CQC Board Meeting - November 2025 - Wednesday 26 November 2025, 1:30pm - Care Quality Commission

CQC Board Meeting - November 2025
Wednesday, 26th November 2025 at 1:30pm 

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  1. Sir Mike Richards
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  1. Kay Boycott
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  1. Esther Provins
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  1. Arun Chopra
  2. Esther Provins
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  4. Sir Mike Richards
  5. Arun Chopra
  6. Dr Toli Onon
  7. Arun Chopra
  8. Sir Mike Richards
  9. Chris Day
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  11. Arun Chopra
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  13. Alex Kafetz
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  15. Arun Chopra
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  1. Chris Usher
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  3. Kay Boycott
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  5. Chris Usher
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  7. Esther Provins
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  9. Richard Barker
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  2. Chris Badger
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  5. Chris Badger
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  7. Chris Day
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  1. Sir Mike Richards
  2. TU Representative
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  4. Arun Chopra
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  6. Chris Usher
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  8. Alex Kafetz
  9. Sir Mike Richards
  10. Esther Provins
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  12. Network Rep
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  15. Sir Mike Richards
  16. Network Rep
  17. Kay Boycott
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  19. Kay Boycott
  20. Network Rep
  21. Esther Provins
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  25. Chris Usher
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  1. Sir Mike Richards
  2. Mr David Croisdale-Appleby
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  7. Sir Mike Richards
  8. Chris Badger
  9. Sir Mike Richards
  10. Arun Chopra
  11. Mr David Croisdale-Appleby
  12. Arun Chopra
  13. Sir Mike Richards
  14. Richard Barker
  15. Sir Mike Richards
  16. Dr Toli Onon
  17. Sir Mike Richards
  18. Webcast Finished

1.0 Opening matters

1.1 Apologies:

Sir Mike Richards - 0:00:00
Sir Mike Richards - 0:00:02
So, in terms of we have some apologies
and we have some people joining remotely,
so they're not with us in the room.
The apologies are with Melanie Williams, but in terms
of people joining online, we've got Bola, I think -
Welcome Bola from the United States of America.
And Ruth Owen, who I think is nearer at hand, but not with us today.
And then Joyce Frederick, who often does attend this meeting, is not attending today.
And I think that took all the apologies.

1.2 Welcome and Introductions

But the welcomes then are to Zi Shriupinda and to Dee McEvoy.
Zi is the Equalities network rep and Dee is the trade union rep.
And we'll be hearing from them later on.
I have a question for you.
I can also mention the fact that we have attending with us today -
Sorry, I introduced them for the private board this morning.
But Phil Llewellyn who is attending as
an observer and Jane Burns who is
attending with a very important role in terms
of governance that we are working on.
So, general welcome to everybody.
There are no board members attending
who have not attended before.

1.3 Declarations of Conflict of Interest

Declaration of Conflict of Interest.
Kay, do you want to say a word about what it's to note?
Sorry, I nearly didn't switch it on.
Just to declare that my husband is now working as a director
general in the departments of health and social care and also
across NHS England.
Thank you.

1.4 Any Urgent Business

Kay Boycott - 0:02:23
Sir Mike Richards - 0:02:24
So that then takes us to urgent business and obviously the main urgent business since our last Board Meeting is that our Chief Executive, Sir Julian Hartley, has stood down. And people will be aware of the circumstances
relating to that because he was previously a chief executive at Leeds where there were
concerns about maternity. But in response to that I'm absolutely delighted that Arun
Chopra, sitting next to me, has agreed to be the interim CEO and with him Chris Usher
has agreed to be interim deputy CEO and
Chris
Dzikiti,
who actually should have said is not
with us this afternoon, he's been appointed to Arun's
previous role.
So he's the interim chief inspector of mental health.
So those are some important changes that we have got to

2.0 Governance Matters

note. Any other comments or questions about that before I move on?

2.1 Minutes of the previous Public Board meeting held on 24th September 2025

If not, we can go to the minutes of the last public board meeting.
That was the one on the 24th of September.
You've had the minutes.
I suppose the first question is are there any points of fact
or accuracy that we need to mention?
And then are there any, if not, are there any matters arising?
I'm not sure if I'm getting the right answer.
Sorry, Esther.
I didn't spot you.
Thanks, Chair.
Just correction on page 8 of the minutes.
We talk about the acronym LGBT plus.
The comment that we made was actually relation to the data that we were
discussing that was purely relation to LGB and not T.
So my point being that there is an issue around the reporting that we
Esther Provins - 0:04:19
have between gender and sexuality.
And that was the point.
So we just got that wrong in the minute.
Thanks.
That's important.
We can correct that.
Any other points of fact that we need to consider?

2.2 Review of the Matters Arising and Action Log

Sir Mike Richards - 0:04:37
If not, we can move on to the matters arising
and the action log and the action log and the decisions
log or the action log is wonderfully short, there's nothing on that, so that's good.
And then there's the decisions log, but I don't think there's anything there.
They were all things that were approved or agreed.
So we'll note that.

3.0 Board and Committee Matters

Good.

3.1 ET Report to the Board

I think, Arun, that brings us on to your report, the ET report to the board.
Thanks, Sir Mike.
Good afternoon all.
I'll start by just saying thank you to colleagues at
board and across the organisation for their
support as I've been taking on the interim role.
So thank you to colleagues.
Arun Chopra - 0:05:29
I'd like to mention at the outset over the last couple
of weeks we've held a series of events across the
country with in-person events with colleagues from
across the CQC, Leicester, Manchester, Newcastle and
London, delighted to say we've had over a thousand
colleagues together.
And it's been an absolutely brilliant opportunity to discuss our rebuilding the organisation
roadmap with colleagues and provide that detail and assurance to them about how we are working
together to rebuild some of the foundational improvements that we know need to be made.
I'm going to invite Esther to speak a little bit more about that at the end of this update.
It's also been an opportunity to listen to colleagues about the concerns that they have.
and as an executive team demonstrate how we are working together to address those concerns
as per the roadmap and other areas that they've highlighted to us.
It's also been a really important opportunity to reflect on the great work that many colleagues
are doing towards our core purpose, which is about protecting patients and people who
use services and supporting services to improve.
and an opportunity to express our gratitude again to Sir Julian for his leadership,
the clear plan that he provided around our foundational improvements,
which we are very much sticking to.
So I just wanted to say that right at the outset.
So Mike's already mentioned Chris Dzikiti stepping into the interim
Chief Inspector of Mental Health role and my gratitude to Chris again for that.
I also wanted to mention a couple of changes that we've made to the portfolio
within the executive team, which are as a result of recent changes.
So I'm pleased and would like to say thanks to Chris Badger for taking on the role of
Caldecott Guardian and to Toli Onon for taking on the role of executive sponsor for
Freedom to Speak Up.
So thank you to both of them.
On another exec portfolio update, thanks to Professor Bola Owolabi who is joining us
remotely today who has taken on the executive lead
for our work around health inequalities.
Bola is recognised around the world for her leadership
in health inequalities, quite rightly so,
and she's gonna be playing a pivotal role
in making sure that our assessment framework
is a powerful tool to use the regulatory levers
to ensure that we are reducing health inequalities.
So thanks to Bola.
Just a couple of areas before I...
Thank you. Hopefully you can hear me again now.
Just a couple of other areas. I wanted to mention our assessment framework consultation.
The assessment framework is an absolutely powerful tool and the mechanism that we use
when we cross the threshold and when we're looking at services to see how they are, how
they're working. The assessment framework consultation is open.
It closes on the 11th of December. We've already had a great response. I think more than 800
responses. Chris Day is going to speak a little bit more detail about that in a second.
And I also wanted to mention the work that's taking place at NHSE on the quality strategy.
We think we're really supportive of this quality strategy.
I think it's a mechanism to make good on some of the recommendations that we saw from Lord
Darcy's review and from Penny Dash's review about how we embed quality as a principle
within our services.
We are really keen to play our part.
Again, going back to the assessment framework, the way the assessment framework and the rating
characteristics about what good and what outstanding looks like will be really important to embed
into the quality strategy.
So we're really looking forward to continuing that work.
Of course, the NQB is chaired by Sir Mike and Penny Dash, so we're really looking forward
to working on that.
On that note, I'm now going to bring in Esther to speak a little bit about the roadmap that
I mentioned.
So over to you, Esther.
Thanks.
So just a set of context for colleagues.
Colleagues may recall a previous board meeting --
Esther Provins - 0:09:39
-- for our digital rebuild programme, really acknowledging the report that Peter Gill did in his recommendations
that we took at public board as well as other recommendations we received about the challenges with our regulatory platform.
Since we released that indicative roadmap, we did quite a widespread --
and external stakeholder views on that roadmap.
One of the questions that we had, and quite rightly so, is how our digital roadmap fitted
in with our other change programmes.
The paper here that we have, the very simple one slide, is a summary of our roadmap, our delivery roadmap
across all of our foundation improvements.
So just a very brief whistle-stop tour for colleagues
just to orient you to this slide.
So the first kind of swim lane or horizontal section
is around our policy work that Arun has just mentioned.
So our public consultation is now live.
There is also sector-specific consultation work
that is underway led by our chief inspectors.
And you'll see the date ranges of that across the top.
The next kind of horizontal swim lane
is about our integration work.
So again, colleagues will be aware
that we moved into sector sector-specific teams
on November the 3rd.
That is not the end of that journey.
It's only the start.
And so there is activity ongoing in that space as well.
And then the third and the fourth
are around our digital and data roadmaps.
So a couple of principles that, again, I'd
just like to outline for colleagues and anyone watching.
The reason we have sequenced our digital roadmap in this way
is because we are prioritising the area of most risk first.
So we are prioritising our assessment functionality first
in real recognition of our key aims
to increase the number of inspections that we are doing,
but also in recognition of the real challenges
on the ground our colleagues are facing
from a health and wellbeing perspective.
Absolutely acknowledging that other areas
have experienced challenging,
and I'd really like to acknowledge that our providers
who have previous problems with our registration
functionality and also providers who have had problems
with our provider portal are absolutely not forgotten
and we have planned those into the roadmap in phase two.
So I think that's probably all I was going to say,
Arun and Chair, just to orient colleagues to that.
But again, you'll just see those stop signs
and what we are really, really trying to emphasise,
and we've been doing that at our events as well,
is to just share with colleagues,
this is a really planned and structured approach, and we will be pausing and taking stock if
we don't feel it's safe to proceed. So I hope that's a helpful summary. Thank you.
Thanks very much, Esther. And should we go on straight on to Chris next, or do you want
Arun Chopra - 0:12:41
to come back on that? Just a couple of things. Thanks, Esther. Just before we come to Chris,
Sir Mike Richards - 0:12:43
I'd checked in with my exec colleagues,
and if there's any other updates,
we can take them in a second too.
Arun Chopra - 0:12:50
But I know, Toli, you were very keen
that we spoke about an issue
which we think is of great importance,
and we'd like to talk about that now.
Thanks.
Thank you, Arun, and Chair,
for prioritising time at the board
for me to give this public apology
to Sarah Hawkins and Dr. Jack Hawkins,
who are the parents of baby Harriet Hawkins.
Dr Toli Onon - 0:13:12
Harriet was sadly stillborn at Nottingham City Hospital
in April 2016 after a series of mistakes in care
by hospital staff.
Last year, we decided to commission
an external independent review into CQC's knowledge
and handling of information relating to Harriet
and our engagement with the Hawkins family.
The need for this review arose in response to concerns
about how we'd handled information that came into CQC
regarding the care received by Harriet and her mother Sarah.
We're working directly with Mrs. Sarah Hawkins
and Harriet's father, Dr. Jack Hawkins,
to develop the terms of reference for the review
and to agree next steps.
Now, while I don't want to preempt the findings
of the review, I do understand that we have evidence
that indicates that we, CQC, provided a statement
in June 2024 that was inaccurate. We provided that statement to the producers of an ITV
documentary, Maternity; Broken Trust, and it was not accurate in relation to when we were
first made aware of the details of Harriet's case. On behalf of CQC, I've apologised in writing to
the Hawkins family for this error and for the distress it's caused them. I know we're all truly
sorry. I have shared my commitment to ensuring that the independent review
will provide clarity answers and learning and that will be our
contribution will be through the terms of reference it is otherwise an
independent review but we will take the learning that arises from it to improve
how we handle information coming into the organisation so that we're
transparent accurate and compassionate in our dealings with families patients
and service users and I have also written to the production company with
our apologies for the inaccuracy of that statement. Thank you.
Thank you, Toli. Thank you.
My thanks, too, for that. Shall we now go on to Chris? I think you were going to mention
Arun Chopra - 0:15:16
a bit about the assessment framework consultation. Just to provide colleagues with an update,
Sir Mike Richards - 0:15:24
the numbers change all the time. We've got around 1,000 responses now from providers,
stakeholders, particularly stakeholders who represent people who use services, from colleagues
Chris Day - 0:15:34
in CQC and also directly from members of the public.
As Arun said, the consultation closes on the 11th.
Just a couple of key themes that appear to be coming through in the early sort of conversations.
The reintroduction of ratings characteristics with a clear, simple definition of what services
what it means for services to be good, outstanding,
or indeed requires improvement and appears to be finding
quite a lot of favour, as well as the reintroduction
of sector specific assessment frameworks
that help us understand what good looks like
in the different sectors that we regulate.
Just a further plug, we've got over 3,000 providers
and people who use services who will be involved
in the next stage of our work around
the assessment frameworks, and there's still opportunities
for colleagues to be, for people to be involved,
you can go to our website to register your interest in that.
It's clearly linked on the home page.
Just to make one further link between what Arun said
around NQB, it was really important in the conversation
we've had with NHS England and DHSE that we are able
to find a strong link between what good looks like
in the context of the assessment frameworks
that we have for different sectors,
and what quality looks like articulated
through the quality strategy.
So we're working very closely with our colleagues
in DHSC and NHS England, and I'd like to thank them
for the way in which they've worked with us
around making sure that the work that we do,
the work in the assessment frameworks,
the five key questions, relate strongly
to how the quality strategy will eventually be deployed.
Thank you, Chris. Arun, any further points on your report?
Thank you, Sir Mike. Thanks very much, Chris. It is just so important. The assessment framework
Sir Mike Richards - 0:17:34
is how we will ensure that patient voice and what matters to patients, carers and people
who use services is central to what we look at. So it's really, really important to us.
Nothing further from me.
Arun Chopra - 0:17:45
I just want to check if there's any other further updates from any of my exec colleagues
that they'd like to share.
Thank you.
Or indeed comments and questions from other board members about what we've heard in the
Sir Mike Richards - 0:18:03
executive team report and Arun's report.
Alex.
Yeah, thank you, Mike.
Thank you Aaron for the report and thank you Tolly for for making that apology and I just want to pick up on
Your and Chris' points about the National Quality Board
Alex Kafetz - 0:18:23
And I welcome the fact that Mike was asked to co-chair it and all the points you've emphasised in in your report
And I think perhaps the other point
CQC - CQC should make and we can we have the levers to help is to ensure that the providers we regulate of all
flavours are putting
discussions on quality and outcomes underpinned by high quality data at the
heart of their discussions and I think when you look at board papers often
they are pivoting to the finance and to performance targets and decoupling
that from the wider quality so in the world I operate in, in a
acute trust really they're not looking at outcomes they once were around risk
adjusted mortality, readmissions, length of stay,
and so on and so on.
So I would welcome CQC pulling our levers
to ensure that those discussions are returning.
We all support that.
Arun, back to you.
Thanks, Alex.
I mean, it's one of the themes that's
come up at every one of our events
that our inspectors are saying it would be so helpful for us
Sir Mike Richards - 0:19:29
to have very powerful clinical outcomes as part of our data
and insight tool so that we have that information to hand
when we're going out.
So absolutely.
and it's very much part of the roadmap around the data and the digital space that we're
Arun Chopra - 0:19:44
in and we'll be working with our sectors to make sure we've got the right sort of clinical
outcomes in our data and insight tool available for our inspector and enforcement colleagues.
Thanks.
Any other points on this agenda item?

4.0 To Discuss

If not, we can move forward.

4.1 Market Oversight Update

Sir Mike Richards - 0:20:06
So I think our next item is market oversight.
Have we got the relevant person here for that?
Not yet.
I was just going to guess who.
Right, but it's in the building as well.
As far as I know.
Okay, well we'll hold on for a moment and see if James White is around.
Not here yet.

4.2 Performance, Finance and Risk Assurance Updates for Q2

If that is the case, Chris, could we do the finance book one, Performance Finance Risk
Assurance?
Yeah, happy to.
So, this is the performance update to the end of quarter two, so the end of September.
Chris Usher - 0:21:02
I'm just going to pull out some of the key areas to focus on and just say a bit about
risk and a bit about finance.
So in terms of assessments, we set ourselves a target of delivering 9,000 assessments by
September 2026.
We're on track for that.
We've currently done just short of 3,000 to date,
or at the point at the end of September,
which is above the target we've set out
for that point in the year.
We are just monitoring that closely.
That's good, and that's positive,
and it's above where we need to be.
But we have also just realigned colleagues into sectors,
and we will be rolling out.
As I said, we've got a roadmap of change.
So we just need to monitor that closely
and ensure that we remain on track.
There are areas within the delivery you can see in the detail of the balanced scorecard
where we're slightly behind where we need to be, mental health sector being an area
to pull out, which is largely due to the complexity, I believe, in that sector as well as resource
and challenges.
But overall, we're on target to where we need to be.
With regards to registration, the overall volume of registration that we have in the
system is reducing, as is that over 10 weeks old.
So we now have just over 2,700 registration applications
over 10 weeks old.
That's 30% lower than it was at the end of quarter one.
So you can see overall, and the main metric
that we track in terms of over 10 weeks old is coming down.
In September, we completed the most applications so far
this year.
Our KPI is shown red because we have set ourselves
the target of clearing over 10 weeks old by the end of the year.
So whilst there's good performance, good trajectory, it is still red based on that assumption,
and we're just reviewing our forecast and our trend and how realistic it is that we
deliver on that.
Information of concern is a slight outlier in our performance.
I did another one to pull out.
We've done great efforts to clear backlogs of information of concern that we had earlier
in the year.
We've cleared through them and what we've now set ourselves as ambitious targets to get back to business as usual KPIs.
And I think that transition is proving quite a challenge as colleagues are delivering
Respond to information concern and our assessment targets at the same time
And so all areas are kind of currently below target and struggling to see consistent improvement
I can see the figures beyond this period and I can say we are starting to see improvement in those areas and there is a
target that focus on that, but that remains an area,
an outlier in our performance.
Some positive areas to pull out as well,
in addition to the ones we've already talked about,
our timing is to complete assessments is below the target -
is below the targets we've set, both in adult social care
and primary community care, 37 days on average,
and in mental health and specialist care, 83 days,
which is both below the targets we've set.
We've also got the NCSE call lines continue
to deliver really strong performance across the board,
which is really good performance this year.
A local authority assurance delivery is progressing well,
and our mental health monitoring visit
are also performing well.
So you can see in the balance scorecard,
there's lots of positive areas to pull out.
We are tracking risks across the organisation,
as you would expect.
We're also just in the process of introducing
a board assurance framework,
as well as reviewing our corporate risk register.
The current register has 24 risks in there.
The majority are rated higher than we would want.
And just pulling out the kind of the key risks
that we have at the minute,
improving our longer term productivity.
I've talked about the 9,000 target,
but we also need to make sure
there's a sustainable uplift beyond that.
That's currently highly rated on our risk register.
I think our focus on the programme of change
and the roadmap that Esther talked about,
our better systems, revised methodology,
will all help enable, unlock longer-term productivity.
Staff wellbeing morale is one of our highest risks.
There is still a lot more to do.
We touched briefly on the conferences this week,
which we've gained a lot of good feedback for,
but there is more to do,
and this will kind of centre around our values
and behaviours looking forward.
Another closely linked risk is our culture,
leadership culture.
We've had lots of feedback about inconsistent leadership
across teams and CQC and the work that we're setting out
to do on those hexagon pieces in the update before
kind of shows our plan around how we can address this
through leadership development.
And lastly, stakeholder confidence and our ability to improve
is another risk that we're tracking.
It's currently rated highly and we're tracking closely.
Chief inspectors working closely with stakeholders
across sectors on our rebuilding work
and how ensuring they can be involved in the consultation
on assessment framework as we've talked about.
Finally, just in terms of money, at the end of July,
we were running with a 0.1 million deficit.
We're forecast to have 0.7 million underspend
by the end of the year.
Our depreciation this year, and the level of depreciation
is playing a key role in our underspend
because we have an impairment of our regulated platform
and low capital spend without that under spend
on depreciation we would be forecasting
and overspend as an organisation.
So that's a fortuitous position.
And on capital we've spent minimal capital to date
and we expect to be under spent for the end of the year
and in conversations with the department about that
and about whether we return money back to them.
And that was it from me.
Thank you very much indeed Chris.
Sir Mike Richards - 0:27:01
So quite a lot that's positive, but still a long way to go on some of those metrics. So let's open it up to discussion, Kay.
Great to see the the positive trajectory and I wasn't around the board table when those performance metrics were set and
Kay Boycott - 0:27:16
I just wondered how we are also looking at the quality of
some of those outputs because the danger is if you start chasing
quantitative targets that actually we don't have a full picture on the quality. I'm not that I imagine is quite a complicated
performance measurement question and we might not come back might not be able to do it here
but I would like us to come back to that
otherwise you could end up on intended consequence as you're chasing volume targets.
That was number one and the number two and you would expect this from the audit and risk chair
there's a lot of risk outside of tolerance
and it just might be helpful to understand
what the exec are doing in terms of risk management
in a little more detail.
Do you want to come back on those, Chris?
Yeah, I think that's a fair challenge, Kay,
in terms of looking at our outcomes
and I'm conscious of Alex saying to focus
on performance and finance and then I do an update
that doesn't focus on outcomes,
Sir Mike Richards - 0:28:12
play around to that question.
Chief Inspector colleagues might want to come in
in terms of the outcomes and the quality inside
that we're trying to deliver.
In terms of the risk, so we've recently set up
a subcommittee of an executive team,
Chris Usher - 0:28:27
a risk committee to focus exactly on this.
We're having a review through all of our risks,
looking at our path to green, if you like,
and when we expect to see those risks
and what activity we can do to support that
and where we need to do more.
Because agree, the view across the risk register
isn't where we'd like it to be,
and we need a plan to get out of where we currently are
in terms of the level of risk.
Completely agree with you Kay, that it's not just quantity,
but we have to have quality in what we do.
And I think one of the things that I would say to that
Sir Mike Richards - 0:29:02
is part of the purpose of getting back into the sectors
is with chief inspectors leading that,
they will also be responsible for making sure
that our inspections and our reports are of good quality.
it is very early days to having the four chief inspectors but that is going to be
a major part of their function.
Esther. Thanks chair just a couple of things I wanted to pick up the report
and thank you Chris. So the first one was just to say a big thank you to my
registration colleagues because I know they have been engaged in such hard work
to make improvements and reduce the backlog so a really big thank you to
Esther Provins - 0:29:40
those colleagues, they've introduced some really good practise stuff, so some additional
quality checks and some streamlining of their processes. But absolutely appreciate there's
more to be done in that area, but I just wanted to say thank you to them.
The two other pieces I just wanted to raise were under the people section. So colleagues
will note that our technology in a digital space has quite a high number of vacancies,
and I just wanted to explain why. And that's because colleagues, our pay scales limit us from
limit us from paying industry standard rates for a highly technical skilled role. So we
actually use alternative methods to kind of deliver those resources, but that's the reason
why I just wanted to explain that. And then thirdly, just picking up your point, Chris,
in terms of culture, just again reflecting on our events over the last couple of weeks,
totally agree there's some real positivity in the room. And it just made me reflect a
a lot of what I heard from colleagues when we met them was,
we really like the words, we really like where this is going,
but we need to see tangible improvement.
And it just really struck home to me about how we as a board
are responsible for that tangible behavioural values
and ways of working shift
that our colleagues really want to see.
Thanks Esther.
Bola, your hand is up.
Sir Mike Richards - 0:31:11
But thanks Mike, I just wanted to come back on the question in relation to quality. I
think it's an entirely reasonable question to ask, particularly Kay as you say as we
go towards driving up the volume. What we have been saying as chief inspectors is we
need to drive up the volume, the consistency and the quality of the assessments and the
inspections that we are carrying out. A number of things are going to help us in that endeavour.
As Mike has just said, the return to sector alignment, the reprioritisation of subject
matter expertise will be incredibly important in reinstating that quality element. The other
thing that is very clear to us is that in addition to the assessment framework review
and refinement. There's something about how we train, upscale and support our frontline colleagues,
whether that's inspectors or operational managers. And we're all clear-eyed that actually as the
front line part of the CQC, we do need to invest a huge amount of effort and energy in the training
and upscaling of those frontline colleagues to make sure we do have that consistency of quality.
Beyond a CQC purview, I think the development of the quality strategy is another really important system-wide development,
which as chief inspectors, we will be leaning into that space going forward along with Chris Day and his team and the work they've been doing there,
because it's really important that we support the system
as it defines what quality means.
Because of course, as the regulator,
it will be on us to hold the system to account,
to deliver on what the quality definitions are.
So internally as the CQC, return to sector alignment,
subject matter expertise, training and development
of our frontline staff on a system level,
chief inspector involvement
as the national quality strategy is developed,
just in response to your question, Kay. Thank you, Chair.
Thank you very much, Bola. Any other questions on performance, finance, risk assurance? Richard.
Just briefly to acknowledge, although we're clearly unhappy about the number of risks
that exceed tolerance, et cetera, quite a few of them are interlinked and the CQC way,
Richard Barker - 0:33:50
the plan and the strategy, I would hope we'll see a bit of momentum behind. So two or three
things that they get right, particularly things like data quality, other things flow from
that. So I mean perhaps what we ought to maybe look at from the executive team is just look
at what a trajectory of change might look like on this and how some of the interlinked
indicators might create this, you know, a positive outcome, you know, by when and by
what milestones.

4.1 Market Oversight Update

I think that's all on this item.
But I think we do now have James White in the building.
Sir Mike Richards - 0:34:30
So we'll bring him in so that we can discuss market oversight.
Chris, once he's here, do you want to do an introductory bit reminding people what market
oversight is all about?
Welcome, James.
So I'm going to ask Chris to introduce this and then we'll hand over to you.
Thanks, Chair, and I'll pass over to James shortly.
Just to remind especially for colleagues new to the board that market oversight is a distinct
responsibility CQC has in relation to the adult social care market, in particular to
have in-depth and intense monitoring, in a sense, financial surveillance of the vitality
Chris Badger - 0:35:21
and risks associated to business continuity of the largest care providers, either through
things like number of home care hours delivered or number of care home beds, with the crucial
purpose of making sure there is early warning signs of any potential risk to service continuity,
which of course in reality means continuity of care to people across
England. The team work very closely with providers to share information and
insight with of course the approach being to try and identify problems as
early as possible. In addition to that that surveillance provides a insight
into the overall care market albeit it is a certain part of that market and
James has insight and data that's representative of that segment which he produces
on a quarterly basis to share to board and he's here today to do that. Thank you.
Over to you James.
Thank you Chris. Before I go on and speak to the paper I'd just like to cover off inclusion
in market oversight is purely down to your size which makes you potentially difficult
Sir Mike Richards - 0:36:24
to replace. In no way does it reflect heightened or lessened risk of business failure. Presently
there's 62 providers in the market oversight scheme and that's split roughly one third
of those providers are care home for older people providers, one third are home care
providers and one third are specialist providers who predominantly care for people with a learning
disability and autistic people. In terms of the paper itself it covers a two year period
up to and including 30 June 2025 and importantly to note in that period it also covers the
quarter from the 1st of April 2025 which is where we see the impact of last October's budget
for the first time in terms of an increase in national living wage, NLW, and an increase
in employers' national insurance costs, ENIC.
Given those two increases, we've done some analysis work with the providers and other
stakeholders, we estimate that leads to an increase in staff costs from the 1st of April
round about 9% and upwards.
We also know from other stakeholders and work we've done with providers that there have
been uplifts from LAs in the region of 5% to 6%
from home care providers and specialist providers,
and 4% for care home for older people providers.
What that means is there is a funding gap for those MO
providers which they'll have to address
in the short to medium term.
What it also means is that we were not particularly surprised
to see a decline in EBITDA margins
across those three sub-sectors for the period
from the 1st of April 2025. I now move on and speak to each of the three sub-sectors in term.
In terms of care homes, one of the measures we find particularly useful to understand their
financial performance is their occupancy level. As at the 30th of June 2025, it's at 87.5%
and that's recovered and recovered well. Pre-COVID March 2020, that was at 87.1%
It took quite a large decline during COVID
due to increased mortality levels, unfortunately,
but that has built back.
To give you some further context around that occupancy level,
we estimate to reach a cash-even, break-even level
for providers in market oversight.
They need occupancy level around about 85%.
So that 87.5 is an average occupancy.
So that does mean there are some providers
in market oversight who still are not
at that cash break-even level.
In terms of home care providers, I think this sector for the two years to 30th of June 2025
could probably best be described their performance as fairly flat.
Look, we've reached that opinion from conversations with their management team.
There is a cohort of providers in that sub-sector, around about 40% of them have sought to grow
their hours organically.
We've actually seen a slight decline in those hours of 1.3% points over that two-year
period to 30th of June, 2025.
We've also seen in that same period four quarters
of decline in EBITDA margin to the 30th of June, 2025,
1.7% points.
It remains a really competitive environment, home care.
I think, and this is in the state of care,
for period 2023/24 CQC, we saw an increase
of 11% of the number of providers
registered for home care.
Moving on to specialist providers, pretty much all of their revenue is state funded.
That's either LA funded or NHS funded via ICBs.
Given that fact, quite often in their negotiations for fee uplifts each year, they're in a position
where they're a price taker and that's partially been reflected in an EBITDA decline in margin
of 0.8 percentage points to the 30th of June 2025.
On the flip side of that, it's been pleasing to see an increase in EBITDA on margin for
the two years to 2025, June 2025 of 1.5 percentage points.
And what we've also not seen, and we were concerned around this and I think other stakeholders
were, we've not seen the level of contract handback which we thought may have been a
result of that increase in the employer's national insurance
cost and also the national living wage.
I'll now move on to the outlook for the sector.
One point I particularly wanted to speak to
was in relation to MO providers and ASC generally in terms
of we've seen quite heightened activities of mergers
and acquisitions, particularly within the Care Home
for Older People space.
And we think that will continue into 2026.
A large amount of that activity has been undertaken by real estate investment trusts or what we
call REITs and their business model at its most simplistic is relatively straightforward.
They buy the bricks and mortar, so they buy the care home, the properties, they then partner
with an operator who will lease the care home and they will deliver the care.
In October just gone, we saw two very sizeable transactions.
That was by a US listed REIT, Welltower Inc, where they acquired the property portfolio
of Barchester for £5.2 billion and also took a shareholding in HC1 of £1.2 billion.
And they're two of the larger care home providers in the UK.
I think ultimately these transactions and this investment is underwritten by the ageing
demographic of the UK population.
You know there's going to be demand there, unfortunately.
I also think it shows some confidence in the UK economy and the business sector.
I also think it shows some confidence in the regulatory environment here in England for adult social care,
but also in the other three home nations. Thank you.
Thank you very much indeed, James, and a very important topic area. Chris, do you want to add to that?
Sir Mike Richards - 0:42:28
The other thing I would add, and James has referenced it in the slides, is around really
positive reduction in agency spend, which is in those MO providers, which is obviously
important financially for those organisations because agency spend costs more, but now as
importantly, more importantly, in terms of continuity of people that are delivering care
Chris Badger - 0:42:47
and support for people that take those services, see those services having staff that they
know and trust is really important.
My word of warning looking into the future
is that that reduction in agency spend,
we believe in quite significant part
would have been related to increases
in international recruitment.
I think in the state of care report and launch last month,
I was clear that changes to that will, I think,
mean that the care workforce in terms of overall quantum
is more fragile than perhaps it appears.
So the future outlook is one that I think still presents quite significant risks to
the care sector and I think it's important to note that and for us to understand that
that risk may well emerge over the next year or two.
Thank you.
Thank you very much, Chris.
Questions or comments about market oversight?
Chris Day.
Sir Mike Richards - 0:43:50
Just to say this is really, really important work and thank the Market Oversight team for
the way in which they produce this.
Chris Day - 0:44:02
As we say, we use this a lot in the state of care report.
A couple of things are really interesting to note.
The paper mentions the growth in private funded care businesses and specialist private funded
care in terms of EBITDA.
it'll be interesting to see what impact that might begin to have on the variation in care
across different parts of the country. And I know that's not, I know you provide a national
service, but I think there's a, there will be interesting to see how that plays out regionally.
And I think your point about continuing to watch the relative fragility of the workforce,
again, potentially by different sector and by different area will be really important.
But thank you for the work.
It is important for our regional and national oversight
of all the sectors.
But as colleagues will know, what happens in one sector
affects what happens in the others as well.
So it really does give an indicator
of where concerns and issues might rise.
Thank you.
OK, thank you.
Thank you very much.
Thank you.

5.0 Equality Network and Trade Union Updates

5.1 Trade Union and Equality Networks Updates

So we now move on from there to our Equality Network and Trade Union updates. Who would
Sir Mike Richards - 0:45:21
like to go first, Zi or Dee?
I think we've agreed I'm going to go first, Zi. So thank you very much for inviting us
again today. I'm Dee McEvoy, I'm the lead steward for the Royal College of Nursing and the Joint
trade unions at CQC. And I'm just here to give you some feedback from our members on
TU Representative - 0:45:45
some key issues. I wanted to say, and I'm sure Zi will say the same, that our members
are committed to the improvements and delivery of effective regulation. But they're all so
clear about some ongoing challenges, and we've already heard – Esther's been very transparent
about that in terms of the tools and methodology,
the increased demands, and we see that in Chris' report
with the competing priorities, you know, the assessments
and the priority cases and so forth.
And so that does continue to place some strain
on some of the teams.
I think it's our aim to provide that constructive feedback
and also to continue to highlight those areas
of collaboration where we can strengthen
our wellbeing support for our staff,
and also ensure actually that the frontline voice
of colleagues is reflected in discussions and decisions.
And we welcome the boards and recognise
the board's commitment to improve
that continued partnership and we're
grateful for that.
So I think we have three main areas to talk about today.
The first was the move back to sectors, so huge piece of work.
We recognise the joint trade unions,
recognise and support absolutely that strategic intent
behind the move, as outlined by Penny Dash and our own Mike
last year.
It's gone reasonably well.
There have been some hiccups, but overall,
and I think it's been welcomed by our members,
certainly, I've been told to say thank you to Esther for the shout out on all colleague
calls and the thanks for the wealth of activity that takes place behind the scenes to get
us there.
So people were really keen that we – to say thank you for the recognition, actually,
because some people, you know, they beaver away.
So in terms of some of those pressures, capacity issues, so concerns are being expressed around
capacity issues in teams, that's across regions, primarily we're hearing feedback about adult
social care and secondary care, so that's hospital inspections.
We understand that there are still some vacancies.
We know we've got inspectors on-boarding and we've got some new managers coming in to post.
But there are gaps and that does then place those adverse effects on our colleagues and our members.
And we know that's being addressed.
We're very much looking forward to the workforce plan.
something tangible that we can share
and be transparent about.
I think there's a real sense that the numbers in ops
are not quite right.
I know the budget is tight, Chris, and fees are difficult,
but we can have those conversations elsewhere.
And we would hope that that plan then would have
those realistic projections, accurate data,
and that it considers the training and development,
just like Bola has been talking about,
upskilling our people and preparing them for the good quality work that we want to continue
to do.
And then finally I wanted to touch on the CQC way. So we've got some recent autumn events
that are bringing colleagues from around the regions together. And that's to help us gain
in a deeper understanding of our shared purpose, values and behaviours, but also about how each
role plays a part in the delivery of that CQC way. And not just that, but our whole
strategic direction. And I think the trade unions see that as a litmus test of the success
of the CQC way, actually, is whether or not it's being felt in all parts of our organisation.
and it seems it's not being felt everywhere. So our colleagues - and I know you've spent
time there, Arun - but our colleagues in the National Customer Service Centre, for example,
the feedback from them is that they feel quite excluded at times from some of those CQC events
and matters, the all-staff calls and so forth. They're our first port of call, aren't they?
they're the door to CQC, they do a really difficult job,
but there's a sense that they're being excluded
and maybe their concerns aren't being heard or passed on to senior leaders.
And again, we can talk about that outside of here.
We continue to hear around those cultural issues
and that's been addressed as well, I think, in our risk register
with our leaders continuing to develop that culture.
For example, the freedom to speak up function and the accountability framework for the CQC way,
we're hoping that that's going to give us, you know, that will be another big step forward in terms of the culture.
And Chris, you and I have been working with Jackie Jackson around a restorative just culture approach,
which I know Julian was really keen,
and which is a very successful tool for organisations like ours.
So we're looking forward to getting some work done on that in the new year,
working with Jackie Jackson and her team
to look at some of those people policies with a new lens
in terms of our culture and focus.
Yeah, and just finally, just around the wellbeing initiatives,
It's really important for our colleagues.
The market is saturated with tools out there,
but we're still seeing, actually,
colleague sentiment surveys marking that colleague health
support and well-being as quite low.
And so it's about how we're evaluating and measuring
what are the most effective tools that we have in terms
of helping our members and our colleagues
to maintain their health and well-being
and thrive in our organisation. So those were the three key messages from the joint trade
unions. I'm happy to take any questions when Zi's finished.
Dee, thank you very much indeed for that. Arun, do you want to make any comments?
Sir Mike Richards - 0:52:45
I would like to if that's okay. I know Chris is keen to as well. We might be saying the same thing but Dee, thank you for those
observations.
They're really welcome.
I just wanted to say something on NCSE.
You know that I spent a day with them.
Arun Chopra - 0:52:55
The skill and the compassion that I saw from colleagues
at NCSE taking calls from very difficult circumstances
where people were calling was just very moving.
And they're also the very front line
in hearing about the problems that we
have in the organisation.
So I wanted to recognise that.
I cannot recognise every team just now,
but just in the last couple of weeks,
through those engagement events, one
of the things that we've been saying when we noticed that
people were clustering together in the teams that they know is
to use that as an opportunity to reach out because I know we'll
be a much stronger CQC if we are connected and we understand how
each of us contributes to that absolute purpose of keeping
people safe and helping services to improve.
But the work of the registration team, the legal team, the
enforcement team, the QI team, the complaints team, that's what
I heard lots about.
These are teams that I didn't know that well because I was in
an operational space, but just listening to their work has been really helpful to understand,
and I totally agree with that sentiment, and very much so on the wellbeing point as well.
Thank you.
Chris.
I was going to say ditto to what Arun's just said, but just to elaborate, but I think,
I mean, firstly on NCSE, absolutely agree. I think, I mean, I touched on their performance
Sir Mike Richards - 0:54:07
Chris Usher - 0:54:09
is tremendous this year, and they play a vital role, and it's not, I mean, last year was
tricky for their performance.
It is generally a fantastic achievement.
I think picking up on Arun's point, there was a lot of -
I had a lot of chats with different colleagues
across different events about what about us,
and we don't get to mention registration support,
for example, a team that said similar,
and it is hard to try and make sure we've got -
we factored in everyone in our thinking.
But there's something you said
around that rippling out of the CQC way.
And I think that's noted in that knowledge,
and I mean I touched on that with that risk
and the inconsistency of leadership
across the organisation.
So I guess what it says we're aware of that,
and that'll take time, it'll take time for that culture
to be rippled out across all of the organisation -
three and a half thousand people and various leaders.
But I think we're aligned in our thinking,
which is probably a positive.
of.
Thank you.
Alex?
I just wanted to echo about NCSE.
I had the privilege of shadowing a colleague there, and thank you for the secretariat for
Sir Mike Richards - 0:55:19
arranging that, and really opened my eyes to the scale of the different topics they
dealt with.
Alex Kafetz - 0:55:25
And I won't embarrass the individual, but they were towards the beginning of their career
and the compassion and the way not only they dealt with that, they took me through the
IT and how they have to log things and how we don't lose anything and how they pass it
on to different parts of the team.
And again, in an area of CQC I wasn't familiar with, so I think we're all saying very similar,
but I find it a real privilege to be able to shadow that individual.
Sir Mike Richards - 0:56:07
Esther. Thanks Mike and thanks Dee. And please pass on my thanks back, it's been a pleasure to support colleagues. I just wanted to pick up the point following from Chris' comments around isolated teams
because I was also really struck at the events, the number of colleagues I spoke to who felt
Esther Provins - 0:56:13
isolated and in small teams and felt very disconnected from the wider work of the organisation.
And so one of the themes that came up time and time again was how we communicate with
colleagues.
And I just wanted to acknowledge the challenges of doing that in a remote working organisation.
I'm not saying that's not kind of an excuse, but it is more difficult to do that.
And we've been reflecting as an exec team about how we might do that better.
And I know we've been talking about different ways of doing that.
So I just wanted to reflect that, Dee, because I think it was a theme that came up time and
time again.
and I think we have absolutely heard
and we are thinking through that carefully.
Thanks Esther, I would echo that.
It came up when I was doing my review
this time last year,
the number of different teams that are isolated
Sir Mike Richards - 0:57:04
and I think how we build one CQC
is really a challenge for all of us in this room
and it's something we've got to keep working at
because it came through loud and clear
from the events that we've just been holding.
We can go on to you Zi, do you want to give us your introduction?
Yes, good afternoon colleagues, I'm Zi Shirepinda, I'm a co-chair of the Race Equality Network
together with my other co-chair, Blessing Hale, who is not here today. The Race Equality
Network Rep - 0:57:45
Network welcomes the opportunity to speak to the board today. I first want to acknowledge
the appointment and confirmation of the executive sponsors for our networks, which are the carers,
the gender, disability, LGBT and disability, I think I have mentioned everyone. So I just
wanted to touch briefly on the importance of network executive sponsors, because in life and
their ability to drive impact and inclusion within the organisation.
We haven't heard them for a little while, so now that we are on board, we welcome them
as advocates for both their networks and the broader diversity, equity and inclusion initiatives,
providing strategic direction to our team's network members and securing resources that's
directed to Chris Usher, and acting as a vital link between network members and senior leadership.
We hope that our six points of involvement will be crucial for our networks is to help
us in amplifying the voice of our members, promote the value of the networks, and ensure
that the activities of the networks are aligned to the organisational goals. And in addition
to that, we would want to see the impact of the networks and the support network initiatives
that we have and just encouraging participation from the board members as well.
My second issue is around recruitment. We've had issues around recruitment and did a number
of reviews. Equality networks welcome the increased involvement, conversations with
the people directorate.
We've had the opportunity to meet the director of the people
directorate and their deputies.
So we are working at pace together.
And I think we've seen those positive relationships grow
deeper.
So we are, again, working with them closely
to see how we can implement the recommendations of all
those recruitment reviews that have happened
in the organisation.
I now come back to the work of the Race Equality Network.
And we just thought of I would recognise the success of our network as we have been involved
in across the organisation and highlight areas we look forward to working with other networks
in the board in the coming months.
I will start with the recent milestone.
As we have finished one of our most successful Black History Month events, thank you to those
colleagues who came, those who didn't come this next year, who come back bigger and stronger
with more funding from Chris Usher.
Members and allies showed the commitment to celebrating the professional contributions
of our black colleagues, as well as their culture and heritage.
We are looking to build on this momentum and consider ways we can continue to recognise
the colleagues through our Rebuild programme.
There is also an important element to this in that we are seeking to help the organisation
embed the CQC way in the equality objectives.
Our focus is on how we can support our members, colleagues, the leadership right through to
the board to translate the CQC way into how we behave at work, how we hold each other
into account, but more importantly, to work externally to ensure that providers continue
to provide high quality standards of care, particularly to those marginalised members
of our communities who we represent in the Race Equality Network that they do have access
to equitable care.
We are also grateful as a network, like other sister networks, that we are a strategic partner
to the organisation.
And one brilliant piece of work we have done, I think you agree with me, is
Making CQC an anti -racist organisation.
Our collaboration with teams, the Equity Rights Team,
has been intense, hectic.
We have had input from the Policy and Strategy Team,
the People and Wellbeing Team, and the Academy.
And we were really a key part to the progress of this work.
We did incorporate our insights from our lived experiences
into the well-received anti-racism training module.
By the way, if you haven't done it,
please, it's still available for the board members to do.
So we've used that and we are working,
contributing to the participatory action research group
for a meaningful development opportunities for members.
And the example - and this is a great example
of how we as a network are solutions-focused.
REN looks forward to supporting CQC in meeting the ambitions
outlined in the Government 10-year plan.
We are excited about this plan because it helps us give perspectives
on how we can improve equity of care,
and we are committed to see that the reforms do not widen those inequalities
and also that we can use the expertise of our members in embedding equity through our
lived experiences and to ensure the health system includes everyone whilst it evolves.
It is also important at this point for us to recognise and celebrate the latest addition
to our REN Equality - Race Equality Network family.
Welcome to our executive sponsor, Chris Badger.
We demand and ask a lot from you.
We look forward to working with you
as we help the organisation strengthen its approach
to equity, diversity, and inclusion.
Our members will expect our REN leadership team
and our new exec sponsor to amplify our voices
Yes, we are here today. Thank you for this opportunity. Happy to take any comments and
any questions.
Zi, thank you very much indeed. And thank you for being one of the people who led on the
Sir Mike Richards - 1:04:41
videos that we've been using in our autumn events as well. Please, any comments that
– yes, Kay.
Thank you for that, and the variety of what you're doing.
I'm Kay, I'm a relatively new board member.
Network Rep - 1:04:56
Sir Mike Richards - 1:04:57
It would be really good to understand a
little bit more about the recruitment
Network Rep - 1:05:02
review and what the desired outcomes are
Kay Boycott - 1:05:05
from that and what you think are the
critical success factors.
Thank you for that question, Kay.
I can briefly say there have been issues around colleagues of ethnic minorities not having
Network Rep - 1:05:24
equal opportunity to progress within the organisation and where we have challenges of people being
overlooked for just development opportunities.
So we have had a number of programmes put in place like the inclusive leadership pathway,
successful manager, reverse mentoring to enable our leaders to understand where we are coming
from and the challenges we face.
We have made headway but we are not yet there.
Quite a number of reviews have happened and we are starting to pick one by one what is
recommended.
It is a big task but now that we've got the people directorate on board I think we will
make good progress and we'll see those small changes happening with our colleagues of an
ethnic minority background. Happy to talk outside the room.
I've actually got a question probably for Chris or someone else which is we have an
item this morning about our governance so it would be helpful to know where
that those actions are being tracked and how then assurance comes up to the board
Kay Boycott - 1:06:37
I mean I know we have the sort of annual reports and things but it but those
particular actions I mean having seen that in other organisations it makes
such a such difference and we are we have just slipped into amber about the
percentage of colleagues from ethnic backgrounds so I think it's really
important that maybe we could just think about it outside.
It's not a question Zi, it's a couple of comments and a big thank you. I always
Network Rep - 1:07:08
enjoy hearing your updates so thank you so much. Just a couple of comments
following on from your update. Just absolutely delighted, I know colleagues
Esther Provins - 1:07:16
around the room will be to have our effect sponsorship announced and so I've
got the privilege of sponsoring a disability equality
network, which is appropriate because colleagues will know
that we didn't get our accessibility requirements
in regulatory platform right last time.
So I'm really looking forward to supporting those colleagues.
And it's disability history month at the moment.
So for colleagues listening in the room,
we're doing some work around that.
So please watch this space.
And just a big thank you to colleagues
who joined our brave spaces coming out sessions recently
because they were very profound.
and my thanks to the panel members who shared some really personal stories about their families
coming out and their coming out stories I know a number of colleagues approached me
afterwards and just reflected on how helpful those sessions have been for them, both at
work and their personal lives. I just wanted to acknowledge colleagues' involvement. Thank
you. Thank you, Esther. Bola.
Thank you, Chair. Zi, Thank you so much for giving us that very comprehensive, yet concise
Sir Mike Richards - 1:08:24
update of the work of the Race Equality Network. And to congratulate you and your co-chair
and the Network on an outstanding Black History Month celebration. I think you put together
a truly impressive and impactful programme of activities during October. So I just wanted
to acknowledge that. I'm going to pick up a couple of points that you made. One is the
support of the Race Equality Network in CQC achieving its organisational objectives. And
I really do welcome the work that you're doing in terms of the review of our recruitment
processes. I think it's a very important intervention that makes this meaningful and tangible, not
a tokenistic way of transacting business. The second is the point around the CQC way
and how the network can support us to make the CQC way real. It's a commitment from us
as an executive team and the entire board that we get to a position where the CQC way
is not simply a conceptual framework, but the lived experience of colleagues right across
the CQC. So welcome the network's support in enabling us to do that. And finally, the
work that the Race and Health Observatory are doing, they've been commissioned by the
Department of Health and Social Care to do a whole nation review of the gap in ethnicity,
recruitment, progression and pay gap. It's a very large programme of work. They're right in the middle
of that. And I really do see REN from a CQC point of view potentially making a significant
contribution to that Department of Health initiative, which is being deployed and
delivered by the NHS Race and Health Observatory. But thank you so very much for the work that you
and colleagues are doing in this space. Thank you.
Welcome, Bola. Thank you. And thank you for being one of our guest speakers, it was a delight
having you.
Thanks, Bola. Over to Chris Usher.
Network Rep - 1:10:42
Sir Mike Richards - 1:10:43
Also just the thanks for a brilliant Black History Month and the things I attended were
great. And also to Bola, because you just touched on it there, but Bola opening Black
History Month was one of the best speeches I've ever heard. It was tremendous and I think
Chris Usher - 1:10:56
everyone felt about 10 feet taller following that.
Just picking up on the recruitment aspect,
one thing I should have probably drawn on,
if you remember early in the board,
there was, as part of the ET update,
there was a slide with hexagons,
which Arun called the blockbuster slide,
of the CQC, and now I can't think of anything else
to call it other than the blockbuster slide,
but one of the bits on there is about the employee life cycle
and that is how we recruit colleagues,
We induct colleagues, we train colleagues, we do effective performance conversations
and there has been a recruitment review carried out and I think it would probably be helpful
if we set out what consists under that employee life cycle, what's already happened, what
more are we doing because throughout that is our, what we need to do is make sure that
throughout that employer lifecycle,
it's built around our values and behaviours
with inclusion right throughout.
So how we can amplify inclusion in what we do.
So I think we can probably bring that back
into a future session.
Thanks.
Chris, another Chris, Chris Day.
Sorry, too many Chris'.
A couple things for me, just firstly to say to Zi,
Sir Mike Richards - 1:12:15
I thought the way the Black History Month was delivered
Chris Day - 1:12:22
is entirely setting the precedent for how we should do those things moving forward.
And I know we've had in my own network, the LGBT plus network, we've had a similar share,
but I think it really speaks to what we mean by the CQC way and our commitment to colleagues.
So I just wanted to thank you as well, along with others.
I also wanted to sort of build on a point that I think Bola made.
The work of the colleague advisory group, which includes the networks and union representatives,
will be really important in terms of how we deliver the organisational change that we
are currently going through. Their advice, their support, their thinking about how messages
will land and how to position messages has already been invaluable and will be invaluable
as we go forward. So I just want to thank our colleagues here today but also colleagues
not here who are part of that network as well.
So lots and lots of very positive comments, particularly about Black History Month, but
other things as well.

6.0 Any Other Business

Sir Mike Richards - 1:13:19
I think if there are no other comments on that, we can progress to any other business.
And is there any other business around the table?
David, where's Dale Appleby?
Thank you very much indeed.
I was at the GMC annual conference this morning, but I'm not going to debrief you on that. I wanted to raise
- raise one point. I was inundated
Mr David Croisdale-Appleby - 1:13:47
perhaps an over
simplification but many many questions about whether the
much appreciated move
to sector specific inspections, which you know
everybody
really really approved of but the question
the questions behind it were, David,
are these the same people who were in the general inspection?
And they've been split into, well, in their case, GMC.
It was essentially three, Chris, rather than four, obviously.
Or are there new people in there?
Or are they existing people who are being retrained?
Or what makes them really capable of this focus
in that particular sector?
So I'm just raising that because it
was surprising the degree to which that question kept
coming up.
I can start, and then Arun may want to come in
and Chris. I mean, I think a lot of the people who
were in the general operations directorate
Sir Mike Richards - 1:14:55
had backgrounds in specific sectors from their past lives,
and what we have largely done is say,
go to where you are most at home,
and it's exactly the same as we did in 2013.
But does that leave us with the right numbers
in the right area?
Almost certainly not.
And that is something that we will be looking at
very carefully over coming weeks.
I mean, it's an urgent matter.
Chris Badger.
Sorry, forgive me, Mike.
I just wonder if I've got the opportunity to go back to a number of these people with
more specific responses.
Mr David Croisdale-Appleby - 1:15:38
Sir Mike Richards - 1:15:40
If there are any that you can give me on that, additional training that's taking place, anything
Mr David Croisdale-Appleby - 1:15:46
of this sort, looking at the three, Bola to you and not so much Chris.
I'd be very grateful if somebody could drop me a line because I think when people raise
questions, although I was able to give a certain amount of satisfaction in the answers I gave,
it's always an opportunity to go back to these individuals and give them more specific information.
So if you three chief inspectors have anything you can help me with on that, I'd be very
grateful. I think it would be worthwhile. Thank you, Mike.
that's a request to the three
medically orientated if let's put it that way
Sir Mike Richards - 1:16:29
Chief inspectors, I think well, let's hand over to Chris's
Yeah, so I'm the non medically orientated chief inspector, but but the one with the most inspections
I
Would just say yeah
Your point might that a lot of colleagues have come from those sectors originally when they were already sector specific
Chris Badger - 1:16:46
but I'd also add two points.
One is, a number of colleagues I've spoken to
have valued the opportunity to work in integrated teams
because now they understand health and social care systems
more comprehensively than they did before
and we know that when people receive care and support
that is across sectors, so I think that's helpful.
Of course, as chief inspectors, we will -
and it's early days, but we will be making sure
that those colleagues have the right skills,
training and expertise to deliver their roles both now and in light of future developments
that might be coming, whether it be the 10-year plan, liberty protection safeguards and so
forth.
And changes in the employee life cycle that Chris mentioned, particularly around things
like induction, are really important powerful points to make sure the skills and expertise
of particularly inspectors are secured and that we have a significant quality assurance
process to monitor the effectiveness of those colleagues and put in support where we need
sector. Thanks Chris. Arun.
Thank you. David, thank you for your question. It's probably also worthwhile reflecting on
the fact that in the past our inspectors were sector specific and it was kind of our leaders
Sir Mike Richards - 1:17:56
who were in more generic roles. On Monday we had a meeting of the senior leadership
team where one of our directors actually said that their team are reflecting on how they
Arun Chopra - 1:18:06
feel like they're coming home in terms of being in their sectors.
That was exactly the answer that I gave them, that this was a kind of reversion to the thing
that our inspectors felt was, in a sense, more natural for them.
Yes.
And that also provides us the opportunity for bespoke training to bring our SPARs, our
Mr David Croisdale-Appleby - 1:18:28
national professional advisors in, to ensure that we're getting bespoke training for the
needs of inspectors within their sectors.
Arun Chopra - 1:18:33
So all that work is now taking place.
Thanks.
Sorry, Bola's hands up as well.
Bola, was your hand up, Bola?
Thank you, Chair.
Arun has eloquently captured the contribution I was going to make.
Thank you.
Richard.
Sir Mike Richards - 1:18:59
Thank you Mike. Just an observation on this conversation. I think Chris expressed it well.
There's a bit of a danger if we all kind of went to one side of the boat for the last couple of
Richard Barker - 1:19:13
years and then every charge of the other side of the boat and it still capsizes. How patients,
citizens, public experience care. They experience often all four sectors and I just think we need
to be sector specific in our expertise but widening our view to how people really experience
our services and we talk a lot through the 10-year plan about integrated care, about
neighbourhood care and I know I've talked to all of the execs about once we kind of
get back on the right track how we evolve going forward in terms of our inspection processes.
So I think it's just a good, I think David's introduction to the point is a good reminder
that let's not just all go to one side of the boat, let's kind of keep a balanced view
about how people experience health and care services.
Really important point.
OK, any other business before we come on to the questions
from the public?
Sir Mike Richards - 1:20:04
We have three questions from Robin Pike.
I think they're all from Robin Pike.
And the good news is that these are
going to be answered by others, not myself.
but I shall read out the questions. How does CQC hospital inspections ensure that trusts
comply with legal requirements of the NHS constitution in relation to complaints, particularly
in respect to trusts comprising a number of hospitals on different sites? Toli, I think
this one's come to you.
Yeah, thank you very much, Chair. I'm happy to address that. Just to remind the Board,
really of what the NHS constitution says
in relation to complaints.
So the constitution sets out the rights
of the public in relation to complaints,
Dr Toli Onon - 1:20:54
rights including having your complaint
acknowledged within a timeframe,
three days and properly investigated,
being able to discuss who handles that complaint and when,
and being able to go to the parliamentary
and health service ombudsman if you're not satisfied
with how the NHS has handled your complaint,
the right of judicial review and compensation and so on.
The question is about how CQC hospital inspections
ensure the trust comply with that.
CQC looks at compliance with the regulations,
but the regulation pertaining to complaints,
which is regulation 16 of the 2014 regulations
of the Health and Social Care Act of 2008,
Regulation 16 overlaps significantly with the NHS Constitution requirements of trusts
and Regulation 16 is the basis for our inspection.
So our assessment framework around Regulation 16 means that our inspectors will inspect
in relation to complaints at a service level and for trusts at trust level.
So if the service, for example, is maternity or the emergency department, the key question
is covered under the responsive domain
and there is a quality statement called
Listening to and Involving People.
And that's the key quality statement
in relation to responsiveness around complaints.
But actually complaint handling's not just looked
at responsiveness, it's also looked at under safety.
How does that organisation take the learning
from complaints to make its services safer?
Complaints handling is also looked at
at service level under well-led of that service. Does the service have the appropriate policies,
procedures and oversight in place? And then of course, particularly in this context, and
it's a really good question talking about multiple hospital locations and a big provider
trust, that's where the trust level inspection is key. Does that well-led at trust level,
does that account for how the organisation manages
complaints?
And so within the quality statements we use for well-led,
there are three quality statements, again,
that are really relevant to handling of complaints.
So are the leaders capable, compassionate, and inclusive?
What does the governance, management, and sustainability
look like in terms of the actual governance of the process
and the oversight of it?
and then under learning improvement and innovation,
how does the trust receive that feedback?
And that's both a process question on how you deal with it,
but it's also a cultural question.
Does that organisation regard complaints as a nuisance,
or does that organisation actually regard complaints
as a gift to support improvement?
So that's really how the CQC would regulate.
It is not for the CQC to tell a provider
whether you should have policies for each of your areas
is all overarching, but it is for the CQC to look at the consistency of how that trust
handles it and that would pick up really how the organisation divides it up. So I hope
that will assure our questioner that there is a robust process to assess trust with regard
to how they handle complaints. Thank you, Chair.
Thanks very much, Toli. I think and hope that shows that we take this really very seriously
is part of our inspection process.
So we'll go on to question two,
Sir Mike Richards - 1:24:24
which is why are dental practises inspected so infrequently,
many at intervals of over 10 years?
Bola, are you in a position to answer that?
Thank you, Chair. Yes, I will.
I will respond to that. Thank you.
And really important question.
When we first had the powers to inspect dentists,
we made a commitment to review 10% a year.
At the time, the decision was made due to the assessed risk
in that sector.
And also a recognition that we don't have the powers
to rate dentists in the same way that we would
other sectors.
But we do undertake responsive inspections.
and this means when we receive insights or feedback from other sources that give an indication
of risk or deterioration in the quality of service, we will stand up a responsive inspection.
Also as with all the other sectors, we are currently looking at our assessment framework
And as part of that, it's considering what should the minimum frequency of inspections
be.
And so that's not only in oral health and dentistry necessarily, but across the board
as part of the assessment framework review that is currently underway.
So it's to give an explanation about how we arrived at the current status to give you
sense that even within that we have mechanisms to mitigate risk through responsive inspections
if we receive information that gives us concern about deterioration in the quality of service
that people are receiving and an indication of the way forward as part of our assessment
framework review and refinement in terms of the frequency of inspections. I hope that
gives our questioner the answer to that particular question. Thank you.
Bola, thank you very much indeed for that. I suspect that our third one is coming your way
as well. The third question is during GP practise inspections, how do inspectors assess the ease of
access of patients to GP appointments? Thank you again, Chair. So again, referring to the
assessment framework, which is the methodology
that we employ in conducting these inspections.
The assessment framework contains a section
that we call quality statements.
And these are the statements, or if you like,
the questions that we use to assess quality
in particular domains.
So there is a domain of the assessment framework
called responsive.
and so we use that responsive domain of the quality statements to assess the ease of access
from different communities. The quality statement also enables us to inspect and also seek assurance
that people can access the care, the support and the treatment that they need when they need it.
The other thing to add is that when we're looking at this area, our inspectors consider whether the process promotes equity.
So it's not simply a universalist view, but whether the processes in place promote equity and that access is timely and in line with best practise.
A significant part of that is assessing that people are able to access services when they
need it, particularly in relation to physical or digital barriers, including accessibility
out of hours, if you like, and in an emergency.
So the responsive element of the quality statements from our assessment framework gives us the platform
and the methodology of inspecting this particular area and seeking assurance from the practise
in question that accessibility is of the quality that it can be for patients across the board
but also from an equity perspective as well. Thank you, Chair.
Thank you very much indeed, Bola, for that. I think that's very clear that we do take
sense that we have to be able to take both access and equity in
access very seriously.
Any other final points?
That's the questions from the public that we've dealt with. I
can't see any hands going up around the table.
So at this point I'm going to say thank you all very much
indeed.
and we next meet on the 11th of March.
It's the 11th of March, is it?
Yes.
Right. Good.
And so I declare the meeting closed.
Thank you.