►
From YouTube: CQC Engagement session | Changing the way we work pt 2
Description
Victoria Watkins facilitates the feedback session and leads on the multidisciplinary team meeting presentation and chairs a full group discussion around MDTs.
A
What
I'm
planning
to
do
is
take
us
from
what
I
think
we've
heard
about
now,
so
that
kind
of
feedback
around
relationships,
as
is
some
of
the
themes
of
what
we've
talked
about
and
then
get
us
to
what
I
think
we've
heard
about
the
future,
but
then
I'd
really
like
to
kind
of
put
it
out
there.
Does
that
sound?
Like
all
the
big,
the
big
themes?
If
that's
okay,
so
there
will
be
a
chance
to
come
in
okay.
A
So
so
lots
for
us
to
take
away
there,
and
I
think
so,
some
of
the
specifics
that
I've
drawn
out.
We
really
need
to
think
about
who
who
it
is
that
has
the
dialogue
with
you,
because
we've
definitely
heard
it's
come
from
a
couple
of
rooms
that
actually
the
purpose
of
that
interaction
is
sometimes
and
often
more
important
to
you
than
who
it
is
and
meeting.
The
point
and
requirements
of
that
interaction
point
is:
is
your
kind
of
primary
driver.
A
Who
is
it
and
why
being
the
you
know
priority,
but
equally,
how
do
we
ensure
as
well
that
we
keep
that
trust
and
consistency
alive
and
what
is
the
role
of
the
inspector
in
there?
Actually,
I
was
in
group
one.
I
think
where
there
was
a
comment
around
and
I'm
not
actually
sure.
Sometimes,
who
is
that
contacts
me
when
they
say
hi,
I'm
the
relationship
owner
is
that
my
inspector,
so
once
we've
established
our
model,
absolutely
to
ensure
everybody's,
really
clear,
okay
type
types
of
relationships.
So
I
heard
a
lot.
A
I
think
it's
come
from
one
or
two
groups
about
the
value.
Actually,
the
value
of
some
of
our
slightly
different
approaches
in
response
to
covid,
so
there's
been
a
couple
of
references
to
what
we
called
the
tma
lovely.
We
love
acronyms
the
transitional
monitoring
approach,
so
that
would
be
where,
if
you
think
you
had
a
call
from
your
inspector,
it
was
along
the
lines
of
let's
start
with
how's
it
going.
A
Is
there
anything
I
can
sign
post
you
to
actually
out
in
the
system
or
in
terms
of
guidance
as
well
as
unpicking
and
really
exploring
you
know?
What's
your
current
risk
level?
And
you
know
what
can
we
do
hand
in
hand
to
ensure
that
we're
kind
of
supporting
you
in
the
system
and
time
posting
you
to
ensure
quality
and
safety
for
those
accessing
your
services?
A
So
some
really
high
value
was
seen
in
those
phone
calls
that
were
the
transitional
approach,
so
some
good
stuff
that
we
need
to
think
about
there,
because
the
flip
side
of
that,
what
we've
heard
and
what
I've
drawn
out,
is
actually
in
our
risk-based
approach.
At
the
moment,
it
can
often
feel
that
we're
in
touch
with
you,
with
a
negative,
with
a
problem
with
a
and
there's
less
of
the
continual
kind
of
contact
and
touch
point
generally
about
the
service
or
your
provider.
A
So
definitely
something
we
need
to
think
about
there
in
terms
of
our
approach
and
the
relationships,
the
relationship
manager,
I've
covered
that
okay,
the
some
good
features
some
good
stuff
from
a
couple
of
rooms
again
around.
Actually
the
relationship
owner
is
that
the
inspector
and
then
equally,
who
is
it?
Who
is
it
that
comes
to
what
might
be
regional
events
or
sector
specific
events?
A
Are
they
one
and
the
same
or
do
we
want
somebody
actually
who's
more
encompassing
more
holistic
of
the
regulator,
and
some
of
that
depends
upon
the
niche
subject
matter
of
the
event
we
might
be
coming
to,
but
equally
some
good
feedback
about
where
it's
worked
well
or
not.
Well,
when
it
might
be
the
frontline
inspector,
so
something
for
us
to
think
about
there
when
we
want
to
steer
and
support
and
drive
and
accelerate
improvement
beyond
and
outside
of
one
provider's
walls.
Definitely
a
really
good
point.
A
So
I'm
going
to
put
it
out
there,
because
I
know
it'll
be
on
some
people's
minds
around
to
steer
us.
We
need
to
think
through
the
impact
of,
for
example,
local
authority
assurance
and
our
future
role
there,
but
equally
it
will
be
the
integrated
care
systems
work
as
well
and
our
role
in
there.
In
terms
of
why
do
we
need
to
think
through
it?
What
did
I
hear
it's
about?
A
Actually,
what's
the
impact
on
the
dynamic
when
it
could
be
one
and
the
same,
or
is
it
one
on
the
same
whom
we're
out
looking
at
the
local
authority,
the
integrated
care
system
and
indeed,
still
entwined
with
looking
at
the
provider?
Will
there
be
an
impact?
How
will
providers
feel
that
so
keep
that
thought
in
mind?
The
couple
of
people
who
are
now
talked
about
it,
because
we
want
you
to
think
about
that
in
the
next
discussion
about
our
multi-disciplinary
teams.
A
Okay,
so
then,
I
think
I've
heard
loads
of
stuff
and
drawn
it
out.
I
hope
colleagues
but
cqc
colleagues
you're
still
in
the
document,
I'm
not
so
if
I
miss
anything,
tell
me
in
terms
of
the
the
future.
Okay,
a
few
things
here
in
no
particular
order
haven't
progressed
that
far
so
burden
impact
data
requests.
A
A
We
want
to
get
the
answer
to
our
question
or
the
response
on
the
assurance
that
we've
submitted
or
the
whatever
it
is,
and
we
want
it
and
we
want
it
quickly
from
the
regulator,
so
a
good
steer
there
and
some
stuff
around
process
and
approach.
As
I
say,
some
of
that
being
around
the
data
requests.
How
do
we
prepare?
How
do
we
have
that
ongoing
insight
and
relationship?
But
equally,
how
are
we
you
know
conducting
on
site,
and
we
talked
to
that
most
recently
as
crossing
the
threshold
activity?
A
Why
are
we
there?
What
are
we
doing?
How
can
we
do
it
in
a
sharp,
succinct
manner
to
minimize
again
that
burden
when
we're
on
site?
And
lastly,
here
no
surprises-
I
like
that
one
can't
remember
which
group
it
was,
but
you
know
we
want
to
ensure
that
we've
got
that
ongoing
liaison
contact
point,
and
you
know
if
there
is
a
risk.
If
there
is
an
issue
there
will
be.
A
This
is
health
and
social
care
that
we're
talking
to
you
that
we're
aware
of
it
and
that
we're
kind
of
working
hand-in-hand
in
ensuring
that
we're
getting
that
assurance
and
that
you're
supported
out
in
the
system.
Where
are
the
examples?
Where
is
the
innovation?
Where
is
the
strength
in
the
system
around
so
that
you
can
kind
of
join
and
if
we've
got
that
knowledge
share
it?
So
some
some
really
good
steer
for
us
there,
I'm
going
to
pause,
take
a
breath.
A
A
A
I
can
see
nods
from
those
on
the
screen.
Thank
you
thanks.
Well,
thanks,
bernadette,
okay
right,
so
we
can
revisit
that
though.
If
you
do
have
any
thoughts
you
can
send
them
to
us
anytime
or
use
the
chat
and
I'm
going
to
move
us
on
slightly
now
then,
to
our
next
topic,
which
is
multi-disciplinary
teams.
May
I
request
the
slides
please.
A
A
Okay,
thank
you
very
much.
Okay,
before
we
get
into
the
detail
lib.
So
what
about
multi-disciplinary
teams,
if
I
can
just
start
with
a
little
bit
of
context
here,
so
the
reason
that
we're
talking
about
multi-disciplinary
teams
is
because
it's
very
different
to
how
we
work
now.
So
that's
the
bit
that
I'll
just
give
a
flavor
on
and
currently-
and
you
will
be
familiar
with
our
inspectors.
Our
adult
social
care
inspectors
are
our
primary
medical
services
inspectors
or
indeed
our
hospital,
our
mental
health
inspectors.
Now
that's
not
going
anywhere.
A
We
will
keep
our
specialisms
and
expertise
just
to
put
that
out
there
immediately,
but
at
the
moment
those
inspectors
or
specialists
work
in
different
inspection
directors
just
internally
in
the
term.
In
terms
of
how
we
are
structured,
we
have
three
inspection
directors,
model,
social
care,
primary
medical
services
and
integrated
care
and
hospitals
directorate,
of
which
mental
health
is
housed
in
there.
A
But
we
established
ourselves
in
those
three
inspection
directorates
now
again
playing
for
some
of
the
conversations
I
know
you've
already
had
in
the
room
think
about
our
ambitions
for
local
authority
assurance
and
indeed
our
ambitions
for
the
integrated
care
systems
and
imagine
that
for
us
to
deliver
on
that
really
well,
we
want
to
ensure
that
our
teams
work
together
every
single
day,
it's
natural,
it's
organic,
they're,
knitting
together
the
provider
and
sector
view
in
terms
of
quality
and
safety
and
that's
live.
It's
an
everyday
conversation
rather
than
a
specific
planned
touch.
A
Point
where
we're
thinking
about,
and
why
would
we
want
to
do
that?
It's
all
around
thinking
of
the
quality
and
safety
of
people's
experiences
in
that
place,
moving
around
from
the
care
home
to
the
ed
department
back
out
again,
and
we
want
to
think
about
that
entire
journey,
as
well
as
always
ensuring
the
regulation
of
provider
service
levels.
A
So,
on
the
side
there
to
get
to
the
point,
you
can
see
our
thinking
the
high
level
principles
for
our
multi-disciplinary
teams
and
what
this
means
to
us.
It
means
something
to
all
of
us,
I'm
a
nurse
by
background.
I
know
what
it
meant
to
me
when
I
was
a
nurse,
so
we
want
to
be
really
clear
with
people.
What
does
multidisciplinary
teams
mean
to
cqc?
A
It
means
our
sector
experts
working
together
every
day
across
specialisms
in
a
geographical
area.
It
means
those
team
members
being
really
flexible,
drawing
on
the
variety
of
experience
that
together
they
hold
forming
that
view
of
quality
of
care
in
an
area
and
being
able
to
respond
really
quickly
where
there
is
high
risk,
where
there
is
issues
and
explore
those
complex
services
and
pathways
and
person-centered
delivery
models
together
in
and
across
the
system.
A
Excuse
me,
but
those
experts
will,
as
I
say,
continue
to
deliver
our
regulatory
activity
at
provider
and
sector
level.
There
is
no
change
there.
This
is
about
accelerating
our
capabilities
in
the
system,
so
I
will
open
up
for
our
all
group
we're
all
going
to
stay
here,
discussion
in
just
a
moment,
but
before
I
do
really
important
to
run
through
what
won't
change,
because
that
is
a
significantly
different
way
of
working
for
us.
So
on
this
slide,
our
purpose,
our
values
and
excellence,
integrity,
teamwork
and
caring
they're,
not
changing.
A
They
remain
core
to
what
we
do
and
what
drives
us
every
day.
As
the
cqc
team
we'll
continue
to
use
our
legislative
powers
regulating
at
provider
and
location
level.
As
I
say,
that
means
nothing.
Changes
in
terms
of
we
will
continue
to
inspect
rate
register
enforce
when
we
need
to
to
hold
providers
to
account.
We
will
still
cross
the
threshold,
no
change
there
site
visits
will
happen
and
we
will
maintain
that
operational
sector
specialism.
A
A
Okay,
I
hope
that's
helpful.
What
won't
change
to
put
it
out
there
and
align
any
concerns,
so
we're
gonna
have
a
group
discussion
now,
if
that's
all
right,
you've
heard
quite
a
lot
there
around
our
plans
for
the
strategy.
But
what
does
that
mean?
Why
do
we
need
integrated
multi-disciplinary
teams
so
really
keen
to
put
it
out
there
now
for
everybody?
What's
your
views?
What
do
you
think?
What's
your
reactions
to
hearing
about
us
working
in
multidisciplinary
teams,
and
what
do
you
see
as
it
says,
benefits
here?
A
So
that's
great,
let's
think
about
the
benefits,
but
equally,
if
you've
got
anything
on
your
mind
and
you
want
to
feed
back
to
us.
Have
you
thought
about
this,
I'm
concerned
about
that?
Let's
hear
it
all
happy
to
hear
any
of
it.
It's
really
helpful
for
us
and
the
team,
so
I
think
we
can
open
it
up
who
might
like
to
go
we're
staying
in
here,
brilliant,
I
think
that
said
beverly,
but
my
screens
just
moved.
Yes,
it
did
beverly
opera
to
you
thanks.
B
A
A
This
is
broader
than
the
emergency
department,
so
in
that
scenario,
our
teams
can
continually
monitor
continue
through
the
relationships
to
apply
that
influence
around
the
the
rest
of
the
story.
Additionally,
as
we
start
to
develop
and
the
piloting
will
be
next
year
and
then
we
will
aim
to
be
up
and
running
the
following
year,
our
integrated
care
system
assessments
then
equally
we'll
be
able
to
formally
kind
of
play
back
and
shape
and
steer
at
the
system
level
really
formally
which
which
we'll
need
to
think
about.
A
We
haven't
written
the
approach
yet,
but
we're
going
to
need
to
knit
the
person-centered
experience
of
the
provider
right
at
that
detailed
front
line
right
through
to
the
integrated
care
system
level
and
indeed,
all
of
the
tiers
I'm
going
to
call
them
for
onto
a
better
word.
That's
sitting
between
the
place,
the
neighborhood,
the
alliances.
How
is
it
all
moving
through
and
how
is
that
system
assured
and
what's
the
system's
rule
where
a
particular
provider
might
be
struggling?
So
I
hope
that
helps.
D
Yeah
my
name's
nick
stulls,
I
represent
the
british
dental
association
and
I'm
a
dentist.
We've
been
talking
a
lot
about
provide
collaboration
reviews
over
the
last
couple
of
years,
and
I
think
we
accept
that
it's,
it's
probably
going
to
be
the
best
to
have
some
sort
of
cross
discipline
inspections
of
this
nature.
D
But
can
I
just
ask
you
about
fee
structure?
Primary
care.
Dentistry
has
always
been
self-funding.
It's
kind
of
been
ring,
fenced
the
profession
funds,
the
regulation
for
it.
If
we
now
start
to
look
at
pathways
that
cross
over
outside
dentistry,
it
might
be
worth
re
reviewing
how
the
whole
of
the
funding
system
is
going
to
be
approached,
because
I
see
that
as
being
a
problem,
there
hasn't
been
a
massive
amount
of
noise
in
the
dental
system
over
the
last
two
or
three
years
with
regard
to
funding
and
how
much
we're
paying.
A
Yeah
excellent
point
nick
and
something
that
is
very
alive
in
our
thinking
as
well
as
we
are
moving
into
the
integrated
care
systems
and
our
role
in
there.
I
don't
have
definitely
don't
have
the
answers
this
morning,
but
I
do
know
that.
How
is
this
funding?
How
is
this
recruit
recoup
to
enable
the
regulator
to
undertake
this
system
level
activity?
This
pathway,
person
centered
at
which
we're
looking
across
the
piece?
I
do
know
that
that's
something
that
we
are
considering
well
and
in
a
thorough
way
at
the
moment,
but
I
don't.
A
A
C
Yes,
thank
you
just
to
pick
up
on
nick's
point
with
regard
to
dentistry.
Of
course,
there
are
two
elements
to
this,
perhaps
worth
remembering:
there's
the
the
actual
delivery
for
the
dental
practice
and
cqc's
role
there,
but
there's
also
the
other
role
in
oral
health,
which
is
why
I
reckon
I
think
the
multidisciplinary
approach
is
an
excellent
one,
because,
obviously
in
care,
homes
and
other
establishments
the
cqc
regulates,
then
it's
really
important
that
we
have
that
input
as
well
and
the
people
getting
involved
understand
both
elements.
A
Excellent
you've
used
an
example
that
we've
even
turned
to
internally
there
oral
health
matters
and
it
might
be
the
gateway
to
what's
going
on
when
you're
on
the
mental
health,
ward
and
the
mental
health
teams
are
out
where's
your
room,
the
spot.
Thank
you,
malcolm
here.
That's
really
great
fatma.
How
are
you
doing
with
your
mute?
E
Hi
yeah
and
I
think
the
the
mdt
seems
to
be
a
really
good
way
forward
and
presumably
they'll
be
lead
professionals
for
different
aspects
of
the
system.
I'm
just
wondering
how
sometimes
there
may
be
unnoticed
or
in
potentially
inherent
conflicts
of
interest
within
an
mdt
with
people
trying
to
defend
their
bit
of
the
system,
because
they
understand
that
particularly
well
so
it'd
be
interesting
to
think
how
those
dynamics
are
worked
through
and
also
how
speedily
and
how
swiftly
cqc
might
be
able
to
to
step
in
to
sort
of
suggest.
E
Apparently,
some
gp
practices
have
never
heard
of
this
requirement
before
we
had
a
bit
of
an
interesting
discussion
last
week
with
one
of
them
you
know
there
are,
I
think
there
are.
There,
are
different
interest
groups
within
those
systems,
so
I
think
the
mdt
is
a
really
good
way
of
of
having
that
expertise.
But
how
will
those
almost
embedded
challenges
be
be
sort
of
you
know
if
they're
kind
of
played
out
within
the
mdt?
How
is
how
is
that
going
to
be
managed
and
resolved
is?
Is
an.
A
Excellent,
thank
you
and
we
can
definitely
take
that
one
away
and
and
into
our
design.
I
think
certainly
one
of
the
bennett
the
conflict
bit.
We
could,
we
think
about
the
benefit
of,
and
that
kind
of
flip
side
our
our
inspectors
will
maintain
the
sector
specialisms,
as
I
say,
but
from
coming
together.
One
of
the
ambitions
and
working
just
organically
in
a
team
together
is
that
they
develop
that
broader
understanding
from
being
in
a
team
together
where
they're
able
to
you
know
really
absorb
and
become
familiar
with.
A
Actually,
this
is
the
story
at
the
other
end
of
the
system,
and
this
is
and
be
thinking
to
that
when
they
might
be
interacting
with
one
particular
provider
or
sector
or
another,
and
and
really
able
to
kind
of
see
that
bigger
picture
as
well
and
explore.
So
you
know,
what's
the
support
like
from
the
system
and
are
you
you
know?
Are
you
getting
your
partnerships
here
here
here?
We
know
to
be
effective
rather
than
kind
of
being
head
head
down
within
the
sector
specialism.
So
so,
yes,
it
could
pose
a
conflict.
A
Equally,
it's
about
the
inspectors
really
absorbing
the
bigger
system.
Thinking
in
in
planning
and
approaches,
so
some
good
stuff
just
on
your
enforcement
point,
wouldn't
it
be
a
great
thing
if,
because
the
the
point
of
the
accelerated
improvement
and
safety
through
learning,
we
want
to
be
out
there,
sharing
that
innovation,
creativity,
really
good
stuff
for
people
to
learn
from,
and
actually,
if
that
resulted
in
no
enforcement
action
anywhere
in
the
country,
it
means
we're
doing
that
bit
really
well,
doesn't
it
if
we
are
part
of
the
accelerating
and
driving
improvements.
F
F
Afterwards,
it's
a
common
idea,
I'm
a
gp
from
birmingham
and
and
thank
you
so
much.
I
think
I
think
my
thoughts
are
that
a
system,
regulation
and
pathway
performance
is
really
welcome
and
and
and
long
overdue.
My
question
is
really
just
thinking
about
ratings.
How
would
how
is
there
is
there?
Are
there?
Are
there?
Is
there
a
conversation
happening
around
a
ratings
overhaul
in
when
you
are
looking
at
pathways
and
putting
in
the
the
system
context
within
that
rating?
F
So
if
I
could
give
an
example
within
where
I
work
in
birmingham,
we
have
161
gp
practices,
nobody
is
inadequate
within
general
practice
and
that's
been
the
case
for
three
years.
We
have
above
average
outstanding
and
above
average
good,
and
our
rise
is
about
2
out
of
161,
which
is
really
good,
but
in
terms
of
the
rest
of
the
providers
you
know,
our
biggest
trust
is
now
requires
improvement.
F
Mental
health
trust
is
right,
communities
are
right,
local
authority
is
inadequate,
so
we
are
operating
in
a
system
where
general
practice
is
working
within
a
system
where
it's
almost
falling
slightly
falling
apart
around
it.
How
would
that
have
a
bearing
in
terms
of
when
you're
looking
at
ratings
and
pathway?
A
But
how
are
you
playing
your
role
in
the
system
and
that
will
reflect
on
our
our
judgment
about
that
provider
at
the
provider
level?
Equally,
and
in
turn,
though,
which
is
the
really
important
point
isn't
it?
How
is
this
system?
You
know
we're
not
going
to
go
out
and,
for
example,
hypothetically
speaking
rate
and
integrated
care
system
as
outstanding,
where
there
is
a
whole
cluster
and
pocket
of
now,
there
will
always
be
potentially
some
some
elements
of
inadequate,
let's
say
a
load
of
care
homes.
A
Now
that
might
happen,
and
if
the
system
is
responding
and
has
its
assurance
mechanisms
in
place
to
wrap
their
arms
around
then
that's
actually,
you
know
a
signal
of
a
good
system
functioning.
Its
governance
is
working.
It
knows
where
its
hot
spots
are.
However,
if
we
were
to
repeatedly
see
this
system
is
not
responding
and
supporting
these
small
scale
providers
on
the
front
line
who
are
really
struggling
and
need
the
support,
then
that
will
impact
some.
A
So
the
point
of
what
I'm
saying
is-
and
we
don't
quite
know
what
it
will
look
like
yet,
but
we
do
know
that
we
will
be
looking
at
provider
level
to
how
are
you
contributing
to
the
system
and
that
system
level,
and
how
are
you
contributing
out
to
your
providers
and
who
need
that
support
and
so
yeah
it
would.
It
will
be
absolutely
a
two-pronged
approach.
G
No,
I
was
just
going
to
say:
we've
got
a
few
comments
in
the
chat,
so
I
don't
want
to
go
through
a
couple.
So
vanessa
was
saying
so,
while
you
say
they
have
sector
specific
experience,
how
specific
will
the
inspectors
be?
For
example,
I'm
from
a
hospice
and
our
inspectors
are
not
from
a
hospice
background
or
have
specific
hospice
knowledge.
A
A
I
get
my
words
out
portfolio,
so
that
is
the
teams
who
are
skilled,
equipped
and
knowledgeable
in
inpatient
outpatient
of
the
of
the
acute
and
community
and
mental
health
world.
Now,
that's
not
setting
stone
that
there
can't
be
any
changes
at
a
future
point
that
we're
really
challenging
ourselves
on
and
really
testing-
and
this
is
one
of
the
things
I'm
looking
at.
A
I'm
leading
the
organizational
design
of
the
future
is
actually
how
are
we
drawing
on
our
external
expertise
really
really
well
and
making
sure
that,
because
we
need
the
substantive
teams,
we
need
those
roles
inspectors
how
we're
using
our
external
colleagues
and
partners
who
who
are
not
just
experts
in
in
their
particular
field,
but
live
and
current
and
still
with
it
at
the
forefront.
And
so
we've
got
some
work
to
do.
We
know
we
have
on.
You
will
hear
us
talk
about
and
the
phrase
spars
our
specialist
familiar
term
to
you
all.
A
So
we
we
are
really
thinking
through
live.
Actually,
how
do
we
optimize
and
better
use
our
external
workforce
really
really
well
to
ensure
that
yeah
we've
got
the
process,
the
approach,
the
skill,
the
expertise
to
get
the
regulatory
side
done,
but
that
we've
got
the
right
experts
working
hand-in-hand
with
us.
So
I
think
the
hospice
sector
is
a
really
good
example.
Somebody
talked
earlier
about
independent
doctors
there's
another
one,
for
example,
so
we
know
where
they
are.
We
know
where
the
the
hot
spots
are
and
we
are
working
on.
G
You
next
time
well
just
conscious
of
time
so
I'll
go
to
this
one.
That's
had
a
few
thumbs
up
on
it.
Will
you
be
commenting
on
commissioning
decisions
if
there
are
delays
in
discharge
arrangements
not
caused
by
providers
but
no
sorry
not
caused
by
the
provider,
but
no
evidence
of
alternatives
commissioned
or
care
packages
commissioned.
A
I'd
love
to
say
an
absolute
100:
yes,
we're
still
awaiting
they're.
Quite
what
is
the
ask
and
the
final
detail
of
the
bill
for
cpc
in
terms
of
the
systems,
but
in
theory
absolutely
this.
You
know
we
know
from
some
of
our
thematic
activity,
for
example,
that
our
biggest
weight
and
clout
behind
us
is
being
able
to
talk
to
the
commissioning
arrangements
and
think
about
the.
A
I
hope
some
of
you
are
familiar
with
the
local
system
reviews
program
of
2018,
where
we
were
looking
at
care
and
for
those
ages
over
65,
moving
between
health
and
social
care.
Now
we
were
because
that
was
a
thematic.
You
know
slightly
different
powers,
which
I
want
derailers
here
with,
but
that
meant
that
we
could
talk
about
and
lever
findings
around
commissioning
as
well.
So
our
ambition
is
that
we
will
be
able
to
do
that.
A
Yeah,
okay,
thank
you.
Will
there
be
time
adjustments
to
allow
providers
to
adjust,
and
we
will
certainly
be
very,
very
clear
about
the
changes
that
we've
made
and
what
it
means
in
terms
of
our
internal
ways
of
working
in
terms
of
the
inspector
or
whomever
we
have
that
discussion
earlier
with
the
relationship
owner,
whoever
it
is
that
is
in
touch
and
in
contact,
they
will
still
be
and
always
forever
maintain
that
specialism
in
your
particular
service.
A
I
don't
know
which
one
which
sector
it's
about
and
so
we'll
be
able
to
keep
in
touch
with
keep
that
contact
alive
up
to
date
with
cqc's
approaches.
What
it
is
that
we
need
from
you
and
equally
what
it
is
that
we
can
support
with
in
in
the
system.
So
I'm
not
anticipating
that
there
should
be,
or
will
be,
a
huge
and
significant
different.
A
With
the
pandemic,
we
tried
to
ensure
we
were
doing
the
right
thing
to
support
systems
and
providers,
so
some
of
it
to
press
has
been
fast-paced,
but
in
terms
of
the
bigger
future,
some
of
what
we're
talking
about
today,
the
ways
of
working
and
indeed
the
regulatory
model,
which
I
think
you
talked
about
last
time
and
our
plans
there.
Then
I
think
that
that
will
be
introduced
and
rolled
out
in
a
way
that
that
is
best
fitting
of
providers.
A
D
A
Oh
that's
really
knocked
me
off.
I
haven't
seen
you
for
years
and
this
success
factor
there
for
the
provider.
Collaboration
reviews
was
absolutely
around
play.
This
back
to
the
system,
tell
them
where
the
pockets
are
of
excellent,
amazing
stuff
that
they
might
not
even
be
able
to
see
at
system
level
and
then
share
it
nationally.
Get
it
out
there.
Look
at
this.
Look
at
that
because
everywhere
is
under
pressure.
There
are
risks,
there
are
significant
risks
and
issues
for
children,
young
people's
mental
health.
At
the
moment
we
all
know
those,
but
the
flip
side
is.
A
H
A
Actually,
let's
go
and
ask
this
system.
What
are
you
doing
about
discharge
planning
here?
What's
going
on
what
what
you
know?
How
are
you
all
working
together?
How
are
you
using
the
entirety
of
the
sectors
and
the
partners
around
the
table
to
think
about
this
pressure?
Point
on
that
pressure
point
so
yeah
and,
in
short,
on
the
exact
ambition
here,
is
to
have
those
teams
together.
Thinking
about
the
place.
H
A
G
I
don't
think
so,
but
just
to
let
people
know
that
we'll
take
all
of
their
comments
from
the
chat
as
well
and
they'll
be
included
in
the
notes.
And
if
there
is
anything,
then
you
know
feel
free
to
follow
us
up
follow
up
with
us
on
email.
I
think
there's
some
comments
that
cross
over
to
our
systems
working
so
we'll
make
sure
that
if
there
is
anything,
that's
particularly
relevant
to
other
areas
of
our
work,
we'll
share
with
relevant
colleagues
as
well,
brilliant.
A
A
So
I
think
that's
all
there
is
to
say
other
than
an
enormous.
Thank
you
for
giving
us
your
time
this
morning.
I
certainly
feel
like
we've
had
a
really
valuable,
excellent
discussion.
So
I'm
really
grateful
to
you
all
for
taking
time
out
of
your
very
busy
days,
I'm
sure
so
with
that
in
mind,
I'll
close
us
for
today
and
hope
to
speak
to
you
all
soon.
Thank
you.