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From YouTube: CQC BoardMeeting 16 October 2013
Description
Agenda for the meeting of the Care Quality Commission on 16 October 2013:
1. Apologies and declarations of interest 0:00:01
2. Minutes of the meeting held on 18 September 2013 0:00:20
3. Matters arising and action log 0:00:25
4. Chief Executive's report 0:00:33
5. Chief Inspector of Hospitals update 0:26:40
6. Chief Inspector of Adult Social Care update 0:44:53
7. Chief Inspector of General Practice - introduction 0:57:56
8. Finance report 1:23:50
9. Transformation programme update 1:35:03
10. Complaints update report 1:36:48
11. Healthwatch England 1:59:47
12. Any other business 2:08:41
Read more about CQC's Board Meetings at
http://www.cqc.org.uk/public/about-us/our-people/board-members/board-meetings
A
Welcome
everyone
don't
forget
to
press
the
mic
when
you
want,
when
you
want
to
speak,
kamila
and
Jennifer
are
coming
on
their
way
and
we've
got
apologize
for
Mike,
who
is
doing
leading
an
inspection
at
parking,
&
Redbridge
right.
Everyone
happy
with
the
minutes.
Yeah
I
think
that
most
of
the
action
points
are
picked
up
in
David's
report
now
elsewhere,
so
we'll
come
back
to
them
at
the
end,
if
they're
not
for
some
reason
and
today,
but
we
just
read
to
your
report,
please.
B
Thank
you
David
good
morning,
everybody
so
I'm
slightly
briefer
than
the
last
one
I'll.
Do
it
quickly
to
welcome
Steve
and
Andrea
to
the
first
formal
meeting
I
think
Andrea
was
doing
a
guest
appearance
at
the
last
meeting,
but
I
am
confirming
that
Steve
and
Andrea
now
join
Mike
and
we've
got
a
full
complement
of
chief
inspectors.
I've
spoken
to
about
a
dozen
people
who
have
an
interesting
corporate
services
and
part
of
my
HR
directors,
pause
and
I
hope
over
the
next
week.
B
We
can
actually
make
some
progress
and
actually
bring
somebody
in
in
relation
to
those
positions.
David
and
myself,
and
member
of
the
exec
team
will
work
out
the
interview
timetable
for
those.
Oh
there's
a
further
report
elsewhere
in
the
agenda,
but
I'm
just
covering
in
annex
paragraph
two
high-level
progress
in
relation
to
the
transformation.
B
We've
got
a
program
plan
in
place
for
the
transformation
we're
developing
in
parallel
to
that
a
training
and
development
plan
around
the
Academy.
The
change
to
the
new
organizational
structure
is
really
were
the
senior
team
we're
going
to
focus
on
the
period
between
now
and
the
end
of
the
year.
We
had
a
on
Monday
of
this
week,
a
conference
where
we've
got
three
indeed,
managers
from
within
CQC,
so
whether
people
manage
one
person
or
manage
30
people,
we
brought
everybody
together
and
went
through.
B
We
do
need,
however,
to
bring
in
some
additional
capacity
to
help
us
to
do
this
and
I'll
be
bringing
forward
proposals
in
that
respect
in
due
course,
and
then
later
this
month,
beginning
of
next
month,
we
begin
a
gateway
review
from
the
Department
of
Health,
which
is
an
external
scrutiny
of
the
program
arrangements
and
a
check
and
a
test
of
whether
we're
good
to
go
care
bill
goes
into
Parliament.
It
will
be
the
causes
which
affect
us
are
going
to
be
considered
today
and
next
week
and
I'm
just
pointing
out
here
the
announcement.
B
The
secretary
of
state
made
a
the
Conservative
Party
conference
about
the
government,
will
move
amendments
in
the
care
bill
in
relation
to
the
independence
of
CQC
still
on
legislation.
The
Department
will
publish
for
consultation
there
too
this
month
draft
regulations,
which
will
be
the
basis
of
the
legal
legal
basis
of
the
judgments
that
we'll
make
on
our
new
methodologies.
So
that's
a
significant
publication
that
will
go
out.
B
We've
made
changes
to
the
way
that
we
are
registering
and
the
action
that
we're
taking
in
relation
to
the
issuing
a
fixed
penalty,
notices,
which
you
discussed
the
last
board
meeting
so
I'm,
providing
in
an
update
here
on
the
work
that
will
are
putting
in
place
to
advance
that
on
performance
for
this
current
year.
You
have
not
got
the
detailed
report
in
this
agenda.
Performance
remains
on
track.
B
I
receive
a
weekly
monitoring
report
in
relation
to
this,
as
do
the
original
directors,
and
progress
is
good
slightly
behind
plan
for
this
time
of
year,
but
the
bank
has
now
been
recruited
to
at
the
time
of
drafting
this
we've
got
under
the
92
bank.
Inspectors
will
be
assisting
in
delivering
the
program.
B
Paragraph
seven
have
highlighted
an
FOI
request.
We
got
from
the
MP
Stephen
Barclay,
which
received
a
third
degree
of
publicity
press
coverage
over
the
weekend
of
the
fifth
and
sixth
of
October
and
just
set
our
decision
to
publish
this
information.
The
key
issue
from
CQC's
point
of
view
was
about
whether
we'd
extended
the
courtesy
to
previous
ministers
and
advising
them
that
we
publish
this
we'd
release
this
information
for
publication,
anticipating
that
this
would
find
its
way
into
the
press.
B
We
didn't
advise
these
two
ministers
that,
before
we
issued
this
information-
and
we
should
have
done
that-
and
that
was
a
courtesy
we
should
have
extended.
The
Cabinet
Office
guidelines
in
relation
to
previous
ministers
is
about
the
publication
of
documents
and
I
draw
a
distinction
there
between
documents
and
emails,
but
nevertheless
we
feel
that
we
should
have
extended
that
courtesy.
You
asked
and
I
think
this
picks
up
on
your
introduction.
David.
B
At
the
previous
meeting,
there
was
an
action
about
what
our
engagement
is
with
local
authorities
in
relation
to
children's
safeguarding
and
looked
after
children's
worked,
and
what
I've
tried
to
do
in
paragraph
nine,
with
the
assistance
or
the
colleagues
that
lead
this
work
directly
is
just
set
out.
What
our
look
is.
B
Essentially,
what
this
is
saying
is
our
locus
in
children's
safeguarding
and
children
looked
after
is
to
focus
on
the
health
care
needs
of
those
children
and
what
it
is
that
healthcare
organizations
contribute
to
meeting
the
welfare
and
well-being
of
those
children
and
therefore
our
locus
isn't
with
local
authorities.
What
we've
done
in
the
bullet
points
at
the
bottom
of
page
five
and
the
top
of
page
six
is
so
a
set
out
where
we
find
issues
in
relation
to
the
welfare
and
well-being
of
children.
B
We
can
draw
those
to
the
attention
of
Ofsted
to
the
local
children's
safeguarding
board
and
there
can
then
be
picked
up
in
the
work
that
those
organizations
do
and
then
the
last
point
just
to
dry
out
David
is
that
you
and
I
are
to
appear
before
the
Select
Committee
the
help,
so
that
can
next
week
for
our
annual
accountability
meeting.
So
that's
the
report.
C
Sorry,
I
think
this
clarifies
position.
Matt
looked.
Our
teacher
is
very
very
helpful,
but
this
area,
more
than
any
other,
is
one
where
we
know
that
cases
fall
through
the
cracks
and
if
we
just
get
stuck
on
a
very
closed
definition
of
our
responsibilities
and
we
could
end
up
being
on
the
wrong
side
of
a
very
bad
case
and
and
poor
publicity.
So
while
this
is
necessary,
I
think
you
know,
the
staff
have
to
be
a
bit
sort
of
outgoing
on
this,
possibly.
B
I
think
the
stuff
that
under
tech,
this
worker
well
aware
of
the
risks
but
run
and
I
think
the
recent
case.
Reviews
have
actually
demonstrated
what
the
risks
are
of
people,
not
recognizing
the
signs
and
symptoms
and
then
communicating
effectively
so
I
think
they
are
alert
to
it
and
constantly
vigilant
about
this.
I
think
this
is
something
that
we
actually
need
to
consider.
B
Camille
has
been
raising
questions
with
me
as
well
about
this
and
I
just
think.
We
should
continue
to
debate.
How
would
position
this
to
make
sure
we've
got
the
most
effective
arrangements
in
place.
Whilst
we've
got
this
responsibility,
if
it
is
a
view
that
this
isn't
responsibility
we
need
to
take,
then
we
can
consider
that
as
well,
but
at
the
minute,
I
think
this
is
just
a
straight
response
to
the
question
that
was
asked
about
what
our
engagement
with
local
authorities
are.
I.
Think
your
broader
points
about
how
we
discharge
our
responsibilities
is
is
key.
B
B
So
there's
a
team:
that's
headed
up
by
Sir,
Matt
Millen
and
in
our
new
structure
we
propose
that
Steve
will
lead
on
this,
where
all
the
integrated
work
goes
in
Steve's,
Directorate
and
it
over
his
team,
so
that
team
of
inspectors
will
transfer
to
him.
These
are
all
people
with
a
health
and
care
background
who
are
carrying
out
these
inspections
and
they're,
led
by
as
soon
like
million
who
Macmillan
who's
one
of
our
senior
managers
or
the
normal
debates
about
what
is
the
background
of
these
people
exactly?
A
D
Mean
I
think
I've
made
my
peace.
I
mean
I'm
concerned
about
this
I'm,
not
sure
what
that
I
think
we
need
to
just
as
Steve
said,
be
a
bit
careful
am
I,
not
clear
I'm,
still
not
entirely
clear
what
value
we're
adding
to
it.
What
is
a
very
complicated
picture
where
there
are
an
enormous
amount
of
regulators
already
said,
I
mean
but
I
think
we're
gonna
have
that
discussion.
So
we
just
don't
want
to
really
go
over
it
now.
David.
B
Come
on,
let
myself
with
been
in
correspondence
all
of
the
conversation
and
just
run
through
the
arguments.
I
think
the
key
issue
here
is
that
some
what
we
did
was
a
contribution
to
the
multi-agency
inspections
that
Ofsted
led
the
tradition
around
multi-agency
inspections
really
comes
from
Victoria,
convey
and
Herbert
lemons
report.
When
one
of
the
challenges
to
the
inspector
'its
was
the
word
joined
up
and
therefore
one
of
those
recommendations
was
the
Ofsted,
as
the
children's
inspector
should
lead
multi-agency
inspections.
B
I
did
the
probation
inspector
I
did
the
police
inspector
because,
for
obvious
reasons,
they're
involved
in
relation
to
a
variety
of
plot
parts,
where
the
criminal
justice
system,
such
as
the
inspection,
the
decision
was
taken
by
Ofsted
that
they
wanted
to
focus
on
their
own
work
and
they
have
stood
down
for
a
two
year
period.
The
multi-agency
inspections
issue
that
it
then
leaves
for
us
is
whether
not
just
those
but
broader
interest
I
mean
the
Department
of
Health
air
and
it
s.
England
will
be
satisfied
with
no
inspection.
B
B
So
there's
what
is
the
function?
We're
being
asked
to
carry
out
and
in
carrying
out
that
function?
Can
we
be
clear
that
what
we
do
is
effective,
I
think
they're,
both
absolutely
legitimate
questions
and,
as
we
go
through
this
process
of
reviewing
what
we
do,
how
we
do
it,
who
we
do
it
with
it's
a
legitimate
question
for
us
to
ask
so
I
think
we
should
do
that.
Meanwhile,
we've
got
an
inspection
program
that
until
we
change
it,
I
think
we
should
continue
with
that
inspection
program.
E
Thanks
it,
it
does
seem
like
an
anomaly
that
some
of
the
most
vulnerable
people
in
the
because
of
their
health
problems
are
not
primarily
our
concern.
If
I
put
it
that
way,
and
it's
not
difficult
see
how
that
might
have
that's
come
about
because
of
a
series
of
reports
and
investigations
from
a
particular
perspective
from
a
social
care
perspective
from
a
criminal
justice
perspective,
but
but
the
the
fact
is
that
the
other
organizations
have
different
priorities
from
us
there.
Their
expertise
is
likely
to
be
less
than
ours.
E
Their
interest
is
likely
to
be
slightly
different
and
and
yet
the
long-term
consequences
for
some
of
the
children.
We're
talking
about,
may
well
be
more
dependent
on
what
happens
to
their
health
care
than
it
is
on
what
happens
to
some
of
the
other
agency
involvement.
So
I
can
see
why
we
are
in
the
position
were
in
at
the
moment,
but
that
doesn't
feel
like
a
very
comfortable
position
for
the
future,
and
so
it
would
be
useful
to
know
what
what
kind
of
reconsideration
of
this
might
happen.
E
I
understand
that
you
know
that
CC
has
a
broad
agenda
already
and
whether
whether
this
will
is
likely
to
change
whether
our
role
will
be
either
cutout
moths
or
discrete
role,
where
we
take
responsibility
for
a
particular
bit
of
the
care
or
whether
our
involvement
will
be
greater
more
formal.
One
of
the
complaints
of
agencies
on
the
ground
by
the
way
is
often
that
health
doesn't
get
involved
very
well
and
where
health
is
not
the
primary
agency.
E
So
we
are
not
very
good
at
being
the
being
second
in
in
this
multi-agency
discussion,
and
while
that-
and
you
know,
you
could
argue
that
one
of
the
one
of
the
ways
in
which
that
secondary
position
is
confirmed
is
the
position
of
CQC
in
relation
to
inspections.
So
it
doesn't
feel
very
comfortable
that
we
don't
have
a
primary
role
in
the
care
of
these
built-in.
E
So
my
question
is
whether
we
are
whether
there
will
be
plans
to
change
that
or
at
least
discuss,
possibly
possibility
of
change,
and-
and
the
second
thing
is
that
in
the
meantime-
because
there
will
be
a
meantime
anyway
and
do
we
know
what
happens
once
we've
made
recommendation
once
we've
shared
the
information
with
Ofsted
as
the
reporters
do
it
do,
we
know
what
then
happens
to
that.
Do
they
report
back
to
us
on
how
they
deal
with
that
and
do
we
do?
We
have
any
kind
of
follow-up
through
the
local
authority.
B
So
I
think
we
do
have
a
primary
role
and
the
primary
role
is
to
inspect
the
health
care
contribution
to
children
who
need
safeguarding
and
children
looks
after,
and
the
purpose
of
that
inspection
is
to
check
the
effectiveness
of
those
services
in
safeguarding
looked
after
children
and
safeguarding
children
who
are
in
need
and
vulnerable.
So
I
think
we
do
have
a
wrong
in
terms
of
what
happens
next,
any
information
we'd
show
with
Ofsted
will
inform
their
future
inspection
plans
of
both
local
authorities
and
local
children's
safeguarding
board.
B
B
My
your
observation,
Louis
that
many
other
agencies
reflect
on
the
absence
of
health
at
children's
safeguarding
meetings
and
I.
Think
that's
one
of
the
reasons
why
safeguarding
inspections
need
to
be
multi-agency.
I
thought
Lord
Lehman.
Had
it
right
that
if
we
wanting
people
to
behave
in
a
multi-agency
way
at
a
local
level,
then
the
inspection
of
that
should
be
multi-agency
as
well.
B
So
I
think
we
should
continue
to
contribute
to
make
sure
we
were
doing
this
work
effectively,
that
the
impact
of
this
work
and
the
outcome
of
this
work
is
leading
to
improvements,
and
it
is
a
challenge
that
we
put
back
into
the
system
that
leads
to
those
services,
improving
that
the
way
they
actually
provide
this
one
of
the
key
issues
as
we
go
around
during
our
hospital
inspections
is
how
much
prominence
are
we
giving
to
safeguarding?
How
far
do
we
check
when
we're
embarking
today?
How
that
safeguarding
work
is
being
taken
forward?
B
B
We've
got
around
safety
and
the
safety
of
health
care
services
and
how
those
services
promote
the
safety
and
well-being
of
children,
but
I,
don't
think
we
should
rule
anything
out
in
terms
of
our
review
of
what
is
it.
We
do
why
are
we
doing
it?
How
are
we
doing
it
and
are
we
doing
it
in
the
most
effective
way?
B
It's
just
saying
there
is
a
strong
correlation
between
the
appropriateness
of
mental
health
services
and
some
safeguarding
services
for
children
as
well.
So
I
think
we
need
to
ensure
this
is
embedded
in
all
the
work
that
we
do
not
compartmentalize
it
to
a
team
that
is
doing
children's
said
garden
inspections,
but
that's
that
would
be
a
personal
view
that
needs
to
be
opened
up
and
I
wouldn't
want
to
print
a
conversation
that
I
think
we
do
need
to
be
internally
about
how
best
to
check
that
that
work
forward.
I.
A
C
B
No
I
think
this
is
well
it's
an
additional
risk.
Well,
yes,
this
additional
risk.
Just
less
speakers.
It
is
yes,
there
is
additional
risk
and
we're
mitigating
that
risk
by
being
absolutely
clear
about
this
program
and
because
Ofsted
have
deferred
this
to
lot
till
15.
This
is
why
we've
got
a
two-year
program.
It's
not
we're
trying
to
fill
a
space
is
we're
trying
to
discharge
what
our
responsibilities
are
around
and
assuring
that
services
for
children
are
particularly
in
relation
to
safeguarding
and
the
special
vulnerabilities
of
children.
D
Sorry,
it's
the
other
point.
I
wanted
to
make
I
mean
I.
Think
we
have
the
effectiveness.
Issues
is
really
clear
and
we
need
to
just
take
account
of
the
changing
landscape,
because
obviously
the
GMC,
the
Royal
Colleges
unit,
that
the
BMA
they're
all
getting
involved
in
this
space,
but
also
I,
think
the
multi-agency
approach
has
failed,
its
failed
disastrously
and
it's
become
a
barrier
to
the
safety
of
children.
D
B
B
It's
not
just
the
poor
stop
when
you
intervene
after
something's
gone
wrong,
which
is
what
we've
had,
but
how
far
does
the
the?
In
a
sense,
the
anticipation
that
we're
going
to
visit
and
ask
questions
hard
questions
about
the
robustness
of
systems
lead
to
a
number
of
organizations
taking
action
that
they
might
not
otherwise
have?
Second
and
I
just
think
there
is
a
reputational
and
deterrent
issue
that
needs
to
be
factored
into
the
way
that
we
work.
B
My
personal
belief,
I
have
no
evidence
for
it
is
people
do
behave
differently
as
a
consequence,
as
was
saying
we're
going
to
do
things
first,
question
I
got
at
the
foundation.
Trust
network
conference
yesterday
was
about
perverse
incentives,
so
we
can't
have
this.
Always
you
know
if
if
people
do
what
we
ask,
then
actually
there's
merit
in
us
asking
about
children
safeguarding
and
if
a
perverse
incentive
is
that
people
said
God
children
more
effectively,
I'm
in
for
it.
C
B
A
F
F
But
in
listening
to
the
conversation,
it
sounds
to
me
like
actually
there's
a
there's,
a
question
in
our
minds
about
whether
Ofsted
have
made
the
right
decision
or
or
maybe
we
need
to
go
it
alone,
separately
and
and
I.
Don't
think
we
should
just
kind
of
sit
and
say
well,
that's
the
decision
they've
made,
so
we've
got
to
respond
in
in
this
way,
but
rather
give
ourselves
afford
ourselves
the
time
and
space
to
think
about.
F
Well,
what
way
do
we
think
it
ought
to
be
and
then
to
work
with
with
government
and
others
to
see
if
we
can
arrive
at
the
right
solution?
So
if
we
think
there's
an
issue,
I
think
we
should
grasp
it
and
and
try
and
shape
a
response
to.
It
is
what
I'm
saying,
rather
than
just
deal
with
our
own,
our
own
house,
if
you
like.
A
B
Now
we
need
to
check
that
and
we'll
continue
to
do
it.
I
think
this
is
a
hugely
important
part
of
our
responsibilities,
but
let's
have
the
debate:
let's
have
the
discussion
internally
about
where
we
are
with
it,
and
if
we,
if
you
feel
we'd,
not
fill
the
space
in
an
appropriate
way,
then
we'll
fill
the
space.
This
isn't
something
to
sit
back
on.
Sorry.
G
Steve
yeah
thanks,
given
that
I'm
taking
this
responsibility
on
I
mean
I.
Take
this
really
seriously
from
a
practicing
GPS
point
of
view.
You
know
in
Birmingham
and
for
many
years
I
carried
around
the
Klem
vo
report
in
my
bag
because
he
had
such
a
profound
effect
on
on
me
personally
in
the
brief
10
days
of
induction.
G
To
this
this
role,
I
mean
it's
clear
that
we
have
a
responsibility
and
Ofsted
doesn't
on
inspection
and
regulation,
and
the
health
service
sector
problems
always
happen
in
the
handoff
or
interface
between
organizations
and
certainly
I'd
be
committed,
and,
as
we
later
on
talk
about
the
new
structures
that
to
deliver.
This
will
be
an
important
part
of
of
my
team's
role
and
we
need
to
make
sure
we
get
it
right
and
I.
Think
Kimmel
is
absolutely
right.
G
There's
a
history
of
joint
in
joint
work
between
all
sorts
of
different
agencies
which
isn't
as
effective
as
it
it
could
be.
We
had
a
brief
discussion
with
Ofsted
yesterday
committed
to
working
very
closely
with
them,
but
my
understanding
was
I
think
it
was
the
Munroe
report
in
2011
reinforced
the
need
for
joint
inspections.
The
government
came
out
very
committed
to
making
sure
they
happened
and
we
need
to
be
in
a
leading
role
rather
than
passive.
In
this.
H
H
Just
at
some
point,
it
will
be
helpful
for
us
to
just
kind
of
talk
through
what
it
actually
means,
because
you
know
we're
saying
we're
going
to
speak
without
fear
or
favor
we're
going
to
speak
truth
to
power,
which
is
great,
but
at
the
same
time
we
can't
campaign
and
I
think
it
would
be.
You
know
and
I
know:
we've
got
things
like
partnership
agreements
and
mo
use
in
place
and
all
that
we
need
to
make
sure
that
we
kind
of
implement
them
and
scrutinize
them
and
all
that
sort
of
thing.
H
But
you
know
particularly
for
as
well
the
the
board
and
the
directors
as
to
what
we
can
sort
of
reasonably
say
without
you
know
feeling
that
we're
being
inappropriate
or
you
know,
because
I
think
the
public
now
do
expect
us
to
speak
out.
You
know,
but
we
of
it.
Obviously
we
can't
campaign
so
and
it
may
be
part
of
all
development.
That's
something
we
could
discuss
a
bit
a
bit
more,
but
I'd
certainly
welcome
some
clarity
on
it,
so
that
we
can
be
quite
clear.
A
And
we
could
pick
that
up
at
the
next
meeting.
Will
it'll
be
clearer,
I
think
by
then
I
mean
I,
think
the
intention
I
mean
he
drew
he's
drawn.
The
two
analogies
I
think
one
with
the
BBC
and
one
with
the
Bank
of
England
in
terms
of
what
is
our
independence
I
mean
he
does
mean
it
to
go
beyond
being
tokenistic,
it
is
symbolic,
but
he
he
he
wants
to
be
sure
that,
as
he
would
have
put
it
never
again,
would
we
not
we'll
say
the
truth,
because
it
might
be
politically
embarrassing.
A
I
mean
that
is.
That
is
his
clear
intention,
but
should
we
come
back
at
the
next
meeting
when
it's
been
more
little
be
in
the
care
bill
by
there
anyway,
any
and
any
other
issues
for
David
now
Mike
Mike
is
I'm.
Really
sorry,
I
mean
this.
Is
this
won't
happen
again?
It's
just
that
Mike
is
chairman
of
the
inspection
team
at
barking,
Havering
and
Redbridge,
which
is
there
an
important
hospital
to
look
at
and
so
I
felt
it
was
right.
He
should
be
doing
there.
David
do
you
want
to
know
I
mean
everyone's
got.
C
This
is
just
around
the
publication
of
reports.
It
looks
as
if
in
November
and
December
we're
publishing
four
together
or
we
or
we
publish
them
singly
because
it
seems
to
be
them.
I
can
understand
starting
off.
There's
a
there
are
in
the
sense
it's
got
to
stop
being
about
us
and
start
being
about
the
Trust's.
The
first
lot
may
be
about
us,
so
public
people
are
interesting.
You
know
this
is
a
new
thing
right
and
I
can
understand
doing
four
together
about
that,
after
that,
I
think
they
need
to
be
published.
B
I
think
that's
a
plan
there
has
been
this
debate
about,
should
the
being
a
blocker
should
to
be
individually
and
I'm
I'm
with
you.
If
we've
not
settled
that,
then
let's
confirm
that
at
the
next
meeting
that
that's
our
intention
to
do
that
and
I
think
it
for
exactly
the
reasons
you've
said.
Paul
I
think.
A
I
We
need
to
we
need
to
do
the
work,
see
what
we
find,
how
long
the
actual
on-site
inspection
takes
for
for
each
of
these
before
we
firmly
commit
to
how
many
the
intent
is
very
much
her
to
publish
as
many
of
the
18
as
possible.
My
my
assumption
is:
is
more
likely
to
be
around
half
of
them,
either
a
tour
or
possibly
pushing
up
sort
of
to
12.
But
let's,
let's
see
what
we
find
and
let's
also
see
the
extent
to
which
the
their
trusts
have
concerns
about
our
finding.
A
Other
issue
of
Paul
is
that
I
think
might
fell.
I
think
rightly
that
in
terms
of
deciding
which
trusts
were
outstanding,
which
were
good,
that's
quite
a
until
you've
got
a
number
of
reports,
it's
quite
hard
to
get
a
balance
for
that.
So
I
think
the
feeling
is
that
we
will
be
publishing
the
reports.
I
think
you're
right
when
they
come
out,
we've
been
not
putting
up
be
putting
a
rating
until
I.
Think
April
Paul
is
that
right
so.
I
Those
will
also
be
shadow
ratings
because
of
the
we
won't
have
the
legal
basis
for
for
the
formal
ratings
for
the
second
wave
of
acute
trusts,
and
that
will
not
to
announce
shortly.
We
would
expect
to
rate
all
of
those
again
in
shadow
form
and
now
that
were
carried
out
between
January
and
March
and
once
we're
through
into
April
subject
to
the
passage
of
the
bill.
All
trusts
would
then
be
then
be
rated.
A
B
B
We're
moving
in
I
think
these
bigger
expanded
teams
with
clinicians
experts
by
experience,
spending
longer
speaking
to
people
about
their
experiences,
spending
longer
speaking
to
staff,
people
absolutely
get
that
and
welcome
that,
but
by
the
same
token,
I
think
there
is
an
anxiety
about
what
all
this
means
for
us.
So
it's
a
mixture
I
think
it's
a
bit
brutally
honestly.
F
Sorry
so,
as
some
some
some
people
around
the
table
know
we
had
a
meeting
with
Ofsted
last
night
and
which
was
extremely
interesting.
Some
of
the
things
they
do,
but
one
in
particular
thing
that
I
just
like
to
put
on
the
table
more
formally,
which
was
I
hadn't
realized,
but
that
they
at
the
end
of
the
inspection,
will
write
a
report
for
children
in
a
school
which
seems
to
me
to
be
an
enormous
ly.
F
Important
thing
to
do,
not
least
because
when
it
does
is
focuses
the
mind
on
what
the
key
messages
are
to
users
of
the
service
and
I
just
like
to
ask
that
we
give
some
thought
to
whether
we
could
do
the
same
in
respective
I
mean
if
we
possibly
could.
The
very
first
inspection
reports
and
I
know
that's
a
tall
order,
because
we're
well
down
the
path
in
that
respect,
but
I
think
beginning.
That
process
would
be
great
and
I
think
one
one
way
to
think
about.
This
would
be
that.
F
We
know
that
when
people
are
involved
in
these
kinds
of
processes-
and
we
have
involved
many
more
ordinary
people
who
are
users
of
service
in
the
early
stage
and
I,
think
you
were
a
public
meeting
David
last
night
for
the
barking
and
Havering
inspection.
So
a
lot
of
people
have
been
drawn
together,
including
through
local
HealthWatch
and
elsewhere,
to
become
involved
in
these
inspections
and
what's
really
important
to
people
who
do
give
up
their
time
to
do.
That
is
that
they
get
direct
feedback.
F
A
E
Yes,
well,
the
other
thing
that
officer
people
said
last
night.
It
was
very
interesting
conversation
that
was
honestly.
I
was
struck
most
by
there
one
of
the
things
they
do
when
they
are
awarding
outstanding
ratings,
which
is
that
they
will
not,
as
if
I
understood
correctly,
they
won't
issue
a
rating
of
outstanding
to
schools
which
are
unable
to
demonstrate
benefits
to
a
particularly
vulnerable
group
of
pupils,
and
in
this
case
their
example.
It
was
children
who
were
getting
free
lunches
for
eat.
E
A
C
B
No
we're
trying
not
to
do
that,
but
one
of
the
key
issues
from
monitoring
the
TDA's
points
of
view
is
that
they've
got
a
number
of
applicants
in
the
park
line
that
are
community
and
mental
health
trusts.
So
the
congestion
has
really
been
about
whether
the
model
that
we've
got
for
inspecting
community
mental
health
trusts
is
good
to
go.
So
this
is
where,
in
paragraphs
8
onwards,
I
think
Steve.
B
We've
talked
about
the
hot
house:
events
that
we've
held
to
accelerate
the
development
of
the
model
and
the
time
tabling
of
the
availability
of
mental
health
and
community
trusts
that
we've
talked
about
being
ready
for
that
post.
Christmas
period
is
so
that
there's
no
nothing
backing
up
the
narrative
out
there
is
that
the
pipeline's
block,
because
we've
not
done
our
approach
around
how
we're
going
to
assess
community
and
mental
health
trusts
so
we'll
put
that
right.
B
I
think
some
of
them
won't
get
through,
not
because
we
haven't
got
our
approach
right
because
they're
not
good
enough
to
go,
but
actually
the
anyway
to
export.
That
is
for
us
to
get
our
methodology
out
and
get
that.
So
that's
what
we've
been
working
on,
and
so
we've
had
what
we
called
a
couple
of
hot
houses
where
literally
people
have
gone
away
for
a
full
day
and
really
not
come
out,
and
so
they
really
work
through
the
issues
and
just
accelerated
the
way.
B
The
learning
that
we've
been
able
to
do
so
that's
gone
well,
and
we've
made
a
good
progress
from
that
and
so
I
feel
that
we're
not
going
to
be
backing
these
up,
but
but
clearly
monitor
in
particular,
looking
for
assurance
from
us
that
we've
done
a
full
and
effective
inspection
of
those
services
and
our
judgments
about
quality.
It's
based
on
a
robust
approach,
and
that
means
we
need
to
apply
our
new
methodology
to
inspecting
these
services.
We've
got
that
methodology
for
acute
and
were
in
the
process
of
finalizing
that
methodology
for
mental
health
and
conditions.
E
B
He
took
ten
years
in
the
department,
the
razorba,
to
think
this
he's
down
that
this
is
difficult.
So
what
this
is
saying
is
Dewey's
outstanding
good
requires
the
improvement
inadequate
against
each
of
the
five
safe,
effective
etcetera.
It
plays
a
little
bit
to
the
point
you
were
making
about
what
way
to
give
things
and
what's
the
gearing,
that's
driven
in
the
way
that
we
arrive
at
those.
So
your
points
about
Ofsted
won't
give
an
outstanding
unless
children
on
the
pupil
premium
are
being
dealt
with
properly.
B
What's
the
threshold
between
good
and
because
of
the
issues
about
what
sincere
found,
what
seeing
well
led,
for
instance,
what's
the
barrier
between
those
as
well
so
I
think
conceptually
it's
easy,
you
just
really
to
those
five
domains
when
you
were
come
at
it
technically
about
what
are
the
domain
boundaries?
What
were
the
criteria
for
each
domain?
It's
difficult
we're
not
using
the
word
challenging
saying
it's
impossible,
but
we
are
saying
that
there
are
some
pretty
important
issues
about
definitions
and
particularly
on
each
of
the
thresholds.
B
So,
what's
the
difference
between
good
and
outstanding?
What's
the
difference
between-
and
this
will
be,
the
key
one
I
think
requires
improvements
and
outstanding,
good
yeah.
Sorry,
so
one
of
the
issues
is
going
to
be.
Could
you
have
staff
working
very
hard
and
being
very
committed
without
good
leadership,
we're
going
to
go
into
hospitals
where
leadership
is
an
issue
and
we're
going
to
say
staff
working
very
hard?
How
do
we
call
that?
Could
you
be
a
good
hospital
if
you've
got
poor
leadership.
B
It's
a
really
interesting
issue,
and
so
that's
what's
that
behind
that.
How
do
we
get
to
the
threshold?
And
if
you
look
at
Ofsted's
grid
criteria,
they
lay
this
out
pretty
clearly
and
in
our
consultation
document
earlier
in
this
summer
we
did,
but
we
did
it
not
for
each
of
the
five
domains.
We
actually
did
it
for
the
general
descriptors
of
certain
facts,
about
cetera
for
an
institution
rather
than
looking
at
whether
we
can
do
it
across
each
of
the
domains.
B
So
there's
more
work
to
be
done,
which
is
why
we're
piloting
this
so
whilst
we'll
publish
three
ratings
and
they'll
be
in
December
and
Paul's
run
through
the
hospitals.
That
will
do
that.
Only
the
trust
will
do
it
on
we're
actually
looking
at
how
we'll
apply
this
on
each
of
the
14
inspections,
because
we
need
to
you
know,
run
it
as
a
live
chat.
B
B
I
We
are
where
we're
working
as
we'll
go
and
we're
using
people
at
the
Kings
fund
and
Michael
West
on
our
whole
leadership
agenda,
so
that
we
have
clear
standards
that
we
can
inspect
against
on
well-led,
it's
going
to
be
difficult
to
assess
a
particular
services,
well
letting
us,
while
we're
developing
that
framework.
That's
so
that's
one
issue,
we're
aware
of
the
other.
I
There
are
certain
services
where
it's
quite
difficult
to
simply
define
what
for
some
domains,
what
the
the
answer
would
be
so
in
a
in
a
what
clinically
effect
in
eclis,
effective
a
A&E
service
is
quite
difficult
because
of
the
the
play
through
the
rest
of
the
hospital.
The
importance
of
the
consultants
that
aren't
working
in
A&E
but
clearly
take
ownership
of
patients
who
are
admitted
so
the
point
we
need
to
hold
on
to
throughout
this.
This
is
a
learning
process
for
us,
at
the
same
time
as
being
a
regulatory
process.
That's
why
it's
challenging.
A
Paul
you
mentioned
Michael
West
that
who's
doing
this,
whether
the
king's
fund
for
us
on
this
world
lead
domain
I
think
it
will
be
really
helpful.
I
don't
know
he's.
They
must
be
getting
quite
near
the
end
of
doing
that
work
now,
whether
when
it's
done
or
before
it's
set
in
concrete.
Rather
maybe
he
used,
or
he
might
come
to
one
of
our
meetings
here
and
just
lay
out
what
his
thinking
is
on
there
that'd
be
all
right.
I
Yes,
absolutely
said
on
the
timescale
of
that
he's:
it's
a
two-faced
piece
of
work,
going
up
to
Christmas
the
first
phases
to
get
the
conceptual
framework
right
and
effectively
the
lock
down
step
for
that.
It's
a
22nd
of
October,
and
so
we've
had
sight
of
the
the
framework.
We
have
one
more
big
event
to
test.
If
there
are
any
significance
concerns
and
as
part
of
that
work
working
closely
with
tvam
monitors,
we
have
a
single
approach
to
quality
governance.
Then
the
task
becomes
to
make
sure
that
it's
not
just
an
interesting
concept.
I
H
It's
it's
it's
a
bit
different
and
at
some
point,
I
would
like
to
be
able
to
kind
of
describe
what
sort
of
user
patient
public
involvement
in
inspections
is
like,
because
I
mean
it's,
it's
good
that
we
can
give
people
a
copy
of
the
report
and
we
have
experts
by
experience
on
the
inspection
teams.
But
it
strikes
me
that
there
could
be
some
well.
There
should
be
some
very
strong
involvement
and
influence
in
the
ratings,
for
example.
H
H
So
there's
just
a
mayor
and
also
I
had
another
point
which
was
plea
really
not
to
forget
learning:
disability
services,
because,
whilst
most
services
for
people
with
learning
disability
are
in
the
community,
there
are
some
people
in
hospitals
and
that's
going
to
fall
across
the
two
chief
inspectors
and
I
know
again.
I
know
it's
early
days,
but
the
people
in
hospitals
are
particularly
vulnerable
and
it's
something
that
we
kind
of
RIT
and
also
see
it
relates
to
Winterbourne.
Obviously,
but
it's
something
that
we
kind
of
really
need
to
sort
of
get
get
to
grips
with.
A
Okay,
on
the
first
point,
we
asked
Mike
for
the
next
meeting
to
address
that
issue
about
the
user
involvement
in
them
and
unloading
them.
Does
that
I'm
sure
Steve
has
noted
that
as
well?
Thank
you
very
much
Andrea
you're
next
on,
and
this
is
your
first
meeting
Andrea
and
you
started
off
with
a
with
a
bearing
yesterday,
actually
just
heard
of
how
that
went
as
well
with
okay.
J
Thank
you
and
thank
you
very
much.
Oh,
you
have
a
report
in
front
of
you,
which
is
incredibly
short
and
I
can't
promise
to
make
it
one
side.
Long
and
but
I
did
write
it
on
the
afternoon
of
my
first
day,
which
was
last
week,
and
it
probably
took
me
longer
to
write
the
template
cover
than
it
did
to
write
the
paper.
J
As
you
quite
rightly
say,
David,
we
launched
the
fresh
start
for
the
inspection
and
regulation
of
adult
social
care
document
yesterday,
and
although
that
was
only
in
my
second
week,
it
was
the
product
of
an
awful
lot
of
work
that
had
gone
on
beforehand
and
I'm,
really
grateful
to
Paul
and
his
team,
particularly
Rachel
Dodgson
and
Jill
Morelle,
for
their
help
in
all
of
that,
you've
had
the
content
shared
with
you
already,
and
it
sets
out
how
adult
social
care
fits
in
to
the
overall
strategy.
The
key
priorities
going
forward.
J
How
were
actually
going
to
engage
with
people
on
the
various
discussions
and
to
put
it
all
into
place
in
terms
of
response
and
kind
of
break
it
down
into
three
areas:
the
media,
the
public
and
the
sector.
So
in
terms
of
the
the
media,
I
think
you
know,
Christie
and
his
team
played
a
blinder
in
terms
of
supporting
as
having
some
very
extensive
and
positive
coverage
about
the
issues
that
we
were
raising
an
awful
lot
of.
J
It
focused
on
the
issue
of
hidden
cameras,
mystery
shopping,
which
in
a
way,
although
it
kind
of,
took
a
prominence
which
I
think
it
doesn't
really
have
in
the
document.
It
did
enable
us
to
actually
get
the
the
airtime
to
extend
the
debate
and
the
discussion
into
issues
of
our
adult
social
care
quality.
J
J
Secondly,
the
public
so
reflecting
on
the
calls
that
we
hand
through
to
the
contact
center
yesterday
and
also
the
reaction
on
Twitter
and
and
elsewhere.
So
people
have
come
forward
really
infused
I
think
by
the
proposal
to
expand
the
involve
bunch
of
experts
by
experience
and
lots
of
people
suggesting
that
they
would
want
to
do
that.
J
It
makes
it
very
clear
as
to
why
we
need
to
have
the
debate,
because
there
are
extremely
wide-ranging
views,
those
who
kind
of
think
that
we
should
be
doing
it
yesterday
and
everywhere
and
all
the
time,
all
the
way
through
to
those
who
kind
of
think
that
this
is
a
Big
Brother
approach
and
we
shouldn't
be
contemplating
it
at
all.
I
think
where
I
am
is
that
we
need
to
be
considering
the
that
the
rights
for
privacy
and
dignity
of
the
people
who
are
receiving
services,
and
we
have
to
absolutely
be
clear
about
that.
J
But
I
think
that
it's
really
good
that
people
are
engaging
and
we've
also
had
some
very
specific
questions
about
other
aspects
of
the
document
as
well.
In
terms
of
the
sector,
we've
had
really
an
encouraging
response,
so
across
the
providers
who,
of
course,
will
be
kind
of
at
the
sharp
end
of
all
of
this,
a
really
positive
response
and
and
I
think
new
kind
of
just
reflecting
upon
what
David
said.
A
few
moments
are
going
about.
J
It's
all
well
and
good
in
the
contest,
the
conceptual
framework
that
this
is
the
way
that
we
want
to
do
it,
but
eventually
it
will
happen
to
me
and
what
will
I
think
then
I'm
in
that
honeymoon
period
of
people
thinking.
Yes,
we
want
a
strong
and
robust
and
tough
regulator
who
sets
as
that's,
not
what
they're
going
to
do
and
how
they're
going
to
do
that,
and
that's
very
welcome.
J
But
although
my
kind
of
first
week
has
been
utterly
dominant
by
trying
to
get
this
landed
and
out
there,
you
know
really
the
real
work
starts
now
and
it's
all
about
the
engagement
having
those
kind
of
proactive
discussions
with
people
and
moving
that
forward.
Designing
the
new
regulation
and
inspection
approach
and
preparing
for
the
consultation
which
will
take
place
next
spring.
And
so
you
can
expect
regular
updates,
I'm
sure
and
until
then,.
J
Again,
people
I
think
kind
of
really
get
it
and
that
it's
the
it's
kind
of
putting
somebody
somebody
described
it
as
putting
humanity
into
what
we
do
is
it
as
inspectors
and
regulators,
which,
frankly,
is
kind
of
what
I
was
trying
to
get
across.
So
that's
that's
great,
so
people
have
have
have
been
have
been
positive
about
that.
J
H
K
You
can
I
ask
a
question
about
the
five
priorities
and
one
which
particularly
interests
me,
which
I
lobbied
for
a
couple
of
years
ago
and
didn't
get
anywhere
with,
which
is
the
developing
and
approach
to
monitoring
of
finances
as
some
adult
social
care
providers
and
whether
you
I
know
it's
very
early
days.
But
if
you
have
any
thoughts
about
how
you're
going
to
develop
that
capability,
is
it
possible
for
you
to
share
those
with
us
now.
J
Those
skills
and
experience
within
the
organisation
at
the
moment,
so
we're
going
to
have
to
think
about
how
we
build
that
into
the
new
structure
as
we're
going
forward,
and
the
final
thing
to
say
is
that
our
our
focus
will
be
on
the
larger
providers,
the
50
to
60.
We
reckon
and
larger
providers-
and
you
know
to
be
honest-
a
lot
of
them
are
already
kind
of
doing
work
about
the
information
that
they've
got.
I
mean
they've
got
boards
that
they're
reporting
to
which
we'll
be
receiving
information.
J
So
one
of
the
things
that
I
want
to
be
able
to
do
is
to
have
conversations
with
some
of
them
about
what
it
is
that
they're
already
doing,
and
how
can
we
make
sure
that
we're
not
adding
a
huge
burden
but
actually
skimming
off
new
the
sensible
and
useful
information
that
they
already
have
and
new
after
yesterday,
I've
already
had
a
few
of
them
kind
of
suggesting
that
they'd
like
to
come
and
have
the
same
conversation
with
me
to
say
we'll.
Take
it
forward.
So
I'm.
B
And
just
to
make
the
point
that
the
issue
is
on
this
is
this:
is
the
poor
Southern
Cross
question
about?
How
do
we
assess
financial
resilience
and
robustness
of
organizations,
and
we
in
fact
become
the
service
continuity
regime
for
social
care?
So
so
just
to
reinforce
Andrea's
point
I
do
not
believe
we've
got
the
business
analytical
skills
that
required.
These
are
not
economic
skills,
its
business,
its
organizational
fear,
financial
failure,
skills
that
we
require,
so
it's
more
likely
to
be
in
McKinsey's
PwC,
the
organizations
that
do
insolvency
regimes
etc.
F
So
so
I
think
it's
it's
great.
That
you've
got
something
out
there
for
discussion
so
so
quickly
and
I.
Just
think
it
will
be
really
important
in
your
conversations
going
forward
to
make
sure
that
there
are
a
series
of
points
at
which
you
keep
this
kind
of
out
there
in
a
in
the
public,
mind
to
show
that
we're
moving
it
forward.
J
That's
what
I'm
going
to
be
doing
and
and
I
think
that
the
way
that
we've
set
out
the
process
of
engagement
and
co-production
with
people
who
are
both
using
services
and
concerned
about
the
services
that
are
being
delivered
in
an
adult
social
care
will
give
us
a
lot
of
opportunity
and
to
keep
that
in
the
public
domain
and
and
I.
Do
also
think
that
the
relationship
between
the
Care,
Quality,
Commission,
HealthWatch,
England
and
individual
health
watches
is
going
to
be
really
important
in
terms
of
keeping
that
going
as
well.
J
So
so
I
think
that
there's
you
know
the
good
will
to
build
on
as
Kay
countly
mentioned,
and
the
expectation
that
we
will
do
that
as
well,
which
I
think
that
we
kind
of
have
to
deliver
on.
But
you
I'm,
expecting
you
know,
support
from
other
bits
of
the
organisation
and
I
have
to
say
that
I
am
absolutely
getting
that
support
and,
and
that
will
help
in
terms
of
us
being
able
to
do
it.
A
G
I
was
asked
to
give
an
oral
report,
but
I
so
I
will,
if
that's
okay,
so
we're
in
the
first
few
days
here,
I've
genuinely
been
hugely
impressed
by
the
support
that
I've
been
given
for
being
hired
to
set
out
to
support
and
lead
on
a
series
of
areas
of
which
general
practice
has
had
the
prominence.
But
actually
there
are
equally
important
there
within
the
portfolio
and
I
thought.
What
I
do
is
just
outline
some
of
the
areas
and
then
just
say
where
we
are.
This
is
very
very.
These
are
very
very
early
days.
G
General
practice
is
a
new
area.
We've
started
in
CQC
some
visits
already,
which
we'll
use
as
for
learning
in
order
to
build
a
new
system,
but
in
in
general
practice
there
are
over
seven
thousand
three
hundred
GP
practices
and
even
more
sites
across
England,
in
dentistry,
we're
up
in
the
ten
thousands,
and
so
there's
a
lot
of
sites
scattered
around
England
that
we
will
need
to
have
a
new
system.
G
A
lot
of
the
time
in
the
last
few
days
has
been
working
with
Hilary
and
others,
trying
to
put
together
a
system
for
inspection
so
that
we
can
bring
proposals
to
the
board.
So
we
can
move
forward
and
working
with
Paul
looking
at
the
intelligence
part
of
this,
so
for
both
general
practice
and
dentistry,
we
have
a
surveillance
and
inspection
regime.
G
The
lessons
from
dentistry
already
are
that
dental
care
is
pretty
good
across
England
and
in
fact
the
visits
we've
had
have
been
very
well
received,
but
in
general
practices,
we've
only
just
started,
and
our
commitment
is
to
a
two-year
rolling
program
to
visit
every
GP
surgery
in
England
over
that
time
and
we're
putting
together
some
ideas.
My
current
thinking
so
I
think
it's
worse
for
sharing.
G
We
will
look
at
an
early
stage
to
work
with
Andrea
look
at
medication
prescribing
and
provisioning
care
homes,
which
has
been
a
problem
for
a
long
time
now,
not
just
in
health
but
in
the
social
care
aspects
of
that
which
will
improve
safety,
but
also
should
reduce
admissions
to
hospital,
which,
I
think
is
a
really
important
area.
It's
something
which
hasn't
systematically
been
reviewed
and
looked
at,
and
the
idea
would
be
that
we
go
into
clinical
commissioning
groups.
G
We
work
very
closely
with
the
local
HealthWatch
so
that
we
can
have
a
lot
of
patient
and
potential
patient
involvement.
But
we
would
have
a
general
practitioner
on
each
visit,
which
I
think
is
that
he's
a
key
way
of
looking
at,
what's
really
happening
in
general
practice,
with
some
really
good
inspector
leading
that.
But
I
would
also
like
involvement
of
nurses
and
trainees
in
general
practice,
so
we're
building
up
a
model
so
that
it
can
be
priced
so
that
we
can
start
to
recruit.
So.
G
But
we
can
really
move
on
this
in
April
of
next
year.
The
other
areas
that
I'm
responsible
for,
as
we
mentioned
earlier,
on,
of
a
children's
safeguarding
agenda,
which
again
as
a
GP
and
then
in
this
city,
I've,
been
on
and
in
the
middle
of
issues
between
different
agencies,
which
I
think.
If
we
take
a
leadership
role
in
there
on
health,
we
can
help
resolve
some
of
those
issues.
Something
which
will
increase
over
the
next
year
or
two
is
the
health
and
justice
area
as
well,
which
I
know.
G
Lewis
is
an
expert
on
in
prisons
and
secure
environments,
as
well
as
the
pharmacy
area
of
control,
drugs
and
medications,
but
I
think
one
of
the
big
areas
which
is
really
exciting.
Is
this
around
themed
reviews
and
integration,
and
that
will
mean
working
very
very
closely
with
Andrea
and
Mike,
as
the
other
two
chief
inspectors
to
try
and
look
at
what
would
be
good?
What
he's
good,
what
he's
not
working
and
shine
a
spotlight
on
that
and
encouraged
a
Health
Service
to
move
into
a
much
more
collaborative
and
an
integrated
way.
G
A
lot
of
work
needs
to
be
done.
Looking
at
the
surveillance
areas
on
ratings,
as
well
as
the
model
of
inspection,
but
in
the
last
few
days
we've
worked
long
and
hard
to
start
that
work.
So
I
apologize
for
not
having
a
written
report,
but
it's
changing
every
few
hours
at
the
moment
and
hugely
exciting.
L
L
K
L
I.
Think
the
like
other
colleagues
who
worked
at
dinner
last
night
I
was
very
impressed
by
Ofsted,
including
particularly
impressed
by
Lorraine's
sort
of
operational
description
of
aspects
of
Ofsted
and
I.
Think
two
in
particular,
which
I
think
are
relevant
to
the
three
inspectors
reports
I
think
it's
these
letters
which
go
to
and
I
was
just
on
my
flicking
through
my
iPad
finding
and
just
reading
a
few
just
now.
L
G
L
L
E
This
might
well
be
a
particular
problem.
I
suppose
there'll
be
good
data
on
elements
of
the
COFF,
I,
suppose,
information
where
you
know
the
informations
had
to
be
collected
for
contractual
purposes
or
something
else
like
that.
But
where
we
go
beyond
that,
my
fear
is,
it
might
be
quite
difficult
so
into
areas
that
we're
talking
about
in
relation
to
hospitals
like
complaints
and
compliments,
patient
satisfaction,
there's
a
commentary.
E
Those
kind
of
things
I
just
want
to
get
your
impression
as
to
what
extent
to
it
and
that
that
information
is
somewhere
in
there
waiting
to
be
brought
out,
because
if
it
needs
to
be
collected
than
you,
that
is
a
no.
That
is
a
whole
rigmarole
through
the
health
service
and
very
difficult
nowadays
to
to
achieve
I.
G
Think
we'd,
general
practitioners,
we'd
say
we're
drowning
in
data,
but
it's
how
you
use
it
and
how
you
present
it,
which
is
important
and
particularly
how
patients
and
the
public
have
access
to
information.
For
example,
all
pathology
requests
in
England
are
collected
and
can
be
analyzed
on
one
system.
Yet
we
know
this
huge
variation
between
the
number
of
tests
which
are
done
and
the
appropriate
of
tests
if
you've
Mike
Richards
was
here.
G
G
So
what
I'm
looking
forward
to
is
working
with
Paul
and
his
teams
on
looking
at
what's
important,
working
with
NHS
England
as
well
on
what
they're,
gonna
publish
so
there's
a
transparency
of
generate
and
then
there's
what's
appropriate
in
order
to
judge
and
the
judgment
and
the
ratings
in
general
practice
I
think
are
going
to
be
really
really
important
again
about
what
is
a
practice
that
needs
improvement
but
as
well
what's
outstanding
and
what
can
people
aspire
to?
So
that's
a
really
really
key
piece
of
work.
G
I
Care
and
people
have
a
range
of
different
views
about
that,
but
that
is
a
potentially
hard
metric.
That's
currently
not
used,
but
might
be.
The
other
I
think
really
interesting
part
is
the
technical
and
technological
changes
that
are
happening
around
the
ability
to
extract
general
practice
data,
what
they
call
the
GP
extraction
service,
there's
rather
than
the
information
center,
because
of
its
ability
to
link
to
secondary
care
outcomes,
so
without
getting
too
techie
about
it.
I
The
idea
of
actually
knowing
how
patients
fared
in
terms
of
what
was
done
in
general
practice
and
linking
that
through
to
secondary,
carries
both
importance,
an
integration
perspective,
but
it's
also
very
important
in
understanding
what
the
quality
of
the
care
the
patient's
got
in
their
in
their
primary
medical
service
and
that
will
be
available
by
the
middle
of
next
year.
So
we've
got
to
go
on
a
journey
where
we
don't
wait
for
these
big
technical
changes,
but
we're
also
pretty
confident
that
could
significantly
change
our
ability
to
understand
quality
in
general
practice.
H
I'm
quite
interested
in
what
kind
of
well
lead
might
mean
in
general
practice
and
I.
Don't
have
any
evidence
to
support
this,
of
course,
but
it
seems
to
me
that
that
often
GP
surgeries
practices
are
well
managed,
but
not
necessarily
well
lead,
because
you
know
when
I
speak
to
GPS,
which
is
inaudible,
that
they
tend
to
sort
of
suggest
that
they're
being
done
too,
you
know
so
they're
managing
their
practice,
but
there's
stuff
coming
from
elsewhere
everywhere
else,
and
they
said
they
feel
kind
of
disempowered
and
and
I
just
wondered.
H
You
know
as
we're
thinking
ahead.
You
know
what
we
might
look
at
in
terms
of
what's
well
lead
in
it.
We
do
with
a
view
to
actually
I
suppose
in
a
way
helping
to
transform
how
GP
surgeries,
GP
practices
CCGs
work
and
whether
you
had
any
kind
of
early
thoughts
on
that
and
whether
I'm
just
talking
a
little
rubbish.
G
No
I
mean
there
was
an
issue
about
management
and
leadership
in
practices
and
but
also
I,
think
we
did
acknowledge
as
GPS
that
it
is
very,
very
difficult.
I
mean
there
is
one
there
was
a
contract
at
the
moment,
and
that
is
an
issue
as
well
over
how
flexible
that
contract
is
whether
the
quality
and
outcomes
framework
has
led
to
a
deep
professionalizing
of
some
of
our
work,
because
it's
become
more
tick-box,
but
obviously
the
contract
negotiations
are
not
part
of
what
we
are
involved
in
at
all.
G
You
also
found
a
lot
of
frustration
and
if
you
were
to
look
at
an
example
of
an
extremely
well
led
practice,
vitality,
which
is
a
group
of
six
or
seven
practices
in
the
West
Midlands,
they
have
a
different
leadership
model
now
that
the
practices
have
work
together.
If
you
go
to
London
and
look
at
and
Claire
Gerard's
practice,
their
early
practice,
they've
got
a
hundred
or
so
salaried
doctors.
They
have
a
very
different
leadership
style
and
so
I
think
one
of
the
things
which
is
really
exciting
about
this
is
demonstrating.
What's
outstanding
and
I.
G
G
Is
such
an
obvious
area
to
work
in,
but
we
haven't
yet
got
some
of
the
basics
right
on
standards
and
on
what
patients
should
expect
most
patients
don't
know
what
good
is
and
also
there's
a
great
loyalty
of
patients
to
practices,
even
if
things
have
gone
wrong,
and
so
it's
not
simply
transparency
and
publishing
data.
It's
a
it's
much
more
complex
than
that,
as
it
is
a
real
human
level
thing
they're
both
on
the
practitioner
and
the
patients.
D
Can
I
just
offer
three
brief,
disconnected
thoughts?
One
is
obviously
following
on
from
what
Paul
said:
I
mean.
Presumably
one
of
the
things
we
want
to
rate
people
on
is
what
is
the
extent
to
which
they
will
share
medical
records
and
that's
in
both
primary
and
secondary
care,
because
if
you,
if
you
go
up
to
North
West
London
to
the
role
3
the
GP,
is
there
basically
push
the
consultants
to
you
know
orchestrate
a
proper
system
where
they
could
share
information?
D
D
I
was
just
thinking
about
my
own
children
and
back
to
what
you
said
about
safeguarding
and
when
you
I've
got
three
primary
age:
children
when
you
have
a
child
on
the
NHS
today,
you've
got
to
think
of
the
red
book,
and
the
red
book
has
all
this.
You
know
it's.
It
says
what
vaccinations
you
should
get
and
it
has
its
hour
intervals
at
which
your
child
should
be
examined.
D
None
of
my
children
has
ever
had
any
of
those
examinations
and
whenever
I've
asked
the
GP
I
think
it's
18
months
and
three:
is
it
perfectly
sensible
stages,
which
is
exactly
what
they're
doing
front
GP
looks
astonished
it
says?
Well,
no,
we
don't.
We
don't
do
that
anymore
question.
Is
that
true,
you
know.
D
Is
that
something
that
is
no
longer
done,
or
should
it
be
done
and
that's
the
safeguarding
point
I
mean
I
know
this
sounds
very
basic,
but
when
you
take
a
child
to
the
doctor
in
France,
the
child
is
examined
and
their
clothes
are
taken
off
and
they're
examined
and
that
one
single
thing
would
do
more
for
safeguarding
children
in
some
of
the
terrible
cases
we've
read
about
I
think
than
any
other
thing.
It's
so
many
of
the
serious
case
reviews.
D
What
we've
seen
is
that
the
injuries
were
missed,
because
for
some
reason
in
this
country,
GPS
do
not
routinely
examine
children
without
with
their
clothes,
I
mean
I'm.
Sorry,
it's
a
small
but
I,
think
actually
quite
fundamental
point
and
then
the
last
punch
is
slightly
more
cheerful
is
I,
don't
know
if
you've
talked
to
Tom
Hughes
Hallett
who's
just
finished
his
commission
in
Essex.
Looking
at
how
to
integrate
health
and
social
care,
it's
really
worth
actually
just
having
a
look
at
his
report,
but
he
they
went
out.
D
They've
got
a
panel
of
a
hundred
people
in
Essex
and
they
spent
a
day
with
them
and
they
said
right.
If
you
had
the
budget
the
three
billion
budget,
what
would
you
do
with
it?
And
one
of
the
lot
of
astonishing
things
is
that
everybody
said
they
would
move
the
money
away
from
GPS
and
towards
pharmacists
because
they
found
the
pharmacists
were
far
more
responsive
and
far
more
useful
to
the
GPS
work.
So
I
just
leave
you
with
that
thought.
G
The
theme
now
this
is
really
good.
I
looked
at
I
think
the
challenge
is,
is
really
really
important,
so
I'm
just
briefly
on
shared
records
when
I
led
the
Future
Forum,
we
had
a
whole
report
on
records
and
access
and
communication.
My
belief
is
that
the
patient
should
have
access
to
their
own
record
again.
G
Government
is
committed
because
they
agreed
with
our
Future
Forum
recommendation
that
some
patients
should
have
access
to
the
records
by
I
think
it
was
2015,
I
I'm
committed
to
that
and
I
think
that
should
be
something
which
is
an
outstanding
criteria.
Personally,
our
own
practice
is
not
at
that
level
yet,
but
we've
just
changed
our
computer
system
in
order
to
push
it
next
year.
So
I
think
we
should.
G
So
right
at
the
top
of
the
agenda
and
I,
don't
think
we
as
CQC,
should
shy
away
from
making
statements
about
the
workforce
and
working
with
health
education
England,
which
hasn't
come
up.
Yet
on
that
on
pharmacy.
There
is
increasing
evidence
that
pharmacists
can
manage
guideline
based
care,
long
term
conditions.
Many
can
prescribe
now
they're
an
untapped
resource.
G
Their
training
has
gone
up
to
four
and
now
five
years
in
some
areas,
but
as
GPS
we
tend
to
be
rather
protective
on
one
hand
about
what
we
do
and,
on
the
other
hand,
say,
as
kay
said,
we're
exhausted,
because
all
the
work
is
coming
at
us
and
I.
Think
one
of
the
things
about
leadership
which
Kay
might
want
to
reflect
on
is
leadership,
isn't
just
about
protecting
your
own
and
doing
more.
It's
about
working
with
teams
in
a
much
more
constructive
way
and
building
the
teams.
C
No,
it
was
a
bit
of
reassurance
to
Camilla,
but
the
work
we're
doing
on
the
national
information
Governance
Committee
is
more
about
sharing
than
restricting
information
and
I.
Think
that's
the
area
we
think
as
a
committee
and,
of
course
the
board
will
have
to
take
a
view
on
that
when
we
bring
it
to
you
and
that
that
is
the
area
where,
where
there
is
the
most
urgent
work
to
be
done,.
B
Thank
you.
So
if
I
just
draw
colleagues
attention
to
the
table
in
paragraph
two,
this
sets
out
the
summary
the
high
level
of
our
performance.
Today.
This
is
at
the
30th
of
September.
You
can
see
the
budget
available
to
that
point
in
time
is
43
million
we've
spent
37,
that's
a
variance
of
6.2.
If
you
put
the
round
in
Xin,
that's
broken
down
further
in
paragraph
2.2,
which
shows
the
recurring
revenue
budget
ensures
to
figures.
There
were
the
equivalents.
Are
the
budget
for
the
period
to
the
30th?
B
Is
thirty
seven
point
two
million
and
we've
spent
thirty
four,
that's
giving
the
variance
of
three
point
two,
and
if
I
can
just
rich
it
to
two
point
three,
this
shows
the
transformation
budgets
and
the
current
performance
again
budget
is
six
point.
Five
spend
is
three
point:
five
unit
variance
or
three
I'm,
not
particularly
worried
about
this.
At
the
present
time,
we've
got
contracts
which
we
need
to
let
in
terms
of
the
transformation
which
we'll
spend
against
our
overall
budget,
I.
B
B
All
but
eleven
point
five
is
allocated,
so
we've
got
eleven
point
five
and
allocate,
and
that
explains
a
large
variance
in
relation
to
the
capital
spend,
and
that
is
something
that
we
need
to
look
at
as
we
go
into
the
next
stage
of
the
transformation
program.
We
need
to
settle
this
issue
about
offices
and
hubs.
We
need
to
settle
the
issue
about
what's
the
information
platform
that
we
need
to
move
forward
on
the
majority
of
the
money
that's
been
spent
in
capital
today,
it
is
really
about
developing.
B
The
information
technology
infrastructure
on
which
we
operate
and
I
think
as
we
develop
further.
Our
new
methodologies
will
be
further
requirements
to
set
plans
against
that
unallocated
capital
budget
which
will
bring
by
so
brother.
That's
the
report,
David
I
think
we're
in
a
healthy
place
in
relation
to
the
budget,
as
our
say,
I'm
not
personally
worried
about
whether
we've
got
these
under
spends.
B
D
I,
don't
think
it's
possible
for
the
board
to
assess
from
these
charts
whether
the
money's
been
spent
effectively.
I
mean
it's
just
not
possible
for
us.
Is
it
because
we
can
see
it's
really
it's
all
relative
to
budget,
but
we
don't
have
any
more
detail.
So
I
thought
we'd
had
a
discussion
about
this
before
we
were
going
to
get
more
detail,
I
mean
whether
that
goes
to
a
separate
committee.
I,
don't
mind
but
I'm
sure
I'm
just
concerned
that
we
don't
I'm,
not
I,
don't
know
what
other
people
feel.
D
A
To
be
honest,
with
young
I'm
waiting
to
work
point
of
the
Director
of
Corporate
Services
before
we
really
grip
this
and
I
put
a
formal
way,
because
that
will
report
to
that
person,
finance
and
I
mean
I,
don't
think
I
don't
want
the
board
to
spend
a
lot
of
time.
I
think
the
other
issue.
The
regulatory
issues
that
were
discussing
are
more
important,
but
we
do.
But
we
do
you're
saying
we
do
need
to
have
assurance
that
the
money
is
being
spent
properly.
A
D
Raised
this
before
and
I'm
just
a
bit
concerned
that
we
haven't
sort
of
got
there
so
I
mean,
if
you
you
know,
if
you're,
presumably
whatever
the
I
agree,
we
don't
want
to
spend
huge
amount
of
time
on
it,
but
the
Director
of
Corporate
Services
is
going
to
need
to
see
detail.
Aren't
they
so
it
should
be
in
the
system
for
someone.
C
Steve
I
think
Camille
has
got
a
very
strong
point,
but
I
think
in
other
organizations
that
I've
been
involved
with.
You
have
to
have
performance
on
the
same
agenda
as
the
budget
budget
performance,
because
one
reflects
the
other,
and
you
know
when
we
get
the
director
of
corporate
governance,
then
maybe
that's
the
way
to
approach
it,
because
both
of
both
weeks
of
the
expenditure
and
the
performance
have
to
relate
back
to
a
business
plan
and
they
have
to
be
tied
in
quite
closely
together
and
I.
C
K
Could
I
just
need
to
support
that
support?
That
I
mean
I've
got
two
concerns.
The
first
is
about
the
overall
reporting
of
Finance
against
activity
and
against
objectives.
The
other
is
David
preempted.
My
question
by
reassuring
us
that
there
isn't
a
problem
with
the
transformation
budget,
which
is
now
significantly
adrift
from
the
profile
that
we
originally
adopted.
I
mean
I,
accept
I've,
raised
this
before
I
accept
the
assurance
that's
been
given
today,
but
I
am
still
very
uneasy
that
this
banana-shaped
profile
of
spending
is
getting
more
and
more
difficult
to
achieve.
K
In
particular,
the
significant
part
of
the
underspend
on
the
transformation
budget
is
to
do
with
the
new
approach.
I'm,
not
quite
sure
what
that
means.
I'm,
not
looking
for
an
answer
now,
I'm
just
saying
I'm,
I
think
when
we
get
the
Director
of
Corporate
Services,
it
would
be
really
helpful
if
he
could
or
she
could
as
an
early
stage.
F
I
I
do
want
to
agree
with
Camilla
that
I
think
we
don't
have
what
we
need
if
we
as
a
board,
are
to
be
accountable
for
financial
management
of
the
organization
and
I.
Suppose
that's
that's.
That's
slightly
my
my
my
question
Marquis,
because
I'm
kind
of
mindful,
if
the
relationship
between
the
board
and
the
accounting
officer,
responsibilities
and
I
just
think,
there's
a
there's,
there's
a
question
about
what
level
of
detail
gets
put
in
front
of
us,
but
there's
also
a
question
about
what
we
think
the
right
governance
is
around.
F
The
finances
of
an
organization
such
as
the
CQC
and
I
would
really
welcome.
Having
that
conversation
and
I
I
think
perhaps
we
might
be
able
to
have
that
conversation
ahead
of
a
director
of
corporate
resources,
but
certainly
I
think
if
not,
it
should
be
a
priority
for
them,
because
because
I
think
that's
the
issue
for
me
is
what
are
we
actually
accountable
for
and
then
follows
from
that?
What
do
we
need
to
have
put
in
front
of
us
I.
A
H
Also
it
it
the
situation
we
have
at
the
moment.
It's
unusual,
if
you
like
you,
know
it's
changing
day
hour
by
hour,
and
you
know
I
absolutely
support
that.
We
need
to
get
get
this
right
and
you
know
there's
nothing.
I
disagree
with,
but
I
think
I'm.
Also
at
the
moment
we
are
in
quite
a
unusual
situation.
That's
you
know
we
haven't
got
time
on
our
hands
we've.
You
know,
we've
got
a
lot
to
do
so.
I
just
wanted
to
make
that
point.
The
so-called
current
context,
yeah,
okay,.
E
Add
to
that.
Well,
it's
different
a
slightly
different
point,
but
the
the
question
is
probably
what
what
questions
do?
We
have
as
a
board
that
we'd
like
to
know
the
answer
to
and
what
what
one
of
them
is
a
slightly
less
technical
and
detailed
question
than
the
way
that
is
set
out
and
that's
how
we
divide
the
resources
of
the
organization
between
different
work
streams,
different
parts
of
what
we
do.
So
we
now
have
three
major
work
streams
as
I
understand
it.
We
have
under
the
three
chief
inspectors
and
it
it
would.
E
It
would
help
me
a
lot
to
understand
how
our
resources
are
divided
between
those
work
streams.
I
realize
that
some
of
the
money
may
not
be
easily
allocated
to
one
or
another,
but
it
would
still
be
useful
to
know
because
that
will
give
an
impression
about
the
relative
priority
within
the
organization
yeah
there's
a
supplementary
to
that,
which
is
the
second
question
would
be
when
the
Francis
report
came
out
and
there
was
a
government
response
to
CQC.
E
There
was
talk,
then,
of
us
an
additional
sum
of
money
which,
which
maybe
I
just
don't
know
the
same
as
the
transformation
budget,
except
that
the
amounts
were
that
were
in
the
public
domain
were
a
little
bit
different
from
what's
in
this
paper,
so
people
are
talking
about
40
million
pounds
and
I
don't
see
40
million
in
this
pip.
So
my
first
question
was
about
the
allocation
within
the
organization's
priorities.
The
second
one
is
what
is
happening
to
the
additional
money.
E
A
Look
there
are
three:
there
are
three
questions
there
there's
the
ongoing
good
financial
governance
of
the
organization,
which
I
think
was
what
Camille
has
started
from
and
I
think
we
can.
We
must
address
that
and
we'll
do
we
will
do
I
know.
We
said
that
last
time
I
think,
but
we
will
do
then
that's
the
first
point.
The
second
point
that
you
make
Lewis
is:
can
we
allocate
the
money
between
the
three
sort
of
chief
inspector
areas?
A
If
you
like
and
I
think
at
the
moment
it
is
too
early
to
do
that
really,
but
we
can
do
when
we
do
the
budget
but
next
year.
Clearly,
that
is
how
we
will
do
it.
So
you'll
see
that
very
clearly.
Another
third
point
is
just
which
is
related
to
the
first
point
is
just
getting
a
grip
on
this
transformation
budget,
how
much
it
is
and
how
we're
spending
in
so
can
you
leave
it
for
us
to
bring
back
to
thank
board?
You
make
a
note
that
we
will
do
that.
K
A
B
B
Sorry
do
apologize
and
did
anybody
get
any
of
that?
So
this
is
the
transformation
program
report.
We're
reporting
our
overall
progress
at
red
amber.
This
is
the
governance
that
we've
got
in
place
in
relation
to
the
specific
projects
and
programs
at
the
part
of
the
transformation
program,
progress
is
being
made
and
as
I'm
saying
in
the
last
paragraph,
there
is
to
be
a
gateway
review.
This
is
an
external
assessment
of
the
preparedness
of
this
program
and
the
robustness
of
the
program
so
actually
delivered
a
project
that
we've
got
in
place.
B
Numbered
1,
&
2,
the
top
of
page
3,
gives
a
hope,
a
sense
of
both
the
overall
volume
of
complaints
and
how
they've
been
subdivided
as
some
analysis.
In
the
following
paragraphs
in
3,
we
go
on
to
look
at
what
some
of
the
learning
is
to
be
extracted
from
these
complaints
and
how
changes
are
being
introduced
as
a
consequence
of
the
complaints
and
in
paragraph
5,
we
again
flag
up
the
further
work
that
will
undertake
in
relation
to
complaints.
Paul
has
that
future
work
in
hand.
B
The
other
issue
that's
drawn
out
is
there
are
a
number
of
people
and
I'm
not
sure
the
language
is
right
here,
carry
myself
without
some
exchange
about
this.
Over
the
past
couple
of
weeks,
I
saw
about
how
people
who
have
complained
often
to
our
predecessor,
organizations
or
those
to
this
organization.
So
they've
been
doing
this
for
an
awful
long
time
and
occasionally.
B
That
has
caused
problems
in
the
way
that
the
both
described
in
internal
reports,
a
language
that
we've
used
internally
and
and
also
about
knowing
what
the
next
steps
are.
How
well
do
we
deal
with
people
that
have
been
complaining
for
a
protracted
period
of
time?
What
is
the
appropriate
relationship
to
have
with
them?
How
can
people
treated
in
a
way
that
signals
care
and
compassion,
particularly
if
people
have
been
complaining
over
a
number
of
years
and
indeed
we're
after
a
number
of
years?
B
People
then
see
one
part
of
the
system
about
which
they'd
been
complaining
and
accept
that
they
got
this
wrong
ten
years
ago.
It
is
one
of
these
key
issues
about
how
people
feel
listen
to
it,
not
listen
to
and
what
our
role
is
in
there.
So
we've
tried
to
set
this
out
in
paragraphs
2.2
and
beyond
about
whether
we've
got
the
right
policy
and
how
we
deal
with
that.
We
do
have
some
arrangements
in
place,
which
is
set
out
at
two
point:
five
about
what
we've
called
complex
complaints
where
a
panel
is
brought
together.
B
So
it
puts
less
of
the
responsibility
on
the
complaints
team.
The
central
complex
in
which
is
a
very
small
resource
in
the
way
that
they
can
actually
bring
more
than
one
Minds
sort
to
speak
so
responding
to
these
complaints
so
hope
what
this
does.
David
and
colleagues
is
just
set
out
activity
over
the
first
six
months
of
this
year.
She
sets
out
some
of
the
learning.
It's
also
flagging
that
there's
more
work.
B
H
H
It
seems
a
bit
low.
The
number
of
complaints
we
get
actually,
but
also
we
know
we
need
in
terms
of
if
there
is
a
complaint.
You
know
we
need
to
make
sure
that
the
staff
feel
comfortable
in
recording
it
and
reporting
it,
because
we
have
had
a
culture
that
we
know.
That
has
been
quite
fearful.
Should
we
say-
and
it's
quite
you
know
it's
a
big
deal
to
have
a
complaint
raised
it
against
you.
H
To
be
honest,
you
know
and
how
we
deal
with
that,
because
it
seems
that
that
you
know
it
does
need
to
be
managed,
because
it
takes
a
lot
of
time.
You
know
and
they're
also
people
to
be
frank,
and
there
may
be
a
separate
group.
I,
don't
know
who
have
have
actually
been
quite
a
pieceof
and
I
think
that,
certainly
on
two
things,
I've
heard
I
feel
that
it's
overstepped
the
mark.
Now
it
seems
that
we
are
dealing
with
it
in
terms
of
having
you
know,
recorded
messages
and
what?
H
But
it
is
a
fine
line.
You
know,
particularly
people
have,
you
know,
suffered
very
badly
and
also
have
suffered
a
lack
of
justice.
So
it's
you
know
I'm,
very
pleased
to
hear
that
we're
dealing
with
that.
What
I
did
wonder
is
whether
the
regulatory
governance
and
values
committee
has
a
role
I,
don't
particularly
define
it,
but
and
it
would
it's
along
the
lines
of
partly
taking
the
pressure
off
the
staff
as
well,
but
it's
also
to
bring
in
an
element
of
sort
of
scrutiny
or
oversight.
H
For
example,
you
know,
say
there
was
somebody
who
had
been
complaining
a
lot
and
was
taking
a
lot
of
time,
and
there
was
felt
that
we
needed
to
implement
the
persistent
complainers
policy
or
whatever.
It
could
be,
for
example,
that
one
or
two
members
of
the
our
G&V
committee
could
actually
look
at
that
to
check
whether
we've
done
everything
we
could.
Is
it
reasonable
fair?
You
know,
and
indeed
whether
there
was
any
other
role
for
that
committee.
Also
around
complaints
as
well
I,
don't
think
we
should
get
heavily
involved
in
overseeing
all
the
complaints.
A
I
I
So
one
is
to
be
much
clearer
on
our
website
and
general
communications
about
what
our
role
in
concerns
is,
and
we
finally
want
to
dispel
the
myth
that
we
don't
look
at
or
shouldn't
look
at
concerns.
We
do,
and
we
should.
There
is
a
difference
between
awesome,
looking
at
individual
concerns
for
the
purposes
of
understanding
the
quality
and
safety
of
services
versus
the
investigating,
on
behalf
of
the
individual
for
the
purposes
of
recourse,
and
we
can
make
that
clear.
I
But
it's
really
important
seems
to
me
that
we
go
straight
through
that
myth
that
we
don't
or
shouldn't
vote
for
the
public
and
for
our
staff,
so
they
know
what
their
what
they
can
do.
They're
empowered
to
do.
The
other
part
of
that
Mike
and
I
are
working
on
quite
closely
is
how
we've
more
heavily
played
people's
concerns
and
staff
concerns
into
the
inspection
process
and
we're
looking
at
how
we
can
gear
up
for
that
at
least
a
month
before
we
we
go
in
for
an
in-depth
inspection.
I
We
think,
for
example,
interviewing
people
are
willing
to
come
forward
recent
whistle
blows,
for
example,
a
representative
sample.
The
public
is
something
well
worth
exploring
something
we
look
to
test
as
part
of
wave
2,
so
just
to
cite
the
board
on
those
two
pieces
and
the
mold
to
get
halts.
The
incoming
strategy
unit
director
starts
on
Monday,
we'll
be
taking
on
this
piece
of
work
as
a
priority
for
him.
K
E
That
that's
very
helpful
before
actually
and
I
think
we
are
at
the
moment.
We
are
trying
to
do
something.
That's
quite
a
difficult,
quite
a
difficult
balance,
because
we
are
putting
out
the
message
that
we
want
to
know
more
about
complaints.
We
want
to
hear
more
from
people,
who've
got
complaints
to
make
and
we
will
use
complaints
in
the
way
that
we
assess
organizations
and
but
when
people
contact
us
about
complaints,
we
sometimes
say
that's
actually
not
our
our
role,
and
that
is
and
getting
that
message
right.
So
it's
clear
what
what
we
are
saying.
E
They
are
often
at
the
point
of
saying
something
happened
which
may
have
meant
that
something
went
wrong,
but
it
has
been
very
distressing
and
we'd
like
to
know
what
what
it
was
that
happened
and
what's
our
way
of
finding
that
out,
and
certainly
what
people
will
say
to
me,
is
that
it's
that,
at
that
point
of
asking
what
happened
that
they
find
the
totality
of
the
system
quite
bewildering
and
so
may
contact
CQC.
But
it
might
not
be
so
easy
to
hear.
Well,
actually,
you
can't.
E
We
can't
consider
this,
because
the
Trust
has
to
consider
it
first
or
the
there's
the
Ombudsman
or
there
may
be
the
coroner.
There's
a
whole
set
of
people
and
a
kind
of
order
to
events
which
has
to
be
applied,
and
people
find
that
very
they
do
find
that
puzzling
and
bear
in
mind
that
they're
often
in
a
distressed
state.
F
Thanks
very
much
so
I
very
much
welcome
that
what
I
take
to
what
I'm
describing
preliminary
work?
If
you
like
this
kind
of
grappling
with
what
kind
of
complaints
we
get
and
this
categorization
I
think
really
helpful
and
kind
of
pulling
those
three
areas
apart
and
getting
some
of
the
data
in
front
of
us
about
how
many
and
of
what
sort
and
which
areas
and
things
that's
that's
all
great
and,
of
course,
Paul
sorts.
Absolutely
right.
F
Unless
we
are
quite
exemplary
in
this
space
and
I,
think
that's
you
know,
that's
a
really
big
challenge
and
I
would
observe
that,
and
this
is
not
a
comment
on
the
individuals
concerns
at
all
inside
the
CQC,
because
I
think
it's
a
terribly
difficult
thing
to
get
right.
But
I
don't
see
that
in
this
report
and
I
suppose
one
of
the
things
I
don't
see
in
this
report,
which
I
would
really
hope
that
we
would
get
next
time.
F
We
think
about
this
one
once
more
has
sort
of
thought
about
it,
a
bit
more
and
it's
a
really
clear
sense
of
what
what
the
outcomes
are,
that
we
want
to
promise
people
in
relation
to
complaints.
So
what
I
see
here
is
lots
of
management
and
process,
and
there's
no
question
that
you
need
all
of
that.
But
what?
What?
What
is
our
promise
to
these
three
categories
of
complainant
about
what
outcomes
we
want
to
deliver
for
them
and
I
don't
mean
you
know
that
they
will
always
be
happy
with
what
it
is
that
we
say.
F
C
There
are
the
ones
that
are
about
and
the
CQC's
performance,
and
there
are
ones
about
services
that
we
regulate
and
I
think
we
we
possibly
need
to
split
them
apart
a
bit
more
in
these
reports
in
future
and
I'm
concerned
that
we're
getting
so
many
about
staff
conduct,
which
is
Luis
said,
is
often
as
a
result
of
frustrations
with
the
system
and
they're.
Just
understandably,
if
not,
you
can't
necessarily
agree
with
them.
C
The
information
is
really
at
the
heart
of
this,
because
if
we
get
that
right,
then
some
of
the
anger
will
dissipate
if
they
feel
that
their
message
is
getting
across.
I.
Think
my
experience
with
people
who
make
complaints
is
generally
they
just
don't
want
it
to
happen
to
anyone
else.
They
accept
a
mistake
has
been
made.
If
there's
an
apology,
if
there's
a
right
approach
that
often
dissipates
the
effect
and
then
just
on.
Lastly,
on
point
case:
point
I
would
just
be
cautious,
because
I
think
complaints
have
to
come
to
the
board.
C
I
think
it's
really
important
that
the
the
board
deals
with
and
the
complaints
report,
because
this
is
where
the
learning
has
to
start
and
then
the
second
part
of
that
not
but
I.
Don't
think
there
is
a
role
for
the
new
committee.
The
procedure
around
complaints
has
got
to
be
absolutely
transparent
and
crystal
clear,
and
if
you
have
a
committee
that
can
occasionally
dip
in
when
something
looks
a
bit
complicated
and
that
way
madness
lies.
So
I
would
just
caution
about
that.
K
K
The
majority
80%
are
usually
upheld
on
the
grounds
of
poor
communication,
not
telling
people
when
there
is
going
to
be
a
delay,
not
communicating
with
people
in
a
timely
manner
or
raising
their
expectations,
insert
that
something
will
be
done
and
they're
not
doing
it.
Now
that,
as
a
seasoned,
bureaucrat
I
started
to
dissect
that
sentence,
and
there
are
two
issues
that
emerge
for
me
from
it.
The
first
was
the
complaint
may
well
have
been
about
something
else,
but
was
upheld
on
those
grounds.
K
So
I
would
quite
like
to
be
clear
not
now,
but
at
some
point
in
the
future.
The
extent
to
which
the
complaint
was
about
a,
but
we
upheld
it
on
the
grounds
that
we
hadn't
reacted
to
a
in
an
appropriate
way,
rather
than
the
substance
of
whatever
a
was
about.
That
seems
to
me
a
critical
issue.
If
the
complaint
was
about
taking
a
long
time
or
promising
things
that
we
didn't
do
then
obviously
a
and
this
these
words
are
the
same
thing,
which
is
different.
The
that's
my
first
question.
K
The
second
query
was
really
what
then,
we've
done
with
all
of
that.
It
crucial
piece
of
information
and
I,
looked
through
with
the
learning
from
complaints
and
I
looked
through
various
other
bits
and
I
couldn't
really
find
what
the
significance
of
that
reporting
was.
What
is
this?
A
generic
problem
is
a
particular
problem
in
particular
parts.
K
The
organization
is
there
something
that
we
need
to
do
about,
expect
our
expectations
of
colleagues
when
they
respond
to
complaints
when
they
talk
to
people,
ordinarily
and
so
on,
and
it's
that
learning
about
the
substance
of
particularly
of
complaints
which
are
upheld
rather
than
you
know.
The
very
interesting
issue
about
persistent
complainants,
which,
frankly
I
think
ought
to
have
been
in
an
appendix
rather
than
in
the
the
substance
of
the
report.
So
I'm
sorry
to
in
my
usual
style.
Leave
you
with
more
questions
and
answers,
but.
L
To
to
the
issue
K
raised
in
fact,
I
think
Claire
is
arranged
for
Suzanna
burden
to
come
to
the
what
will
be
the
first
meeting
of
the
regulatory
government's
and
values
committee.
This
much
delayed
meeting,
which
I
think
the
good
news
is
every
member
of
the
committee,
can
now
attend
on
the
new
date
and
also
I
think
we're
arranging
it
possible
for
James
took
them
to
be
at
that
meeting,
because
complaints
are
going
to
be
on
the
agenda.
I
actually
found
about
that.
I
found
this
report
quite
confusing.
L
There
are
a
significant
number
of
complaints
about
the
services
that
CQC
regulates
and
I
wasn't
clear
whether
this
is
a
point
about
when
I
complained
about
the
service,
then
it
becomes
a
complaint
about
the
CQC
I
think
we
need
to
get
a
better
understanding
of
that.
So
I
think
that
there
is
some
room
here,
for
you
know
again
take
John
the
point
without
being
overly
bureaucratic,
just
sort
of
classify
these
complaints
in
a
in
a
slightly
different
way.
I
was
also
very
surprised
that
well
that's
again,
it's
difficult
to
track.
L
Care
homes,
in
particular
are
accept
the
judgments
that
are
made
by
them,
but
I
was
surprised
at
how
few
complaints
that
were
about
the
inspections
themselves,
but
this
may
be
a
classification
issue
and
I
think
it
just
would
emphasize
the
importance
of
really
understanding
what
each
of
these
lines
actually
means.
But
we
will
have
a
first
go
at
this
at
our
first
meeting.
F
Thanks
very
much
I
won't
take
much
time
because
I
know
we
don't
have
much
time.
I
just
wanted
to
pick
up
I'm
something
that
Steve
talked
about
earlier
on.
He
talked
about
patient
loyalty
to
GP
practices
and
which
is
exactly
what
the
the
primary
thing
that
I
wanted
to
report
on
to
the
board.
Our
annual
report
is
all
about,
so
it's
titled
grateful
today
and
loyal
today.
F
Whatever
grateful
today,
powerful
tomorrow
and
I
suppose
two
things
about
this
report,
one
is
I,
know
you've
all
got
copies
of,
but
one
is
that
I
understand
this
report
I
take
this
report
as,
if
you
like,
as
being
a
setting
out
of
the
HealthWatch
England
stall.
This
is
what
we
will
be
about
as
an
organization.
It's
not
quite
finished
business
as
you've
seen
if
you've
had
a
chance
to
read
it.
F
The
rights
that
we've
published
are
still
going
to
be
subject
to
some
further
consultation,
but
but
but
this
will
set
an
agenda
for
the
organisation
for
the
medium,
if
not
the
long
term.
So
so
I
think
it
is
very
important
for
us
and
I'm
personally
really
really
pleased
to
have
it
out
there
and
being
discussed
and
it
is
being
discussed,
which
is
also
a
great
thing,
and
we
I
want
to
just
point
you,
though,
not
to
the
hard
copy
but
to
the
website,
because
the
material
on
the
website
is
very
differently
presented.
F
Deliberately
it.
You
can
print
out
a
PDF,
but
you
don't
have
to,
and
actually
you
can
begin
to
engage
in
a
conversation
with
us
and
with
each
other
about
the
rights,
and
there
was
a
lot
of
activity
on
on
that
site.
That
day
it
was
launched
under
eat
there
all
sorts
there's
a
kind
of
BBC
type
forum
where
people
can
talk
about
their
understanding
of
each
of
the
rights
and
their
response
to
what
we've
said.
F
They
are
all
doing
such
different
things
at
the
moment,
so
this
map
will
continue
to
build,
will
put
up
new
examples,
and
so
the
website
that
sort
of
additions
around
the
annual
report
are
not
a
dead
annual
report.
They
are
a
live
conversation
with
the
public
that
are
what
we're
saying
and
a
live
cook
live
sort
of
opportunity
to
see
what
local
healthwatch
are
doing.
As
we
add
more
example,
so
I
very
much
encourage
you
to
have
a
look
at
the
website.
J
As
you
know,
and
you've
heard
me
say
this
before,
despite
the
name,
HealthWatch
does
indeed
cover
adult
social
care,
social
care
as
well
as
health
care,
but
so
I
think
that
the
rates
kind
of
going
into
that
territory
is
really
helpful
and
but
I
think
that
there
is
something
that
we
perhaps
collectively
need
to
think
about
and
work
with
you
on
around
how
we,
how
we
make
that
clear
with
people
how
the
coordination
across
with
what
does?
What
does
the
NHS
Constitution
mean
for
people?
J
How
does
it
all
link
up
with
the
race
and
how
we
can
use
this
in
adult
social
care
as
well
and
linking
up
with
some
of
the
other
initiatives
that
have
happened,
and
particularly
in
Social
Care,
like
the
think
local
at
personal,
making
it
real
I
statements
which
again
are
very
powerful
and
have
been
co-produced
with
people
who
are
using
services
and
carers?
So
I
think
I
think
there's
a
bit
of
that
work
to
be
done,
but
kind
of
really
great
to
see
you
where
I'm
starting
the
conversation
a.
C
F
Thing
about
just
the
NHS
Constitution,
which
is
really
just
to
say
that
I'm
you're
absolutely
right.
It's
a
discussion,
not
finished,
but
it
is
a
discussion
that
began
six
months
ago
with
the
expert
group.
That's
been
advising
on
the
NHS,
Constitution
and
I.
Think
Steve
was
at
a
meeting
yesterday
where
there
was
a
very
lively
conversation
about
this.
The
relationship
between
our
work
and
the
NHS
Constitution,
but
what's
really
clear
and
I,
think
I've
reported
before
but
I'll
repeat
myself,
is
that
the
NHS
Constitution
sits
very
comfortably.
F
It
really
does
sit
comfortably
within
our
rights,
so
our
rights
are
kind
of
broader,
as
you
rightly
say
in
terms
of
Social
Care
there,
and
there
is
a
slightly
higher
level.
They
have
less
that
they're
less
granular
than
many
of
the
things
within
the
NHS
Constitution
they're
not
meant
to
be,
instead
of
at
all.
They
are
and
I
hope
what
will
be
an
enhancement
and
the
further
development
and
some-
and
we
are
actively
talking
about
how
we
can
pull
the
two
together
in
communication
with
users
and
consumers
of
health
and
social
care.
H
I've
been
sort
of
following
a
few
help:
local
healthwatches
and
some
one
are
doing
great.
What
I
can
offer
to
the
others
are
at
an
earlier
stage,
and
you
mentioned
that
they're
all
doing
very
different
things.
So,
on
one
hand,
I
think
you
know,
diversity
is
good,
but
it's
also
I
find
it
quite
difficult
to
actually
say
what
HealthWatch
does
you
know
because
people,
you
know
I
feel
I
want
to
be
able
to
say
well
this.
You
know
this
is
healthwatches
role.
H
Well,
this
should
be
HealthWatch,
but
because
it's
so
different,
a
local
level,
it's
difficult
to
say
that
and
other
than
to
say
it's
the
voice
of
consumers
and
I'm,
not
sure
what
the
answer
is.
But
but
it's
it's.
You
know
and
I
end
up
saying
not
very
much.
You
know
and
I
just
wondered
what
you
thought
about.
You
know
how
I
mean
it's
partly
the
relationship
between
HealthWatch
and
CQC.
Actually,
because
we
haven't
had
a
lot
of
discussion
about
that
for
various
reasons.
F
There
is
a
body
of
work
which
is
beginning
now,
which
is
about
trying
to
establish
what
the
standard,
what
you
good
might
look
like
for
local
HealthWatch.
So
in
my
report,
there's
reference
to
and
outcomes
an
impact
tool
which
we've
been
developing
with
the
LGA.
That's
the
Local
Government
Association.
So
that's
the
first
step
on
that
path.
Local
HealthWatch
will
all
produce
their
first
annual
reports
in
March
and
I.
F
Think
that
will
give
us
a
much
better
picture
for
what
they're
doing
across
the
whole
spectrum
of
their
responsibilities
and
we're
doing
an
annual
survey
of
all
local
HealthWatch
between
then
and
now,
which
will
also
give
us
a
much
better
picture.
So
by
the
time
we
move
into
kind
of
the
spring
of
2014
I
think
we
will
have
a
much
better
sense
and
that
will
help
us
to
develop
some
standards
around.
M
A
M
With
regards
to
what
mr.
field
was
talking
about
minutes
ago,
with
regards
to
Records
two
years
ago,
I
was
invited
to
the
NHS
at
st.
Mary's,
and
we
will
inform
there
that
all
records
were
big
computerized
so
that
doctors,
hospitals,
ambulance
drivers,
all
have
patient's
medical
histories
at
their
hands.
So
they
can
do
it
still.
M
It
still
hasn't
happened,
so
you
get
somebody
taken
away
and
even
the
hambulance
driver
asked
to
ask
an
aide
a
relative
or
what's
happened
to
the
patient
themselves
without
going
on
the
computer,
because
it
still
hasn't
happened
with
regards
to
senior
social
services.
That's
our
biggest
obstacle
at
the
moment.
I'm
sorry.
It
says
we
find
it
all
the
time
they
alienate
us
all
the
time
as
soon
as
we
they
think
we're
getting
in
too
deep
with
people
that
need
help.
They
alienate
us,
but
done
it
with
one
particular
case.
M
We
found
out
that
a
particular
lady
she's
94
years
old,
and
we
found
out
that
she
had
figures
in
that
region
of
six
figures
in
the
bank.
Now
we
decided
that
she's
got
no
family
and
she
also
agreed
to
it,
and
she
came
from
funny
enough.
She
came
from
the
same
town
as
Laura
Donaldson,
so
they
were
able
to
communicate
verbally
between
the
fair
of
them
because
they
have
things
in
common.
We
decided
to
make
our
make
her
will
out
because
she
wants
it
all
her
goods
and
shackles
to
go
to
st.
John's
hospice.
M
Then
suddenly,
some
other
social
services
get
involved
and
we
get
alienated,
suggesting
that
we
are
after
the
money.
So
then
we
said
okay,
then,
if
that's
the
way
you
feel
will
as
the
solicitor,
if
he'll
go
as
benefit
as
the
name
on
the
will,
and
that
sex
was
also
dumped
in
the
equation.
Then
oh,
no.
Nothing
then,
since
then,
that
lady
has
got
enough
money
to
provide
care
for
the
rest
of
her
life
to
the
decency
that
she's
she
should
get.
M
But
she
doesn't
I've
had
counselors
come
to
meetings
with
us
and
promised
us
with
a
cohort
of
I'm,
not
gonna,
give
out
any
names,
a
co-author
of
hers,
promising
us
that
that
lady
will
get
specialist
dementia
care
every
person.
That's
come
from
that
particular
care
agency.
That's
earned,
or
do
you
work
for
Westminster
get
their
own
dementia
care.
No,
we
work
for
such
a
sort
of
thing
and
out
of
the
four
carriers.
She's
got
only
one
she
can
relate
to
and
she
appreciates
and
understands,
and
they
both
understand
each
other.
M
Now
they
changed
that
lady's
hours.
That's
one
instance.
My
partner
had
a
stroke
and
therefore
I
requested.
Obviously
when
she
came
out
of
rehab
and
does
she
get
there
and
she
needs
cash
because
she's
paralyzed
down
one
side,
one
of
my
degrees
is
in
psychology.
I
understand
it
with
the
stroke.
It's
not
just
a
paralyzed
bit.
You've
got
to
understand
it's
this.
If
you're
paralyzed
on
the
left
hand,
side
the
right
hand,
side
of
your
brain
isn't
working.
Therefore,
you've
got
to
accommodate
that,
so
that
the
right
left
side
can
eventually
take
over
care.
M
Workers
are
not
instructed
to
be
able
to
understand
things
like
that.
They
come
change.
Your
nappy
do
things
and
shoot
up
now
then,
once
social
work
once
social
care
manager
wanted
me
to
sign
ours
that
care
workers
weren't
even
there
and
I
refused
to
do
it
because
I
found
it's
fraud.
So
then
she
turns
to
my
partner,
says:
well,
you've
got
one
arm.
You
can
sign
it
I'm!
Sorry,
no!
That's
not!
What's
going
to
happen,
we
got
rid
of
her
got
a
new
care
company.
M
M
Apart
from
changing
your
obviously
and
I
was
advised
that
it
would
affect
my
health
if
I
didn't
pull
out
away
from
the
they're
helping
this
lady,
so
I
did
do
I
had
a
meeting
with
the
care
company
five
weeks
ago,
two
weeks
down
the
line,
the
care
so
could
the
social
care
manager
decides
to
ring
me?
Oh
can
I
have
a
meeting
with
you.
I
want
to
ask
you
these
questions.
Excuse
me,
I've
already
answered
these
questions
to
the
care
company.
We're
deciding
what's
going
to
go
on
you
contact
them.
M
You
keep
in
touch
with
them.
You
can
see
what
goes
on
now,
even
as
far
as
this
week,
which
is
now
five
weeks
down
the
line
he's
still
not
taken
over
the
the
care
of
that
lady's
bank
accounts
and
finances.
The
care
company
can't
do
it,
because
the
care
workers
are
not
allowed
to
touch
the
money
they
weren't
allowed
to
touch.
The
medication
I
got
the
medication
put
into
blister
packs,
apart
from
the
warfarin,
which
is
separate
because
the
dose
changes
every
week.
M
Therefore,
the
district
nurse
has
to
apply
warfarin
I've
got
no
problems
with
that,
but
our
biggest
stumbling
block
is
social
care,
adult
social
care
and
then,
when
I
wrote
it
when
I
got
into
the
depth
of
it,
I
wrote
to
the
managing
director
of
this
particular
care
for
him
and
of
course,
they
quoted
well.
We've
been
accredited
by
the
quality
care
Commission.
That
sense
was
straight
onto
your
website
then,
and
we've
found
out
your
little
green
six
and
it
all
looks
fine
and
rosy
until
you
go
into
the
little
green
six.
M
A
previous
check
of
this
standard
was
based
on
declarations
and
evidence
given
by
this
care
service.
They're
not
going
to
tell
you
that
I
know
we're
a
rubbish
company
and
we
don't
do
this
down
the
other.
Are
they?
That's
me,
honest,
they're
gonna
be
wine
and
roses,
oh
yeah
sure,
so
the
managing
director
quoted
that
to
me
and
I
also
coated
it
to
him
that
it
was
based
on
a
telephone
call
and
not
a
physical
inspection,
regular
care
workers,
timekeeping.
M
By
CQC,
for
you
to
be
able
to
put
your
name
or
their,
you
then
put
your
name
our
CQC.
On
their
letter
headings,
people
should
be
careful
by
staff
properly
qualified
enables
to
do
their
job.
I
pulled
one
of
care
workers.
It
was
no
more
than
20
years
of
age
in
the
kitchen
butchering
this
pair
and
I
said
to
her.
What
are
you
doing
there
she's?
Well
I.
Don't
normally
do
this,
my
mother
does
this
for
me,
then
she
couldn't
use
the
washing
machine
same
thing.
My
mother
used
to
do.
I
then
asked
her.