do
in
relation
to
this,
but
it
would
be
wrong
to
pass
over
this
with
a
without
giving
an
acknowledgement
and
that's
what
that
last
brief
paragraph
in
paragraph
5
on
primary
medical
services
is
attempting
to
do.
D
C
The
and
I'm
pleased
that
we're
doing
sort
of
co-production
with
the
GP
community,
but
my
question
is
you
know,
obviously
co-production
needs
to
be
with
patients
and
patients,
groups
and
they're
an
important
voice
in
this.
You
know
what
do
they
want
from
inspections
of
primary
medical
services,
so
I
guess
my
question
is
to
Steve:
how
are
we
making
sure
that
we
get
an
equal
patient
voice
into
some
of
these
discussions
and
our
future
plans
to
inspect
and
regulate.
I
Thanks,
that's!
It
is
really
important
as
we're
doing
this
on
behalf
of
patients
and
the
public,
and
we
have
it
in
the
in
engagement
team,
which
sitting
pulls
Directorate
which
are
helping
us
with
that,
but
the
the
future
strategy
work
going
forward.
That
you'll
be
aware
of
his
a
joint
piece
of
work
between
us
and
policy
and
strategy,
and
the
meetings
were
having
with
co-production
our
aim
to
include
people
not
just
in
the
public,
but
also
from
charities
and
others.
I
C
Yeah
and
I
mean
I
think
but
in
particular,
I
mean
I
would
be
I'd
value,
actually
knowing
what
patients
of
the
public
are
saying
about
what
they
want
from
primary
medical
service
regulation,
because
I
know
I
just
haven't
heard
that
perspective.
All
that
that
fort
is
it
seems
to
be.
You
know,
the
voice
of
general
practitioners
is
very
loud
and
obviously
it's
important,
but
I
actually
haven't
seen
or
heard
what
patients
in
public
want
from
from
the
regulation.
Yeah
Paul.
G
What
is
it
it's,
it's
pretty
much,
the
years
anniversary,
since
we
brought
the
public
engagement
strategy
to
the
board,
so
maybe
for
meeting
coming
februari
or
in
March
the
surgeon
permits.
We
could
bring
back
over
war.
What
people
are
telling
us
about
all
the
sectors
and
that
would
include
general
practice
and
that
be
timely
in
terms
of
the
new
strategy.
D
So
I
just
wonder
whether
just
pick
up
on
cares
points
as
well
as
that
Paul.
We
might
also
just
speak
to
their
engagement
team,
about
confirming
back
in
a
note
to
the
board
about
precisely
what
we're
doing
around
primary
medical
services.
As
part
of
the
strategy.
We've
got
a
pretty
extensive
program
care
going
on
at
the
minute,
which
is
kicked
off
this
week.
Paul
and
I
did
one
of
the
first
sessions.
I
think
andrea
is
doing
to
at
the
end
of
the
week.
D
C
H
A
K
D
A
Recap
for
those
that
don't
know
that.
Thank
you,
the
full
story.
Summer
2013
there
was
the
tragic
death
of
Connor
sparrowhawk
with
in
southern
health.
He
drowned
while
in
a
bath
following
that
Connors
mother
met
with
David,
Nicholson
and
Jane
Cummings,
and
that
led
to
Mars
being
commissioned
to
do
a
report.
In
the
meantime,
first
of
all,
in
October
2014
we
did
our
first
comprehensive
inspection
of
southern
health
which
rated
it
as
requires
improvement
that
was
published
in
February
2015.
A
We
then
did
a
further
unannounced
inspection
in
August
2015,
specifically
of
Forensic
Services
and
learning
disabilities
services,
and
that
was
published
in
October
with
a
number
of
requirement
notices.
Then,
in
December,
just
around
the
time
of
the
last
board
meeting,
the
Mars
report
came
out,
as
you
remember
that
there
a
very
large
number
of
deaths
over
a
four-year
period,
10,000
just
over
10,000
deaths
of
patients
who
were
associated
with
that
trust,
but
that
doesn't
necessarily
mean
that
they
were
deaths
on
trust
property,
if
you
like.
A
So
we've
been
asking
for
information
about
risk
registers,
governance
structures
or
deaths,
as
you
will
be
not
surprised
to
hear
serious
case
reviews,
complaints,
handling,
duty
of
candor,
all
those
sorts
of
things
we've
already
compiled
and
as
well
as
interviewing
senior
management.
We
are
under
taking
a
focused
inspection
of
some
parts
of
the
trust
that
will
include
learning
disabilities
at
units,
but
other
areas
as
well.
So
I
can't
obviously
yet
say
what
we
found
gives
it
that
it's
in
progress
today.
A
Think
simple
answer:
that
is,
we
don't
yet
know,
but
we
need
to
find
out,
and
what
we
have
already
committed
to
is
that
our
future
programme
of
work
will
not
just
be
confined
to
mental
health
trusts.
But
it
will
look
at
trust
of
all
types
and
seeing
because
a
lot
of
the
deaths
of
people,
let's
say
with
learning
disabilities,
actually
take
place
in
acute
trusts.
So
how
well
are
they
are
investigating
those
deaths
as
well.
F
Obviously,
absolutely
welcome
that
what
you
just
said,
but
could
the
last
thing
you
said,
indicated
that
perhaps
in
relation
to
some
of
this
activity
there
may
be
things
that
should
be
being
done
by
other
bodies
other
than
southern
health,
because
that
most
people
in
our
in
the
community,
our
responsibility
in
caring
terms
of
more
than
one
organization,
and
my
previous,
albeit
limited
experience
m-files-
is
that
there
are
many
cracks
through
which
unfortunate
and
honorable
people
can
fall.
I.
F
Just
wonder
where
there
are
inspection
process
sandy
back
allows
us
to
follows
through
cases
from
one
place
to
another,
in
order
to
establish
now
for
weather.
What
our
remit
and
inspection
means
that
we
stop
at
the
front
door
of
the
order
boundary
rather
of
the
institution
we're
currently
inspecting
and
I.
Wonder
if
that's
an
issue
I.
A
Think
we
will
discover
taught
extent
that
is
an
issue,
but
that's
why
we're
deliberately
setting
the
scope
of
the
future
but
to
work
more
widely
to
look
at
it,
partly
how
one
trusts,
let's
say,
communicates
with
another,
so
the
10,000
to
146
death
or
whatever
the
number
was
that
were
of
patients
who
had
been
under
the
care
of
southern
health.
First
of
all,
how
does
that
information
flow
into
the
trust
when
only
127
of
those
had
been
on
trust
premises?
How
did
they
decide
which
one's
of
those
are
warranted
being
designated
as
an
incident?
A
How
did
they
decide
amongst
the
incidence
which
ones
are?
Those
are
warranted
investigation,
but
I
think
we
would.
We
would
take
the
same.
Look
at
people
who
are
dying
under
the
care
of
a
community
health
service,
trust
or
under
the
care
of
an
acute
trusts
as
well.
So
I
think
we
will
get
that
picture
and
we
will
also
get
the
picture
of
how
well
is
one
trust
communicating
with
another.
How
does
that
flow
of
information
happen?
H
A
quick
question
and
in
our
discussion
last
time
I
think
we
felt
that
the
how
you
actually
calculate
the
overall
mortality
in
this
kind
of
trust
you
mentioned
10,000
and
I-
think
from
our
conversation,
we
weren't
so
confident
that
the
methodology
exists
really
to
attribute
mortality
appropriately
to
a
trust
and
is
it
whose
job
is
this
now
in
the
system
to
scan
and
monitor
trust
like
this
to
decide
what
would
be
the
best
methodology
to
identify
outline
trusts.
Given
our
conversation,
I
did
think
we
landed
that
last
time
I'd.
A
And
and
I
think
there
are
a
number
of
different
things
going
on.
First
of
all,
in
the
acute
trusts
sector
and
Paul
who's
just
joined
us
can
also
comment
from
a
mental
health
trans
perspective,
mortality
and
morbidity.
Review
meetings
are
ma'am,
much
better
established,
I
think
they're
working
better
in
some
places
and
others,
so
are
all
deaths
being
reviewed
within
an
acute
trusts,
and
does
that
then
apply
to
people
who
died
on
the
premises
of
mental
health,
trust
I,
think
one
of
the
programs
and
I
think
Robert
knows
about
this.
A
Is
the
medical
examiner
program
which
has
been
waiting
in
the
wings
for
a
while.
Now
that
is
a
process
whereby
every
death
would
be
subject
to
somebody
reviewing
other
case
records
speaking
to
the
family
and
also
then
learning
lessons
now.
I
have
been
to
trusts
where
this
is
in
action
as
the
pilot
sites
and
I
think
it's
a
very,
very
valuable
approach,
because
you
also
get
the
view
from
relatives
about
whether
they
were
concerned
about
what
might
have
happened
and
a
couple
of
trusts
I've
been
to
where
this
is
in
action.
A
H
J
J
What
I
understand
they
did
was
was
to
to
go
to
the
office
of
national
statistics
and
look
at
be
the
death
certifications
that
are
received
there
and
those
that
those
then
can
marry
up
with
the
patient
administration
system
in
a
trust,
and
you
could
enter
fire
are
in
receipt
of
care
who
have
died
over
a
period
of
time.
That's
how
they
identify
the
10,000
people
who
died.
J
B
The
scuffle
points
to
make
that
and
I
think
it
is
very
difficult
to
benchmark
exactly
for
the
reasons,
of
course
have
said,
and
there
is
no
source
of
data
by
the
way,
which
is
the
confidential
enquiry
into
learning,
disability,
debt
search
and,
of
course,
their
remit
is
to
look
across
sectors.
But
even
then
benchmarking
is
another
issue.
I
think
and
close
make
a
couple
of
broader
points.
First
of
all,
mike,
I
think
it's
very
good
pleasing
to
hear
that
we
are
also
thinking
about
how
other
trusts
in
other
sectors
are
dealing
with
this
same
issue.
B
That
is
a
very
important
part
of
the
next
step,
and
and
also
that
there
is,
in
the
current
inspection,
a
strand
of
follow-up
to
the
requirement
notices
from
a
few
months
ago,
because
that
there
is
a
slight
sense
here
of
repetition,
about
the
process.
We're
engaged
in
and
and
the
I
understand,
the
reasons
why
we're
back
there,
but
I
just
want
to
make
sure
that
we
are
clear.
B
What's
what
are
we
are
doing
in
relation
to
these
deaths
that
the
report
that
came
out
in
December
didn't
do
because
it
was
exactly
on
these
issues
and
it
was
only
a
few
months
ago
that
it
that
it
was
in
the
trust
so
that
it
raised
a
couple
of
critical
issues.
One
was
this
one:
we're
talking
about
the
systemic,
systematic
approach
rather
to
the
identification
of
deaths,
particular
by
people,
learning,
disability
and
and
then
a
proper
level
of
investigation.
B
That
is
quite
a
complicated
thing
and
the
I'm
not
sure
that
the
are
not
a
big
fan
of
the
unexpected
expected
divide,
which
the
report,
the
nozzles
report
focused
on
and
for
a
number
of
reasons,
not
least
of
which
is
that
even
deaths
that
are
expected.
I've
got
remediable
factors
at
some
point
in
the
history
and
the
question
is
really
about
modifiable
risk.
What
are
the
risk
factors?
B
What
are
the
risks
that
appeared
in
this
person's
history,
which
something
could
have
been
done
to
give
in
to
intervene
over
and
that's
a
more
practical
question
than
the
one
that
they
expected
unexpected
divided
provides.
So
there's
that
question
that
about
the
investigation?
There's
question
about
the
quality
of
reports,
which
is
a
periodic:
a
universal
problem
across
mental
health
learning
disability
likely
the.
What
is
a
report
into
a
death
at
all?
B
There
was
a
third
issue
about
the
role
of
the
board
in
understanding
what
investigations
were
showing
and
ensuring
that
learning
was
taking
place
and
services
were
changing
and
the
fourth
criticism
was
about
the
involvement
of
the
families
in
the
investigations
and
so
I
just
want
to
make
sure
that
we're
moving
on
from
there,
so
that
we're
not
just
going
to
find
that
those
things
are
a
problem
and
that
we
weave
weave
fold
that
up
and
in
particular,
that
we're
perhaps
modeling
the
involvement
of
families
that
we
are
suggesting,
that
the
trust
isn't
very
good.
At.
A
Yes,
I
believe
we
are
taking
things
for
further
forward.
I
think
it's
important
remember
that
the
trust
has
been
in
receipt
of
at
least
a
draft
report
for
several
months.
So
one
of
the
things
that
we
want
to
know
from
this
is,
first
of
all
at
board
level.
What
is
their
current
approach
to
decide
in
which
deaths
to
investigate
and
I
agree
with
you
and
not
dividing
those
into
expected
and
unexpected,
because
I
think
that's
a
risky
thing
to
do
until
you've
actually
done
the
investigation
so
I.
A
But
what
is
the
board's
policy,
and
also
by
not
just
focusing
on
the
board
in
this
inspection,
but
also
are
going
to
certain
parts
of
the
trust?
We
will
also
find
out
whether
the
staff
have
a
clear
idea
of
how
this
process
works
from
finding
out
that
a
patient
has
died
to
deciding
which
ones
to
report
it
as
an
instant
to
decide
in
which
ones
need
investigation
said
that
that
we
will
be
doing,
and
just
in
response
to
your
last
point
about
discussing
this
with
families.
A
We
can't
clearly
deal
with
ten
thousand
three
hundred
and
six
families
and
relatives,
but
we
are
very
open
to
the
idea
of
meeting
with
families
and
I
know
that
the
head
of
inspection,
who's
leading
this
inspection
is
actively
making
that
offer,
particularly
to
certain
people
who
have
already
got
in
touch
with
us.
So
I'm
about
to
draw
this
this
particular
bit
to
a
close
but
k.
You
wanted
just
to
see
service.
C
Yeah,
absolutely
it's
it's
more
of
a
comment,
so
I'm
not
particularly
asking
for
a
response
at
the
moment
and
obviously
I
do
welcome
the
fact
that
we're
looking
at
how
deaths
are
reported
and
investigated.
That's
that's
that's
food,
but
I
think
that
what
moments
also
realize
is
that
if
you
think
of
connor
there
is,
he
should
not
have
died
in
a
mental
at
NHS
unit,
but
actually
it's
he
shouldn't
actually
have
been
in
vision.
Frankly,
he
could
easily
have
been
managed
at
home
if
they've
been
provided
with
the
adequate
support
and
they
asked
for
it.
C
You
know
so
that
the
preventable
thing
was
that
he
actually
shouldn't
have
been
in
the
hospital
in
the
first
place
and
I
think
him.
You
know
as
we
go
forward,
I
think
and
it's
not
just
for
us
obviously
but
I.
Think
as
we
go
forward.
We
must
realize
that
that
actually,
the
preventable
factor
was
the
fact
that
that
he
was
in
hospital.
C
You
know
so
it's
it's
more
about
policy
and
responding
to
people
in
the
community,
and
you
know
not
just
about
investigating
deaths
when
they
occur
and
say:
oh
well,
he
should
have
had
a
proper
risk
assessment
and
he
should
have
had
someone
checking
on
him
and
all
this
sort
of
thing.
Yes,
yes,
but
actually
the
the
biggest
preventable
factor,
was
the
fact
that
you
shouldn't
actually
been
there.
So.
A
I
think
this
is
I
know
you
wanted
to
say
them.
Poor
value,
I
think
the
reality
is
this
is
this
is
really
important.
It's
also
complex
its
work
in
progress.
As
far
as
we're
concerned,
Mike
you're
probably
have
something
to
say
at
the
next
board
meeting
and
probably
the
board
meeting
after
that,
as
well
as
as
this
develops
so
I
think
I
think
we
need
to
come
back.
Bruh
in
the
comments
have
been
made
very
helpful.
Okay
David.
Should
we
move
on
with
your
report.
D
D
This
was
a
notification
really
about
the
developments
in
relation
to
HealthWatch
that
they
will
become
more
closely
aligned
with
CQC,
but
the
statutory
remittent
function
will
remain
the
same
and
Jane
and
Susan
who's.
The
acting
chief
executive
are
working
with
Ursula
Gallagher,
one
of
our
deputy
chief
inspectors,
who's
running
this
trans
Change
Program.
D
The
business
plan
in
process
for
next
year
also
needs
to
be
undertaken
by
health,
watching
them
work
and
set
out
and
I.
Think
in
the
setting
out
of
the
priorities,
for
the
word
actually
will
give
some
sense
of
the
continued
operational
independence
of
HealthWatch
England
from
CQC,
and
that's
where
the
priorities
can
be
set
out.
I
think
we're
clearer
about
the
financial
resources
will
be
available,
although
they
need
to
be
confirmed,
and
so
I
remain
optimistic
about
management
of
a
pretty
smooth
transition
over
this
next
period
of
time.
D
In
paragraph
10,
I
think,
there's
been
some
publicity
about
this
day,
my
lien
sales
appts
as
the
first
national
guardian
for
speaking
up
safely
in
the
NHS
that
was
announced
in
the
first
week
in
january
personally,
delighted
that
Eileen
has
been
appointed
to
this
I
think
she'll
be
outstanding
in
the
RIP
in
the
role.
I.
D
Think
the
important
thing
about
this
and
make
these
comments,
quite
specifically
in
relation
to
some
of
the
views
that
have
been
expressed
about
the
time
that
she's
gone,
which
is
she'll,
make
a
fabulous
contribution
in
the
time
that
she's
got
available,
she's
committed
to
actually
doing
the
job
and
will
make
that
happen.
But
the
other
important
point
to
stress
is
that
there
will
be
a
team
that
will
support
her
they'll.
Be
this
isn't
just
about
what
one
person
is
going
to
do.
D
This
is
a
massive
job
and
the
way
that
we've
planned
this
is
that
there
will
be
a
team,
a
small
team,
but
nevertheless,
a
team
which
will
provide
cover
through
the
week
and
will
support
her
and
the
plans
to
begin
the
recruitment
process
for
that
or
well
advanced.
A
consultation
on
this
from
CQC's
perspective
is
still
out,
and
then
one
that
is
completed,
Eiling
will
set
out
plans
for
the
future.
The
separate
websites
etc,
which
give
that
sense
of
Independence
I.
D
Think
in
many
respects
is
a
similar
issue
between
I
install
and
issues
about
HealthWatch
England
around.
How
can
an
organization
like
CQC
ensure
the
operational
independence
of
those
two
important
functions
that
provide
them
with
the
cover
that
they're
requiring
terms
with
the
provision
of
infrastructure
and
actually
just
enable
the
running
which,
ultimately
to
the
public
purse,
is
going
to
be
a
better
use
of
money?
D
Drawing
attention
also
to
the
planning
guidance,
particularly
because
there
are
some
significant
additions
to
the
planning
guidance
over
previous
years
about
how
quality
is
to
be
improved
through
the
planning
guidance
and
the
fact
that
some
there's
some
important
questions
which
are
located
within
the
planning
guidance
about?
How
is
the
trajectory
of
improvement
interests
going
to
lead
to
improved
care,
but
also
improved
recognition
from
CQC
in
relation
to
our
ratings,
which,
in
terms
of
embedding
our
work
within
the
system,
I
think
is
a
significant
development
again
to
use
this
word.
D
Independence
I,
don't
think
signing
the
planning
guidance
compromises
our
independence,
the
last
two
items
on
drawing
attention
to
the
junior
doctors
strike,
Mike
wrought
out
and
Steve
brought
out
two
general
practices
and
to
trust
that
we
were
due
to
inspect
on
the
day
of
the
strike,
to
give
them
the
option
of
saying
that
they
felt
this
was
a
step
too
far
to
actually
run
services.
Well,
so
strike
was
taking
place
and
entertain
the
CQC
inspection.
D
A
very
interesting
thing
is
I
think,
with
the
exceptional
wanji
general
practice,
like
seven
general
practices,
all
the
Trust's
and
the
majority
general
practices
said
they
wanted.
The
inspections
go
ahead,
which
I
think
can
is
all
credit
to
to
those
troughs
and
general
practices.
That
said
that,
and
the
last
thing
that
if
I
made
Peter
just
to
draw
the
board's
attention
to
I,
think
Cain
Andrea
over
the
weekend
were
involved
in
social
media
conversations
with
some
people
about
the
experts
by
experience
contract.
This
is
a
contract
that
we've
taken
through
the
board.
D
D
Just
briefly,
I'm
quite
happy
to
say
more
in
private
session,
and
the
reason
for
this
is
that
this
contract
is
still
in
the
process
of
being
finalized.
So
there's
commercial
negotiations
and
conversations
going
on
so
it's
very
difficult
to
say
more
in
a
public
session
at
the
meeting.
But
I
think
this
was
precipitated
by
a
letter
that
age
UK
sent
out
to
a
number
of
the
people
that
they're
currently
recruit
as
experts
by
experience
or
view.
Is
that
that
letter
had
some
inaccuracies
in
it,
which
are
then
set
off
social
media
communication.
D
Who
are
the
two
organizations
have
been
awarded
the
contract?
That's
in
the
public
domain
about
the
detailed
workings
of
the
contract.
So
I'm
quite
happy
to
go
into
more
detail
later
today.
But
I
just
wanted
to
place
on
the
record
that
I
think
there's
been
a
very,
very
good
piece
of
procurement
activity
and
a
second
I
think
the
decisions
taken
by
the
executive
team
and
aboard
with
good
decisions.
I
think
we
are
extracting
more
value
from
this
contract,
getting
more
experts
by
experience
or
more
inspections
as
a
consequence
of
this.
D
But
there
are
some
issues
that
do
need
to
be
settled
as
we
bring
this
contract
to
final
signature
and
conclusion
and
completion.
So
I
just
wanted
to
show
show
that
with
you
and
as
I
say
more,
I'm
more
than
happy
to
go
into
more
detail.
We've
got
some
contracts
later,
and
that
is
coming
for
that.
So
if
we
wanted
a
full
of
discussion
about
the
details
that
sit
behind
that
which
are
not
in
public
because
of
the
sensitivities
in
that
we
can,
we
can
do
that.
No.
A
C
A
quick
one,
yeah
I
mean
I
absolutely
agree
that
the
work
that
the
engagement
team
did
around
the
procurement
to
make
sure
that
user-led
organizations
were
involved
was
exceptional.
I've
said
that
before
and
I
and
I,
it's
still
the
case
and
it's
good
to
know
that
actually
negotiations
are
still
ongoing.
It
is
difficult
to
reply
when
this
there's
some
sensitivity
around
it.
So
and
of
course,
I
don't
mean
I
think
we
have
to
recognize
that
people
are
upset
about
this
and,
and
understandably
so.
So
thank.
L
A
mandate
to
carry
out
he's
basically
saying
is
120
billion
pounds
buy
me
some
health
care
and
the
mandate
this
year
says
by
2020.
The
majority
of
the
population
will
be
receiving
new
models
of
care,
which
is
saying
the
majority
of
the
health
service
will
be
providing
integrated
care
in
four
years
time
and
the
size
to
the
point
you
were
making
about
inspecting
inspections
finishing
at
the
door.
L
We're
going
to
be
expected
in
four
years
time
to
be
inspecting
in
a
different
way
for
fifty
percent
of
the
population
and
for
another,
fifty
percent,
the
population
of
inspecting
the
old
way,
and
so
the
NHS
is
going
to
be
doing
two
very
different
things
and
we
are
part
of
that
ramping
up.
So
it's
quite
a
quite
significant
changes
going
on
around
us
and
the
second
thing
and
in
a
sense
because
all
these
things
are
new,
I
think,
there's
some
hiccups.
L
So
the
letter
that
went
out
from
assam
from
NHS
improvement,
very
important
letter
going
people's
attention
to
quality
and
to
money.
The
final
paragraph
by
action
was
all
about
turn
around,
which
is
essentially
a
financial
issue
and
not
about
improvement,
and
it
needs
people
will
be
will
see
that
as
a
continuation
of
actually,
oh,
it's
real
about
the
money
and
I
think
I
think
we
need
two
people
can
get
turnaround
directors.
L
They
can
do
all
of
those
things
but
they're
not
so
sure,
still
about
what
to
divide
putin
and
so
when,
when
there's
a
meeting
of
the
11th
or
something
with
thee,
it's
actually
talking
to
NHS
improvement.
This
is
in
their
title:
it's
called
NHS
improvement
for
some
reason:
it's
not
good
in
HS,
money
and
and
therefore
therefore
I
think
and
that's
going
to
be
difficult,
because
actually
everyone
has
been
appointed
to
that
organization
to
do
with
the
money.
D
Oh
thanks
for
a
really
important
and
we're
in
pretty
active
discussions,
whether
it's
josiah,
the
minute
about
turnaround,
has
got
to
be
about
quality
as
well,
and
it's
a
really
interesting
reflection
bike
that
you
just
shared
with
us
that
we
will
reflect
further
on.
But
if
we
look
at
places
like
med,
where
their
turnaround
is
as
much
about
a
call
to
turn
around
as
it
is
about
a
financial
turnaround,
so
we
do
need
to
think
about
the
language
that
we
choose
on.
D
An
old
Mike
is
actively
involved
in
this
and
there's
now
a
number
of
models
where
you've
got.
You
know
what
friendly
have
done
it
had.
The
one
in
wrexham
part
you've
got
guys
in
Tommy's
in
a
turn,
medway,
etc.
So
I
think
there
is
almost
a
live
experiment
going
on
about.
How
do
you
improve
the
quality
in
some
of
these
places,
which
again
I
think
it
is
the
significance,
as
you
pointed
out,
to
the
guidance
about
hardwiring
quality
and
quality
improvements
into
the
way
that
the
system
needs
to
operate.
A
Can
I
just
add
to
that
that,
of
course,
the
analyses
that
we
have
done
show
a
very
close
link
between
poor
performance
on
quality
and
our
poor
performance
on
Finance,
so
I
believe
turnaround
is
about
turnaround
in
both
quality
and
finance
and
doing
that
together
and
that's
certainly
the
conversations
that
I've
been
having
with
Jim
Mackay
I'm,
poor
I
would
just
add.
I've
had
some
really
good
discussions
with
both
head
Smith
and
Jim
Mackay,
and
they
they
are
really
focused
on
the
improvement.
A
Now
they
do
understand
what
what
the
name
implies
and
I'm
really
encouraged
by
some
of
the
disco.
Sorry,
some
of
the
discussions
that
we've
been
having
with
them.
The
other
pie
just
occurred
to
me
I
mean
I,
think
you're,
absolutely
right
that
yeah
we're
going
to
be
looking
at
two
very
different
types
of
delivery
models
for
care,
but
actually
it's
going
to
be
more
complicating
that
isn't
it
because
there
will
be
probably
quite
significant
variations
of
what
the
new
models
look
like
and
there
will
be
quite
a
long
transitional
period.
A
K
C
I
wanted
a
firm.
We
could
have
a
son
bought
board
with
an
HS
improvement,
so
it's
a
request
because
I
think
it
would
be
good.
You
know,
because
we
need
to
work
together
effectively
and
I.
Think
having
a
connection
at
board
level.
I
appreciate
your
having
conversations
but
I
think
it'd
be
very
helpful.
You
know
for
us,
but
an
HS
improvement
and,
more
importantly,
the
public
that
we're
you
know
working
together
to
get
this
right.
I'm.
A
Very
proud
to
go
to
say,
I'm
actually
ahead
of
you,
David
and
I
were
discussing
this
earlier
this
morning.
So
it's
as
you
all
know
that
they
are
building
the
board.
So
it's
a
question
of
timing
for
a
full
board
to
board,
but
there
may
be
other
ways
that
we
can
maintain
the
dialogue
and
involve
the
whole
board.
So
absolutely,
okay,
let's,
let's,
let's
move
on
then
I
speak
up
policy
speak
up,
I
mean.
K
K
So
things
very,
very
important
piece
of
work,
and
this
policy
comes
to
the
board
because
the
board
actually
plays
a
part
in
its
very
formal
execution,
around
responsibilities
under
whistleblowing
legislation
and
I
wanted
to
thank
Paul
rue
for
his
part
as
the
chair
of
a
CGC
in
terms
of
them
just
helping
to
set
that
context
in
that
framework,
and
also,
of
course,
do
thank
Robert
for
his
contributions
and
which
have
been
thoughtful
and
important.
As
you
would
expect
around
the
fact
that
what
we're
trying
to
do
here
is
actually
twofold.
K
K
So
it's
twofold.
It's
setting
out
the
rights
and
obligations
and
how
we
execute
those,
but
also
the
work
on
culture
and
behavior,
and
the
support
I
want
to
invest
in
that
around
moving
as
CQC
as
an
organization
forward
linking
back
to
what
David
talked
about
in
terms
of
if
we
hold
others
to
account.
So
should
we
be
able
to
say
that
we
are
also
doing
the
same
to
ourselves
and
the
speak
up
agenda
is
clearly
a
very
important
place
where
we
should
be
seeking
to
do
the
same.
F
Just
to
say
how
much
I'm
I
welcome
the
tone
of
this
document.
Obviously,
we've
had
the
organization
obligations
under
a
very
obscure
piece
of
legislation
for
some
time
which,
in
my
view,
is
sought
to
obscure
what
the
reality.
What
really
needs
to
happen,
which
is
in
every
organization,
including
this-
that
speaking
up
when
you're
worried
that
about
the
way
in
which
people
work
is
being
done.
F
That
should
be
a
normal
activity
which
is
welcomed
and
supported,
and
so
I'm
really
pleased
that
this
document
seeks
not
with
it
me
mentions
it,
but
it
does
seem
to
get
away
from
the
somewhat
pejorative
word
that
sometimes
I
use
a
whistle
blowing.
So
I
think
that
is
really
helpful.
We
as
an
organization
must
listen
to
stuff
and
we've.
F
C
Okay,
thanks
I've
now
had
a
slightly
different
view
on
it
absurd
and
three
from
someone
who
did
speaker
and
I
just
wonder
if,
if
we
have
actually
run
this
by
people
who
have
spoken
up,
you
know
just
to
get
their
views
on
it,
because
when
I
read
it
I
kept
seeing
loopholes.
C
C
Just
think
that
if
somebody
read
this
policy
wenting,
where
things
have
gone
wrong,
they
would
see
a
lot
of
loopholes
in
it
because
I
mean-
and
another
thing
is,
that
the
national
and
the
National
Guard,
not
the
National
Guard
and
the
guardian
for
speaking
up
in
CQC
the
roles
not
defined
you
know.
Would
it
look
at
individual
cases
to
provide
extra
scrutiny
and
protection?
You
know
and
again
that
it
just
feels
to
me
that
that.
C
It
doesn't
give
clarity
on
how
would
we
would
make
sure
that
when
people
speak
up
and
they
run
into
problems
that
we
would
have
a
sort
of
effective
independent
look
at
what
was
being
said.
You
know
I'm
not
seeing
we
wouldn't,
but
it
does
happen
and
it
has
happened,
and
it
has
happened
in
CQC
in
the
path.
So
I
think
that
it
that
it
will
be
good
to
get
some
sort
of
whistleblower
views
on
this.
So.
A
A
But
to
me
it's
all
about
the
culture
of
the
organization
and
I've
seen
that
elsewhere.
If
there
is
a
culture
where
people
do
feel
they
can
raise
concerns,
then
actually
these
processes
become
less
important.
If
the
culture
isn't
it
doesn't
allow
that
then
actually
really
almost
matter
what
process
you
have.
A
A
A
K
The
individual
involved
said
that
they'd
received
exemplary
support
and
that
this
approach
and
policy
is
very
consistent
with
what
they
received
so
I'd
like
to
just
offer
assurance
so
where
we
have
had
opportunity
to
talk
to
and
seek
feedback
from
a
key
individual
who
was
a
significant
whistleblower.
Their
feedback
has
been
incredibly
positive
about
the
degree
of
support
that
they
felt
and
encouragement
to
do
the
right
thing.
K
We
can't
be
absolutely
specific
about
what
it
will
look
like
now,
because
we
actually
need
to
get
an
individual,
just
as
we
have
with
eileen
seals,
who
will
take
a
view
as
to
what
is
appropriate
for
CQC
and
to
work
with
us
to
ensure
that
it's
shaped
properly
and
anything
else
that
Tracey
wants
to
add
because
she's
been
lived
and
breathed.
This
I
invited
to
do
so,
but
I
wanted
to
offer
that
assurance.
Tracey.
M
Particularly,
I
just
I
think
to
say
that
I
do
see
the
guardian
role
has
been
quite
important
into
in
promoting
that
culture.
We
do
have
few
whistleblowers
in
CQC,
whether
we
should
have
more
you
know,
maybe
having
the
Guardian
may
help
help
to
create
that
culture
if
more
people
might
come
forward,
but
I
think
the
Guardian
here
in
terms
of
the
role
I
think
will
be
initially
about
promoting
that
openness
and
transparency,
culture
and
then
also
providing
the
scrutiny
role
as
to
how
the
organization
is
responded
to
concerns
that
are
raised
and
the
posts
will.
M
H
Jennifer-
and
it
looks
very
good
to
me,
but
it
strikes
me-
we
have
the
best
available
expert
by
experience
around
the
table
that
you
know
there
are
something
simply
we
can't
see
because
we
haven't
been
through
it
and
I
think
what
you
say
really
stands
up
and
I'm
sure
that
there'll
be
chance
to
input
and
and
would
be
welcomed.
So
I
support
what
case
saying
thanks
bedroom.
N
C
There's
lots
of
opportunities
for
people
to
do
that
in
terms
of
responding
directly
to
David
and
his
weekly
message
or
me
or
mine
org.
You
know,
and
staff
forums,
their
trades
union
conversations
all
sorts
of
things,
and
but
actually
so
yes,
that's
important
and
I'm
sure
the
guardian
in
terms
of
the
senior
manager
will
take
this
on
and
will
really
help
strengthen
that
I.
Think
it's
just
that
little
bit
of.
If
all
of
those
things
have
worked
really
well
and
somebody
still
feels
unhappy,
then
then
what
do
we
do?
C
And
maybe
it's
just
that
time,
ttle
bit
that
we
could
we
could
address
because
I
think
that
the
mood
music
is
is
all
heading
in
the
right
direction
and
but
equally
as
Jennifer
says,
we
shouldn't
neglect
the
advice
and
inside
that
you've
got
a.
F
System
Adam,
absolutely
sizes,
I
would
with
KKK
and
and-
and
we
must
hear
very
carefully
what
what
she
says
from
her
experience.
I
would
have,
regardless
as
a
container
like
most
things
appear
as
a
work
in
progress,
and
one
part
of
it
is
to
suck
it
and
see.
But
now,
for
instance,
in
relation
of
the
Guardian
I
noticed
it
is
very
likely
draw.
But
then,
if
you,
we
actually
need
someone
in
the
post
to
create
it
rather
than
to
tell
them
what
to
do
so.
F
That's
the
first
point
anybody
I
would
make
about
the
guardian,
which
perhaps
isn't
explicit
here,
but
I
hope
is
is
seen.
Is
that
rather,
like
our
national
garden
is
someone
who
should
be
able
to
open
the
doors
to
senior
people
at
all
levels
when
he
were
seized
these
fit
the
same
wall
to
apply
to
the
our
garden
in
relation
to
anyone
in
the
organization?
It's
a
door
opening
12
as
much
as
said
that,
undoubtedly
my
view
would
involve
helping
individual
people
where
appropriate.
So.
A
If
everybody's
in
agreement,
what
I'd
like
to
suggest
is
that
we
approve
the
policy
because
it
clearly
is
a
big
step
in
the
right
direction.
As
you
say,
okay,
if,
if
you
have
some
time
and
have
got
some
more
detail
points
you
want
to
raise
with
the
team,
let's,
let's
do
that,
because
that
can
be
incorporated.
I
think
what
you
said
a
minute
ago:
Roberts,
absolutely
right!
You
want
to
just
then
then
see
how
it
how
it
works.
A
Nothing
is
cast
in
stone
forever,
but
I
think
it
would
be
a
shame
if
we
don't
get
this
in
place
and
get
moving
on
it.
So
it
doesn't
really
feel
right
now,
I,
don't
know
who
came
up
with
the
with
that
with
a
name,
but
I
mean
almost
that
alone.
I
think
starts
to
change
the
culture.
So
great,
sorry,
Michael!
Yes,
sorry.
O
Just
one
point
which,
in
a
way
Roberts
raised
but
I
was
going
to
raise,
it
does
take
two
paragraph
eleven
before
the
appointment
or
the
creation
of
a
Speak
Up
Guardian
that
the
CQC
is
going
to
be
implemented
and
yeah
I
would
have
thought.
You
know
this
is
so
important
part
of
our
because,
after
all
we're
revising
the
policy.
But
most
of
this
policy
is
exactly
the
same
as
the
previous
policy.
A
Good
point
noted
you
can
look
at
that
yeah.
Okay,
are
we
happy
to
to
improve
subject
to
all
the
points
that
have
been
been
made?
Fantastic,
very
good.
Is
there
any
other
business?
Anybody
wanted
to
two
rows.
Sorry
will
come
to
you
in
a
member
just
just
on
the
board
only
and
anything
else
from
the
board.
Okay,
so
the
two
things,
one
we're
actually
finishing
only
a
minute
late
I
never
managed
to
do
that
at
Yeovil,
as
the
company
secretary
there
would
confirm.
So
that's
that's
a
real
achievement.
Thank
you
all
for
that.
A
I'm
also
very
clear
that
this
is
a
meeting
we
hold
in
public.
It's
not
a
public
meeting,
however,
since
some
of
you
have
made
long
journeys
to
get
here.
We've
got
a
couple
of
minutes.
If
there
was
something
I
hand
went
up,
that's
that
you
wanted
to
raise.
Please
do
I
think
that
would
be
really
helpful.
Yeah.
N
Over
the
Christmas
period,
I
was
with
a
very
distraught
lady
daughter
who
her
mother
had
gone
into
a
care
home
and
was
in
a
really
rather
miserable
state
and
as
I
always
do
in
these
cases,
I
looked
up
what
the
CQC
had
said,
and
it
was
what
I
always
think
of
as
the
old
deanery
situation,
where
the
CQC
has
said
that
it
is
good
for
caring.
The
home
was
good
for
caring
and
then
the
evidence
about
some
evidence
emerges
which
suggests
that
isn't
quite
as
good
as
we
had
thought.
I
really.
N
My
question
is
for
Luis
here
we're
going
back
to
the
regulatory
commission
committee
meeting.
You
discussed
a
lot
of
important
things,
but
one
who
didn't
discuss
I
think
was
the
methods
of
inspection
and
whether
they
are
really
adequate.
I'm
not
saying
that
as
a
definite
answer
about
that,
but
I
think
in
the
area
of
caring
and
in
particular
in
the
area
of
social
care.
B
But
but
I
do
I
do
agree
with
you.
This
is
a
very
important
issue
and
in
fact,
that
our
board
dinner
last
night
amid
a
similar
point,
in
fact
and
I-
suppose
the
timing
it
with
everything
about
what
we
do
is
now
up
for
discussion,
I,
suppose
we're
or
planning,
of
course,
for
the
the
next
phase
of
how
we've
got
about
inspections.
We
were
planning
for
that
now.
Although
the
inspections
cycle,
it's
not
at
an
end,
so
I
think
maybe
we
can
reassure
David
that
that
point
has
been
understood.
B
B
All
day,
every
day,
people
who
are
witnessing
the
small
things
about
how
people
are
treated
which
actually
reflects
something
much
larger
about
the
attitude
of
an
organization
and
picking
up
those
small
things,
sometimes
they're,
not
small
by
the
way,
but
but
picking
up
those
small
things
would
help
us
enormously
and
when
we
get
it
further
into
the
discussions
about
how
we,
where
we
go
to
with
our
ratings
and
our
inspection
plans,
I
do
think
we
do.
We
have
to
address
the
point
that
David
is
right.
A
It
just
seems
to
me
that
the
reality
is
that
you
could
have
a
very
good
organization,
whether
it's
a
home
or
a
hospital
or
anything
else.
That
does
not
guarantee
that
on
every
day,
every
person,
every
every
member
of
staff
will
do
everything
that
they
should,
and
we
have
to
recognize
that
that
reality
and
the
second
point
I'd
make
and
I
that's
not
to
be
defensive
about
the
system
and
it
will
evolve
and
is
evolving.
A
Is
that
you
know
unless
you
are,
unless
you
have
inspectors
to
living
in
the
place
all
the
time,
you
will
never
get
that
one
hundred
percent
assurance,
so
those
are
those
there
is
a
judgment
that
has
to
be
made
and
I
think
that's
judgment.
Partly
that
goes
to
our
resource
is
spent
because
you
know,
as
I've
said
in
another
occasion,
whilst
I
think
the
work
that
CQC
does
is
Hugh
important,
I'm,
very
conscious
that
every
pound,
we're
spending
is
apparently
isn't
available
for
the
front
line.
A
So
you
know
that
there
has
to
be
a
balance
in
all
of
this.
But
your
point
is
understood,
and
you
know,
as
things
develop,
we
will.
We
will
take
that
very
much
to
heart.
I
am
conscious,
it
is
now
almost
half
past.
We
are
running
a
few
minutes
late,
so
could
I
suggest
that
we
would
bring
matters
to
a
name
now,
there's
coffee
outside
and
will
resume
the
part
2
of
the
board
meeting
in
10
minutes
time.
Thank
you
all
very
much
indeed,.