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From YouTube: CQC Strategy 2021: Smarter regulation for a safer future – Driving and supporting improvement
Description
Hear from Kate Terroni our Chief Inspector of Adult Social Care, as she introduces you to one of our emerging strategy themes ‘Driving and supporting improvement’.
Webinar 13 July 2020
A
Hi
I'm
good
afternoon,
everyone
I
am
Katie
Roney,
I'm,
chief
inspector
of
adult
social
care
at
the
Care,
Quality,
Commission
and
I'm
delighted
to
have
you
join
us
today.
So
if
you've
done
team
events
live
team
events
in
your
organisation's
you'll
know
that
they're
quite
a
different
experience.
So,
whereas,
when
you
usually
do
a
team's
call
or
a
zoom
call,
you
have
the
benefit
of
seeing
people's
faces
and
interacting
and
people
are
chipping
in
and
commenting
and
like
with
the
team's
live
core,
where
it's
very
much
a
broadcast
function.
A
So
I'm
going
to
be
talking
to
you,
but
I
would
really
value.
I've
got
my
chatbox
open
on
the
side
of
my
screen.
I
would
really
value
you
to
be
checking
back
reacting
to
me
in
that
column,
so
that
I
know
that
I'm
not
talking
to
into
an
abyss,
but
that
I'm
talking
in
it's
making
sense
or
you're
you're,
responding
to
what
I'm
saying
so,
please
say:
hi.
Let
us
know
you're
here
and
and
react
along
as
you
go
as
well
as
posing
any
questions.
A
So
I
made
the
mistake
of
asking
my
colleagues
who
are
on
the
call
with
me
and
as
to
who's
signed
up
to
join
us
today
and
I
was
delighted
/
a
little
intimidated
by
the
fact
that
there
should
be
a
thousand
of
you
on
the
call,
so
very
warm
welcome
to
all
of
you
out
there.
So
the
plan
for
today
we've
got
an
hour.
We
are
going
to
be
talking
to
you.
I
am
going
to
be
talking
to
you
about
what
our
potential
Care
Quality
Commission
strategy
should
look
like
from
2021
onwards.
A
We
think
our
new
strategy
is
going
to
be
called
smarter
regulation
for
a
safer
future
and
I'm
going
to
be
focusing
in
on
what
we
think
is
going
to
be
one
of
our
four
main
kind
of
strands
which
is
around
driving
and
supporting
improvement.
So
that's
what
we
are
talking
about
today
and
my
colleagues
are
going
to
click
on
to
the
next
slide.
A
So
I
can
just
give
you
an
overview
of
what
we're
what
we're
going
to
cover
so
I'm
Kate
I'm,
joined
by
Gillian
and
tanzy,
who
are
from
the
team
that
are
going
to
be
doing
some
of
the
writing
on
this
strategy
and
then
Jen,
Steph
and
Abigail,
who
will
be
there?
Are
my
engagement,
colleagues
and
they'll
be
moderating
what
you
say
in
the
column
so
that
they
can
share
with
me
the
feedback
that
you
gave
us
we
go
through.
So
that's
how
you've
got
on
on
the
call
from
CPC
side
of
things.
A
So
if
we
can
move
on
fleece,
so
the
plan
for
today
is
we're
going
to
talk
about
our
purpose
and
vision
going
to
share
with
you
a
bit
about
some
of
our
learning
and
from
covert
19.
You
know
talk
to
you
about
how
we
think
we
need
to
change.
Give
you
a
bit
of
a
timeline
and
then
we're
going
to
major
in
on
this
topic
around.
What
should
the
regulators
will
be
around
driving
and
supporting
improvement?
And
it's
really
important
to
say
that
this
is
absolutely
not
nailed
down
yet.
A
So
this
is
an
active
conversation
we're
having
within
the
organization
with
my
inspectors,
with
a
few
guys
out
there
who
were
busily
delivering
services.
So
you
have
a
serious
opportunity
today
to
influence
the
way
you
think
they
should
work
in
this
space.
So
please,
as
we
go
through
the
CD
information,
a
form
of
you
and
then
contribute
as
we
go
about
what
you
think
we
should
be
doing
in
this
space.
So
that's
what
we're
going
to
cover
if
you
want
to
move
a
son
steps?
A
Okay,
so
if
you're
on
this
call,
it's
probably
because
you're
a
provider
in
health,
primary
medical
services
or
adult
social
care.
So
no
doubt
you
will
be
very
familiar
with
this,
but
just
to
recap
in
case
you're,
not
the
purpose
of
the
Care
Quality
Commission
is.
We
are
the
independent
regulator
of
Health
and
Social
Care
in
England
and
we
regulate
30,000
ish
providers.
A
We
ensure
that
people
get
safe
health
and
social
care,
and
that
is
effective
and
compassionate.
We
have
an
ambition
going
forward
to
be
a
world-class
regulator,
so
we
want
to
be
the
best
regulator
we
can
possibly
be,
and
the
reason
why
we
want
to
do
that
is.
We
think
we
have
a
really
important
role,
working
in
partnership
with
you
to
ensure
that
people
get
the
best
quality
care
that
they
can.
A
So
we
have
ambitions
for
ourselves
to
be
the
best
type
of
regulator
we
can
be
so
that
we
are
together
all
ensuring
that
people
are
getting
their
the
most
high
high
quality
care.
So
that's
what
we
do
and
what
we,
what
we
want
to
strive
to
be
fabulous
and
you're
starting
to
comment
as
well,
which
is
lovely
great,
okay,
that's
good!
So
so
why
do
we
need
to
change
so
so
much
of
this
is
pretty
obvious,
but
in
order
for
us
to
deliver
our
purpose
we
need
to
be.
We
need
to
be
responsive
and
agile.
A
So,
as
a
regulator,
we
hold
ourselves
by
the
same
standards.
We
hold
providers
too.
So
we
know
that
good
and
outstanding
providers
are
those
who
actively
seek
feedback
who
are
always
looking
outside
of
their
own
service
or
best
practice.
Who
were
quick
to
say,
we
didn't
get
that
right.
We
need
to
learn
from
it
and
do
better.
So
we
we
are
saying
we
don't
always
get
it
right
in
CQC
and
we
need
to
ensure
that
we
constantly
strive
to
do
better.
So
we
can
be
the
best
possible
regulator.
A
Health
and
social
care
is
changing,
it
was
changing
a
pretty
phenomenal
rate
and
then
Kovac
happened
and
anyone
who
runs
a
business
anywhere
has
had
to
significantly
transform
and
that's
been
particularly
evident
in
health
and
social
care.
So
we've
seen
you
know
the
vast
amount
of
GP
practices
transferring
their
business
on
to
online
online
consultations.
We've
seen
huge
amounts
of
innovation
happening
across
all
the
sectors
about
supporting
people
to
maintain
relationships
with
people
when
they're
not
able
to
meet
in
person,
so
the
health
and
care
landscape.
A
The
way
care
is
delivered
and
is
changing
rapidly,
and
we
need
to
make
sure
that
we
are
able
to
respond
and
not
block
and
support
that
innovation
and
that
kind
of
dynamic
way
of
delivering
things,
but
also,
we
know
that
the
way
we
regulate
currently
means
that
we
don't
always
have
a
full
picture
of
care,
so
we
regulate
individual
providers,
so
we
hold
you
to
account
as
a
homecare
agency
or
as
an
acute
hospital
about
the
quality
of
care,
you're,
delivering
and
I
anticipate.
That
will
always
be
the
case.
A
We
will
always
want
to
ensure
that
the
care
your
delivery
is
of
high
standard,
but
actually
we
are
really
interested
in
how
providers
work
together.
So
we
know
that
people's
experience
of
the
quality
of
their
care
is
influenced
quite
majorly
by
two
things:
one:
the
ability
to
access
it
in
a
timely
way
and
two
how
joined
up
at
that
care
is
so
particularly
for
people
with
multiple
needs,
how
their
health
or
social
care
professionals
work
together.
Share,
information
and
support
them
is
absolutely
critical.
A
So
we're
really
keen
again
when
we
think
about
how
we
want
to
regular
in
the
future.
How
we
can
move
to
regulating
providers
in
a
way
that
says
as
well
as
running
your
bit,
if
the
business
really
well
as
well
as
running
your
nursing
home,
really?
Well,
your
GP
practice
really
well.
How
are
you
working
with
the
local
dentists
practice?
A
How
are
you
working
with
your
local
hospital
to
ensure
that,
when
people
move
between
those
different
services
there
as
joined
up
as
they,
they
need
to
be,
and
finally,
and
all
of
us
to
do
that,
we
need
to
make
sure
we've
got
the
right
tools
and
capabilities
as
an
organization
as
well.
So
if
you
want
to
move
us
on
assess.
A
Okay,
lots
of
lovely
hello
comments,
I'm
feeling
feeling
like
I'm
in
friendly
company.
That's
great
really
good
to
have
you
here
and
okay.
So
let's
talk
a
bit
about
Covey's
and
what
has
been
the
most
exceptionally
challenging
times
that
probably
any
of
us
have
ever
experienced
in
our
career
and
possibly
personally
as
well,
so
so
CQC
and
Kovich.
So
you'll
know
that
at
the
in
in
March,
I
think
it
was
towards
the
end
of
March.
We
wrote
out
to
all
of
our
providers
and
said
a
few
things
we
said.
A
Our
priority
is
like
yours:
ensuring
that
people
get
safe
care
and
as
a
result
of
that,
we
made
the
decision
to
stop
routine
inspections.
So
weighing
up
the
risk
of
our
inspectors
going
out
and
potentially
bringing
infections
into
services,
we
made
the
decision
that,
where
services
were
not
high
risk,
we
would
not
be
regularly
crossing
the
threshold
during
kovat,
but
we
committed
at
the
beginning
that
as
and
when
the
risks
were
there,
we
would
absolutely
go
out
and
look
at
a
service
and
impersonal
as
and
when
needed,
so
reports,
routine
inspections.
A
And
then
we
basically
started
thinking.
How
do
we
have
the
best
possible
view
of
what
people's
experiences
are
of
care
when
we're
not
out
there
seeing
it
in
person?
So
we
at
peace
developed
something
that
was
called
our
emergency
support
framework,
which
is
a
way
of
having
a
kind
of
structured,
supportive
monitoring
conversation
with
providers
with
quite
a
narrow
focus
about
ensuring
that
those
providers
were
as
ready
as
they
could
be
about
preparing
for
kovaydin
and
surviving
the
the
first
few
months
of
code.
A
But
it
was
also
about
hearing
what
those
challenges
are
for
providers
so
that
we
could
help
address
them.
So
in
adult
social
care,
we
spoke
to
you
over
20,000
of
our
providers.
There
were
major
things
as
I
know.
You
know
in
the
beginning,
around
getting
access
to
PPE
major
issues,
around
testing,
significant
issues
about
the
multiple
bits
of
guidance
that
were
issued
out
and
just
as
someone
who's
trying
to
run
a
very
challenged
service,
only
coping
with
this
influx
of
different
kind
of
changing
changing
guidance.
A
So
the
plan
was
for
our
inspectors
to
be
there
in,
in
maybe
more
of
a
supportive
role
than
we've
ever
been
working
with
people
who
are
running
services
to
say
how
are
you
doing?
What
are
the
issues?
What
can
we
escalate
on
your
behalf,
and
what
can
we?
What
can
we
help
resolve
I?
Think
for
most
providers,
it's
been
a
positive
experience.
A
I
would
be
really
I
mean
it
would
be
not
opportunistic
of
me
to
not
take
this
time
to
say
if
you've
had
the
emergency
support
framework
conversation,
it
went,
live
in
adult
social
care.
First,
then
it
rolled
out
to
primary
medical
services,
and
now
it's
in
parts
of
in
that
parts
of
the
Hospital
landscape.
If
you've
had
an
emergency
support
framework
conversation
with
your
inspector
or
you've
had
regular
contact
for
your
from
your
inspector
during
this
time.
A
Can
you
let
us
know
how
you
found
it
and
you
don't
don't
tell
me
what
I
want
to
hear.
Tell
me
how
your
experience
was.
Did
it
work
for
you?
What
was
your
feedback
on
that?
So
we
learned
a
lot
during
kovat
and
we
are
still
learning
huge
amount
about
how
we
can
be
as
effective
as
possible,
gathering
together
all
the
intelligence
that
sits
out
there.
So
all
the
intelligence
we
have
from
whistleblowers
all
the
intelligence
would
have
some
safeguarding
the
information
that
sits
within
clinical
commissioning
groups
and
local
authorities.
A
So
if
you
want
to
move
us,
if
you
want
to
move
us
on
fleas,
death
and
I'm,
just
gonna
take
a
second
to
have
a
great,
really
good.
Thank
you
for
your
comments
and
I'm
in
the
chatbox,
that's
fab,
and
so
what?
If
we
learned
so
we've
learnt
the
critical
need
to
ensure
that
where
information
is
sat
out
there,
we
effectively
bring
it
all
together
and
have
the
best
possible
view
of
what's
going
on
and
that's
important
for
a
couple
of
reasons.
A
It's
important
because
it
gives
us
the
best
view
of
what's
happening,
but
also
it's
really
important
to
avoid
asking
for
the
same
information
more
than
once
from
providers.
So
again,
if
you're
a
provider
most
of
the
philosophy.
The
last
thing
you
want
is
an
interesting
than
asking
you
for
information.
Is
your
local
authority
contracts
team
asking
you
for
information?
A
It's
a
regulator
asking
you
for
information,
so
it's
really
important
that
we
do
a
better
job
at
taking
that
information
and
squeezing
out
of
it
everything
that
we
possibly
can
that
reduces
wherever
possible
the
multiple
information
with
rush
you
get
as
a
busy
provider
trying
to
focus
on
the
people,
you're
providing
and
support
for.
We
really.
A
We
went
live
last
week
with
a
campaign
called
hashtag
because
for
your
care,
in
partnership
with
HealthWatch
England,
making
a
big
plea
to
people
out
there
receiving
services,
they're
kept
their
loved
ones,
their
families
and
friends,
and
people
who
work
in
health
and
care
to
tell
us
what's
going
on
out
there.
So,
even
if
we
were
doing
our
routine
inspections,
you
will
know
that
routine
inspections
happen
every
so
often
every
six
months,
every
two
years,
depending
on
the
kind
of
quality
and
what's
going
on
on
that
service.
A
But
it's
only
of
a
snapshot
and
actually
what
we
want
to
do
is
we
want
to
get
to
a
place
where
we
have
the
best
view
of
what
it
feels
like.
There's
someone
called
Clinton
Fox
and
who
is
the
chair
of
think
local
at
personal
and
what
Clinton
says
he
says.
How
do
you
know?
People
are
getting
quality
care
at
twelve
o'clock.
A
You
know
on
a
Sunday
evening
when
no
one
else
is
around
apart
from
the
people
receiving
care,
and
we
want
to
get
to
a
point
where
we've
got
the
best
possible
view
of
what's
happening
out
there
and
people
who
use
services
and
and
the
people
who
work
with
it
are
a
great
resource
to
tell
us
what's
happening,
what's
happening
out
there.
The
other
thing
we
learned,
which
wasn't
new
but
it
reinforced
it
for
us,
is
the
importance
of
joint
working.
A
A
And
then
we
started
a
series
of
conversations
a
few
weeks
ago
with
providers.
So
you
may
have
had
some
of
these
to
find
out
what
has
worked
well
in
terms
of
joint
working
and
what
has
fallen
short
and
again.
We
found
very
similar,
very
similar
set
of
ingredients,
and
this
week
we're
going
out
to
11
places
around
the
country
to
undertake
what
we're
calling
calling
provider
collaboration
reviews,
which
is
where
virtually
we
are
going
to
be
speaking
to
the
director
of
social
services.
A
So
the
importance
of
saying
I,
don't
think
anyone
is
sitting
here
today
and
I,
certainly
I'm,
not
thinking
that
everything
we
did.
Every
decision
we
made
was
absolutely
the
right
decision
and
we
all
know
hindsight
is
a
wonderful
thing
and
we've
all
learned
so
much
about
what
this
disease
is
in,
compress
it
to
where
we
were
in
the
beginning,
and
it's
really
important
that
we
in
order
to
properly
learn
from
this,
that
we
all
feel
able
to
say
on
reflection.
A
Maybe
I
would
have
called
that
differently
or
maybe
I
would
have
approached
it
in
a
different
way
or
maybe
I
would
have
shared
that
differently.
So
the
theme
around
transparency
us
being
transparent
as
a
regulator
inviting
you
guys
to
be
as
transparent
as
you
possibly
can
as
well,
so
that
we
can
sit
alongside
each
other
and
try
and
do
some
learning
from
this
together
feels
feels
really
informal.
So
that's
some
of
our
learning
from
the
co-lead.
A
Well,
I'm,
looking
at
lots
of
really
positive
comments
in
the
box,
which
is
wonderful,
just
don't
do
it
again.
You
know
tell
us,
tell
us
what
you
think.
So,
if
we
are
as
equally
receptive
to
something
that
hasn't
worked
very
well
or
maybe
you
had
your
ESF
call
and
it
worked
well,
but
you
think
it
should
be
focused
on
something
different
or
expand
it
out.
A
So
we
are
really
interested
in
thinking
about
how
we,
how
we
regulate,
how
we
encourage
providers
to
deliver
care
in
a
way
that
makes
sense
and
matters
to
people,
and
in
that
we
are
also
thinking
about
not
just
looking
at
people's
experiences
of
care
when
they
come
into
care,
but
actually
that
access
point.
So
we've
talked
before
in
our
annual
report
and
your
state
of
care
report.
A
We've
talked
about
access
issues
and
we've
talked
about
waiting
lists
and
we
last
year
talked
about
ATK's
1.5
million
people
who
weren't
fully
having
their
care
and
support
needs
met.
So
we've
talked
about
access
before
because
we
know
accesses
is
a
key
indicator
for
people's
experiences
and
quality
of
care.
So
so
we're
interested
in
what
role
we
should
have
do
have
around
people's
experience
of
getting
access
to
the
right
information
and
advice.
A
The
right
support
the
right
ability
to
access
services
and
in
that
might
be
play
an
increasing
role
in
asking
people
who
work
in
systems
what
their
understanding
is
of
their
local
population.
What
their
understanding
is
of
inequalities
and
what
they're
doing
collectively
to
address
the
inequalities
issue.
I,
don't
know
what
your
thoughts
are,
but
my
concern
that
the
inequalities
that
existed
prior
to
kovin,
potentially
having
just
grown
during
this
time
and
I,
wonder
whether
we
might,
as
the
regulator
might
have
a
role
in
our
independent
voice
about
talking
about
inequalities
and
what
that
looks
like.
A
A
So
if
you
were
a
good
rated
service
and
we
would
come
back
in
it's
two
and
a
half
years
or
whatever
it
might
be-
and
we
want
to
move
away
from
that
to
having
a
much
more
proportionate
approach
as
to
how
we
as
to
how
we
inspect
but
also
a
wider
range
of
inspection
approaches.
So
we've
got
some
examples
of
this,
so
in
hospitals,
primary
medical
services
and
now
that
social
care,
we
have
an
approach
to
a
much
shorter
type
of
inspection,
so
it
has
different
names.
A
So
in
the
hospitals
and
pms
primary
medical
services,
we
call
the
focused
inspections
in
doubt:
Social
Care.
We
call
them
targeted
or
responsive
inspections,
so
they
a
bit
more
narrow
looking
at
a
couple
of
the
key
lines
of
inquiry.
But
what
we're
interested
about
going
forward
is
actually
how
do
we
have
a
much
way
of
regulating?
A
So
how
do
we
increase
our
monitoring
function
so
that
we're
only
crossing
the
threshold
as
and
when
we
need
to
how
do
I
take
what
we've
learned
about,
how
we
can
regulate
remotely
and
maybe
make
that
part
of
our
core
business.
So
a
conversation
we've
started
in
the
home
care
world
and
it's
very
early
days,
but
actually
we've
post
a
question.
What
is
the
value
add
of
an
inspector
coming
to
our
home
care
agency
and
sitting
in
the
office
where
maybe
there's
two
members
of
staff?
What
would
it
look
like?
A
Instead,
if
the
way
we
regulate
home
care
services
was
we
looked
at
your
policies
and
procedures
remotely?
We
spoke
to
staff
when
they
were
off
sites
and
maybe
encouraging
them
to
speak
even
more
freely
and
what?
If
we
spent
an
increasing
amount
of
time
having
zoom
calls
or
team
calls
with
people
who
receive
personal
care
in
their
own
home,
and
that's
just
a
for
example,
and
it's
by
nowhere
no
way
I
mean
means
resolved.
A
That's
what
we're
doing,
but
we
want
to
challenge
ourselves
to
say:
we
want
to
make
sure
that
when
we
going
into
someone's
home
or
into
the
GP
surgery
or
we're
sitting
in
emergency
department,
that
we
are
doing
the
stuff
that
we
absolutely
couldn't
do
remotely
that
we
are
they're
getting
every
bit
of
value
out
of
being
there
in
person.
That's
a
bit
about
smart
regulation.
The
third
one
is
around
safe
care,
so
safe
care
is
not
new.
We've
been
talking
about
this
for
years,
but
how?
A
How
do
we
move
to
a
place
where
people
are
not
and
intentionally
harmed
as
a
result
of
the
health
and
care
that
they
received
and
the
way
that
I
the
way
this
kind
of
sticks
in,
in
my
mind,
is
in
Health
Services?
There's
something
like
please
don't
quote
me,
but
there's
something
like
250
million
medication
errors
reported
a
year
and
in
adult
social
care
we
don't
have
the
same
reporting
mechanism.
A
We
don't
have
the
same
national
way
of
collecting
that
data,
but
one
of
the
ways
we
collect
data
in
adult
social
care
is
through
our
provider.
Information
returns
and
what
I
find
fascinating
is
that
50%
of
our
provider,
information
returns.
Approximately
50%
report
no
medication
errors
over
the
previous
year
and
that
just
kind
of
poses
a
question
for
me.
That
says:
are
we
every
time
something
doesn't
go
quite
the
way
we're
born?
Do
we
have
do
we
recognize
it?
A
Do
we
have
a
way
of
recording
it
and
capturing
it,
and
then
how
do
we
systematically
learn
from
it?
So
that
we
are
all
raising
the
bar
on
our
safety
for
people,
so
that's
a
little
bit
about
safety
and
care
and
then
we're
going
to
move
on
to
driving
and
supporting
improvement.
So
if
we
could
click
on
to
the
next
slide,
when
you're
ready,
please
steps
that
would
be
fat.
A
What
ping
you
an
email
after
so
can
you
just
tell
us
which
service
you're
from
and
then
I
can
just
make
sure
I
I
follow
up
as
well
with
my
team
to
make
sure
that
so,
okay,
so
this
is
where
we
are
in
the
timeline.
So
we
are
currently
in
the
middle.
The
middle
blob,
which
is
we've
done
some
early
thinking
and
we
are
taking
the
kind
of
six-month
period
that
were
in
to
have
these
early
days.
A
Conversations
with
you
to
make
sure
that
the
learning
we
took
from
and
we
continue
to
take
from
Co
vid
is
informing
our
thinking
about
how
we
need
to
regulate
in
the
future.
It
will
lead
to
a
forum
or
consultation
that
will
be
happening
in
winter
and
then
our
new,
a
new
strategy
of
go,
live
in
may
21,
so
so
that
is,
that
is
the
timeframe
that
we
are
working
to.
So
if
you
want
to
move
on.
A
Okay,
all
these
there
are
really
interesting
comments,
so
Laura's
with
the
CCC
consider
introducing
social
isolation
and
lonliness
measures
into
their
inspection
framework.
Oh
that's
a
that's!
A
really
interesting
comment.
Great
yeah
just
tells
you
it
just
tells
you
ideas
as
well,
so
driving
and
supporting
improvements
so
early
day
thinking.
So
some
of
this
is
what
we
do
already.
So
if
we
think
about
the
spectrum
of
where
we
are
and
where
we
might
transform
to
kind
of
nothing's
off
the
table.
A
So
if
you're
sitting
there
with
a
really
radical
idea
about
what
you
think,
your
regulator
should
be
doing
around
improvement,
just
put
it
down,
so
don't
be
limited
by
some
of
the
things
I'm
going
to
run
through
now,
because
this
is
just
our
thinking-
and
you
know
why
would
you
just
take
our
brains
when
we've
got
a
thousand
extra
brains
on
this
call
so
and
so
I
think
what
we
do
around
improvement
at
the
moment
is
I.
Think
often
there's
that
relationship
between
the
inspector
and
provider,
where
there
is
that
improvement
component
to
it.
A
So
you
know
some
providers
talk
to
me
about
thinking
that
the
phone
to
inspector
kicking
ideas
around
if
you've
got
a
relationship
manager,
maybe
talking
having
some
early
conversations
with
them
about
the
way
you
deliver
care
and
thought
so
there's
some
times
that
improvement
relationship
in
that
kind
of
one-to-one
dynamic.
We
do
a
lot
around
publications,
so
you
might
have
seen
our
driving
improvement
range
where
every
year
or
two
we
do.
A
We
shone
a
spotlight
on
health
and
social
care
providers
where
they've
kind
of
gone
up
to
racing
wrong
so
from
an
adequate
to
good
or
from
requires
improvement
to
outstanding
to
find
out
how
they've
achieved
it.
What
were
the
components
of
it
and-
and
it's
often
it's
often
the
same
things
such
as?
Yes,
a
outward-looking
providers.
You
know
a
constant
focus
of
feedback
in
a
willingness
to
learn,
managers
with
open
door
policies,
etc.
So
we
produce
that
driving
improvement
range
every
so
often
and
then
I
think
the
also
drive
improvement
through
our
our
publication.
A
A
You
know
having
a
care
plan
around
how
to
support
them,
working
their
teeth,
having
access
to
toothbrushes,
toothpaste,
all
the
way
through
to
term
it
is
about
not
being
able
to
physically
access
your
dentist
dentists,
training
needs
around
maybe
going
out
and
providing
or
health
examinations
for
learning
disabilities
or
people
with
dementia,
for
example.
So
we
do
publications
that
we
shine
a
spotlight
or
something
that
we
think
is
an
issue,
and
then
we
weave
that
into
how
we
inspect
so
that
we
can
measure
what
sort
of
impact
that
had.
A
A
We
help
providers
to
have
the
self
by
thinking
about
our
guidance
and
framework
we've
recently
published.
So
innovation
is
a
really
interesting
one
and
I've
been
here
in
CQC
for
a
little
over
a
year,
and
over
the
year,
I
heard
I've
heard
many
many
times
providers
saying
to
me.
Well,
the
regulator
is
the
reason
why
innovation
is
blocked
or
your
inspectors
come
into
services
when
they're
trying
to
do
something
new
and
dynamic
and
are
anxious
or
worried
or
mark
us
down,
or
what
not.
A
So,
we've
been
doing
our
best
to
bust
that
myth
and
say
actually
you
know
provided
that
people
are
getting
saved
care
and
they
want
to
be
involved
with
innovation.
People
who
receive
housing
care
please
get
on,
and
do
it
and
I
think
David
has
been
a
fantastic,
a
fantastic
example
of
what
can
be
achieved
so
about
a
month
ago
we
published
300
examples
of
great
innovation
and
health
and
social.
So
so
that's
something
we've
done
in
that
space.
A
We
champion
improvement
in
areas
that
matter
and
to
the
public
and
we're
thinking
about
our
role
in
research
and
evidence-based
approach
to
regulation.
So
some
of
us
what
we
do
already
that
we
might
want
to
soup
up,
but
this
is
where
I
would
like
your
ideas.
So
if
we
can
scoop
onto
the
next
slide,
please
death.
A
Do
you
think
CQC
would
be
a
good
place
to
offer
you
know?
Do
you
think
we
should
be
doing
more
in
the
improvements,
so
it's
the
regulator,
the
right
organization
to
offer
that
what
would
it
look
like
if
there
was
an
improvement
almonds
to
EQC,
so
so
I
was
just
thinking.
So
tell
me
what
you
think.
So,
if
your,
if
your
health
provider
and
you
go
into
special
measures,
there
is
often
as
swoop.
This
is
my
perception.
A
If
your
health
provider,
this
is
not
the
case,
tell
me,
but
there's
often
a
kind
of
swooping
in
the
support
this
kind
of
support
package
it
smack
around
you
and
I,
wonder
whether
that's
the
same,
if
you're
in
an
if
you're,
in
independent
health
or
or
if
you're
in
adult
social
care
and
I,
don't
think
it
is.
But
what
do
you
think
and
do
you
think
there
should
be?
A
A
What
would
it
look
like
if
an
AMA
CQC
came
in
to
work
alongside
you
to
shadow
your
registered
manager
to
be
with
you
on
staff
development
days
sitting
on
interview
panels
and
what,
if
they
worked
side
by
side
with
you
and
at
the
point
that
you
and
them
thought
that
you'd
got
things
to
where
they
needed
it
to
be?
What
if
that
then
could
trigger
a
new
inspection,
for
example?
So
I
know
providers
talk
about
their
frustrations
when
they've
got
an
inadequate
or
requires
improvement
rating.
Often
providers
are
desperate,
they
come
back
out.
A
Look,
you
know,
we
turned
it
around
or
we've
improved
on
this
come
back
out
and
we
expect,
because
actually,
your
rating
has
a
big
impact
on
how
we've
received
as
an
organization
my
ability
to
recruit,
etc.
So
what
if
there
was
a
relationship
between
a
service
that
needs
to
support
an
improvement
component
with
CQC
coming
out
and
properly
rolling
up
their
sleeves
and
working
alongside
you
and
then
in
collaboration
when
you
thought
you've
got
to
the
right
place,
then
trigger
in
a
real
inspection.
Just
I
haven't
taught
this
through
my
teen.
This
is
just
that.
A
It's
just
something
I've
been
mulling
on
over
the
last
few
days.
What
my
success
will
be
in
terms
of
benchmarking
and
do
you
think
we
should
ever
roll
in
different
parts
of
the
sector?
So
if
you're
sitting
there
with
a
fabulous
improvement,
offer
from
NHS
improvement,
then
maybe
this
is
a
bit
irrelevant
or
you
think
this
isn't
the
regulator's.
Well,
if
you
don't
have
that,
what
do
you
think
so?
I'm
gonna
pause
for
a
minute
and
probably
Jim
having
our
staff
have
been.
A
B
So,
just
to
say
that
we
have
captured
everybody's
comments,
so
there's
a
lot
of
comments
coming
through
on
ecovillage
on
testing
and
PPA,
and
if
you've
left
your
name,
we
do
have
your
email
address,
so
we'll
get
back
to
any
of
those
queries.
There's
some
great
comments
coming
through
about
the
ESF
and
experiences
Kate
with
inspectors
and
finding
those
really
really
positive
and
supporting
and
again,
if
there's
any
queries
around
those,
we
will
follow
them
up
afterwards.
B
B
A
A
What
would
be
the
role
of
you
in
giving
giving
us
feedback
telling
us
how
we're
doing
what
would
be
the
role
for
people
who
access
our
services
and
use
our
and
use
our
information
to
make
informed
decisions
about
where
to
go,
to
receive
care
in
terms
of
telling
us
how
we're
doing
but
I
think
that's
a
that's
a
fabulous
challenge.
I
will
I
will
give
that
some
more
thought
and
see
whether
anyone
else
has
got
any
bright
ideas
and
the
supportive
thing
is
really
interesting.
A
So
reading
some
of
these
comments
and
what
I've
heard
so
far,
my
impression
is
that
most
providers
have
so
this
might
be
a
bit
bold
and
they
might
shoot
me
down
I.
Think
most
providers
talk
about
having
this
supportive
relationship
with
inspectors
that
has
increased
during
Colvard.
So
this
notion
that
we're
all
in
the
most
unprecedented
times-
and
we
need
to
rally
together
to
think
about
how
we
address
some
of
these
massive
challenges
and
you've
been
facing
I-
am
witnessing
over
the
last
year.
A
A
As
being
that,
you
know
that
kind
of
coming
in
saying
you
know
a
sham
than
that
and
and
the
provider
responding
in
that
kind
of
defensive
way.
I
really
want
to
have
an
adult
adult
relationship
and
I
am
really
keen
to
think
more
about
about
how
that
is
what
your
experience
is.
Consistently
commissioning
is
just
it's
so-so,
UK
hates
you
at
the
UK,
Home
Care,
Association
and
Jane
and
Colin
who
run
that
organization.
Whenever
they
meet
with
me.
A
They
say
you
are
judging
us
on
quality,
but
you're,
not
looking
at
commissioning
and
actually
the
way
we
are
commissioned
to
deliver
services,
hugely
impacts
on
our
ability
to
deliver
high-quality
care.
So
that's
that's
what
I
have
heard
and
from
providers
it's
not
in,
we
don't
have
the
legal
powers
to
do
so,
but
I
think
it's
interesting.
A
If
we
think
about
our
strategy,
which
is
about
regulating
from
the
experience
of
the
person
who
receives
care,
I,
wonder
whether
there's
more
we
can
do
in
terms
of
commenting
on
the
impact
commissioning
has
on
how
house
and
care
is
delivered
in
a
place,
noting
that
we
don't
have
the
legal
powers
to
do
that.
But
you
know
there's
there's
a
thousand
of
you
on
this
call.
This
gives
some
really
strong
content
for
when
we
are
having
these
conversations,
which
we
continue
to
have
to
be
able
to
say.
A
This,
isn't
just
us
saying
that
this
plays
a
really
key
role
in
the
quality
and
outcomes
people
experience.
If
we
are
hearing
with
one
loud
voice
from
all
of
our
provider,
you
know
from
all
of
our
providers
that
this
is
something
that
cannot
be
ignored
and
these
are
stronger
focus
and
that
that
really
helps
with
some
of
the
discussions
we're
having
as
well.
A
So
so
I
I
think
we've
got
pretty
strong
foundations
here,
but
I
think
we
can
do
a
whole
lot
more.
So
we
have.
We
have
group
of
people
hold
experts
by
experience.
We
have
a
contract
for
people
who
have
family
who
have
family
carers
of
people
in
receipt
of
care
or
who
received
hair
themselves
and
wherever
possible,
we
have
an
extra
buy
experience,
go
out
with
our
inspectors
to
go
and
see
services
we
want
to
do.
A
We
call
a
closed
culture,
so
a
service
where
maybe
there
isn't
that
much
coming
and
going
of
external
professionals
where
the
people
are
maybe
placed
a
long
way
from
their
family
home.
So
they
don't
have
regular
visits
from
the
family
and
maybe
people
with
additional
communication
needs,
and
so
maybe
they
don't
have
verbal
communication
or
maybe
the
sign
language
or
Makaton
etc.
So,
in
those
circumstances
we
need
to
do
a
whole
lot
more
and
we
need
to
work
with
local
advocacy
organisations.
We
need
to
commit
even
more
to
hearing
from
families.
A
You
know
how
are
we
what
should
be?
What
should
be
my
expectation
of
my
inspectors
in
of
being
able
to
communicate
directly
with
people
with
additional
communication?
These
now
I,
you
know
it
seems
I'm
realistic
to
think
of
all
the
inspectors
and
CQC
being
trained
in
sign
language
and
Makaton
and
etc,
but
actually,
what
more
should
we
be
doing
so
that
there
aren't
those
barriers
there
to
hear
directly
from
people
with
lived
experience?
So
so
we
we've
done
a
piece
of
work,
particularly
around
closed
cultures
and
the
way
we
need
to
regulate
those
services
differently.
B
A
So
so
I
think
I
think
we
definitely
can
in
terms
of
regulated
services,
so
the
move
with
so
we've
been
trying
to
think
more
about
how
we
have
a
better
presence
within
our
place.
So,
whether
and
when
you
know
the
whole,
how
do
you
define
a
geography?
Is
it
the
STP
ICS
latest
health
description
about
how
its
organized
I
often
think
about
its
work,
its?
How
people,
despite
what
their
home
is
so
I
live
in
oxytocin?
A
My
my
place
would
be
oxygen
if
you
live
in,
you
know
the
London
borough
of
or
if
you
live
in
Birmingham,
and
so
so
I'm
really
keen
that
we,
as
the
regulator,
have
a
really
good
understanding
have
locally
based
inspectors.
You
know
the
health
and
care
providers
in
their
patch
who
have
a
pretty
good
view
of
risk
of
what's
going
on
in
in
that
place
and
who
can
work
to
help
connect
providers
up
from
work
with
the
local
commissioners,
etc.
A
I
think
I
think
the
shortcomings
with
that
approach
is
that
so
much
fabulous
activity
sits
out
there
in
the
voluntary
sector
in
the
community
groups
in
the
self-organizing
advocacy
organizations
and
I
just
wouldn't
want
us
to
be
too
narrow
in
that
and
so
I
don't
know
whether
we
would
be
best
placed
I,
don't
know
whether
the
information
we
have
about
regulated
providers
within
a
patch
could
feed
into
more
of
a
local
and
a
local
approach
to
really
know
what
that
offer
is
locally.
But
that
happy
happy
to
have
your
feedback
and
reflections
on
that.
B
A
So
this
is
interesting
and
it's
interesting
in
terms
of
our
role
around
an
improvement
so
role
in
improvement.
Being
a
bit
more
specific,
so
I
know,
providers
often
ask
us
well,
which
you
know:
I've
want
to
move
to
electronic
care
planning
which,
which
one
would
you
recommend
or
I,
want
to
introduce
a
new
way
of
doing
this,
which
one
would
you
recommend
and
we
tend
to
avoid
being
too
specific
because
I
suppose
I
suppose
we
are.
We
are
acutely
aware
of
the
impact
we
have,
as
you
know,
as
the
regulator
and
the
risk
is.
A
If
we
say
it's
that
one,
then
suddenly
everyone
will
think
that's
the
one
they
need
to
use
and
I
get
torn
between
whether
our
role
should
be
more
about
outcomes.
So
no
we're
interested
in
people
receiving
really
great
bespoke
persons
and
eclair
kind
of
how
you
get
there
is,
if
is
up
to
you
but
I,
guess,
if
you're
a
small
provider,
maybe
without
a
massive
result,
you
don't
have
a
massive
head
office.
You
know,
then
maybe
that
would
be
something
that
would
really
add
value
to
you
so
I.
A
You
know
I'm
really
happy
that
we
consider
that
that
request
about
could
we
be
more
specific
or
and
have
a
bank
have
a
suite
of
information
that
says
this
is
this.
Is
this
is
a
good
capacity
assessment?
This
is
a
kind
of
ingredients
of
what
a
good
mental
capacity
assessment
looks
like.
So
let
me
take
that
away
and
have
a
think
about
that.
So.
B
This
one's
more
of
a
thought
cake,
but
it's
a
good
discussion,
I,
think
commissioning
and
partners
in
brackets,
GP
hospital
discharge
Pharmacy
hugely
impact
our
service
provision.
The
regulator
needs
to
approach
the
provide
the
provider
in
the
holistic
journey.
If
something
is
impacting,
the
individuals
journey
understanding
that
care
providers
will
not
be
able
to
provide
the
best
care
as
we
are
dependent
on
other
partners.
It's
about
look.
A
If?
What?
If
that's
the
way
we
regulate
going
forward,
if
she's
got
out,
you've
got
to
deliver
absolutely
high
quality
care.
But
what
if
there
was
some
sort
of
thing
that
you
had
to
pass
and
an
order
to
pass
that
you
had
to
show
how
he
worked
in
collaboration
with
other
other
providers,
to
deliver
to
deliver
good
good
joined
up
care
as
a,
for
example.
A
Yes,
so
that's
so
that's
a
perfect
reason
why
you'd
maybe
say:
well,
maybe
you
would
say:
don't
do
it
or
you'd
say
you
need
to
think
super
carefully
about
this,
so
that
was
the
first
reaction
when
I
when
I
talked
about
this
with
some
people
in
my
organization,
there
is
definitely
a
nervousness
about.
How
would
that
work,
and
then
so
I
don't
know,
but
I
wondered
whether
it
could
work
a
few
ways.
So
you
keep
your
bespoke
inspectors
over
here.
A
Let's
still
have
a
relationship
with
our
providers,
but
what,
if
over,
here
you
had
inspectors
who
specialized
in
improvement?
What?
If
no,
what?
If
you
were
good
or
outstanding
provider?
What
would
it
look
like
if
a
couple
of
your
staff
or
seconded
into
the
improvement
in
what,
if,
if
you're
a
family
carer
or
a
person
with
lived
experience,
you
were
in
that
improvement
team
as
well?
A
What,
if
what
if
we
had
it,
wasn't
just
CQC
as
fate
as
if
there
was
a
suite
of
so
so,
if
I'm,
oh,
if
I,
if
we,
if
I
run
a
business
I've
got
a
fabulous
register
manager
he's
coming
to
my
service,
really
raise
it
standards,
my
services
now
I've
seen
walk
solid
and
really
delivering.
What
would
it
look
like
if,
one
day
a
week,
I
seconded
my
registered
manager
into
the
CCC's
improvement
team?
Who
then,
who
then
goes
into
another
service
with
the
ccc
improvement
inspector
and
was
able
to
say
look?
I
won.
A
I've
run
a
service
similar
this.
This
is
some
of
the
ways
we've
approached
this
I,
don't
know,
but
I
I
think
if
we
wanted
to
do
it,
I
think
if
it
was
the
right
thing
to
do,
I
would
be
confident
that
we
would
be
able
to
work
out
together
how
how
we
would
draw
that
draw
that
distinction
between
between
the
two
yeah.
A
B
Great
and
we
all
right
to
keep
going
Stafford
with
it
just
one
more
question
before
we
move
on
so
okay
yeah,
we
can
have
one
more
question:
yeah,
that's
that.
So
this
is
more
a
comment
and
but
it
was
said
earlier
so
I
don't
want
to
miss
it
and
I
like
the
idea
of
working
alongside
CQC.
To
get
it
right,
we
could
be
left
to
work
through
the
improvement
plan
and
then
some
some
things
still
may
not
be
right.
B
A
A
So
so
so
definitely
get
that
and
I
know
we've
got
so
it
goes
back
to
that.
Do
we
have
a
parent-child
relationship
or
do
we
have
an
adult
to
adult
relationship
where
the
inspector
I
don't
know
I
mean
there
will
always
be
that
I
actually
get?
There
will
always
be
that
kind
of
power
power
dynamic
there
I
wonder
so,
I
wonder
whether
the
difference
would
be
the
inspector.
It
wouldn't
be
like
an
inspection,
so
the
inspector
wouldn't
be
saying.
Can
you
pull
me
five
care
plans?
A
Can
you
show
me
where
access
Donal,
you
know
I
wonder
whether
the
difference
would
be
you
know,
maybe
the
inspector
would
the
improvement
inspector
would
like
work
shift
with
your
team
or
just
get
themselves
immersed
in
how
the
care
and
the
health
care
was
being
delivered.
So,
instead
of
drawing
asks
down
from
you,
they
would
be
there
a
bit
rolling
up
their
sleeves
and
then
whether
at
the
end
of
the
day,
you'd
have
a
kind
of
debrief
or
an
opportunity
to
share
reflections
again.
I,
don't
know,
I
definitely
don't
have
the
answers.
A
This
is
very
early
days
thinking
and
it
may
be
that
we'd
go
a
bit
down
this
road
and
then
we
say.
Actually
this
is
not
we're
not
the
right
place.
This
is
not
the
thing
to
do,
but
I
think
that
would
be
the
differences
it
wouldn't,
hopefully
shouldn't
be
calling
it
shouldn't
be
depleting
where,
where
maybe
I
guess,
sometimes
an
inspection
is,
you
know,
you're
trying
to
run
your
business
and
then,
oh,
my
god,
I've
got
a
CQC
inspectors.
Sat
in
my
office.
Asking
me
for,
like
you,
know,
load
of
things.
A
I
would
envision
it
more
that
they
would
be
part
of
your
team
for
a
little
while
you
know
what,
if
they
came
and
worked
in
your
service
for
a
week
and
gave
you
those
reflections
each
day
and
you
try
and
do
something
a
bit
different
the
next
day,
just
just
seriously
only
taste
thoughts
but
but
yeah.
That
was
that
was
my
my
my
my
sections
on
it.
So
far.
B
Just
quickly
before
we
move
on
because
I
don't
want
to
lose
it
in
the
thrill
that
was
and
yeah
there's
been
a
few
comments
about
our
relationship
with
skills
for
care
and
whether
we
could
join
up
with
them
on
creating
some
improvement
resources
and
things
like
that.
With
with
a
new
strategy,
yeah
yeah.
A
So
I
say
we
did
do
something
in
this
space.
There
no
way
would
I.
Think
that
we
were.
You
know
the
answer,
though
we
were
the
answer
at
all:
I
wonder
whether
it
would
be
more
that
we
would
have
coordinate,
bringing
in
the
different
expertise,
so
you've
got
so
now,
don't
so
she
can
have
taken
me
House
colleagues,
on
the
court,
yeah
skill,
so
care
you've
got
the
work
force,
resources
you've
got
the
family
space
recruitment
resources.
You've
got
a
lot
of
knowledge
that
sits
in
Scylla,
so
she
can
Institute
for
excellence.
A
We
might
put
a
draft
policy
on
there
to
ask
for
feedback
in
comments.
So
if
you
wanted
to
sign
up
to
our
citizens
lab
that
would
be
great.
We
regularly
publish
a
provider
bulletin
which
hopefully
draws
together
all
the
different
bits
and
bobs
that
have
happened
in
those
previous
few
weeks
that
you
that
you
need
to
know
about,
and
then
then
we
are
on
Twitter,
so
we're
on
Twitter
as
at
CQC
profit,
but
also
I'm
on
Twitter.
A
A
Okay,
so
before
I,
just
pause
and
say,
I
am
absolutely
delighted
with
how
active
this
has
been
as
a
as
a
conversation,
and
this
feels
incredibly
constructive.
So
just
if
you
could
taken
the
time
to
give
up
an
hour
and
to
add
your
comments,
we
will
be
absolutely
you
know
scrolling
through
this
to
make
sure
we
don't
miss
anything.
So
so,
if
I
get
any
final
questions
Jen
that
we
want
to
ask
before
we
wrap
up
this
session
and.
B
A
Yeah,
so
so
yes,
I,
think
so
a
few
things
that
my
few
things
about
it's
obviously
a
whole
load
of
our
providers
just
provide
support
people
who
are
self
funding
and
don't
have
a
particular
relationship
with
their
local
authority
unless
as
a
safeguarding
or
that
sort
of
issue,
so
I
think
I.
Think
I
just
want
to
recognize
that
out
front.
That
would
maybe
work
if
some
slash
a
large
chunk
of
your
business
comes
from
the
local
authority,
but
we
just
need
to
be
mindful
of
provider
to
who
just
provides
us.
Our
funders
I
think
so.
A
Obviously,
local
authorities
have
well
depending
on
what's
local
authority.
They
often
have
a
kind
of
quality
monitoring
function.
Obviously,
clinical
commissioning
groups
have
their
quality
surveillance
groups
and
their
quality
teams.
Sometimes
there
are
health
teams
out
there
that
go
into
services
to
provide
support.
A
So
there
is
again
there
is
that
suite
of
support
out
there,
I,
just
wonder:
I
wonder
whether
it's
sufficient,
whether
it
hits
the
spot,
whether
it
could
be
more
coordinated
and
whether
there's
more
that
we
can
do
in
that
space,
but
I
think
either
way
where
the
local
authority
will
be
absolutely
critical
in
terms
of
sharing
information
and
yeah
use.
Accenture.
B
A
Ok,
great
yeah,
the
fact
I'm
so
sorry
miss
just
put
the
own
inspection.
If
it's
off
it's
much
respective.
How
do
we
move
to
that
more
real-time
view
of
what's
going
on
or
services,
and
that
is
that
is
so
mean.
That
is
what
we
that
that's.
What
we
want.
That's
the
ambition
so
fab.
Okay,
well,
keep
I!
Think
this
chest
stays
open
even
as
we
wrap
up
so
so
keep
commenting
on
it.
You
you
will
have
the
engagement
teams
details,
probably
through
how
you
put
this.
A
So
if
anything,
pops
into
your
head
after
that,
you
wish
she
said,
I'm
conscious
you
and
sign
up
to
our
citizens
lab.
So
we
can
keep
the
discussion
going
and
just
a
massive
massive.
Thank
you
for
me.
It's
been
a
really
I,
always
felt
a
bit
away
because
it
kind
of
you
especially
your
contributions
as
made
made.
It
not
feel
one
way,
which
has
been
great
so
I
think
unless
it's
anything
else,
Jenn
Steph
team
I
will
suggest
we
wrap
up
there.
Yeah.
That's
great
thanks,
Kate,
okay,
really
massive!
Thank
you
to
you!
A
Oh
and
just
one
final
thing
before
you
go
just
just
want
to
take
this
opportunity
to
just
say:
thank
you,
I
can't
imagine
how
tough
the
last
fourteen
sixteen
weeks
has
been
for
you
and
you
know
just
a
massive
thank
you
from
me
to
you
and
if
you
could
pass
it
on
to
your
your
team,
your
dedicated
staff
and
the
people
that
say
goodbye
to
their
families
to
go
off
and
deliver
health
and
care
to
people.
So
just
a
massive.
Thank
you
from
me
for
everything
that
you
all
do
every
day.