CQC Board Meeting - September 2025 - Wednesday 24 September 2025, 1:30pm - Care Quality Commission

CQC Board Meeting - September 2025
Wednesday, 24th September 2025 at 1:30pm 

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  1. Sir Mike Richards
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  1. Richard Barker
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  1. Alex Karetz
  2. Sir Mike Richards
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  1. Esther Provins
  2. Sir Mike Richards
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  1. Kay Boycott
  2. Sir Mike Richards
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  1. Sir Julian Hartley
  2. Sir Mike Richards
  3. Esther Provins
  4. Sir Mike Richards
  5. Chris Day
  6. Bola Owolabi
  7. Sir Mike Richards
  8. Jackie Jackson
  9. CQC Network Representative
  10. Sir Mike Richards
  11. CQC Trade Union Representative
  12. Sir Mike Richards
  13. Mr David Croisdale-Appleby
  14. Sir Mike Richards
  15. Sir Julian Hartley
  16. Sir Mike Richards
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  1. Jackie Jackson
  2. Presenter 1
  3. Sir Mike Richards
  4. Jackie Jackson
  5. Sir Mike Richards
  6. CQC Trade Union Representative
  7. Sir Mike Richards
  8. Melanie Williams
  9. Jackie Jackson
  10. Sir Mike Richards
  11. Sir Julian Hartley
  12. Presenter 1
  13. Sir Mike Richards
  14. Bola Owolabi
  15. Presenter 1
  16. Sir Mike Richards
  17. Kay Boycott
  18. Sir Mike Richards
  19. Presenter 1
  20. Jackie Jackson
  21. Sir Mike Richards
  22. Esther Provins
  23. Sir Mike Richards
  24. Arun Chopra
  25. Sir Mike Richards
  26. CQC Network Representative
  27. Sir Mike Richards
  28. Jackie Jackson
  29. CQC Trade Union Representative
  30. Sir Mike Richards
  31. Sir Mike Richards
  32. Bola Owolabi
  33. Sir Mike Richards
  34. Melanie Williams
  35. Sir Mike Richards
  36. Alex Kafetz
  37. Chris Badger
  38. Sir Mike Richards
  39. Dr Toli Onon
  40. Sir Mike Richards
  41. Chris Day
  42. Sir Mike Richards
  43. Esther Provins
  44. Sir Mike Richards
  45. CQC Network Representative
  46. Sir Mike Richards
  47. Arun Chopra
  48. Sir Mike Richards
  49. Chris Usher
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  1. Sir Mike Richards
  2. Sir Julian Hartley
  3. Sir Mike Richards
  4. Mr David Croisdale-Appleby
  5. Chris Usher
  6. Sir Mike Richards
  7. Mr David Croisdale-Appleby
  8. Chris Usher
  9. Sir Julian Hartley
  10. Sir Mike Richards
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  1. Chris Badger
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  4. Arun Chopra
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  8. Sir Mike Richards
  9. Melanie Williams
  10. Sir Mike Richards
  11. Bola Owolabi
  12. Sir Mike Richards
  13. Richard Barker
  14. Presenter 1
  15. Sir Mike Richards
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  1. Jackie Jackson
  2. Sir Mike Richards
  3. Kay Boycott
  4. Jackie Jackson
  5. Sir Mike Richards
  6. CQC Trade Union Representative
  7. Sir Mike Richards
  8. Esther Provins
  9. Sir Mike Richards
  10. CQC Network Representative
  11. Sir Mike Richards
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  1. Sir Julian Hartley
  2. Sir Mike Richards
  3. Sir Julian Hartley
  4. Presenter 1
  5. Sir Julian Hartley
  6. Presenter 1
  7. Sir Mike Richards
  8. Sir Julian Hartley
  9. Sir Mike Richards
  10. CQC Trade Union Representative
  11. Sir Mike Richards
  12. CQC Trade Union Representative
  13. Sir Mike Richards
  14. Richard Barker
  15. Presenter 1
  16. Sir Mike Richards
  17. Esther Provins
  18. Presenter 1
  19. Sir Mike Richards
  20. Sir Julian Hartley
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  1. Sir Mike Richards
  2. Chris Usher
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  4. Arun Chopra
  5. Sir Mike Richards
  6. Richard Barker
  7. Chris Usher
  8. Sir Mike Richards
  9. Chris Badger
  10. Sir Mike Richards
  11. Dr Toli Onon
  12. Sir Mike Richards
  13. Bola Owolabi
  14. Sir Mike Richards
  15. CQC Trade Union Representative
  16. Sir Mike Richards
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  1. Sarah Vallotton
  2. Sir Mike Richards
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  4. Dr Toli Onon
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  6. Sir Mike Richards
  7. Dr Toli Onon
  8. Sir Mike Richards
  9. Bola Owolabi
  10. Presenter 1
  11. Sir Mike Richards
  12. Chris Day
  13. Sir Mike Richards
  14. Richard Barker
  15. Presenter 1
  16. Sir Mike Richards
  17. Dr Toli Onon
  18. Sir Mike Richards
  19. Presenter 1
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  1. Sir Mike Richards
  2. Bola Owolabi
  3. Sir Mike Richards
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  1. CQC Trade Union Representative
  2. Sir Mike Richards
  3. CQC Network Representative
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  1. Mr David Croisdale-Appleby
  2. Sir Mike Richards
  3. Sir Mike Richards
  4. Sir Julian Hartley
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  6. Chris Day
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  8. Chris Usher
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1.0 Opening matters

Sir Mike Richards - 0:00:01
Welcome everybody to the CQC Public Board meeting. This is on the 24th of September
for those watching on catch-up with it is live streamed as people know. I
have a couple of apologies Michael Mier one of the non executive directors can't
be with us this afternoon and Alex Kafetz is going to have to leave before
the end and Joyce Frederick who usually joins us as director of policy and

1.2 Welcome and Introductions

strategy is unable to be here today. But on the other side, the welcome and
introductions, the really good news is we've got a full suite now of
non-executive directors and chief inspectors and executive directors and
so just to welcome specifically Ruth Owen who was not here at the last
meeting but is one of our NEDs, Richard Barker who is an associate non-executive
member who was not at last meeting.
And Chris Usher, congratulations on your appointment
as Executive Director of Finance and Corporate Services.
And Esther Provins, congratulations
on your appointment as Chief Digital Data and Registration
Officer.
So they are full voting members of the Board.
Welcome to all of you.
And then welcome today to our Equalities Network
rep Drew Noble and our trade union rep Sooz Cesker. And then just to let people
know about committee appointments the audit and risk assurance committee which
is chaired by Kay Boycott but that's an appointment made by the HSC but on top
of that Melanie Williams is there as a non-executive director member as is Ruth
Owen, and then there are two independent members, Adebola Adebayo and Simon Milhouse.

1.3 Declarations of Conflict of Interest

And then the other subcommittee of the Board, the Regulatory Governance Committee, I am
chairing that at least for the time being, but I'm joined by Michael Mier - NED, Alex
Capet - NED, and Richard Barker, who's an associate NED.
And then finally in all this list to announce the CQC's non-executive director with responsibility
for freedom to speak up.
That is Ruth Owen again, so thank you for taking that on.
With that, I think we can move on to declarations of any conflicts of interest.
and I think the only person who hasn't yet had those read into the minutes is
Richard Barker - 0:03:13
you Richard Barker. Would you like to do that? Yes, I have two current declarations.
One is I'm on the governing body of Sunderland University which has a major health
faculty. I don't think it's a direct conflict in our role in the University but many of
the trusts that work with the University obviously are under the regulatory regime of the
CQC. I'm also temporarily the SRO for the transformation programme leading to
changes in the Department of Health and Social Security and NHS England
leading to the eventual abolition of NHS England. The conflict there is that the
DHSC obviously has an oversight role of the CQC but my role is not in that space at
all but it is a potential conflict. A third just is potential future conflict
of interest. My daughter's a registered medical practitioner, she doesn't work in
in the UK at the moment, but I'm hoping that she will come back
before long, in which case I won't have to declare that again.
- Unintelligible -
Sir Mike Richards - 0:04:08
Thank you very much, Richard, and it's because of your role
in the transformation of NHS England
with the Department of Health and Social Care
that you are currently an associate and non-executive director
and a non-voting member, but as and when you've completed that task,
we will welcome you as a full non-executive director.

1.4 Any urgent business

Next question is, is there any urgent business that people want to raise?
I haven't been informed of any, but now is the time to say so if there is.

2.0 Governance Matters

I'm not hearing anybody saying anything or seeing anybody.

2.1 Minutes of the previous Public Board meeting held on 25 June 2025

If that's the case, we can then go on to the minutes of the previous public Board meeting,
and that was the one held on the 25th of June.
First of all, any points of factual accuracy that people wanted to raise?
Alex?
Alex Karetz - 0:05:11
Sorry, Mike, it's just a very minor one, but my name's spelt wrong on page one and page
two of the minutes.
Sir Mike Richards - 0:05:18
So it is. Apologies Alex, Alex Kafetz So we will get that corrected but thanks for spotting that.

2.2 Review of the Matters Arising and Action Log

Any other points of fact? In which case that's all okay. We can then move on to the actions arising, the action log.
There was a point about the response to Ofsted inquest that actually is going to
be coming to the Board in November is that right Chris? Excellent so we can
park that for today. The draft business plan was the second point where we had
to add baseline figures to the performance metrics that's been
completed I understand Chris I sure on this occasion so we can close that one.
Then there was the one about again from the draft business plan amending that
the metric on the percent of providers who have positive sentiment on the new
portal is an improvement on the previous portal. Esther, anything to say on that one
Esther Provins - 0:06:35
or can we close that one? Thanks Chair, just, yes, to support the closure we need to link that
Sir Mike Richards - 0:06:43
to our roadmap and so I think we have a way forward. Thank you. And then the final
one was on the dementia strategy and independent voice but that's not due for
a few months time so we can keep that open but but it's not active as yet.
Good. Any other matters arising that people think we ought to discuss?

3.1 Summary of the Regulatory Governance Committee Meeting on 4 September 2025

If not, we can go on to item 3.1, which is the summary of the regulatory governance committee.
As I've already noted, I am, at least for the time being, sharing that.
Just to let people know, the RGC is taking a deep dive into the so-called foundational
improvements that we have set for ourselves.
But as Julian you'll be mentioning those I don't see any point in
rehearsing that twice so I'll leave that for you to cover in your chief executive
report but that is now underway it's an important part of our work and we will

3.2 Summary of the Audit & Risk Assurance Committee (ARAC) Meeting on 11 September 2025

be coming back back to it anybody want to raise anything on that one if not I
I think we move on to the audit and risk and that's over to you Kay.
Kay Boycott - 0:08:05
Thank you.
So as Mike said, I'm the new chair of the audit and risk committee.
There haven't been a meeting since March, so there were quite a number of items to receive and discuss.
We talked with our external audit colleagues about the annual report and accounts and the approach to the year that's just completed, which is currently in progress.
We received a fair number of internal audit reports and the annual audit opinion and discussed
the issues raised from that.
There was a reset and scrutiny of internal audit actions because there's quite a long
list and the committee was satisfied that the approach was proportionate going forward,
but there will need to be quite a lot of continued monitoring there.
We had updates on risk management and governance and I think that's something we will return
to both the committee and Board. We have the annual report from the senior
information risk owner and received that and another report on incidents and
complaints which is going to be something that we are going to look at
our approach. So I think that just gives a flavour of what the breadth of what's
talked about and will go forward. There was a running theme throughout which
which is there's a lot on.
And so the other area that kept coming up
was around programme management and assurance
and being very clear about what is being done
in what sequence and then how we think about the risks
that we're carrying in the meantime.
But I'd say it was a bumper meeting,
but we reset and felt that we're in now a good place
of understanding where we are.
Sir Mike Richards - 0:09:43
Thank you very much indeed, Kay.
and actually thanks for a lot of work that's going into this from both you and
other members of the audit and risk committee any questions or comments that
people wanted to make on that

3.3 ET Report to the Board including an Update on the 4 Immediate Actions and 5 Foundational Improvements

Sir Julian Hartley - 0:10:10
apparently not so that's good so Julian it's over to you thank you thank you
Thank you very much Mike.
Well, good afternoon everyone.
I wanted to present the executive team reports
since we last met, there's been a lot happening.
And just to add Mike to what you have already said
on the executive team, very pleased to
note the appointment of Esther and Chris
in their executive roles as you've set out.
And also to have around the table our four chief inspectors,
which I think really signals and manifests the approach
to our sector regulation to strengthen our expertise,
credibility, and insight in that area.
So delighted to have us all together.
Given that stability now has developed,
that's allowed us to clarify some of the key
cross-cutting roles that we need to play and I would emphasise the importance
that we do have that necessary expert sector leadership but we also recognise
the need for our four chief inspectors to work very much as a team given the
direction of travel for health care and indeed the importance of health and
social care working particularly closely. I'll say a little bit more about that
in the context of the 10-year plan.
But just to emphasise organisationally
how we're working as a team,
pleased that Arun has agreed
to become our Caldicott Guardian.
Thank you, Arun.
The Caldicott Guardian is, of course,
responsible for safeguarding confidentiality of information,
ensuring it's used appropriately
and ethically upholding the Caldicott principles.
I think important to have a member of the exec team
at the chief inspector level responsible for that.
Esther, thank you for taking on the Senior Information Risk Owner.
SIRO is the acronym.
And the SIRO is responsible for overseeing our risk policy around information, implementing
measures to manage those information risks, ensuring we comply with relevant data protection,
GDPR and so on, and promoting information security.
Very important at a time when we're conscious of many of the threats out there in relation
to information security.
And as a regulator in health and care, vital that we have a strong and serious approach
to that.
So many thanks, Esther.
And I'm very pleased that Bola has agreed to, Bola, of course, our chief inspector
of primary and community care, agreed to be the executive lead for neighbourhood health.
And I think again a crucial at a time when we're seeing neighbourhood health be a key
part of the 10-year plan, the direction of travel, and that's going to be an important
role in terms of leading, working very much with other directors and chief inspectors
and indeed the whole organisation to lead our thinking and development on that.
So that really takes me to just saying something about our role in the 10-year plan.
So we have attached it as an appendix to the report.
It is in the papers.
Without going through it exhaustively, I did just want though to highlight the fact that
at CQC we strongly support and welcome the 10-year plan.
It doesn't mark a significant shift in terms of that new model of care across the NHS and
indeed aligning with adult social care.
And just to say, I think that we are thinking hard
about how we can enable and activate
some of the important issues in the tenure plan
through our regulatory role
and how we organise ourselves to respond
to some of those challenges.
There's also, I think, an alignment with what we expect
to see published in our state of care report that we'll see later this autumn, which will
highlight I think very clearly why we need that 10 year plan and why we need to make
a reality of many of the things that it describes.
So in specific terms, the plan of course highlights the three key shifts that need to happen across
health and care, hospital to community, analogue to digital treatment to prevention.
And we will be responding to that and helping support that through four key areas of focus.
So over the next six months, we will be resetting what good looks like and ensuring we provide
the right timely response.
We have a lot of feedback from people that use services, from providers, from stakeholders
about how we work and we'll be taking account of that
in the context of our work to look at
how we assess organisations.
Secondly, as a key component of our work,
our data strategy and our evolution
to a more modern data driven regulator.
There's a lot in the 10 year plan
about the importance of data.
It was very clear in the work on CQC specifically
that we needed to think more about outcome data
in the context of our work and our reports and our activity.
So that is going to be a central part
of how we support the evolution of the 10-year plan.
Thirdly, strengthening our public-facing assessment
and intelligence approach.
So thinking about how we frame our assessments,
how we make them understandable and clear,
give good information to the public,
reflect back the public's experience of care, treatment and fourthly our ability
to adapt to neighbourhood focused models of care because albeit we have four
chief inspectorates, we know that neighbourhood health crosses boundaries
in respect of key service areas so that emphasises the importance of the way we
team and indeed Bola what you'll be working on in terms of how we respond to
that as an organisation so I think those are four key areas that are going to be
central for us to help support the implementation and delivery of a
10-year plan and no doubt there'll be much more on that to come as the
delivery work streams are developed as part of the 10-year plan but we're
making sure that we're we're playing our part in terms of effective regulation
and indeed our refreshed purpose around protecting people
that use services, but also supporting providers
and systems of care to improve.
So, moving on to our work to improve what we're doing.
We, as you rightly said earlier, Mike,
we've been focusing very much on our four immediate actions
and our foundational improvements.
Now, I won't dwell on the four immediate actions
because actually we've made a lot of progress there
and we can pick some of that up in the performance report
that Chris will outline later.
Chief amongst which obviously is
we are doing more inspections,
which is a critical part of what we set out to improve.
On the foundational improvements,
these are really the underpinnings of
a modern, credible, effective regulator in health and care.
We've had a lot of work to do on our culture,
And that has been, and there's been I think no accident or argument about the fact we
very much started with reframing the organisations culture, values, purpose, vision.
I'm very grateful and it's really good to have sat around the table, Drew and Sooz,
because trade union colleagues, staff networks have been central to the work that we've been
doing together on this.
And I think that we're pleased that we've now crystallised our vision, our purpose,
how we work through our shared values, and indeed our commitments to those that we serve.
So we're making very clear commitments, which we'll be saying more about over the coming
weeks and months to the public, providers and systems of care, our people, and those
partners who share our purpose.
We launched that approach internally in July,
but we're planning to take that out further.
We're embedding that across the organisation.
And I hope that, I'm sure colleagues,
some colleagues will be watching this Board meeting,
but you're starting to get a sense that at CQC,
we are really focused on listening to the feedback
that we've had and received on an ongoing basis
and responding in a way that makes sure
we're putting our commitments around improvement,
around expertise, around rebuilding our work centre stage.
And I'd encourage all of you to feedback
on how you think we're doing in relation to that.
So that vision, that purpose,
commitments and values will all play a key role
in taking us forward.
And now we've got our four chief inspectors in place,
we've strengthened our expert sector-based leadership,
we're working in a collaborative way
to make sure when we revise our assessment framework,
that hits the mark in terms of our stakeholders, providers,
and makes it easier, frankly,
for our valued colleagues to do their work,
making sure we address some of the issues
and challenges of the technology.
So, on the specifics of what we will be doing over the coming weeks and months,
integrating our regulatory leadership and operations, that's been a big piece of work.
It's sort of reaching a point where we can see where we're aiming to get to in the not too distant future
in terms of going through all of that.
Again, I'm grateful to trade union colleagues, been working very closely with them on that.
But that is all about making sure we're aligning our colleagues to the
sort of chief inspector teams and making a reality of the recommendation to work
as a sector-based regulator. That I think will obviously take us to a point where
we'll have those teams in place. There'll be inevitably some challenges along the
but we're doing our best to really make sure
where we're listening to colleagues,
we're working closely with trade union colleagues
with HR and indeed we've got Chris Dzikiti
doing a really important piece of work
around managing that whole transition.
And I think it's fair to say Chris,
we feel like we're making headway
and colleagues are starting to support
and understand how we want to make a reality of that.
So that's an important piece of work internally,
but it will be felt, the benefit and impact of that
will be felt externally, I'm sure.
On the assessment approach, very important
that we take full account of the reviews
that we had the benefit of last year,
particularly, gentleman to my left,
at a different point, Mike, in terms of your work
on the single assessment framework,
Penny's review of our operational effectiveness and the care provider Alliance report and Vic Rayner
convene but very important messages from the care sector all of those three things together with the feedback from our own staff have fed into
the
proposed
consultation on
Revising our assessment framework has been a lot of feedback about the shortcomings of the single assessment
framework and the way providers have experienced this and indeed the experience for staff.
So we're planning to make changes to that but we want to ask through consultation we
want to ask some important questions about those changes and the way in which we make
that clearer, simpler, more effective.
And finally, alongside that, given the very, very clear failures in the
organisation on technology implementation, it's absolutely critical
we get that right. So the way that we attempt to tackle those issues, have a
clear plan for taking forward the way in which our colleagues can use technology
to assess and inspect is going to be critical. So all of the work on the
regulatory platform, all of the work on the technology and data, we've got an
indicative roadmap. The Board are fully focused on this and once that plan is
worked through the appropriate governance we'll be sharing that with
with colleagues more widely and indeed giving a sense of exactly how we plan and over what time
period we plan to make those improvements and changes which will of course need to align with
our assessment approach and the changes there. So in short a huge set of challenges ahead but
But I have to say, Mike, I feel positive about the fact that I think we're clear what we
need to do.
We're thinking hard about the phasing of that.
We're learning the lessons of the past in terms of how we've addressed that.
And we aim to work very much in the CQC way on taking forward these challenges and making
sure we keep faith with the values, behaviours, purpose that we've collectively agreed on.
So I'll stop there and happy to take any questions or indeed any of my exec colleagues to add to what I've said.
Thank you Julian very much for that.
Let's open it up to any discussion.
Are we heading in the right direction?
Sir Mike Richards - 0:25:04
Have we got the right fundamentals that we are considering?
Any members of executive team or non-executives want to comment at all?
Thank you, Esther.
Esther Provins - 0:25:19
Thank you, Chair.
I just wanted to add to Sir Julian's comments around the technology and data roadmap.
And you will see from the minutes from our last public Board meeting, as well as colleagues
and anyone who was watching that, we did discuss an indicative roadmap at our last meeting.
Alongside that, we absolutely took a decision to socialise and seek feedback
across the organisation, both from our internal colleagues but also those from
our external stakeholder groups. And one of the really kind of key pieces of
feedback that came back, and Julian I think you alluded to this, was the need
to understand the relationship of our digital roadmap with the other
foundation improvements. So you'll note from Julian's update that we are intending to
publish a revised plan.
That plan absolutely needs to respond
and will respond to the feedback
that we've received around that.
But I just wanted to just be really clear,
that plan absolutely does still acknowledge
the real kind of pain our colleagues, both internally,
but also our provider colleagues are experiencing
with our current technology.
So that's absolutely in the forefront of our minds
and those kind of current challenges
and the need to resolve this really underpin
our new plan that will be released as soon as students said it's gone through the appropriate
government. So I hope that's a helpful addendum. Thank you.
Sir Mike Richards - 0:26:42
Thank you very much indeed Esther. That's very helpful. Chris.
Chris Day - 0:26:48
I just wanted to build on one of the points that Julian mentioned around the redevelopment
of our assessment framework and to acknowledge the support and thanks that we've had from
from providers and from colleagues
and from people who use services
in the work we've done so far.
So this is the development work
that we're doing on this assessment framework now
is built very much on the conversations
we've had with colleagues, with providers,
and with people who use services over the last few months.
And I know that many of those groups
have been very supportive of the work
that we've been doing to sort of re-look at
what it means to have good services
in the different sectors that we regulate.
So it was just to say to thank you for those people
who've been involved in that work,
to recognise that there is still more work to do.
We've got some work that will be led by the chief inspectors
on the assessment frameworks in each of the sectors
that we regulate, and that will need the support
of our colleagues, providers, and people who use services.
And just to end on a point, some of the work we're doing
are bringing those colleagues together, perhaps,
for the first time in a few months,
to really think about what it means to be good
in each of the sectors that we regulate in.
That isn't just important technically,
but it's important culturally to get the organisation
and people who use services and providers
back onto a common frame of reference.
Bola Owolabi - 0:28:17
Great. Thank you, Chair, and thank you, Julian.
Just really to build on some of the points that Julian was making there,
myself and my chief inspector colleagues are delighted
to be here, particularly as it pertains to restoring that subject matter expertise and
actually sector expertise.
We heard loud and clear the feedback from providers and the system about the need for
us to rebuild our credibility and the trust and confidence that both our public and providers
have in the CQC.
So we're delighted to be here to start leading the work to actually rebuild that trust.
And also building on Chris' point about making sure
that the tools and processes that we use,
including the assessment framework, are fit for purpose.
Fit for purpose for our colleagues at the frontline,
for providers who are being regulated,
and indeed for the public to be able to be clear
about the quality of care that they're receiving.
And we're delighted to be really leading the charge
in terms of bringing together the operational
and regulatory functions of the CQC into a coherent whole that galvanises behind those
foundational improvements that we've talked about and the immediate actions that we need
to take. So we're delighted to be here, very much looking forward to working with Julian
and the rest of the exec and the Board to drive those improvements forward.
Sir Mike Richards - 0:29:44
Thank you, Bola. And just a couple of points from me. I really welcome the work that's
getting going on what what good looks like that came through very strongly in the review that I undertook last
Autumn there was a plea from the provider sector that was providers in hospitals providers in adult social care
They really wanted us to do that so that and but that's been waiting till we had the chief inspectors to lead it
And it's great that we now have those chief inspectors
the other point I don't think
mentioned as yet the
The consultation we will do on the assessment framework
is within a matter of a few weeks now.
It is coming up really quite soon.
Jackie.
Jackie Jackson - 0:30:28
Just to add my thanks to Julian's staff networks
and trade union colleagues.
We have got such a lot of work
where we are relying on each other.
And I think certainly with trade union colleagues,
I think we have got 15 work streams, which is significant.
It's not lost on me that internal reps have a day job to do as well.
And just really appreciate your pragmatic and supportive approach to everything that
we're trying to do.
Thank you.
CQC Network Representative - 0:31:05
Thank you Julian.
Thank you chair.
We've a very positive road forward and grateful for the steps that have been outlined in the
as in that have been all being taken to move us
in the right direction.
I think, whilst undoubtedly positive,
I'm really keen that we consider the continued disruption
and challenges that our colleagues in the wider health
and social care sector face very much well
in the organisations consideration about the impact
that these ongoing changes have, even whilst positive,
and how we can make the improvements in a way that
balances that effectiveness with the avoidable disruption
at a time of already great stress on the sector a lot.
Thank you.
Sir Mike Richards - 0:31:43
Thank you Drew.
CQC Trade Union Representative - 0:31:46
Thank you. I just wanted to add, I think that you mentioned something about establishing what good looks like.
I'm gonna think some of the feedback from our members is that that's a great starting point,
but as a regulator we should be pushing for improvements.
And one of the challenges our inspector colleagues face is defining what outstanding looks like.
So an inspector might go to a service and deem them outstanding and then there is a challenge internally to get that published.
And I think that whilst we're looking at what good looks like, we should be stretching to
see what does this outstanding look like consistently and how do we support our colleagues to identify
that and to easily get that through the sign-off processes so we can celebrate your successes
in the care sector.
Thanks.
Sir Mike Richards - 0:32:23
Thank you.
I think that's a really important point.
I think it will be easier when we have defined what good looks like to say what goes beyond
that.
And of course, it doesn't stay static over time.
What might be considered outstanding now in three or four years time might be quite routine and therefore be good
But that's a good thing and then other things will come along that will be outstanding
That certainly was my experience when I was a chief inspector
So so we'll keep that one under review, but there is some work going on on that anyway
David.
Mr David Croisdale-Appleby - 0:33:00
Thanks very much, Mike.
I just wanted to pick up as this was the report from Julian.
One of the very successful parts of the embedding of the CQC way, I think, has been the way
in which the HR and people function has been handled
within the organisation.
And I say that because I think most ALBs are finding
this probably the most difficult area to deal with.
And it's an area that can sometimes be taken for granted.
And I've got personal experience working closely
with Jackie Jackson and her team on the work
that they've helped us with with Healthwatch.
And Healthwatch is a very sort of dynamic small part, and we have very high morale.
And because of the work with Jackie, and she's brought in the unions to this very significantly,
we've maintained that high morale within the organisation.
And we have a network of 153, and they constantly ask us questions about HR and people and how
they should handle this and what risks they take, et cetera.
And I have to say that I found absolutely unfailing support
from Jackie's team to help us with that.
Where we've asked a question, we've
had it answered immediately.
Where they couldn't answer it and they've gone away.
And you know what it's like, Julian,
people say, well, we'll go away
and we'll come back to you on that.
They've always come back to us on that.
And they've given us an answer that's actually
rather better than the question that we
posed to them in many cases.
So because it's an area that it's when it works well, it's very easy to overlook
So I just wanted to make that point because some of my colleagues won't be
Necessarily as aware of it because they're not closely involved with it
Sir Mike Richards - 0:35:04
But I think it's a great testament to your your leadership the executive team's leadership and Jackie's leadership of that function.
David thank you very much for those comments
Sir Julian Hartley - 0:35:14
Julian, anything else you wanted to add on this item?
Perhaps just to underpin, Mike, the importance of the consultation on that assessment framework
and the fact that we expect over the coming weeks to be consulting widely with colleagues
on providers and stakeholders on that given I think you know we are
conscious of the time that's elapsed since you and Penny and others wrote
those reports we want to make and indeed the concerns we get from our provider
colleagues that and now we have chief inspectors in place the ability to sort
of positively address some of the issues and challenges with the current
the current framework and indeed in tandem address
significant issues and Drew, you drew attention to the problems
that many of our colleagues are facing right now
to try to ease some other challenges and burden
on them as well so that once we get through that
we'll be in a place where we've got a clear assessment
framework supported by good technology that empowers
and enables our colleagues to do their best work.
So that's the goal and we're on the cusp of getting out there with that consultation document.
So thank you for highlighting that, Mike.
Important to reinforce, I think.

4.0 To Approve

4.1(a) Equity, Diversity and Inclusion Survey Results & Strategy

Sir Mike Richards - 0:36:49
Thank you, Julian. So I think that's all on that item.
So we go on to item 4 .1.
And this is you, Jackie, to lead us off on equity, diversity and inclusion survey results and strategy.
So we're just waiting for one other person to join us in the room.
Welcome.
This is Nadiya Rahman, our Equality, Diversity, Inclusion Manager, who has to take a lot of
credit for these reports, so it's right that Nadiya is here to speak to us today.
Jackie Jackson - 0:37:53
From my point of view, these are two really, really important papers.
And we'll see in the papers, and I'm sure Nadiya will bring them to life,
that we're definitely making some inroads and improvements in this area.
I'm not going to sugarcoat anything. We have a long way to go with where we want to be.
But from our perspective, the conversations, the interest, the time and support from executive
team members is really having an impact on what this is starting to look and feel like.
So whilst the papers go some way to give an overview and a feel, I think it's very much
about our collective commitment to an organisation,
to the conversations, to the time, to the importance
against the backdrop of so many of the priorities
as to how we do not take our eye
at this really important area
that we are absolutely committed to.
So with that, I'm going to hand over to you Nadiya
and just to bring some of this to life and then we'll take some questions.
Thank you Jackie. I wanted to really talk about some of the structural levers that we need to pull this year so we could embed the EDI strategy and see some sustainable progress.
Presenter 1 - 0:39:34
So firstly, the organisation design and operations that will help to stabilise people's experiences and it will help some of the talent development work and equitable experiences.
Secondly, the performance system that we want to refresh as part of the CQC way.
That will be really, really important for objective setting and to help the work on freedom to speak up and bullying and harassment that we want to do.
And then finally, the business plan.
The business plan is actually very, very critical because there will be a cascade across the organisation.
People will be able to have clear objectives right from the top.
That will help with our strategic workforce planning.
It will help with objective setting, responding to all of the feedback that we've had in the
survey around talent development and equal opportunities.
It will also critically impact people's stress levels because they'll feel less stress because
they have more clarity.
Right now there's a lot of ambiguity, there's a lot of core communication and that's been
fed back as experience through bullying.
So we see in the survey annually, and this is pre the transformation, poor email tone,
excessive criticism, micro-management, colleagues being ignored.
So hopefully the business plan does help gain that stability and then we're able to tackle
some of these behaviours systemically. If we don't do that, especially with the
performance refresh, there's a bit of a risk because we could embed those behaviours.
and then that will increase trade union colleague work, HR work, so we need to use the CQC way
or the inclusion learning, the leadership development work and colleague learning to
really focus on challenging those behaviours. It's not just race and disability that we
need to look at, this is wide scale equality inclusion learning, especially because marginalised
groups they tend to feel bullying and discrimination if an organisation itself is going through
a lot of struggles because they have existing structural barriers in place. So it's really
really important that we think about that as we do all of the CQC way learning that
we want to do. If you do have all of these levers aligned you will start to see change
as we come back to report on the strategy. As Jackie mentioned we've seen some improvement
but if you pull the structural levers, you'll start to see more change and you'll see more
accountability as well from people.
Thank you very much indeed Nadiya Jackie back to you.
Sir Mike Richards - 0:42:12
So I think going forward we just need to also cross cheque the points Nadiya made around our
Jackie Jackson - 0:42:21
structures, how we work with the chief inspectors as the head count is more manageable.
And then we can look at how the interventions we've already put in place are having a positive
impact or they're having a positive impact.
So the race training has had really good feedback, really positive, but it's about what next
and what that means.
So whilst we can absolutely encourage and focus on completion, that's only a small part of the story.
So I think looking at all the interventions that we've got in place, thinking about our CQC way, our freedom to speak up focus, revision of policies.
I think this is all through an optics of the the colleague experience
And this forms a really really important part
Thank You Jackie, I think we can open this up for discussion
Who would like to start off on this? Sooz would like to
Sir Mike Richards - 0:43:33
Thank you. I just wanted to add on to what Jackie was saying there. I think that measuring
the impact of these actions is key because otherwise we are there's a lot of activity
CQC Trade Union Representative - 0:43:47
going on. And if we aren't measuring the impact of our results and the output we're putting
out there on the impact it feels to individuals. Yeah, we're not going to move that dial as
I said. So I think as an analyst at heart, measurable outcomes is where I'd be asking
for us to focus with this sort of thing. What does it feel to individuals rather than a
box on an action plan. Thanks. I see a lot of support around the table as you said that.
Melanie. So I'm not sure if I'm going to be answering this one or item 4.2 and 4.3 because
Sir Mike Richards - 0:44:16
it's a lovely set of reports isn't it? So I do apologise colleagues I'm sort of slipping across
Melanie Williams - 0:44:23
the papers Jackie but I think first it's really important to see this data because one of our key
roles as a Board is to make sure there's that visibility, accountability and transparency so
thank you for bringing in fact all three of them because it really reflects lived experience, which is so essential.
I guess Jackie I was just really curious as to what else is needed.
I'm sat here thinking as a non-executive director and ensuring we take this the next step and it's like I say it's what bleeds into the
objectives that we've got into item three. But is there anything else in terms of leadership? It seems there's a lot of actions below.
It felt like there were lots of workforce actions and I'm really curious about the governance
actions that we may need to have in place to make sure we continue this visibility and
delivery.
I agree with that.
I think there is a lot of activity but I think it comes back to oversight and ownership
Jackie Jackson - 0:45:19
And I do think as we move into a steadier state with established structures and we look at some of the metrics around recruitment, training, opportunity, development.
I think that's where we start to plug in even more metrics and also interventions and training and scrutiny.
And I think as we move forward, it feels to me as though that might be easier in the structures
that we are pulling together.
And also the fact that the first point I made, it feels as though from our perspective, and
I'm sure Nadiya would agree, we are pushing on an open door at the moment.
people I want to have conversations or asking about, you know, themed weeks, whatever it
might look like. And I think it feels much healthier conversation to have and just have
to build on that as well.
Julian.
Thanks very much, Jackie, Nadiya. That was really good to hear your reflections. I was interested
Sir Mike Richards - 0:46:30
maybe in your response and indeed other colleagues,
I think particularly Sooz and Drew,
on when we look at the results,
Sir Julian Hartley - 0:46:36
one thing that struck me which I found interesting was
we've had that increase in positive sentiment
about working at CQC.
I think an increase of 27 percentage points
on October of last year
and an improvement on psychological safety
and confidence in efforts to build diverse teams,
but set against that decreases in the perception
of equal opportunities for career progression
and fewer feel they're being treated
with respect and fairness.
I found that quite interesting sort of dichotomy
in terms of how we can use this to really focus
our efforts on bringing to life our values, behaviours, the way in which we move forward
together to, and it might come back to what you were describing about some of those levers,
but I think I'm really interested in how we can derive the most benefit from what we know
through the survey, because a lot of colleagues made time to fill it in and kind of take forward
the learning or the action which we think are going to be needed to address the areas
where we're falling short.
It will give clarity from the top on objectives, so right down to each directorate they'll
be able to set clearer objectives, so then that will enable more equitable opportunities
for career development because at the moment if people are stressed and they're not quite
Presenter 1 - 0:48:20
clear what they need to do, sometimes as humans because of bias, when a project comes in you
might automatically be giving it to the person that you know will be able to deliver. But
then that inadvertently does not give other colleagues who are more than capable to deliver,
deliver and you'll create that cycle. Because it's interesting, last year we had a lot of
pilot projects during recovery mode and yet people have fed back that they didn't feel
equal opportunities for this. There certainly should have been lots of opportunities with
a number of projects that happened. When I speak to people, the sentiment hasn't changed
since the development of the strategy. There's not enough equal opportunities and that is
affecting people's feedback in terms of promotions and their opportunity to get involved with certain projects
and that's why the other data point about retention is getting better, but then at the
same time people are saying there's not enough opportunities. We forget that the CQC also
has other draws. We work from home completely compared to other public sector departments.
There are certain perks that mean that people do stay on, but then from a talent perspective
there is an issue because if we have an ageing workforce, and one of the main reasons is
retiring, and we are not attracting and retaining people between 20 to 30 from a strategic workforce
planning perspective and to deliver as a regulator, that is a risk for us. There is supposed to
be a strategic workforce plan published by the government in the next month, and the
regulators are being looked at by the Department for Business and Trade because I've been speaking
to them, because they do want to ensure that regulators are skilled to deliver for the
future. So all the work that we do on talent will have a bigger impact in terms of our
strategic workforce planning and hopefully if we de-bias the system through better business
planning and strategic workforce planning, we create the conditions for people to have
better experiences in relation to their careers. And also in terms of the bullying points,
the experiences about email tone and ignoring. If people are less stressed, then hopefully
that helps with the way that we are communicating with each other. Hopefully we're in less meetings,
so we could have more opportunities to deliver some messages that might be better delivered
by speaking to someone rather than to write it out because tone is very difficult to tell
when you're writing it out and if you are busy and you write something really really quickly
you can land a lot harsher than having a conversation and following it up to say this is what you're going to do.
I think Bola and then Kay.
Thank you, thanks Nadiya.
Sir Mike Richards - 0:51:27
Just some reflections, I just really wanted to highlight the progress that we see in the
Presenter 1 - 0:51:32
data in relation to colleagues with disabilities and colleagues from our LGBTQ community.
I think it's really important that we acknowledge that a lot of the work that is being done
is moving us in the right direction.
That is not in any way to say it's mission accomplished or that we should be complacent.
But I think when we are leading in a very complex system such as we are, it's important
Bola Owolabi - 0:52:02
to name the progress that we're making.
I just wanted to say that specifically and to say a huge well done to everyone who's
working across the organisation to get us to that position.
And to perhaps reflect on how we might take some of the learning from how we've been able
to make that progress in relation to those two populations of staff to then think about
what the data is saying in terms of our ethnic minority colleagues, whether that is in terms
of representation at senior levels,
or indeed what it says in terms of career progression.
So in the spirit of building on strength,
I do think there is something about perhaps reflecting
on how we've made progress in some of those other areas
and what we might be able to implement and adapt
in relation to ethnic minority colleagues.
And the second thing really is to recognise
that the answers don't always lie just within us
as an organisation, the NHS Race and Health Observatory,
with whom we work very closely,
are leading a piece of work in terms of career progression
for colleagues from ethnic minority backgrounds.
And I would suggest that as part of our strategy,
we continue to strengthen the collaboration with the RHO,
because I think it will get us further forward
in relation to this group of colleagues as well.
Thank you, Bola. Over to you Kay.
Well so, Bala got in sort of with what I was going to say. So I think this
Sir Mike Richards - 0:53:39
conversation has crystallised something I saw in the paper. I was, I think I was
most concerned still around the outcomes to do with ethnic minority applicants,
colleagues in terms of successful appointments pipeline. What I saw
Kay Boycott - 0:53:55
or huge amounts of work going on. A really comprehensive plan, lots of thought and the
conversation has just put more of that thoughtful action there but it's incredibly difficult to
I think pinpoint particularly on that issue which I think is the one that bothers me most.
What are the really really key actions that need to happen and how do we get assurance that they
are being delivered to time and I think back to Melanie's point and that we can
keep oversight on that because it's that slight wood for the trees piece on
it and you've not been now during the previous conversations but you'll get it
there's a lot going on that we need to be tracking and keep and I think it's
really important and for me that is one of the most important things in here as Bola touched on.
What do we need to focus on? What are the three things?
Either Jackie or Nadiya want to come back on that with your top two or three?
Sir Mike Richards - 0:55:04
Definitely the learning that we need to do to look at talent and also performance, the
objectives when we refresh because that will get the accountability and the visibility
Presenter 1 - 0:55:13
and then some of the system levers like the business plan, the governance, improvements in governance
that will help with tracking progress, also the performance objectives that we're looking at.
And when I mentioned the business plan will help with talent,
so one of our interventions is inclusive leadership pathway for ethnic minorities and disabilities.
If we don't embed into our processes better talent management, then we can invest in these programmes,
but after colleagues go through the programmes we are unlikely to retain them or promote them
or then to have a very good experience or actually support their career development.
So there's three things talent, learning and performance.
I'd just add as well I think as well recruitment. We know that we've got work to do organisationally
because when you look at some of the percentages we start off with some roles quite positive and
as it goes through each stage, it starts to get reduced.
Jackie Jackson - 0:56:15
So we know from a recruitment and attraction perspective,
need to think probably more creatively and also track
and how we support colleagues who are hiring managers,
are looking for a particular role,
to think about it quite
specifically and how we can support that.
OK, we've got three points on this side, which we will come to Esther and then Arun and then Sooz,
And then we'll move on.
Sir Mike Richards - 0:56:54
Thanks, Chair. So thank you, Colleagues, for a really interesting report.
I think, you know, the systemic kind of action plan around this absolutely support that.
Esther Provins - 0:57:05
And I was just reflecting as I was listening to the conversation and reading this before
around events over the last couple of weeks have happened internally.
We had a national inclusion week last week that we launched and I had the opportunity
to speak a couple of the events there.
We've had been celebrating psychological safety week and how we can support that kind of safe
environment both physically and psychologically for our colleagues.
And what was really interesting just to kind of supplement the data in here was that really
open dialogue that our colleagues joined those calls and felt, I hope, really, and
it felt they did, really kind of open and kind of honestly able to share their
kind of feelings about how we as a leadership team could support that but
also how they were feeling at the time. And I guess just, you know, my reflection
is it's really, it really just kind of warms my heart, I suppose, that we're having
this conversation because it kind of evidences to me that as a Board and as
and executive team what a priority that this is
and how from a values perspective,
this how important this is to all of us.
And I guess from a kind of a moving forward perspective
that open and honest dialogue with our colleagues
across the organisation is absolutely one
that I know we all support.
Thank you. So, Arun.
Thank you, Chair. Similar to Esther and others here today,
I've been on one of those panels
around Psychological Safety Week this week.
Sir Mike Richards - 0:58:31
Thank you Nadiya for organising those and inviting us.
I was, like Esther, really struck by the positivity
Arun Chopra - 0:58:37
and the momentum from the about,
there was about 100 colleagues who joined on that call
and the way that they were really keen
to take the rebuilding activity forward
and were coming up with really good ideas
about how we can build back better
and they had really strong ideas around performance,
appraisal, training, all of which will create that culture
which we want in keeping with the CQC way.
So really, really kind of the organisational learning
and the ideas that were coming through from our colleagues
around those areas will be crucial to delivering
on some of the actions we've described.
So again, thanks to Nadiya for organising those.
Thanks Arun.
Sooz.
Yeah, I just want to add that I think there has been
a lot of positive activity as we were on the panel
earlier this weekend.
And I think that's really great to see.
I want to sort of draw focus from something
Sir Mike Richards - 0:59:24
that you said Mel around what can we do.
is the data is great.
So there were DES reports saying that we are recruiting
and promoting more disabled colleagues.
But I think that the challenge I would put is,
how are we assuring ourselves that when they are put in post
CQC Trade Union Representative - 0:59:38
that we are supporting them with things like reasonable
adjustments?
So our trade union reps are most frequently
busy with having discussions with managers and our members
about getting reasonable adjustments put in place.
Even when there's a workplace passport,
we have the stats around the number of workplace passports.
But how are they being used?
And is that effective?
and are the right things being put in place,
because having a document that says what you need,
and then having an inspection planning team not have access
to the information to appropriately slot you
into an inspection does create barriers.
And I think that's where some of the progress needs to happen.
It's great we've got the data.
I think there's a lot more to do.
And like you and Esther said, Arun,
I think we have colleagues who are open.
They're giving us the information to improve.
And we need to make sure we're listening to them
and putting their words into action.
Thanks.
Thanks, Sooz.
Drew.
Thank you so much.
I just want to pick up a point from Bola before.
As co-chair of CQC's LGBT+ network, I'd be very keen to currently towards any shared
Sir Mike Richards - 1:00:33
learning or good practise opportunities going forward.
The network team are very proud of the part that we've played in the progress in this
CQC Network Representative - 1:00:43
area, recognising that we've still got a long way to go.
We're continuing to make efforts around building that psychological safety that we've had discussions
around this week and very valuable discussions around this week and that trust the community
at CQC and that kind of equitable representation within and external to the organisation as
well.
We certainly don't have all the answers but I'd be really keen in what the opportunity
alongside our members to do more collaboratively in that space with other networks and with
the wider organisation.
Thank you.
Thank you, Drew, for that offer from the networks.
Any final comments Jackie on either 4.1a or b? No just to thank colleagues for all the
Sir Mike Richards - 1:01:24
contribution and this is an ongoing dialogue and you know we can take
certainly the points raised away and working across the organisation really
Jackie Jackson - 1:01:36
to move things forward but looking forward to working with executive
colleagues on the new structure and what we can do to positively influence that
as well. So thanks very much.
Thanks, Jackie. And I think that takes us neatly into
Paper 4.2.
Bola, you're going to lead off on new equality objectives.
Sir Mike Richards - 1:01:59
Thank you, Chair. So just in terms of the equality's objectives,
I just wanted to preface the paper by saying that it's built on two

4.1(b) WDES/WRES Report and Action Plan

fundamentals. And the first is our CQC way, the vision
that we've set out, the purpose that we've outlined,
Bola Owolabi - 1:02:15
and the commitments both to the public providers
and our stakeholders at large.
But there is a legal duty,
and I've deliberately led with the CQC way
because it's more than simply fulfilling
a set of legal duties.
It's very much what we want to be doing as an organisation.
It just so happens that we have a legal basis for doing so.
So that was the first thing I wanted to outline to the Board.
So, last year we had five objectives, five equalities objectives, and we've provided
detail of what those were in the appendix.
There is also further detail in terms of the progress that we made across the five, notably
to say in terms of working with others to address health inequalities and using our
independent voice were two areas where we made particular progress in terms of the equalities
objectives.
We found it a little bit more challenging in relation to using data for equity for all
the reasons that we've already rehearsed in this Board, which links to the foundational
improvements that we've set out in Julian's opening remarks.
So just to give you a précis about where we got to in the previous equalities objectives
that we set.
Looking forward then to 25-29, we've taken a very strong evidence-based approach.
A piece of research was commissioned to look at the role of the regulator in addressing
health inequalities.
We also launched a self-assessment amongst providers in terms of the progress that they
are making, huge consultation and engagement across the organisation, including with exec
colleagues but indeed through our staff networks as well. So just to say that a
body of evidence and engagement underpins the four objectives that we're
now putting forward. So the first is voice and that is being retained from
before which is actually how we amplify and enable the voices of people who are
most likely to experience inequities in access experience and outcomes. The second is the data we propose to continue to retain
the use of data to address health inequalities
as one of our equalities objectives going forward.
As we've talked about through the course
of the Board meeting today,
the importance and the imperative of data
to surface the inequalities,
but also to help us to track the progress
that we're making.
The third is to use our core regulatory activities
to address inequalities, particularly for example,
we've talked about assessment today,
the assessment framework, I've been out on visits myself to some of our GP practices
and I could not emphasise enough the role of the regulator in really surfacing the inequalities
that some segments of our society experience.
So one of our objectives that we're proposing is to use those core regulatory activities
to advance equity.
And then the final one, knowing of course that it doesn't really matter what objectives
we set out in a population facing way without having equity, diversity and inclusion amongst
our own workforce, it's unlikely that we will be able to make progress. And so the fourth
objective we propose is around inclusive workforce, just building on the point that Jackie and
Nadiya have just been making there. So I just wanted to set out those proposed four going
forward. And to say that in relation to equalities objective one, our proposal is that each
directorate will take the leadership in setting out their own objectives that they will deliver
against in relation to EO1.
And secondly, we are working to identify a set of success measures by which we will tangibly
and measurably demonstrate progress in relation to each one of these objectives that we propose.
And we'll be having a conversation internally as the executive team in terms of what is
a balance of pragmatic, proportionate, and meaningful measurements that we may be able
to adopt.
And just finally is to say that each one of these objectives has an executive sponsor,
as we've set out in the paper.
We think that's incredibly important to demonstrate leadership and also to galvanise organisational
support around these objectives.
So I'm just going to leave it there.
I really welcome comments and questions, but I'm seeking to give you the rationale and
the progress in terms of where we've been and where we're heading.
Thank you, Chair.
Thank you so much.
And I think I would say I warmly welcome the fact that not only have you taken a lead on
Sir Mike Richards - 1:07:06
this with your great experience in the area, but on top of that, it's going to be a shared
responsibility at a very senior level to make this happen.
So thank you for that.
So let's open it up to any any comments. Mel
Really welcome this and I like the object is very simple very clear.
I did think we could make it much more explicit
This is also a function of the unitary Board because it can't I mean maybe it's just the way I read it
Melanie Williams - 1:07:32
But it almost read that the exec team will do it and then the Board will hold that to account
Whereas we're our objective is to deliver equality, diversity and inclusion
So I know that may be playing on words a little but I just thought I wanted to make absolutely
explicit and that we will have an objective as a Board to do that.
Very good point there. Alex.
Sir Mike Richards - 1:07:59
Alex Kafetz - 1:08:06
Thank you for that excellent paper and as Mel said very clear. I just wanted to echo my support for all of them but especially I think the third one about using our regulatory levers and we talked about this offline but you know making sure within the limits of our powers as we review the single assessment framework
and everything that goes with that, that this is kind of writ large against everything we
do. And you know, making sure there's cheques and balances, again, within our powers, that
you can't be, you know, outstanding for responsive care if you're widening inequalities by maybe,
you know, cherry picking all the easy people from affluent areas off your waiting list
or whatever that might be. So I really support that and hopefully we can add that cheques
and balances which I know you were.
Just to add to what Bola said and Mel actually, we as Chief Inspectors feel that this is absolutely
Sir Mike Richards - 1:08:58
core to our role in sector leadership. Since the last Board meeting the leader report on
Chris Badger - 1:09:01
avoidable deaths for people with a learning disability was published and once again was very difficult
reading still twice as many avoidable deaths in the population of people with
a learning disability than the general population that is something that you
can't read and pass by that needs to be absolutely central to what we're doing
in terms of regulation and supporting the wider health and social care system
addressed as an example that would serve to illustrate I think the role that each
of us as chief inspectors has to follow through our leadership in this area to
make sure that we can address those outcomes for people as effectively we
can both in our own work and in our influence of wider work across health
and social care so I wanted to echo that and offer our support as chief
inspectors and to Bola's work on this.
Tony. Thank you chair and just to follow up from the remark Alex made about
Sir Mike Richards - 1:10:01
EO3 in particular I mean it is really stark isn't it in certain areas of
Dr Toli Onon - 1:10:06
health care, it references black men's mental health, which of course is Arun's area
of expertise, but also access to testing and treatment, for example, and prostate cancer
and maternal mortality.
I think the figures are so stark, the risk of dying being three times greater is just,
it could not be more stark really.
So the opportunity as a regulator to be able to assess this within providers, I think is
key and articulating as you have been so helpful.
Thank you.
Thank you, Toli. Chris?
I just wanted to draw the link between EO1 and our commitments that Julian talked about earlier.
Sir Mike Richards - 1:10:42
Chris Day - 1:10:47
It's a really strong and important link for me in terms of continuing to rebuild trust with people who use services,
that we are able to amplify their voice well and it speaks exactly to the commitments that we set out for the public
as we launch our thinking around our values and behaviour.
So I just wanted to say this is, for me, an example of doing what we said
we would do with regards to our commitments to people who use services.
Thanks, Chris. On to Esther.
Thank you, Chair, and thank you, Bola.
It would be remiss of me not to talk about EO2
Sir Mike Richards - 1:11:23
and the kind of red or limited progress we've made so far
in our use of data to understand our equality risks.
So I just wanted to share that absolutely this
Esther Provins - 1:11:33
will be part of our roadmap going forward.
And a systematic approach to this,
we are already strengthening rather than the piecemeal one
perhaps we've been working with until now.
So we've put in place some additional support
from a governance perspective around how we manage
and utilise our data and how we can improve our provision
in that respect to support us improving in that area.
Thanks.
Thanks, Esther.
Drew.
And then Arun.
Thank you.
Fully support the proposed objectives
and how, as I suggested, how clear they are.
Very helpful paper.
Sir Mike Richards - 1:12:07
Particularly welcome, EO1, Amplifying Voices.
Having spent many days, over the last few months,
CQC Network Representative - 1:12:15
at events with the LGBT community particularly,
we've heard very much firsthand how so often the very basics,
the fundamentals of care are missing for LGBT plus people that otherwise we would be to
act on in more normative environments. Again, please consider utilising our connections,
our lived experience and expertise to reach out to communities that we don't always do
well enough to contact and utilise us in our roads and when we go about these activities.
Thank you.
Thanks, Drew.
Arun?
Thank you, Chair.
Toli mentioned the work that we're doing around black men's mental health.
And in response to Alex's observation on EO3, I wanted to just talk about a specific piece
Sir Mike Richards - 1:13:03
of work that we're doing.
Arun Chopra - 1:13:04
Our inspectors within the Mental Health Inspectorate and our Mental Health Act reviewers will be
actively working with providers about their implementation of the patient and carer race
equality framework in their inspection and Mental Health Act review activity
and really supporting improvements where they see it, highlighting areas of good
practise to correct one of the injustices which has driven the Mental
Health Act or the Mental Health Bill that's working its way through
Parliament. So we're really determined to use our regulatory levers to correct
those injustices where we can. Thank you.
Thank you Arun, really important. I don't see any other hands at the moment so on
that note I think we can probably move on but a really important discussion and
Sir Mike Richards - 1:13:50
I hope everybody's heard the level of commitment to this around the table
Bola back to you. Just for the purposes of the minutes chair can we take a read
that the objectives are therefore approved by the Board? Sorry that's a
really important point can we take them as approved yes we can thank you chair
So I think that takes us on to the business plan. Chris Usher. Thanks chair.

4.2 New Equality Objectives

So this is our business plan for 25-26. Colleagues may remember we had the
measures that we plan to use in our June Public Board. This is now a chance to see

4.3 Business Plan 2025-2026

Chris Usher - 1:14:36
the full business plan including narrative. We pitched this as a bridging
plan for this year, recognising the need to lay foundations for the future and
and we split it into two parts.
Part one focuses on the immediate actions
that we've agreed we need to focus on
and the foundation improvements that we need to build on.
Part two includes our wider work
and regulatory commitments we have.
It's intentionally targeted that way,
recognising that what we call the four plus five
are our core focus right now.
Plan sets about how we'll go about our business,
our commitments to public providers, our people,
partners as well as the values we'll uphold.
And we've included the set of measures that have been developed with acknowledgement of where we are in our journey.
It helps provide a basis to demonstrate our improvements but hopefully show visible progress as we go through the year.
So that's all I was planning to say in a way of an opening chair.
That's fine. Put it open to discussion. Julian, is there anything you'd like to add?
Thank you Mike and thanks Chris. I think just to say this is this is obviously
Sir Mike Richards - 1:15:46
Sir Julian Hartley - 1:15:54
important in the context of giving some quantifiable clear indicators of what
we're aiming to achieve both on the four immediate priorities we've been focusing
on but also signalling the importance of the work on the foundational
improvements and indeed the wider activity. I know that there'll be
colleagues in providers who might want us to be doing - to be going further
faster on some of the metrics and indeed will be some colleagues who will feel
anxious about what we're committing to. So they'll mix perspectives on this
but I think the important thing is that we've been very thoughtful about this.
We've engaged a lot with our provider colleagues and within the organisation
about how we approach this,
about how we ensure that we are accountable as a regulator in terms of the
clarity of delivery against this. And a number of,
a number of colleagues and organisations that I've spent time with during the
first few months of in this role have been,
urging us to be clear about what we're aiming to do by when quantifying our goals, being
clear about the metrics we're going to hold ourselves to.
So I think it's important actually that we've got this and it's important that we are setting
out for the rest of the year where we aim to be.
And I would also say we've had important conversations with colleagues in DHSC about this work.
and making sure that we're setting ourselves up
in the right way to tackle this.
And this does represent that sort of
incremental but positive and important return to
better performance, but it is the start, not the end.
And I think it's just to emphasise that
in terms of managing expectations.
But it sets us on the right path, I believe,
to getting to a better position in terms of our overall performance.
So thank you.
Thanks Julian.
Any other points that people want to raise on the business plan?
David.
Sir Mike Richards - 1:18:20
Just a very quick question which is are we going to review it subsequently through the
year?
What is the process going to be, Chris, to look at business plans,
Mr David Croisdale-Appleby - 1:18:32
see if there are changes that could be beneficially made to it?
Yes, I think we're in the odd position
that we're halfway through the year and agreeing a plan.
So we're already a bit out of sync.
I think our focus needs to be on measuring our performance
for the rest of the year
and thinking about how do we set a plan in the coming year
Chris Usher - 1:18:50
and how we measure ourselves against that.
So I think it's a constant evolution.
but recognising the oddness that we are midway through the year and setting the plan.
So just to say we're coming on to performance finance and risk assurance.
The question really is will there be any form of formal review that the Board will see of this
Sir Mike Richards - 1:19:12
plan or are you saying that no that won't be the case there'll just be performance measures
Mr David Croisdale-Appleby - 1:19:18
and really we're moving to the next year. Effectively that's what I'm yeah.
I sense, David, I just wanted to kind of amplify Chris's response on that.
Chris Usher - 1:19:33
Sir Mike Richards - 1:19:37
I think it's been a judgement and I think it's been a very important one that we have prioritised
quite sort of clearly the things that we know we need to focus on and the business plan
is built around those.
Sir Julian Hartley - 1:19:51
We will be tracking performance against those, absolutely.
and I think through the routine performance monitoring and indeed what comes back to the
Board.
But in the usual way, we'll be reviewing how we're doing against these to inform next year's
plan to make sure that I think in terms of your question that we take the necessary learning
and understanding as we work through all of the things we're aiming to achieve to make
sure that when we're setting next year's plan we're pushing ourselves where we
need to, we're being realistic about maybe what we haven't done as much of
because frankly given where the CQC has been you know we've got to be judicious
about how many things we take on and how we deliver on those
commitments that we're making.
Any other points on the business plan? Because if not, I think we do have to approve this
Sir Mike Richards - 1:20:56
one. So does it have approval? It does. I'm saying that the good news is that having done
that we have got a quick break. I suggest we start again at 3 o'clock.

Comfort Break

I think this report into independent care education and treatment
reviews is logically placed on the agenda after our discussion on the
Sir Mike Richards - 1:21:39
equality objectives and particularly the need for us to be active participants in
Sir Mike Richards - 1:21:42
addressing inequalities for people. In this instance clearly it relates to
people's long-term seclusion for people with learning disability and autism
Chris Badger - 1:21:57
very much in response to Baroness Hollins's report in 2023 which is called
My Heart Breaks. I think and Rebecca will take us through this will
illustrate the work that we've done to really actively and practically try and
help people and reduce the really profoundly damaging effect that long
term seclusion can have on people. I would also stress that the work that
we've done on this that I sponsored will sponsor from now on doing close
collaboration with Arun which hopefully again serves to illustrate the

5.0 To Discuss

of cross sector working in our new structure.
But I'm really pleased that Rebecca
is here with her leadership to
present on progress today in next
steps. Thank you.
Thanks Mike. Thanks Chris for the
introduction. So thank you everyone
for giving me the opportunity to
update today on the independent care
and education treatment review programme
that we've been running for the last
15 months since the two year programme.
As Chris has already said that the context of this is following Baroness Holland's report My Heart Breaks.
It was published in November 2023 and we were asked as part of that to run the programme for two years
When we talk about long-term segregation, we're talking about 48 hours
Presenter 1 - 1:23:15
where people have been detained and
segregated and that's people who learn disability and autistic people.
So we launched the actual programme following
the recruitment of chairs in May 2024. We had a phased roll out of panels and we
worked collaboratively with NHS England and regional teams which is
really important to really understand who was waiting for an independent care
and education treatment review and who we needed to make sure that we could
review basically the safety and care of those people to support them to move out
of long-term segregation. That is the aim and purpose of an independent review by
independent chairs. So from - to-date, we've actually carried out 71 ICTRs and we
have managed to support 19 people to leave long-term segregation into their
own homes or off of long-term segregation onto a ward. This is quite
significant and in terms of the number of people now in LTS, long-term
segregation, 74
Previously it was 95 and it was also in the hundreds
So we've made it we've had a significant impact on this work programme to really support people to move out of long-term segregation.
So early indicators of impact impact really
You know that really positive feedback from people themselves
We've had really positive feedback from the chairs from supporters of those in long-term segregation about our approach.
So in terms of you know we continue to seek feedback from people throughout the
process right at the beginning and three to six months down the line to see
actually what difference has this made. In terms of oversight and governance we
have an external oversight panel that's run by two independent chairs that's
Oliver Shanley and Clenton Farquharson and that panel oversight panel
scrutinises the reports that we are producing following the reviews for
for people that have been in long-term segregation,
pulling out the themes and trends,
but the impact of our review,
but also how are people's quality of life
being experienced and benefits from it.
That group meets quarterly,
and actually the feedback from that group
is going to be really important
in terms of our national reporting.
So they've already informed part of our state of care,
reporting, they will inform the mental health report,
annual report that we produce,
but also our independent voice piece that we will be producing in the spring and summer of next year.
In terms of improvements for people, what we found is important and the review process itself
is that we've enabled communication to be better for people that are going through the review
process. They've had access also to activities that are important to them, but also it's about
person-centeredness and personalisation of approach. In terms of influence and
impact I mean, I think for us what we're finding we're really trying to
find out actually what is we need to prevent long-term segregation and for us
it's about looking at what practise is going on in other parts of the country
so for example there are some organisations that refuse to use
long term segregation. We want to shine a light on that and so our reports will
reflect that going forward and also our feedback from our external oversight
panel will be able to capture some of that information and will inform our
reporting. In terms of key themes you know you'll see from from the paper we
focused on discharge planning and how important the planning stage is also the importance
of collaboration across the health and social care sectors in terms of
commissioners and also just the right support at the right time for people to
move on. In terms of next steps for this programme we're waiting for confirmation
from the Treasury around further funding. We will continue this work programme until
March 2026 and as I said we'll be reporting publicly on this in the
spring and summer. We will continue to engage with stakeholders in terms of NHS England
but also our providers on the ground to work with them and we will also be aiming to recruit
more Mental Health Act chairs if we get further funding. At this point I'm going to hand over
to Arun, so thank you.
Arun.
Thank you, Chair. Thanks, Rebecca. Thanks, Chris. I just wanted to say how fantastic
this work has been and how brilliant it's been to see the results that the team have achieved and
thanks to the teams that have been involved in this. For those 19 individuals, their families,
carers, supporters, for them to move from segregation to being in a communal setting
Sir Mike Richards - 1:28:21
with other people, whether that's in a healthcare setting with other people or whether in their
Presenter 1 - 1:28:26
home, that's transformative and it's about human rights. So it's fantastic that we're doing that
Beyond the numbers, I also wanted to make the point about the anticipatory effect
Arun Chopra - 1:28:35
that regulation has and that this has in helping providers and others think about
not even going down the path of segregation because actually when you
know that there's going to be oversight it does help to make people think of
other options. So I just wanted to highlight the anticipatory effect of the
work that's been done beyond the numbers that Rebecca has presented so thank you.
Really important point, thanks for that Arun and I have to say I found the tables here
really and graphs really very helpful and the fact that 14 of those people have been
in segregation for five or more years, just the thought of that is pretty awful. So anything
we can do to it - what maybe I can ask a question which is what is it about us
Sir Mike Richards - 1:29:26
doing these reviews that enables people to be moved from segregation to other
settings so I think the difference with our ICTR programme is that we are able to
set out a clear plan of action following the review that needs to be acted on and
followed up. We also follow up with the person after the review to ask them and their supporters,
advocates, to see what did it feel like for them, what differences it may come. But we
Presenter 1 - 1:30:03
also follow up three to six months later to really see, actually, has this happened? And

5.1 Independent Care Education and Treatment Reviews (ICETR) Programme Update

I think that that is the impact of us as a regulator leading this programme and carrying
out the reviews themselves. And as Arun has said, in terms of those anticipatory levers,
as a regulator, you know, people know that we are looking and we are scrutinising and
we really want to make a difference to people's lives.
This is having an impact.
So some people that were where we had set up a review for them, actually, they also
left long term segregation as a result of that.
So I think this all really lends itself to thinking about market shaping, as I've said,
thinking about the 10 year plan, thinking about the Casey review, the importance of
social care provision at the right time for people and so I think that we've
done well so far we really have and I think we want to keep going with this
because it is making a difference for people thanks thanks very much indeed
but clearly this is one of the programmes that is funded out of granting aid so we
have to await decisions on that but we - certainly I would be very supportive and
I get the impression that the Board would be very supportive of that as well.
Any other comments on this really important -
Yes, Mel, certainly.
Yes, of course I would want to speak on this item.
So firstly, Chris and Rebecca, thank you so much for taking me through, reporting some
Sir Mike Richards - 1:31:30
more detail.
I really appreciated that.
So I just want to highlight this and just remind everybody of Chris' comment earlier
about the Leader report.
So we know that people with autism and learn disability are detained.
It actually causes premature death
for this group of people.
And long long-term segregation is such a significant
and detrimental and often long-term impact
on somebody's health and their well-being.
Presenter 1 - 1:31:53
So this intervention has been so important.
So thank you for highlighting that work, Rebecca.
And certainly from being on the other side
and knowing some of the individuals that
have been through that process, what regulation brings
is some accountability and oversight, as Arun said.
So it makes people think about what they're doing,
rather than just slipping into that responsive because it's difficult working in these settings,
you get into a responsive mode, but then there's some visibility. So often the chairs are the
people that are having some visibility and bringing people together and ensuring equality
of voice. So there is that, the professionals around the person, the carer, the family and
the person themselves have some voice in that circumstance. So it's really important work.
So I really hope that we get that support from Treasury, but thank you for the report. Bola?
Thank you chair, thanks Rebecca, really good to see you.
Just to emphasise that actually picking up the conversation we had earlier on around
the equalities objectives, I think this is a key example of how our regulatory activities
Melanie Williams - 1:33:00
can actually change the climate and I think the change in behaviour that you've just been
Sir Mike Richards - 1:33:09
talking about and how this programme of work has driven that, buttresses the point that
Bola Owolabi - 1:33:13
our core regulatory functions can have incredibly powerful impact in terms of how the system
behaves and how it treats those who are seldom heard or for other reasons on the peripheries
of society.
So just to say a real well done to everyone involved and hoping that this is supported
to continue.
Thank you.
Sorry, Richard.
Yes.
Thank you.
Really fascinating report, and was also obviously massive for those individuals selected.
I'm wondering about the learning, and I'll take Arun's points, and your own, like, about
the kind of anticipatory impact now of the people who would be much more careful about
their decision making.
But in looking at the point at which a decision is made, I don't expect you to answer this
Sir Mike Richards - 1:34:05
now but are there any trends or typical situations that make that more likely
Richard Barker - 1:34:13
and I'm wondering about things like out of hours, weekends, times when the people
who are making decisions aren't maybe fully staffed with the right experience and
capabilities so once people then step into this setting it's very hard to
then get out again and so don't expect you answer that now but if there is any
learning about that I suspect I may not be right but I suspect that might
contribute to it and there's some supply side factors that we need to be
addressed and it isn't a demand issue - supply issue that could be triggering
inappropriate decisions basically. But any learning on that and be really good to
export that to people who are in that setting so that we can actually target
some of the things that lead to this risk being higher in that place as
opposed to to that place. Yeah thanks Richard I think that the analysis that
we're doing in terms of the data we're collecting but also the feedback from
people, clinicians, chairs, commissioners,
will enable us to understand the themes and trends for that,
absolutely.
And we will be wanting to report on that.
And I think provision being available at the right time
for people is very much about the agenda of reducing
admission into hospital in the first place.
So it's a whole preventative agenda
that we want to be influencing and informing.
So yeah, hopefully we will have some key themes and trends,
Presenter 1 - 1:35:27
I think, in terms of informing the learning.
Thinking about the culture and mindset and changing commissioning practise,
thinking about the human rights based approach to commissioning would be the way that we would like things to move forward.
But it's early days and I think collecting that information will be critical to that, so thank you.
Thank you very much indeed. So I think this has got a lot of a lot of support. And unless
there are any other final comments, it will be many thanks to you, Rebecca, in particular
for the work on this, but also the support from executive directors and chief inspectors.
Thank you.
Sir Mike Richards - 1:36:19
We now move on to the People Assurance Report. I think there is a slight error in the covering
paper where it says that 79.7% of candidates come from the LGBT community. I think that
wasn't actually the correct way round. It's 79.7 are recorded as heterosexual and 8.4%
LGBT. Drew, I think you would probably have noted that yourself.
With that in mind, Jackie, over to you.

5.2 People and Culture Update

Yeah, thanks. Yeah. If only my job would be done, wouldn't I? So, yeah. So this is the
First of the new format of the People Data Pack,
following feedback around content and presentation.
You see some areas are showing some positive movement,
some as you would expect this work to be done,
we've touched on some of it in the previous agenda item.
Before we get into the data and also what next,
Jackie Jackson - 1:37:34
I think it's also worth just recognising that what it doesn't do is bring to life the concerted
and focused effort across the whole organisation and the commitment in terms of the work on
our priorities and integration and where that fits into recruitment, managers supporting
interviews supporting their staff, thinking about the conversations that have taken place
with colleagues around how we execute the integration.
And I think there's a direct correlation around how that has been addressed and some of the
data in here.
I don't intend on going through it line by line, but obviously we can have conversations
about anything specific. I think going forward what we need to do is carry out some of the work
that's already started. So we'll have two reporting systems ESR and Cignam. So we're
looking at how we bring them together so the data gives more accuracy. Thinking about sector specific
and directed specific data so we can see trends, patterns and focus any support to managers and
leaders in terms of any interventions or guidance. I think the other thing is we need to look at how
we benchmark across other organisations and how we ensure that we have consistent and timely
conversations around emerging patterns, what the data is telling us. So looking at how we collate
the data and our people hub, thinking about how we can make the data more readily available, timely
and working with data colleagues as well on how we might do that. So I think that's all I wanted
to say around where we are with the pack now, plans that create greater support and insight
for leaders and managers and how really it will emerge and any feedback more than welcome
that would help these conversations and also conversations in the organisation. Thank you.
Thank you Jackie. I think we can open this to discussion.
Kay. Can you pop your thing on?
Yeah, Reflect it. It's a really, really helpful report and I'm absolutely one for keeping it
short and focused and the metrics, seeing the trend reports. I suppose in the last conversation,
Nadiya talked and it's come up a couple of times, the importance of performance
Sir Mike Richards - 1:40:37
and performance objectives and it was just whether how changes planned in that
area were reflected here. I think we all know that those conversations are
Kay Boycott - 1:40:49
really really important in terms of driving a lot of the right
behaviours so it just in a future report it might be helpful to come back to that
and also because we are bound to, as all organisations are, be looking at
productivity and it all goes hand in glove.
So we're looking at working with our performance colleagues on our objectives, appraisals and
performance conversations, but much wider than that in terms of what does a good conversation
look like? What are the organisational objectives going to be that maybe apply to everybody?
What are the sector specific objectives?
So I could say the two go hand in hand,
the performance and objectives and appraisal system.
Jackie Jackson - 1:41:35
So hoping to get a proposal together by the end of September,
start of October, specifically looking at that.
Other comments on this.
Sooz. Thank you. I think it's really good to see the required learning on here and
I think as a union side we would like to see the breakdown of mandatory
information for managers especially around some of the modules that are
targeted around some of the cultural things for the anti-racism. I understand
that I will sit here and say that I have a week left to do my anti-racism
training so I'm part of the red statistics on this slide but those
Sir Mike Richards - 1:42:15
figures are quite low. I think we're conscious of that people in leadership
positions have more influence and therefore if we're not getting their response rates
CQC Trade Union Representative - 1:42:23
from managers who are very busy, I want to acknowledge that managers are union members
as well.
We'd like to highlight that.
Everyone has a lot on at the minute, but how do we empower people to take that training
and ensure that the people with the most influence are given the tools to get on Board with the
cultural change we are all looking to see?
Esther.
Thanks, Chair.
Thanks, Jackie.
I just wanted to comment on our use of the acronym LGB plus.
I just don't want to be not inclusive of our colleagues who identify as trans or of our colleagues who do not meet the LDG or the B criteria,
Sir Mike Richards - 1:43:08
recognising the intersectionality and colleagues may not feel like they fit into one of those groups.
So I just wanted to specifically say that I don't think there's any intention about not being inclusive,
Esther Provins - 1:43:16
but there may well be colleagues watching this or reading this that may well react to that.
So I thought it's important to share.
I think that's an important point. Thanks for raising it, Esther. Drew.
Thank you, Esther, for picking up on the point that I was going to mention, that separation between gender and sexuality in this case doesn't feel wholly effective or beneficial.
So I do wonder whether we can look into what a KPI target
might look like for that workforce representation
and in senior leadership for LGBTQIA plus people.
Sir Mike Richards - 1:43:51
If there is not a comparative labour market data,
is there other routes that we can explore?
Again, happy to work with you on that.
CQC Network Representative - 1:43:58
Wonderful.
Yeah, thanks so much.
Any other points on this? I don't see any, so thank you very much indeed.
I think that takes us on to freedom to speak up.
It does indeed and I think we are welcoming Amanda.
Do we need to...
Is she Jackie?
She is.
She's coming.
Great.

5.3 Freedom to Speak Up Report and Action Plan

Sir Mike Richards - 1:44:35
Amanda, welcome.
Sir Julian Hartley - 1:44:58
Do you want to take the hot seat, as it were?
Colleagues, Board members,
I wanted to introduce this item.
This is an important item,
and I'm very grateful to Amanda joining us.
Amanda Oates, who, Amanda, I'm sure,
do you want to just introduce yourself
in terms of your background?
Sir Mike Richards - 1:45:25
Hi, my name is Amanda Oates and I'm formerly the Chief People Officer for the NHS and Deputy
Sir Julian Hartley - 1:45:31
Chief Exec and I'm also recently appointed as a Non-Executive Director as well.
Thank you very much.
Thank you.
Reason we asked, you know, Amanda's done a lot of work over the course of her career
on establishing and leading and creating
in healthcare organisations, fair and just cultures,
Presenter 1 - 1:45:53
and given the challenge we face at CQC,
particularly with our freedom to speak up process,
we felt it was important on the back of a number of issues
and reports about shortcomings in our approach
Sir Julian Hartley - 1:46:06
to commission Amanda to do a review
of our freedom to speak up arrangements
with a view to seeing how we can support
and strengthen those.
Now this follows, I think, a difficult period for CQC,
as is, I think, very clear to everyone,
but experienced quite profoundly by colleagues
within the organisation in terms of their experience
of attempting to speak up and finding that problematic
or feeling it's at a sort of senior leadership level,
hasn't been recognised.
What I did want to do is draw a distinction between
the response that some people have met
and our excellent Freedom to Speak Up colleagues
because we are fortunate to have some excellent colleagues
in the organisation who've acted as Freedom
to Speak Up champions and have continued to do so.
If I can just put on record my thanks to Carolyn Jenkinson
who many of you all know has acted tirelessly
as our Freedom to Speak Up champion with the support of other colleagues.
But it's been tough for her and indeed the other guardians.
And I think particularly the work that we've done developing and co-creating CQC Way,
we've seen a lot in there about the problems with Freedom to Speak Up.
And so in order to really eyeball that,
to tackle that, to think about how we support
our freedom to speak up, guardians and the work that they do
and indeed how we sort of deepen, strengthen
the sense of psychological safety across the organisation,
we asked Amanda to come in and lead that work.
We've done a lot of focus groups, networks,
and I'm grateful Amanda for you having done all of that.
I also wanted to say because both Sooz and Drew will know how important this work is and how
much this has been a conversation that we've had about the need for us to address this on the back of a lot of
difficult issues in in the past. I'm pleased to say I now meet frequently with Carolyn and the other
Guardians, it's invaluable in terms of what they offer
I'm also pleased that just to reinforce the point that you made earlier Mike
that we've we've now got Ruth as our non-executive Freedom to Speak Up
champion. I want to thank Chris Dzikiti for having been in place as our exec lead
who's handing the torch on to Arun as our exec sponsor for Freedom to Speak Up.
So we want to make sure we're giving it the proper level of attention
and seriousness at Board level, both non-exec and exec.
And I have a personal commitment and interest
in making sure we get this right.
So a lot for us to do, but I think very important
that as a Board, we're listening to what Amanda's got
to say in terms of the recommendations she's setting out.
We're being asked to consider those and think about those
in terms of how we take it forward.
But I think it's an important moment, I guess,
for us given everything that has happened in the organisation,
that we're talking about this and being very open and public about it.
So with that introduction, Amanda, I'll hand to you.
Thank you. Thank you very much.
And thank you, colleagues, for receiving this report.
And a wider thank you to all the colleagues who I've engaged with,
who've done so with total honesty and transparency and vulnerability as well.
They've really leaned into this work.
So as an external advisor, I'm fully aware of the challenges
that CQC have been facing around freedom to speak up, but I also see tremendous potential
in the organisation to get this right going forward.
I've drawn on analysis, both qualitative and quantitative, which has given insight to where
the CQC is now and where it's aspiring to go.
And whilst the report and recommendations do highlight gaps, I've witnessed strong willingness
Presenter 1 - 1:50:17
to engage and seek resolution from all the parties to drive the change that is necessary.
The review is an integral part of CQC's overall transformation programme. I know the Board are
sensitive to the fatigue that exists within the organisation, to colleagues feedback about
normalising inappropriate behaviours and actually the different experiences from those colleagues
with protected characteristics and the historical harm that has occurred. I know you're aware of that.
But we can't underestimate the support that is needed for leaders and colleagues to lean
into the CQC way and speak up culture to live the values of the organisation even when no
one is watching because that's the true test.
There are nine recommendations which really represent a roadmap to enact and lead cultural
change.
And the key for me is the enactment, is the monitoring, is the ongoing evaluation against
the outcomes that you describe and agree on. There's three overarching pillars, the first one
being policy systems and feedback, and really simply that's about having clear processes and
very, very clear timelines enabled through digital tracking so you can monitor and report. And that's
not just for Board to have insurance that the interventions that are being put in place are
working, but it's also for staff as well, so staff know what then when they raise concerns that the
interventions are actually leading to improvement because that
leads to a more positive speak-up culture. So really being clear about closing those feedback loops
which is what I've heard as a gap from colleagues that I've spoke to.
Leadership culture, so it's great to hear those appointments both for both exec and non-executive
director colleagues, and I think that will be really well received within the organisation.
There's a component about safety training, psychological safety training and just culture training.
and we're starting some of that this week within the organisation and particular support for those colleagues who have got a protected characteristic.
And then there's some structural support that's being recommended for network chairs, for people processes and for guardian capacity.
So I know in the report it says hopefully a lead guardian will be out for appointment in September.
I know they're just going out for final, you know, final ratification of that.
So it's probably going to be in October.
The next steps are covered on page 9, but if I can just pull out a couple of those next steps.
I think really, really critically is for the Board and the people committee to agree the key
metrics that are required both for freedom to speak up and for people processes to make sure
there's transparent reporting and monitoring against them and adherence to policy time scales,
but also adherence to understand what interventions have worked and what need further
escalation or intervention to ensure that loop is closed down. And so real clarity on any
outstanding cases that exist within the organisation currently and have been outstanding for a period of time.
We have clear communicated dates when they will be completed because I think that's a real
message to the organisation that it's taking this approach really really seriously.
I absolutely firmly believe with the people around this table and the people I've spoken to that the CQC can
drive a change for freedom to speak up, enabled through the CQC way with full Board commitment.
The true test is that every member of staff is able to raise a concern and when they do so they feel listened to
without having a defensive response.
So it's really important that leaders lean in and be curious when somebody speaks up to really start encouraging
line managers to be the owner and be that first contact point to deal with
simpler issues as and when they arise. The ability for the speak-up culture to tell the boss bad news.
That's the two tests, but equally for colleagues to be able to give feedback and that to be listened to
without fear of being gaslit or blamed. So I'm really pleased to present this report and happy to take any questions. Thank you.
Amanda, thank you so much for that.
That's really clear.
Do you want to say more at this point, Julian?
Just very briefly, because I know Sooz is poised to speak,
but I did want to just really underline that point Amanda's just made.
This is for all of us.
It's impossible for our freedom to speak up guardians,
however good they are, to do this for the organisation.
Sir Mike Richards - 1:55:03
It requires everyone to be a part of this and we need to support them in the way that
you described and I think that this is a kind of cornerstone of how we improve and change
Sir Julian Hartley - 1:55:18
the experience that staff have had previously in the organisation.
Thank you.
Sooz.
Thanks very much.
Of course this is one that I was going to jump in on.
So first off, I wanted to say thank you, Amanda,
for engaging so wonderfully with the trade union.
It's been nice to be listened to.
As often, we are the stopgap when speaking up doesn't go
well, and that we become the independent voice
or the place of psychological safety for our colleagues
and our members.
I think it's a great report and some great recommendations.
But unfortunately, it doesn't come as any surprise
what you've written to myself and D as union leads.
Sir Mike Richards - 1:55:54
And there's just a few things that I guess took out,
is I believe that your recommendations around
and empowering our guardians is key.
CQC Trade Union Representative - 1:56:02
I was quite shocked as I naively thought
that guardians got protected time.
It turns out that they don't.
And that, I think, our freedom to speak up process
has previously run on goodwill, which isn't sustainable.
And the cost of that is on the individual
often to juggle humans, which never
feels like the right kind of juggling.
And there's a few things in your report,
as we discussed today this week.
I just wanted to sort of draw the attention of the Board.
Firstly, I think the accountability for the CQC way is key.
I think it hark back to the psychological safety panel discussion with Arun around
having that curiosity and that lack of defensiveness and how do we empower our leaders to curiously
hear how their words have landed and rather than focusing solely on the intent because
I think that's where further damage is caused of speaking up and not feeling listened to.
There was an element around the completed actions and making sure that the Board has
of when an action is completed or, yeah,
the activity around a speak up item is completed.
I just want to sort of mention that I think it's key,
similar to the previous comments,
that this isn't a tick box exercise
and that we ensure that the individual is looped in
and that they feel that the action was appropriate
and that they have been listened to
and that we reflect whether there's ever any learning
that that person doesn't feel the action does,
has completed their speaking up.
A lot of people do want to be heard,
but they also want to see some action in the organisation.
And the last thing I'll say is that there is a phrase in this report, which I've talked to
Amanda already, as the phrase 'you said, we did', and I would implore us not to use that. It is a
phrase or a buzzword that was used. I have been in the organisation quite a while and I look back
in my mailbox and there's a 'you said, we did' response email from 2016 off the back of some
staff survey results. And as we will all acknowledge, there's often not a lot of movement
in the positive metrics in our staff survey results.
And so I think this one carries some legacy.
And at the minute, in reflection of our current slash
previous climate, that that might
be perceived as you haven't understood what we've done.
And so it pushes it back to the individual
to say, we've done something.
You just can't see it, or you don't understand that.
So I think we need to change the rhetoric around this
and really make it that inclusive, person-centred
approach.
There's valuable learning from this,
and it has massive cultural impacts.
Thank you.
Thank you, Sooz.
Other comments around the table?
You will have observed that there are no fewer than nine
recommendations.
Now technically, this paper is down for discussion.
But I suppose the question is, are there any or all of those
that we could approve?
And Julian, I don't know.
I've only just sprung that on you,
Sir Mike Richards - 1:58:48
recognising that this is a discussion paper, not
an approval paper.
But Sooz.
There was one thing I forgot to add.
And that was just to note that while I think the technology
solution is what is needed, and that tracking,
and that oversight, and that real I'm all about transparency,
I just want to acknowledge that in amongst everything we're
trying to do in a tech space, that we should be carefully
considering where that sits in priority.
it obviously will add value,
but our tech roadmap is already very busy
and I just think we are trying to do a lot
and we have to be mindful about where that fits in
and doing the right thing.
So maybe we could do something internally as an interim,
but for not to be the reason it's dismissed
because I do think that will add a lot of value.
Thanks.
CQC Trade Union Representative - 1:59:29
Richard.
So I'm getting a bit out of sync here.
It's really a question back to Amanda
or a question slash point.
In my experience of this when we get things working really well the number of routes goes up and that would be a good thing.
But then at some future date you want them to go down because people feel that they don't need to use that route.
They could use the pine management, team briefing, meetings, whatever else to be heard.
Sir Mike Richards - 2:00:02
I just think Amanda for us as Board we should have an idea of a trajectory that we need to look at.
Richard Barker - 2:00:08
and your advice hopefully you can say,
well, you know, it would look good if it went up like that,
but if it still keeps going up in two years time,
we haven't got this right, have we?
So when we should be starting seeing something reduce,
so I guess just for us in terms of monitoring this
going forward, what sort of profile
or would we be looking at?
Yeah, I think that's a really good reflection, Richard.
And I think, you know, absolutely a higher level
of reporting is a good indication,
but I suppose a lower level of impact in terms of harm
or hurt for colleagues that are raising concerns.
And a really good indicator would
be a reduction of the Julian, what's
going direct to Julian in the inbox.
So if it could go direct to the line managers,
or indeed the freedom to speak up guardians.
But you notice in the report one of the recommendations
about establishing a triage group or a sort of coordination
group.
Presenter 1 - 2:00:57
Because I think that's really important.
Because what I've noticed is sometimes
freedom to speak up concerns, the freedom
to speak up guardians don't know, and neither do HR.
It might sit with a line manager and you know both sides of that coin could be getting
unfairly, it's also finger pointing to say well, I've raised this concern and nothing's happened
But if they don't actually know and I have had experience when I spoke at some of the focus groups of that learning and insights
I think the triage group will be really really helpful and coordinating to make sure the organisation is fully aware
What freedom to speak up concerns are out there and exist currently.
Esther.
Thanks, Amanda.
And Sooz took the words out of my mouth.
Very supportive of your recommendations, Amanda, but conscious of the need to build that in
at the right time from a digital roadmap perspective with regards to that recommendation.
And then just a comment relating to Recommendation 7, but also I think some of your opening comments
and that's around the time we allow our colleagues working in this space to really focus on these
Sir Mike Richards - 2:02:05
these roles and that feels really, really important.
And I guess what I don't know is whether, for example,
our network chairs have allotted or allocated time
Esther Provins - 2:02:15
to do those roles in addition to the kind of the freedom
to speak up guardian roles.
And so just from previous experience
when in other organisations, when we tried to do this
and not give colleagues that allocated time,
it is really, really challenging.
It doesn't really kind of lend itself
to our focus and our priority in this area.
So, would really support kind of the appropriate amount of time
that colleagues need to do these roles properly.
And I fully support that, and I'd actually say
that's one of the strengths of the organisation.
You do give colleagues support for network, chair roles.
But I suppose what this was alluding to
is that I think sometimes unfairly colleagues
have been leaned into or brought into things
that are beyond their ability or the resource
in that chair role to support.
And actually it may be better to have strong partnerships,
you know, with disability networks nationally,
Presenter 1 - 2:03:08
the NHS Race Observatory,
to be able to pull in expertise when it's can add value,
because not all of that may resource,
may be needed full-time internally within the organisation,
but you need to have those contact points
so you can pull it in at the appropriate times.
So I hear a lot of support in general for this. I think rather than trying to approve every one of
the nine recommendations we might ask you Julian to take this away and come back because some of
them may take more time. I mean you know we've got one of them is about developing a dedicated IT
system and I know Esther's got quite a lot on her plate so exactly what the
Sir Mike Richards - 2:03:57
timescale for that would be I think we maybe ET could could review this I think
there's huge support for them for the principles here and actually for all
nine probably but let's get a timeline on it and really rather than just
waving it through. I was going to say Mike I think that we want to make sure
we do this right, we want to make sure that we are delivering against the both the sort
of spirit and the substance of the recommendations. I think what would be helpful would be, I
think the mood of the board is very clear about supporting this and what I'd be keen
for us to do is perhaps take your recommendations, Amanda, turn those into a clear sort of plan
Sir Julian Hartley - 2:04:41
around how we deliver it with key timelines and so on and making sure we're aligning the
right resources to get that right. We'll be engaging with you, Sooz and Trade Union
colleagues and obviously Drew with staff networks on this. The fact that
we're talking about this in public Board I think is a good start as far as
opening this up and owning the problems we've had and got and how we
how we improve that. So I think Mike if we bring back that plan once we've looked at the detail of
that taking into account the other challenges particularly that point around IT but
there are some things we can do and indeed there's some things we've already done in here so I think
that's that doesn't stop us making making rapid progress but can I just thank you Amanda for
I know this has been a lot of work and I know you've put a lot into engaging with colleagues
across the whole organisation and equally I know there'll be a lot of colleagues watching
this Board meeting who have felt we needed to really think about how we seriously address
this and act on this and I hope that colleagues feel confident and assured that we're clear,
we need to take significant steps to strengthen and improve and just to say once again a bit
thank you to our Freedom to Speak Up guardians who've been central to this and
I'm looking forward to working with them as we take this forward so
thank you. Thank you everybody. Thank you.
Right, very good. So next we go on to performance finance and risk assurance
updates. I think Chris Usher, that is you. Yeah, so no sooner did we sign off the
business plan, then we're reporting on it.
Lovely segue.
So I've got, I'll pull out some key bits on performance,
say a bit on risk and then a bit of finance
and then open it out for others to come in on.
Presenter 1 - 2:06:46
Sir Mike Richards - 2:06:46
So with regards to, so this is our pack for quarter one
plus a bit of July, because Board didn't meet in August.
We've added in July just for context.
So with assessments, our target, as you will know,

5.4 Performance, Finance and Risk Assurance Updates

is 9,000 assessments by September 26.
We've completed just short of 2,000 to date,
which is above target.
Chris Usher - 2:07:08
Some areas are showing signs of this
being more of a challenge.
For example, mental health, which
Arun may want to touch on.
Other areas are kind of ahead of target,
but it's generally is an area that we just
need to maintain progress on.
There's a long journey through to September 2026.
I'm acutely aware that colleagues will experience change as they move into the sector alignment.
So we can't rest on our laurels in terms of assessment numbers.
So that's something we're closely tracking.
In terms of registration, the overall volume of registration is reducing, as is those over
10 weeks old.
We aim to reduce or clear those over 10 weeks old.
So you can see that the status for the volume and percentage
of over 10 weeks old is red, and it will be
until we've cleared that.
We've looked at interventions,
specifically around domicile care agency registrations
and doing rapid improvement work,
given there's high volumes involved in there.
So hopefully that's one of the things
that's helping see the reduction and will continue.
We are tracking though the percentage over 10 weeks old
as a proportion of overall volume
and that remains out of kilter, so that remains red.
Information of concern.
So all areas are below target.
There's a lot of work gone in by colleagues
aiming to clear backlogs we've had in place
that we've been tracking for some time.
That's taken a lot of efforts.
So those backlogs have cleared through and we're starting to see improvements now, but
I think this is one that's going to take a concerted effort to focus on performance.
And it's also one that where colleagues are facing competing priorities in terms of delivery
assessment.
So it is improving in areas, but it's one that we continue to monitor closely.
Other bits just to pull out in some positive sentiment would be NTSC call lines, really
strong performances as seen in the call lines we've got in our call centre.
Targets are MNSI, contact and trust in families, and you see strong performance there, and
also progress against our local authority assessment journey as well.
In terms of risk, so we're just in the process of reviewing our approach to
risk, including new policy framework and we've also recently introduced a new
subcommittee of our executive team to really focus in on risk and how we
manage and mitigate our risks that we have. The four highest scoring risks just
to pull out from our register would be around a productivity and number of
assessments as I've just touched on the 9,000 target being a key focus for us. So we need to manage any risks associate with that.
Staff well-being and morale
We've touched on already in this conversation kind of progress or
trends in our EDI survey, but it also shows and other elements this conversation pulled out this there's a lot more work
We need to do
around well-being morale and
structures and leadership. So we've got the alignment of operations about to
take place but what we've talked about in our risk committee was about splitting
this risk out. One around structures which will hopefully mitigate
shortly but then really the risk here remains with our the kind of quality of
our leadership and the work we need to do to ensure that we've got effective
leadership in place throughout the organisation. And finally meeting
stakeholder expectations, engage in stakeholders and change and actively seeking feedback is
something we're working on and there'll be more evaluation of sentiment in November coming
through.
And then finally, just in terms of our money, at the end of July, we've got a half a million
deficit on our revenue position.
We're forecasting this will be down to 200k under spent by the end of the year.
We are managing our pressures in years.
We continue to operate within our existing funding envelopes.
So that's a constant challenge we're faced with.
And on our capital spend, we've had minimal spend to date.
We're looking at plans around that
linked to our foundation improvement work.
But it's potential that we won't utilise
all of our capital this year.
So there are the headlines from each.
And I'll stop there for any comments or questions.
Chris, thank you very much indeed for that.
I think I'll open it straight up for questions around the Board.
Arun.
Thanks, Chris.
Excuse me.
You mentioned around some of the challenges in some of the areas.
I just wanted to say a little bit about the mental health sector.
We've had discussions within the mental health sector about the priority that it is for us around
Sir Mike Richards - 2:12:20
driving up both the volume and the quality of the mental health inspections.
It's fundamental to what we do. It's been great to join some of our teams on those
mental health inspections and understand some of the challenges from the
perspective of the inspectors around getting those done and it's been it's
Arun Chopra - 2:12:36
been really good to join those teams. As a senior leadership team within mental
health we've been thinking about what measures we're going to put in place
proactively to support our inspectors around performance, training and
appraisal.
And we're really very much looking forward
to moving the operational teams into sector specific teams.
But yeah, I just wanted to mention
the great work that's taking place
and joining those inspection teams.
But the priority is for us around driving up
those inspections.
Richard, and then Toli.
One question, Chris.
It's reassuring that we're ahead of trajectory
on the total volume of assessments but we don't see we move the dial on the 10
weeks old and that concerns me there's either two things not right here either
our target on the number of assessments is too small - we need to do more or, where
the assessments are being targeted it's not prioritising the longest and
Sir Mike Richards - 2:13:37
therefore we're not moving the dial on that I just wonder if you've got any comment?
Richard Barker - 2:13:43
We're roughly about 33 to 35 percent, quarter of a month on month.
We'd like to see that start to come down.
So I think there's two things at play here, Richard, I think.
So we've got volume of assessments that we're tracking.
We're trying to hit 9,000 by September 2026, and we've broken that down by sector.
And then separate to that, we've got a volume of registrations that are coming in,
which were handled by a separate team in CQC.
and for that, so that won't be a competing priority
in terms of it's, no, no.
But it's an important point obviously,
the volume of registrations and that's one
of our key priorities, but yeah,
it's separate to our assessment work.
Chris Usher - 2:14:22
Chris.
But I think that it does illustrate a point
that our commercial colleagues are working on,
which is that balance between assessments
that we're trying to address because they're old or aged as it were and
therefore of less value to the public and having to take assessments on
because a risk is identified to our teams locally where we have to act on
that's a really fine balance and that's one I think we need to we're gonna need
Sir Mike Richards - 2:14:54
to keep reflecting on and iterating as we go through over the course of the
next - next year and as we go into sector specific teams because that balance may
Chris Badger - 2:15:04
be subtly different in each sector and that's okay I think we just need to be
consistent rather than necessarily uniform on that and be clear and
transparent with the sectors that we are in charge of as well. Toli?
Thank you chair and just to say in context of the finance and as we move
into our sectors based structure I'm certainly conscious that all our
registered providers who are from the public sector will be battling
significant financial problems and I guess it's incumbent upon us even you
we're in the fortunate position of not being like that to still have that scrutiny through our sectors,
Sir Mike Richards - 2:15:44
ensure that we're on top of our individual parts of our budget and understand why there are certain
Chris Badger - 2:15:46
pressures. So for example, you know, MNSI, it's a bit different, but nevertheless just so that we
Dr Toli Onon - 2:15:52
understand those pressures and I think I would imagine that our providers would look to us to
ensure that we are as prudent with our spending as they are, not unreasonable I think. Thank you.
Thank you chair. I just wanted to come back on Richard's comments earlier on in terms
of the registration. Just a bit of a voiceover. So there is quite a lot of work that colleagues
are doing to introduce quality improvement methods into that space. Some of the drivers
is around domiciliary care and the volume of people coming forward to register single
Sir Mike Richards - 2:16:37
Bola Owolabi - 2:16:40
person, single customer type of scenarios where we just have this enormous volume actually
of single entities seeking to register themselves.
And it's interesting when you see the effort that goes into getting the registration right,
people then go immediately dormant.
So there is something there about actually market forces
and the impact that they're having,
from an organisational point of view,
in our driving improvement in that area.
That's not to say that the data isn't what it is.
I'm just trying to give a sense of the context
in which this data is arising
and the work that people are doing
to try and streamline that process,
screen out applications that really shouldn't be
going forward in the first place,
but recognising work still needs to be done in that area. Sooz.
Thank you.
I just wanted to comment in on the mental health assessments.
I think it's really great that you've come in, Arun,
and that you've been curious, and we've
been out engaging with the team and seeing
what it looks like on the front line.
I guess a bit of the sentiment from our members
in mental health that I wanted to share
was that the message that we haven't reached a target
and that new targets will be issued
has created some nervousness that if we haven't reached
a target, just increasing the target,
is how do we get there without doing more,
has felt quite uncomfortable for some people
as our staff are trying to do as much as they can.
And if they're not meeting our current targets,
Sir Mike Richards - 2:18:04
how do we work with them on what needs
to be tweaked or changed to support them
to reach those targets rather than just expecting
them to do more.
CQC Trade Union Representative - 2:18:10
And I don't think that's the approach you've come in with,
but I think it shows us some of the nervousness of maybe
the previous culture that we had in place of just get it done.
And so yeah, I'd appreciate either a discussion
or just to engage with the members in mental health
about how that can be achieved.
sensitively, I try and do a good job.
And I see that you see that, but a numbers based approach
can often be a bit inhumane.
Thanks.
And I think it's worth saying on that,
that as we get back into the sectors,
we will have to review what the numbers in each sector are
and what's really needed.
But we need to get back into the sectors
first with what people most naturally went to,
and then we can review that.
So, I think that we take that as a good update
Sir Mike Richards - 2:19:04
on where we are.
Still a lot of challenges, we know,

6.0 To Note

but definitely making progress at month four.

6.1 MNSI Annual Report

Can we move on now to the MNSI Annual Report?
and Toli are you being joined by Sandy Lewis?
As far as I'm aware, I'll come and see if she's the...
I've been told she's here, so...
Oh, that's good.
Welcome, Sandy.
Do you just want to introduce yourself so that people are remembering that this is being
streamed around the country and know who you are but then I'll ask Toli to
introduce the item and then you to present. Thank you, my name is Sandy Lewis
Sir Mike Richards - 2:20:27
I'm the director of the maternity newborn safety investigation programme.
Thank you very much chair, thank you Sandy for being here to present. Just to
remind colleagues that MNSI became hosted by CQC just short of two years
ago and it's a hosting arrangement so it's important to preserve the
independence of MNSI because the benefit for the regulator is having the
Presenter 1 - 2:20:57
relationships the access to the tremendous learning that's generated
Sir Mike Richards - 2:21:02
from the work here and some context really around the origins of MSNI and
Sandy will correct me if I'm wrong but I think it's all stems from the National
maternity safety work about a decade ago,
wasn't it, the safety ambition.
The ambition really was to halve the rates of stillbirth
neonatal death, maternal death, by now, a decade later.
Regrettably, that has not happened in relation
to maternal death.
Maternal death has plateaued and even risen, really,
Dr Toli Onon - 2:21:30
in the last five years.
There is a really stark set of inequalities apparent,
both with the risk of dying in pregnancy or childbirth
for a black woman, which is double,
and also in relation to deprivation.
So women from the most deprived areas, again,
have double the risk of dying compared to women
with not that level of deprivation.
So the work of MNSI is all the more important.
And I guess I would want to say things
that Sandy would probably be too modest to say,
but I think it is just fantastic work.
And the relationships that they're
able to build with their stakeholders,
particularly families, are tremendous.
And I think the ethos of seeking to investigate and learn
without blaming really allows the extraction of so much more
valuable information than otherwise would be.
It's no secret to say there is a concern about some
of the culture around maternity care now.
and providers are anxious.
And actually, an organisation like MNSI does terrific work
providers.
I've recently been one, as you know.
And I think the provider sector has a great deal of respect.
So I just wanted to say that because I
didn't think Sandy necessarily would.
But I'll hand over to you.
Thank you.
Thank you, Toli.
So thank you, colleagues.
I'm here today to present the MNSI Annual Report, which
is for 2024-25.
But firstly I'd really like to thank the families that we work with.
They are an important part. They share their stories and their experiences at such tragic times in their lives.
Presenter 1 - 2:23:23
And our team work really closely. Without them we would not be able to produce some of the interesting findings that we see from our investigations.
This is also true of the trust and the staff that we work with, who their candour and their
openness supports us to ensure that our investigations reflect the whole picture and not part of
that picture.
And I'd also like to thank my MNSI team, again without the work they have undertaken and
I think our report reflects the many initiatives, the work they do above and beyond investigation
work to support and develop the programme going forwards. So the report reflects our
ambitions for 2024 and 2025 and those ambitions remain and will continue to grow over this
next year. So we talk about thematic learning, we talk about equity, diversity and inclusion
and we talk about opportunities to maximise the impact of our work and investigation excellence.
If I move quickly on in relation to our performance, so in the last year we have, there's a minor
error in this annual report which will be updated, we have progressed 618 investigations -
through to investigation. To date we have given trusts 1,122 safety recommendations.
Now that sounds vast and I know there's lots of discussion out in the system about too
many safety investigations. Ours are focused and agreed with trusts so that actually it's
pieces of work they can go on locally. These are not national recommendations, they are
local recommendations to support trusts with their services and the resources they require.
We've also introduced safety prompts. Now, we often find in our investigations up until
last year, there were occasions where we found interesting areas of learning, but we didn't
have all the evidence behind it to make a safety recommendation. So the purpose of introducing
a safety prompt supports us to say to a trust, have you thought about this? Here's a question
for you. And to enable them to go and have a look and get a little bit more detail. It
prompts the idea, it prompts a different way of asking trust to think about how they learn.
The other thing I'd just like to mention is since inception, we have completed over 4,000
investigations so that goes back to 2018 and that milestone was reached this year.
So a few key achievements I'd really like to draw everyone's attention to.
Thematic learning so with that completion of over 4,000 investigations
we are in a position where we have a wealth of knowledge and understanding
how every hospital who's providing maternity care in the country what work
they're doing and where those themes sit. We often hear Trusts say to us, you know, a
problem for them can feel enormous and unachievable, but it enables us to say to them, you are
not this - you're not here alone. Actually, this is a theme we see in many places.
We are starting to present that work and in the last year we have strengthened and for
2025-26 we will continue to strengthen that work about how we are presenting that
both nationally and internationally, and actually thinking how can we share and in what formats
can we share so that learning becomes everything that a frontline clinician can look at, relate
to, and actually be able to put into practise.
The strengthening our approach around collaboration. Prior to moving across to be hosted by CQC,
we worked very much in an independent perspective, not really thinking and exploring how that
collaboration could really benefit the wider system. I think this really focuses and strengthens
the wider work around the maternity rapid review and other discussions that are going
on in the maternity system at the moment to think about how our work strengthens but reduces
some of that duplication of work that's going on in other areas.
In addition, we've started producing webinars and we've had over a thousand people sign
up for our webinars. There was a huge amount of interest in the areas of working. It creates
a discussion, it creates a debate and we often invite other stakeholders into those meetings
to help us and assist us. We've produced external bulletin which now goes out to stakeholders
and within that we are putting in a safety spotlight. This comes back to another means
of how do we share our learning. So we might see something in two or three investigations
we think is really important. An example of that is around exchange transfusions. It's an unusual, rare event but it enabled another
organisation to support that and actually strengthen that message and that came through
in the spotlight.
As part of producing our annual report this year, a commitment we made last year was to
also publish all of the safety recommendations that we have made. We will be continuing that
theme this year, it will be in a similar format and that is a piece of work that will be concentrating
on next year to ensure that format might look slightly different and I will talk about that
shortly.
The themes that have come out of our safety recommendations this year relate to clinical
assessment, escalation, guidance, clinical oversight and communication and I anticipate
in this room none of those are particularly a surprise.
A huge, another area of work that our team have been working on and it's going from strength
to strength and listening to the previous conversation in the room is around our health
equity.
We have developed a health equity tool and this tool and the toolkit that supports it
enables in every one of our investigation reports to explore that EDI component with
our families, often posing a mirror to them of things that they may not have seen for
themselves. It's hugely strengthened the area of work, we look at protected characteristics
and this informs additional other work that we've been undertaking to think about how we
ensure our investigations are as accessible as they possibly can be. Our work from Talk
to Families is about how can we communicate with you that provides you a mechanism that
works. We know there's lots of areas which are talked about but actually how much we
know around that deprivation, particularly things like digital deprivation and thinking
about how does somebody who doesn't have a smartphone or a computer or access to one,
how do they access this information. So there's a huge amount of work in relation to that.
In relation to our Hearts and Hughes, which is our equity toolkit, we launched that in
December with our team and we now have six months worth of data and that's building on
existing data and that's starting to really demonstrate to us an interesting picture.
We already have in place an extensive translation and language service. All of our reports and
our interactions with our family are supported by language services and at the request of the
family we'll provide a report in the language that they request. To date I think we're around
34 languages that we are translating our reports into. In addition to this we've been doing some
work around safety culture in organisations and we have produced a piece of work called Compass.
It comes off a piece of work that was done by the patient experience library,
which I believe Chris supported to be undertaken initially as part of CQC work.
And we've adapted it to ask trusts and do some evaluation around what is the trusts
culture or cultural approach to safety.
And we are really mindful around that, reflecting in relation to our investigations.
And that is our question around how do they manage that and how do they support that?
How do they support their teams? How do they communicate with each other? How do they behave
towards colleagues when they've experienced or been part of an event that for most colleagues
we know impacts significantly on the decisions they make around their career?
We've also been in work around our investigation and development. So we've introduced a new
report template and this was important to introduce, to actually think about different
approaches in different ways and to bring our work up to date. It's really important
that we do not sit back on our laurels and think that by producing one template it supports
the work we do. We've had very positive feedback from trusts, that introduction of safety prompts
has been well received. We've recruited and trained 28 investigators. To recruit and train
an investigator for our team takes approximately six months for the recruitment and six months
to have them fully trained. It is an extensive process and we cannot pick our team off a
peg and ask them to get up and running with our work. It's the complexities of it and
the work that we're asking and therefore we are very privileged to have an experienced
team. We've introduced a number of QA processes
as well because whilst we talk externally to our trusts and to our families and think
about how we're learning, there's an important component of our work is how we learn.
So how are we learning around our processes?
Are our processes robust?
Are the quality of our reports the standard that we expect
for every family and every trust to receive?
The other area we're doing some work on
is around our family and trust feedback.
So we know that our family feedback -
the numbers of families who feedback to us is low.
We have some very positive feedback from our families.
But is it truly representative of all the families we work with?
There's further work to be done there.
What we do know from the families who do feedback to us
is they describe our work around that consistency,
they feel heard, they feel respected
and they feel included in everything that we are doing.
Likewise, we're doing some work with our trusts.
So trusts, again, there's further work to do with them
and as part of some strategy work we've been doing,
we've obviously heard some further feedback from them around areas of what we do well
and other areas we could be thinking about. What they say to us, our processes are clear.
They say we are improving the safety culture within their organisation. They fill the interviews
and the work that we do with the staff at trusts is open, it's focused and it does not
apportion blame and many staff come back to us and reflect that as well.
So finally I just wanted to touch on some of these next steps of the work that we're
undertaking that's reflected in this report. We are currently doing a piece of work around
our strategy. This is to continue to grow and develop and ensure that work going forward
remains focused and in relation to our families remaining central but we continue that collaboration
and that work that we are doing.
We're doing a piece of work around coding and AI work.
This will really inform our thematic work and really enable us to demonstrate
what we are seeing from our themes and the evidence base behind them.
I've already touched on the family and the trust feedback.
I've touched on improving the processes.
Working within the system is another key component.
We are part of this conversation around the maternity rapid review and we are building
innovation is another area and we will continue to do so over the next year.
That is the conclusion for our annual report.
I'm happy to take any questions.
Thank you very much indeed Sandy for that.
I'll open it up for discussion.
I mean this is a report from you to us which we then make or you will then publish so it's
written and we have to sort of approve it to be published but that's but that will do.
Toli, did you want to add anything?
Thank you Chair and thank you Sandy.
Sir Mike Richards - 2:35:32
I'd be particularly interested to learn more when the time comes about the compass tool
because I guess there's also a link with our well-led that look at culture in an
area. The complexity around maternity care and the multidisciplinary nature of
the care provision I think means that the culture is really important and it
would just be I think fascinating to see what you find from it and how it will be
Dr Toli Onon - 2:35:58
applied and I say how it links into our regulation through Well Know. Thank you.
Bola. Thank you, Toli and Sandy, and thanks for a very comprehensive report.
Just in terms of looking forward and working with others, it occurs to me NHS resolution,
so mindful that they do have the maternity incentive scheme, and I'm not always clear
Sir Mike Richards - 2:36:32
what the mechanism for actually tracking the data that sits behind trusts submissions
Bola Owolabi - 2:36:35
of compliance with that scheme, given the statistics that Toli has already shared with
the Board.
So it really is just a suggestion that it's perhaps one of the most powerful structural
levers that we have to genuinely drive improvement in this space.
But I'm not entirely clear what our role could be in just ascertaining the extent to which
that lever is doing what NHS resolution intended.
And I see that in the context of maternity safety incidents being by a long mile the
largest contributor to the claims burden on the NHS from a financial point of view.
So if I can respond to that. So we work very closely with NHS resolution. So we co-own
Safety Action 10 as part of the maternity incentive scheme. And that safety action is
around reporting of incidents, it's around being compliant with duty of candour and also
about sharing information about the work MNSI do and the work NHS are doing in a format
in a format that every family can understand.
We're just in the process of reviewing the MIS scheme
alongside NHS resolution and thinking about
is there more that we could do?
And partly because that associates purely with babies
who've experienced harm.
Presenter 1 - 2:38:05
And so there's some question around one area
we struggle with, we have no remit to ensure
that our safety recommendations have been implemented.
And there's a sort of a thought, is there something more we could do within that safety action to seek further assurance from trust?
But we're working very closely with that interest resolution in that area.
And Bola, if I can just add to that, I think it's something that as we do our maternity inspections,
we need to be assuring ourselves that those 10 safety actions really are in place.
So that that may be something more that comes back to us.
Infact, when Sandy and I were talking just a few weeks ago,
one of the things we need to make sure
is that the linkage between MNSI and CQC is better.
Sir Mike Richards - 2:38:56
You're hosted by us, but this is not blaming MNSI.
I think when we were not in sectors
and not having relationship owners for individual trusts,
it was very difficult for MNSI to know who to -
communicate if they had a concern, who should they communicate that to?
And that was, you know, so by getting back to having
relationship owners that could be solved. Chris?
Thanks, that's a really comprehensive report, thank you.
I'm really pleased that you're using the Red Flags
report to sort of shape how you -
how we all collectively understand early warnings of concerns and I'd be
I'd be really interested in having a conversation with you about how you're using that information
and perhaps how we can learn from that as well. I think the second point for me is, and it's a
golden thread through the report, how we build trust with people that are using the
Chris Day - 2:39:54
alternative services alongside people that are using services more generally and how we hear
their voice and how we act on their concerns is something that I think we have collective intent
around. So again it'd be interesting to think about what we can do collectively to act on that voice
to make sure we're collectively hearing the voice of people and using it to drive change. Richard. This is a very (unintelligible) question. But I can't - how where I to be encouraged ---------- with the criteria. That's fine, I think I'm encouraged by that
but you can tell me if that's the wrong interpretation. Flip side of it is how would
Sir Mike Richards - 2:40:44
we know, how would you know if trusts were not referring things that they should? Have
you got another kind of correlation say or BCS codes or something else that kind of could
Richard Barker - 2:40:52
make sure that wasn't the case? I'll take those in two parts. So in relation to our
investigations that are rejected we require consent for families to progress an investigation
Sorry, so we require consent to progress an investigation and so some families don't
consent for us to take forwards an investigation so we can't do those.
There is an element of duplication sometimes around referrals and then the other part is
they don't meet our criteria.
Presenter 1 - 2:41:23
We encourage trusts to refer everything they suspect and therefore we can then make the
decisions about whether that does meet our criteria or not.
In relation to trusts referring, so we do do some verification work for our severe brain injury babies and we do map that against a national data set.
We think the numbers are right. Could I absolutely say that I believe we're getting all the referrals? I can't.
Because it's really difficult to map around data sets to ensure that data set is correct and we know everything's being referred.
We do have some great relationships with trusts and we do intermittently ask those questions
to support them to ensure they are referring things.
There are occasions which trusts will come back to us and say maybe our processes weren't
quite right and we'll do a look at back exercise with them and that may bear a few more cases.
But overall we don't have an entirely robust sort of data set system to map everything
against to ensure we're getting we believe we should. I think it's just
worth adding to that again conversation I was having with Sandy the criteria
that you work to are pretty tight yes it's all maternal deaths but it's I
think in terms of stillbirth it's only intrapartum and only 37 weeks plus so
it's quite a tight one and I think one of the things we need to look at is how
Sir Mike Richards - 2:42:56
this is working alongside the new perinatal mortality review tool where
the last report I've seen on that covered four thousand in the last year
or so, which is a wider pool of adverse outcomes. So we need to look at that
alongside each other.
Toli. Thank you chair and if I might just say I guess for the record to make
explicit what I know we all know but when we talk about maternal death and forgive me for using a
very technical term as it were but it is the tip of the iceberg of a huge amount of harm that comes
to women and so it's obviously a very definable metric but you know it's just us being conscious
of all that amount of harm that's going on as well thank you thank you for that so I think on that
Dr Toli Onon - 2:43:52
note, the Board is asked to receive this report and approve it for publication. I see everybody
nodding their heads, so the answer is yes to that.
Thank you.

6.2 Research and Evaluation Annual Report

Sir Mike Richards - 2:44:13
So next we have the research and evaluation annual report and Bola, you're going to lead
us off on this.
Thank you, Chair.
So I just want to acknowledge the work of Gillian Marston, our colleague and colleagues
who work in the CQC's research and evaluation team and the work that they've done in putting
Presenter 1 - 2:44:32
this annual report together.
Sir Mike Richards - 2:44:37
Just to start by saying that research is a core element of the work that the CQC does.
Bola Owolabi - 2:44:46
and indeed it's done in collaboration with other organisations as set out in the report
including the King's Fund, the This Institute at the University of Cambridge and others.
And I think that really strengthens the quality of output that we derive.
Also to say that the research priorities and areas of focus seek to align with the CQC's
priorities, particularly in the context of the conversation we've been having around
the four plus five.
So wanted to just set that out clearly to the Board.
In the annex, we set out - colleagues have set out the research activities done in 24/25
and the impact that that has had.
I wanted to draw out particularly the evidence review in relation to the dementia strategy,
which Board received at its last meeting in June.
Also to talk about the research piece
around inequalities in maternity care,
picking up the point of the MNSI annual report
that we've just received.
Also in terms of the prevention of mortality
in mental health settings,
again picking up on the conversations with Arun
throughout the course of today's meeting.
There is also a piece of work that was done
in understanding the systemic issues that may affect the CQC's rating of GP practices,
particularly those who are operating in some of the most socioeconomically deprived areas
of the country and how the CQC's regulation of those services could actually be impacted by the
context in which they are operating. Finally, to draw up the regulatory model evaluation that
they did and how that is impacting and supporting the further work that is being done now around
the assessment framework and other areas in the foundational improvement.
So I just wanted to call out those specific areas in terms of the research that has been
done and the positive impact that that is having on the organisation.
Looking forward, the Chief Inspector now being in post, we will be working with Gillian and
our colleagues to actually determine what are the next priority areas for research that
align very precisely with the priorities that we're setting out as an organisation.
We think it's an incredibly important resource, but even more so, the more closely it's aligned
with our organisational priorities.
In terms of governance, just to say that the governance of the work is another important
area. Esther and I have been working with the team to just think about the process by which we arrive
at our research priorities going forward, how Chief Inspectors are very much involved in that
conversation early, and also how we review and sign off publications going forward, particularly
those that are public facing. So just really to acknowledge the important work that colleagues
have done as set out in the report and to give the Board a sense of how we are
seeking to work with them around the governance but also in terms of the
priority areas as we go forward and I'll stop there for feedback and reflections.
Bola, Thank you very much for introducing it. I think I'm right in saying that this is
research to inform how we can do our job better basically and so that's got to be
at the centre of our thinking about research,
how are we going to be able to inspect,
how are we going to be able to rate,
how are we going to be able to enforce,
whatever it may be, what research will be useful.
And I think the partnership that we have
Sir Mike Richards - 2:48:41
with external organisations like the FIS Institute
or the King's Fund are really important in that regard.
I think it came up earlier about what do we mean by outstanding,
and there is work going on there.
So I think it's an important function, but it's one that I think now we've got the chief inspectors in place
We can really think what's going to be most valuable with with
inevitably a limited resource
Any questions or comments that people want to make on that?

7.0 Equality Network and Trade Union Updates

7.1 Trade Union and Equality Networks Updates

Seems to have captured it then so that's that's good on that one that then takes us on to item seven
the quality network and the trade union updates.
Sooz you're going first on this one.
I think we haven't decided who is going first,
but we're both prepared.
You're first on my list, so there we go.
Amazing.
Well, thank you very much for the discussions today.
I think I will continue with what we started up
at the last Board session,
and I have three key headlines that we'd like
at the trade union site to share with our Board members.
And I've kind of covered some of them,
I've touched on them in previous parts,
I guess because they are far-reaching.
So what we have to share today is we feel like the accountability for the CQC way is key to the cultural change.
I spoke about this around the Freedom to Speak Up report.
And I think I want to focus this about where the peer-to-peer conversations aren't possible.
CQC Trade Union Representative - 2:50:09
Because I think some of the launch of it is about getting to a place where we can have those discussions.
I think it's a phrase of call them in before calling them out, or calling them out before calling them in.
I never get that the right way around, but I like the attitude of it.
But I think we need to have some accountability
and some extra protections in place
for where those discussions aren't possible,
especially where there's an imbalance of power.
It does link in with the psychological safety
week and inclusion activity.
It's a real pertinent point at the minute.
The second point was around our adherence to the Equality Act.
And this one's a bit of a sensitive one.
It was highlighted in our Listening, Learning,
and Responding to Concerns report in 2023
that there was concerns that we weren't adhering fully
to our equality act.
I'm not too sure there's been much progress in some areas.
And while there are pockets of good practise and activity
across CQC, we as a union site are still
seeing that we're missing some of the basics in other areas.
And so there are hot spots of poor activity.
And this is in terms of people having
reasonable adjustments in place, which
links to how are we using the workplace passports?
Are they effective?
Are they leading to the right conversations
and the right support measures being put in place
for individuals?
And we have examples recently where our disabled colleagues
are having issues with the health and safety
elements of our reg platform.
And despite that being a well-known issue to this Board, those local conversations are still requiring trade union input and
escalation of concerns to get some of the basic adjustments that are in place that have been agreed or in workplace passports.
And so I think we'd like to look at where we're getting it wrong because unless we're getting it right for everybody
we're still slightly failing and the Equality Act and the legal obligation
doesn't have exceptions.
And the third point, I'm trying to be very quick, is
I think I've mentioned it before, but we just have a lot of activity planned and underway,
and while it's valuable and we need to get so much done to recover, to improve, and to
be a really effective regulator, I would like to ask, as a collective, to be mindful of
the impact that has on individuals.
We have a lot of fatigue colleagues, and so change fatigue, as you mentioned, and I feel
like that sentiment is felt by the Board, but a bit more of consideration where somebody
might be in an area that's considered a low priority.
Because we're trying to do so much,
there are some people where the changes that
will make their jobs easier or make their daily life at CQC
that little bit smoother might be quite far down the line.
And so that is part of our roadmap and our plans.
But also be mindful when we pause activity,
because something has a greater priority,
but how do we put some of that wraparound support
so those people who don't feel that that lower priority -
that their area being a lower priority isn't felt personally
or that their work isn't being valued by CQC.
I do appreciate, Julian, that you acknowledge the trauma
that a lot of our staff have felt
and the difficult period of people have gone through.
I think we need to keep that at the forefront of our minds
because until we prove to people we're doing something
different, there is going to be a lot of nervousness
that we haven't changed or that things
are being done in an old way.
Yes, I think overall, we are trying to do a lot.
And we do have colleagues, as I said, that are really
invested in making CQC a top class regulator.
And so yeah, just let's remember that we're all people
at the end of the day.
And while we're trying to do everything,
we can get further by being mindful of each other
and just that little bit of wrap around.
And sometimes the little things have the biggest impact.
So good communication delivered on time,
not hearing from a colleague about a decision that's
made about your area before you've
had the communication directly.
And I think that will positively contribute
to our cultural change.
Thanks.
Sooz, three very very good points there I think and well noted. Drew do you want to
It's a very hard act to follow. I'm not going to repeat but I'll certainly echo a lot of the sentiment
that Sooz has referred to. It's also echoed within our membership as well in respective particularly
system challenges and such. I want to celebrate a few things that we've done within the Equality
Networks over the past few months. I mentioned it earlier on but certainly our attendance at some
Sir Mike Richards - 2:54:01
the LGBT events that have occurred over the past few months throughout the country, during
which we asked attendees to tell us what good care looks like for them.
CQC Network Representative - 2:54:11
Very good engagement around those.
We had various boards that people have attributed to and they vote on what that looked like.
Sadly, a lot of that was the basics.
It was the fundamentals of care that we would expect of any other service.
What that has helped us to do is to start thinking about how that translates to our
assessment programme, what that looks like when we go out
to inspect what questions are we asking,
and how do we equip our colleagues
to ask the right questions and look for the right things,
but also understand what those answers mean.
So early work that's began around that and how we,
as I say, make sure our colleagues are equipped
to be culturally competent if we want to use that phrase.
We also, during those events, offered people
the opportunity to use a dedicated QR code that
up them to our Give Feedback on Care service.
We saw the uptake of that usage of that unique QR code
aligning with the national standard for these living
campaigns.
So we're really happy to see that that was a success
in that respect.
We'll hopefully be doing so again in the future as well.
Really good opportunity for us to get CQC out there
and show that we are approachable
so that people can share their experiences with us
and help influence the outcomes for LGBT plus people
in health and social care.
We want to acknowledge the launch of the NHS LGBT Health
Inequalities Review.
I think it's a really important piece of work.
We look forward to working with colleagues around the room
and across the organisation on how we respond to the findings
whenever they're inevitably published.
One concern for our members in some parts
is the publication of the Equality and Human Rights
Commission's guidance following the Supreme Court judgement
earlier this year.
This will understand that we have implications
on both our work as an employer and as a regulator.
We're very keen to work alongside colleagues, again,
in various parts of the organisation
to consider that implementation when the guidance is published
and how we maintain taking any respect for all those working
at CQC and receiving health and care.
And more broadly, a concern for members is also the current external climate around migration.
I'm keen that the organisation considers the impact that this may have both on our colleagues
working at CQC and our host of organisations, but also the wider impact across health and
social care.
We're already hearing first-hand challenges that employers have in regards to recruitment,
and retention and sustainable delivery,
given the pressure that is on certain parts
of the wider community.
So just to ask for the organisation
to consider what that looks like internally,
and also on delivery of safe and effective care.
Thank you.
Thank you very much.
Thank you very much indeed, Drew, for that.
Any comments on what we've heard either from or Sooz or Drew?
I think there's a lot of support that I'm hearing from what you both said.

8.0 Any Other Business

If that's the case, we're now into any other business.
And also, is there any other business from people around the table?
First of all, David.
Sir Mike Richards - 2:57:31
One piece if I may, Mike, it's really about the non-executive directors.
We've heard that we're going to have the arena event coming up in November, which is marvellous.
And also, of course, we've been invited very warmly to join the inspection teams.
Again, that's excellent.
But I would mention that every two weeks we have the leadership team briefing sessions,
and these only last about an hour.
Mr David Croisdale-Appleby - 2:58:08
I find them immensely useful because they, you know, they're led by a different person
most of the time, so you get a different viewpoint.
And the questions demonstrate to me, you know, the engagement of our staff, et cetera.
And they are a fabulous learning experience.
It's only an hour every two weeks.
I would encourage, if I may, through you, my non-executive director colleagues
to see if they can join that, because it is such a good experience.
Thank you very much for that, David.
We can certainly inform non-executive colleagues
about when these meetings are going on,
so that if they have time, they will be very welcome to join them.
I'm looking at Chris Day who is nodding his head vigorously, so we'll make sure that
At least the information about that and then people can decide whether they've got the time to do that
Sir Mike Richards - 2:59:10
But that thank you for bringing that up. I
think we know -
Just one thing and my apologies I neglected to make the connection earlier right when I was talking about the business plan
So just to cover that off
Just important to note, cast your minds back to the business plan.
We wanted to say that we're planning to make sure we reflect the audit recommendations in that as part of that,
because it was important, Chris, wasn't it, that we gather the appropriate recommendations,
learning from the audit that we've been through as part of our planning for the next several months.
Sir Julian Hartley - 2:59:53
But just important point I neglected to make that I'm like apologies, but just to cover that off for the record
That's that's fine
Noted and we can bring that together. We now have the opportunity for questions that have already been sent in to us from
people outside
And I think people have been warned as to who is going to
address them
There's a question coming from Tony Benfield
about time scales for re-inspection and how quickly we can do re-inspections.
Sir Mike Richards - 3:00:25
Chris, are you going to tackle that one?
Yes, thank you for the question Tony.
Just to slightly correct your premise about the question,
it just talks about how things have changed.
So the 2008 Act actually sets out our statutory functions,
including our requirement to publish what's called a Statement of Frequency,
outlining how we'll inspect in organisations. This hasn't changed since the Act in 2008.
As you'll be aware from the conversation today, the independent review has led us to prioritise
four immediate actions, one of which is about increasing the number of inspections.
Chris Day - 3:01:01
Currently we average just over a year to come back to services that are inadequate. There are many
services obviously will be expected more frequently than that, but we know we need to
improve this. As I said elsewhere in the meeting our regulatory approach is
currently being updated and particularly looking at our assessment framework and
how we improve it. Once we've confirmed our new approach we intend to introduce a
frequency schedule for individual organisations in each of the sectors
that we that we regulate and this will take into account previous ratings and
other factors such as emerging risks. However this does not prevent us from
going back into assessing providers quickly.
I think Chris mentioned earlier that we know that we do follow up on risk immediately all
the time, so that we will continue to look at risk and emerging risk as part of the requirements
to go back in.
But just to try and answer that question directly, we will publish that frequency again once
we complete the work on the assessment framework.
Thank you, Chris, very much for that.
I think the next two questions are probably for me.
Why has CQC reduced the number of its Board inspections in public from eight in 2010 with
members of the public in attendance to five in 2025 with no members of the public in attendance?
In terms of members of the public in attendance, it's partly because of the space that we have
Sir Mike Richards - 3:02:30
here and it's partly that we do of course stream these meetings so that
anybody can watch them and can watch them on catch-up if it's more
convenient and but alongside that what we have done for some time now is to
enable people in advance to submit their questions I think by getting them
submitted in advance we actually get better answers to them frankly than if
were just taken by surprise. In terms of the numbers of Board meetings, I don't
know there is a right number of Board meetings. At the moment we scheduled
four or five per annum as public Board meetings, on top of which we have Board
strategy days, which I think at this stage is particularly important as we
evolve our new approach to inspection and where the strategy should go.
people will know that we have a duty set for us in the 10-plan to become
amongst the best health and care regulators in the world. That's going to
require a lot of thought. We also have a governance review underway at the moment
and one of the things that we can reconsider as part of that is what the
frequency of different boards and sub-board meetings should be. So that is
all in hand. The next question, which also comes from Robin Pike, says,
why has CQC's regulation of maternity services been ineffective?
Well, it may not have been as good as it might be, but it hasn't been totally
ineffective in that we did a complete round of 131 maternity services in 22/23
and almost half of those inspections were rated either requires improvement
or inadequate so I think we were amongst the first that were really demonstrating
the breadth of problem there is in maternity services that does not mean
that we couldn't do better in terms of our maternity inspections just a few
minutes ago we were talking about the ten safety actions. Are we rigorously
looking at that? For example. Are we making use of the fact that trusts now do undertake
their own perinatal mortality reviews? Are we looking sufficiently at the culture within
maternity services? Are we looking at the leadership, trust level of maternity services?
So we are very actively looking at all of these issues, and I'm taking a personal lead
on that for CQC for the time being.
So we're not complacent about this at all,
but it's not fair to say that we missed everything.
We certainly haven't, but we can do better.
So I think the final question is coming to you,
this Chris, Chris Usher.
What measures is CQC taking
to reduce its overall expenditure?
Yeah, thanks for the question.
So I think it's important to know we've not changed our fee scheme since 2019-20.
This means for most providers they won't have seen a fee change unless it's linked to a
variable in that sector.
It also means over that time that we've had to absorb any inflation, whether that's pay
or predominantly pay inflation or non-pay.
So really for us it's about living within our means and our existing funding envelope and ensuring that we manage our
Chris Usher - 3:06:05
expenditure appropriately to deliver on that which helps
Thank you
Any other comments that people want to make
If not, I think I will draw this meeting to a conclusion at
quarter to five so we're actually ahead of our target time so thank you all very much indeed.