►
Description
Hear from Ted Baker, Chief Inspector of Hospitals as he discusses our transitional regulatory approach and the latest on our emerging strategy for 2021 and what this means for those working in NHS and independent healthcare services.
B
Good
morning,
everyone,
this
is
ted
baker,
chief
respect
of
hospitals
here
at
cqc,
and
thank
you
for
joining
our
webinar
this
morning
this
morning,
we're
going
to
update
you
on
our
transitional
regulatory
approach
and
our
strategy,
so
we're
looking
at
what
we're
doing
in
the
immediate
future,
but
also
our
plans
for
the
longer
term
future
over
the
next
five
years.
B
During
these
challenging
times,
the
cqc
has
been
using
what
we've
learned
during
the
kovid
pandemic
to
actually
inform
our
way
forward
and
I'll
be
explaining
that
as
we
go
through
and
try
to
explain,
explain
to
you
what
our
approach
is
going
to
be
and
give
you
the
chance
to
interact
with
us.
Ask
ask
us
some
questions
and
I
hope,
as
well,
get
involved
in
feeding
back
on
our
strategy
going
forward.
So
thank
you
again
for
joining
me.
I'm
joined
with
some
colleagues
from
the
cqc
and
steph.
B
Do
we
have
the
slides
up
on
the
screen?
Oh
yeah,
that's
great!
Thank
you
very
much
for
that.
So
I'll
be
talking
to
some
slides,
we'll
go
through
as
we
go
through
the
seminar
today,
I'm
joined
by
some
colleagues
from
the
cqc.
You
see
their
names
there.
They
may
well
answer
your
questions
on
the
chat
or
they
may
well
step
in
to
help
me
with
some
of
the
questions
when
we
get
to
the
question
and
answer
session.
So
thank
you
for
colleagues
regis
cqc
from
joining
me.
B
We
can't
hear
your
voices
on
this
on
this
session,
but
you
can
feedback
on
the
q
a
section
of
of
the
of
the
team's
chat.
So
please
do
feedback
and
ask
questions
I'll.
Stop
at
a
couple
of
points
during
the
sem
the
webinar
to
make
sure
this
opportunity
to
answer
some
of
your
questions.
We
may
not
be
able
to
answer
all
of
them,
but
all
of
them
will
take
note
of
and,
if
necessary,
we'll
feed
back
to
you
later.
Okay,
steph.
Can
we
have
the
next
slide
please?
B
So
what
are
we
going
to
cover
today?
Well,
we've
got
an
hour
and
we'll
finish
on
time
I'll
I
will
only
be
able
to
cover
some
of
the
headlines
about
our
transitional
approach
and
strategy.
The
detail
is
on
the
website
and
we'll
give
you
those
links
at
the
end
of
the
webinar.
B
If
you
need
to
follow
up
following
the
the
discussion,
but
we'll
be
talking
a
bit
about
the
timeline,
our
transitional
approach,
as
I
say,
our
future
strategy
and
the
way
forward
for
the
cqc
and,
as
I
say
at
the
end,
there'll
be
an
opportunity
for
you
for
us
to
explain
to
you
how
you
can
get
further
involved
next
slide,
please
steph,
okay,
so
a
lot
is
changing
at
the
moment,
but
one
thing
that
is
not
changing
is
our
underlying
purpose.
As
a
regulator,
we
still
have
the
fundamental
standards.
B
We
still
have
the
regulations
and
they
are
not
we're
not
anticipating
that
they
will
change,
and
so
our
purpose
as
a
regulator
stays
the
same.
We're
going
to
change
the
way
we
regulate
in
many
ways
and
I'll
explain
that
as
we
go
through,
but
our
underlying
purpose
stays
the
same.
Our
purpose
is
to
make
sure
that
services
provide
people
with
safe,
effective,
compassionate
high
quality
care
and
to
encourage
services
to
improve,
and
that
last
element
to
improve
is
an
important
part
of
our
strategy
going
forward
next
slide,
please.
B
So
why
are
we
changing?
Well,
I
suspect
I
don't
need
to
explain
this
to
you.
You
are
out
there
working
in
the
services
that
we
regulate
and
the
services
are
changing,
they're,
changing
in
response
to
new
technology,
new
approaches,
new
understanding
of
how
to
better
provide
services,
but
also
the
changing
needs
of
the
population
we
serve.
So
as
the
services
change,
we
need
to
change.
B
B
This
is
driving
our
purpose
and
particular
element
of
how
do
we
encourage
your
service
services
to
improve
as
a
core
element
of
what
we're
doing
so
we
need
to
learn
from
from
our
past
from
the
feedback
we've
had
from
you
and
from
the
experiences
we've
had
over
regulating
over
the
last
few
years
and
of
course,
technology
is
changing
and
we
need
to
adapt
and
respond
to
that.
So
there
are
lots
of
reasons
why
we
need
to
change
as
a
regulator
and
going
forward.
B
So
this
is
a
timeline
and
I'm
not
going
to
go
through
this
in
detail,
but
we're
halfway
through
a
change
process.
If
you
like
now
phase
three
there
in
the
center
of
the
slide-
and
it
is
the
transitional
approach
which
I'll
be
talking
to
you
to
you
about
in
the
mo
in
a
moment
as
we
go
through
winter,
we
will
be
launching
our
new
strategy
in
january
of
next
year
and
there'll
be
an
opportunity
for
a
formal
consultation
around
that
strategy
in
january.
B
B
But
in
a
sense
we
are
still
learning
because
covid
the
coveted
pandemic
has
been
such
a
big
challenge
to
all
of
us
to
you,
I'm
sure
it
has
affected
the
way
you
provide
services
enormously
and
has
created
enormous
pressures
for
you,
but
for
us,
as
a
secrecy,
as
a
regulator
has
been
a
big
challenge,
how
do
we
adapt
effectively
to
fulfill
our
purpose
during
a
pandemic?
And
what
can
we
learn
from
that
going
forward?
And
I
think
there'll
be
a
big
theme
of
that
as
we
go
through
the
slides
this
morning.
Next
slide,
please.
B
So,
first
of
all,
I'm
going
to
talk
about
our
transitional
regulatory
approach,
and
that
is
the
approach
we
are
using
now
and
the
approach
we'll
be
using
for
the
next
six
to
eight
months
or
so,
and
it's
a
transition
between
where
we
are
during
a
pandemic
and
regulating
during
a
pandemic
and
where
we
want
to
be
in
terms
of
our
new
strategy.
That's
why
we're
calling
it
the
transitional
approach
and
it's
transitional,
because
it
is
a
process
we
will
be
learning
and
it
will
be
developing
over
those
months
in
response
to
the
change
of
circumstances.
B
Externally,
but
also
in
response
to
how
we
we
learn
from
the
actually
applying
the
process
over
the
next
few
months.
So
for
us
it
is
a
very
much
an
iterative
process
going
forwards,
but
will
eventually
lead
to
our
future
regulatory
approach,
which
we'll
be
implementing
in
the
second
half
of
the
next
calendar
year
from
summer.
2021
next
slide,
please.
B
So
just
to
recap,
as
I
said,
the
the
covenant
pandemic
was
a
big
challenge
for
us,
as
it
was
for
you,
and
one
of
the
things
we
had
to
do
early
on
in
in
the
kobe
pandemic
is
adapt
our
approach
quite
rapidly
to
make
sure
we're
in
a
different
position
from
our
traditional
approach,
where
which
was
very
driven
by
large,
comprehensive
inspections
to
an
element
which
is
much
more
driven
by
monitoring
and
relationship
building,
backed
up
where
necessary,
with
inspections,
but
not
driven
centrally
by
inspections,
and
that
initially,
we
called
the
emergency
support
framework
that
was
put
together
by
colleagues
at
the
cqc
very
rapidly
in
the
spring
in
response
to
the
pandemic,
and
we
got
a
lot
of
very
positive
feedback
from
providers
about
it.
B
We
managed
to
support
verizon,
getting
ppe
and
also
providers
in
exploring
how
they
could
improve
their
infection
prevention
and
control
so
to
deal
with
some
of
the
real
risks
they
were
facing
in
the
face
of
the
kovic
pandemic,
but
it
also
allowed
us
to
assess
risk
and
to
make
decisions,
whether
we
as
a
regulator
needed
to
do
any
more.
The
fundamental
building
block
of
the
success
of
the
emergency
support
framework
was
having
open
and
honest
conversations
with
providers,
and
that
is
absolutely
fundamental.
B
So
we
as
a
regulator,
need
to
adapt
our
behavior
to
make
sure
that's
true,
but
also
we
challenge
providers
out
there
to
adapt
their
behavior
to
build
a
new,
stronger
relationship
with
that
with
us
as
a
regulator
going
forward
the
transitional
regulatory
approach
using
what
we
are
using
now
it
replaced
the
emergency
support
framework
and
built
on
what
we've
learned
from
the
emergency
support
framework.
Again,
it
is
built
very,
very
much
on
monitoring
and
a
structured
relationship
with
providers
backed
up
by
other
regulatory
activity
when
necessary.
B
Working
in
acute
trusts
with
emergency
departments
know
that
they
are
facing
enormous
pressures
at
the
moment
with
kovid
on
top
of
the
normal
winter
pressures,
and
we
saw
that
was
going
to
be
a
risk
going
into
winter,
and
we've
been
working
with
emergency
department,
clinicians
from
good
and
outstanding
emergency
departments
across
england
over
the
last
few
months
to
to
bring
together
the
best
resource
possible
for
emergency
departments
to
use
in
addressing
the
real
major
challenges
they
face
at
the
moment
and
going
into
winter
and
we've
caught
this
patient.
B
First,
it
was
published
two
or
three
weeks
ago.
It
was
very
well
received,
but
patient
first
is
a
resource
built
on
the
the
experience
of
the
best
services
in
dealing
with
the
pressures
that
emergency
departments
face,
and
we
want
to
use
that
in
a
constructive
and
supportive
way
with
providers
and
going
forward
we'll
be
focusing
on
the
areas.
The
five
areas
there
that
highlight
at
the
bottom
of
the
slide
in
terms
of
patient
first
flow
infection,
control,
reducing
media
tendencies,
staffing
and
treatment
those
areas
and
do
have
a
look
at
this
resource.
B
It
is
resource
for
the
whole
trust
and
it
is
a
resource
for
the
system
in
which
the
trust
works,
because
it
is
very
clear
that,
in
order
to
address
the
problems
of
persons
departments,
everyone
needs
to
work
together
and
that
kind
of
system
collaborative
working
again
is
a
real,
strong
theme
going
forward
in
our
regulatory
approach.
Next
slide:
please
don't
okay!
So
where
are
we
now?
B
We
want
it
to
be
effective
as
it
is,
but
we
want
it
to
become
more
effective
going
forward
so
that
we
can
mature
into
the
kind
of
regulator.
We
want
to
be
that
I'll
discuss
in
our
strategic
themes
later
on,
so
that's
going
on
now
and
that
will
continue
for
the
next
six
to
eight
months
until
we
we
roll
out
a
new
approach
following
the
the
consultation
on
our
strategy
in
january
next
slide.
Please.
B
But
it
will
be
different
from
the
comprehensive
inspections
that
were
the
main
elements
of
our
of
our
inspection
activity
before
these
will
be
targeted,
focused
inspections,
they're
targeted
and
focused,
because
we
want
to
focus
on
risk
but
they're
targeting
focus,
because
we
want
to
reduce
our
impact
on
the
ground
during
the
covered
pandemic.
And
we
recognize
that
inspections
are
an
extra
burden
for
trust
to
bear,
and
we
only
want
to
use
them
where
there
is
identified
risk,
because
that
is
what
we
we
need
to
do
to
fulfill
our
purpose.
B
If
we,
if,
if
we
use
the
transitional
monitoring
approach
effectively
and
if
we
build
a
strong
relationship
with
trusts,
then
that
will
lessen
the
need
for
us
to
do
targeted
and
focused
inspections.
But
when
we
identify
risk,
we
will
still
take
that
activity
next
slide.
Please.
B
So
the
monitoring
approach,
as
I
said
it's
built
on
the
emergency
support
framework
and
our
existing
key
lines
of
inquiry
in
the
initial
stages
at
the
moment,
we're
focusing
on
safety,
access
to
care
and
leadership.
Leadership,
of
course,
is
absolutely
key
in
this,
but
we're
particularly
at
risk
in
terms
of
things
like
infection,
prevention
and
control
and
as
I've
mentioned
in
the
emergency
departments,
for
instance,
issues
related
to
flow
and
emergency
departments,
so
we
will
be
focusing
on
those
risks.
B
B
We
all
we're
also
reviewing
the
information
we
get
from
other
sources,
and
one
of
the
things
we've
been
doing
over
the
last
couple
of
months
is
developing
what
we
call
provider
collaborator
collaboration
reviews.
Now
these
are
reviews
that
are
done
virtually
they
don't
they
don't
they
don't
involve
any
on-site
activity,
but
what
we're
doing
is
talking
to
providers
across
a
system
to
understand
how
they
are
collaborating
within
the
system.
B
The
initial
work
we
did
was
around
11
areas
in
england
across
england
to
look
at
how
providers
were
collaborating
around
clovit19
and
the
results
of
that
were
published
a
month
or
so
ago.
Currently
we
are,
we
are
working
with
systems
to
look
at
how
providers
are
collaborating
around
emergency,
urgent
and
emergency
care
so
again
focused
on
that
risk,
around
urgency,
emergence
care
and
understanding
what
drives
successful
provider
collaboration
in
those
in
those
areas
going
forward.
B
The
next
stage
we'll
be
looking
at
how
providers
collaborate
around
cancer
services
and
then
we'll
be
looking
probably
further
on
about
learning
disability
services.
So
we
want
to
look
at
particular
areas
and
look
at
how
providers
collaborate
in
those
areas.
This
of
course,
comes
back
to
our
strategic
theme
focusing
on
patients.
It's
focused
on
patients
how
patients
experience
care
within
systems
not
just
from
individual
providers.
So
it's
going
to
be
very
important
in
forming
our
way
forward
and
builds
on
the
work
we
did
on
local
system
reviews
a
couple
of
years
ago.
B
We're
also
looking
piloting
other
ways
of
gathering
information
both
from
people
using
services
and
from
providers,
and
so
we
will
be
piloting.
We
may
be
coming
to
individual
providers,
suggesting
we
run
a
pilot
to
understand
how
we
can
change
and
adapt
our
regulated
process
going
forward
now
coming
out
of
all
this,
there
will
be
risk
assessments
which
will
help
us
make
decisions
about
any
regulatory
intervention
such
as
inspections
we
need
to
undertake,
but
those
will
always
be
professionally
freshly
driven
by
our
professional
inspectors.
B
B
B
It's
tentative
for
the
time
being,
and
let's
be
clear
about
this,
we
will
only
move
as
fast
as
we
are
confident
that
we
can
assess
the
risks
effectively,
but
during
the
kobit
pandemic,
our
our
inspections
have
been
predominantly
driven
by
assessment
of
risk
and
where
we
fact
where
we
think
there
are
concerns
about
services.
Some
of
that
is
coming
from
our
monitoring
activity.
Some
of
it
is
coming
from
other
intelligence
and
one
of
the
really
positive
things
during
the
pandemic
is
we've
seen
an
increase
in
frontline
staff.
B
Raising
concerns
with
us
and
we've
seen
an
increase
in
patients
raising
concerns
with
us,
and
we
think
that
reflects
a
an
improvement
in
the
openness
of
the
system
and
we
welcome
it
and
we're
very
grateful
to
everyone
who
does
raise
concerns
directly
with
us,
because
that's
really
helpful
in
us
understanding
the
risks
in
the
system
and
making
sure
we're
focused
in
the
right
way.
What
we're
moving
away
from
is
the
frequency-based
rules
on
inspection
frequency.
B
I
I
say
we
won't
be
going
to
an
inspection
just
because
it's
due
we're
going
to
going
to
do
an
inspection,
because
it's
necessary
and
those
inspections
will
be
focused,
so
they
will
be
limited
in
their
scope,
focusing
on
where
we
believe
the
risk
is
next
slide.
Please
death.
So
what
about
ratings?
And
I
think
this
is
a
big
question
for
us.
It's
a
big
question
for
the
public
and
it's
a
big
question
for
providers.
B
So
the
majority
of
times
when
we're
doing
focused
inspections
under
the
transitional
methodology,
we
will
be
using
that
to
drive
regulatory
activity
rather
than
using
it
to
drive
ratings.
Occasionally
it
may
drive
changes
in
ratings,
and
so
so
I'm
not
saying
there'll
be
no
changes
in
ratings,
but
that
will
not
be
the
main
driver
behind
it,
but
we
need
to
understand
how
we
are
going
to
keep
our
ratings
up
to
date.
You
want
our
ratings
to
be
up
to
date
and
the
public
wants
our
ratings
to
be
up
to
date.
B
So
we
need
to
make
sure
we
can
do
that
and,
of
course,
covid
because
of
the
hiatus
it's
created
in
rating
inspections
is
a
concern
in
that
regard
and
we'll
be
bringing
forward
plans
to
make
sure
our
ratings
are
up
to
date
as
soon
as
we
possibly
can,
and
we
want
to
deliver
that
as
early
as
possible
in
2021
as
we
can,
but
those
plans
are
will
be
coming
out.
I
think
in
the
relatively
near
future,
but
they're
not
yet
part
of
our
transitional
methodology.
B
Next
slide,
please,
which
I
think
is
the
question
slide.
Is
it
not
okay?
So
everyone,
thank
you
very
much
for
listening.
That's
20
minutes
of
information
for
you.
I
hope
it
all
makes
sense.
What
I'd
be
keen
to
understand
is,
do
you
have
any
concerns
or
questions
about
the
transitional
approach?
So
it's
open
to
you
for
questions
in
the
q,
a
session
we'll
try
and
answer
them
as
best.
B
We
can
we'll
just
take
five
to
ten
minutes
on
this
and
then
we'll
move
on
to
discussing
our
forward-looking
strategy
so
over
to
you
any
questions.
So
sarah
are
you.
Are
you
fielding
the
questions
for
me.
A
Yeah,
so
we've
got
a
few
that
have
come
in
one
around.
I
think
you
touched
on
that
and
we
won't
be
re-rating,
but
there's
a
comment.
That's
had
quite
a
few
likes,
so
probably
resonates
with
a
few
people
that
their
relationship
owner
has
told
them
that
their
rating
can't
change
without
a
full,
comprehensive
inspection,
but
that
their
intelligence
suggests
that
they've
improved
in
many
areas
since
their
last
inspection.
B
Well,
thank
you
for
the
question
and
thank
you
for
the
likes.
The
question.
I
think
it's
a
really
important
question
and
it
is
really
at
the
forefront
of
my
mind.
Of
course,
we
as
a
regulator
have
to
address
risk,
but
equally
we
want
to
demonstrate
the
improvements
that
people
have
worked
so
hard
to
deliver
and
I
think
that's
really
important,
so
I'm
very
keen
that
we
develop
a
way
forward.
That
does
not
require
a
full,
comprehensive
inspection,
because
what
people
have
been
told
is
entirely
right
at
the
moment.
B
Under
our
current
methodology,
ratings
require
a
comprehensive
inspection,
but
but
it
is
not
realistic
to
think
we
could
do
that
during
the
curving
pandemic.
I
mean
clearly
the
risks
of
that
would
be
to
the
service
and
to
to
to
staff,
and
people
using
the
service
would
be
too
great,
but
also
the
burden
would
be
too
great.
But
equally,
there
is
a
real
need
for
us
to
demonstrate.
Our
ratings
are
up
to
date
and
to
demonstrate
the
improvement.
B
You've
been
talking
about
there
and
we
are
really
focused
on
how
we
can
drive
that
forward
as
soon
as
possible
in
the
new
year,
and
we
will
certainly
be
producing
plans
for
that
that
soon
it
means
that
we
may
have
to
start
thinking
of
a
different
approach
to
ratings,
going
forward
as
I'll
talk
about
in
our
strategy.
In
a
few
minutes
time,
our
vision
long
term
is
for
a
very
different
approach
to
ratings.
B
So
in
a
sense
we
want
to
build
a
bridge
between
where
we
are
now
and
our
long-term
vision
and
we're
keen
to
undo
that
in
a
way
that
keeps
our
ratings
robust
and
rigorous
and
credible,
but
at
the
same
time
enables
us
to
deliver
them
in
a
more
frequent
basis.
So
we
are
very
much
focused
on
that
at
the
moment
and
we'll
provide
guidance
on
that
as
soon
as
we
can
any
more
questions.
Sarah.
A
Yep
so
one
question
around
and
without
a
frequency
rule
around
inspections
and
monitoring,
this
could
open
a
large
volume
of
monitoring
checks.
How
will
these
be
managed
to
avoid
trust
being
overwhelmed.
B
Well,
I
think
it
is
important
that
we
do
have
a
regular
interaction
with
trusts
and
other
providers,
so
so
that
means
regular
phone
calls
or
video
calls
such
as
this
occasional
visits
as
well,
but
but
but
we
don't
want
those
to
be
onerous
or
burdensome.
B
What
we're
looking
for
is
that
relationship
to
be
a
supportive
relationship
I'll
come
back
to
the
improvement
issue
in
our
strategy
in
a
few
minutes
time,
so
we
hope-
and
we
want
people
to
welcome
that
interaction
rather
than
see
it
as
a
burden,
but
of
course,
for
us
it's
doing
two
things.
It's
one
helping
us
support
trusts
and
help
them
help
them
find
improvement
going
forward,
but
also,
I
hope,
give
us
the
good
confidence
that
those
trusts
are
managing
their
risk,
their
risks.
B
Well,
it's
that
open,
honest
discussion
that
we're
really
looking
for
and
those
trusts
that
do
this
well
with
us,
I
think,
have
got
real
benefits
from
it.
It
is
about
us
understanding
the
risks
through
the
eyes
of
the
provider
and
become
getting
confidence
that
they
are
managing
those
risks
effectively.
That
gives
us
confidence
that
we,
as
regulators,
don't
have
to
intervene.
I
think
those
providers-
and
there
are
still
many
out
there-
who
try
and
keep
the
regulator
at
arm's
length
as
much
as
possible,
are
the
ones
that
give
us
the
most
concern.
B
A
B
Yeah,
okay,
the
the
the
the
the
questions
we'll
be
asking
during
the
monitoring
process
are
on
our
website
and
we'll
give
you
that
link
towards
the
end.
So
in
a
sense
we
want
to
be
as
transparent
as
possible
about
understanding.
B
What's
going
on
we're
not
looking
to
produce
risk
assessments,
I
don't
if
those
of
you
who've
been
around
a
few
years,
will
remember
intelligent
monitoring,
which
was
something
that
was
rolled
out
in
2014
for
for
two
or
three
years,
and
we
produced
scores,
risk
scores
for
trusts
and
people
before
that
may
even
remember
the
quality
risk
profiles
that
came
back
before.
I
remember
those
as
well,
when
I
was
in
a
trust
that
we
don't
want
to
produce
risk
scores
that
then
become
a
kind
of
surrogate
rating.
B
We
want
to
see
risk
as
much
more
dynamic
process
from
day
to
day
and
those
discussions
with
you
will
be
about
risk
and
about
how
you
see
the
risk,
but
also
about
how
we
understand
the
risks.
Those
discussions
will
be
opportunities
for
us
to
share
our
assessment
with
you,
but
for
you
to
share
your
assessment
with
us.
A
Thank
you
and
then
a
question:
how?
How
are
we
ensuring
that
we
don't
compromise
our
role
as
the
independent
regulator
in
providing
support?
Well.
B
B
Our
support
can
be
helping
you
find
other
people
who
can
give
you
the
advice,
we're
coming
in
to
our
strategic
themes
in
a
minute,
and
one
of
them
is
improve
and
we've
had
really
focused
discussions
and
how
we
can
drive
improvement
better
without
becoming
the
improvement
agency,
and
there
is
a
real
conflict
between
a
regulator
being
a
regulator
making
judgments
about
services
and
giving
them
direct
advice
about
how
to
improve,
and
we
must
be
very
careful.
We
don't
get
on
the
wrong
side
of
that
of
that
conflict.
B
So
that
that's
a
very
important
point
and
it's-
and
I
think
it's
important
people
often
will
say
to
us
look.
You
know
you
spend
your
time
telling
people
they've
got
problems,
but
you
never
tell
them
how
to
sort
them
out
and
that's
true-
and
that
is
true,
and
because
there
is
an
intrinsic
conflict
between
us,
giving
people
the
answers,
we're
here
to
ask
the
questions
and
make
the
challenges.
B
A
B
A
B
Site
inspections-
oh
I
see.
Oh,
I
see,
okay,
fine!
So
when
we
when,
in
a
few
minutes
time
I'll
be
talking
about
smart
regulation
and
smart
regulation,
is
understanding
the
risks
in
systems
and
one
of
the
things
that
we
are
challenging
ourselves
to
do
is
understand
culture
much
better
yeah,
for
instance,
I
was
talking
to
henrietta
hughes,
the
national
freedoms
pick-up
guardian
last
week
and
she's
produced
an
assessment
of
freedom,
speak
up
scores
across
all
trusts
in
the
country,
and
that
is
a
measure
of
the
speak
up
culture
in
those
trusts.
B
Well,
freedom
speak
up
is
so
central
to
a
healthy
culture
and
organization.
That
may
be
a
very
important
measure.
We
will
certainly
test
it
out
other
issues
such
as
the
staff
survey,
such
as
the
res
schools,
for
instance,
and
we
know
that
the
rescores
are
a
strong
reflection
of
the
cultural
organizations.
So
there
are
lots
of
aspects
of
culture
that
we
can
look
at
to
make
sure
the
trusts
have
got
the
right
culture,
but
I
suppose
one
of
the
things
I
would
like
to
say
to
trustees.
What
are
you
doing
to
assess
your
culture?
B
What
have
you
done
to
assess
your
culture
and
what
confidence
do
you
have
that
you
have
the
right,
open,
honest,
transparent
culture
in
your
organization?
Can
you
demonstrate
to
us
you've
found
that
out
and
you
can
demonstrate
that
to
us,
because
again,
this
is
a
a
conversation
where
we
want
to
challenge
trust,
because
sometimes
they're
going
to
have
better
ideas
how
to
follow
this
up
than
we
do.
But
we
want
to
challenge
them
to
explore
those
ideas.
A
Thanks
ted-
and
I
think
probably
a
final
question
for
for
this
section-
it
looks
like
we've
got
a
few
hospices
on
the
webinar,
which
is
great
and
there's
a
few
questions
around
kind
of
pointing
out
that
they
are
a
lot
of
them.
Are
charitably
driven
and
charitably
funded
and
as
a
charity,
their
inspection
status
can
have
an
impact
on
their
ability
to
fundraise,
which
is
vital
at
this
time.
A
So
some
of
them
saying
that
they've
been
through
significant
transformational
change,
which
might
change
their
rating
and
other
questions
around.
How
the
transitional
approach
and
the
change
to
how
we
manage
and
monitor
kind
of
balance
with
balances
with
their
needs
to
to
fundraise
and
how
they're
waiting
for
I'm
sure.
B
There'll,
be
lots
of
reasons:
hospices,
you're,
talking
about
fundraising,
there'll,
be
other
providers.
We
have
that
have
got
you
know
business
interests
in
their
rating.
There
are
others
who
who
feel
it.
It
affects
their
external
reputation.
Now
we
are
very
conscious
of
that.
We
realize
how
important
ratings
are
as
an
organization.
You
know,
and
I
think
we're
as
frustrated
as
anyone
that
covid
has
kind
of
really
got
in
the
way
of
doing
that
as
we
go
forward,
we
want
to
produce
much
more
up-to-date
ratings
and
I'll
come
back
to
that
under
the
strategy.
B
In
a
few
minutes
time,
and
as
I've
said
to
you
already,
I
think
we
recognize
the
issue.
We
are
very
focused
on
it
in
terms
of
what
we
can
do.
It
is
important
going
forward
that
we
can
get
people's
ratings
as
up
to
date
as
possible,
and
we're
very
mindful
of
that.
It's
not
going
to
be
easy,
though,
because
during
a
coveted
pandemic,
we
cannot
do
big,
comprehensive
inspections
that
that
would,
I
think,
be
unreasonable
in
the
light
of
the
pressures
on
the
service
and
the
risks
that
would
entail.
B
But
we
need
to
find
another
way
of
providing
reliable,
rigorous,
credible
ratings,
and
we
are.
We
are
focusing
on
that
at
the
moment.
So
so
we
are
very
much
focusing
on
that
going
forward
and
we'll
come
forward
with
plans
for
that
going
forward.
What
we
don't
want
to
do
is
in
any
way
undermine
the
the
value
of
the
ratings
by
not
keeping
those
rigorous
as
they
have
been
in
the
past.
So
we
want
to
make
sure
that
future
ratings
are
as
valuable
as
past
ratings.
B
A
Great
thanks
ted,
so
we
do
have
more
questions,
but
I
think
if
you
want
to
move
on
to
the
next
part
of
the
presentation
and
we've
got
a
bit
more
time
at
the
end
for
questions.
B
And
I
do
think
I
ought
to
move
on
so
so
we
will
have
time
at
the
end
for
more
questions.
Everyone-
and
I
know
this
question-
is
really
good.
So
thank
you
for
them
and
thank
you
for
your
thoughts
there.
So
the
strategy.
So
as
I
say
that
draft
strategy
was
released
in
november
sorry
september,
end
of
september.
It's
there
available.
B
B
So,
as
I've
said
already,
we
are
changing
because
the
world
is
changing
and
we
have
learned
a
lot
in
the
last
few
years,
both
from
our
regulatory
activity,
but
also
for
our
interaction
with
different
parts
of
the
system.
So
we
recognize
that
in
order
to
stay
relevant
and
to
drive
that
purpose
forward,
we
need
to
change,
and
that
is
what's
behind
our
new
strategy
next
slide,
please.
B
So
our
strategy
has
four
themes:
they're
there
at
the
top
people,
smart,
safe
and
improved
now
they'll
probably
have
different
slightly
different
titles.
By
the
time
the
final
strategy
comes
out.
Those
are
just
the
short
titles
at
the
moment.
The
first
one
on
this
slide
is
people,
and
a
couple
of
points
I
want
to
make
is
that
that
we
really
feel
that
we
need
to
make
people
using
services
at
the
real
center
of
our
strategy
going
forward
and
there's
several
aspects
to
that
which
really
important.
B
We
need
to
be
better
at
listening
to
people
listening
to
their
views
and
look
and
looking
at
services
through
their
eyes
and
remember.
We
rate
services
and
report
on
services
for
the
benefit
of
people
using
services
and
that's
really
important,
and
we
need
to
keep
that
really
central
to
what
we
talk
about.
B
So
we
want
to
have
a
look
at
services
through
the
eyes
of
people
looking
at
pathways
of
care
and
how
the
system
serves
people
as
much
as
how
individual
providers
provide
quality
of
care
once
people
are
inside
the
the
providers
space
so
so
seeing
things
through
people's
eyes
means,
I
think,
a
more
system
view
of
people's
experience
of
care
and
that's
going
to
have
to
inform
how
we
go
forward.
I've
touched
on
that
already
in
our
transitional
approach
and
we'll
be
driving
that
forward
more
going
forward.
B
Another
important
aspect
is
that
the
people
from
different
parts
of
society
and
from
different
backgrounds
experience
care
in
different
ways,
and
so
we
want
to.
We
want
to
be
more
vocal
in
assessing
people's
experience
of
inequalities
in
care,
and
I
think
it
is
increasingly
clear
that
you
cannot
have
high
quality
care
if
you
are
not
tackling
inequalities
of
care,
to
make
sure
that
everyone
has
the
best
chance
of
accessing
the
care
they
need
and
has
the
best
chance
of
the
best
outcome
for
them
as
an
individual.
B
So
we
will
be
building
inequalities
of
care
and
how
providers
and
systems
assess
those
and
manage
those
how
they
focus
on
the
care
of
their
individual
population
and
the
needs
of
their
population
to
be
much
more
central
in
our
assessments
going
forward.
There'll
be
other
aspects
of
this
too.
As
I
say
we
we
will
be.
We
want
to
up-to-date
our
ratings,
so
they're
more
frequent,
because
people
have
told
us
they
want
to
know
what
the
quality
of
services
providers
is
now
not
what
it
was
several
months
or
several
years
ago.
B
They
want
to
know
what
it
is
now,
so
we
need
to
make
sure
our
ratings
are
up
to
date
and
also
our
reports,
I
think,
have
often
felt
as
though
they're
driven
by
the
needs
of
us
as
a
regulator
or
you
as
a
provider
rather
than
by
the
needs
of
people
who
are
looking
at
services
and
wanting
to
make
judgments
about
which
services
they
access.
So
what
our
reports
become
much
more
if
you
like,
targeted
on
people
who
use
services
rather
than
the
professionals
who
provide
them,
so
the
reports
are
probably
going
to
change.
B
They
probably
won't
be
documents
so
much
as
web
based
reports
and
they'll
probably
be
more
summary.
Reports
are
highlighting
the
aspects
of
care
from
people's
perspectives,
so
they'll
be
backed
up
by
all
the
detailed
evidence,
but
the
evidence
will
not
be
there
in
the
detailed
report.
Next
slide.
Please
so
next
next
would
occur
is
what
we
call
smart,
which
means
smart
regulation.
I
suppose,
and
what
we're
saying
here
is
how
do
we
become
a
modern
regulator?
B
We've
had
a
very
paper
driven
system.
Up
to
now,
we
of
course
need
to
digitize
our
systems
and
one
of
the
things
we've
been
doing
with
the
immersion
support
framework
and
our
transitional
regulator
approach
is
to
build
that
on
a
digital
platform
rather
than
the
paper-based
platform,
and
going
forward
we're
going
to
build
on
that
digital
platform,
so
we'll
become
a
very
digitally
based
that
helps
in
many
ways
one
it
helps
internally
within
our
with
our
system
to
to
drive
productivity
and
consistency
between
the
system.
B
We
recognize
that
our
data
requests
to
provide
us
often
very
burdensome,
we've
heard
this
and
we
we
we
want
to
reduce
our
data
request
to
provide
us
to
only
ask
for
data
from
fridays
where
it's
absolutely
necessary.
Ideally,
we
should
be
accessing
all
our
data
from
externally
available
sources
from
national
data
sets,
etc
and
where
those
native
sets
don't
exist,
we
need
to
be
making
this
making
the
case
for
those
data
sets
to
be
established.
B
One
of
the
things
that's
been
good
during
covert
is
there's
been
much
more
transparency
of
data
at
a
national
level
with
the
different
arms
and
bodies
sharing
data,
much
more
freely
than
perhaps
I
have
in
the
past.
That's
something
we
want
to
build
on.
We
want
to
make
that
positive
going
forward.
One
of
the
things
we've
discussed
with
some
providers,
which
again
we
want
to
build
on,
is
since
providers
look
at
the
data
internally
within
their
organization.
B
Can
we
access
that
data
correctly
directly
by
accessing
their
data
systems,
rather
than
having
to
go
through
a
transitional
transactional
approach?
Where
we
ask
them
to
write
data,
they
have
to
fill
out
a
spreadsheet
and
send
it
to
us.
Why
can
we
not
look
straight
at
their
data
as
a
regulator,
so
we
can
see
what
you
can
see
and
we
can
understand
the
characters
you're
facing
for
your
perspective,
but
also
see
how
you're
addressing
them
and
again
that
will
drive.
I
think
a
much
better
discussion
between
you
and
us.
B
The
the
other
aspect
of
smart
is
this
issue
about
ratings
and
assessments.
We
want
to
make
these
ratings
and
assessments
much
more
up-to-date
and
we're
kind
of
using
the
shorthand
of
how
do
we
create
real-time
ratings?
Now
they'll
never
be
truly
real-time,
but
how
can
we
make
sure
the
ratings
are
never
more
than
a
few
months
old?
Now
that
cannot
be
by
driving
ratings
by
comprehensive
inspections.
It
has
to
be
by
a
different
approach
and
we
are
actively
exploring
that
approach.
B
As
I
say
in
the
short
term,
it's
trying
to
meet
some
of
your
expectations
for
early
refreshment
of
your
ratings,
which
we're
keen
about,
but
also
in
the
long
term,
going
forward,
so
so
that
we
will
be
going
through
a
system
whereby
rate
people's
ratings
will
be
current
all
the
time,
and
I
think
that's
really
going
to
be
important
going
forward.
So
we
want
to
become
a
smarter
regulator
and
that's
one
of
our
central
themes.
Next
slide,
please
safety!
B
Now
safety
is
one
of
these
aspects
that
that
we
haven't
really
cracked
and
I've
said
publicly
that
I
don't
think
we've
turned
the
corner
on
safety
in
the
way
we
should
have
done,
and
that's
it's
not
a
criticism
of
anyone.
It's
just
a
recognition
that
we
haven't
got
ourselves
into
the
position
where
we
really
are
approaching
safety
in
the
right
way
and
we,
as
a
regulator,
explored
safety.
18
months
ago
we
published
a
report
on
never
events,
and
the
key
finding
of
that
report
is
that,
if
we're
gonna,
we're
gonna
reduce
adverse
incidents.
B
Excuse
me
in
terms
of
never
events.
We
first
of
all
have
to
address
the
safety
culture.
It's
not
a
process
driven
thing
process
only
works
if
the
culture
is
right
and
so
going
forward
in
terms
of
safety,
we
want
to
be
part
of
driving
the
best
possible
safety
culture
across
the
whole
system
across
providers.
B
That
is
a
real
challenge
and
I
don't
think
it's
going
to
be
easy,
but
unless
we
are
pushing
towards
it,
we'll
never
get
there,
and
so
we
want
to
get
people
on
our
side.
We
want
to
build
a
coalition
of
safety
focusing
on
safety
culture,
accepting
the
fact
that
errors
do
occur.
Of
course
they
occur.
The
avoidable
harm
is
bound
to
occur,
but
while
it
is
inevitable,
we
should
never
get
into
the
position
where
we
are
behaving
as
though
it's
acceptable.
B
Some
of
it
is
about
expertise
on
safety,
and
I
suppose
that
one
of
the
problems
we
have
is
that
safety
expertise
often
assumes,
but
we
don't
have
a
real
sense
about
what
safety
expertise
is
as
other
safety
driven
industries
do.
So
what
we
want
to
do
is
encourage
a
much
stronger
focus
on
safety
expertise
both
within
providers
but
also
within
ourselves,
the
cqc,
because
we
recognize
we
have
a
lot
to
learn
as
well.
B
We
also
want
to
involve
patients
and
service
users
in
safety
much
more
actively,
not
just
you
know
if
they
make
a
complaint
or,
if
there's
a
serious
incident,
but
how
can
we
make
them
real
partners
in
safety,
so
they're,
not
passive
recipients
of
safety,
but
active
partners
in
safety?
So
it's
a
big
change
in
culture,
we're
looking
for
in
terms
of
safety,
and
we
want
to
be
part
of
that.
We
know
we
can't
do
it
by
ourselves.
We
need
a
coalition
of
partners
to
drive
this
through.
I
hope
you'll
join
us
on
that.
B
So
the
final
issue
is
improved.
We've
touched
on
this
already,
as
we've
been
talking
through
these
slides,
and
we
recognize
and
lots
of
providers
have
said
this
to
us.
You
tell
us
what's
wrong,
but
you
don't
tell
us
how
to
address
the
problem.
We
work
very
closely,
of
course,
with
other
bodies
such
as
nhs
improvement
to
help
people
get
the
support
they
need.
We
want
to
make
that
much
more
active,
going
forward,
and
not
just
within
ahs
providers
and
across
all
providers
in
health
and
social
care,
in
the
nhs
and
in
independent
services.
B
So
we
want
to
make
sure
that
all
providers
can
access
the
improvement
support
they
need
so
that
when
we
come
in
and
find
a
risk
and
ask
you
to
address
it,
we
can
follow
that
up
with
saying.
But
this
is
the
improvement
support
that
is
available
to
you
and
we,
as
a
regulator,
are
making
sure
we're
on
your
side
to
make
sure
that
improvement
support
is
readily
available
when
it's
needed,
so
people
can
drive
improvements.
We're
talking
about
this
in
terms
of
an
improvement
alliance
and
improvement
alliance.
B
Now
that
is
never
going
to
be
the
cqc,
giving
you
the
answers.
It's
going
to
the
cpc
helping
you
find
the
answers,
and
that
is
the
fundamental
difference.
We
are
a
regulator.
We
can't
step
over
into
being
an
improvement
agency,
but
we
recognize
there
is
need
for
a
really
strong
improvement
side
across
all
health
and
social
care
providers,
and
we
are
committed
to
to
working
with
others
to
make
sure
it
is
available,
and
we
are
actively
looking
for
partners
to
work
with
us
in
this
regard.
B
So
that's
improvement
next
slide,
please.
So
that
is
where
we
are
now.
We
are
consulting
on
our
strategy,
giving
you
some
headlines
from
that.
Please
do
look
at
the
whole
document.
We
are
developing
our
transitional
approach
and
we're
building
up
to
the
strat
the
formal
consultation
on
strategy
in
january
of
next
year.
B
As
we
go
forward
with
the
transitional
approach,
there
will
be
iterations,
it
will
change
over
the
next
few
months.
It
is
not
fixed
in
stone.
Now
we
recognize
it
needs
to
change.
We've
talked
about
the
ratings
being
an
important
area
that
we
still
need
to
explore
and
we
recognize
that
we're
also
going
to
learn
during
the
as
we
develop
the
transitional
approach,
because
that
learning
will
help
inform
how
we
implement
our
strategy
going
forward
from
next
summer
onwards.
B
Next
slide,
please
so
the
future,
as
I
say,
consultation,
will
begin
next
next
january.
Now
everything
is
not
going
to
change
overnight.
It
is.
It
is
actually
surprising
how
the
pandemic
has
meant.
A
lot
has
changed
very
quickly
and
I
think,
we've
all
surprised
ourselves.
I've
certainly
seen
some
services
that
have
really
changed
the
way
they
provide
care
quite
dramatically
quite
quickly.
In
response
to
the
pandemics.
There's
been
a
lot
of
really
good
work
in
response
to
the
pandemic.
We've
changed
the
way
we
operate
in
response
to
the
pandemic
again
very
quickly.
B
I've
surprised
ourselves
in
that
regard,
but
a
strategy
is
a
long-term
aim.
We
will
not
deliver
this
all
overnight,
but
we
want
to
make
sure
that
as
we
go
forward,
we
have
really
strong
implementation
plans
and
strong
partnerships
in
place
to
deliver
our
strategy
over
the
next
five
years
or
so
next
slide.
Please,
which
I
think
is
the
questions
again:
okay,
right,
fine,
so
that
is
all
the
slides
I'm
going
to
talk
to
in
terms
of
our
transitional
approach
and
strategy.
So
back
over
to
you
to
ask
any
questions
or
make
any
comments.
A
Yes,
thanks
ted,
so
just
to
start
by
saying
that
we've
had
lots
of
comments
and
lots
of
questions.
So
if
we
don't
get
to
all
of
them,
which
we
might
not
do
and
just
to
be
assured
that
we're
taking
everything
in
and
we're
feeding
it
into
our
teams
to
inform
how
we
develop
the
strategy.
A
So
your
points
will
be
they
are
being
logged
and
looked
at
so
a
a
question
around
the
improvement
alliance
and
whether
you
could
provide
any
further
insight
into
how
that
type
of
support
could
work
and
what
we
might
think
of
that.
I
think,
particularly
in
the
context
of
maybe
nhs
and
independent
health
providers.
A
B
B
What
we
want
to
do
is
to
work
with
other
third
parties,
be
nhs
improvement.
Of
course,
lgs
improvement
is
going
to
be
central
to
this,
but
perhaps
other
third
parties
as
well
such
as
independent
bodies
such
as
different
trusts.
So
I
mean
one
of
the
really
positive
things
have
come
out
of.
Some
of
our
reports
is
where
we've
found
really
good
practice
in
one
trust.
They've
become
really
helpful
in
supporting
other
trusts,
follow
up
and
learn
from
them,
and
we
want
to
do
more
of
that.
B
So
what
we
want
to
do
is
by
identifying
the
issues
we
want
to
work
with
these
other
providers
to
help
them
find
their
solutions,
and
so,
when
we
find
an
issue
in
our
trust,
say
it's
a
cultural
issue,
we're
talking
about
culture
and
cultures.
It
is
so
important
in
driving
quality.
If
a
trust
has
a
problem
with
a
cultural
issue,
we'll
say
well,
actually
we
know
an
organization
that
has
done
a
lot
of
work
successfully.
Trust
to
address
this.
B
Let
me
put
you
in
touch
with
them,
or
we
know
a
trust
that
has
addressed
a
similar
issue
successfully.
Why
do
you
want
to
be
put
in
touch
with
them?
I
suppose
it's
that
kind
of
alliance
so
that
we
know
the
good
work
going
out
there.
We
know
what
is
available
and
we
can
help
people
find
it
that
is
going
to
be.
I
think
what
we
want
to
do,
and
so
driving
quality
is
not
going
to
be
so.
Driving
improvement
is
not
going
to
be
just
purely
by
us
doing
things.
B
It
is
by
us
finding
the
help
out
there
and
we
are
actively
looking
for
partners
and
be
they
other
providers,
be
their
third
party
organizations,
and
this
is
not
just
in
the
nhs.
I
should
say
it
is
in
independent
health
care
as
well.
So
we
are
very
keen
to
find
improvement
third-partism
and
supports
across
the
whole
health
and
social
care
system.
In
the
truth,
the
nhs
trusts
have
had
energious
improvement
for
a
while.
Now
we
can
build
on
that.
A
Thanks
ted,
a
few
comments
and
questions
around
the
kind
of
information
and
data
sharing
and
the
data
that
we
might
use
ourselves
so
particularly
independent
healthcare
providers,
don't
submit
to
several
data
sets,
for
example,
national
audits
and
some
of
them
is
set
up
for
some
of
the
national
data.
A
Sets
are
set
up
for
large
nhs
trusts
and
aren't
appropriate
for
or
accessible
necessarily
for
small
independent
healthcare,
and
so
what,
when
it
comes
to
independent
providers
or
those
smaller
providers,
what
digital
data
will
be
used
and
how
will
the
approach
be
adapted
for
for
some
of
the
smaller
providers,
so
that
providers
aren't
at
a
disadvantage.
B
Yeah
a
good
point-
and
I
think
we
are
being
we've
already
been
for
for
a
while
now
strong-
advocate-
that
these
data
sets
should
be
available
to
all
to
to
enter
data
into
not
not
kind
of.
B
If
you
like,
kept
for
a
privileged
few,
so
things
like
the
nhs
national
audits,
we've
been
encouraging
independent
health
care,
but
also
the
national
audits
themselves
to
to
come
together
so
that
you
know
the
nhs
orders
can
include
independent
healthcare
and
remember
a
lot
of
independent
hospitals
are
treating
nhs
patients-
it's
not
as
though
they're
from
outside
the
nhs.
So
a
kind
of
real
sense
of
we've
all
got
to
work
on
this
together,
because
this
is
everyone's
interest
to
make.
These
data
sets
really
effective
in
understanding
risk.
B
I
think
for
those
sectors
that
don't
have
established
data
sets,
then
we
want
to
work
with
them
to
how
those
data
sets
can
be
established.
How
can
you
know
this
sector
make
sure
it's
got
the
data,
it's
necessary
to
assess
risk,
and
this
is
a
dynamic
process.
We
learn
about
it
over
time,
but
we
want
to
engage
in
that.
So
it's
not
a
matter
of
penalizing
people.
What
we
want
to
do
is
go
to
say
a
sector
and
say
you
know
you
don't
really
have
any
good
data
national
data
sets.
B
B
So
we
want
to
become-
and
this
ties
in,
of
course,
to
the
the
improvement
side,
we
want
to
become
an
enabler,
a
supporter,
a
facilitator
of
people,
getting
the
right
data
and,
of
course,
that
data
is
a
valuable
to
them,
most
importantly
valuable
to
them.
It
also
helps
us
understand.
What's
going
on,
so
I
I
totally
accept.
There
are
sectors
across
across
health
and
social
care
that
do
not
have
much
in
the
way
of
national
data,
and
that,
of
course,
has
been
made
very
clear
by
the
kobe
pandemic.
B
A
Thank
you
and-
and
I
suppose
slightly
building
on
that
question.
How
will
providers
quality
and
safety
information
be
shared
between
regulators
to
ease
the
burden
on
all
providers
and
will
it
be
clear
in
the
new
strategy
and
what
information
is
being
shared
and
when.
B
B
So,
if
you're,
having
a
conversation
about
quality,
you
should
be
including
us
if
we're
having
a
conversation
about
quality
in
your
provider,
we
want
to
be
including
you
and
we
want
to
try
and
get
to
that
kind
of
trusting
open,
transparent
relationship
and
likewise,
if
I'm
talking
to
other
parts
of
the
system
about
quality
and
a
provider,
we
want
the
provider
to
be
aware
of
that.
We
don't
want
the
provider
to
if
you
like,
not
know
what
our
concerns
are,
because
you
know
ultimately,
it's
the
priority.
B
B
What
data
is
the
data
we
should
all
be
looking
at
and
one
of
the
things
I've
been
trying
to
do
on
the
national
quality
board
is
working
with
the
other
arm
states
bodies
to
try
and
make
sure
we
have
an
agreed
assessment
of
what
quality
in
individual
providers,
but
also
in
systems
is
to
make
sure
that
we're
all
looking
at
the
same
thing.
Now
that's
a
dynamic
process
and
there
isn't
a
kind
of
fixed
point
where
we've
defined
the
data
that
we
need
to
look
at
quality
and
say
a
system.
B
It
will
be
dynamic,
it'll
change
over
time,
but
we
ought
to
have
a
common
understanding
of
what
the
most
important
elements
are
and
make
sure
we're
assessing
them.
One
of
the
things
that
I
think
we
will
a
cqc
become
more
focused
on
is
system
data
as
much
as
single
provider
data.
You
know,
and
I
think
if,
if
there
are
risks
identified
in
the
system
from
system
data,
then
we
will
come
to
the
providers
within
our
system
and
say:
look
we've
seen
these
risks
in
your
system.
How
are
you
involved
in
addressing
them
and
resolving
them?
B
A
Thank
you,
ted,
I'm
just
moving
to
a
bit
more
of
a,
I
suppose,
an
operational
question,
and
but
one
that's
got
the
most
likes,
whether
there's
still
a
requirement
to
complete
the
pir
prior
to
a
visit
and
link
to
that
will
it
be
modified
to
be
less
onerous.
B
Yeah,
well,
we
haven't
issued
any
of
the
kind
of
comprehensive
inspection
pirs
for
quite
a
while
now,
so
they
are
a
feature
of
our
comprehensive
inspections
and
so
we're
not
going
back
to
comprehensive
inspections
in
that
way.
As
I
say,
we
need
to
find
ways
of
rating
and
we
may
need
to
do
some
data
requests
in
order
to
form
our
writing
process.
B
That's
an
open
question
I
don't
know
as
yet,
but
but
that
that
may
be
so
we're
not
going
back
to
the
comprehensive
inspection
pils,
though
I'm
not,
I
can't
say
at
this
stage
there
will
be
no
pirs
during
our
inspections,
our
risk-based
inspections
that
we're
doing
at
the
moment
they
are
not
usually
preceded
by
a
pir,
they're,
usually
unannounced,
on
the
basis
of
risk.
B
We
may
ask
for
data
after
the
inspection
just
to
make
sure
we've
got
a
full
view
of
the
evidence,
so
they're
much
less
burdensome,
which
is
one
of
the
reasons
why
we're
focusing
on
them
at
the
moment,
rather
than
the
comprehensive
approach.
But
I
think
we
we've
heard
loud
and
clear
from
many
of
you
how
burdensome
some
of
the
pirs
have
been,
and
we
do
want
to
move
on
from
that.
B
So
so
we
are
doing
absolutely
our
utmost
to
make
sure
we
don't
go
back
to
that
position,
but
it
does
mean
it
does
mean
that
the
kind
of
big
reports
that
we
produce
in
terms
of
the
evidence
dependencies
for
nhs
trusts
will
not
be
published
in
the
same
way
going
forward,
because
a
lot
of
that
was
driven
by
the
pi
pir
information.
B
We
need
to
look
at
the
data
we
have
already
and
make
sure
we're
using
that
effectively
to
assess
risk
and
only
ask
for
additional
data
where
necessary
and
as
I
say,
if
one
of
the
things
we
could
do-
and
this
is
not
going
to
be
easy
to
deliver-
is
to
access
your
systems
directly.
Then
we
don't
need
any
kind
of
transactional
intervention
with
you
at
all.
We
don't
have
to
ask
you
for
information.
We
can
monitor
it
on
an
ongoing
basis,
and
I
think
that
would
be
where
we
would
like
to
get
to.
B
If
we're
going
to
get
to
this
real
time
assessment
of
of
quality
going
forward,
that's
not
going
to
happen
overnight,
but
I
think
it
would
be
a
great
a
great
advantage
if
we
could
get
to
that,
and
certainly
with
big
nhs
trusts
with
with
sophisticated
data
systems
that
should
be
achievable.
A
Thank
you
and
then
a
question
about
systems
so
great
that
we're
looking
at
the
path,
the
patient
pathway
and
system.
But
there
is
an
inherent
problem,
as
you
rate
organizations,
not
systems
where
a
good
rating
does
not
really
relate
to
a
good
system
worker,
as
it
forces
organizations
to
look
in
not
out.
How
do
you
plan
to
address
this.
B
Well,
I
think
our
ratings
going
forward
and
again
this
is-
is
for
the
new
strategy
well
likely
to
reflect
system
interactions.
Much
more
and
so
can
you
have
an
outstanding
provider
in
a
poor
system,
we'll
probably
say
we
find
some
way
of
building
into
our
assessment:
the
fact
that
you're
working
in
a
poor
system
you're
not
showing
effective
system
leadership.
Therefore
that
reflects
on
the
provider
rating.
So
I
think
we
are
conscious
of
that
and
that's
one
of
the
things
we
need
to
do.
B
A
Thank
you
and
a
question
around
patient
experience
data,
so
we
say
we'll
be
using
more
patient
experience
data.
How
will
how
will
we
be
gathering
that
or
will
we
be
asking
trusts
to
share
data
already
gathered?
I
I.
B
Think
what
if
I
could
just
express
one
of
my
frustrations
is
that
that
one
of
the
things
we've
seen
not
very
much
of
interest
inspections
is
a
collection
of
patient
experience,
data
beyond
friends
and
family,
and
there
seems
to
be
kind
of
focus
on
on
that
as
a
core,
and
I
think
one
of
the
things
we
want
to
challenge
trust
to
do
is
how
are
you
assessing
patient
experience
more
in
more
detail
than
perhaps
just
you
know,
the
kind
of
the
contractual
requirement
to
do
friends
and
family?
B
So
I
think
that
that
would
be
important
going
forward.
We've
developed
a
new
system
which
was
launched
this
year
called
give
feedback
on
care,
which
is
a
web-based
system
that
people
can
on
their
phones
or
their
their
tablets,
as
well
as
on
their
computer,
can
give
can
give
feedback
on
their
care
from
different
providers.
That
has
really
gone
down
very
well.
We've
seen
a
big
surge
in
the
amount
of
patient
and
user
feedback
we're
getting
on
that
which
is
really
good.
So
so
we
will
explore
ways
of
us
getting
direct
feedback
of
patients.
B
We
will
explore
ways
of
developing
focus
groups-
perhaps
virtual
focus
groups,
but
focus
groups
to
to
actually
understand
what
patients
experience
of
systems
is.
But
equally,
I
think
we
want
to
challenge
providers
about
how
you
getting
that
patient
feedback
in
the
way
that
makes
a
real
difference
to
care.
A
Thank
you,
and
I
think
we
might
have
time
for
one
last
question:
will
we
return,
will
cqc
be
returning
to
the
previous
inspection
strategy
or
approach?
Or
do
we
see
this
as
your
permanent
approach
going
forward
with
or
without
covid.
B
By
I
think,
our
transitional
approach
is
our
approach
for
the
next
few
months,
the
permanent
approach
beyond
that
which
will
build
on
learning
from
the
transitional
approach.
So
it's
going
to
be
a
continuum
with
it
will
be
implemented
next
year.
We're
not
going
back
to
our
previous
approach
in
its
full
form.
I
mean
clearly
we're
going
to
be
living
with
kovid
for
the
next
six
months,
at
the
very
least,
so
there's
not
going
to
be
an
opportunity
to
go
back
to
that
before.
B
We
launch
our
next
strategy
and
our
next
strategy
is
forward,
looking
not
backward
looking
so
so,
I
think
the
kind
of
big,
comprehensive
set-piece
inspections
are
probably
by
force
of
circumstance
with
the
pandemic
not
going
to
return.
At
this
point,
we
will
have
a
new
system
based
upon
what
we've
learned
during
the
pandemic
and
our
strategy
from
next
summer
onwards.
B
B
Sarah
we're
just
about
out
of
time.
So
can
I
just
go
to
the
the
last
slide
here
which
is
about
getting
involved
now
I
did
say
that
we're
keen
that
you
should
be
involved
in
feeding
back
on
what
you've
heard
today
on
our
strategy,
our
draft
strategy
and
on
your
experience
of
our
transitional
regulatory
approach.
This
is
very
much
something
we
are
learning
from.
So
don't
feel
that
you
know
we're
not
receptive
to
your
feedback.
We
are
very
keen
on
your
feedback.
We
recognize
that
this
is
an
interview
process
going
forward.
B
B
Please
do
look
at
look
at
that.
That's
all
available
and
you'll
get
it
headlined
on
the
twitter
account
etcetera.
So
so
please
do
stay
in
touch
with
us
and
do
give
us
your
feedback
going
forward.
We
are
just
coming
up
to
11
o'clock,
so
I
want
to
thank
you
for
joining
us
today.
I
hope
you
found
it
helpful.
B
Thank
you
for
the
really
challenging
but
interesting
questions,
and
we
will
look
at
all
the
ones
we
haven't
been
able
to
answer
and
take
that
comment
and
feedback
and
see
if
we
can
provide
answers
in
different
ways.
So
thank
you
very
much.