CQC Board Meeting - June 2026 - Wednesday 3 June 2026, 2:30pm - Care Quality Commission

CQC Board Meeting - June 2026
Wednesday, 3rd June 2026 at 2:30pm 

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  1. Kay Boycott
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  1. Chris Badger
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  3. Richard Barker
  4. Professor Bola Owolabi
  5. Dr Toli Onon
  6. David Croisdale-Appleby
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  8. Kay Boycott
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  8. Chris Usher
  9. Esther Provins
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  7. Webcast Finished

Kay Boycott - 0:00:00
I'm the interim chair of the CQC.

1.0 Opening Matters

If you'll forgive me, I think I ought to introduce
why I am sat in the chair today.
As reported at the last public board meetings,
Professor Mike Richards has resigned
as the CQC chair earlier this year.
Because the new chair appointment is taking longer
than was originally envisaged,
for personal reasons, Mike gave notice of his intention
to leave as of the end of May.
I'd just like to say again,
I know we mentioned it last time,
to express our thanks to Mike's contribution to CQC,
both in terms of the Richards review
and also his role as chair.
We have marked this, obviously, with a card
and a small token of our appreciation for that.
The new Secretary of State is still to announce
his preferred candidate as chair,
which will go to a pre-appointment hearing
for approval by the Health and Social Care Select Committee.
So I've been appointed interim CQC chair
while we await this announcement.
Some people may know we are also progressing with recruitment for a permanent chief executive of the CQC.
This is still being progressed but continued delay of the chair is regrettable.
We are continuing to liaise with the Department of Health and Social Care in the hope that this will be resolved as soon as possible.
So I just wanted to explain why I was sat here and now I'd like to dive into,
We've got really loads of important things to get into.
So if I can go straight to it.

1.1 Chair’s opening remarks, welcome and apologies

We have apologies from Michael Mire and Chris Dzikiti.
Welcome to Julia Corrigan-Davis,
who's joining us as a representative
of the Careers Equality Network
and Sooz Ceska, who's our Trade Union representative.
For the public record, I would just like to confirm
that Professor David Croisdale-Appleby
has been reappointed as the chair of Health Watch England and a non-exec director of the CQC from
the 1st of June 2026 to the 31st of July 2027 or until Health Watch England is disestablished.
And Richard Barker has also been appointed as a non-exec director of CQC for three years from

1.2 Declarations of Conflicts of Interest

the 1st of April 2026. No new declarations of interest have been made since ahead of the meeting.
Is there anything from anybody around the table?
No, thank you.

1.3 Any Urgent Business

And is there any urgent business to raise
at the start of the meeting?
Thank you.

1.4 Feedback from the Private Board Meeting

We did have a private board meeting earlier this morning.
These are for confidential matters.
The board considered detailed updates on risk management,
turnaround and rebuilding, business plan and strategy,
revised delivery targets, and also focused on routine
governance, financial and policy matters.
A number of those are also coming to this public board
and will come to future boards as well.
In terms of the minutes for the meeting held on the 11th of March,

2.1 Minutes of the Meeting held on 11 March 2026

are there any comments on those minutes? Are we happy to approve? Thank you

2.2 Matters Arising, Action Log and Decision Log

There where no matters from that for the board to review. So I'd like to hand over to Richard who is going to do the report from

3.1 Report from Regulatory Governance Committee on 23 April 2026

the regulatory governance committee on the 23rd of April. Richard over to you.
Thank you chair. The papers include our what we call AAA report which is advise, alert
and assure and I'm going to take the papers rent and end up going through every single
detail on it. Many of the issues in the paper either are on the board later on today in
specific alternative items or will be coming to future boards. I do want to highlight two
things however. Firstly is in the alert section of the paper. We refer to our
specialist professional advisor task force. Our specialist professional
advisors are a really important group of people supporting us in terms of our
primary care inspections. They are not ubiquitous in terms of availability and
they are a key resource and working to make sure we've got the right number of
people and that their roles meet our most important requirements for those roles has
been a key issue for us and our Inspector of Primary Care and Community Health Services
has been leading the task force on that and we had an update and we will get further updates
in due course but we're hopeful that through that task force we will be able to resolve
that bottleneck and challenge.
The second issue I wanted to refer to was just one of the issues in the Advise section
of the report and it's bullet point three and it's quality assurance and quality control
processes across the inspectorates. As many people will be aware the CQC is increasing the number
of inspections that it undertakes from what was we know a low base a year or so ago. As
we increase the numbers and we are increasing the numbers more later in the performance
section of the report we need to make sure that we achieve the required quality alongside
that increase in numbers. So we had a really good discussion, all of the chief inspectors
assured us about the things they are doing to make sure that quality can be assured and
I wonder whether one of the chief inspectors might want to elaborate a bit on that for
the purpose of the board.
Yeah, thank you, Richard, and I think I'd echo that and I think one of the things that's
been helpful in terms of that ability to have a renewed focus on quality assurance and control
Chris Badger - 0:05:58
probably moving into the sector specific teams in November which has helped us I think really
coalesce our management responsibilities with sector specialism and knowledge and I think you
need that knowledge and expertise to get your really quality QA and quality control processes.
So we've done I know in adult social care and I know other chief inspectors have done similar
have sort of reviewed how that works on an ongoing basis and what we've already seen is the ability
for our leaders, managers and inspectors to be focused on one sector has a - helped
to clarify the specific needs of an inspection report in a given sector but
also made sure that those that undertake those quality assurance processes are
best placed to do that, i .e. have that sector expertise and have got that focus
on the individual aspects of a sector which if we're honest are the key
components of a quality report and I think that's just an example of why that
move in November was really important.
I mean, a lot of benefits are going into
sector-specific teams, but I think that's one
that's particularly stood out for me.
Thanks, Richard.
Melanie Williams - 0:07:09
So Richard, you mentioned the task force
with specialist professional advisors,
and you mentioned those sitting in primary
and community area.
So I told them i'd check two things.
So the first is that it's about the SpA workforce across the piece
and I think the second thing is early on when I started as a non-executive, I had both some
of the SpAs who I know in the mental health area but also the network called me to a meeting
and were talking about long recruitment, they don't feel they use the best and they were
really sort of really keen to sort of get in and support inspections.
So I just wondered whether it's going to be tackling all those areas and whether you've
got some assurance that we're getting some of the root causes of those issues.
Richard Barker - 0:07:55
Thanks. Melanie, you have got the chair of the task force sat next to you, maybe, who
would want to elaborate.
Professor Bola Owolabi - 0:08:00
Thanks, Mel. So, yes, you're absolutely right that the SpAs work across all of our
inspectorates, not only primary care and community services. And like you, when I arrived in
July last year, I would say the biggest thing in my entry was the issues around SpAs. And
And in order to bring coherence and coordination to how we tackle it, I set up a taskforce
supported by our Director of People, Jackie Jackson, and we co-chair that taskforce.
We've been able to surface the common issues that people have raised around generally availability,
being able to schedule when they can do inspection work with us, the recruitment process on boarding
and induction, and the data that underpins all of that as well as workforce planning.
So, the taskforce has been doing quite a bit of work since November when it was set up.
One of the key achievements is around significantly reducing the lead time in terms of recruitment.
From a primary care and community services point of view, we've really streamlined the
onboarding process as well because that was one of the challenges that people had raised
with us.
And so, lots of progress has been made, a lot of work yet to do and I'm really pleased
that now Chief Inspectors do have these forums. For example, I meet with all the SpAs in PCC
every month and I know that other Chief Inspector callings have their own mechanisms for that
really robust engagement with them. So I'm reassured that the taskforce has taken forward
the cross-inspectory challenges and going forward each inspectorate will be able to
take on the particular issues in their Inspectorate as you've just alluded to there.
Thank you.
Toli wanted to come in and then David.
Yeah, thank you, Chair.
And just following on from what Bola said,
it's been so helpful having that task force.
It's really supported us in hospitals
with our recruitment of specialist advisors.
So that's very much led by our national professional
Dr Toli Onon - 0:10:01
advisors, and in fact, just this week,
two of them have dedicated a lot of time to interviewing.
And it's thanks, I think, to raising the profile of that,
but also to our providers.
A lot of providers have come forward, have advertised the roles within the organisations.
Some of the Royal Colleges have helped us out with that.
So I think having that specialist expertise will really raise the quality of our inspections
and it plays to our assessment framework that we're just coming up to the close of consultation
soon where we've said we want more professional judgement from our inspection teams supported
by those specialist advisors.
Thank you for that.
David Croisdale-Appleby - 0:10:40
Richard on your fourth point and advice on new regulatory powers update that you gave
us, just to let you know that given the importance that is being attached to neighbourhood health
care and its delivery and the structures through which it will be done, the NIHR have appointed
me to chair a three-year programme to look at the assessment methodology that we use
for the effectiveness of this relatively new development. So I look forward to liaising
with you in some detail as that develops.
Alex Kafetz - 0:11:23
Yeah, thanks. Just to go back to the SpA discussion, which I really welcome the RGC.
We also kind of discussed how we might widen the skill set of our SpAs.
And I was advocating potentially we might want some SpAs that help us think about digital
solutions in our providers, especially AI.
And I mean, it's good to say I really welcome CQC's statement on AI, which we published
looking at Arun last week or the week before, I can't remember.
So it'd be good just at a later date to think about how we widen that skill set to make
sure we're getting the professional advice that keeps up with how health and
social care providers are delivering services.
Sorry we could end up talking about the whole organisation in this item so
Kay Boycott - 0:12:12
Bola if you want to come back on that and then we'll probably move on if that's alright?
Professor Bola Owolabi - 0:12:20
Thank you chair and Alex thanks for that comment. One of the key things at the
task force is the need for us to diversify the professional background of our SpAs and
make sure that it's reflective of the multidisciplinary nature of how general practice, mental health,
all our health sectors, dare I say adult social care, it is a multidisciplinary approach to
doing the work. And so going forward we will be reflecting that in the diversity of professional
Kay Boycott - 0:12:52
background that our SPARs come from as well. Thank you everyone. Thanks Richard. I'm going
to talk to the next item which is the report from the Audit and Risk Committee meeting
because I am the substantive Audit and Risk Committee chair. Given the interim arrangements,
The deputy audit and risk chair is Mel Williams,
so she's going to be stepping up to do more in that role
during this interim period.
But I didn't think I'd make her do this update.

3.2 Report from the Audit & Risk Assurance Committee Meeting 30th April 2026

So, because I think she might not have been at that meeting.
So there are some items that are on the agenda
that were discussed at this meeting.
The annual report and accounts,
which we've got later on the board assurance framework.
In terms of the alerts, it's documented,
and we've had, we've been putting in a new governance framework, one of the things that
we were very keen is that any unsatisfactory audits are clearly escalated through the governance
routes so that is just being made sure that's absolutely in place. The other thing that
the audit and risk committee has put in place is, and we have presented this time, a framework
explaining how CQC listens, responds and learns across all concern routes and how that is
escalated and actions developed that.
We have been receiving at audit and risk
a report on that since I became chair.
We are still evolving that, but it does look
at those themes and it looks at process metrics as well
because that's such a key part of how we get assurance
but also understand where there are emerging risks as well.
So I just wanted to highlight that.
Happy to take any questions, but I say
the substantive items are actually later in the agenda.
Okay, David.
David Croisdale-Appleby - 0:14:41
In terms of looking at risks,
we obviously look at those things that could go wrong,
possibly not go as planned, could delay,
et cetera, et cetera, but I would make a plea
that we also look at the risk register
kind of from the reverse side for any opportunities
that may occur as a consequence of those risks,
something we might do differently,
something that we might otherwise have missed.
So it's really looking at the glass half full in a way,
rather than just purely looking at the risks.
Thank you, David.
Kay Boycott - 0:15:16
Are there any other questions on this?
Because otherwise that very neatly gets us
into the board assurance framework.
And I could get Chris to respond to that as part of that.
Anything else for me?
No?
Okay.

3.3 Board Assurance Framework

So, Chris, board assurance framework and David's very personal comments.
Kay Boycott - 0:15:32
Chris Usher - 0:15:32
Chris Usher - 0:15:34
Thanks, Kay. So, I mean, firstly, just to start with David's comment, I think that is a really good point.
I mean, we are – well, I'll say a bit about the BAF and then I'll come back to that, I guess.
So, board approved the board assurance framework in March this year. This paper provides an update on progress.
What we're aiming to do is demonstrate a strengthening on our approach to governance and our approach to risk management.
and what we've been trying to do is really stabilise
our view on risk from where we've been.
I think your lens of opportunity is a really good one,
and probably something we need to focus on as we go forward.
Just trying to emphasise, this is the first time
we've had the board assurance framework in a public board,
so showing where we've got to in an open and honest
assessment of where we are.
It presents 12 principle risks, eight of which
which are rated high, that we've been discussing.
Our focus now is on maturing assurance
and working through action plans to bring those risks down.
The BAF is now also, is operational
and relevant principle risks reviewed
through our executive subcommittees
and we also have a risks subcommittee
which reviews everything in the round.
So hopefully we're starting to mature our approach to risk
and that was all I was gonna update.
The paper is to note,
I'm happy to take any comments or questions.
Network Rep - 0:17:03
I just wanted to start off by saying that I really appreciated the transparency around
this and to see some of our risks, I think, connecting the closing loop between risks
being identified and raised and them being, seeing how they're being managed by the board
and at a senior level is really important to our trading members and just general colleagues.
I did have a question around some of the tolerance levels around the internal cultural risk versus
the external reputational risk.
I just wondered what was the rationale, if you're able to say it quickly, for putting
that as a higher tolerance as I think that our internal rebuilding work really underpins
our public confidence and reputation rebuilding as well.
So I just wondered if you could answer that.
Thanks.
Chris Usher - 0:17:50
Sooz, good point.
So we've set an appetite level
that is probably not where we want to be as an organisation.
I think it represents where we are right now
and some of the things that we'll need to tolerate
beyond where we'd probably want to be.
So it's trying to be realistic about where things are.
So there's some things that might be in a moderate space
that you wouldn't ordinarily see there.
Hopefully that helps, Sooz.
Kay Boycott - 0:18:20
Melanie Williams - 0:18:25
So Chris, it's really great to see this and ARAC, for some time now this has been one
of our not surprisingly big pieces of work and it's taken a huge effort to get here.
I think what we can see from it, so it's great and as Sooz says the transparency is brilliant,
but it also highlights that we're managing a lot of risk with quite a short timeline,
So really curious about how we're implementing this and into the executive team.
So that would be helpful to understand that.
Yeah, can touch on that Mel.
Chris Usher - 0:18:54
So we've got a risk subcommittee of our executive team that looks at all of the risks in the
round.
Every subcommittee of the exec team has responsibility for an element of this board assurance framework,
so that's flowing through those structures.
The action plans that sit underneath this are regularly reviewed and have been discussed with our wider leadership team.
I think the thing we need to make sure and strengthen on, and when we come on to talk about turn around later,
is the BAF should really be the centre of everything and flowing through everything.
What we don't want is separate action plans for different things that don't align with the Board Assurance Framework.
So this really gives us a grounding centre for everything we're trying to do.
So what we need to do in that is also just make sure that what we're setting out to do is realistic and achievable and
we're not kind of overburdening ourselves with too many things to try and do in a space of time
That's the work that we're doing now through those subcommittees
Esther Provins - 0:19:54
Thanks chair, thanks Chris just following on from Chris' points Mel
I think for me what this does that gives us an opportunity to reflect
proportionately on the level of risk.
It would be easier for us to, perhaps individually,
reflect on risks in our own area.
But this brings it all together.
And I know as an executive team, we've
really benefited from being able to discuss this at the forums
that Chris has just mentioned, but also have some really good
support and challenge with each other
as to where our priorities lie and whether we've got
our mitigating actions right.
So both through the lens of does this feel right?
Does this feel like it represents
the risk of what we're currently carrying as an organisation,
as well as do our mitigating actions kind of feel right
that obviously sit behind this.
So for me, I'm used to a BAF,
I think many of our provider organisations
would be used to board assurance framework as well.
I think it's a really, really positive step for the CQC
that we've adopted this
as part of our new governance approach.
And I know that we are continuing to strengthen
our approach to this and our use of it.
Just in response to Sooz's question about appetite.
Sooz, it's a really helpful question
because although we've got a single appetite score on here,
it's much more nuanced than that.
And so to give an example, you know,
the data score is a moderate kind of appetite.
However, we wouldn't take that lens through things
like information governance that we have kind of compliance -
statutory compliance kind of regulations around.
So I think there is more nuance to that.
But I think your question helpfully brings it out.
So thanks.
Thank you, everyone.
Kay Boycott - 0:21:25
If I might add just as the ARAC Chair again,
I mean I think what we've really welcomed
is the improved clarity and the huge amount of work
has been done on this and making it reflect
the reality of the organisation.
There is still, for everyone around this table,
a lot of disquiet with how many risks
are outside of tolerance.
So I don't think there's any underestimation
of the work to be done.
But I think, as you said, I think just to summarise
the conversation, transparency's been welcomed,
the tolerance levels are not where we want them to be.
There are lots of risks with some short timelines,
and we will keep working on keep bringing this back,
I think as an action, if we could have an action
that we report back on next time,
which is David's point about the opportunity lens as well,
to make sure that that's worked through,
I think that will be really important.
So thank you, Sooz, yes.
Just a last question.
I've looked at some of the data around this,
Network Rep - 0:22:19
and I think it would be helpful to understand
And if we, as a trade union site, identify some gaps in some of the controls under these,
how would we engage with ensuring they also are captured?
I think there might be some hints at some things.
I wouldn't want to go into detail here.
But seeing some of the – what the current controls look like, as I can immediately see
from the papers, there might be some things we're doing well in some parts of the organisation.
Of that, let's share the good practise to help bring some of this back in line.
Kay Boycott - 0:22:44
Sooz, that would be really good insight.
Chris Usher - 0:22:46
I mean, I'll pick up with you separately how we can do that more formally.
Kay Boycott - 0:22:54
in the meantime let me know. Thank you, thank you for that. That was the
Board of Assurance framework. Now over to Arun for the Chief Exec Report and the report
from the Exec Team. Thanks Kay and I noted you were talking about
Arun Chopra - 0:23:08
your role as the ARAC Chair just a second ago and can I just start by welcoming you
to this new role and just on behalf of all of us saying
thank you for taking on this role and providing leadership
to us as a unitary board.
So I just wanted to say that at the outset.
Colleagues, there's just a few things that I wanted
to update on in this section.
As colleagues across the organisation know
and the leadership group know, we've been talking
about the green shoots of recovery that we've seen
in terms of the CQC's stabilisation
and meeting some of the targets that we set out
January of last year.
So you'll recall there were four immediate priorities.
And it's been really good to see month on month, over
the last few months, progress being made

4.0 Executive Updates

towards those metrics.
I just wanted to say thank you to colleagues around
the table and within the teams for all the work
that's taken place on that, whether that's in
registrations, whether that's in the number of
inspections we're doing.
And we are exceeding the target where we should be
for the moment in time and I'm confident that we will meet the target that we've set out
if not exceed it and on information of concern and the various other aspects that we described
as when we set out as metrics. So thanks for all the work that's gone into that and we've
talked about that in our old colleague calls recently. I do need to kind of also mention
that one of the things that we've been looking at through that process and as we've been
recovering is looking at the significant variation that we do see within teams and between teams
on our progress towards our targets.
And I know that is something that we need to do more about to support colleagues and
support teams so that we are achieving everything that we want for this organisation and for
the important function that we have towards patients and people who use services.
The next thing that I wanted to speak about is that we are now entering a phase of business
planning. So those targets that I've just spoken about, they were up to September of
this year. We're now at the stage where we are thinking about where we go from October
and what we do next. And I think it's important that we've started to have those conversations
about what ambitions, what numbers we're going to set, which represent the ambition that
we have for this organisation. And I know I'm talking about numbers here, but every
time we cross the threshold of a service that we visit it's an opportunity for us
to be able to see what's working well, what isn't working well, for services to
demonstrate the improvement journey that they're on and for us to discharge the
function of ourselves as a regulator of keeping people and patients safe and
promoting improvement within services. So it's really important for us to be
setting ourselves targets that reflect our ambitions. At the same time we've got
to balance that need with the pace that we have for turnaround and turnaround isn't just
in this one area of productivity, turnaround is across the board at CQC. There's so much
work that we need to do, building a better culture, making sure we've got the right regulatory
tools as well as the productivity piece that I've mentioned and about our role in the health
and care landscape. So we've got to balance all that work against the turnaround piece
that we need to do and we've also got to ensure that the quality of the work that we do is
is high, and I know we've already spoken a little bit about that, but that is going to
be central to our recovery.
Chair, that, they were the kind of key points that I was keen to just talk about as an organisation.
I was going to just ask Bola, who is the exec sponsor for our work around the transition
of HSSIB into CQC within the health bill, to say a few words on that, because that's
an important piece of work in our role in the external landscape.
And Chris Badger, if he could say a little bit about a very consequential judgement at
the Supreme Court just yesterday, which I think it would be helpful for us to be thinking
about.
Thank you.
Thank you, Arun.
Professor Bola Owolabi - 0:27:09
So just in terms of the transfer of the Health Safety Investigation Branch to the CQC, just
to confirm that we are committed to supporting the implementation of the government's policy
around that. We have live conversations ongoing between the CQC, the Department of Health
and Social Care, as well as HSSIB itself, and we have established an internal working
group here in the CQC supported by our non-executive directors so we can work through the practicalities,
the governance, the assurance, considerations that we need to be focused on in implementing
in that policy.
So, and as you've said, executive lead for that,
I'm very much looking forward to working through that
over the coming months.
Yeah, thanks, Arun, for mentioning
Chris Badger - 0:28:00
the Supreme Court judgement as colleagues will know
that revolved around the Cheshire West ruling,
particularly around deprivation of liberty, safeguards,
that's of relevance to providers across health
on social care and individuals receiving care and support.
Just to say really at this point,
we're carefully considering the court's judgement,
which was handed down yesterday,
and implications for our regulatory approach
will be obviously liaising with other agencies
within government and government departments about that,
and we'll make sure we communicate our position on that
as soon as we've come to that,
and we'll make sure all our providers understand that,
and we're really clear about that.
Thanks.
Ruth Owen - 0:28:47
Arun, I wonder if you could say a little bit more about why you see the variation across the parts.
Arun Chopra - 0:28:54
Thanks Ruth, a really important question. I think it is part of, you know, we need to build up that understanding of why there's a variation between teams.
I might hand over to Toli to give a little bit of a sense of some of the work we've already done about that and some of the thinking. Thank you.
Dr Toli Onon - 0:29:10
Thank you, Arun, Thanks, Ruth. Yeah, if I can put some detail behind that, if I may.
So Arun talked about our core purpose, you know, for the public, for our sector, for
patients and providers in terms of inspecting in order to be able to support, you know,
improvements in care. So as Arun said, it means getting across the threshold. And, you
know, we're aware ourselves. We've got some teams in our sector who get a vast amount
of work done, really efficient, do great inspection activity that drives improvement. And we've
got some teams that are not able to achieve as much activity and we need to be able to
support those teams because they want to. So how can we learn from the best practise
that we're seeing in our own sector? What are they doing differently? How can they help
us across our sector? That's the beauty of coming together in a sector specific way so
that we can share that learning. So we're taking a sort of quality improvement approach
to that and also thinking about what personalised support we need to put in place so that people
are able to get out. We know from providers that there are many organisations that have
never been rated. There are many with so-called aged ratings where we've not been in for years.
It's a frustration for them and it's not helpful for patients who use the services. So we want
to support them by doing what we do best which is getting out, inspecting and rating with
the view to improvement. Thank you.
Kay Boycott - 0:30:32
Thank you. Are there any other questions about Chief Exec Report or Exec Director Update?

4.1 Chief Executive Report

David?
David Croisdale-Appleby - 0:30:40
Yes, I was just going to ask, if I may address it to Toli, just following on from what you've
said. Are we looking actively for information we could get, key ideas we could get from
other people who are, for example, inspecting hospitals, not only in the four nations here,
but overseas, where there are different processes, etc. Are we collecting some of that information?
Are we a method of incorporating it in the developments that you've talked about? I think
that would be very helpful to know that, because we want to keep more than just up to date
with inspection methodology.
Dr Toli Onon - 0:31:24
Yeah, thank you David. So a lot of work has been done in that regard. I think for example
last year a piece of work was done looking at international regulation and some of that
work informed our approach to our draught assessment frameworks. So I agree with you there's a
lot of good practise out there to learn from. Our own chief exec was a regulator in Scotland
so it's an informal approach he brings us. We haven't asked him formally but again you
within our own nation, we have that opportunity to learn. So yes,
absolutely, thank you.
Kay Boycott - 0:31:58
Network Rep - 0:32:00
Okay, Sooz. I just had a couple of questions around the report from the chair.
I think the overseas working development is very interesting, I know
there's a lot of trade union members who had previously requested this and
thought the organisation had got a hardline stance on that. So I'm keen to see the
of what is being decided here and the planned approach to maybe reach out to those who previously
requested it, whether through line managers, as they are keenly waiting for an update around
this I think is what I'd probably share.
And the second point was just around the support and performance improvement.
Just to cite that we have been looking at four key policies for embedding the CQC way
and one of them is what was capability and has now been renamed in draft form at least.
support and performance improvement to take a different lens about supporting our colleagues
rather than assuming that they are not delivering in their job.
So I would just ask that that is currently going through the policy route for sign-off
so I think it would be good to maybe fast-track or expediate that one to help with that particular
aim.
So thank you.
Arun Chopra - 0:33:11
Thanks, my understanding is that Jackie Jackson, Head of HR is working on the communication
around the overseas workers' policy.
On the second point, very happy to have a kind of conversation about that and how we
factor that in.
I was kind of very much about supporting colleagues.
I know that when I'm out and about, colleagues want to absolutely deliver for patients and
people who use services and we need to be able to support them to be able to do that.
Thank you.
I think that's a good point.
Anything else on that item?
Kay Boycott - 0:33:43
No.

5.0 Organisational Performance

Could we move to organisational performance so that here's some end of year pieces.
I think, Chris, you're leading that.
Chris Usher - 0:34:00
Yeah, I was going to just say a bit about our annual reporting accounts, if I may.
So, we have just laid our 24/25 annual reporting accounts.
That has for the past few years been delayed due to assurance work around the external
audits required to undertake to gain assurance around pension asset valuation.
So we've experienced these delays for a few years.
That's not exclusive to CQC and is outside of our control.
However, in addition, we've also been undertaking work on the valuation of our intangible assets
to reverse a qualification that we had in 23/24. We've done that work and the qualification
has been reversed, so that is good news.
An unsatisfactory internal audit opinion within the report. So for 24 -25 year, which is probably
not unexpected. Reflecting that is 24/25. It's worth saying significant work's been
undertaken to stabilise our organisation, our leadership, our governance, our approach
to risk management as we've discussed before which form the basis of the findings. Obviously
we'll continue to work on that and strengthen that and look forward, hopefully bring forward
the publication of future annual reporting accounts ahead of the timeline we've experienced
now.
Kay Boycott - 0:35:31
We did have an extraordinary board meeting to approve the annual reports and accounts
but it felt important that this came to the public board because it was laid a couple
of weeks ago. But if there's no questions, shall we move on to the end of year 25/26
report? Is that alright with everyone? Thank you. Chris?

5.1 Annual Report and Accounts 2024/25

Yes, thank you.
Chris Usher - 0:35:52
So for 24/25, there is, sorry, 25/26,
there's probably quite a bit to pull out here.
This is the first time we've presented
a combined performance people and finance packs.
We'll run through the key areas,
but there is quite a bit to pull out.
On performance, we've included a two-page summary
just so we've got a graphic of the performance
across the year.
At a glance, we tend to do this at the end of the year
just to help illustrate performance.
In terms of assessments, we've achieved the target
or on track with the target of the 9,000 in the year.
We delivered 6,382 assessments,
which is still not the levels
we wanna be at for the future,
and we've well documented that,
but considering the prior year was 3,800,
it is a marked improvement on that.
Registration, we track the volume
of registration applications over 10 weeks old.
Overall volume has been reducing, but the old over 20-week old has really come
down, ending the year at 987.
That's a 75% reduction from the 12 months point prior to that.
And we've also processed 33,000 applications that are in completed stage.
So focus moving forward is making sure we've cleared those over 10-week old registration
applications but also get back into a business as usual measure of performance.
Information of concern and other areas to just pull out. This is just as a reminder
as feedback received directly from staff information about people's experience or information from
partner organisations. We get about 200,000 of these a year. We did a lot of work early
in 2025 to clear backlog of cases and what we've been trying to do since that point is
get back to a more business as usual measuring of performance. We've not quite hit the 95%
target but you can see quarter four performance has shown sustained improvement. Priority
one referrals hit the target in March, priority one taking action was just below and priority
two and priority three are now sustaining delivery above target. So that has stabilised
and that performance is continuing which is good to see.
And amongst the other areas that I haven't pulled out,
we've done really strong performance on our call lines
and NCSC throughout the year,
which performance has been really strong.
And we've also delivered our assessments
around our local authority assurance programme in year,
although delivery of publications does continue on,
but the assessments were delivered.
On our finances, we ended the year
with a 5.6 million surplus.
The main component part of this
was a three and a half million underspend relating to depreciation, given lower capital
spend and related to our impairment work. There was also lower than anticipated spend
in our digital and data space. That's not a recurring position. We're carrying financial
challenges into 26/27. We've applied some saving targets into the organisation and we
expect that financial period, financial position to be challenging. On capital, we finished
the year with the 3.9 million underspend, which we were expecting.
And then finally I'll just talk on our people side.
So workforce vacancy rates are 10.5%, which is higher than target, but is slightly intentional
given need to just manage our workforce composition and the controls that we've put in place around
workforce.
Recruitment and representation, we're seeing good transition rate for disabled and LGB
plus colleagues through application to offer stage.
This is supported by an increase in overall
and senior leadership representation
with a marked increase in disabled colleagues
in senior leadership roles.
With ethnic minority colleagues, however,
we're seeing no issue in attraction,
but an issue in conversion through to offer stage,
and a really positive increase in workforce representation,
but a drop in senior leadership,
which makes the KPI target some distance
at this present moment.
A lot of work has been undertaken. Attraction isn't our issue. What we're looking at is
more targeted campaigns. And then finally on required learning, on
mandatory learning, we've moved to a phased quarterly delivery of a mandatory training.
We've hit above 90% completion the first half of the year. The second half was
around 80% above the most training programmes. So it's good progress, shows the
phased approach is benefiting, but still work to do given this is mandatory training and
should be aiming for a higher towards 100% completion. There was a lot to get through
so apologies for the length of that but I'll pause there and happily take any comments
or questions.
Kay Boycott - 0:40:39
Thank you and it's a very comprehensive report. Any questions or comments? David.
David Croisdale-Appleby - 0:40:51
Thanks Chris for going through that in some detail. I just wanted to pick up one point
on your required learning, which was the figure
for cyber security, the 81.3%
Cyber security is so crucial to us that it should be something
that is as close to 100% as we can possibly get
because anything short of that is a potential major threat
to the organisation.
And I just wondered whether you had any specific initiatives
on that to drive that figure up.
Esther Provins - 0:41:30
Thanks David and I would 100% support your view of the importance of training
in cybersecurity. So a couple of things to note we have our new digital and data
executive committee which is responsible for our cyber risk that we talked about
in our board assurance framework item and it's our responsibility as a
committee to make sure that our colleagues are appropriately completing
training. The board is new, the committee is new and we are in the middle of
working through how we may do this better because I absolutely recognise
we are not where we should be. Secondly we are doing work as part of our
rebuild programme on our training to support our colleagues to understand
this area better. So we are monitoring it through that committee but I understand
and completely agree we need to do more and that is the job of that committee to assure.
Esther thank you for that.
David Croisdale-Appleby - 0:42:19
Just a follow-up, if I may.
It's a question about in the work that you're doing, have you had real cut through with
our staff colleagues on the importance of cybersecurity?
Is it something that they instinctively now feel is really vital to the well-being of
the organisation?
or are we as many organisations in the past have been sort of, we are cyber security where,
yeah, I know it's important, but it's not going to hit me very hard. Can you just give
us a sense of that?
Esther Provins - 0:42:57
So my sense of that, David, I think most people will be aware of the risk. I think where we
need to do more work is what that means to individual colleagues on the ground. I think
it's the operationalisation.
Can't say that today.
It's that piece of the application of that,
of understanding the risk into what that means
for our colleagues on a day-to-day basis.
It's the same with some of our other areas
like records management and data quality.
Actually actions of each and every one of us
in our day-to-day working life have an impact on those risks.
So there's more work to do to apply that knowledge
And I think in the cyber improvement plan that we have, alive and well, we have plans
in place to support colleagues to better understand this, but that will be part of our improvement
programme over the next year.
Thank you, Chris.
Alex Kafetz - 0:43:55
Lots of numbers and, as Arun said, I think lots of green sheets in there.
I just wanted to dwell on the registration figures and actually just celebrate where
we got to on that and I'm not just saying that because I've been sat between the two
execs that have been looking after registration, but when it was announced I was joining CQC,
I was contacted by a number of organisations even before I'd started, especially I think
in, you know, at the health tech world to say they were stuck in the registration queue
and what are we going to, what are we going to do about it and it was clearly a big issue
for people and a number of which in the independent sector couldn't start generating income that
that they predicted until they got through that.
So I think lots of successes in your data,
but I think that's one where, obviously,
it was one of our core five, where I think we really have
made some significant improvements.
I know there's probably some more to do on that,
but I thought it was worth just noting
that I think that's something where probably I wouldn't
be contacted in the same way this year.
Kay Boycott - 0:44:58
Could I build on that, actually?
So you've just touched on the 24/25 and the report which showed no picture of where anybody
wanted to be. Huge amount of work done in the last year and I think you can really see
some of those greens, very, very hard ones. So I'd like to say as well as Alex's thing
about registration, there's a huge amount of work gone into turning some of these greens.
And I was just wondering, I don't know if this is you Arun or anyone in the team really,
which with what's left, what are the stubborn reds?
And what have you learned from the things
you've almost turned green that you could apply to those
or where things haven't turned green as fast as you thought?
Just so we're sort of aware of where the challenges lie
over the current year.
Is that you, Arun?
Chris?
Chris Badger - 0:45:56
I think my learning from where things have turned green
is that the wisdom on particularly very much frontline operational metrics, which are probably
the ones that are most important to us anyway, the wisdoms from the people that are undertaking
those processes of inspections every day and actually the better we can be at listening
and acting on what our colleagues tell us, the better we'll be in terms of turning the
corner on some of the performance. I think applying some of that learning to the ones
that are read, you know, or not where we want to be, I think it's going to be a helpful
lesson to take across.
Professor Bola Owolabi - 0:46:34
Thank you, Chair. It's really just to echo that point that Chris has just made, that
for example, in terms of coming up with creative and innovative solutions, we've had some really
good insights and intelligence from some of our senior specialists, for example our inspector
colleagues, an example of that sort of creative approach is the return to good and outstanding
project, and that was very much a frontline driven example of how we drive improvements,
so couldn't emphasise that importance more. Thank you.
Kay Boycott - 0:47:12
I'm going to remind everyone of my question, which is where do you want to apply that to
stubborn reds. So I would like to know those as well. Esther, but I might come back to
Esther Provins - 0:47:22
Arun on that. Thanks Kate. I won't repeat Bola and Chris' points, but I think, you know,
particularly in registration, our colleagues have done so much kind of QI quality improvement work
on improving current processes. I think the stubborn reds are around where our, where we
still have manual processes in place and I think that relates to a conversation around performance,
how we are going to improve our processes.
I know I'm being quite generalistic there, Kay.
But I think there are many processes across the organisation
that we know could still be significantly improved.
And actually that relies on the colleagues
who are actually undertaking those processes
to help us and help us redesign them.
And I think that's where we're going into in our next phase.
Kay Boycott - 0:48:08
Any other...
Do you want to Arun, just come back on that,
but or is it a different point?
Okay, yeah.
Thanks, Kate, helpful question.
Arun Chopra - 0:48:18
I mean, there's a few different buckets here.
So there's some areas where I think stubborn reds reflect
our resources and our recruitment.
So for example, in one of the mental health domains,
we've got second opinion appointed doctors,
vital safeguard for people who are getting treatment
under detention, and we've been red for a while.
And we do need to think about new ways of working there.
And we've taken steps towards that
within the mental health inspector.
Chris Dzikiti not here today,
and we mentioned his apologies earlier,
but he'd speak to that.
Second area is where we've got some stubborn reds,
is where we've had huge progress,
but we've set really good targets,
which is 95% of information of concerns
should be turned around within that timeframe,
because we want those concerns
to be dealt with really swiftly.
Actually, we've kind of moved to 94.6% in some areas,
or 93%, so we have made a huge amount of progress,
but there's just that little bit further,
but it is that second bucket of setting really high targets.
The third bit is around that point that I made earlier,
or the third bucket is around that significant variation.
So if you look at some teams,
they are showing red in some sectors,
but when you go at the level beneath that,
you can find that even within those sectors
where there's a stubborn red,
there are teams that have somehow managed,
despite these challenges, to turn green
and to actually achieve their team target,
do the work for patients, for providers,
that everyone wants to do.
And I think we need to learn from those areas
that have actually demonstrated,
that they've managed to get around this
through different ways of working.
And I think we need to take the learning from those teams
and spread that across the organisation.
Thank you.
Thanks, Arun.
Sooz.
Kay Boycott - 0:49:58
So my normal general comments.
Network Rep - 0:50:00
I think I wanted to shout out to just the heroic efforts
of all of our colleagues, union members and non-union members
to get us through a lot of these greens and the people who
are sitting in areas that are still red,
I know that they are working very hard to try and get us
there in those close margins, feeling like there's green
in sight, let's say, Arun.
I had a couple of questions, though,
around the mandatory training as it
does seem like the completion rates trailed off
by the end of the year.
So I wondered if there was a different approach being taken
this year, as I think the staggered approach has worked.
But I think there are still some, I would say,
less than satisfactory figures around things like fraud
prevention, safeguarding.
I think 80-odd percent is quite a chunk of our organisation that doesn't have that, and
our fraud prevention team is very small.
So I feel like we should be focusing on the prevention rather than the catching it and
investigating potentially afterwards.
And my second question, just to throw it in there, is around the recruitment data.
I think it's great to see some improvements.
We are hearing – the trade unions are hearing from members that recruitment is taking a
long time to take impact in operations, and whilst people leave, that can leave a gap.
So I just wondered whether you had considered reporting on recruitment timelines to try
and get a better sense of whether some of the efficiencies around the SpA recruitment
could be reflected in our general operations front line where we really need those staff
the most.
So thank you.
Kay Boycott - 0:51:17
Who - does anyone want, Chris do you want to respond to that?
Yeah, great question Sooz.
Chris Usher - 0:51:23
On the first one I think the phased approach feels better, feels like it's working but
I think the reason the first half is better than the second half of the year is because
they've stayed open.
So you've got another half to complete the one and two.
So there's a bit of a misleading position I guess in a way because we've just cut off
the year for the second half, so there was 80%.
I think we need to get into a place where building on that approach we really get colleagues
into a place where the work's completed on the quarter.
So I think it is just that more promotion and more making sure it's recognised as important
as it is.
On the recruitment timescales, can I take that one away?
I think that's a good suggestion,
but let me just take that away and see how feasible that is,
but appreciate the question.
On the mandatory training, is there any evaluation
of its effectiveness?
TU Representative - 0:52:11
Because we often get that it feels like a bit
of a tick box exercise, do it now kind of thing.
I'll leave Chris to comment more widely, but certainly with the ones that are in my area.
Esther Provins - 0:52:41
So certainly for the ones in my area, we absolutely review their effectiveness along with our
colleagues in the academy.
I think as I said earlier, there's work to do in some of the digital cyberspace ones,
but we do have a mechanism in place now to review their effectiveness, I'm not sure,
of history.
Thanks.
Professor Bola Owolabi - 0:53:03
It's a really important question, and it comes up not only here but in several organisations.
I think my reflection would be that our patients, the public and service users, do look to these
numbers to get a degree of assurance that actually we're focusing on the right things.
So whether that is in terms of our anti -racism training, which you'll see it's one of our
highest uptake areas, that matters a lot to our stakeholders in terms of how much do we
care about these things. And you're right to ask the question about the effectiveness,
But actually the level of engagement with the training itself speaks volumes to people
who use our services.
And I think we shouldn't underestimate how much it means to people that we are doing
the safeguarding training, we are doing the EDI training, you know, we are doing the cyber
security training and so on because they look to us as the independent regulator to keep
them safe.
and this is just one way we demonstrate
that we're doing those things well.
Thank you, Chair.
In fact, Julia, the issue you raise,
Dr Toli Onon - 0:54:17
NHS England are doing an awful lot of the work,
a lot of work right now,
looking at their provision of statutory management training
and moving towards an outcomes
and effectiveness -based approach
rather than purely compliance with undertaking the activity.
and that's an approach that we've supported,
both Julian and Aaron, you know, confirmed support for that.
So although we have no firm plan to do the same ourselves,
I think we support the principle of it, don't we?
So yeah, good point you raised, thank you.
Kay Boycott - 0:54:54
Any other, yeah, any other comments or questions?
No?
So thank you for that.
I mean, really, I think Susan said it,
and it's come up at various times,
there's been a huge amount of work that's gone on.
Really great to hear how much everybody
is leaning on colleagues' expertise
and really pushing through that sort of
continuous improvement.
Still ways to go, but fantastic green shoots.
It does feel, the train's just come up a few times.
It might be helpful to consider whether
something a little bit of a review on that could go I don't know that's the
people and culture committee or somewhere but I think it would be
helpful to report that through to board so we we sort of know what the direction
is on that but thank you very much if there's nothing else on that item we

6.1 Our Networks Update

have our networks update I think we're going to start with Sue's and that's
All right.
That's absolutely fine.
Network Rep - 0:56:01
I don't think we discussed who was going first on this one.
No, it's all right.
Do you have any people to go first?
No, no, fine.
What's in them?
So as usual, you have the three key updates for the board,
or key headlines from members from your joint trade union
side.
So the first one was, I've already
mentioned the positive work we're doing around the policies
and embedding the CQC way, and trying
to unpick some of the inequalities that
have been highlighted in previous reports.
but the trade unions jointly have ongoing concerns about some of the equality data we're
seeing around some of our formal processes and whether we're meeting our public sector
duties. We've been working with the deputy directors in the People's Directorate to look
at this and unpick it a little bit further, but I think there's a lot of work to do in
this area to ensure that we're creating a fair and equitable working environment for
our colleagues. Some of this is reflected in the equality impact assessments work, which
is under review. Barry Hutchinson from the Royal College of Nursing delivered some really
fantastic equality impact assessment training to try and bring in breast practise. I know
there's a QI project going on to look at what our base level is for impact assessments or
EIA's. And it's great to hear some of the fantastic work that Bala has been doing around
health inequalities and seeing that start to be reflected inwardly. That was that. The
second point is around, and I feel this is a delicate one to raise in this room if I'm
honest, the engagement from the board. So we'd like to invite board colleagues to consider
how you engage with CQC colleagues and how that can be strengthened. I think there's
a disconnect between the engagement at senior level when concerns are raised and followed
up. I think that's reflected in our staff survey and how we close that loop. And I think
there's some really valuable discussions here, but these interactions are limited.
And under our previous board and executive leaders, concerns are raised about overreliance
on management updates and a bit of a lack of curiosity around what that felt like for
the general employee, the people doing the work.
So we, it was identified as a contributing factor
to the issues experienced during the transformation programme.
And so it's a little bit disappointing to feel
for members to report that they're still feeling
that the speaking up doesn't always get responded to
while they don't feel that their words reach
the highest level where there is that influence.
So meaningful engagement is not just about hearing concerns
but it's about visible follow up and accountability.
So this is especially important when we're trying to recover
and to get all of those metrics into green and in the gap of our freedom to speak up
recommendations being fully embedded. So the trade unions would like to invite the board
to reflect on how well you engage directly with colleagues and staff representatives,
how the employee voice is balanced alongside other management assurances, how concerns
at board level are followed up, tracked and communicated, which I know is part of the
freedom to speak up recommendations, but haven't had that discussed at September, we've been
delayed in implementing some of that.
And what further actions are needed to demonstrate learning
from past failures and commitment to the freedom
to speak up recommendations.
And then I think the third one, I
realise this is a lot to go in one go.
The third one is around workloads.
And a staff survey echoes this as well,
but our members still report that there are areas
where a lot of people feel they have an unmanageable workload.
Operation staff are really keen to see what our workforce
model, resource model, whatever we're calling it,
looks like and just how that can be looked at a macro and a micro level.
As I think looking at the best practise in teams, how we share how people are
doing things efficiently and how we balance out the different pressures in
different teams. The unions recently ran a survey with our members that picked
up this thread exactly so we'll be sharing that with senior leaders to sort of
Kay Boycott - 0:59:38
strengthen that conversation going forward. Thank you. Thank you. Can I
I would suggest, who wants to take the equalities point?
Bola, if you take that, I'm just gonna say,
on the concerns piece, I'll answer that.
I might ask Ruth to come in as our freedom
to speak up, and Gordon as well.
And who wants to take workload?
Chris, right, we have, thank you, Suze.
Thank you so much, Bola.
Thank you so much, Suze,
Professor Bola Owolabi - 1:00:03
and thank you for the very kind comments
about the work on the health and equalities.
I just want to say here that Laura Saunders, who is one of our deputy directors, has been
doing a phenomenal job, as you can see, working across the CQC but actually beyond to provide
a clear articulation of the role of the CQC as a regulator in using its powers and processes
to essentially be the powerful voice on behalf of the powerless, if you like.
So really good to hear that.
I think the broader point in terms of equality
is around colleagues' experiences.
As you know, the executive team recently
supported the anti -racism piece of research,
which was a whole organisation action research process.
And what we've said is that the learning
and the recommendations that have come through that
are hardwired into our core work,
because what would be a missed opportunity would be for us to see that as a separate
and standalone action plan when actually we have the opportunity to thread all of that
into some of the data that is coming through this report. And I think that's the way we
make meaningful progress in what really matters to people. So I just wanted to flag that that's
a really important piece of work and we need to hardwire it into how we do business as
usual. Thank you.
And Susie, should we just go around and then if you want to come back at the end then or
do you want to come back on each individual?
Oh, that's fine, I'm happy to.
Okay, thank you. Just on how colleagues feel and I think it's, you know, we need to say
how people feel is really, really important and if there's that perception then we need
to tackle that. So I was just thinking about, I know I and other board members were lurking,
I did, I looked on a couple of all colleague calls
and leadership team calls last week,
Kay Boycott - 1:02:03
because I am curious and I know other colleagues
and non -exec directors around the table
are really curious about what colleagues are saying.
And in some ways don't want to be,
we want to be lurking and listening,
but that doesn't mean that that's visible
and it doesn't mean people feel that.
So that's a really important point.
And let us take that away and reflect on,
on how we can make that more visible to people.
In terms of the general concerns I outlined
in the ARAQ chair piece about that. That's something I feel very, very passionately about
and Chris Usher will say I've been a bit of a dog with a bone about it, about making
sure we close that loop and that is why it is a standing item on ARAQ. The reporting,
it's taking time, this stuff takes a while to go through but it's absolutely on there
in terms of formal governance and we'll take your comments away again. It's making
sure that people feel it as well as it's there and also maybe there are gaps. So that's
just from that point of view, and maybe it's worth the conversation outside to sort of
hear other ideas, but Ruth, do you want to, Ruth is our Freedom to Speak Up board, I don't
Ruth Owen - 1:03:12
know your official title, but I know you are very committed and take a lot of time on it,
so. I do indeed, I am the Freedom to Speak Up and I've taken it very seriously and as
Aaron and the team know, I give everybody a good proportion of my time, my feedback
to the team the themes without breaking any confidentiality because I think it's important
that people can trust me. I like to see action from that. I think it's important. I think
the work, any work we do around culture, hopefully that will start to even bring out, you know,
even more of a transparent culture that's what we want to get to. So I enjoy it very
much. Some of the conversations have been difficult. I won't, won't dress that up.
they've not been easy, but hopefully they feel that they've been listened to and I certainly
know from the exec, they take action on those themes appropriately.
Kay Boycott - 1:04:05
Yes, and those themes and actions we're now trying to get the tracking through ARAQ in
a more systematic way, but it's taking time. So, and again, I'd like to thank Ruth, she
Chris Usher - 1:04:25
Yeah, thanks, Suze. I mean we can look to share relevant insights with colleagues
with the first thing I would say. We have had some support just to look at
current delivery and some of the headwinds as we call them, some of the
challenges that colleagues face in which probably tallies with the things that
colleagues are saying in terms of just the things that get in the
way, whether it's spark cancelations or whether it's the level of new
colleagues and the time it takes to onboard and various other things.
So we're just reviewing that modelling to understand capacity and prioritise realistic workloads
ahead of what we do next in terms of our business plan, our turnaround.
So that's probably where we'll get into more of this, what do we do with all this, but
we can share insights with you.
Thanks, Sue.
Esther Provins - 1:05:18
Just following on from Chris, I think there is also something really important about working
smarter, not harder. And I say that in recognition and the knowledge that many
of our tools that we use, you know our regulatory platform and other systems
and processes are manual and need improvement and I think that colleagues
will start to feel an improvement in this as we roll out additional
capability and also expand our use of artificial intelligence to help us
automate and do things smarter. So I wouldn't want to, it would be remiss to
not to say that I absolutely recognise the feeling from staff that they are under pressure.
I think there are tools and plans in place that will support that as well.
Kay Boycott - 1:06:02
Thank you. Julia. And then Alex.
TU Representative - 1:06:07
Flexibility, I mean it's a pressure but it's one that we need to harness more and we see
this in sort of teams where there's very flexible working processes which all arrangements which
is a great, you know, supports lots of colleagues in being able to do what they do, but we also
need to reflect and recognise the pressures on the managers of those teams. We do have
very inconsistent practises. We've never really got to the bottom of why that happens, but
you know, if I imagine the manager that's got eight full -time people and another manager
that's got 12 people with a whole mixture of working patterns, there's a big pressure
there for the manager to give a lot more people time, and this could also go back to the common
about performance of teams and the variation.
So I don't know if there's any analysis against
how teams are comprised in terms of how they deliver.
That's a really good point.
Chris, is that?
I mean, just very, but that was exactly
one of the headwinds that came out.
Chris Usher - 1:07:02
The variation and the issue around spans of control
was one of the problems and the challenges.
So I just agree, Julia.
And just then how we support those managers with that,
TU Representative - 1:07:14
because it's not just the people that need the support, the managers need it too,
and how we get those massive variations, particularly in the carers network,
where somebody's got a certain arrangement, but that doesn't apply for anybody else,
and all the conflict that then creates.
Julie, we're starting to stray into your area, but Alex had one more point.
Does anyone else have any more points?
No, no, no, don't apologise, but Alex.
Kay Boycott - 1:07:43
Alex Kafetz - 1:07:46
Thank you Sue for that report and just on the point about how the board can engage more
with colleagues and just to echo Kay, I think it's something we should, I think we should
tell you what we have been doing because I'm not sure that's visible but I think certainly
we should talk about it and be able to respond to that. Like Kay, I do tend to lurk on those
Wednesday leadership calls and I'm very grateful I'm invited to those and I attended part of
the All Staff Corps and I've been quite privileged to meet quite a number of staff in DOTA and
digital but I suppose just to say I'm very happy to do that it's you know
cognizant of our role and how we do that but I'm happy to put in the time to do
that I think it's really very important no need to apologise for
raising that at all but I agree with Kay perhaps with Kay and Aaron we we could
come up with a plan for that and in one of our offline meetings and come back
but I think perhaps we're not always visible but often we're there. And if I
Kay Boycott - 1:08:41
important connecting me with why we're here is I went along with colleagues on an inspection
and they were absolutely fantastic but to be able to see that first hand is absolutely
extraordinary, not visible and that's the point we've got to make sure that colleagues
feel that I mean and I took a huge amount away from that so all of these things are
really important but as Alex said well let's take it away.
Suze do you want to finish up and then I'm going to hand to Julia.
If you don't mind it was just a little thing I've realised that I felt uncomfortable because
Network Rep - 1:09:06
I feel like the feeling heard by your board and the more senior levels of your organisation
is that closing the loop theme that's come out
in many different areas.
But I did want to acknowledge that some of the governance
and improved risk reporting and the transparency,
I can see again the green shoots of that work.
And I'm hoping that that will lead to people feeling
that there's that more two -way dialogue up and down
the organisation.
And the only other thing that I forgot to mention around
workload was an emerging issue that operations colleagues
feel that there is a overreliance on reporting
on a lead inspector on assessments
and that we're not maybe at this level looking at the really valuable support that our colleagues
do for secondary inspectors on assessments and just to make sure that we are really capturing
all of the contributions because a lot of the areas where they're green, there's a lot
of people who have helped the one person that we're tracking to get us across the line for
that specific provider, that report, whatever it is. So I just want to really voice that
very live issue that came up on our members call this week. Thank you.
Kay Boycott - 1:10:07
Thank you and a really rich discussion so don't apologise and the work
you do and also to distil everything down to three is no mean feat so thank
you for that. Julia welcome. Oh sorry, Tolly, I said is there anyone else? Tolly
you're killing my chairing here, go on.
Yeah, yeah, yeah, oh right you're moving on. Brilliant. Please. Yeah, yeah, thank you
Thank you very much.
Dr Toli Onon - 1:10:35
So, just to say, it's my privilege to be the exec sponsor
for the Careers Equality Network.
So, obviously, in my biassed way, delighted that Julia
is here today to talk about our network.
And just wanted to frame it very much because next week
is UK Careers Week, 8th to the 14th of June.
And Careers Week is an annual campaign to raise awareness
of and celebrate the caring that goes on.
So it's to highlight the challenges
that unpaid carers face and recognise the contribution that they make to families and
communities and to our culture in this country. We want to be a country where caring is valued
and I think we recognise how hard unpaid caring is but also how rewarding and joyful it can
be for people to feel they've cared for their loved ones and the network plays such an important
role in helping us as the employer be better at doing that. So over to you Julie if I may,
Thank you. Thank you, Tolly. Just a quick overview of the carers network and we
TU Representative - 1:11:36
have about 300 plus members. Our membership is quite fluid because caring
can stop, start, finish, change shape completely so people do join the group
probably when they more have acute needs and hopefully most of them will stay.
And members often belong to more than one diversity group. We found that where
they're caring for relatives that have a particular condition that carer, that
sort of multi -complex challenges.
The network's inclusive, participative,
and one of the great strengths of it
is people sharing their experience
of navigating care systems,
particularly around support for children
with educational needs and things.
I've not been in that place,
but I've certainly learned a lot from that.
Progressed, I would say, in the last couple of years
with a lot more recognition of carers at CQC,
and also more openness to the flexibilities
of how people might work with their care in roles
and responsibilities. The appointment of Tolly is the senior sponsor. It's great, we need
to do more work on that. We'll come back to senior sponsorship. And as I said, strong
peer support. We engage not only as chairs but also with our members in any policy revisions
and updates. In terms of improvements, I think I've probably covered the thing about line
managers with the very varied sort of teams and the teams need. I'm just whipping down
there. One thing I would like to see is an area to improve is supporting after a care
enrolment ends. Often, I'm not saying it's any different to any other kind of bereavement,
but often the role ends with a bereavement and the impact can have sort of many different
aspects, sort of practical guilt. I've even had people feel that they've lost their purpose,
a financial impact where whatever was coming into the house was probably supporting, you
know the very poorly person and somebody actually had to move home on top of
everything else and sort of some support systems for people transitioning from
being the carer to not being a carer as such and one example of that was
somebody it took four and a half months to remove medical equipment from their
house so they lived with seeing that every day and went through a whole mix
of emotions that actually caused that person you know sort of other issues and
then building on from that obviously with Sue's comments about the senior
engagement. Over the last two days, and I only just came back to work last week after
an illness myself, network colleagues have almost overwhelmed with the issues that they
wanted to raise, and it just felt like a five -minute slot at a board two or three months apart.
Isn't really sufficient to do that. I don't feel that's fair to our workforce and our
needs as diversity groups. And sometimes it can feel like we're sort of like kicking the
and refining its shape, but what we need to do is rip the lid off and get down into the content and really work through some of the key specifics that will support our people better and how we work with those.
Working with the board and exec sponsors more to ensure our approach both as a regulator and employer leaves no one behind, and I think that's quite crucial and critical.
And from that, I believe there's a strong case for a structured engagement workshop
type session with co -chairs and exec sponsors where we look at some of the issues across
the groups and look at some of the issues specific to the groups and have a very clear
joined up approach and a plan how we will use our time, our expertise and that to really
drive these five or six networks forward.
Thank you very much.
I've just seen Esther wants to come in.
Yeah, Julia, thank you for that reflection.
Esther Provins - 1:15:22
And I guess what I'm just following on
from the question around board engagement.
What I'm reflecting on is that we all are exec sponsors
for a network and yet I'm interested
because actually our updates around those staff networks
and our exec role haven't come through
in our papers at board.
And I think there is something about that.
I think there is absolutely each of us are very dedicated
to supporting the networks because they are so important and our members within them are
so important. But I'm reflecting on my own part in what you've just said, so thank you.
I think my thanks to you and to all of the other chairs and colleagues who work hard
in the networks often go over and above and beyond the work or the hours you are given
to dedicate to doing this, so thank you so much. And also I want to say to my colleagues,
It is Pride Month. My LGBTQIA staff network colleagues will not forgive me if I don't mention that.
So please do take a moment to recognise how far that community has come in the last few years
and the discrimination that community still faces.
But obviously, all our colleagues and staff networks are very valued and we want to support you.
TU Representative - 1:16:28
Just to add to that, we're still awaiting the diversity data from the last staff survey.
and particularly, previous surveys that some of the outcomes have actually shown, you know,
the sort of impact on people with diverse conditions and particularly, I'd say disability
where people have fed back through the surveys that they felt discrimination.
Thank you, Julia. And we've actually got that coming up in a future item, next but
one item so Chris you might want to just touch on that then. Thank you very much I think
you've given us things to think about. You make a really good point Esther, you wear
Kay Boycott - 1:17:16
multiple hats, are all of those hats coming through on our reporting? I think what you're
giving us is a bit of a wake up call about how explicit, as you said there's some green
issues, there's a lot going on, how explicit and visible is it, but also that closing the
loop. So, you know, we will go away and really think about that going forward. So, thank
you so much and everyone else. Sue, sorry.
Network Rep - 1:17:39
That's all right. I just thought I would echo that I think a suggestion of a different forum
to hear the employee voice in a more informal capacity, as much as we're very appreciative
to be here. We are aware that there's a public forum and I know that I am very diplomatic
with the way I say things because I care about the reputation of our organisation and I would
never want to, yeah, I would want, there's definitely topics to discuss, but just having
a less rigid or formal conversation would be beneficial to maybe move some things forward
a bit quicker. I think we often get a little bit tied up in bureaucracy. So yeah, just
Kay Boycott - 1:18:16
to echo Julia's point. Thank you, thanks very much. There's nothing else, but we started
with our employee voice and we're now going to move on to provider and stakeholder insight.

6.2 Provider and Stakeholder Insight

Arun Chopra - 1:18:28
Thanks Kay. So just a few updates from me on what we're hearing from our stakeholders.
I'm very grateful to engagement colleagues for compiling all this information. There's
just a few key points that I want to make sure that we are thinking about and is informing
the decision making that takes place in the organisation. Our stakeholders are really
supportive of the direction that we've set out for the CQC and the recovery plans that
are in train. What they're saying very clearly, though, is that in order to maintain that
confidence and that window that we have, we have to keep on delivering and showing delivery
across the key areas. They've been really encouraged to see the progress that we've
made on the assessment frameworks and the draught assessment frameworks being published,
the road shows that have taken place, real strong support for that activity and grateful
for operational and policy colleagues and engagement colleagues for all the work that's
gone on in that area.
What we're hearing very clearly now though is a need for us to build on that, to increase
the volume and the quality of the inspections.
Very much kind of what we're thinking is very much what is being reflected back to us.
They're also asking us to prioritise the right services
to look at, and they're saying it's really important
that as well as the volume, you're thinking about
which services you look at.
I know we've recently published our priorities
for each sector.
They're kind of really thinking about
where do people experience the most risk?
Where do patients experience the most risk?
What services have we not been to in a long time?
So those sort of conversations are coming through
very strongly, and that's very much in keeping
with the sort of 10 -year plan vision for the regulator
and where we ought to be getting to. I wanted to just finally make a comment on the external
strategic advisory group. Some brilliant conversations have been taking place there. That's a forum
that brings together many of our key stakeholders. We talked a little bit about the work that
we're doing around turnaround in the organisation and we talked not just about performance but
also about the culture and there's a real strong support for that. The culture of the
to think about that, as well as the regulatory tools
in people's pockets, and as well as making sure
that the CQC is playing its role on the external landscape.
What they're saying very clearly is that they would like
to see an emphasis on quality and clarity of the reports
that we provide, both for public, patients,
people who use services, that's really important.
And they're saying that it's important for us
to balance the pace of the turnaround with the need
for the quality and consistency of our reports.
And again, they ended on talking about the assessment frameworks.
They have landed well and thanks to all the colleagues who have been involved in that
work.
There was a clear ask around the assessment frameworks about how we are making sure that
we are prioritising an emphasis on outcomes.
What outcomes do people who use services experience and patients experience and how do we ensure
that our assessment frameworks are looking at outcomes?
I was going to bring Chris Badger in to speak to a little bit of the detail on outcomes
before I open that up for any questions. Thank you.
Chris Badger - 1:21:40
Yeah, thanks Alan. I know a lot of us have been out and about as part of the assessment
framework consultation. I know I've personally been in discussions with actually thousands
of different providers on it. One of the themes that I think we and providers and people that
use services have come together on is the idea of trying to make our assessment framework
more consolidated, simpler, clearer, and I think doing that around the idea that
people's experience of care is what we're really here to be about and focus
on, so how effective care and support is but also how they experience it given
what a big part of people's lives actually is. And I think making sure we
deliver a set of assessment frameworks that are in a sense rationalised to
allow us and our teams doing assessments and inspections to have a real focus on
that and building enough time for them to really hear and listen to people that
receive care and support and those that that care for them is really important
and that goes all the way through from all sectors to work we do with local
authorities to care homes to home care agencies to big hospitals those
principles remain the same and I think it's important that we've seen the
strong consensus behind doing that and that as we finish the consultation on
the assessment framework and listen to what we've heard we reflect on that and
make sure that's really visible in our final set of frameworks when we agree with them.
So I think I'd really echo that sentiment and I've been struck by the strength of the
opinion that we've come across across the country on that.
Richard Barker - 1:23:15
Thanks, Chad. Just to say that I joined Aaron in the last Strategic Advisory Group meeting
with all the external stakeholders. It was my first meeting as a UNED. The guild decision
I was just repeating everything Aaron said,
because all those things are true.
But I just felt personally that,
firstly, how supportive our stakeholders are
of us as an organisation and what it is we do,
and how important that is.
And in that sense, as Aaron said,
very supportive of us in getting this right.
But I also, equally, I'm just repeating what Aaron said,
really, sense that, but if we don't get it right,
they'll be telling us.
So I think there is that window,
as Aaron actually clearly said.
I think it's interesting, slightly different views
from whether you come from a provider perspective
or from a patient user or service user perspective.
Some of the providers were saying they really welcome
the new methodology and new assessment frameworks,
but they want to get it done now.
Can we just finish it so they know what good looks like
and they can get on with supporting their organisations
to provide the highest quality possible.
Some providers were talking about,
Aaron mentioned inconsistency with science proportionality.
of how many inspectors were turning up,
whether it be the size of their organisation.
And maybe there's something we can look at there,
given we've got a challenge of capacity anyway,
we should make sure that we're spreading our resources
equally across our registrants, if I can call them that.
And just finding from maybe from the more patient
and user groups, raising inequalities is an important issue
when we know there are inequalities in outcomes
based on various demographic criteria.
and are we doing enough to build that into our inspections,
as was on Chris' point about outcomes.
So there were just kind of three other things
that I picked up from that discussion,
but I thought it was a really, really, really good meeting.
Thank you, Chair.
David Croisdale-Appleby - 1:25:08
I want to start by thank you for this six -page report, Aaron.
I thought it was very good, very concise, you know,
to the point, and that's not always easy to do.
I have the advantage of getting out to around our network a lot because of my health watch
role. So I meet a lot of ICBs, local authorities, provider collaborations, et cetera. And so
I get direct feedback from them. And I just wanted perhaps to add three particular points
to those bullet points that you've put in here that I've observed. Perhaps three and
half points because you've mentioned variation.
But in fact, I think variation goes across just
about everything that we're doing at the moment.
The form of it, the content of it,
the length of the report, et cetera.
Now, I'm not asking in a sense for all the reports
to be formulaic because that would be completely pointless.
But I think there's some tightening up that needs
to be done there, a sense of what is working well
and what is perhaps not working less well.
My second point is that what I have noticed and what people have said to me
for a long time is that there is a lack of triangulation of evidence
in the inspection teams.
In other words, there will be a comment on there that is picked up,
but when it's been questioned, it's not clear who that's come from.
It's not clear whether that's been triangulated.
You know, it might be a staff member who's made a comment.
Was that checked out in any way with a patient, with a carer,
et cetera, et cetera.
Now, you know, I know I sound like I'm speaking from my role
in NICE, but you know, this triangulation of evidence
goes right to the heart of our authenticity.
And I think there's work to be done there.
My third point is really that we have
153 local health watchers who are really engaged at neighbourhood level.
And yet I think it's fair to say that they are not frequently really consulted about
what they know about what is going on in that care home, that hospital, that GP practise,
that community health provider, et cetera, to the degree that they have.
It comes back to me in the sense of when they see a report, they say, well, why didn't the CQC team ask us about that?
Because we've just done a report on that and there's no mention of it.
So there's something to be done there.
And I suppose I would sum it up by just reminding us that although we are definitely not an improvement agency,
part of our mission is to be an agent for improvement.
And I just think there's more work to be done, Aaron,
on meeting that latter point.
Just before you come in,
Kay Boycott - 1:28:15
can I just build on David's last point,
which was, I mean, it was around Health Watch
and getting that insight and how that's there,
but the one thing that struck me about the report,
we talk a lot about pace and transparency
and feedback loops, but there was a lot in there about integration of intelligence, and
I think that speaks to David's point about that wider intelligence. So it would be really
helpful to know where we are on that and whether that is as visible as some of the other elements.
Esther and then Bala. Thanks, Kate. Thanks, David. And your phrase
Esther Provins - 1:28:50
at the end about us being nature for improvement was going to be my starting point because
I2K picked out the points in here around integrated intelligence.
I think it's very clear from what we know that our stakeholders and partners have an
expectation on us to do that and I think it's clear that we are also not there yet.
We have had a conversation at board a few months ago about how we might want to step
into this space.
Okay, I think part of this is about our turnaround and building our fundamentals to enable us
to do this.
I think there is a future board conversation about how we do this well alongside our partners.
Early conversations are in progress with our partner organisations,
but I do think we need to have that conversation as a board
because I 100 % agree that we have more work to do and this is where we need to get to.
Professor Bola Owolabi - 1:29:44
Thank you, Chair. I just wanted to speak to the observations that Aaron has picked up there.
they very much echo what I've heard and just to say we are responding.
So for example, one of our directors in the Primary Care and Community Services Inspectorate
is tasked with leading our work to streamline our systems and processes and ensure that
they are fit for purpose to drive up the volume, the quality and the consistency of our reports.
I'm hearing from a sector specific point of view around the clarity of what good looks
like, clarity of the evidence that we're looking for, that our processes are streamlined and
consistent, timeliness of our inspections and re -inspections.
And a really big plea to remember that the assessment frameworks are tools and how important
entities that we train and support our inspector colleagues, particularly as we rely more on
professional judgement so that that is both objective and consistent. So just to say that
we are on with that work and triangulate in terms of what we're hearing.
Thank you for that really useful conversation. I think maybe as an action we should just
on the board forward plan about the integrated intelligence, including how Health Watch and
other sources, broader sources of insight are being used. I think that would be great.
But really, thank you for bringing that item because I don't think we've again, we've
Kay Boycott - 1:31:22
had that as routine. I think it's really important.
We are a little bit behind time. We're going to go into the people and culture update.
I'll hand to Chris in a minute, but just as a framing,

7.0 People and Culture

this did have a long conversation at a board seminar.

7.1 People and Culture Update

The results and some of the results have been socialised
with, sorry, the results, not some of the results,
but this has been socialised with colleagues
across the organisation, but it's really, really important
that we also have this at our public board meeting.
So I just want to say this is not the first time,
but this, you know, it's a really important item.
So over to Chris.
Thanks, Chair.
Chris Usher - 1:32:07
Yeah, just, I mean, just a few bits to pull out, if I can.
So generally, we're showing, we can see signs of recovery from a low point in 2024.
However, it's clear there is a lot more to do.
I can, obviously, I've looked through all of the survey, all of the comments and all
of the detail, there is disparity across the organisation. There are some areas that are
showing really strong. I've seen teams with really strong scores, really strong. I've
also seen the opposite of that and it's way beyond what we'd want those areas of business
to be and to score. So it's worth putting that out there. There is some real contrast
in positions across the organisation. Looking at the analysis and just drawing this out
in the way it's been framed.
So in terms of our purpose, 73 % of colleagues
feel that their work improves care.
So there's a strengthening between colleagues' role
and our purpose.
And on our clarity, this has improved locally
and within teams.
However, organisational clarity is not yet strong or consistent.
I think the work we've been doing
around the four strategic pillars and our turnaround
will hopefully help support this in the direction of travel
we're in.
but obviously this is just early days around that.
In terms of leadership and teamwork,
line management and teamwork is really strong.
It usually is within CQC,
but we shouldn't underestimate that.
Views on executive alignment with values has improved,
but we have much more to do.
And there's a key bit in this space,
which is around the leadership strategy
that we wanna bring in
and strengthen our leadership approach.
Improvement and voice colleagues are willing to contribute,
but there is a low confidence that action will be taken,
which plays to some of the conversation we're having earlier. There's a strong sentiment
of avoiding follow -through or even closure, and that comes out in the comments as well.
So that's not always about agreeing, but that is about closing the loop and the rationale
for not agreeing or for not taking something forward. I think that lack of closure sometimes
erodes trust, so it has to be an area of focus. On consistency, around 55 % of colleagues have
clear objectives in a recent performance review. The timing of the survey may have impacted
this just in the period it was run. We've done a lot of work around objectives and hopefully
we should have a clearer view on that. But they are, as you'd obviously expect me to
say, but vital because it helps assess how we manage performance, how we can develop
and what's expected of us. And finally, in terms of inclusion, respect and inclusion
is improving, 75 % positive, but the concerns remain about fairness and equity. So it shows
a culture may be improving but structural issues remain. They were all the bits I was
to pull out a chair and happy to take anything on the survey.
Melanie Williams - 1:34:58
So I'm mindful that we have an item at ARAQ coming up to have a look at assurance on the
CQC way. Is there anything, Chris, that we might miss? Because you've talked about all
of the conversations we've had and we've looked at this extensively as a board of different
forums. So with the ARAQ look at the assurance of the CQC way, are there any sort of actions
to hear that we might have missed many of those work streams that we would need to pay
Chris Usher - 1:35:25
attention to. I'd hope not Mel. I think there should be
a line, the work we're doing, the work we present through and then the follow on conversation
we have in board in July. It should align with what we're seeing here. Some of these
areas will be harder and knotty to address but the work we're doing with that CQC way
Esther Provins - 1:35:45
should address them. I just wanted to make a kind of, to align
this conversation with the question you asked us earlier,
Kay, around where we see green shoots
and how might we apply them to red shoots.
And we talked about red shoots.
That's not the right word, but you know what I mean.
We talked about the need to engage colleagues
in helping solve the problems or overcome
the challenges effectively.
And I think this is a really important lens
to look at our people survey results
in because we all know that culture is not just one thing.
There are numerous microcosms of culture across the organisation.
In teams, we see that from the results of our kind of incidents
and kind of concerns that are raised.
We see that from feedback from our colleagues and staff networks.
So there is an inconsistency in how it feels to work for the CQC,
depending which team you're in.
And so for me, this is really important because we had a leadership group
for them, we had a discussion about how we might better involve our teams in what the
solutions to some of our challenges from a culture perspective would be and Bola really
helpfully talked about that from an appreciative inquiry lens. So I just wanted to make that
link because I think, you know, us having an idea around culture is one thing but to
your point, Suze, unless we really know how things are on the ground, it's very difficult
and we need to seek that input from colleagues.
David Croisdale-Appleby - 1:37:11
On your point five, I just wanted to comment. If people aren't properly and fully involved
in the discussion about their objectives and agreeing their objectives, if that isn't the
case – and, Chris, you pointed out what the figures are, 55 percent at the moment
– then two things. In a way, the less important of which is that we can't really hold them
accountable because we haven't got clear objectives to hold them accountable against. But that
isn't the main point. The main point is that how can we know how we can help them? Because
if we don't know what their objectives are because they haven't been set or the recipient
is not clear about what those objectives are, it's very difficult for executives to find
a way of intervening in a situation to help those people achieve those objectives.
Arun Chopra - 1:38:21
We're going to do anything about it. We're going to be tracking how colleagues within
the organisation have objectives and make sure that people do have that. Without that,
I totally agree with your point, David.
If people haven't had clarity around objectives,
then it's very difficult to kind of see
where how we support them best.
Just a little note of caution
Network Rep - 1:38:43
around the great tracking objectives
and that engagement at local level,
which is really vital to people doing their best at work,
is happening, but a word of caution
to not just trust the stats around that,
as if we're just looking at a system.
I did have, unfortunately, some reports from members
back in the last year that they hadn't had one -to -ones, their teams were really busy with all the recovery work and at the end of
the year the manager completed a review of the year and just sent it through as if they'd had a
conversation and I think that was quite damaging to the individual to feel that a box was ticked,
their manager looked like they completed it, but some caution and I don't know how we get under that.
But yeah, just that, it's that closing the loop of does it, what we're intending and what we're tracking,
Does it is it actually landing at that real local level and the broader comments was just that I wanted to
Acknowledge the honesty and transparency around the results
I think it's a difficult one this year because I can see some real improvements from where we were
Last year, which was quite a sorry place to be as an organisation and for people working for CQC
So I really do want to celebrate some of the winds, but there is still some real concern in results
But the way that this has been presented at board papers, I think is markedly different from previous years. There hasn't been a
glossy sort of veneer put over it.
And I think really being honest at where our problem areas are
will be really appreciated by CQC colleagues.
Thank you.
Kay Boycott - 1:40:04
Bola, I'm going to bring you in.
The only thing I'm going to, no, that's all right.
The only thing is just we're a little bit ahead of time.
We've got two more really, I mean,
that's a really important item.
But we have got Aaron's going to briefly talk about turnaround.
He's also going to talk about some bits
on the external landscape.
and we have had three questions for the public and one deferred from last time,

8.1 Turnaround Update

which I would just like to get to if we can.
So, but if there is anything I'm just going to just bring us back to it's called Fast Four.
Is there anything else on that item?
No. Thank you, Chris.
Very live conversation.
We've got one in 10 days about assurance around the CQC way.
This will keep going. And thank you, Susan.
I think hopefully you'll see the transparency is something we really, really want to have here.
Aaron, I've shut everybody up.
time for you. And I will be succinct on this one and actually it's interesting
Arun Chopra - 1:40:53
we've set it as a separate agenda item to make sure that we give it the
prominence that it deserves but it's been threaded through pretty much every
conversation today has been around turnaround. I just want to kind of just
overarchingly we did the work around stabilisation those four immediate
priorities and five foundational improvements recognised the work that's
gone in to getting to those metrics as we set out before. We're now in the place
where we need to look at broader turnaround, where do we want to get to and deliver and
enact on that. As I've said before, it's four quadrants. It's about the people, the culture
within the organisation, recognising that needs to change, as well as our productivity,
quality, the value for money that we demonstrate. That's important in our performance. Making
sure that colleagues who are doing the inspections and doing that activity are so well supported
with the right tools to do the work. There's a lot of work that we need to do on that to
get those things done in the right time.
And then we've got to kind of look at our role
in the landscape, how do stakeholders perceive us,
which is some of the work that Richard and I
were both commenting on what the external
strategic advisory group were telling us.
So we've got to make changes and demonstrate,
and that was the other thing that came through.
There's a window of opportunity.
We have to really seize on that and deliver
for patients, for people who use services,
and for providers so that we can support them
on their improvement journey.
I will stop there and turn around.
Esther Provins - 1:42:19
Thanks Kay, just one specific element of turnaround I just wanted to call out because it is live
and kicking. We talked earlier about our new assessment frameworks, we are currently seeking
views on the detailed content of those and tomorrow we'll be publishing our approach
to piloting and evaluating our new assessment frameworks that will go live tomorrow, so
colleagues and providers and others watching this please do look out for that. Obviously
that the rollout of our new assessment frameworks or how we adopt them
internally very much relies on our digital systems and we are having now
live conversations as to when we will be able to start rolling out our new
assessment module and at what point we will have fully adopted our new
assessment frameworks across all of our sectors. Obviously that will be the
subject of future board meetings and will require us to carefully communicate
and engage with our provider colleagues but I just wanted to talk about that as
Kay Boycott - 1:43:18
work live in progress. If I can press you on that do you think we'll have a very
Esther Provins - 1:43:27
comprehensive update at the next public board? I can provide an update, yes.
Arun Chopra - 1:43:35
We're taking this work forward through that sort of business planning
prioritisation the metrics so that there will be an update and we will have kind
of clear metrics that we can then set out to the board and we'll be you know
really looking forward to getting to this session of business planning
because we'll be discussing this with colleagues around the metrics that we're
setting and what turnaround actually tangibly looks like for across the
organisation thanks and just to finish I'd just like to say I think board
Kay Boycott - 1:44:01
members we're all aware there's a huge amount of effort going into this there's
a lot of very live conversations to try and get some of that clarity that people seek
and the board are investing more time to ensure that those conversations happen at pace so
that we can get there. And I'd like to thank everybody for that extra effort and investment
that's been put in. External landscape.

9.0 Forward Plan

9.1 External Landscapes

Arun Chopra - 1:44:26
Thank you. This is a really exciting paper. I mean, we've been talking a lot about the
work that we're doing internally so that we're delivering on some of the key functions that
we do as a regulator. But it's quite right that the health and care landscape expects
us to be a regulator that makes a difference across a number of areas. This paper sets
out various areas that we're working on with partners that we've been asked to take a role
on. I mean, there's various different things within the health bill that we've been – Bala's
already spoken about one of those. It sets out some of the asks from the external landscape
that we're responding to all at the same time whilst we're working on this turnaround.
I've already mentioned some of the things from the health bill.
I would also mention events regulation, which is a kind of key area for us and the registration
of those organisations and the timeframe for that.
And we've also, and Tolle spoken to this earlier, about how we provided evidence to the AMOS
review and we're really kind of keen to make sure that we're making a difference in that
space as well. But yeah, neighbourhoods, so many areas, it's a really kind of exciting
paper to see the kind of all the areas that we're intervening on. Thank you.
Kay Boycott - 1:45:41
Any questions from anyone on that? I'm sure we're going to see more of that in future
board meetings, lots, lots there. No. Okay. Any other business from any board members?

10.0 Any Other Business

Okay, as I say, we had a question last time and we didn't – the responsible chief inspector
wasn't available to respond, so we've deferred that from the last meeting.
But if I could read the questions out, and thank you for people to put in questions to
us.
It's part of us listening to the public and we are really curious about this, so thank
you to those who submitted questions.
How will the CQC ensure there is public and carer involvement during local authority assessments?
And I think Chris, you're going to take this.
Chris Badger - 1:46:32
Thanks Kay, yes, we've been doing local authority assessments just for the quality benefit of adult social care functions over the last two years.
A couple of things we've been doing already that I'll just outline.
Firstly, obviously we engaged directly with community groups, voluntary sector organisations within the local authority area,
both during, before and after those assessments.
We do track individuals' journeys through an adult social care system where we think
it's really important to understand how they interact with the local authority, with professionals
and how that works.
I think the thing that struck me most, that's been most impressive and I've had personal
experience of this, is that we do use experts by experience to engage with unpaid carers
in particular.
So I've done work with the unpaid carers that we commission who I think get a much better
sense of unpaid carers experience through their work and empathy that they
can sort of show with unpaid carers in terms of understanding the experience
the unpaid carers in the given area have with their local authority. We also
review and assess how well each council engages with their communities and you
know for example how co -productive is their work and I think that's really
really important. As we move on to our next stage local authority assessments
so going beyond the base lining period this is an area where we're looking to
do more on. We've got work where we're going to be doing ongoing engagement
with community groups, not just when there's an inspection.
We've introduced sampling of people's experiences
through reviewing records alongside local authority staff.
So not case tracking, but actually going into systems,
bringing people up, understanding their experiences,
more work on unpaid carers,
which I think is really, really important.
And I think it's also important to say,
working with care providers in a given area
about experiences they may have with the local authorities,
speaking to people in receipt of care and support services
that they care for too.
So looking to build on what we've already done
but we think it's a really important part of both the methodology and the assessment
framework that we have with our local authority work. Thank you.
Kay Boycott - 1:48:25
Thank you, Chris. The second question is how can CQC improve its response times to expression
of concern that have been received from members of the public? So we touched on a little bit
of this in the performance report, but I think, Tolly, you're going to answer those.
Dr Toli Onon - 1:48:43
Yes, thank you, Chair. And as you say, we did touch on that and we do have specific
targets around responding to those areas of concern, which are very serious in relation
to safeguarding potential criminality and so on.
But in terms of the broader receipt of expressions of concern, so these are still a really important
source of intelligence for us because they help us identify risk and protect people who
use services.
But what we cannot do, what we're not empowered to do at CQC is investigate or respond to
individual concerns.
We just don't have those legal powers.
So what we do with that information,
aside from the safeguarding and potential criminal issues
I've mentioned, what we do with that is it informs us
in our ongoing monitoring of services.
It may even trigger direct contact with a provider
or more rapid inspection or urgent review.
We have the power to share that information
with other regulators such as professional regulators
or other service regulators.
and we can also signpost the individual who sends us that concern to other organisations
that can better help them individually. Because there's such a range of things we can do,
we don't therefore have a particular standard in terms of time for when we deal with that.
But if a concern is raised about our conduct at CQC, then we do have a standard to resolve
that within 30 working days. So it's obviously really important that the public have the
opportunity to raise that and that they know what we're
doing now. So we welcome such questions. We want to continue
to improve how we communicate and also be clear about the
limits of our role but support complainants to sign post in
the right way. Thank you.
Kay Boycott - 1:50:27
Thanks, Tolly. And now we've got a couple of questions which I
think Bala is going to answer. First one is what targets to CQC
have for the frequency of inspection of GP practises and
dental surgeries?
Professor Bola Owolabi - 1:50:41
Thank you, Chair. So in terms of the frequency of inspections for all the sectors that we
regulate, the frequency of our inspections depend on the information we receive, the
evidence that we collect. Inspections may be planned. In some instances they could be
responsive. So for example, building on Tolly's point where we received concerning information,
and then we can carry out a responsive inspection in those circumstances.
There's more information on our website about the frequency of assessments and inspections
and that's published on our public facing website.
We're currently operating a national risk -based approach to inspections and last week we published
our priorities for delivering more assessments and tackling aged ratings.
I do sign post people to have a look at that.
it sets out overall and also by sector
how we prioritise our inspection schedule.
And I think that's the most live document
that we have in that regard,
and it was only published just in the last week or so.
Thank you.
When inspectors visit GP practises,
how do they assess the availability
of GP appointments for patients?
So our current assessment framework,
One of the five key questions is around how responsive services are.
And that does particularly ask whether people can easily access care, support, treatment,
particularly in ways that meet their individual needs.
And so we look at their circumstances, including needs like protected characteristics.
We have a quality statement that specifically asks about equity of access within our current
framework.
So that's one way that we look at that.
So our expectation of providers is to ensure that everyone can get the care they need when
they need it.
But to also say especially that we regulate against our standards.
So, you know, we do not regulate against NHS performance metrics.
So when people look at what we do, you know, you won't hear us talk about how many patients
should be registered with a particular GP, how many appointments should be offered, and
so on.
What we do is look at those regulatory standards and our providers delivering against that.
And I'll signpost again to another article which is on our website about access to GP
services. It's a myth buster and it just gives further clarification around how we approach
those issues.
Kay Boycott - 1:53:32
Thank you very much everyone for answering those questions. I'd just like to thank everybody
for, we've covered a huge amount of ground in this board meeting. Thank you for the honesty,
transparency and the challenge from everybody. Our next public board meeting is on the 16th
September but I'll say good afternoon for now.