►
From YouTube: CQC Board Meeting 30 July 2014
Description
Agenda for the meeting of the Care Quality Commission Board, held on Wednesday, 30 July 2014:
1. Apologies and declarations of interest 0:01
2. Minutes of the meeting held on 18 June 2014 0:16
3. Matters arising and action log 0:28
4. Chief Executive's report 0:32
5. Quarterly Corporate Scorecard and Risk report 1:42:57
6. Wave 1 and 2 Acute hospital inspection evaluation report and CQC’s response 2:23:25
7. Report from ACG meeting held on 16 July 2014 2:56:36
8. Update on Intelligent Monitoring 2:56:36
9. Update from Healthwatch England 2:56:36
10. Questions from the floor 2:56:54
Read more about CQC's Board Meetings at
http://www.cqc.org.uk/public/about-us/our-people/board-members/board-meetings
A
A
B
B
In
the
business
plan
for
14,
15
and
1516,
it
was
a
two-year
business
plan.
We
committed
to
actually
inspect
all
hop
trusts,
general
practices,
dentists
and
all
other
social
care
facilities
in
that
two-year
period.
The
trajectory
for
that
was
a
lot
of
it
was
backloaded
into
the
second
into
the
second
year
1516..
B
B
What
I'm
asking
for
in
this
report.
What
the
executive
team
are
asking,
because
this
has
been
debated
and
discussed
endlessly
at
the
executive
team,
is
for
you
to
agree
that
approach.
So
what
I'm
asking
you
to
agree
is
that
we'll
do
fewer
inspections
than
in
the
same
period
last
year,
but
they'll
be
more
thorough.
More
comprehensive
and
it
will
result
in
more
inspection
days.
The
consequence
of
that
is
it
will
give
some
relief
to
our
workforce.
Our
staff,
our
colleagues
who
are
experiencing
overwork
and
the
risk
is
that
our
sickness
levels
will
go
up.
B
The
quality
of
work
will
suffer
and
then
we'll
end
in
fairly
in
doing
what
we've
set
out
to
do.
So,
what
we're
trying
to
do
here
is
strike
a
balance
between
supporting
our
staff
to
do
what
we're
asking
them
to
do
and
actually
delivering
against
our
two-year
work
program
as
set
out
in
the
business
plan.
So
if
I
pause
at
that
point,
david.
C
Okay,
both
of
us
would
I
mean
I.
I
think
that
what
we're
finding
is
that-
and
I
think
that
this
is
in
common
across
the
inspectors-
is
that
the
the
new
style
of
inspections
takes
longer.
You
know
it
takes
longer
because,
as
david
says,
it
is
more
in
depth,
it's
more
thorough
and
it
will
be
a
much
better
quality
of
report
and
judgment
that
we
make
at
the
end
of
it.
C
So
that's
the
kind
of
demand
side
of
it
and
then,
if
you
look
at
the
supply
side
of
it,
which
is
the
numbers
of
inspectors
and
their
managers
that
we
need
to
make
sure
are
doing
this,
we
set
our
plans
with
the
expectations
really
of
having
an
establishment
from
the
beginning
of
the
year,
which
would
help
us
to
deliver
that
you.
Actually
you
know
we
were
never
going
to
be
there
really,
and
we
probably
should
have
worked
that
one
out
earlier.
C
You
know
the
the
the
the
pipeline
of
new
staff
coming
in
is
much
much
slower,
so
we're
not
actually
going
to
see
the
the
levels
of
people
needed
to
do
that
activity,
and
certainly
what
I'm
getting
back
from
inspectors
in
adult
social
care
is
that
they
are
feeling
very
pressurized
that
they're
working
very
long
hours-
and
you
know-
certainly
we've
had
members
of
staff
feeling
quite
stressed
as
a
co.
As
a
consequence
of
that.
C
So
I
think
that
you
know,
given
that
we
have
a
duty
of
care
and
to
our
staff
to
make
sure
that
they're
capable
of
doing
the
job
properly.
We
need
to
make
sure
that
we're
balancing
those
two
things
up,
so
we
have
discussed
it
at
length
and
we've
gone
over
these
figures
and
we've
discussed
that
within
each
of
our
senior
management
teams
as
well.
So
I
think
that
this
is
a
considered
position
that
we've
brought
to
the
board
today.
D
Thanks
so
I
can
see
the
in
in
principle.
I
think
it's
hard
to
disagree
with
the
general
thrust
of
trying
to
make
put
emphasis
on
our
priorities.
You
can
always
check
that
that
we've
gone
far
enough
in
doing
that,
the
so
just
looking
at
your
paper
david
it
we
we're
planning
to
inspect
services
that
don't
actually
lead
to
ratings,
so
that
so
some
some
of
the
services
in
the
dental
sector
children's
services.
D
Now
I
can
see
why
we
might
want
to
inspect
them,
but
if
they
don't
lead
to
ratings,
is
that
our
priority
we've
got
10
000
social
care
inspections
in
the
old
approach
which
I'm
assuming
are
not
risk-based.
I'm
just
trying
to
remember
this
right
because
it's
not
they're
not
listed
listed
as
risk-based
in
the
table.
So
that
means
the
the
basis
of
selecting
those
10
000
is
routine.
D
Now,
if
that's
true,
maybe
we
should
be
pushing
ahead
with
a
decision
to
reduce
the
size
of
teams
and
therefore
make
more
inspections
possible.
So
general
yeah.
My
point,
I'm
in
support
of
the
general
thrust
of
what
you've
said
and
no
there's
any
criticism
attached
to
anything.
You've
said,
but
have
we
are
we
do
we
need
to
do
some
of
the
things
that
we're
still
committed
to?
I
think
your
last.
C
On
on
the
adult
social
care,
there's
two
really
important
things
to
say
about
why
we're
continuing
to
do
the
old-style
inspections?
The
first
is
that
we
are
prioritizing
those
inspections
on
the
basis
of
responding
to
risk,
so
that's
risk.
That's
either
identified
through
safeguarding
or
whistleblowing,
and
sometimes
that's
just
bringing
forward
the
date
of
the
inspection
as
opposed
to
being
completely
de
novo.
C
The
second
thing
to
say
is
that
learning
and
we're
going
to
pick
up
on
the
action
from
orchid
view
later.
But
one
of
the
things
that
we
learnt
from
the
introduction
of
new
methodologies
and
new
ways
of
doing
things
in
the
kind
of
2010-11
period
of
time
was
that
we
didn't
do
inspections
and,
according
to
the
level
that
we
might
have
expected
and
the
level
of
enforcement
activity
fell
significantly
at
that
time
too,
and
so
there's.
C
Although
I
I
don't
have
the
the
blessing
that
mike
has
of
the
the
kind
of
risk
data
and
that
enables
us
to
be
very
focused
about
where
we
should
be
going,
what
we
do
know
is
that
the
inspections
that
we
carry
out
will
uncover
risk,
and
if
we
don't
do
that,
we
are
potentially
leaving
people
vulnerable
to
to
that
at
that
continued
risk.
So
I
think
it's
it's
important
for
us
to
continue
to
be
doing
that,
so
that
we're
not
leaving
services
too
long
until
their
next
inspection.
C
But
what
I
have
done,
lewis
is
written
out
to
all
staff
and
managers
within
adult
social
care
to
say
your
first
priority
is
to
respond
to
those
issues
that
are
being
raised
with
us
as
concerns,
and
that's
what
we
want
to
do.
We'll
do
scheduled
inspections
if
we
can-
and
we
are
continuing
to
do
that,
but
their
first
priority
is
the
is
responding
to
risk.
D
D
My
point
is
if
we
haven't
got
enough
staff,
maybe
of
course
I
agree
that
where
risk
has
been
raised
with
us,
they
become
a
priority
for
inspection.
I'm
just
asking
why
we're
doing
so.
Many
by
an
old
system
sounds
like
quite
a
few
of
them
haven't,
had
a
risk
raised
about
them,
and
I
I
know
that
some
of
them
will
have
risks
that
we
haven't
uncovered.
C
So
that
is
what
we
have
done,
and
I've
written
out
and
been
very
clear
in
the
kind
of
bullet
point
list
of
starting
at
the
top.
These
are
the
priorities.
That's
the
expectation
that
the
deputy
chief
inspectors
and
heads
of
inspection
have
with
their
inspection
managers
in
terms
of
planning
and
scheduling
the
inspection
activity
that
we're
doing
in
adult
social
care.
C
So
I'm
sorry,
I
can't
give
you
the
precise
numbers
as
to
how
the
10
000
breaks
down
into
what's
risk-based
and
what's
not
and
and
paul
is
suggesting
that
he
might
be
able
to
help
me
there.
But
we
we
have
been
very
clear
with
staff
that
that
the
sort
of
new
scheduled
expect
inspection,
standard
inspections.
C
We
we
do
if
we
can
and
the
the
other
issue
to
be
clear
about
as
well,
is
that
this
is
not
it's
not
kind
of
uniform
across
the
country.
So
we
have
particular
pressures,
for
example,
in
our
central
region,
where
we've
got
a
much
higher
level
of
vacancies
and
we've
got
more
staff
available
in
other
parts
of
the
country.
C
E
On
the
numbers
on
the
ten
thousands
that's
totals
over
the
year
and
the
vast
majority
have
already
happened.
So
this
is
the
ten
thousand
is
planned
for
quarter
one
and
quarter
two.
So
five
thousand
certainly
happened
in
quarter
one,
and
we
continue
that
progress
through
the
quarter
that
we're
currently
in.
So
it's
not
a
question
of
having
ten
thousand
in
the
future.
F
From
hospitals
I
mean
like
andrea,
we've
got
a
much
clearer
idea
now
of
the
demand
side
than
we
did
at
the
beginning.
It
has
taken
time
to
recruit.
We
had
also
to
see
how
many
staff
wanted
to
go
into
which
directorate,
and
fortunately
we
were
in
a
position
to
be
able
to
accommodate
everybody
into
their
their
first
choice
of
of
directorate.
That
did
mean
that
in
certain
parts
of
the
country,
for
example,
in
mental
health,
we
were
very
short.
F
We
are
now
going
absolutely
full
tilt
at
recruitment
and
training,
and
so
I
think
this
will
get
better.
The
other
additional
thing
that
we
are
doing
now
is
actually
to
invite
people
to
come
on
secondment
and
and
to
see
qc
from
the
nhs
and
we've
just
written
out
to
trusts.
Saying
find
us
your
best
staff
as
a
sort
of
middle
grade
come
to
work
for
cqc
for
a
couple
of
years.
F
We
will
train
you
in
our
methodologies,
but
then
my
hope
is
that
they
would
then
be
able
to
go
back,
and
that
would
actually
help
to
improve
quality
and
safety
in
the
nhs.
So
I
think
we're
doing
everything
we.
We
can
specifically
on
lewis's
point-
and
we
can
come
back
to
this,
of
course,
with
the
kieran
walsh
report.
F
We
were
experimenting
at
that
stage
about
what
was
the
size
of
team.
That
would
be
best
for
that
sort
of
do.
Do
you
have
a
longer
inspection
and
get
take
one
team
around,
or
do
you
have
effectively
three
teams
working
in
parallel,
which
is
what
we
chose
to
do.
As
a
pilot
of
that
I
don't
know,
there
is
necessary
a
right
way
or
a
wrong
way.
I
don't
think
we
would
have
teams
of
that
size
again.
G
I'm
just
to
say
that
I
do
support,
what's
outlined,
obviously
as
a
good
employer,
but
also,
I
think
you
know.
In
the
past,
I've
been
quite
concerned
that
we've
focused
too
much
on
sort
of
quantity
and
hitting
targets
a
number
of
inspections
and,
of
course,
inspections
are
important
and
they
are
our
kind
of
linchpin,
but
I
also
think
that
it's
you
know
we
need
to
also
say
you
know
that
this
is
is
also
about
quality.
I
know
you
have
said
that,
but
I
think
we
need
to.
G
Maybe
even
you
know
this
isn't
simply
about.
We
can't
meet
the
numbers,
it's
actually
that
we
want
to
do
things
differently
and
we
want
to
do
things
of
a
better
quality
and
it
isn't
just
about
inspections.
It's
also
about
responding
to
concerns
liaising
with
patients.
Other
bodies
writing
good
reports,
you
know,
and
all
that
is
part
of
the
kind
of
the
quality.
G
A
E
We
have
significantly
more
confidence
than
we
had
in
the
past
on
the
qualifier
intelligence,
but
it
does
still
very
significantly
set
to
by
sector
it's
probably
strongest
in
the
acute
sector,
and
we've
used
the
intelligent
monitoring
system
to
as
one
of
the
inputs
into
who
we
inspect
early
on,
which
is
why
there
are
more
potentially
riskier
trusts.
I
put
it
that
way
in
the
14-15
program,
what
we've
announced
so
far,
and
that
was
a
conscious
decision
and
we
look
at
that
quarter
by
quarter
mike
and
myself
and
others.
E
But
what
I
don't
think
david
said
at
all
was
that
we
were
planning
to
push
out
the
back
end
of
the
program,
because
there's
so
much
between
now
and
either
december
2015
for
the
acute
sector
or
march
2016
for
at
our
social
care
and
prior
medical
services
that
we
still
need
to
settle.
We
need
to
look
at
what
our
recruitment
profile
is
going
to
be.
E
We
need
to
look
at
what
the
efficiencies
in
the
model
can
be,
and
we
need
to
learn
from
the
wave
programs
that
are
currently
underway,
that
it
wouldn't
be
right
to
say,
because
we're
doing
less
activity
than
we'd
originally
had
projected
in
1415.
That
definitively
means
we're
pushing
the
back
end
of
the
program
out.
There
may
be
ways
to
catch
it
up.
A
Just
on
the
the
real
substance
of
robert's
question,
though,
is
how
good,
how
good
is
our
intelligence
at
picking
up?
I
think,
particularly
in
hospitals,
but
I
think
across
the
piece
I
think
we
need.
We
must
come
back
to
that.
I
think
we
will
discuss
it
a
bit
in
the
performance
report
later
on
today,
but
I
think
it's
such
a
such
a
crucial
area
that
maybe
we
can
come
back
and
spend
some
more
time
on
that.
In
you
know,
september
or
october,.
E
I
I
Ultimately,
after
the
first,
you
know
wave
of
inspections,
new
style,
so
we'll
have
to
obviously
pull
point.
You
know
revise,
I
guess,
keep
under
revision.
The
depth
breadth
frequency,
risk-based
nature
of
the
analysis,
and
that
relates
to
fees
too.
Doesn't
it
that's
implication,
so
I
think
just
to
keep
returning
to
this,
or
is
the
obvious
point.
B
But
what
this
proposal
that
we're
discussing
is
asking
you
to
do
is
note
the
position
for
this
current
year.
Our
objective
was
by
march
16
to
have
inspected
and
rated
everything,
we're
not
making
any
proposal
in
relation
to
whether
that
should
be
altered
at
all,
but
to
come
to
your
point,
jennifer
on
recruitment.
B
B
B
So
I
think
the
work
that
we
need
to
do
and
I've
asked
we
get
already
a
weekly
report
on
the
numbers
of
people
coming
through.
I
did
the
corporate
induction
this
morning.
There
were
three
earlier
this
week.
There
were
three
inspectors.
I
did
one.
Two
weeks
ago
there
were
seven
inspectors,
so
people
have
started
to
come
through
the
recruitment
campaign
and
the
corporate
induction.
The
issue
is
whether
that
flow
is
going
to
be
rapid
enough
to
hit
the
numbers
that
we
originally
thought.
B
We
need
to
look
at
the
second
floor
that
we
need
to
get
is
all
those
new
people
coming
through
need
to
go
through
the
academy
and
get
30
days,
training
before
they're
good
to
go?
So
that's
the
second.
Now
that's
up
and
running
that
work
has
begun
and
current
inspectors
need
to
go
through
15
days,
training
elsewhere.
In
my
report,
we've
got
the
need
for
people
to
be
trained
in
the
regulations
that
that's
simply
the
acquisition
and
knowledge.
That's
not
a
skill
base.
You
just
need
to
know
what
the
regulations
say.
B
We're
asking
them
to
do
and
they've
got
to
be
available
for
the
beginning
of
the
next
year
so
effectively.
What
this
decision
I'm
asking
you
to
take
today
is
doing
is
saying
the
trajectory
by
which
would
get
to
march.
16
is
changing
the
flight
path,
so,
instead
of
a
gradual
takeoff,
what
we've
got
is
a
takeoff
and
there'll
be
a
steep
climb
in
the
second
year
so
to
have
a
steep
climb
in
the
second
year.
We
need
enough
people
and
they
need
to
be
good
to
go.
B
So
I
think
that's
our
job
in
the
autumn,
in
the
business
and
the
detailed
business
plan
to
set
out
how
we
can
do
that
and
if
there's
a
risk
to
us
doing
that,
we
need
to
identify
that
and
bring
that
back
to
the
board
as
part
of
our
planning.
So
so
the
degree
of
I'm
confident
about
the
intelligent
monitoring,
although
I'm
sure
we'll
talk
about
false
positives
and
false
negatives.
B
When
we
get
to
that
report
in
relation
to
next
year,
what
we're
saying
is
we
need
to
do
the
detailed
planning
not
on
a
modeling
places
where
we
say
if
we
have
this
many
people.
This
is
how
much
we
could
do,
but
on
an
actual
basis,
we've
got
this
many
people.
This
is
what
we
can
do
and
what
we've
had
in
the
business
plan
is
a
model
based
on
our
assumptions
about
how
the
new
inspection
methodology
will
work
and
already,
I
think,
that's
been
challenged
by
the
number
of
repeat
inspections.
B
We've
got
and
there
really
are
picking
up
two
concerns
that
have
been
reported
through,
which
admit:
we've
gone
back
to
more
places
than
we
originally
anticipated
in
the
first
model.
Not
just
that
our
inspections
are
taking
longer
than
they
previously
did.
That's
why
we're
delivering
more
inspection
days,
because
there's
a
bigger
proportion
of
revisits
or
inspections
which
are
a
response
to
a
concern
which
is
being
raised,
and
I
don't
think
we
anticipated
all
of
those
I
think
we're
anticipating
about
one.
J
J
In
the
case
of
orcid
view,
you
know
various
pieces
of
data
like
the
local
authorities,
stopping
sending
residents
to
orcid
view
the
unexpected
fatalities
and
so
on,
because
I
think
that
would
give
a
lot
of
confidence
to
to
the
cqc
being
able
to
say
you
know
we
have
now
put
in
place
a
much
better
risk
tracking
capability
and
therefore
the
inspections
that
we
are
going
to
do.
What
we
will.
We
will
not
not
inspect
somewhere,
where
there
are
indications
of
risk.
E
So
because,
on
the
adult
social
care,
intelligent
monitoring,
we're
still
at
very
much
at
the
prototyping
stage
and
it
won't
go,
live
until
quarter
three,
it
is
too
early
to
say
definitively.
We
would
pick
up
an
orca
view
or
other
sort
of
similar
case.
What
we're
doing
as
part
of
the
testing,
though,
is
to
look
at
the
various
metrics
that
we're
using
and
then
run
run
them
back
and
say
exactly
that
question.
Would
this
have
picked
it
up
within
that?
E
It's
that
combination
of
sort
of,
like
pejorative
terms,
the
hard
and
the
soft
data,
but
is
absolutely
part
of
the
testing
process
to
look
at
real
examples
in
much
the
same
ways
we
asked
ourselves
would
we
have
picked
up
mid-staffs
with
our
new
acute,
intelligent
monitoring
and
we
feel
they're
much
more
confident.
We
would
have
done
partly
on
the
basis
of
the
concerns
and
complaints
data,
also
on
the
basis
that
mid
staffs
without
lying
on
mortality.
C
And
one
of
the
critical
relationships
are
the
inspectors
and
inspector
managers
with
local
authorities
and
we've
structured,
the
adult
social
care
directorate,
so
that
our
kind
of
unit,
if
you
like
of
of
reference,
are
the
local
authority
boundaries
so
that
we
can
identify
key
people
who
can
be
liaising
across
and
we've
got
some
excellent
examples
which
we're
trying
to
make
sure
we
replicate
across
the
country
where
inspectors.
Inspector
managers
with
their
colleagues
and
local
authorities
are
indeed
proactively.
Sharing
that
information
between
each
other
around
the
problem
areas.
C
How
each
bit
of
the
system,
either
from
a
safeguarding
point
of
view
or
a
regulatory
point
of
view
or
whatever
else
it
may
be,
are
responding
to
the
risks.
So
so
I
think
there's
another
element
of
it
from
our
point
of
view,
which
is
making
sure
that
we're
getting
that
local
intelligence
and
using
it
in
a
much
more
meaningful
way.
E
E
F
Can
I
just
build
on
what
andrew
has
said
about
local
intelligence
and
going
back
to
robert's
original
point?
I
am
a
huge
supporter
of
the
intelligent
monitoring
it
and
it
is
proving
useful,
but
it
is
not
enough
on
its
own
and
I
think
it
is
important
to
say
that
we
have
at
least
one
trust-
that's
gone
into
special
measures
that
did
not
come
out
high
on
intelligent
monitoring,
so
it
is
possible
to
have
trust,
and
so
we
need
the
local
intelligence
as
well.
We
we
need
to
look
at
all
of
those
different
things.
F
It's
what
we're
finding
in.
In
general
terms,
when
things
come
out
as
high
risk,
we
find
problems
not
always,
but
in
general,
but
even
in
the
acute
sector.
I
don't
think
we
could
absolutely
around
intelligent
monitoring
and
I've
said
to
others.
If
we
could,
then
we
wouldn't
need
to
be
doing
the
inspecting
so
so,
yes,
we
need
the
inspecting
and
the
local
intelligence.
B
B
If
I
could
ask
that
colleagues
delete
serious
from
the
sentence
in
that
last
paragraph
on
page
three,
I
think
the
powers
are
more
about
investigating,
where
there's
risk
of
harm
to
people,
but
over
the
page.
What
we
set
out
are
the
triggers
that
we
should
use
for
where
we
do
use
the
powers
that
we've
got
to
carry
out
an
investigation.
B
What
I
and
the
executive
team
and
colleagues
that
have
been
working
on
this
issue
are
asking
is
that
you
know
this
work,
not
that
there's
further
work
to
do,
but
in
the
meantime,
that
we'll
use
the
triggers,
which
are
at
the
top
of
page
four,
to
take
forward
any
investigations
that
we
carry
out
from
here.
The
purpose
of
that
is
we'll
get
some
consistency
across
all
our
areas
of
work
in
the
way
that
we
take
it
forward
and
we'll
do
some
further
work.
B
The
reason
the
further
work
is
required
is
just
to
make
the
points,
and
perhaps
I
should
have
put
this
into
the
report.
There
is
an
ongoing
discussion
about
whether
some
of
the
functions
that
currently
reside
with
nhs,
england
on
city
should
transfer
to
us
and,
of
course
they
will
have
a
bearing
on
exactly
this
issue,
so
this
work
isn't
completed,
not
because
we've
not
done
the
intellectual
lifting
on
this,
but
because
there's
further
developments
that
we
need
to
take
forward.
B
H
The
julian
asprey
case,
which
you
mentioned
in
the
in
one
of
the
bullet
points
quite
rightly,
is
a
classic
example
of
a
case
which
there
was
significant
resistance
to
being
investigated
as
an
individual
case.
Despite
everything
you
say
about
it
about
it
there,
so
I'm
not
in
any
way
saying
your
bullet.
The
bullet
points
here
are
wrong.
They're,
clearly
not
wrong,
and
there
needs
to
be
a
system
whereby
it's
decided
which
cases
are
worthy
of
being
investigated
individually.
B
I
think
there
is
a
risk
of
that
robert
just
to
in
a
sense,
give
a
straight
answer
to
a
straight
question.
The
issue
for
us,
though,
is
what
we
will
do
as
distinct
what
others
will
do
and
part
of
one
of
the
things
that
we
need
to
assure
when
we're
inspecting
particularly
trusts
and
when
mike's
teams
going-
and
this
speaks
to
the
point
earlier
mike-
was
discussing
with
lewis
about
the
composition
of
teams.
B
If
we
think
there
are
concerns
about
the
way
incidents
are
investigated
in
a
trust,
then
we
need
to
make
sure
that
the
team
going
in
to
do
the
inspection
is
able
to
actually
explore
that
issue
on
site,
and
you
will
know
better
than
any
of
us
just
how
variable
it
is,
how
investigations
take
place
and
certainly
pulse
bag-
that,
I
think
might
guess
I
will
get.
Certainly
david
will
get
will
be.
B
There
will
also
be
cases
where
people
feel
that
they've
not
got
anybody
to
listen
to
them,
let
alone
investigate
their
complaints
in
any
kind
of
detail.
So
I
think
there's
a
difference
here.
There's
two
things
we
need
to
do.
Firstly,
we
need
to
make
sure
that
those
organizations
which
have
a
responsibility
for
carrying
out
investigations
in
the
first
place
and
then
communicating
with
the
people
that
have
suffered
as
a
result
of
the
issue,
that's
being
investigated.
B
Those
people
carry
out
those
investigations.
I
don't
mean
coroner's
courts,
I
mean
the
trust
themselves
and
then
the
second
thing
I
think
this
report
is
saying
is
where
things
do
come
to
us.
There
will
be
some
circumstances
where
we
actually
do
need
to
look
at
individual
cases.
Indeed,
I've
got
an
individual
case
at
the
minute
which
we're
working
with
nhs
england
to
carry
out
an
investigation.
This
is
a
very
old
case
of
a
family
whose
child
died
they've
not
had
resolution.
B
They
feel
nobody's
listening
to
them,
including
cqc,
and
we're
taking
some
action
to
work
with
nhs
england,
where
they
can
use
their
powers
to
carry
out
a
much
more
historic
investigation
to
see
if
we
can
actually
get
some
resolution
to
those
individuals.
I
think
that's
a
very
exceptional
case
and
I'm
sure
you'll
get
more
exceptional
cases.
B
So
I
think
what
we're
trying
to
do
here
is
strike
a
balance
in
truth,
and
maybe
some
of
my
language
in
this
report
has
been
too
cautious.
I
think
there's
been
a
presumption
that
all
deaths
of
people
with
mental
health
problems
will
be
investigated,
and
this
is
the
ambigu.
This
is
the
ambiguity
point,
and
what
we're
trying
to
do
here
is
just
be
absolutely
clear
about
the
approach
we're
going
to
take
on
that
part
of
the
discussions
with
nhs.
B
England
is
of
the
transfers
that
come
are
some
of
the
transfers
about
what
they
would
otherwise
investigate,
or
do
they
keep
those
investigation,
and
this
is
still
fluid.
I
mean
that's
still
the
subject
of
the
discussion
that
we
need
to
land.
Those
conversations
will
take
place
over
the
summer
and
into
the
early
autumn,
and
I
hope
that
we
can
get
some
clarity
in
relation
to
this.
K
Investigations
in
different
areas
are,
I
understand
quite
differently,
I'm
not
an
expert
on
on
on
on
on
all
the
sectors.
Quite
clearly,
that's
not
my
my
baby
whip,
but
one
of
the
things
that
has
come
to
our
attention
that
healthwatch
england
particularly
is,
is
exactly
this
question
of
deaths
in
of
people
with
mental
health
issues
in
in
in
in
secure
institutions
and
the
the
the
legislation
around
the
requirement
for
investigations
in
that
area
is
quite
different
to
the
legislation
that
applies
in
in
in
other
sectors.
K
So
and
it's
lesser
in
terms
of
the
independence
of
investigation,
so
so
it
seems
to
me
that
this
is
not
a
level
playing
field
and
and
in
a
way
to
to
speak,
to
robert's
point
two.
I
mean
I
think,
there's
there's
something
in
your
criteria,
which
needs
to
reflect
the
fact
that
the
context
in
the
sectors
will
be
different
and
that
the
powers
that
other
players
have
in
each
of
the
sectors
probably
also
different,
and
that
needs
to
be
taken
account
in
the
in
the
decision
so
crazy
for
us
to
do
something.
K
A
Thanks
anna,
I
I
didn't
like
the
policy
position
statement.
I
have
to
admit
I
I
read
it
and
I
don't
think
it's
very
clear
and
it's
not
quite
a
non-sequitur
in
the
middle
of
it.
But
it's
when
I
read
it.
I
thought
it
was
because
the
word
the
words
this
means
that
I
mean
it
doesn't
the
first
bit
doesn't
mean
that
it
might.
That
might
be
a
part
of
what
it
means,
but
I
just
felt
that
when
I
read
it,
I
didn't
really
understand
it.
J
J
So
I
was
concerned
about
this
last
not
concerned
about
the
last
bullet
point,
because
I
agree
with
the
last
bullet
point,
but
whether
it
was
in
fact
consistent
with
saying
that,
there's
a
presumption
that
we
would
not
investigate
every
incident,
because
the
those
involved
in
the
instance
in
the
last
bullet
point
at
least
most
people
would
say
their
particular
tragedy
is
such
that
the
last
bullet
point
comes
into
play,
in
which
case
we
end
up
investigating
every
instance.
So
it
was
more
that
my
concern
was
more.
The
compatibility
between
this
means.
J
There
will
not
be
a
presumption-
and
this
last
bullet
point
because,
as
I
say,
really
on
two
grounds
first
in
order
to
establish
whether
something
is
egregious
and
so
on
implies
an
amount
of
investigation,
and
secondly,
every
relative
will
feel
their
instinct
is
characterized
by
what
said
in
the
last
bullet
point.
So
those
were
my
my
concerns
about
the
policy
position.
B
E
Great
well
so
dave's
exactly
right
that
the
that
last
bullet
point
is:
is
there
as
the
backstop
but
in
in
order
to
be
able
to
implement,
as
you
say,
because
there
will
be
many
people
who
will
feel
that
their
cases
are
exactly
in
that
category.
What
we're
looking
at
is
having
an
assessment
phase
prior
to
launching
the
full
investigation.
So
we
have
a
number
of
people
who
are
very,
very
effectively
trained
in
investigations
that
go
back,
for
example,
to
our
healthcare
commission
days
and
other
bodies
as
well,
and
they
would.
E
The
idea
was
that
they
would
look
at
different
cases
on
their
merits
and
look
at
these
triggers
and
say
which,
if
any,
are
tripped
on
a
review
of
the
data
on
a
review
of
discussions
with
inspectors
from
other
parts
of
the
system,
so
that
it
wasn't
a
full
investigation.
But
we
had
done
some
work
first,
without
going
too
far
into
the
governance
that
we
think
that's
important.
That
goes
through
the
executive,
but
it's
also
without
something
we
think
non-executives
might
want
oversight
of
as
well
in
terms
of
the
different
sectors.
E
I
think
it's,
the
antonio
case,
which
showed
that
the
legal
requirement
on
a
state
to
investigate
was
could
be
discharged
through
the
coroner,
so
in
some
way
some
of
the
issues
that
had
grown
up
around
this
whole
question
of
should
we
always
investigate
particularly
deaths
and
detention
under
the
mental
health
act
there
with
the
law
has
appears
to
have
changed
or
the
case
law
has
changed,
which
can
impact
our
decision,
but
that
isn't
to
say
that
we
have
to
take
a
de
facto.
Every
sector
must
be
exactly
equal.
E
We
think
there's
enough
nuance
in
the
triggers
to
allow
that
that
differentiation,
but
if
we
don't
don't
think
so
we
can.
We
can
definitely
revisit
that.
On
the
on
the
specific
of
the
wording
and
the
potential
non-secretary,
I
think
there
is
whether
it's
clear
or
not.
I
don't
think
it
adds
anything
to
say
this
means
that
also,
I
think
we
could
just
take
that
out,
but
let's
go
back
as
well
and
say
even
with
that,
whether
the
form
of
words
quite
settles
it.
E
But
the
final
point
I
was
going
to
say
was
to
david's
holding
position
and
they
transfer
some
of
the
functions
from,
for
example,
nhs.
England,
one
of
the
things
they
have
been
looking
at
is
setting
up
an
investigations
branch.
This
is
why
it's
quite
difficult
to
settle
a
final
position
until
we
know
exactly
where
we
are,
but
certainly
we
want
to
be
more
front
foot
and
feel
we
can
confidently
project
what
we
will.
We
know
we
will
do
under
what
conditions.
I
Quick
point,
so
the
obvious
point
is
the
lack
of
clarity
in
the
roles
of
other
statutory
bodies
as
just
discussed,
and
clearly
that's
a
that's
a
big
issue.
I
thought
that
this
looked
fine
as
a
way
forward
as
a
working
brief,
but
I
wondered
whether
or
not
it
might
be
possible,
maybe
with
other
agencies
as
appropriate,
to
monitor
a
sample
of
those
which
fall
out
of
our
definition,
just
to
see
whether
or
not
really
in
hindsight
they
would
have,
and
I
don't
necessarily
think
we
should
do
that.
I
It
may
be
that
a
combination
of
us
and
other
agencies
who
we
think
are
appropriate
depending
on
their
roles
and
how
they're
clarified,
might
think
of
doing
something
in
that's
appropriate.
That
doesn't
also
set
up
too
many
expectations
amongst
the
families
of
those
who
are
affected,
but
any
kind
of
casting
the
net
is
going
to
mean
that
that
it
can
never
be
cast
iron.
D
First
of
all,
just
to
pick
up
the
mental
health
act.
The
point
the
the
issue
in
mental
health
is
that
there
are
about
300
people
die
every
year
while
detained
under
the
mental
health
act,
so
they.
So.
This
is
people
who
are
detained
for
their
health
care
detained
by
effectively
by
the
state
and
who
then
die.
So
so
you
could
argue
that
there
is
a
very
special
category
of
incident,
which
we
should
take
particular
responsibility
for,
at
least
at
least
ensure
that
somebody
has
investigated.
D
But
then,
when
you
look
in
detail
who
those
300
people
are,
it
turns
out
that
most
of
those
deaths
are
natural
cause
deaths
and
now
that's
not
to
diminish
the
importance
or
suggest
that
they
may
not
have
been
failings
in
care,
whereas
when
somebody
dies
of
natural
causes,
but
they
are
often
older
people
dying
of
natural
causes
in
settings
where
for
to
to
an
extent
technical
reasons,
they
are
also
detained
under
the
mental
health
act.
So
they're,
not
all
the
same
is
the
point.
D
D
That
may
just
be
because
of
the
phase
we're
at
but
testing
this.
You
know
it's
easy
to
read
the
bullet
points
and
think
well,
each
of
them
sounds
reasonably
correct,
but
it
will
only
work
once
that
detail
is
written
into
it,
not
just
because
of
differences
between
sectors,
but
because
it
will
throw
up
the
fact
that
some
cases,
even
though
they
might
fall
outside
what
seem
like
sensible,
high-level
criteria.
D
Those
cases
need
an
individual
investigation
by
somebody,
so
that
sense
of
how
does
the
matrix
of
potential
investigators
fit
together
should
be
addressed
that
level
of
specificity
about
the
range
of
incidents.
That
might
happen
I
would
suggest,
needs
to
be
addressed
and
even
where
there
is
a
setting
where
you
would
think
there's
an
obvious
case
for
investigation
like
deaths
under
the
mental
health
act.
D
There
are
differences
which
have
to
be
reflected
in
how
the
document
is
put
out,
and
so
I
don't
be
too
critical,
because
I
understand
you've
got
to
a
particular
point
and
there
needs
to
be
further
work
and
further
work
with
others.
But
it's
that
level
of
detail
which
will
make
this
work
and
I'm
not
sure
we've
got
the
clarity
of
that
just
yet,
maybe
maybe,
for
understandable
reasons.
B
So
kind
of
take
from
that
chair
that
people
are
content
with
the
triggers
we'll
work
on
the
policy
statements
we'll
build
in
some
monitoring
and
the
further
work
needs
to
be
that
granularity.
That
lewis
has
just
pulled
out
just
for
just
for
clarity
is
that
okay,
I'll
I'll
bank.
That
one
third
item
then,
is
on
covert
surveillance.
B
I
think
the
place
we've
got
to
in
relation
to
the
use
of
covert
and
or
surveillance
is
that
views
are
mixed,
and
so
what
we're
trying
to
do
in
this
report
is
settle,
how
we
should
advance
this.
So
the
second
paragraph
is
saying
that,
where
cqc
uses
surveillance,
it
should
only
use
it
as
a
last
resort
and
in
extreme
circumstances,
so
that's
a
cqc
when
we're
acting
to
investigate
to
inspect.
B
B
B
B
So
in
effect
we're
saying
we
will
use
our
powers
as
appropriate,
but
in
extremely
rare
circumstances
and
we're
going
to
adopt
what
is
effectively
a
neutral
position
and
saying
if
you
providers
are
going
to
use
these.
These
are
the
issues
that
you
must
take
into
account
and
they're.
The
bullet
points
at
the
top
of
page
5.,
but
we're
not
going
to
advocate
that
this
should
be
used.
We're
taking
a
neutral
position,
I
think,
is
the
best
way
to
present
this.
C
D
I
felt
a
bit
uneasy
reading
this.
Actually,
I
thought
this
is
a
very
important
issue
and
for
us
to
take
a
neutral
position
on
such
an
issue
that
matters
so
much
to
the
public
seemed
a
little
bit
a
little
bit
weak
and
as
if
we
were
handing
over,
you
know
we're
going
to
focus
on
something,
that's
quite
narrow,
which
is
cova
covert
surveillance
by
cqc.
That
seems
to
be
our
top
concern,
and
actually
this
is
about
covert
and
overt
surveillance
by
the
sector
as
a
whole.
D
Now
it
may
just
be
that
it
started
off
in
about
covert
surveillance
by
cqc
and
that's
giving
the
wrong
impression,
but
we
then
seem
to
hand
over
to
it
to
everybody
else.
The
decision
making,
even
though
we've
looked
at
the
issue-
and
I
can
see
why
we
might
not
be
able
to
recommend
surveillance,
because
maybe
the
evidence
isn't
so
clear,
but
I
think
we
can
do
more
than
adopt
a
neutral
position.
I
think
we
can
be
clear
about
what
we
expect
the
benefits
to
be
and
and
reflect
public
concern
as
to
why
they,
why?
D
Why
does
the
public
think
that
covert
surveillance
might
be
needed
at
all?
And
I
I
maybe
I'm
misinterpreting
your
what
you
mean
by
a
neutral
position,
but
it?
But
unless
we
reflect
that
public
concern,
which
has
raised
this
to
a
very
important
issue
for
a
number
of
people
and
unless
we
can
say
something
about
the
potential
benefits
and
where
they
might
be
applied
and
therefore
when
it
might
be
a
good
idea
that
might
be
consistent
with
an
overall
neutral
position.
D
D
That
seems
to
me
to
be
the
likeliest
thing,
so
not
that
I
know
people
are
concerned
about
putting
in
a
slightly
shaky
hidden
camera,
which
picks
up
wrongdoing,
and
that
may
well
work,
but
it's
more
likely
that
the
awareness
that
people's
actions
are
under
scrutiny
will
make
staff
behave
better
and
will
protect
people
as
a
result.
Now
we
should
be
prepared
if
we,
if
we
decide
that
we
may
not.
D
D
This
isn't
just
in
the
end
about
care
homes,
because
the
principle
might
apply
to
other
settings,
and
you
know,
secure
mental
health
units
might
be,
might
be
one
for
example,
but
but
I
I
won't
go
and
I
I
think
we
can
say
more
than
adopt
a
neutral
position
and
then
it's
over
to
other
people
to
make
them
their
minds
up.
And
I
think
that's
a
slightly
over
reserved
position
to
adopt
on
such
a
contentious
and
concerning
issue
for
the
public.
G
Yep,
but
I
think
it
would
be
helpful
to
distinguish
between
overt
and
covert
because
there
are
different.
You
know
they're
different
scenarios.
You
know
there
are
different,
different
sort
of
legal,
a
legal
context
for
sort
of
covert.
It's
it's
reaperism
or
something
and
overt
is,
is
slightly
different.
So
I
think
we'll
perhaps
need
to
be
a
bit
clearer
about
that.
G
Yeah
and
also
to
distinguish
between
cqc
providers
and
families
a
bit
more
because
they're
again,
the
sort
of
legal
context
is,
is
different.
I
think
so.
It
probably
plays
to
the
point
lewis's
point
to
some
extent,
in
the
sense
that
if
we
were
a
little
bit
more,
you
know
clearer
on
what
we
were
saying
about
the
different
scenarios.
H
I
I
think
I
I
well
I
very
much
sympathize
with
what
liz
and
kay
say.
I
think
the
trouble
with
us
having
a
view
on
whether
on
the
merits
of
overt
surveillance
is
that
there
is
no
consensus
so
what,
for
instance,
worthy
this
organization
to
say
it's
a
good
thing
in
certain
circumstances.
Presumably
we've
then
been
expected
to
inspect
to
that
standard,
and
I'm
not
sure
that
that
we're
anywhere
near
someone
will
tell
me
if
we
are
anywhere
near
a
consensus
which
would
allow
that
to
be
thought
of
as
general
practice.
H
I
do
think
it'd
be
a
good
idea
to
set
out
what
the
benefits
and
disadvantages
are.
For
instance,
over
all
covert
surveillance
is
an
invasion
of
the
privacy
of
the
of
the
residents,
the
service
users,
the
staff,
the
visitors
and
everyone
else,
and
therefore,
to
do
that,
even
if
it's
overt
needs
to
have
a
reason,
you
can't
just
do
it
covert
surveillance.
H
The
second
part
is
about
our
own
use
of
surveillance,
and,
while
I
think
it's
perfectly
acceptable
to
say,
we
would
only
use
it
in
extreme
circuit
or
rare
circumstances.
I
think
it's
better
than
extreme.
Any
suspicion
of
abuse,
which
can
only
be
uncovered
by
by
the
use
of
its
thought,
could
only
be
uncovered
by
the
use
of
covert
surveillances.
H
I
would
have
thought
an
extreme
circumstance,
but
if
we
are
to
use
it
at
all-
and
I
I
imagine
there
will
be
circumstances
where
we
would
want
to-
then
it
seems
to
me-
we
should
firstly
have
a
system
of
governance
around
how
we
use
it.
We
should
know
what
that
is
at
the
board
and,
secondly,
we
should
be
transparent,
as
we
can
about
the
frequency
with
which
we
use
it.
In
other
words,
that
we
need
to
put
in
our
annual
report
or
wherever
something
about
the
use
of
covert
surveillance.
I
L
Process,
while
supporting
what
robert
says,
particularly
in
religion,
to
covert
surveillance,
I
think
we,
I
would
agree
with
others-
who've
been
a
little
bit
more
supportive
of
overt
surveillance
being
something
which
we
don't
knock
back
too
far.
Personally,
I
think
that
there
may
be
a
lot
of
technologies
that
can
help
providers
provide
really
good
care
more
quickly
and
safely
to
people
that
and
surveillance
and
on
overt
basis
might
be
one
of
those,
and
it
does
seem
to
me
that
the
the
language
which
we're
using
is
negative
in
that
respect.
L
It
may
be
that
there's
more
work
to
be
done
to
work
out
how
to
use
it,
and
we
should
we
could
say
that,
but
I
don't
think
we
should
be
negative
towards
this.
It's
happening
in
all
sorts
of
other
areas
of
life
in
a
very
positive
way,
and
I
think
we
need.
We
need
to
be
careful
that
we're
not
being
a
drag
on.
It
seemed
to
be
luddite
in
that
respect.
C
So
just
to
address
the
points
that
people
have
raised,
I
think
that
what
you've
got
here
is
a
very
summarized
position
in
terms
of
what
we
want
to
do
and
the
reason
why
we're
bringing
it
to
the
board
today
is
to
ensure
that
and
the
detailed
work
that
needs
to
be
done
to
actu
actually
answer
some
of
the
kind
of
more
specific
points
that
people
have
raised.
We're
kind
of
doing
that
within
a
direction
of
travel,
that
the
board
is,
is
content
with,
and
so
I
think
some
of
the
challenges
about
well.
C
So
I
think
that
what
we,
what
I
would
like
us
to
do
is
to
recognize
that's
the
circumstance
in
which
people
are
making
those
decisions.
What
are
the
other
things
that
they
can
do?
What
are
the
kind
of
conversations
that
they
could
have
where?
Where
are
the
other
places
that
they
could
go
to
to
get
help
and
so
set
it
in
that
context?
C
Well,
so
I
think
that
you
again,
we
have
to
be
kind
of
balanced,
really
and,
and
what
we
want
to
be
doing
is
being
absolutely
clear
about
the
issues
that
we'd
be
expecting
providers
to
take
into
account
and
which
comes
to
the
points
that
you
were
raising.
Robert
and
others
alluded
to
around
and
people's
envision
of
privacy
and
dignity
and
respect,
so
you
know
there
are.
C
So
I
think
that
what
we
will
come
out
with
in
terms
of
the
detail
would
help
to
address
some
of
the
points
that
that
people
have
raised.
I
completely
take
your
point
jennifer
about
the
evidence
base
in
terms
of
we
could
contribute
to
that
as
we
go
forward,
because
the
evidence
base
isn't
fantastically
strong
in
terms
of
saying
you
know
you
put
a
camera
in
and
you
get
these,
you
absolutely
get
these
outcomes
or,
if
you
don't
have
them
you,
you
yeah.
C
What
that
that
is.
So.
I
think
that
we
should
be
thinking
about
how
we
will
learn
from
others
and
how
we
will
learn,
for
example,
from
the
experience
that
one
of
our
larger
providers
hc1
is
going
through
at
the
moment
they
are
consulting
on
the
use
of
cameras,
consulting
with
resident
staff
as
well
as
relatives
and
and
they've.
C
J
You
know
we
would
then
have
inspected
that
home,
but
would
we
have
actually
been
able
to,
through
a
standard
inspection,
be
able
to
pick
up
what
the
relatives
or
you
know,
panoramas
filming
actually
picked
up.
So
I
think
there's
there's
seems
to
be
there's
an
issue
here
about
whether
surveillance,
covert
surveillance
or
overt
surveillance
can
just
simply
capture
events
that
our
inspections,
you
know
by
their
nature,
just
just
can't.
J
J
C
C
A
I'm
just
going
to
move
to
paul
and
lewis.
Can
I
just
just
chip
in
myself
just
for
a
minute,
it's
just
the
words
as
a
last
resort.
In
extremely
I
mean
the
cqc
only
use
kerber
as
as
a
last
rule,
in
extremely
rare
circumstances,
I
mean
I
just
wonder
whether
the
words
last
resort
inextremely
just
make
it.
A
C
B
A
D
D
The
yes
there's.
No
evidence
or
no
convincing
evidence,
and
but
that's
often
the
case
and
that's
where
we
need
judgment
and
yes,
there's
no
consensus.
I
wasn't
100
sure
whose
consensus
we
were
talking
about
the
public
is:
do
we
have
to
do
what
the
our
consultation
says?
I
mean
I
think
we're
allowed
to
make
a
judgment
about
about
this
and
its
potential
benefits,
and
I
worry
that
our
conservative
neutral
position
is
too
conservative.
D
For
example,
if
you
take
the
phrase
for
the
public,
the
decision
to
install
hidden
cameras
is
for
them
and
the
families
to
make.
That
seems
to
me
like
pushing
it
away
and
saying
we're
not
going
to
get
involved,
that's
their
decision,
and
actually
we
should
be
understanding
why
they
might
feel
so
desperate
as
to
want
to
make
that
decision,
and
we
should
be
prepared
to
help
them
and
whether
that
means
help
them
by
giving
them
the
camera
or
telling
them
how
to
do
it
becomes
immaterial.
D
We
should
help
them
and
if,
in
the
end,
the
help
leads
to
covert
surveillance,
then
we're
supporting
curvature
surveillance
in
some
circumstances.
So
by
all
means
that's
not
come
out
in
favor
of
it
everywhere
and
covertly
underwear,
because
these
are
different
issues
and
it's
a
complex
issue.
But
let's
not
adopt
what
we
call
a
neutral
position,
which
is
actually
a
reserved
and
essentially
negative
position.
E
So
I
disagree,
I
don't
think
it's
conservative.
I
think
the
reason
why
we've
arrived
to
this,
which
is
part
partly
as
a
result
of
the
the
co-production
work,
but
also
as
a
result
of
the
policy
thinking
and
quite
a
lot
of
the
exchanges
and
discussion
within
the
building,
is
because
of
the
difference
in
circumstances
across
the
hundreds
of
thousands
of
people
in
residential
care
and
home
care.
E
There's
simply
there's
too
many
different
variables
at
play
and
there's
too
many
personal
views
and
most
of
all
the
individual
resident
if
they
have
capacity
or
the
individual
person
being
cared
for
if
they
have
capacity
their
view.
But
what
we're
absolutely
not
saying
is
that
we
wash
our
hands
of
it
in
any
way.
At
all,
we're
saying
that
we
will
provide
guidance.
E
There
are
some
things
that
break
the
law.
For
example,
there
are
many
things
that
don't,
but
there
are
very
simple
things
like
when
we
talk
about
people
putting
in
hidden
cameras
a
panorama,
because
that
was
incomes
in
people's
rooms,
but
one
can
imagine
such
a
situation
which
people
might
not
realize
that
putting
hidden
cameras
in
more
shared
areas.
E
For
the
good
of
their
or
perceived
good
of
their
individual
family
member,
of
course,
that
would
completely
compromise
other
people's
human
rights.
So
we
will
provide
guidance
on
the
appropriate
use
for
providers
and
for
members
of
the
public
to
to
inform
their
decision,
and-
and
the
second
reason
I
don't
think
it's
passive
at
all-
is
that
we're
making
a
statement
we
haven't
previously
made
by
clarity
that
we
will
act
on
the
evidence.
D
B
D
D
C
B
B
B
This
was
a
ten
page
report
when
it
was
first
prepared,
and
we
tried
to
reduce
this
in
the
interest
of
getting
this
there,
and
I
think
what
we've
just
done
is:
we've
just
kybushed
a
whole
range
of
issues
that
were
in
the
fuller
report
and
the
key
issue
on
munchausen
syndrome
by
proxy
and
and
you
would
have
taken
all
those
kind
of
things
through
ethics
committees
about
how
you
should
actually
deal
with
those
and
what
this
does
in
shared
areas
is.
It
raises
the
issue
about
where
intimate
and
personal
care
is
being
delivered.
B
B
B
B
So
I
think
there's
some
really
important
issues
that
we
need
to
tease
out
about.
What
is
our
position?
I
think
paul.
I
just
wonder
whether
neutral
and
over
conservative
and
paul's
point
about
actually
technology
is
going
to
contribute
here.
You
do
need
to
embrace
it
and
use
it
positively
is
how
we
actually
combine
the
position
that
lewis
was
raising
with
paul's
point,
and
I
think
it
picks
to
the
point
that
robert
is
using
about
what's
the
appropriate
governance
about
where
this
is
going
to
be
used.
B
B
B
Who
gets
to
look
at
those
tapes
who
stores
them?
How
long
are
they
stored
for
so
the
stuff
that
hc1
are
doing?
They've
got
to
address
that
issue
now
we
can
think
our
way
through
each
and
every
one
of
those
aspects,
or
we
can
actually
take
another
view.
Have
you
ever
gone
to
a
swimming
gala
with
your
kids
and
actually
watch
what
happens
with
cameras
because
of
nobody
wants
images
of
young
children
being
taken
and
then
circulated,
and
I
think
there
are
issues
that
we
must
consider
as
we
actually
develop
this
policy.
B
So
I
don't
want
to
be
an
apologist
to
it.
I
don't
want
to
drop
regulation
all
over
it.
I
don't
want
to
get
in
the
way
of
technology.
We
don't
want
to
stop
people
who
are
so
concerned
that
this
is
their
only
resort
from
seeking
some
resolution
of
their
concerns,
but
I
think,
as
a
public
statutory
body,
we
can't
ignore
those
bigger
issues:
they're,
not
bigger
issues,
those
other
issues
around
morality
and
if
we've
done
a
disservice
to
the
board
by
actually
bringing
a
reduced
report.
A
K
B
This
is
the
best
30
minute
item
I've
ever
had,
but
anyway,
here
it
goes.
So
this
is
the
fourth
item
decision
and
he's
one
that
I
hope
is
self-explanatory.
But
it's
about
the
transformation
program.
We've
had
a
gateway
review
and
first
paragraph
in
italics
on
page
five
is
the
gateway
review
and
that's
her
comments.
B
In
relation
to
the
review.
I
draw
particular
attention
to
the
six
bullet
points
at
the
top
of
page
six,
which
are
the
recommendations
that
that
review
team
made
following
their
field
work
a
couple
of
weeks
ago.
The
conclusion
was
that
this
work
is
progressing,
but
they
do
think
there
are
work.
We
can
do
particularly
on
this
issue
about
benefits,
realization
and
still
almost
to
pick
up
where
anna
left
that
last
item
off,
and
indeed
in
relation
to
value
for
money,
they've
rated
the
competence
assessment
on
delivery
at
amber
david.
B
What
I'm
asking
in
this
report
is
that
you
note
this
report
and
I
think
the
full
report
and
the
response
to
the
recommendations
should
go
to
a
polls
committee,
the
audit
and
corporate
governance
committee.
That's
a
committee
in
march.
I
think
it
was
had
a
full
review
of
the
preparedness
of
the
transformation
program,
so
it
will
be
consistent
with
the
work
that
they
did,
that
they
give
some
further
deliberation.
So
I
think
this
is
a
cautious,
really
positive
report
in
relation
to
the
transformation
program.
B
There
are
some
recommendations
which
the
executive
team
certainly
have
accepted
in
full
and
have
begun
to
act
on
since
they
were
made.
I'm
sure
hillary
and
other
colleagues
will
be
happy
to
answer
any
questions
but,
as
I
say,
I
think
it
probably
needs
scrutinizing
through
the
audit
and
corporate
governance
committee
in
some
further
detail.
G
I'll
be
brief,
thank
you
just
to
say
that
this
is
a
public
sector
methodology
used
widely
using
skilled
assessors,
to
give
an
external
review
about
delivery,
deliverability
and
leading
to
a
rating.
The
real
value
for
us
is
in
the
narrative,
analysis
and
recommendations
that
we
take
forward,
so
it's
it
would
be
really
valuable
to
use
the
audit
and
corporate
governance
committee
to
help
us
test,
whether
we're
doing
all
of
the
things
both
in
the
recommendations
and
the
narrative
that
will
enable
us
to
deliver
the
transformation
that
enables
cqc
to
deliver
its
purpose.
L
Certainly
do
that
I
think
just
to
note
that
the
next
ac
gene
meeting
is
until
the
5th
of
november.
So
it's
quite
a
long
time
ahead.
So
I
think
in
the
meantime,
perhaps
we'll
try
and
do
something
in
into
regular
and
and
if
perhaps
in
a
month's
time,
we
can
have
an
update
for
that
for
committee
members
as
to
what
the
recommendations
are
where
we
are
etcetera.
That
will
give
us
a
starting
point
and
just
keep
monitoring
that
committee
date.
H
G
The
report
focuses
on
the
way
we've
put
the
program
together,
the
way
we're
governing
it,
the
way,
we're
coordinating,
planning
and
driving
delivery
and
the
way
in
which
we're
realizing
the
benefits
it
had
some
both
intelligence
and
documentation
and
also
interviews
and
did
talk
to
staff
and
were
interested
in
the
impact
of
what
we're
doing
and
how
we're
doing
on
how
staff
feel
and
act.
So
there
is
some
of
that
in
there,
but
the
focus
was
more
on
the
the
programmatic
approach.
B
So
I
think
we
can
probably
proceed
more
quickly
with
some
of
these
famous
last
words,
but
in
paragraph
five
on
page
six,
I'm
just
saying
the
regulations
on
fundamental
standards
fit
and
proper
person
and
duty
of
canada
have
been
laid
before
parliament
on
the
7th
of
july
fit
and
proper
person.
Duty
candidate
comes
in
for
the
nhs
from
october
of
this
year
for
all
other
sectors,
it's
from
april
2015,
as
do
the
fundamental
standards,
the
regulations
to
give
us
the
power
to
rate
services
were
led
before
parliament
on
the
11th
of
july.
B
The
key
issue
here
is
about
how
we
prepare
staff
and
the
academy
are
developing
programs,
training
programs
which
will
eclipse
staff
with
a
knowledge
in
relation
to
these
new
regulations.
So
I'm
just
asking
colleagues
to
note
this
item
following
item
on
enforcement
policy.
We
covered
last
time
at
the
june
board
and
that
document
has
now
gone
out
for
consultation
and
pick
up
on
the
regulations
that
are
coming
through
they've
also
been
published.
B
B
B
They
do
this
in
two
different
ways,
which
is
why
there's
two
different
annexes?
I
hope
this
gives
the
board
the
detail
that
they
wish
to
see
in
terms
of
what
did
this
mean?
I've
got
an
apology
to
make
to
the
board
and
and
indeed
to
any
relatives
who
had
the
family
members
in
orchid
view
on
the
very
first
page.
I've
referred
to
this
as
orchard
view,
not
an
orchid
view,
and
I
can
only
apologize
for
that
error.
A
H
C
Well,
what
what
we've
done
with
providers
and
and
with
the
approach
that
we
took
with
fixed
penalty
notices
last
year,
was
to
give
providers
six
months
grace
in
terms
of
somebody
resigning
and
then
recruiting
and
a
new
registered
manager
coming
into
into
post
and
registering
with
us,
because
there's
a
there's,
a
kind
of
process
which
will
take
time.
But
basically
we
would
be
looking
to
make
sure
that
there
was
no
gap
that
was
longer
than
six
months.
C
Yes,
and
and
in
the
main,
what
what
providers
would
normally
do
is
either
they've
got
somebody
into
him
coming
in
and
covering
that
position?
Who
may
well
be
a
manager
but
not
formally
registered
with
us,
but
going
through
that
process
or
or
would
be
acting
somebody
up
so
you
know
I
mean
I
think
that
we've
made
a
really
strong
set
of
taken.
A
strong
set
of
messages
out
to
the
provider
set
say.
Registered
managers
are
absolutely
critical.
C
B
B
This
is
13
to
14,
and
during
that
period
we
had
no
doctors
that
we
needed
to
revalidate,
which
is
why
it's
brief
and
he's
presented
in
this
form
there's
documents
that
sit
behind
this,
but
for
next
for
the
year
that
we're
in
1415,
we
now
employ
a
number
of
doctors
that
will
be
covered
by
this,
and
professor
nigel
sparrow
who's,
one
of
steve's
team
he's
the
gp
advisor
in
steve's
team.
Nigel
will
take
on
that
responsibility
and
oversee
the
revalidation
of
the
doctors
that
we
employ.
B
B
Mental
capacity
we've
previously
had
discussions,
you've
asked
for
an
update.
What
this
is
doing
is
just
giving
you
an
update
on
the
fact
that,
following
the
lord's
report
on
mental
capacity,
where
they
made
a
number
of
recommendations
about
setting
up
a
new
independent
body
and
changing
some
of
the
deprivation
of
liberty
safeguards,
the
governments
have
taken
a
view
that
they're
not
minded
to
do
that.
They've
set
up
a
working
group
and
cqc
are
a
partisan
that
working
group.
B
In
the
meantime,
mental
capacity
and
deprivation
of
liberty
safeguards
will
continue
to
be
a
significant
part
of
the
inspections
that
we
undertake
across
all
sectors.
So
I'm
asking
the
board
to
note
that
the
information
governance
committee,
which
is
a
subcommittee
of
this
board
paul
shares
this
on
our
behalf,
have
actually
undertaken
some
work
where
they've
been
looking
at
reports
and
the
use.
B
So
if
it's
to
do
with
what
might
a
future
government
do
after
the
election,
what
this
means
is
we're
asked
to
go
through
the
permanent
secretary
before
any
discussions
take
place
that
will
be
operable
from
october
of
this
year
and
then
the
last
issue.
Well,
not
quite
the
last
issue
from
here
david,
I'm
just
asking
the
board
to
note
an
item
in
terms
of
changing
some
delegations
effectively
from
eileen
down
to
francesca
neta,
two
additional
things.
I
wouldn't
mind,
adding
some
good
news.
B
I
heard
this
morning
that,
as
a
result
of
some
work
that
has
been
undertaken
with
the
according
human
rights
commission
a
bid
of
funding
to
support
the
training
and
development
of
all
of
our
staff
in
alert
the
equality
and
human
rights
aspects
of
our
work
has
been
supported.
So
we're
due
to
receive
450
000
pounds
from
the
according
human
rights
commission
to
help
us
take
that
work
forward
and
then
just
a
brief
advert.
B
You
remember
we
had
a
debate
here
about
independence
earlier
in
the
year
and
as
a
result
of
that,
one
of
the
outcomes
was
that
we
should
make
a
presentation,
a
speech
in
relation
to
the
national
nature
of
our
independence
that
took
place
last
night
at
the
institute
for
government
and
the
outcome
of
not
just
the
speech.
We
publish
this
pamphlet,
which
is
about
a
snappy
title
of
healthy
regulators,
and
it's
looking
at
how
trust
and
independence
are
critical
to
delivering
our
purpose
of
ensuring
people
get
access
to
high
quality,
safe
care.
B
So
we've
opened
up
some
of
the
arguments
about
the
nature
of
trust
and
independence
in
this,
and
I
hope,
by
the
end
of
the
board,
there'll
be
copies
of
this.
That
will
be
available
for
board
members,
and
if
people
want
copies
of
the
speaks
that
I
gave
the
presentation
I
gave
that
will
also
be
available.
It
was
responded
to
by
stephen
dorrell
and
a
senior
colleague
from
sonia
and
I've
forgotten
her
surname
from
a
witch
who
gave
a
consumer
angle
to
the
presentation.
So
that's
that's
the
that's
me
finished
it
good.
A
B
It
is,
I
think
we
agreed
that
we'd
try
and
present
this
performance
report
in
a
slightly
different
way
with
me,
presenting
the
overarching
messages
and
then,
as
we
go
through
the
detail
of
this,
I
think
chief
inspector
colleagues
and
and
probably
paul
and
eileen
would
make
a
contribution
when
it
got
to
all
the
difficult
questions.
So
what
this
is
doing
is
setting
out
a
high
level
summary
of
our
performance
during
the
first
quarter.
B
B
We've
touched
on
the
wave
programme,
which
is
also
covered
in
my
report,
and
the
development
of
the
transition
programme,
we're
about
to
go
into
the
item
on
the
evaluation
from
manchester
business
school
and
the
king's
fund
on
the
work
that
mike
has
been
leading
on.
So
I'm
not
going
to
steal
the
thunder
of
that.
What
you've
got
is
a
new
look
report,
which
is
attempting
to
do
two
things
part.
B
A
of
this
report
is
going
through
the
strategic
measures
really
attempting
to
address
the
key
questions
about
whether
there's
been
an
overall
improvement
in
services,
our
providers,
confident
with
what
we
do
and
there's
a
huge
amount
of
detail
in
there
about
the
results
of
surveys
that
we've
undertaken
about
how
providers
viewers
I'll
not
dwell
on
those.
I
think
key
to
our
work-
and
I
pull
this
out
in
the
covering
paragraphs
in
the
annex
itself-
are
on
page
17,
which
is
the
length
of
time.
Providers
have
been
non-compliant.
B
B
So
on
pages,
23
we've
got
the
inspection
program.
You've
already
had
a
snapshot
of
those
figures,
draw
particular
attention
to
page
24,
which
is
our
enforcement
action,
which
is
down
on
the
same
quarter
last
year.
Just
to
draw
out
that
particular
point,
and
we
are
considering
that
25
has
the
issues
that
we've
previously
raised
about
so
ads.
You
can
see
the
progress
against
the
plan.
B
Their
colleagues
have
previously
raised
the
issues
in
relation
to
that
26
and
27
e
or
26
is
the
performance
of
the
national
customer
service
center
up
in
newcastle
and
just
gives
you
some
volumes
and
numbers
in
relation
to
their
activity.
This
is
all
activity
which
is
up
on
previous
years
in
terms
of
people.
B
27
you've
got
some
sense
of
the
numbers
of
people
that
we've
got
turnovers
staff
sickness.
This
does
play
to
the
workforce
and
the
impacts
are
on
the
workforce.
Some
of
those
figures
are
increasing
and,
as
you
we've
already
discussed,
vacancies
are
a
high
level,
I'm
not
going
to
dwell
on
28
29
and
30.
We've
covered
those
in
the
transformation
programme
so
far,
but
there's
more
detail
there.
If
board
members
wish
to
challenge
and
interrogate
those
issues
further
and
then,
on
pages
31
onwards,
there's
detail
around
finance.
B
Importantly,
and
this
is
new
and
different
on
page
32,
you've
got
the
run
rate
if
that
level
of
spend
continues
towards
the
end
of
the
year.
What
would
we
expect
to
be
in
in
our
out
turn
position
at
the
end
of
this
financial
period?
2014-15
is
really
what
the
run
rate
is
attempting
to
identify,
and
then
that's
all
drawn
together
in
the
financial
position
and
forecast
on
page
33
and
what
follows
on
page
30,
4.
B
page
35
is
procurement,
and
these
are
the
contracts
that
we're
buying
and
again.
I
think
what
we
wanted
to
do
in
this
is
make
sure
that
there's
a
regular
report
on
procurement,
the
procurement
that
is
taking
place,
but
also
what
the
top
valued
contracts
are,
that
we've
got
that
are
extant
at
the
time
and
they're
captured
on
page
35
and
then.
Finally,
on
page
36
is
a
capital
budget.
B
B
B
So
that's
recently
been
reviewed
by
some
colleagues
on
the
board,
but
not
by
all.
So
I
hope
that's
given
you
a
sense
of
what's
here
david,
it's
a
new
way
of
reporting.
It's
the
first
time
we've
got
this
degree
of
detail
in
this
new
style
of
reporting,
but
I'm
happy
to
answer
the
easy
questions
and
pass
the
difficult
ones
on
to
others.
A
D
Well,
first
of
all,
I
think
the
report
is
really
good,
actually
really
really
helpful,
very
informative
and
just
what
we
need
to
get
into
the
further
detail.
Obviously,
then,
the
question
is
well
what
lies
behind
what's
in
the
report,
but
that's
not
to
ignore
the
fact.
I
think
this
is.
This
is
a
really
helpful
sort
of
item
for
the
you
know
way
of
presenting
data
to
the
board.
D
D
D
What
seems
to
be
a
persistent
failure
to
meet
standards
which
we
expect
and
what
now
will
be
done
about
that
because
it,
I
think
we
would
all.
I
guess
nobody
would
disagree
this.
That
sounds
like
an
unacceptable
situation
from
a
public
point
of
view.
Secondly,
going
slightly
backwards.
The
the
second
question
is
about
find
the
page
on
page
14..
D
Yes,
I'm
sorry
dude,
I
will
have
to
mention
false
negatives
and
false
positives,
but
the
the
I
mean
the
numbers
are
quite
small
at
the
moment,
so
you
wouldn't
want
to
draw
too
many
conclusions
from
the
numbers
on
on
that
chart.
So
this
is
where
this
is
the
one
where
the
intelligent
monitoring
band
turns
into
a
rating
on
inspections.
D
That's
the
one
I'm
referring
to
and
the
the
but
the
bit
that
we
would
have
to
keep
under
close
scrutiny
is
what's
happening
to
the
ones
which
we
think
are
okay,
so
that
so
that's
the
fault.
That
is
the
false
negatives
issues,
so
people
who
that
are
not
being
highlighted
as
troubling
trusts
but
and
therefore
we
think
they're
low
priority
for
inspection
and
depending
on
what
we
think
we're
identifying
here,
either
one
or
three
of
the
four
turned
out
not
to
be
good
and
they
were
less
than
good.
D
Now
there
are
only
four
of
them,
so
it
would
be
ridiculous
to
turn
this
into
a
major
issue,
but
obviously
we
will
have
to
keep
a
close
eye
on
that.
I'm
not
so
reassured
that
19
of
26
were
in
the
band
that
we
thought
they
would
be
based
on
the
intelligent
monitoring.
The
more
important
issue
is:
how
many
do
we
think
are
low
priority,
but
actually
turn
out
to
be
less
than
good,
because
that
means
our
initial
wave.
D
Our
sort
of
screening,
if
you
like,
is
not
picking
up
the
the
potentially
difficult
dangerous
trusts
to
the
right
degree
and
bear
in
mind
that
we
highlight
this
is
a
selected
sample.
So
once
you
expand
bands,
four
five
and
six
to
the
correct
proportion,
that
would
probably
mean
that
there
are
more
numerically,
more
inadequate
trusts
in
our
low
priority
band
than
there
are
in
our
high
priority
band
for
inspection.
D
That's
a
it's
it's
a
very
interesting
question
and
and
what
it's
based
on
is
also
would
also
be
interesting
to
know,
but
the
the
the
middle
result
there
in
that
chart.
So
this
is
question
this
is
page
12..
The
do
you
think
cqc
is
on
the
side
of
people
who
use
services,
60,
say
yes,
40
percent
seem
to
have
said
either
no
or
not
committed
themselves.
D
I
think
this
does
raise
a
question
for
me
about
about
what
we
are
communicating
to
the
public
about
our
our
actions
and
where
cqc
is
taking
the
right
action
and
decisive
action.
I'm
not
sure
we
at
the
moment
are
getting
that
across
cqc
tends
to
be
have
a
public
profile
when
something
has
gone
wrong,
usually
historically,
and
we
we
probably
need
to
be
better
at
what
I
see
as
a
board
member,
which
is
the
actions
that
are
taken
when
problems
arise.
D
I
don't
know
whether
we're
doing
as
much
in
that
public
facing
side
of
our
responsibility
in
a
way
which
would
improve
public
confidence
in
what
we
do,
but
also,
ultimately,
in
the
services
that
they
might
receive
so
more.
I
think
on
what
we,
what
we
present
to
the
public
about
the
the
good
work
that
that's
done
here.
A
E
Yeah,
but
I
think
mike
will
also
have
some
things
to
say
it
is.
It
does
pick
up
on
the
early
conversation
and
the
points
that
you've
raised
before
and
and
it's
and
it's
right,
it
doesn't
intelligent,
monitor,
doesn't
simply
doesn't
pick
up
everything
and
it
does
have
some
fault
positives.
It
does
have
some
false
negatives,
particularly
looking
at
the
the
bottom
set
of
bars,
they're
bands,
five
and
six.
E
That
then
turned
out
to
be
an
antiquated
requirement.
I'm
pretty
sure
the
inadequate
is
more
convey,
isn't
it
mike
and
it's
worth
saying
sort
of
two
things
out.
Firstly,
the
reason
we
picked
the
some
of
the
hospitals
trust
to
go
into
was
because
we
had
other
information
beyond
the
tier
one
beyond
the
comparative
data
that
we
can
publish
in
intelligent
monitoring,
but
we
knew
we
thought
there
were
other
things
going
on.
That's
why
we
prioritized
it.
E
So
what
it
absolutely
isn't
is
a
a
fair
sample
of
ones
that
we
thought
were
fine
but
turned
out
not
to
be.
We
didn't
think
they
were
fine,
it's
just
the
reason
we
didn't
think
they
were
fine,
wasn't
in
the
first
tier
metrics
of
intelligent
monitoring.
It
was
picked
up
through
other
parts
of
intelligence,
and
the
other
thing
to
say
is
that,
because
we
use
that
first
tier
of
in
indicators
because
they're
the
most
robust
they
also,
they
also
tend
to
be
the
most
lagging.
E
So
they
also
didn't
look
back
in
time.
So
if
memory
serves
they
were
banned,
morecambe
was
banned.
Five
for
the
the
latest
data
we
had
available,
which
is
october
2013
compared
to
when
we
went
in,
which
I
think
was
january
or
possibly
february
about
that
time.
But
by
the
time
we
got
to
the
march
publication,
which
was
using
data,
was
the
more
up-to-date
they
were
already
in
band
three.
E
F
But,
very
briefly,
this
is
precisely
why
I
made
the
intervention
earlier
that
we
don't
only
go
by
the
intelligent
monitoring.
I
think
we
did
choose
these
other
hospitals,
because
we
we
had
concerns,
and
so
that
is
that
is
the
soft
intelligence,
the
tier
2
or
other
intelligence
that
we
get,
and
so
just
for
it
for
information.
Paul's
identified
the
inadequate
as
being
more
convey,
and
the
two
requires
improvement
are
cornwall
and
peterborough
that
we
have,
but
we
had
concerns
and
we
went
in.
C
C
There
are
some
that
continue
to
be
non-compliant
in
the
areas
that
we've
identified
and
there
are
others,
the
majority.
I
think
where
they've
been
non-compliant
on
one
issue,
they
fix
that
issue.
We
go
back
in
and
they're
non-compliant
on
a
different
issue,
because
the
focus
has
changed,
and
this
is
where
I
think
that
the
the
way
forward,
particularly
in
adult
social
care,
around
our
new
style
inspections.
C
Looking
at
the
five
key
questions,
and
particularly
looking
at
the
question
of
whether
the
service
is
well
led,
will
help
us
to
identify
those
services
that
really
need
added
extra
effort
to
sort
themselves
out,
which
is
the
reason
why
we'll
be
working
to
develop
a
special
measures
regime
for
adult
social
care
from
october
onwards,
once
we
started
rating
services
is
inadequate,
requires
improvement.
Good
are
outstanding
so
that
we
can
bring
that
in
from
april
next
year.
C
In
the
meantime,
we
are
continuing
to
pursue
the
enforcement
action
in
terms
of
warning
notices
and
making
sure
that
we're
using
the
full
spread
of
the
powers
that
we've
got,
in
particular
the
ability
that
we
have
to
restrict
people's
activity,
if
that's
required,
so,
for
example,
restricting
nursing
care.
If
the
concerns
that
we've
got
are
about
nursing
care
and
sort
of
restricting
admissions
or
or
whatever
the
appropriate
response
should
be.
C
So
inspectors
are
well
aware
of
the
kind
of
things
that
they
need
to
be
doing
there
and
with
support
from
rebecca's
team
and
legal
are
taking
that
forward.
But
I
think
there
are
more
things
that
we
can
do
and
we
will
be
doing
as
part
of
the
special
measures
but
to
pick
up
your
final
point
about
the
communication.
C
You
know
that
that
we
issued
press
release
that
was
followed
up
and
picked
up
by
the
local
press
and-
and
we've
also
had
now
supportive
comments
in
in
the
local
press
from
the
local
mp
about
the
swift
action
that
we've
taken
there.
So
so
we
do
try
in
terms
of
getting
those
messages
out.
There
may
be
more
that
we
can
do
but,
as
we
all
know,
we're
not
the
ones
that
write
the
newspaper
copy,
and
so
you
know
we.
We
need
to
be
making
sure
that
we're
doing
that
proactively.
D
We
don't
make
enough
of
that
as
to
rio,
it's
not
just
about
our
public
image.
It
is
about
reassuring
the
public
that
poor
care
will
be
sort
of
tracked
down
and
acted
on,
and
just
very
briefly
on
the
two
I
mean
there
must
come
a
point.
Wasn't
there
where
just
continued
non-compliance
in
itself
is
the
offence,
and
the
hat
therefore
has
to
be
a
limit,
even
though
it
might
be
changing
the
realist
that
the
the
non-compliant
point
might
be
changing.
There
has
to
be
a
point
where
we
say
right,
and
this
is
it.
C
I
Quick
point:
I
just
wondered
if
there
was
a
pattern
in
the
standards
that
the
types
of
standards
that
people
were
not
responding
to
were
not
compliant
with
over
a
long
period
and
whether
or
not
that
met.
There
is
some
issue
about,
therefore,
whether
some
of
the
standards
themselves
are
need
to
be
revisited.
C
E
A
delayed
node-
yes,
firstly
will.
Secondly,
it's
it,
it
doesn't
mean
it's
the
same
standard
at
all,
that's
being
breached
for
the
totality
of
the
time
scale.
This
is
non-compliance
by
location,
so
it's
quite
possible.
There
may
be
medicines
management,
which
was
an
initial
problem
that
they
trust
them,
but
the
provider
then
puts
that
right,
but
they
slip
off
on
staffing.
We
would
continue
to
raise
them
as
non-compliant
and
13
would
totally
overhaul
all
the
legislation
anyway.
So
we've
got
the
different
fundamental
centers
rather
than
the
central
centers.
K
B
Sorry
kind
of
just
come
back
on
lewis's
point
just
to
supplement
if
we're
going
to
move
on
sorry,
anna,
so
some
of
the
other
things
we're
doing
lewis
on
the
non-compliance
bit,
you
asked
it's
not
acceptable.
It
isn't
acceptable
and
there'll
be
lots
of
different
reasons
behind
why
we've
got
to
this
position.
Some
of
it
have
been
teased
out
by
questions.
Others
will
be
actually
it's
more
work
to
find
something
non-compliance
and
take
action.
B
B
We're
doing
two
things
which
I
think
are
designed
to
make
a
difference
to
this,
in
addition
to
the
cheap
inspectors,
reviewing
those
that
have
been
non-compliant
for
a
long
time
we're
introducing
enforcement
advisors
as
part
of
our
structure
across
all
three
inspection
directorates,
and
these
are
people
that
will
have
knowledge
and
specialise
and
be
available
to
their
colleagues
to
give
advice
on
enforcement.
How
do
you
collect
the
evidence?
What
do
you
need
to
do?
B
B
B
I
think
we
can
guess
and
hypothesize
that
why
that
might
be,
but
by
actually
targeting
some
additional
resource.
We
hope
that
we're
going
to
raise
our
performance
in
relation
to
this,
so
I
would
anticipate
that
if
those
measures
are
successful,
these
figures
should
start
coming
down.
If
they're
not
successful,
we
need
to
look
again
at
what
more
we
need
to
do
and
what
we
need
to
do
differently,
but
it
can't
continue
at
this
level.
K
Thanks
very
much
so
I
I
also
thought
it
was
a
great
report
and
you
can
tell
a
good
report
when
you
get
it
because
it
means
you
ask
a
couple
of
questions,
so
you
can
be
more
targeted,
which
is
great.
So
thank
you
and-
and
I
I
was
interested
in
the
time
issue
that
that
lewis
raised
too
by
two
others.
I'd
just
like
to
raise
one
is
on
slide
16.
So
this
is
the
inspections
genuinely
informed
by
people
who
use
services,
the
public
and
the
staff.
K
It
combines
the
staff
and
the
public
and
service
users,
but-
and
I
mean
we
can
see
in
the
report
we've
got
later
on
on
the
agenda-
that
there's
been
a
lot
of
work,
gathering
feedback
from
staff
about
their
involvement
and
so
on,
and
a
lot
of
emphasis
on
that.
I
I
remain
really
quite
on
I
lack
of
this
green.
I
I
lack
confidence
in
this
green.
I
I
I
just
think
we
are.
K
This
is
this:
this
is
a
potential
recipe
for
us
being
a
little
bit
complacent
about
this
aspect.
I
don't
think
we
have
properly
focused
our
attention
on
it
yet,
and
I
know
we'll
do
a
paper
in
in
september,
but
but
but
what
I'm
hearing
from
local
health
watch,
which
is
reflected
in
a
different
slide
in
the
pack,
is
that
actually
they
don't
have
trust
and
confidence
in
the
public.
Engagement.
K
That's
going
on
around
the
cqc
inspection
regime,
and
I
think
we
all
know
that
the
tool
that
we've
currently
used
is
the
tool
that
was
inherited
from
the
past
of
the
kind
of
the
public
meeting,
but
probably
not
the
best
and
right
way
to
go
about
getting
the
public
as
opposed
to
a
set
of
people
with
a
particular
set
of
issues
that
they
want
to
raise
with
us,
which
is
still
important
to
hear,
but
but
not
about
that
that
kind
of
quality
of
public
engagement.
So
I
just
that
green.
K
K
So,
if
my
understanding,
if
I've
understood
this
correctly,
the
primary
source
of
underspend
is
a
staff
cost,
it
would
be
normal
that,
if
you
underspend
in
a
quarter
on
staff
course
that
actually
that
represents
a
real
reduction
in
expenditure
because
recruits
you,
don't
you
don't,
then
spend
another
quarters
worth
on
on
those
staff.
You
just
you,
have
three
quarters
worth
of
their
staff.
K
If
you
manage
to
recruit
more
so
so,
if,
if
the
primary
reason
is
a
shortfall
in
staff
cost,
it
seems
to
me
the
reforecast
actually
should
reflect
that.
We
won't
have
those
expenditures
unless
it
is
the
case
that
you
anticipate
new
and
unforeseen
expenditure
to
remedy
the
fact
that
we
didn't
recruit
the
staff
in
the
first
quarter.
So
I
just
want
to
test
that
proposition.
A
K
So
so
can
I
can.
I
just
ask
a
related
question
then,
because
by
the
time
we
see
that
again
at
the
end
of
the
six
month
period,
I
my
understanding
is
that
there
will
also
be
a
departmental
six-month,
a
department
of
health,
six-month
review
of
arm's
length,
body
expenditure
and
and
there's
some.
There
will
be
some
pressure
at
the
six-month
point
to
be
not
only
very
clear
about
the
forecast
position,
but
but
also
potentially
to
recoup
to
the
centre
some
of
the
underspend.
K
A
M
I
think
you're
right
absolutely
right
anna
to
to
raise
the
the
issue
of
what
this
presents.
I
think
there
are
two
things:
the
the
media
review
of
the
department
of
health,
the
discussions
to
build
to
that
are
happening
already
in
terms
of
what
position
will
we
show
at
month
six?
What
will
the
out
term
be
at
the
end
of
the
year
and
then,
crucially,
what
will
the
activity
and
the
resource
required
in
1516
to
deliver
to
the
plan
that
we
were
talking
about
earlier?
M
What
we
will
find
as
we
move
into
quarters
three
and
quarters
four,
is
that
a
new
people
will
come
on
board,
so
the
the
pace
of
recruitment
will
pick
up,
so
we
will
see
some
of
those
costs
coming
in,
so
the
the
actual
profile
of
the
cost
changes
month
by
month.
You'll
understand
that,
and
the
other
thing
to
note
is
that,
because,
as
andrea
rightly
noted,
there
are
more
inspection
days
happening
than
there
were
last
year.
M
What
we're
actually
doing
is
deploying
bank
staff
and,
to
some
extent,
also
paying
overtime
so
we'll
see
that
coming
into
some
of
our
figures
also.
So
what
we're
going
to
see
is
that
the
run
rate
of
expenditure
is
going
to
increase,
we'll
be
forecasting
that
carefully,
but
absolutely
critically.
The
discussions
with
the
department
of
health
are
framed
in
terms
of
the
activity
that
we
have
committed
to
and
the
resources
that
we're
require
to
deliver
it
and
the
plans
that
we're
putting
in
place
to
to
realize
those
resources.
M
The
reforecasting
is
happening
during
august
david,
so
I
mean
the
the
most
sensible
time
to
do
to
actually
bring
something
forward
is
the
beginning
of
september,
once
the
reforecasting
and
the
analysis
have
been
done,
it's
not
a
trivial
undertaking
to
go
back
through
the
directorates
to
look
at
what
the
course
profiles
are
and
then
to
be
able
to
reforecast.
So.
A
B
B
N
Say
I'm
still
here,
the
I
think
anna's
point
is
absolutely
vital
on
the
patient
survey,
part
of
it
all
the
public
survey,
part
of
it.
I
I
don't
think
the
num
number
97
people
use
the
services
were
involved
in
the
inspection,
is
a
valid
number
for
primary
care.
To
be
absolutely
blunt,
if
you
ask
a
provider
whether
people
use
the
services,
we're
involved,
they're
going
to
say
yes,
that
might
be
n
equals
one
or
two.
N
What
we're
finding
when
we
go
round
the
practices
is
an
improvement
on
what
we
thought
about
the
number
of
patients
involved
in
patient
participation
groups
and
things
like
that.
But
in
reality,
if
you're,
looking
after
a
population
in
a
geographical
area,
I
don't
think
we're
sampling
well
to
start
with
as
cqc,
and
I
don't
think
the
practices
are
actively
engaging
in
all
of
the
patients
that
they
serve,
particularly
the
vulnerable
groups,
people
with
mental
health
issues
etc.
N
N
A
H
On
the
part,
it's
it
becomes
sort
of
an
acceptance
that
you
know.
This
has
happened
and
nothing
rock
terrible
has
happened
so
far,
and
actually
what
you're
looking
at
is
a
period
of
risk
to
which
people
are
being
exposed,
because
nothing
is
being
done
about
these
matters
by
the
registered
organization.
C
And
and,
and
that's
the
kind
of
conversation
that
we're
having
with
inspectors
in
particular
about
those
areas
where
the
nom,
as
as
paul
quite
rightly
described
earlier,
the
compliance
is
by
location
and
not
by
specifics,
so
it
could
be
just
moving
from
one
to
the
other
and
and
coming
back
to
what
lewis
said
earlier,
which
is
continued
non-compliance.
It
doesn't
matter
whether
it's
kind
of
one
regulation
or
another.
C
I
think
that
we
have
been
hampered
to
some
extent
by
the
compliance
non-compliance
judgment
that
we've
been
making
against
the
regulations
up
till
now.
What
will
significantly
help
us
is
the
focus
on
how
well-led
the
service
is,
because
I
think
that's
how
we
get
the
we
looked
at
it
afresh,
which
I
think
kind
of
helps
us
in
terms
of
saying
we're
not
just
going
to
accept
what
we've
had
before,
but
it
also
gives
us
the
the
assessment
that
says.
G
I'd
just
like
to
go
back
to
the
slide
16,
which
is
actually
about
you,
know
our
inspections
genuinely
informed
by
people
who
use
services
and
I
think,
there's
a
lot
happening
and
more
planned,
and
I
actually
think
that
we
should
look
at
maybe
changing
the
measures
for
this
the
performance
measures,
because
what
we
really
need
to
be
asking.
We
need
to
be
asking
patients
themselves.
G
Experts
by
experience,
local
health
watch,
whether
they
feel
that
our
inspections
were
genuinely
informed
by
people's
views
and
experiences,
whereas
here
we've
got
providers
which
I
think
that
you
know
steve
has
explained
the
limitations
with
that,
and
then
we've
got
a
general
one
about
inspection
teams,
but
that
could
just
be
a
few
inspectors.
I
don't
know
so
you
know
so
I
mean
generally.
I
think
this
performance
report
is
actually
very
good.
G
A
E
We
we
still
do
do
it
and
we
need
to
kind
of
work
out.
That's
just
a
legacy
issue,
but
the
fact
that
we
use
experts
by
experience
the
fact
that
we
look
at
the
computer
complaints
and
concerns
data.
The
fact
that
we
have
all
the
survey
results
and
that
we
do
talk
to
the
local
health
watch
and
we
need
to
get
better
at
it,
means
that
there's
there's
quite
a
lot
of
things
going
on.
We
need
to
test
and
report
on
is
how
well
each
of
those
things
are
going.
A
F
Yes,
I'm
not
absolutely
sure
whether
rachel
edicock
was
going
to
attend
today.
Can
we
just
I'll
go
mark,
you
shall
I
get
she
should
come
in.
I
don't
know
she
wasn't.
I
just
saw
that
on
the
agenda.
She
was
down
to
I
just
in
case
she
was
there
I
didn't
want
to
so
I
I
mean
the
in
terms
of
the
kieran
walsh
report
board.
F
Members
will
remember
that
we've
actually
discussed
an
interim
report
on
this
before
this
is
the
the
final
report
we
commissioned
kieran
walsh
from
university
of
manchester
and
the
king's
fund
to
look
at
our
new
approach
to
hospital
inspection
right
from
the
outset,
and
really
they
looked
at
wave
one
and
then
parked
it
through
wave.
Two
so,
and
I
think
it's
given
us
some
extremely
valuable
and
independent
insights
into
it.
F
I
don't
think
the
report
has
really
told
us
anything
that
we
weren't
aware
of
anyway,
but
that's
good,
but
I
do
think
it
gives
us.
The
independent
report-
and
I
think
where
particularly
the
independent
report
is
invaluable-
is
actually
also
in
finding
out
what
the
providers
we've
been
inspecting
have
to
think
of
of
the
inspection
report,
because
they
they
might
be
nice
to
us.
F
So
from
about
the
conclusions
and
recommendations
which
start
on
on
page
74
onwards,
and
also
we've
listed
here
in
the
covering
paper
for
the
board,
what
is
happening
in
response?
So
we
we
are
accepting
that
the
recommendations
and
we
are
already
working
on
them
and
in
a
lot
of
cases,
things
have
moved
on
a
long
way
or
already
so.
F
F
Now
we
we
will
always
leave
ourselves
some
leeway
so
that,
if
trusts
emerge
as
concerns,
we
can
go
into
them
sooner,
but
we'll
be
we're
starting
to
plan,
for
which
trust
we
might
go
into
for
this
coming
january
or
almost
now,
and
we've
already
decided,
which
ones
we
will
do
between
october
and
december,
so
that
that
is
already
happening.
That
gives
us
the
ability
to
first
of
all
get
the
the
right
inspection
team
members
much
easier,
particularly
with
clinicians.
F
If
we
want
them
to
come
on
an
inspection,
if
they
know
in
advance,
they
can
let
their
trust
to
know
they.
They
can
then
get
out
of
doing
their
routing
clinical
duties
as
long
as
they've,
given
enough
notice.
So
I
think
that
that
helps
us.
It
also
gives
us
much
more
opportunity
to
get
information
from
the
trust
and
to
prepare
exactly
what
we
need
to
look
at,
so
that
that
is
already
in
hand.
F
What
are
the
the
pre-inspection
questions
that
we
will
ask
the
trust
before
we
go
in
we've
slightly
shifted.
The
inspection
around
the
listening
event
is
on
what
we
call
day
naught,
in
other
words
the
planning
day
in
the
evening.
That
actually
means
that
we
can
use
any
findings
from
a
listening
event
to
inform
the
inspection
itself.
F
It
also
balances
out
the
the
inspections
and
we're
giving
people
the
the
rest
day,
because
we
realize
that
these
inspections
are
very
intensive,
but
we've
got
we've
done
well
in
terms
of
recruiting
deputy
chief
inspectors
and
the
heads
of
inspection.
We've
already
talked
today
about
the
fact
we
need
to
recruit
more
inspectors,
there's
a
training
program
underway
as
we
speak
and
again,
the
training
program
has
been
based
around
the
eight
core
services
and
the
initial
feedback
from
and
inspectors
who
are
going
on.
The
training
program.
F
F
I'm
not
at
all
surprised
by
one
of
the
findings
that
was
in
this
report
about
inspectors
not
being
entirely
clear
which
domain
a
particular
finding
might
relate
to.
We've
worked
a
lot
on
that.
Sometimes
it
is,
to
a
certain
extent
arbitrary.
There
are
one
or
two
things
that
we
could
put
into
safety
or
effectiveness,
but
we
want
consistency.
F
We
are
aware
that
we,
we
really
need
to
focus
quite
a
lot
of
attention
now
on
the
post
inspection
process.
We
put
our
major
emphasis
to
begin
with
on
the
pre-inspection
and
inspection
itself
and
how
we
actually
get.
I
get
as
good
a
report
as
we
can
in
a
reasonable
length
of
time,
and
so
all
of
those
things
are
underway,
which
are
all
things
that
kieran
walsh
had
identified.
J
J
I
also
agree
completely
with
mike
about
the
use
of
subheadings.
I
read
the
tem
tame
side
report
and
it
made
it
so
much
easier
to
read
to
have
consistent
subheadings.
You
know
for
safety
across
the
eight
services
and
all
of
the
domains.
So
I
think
that
this
is
a
huge
this.
This
new
style
of
report
is
a
huge
improvement
and
I
think,
will
make
a
difference
actually
to
to
the
user.
J
J
I
think
the
big
issue,
obviously
I
think
all
of
us
are
conscious
of
in
the
in
the
care
and
what
walsh
report
is.
Will
services
improve
as
a
result
of
our
inspections?
I
mean
that
that
is
the
fundamental
question
here
I
mean,
I
think
it's
what
they
call
the
intellectual
logic
behind
the
inspection
process.
J
I
Thanks,
I
thought
it
was
a
very
good
report
and
I
think
it
shows
the
huge
progress
that
mike
and
his
team
have
made
in
a
short
space
of
time
and
also
that
there's
a
way
to
go
still
to
develop
things.
I
do
think
that
it
would
be
useful
for
this
kind
of
study,
perhaps
not
to
the
same
extent,
but
to
be
repeated
in
a
year's
time
just
to
see
where
we
are
with
progress
and
maybe
mikey
began
to
list
and
some
actions
taken
which
looks
entirely
appropriate.
I
But
again
it
might
be
useful
to
have
a
more
formal
follow-up
on
that
as
well.
In
terms
of
the
overall
messages,
I
just
wanted
to
pick
out
a
few.
The
first
one
is
on
impact,
which
might
mean
mike
michael
mentions
paul
will
say,
but
there
is
an
extensive
plan,
at
least
to
evaluate
the
impact
of
cqc's
work
in
a
number
of
domains,
including
this
one.
I
I
The
costs
of
this
initial
initial
phase
of
inspections
that
we
are
we
have
developed
again.
We
have
to
we'll,
obviously
want
to
revisit
that.
We
may
want
to
scale
back
as
we
get
more
experienced
and
become
more
risk-based,
which
again
relates
to
fees
and
our
discussion
earlier
and
the
other
thing
two
other
things
I
just
wanted
to
say.
I
E
E
There
was
a
paper
a
couple
of
boards
ago
that
that
set
out
sort
of
the
hierarchy
of
impact,
starting
from
the
position
of
people
getting
better
services
and
improvement
and
working
back
to
what
the
connection
would
be
to
our
work
and
what
we
have
is
a
sector
by
sector
evaluation
program
to
try
and
hit
all
of
those
metrics
all
the
way
through
to
our
strategic
measures
in
the
in
the
board
report.
But
I
can
happily
bring
back
a
more
comprehensive
approach.
A
E
L
Thanks,
I
thought
it's
a
really
interesting
report
and
very
valuable
one.
I
think
that
the
fact
that
providers
were
really
engaged
in
this
was
was
and
their
their
positive
approach
that
I
thought
was
really
helpful
and
there's
a
huge
amount
of
learning.
That's
going
on
very
quickly
and
there's
a
pace
and
the
recommendations,
I
think,
are
largely
within
our
gift
to
deliver
on
or
the
providers
to
some
extent
and
they
they
may
be
willing
to
do
so.
L
F
Yes,
I
noticed
that
one
person
had
commented
that
they
did
it
because
they
were
badgered
by
mike
richards,
and
that
was
in
the
report.
I
think
I
can
probably
guess
who
it
was,
but
that
I
think
is
partly
actually
trying
to
get
the
very
very
senior
people
who
will
share
the
inspections
and
in
fact,
we
I
think
the
key
really
is
getting
people
to.
F
F
I
think
we've
had
some
very
helpful
and
very
positive
feedback
from
the
recent
ex-president
of
the
royal
college
of
surgeons,
norman
williams,
who
chaired
one
of
our
inspections
and
then
wrote
in
his
own
college
newsletter
about
the
process
very
positively,
and
so
I
hope
that
will
help
us
to
go
on
recruiting.
I
think
we
will
go
on
using
all
our
channels
to
find
the
right
people
to
come
on
these
inspections,
but
actually
quite
a
number
of
people
have
come
back
sever
several
times
over
and
have
been
extremely
good
and
we're.
F
You
know
we
are
learning
who
we
can
rely
on
to
get
quite
short
notice,
particularly
when
we
need
to
do
urgent
inspections,
which,
where
we
can't
give
them
the
full
six
weeks
notice
and
the
fact
that
people
have
been
prepared
to
do
that,
I
think,
is
encouraging
it.
It
will
always
be
a
concern
is
whether
that's
going
to
fall
off
with
time,
but
I
think
at
the
moment
I'm
not
too
concerned
about
it.
D
D
That
was
the
the
point
that
that
they,
we
would
turn
up
and
I've
done
a
couple
of
inspections
but
they're
under
the
old
system,
where
I
thought
one
of
the
strengths
was
that
the
inspector
just
knocked
on
the
door
and
said
I'm
here
to
inspect,
and
that
seemed
to
me
and
the
staff
took
that
incredibly.
Well,
I
must
say,
and
but
it
was
a
I
thought
that
was
a
strength.
D
And
yet
here
it
sounds
like
there
is
quite
a
a
long
lead-in
time
where
people
provide
us
with
information
going
on
for
several
weeks
and
there's
a
recommendation
where
we
might
make
that
even
longer.
And
but
are
you?
How
long
is
it?
What's
the
average
time
at
the
moment
that
people
have
to
prepare,
and
are
you
confident
that
we
aren't
just
giving
people
just
a
bit
too
much
notice?
D
I
do
remember
the
days
in
the
universities
where
we,
where
inspections
began
in
universities,
where
it
was
partly
my
responsibility
in
my
university
to
prepare
and
and
there
were,
the
people
spent
their
entire
time
preparing,
not
necessarily
the
standard
of
education,
but
the
paperwork
that
would
that
would
be
presented
to
the
inspection
team.
Now,
that's
often
what
preparation
means.
D
It's
preparing
the
paperwork,
and
that
does
worry
me
a
little
bit
and
of
course
I
know
that
if
we
want
clinicians
to
take
part
and
be
interviewed-
and
so
we
have
to
give
them
notice,
so
they
can
cancel
clinics
and
so
on.
I
think
that's
very
important.
I
do
accept
that.
But
there
is
a
risk
in
giving
people
a
lot
of
time,
and
it
is
noticeable
that
very
often
we
are
just
finding
out
areas
for
improvement
that
they
already
knew
about.
D
F
Can
I
come
back
on
those
two
main
points?
Announce
first
is
unlatched:
all
our
inspections
are
both
announced
and
unannounced.
We
are
currently
doing
the
announce
first,
because
that
gives
us
the
preparation
time.
We
go
back,
unannounced
to
specific
parts
of
the
trust
and
they
don't
know
exactly
when
that's
going
to
be
done.
They
can't,
in
my
view,
prepare
for
that
and
it
might
be
at
a
weekend.
It
might
not
be
it
might
be
in
the
daytime,
it
might
be
overnight.
F
So
there's
always
an
unannounced
component.
The
other
thing,
I
would
say,
is
look
at
our
reports.
Are
we
saying
that
everything
is
good
or
outstanding?
In
other
words,
even
if
they
have
prepared,
we
are
finding
really
quite
a
considerable
number
of
things
that
that
could
be
improved
or
indeed
in
some
cases
are
inadequate.
F
I'm
not
saying
that
doesn't
happen
in
one
or
two
cases
that
they
attempt
to
do
that,
but
where
that
happens,
our
experience
is
that
people
start
coming
up
to
us
on
the
inspection
whistleblowing
and
we
take
that
very
seriously,
and
there
are
a
couple
of
inspections
that
I've
been
part
of
where
that
has
happened,
and
that
always
raises
alarms
is
the
trust
trying
to
control
this
in
inspection.
Have
they
been
talking
to
their
staff?
Have
they
been
saying
to
stuff?
F
Please
don't
talk,
so
you
can
see
that
is
very
rare,
but
there
are
one
or
two
instances
I
can
think
of
and
where
we
have
then
commented
on
that
to
the
trust
and
actually
that
influences
our
view
on
whether
the
trust
is
well
led,
so
that
that
that's
the
un
alliance
versus
unlatched,
the
the
other
point
you
raised
about
consistency
in
ratings
is
absolutely
right.
When
we've
said
it
here
before,
we
say
it
again,
it's
going
to
be
the
most
difficult
part
to
ensure
consistency.
F
I
think
we
are
learning
as
as
we
go
about
that.
Remember
that
an
individual
trust,
probably
on
average,
gets
about
65
to
70
ratings,
because
most
trusts
are
not
just
one
site
are
two
sites,
and
so
we're
doing
an
awful
lot
of
ratings
on
an
individual
trust.
Just
looked
at
11
trusts
and
between
them
they
have
720
ratings
and
and
so
getting
consistency
across
each
and
every
one
of
those
ratings
is
not
going
to
be
easy.
F
I
can
then
re-rate
and
see
how
that
is,
and
I
think
that's
something
that
we
we
need
to
learn
from,
because
I
think
that
will
highlight
to
us
where
the
difficulties
are
and
remember
that
behind
each
one
of
those
ratings
for
each
trust,
there
may
be
10
15,
20
different
components
that
go
into
a
single
rating.
A
e
and
safety
is
one
cell
on
our
grids,
but
within
that
there
will
be
the
equipment.
K
K
Their
kind
of
ongoing
engagement
and
one
of
the
reasons
why
I
think
that
will
be
hugely
important
is
because
even
these
stakeholders
who
are
in
hospitals
said
at
the
bottom
of
that
bullet
that
there
were
some
underlying
concerns
about
the
costs
of
the
process
and
in
the
next
bullet.
The
report
talks
about
the
sustainability
or
perhaps
lack
of
sustainability,
of
the
very
large
inspection
team
model,
and,
and
there
are,
as
we
know,
very
big
cost
implications
there.
K
So
so
I
think
this
report
raises
some
important
questions
about
if
you
like
value
value
for
money
and
stakeholders.
This
limited
set
are
also
raising
those
questions
and
I
think
that's
important,
because
actually,
when
I've
talked
to
some
wider
stakeholders,
not
least
local
health
watch,
but
not
only
local
health
watch
about
this,
I
think
there
is
this
absolute
sense
in
people
amongst
people
that
what
what
the
cqc
is
now
doing
is
significantly
better
than
what
what
was
there
before.
K
So
you
know
I
hear
people
say
to
me:
did
you
know
they
had
80
people
go
in
and
we
we
know
where
that
was,
but
so
so
there's
there's
a
there's,
a
there's,
a
sort
of
popular
storytelling
going
on
about
the
cost
of
cqc
inspections
and
the
scale
of
them
at
the
moment,
and
at
a
time
when
there,
as
we
know,
will
be
increasing
pressure
downward
pressure
on
costs,
there's
a
little
bit
of
incredulity
about
that
at
a
local
level.
So
there's
a
case
to
be
made
and
that's
again
why?
K
I
think
these
local
stakeholders
are
really
important.
We
need
to
kind
of
understand
them,
but
we
also
need
to
have
a
really
good
story
to
tell
about
in
the
loose
sense
at
this
stage,
because
we
don't
have
the
hard
wired
value
for
money,
but
the
kind
of
the
the
reasons
why
we're
doing
it?
The
reasons
why
we're
doing
it
this
way
and
the
downward
pressure
that
we
will
apply
on
on
on
the
costs
over
over
time.
K
As
I
believe
we
should-
and
I
think
if
we
don't
start
communicating
those
kinds
of
messages,
then
the
the
sort
of
popular
stories
will
will
take
over
certainly
true
for
local
health
watch.
Who
who
who
who
need
to
be
persuaded
that
this
is,
I
mean
they
think
it's
a
better
way,
but
is
it
yet
the
right
way
and
is
it?
Is
it
a
an
unnecessary
or
an
appropriate
set
of
expenditures
or
the
scale
of
the
expenditure?
H
Seems
to
me
firstly,
obviously
it
is
a
very
good
report
and
there's
a
huge
amount
in
it.
That's
very
encouraging
in
particular
that
this
new
method
of
inspection
is
so
much
better
and
we
confirmed
to
be
so
much
better
than
what
preceded
it.
But
the
underlying
concern
here
is
clearly
about
sustainability,
and
what
worries
me-
and
I
think
we
just
need
to
address-
is
not
actually
to
change
what
we
were
doing
before
we
worked
out
what
bits
of
it
work.
H
And
when
I
looked
at
the
idea
of
peer
review
and
this
and
other
contexts,
it
did
seem
to
me
that
there
is
considerable
scope
for
the
use
of
this
sort
of
activity
as
part
of
professional
development
as
part
of
overall
training
and
so
on,
and
to
come
out
of
that
sort
of
budget.
And
I
can't
be
more
precise
than
that,
because
I'm
not
not
in
in
the
field.
F
Yes,
thank
you.
I
completely
agree
with
you
anna
that
stakeholders
need
to
be
set
broadly
in
terms
of
who
were
asking
about
our
our
inspections,
but
both
anna
and
robert
have
raised
the
the
sustainability
issue.
I
think
it
is
worth
remembering
that
the
total
cost
to
the
nhs
of
the
sector
that
I
inspect
is
67
billion
pounds.
F
I
think,
if
we
look
back
at
the
report
earlier,
that
we
looked
at
what
was
there
for
hospitals.
I
know
I
also
have
strong
support
from
strategy
and
intelligence,
but
is
26
million,
so
26
million
versus
67
billion.
We
know
we're
not
spending
a
huge
amount
on
on
this
ex
endeavor
in
comparison
with
the
size
of
the
sector
that
we
are
inspecting.
F
F
I
think
we
can
keep
that
to
a
reasonable
level
and
I
think
it
may
easily
be
that
when
we
do
re-inspections
we
can
also
have
smaller
teams
when
we
know
what
we're
expecting
and
we
know
where
we
need
to
go.
And-
and
so
I
think
we
will
look
at
that-
and
you
said
the
final
point
about
value
for
money
is,
I
think,
until
we
know
what
the
impact
is.
We
can't
really
look
at
value
for
money.
E
Let
me
actually
there's
there's
a
link
point
in
the.
I
think
the
best
communication
we
can
have
locally
as
well
as
nationally,
is
by
demonstrating
the
improvement
to
services.
There's
a
strong
link
back
to
the
evaluation
point
and
that's
why
we'll
bring
that
back
to
the
board.
But
the
other
point
is
when
we're
challenged
on
the
30
or
so
inspectors
or
people
that
come
on
site
for
three
or
four
days.
I
one
things
we
are
doing
is
reminding
people
that
a
hospital
isn't
isn't
a
more
force
entity.
E
It
is
eight
we
look
at
eight
core
services.
Of
course
there
are
multiple
other
services.
It
really
does
break
down
to
having
teams
of
about
three
or
most
four
people
looking
at
the
entirety
of
a
pediatric
service
or
the
entirety
of
the
medical
pathway
or
the
entirety
of
outpatients,
and
I
think
it's
that
comparison,
that
we
can
also
draw
out
more
clearly,
so
maybe
a
lot
of
bodies
in
aggregate,
but
these
are
also
enormous,
enormous
up
to
billion
pound
organizations
in
their
own
right.
A
M
M
If
we
look
at
the
pipeline
of
people
who
are
volunteering
to
take
part
in
inspections
in
mike's
area,
it's
very
encouraging-
and
I
think
recognition
is
that
actually
being
involved
with
the
work
of
cqc,
as
we
talked
about
earlier,
does
bring
a
benefit
back
into
those
trusts.
So
by
and
large,
I
think
we
should
applaud
the
support
that
trusts
are
giving
in
terms
of
the
release
that
they
are
making
of
people
who
are
vital
to
us.
A
Good
well
mike,
I
think,
would
you
convey
back
to
kieran
welch
that
we
thought
was
an
excellent
report
very
helpful,
and
I
think
your
response
and
all
your
response
to
it
has
been
you
know,
just
got
the
most
out
of
it.
So
thank
you
for
that.
The
rest
of
the
agenda
are
really
for
noting,
I
think,
but
did
anyone
who's
tabled.
One
of
the
papers,
paul,
paul
or
anna-
want
to
add
anything.
Or
can
we
just
assume
they've
been
read
and
noted
good,
any
any
other
business
from
the
board.
L
From
the
point
of
view,
robert
was
raising
about
privacy,
so
I
would
rather
hope
that
that
dicta
audio
only
could
also
be
remembered
in
any
future
sort
of
things
about
cameras.
I,
as
you
perhaps
know,
are
very
much
in
favor
of
overt
cameras
because
they
are
preventative
because
they
record
good
care
as
well
as
bad,
but
they
are
extremely
expensive
and
I
think
there
is
a
link
that
one
of
the
ways
to
get
over
cameras
in
place
is
covered
cameras
beforehand,
and
this
is
what
has
really
happened
with
hc1.
L
They
wouldn't
really
be
thinking
about
having
over
cameras.
Now,
if
they
hadn't
been
open,
house
hadn't
been
picked
up
on
panorama,
so
I'm
very
much
in
favor
of
what
lewis
was
saying
about
helping
the
cqc
helping
people,
because,
frankly,
it's
quite
difficult
and
expensive
and
so
on
to
put
in
an
overt
camera.
I
know
that
myself
and
I
also
would
like
to
sort
of
help
in
this
myself,
and
I
would
want
to.
L
If
the
there
was
something
was
said
about
that,
perhaps
on
your
website
or
in
your
newsletters,
I'm
going
to
do
this
anyway,
but
I
hope
I
can
do
it
alongside
you.
The
other
thing
is,
I
went
to
a
care
home
recently
and
a
very
new
one,
and
I
was
delighted
to
find
that
they
already
had
overt
surveillance
in
their
communal
areas,
but
they
said
that
they've
been
told
by
the
cqc
at
when
they
were
being
registered.
A
C
I'll
just
say
I
mean
I
don't
know
the
specific
example
and-
and
maybe
we
we
could
share
that,
because
I've
certainly
had
experience
recently
of
a
provider
raising
a
concern
with
me
that
they'd
been
they
had
interpreted.
What
they'd
been
told
as
us
saying,
you've
got
to
take
the
cameras
down
and
actually
what
had
been
said
was
you
haven't
actually
taken
a
due
consideration
of
the
interests
of
the
of
the
residents
and
haven't
consulted
properly,
and
we
would
expect
you
to
do
that
and
be
before
you
use
them.
C
I'd
certainly
be
thinking
about
the
broader,
because
there
are
a
variety
of
technologies
that
can
assist,
not
just
cameras,
so
I
think
you're
right
to
raise
the
audio.
But
there
are,
there
are
some
other
there's
there's
one
with
sensors
and
all
sorts
of
things
so
and
there's
there's
other
things
that
we
can
look
at
too.
O
O
My
mother-in-law,
who's
got
dementia
and
two
other
members
of
the
family
with
have
had
difficulties
so
to
some
extent
my
experience
is
through
some
expertise
through
experience.
If
you
like
my
background
prior
to
retirement,
was
that
I
was
a
business
consultant
with
my
own
business
in
helping
public
and
private
sector
organizations
to
implement
what
I
consider
to
be
world-class
management
methodologies
and
over
the
past
five
years
I've
been
observing
and
researching
the
nhs.
O
O
I
think,
what's
happening
to
the
nhs
is
what
happened
with
the
car
industry
in
the
1960s
to
90s,
where
the
the
the
management
regime
was
dominantly
command
and
control
highly
directive,
and
many
of
those
managers
had
very
little
knowledge
of
world-class
quality
management
methodologies
and
we
effectively
lost
a
lot
of
british
manufacturing
and
our
own
car
industry.
As
a
result
of
that,
and
that's
a
big
concern-
I
have
that
we
are
the
nhs
is
in
a
similar
state.
O
The
fact
is,
the
nhs
is
being
compared
not
with
trust
by
trust
hospital
by
hospital,
it's
being
compared
with
all
other
industries.
I
wouldn't
get
on
an
airplane
to
go
on
holiday.
Unless
there
was
99.9
certainty,
I
wouldn't
die
getting
there
and
that's
what
I
expect
to
see
in
in
in
the
health
industry.
O
What
worries
me
is
that
I've
talked
with.
Is
it
on
yeah?
I've
talked
with
lots
of
managers,
staff
people
in
the
in
the
health
industry
and
and
come
to
certain
conclusions.
What
worries
me
is
that
when
I
go
into
organizations
I
see
no
evidence
of
teams
of
people
on
the
front
line
trained
in
quality
management
tools
and
methodologies.
O
O
It's
a
huge
body
which
is
bearing
down
on
everybody
and
and
to
me
it
seems
to
create
more
fear
than
it
does
anything
else
and
fear
doesn't
result
in
creative
thinking,
people
pulling
together.
It
results
in
people
holding
information,
avoiding
responsibility
and
whatever
and
that's
the
kind
of
culture
that
I
that
I
see.
O
O
Managers
facilitating
the
process
of
change
rather
than
directing
people,
and
I
feel
that
the
whole
regime
at
the
moment
sitting
above
these
front
line
teams
and
they're
the
only
people
that
provide
services-
everybody
else
does
not
provide
me
with
those
services.
It's
only
the
front
line
team,
and
so
I
look
up
and
think.
To
what
extent
are
these
other
organizations
adding
value
to
these
teams?
A
Can
I
interrupt
that,
I
think
you've
done
you've,
given
an
extremely
perceptive
diagnosis
of
the
the
fundamental
issue
facing
the
national
health
services?
How
do
we
get
continuous
improvement,
and
I
mean
we're
absolutely
clear
that
inspection
is
only
a
part
of
that
process
and
the
the
primary
responsibility
has
to
be
at
hospital
levels
and
with
clinicians?
A
O
O
N
Thank
you.
I
think
your
observations
are
valid
on
our
new
model
of
inspection,
we're
specifically
looking
under
safety
at
how
a
practice
takes
significant
events
and
learns
from
those
so
there's
in
all
of
the
inspections
we're
asking
for
those
and
as
part
of
the
first
pilot,
in
fact,
we're
going
to
ask
for
evidence
before
we
go
in
continually
the
reporting
of
serious
incidents
from
primary
care.