►
Description
In this latest engagement session, you'll hear from Rosie Benneyworth - Chief Inspector of Primary Medical Services and Integrated Care, Matt Tait - Head of Strategy and Ann Ford - Deputy Chief Inspector about our plans to develop our oversight of systems.
We launched our new strategy in May, where we outlined how we plan to change and transform to deliver more effective regulation. Further to this, the Health and Care Bill has indicated that we will have a wider oversight of health and care systems moving forward.
We want to develop how we’ll implement our strategy in partnership with people who work in health and social care. To support this, we’ve been running regular engagement sessions focused on different areas of our work.
We need to make changes to our assessment frameworks to help ensure that any future regulatory model works at provider, local authority and system levels. This session is a chance to hear CQC's thinking on a single assessment framework and share thoughts from a system perspective.
A
A
So
just
a
few
bits
of
speaking
for
today,
we're
very
very
keen
that
everyone
has
a
chance
to
contribute.
This
session
is
really
about
sharing
some
of
our
thoughts,
but
mostly
about
hearing
your
thoughts
and
hearing
all
of
your
expertise,
because
we
think
that
by
working
together
and
by
hearing
lots
of
beings
into
this,
we
will
end
up
with
a
much
better
situation
and
better
product
at
the
end.
So
so
thank
you
for
that.
A
So,
just
in
terms
of
what
we're
going
to
be
covering
today,
we've
got
a
team
of
people
from
the
cqc
supporting
us
today,
which
is
fantastic
and
we
have.
We
will
ask
them
as
they
come
and
speak
to
introduce
themselves
and
to
explain
what
their
role
is.
But
these
we've
got
a
strong
team
working
on
this
going
forward.
It's
something
that's
really
important
to
us
to
get
right
and
we
will
make
sure
that
we
send
out
the
names
and
the
contact
details
of
the
team
in
this
cqc.
A
A
So
that's
that's
the
plan
if
we
could
go
on
to
the
next
slide,
so
the
aim
of
today's
events
is
really
to
update
you
all
and
the
work
and
development
on
our
approach
to
system
oversight
and
insurance.
Why
do
we
think
this
is
important?
Well,
I
just
want
to
share
some
thoughts
from
myself
about
why
this
is
important.
A
I
saw
the
impact
of
good
integrated
care,
particularly
around
things
like
end
of
life
care
and
and
working
together
to
make
sure
that
people's
needs
are
met.
But
you
also
see
where
people
really
struggle
when
services
don't
work
together
and
I
think
more
than
ever,
as
we're
coming
out
of
cobid
or
whatever
the
next
stage
of
covert
is
we're.
A
And
so,
for
those
reasons
we
feel
this
is
really
important,
that
this
is
something
that
we
look
at
and
we
feel
that
very
much
want
to
be
an
enabler
in
this
space.
We
want
to
make
sure
that
we
are
in
a
position
to
to
enable
the
right
things
to
happen
for
people
who
use
services
across
all
services,
so
across
health,
social
care
and
an
independent
sector,
and
every
single
service
that
sits
in
a
local
footprint.
A
A
B
So
what
I'm
going
to
be
talking
about
today
is
is
the
the
early
phases
of
the
work.
It's
the
start
of
a
conversation.
It's
the
early
early
thinking
on
the
overall
approach
to
ics
assessments
as
it
stands
at
the
moment,
but
obviously
we're
we're
still
a
fair
way
from
from
actual
implementation
of
this.
So
it's
a
chance
to
start
the
conversation
and
check
the
the
sort
of
the
early
work
that
we've
done
so
far
as
you
might
have
picked
up.
I've.
B
I've
got
a
bit
of
a
cold
at
the
moment
and
I've
I've
got
particularly
I've
got
a
quite
a
bad
cough,
so
I
may
have
to
put
myself
on
on
mute
from
time
to
time
as
we
go
along
I'll.
Do
my
best,
and
I've
got
someone
on
standby
to
take
over
if
I
just
completely
collapse
and
unable
to
continue,
but
hopefully
I'll
be
all
right.
So
we
want
to
put
this
in
context
of
the
wider
work
that
we're
doing
on
a
new
regulatory
model.
B
B
The
reason
it's
important
to
to
talk
about
the
wider
new
regulatory
model
work
is
that
one
of
the
principles
that
we're
working
to
is
that
as
much
as
possible,
which
should
go
a
long
way
is
that
the
work
on
android
regulation
model
and
all
the
tools,
the
systems,
the
reporting
methodologies,
the
frameworks
wherever
possible.
That
approach
will
apply
it
at
these
new
levels
of
assessment
as
well.
B
B
B
The
main
focus
of
the
discussion
here
is
on
the
integrated
care
system
work,
but
there
is
some
some
useful
context
on
the
local
authority
side
as
well,
which
I'll
cover
briefly
a
number
of
different
principles.
Here,
I'm
not
going
to
read
all
of
these
out
they're
largely
sort
of
set
out
in
in
the
strategy,
and
this
is
really
principles
that
we're
working
to
across
our
new
regulatory
model.
B
There's
a
quite
a
number
of
different
principles
here,
as
you
can
see,
and
and
you'd
expect
that,
because
these
principles
apply
in
different
ways
to
different
parts
of
our
work,
so
some
of
them
are
about
how
we
use
information
being
more
proportionate,
flexible.
Some
of
them
are
specifically
about
the
things
we
look
at
in
our
assessment
frameworks
and
how
we
come
up
with
judgments
and
and
changes
in
emphasis
or
strengthening
things
that
we
already
do
currently.
B
So
so
there's
a
lot
there's
a
lot
there,
but
but
all
of
that
translates
again
to
the
provider
level
single
assessment
framework.
So
again,
if
you're
familiar
with
that
with
our
current
framework,
there
are
five
key
questions
in
the
front
and
in
the
framework
and
there's
those
will
continue
to
be
relevant
at
are
these.
Are
there
slides
people
can't
see
the
slides
right
yeah?
B
So
there
are
five
key
questions
which
apply,
provide
a
level
and
currently
underneath
that
the
key
questions,
as
I
mentioned,
characteristics
key
lines
of
inquiry,
prompt,
prompt
questions,
a
lot
of
detail.
What
we're
trying
to
do
is,
as
I
say,
simplify,
that
down
to
a
set
of
quality
statements
which
will
apply
across
the
board
and
sort
of
distill
everything
to
more
accessible
way,
underneath
that,
as
we
do
now,
we'll
collect
evidence
with
specific
indicators.
B
What
we're
trying
to
do
is
be
clearer,
more
consistent,
more
concise
in
particular,
about
how
we
present
evidence
and
make
again
that
information
more
accessible
than
it
currently
is.
If
you're
familiar
with
cqc
reports
at
the
moment,
they're
often
quite
long
narrative,
it
depends
on
the
sector
and
the
service,
but
they
can
be
very
long.
Dense,
narrative
reports,
we're
trying
to
make
them
more
accessible
and
that
will
also
improve
the
consistency
of
how
we,
how
we
present
information
externally
and
the
transparency
of
our
judgments.
B
B
So
what
all
that
means
for
system
oversight,
so
a
few
sort
of
key
things
we're
thinking
about
as
we
do
this
work,
one
is
about
making
sure
that
we
hold.
This
is
really
about
making
sure
the
assessments
are
tailored
to
the
the
different
level
and
the
system
level
and
recognize
the
differences
between
ics's
local
authorities
and
and
providers
that
deliver
services.
So
what
we're
trying
to
do
here
in
this
phase
of
the
work
is
be
absolutely
clear
about
the
scope
of
the
assessment.
B
B
We
have
previously
carried
out
local
system
reviews,
but
this
is
a
different
type
of
assessment,
and
so
we
need
to
establish
a
baseline
of
what
quality
and
safety
looks
like
that,
then,
will
lead
into
a
sort
of
ongoing
approach
of
assessment,
equality
and
risk
which
evidence
gathering
will
be
tailored
around
what
we
know
about
the
the
different
levels:
the
services,
the
the
the
system
levels
again,
we'll
be
capturing
good,
good
practice
and
encouraging
improvement.
That's
an
important
focus.
B
B
So
in
terms
of
integrated
care
systems.
This
is
just
a
bit
of
context
about
the
core
purpose
of
integrated
care
systems
and
there's
more
detail
underneath
this
and
the
guidance
for
them.
But
they've
got
a
range
of
functions
around
improving
population,
health
and
healthcare,
tackling
unequal
access,
experience
and
outcomes,
enhancing
productivity
and
value
for
money
and
supporting
broader
social
and
economic
development
and
within
all
of
that
and
sitting
across
all
of
that,
obviously,
real
focus
on
integration
of
services
and
collaboration
across
the
ics
geographies.
B
This
is
obviously
early
thinking
in
many
respects,
but
what
we're
looking
at
is
is
grouping
if
you
like,
or
the
the
content
of
an
assessment
framework
or
the
things
that
we'd
look
at
into
three
broad
categories,
one
around
the
the
leadership
functions
of
the
ics
bodies,
all
of
the
different
parts
of
the
ics
around
leadership
and
the
sort
of
strategic
aspects
of
those
roles
assessing
the
needs
of
their
populations.
All
of
that
sort
of
leadership,
side
of
side
of
things,
the
actual
function
of
integration,
collaboration
within
the
ics.
B
How
well
that
is,
is
working
within
each
I
ics
geography
and
and
how
all
the
different
system
bodies
are.
Promoting
that
and
supporting
it
and
then
the
actual
quality
safety
of
as
experienced
by
by
service
users,
the
population
as
a
whole
within
the
ics
geography
and
how
well
that's
understood
by
within
the
ics
and
the
contribution
of
the
ics-2
to
quality
and
safety
within
the
within
the
patch.
B
But
what
we
want
to
do,
broadly
speaking,
is
is
test
this
part
of
our
initial
thinking
with
with
this
group
and
and
check
if
people
feel
that
we're
on
the
right
track,
obviously,
as
we
as
we
go
along,
we'll
be
seeking
more
input
on
the
on
the
detail
of
our
approach
as
well.
Next
slide
thanks,
it
might
be
the
that
might
be
the
end
of
the
first
part
of
the
presentation.
So
we've
got
another
slide.
B
B
So
I
think
I
think
that's
to
be
worked
through.
If
I'm
honest,
I
I
can't
answer
that.
Question
myself,
I'm
not
in
in
the
detail
of
the
local
authority.
Work
myself,
sorry,
but
if
you,
if
you
think
about
it
with
with
I
mean,
I
think
the
same
issue
applies
in
the
integrated
care
system,
side
of
things
as
well.
B
One
of
the
things
we
we
will
need
to
consider
and
as
we
do
with
provider
regulation
is,
is
consider
whether
we
actively
gather
information
ourselves
and
which
type
of
information
we
gather
so
do
we.
Do
we
ask
integrated
care
system
bodies
to
submit
information
to
us?
Do
we
there's
a
range
of
information
gathering
activities
we
can
do
in
terms
of
sort
of
you
know
you
can
do
survey
work.
You
can
do
a
whole
range
of
different
sort
of
bespoke
information
gathering
ourselves
as
well.
So
it
would
with
that.
B
A
And
mark
can
I
just
add
to
that,
because
I
think
it's
a
really
important
point
and
something
that
we
want
to
think
about
at
an
early
stage.
Is
we
know
that
very
often
what
we
focus
on
in
terms
of
what
we
measure
leads
to
kind
of
a
focus
on
that
area
and
the
improvements?
So
I
think
it's
really
something
we
need
to
carefully
think
through
is
what
intelligence
do
we
collect
and
what?
What
intelligence
do
we
look
at?
A
That
is
really
going
to
focus
areas
on
the
right
things
that
are
going
to
drive
the
right,
the
right
areas
to
have
that
focus
on,
because
I
think,
if
we
get
that
right,
then
it
will
drive.
It
has
the
potential
to
drive
significant
improvements
across
systems,
so
thoughts
about
that
would
be
very
welcome
as
well.
C
Do
okay?
Thank
you.
There's
a
couple
couple
more
questions
in
the
chat
and
then
I
know
we've
got
brendan
with
his
hand
up
as
well.
So
if
we
come
to
the
chat
questions
first,
bex
is
asking
how
we'll
recognize
the
additional
challenges
and
complexity
for
local
authorities
where
they
have
more
than
one
ics
in
their
area
and
also
two
tiers.
A
Yes
and
again,
if
I
start
and
then
matt
nan
and
others
might
want
to
come
in,
but
I
think
this
is
why
our
plans
look
at
how
we're
going
to
start
with
the
I
and
we
statements
that
that
tlapp
have
created,
because
actually
we
want
to
look
at
how
do
we
regulate
through
the
eyes
of
people
who
use
services?
How
do
we
really
understand
their
journeys
and
actually
what
does
it
feel
like
a
person
using
services,
because
I
think
several
times
we've
been
asked?
Well,
there's
lots
and
lots
of
different
size.
A
Geographies,
there's
lots
of
different
demographic
situations
within
those
ics's,
but
I
think
if
we
go
right
back
to
actually
what
does
it
mean
for
a
person
using
services
in
that
area
and
start
from
there,
then
that
that
will
help
us
deal
with
some
of
those
complexities.
It
is
a
complex
area
and
we
know
that
there's
different
geographies
there's
different
different
footprints.
We
need
to
test
out
what
we
do
at
which
level
as
well.
What
do
we
do
at
ics
level
place
level?
What
do
we
do
at
a
neighbourhood
level?
Even
so?
A
How
do
we
understand
that?
So
I
think
that's
something
that
we
definitely
need
to
work
through
and
we
don't
have
all
the
answers
at
the
moment
how
we
also
look
at
the
the
different
demographics
and
the
the
kind
of
areas
such
as
you
know.
How
do
you
compare
an
inner
city
area
with
an
area?
That's
very
rural
or
areas
with
higher
deprivation
is
something
we're
going
to
have
to
work
through
with
the
intelligence
that
we've
gotten
the
the
work
that
we
already
have
done
in
this
area.
A
D
No,
I
think
I
think
you've
covered
it
rosie
and
I
think
benjamin's
question
about
the
information,
the
information,
so
we
can
prepare
for
the
process
as
part
of
the
co-production
and
as
part
of
the
development.
Benjamin
will
take
you
through
our
thinking
every
step
of
the
way.
So,
by
the
time
we
start
to
come
to
paper-based
tests
and
test
on
site
you'll
be
very,
very
clear
about
what
we're
looking
at.
D
What
will
what
the
evidence
set
looks
like
the
sort
of
things
we
want
to
talk
to
you
about,
so
you
should
have
pl
and
of
course,
we
will
share
with
you
in
advance
anything
that
we'll
want
you
to
prepare
for
our
arrival.
So
the
whole
idea
of
this
is
to
co-produce
and
be
as
transparent
and
as
open
as
possible
with
yourselves
and
others,
so
we're
very,
very
clear
about
expectations
from
the
off.
D
C
Thanks
thanks
everyone-
and,
I
think,
definitely
just
just
to
kind
of
doubly
confirm
what
anne
was
saying.
We
might
not
have
all
the
answers
to
your
questions
today,
but
that's
because
we're
we're
keen
to
co-produce
everything
with
you
from
the
very
start.
So
these
are
definitely
the
right
questions
to
be
asking.
Can
I
come
to
brendan
next
who's
got
his
hand
up.
E
Again,
this
may
be
one
of
those
early
questions,
but
just
hearing
what
you've
said
so
far,
I'm
just
wondering
how
you
think
what
the
thinking
is
at
the
moment
about
the
way
in
which
you'll
work
with
nhs
england,
with
ofsted
around
cams
and
send,
and
so
on.
You
know
the
partner
regulators
inspectors
that
sort
of
thing.
A
Yeah,
certainly
so,
shall
I
just
again
if
I
start
and
then
others
might
want
to
chip
in,
so
it's
really
important
to
us
that
as
regulators,
we
work
very
closely
together.
We
know
from
our
local
system
review
work
and
the
subsequent
report
beyond
barriers,
that
if
regulators
don't
work
together,
they
can
become
barriers
in
themselves
to
integrate
care,
and
we
are
very,
very
keen
that
that
doesn't
happen.
A
We
already
have
a
really
good
working
relationship
with
ofsted
and
I
lead
a
team
that
works
with
ofsted
looking
at
send
inspections
and
other
parts
of
children's
services.
So
we've
got
some
great
great
learning,
particularly
from
that
work
as
to
how
we
can
look
at
people's
experiences
through
health,
social
care
and
education
in
that
situation,
we're
having
lots
of
discussions
with
nhs
england
at
the
moment,
it's
it's
vital
to
us
that
actually,
the
sum
of
the
whole
between
ourselves
and
nhs
england
adds
up
and
makes
sense
at
the
end
of
the
day.
A
There's
no
point
us
us
duplicating:
we
don't
want
to
all
be
coming
to
systems
who
are
going
to
be
busy
kind
of
with
different
requests
for
data
in
different
ways.
That's
going
to
just
add
to
add
to
the
already
busy
workload
and
we
want
to
make
sure
that
we're
we're
both
in
our
regulatory
action
enabling
systems
to
get
on
and
and
do
what
they
need
to
across
all
of
the
sectors.
A
D
Yes,
please
ever
may
rosie.
The
whole
idea
is
to
make
is
not
to
add
to
the
regulatory
burden
and
I
think
rosie's
being
clear
about
working
very
collaboratively
with
our
partners.
So
we
don't.
There
will
be
a
small
degree
of
overlap,
but
there
won't
be
any
overlap.
There
won't
be
duplication
and
that
when
we
do
come,
we
add
value.
We
share
the
information.
We
share
the
data
we
share
our
thinking
in
advance,
so
we're
fairly
clear
about
where
we
need
to
focus
when
we
arrive
to
do
the
assessment.
B
So
I
think
that's
one
of
the
topics
for
discussion
in
some
ways,
but
I
think
the
broadly
broadly
speaking,
where
we're
coming
at
it
is
that
the
assessment
would
focus
on
on
the
ics
level.
Taken
broadly
there'd,
be
a
range
of
assessment
activity
carried
out
to
inform
that
judgment
of
the
overall
ics.
B
If
things
come
up
in
in
respect
of
individual
providers
that
might
prompt
some
follow-up
activity
with
that
provider
might
identify
things
that
the
provider
needs
to
to
respond
to,
or
that
would
pick
up
with
him,
but
it's
it
wouldn't
be
as
straightforward
as
something
from
an
ics
level
kind
of
in
some
sort
of
mechanical
way,
affecting
a
provider's
rating
in
a
very
straightforward
way.
That's
not,
I
think
how
we
would.
I
would
see
it
happening,
be
more
occasional,
identify
things
that
that
need
following
up.
If
that's
the
case,
can
I
just
add.
A
A
C
Thanks
rosie,
I
I
know
I
think
benjamin
has
his
hands
up
so
come
to
him
in
a
second
just
to
say,
if
we
can't
get
to
all
your
questions
in
this
part
of
the
session,
please
bring
them
into
your
breakout
rooms
and
we'll
definitely
take
them
away
to
inform
our
future
thinking.
But
benjamin
do
you
want
to
ask
a
last
question
before
we
move
on.
F
Yeah,
thank
you.
So
it
was
just
around
and
you
might
not
know
the
answer,
but
around
the
powers
that
cqc
might
have
over
the
ics.
So
what
came
to
mind
then
was
there's
possibly
some
opportunity
around
in
I
work
in
community
health
and
we
have
a
significant
pressures
of
people
coming
out
of
hospital
into
community
nursing
that
type
of
thing
and
there's
massive
national
strategy
around
care
cluster
home
that
kind
of
agenda,
but
what
we
struggle
with
is
getting
our
acute
partners
to
sort
of
release,
money
staff
that
never
sort
of
follows
the
traffic.
F
A
So
those
type
of
things,
if
we
see
things
that
are
not
enabling
good
care
and
they're
impacting
on
care
that
people
are
getting,
then
that's
the
type
of
thing
we
will
call
out
in
our
our
reports
and
the
type
of
thing
we
will
comment
on.
We
are
looking
at
what
escalation
will
look
like
through
this
we're
not
likely
to
have
enforcement
powers,
but
we
will
be
looking
at
other
routes
of
escalation.
A
If
we
don't
think
things
are
happening,
and
I
think
we
want
to
very
much
live
by
the
you
know
why
are
ics
is
set
up.
What
are
the
purposes
of
icts?
Is
you
know
it's
it's
about
looking
at
earlier
intervention,
it's
about
prevention,
it's
about
little,
wider
determinants
of
health.
It's
about
meeting
those
challenges
and
getting
people
really
good
joined
up
care.
So
actually,
if
we
don't
see
that
in
a
system,
then
I
think
that's
the
type
of
thing
that
we
will.
We
will
be
thinking
we
need
to
highlight
to
the
system.
A
D
Thanks
rosie,
I
think
one
of
the
questions
we'll
be
asking
benjamin
is,
if
you
can
you
be
a
good
provider
if
you're
not
a
good
pro,
if
you're,
not
a
good
partner
and
how
that
might
look
so
part
of
being
really
well
led
and
part
of
being
a
good
system
partner?
Is
the
collaboration?
Isn't
it?
I
think
the
other
thing
is
historically
that
the
way
the
funding
streams
are
aligned
and
the
way
success
is
measured.
D
D
We
need
to
perhaps
to
change
some
of
the
national
metrics
around
that
and
we'd
be
in
a
position
to
make
a
comment
about
that.
Wouldn't
we,
after
we've
done
after
we've,
looked
at
systems
and
see
what
the
challenges
are.
So
I
don't
think
it's
worked
out.
I
don't
think
it's
written
in
tablets,
estonia,
but
it's
certainly
something
that
we're
exploring
is
how
we
can.
You
know,
use
whatever
levers
are
available
to
us
to
secure
and
support
improvement.
B
Thanks
sam,
so
this
is
a
sort
of
preliminary
to
the
discussion
questions
here
this
slide.
This
is
obviously
a
a
new
big,
complex
piece
of
work
we
just
wanted
to.
Although
we've
been
talking
at
a
high
level
about
where
the
work
is
up
to
so
far,
and
some
of
the
the
sort
of
the
broad
direction
we're
heading
in,
there
are
obviously
a
whole
range
of
complications
and
sort
of
questions,
issues
that
will
need
to
be
worked
through
as
we
do
this
work.
B
There
are
others,
of
course,
but
these
are
some
of
the
key
ones
around
service
user
voice
at
system
level,
how
we
collect
it
and
how
we,
how
that
informs
our
overall
judgment
of
of
the
quality
and
collaboration
leadership
of
the
system
and
and
more
generally
other
sources
of
evidence
that
whole
point
around
evidence,
gathering
and
and
all
the
different
ranges
of
evidence
that
will
be
available,
ics
level,
around
inequalities
of
access
and
and
population
health
it
all
met.
This
is
a
new
level
of
assessment.
B
Obviously
so
there'll
be
new
sorts
of
sources
of
evidence
that
will
need
to
be
gathered
at
that
level.
The
point
about
variation
among
ics's,
which
has
come
up,
I
think
in
in
the
in
the
chat
as
well.
That's
something
we're
very
aware
of
we
need
to
work
through
and
that
really
plays
out
in
the
detail
of
of
how
we
use
specific
sources
of
evidence
and
then
how
that
all
that
adds
up
to
a
judgment,
how
we
take
account
of
variation
in
scale
and
levels
of
development.
B
Provider
collaboratives
is
an
interesting
one.
How
how
we,
how
provided
collaboratives
should
be
played
into
our
assessments
at
ics
level,
but
equally
the
the
provided
level
is
as
well,
and
what
what
the
performance
of
the
lead
provider
means
for
for
for
that
organization.
All
of
that
sort
of
stuff
duplication,
regulatory
burden
and-
and
I
think
another
one
that
in
terms
of
actually
the
source
of
evidence
point
is-
is
the
question
of
kind
of
the
level
of
detail
that
we
should
report
on
within
within
an
ics.
B
You
know
we
can
do
something
at
the
overall
ics
level,
but
I
think
we're
we're
interested
in
exploring
is
is
what
is
a
useful
level
of
detail
of
reporting
within
an
ics?
Are
there
things
that
we
can
do
at
sort
of
neighborhood
or
place
level
within
an
ics?
That
would
be
helpful
in
terms
of
talking
about
the
quality
of
care
within
ics
within
places
within
ics
and
and
what
would,
if
we're
able
to
do
that?
What
would
that
mean
for
our
judgment
of
the
overall
whole
so
plenty
to
be
worked
through,
I'm
sure,
there's
well.