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Description
Hear from Ted Baker, Chief Inspector of Hospitals and Kevin Cleary, Deputy Chief Inspector of Hospitals and lead for Mental Health as they discuss our transitional regulatory approach and the latest on our emerging strategy for 2021 and what this means for those working in Mental Health - NHS and independent healthcare services.
A
Good
afternoon,
everyone,
this
is
tobacco
chief
inspector
of
hospitals
here
at
the
cqc.
Thank
you
very
much
for
joining
our
webinar
this
afternoon.
We're
going
to
be
talking
to
you
about
our
transitional
approach
and
our
strategy
going
forward.
These
are
two
very
important
developments
here
at
the
cqc
and
I'm
very
grateful
for
you
joining
today.
So
you
can
understand
better
what
what
we're
doing,
but
equally
there'll,
be
chance
to
ask
questions
and
give
us
some
feedback
on
what
you
think
of
our
approach.
So
far,
can
we
go
to
the
slides,
please
steph?
A
Okay,
fine!
So
I'm
going
to
be
leading
this
webinar
supported
by
kevin
cleary,
our
lead
for
mental
health
services
and
kevin
will
be
presenting
the
transitional
regulatory
approach
in
a
moment.
I'm
also
joined,
as
you
see
on
this
slide
by
several
cqc
colleagues.
I'm
very
grateful
for
them
for
supporting
the
webinar
they'll,
be
helping
make
sure
that
your
questions
are
answered
in
the
chat.
A
Please
do
put
questions
in
the
chat
kevin
and
I
will
answer
some
of
them
specifically,
but
those
that
we
can't
answer
verbally
colleagues
will
try
and
answer
it
for
you
in
the
chat.
So
please
do
feedback,
make
comments
or
ask
questions
as
we
go
along
next
slide.
Please
please
steph.
So
this
is
what
we're
going
to
talk
about
today,
I'll
start
off
by
just
reminding
everyone
about
our
role
and
purpose
as
a
regulator.
A
A
So
our
role
and
purpose
to
start
with
now
the
cqc's
role
on
purpose
has
been
the
same
and
will
continue
to
be
the
same
going
forward.
The
regulations
are
not
changing.
The
statutes
in
which
we
operate
are
not
changing.
We
may
be
doing
things
differently,
but
the
purpose
underlying
it
will
be
the
same.
A
So
our
purpose
is
not
changing,
but
the
world
in
which
we
operate
is
changing.
The
services
you
provide
are
changing,
they're,
responding
to
changing
needs
of
the
population
and
they're
responding
to
you
learning
to
provide
them
better
in
better
ways.
We,
as
a
regulator,
have
learned
from
our
regulatory
activity
of
the
last
few
years,
and
particularly
during
the
covid
pandemic,
I
should
say
of
different
ways:
we
can
approach
regulation,
so
we
are
learning.
So
there
are
lots
of
reasons
why
we
do
need
to
change
and
the
change
program.
A
A
The
future
regulating
model
will
come
in
in
may
of
next
year
in
phase
five.
There
you
see
on
the
right
phase.
Four
is
the
next
step,
which
is
where
we'll
be
consulting
in
from
january
on
our
new
strategy
and
our
way
forward
and
you'll
be
getting
some
indication
of
that
in
the
next
few
minutes.
Next
slide,
please
so,
first
of
all
our
transitional
regulatory
approach.
This
is
what
we're
using
at
the
moment
and
I'm
going
to
hand
over
to
kevin
to
talk
you
through
this
kevin
over
to
you.
B
B
It
had
several
elements
to
it.
We
were
using
and
sharing
information
to
target
support
where
it
was
most
needed,
having
open
and
honest
conversations
with
providers
taking
action
to
keep
people
safe
and
to
protect
people's
human
rights
and
capturing
and
sharing
what
we
did
with
people
outside
of
the
organization.
So
our
transitional
regulatory
approach
replaces
the
emergency
support
framework
and
it
helps
us
to
target
our
regulatory
activity
most
effectively
next
slide.
B
So
patient.
First
shared
practical
examples
from
emergency
department
staff
to
help
trust
harness.
The
learning
from
coronavirus
suggests
actions
that
can
be
taken
at
departmental
trusts
and
wider
system
level
to
maximize
capacity,
maintain
effective
patient
flow
and
keep
staff
and
patients
safe.
Recognizing
that
emergency
departments
are
can
be
under
particular
stress
and
it
focused
on
five
key
areas:
flow
infection,
control,
reducing
emergency
department,
attendances
so
that
people
that
were
attending
really
needed
to
be
there.
Staffing
and
treatment
of
patients.
B
Next
slide
so
assessment
of
mental
health
services
and
acute
trusts,
so
we
reviewed
findings
from
over
a
hundred
acute
hospital
inspections,
and
we
were
looking
at
how
well
the
mental
health
care
system
these
patients
were
met
and
we're
trusted
and
wider
system
needed
to
improve.
So,
if
you're
working
in
a
mental
health
service,
you
will
know
that
there
was
a
particular
sort
of
stress
point
in
acute
trusts.
B
We
found
that
staff
were
generally
caring
and
working
very
hard
in
challenging
circumstances.
However,
too
often
it
was
a
system
that
limited
their
ability
to
provide
the
best
possible
mental
health
care
for
their
patients.
We
produced
a
report
which
outlines
system-wide
changes,
trust
level
changes
and
support
for
staff
to
improve
the
quality
of
care
for
people
with
mental
health
needs
being
looked
after
in
acute
trusts,
next
slide.
B
So
where
are
we
now
so
as
the
risks
weight
into
delivery
of
health
and
care
during
the
covet?
19
epidemic
change,
so
we
are
now,
of
course,
in
the
second
wave
and
in
the
lockdown.
We
are
looking
at
our
existing
methodologies
and
the
learning
from
covert
19
to
pull
together
a
transitional
regulatory
approach.
This
will
fill
this
will
be
the
approach
up
until
the
implementation
of
the
new
strategy
and
aspects
of
our
approach
will
provide
learning
on
how
we
want
to
regulate
in
the
future.
B
B
We
will
continue
to
monitor
risk
in
the
service
and
a
clear
focus
on
those
chloes,
an
inspection
activity,
that's
more
targeted
and
focused
on
where
we
have
concerns,
so
we
will
not
be
returning
to
a
routine
program
of
planned
inspections.
However,
I
can't
say
that
since
the
end
of
april
mental
health
we've
carried
out
between
30
and
40
separate
hospital
inspections.
So,
whilst
it
is
a
slimmed
down
program
of
planned
inspections,
we
are
actually
very
active
on
the
inspection
front
at
the
moment
and
we'll
continue
this
and
we'll
continue
to
adapt.
B
B
So,
as
I
said,
we're
building
on
are
learning
from
the
emergency
support
framework
and
using
our
key
lines
of
inquiry.
We
are
focusing
on
safety,
so
patient
safety,
access
and
leadership
increasingly
looking
at
other
areas
like
infection
prevention
and
control,
which
are
critically
important
in
mental
health
services,
we're
looking
information
from
all
available
sources,
including
piloting,
new
ways
of
gathering
information
from
people
using
services
and
provide
collaboration,
reviews
we're
looking.
I
have
to
say
very
strongly
at
whistleblowing
complaints,
incidents
that
are
reported
to
us.
B
B
Our
ability
to
re-rate
is
limited
by
the
pandemic
and
our
published
methodologies,
and
if
we
were
to
change
our
approach
to
our
rating
significantly,
we
would
have
to
go
out
to
a
full
consultation
new
paragraph
new
slide,
so
questions
so
far.
So
launching
questions
for
nhs
and
independent
healthcare
providers
are
on
our
website
and
we've
got
guidance
on
what
to
expect
on
the
website
as
well.
So
questions
okay,.
A
So
over
to
colleagues
for
questions,
thank
you
for
that
kevin
the.
So
our
transitional
approach
to
regulation
is
very
different
from
what
we've
done
before
it's
very
much
a
response
to
the
curvy
pandemic
but,
as
I
said
as
kevin,
has
shown
it's
very
much
forward-looking
to
what
our
long-term
strategy
is
likely
to
be
in
terms
of
our
approach
to
regulation,
we'll
be
learning
as
we
apply
it,
but
equally
we
need
your
feedback
as
we
develop
it
over
the
next
few
months.
C
A
A
B
A
Ratings
are
rigorous
and
valid
and
meet
the
same
level
as
previous
rating
so
that
this
kind
of
continuity
of
the
value
of
ratings
going
forward.
So
we
do
need
to
do
more
work
on
that
and
if
we
need
to
change
our
regulatory
assessment
framework
in
order
to
do
it,
then
of
course
we'll
come
out
to
consultation.
So
it
is
very
likely
that
there
will
be
some
aspects
of
forward
looks
for
ratings
in
the
consultation
on
january
in
january.
A
And
that's
exactly
what
comes
back
to
what
I
was
saying
a
few
moments
ago.
So
it's
a
very
good
question
and
I
think
an
important
one,
because
I
am
very
conscious
of
the
fact
that
the
trusts
and
other
providers
want
to
demonstrate
that
they've
improved
where
they
have
improved
and
we
want
to
be
able
to
demonstrate
that
for
them.
But
in
order
to
do
that,
we
need
a
different
approach.
What
we
can't
do
is
go
back
to
the
old,
comprehensive
inspections,
one
because
of
the
pandemic
and
the
risks
associated
with
that,
but
also
we
don't.
A
Our
future
strategic
direction
is
not
to
revert
to
the
big
comprehensive
inspections.
We
want
to
be
much
more
agile
and
focused
in
our
inspections
going
forward,
but
equally
we
want
to
be
able
to
provide
up-to-date
ratings
and
we
are
looking
at
the
moment
of
how
we
can
provide
up-to-date
ratings
during
the
transitional
approach.
So
over
the
next
few
months
and
as
I
said,
proposals
for
that
will
come
forward
and
that
will
be
ratings
that
can
demonstrate
improvement
as
well
as
as
deterioration,
but
also
how
we
can
create
real-time
ratings.
A
What
we
could
call
real-time
ratings,
but
you
know
up-to-date
ratings,
going
forward
beyond
the
transitional
process
as
we
go
into
our
new
regulatory
framework
and
I
think
we're
very
keen
to
to
move
into
a
new
regulated
framework
that
does
provide
much
more
up-to-date
ratings.
We've
heard
from
providers
and
we've
heard
from
people
using
services
that
they
want
the
ratings
to
be
up
to
date.
They
don't
ratings
to
be
you
know
a
year
or
so
old,
so
we're
very
keen
to
explore
how
we
can
do
that.
B
The
feedback
that
we
got
from
trusts
around
the
large
planned
inspections
was
that
the
pr
ours
represented
a
significant
burden,
and
we
have
listened
to
that
and
wherever
possible,
we
will
not
be
asking
for
pirs
because
they're
not
normally
part
of
a
focused
inspection.
That's
not
to
say
we
won't
ask
for
information,
we
will
do.
We
can
do,
and
I
have
done
in
the
last.
You
know
few
weeks,
but
we
will
not
be
asking
for
large
pirs
anymore
for
now,.
B
Okay,
all
right,
so
the
transitional
approach
is
for
all
providers,
and
so
independent
health,
as
well
as
nhs
trusts,
and
we
have
had
some
significant
inspection
regulatory
activity
in
an
implemented
sector
in
the
last
few
months
and
the
rules
that
apply
to
newly
registered
providers
are
the
same
as
they
are
for
current
providers.
So
there's
no
change
in
our
approach.
C
A
Yes,
very
much
so
we
will
be
consulting
with
commissioners
going
forward
and
I
I
think
the
issue
about
ratings
is
important.
I
mean
clearly
people
need
to
understand
that
faced
with
the
pandemic,
circumstances
have
changed,
and
I
think
everyone,
including
commissioners,
need
to
be
aware
of
that.
But
having
said
that,
I
think
it's
part
of
our
purpose
to
provide
ratings
for
services
both
for
the
providers
and
commissioners,
but
also
for
people
using
services.
So
we
think
it's
very
important.
C
B
We
have
yes,
so
we
have
been
publishing
reports.
We
have
published
a
number
on
nhs
services
and
independent
health
services.
So
the
fact
that
we're
doing
a
focused
inspection
doesn't
mean
that
there
isn't
a
report
at
the
end
of
it.
There
is,
it
may
not
result
in
a
re-rating,
but
there
is
a
report
put
on
a
website
which
is
shared
with
the
provider.
C
A
A
The
way
we
want
to
approach
regulation
going
forward
and
we
want
to
see
these
services
through
their
eyes
rather
through
the
eyes
of
the
system
around
them.
So
so
I
think
this
is
a
big
challenge
for
us
and
of
course
this
has
been
difficult
during
the
curving
pandemic
because
of
the
practical
problems
during
the
kevin
pandemic.
A
I
think
we
are
building
a
assessment
of
service
user
voice
into
our
monitoring
approach
and
we
are
developing
tools
to
do
that
at
the
moment,
so
that
is
going
to
be
central
to
some
of
the
work
we're
doing
over
the
next
few
weeks.
But
but
so
assessment
of
the
patient
voice
is
very
important
and
we
will
be
piloting
various
approaches
to
see
what
is
most
successful.
A
Some
of
it
can
be
done
by
surveys,
and
some
of
it
can
be
done
by,
as
I
say,
the
web
portal,
or
by
having
virtual
focus
groups
with
patients,
so
we're
going
to
be
exploring
all
those
kind
of
options.
I
I
I
do.
I
one
thing
I
would
say-
and
I
I
I've
said
this
to
acute
trust,
so
yesterday,
I'll
say
to
to
to
to
you
today,
is
one
of
the
things
that
that
I
think
disappoints
me
about
what
we've
found
over
the
last
few
years
in
our
inspection.
A
C
A
The
well-lit
part
of
our
inspection
will
continue,
we'll
be
doing
well-led
inspections
on
a
risk-based
and
responsive
approach
and
where
we
do
well
late
inspections,
they
will
tend
to
be
focused
on
specific
issues,
and
we
have
done
those
over
the
last
few
months
where
we
found
issues
that
that
we
need
to
address
through
the
well-led
key
question.
So
just
as
we
could
do
safety-based
inspections,
we
will
do
the
well-led
based
inspections
as
well
in
terms
of
the
focused
inspection.
So
they
will
go
forward.
A
What
the
well
led
did
under
the
previous
approach,
when
we
did
the
comprehensive
inspections
was
the
well
led,
if
you
like,
was
the
final
part
of
an
inspection
that
led
to
the
overall
rating
for
the
provider.
So
we
will
explore
how
we're
going
to
use
that
assessment
of
well-led
in
our
ratings
going
forward.
I
think
all
I
would
say
at
this
stage
is
that
well-led,
the
leadership
and
culture
of
organizations
is
very
much
fundamental
to
quality
and,
I
think,
will
remain
a
very
important
part
of
our
assessment
of
all
organizations
going
forward.
A
A
A
Okay,
steph
no
more
questions
should
we
move
on
then
to
the
strategy.
Is
that
all
right?
Okay?
Thank
you,
then,
for
those
questions,
you'll
be
a
chance
to
ask
some
more
questions
in
a
few
minutes,
but
I
just
wanted
to
talk
to
you
about
our
strategy
going
forward
now.
The
strategy
in
draft
form
has
been
circulated.
A
Now
we
recognize
that
as
a
regulator.
As
I
said
right
at
the
start
that
we
need
to
change,
we
need
to
change
not
because
we
want
to
achieve
different
things,
but
we
recognize-
and
we've
learned
from
my
experience
over
the
last
few
years
that
we
can
do.
We
can
deliver
our
purpose
better,
but
we
also
need
to
respond
to
the
changing
world
in
which
we
operate.
It's
changing
services,
it's
our
changing
understanding
of
it,
but
also
the
changing
demands
of
people
using
services.
A
So
we
think
it
is
absolutely
essential
that
we
do
change
our
approach.
Yeah
in
this
strategy
and
you'll
hear
this
strategy
is
really
very
different
from
where
we
have
performed
regulation
over
the
last
few
years.
It's
got
four
themes
to
it.
The
themes
haven't
got
their
final
names
yet,
but
the
moment
we
call
them
people
smart,
safe
and
improve
and
I'll
just
discuss
the
strategic
ideas
behind
those
themes,
as
we
go
forward
next
slide
please.
A
So
the
first
theme
is
people
and,
as
as
we've
already
touched
on,
I
think
there's
a
real
sense.
We
want
to
see
the
quality
of
services
through
the
eyes
of
people
using
those
services
rather
than
through
the
professional
eyes
or
the
provider
eyes.
So
essentially,
we
want
people
to
tell
us
what
they
think
about
services.
We
want
to
understand
how
they
experience
services
and
we
talked
a
few
moments
ago
about
the
importance
of
listening
to
their
voices
and,
of
course,
that
is
going
to
be
absolutely
central.
A
But
equally,
we
need
to
understand
that
people
don't
necessarily
see
services
as
being
focused
on
a
particular
provider,
and
people
often
receive
services
across
several
providers
through
a
pathway
of
care
through
a
system
of
care,
and
so
we
looking
at
services
through
people's
eyes,
we
have
to
look
at
it
from
a
pathway
or
system
perspective
to
understand
what
the
experience
of
care
for
individual
patients
and
service
users
are,
and
that's
going
to
have
to
be
changed.
The
way
we
approach
things,
so
one
of
the
things
we've
got
to
do
is
become
much
more
system.
A
Focused
kevin
talked
earlier
on
about
a
care
of
people
with
mental
health
needs
in
acute
hospitals,
and
that's
just
one
example
of
where
we've
already
started.
Moving
into
that
area,
people
in
acute
hospitals
often
have
mental
health
needs
and
we've
challenged
those
hospitals.
How
do
they
work
with
their
mental
health
colleagues
to
make
sure
that
people
are
getting
the
right
care
and,
of
course,
the
same
would
occur
in
reverse?
A
How
do
people
in
mental
health
facilities
get
good
physical
care
that
integration
and
join
up
care
is
really
going
to
be
very
important,
but
also
how
do
people
get
care
flowing
from
primary
medical
services
through
community
services
to
inpatient
services,
if
necessary?
How
do
people
experience
that
pathway
of
care?
Are
they
getting
the
right
care
in
the
right
place
at
the
right
time,
and
I
think
that
is
going
to
be
really
very
much
a
focus
of
what
we
do.
A
So
when
we
look
at
individual
providers,
we're
increasingly
going
to
be
asking
not
just
how
do
you
provide
care?
But
how
do
you
work
with
other
parts
of
the
system
to
make
sure
care
is
joined
up
and
people
are
getting
the
right
care
for
their
needs
and
I
think
that's
going
to
become
an
increasing
focus.
So
our
key
lies
of
inquiry
going
to
have
to
reflect
that
and-
and
that's
going
to
be
an
important
part
of
the
way
we
take
things
forward.
A
A
How
can
we
make
sure
that
when
we
look
at
providers
and
the
quality
care
they
provide,
we
take
into
account
how
they
make
sure
that
the
people
in
their
population,
their
local
population,
are
receiving
care,
are
receiving
care
in
a
way
that
reflects
their
different
needs
and
any
barriers
they
may
face
to
accessing
care
so
that
we
can
generate
more
equality
of
care
and
equality
of
outcomes
of
care
going
forward.
So
this
is
a
very
important
part
of
what
we
we're
going
to
be
looking
at
going
forward
and
we'll
be
asking
providers
again.
A
A
So
smart
is
about
smarter
regulation.
It's
about
how
can
we
become
a
a
better
regulator
in
terms
of
the
regulatory
bit
of
what
we're
doing
and
again
a
couple
aspects
of
this?
What
we've
learned
from
the
transitional
approach
and
from
the
emergency
support
framework
is
how
important
that
relationship
between
us
and
providers
is.
A
If
we
can
have
an
open,
honest,
transparent
relationship
with
providers,
then
that
gives
us
much
more
confidence
about
how
we
can
regulate
with
them,
and
I
think
one
of
the
things
that
we've
been
working
over
the
last
few
years
and
one
of
the
things
we
need
to
take
forward
go
in
this
strategy
is
building
up
really
positive,
constructive
relationships
with
providers
and
so
as
a
regulator.
We
want
to
be
seen
more
as
a
partner
than
if
you
like
someone
outside
who
comes
in
and
criticizes
now.
A
One
of
the
other
things
about
smarter
regulation
is
about
better
use
of
data.
Someone
asked
a
few
minutes
ago
about
pirs
and,
and
we
recognize
and
kevin
highlighted
the
fact
we
recognize
pirs
are
often
a
burden
for
providers
because
we're
asking
for
a
lot
of
data,
so
we
can
understand
the
risks
in
their
services.
How
can
we
do
that
better?
Well,
there's
several
things
we
can
do
and
again
during
the
kovic
pandemic,
there's
been
a
lot
of
sharing
of
data
between
the
national
bodies,
and
I
think
we
really
welcome
that
and
that's
really
helpful.
A
A
Of
course,
we
also
want
to
use
that
data,
primarily
in
our
assessment
of
providers
and
not
have
to
go
to
the
providers
and
ask
them
to
on
a
transactional
basis,
to
provide
data
for
us
regularly,
so
so
to
remove
that
burden
that
data
requests
wherever
we
can,
I
don't
think
we'll
ever
be
able
to
stop
asking
for
any
data,
but
we
want
to
reduce
it
to
an
absolute
minimum
where
it's
really
essential.
So
we
need
to
understand
what
is
the
data
that
really
helps
us
understand,
risk
in
that
provider
and
not
ask
for
unnecessary
data?
A
So
we
can
understand
risks
as
you
see
it
and
we
can
throughout
what
hopefully
will
be
a
positive,
constructive
supportive
relationship
be
able
to
discuss
that
with
you
in
a
way
that
enables
us
to
be
confident
that
you
are
managing
it
effectively,
but
doesn't
add
a
burden
on
to
you.
So
how
can
we
create
this
always-on
view
of
data
in
providers,
rather
than
moving
from
the
individual
transactional
approach
that
we
have
at
the
moment?
Those
are
aspects
of
being
a
smart
regulator,
better
use
of
data,
building,
really
constructive
relationships
with
providers
next
slide,
please
safety.
A
Now
safety
is
one
of
the
key
questions
that
that
that
we
ask
one
of
the
five
key
questions
we
ask,
and
it
is
the
key
question
that
we
have
the
most
concerns
about.
The
key
question
is
this
is
the
key
question
where
we
most
often
cannot
answer?
Yes,
this
service
is
safe
and
we've
been
really
challenging
ourselves
about
what
we
can
do
differently
around
safety,
and
I
think
one
of
the
problems
is
that
we-
and
I
think
health
systems
generally
tend
to
have
a
very
process
driven
view
of
safety.
A
A
Now
I
think
processes
are
really
important
in
safety,
but
they
only
work
if
you've
got
the
underlying
safety
culture
right,
and
I
think
what
we
want
to
do
going
forward
is
to
focus
on
the
safety
culture,
and
that
means,
of
course-
and
I'm
sure,
you've
been
involved
in
discussions
about
just
cultures
and
no
blame
cultures,
so
cultures
where
people
don't
feel
threatened
when
things
go
wrong.
People
cultures,
where
people
recognize
that
things
do
go
wrong
in
complex
health
systems,
but
something
going
wrong,
isn't
the
failure.
A
Some
of
that
has
to
be
about
building
a
culture
where
people
can
speak
freely
about
their
concerns,
and
I
think
one
of
the
other
encouraging
things
during
the
curvy
pandemic
has
been
the
a
sense
that
that
frontline
staff
have
raising
their
concerns
more
freely,
both
within
providers
but
also
with
us
and
we've
had
a
big
surge
in
number
of
staff
raising
concerns
with
us
during
covid,
and
we
welcome
that.
We
welcome
it
because
it
means
people
feel
they
can
talk
up
about
concerns
and
we
can
respond
to
those
effectively.
A
But
equally,
we
want
them
to
be
able
to
raise
those
concerns
internally
within
organizations
so
that
you
can
respond
to
those
concerns
effectively
as
well,
so
creating
this
freedom
to
speak
up
culture.
This
culture,
this
just
culture,
this
restorative
culture
and
this
culture-
that
that
has
the
humility
to
recognize
things
will
go
wrong.
But
actually
the
challenge
is
to
learn
from
those
things
to
reduce
preventable
harm
to
an
absolute
minimum.
A
Those
are
the
kind
of
things
we
want
to
explore
and
when
you've
got
the
culture
right,
then
the
processes
will
work
and
we
think
a
step.
Change
in
safety
is
possible
in
healthcare
if
we
approach
this
the
right
way
and
we
we
want
to
be
part
of
a
a
collaboration
working
with
you,
the
providers,
but
also
working
with
some
of
our
national
partners
to
make
sure
that
we're
all
consistently
approaching
this
in
the
right
way.
Next
slide,
please
so
improve.
Now.
A
One
of
the
things
that
we
often
get
criticized
for
is
that
we
go
in.
We
see
problems
we
report
on
those
problems.
We
tell
the
provider
they've
got
to
take
action,
but
then
we
step
back
and
leave
the
provider
to
find
out
how
they're
going
to
address
the
issues
and
and
people
say
why
aren't
you
doing
something
to
help
the
provider
improve?
A
And
the
answer
to
that
is
really
that
there's
a
conflict
between
us
telling
providers
what
to
do
to
improve
and
holding
them
to
account
as
a
regulator
to
improve.
So
our
regulatory
position
makes
it
difficult
for
us
to
be
a
direct
improvement
support
agency,
but
we
recognize
that
in
all
sectors,
providers
want
stronger
external
support
to
help
them
to
deal
with
issues.
A
Of
course,
there
are
some
sectors
that
have
actually
got
a
lot
of
improvements,
such
as
energy
improvement
for
energetic
trust.
There
are
other
sectors
that
there's
very
little
in
the
way
of
improvement,
support
for
them,
and
we
want
to
help
those
sectors
find
the
improvement
support
so
that
all
health
services
have
access
to
specialized
improvement
support,
and
some
of
that
may
be
from
other
providers
and
one
of
the
things.
A
A
A
We
need
to
do
such
as
people's
voice
listening
to
people's
using
services
and
the
issue
about
ratings
which
which
I've
covered,
and
we
recognize
that
we're
still
more
working
in
both
those
areas,
we'll
be
formally
consulting
on
the
final
draft
of
our
consultation
in
january.
So
please
do
give
back
your
formal
feedback
on
that.
We
value
it
and
please
do
recognize
how
you
can
help
us
implement
it
really
effectively.
A
Once
we've
got
that
form
of
consultation,
once
we've
been
able
to
respond
to
it,
we'll
then
be
developing
plans
to
develop
on
you
to
implement
our
new
strategy.
As
I
say,
in
effect,
it's
been
beginning
to
implement
it
with
a
transitional
approach,
but
we'll
be
formally
implementing
it
from
next
may
forward.
It's
a
five-year
strategy,
so
not
necessarily
everything
will
change
at
once,
but
we're
very,
very
committed
to
making
sure
it
is
implemented
fully
over
the
next
few
years.
Next
slide,
please
where's
the
future.
A
Well,
I've
talked
about
the
implementation
there.
We
will
be
clear
how
we're
gonna
do
it
and
so
there'll
be
more
consultations
about
the
process
of
implementation
going
forward
and
we'll
do
our
best
to
keep
you
informed
and
we
welcome
your
feedback
next
slide,
please,
okay!
So
that's
all
I
want
to
say
about
strategy.
I
hope
you
have
a
sense
of
the
the
nature
of
the
change
at
cqc
and
the
ambition
of
that
change.
A
We
want
to
be
the
best
regulator
we
can
and
we
want
to
learn
from
what
we
have
achieved
in
the
past,
but
also
build
on
the
successes,
but
learn
from
the
things
we
can
do
better
and
I
think
we've
highlighted
some
of
the
things
we
can
do
better
as
we've
been
talking
today.
So
any
feedback
or
comments
are
welcome.
Any
questions
you
want
to
ask
please
do
on
the
chat.
C
A
The
world
assessment
will,
I
think,
the
the
well-led
framework
we
introduced
in
2017
directly
with
nhs
improvement.
It
was
a
big
move
from
the
well-led
key
question.
We'd
had
previously
to
look
at
incorporating
elements
of
culture
and
leadership,
culture
and
values
and
quality
improvement
methodology,
and
so
I
think
2017
was
a
big
step
forward.
A
A
I
think
I
think
that
is
very
much
something
that
we
need
to
do
and,
as
I
talked
about
our
strategy,
something
we
want
to
build
on,
we
have
done
some
of
that
already.
So
so
it's
important
to
say
that
we
haven't.
This
is
not
an
area.
We've
totally
neglected.
We've
done
some
that
already
kevin.
Do
you
want
to
talk
about
any
of
the
reports
we've
produced
around
good
practice
and
what
we've
learned
from
from
the
better.
B
Providers,
yes,
certainly
ted.
So
I
think
what
we've
learned
is
that
the
better
providers
are
ones
that
are
actively
listening
to
service
users
and
incorporating
that
feedback
into
how
they
think
about
services.
I
think
the
better
services
also
have
been
using
service
users
and
patients
to
actively
help
design
parts
of
the
care
systems.
B
They
are
involved
in
quality
improvement
within
organizations
actively
involved.
So
that's
not
sending
out
a
questionnaire
and
asking
a
patient
or
service
user.
The
mental
health
service,
what
they
think
about
x
and
y,
but
actually
getting
the
patients
actively
involved
in
the
quality
improvement
processes,
and
there
are
some
organizations
around
which
I
think
do
this
very
well.
B
I
think
the
the
better
providers
are
are
ones
that
we
have
seen
that
actively
are
looking
at
the
culture
of
the
organization
aspects
of
the
culture
of
the
organization.
So,
for
example,
there
are
very
well
developed
safety
culture
tools
which,
which
tell
you
about
culture
within
your
organization
in
relation
to
patient
safety
and
use
that
as
the
basis
for
their
quality
improvement
work.
B
I
think
that
we've
also
seen
that
organizations
which
are
interested
in
the
wider
system,
in
the
sense
that
they're
concerned
about
mental
health
inequalities
within
the
sort
of
general
population
and
are
thinking
about
how
they
can
improve
that
in
partnership
with
other
partners.
So
they
may,
they
may
be
governmental
partners
or
maybe
non-governmental
organizations
that
they
they
perform
more
highly.
So
I
think
you
will
see
a
sort
of
continuum.
B
What
we've
seen
when
we
go
out
is
a
sort
of
continuum
between
organizations
which
are
very
insular
and
very
inwardly,
focused
and
then
others
which
are
much
more
interested
in
sort
of
problems
in
the
wider
community,
not
that
they
see
themselves
as
a
the
the
body.
That's
responsible
for
that
in
the
sense
that
they
are
to
blame,
but
actually
that
they
see
themselves
as
part
of
the
solution,
but
only
doing
that
in
partnership
with
other
providers.
B
C
A
You,
you
know
all
the
reports
we
produce.
We
try
and
always
give
examples
of
good
practice,
and
I
think
we
need
to
do
more
of
that.
But,
but
I
think
what
I'd
like
to
do
is
get
a
position
where,
if
a
provider
has
a
particular
issue,
we
can
point
them
towards
where
they
can
get
the
best
advice
and
support
to
drive
it
forward,
and
that's
often
going
to
be
other
providers.
Who've
demonstrated
they
can
address
the
issue
themselves.
So
so
I
think
that's
real
opportunity
for
us
going
forward.
C
Yeah,
that's
fine!
So
a
couple
of
questions
I'll
bring
together
on
a
bit
more
around
the
data.
So
one
saying
that
obtaining
data
for
private
providers
is
harder
than
for
nhs
trusts
and
wonder
how
that
might
affect
using
existing
data
to
assess
a
service
and
then
a
secondary
question,
but
also
linked
to
data
about
whether
we'll
be
using
the
insight
report
to
identify
risks.
Even
though
it
is
it's
a
bit
out
of
date,
but
improving
all
the
time.
A
Well,
thank
you
for
that,
and
the
inside
reports
are
going
to
be
the
basis
for
developing
our
risk
assessment,
but
but
we're
talking
about
taking
it
to
a
much
more
real-time
approach.
So
to
answer
your
question
about
it
being
out
of
date-
and
I
think
one
of
the
problems
that
we
do
have
is
a
lot
of
data
we
look
at
is
a
bit
historical,
and
so
while
it
is,
it
is
valuable.
A
It's
not
giving
you
a
kind
of
you
know,
up-to-date
view
about
what's
going
on
in
this
provider
now
which
which
then
leads
us
to
asking
for
pirs
and
because
we
want
up-to-date
information,
and
I
think
what
I
want
to
do
is
move
away
from
that.
So
so
the
data
we
have
is
more
real
time
and
and
and
I
think
that
that
is
very
much
much
the
aim
on
that.
Sorry.
What
was
the
second
part
of
the
question?
Sarah.
A
Yeah
yeah,
that's
it
yeah,
okay!
Well,
I
I
think
this
is
a
big
challenge.
I
think
for
many
of
the
nhs
trust
they
will
have
a
lot
of
data
which
we
can
call
on
and-
and
I
say
if
we
can
open
open
a
kind
of
real-time
access
to
their
data
that
can
remove
this.
This
sense
about
we're
always
asking
for,
for
reports,
etc.
We
can
see
things
through
your
eyes
and
understand
the
data
and.
A
A
I
think
we
need
to
challenge
the
the
the
the
sector
to
make
sure
it
is
collecting
the
data
and
the
fact
their
independent
health
and
not
nhs
trust
should
not
change
that
fact.
We
always
our
principal
is
always
we
treat
we
regulate
services
in
similar
ways
and
have
apply
the
same
standards,
be
they
nhs
provided
services
or
independent
provider
services,
and
that's
something
we
will
stick
very
firmly
to.
A
Okay,
the
enforcement
policies
based
on
our
fundamental
standards,
so
the
fundamental
standards
are
not
changing
and
we
will
still
be
applying
those.
I
think
I
suppose
the
point
we
want
to
make
is
that
enforcement
of
those
standards
is
necessary
part
of
regulation.
We
don't
think
it
is
the
fundamental
thing
that
changes
services
for
the
better
across
the
board.
It
only
influences
the
areas
where
we
take
the
immediate
enforcement,
so
so
enforcement
will
continue
and
clearly
our
priorities
for
enforcement
may
change
depending
on
what
we
see
as
as
risks
in
the
system.
A
But
fundamentally
I
don't
think
it
will
change.
The
the
special
measures
is
slightly
different,
because
special
measures,
of
course,
is
a
a
an
nhs
improvement
intervention,
not
a
cqc
intervention,
although
we
will
often
recommend
special
measures
to
nhs
improvement,
we
are
working
closely
with
hs
improvement
to
develop
different
forms
of
intervention
that
can
be
based
around
systems
as
much
as
individual
providers,
and
I
think
you'll
be
hearing
more
about
that
over
the
next
few
months.
A
C
C
A
Everyone
there's
a
lot
there
and
I
hope
I
hope
it's
been
clear
to
you,
but,
as
I
say,
I
think
the
most
important
thing
is
to
understand
our
ambition
to
move
forward
and
we're
ambitious,
because
we're
ambitious
for
the
services
you
provide
and
we
want
to
play
our
part
in
helping
you
provide
them
to
the
high
standard,
which
I'm
sure
is
what
you
want
to
do.
That
please
do
feedback
here
is
how
you
can
get
involved
and
feedback.
These
various
links
will
help
you
get
get
involved.
A
The
system
system
lab
link
at
the
at
the
top
will
take
you
to
where
the
the
discussion
document
around
our
strategy
is.
If
you
want
to
see
that
and
then
you'll
be
able
to
keep
up
to
date
with
blogs
and
provider
bulletins
there.
I
noticed
one
of
the
one
of
the
of
you
said
that
you
get
an
awful
lot
of
information
from
us
already.
I'm
sorry,
if
we
send
you
too
much,
please
do
filter
out
what
is
important
to
you.
A
I
I
recognize
how
busy
everyone
is
in
the
amount
of
emails
and
other
contacts
you
get,
but
we're
very
keen
to
stay
in
contact
with
you
all
you
can
see
you
can
stay
up
to
date
with
our
twitter
account
or
with
cqc
connect
there
at
the
bottom.
So
please
do
take
a
note
of
those
links
and
stay
in
contact
with
the
information
coming
out
from
the
cqc
okay.
That
is
the
last
slide
we're
coming
to
an
end.
Now
it's
just
coming
up
to
three
o'clock.