Interactive webcast player

CQC Board Meeting - September 2026
Thursday, 17th September 2026 at 2:00pm

 
Share this agenda point
  1. Kay Boycott
Share this agenda point
Share this agenda point
Share this agenda point
Share this agenda point
Share this agenda point
Share this agenda point
Share this agenda point
  1. Arun Chopra
  2. Dr Toli Onon
  3. Kay Boycott
  4. CQC Networks Rep.
  5. Kay Boycott
  6. Arun Chopra
  7. Kay Boycott
  8. Alex Kafetz
  9. Dr Toli Onon
Share this agenda point
  1. Kay Boycott
  2. Melanie Williams
  3. Kay Boycott
  4. Alex Kafetz
  5. Arun Chopra
  6. Kay Boycott
Share this agenda point
  1. Chris Usher
  2. Kay Boycott
  3. David Croisdale-Appleby
  4. Kay Boycott
  5. Kay Boycott
  6. CQC Trade Unions Rep.
  7. CQC Trade Unions Rep.
  8. Chris Usher
  9. CQC Trade Unions Rep.
  10. Chris Usher
  11. CQC Trade Unions Rep.
  12. Chris Usher
  13. CQC Trade Unions Rep.
  14. Ruth Owen
  15. Kay Boycott
  16. Alex Kafetz
  17. Kay Boycott
  18. Chris Badger
  19. Kay Boycott
Share this agenda point
Share this agenda point
  1. David Croisdale-Appleby
  2. Kay Boycott
  3. David Croisdale-Appleby
  4. Kay Boycott
  5. David Croisdale-Appleby
  6. James Bullion
  7. David Croisdale-Appleby
  8. Kay Boycott
  9. David Croisdale-Appleby
  10. Kay Boycott
Share this agenda point
  1. CQC Trade Unions Rep.
  2. Kay Boycott
  3. CQC Trade Unions Rep.
  4. Kay Boycott
  5. CQC Networks Rep.
  6. Kay Boycott
  7. Arun Chopra
  8. Kay Boycott
Share this agenda point
Share this agenda point
  1. Chris Usher
  2. Kay Boycott
Share this agenda point
  1. Chris Usher
  2. Kay Boycott
  3. David Croisdale-Appleby
  4. Chris Usher
  5. Kay Boycott
  6. Ruth Owen
  7. Dr Toli Onon
  8. Kay Boycott
  9. Alex Kafetz
  10. Kay Boycott
  11. Arun Chopra
  12. Kay Boycott
  13. Chris Usher
  14. Kay Boycott
  15. Arun Chopra
  16. Kay Boycott
Share this agenda point
  1. Chris Badger
  2. Kay Boycott
  3. Melanie Williams
  4. Chris Badger
  5. Kay Boycott
  6. Chris Badger
  7. CQC Networks Rep.
  8. Chris Badger
  9. CQC Networks Rep.
  10. Dr Toli Onon
  11. Kay Boycott
  12. Chris Badger
  13. Kay Boycott
  14. Chris Badger
  15. David Croisdale-Appleby
  16. Chris Badger
  17. Chris Usher
  18. Chris Badger
  19. David Croisdale-Appleby
  20. Chris Badger
  21. Kay Boycott
  22. Chris Badger
  23. Arun Chopra
  24. Kay Boycott
Share this agenda point
Share this agenda point
  1. Kay Boycott
  2. CQC Networks Rep.
  3. Kay Boycott
  4. CQC Networks Rep.
  5. Kay Boycott
  6. Chris Badger
  7. Alex Kafetz
  8. Kay Boycott
  9. Kay Boycott
  10. Arun Chopra
  11. Kay Boycott
Share this agenda point
  1. Kay Boycott
Share this agenda point
  1. Adrian James
  2. Kay Boycott
  3. Adrian James
  4. Kay Boycott
  5. Webcast Finished

Kay Boycott - 0:00:03
We might want to just make sure we've got microphones set up.
I just think about these individual ones.
Yeah, yeah, it's just sometimes they take bits of warm up so I don't know if everyone's
had them switched on already.
Ah, perfect.
Alright, great.
Okay, should we start?
Is everyone ready to start?
I am going to start with the
floor.
We were just, apologies to everyone for a
slightly late start, we were just waiting to
make sure that we had the ability to record
the meeting.
I would like to welcome members of the board,
colleagues, members of the public.
In terms of apologies,
we have apologies
from Esther Provins and also from Richard Barker and from Michael Mire.
Are there any declarations of interest relating to the items on today's
agenda or for anything anyone wants to declare? No, thank you.
First of all, we're turning to the minutes of the previous meeting
held on the 3rd of June 2026 are we happy to approve those as an accurate record?
Yep okay looking around the room yes those are approved and if we go on to
the matters arising and the action log are there any comments or on any actions that members
should consider that should remain open.
There's a number of things on the agenda today.
Not seeing any comments.
Okay, well I'm going to then start with my report.
Firstly, I want to start with some leadership changes.
I very much welcome the appointment
of Baroness Julia Neuberger as chair of the CQC from the 1st of October.
Julia is a highly experienced chair and has deep healthcare knowledge. We have already started to
prepare for her arrival and I know she's really looking forward to getting started and getting

1.0 Introduction

1.1 Welcome, Apologies and new declarations of interest

to know everybody. I'd really like to thank, this is my last public board meeting as chair,
but not my last board meeting as a board member.
And I'd like to really thank everyone for their support
in my time as interim.
I'd particularly like to thank Melanie Williams
because she's stepped in as interim chair
of audit and risk committee.
And I've really appreciated that.
And I will be back in there in the substantive role
at the end of the month.
We're also looking forward to Emily Miles
starting on the 19th of October.
Emily is a former chief executive regulator
and experienced senior leader.
Again, there's a lot of effort going on
to support a smooth transition.
And both Emily and Julia, and we know colleagues
maybe watching this are really keen to meet staff
and diary dates are going in and the planning is happening
so that that will happen early
as they come into the organisation.
This does mean it is Dr. Arun Chopra's last meeting
as interim chief exec. I was reflecting this it was about this time last year as we were preparing
for state of care, Arun kindly agreed to step up as interim chief exec. I think we probably,
none of us thought that we would still be in this position a year later and the tenacity and the
The commitment and the service that Arun has given in that year is so appreciated.
I think we're incredibly grateful as a board and I'm sure as an organisation for your initial
agreement to step forward, but also the collegiate way in which you've worked through this year
and keeping the organisation moving through this uncertainty.
I know Arun will almost certainly point out this is a team effort, which it is, and I
I would like to thank Chris Usher as well
for stepping forward as interim deputy chief exec
and all the senior and wider leadership team
for the work they've done in this period.
Inevitably, sometimes in public,
focus has been on senior leadership change,
but I think it's really important to acknowledge
that all of this has happened at a time
that there's been a huge amount of work
to create sector specific teams,
which has been a really critical foundation
to recover our inspection rates,
be prepared for the new sector specific assessment
frameworks, and that's really gone under the radar.
And Arun and the rest of the team have really helped us
get in that position.
We're going to hear much more around future plans,
but I do think I'd like to also thank Arun in particular,
but also the rest of the team for the very clear sighted
way they have reviewed the organisation over the last year.
and identified the full extent of the task ahead of recovery
and turn around to rebuild the CQC,
whilst also really starting some very positive steps
on the recovery.
And yes, so a big thank you to you, Chris,
the rest of the team.
This is, I think the only other thing I'd like to say
is that this is, today is a sort of important
transition point, you're going to hear about our performance in quarter one and
Chris is also going to give an update on where we are to date. That's the sort
of first step in our turnaround. We've also met in private as a board to
discover some matters that are more appropriately discussed in a
confidential forum, draught reports and proposals, programme updates and in
in maybe more detail in an earlier stage
than we're ready to come to public board.
The key items we've discussed though
are going to be reflected in today's public board,
and that's our business plan,
which is going to be a really important step forward,
rebuilding our organisation
and rebuilding our regulatory services programme.
So I think this is hopefully,
and I know although it's Arun's last meeting,
He's very much looking forward as well to getting on
with the job of Chief Inspector of Mental Health,
but we've got a lot to do together as a team.
So that's my report.
If anyone's got any questions?
Over to Arun.
Thank you, Kay.

2.2 Chief Executive’s report

Can I start by just saying,
really appreciate the kind words.
Thank you.
You're quite right.
I was going to just reflect on the fact
that we have led as a collective across the executive team
and I want to say thanks to all my exec colleagues.
But indeed, I do want to say thanks
through the entirety of the organisation for the support
Arun Chopra - 0:07:39
they've shown us and shown each other
during a period of a fair bit of change.
So I want to say thanks to all colleagues.
I would particularly like to thank
the Mental Health Inspectorate for their support
whilst I've been in this role.
And I wanted to say thanks to Chris Dzikiti,
who isn't with us at the moment.
He's with NMC in his new role.
and I also want to say thanks to Adrian James.
Both Chris and Adrian have been in the interim
Chief Inspector of Mental Health role.
Thank you to both of them.
Very much looking forward to welcoming Emily Miles
as our new Chief Executive and Baroness Neuberger.
Very much looking forward to them arriving soon.
But Kay, I did want to say thank you to you
because this is your last meeting as interim chair
before you return to a substantive role
as chair of ARAC and board member.
And I just want to say thank you for getting
across all the issues with such attention.
So thank you so much for that.
In terms of the report, I'm going to take that as read.
I did want to bring out just one item around productivity
and quality.
I just wanted to say and acknowledge
the work that has taken place throughout the organisation
and to all our colleagues who have worked so hard
to increase our productivity despite all the change
and uncertainty, we've increased our productivity
by 40% over the last year since we've moved back
into a resectorised teams.
I know that's not enough.
I know it's a staging post in our journey
to be back to being the regulator that we want to become,
but I did want to acknowledge that increase of productivity.
By the end of September, we were set to achieve
9,000 inspection reports.
I think we're closer to 10,500 already,
and I know that has taken place because of the
tireless work of colleagues across the organisation
who are deeply committed to the mission of the organisation,
being a regulator that makes a difference to patients
and people who use services.
So thanks to everyone on that.
I'm not going to go into any of the other areas
as we're gonna be covering them later in the agenda,
but I did want to bring in Toli to speak
to the Thirlwell Inquiry Report,
which we've been looking at since it's been published
just a couple of days ago,
and just to give some initial reflections and response.
So can I hand over to Toli, Chief Inspector of Hospitals?
Thank you very much, Arun.
I know I can speak for all of us as a board
when I say that our deepest sympathies go out to the families
Dr Toli Onon - 0:10:12
who continue to suffer as a result of these terrible crimes.
But all of us who have a role in the delivery,
the leadership, the regulation of healthcare,
must actively consider the findings
of Lady Thirlwall's report in order to help
prevent another situation where premeditated harm
goes undetected for so long.
As CQC, our 2016 inspection of the Countess
of Chester Hospital didn't identify
the increase in neonatal mortality.
It's in the public domain that crucial information
wasn't shared by the hospital,
but actually we must be responsible for the fact
that we as the regulator at that time didn't take an approach that we would now recognise
to be sufficiently investigative and enquiring. We have learnt from that and our assessment
approach has been significantly strengthened since then. We now employ a more probing and
evidence led assessment model and we have much greater clinical expertise through our
specialist advisors. We've also made changes to our assessment to improve our oversight
of neonatal services. So neonatal care is now inspected as a standalone service aligned
to maternity rather than as part of assessment of children and young people. And we have
relevant neonatal data presented to inspectors separately from data for other services so
that the whole team has that clarity around the intelligence. We've also added to the
range of mortality data that we review and we are currently in discussion with NHS England
about accessing additional data they hold which would allow more active tracking and mortality.
We're also truly sorry for the fact that there were significant shortfalls in CQC's document
management that impacted the evidence we were able to provide to the inquiry.
Since that time we've undertaken an independent external review of our information and records
management practises and the learning from that review has been used to improve CQC's information
management practise and document management systems and a lot of work has gone on and
continues to go on in that regard. The Thirlwall report's made it very clear that we need to focus
on our core purpose and we are absolutely committed to improving how we work to keep
people safe and improve care and how we use information to assess quality, identify risks
and therefore take appropriate action. We will ensure that the learning from this report is
embedded in our processes going forward.
We're also committed to working with the Department of Health
and Social Care and all our wider system partners
to play our part as the regulator
in taking forward the recommendations set out
by Lady Justice Thirlwall and her team.
Thank you.
Could I open it up for any questions for Arun
at this point or for Toli?
Kay Boycott - 0:12:59
Alexia first. Alexia, if you could switch on and introduce yourself that would be great.
CQC Networks Rep. - 0:13:15
Hello, I'm Alexia Granatt, I'm the Disability Equality Network Co-Chair and I'm an Adult Social Care Inspector for the day job.
I'm here representing all the Equality Networks and the Staff Forum.
I just wanted to ask how will the board ensure and the executive that its
equality commitments remain a priority while managing financial pressures and
organisational restructuring please.
We committed to the equality objectives were set out set them out in the
Kay Boycott - 0:13:58
Arun Chopra - 0:13:59
business plan as well and we are remaining committing to achieving those.
We're also ensuring that with any of our programmes around change that we're
completing equality impact assessments to ensure that we are
meeting the needs of all colleagues across the organisation through that.
Kay Boycott - 0:14:18
Thank you. Alex, I think you were going to come in. Yeah, no thank you. Thank you,
Alex Kafetz - 0:14:22
Toli. I'll just talk about the Thirwell and I think, you know, welcome everything
and obviously I think we'll welcome the report.
I mean I think this is another indication
to just show how we could be using data better
to help kind of identify potential quality of care issues.
And of course one of the big changes from 2016
is computing power is now a lot faster
before we even start thinking about
how machine learning might help.
So you know I really hope over the next period
we start to, you can analyse that mortality rate
as everyone knows you know to specialty level
in the acute sector, even in certain specialties
down to consultant levels.
So I think there's a lot more data we could be using
to kind of point our inspectors to potential areas
of quality and care, so it welcomes that discussion.
May I respond to that, Chair?
Yeah, yeah, no, absolutely, Alex.
Thank you very much.
Dr Toli Onon - 0:15:18
I mean, for example, we get a lot of data
from the national clinical audits.
So there's a maternal and perinatal audit
and a national neonatal audit.
And we get that outlier data for individual providers.
And that's uploaded into our system
and shared with the inspection teams.
So they have sight of that.
And I did reference earlier our discussions with NHSE.
They recently introduced an excellent system
that's much more responsive.
The acronym is MOSS,
and the maternal outcomes signal system.
and that looks at stillbirths at term,
it looks at neonatal deaths,
which are deaths in the first four weeks,
and it looks at the rate of brain injuries
in babies related to oxygen deprivation.
And again, it highlights where,
at unit level, where those rates are higher than expected,
and it highlights it much more responsibly.
So all the providers have their own data in that way,
and if we could get access to that,
that would be very helpful for us as well.
So we hope to do so in the future.
Thank you.
Thank you.
If there's nothing else on Arun's report,
Kay Boycott - 0:16:27
could we move to the committee reporting please?
So Mel, the audit and risk committee on the 18th of June.
Thank you, chair.
And firstly to note that this meeting was held back in June
Melanie Williams - 0:16:37
and we're due to meet in ARAC in two weeks.
So I recognise a bit of a timing issue
with some of the updates.
So just on alert, so we spent a considerable time at ARAC.
In fact, we indeed for the last two meetings,
looking at the CQC way assurance. So the committee is really concerned that given this is our
cultural change programme and culture underpins CQC success and quality wellbeing, this is
a really crucial bit of work. So we recognise that further work was needed to develop a
clear roadmap with clear deliverables and then assuring, particularly for ARAC's perspective,
appropriate assurance. So we're due to have that report back in September, so really keen
to see that. We had a good conversation on the medium term financial plan. The report
says that we had planned over the summer, but of course that summer has now happened.
Chris Usher will be providing an update on that work because the financial gap that we
heard about in terms of the gap between our income and expenditure has led to the work
on rebuilding our organisation and there will be a verbal update on that on the board agenda.
We spent a considerable time on internal audits, so both having a look at the annual report,
which we're due to have a look again back in September in two weeks' time, but equally
making sure that we had progress between the auditors and ourselves on completing the audit
cycle and programmes. That's been an important part of ARAC as well. And then noting on the
report a number of other governance pieces of work that we're now progressing, Chair,
so thank you.
Kay Boycott - 0:18:07
Any questions? Could I hand over to Alex who's deputising for Richard Barker to update on
Alex Kafetz - 0:18:20
the Regulatory Governance Committee? Thank you, Chair. I'll take the paper as read so
I won't go through all of it. And again, this is the meeting in July, so again, things have
caught up a little bit over the summer.
So the main highlights from RGC is we have strengthened
our terms of reference, slightly kind of tweaked membership
from exec and non-exec colleagues, and as part of that
we acknowledge the workload of RGC, so it is now,
we've now increased the meeting frequency to be able to
deal with all those issues, and I think we're keeping that

2.4 Integrated Performance Report: Q1

under review six monthly.
To highlight one of the alerts, we had a discussion
been led by Toli around location ratings for NHS acute trust.
So this is the complexity of NHS acute trust that have multiple sites over kind of quite
disparate geographies in many parts.
And I think the conclusion was that there'll be some further engagement planned and we'll
come to a decision on that in due course, which of course we will communicate as per
normal.
Just to highlight a couple under advice, we did a deep dive into the inspection run rate,
so this is how many inspections we'll do over our next business plan period.
Chris is going to update on the business plan later in the meeting.
So again, this is superseded, but there was a lot of work gone into that,
and we saw the kind of workings across each of the sector.
And the other thing I just thought I'd highlight
on page two was,
led by Bola, we have to assure people
during the meeting we've started to think about
CQC's role in neighbourhood health,
and I'm sure there'll be further discussions
as the 10-year plan goes through its implementation plays
and how CQC will be at the centre of that.
There'd been a question raised to RGC
around how RGC is assuring the quality of our inspections
alongside just the numbers.
I know Bola was going to talk about that,
but she's at another meeting at the moment,
so probably that's something we could come back to
at another date, unless Arun wanted to say anything quickly,
but just to assure people that that is on the RGC agenda.
Thanks, Alex.
Arun Chopra - 0:20:35
In Bola's absence, I'll just very briefly update.
We are taking much more of a focus on the quality
of our reports, and that's internally one of the things
we want to prioritise, but it's also something
we're hearing very much from our external stakeholders
as well, they are feeling a bit more assured
about the progress that we're making in terms
of our productivity, recognising we've still got
a long way to go, but they want to know about
what we're doing around our quality.
One of the areas we're focusing on is the consistency
of our reports, we've established quality assurance panels
across all the sectors, work in those quality assurance
panels is already taking place, but we're now looking to derive metrics from those
panels that we can understand and report back to RGC with the eventual aim of
having a quality metrics dashboard that will be able to give a sense not only of
the volume of work that we're undertaking but of the quality of that
work and consistency of it. Thank you.
Any more questions or comments for Alex?
Kay Boycott - 0:21:36
No?
Okay.
Could I hand over to Chris Usher for the integrated performance report for Q1?
I think you're going to give us some flash figures for a bit after that as well.
I will.
Thanks, Chair.
Chris Usher - 0:21:57
So I'll report on our position as at the end of quarter one, but I think
What we have discussed internally is just the lag our reporting presents
So I'll do a bit of that but also bring it right up the date just so just so we've got an up-to-date picture
And running through performance with assessments. We set a target as we've talked about previously for to deliver 9,000
assessments by September 26th at the end of quarter one
we were on track in just under 8,500.
Pleased to say we've now delivered that target
and as of this week we're at 10,328.
So exceeded that target.
Just to demonstrate how that's tracked over the year,
at the start of April 25 when we tracked that target
we were delivering about 450 assessments a month.
We're now at around 800 a month over recent times
so we can see that demonstrable increase over that period.
Similarly within registration, at the end of quart one,
we were completing registrations within 10 weeks at 68%.
That's now up to 74.8% and our target is 80
at the latest position.
Not in the pack, but registrations are also working
through a backlog of applications over 10 weeks old.
At the start of the year, that was 1,000.
It's down to 120 of late.
So the registration team delivering great success,
tackling a backlog, and now able to turn their attention
to BAU delivery.
And as of this week, we could see in the registration
delivery, it was 84% against a target of 80.
So A, that lag is there in our performance.
But as of today you can see we are clearing backlogs
and really generating positive work
in our registration delivery.
Information of concern, another area we track closely.
This is feedback we receive from staff information
about people's experience
and information from partner organisations.
We get about 200,000 of these a year.
We did a lot of work in early 2025
to clear through backlogs of cases.
we are now delivering consistently on most of these KPIs.
Our priority one referrals, priority two,
and priority three information concerns
are all running above target.
We have a priority one of completing an action
within one day that is slightly under target
at 93.4 against a target of 95,
which we are continuing to monitor.
But the trend around information of concern
is showing a positive position.
Other areas to pull out in our performance, our NCSE call lines have shown positive progress
throughout the year, tracking above target and with our local authority assessment work
we've now baselined across all 153 local authorities with just one report to publish as at today,
I believe.
Moving on to finance, at the end of quarter one we had a 1.2 million surplus, however
that's largely due to a spend profile. We are forecasting a 5.9 million deficit for
the year. We're tracking our in-year spend on medium-term financial position very closely.
We've also got our main spending focus in year is around our rebuilding regulatory services
work. That requires support financially from the Department of Health and Social Care to
to ensure we can deliver on that.
On our capital expenditure, we've got minimal spend today,
but we expect to use our 30 million allocation,
which again will largely be down to
our rebuilding regulatory services work.
In our people report, a few bits to pull out.
On our workforce vacancy rates have decreased to 7.4%,
down from 10.5%, but still higher than our target of 5%.
That's not unintentional, and demonstrates how we're aiming
to manage our resources in line with budget
and implementing workforce controls.
We are seeing significant vacancies in our data
and insight function, probably the area that
would draw out mostly with high attrition and hard
to recruit roles.
Recruitment and workforce data continue
to demonstrate progress towards diversity objectives
with representation of ethnic minority colleagues at 19.4%,
and disabled colleagues at 17.1%,
which is broadly in line with the official
national statistics working population
and showing continued improvement since April this year.
And we also track our completion and mandatory training.
In quarter one, we break this down into quarters,
and in quarter one, bullying and harassment training
was at 85% and fraud 85% as well.
Finally, included in the pack is our position on risk.
We continue to have strong oversight of risk through our risk committee.
The significant work on each of our principal risks taking place, looking at our controls,
assurances and actions to ensure they are effective.
In this update, our risk scores have remained static.
However, one area to note is our assurance of cyber security has improved from limited
to moderate.
I will pause there, Chair.
I'm happy to take any questions.
Kay Boycott - 0:27:34
David Croisdale-Appleby - 0:27:36
David. Chris you mentioned the 5.9 million anticipated deficit is that something that
we're going to eliminate during the course of the year? That is what we're working on David,
some of that is about funding that we are due from the Department of Health and Social Care and some
of it is around our own financial position.
We are working to have a balanced budget this year,
so I believe we can.
I think we just need to keep monitoring that position.
Thanks, that's a reassurance I was looking for, Chris.
Thank you. Dee?
Kay Boycott - 0:28:10
Thank you for that, Chris.
I just had a couple of points from the trade union point of,
CQC Trade Unions Rep. - 0:28:15
Kay Boycott - 0:28:15
thank you, because it just, I think it doesn't say your name.
Not lagging me off.
From the trade union point of view,
CQC Trade Unions Rep. - 0:28:21
just about the deficits,
The report talks about the expenditure relating to our rebuilding our organisation and it
says that it remains unfunded currently. What contingency is there if that funding is delayed
or if that funding is not approved within the anticipated time scale to get us moving
through this, rebuilding our organisation cost improvement programme?
So the rebuilding regulatory services work. So rebuilding regulatory services, we will
Chris Usher - 0:29:09
utilise two budgets for that. One is our capital budget and the other is our revenue budget.
The revenue element is funding we will receive from the Department of Health and Social Care
and we have agreement with them to utilise up to 10 million a year around rebuilding
our regulatory services. So that is support we will receive from them in year.
That is also predicated on approval of an outline business case that is in with them
at the minute for approval, which we are hoping to receive approval for in the next month.
Well the question was if that is not approved, if that money is not forthcoming, what contingency -
CQC Trade Unions Rep. - 0:29:48
Chris Usher - 0:29:50
I think if that case is not approved I think we'll need to revisit our plans around the
rebuilding regulatory services so that case is in next month. We've had good conversations
with the Department so far. I think we'll need to revisit our planning in-year for delivery
of that programme if that funding is not agreed.
Just one other point. We do notice that the report identifies some vacancies, bank use
CQC Trade Unions Rep. - 0:30:16
and overtime that could have an influence on the financial position. And it might not
be, you can answer this now, but how much of that forecast saving will rely on maintaining
those vacancies? Just thinking of the clash between that finance and then the pressure
in ops to get out and do more work and looking at those vacancies, we carry those vacancies
over a long period of time. So yeah, just wondering, is that forecast relying on maintaining
those vacancies? So the forecast will have assumptions built
Chris Usher - 0:30:56
in around vacancies. I think we need to be pragmatic and realistic around any vacancy
we have in the organisation. We have tighter workforce controls to ensure that we are recruiting
to posts where needed, where sensible, and we will recruit to those posts, but equally
we challenge ourselves about every vacancy we have in the organisation and whether it
is essential to recruit to, given our financial position. That helps.
CQC Trade Unions Rep. - 0:31:26
Ruth Owen - 0:31:29
I'd just like to say well done to the teams for some of the progress. We've made a huge
amount of progress over the last year and I just think we should recognise that. We've
still got more to do, always more to do, but I think when you think about where we were
year ago as a team, you think where we are today, there's progress. So thank you.
Kay Boycott - 0:31:49
Alex Kafetz - 0:31:52
Alex? Yeah, building on that, I just wanted to, I think, call out our registration colleagues under
Chris' leadership and Esther's leadership before that, that we've cleared that backlog.
When I joined CQC before it even started in my sector of digital health, a number of
companies in that backlog contacted me and told me their ways about trying to get digital health
companies through the registration so I just think it's worth kind of taking time to note
that that's been a real success over this this last year or so.
Kay Boycott - 0:32:27
If I may, I've got a question again, congratulations on assessing all the local
authorities within the two-year period and that's new work at a time when
also focusing on other work and I just wondered what the learnings from
that had been particularly, I'm not asking presumably Chris, a summary of the
state of local authorities, more the learnings from an assessment point of
view and what you would change going forward.
Chris Badger - 0:33:09
regulatory cycle
and that includes new forms of assessment,
so the onsite comprehensive assessment,
but also things like assurance meetings
with directors of adult care
to build a more relational approach
rather than just an episodic assessment.
And we're trialling all those things now
and there'll be part and parcel
of the approach going forward.
So we've reflected on that, sought to improve,
but we'll keep all our approaches under review.
Kay Boycott - 0:34:01
Any other questions or comments on the performance report? Thank you. Right and
we've got two items in the next section and I think it's really important as a
board it's very easy to get very internally focused particularly when
you're in a sort of rebuilding or turnaround phase and we need to make
sure that we are hearing from different voices.
And one of the most important voices, of course,
is to ground ourselves in our purpose
to protect people, to promote and improve quality of care.
Healthwatch England has an independent role of the CQC,
but it is a statutory committee of the CQC.
And we have the benefit of having Professor David
Croisdale-Appleby as one of our board members, who
who is also Chair of Healthwatch.
And we've had David speak to our private board before,
really, really insightful about what Healthwatch
are seeing in terms of people's experiences
of health and social care through the issues
that get raised, the work that they do.

3.1 Healthwatch England Update

And so what I wanted is to invite David
to present, I mean, also the latest insight
that there is about from the people we serve
and highlight and then I'll open it to questions.
But I think it's really important that we make sure
that we are really externally focused
and most importantly that we have the voice
of the people that we're here to serve.
So with that, David, over to you.
Thank you very much, Kay.
David Croisdale-Appleby - 0:35:40
Just to remind colleagues that Healthwatch
is essentially a hub and spoke operation
where Healthwatch England has the responsibility
for the integrity of our research methodology
across the whole of the network,
and also ensuring that learning is communicated
across that 153 member network.
The strongest of the 14 themes that are emerging
from the work of Healthwatch England
and the 153 local health watchers
are a focus on reaching people whose voices
might otherwise go unheard, building trusted relationships on acting as an
always on source of community insight, supporting improvement and helping
systems understand and respond to community experiences. These themes do
align very closely with wider health and social care priorities, including
improving access, strengthening community based care, supporting digital inclusion, and of
course promoting prevention.
Our research also demonstrates a hub and spoke network that's increasingly able to work across
organisational boundaries, bringing together local insight from multiple communities to
support the planning, engagement, and improvement at integrated care system level.
But very importantly, the report suggests that impact is based on trust.
Trust within communities, trust between partner organisations, and trust in people with lived
experience and trust in the value of listening to people's own experiences and yet using
those experiences to improve health and social care services.
And my final point on trust, I think, Kay, would be that trust is firmly based on the
independence of the Healthwatch movement.
So I was just going to mention, as I thought colleagues would be interested in, nine of
those 14 that I picked out.
The first is reaching people whose voices might otherwise go unheard.
and collectively Healthwatch reported engaging with more than 370,000 people.
And the strongest theme running through many reports is this commitment to engaging with people
whose experiences are often absent from decision making processes.
Across England, Healthwatch reported work with a wide range of communities
whose voices are so often underrepresented
in any health and care discussions.
These included refugees, asylum seekers, Roma communities,
Eastern European communities, people experiencing
homelessness.
You know how high that is on the prime minister's agenda.
Veterans, carers, people with disabilities, young people,
people experiencing deprivation, and rural communities
amongst, indeed, many others.
My second of the nine would be improving access to health and social care.
And access remains one of the most common themes across our work.
And Healthwatch has reported a broad range of work to improve access.
They covered areas such as GP services, dentistry, mental health, diagnostics,
community services, carer support, hospital discharge, patient transport and information.
Many examples are focused on identifying the practical barriers that prevent people
from accessing timely care and working with services to address them.
My third of the nine is helping services work better.
And a recurring theme is Healthwatch's contribution
to helping these services function more effectively.
Many projects focused on issues such as non-attendance at appointments,
difficulties in accessing diagnostics, barriers to attending clinics,
navigating referral pathways, and challenges moving between services.
Whilst often reported as access issues, they frequently revealed a much wider challenge
within the design and delivery of services.
Annual reports highlighted examples where transport, communication,
and digital exclusion, accessibility, cultural factors,
or lack of information were preventing people
from engaging with the services as intended.
Now these barriers affect patients,
but they also affect providers.
They contribute to missed appointments, to delayed care,
to inefficiencies and increased pressures
elsewhere in the system.
So I mentioned digital, so my fourth point is
making digital healthcare work for everyone.
Healthwatch has supported the move
towards increasingly digital health services.
Their contribution is less about the technology itself
and more about helping people access
and benefit from digital services.
Across the research that we've done,
organisations explored experiences of using the NHS app
and other digital services,
identifying barriers for access
and highlighting concern relating to the accessibility
awareness, confidence, and the worry about digital exclusion.
In many cases, we worked alongside communities,
voluntary organisations, and indeed,
service providers to understand the barriers,
to improve support and increase confidence amongst people
in using digital services.
And this included helping identify
why some communities weren't using digital tools
and supporting initiatives to build digital confidence
and ensuring that alternative routes into services
remained available when needed.
My next point is, which I mentioned earlier,
an always on source of community insight and early warning.
Unlike consultations and engagement exercises
that take place at a single point in time,
Healthwatch are continually listening through community engagement, information and signposting,
volunteer activity, enter and view visits and relationships with local organisation.
Healthwatch has been able to develop an ongoing understanding of people's experiences and
concerns as these move through time.
This means that Healthwatch is often able to provide early intelligence to health and
social care leaders about emerging issues that affect local communities.
And in many places, Healthwatch is valued not simply because of the reports
that it actually produces,
but because it can provide an informed and independent perspective on what
people are experiencing right now.
Safeguarding featured prominently across annual reports from local Healthwatchers
And they've contributed to the safeguarding boards. They've raised awareness of safeguarding
concerns and the nature of those safeguarding concerns. They've supported investigations
and they've helped ensure that the experiences of vulnerable people are informed that these
have informed the appropriate safeguarding arrangements that are made for those people.
My next point I mentioned earlier, Enter and View, and that's a unique statutory power
and it's a distinctive statutory power.
This ability to carry out Enter and View visits to all health and social care services.
Annual reports demonstrate how organisations continue to use this power to understand people's
experiences of care, to identify good practise and highlight opportunities for improvement.
very complementary to the work that CQC itself does.
Unlike many forms of engagement,
Enter in View enables Healthwatch representatives
to observe services firsthand
and speak and listen directly
with people who are using those services,
their families, their carers, and of course the staff.
Examples included visits to care homes,
supported living services,
hospitals and other health and care settings.
But importantly, Enter and View often focuses on the aspects of care that matter most to
people, but can be difficult to measure through performance data alone. And these include
things like dignity, the quality of the communication, choice, accessibility, quality of life that
they experience, the care environment in which care is provided, and whether people feel
safe, do they feel respected? Do they feel that they've been listened to?
I want to talk just very quickly about volunteers, that Local Healthwatch is supported by more
than 4,200 volunteers across England.
And our reports highlight the important role that they play in helping Local Healthwatch
understand people's experience and ensure that communities have a voice in health and
care services.
very frequently.
These volunteers are extraordinarily
capable people, often with great experience of the health
and care systems.
So they bring an informed perspective
in their listening activities.
Just a couple more.
Across the reports, organisations
described contributing evidence and insight to national work
on a wide range of issues.
And these included access to primary care, dentistry,
the NHS app, digital inclusion, patient data, women's health,
trans and non-binary people's experience of healthcare,
NHS online, health inequalities, and the future of health
and social care services.
Such local insights have informed national consultations,
parliamentary inquiries, and wider policy discussions.
And I think in all the reports that have produced
and we discussed some of these earlier today,
you will see the presence of the Healthwatch voice.
My final 1K is building a stronger and more impact-focused network.
And one of the clearest observations from reviewing annual reports
over recent years that I've done
is the continued improvement in how Healthwatch demonstrates its impact.
Increasingly, reports move beyond simply describing activity.
They move on to explaining what has changed,
who benefited, and the difference made because of local Healthwatch work.
Across the network, there is increasing evidence of tracking recommendations,
of following up actions and demonstrating outcomes that are achieved for local people.
This improvement can be seen across Healthwatch, the Healthwatches of different sizes
and operating in very, very different local circumstances.
The reports also highlight the reality that local Healthwatch operate with very varying
levels of funding and activity.
Smaller organisations are unlikely to demonstrate the same scale of activity as larger, better
resourced Health Watchers.
Nevertheless, I have to say that many of the lower funded organisations are increasingly
able to demonstrate meaningful impact within the communities that we serve.
I leave it there and invite any questions.
Thank you, David.
Kay Boycott - 0:47:37
Great to hear the work that Healthwatch colleagues and volunteers do.
If you were, this board now, if you were to think about the summer
and the sort of last three months,
what are the emerging issues that are coming out,
the sort of maybe one or two things that are current right now that you're hearing?
David Croisdale-Appleby - 0:48:02
Well, although I opened my presentation to you by mentioning the key themes, I think
over the last three months, the attention that's been given, for example, to the inquiries
about maternity are right at the front of everyone's mind.
I remember when I was running hospitals and I asked my population, what service, if we
did it really well, they would think represented a hospital that did everything very well.
Not surprisingly, breast cancer and maternity came right at the top of that.
So it's not surprising that all the emphasis recently on maternity has been reflected in
the work we've done.
There is a continuing theme, however, about access and a worry about access, and that
is linked into a fear of digital exclusion, a fear that if I'm not digitally competent,
I'm going to miss out on opportunities and I don't even know what I'm going to miss out
on. So I think those are a couple of really key things.
Kay Boycott - 0:49:10
Thank you. Any more questions? Adrian.
David Croisdale-Appleby - 0:49:17
Adrian James, Interim Chief Inspector of Mental Health. Dave, just want to thank you for your
James Bullion - 0:49:25
report and stressing the important areas that you raise and there's nowhere where
this is more important than in the mental health world. Trust is a very big
issue, listening to voices that are often not heard and digital poverty and
digital exclusion are extraordinarily important and I'm relatively new to CQC
but I have been really impressed with the importance that this this topic is
is placed within CQC, I think that we could do more.
I think that we must always put the needs of patients
and the voices of patients at the centre
of everything that we do.
We do have some programmes that I think are beginning
to bear some fruit, and I want to distress the importance
of the PCREF, the Patient and Care and Race Equality
Framework, which really gives us a sort of a baseline
and a way forward in relation to often our communities that are not listened to and our
services that are not designed to meet their needs. I think it's a real opportunity for
us at CQC and the system more generally to really make some headway in that important
area.
Thank you for that. If I could just briefly respond to that. I think one of the concerns
David Croisdale-Appleby - 0:50:40
about patient voice is that it typically takes a local Healthwatch person about six months
to gain the trust of a community that is otherwise isolated. That might be a diaspora, it might
be geographic, it might be a number of things. But to win the confidence of those people
so that they're willing to speak up genuinely about the problems of health inequalities
and health problems in their community,
and mental health comes right up at the top of that,
as you would imagine, takes six months of investment of time.
And that's a very big thing.
One of the worries with the suggestion
that Healthwatch may not exist in the future is whether
that investment is going to take place by ICBs
and local authorities, because it's a big investment,
not just in money, but in the capability
of the people to do it.
and that's why I mentioned earlier,
amongst our 4,200 volunteers that we have
across the system, so many of those are really experienced
in their local communities.
So they have credibility enabling them
to actually get that patient voice.
Kay Boycott - 0:51:58
I'm just going to take a final question
from Bola who's online.
Bola, welcome to the board.
Thank you, Chair.
I apologise to join late.
David Croisdale-Appleby - 0:52:08
David, I'm here in Belfast
at the International Regulators Forum,
and you will be pleased to know that,
I've just been saying in my speech
about the imperative listening to patients and the public,
and those who use services as an intervention
that regulators must make for us to know
that we're doing the right thing.
That was the first thing I wanted to say.
Secondly, to acknowledge the powerful role
that Healthwatch played when I was National Director
for Health Inequalities at NHS England,
addressing pretty much the areas
that you've just been highlighting in your update there.
Thirdly, is to just say from a CQC point of view,
in terms of listening to seldom heard communities,
I'm really pleased to say that we've just started
a new contract called the Public Engagement Network led by national independent organisations
that can implement the powerful work that Healthwatch does to make sure that we are
listening to those who are seldom heard and underserved and the voices that are more likely
to be marginalised.
So just to say that that is a really important milestone for us going forward.
your point about digital exclusion, Esther and I have had conversations and
we will continue as part of the CQC's population health inequality.
Kay Boycott - 0:53:47
Thank you, Bola, for that. There was a little bit of break at the end but I think you've finished.
Okay, I'm going to take that as yes. You've actually frozen. Thank you, David, that really great food for thought.
I think hearing it's so important that we base everything
in what's going on and what's concerning people
and certainly I've taken some notes from that,
so thank you.
What I'd like to now do is invite an update from Alexia
from our Disability Equality Network
and Dee from our trade union.

3.2 Staff Update

We did have another extended session with you and the board
and there is some action from that,
but I still think it's really important
that you have an opportunity to share your perspectives
about the broader workforce,
and then we might invite questions and comments
from the executive.
So welcome.
Thank you very much, Kate.
CQC Trade Unions Rep. - 0:54:51
And just as you said, we had a very good
and detailed conversation earlier today with our board,
and we shared some of the Trade Union members' feedback and sentiment. So thank you for that.
One of the things we spoke about was the ongoing organisational change within CQC
and the sentiment and feedback from our Trade Union members and colleagues about staff trust and confidence in that process.
We talked this morning about a number of transformations, transitions, recovery and turn around, creating
long periods of uncertainty.
I'm just moving your microphone near it. I'd hate colleagues to miss what you're saying.
Kay Boycott - 0:55:37
CQC Trade Unions Rep. - 0:55:40
Just that long period of uncertainty and instability for our members and colleagues. As you know,
the transformation has been ongoing for about three years or more.
So that they feel they're operating through continuous organisational change,
whilst continuing to deliver, you know, our critical regulation, operational functions,
those corporate functions. I shared with you some of the verbatim feedback. I won't do this here
just now. But there is a growing sense of fatigue following the multiple
organisational restructures, confidence, you know, regarding how we manage change
I would say is low. We've got some work to do there and just concerns around
that cognitive impact of prolonged uncertainty on our colleagues. I
I think we talked this morning around the rebuilding
of that trust and confidence is just going to be critical
to any success of this change programme.
So that meaningful engagement, really clear communication,
visible actions, I think are what also is appreciated.
We say words, not actions.
Actions, not words.
Oh, Sooz will tell me off for that.
Sorry, Sooz.
So that was around how people are feeling about more organisational change.
The other thing we spoke about this morning was the organisational culture, the way we
speak up in this organisation, and the CQC way, which was helping to frame, to reset
our culture.
We have had a number of internal and external reviews about our culture, listening, learning,
responding, the freedom to speak up reviews and the CQC way. So there's been a considerable
effort made by staff and managers to identify cultural issues, to develop solutions, but
I think many people, many members, colleagues are still reporting that the intended cultural
reset that we hoped for is not, you know, it's not being felt day to day. There are
still concerns around psychological safety and raising concerns because of previous experiences.
And we think now this matters now as we go through this massive organisational change.
More than ever we need that healthy speak up and I know Ruth and I and others we've
spoken about that healthy speak up culture for staff wellbeing, for engagement and also
for that learning. People are asking what has been learnt from the previous reorganisation
and the one before and the one before. So the importance of an effective and trusted
speak up function is highlighted during periods of change where people are feeling unsettled
and uncertain about their futures. And then the last thing that we wanted to share with
you today because we've spoken in much more detail already this morning, was a recent
survey completed back in the summer, completed by the joint trade unions within CQC about
our regulatory platform. So this is our IT platform that is causing consistent problems
for our members. We have received high consistent feedback across teams, regions and roles.
Local managers are viewed as being very supportive and proactive, but this is not a local solution.
Solutions are slow and in the meantime people have fed back and we will share the full report.
We have shared it already with health and safety and other seniors within CQC and we'll
send this report to the board. I've sent it today. Around usability and
performance it's difficult to navigate, it's unreliable, it's overly complex. We
looked at the impact on health and well-being, we saw increased stress,
anxiety, reduced confidence in people's own abilities, sleep deprivation
and some stress-related sickness,
as well as physical concerns, RSI,
migraine, and musculoskeletal issues.
So we've shared this survey.
We think it's probably the most recent
and up-to-date feedback around the reg platform
with Esther Provins and with Chris Cope,
who's also working on the new design.
and we hope that that's going to be useful for them and certainly want to continue to
work in partnership to ensure that we can get these improvements in a reasonable time
scale. So I think that's it today. Thank you Kay. Happy for any questions?
Kay Boycott - 1:01:05
CQC Networks Rep. - 1:01:08
Alexia? Thank you Kay. As with the trade unions we
welcomed the opportunity of speaking at private boards so we could share candid
feedback with you from the Equality Networks and Staff Forum which I think is
really important that you hear the voices of the staff. The Equality Networks and
Staff Forum we talked about should be recognised as your strategic
partners because we can provide constructive challenge, insight and early warnings,
because often we hear information that would be helpful for you making decisions moving
forward and also we have a wealth of lived experience amongst all the protected characteristics.
We agreed with the trade unions that the trust requires transparency and feedback groups
that show how concerns have influenced decisions because at the moment there's
not clear communications and that we talked about quite a lot this morning.
And disabled colleagues and other equality networks and the staff forum
shared ways that would help them with the executive and we'd welcome them to
be incorporated because - especially for disabled colleagues who are battling
with anxiety and other conditions that could be exacerbated by bad communications, it's
really important. So we'd welcome that to be shared with you, it's all anonymised and
Chris is welcome to share it on and so is Esther. The equality must remain central during
the rebuilding and financial pressure was one of the things we were talking about.
Equality commitments must remain visible and measurable throughout the
organisational rebuilding and one of the things we spoke about quite a bit was
the equality impact assessment. They should be proactive not reactive which
means - and the right people involved with the right understanding to write them to
make sure that those with protected characteristics have the risks reduced to them.
We spoke about the board should be able to demonstrate how staff and community insights
change decisions so that feedback loop goes back to the communication.
Equality data should demonstrate changes in experience and outcome, not simply increased
data collection I think is a really important thing that our members would like.
And it should demonstrate cultural change because one of the issues that comes out in
staff forum and the Equality Networks is the culture is still not where we would like it
to be as an organisation and certainly not how we regulate against.
The Equality Networks want you to know that they continue to work together to deliver joint awareness raising and work on policies with the People Directorate.
They work together to raise things like suicide awareness and celebrating Black History Month and Disability History Month and Pride Month.
The disability discrimination is starting to be looked at by the Disability Equality Network
and we would like CQC to become an anti-disability discrimination organisation
and we started to propose that this morning
because at the moment the staff surveys consistently show that there's negative experiences
of disabled, neurodiverse and those with long term health conditions and so we would welcome
the board to consider putting their sort of process to being an anti disability discrimination
organisation like we are an anti-racism organisation.
Kay Boycott - 1:05:23
Thank you both. Chris Usher and I attended a network meeting over the summer. I know
how much effort that you and colleagues put in and thank you for sharing so candidly and with such
you know professionalism. I'm going to suggest that a couple of your points around the building
our organisation picked up by Chris Usher when we get to that item, particularly around
the equality impacts and the communications. And Chris Badger, when you do the rebuilding
regulatory services, maybe the impact of regulatory platform. I'm just going to hand over to Arun.
I mean, we cannot do justice to everything that you've just said in two minutes. And
unfortunately, we do, we're going to need to move on to those items. But Arun, I just
I just want you to respond.
Thank you, Chair.
Arun Chopra - 1:06:17
Dee, Alexia, first of all, thank you for speaking up.
I really appreciated the session that we had earlier
where we went into some of these issues
in a bit more depth, but I'm speaking on behalf
of all of us when I say thank you for speaking up.
And I want to recognise what you said
about our colleagues who've been working
and delivering through a prolonged period
of uncertainty and multiple changes in the past.
We're absolutely committed to working with you.
We recognise the insights that you bring.
It's always helpful.
We need to be planning our actions better
and then making sure that we're communicating them well too.
Just on the survey, thank you for sharing that with us.
We've just received it.
We will discuss that at the next executive committee.
So we'll take the survey and then respond to you
on that survey after that.
I totally agree with what Alexia was saying
about the culture of the regulator making a big difference. It makes a huge
difference not to just to our staff but to the services that we regulate and
then on to people who use services and patients. We've got to get that right. I
believe we can get there but we have to be intentional about our actions. Thank
you for speaking up, really appreciate it.
Kay Boycott - 1:07:27
I think we can take those things into the next three items but and we will
also pick up outside the meeting so thank you. So we are going into turnaround
and I think very mindful that this is another thing in a period of, and Chris

4.0 Turnaround

you've lived through much of this, prolonged uncertainty, many changes. I

4.1 Business Plan

think there was a good reminder today, many branding for different change
programmes in the organisation but over to you and Chris Badger for the next three
items sort of get an update where we are. Thanks chair. I think that is hard as an
Chris Usher - 1:08:07
organisation like just reflecting on the point you're making I mean Emily will be
the sixth chief exec I've worked with in two years like that is it's hard and I
mean it's hard to have a static plan that that doesn't bounce and doesn't
change I think we all recognise that we have a business plan that's what I'm
going to talk about now. This is our business plan for the next 18 months
and it is focused on our turnaround and it is focused on what do we need to do
as an organisation to really focus on the things that
matter to help us get to the place we want to
be. I mean much of this work is already progressing in the right
direction as I talked about with our performance update before.
Our assessment activity is increasing, registration
backlogs have gone, BAU performance registration is where we want it to be,
we've already started work about rebuilding our systems, but the plan and
we will launch this next in the coming weeks, it remains honest about
where we are and the further progress we need on quality, culture and trust. It's
framed around four pillars and we've been talking internally around these
four pillars and in some of our board updates. Those four pillars are
productivity and quality.
So that's really about further increases
to our regulatory activity that providers expect,
but also the quality in what we do.
Another pillar is regulatory systems and tools,
and we've touched on this already.
This is really making sure colleagues
have got the technology they need to do the job well,
as well as rolling out our assessment frameworks.
People and culture, again, a core part
of what we've talked about today
and what we've just heard from,
really ensuring we've got the right culture
in the organisation where we're truly
living our values and behaviours.
And the fourth pillar is our external environment.
We can't ignore and take our eye off the ball
with an external environment.
We need to prepare for and implement the health bill,
being one example, but there's many others
that we'll draw out.
But that really boils down to what are the key things
we need to do as an organisation in a turnaround period.
And the last one is around foundational activities.
That's not a pillar, that's a core that runs throughout our business plan.
And that would be things like ensuring we have financial sustainability in what we do.
The report is with the department and requires ministerial sign off.
And from that we'll aim to publish.
So that will either be the end of this month or into October.
But that's all I was going to say on the business plan.
Thank you.
Kay Boycott - 1:10:49
Any comments or questions?
Could I hand back to you Chris for rebuilding our organisation update?

4.2 Rebuilding our Organisation Update

Chris Usher - 1:11:05
So like many organisations, we need to manage our finances carefully and we're seeing the
impact of rising costs.
We haven't changed our fee scheme since 2019/20, but in the last year alone our pay inflation
increased our costs by 8 million.
Over time our spending has become uneven across different parts of the organisation.
We need to respond to that by reviewing how we spend our money in our corporate and support
services.
We are referring to this work as a cost improvement programme or a SIP.
You might hear that phrase across the organisation.
This work will help make sure our resources are realigned towards more effective regulation.
It will also help us deliver a balanced budget and put us on a more sustainable footing for
future. I think a key part of this is I know many colleagues will be concerned
about what this could mean for them. It creates uncertainty and it creates a
level of anxiety. Speaking on behalf of the exec but also for me personally, I'm
committed to communicating more openly, engaging with colleagues and trade
and ensuring we have the right support throughout the process.
We do have an EIA in place,
Quality Impact Assessment. I think we're spending time with the networks on Monday
to go through that in a listening place so we can look through that in more detail.
But that's all I was going to say about the work
we're doing. Thank you.
David.
Kay Boycott - 1:12:53
David Croisdale-Appleby - 1:12:57
Thank you, Kay. Chris, my question is in terms of the rebuilding the organisation. It's a
direct question to you. You know, do you feel in all your experience and you know, you've
had a long experience with CQC as well as elsewhere. Do you feel that it's sufficiently
radical given the world we live in at the moment, the rate of change of all sorts of
things?
Chris Usher - 1:13:28
I think for the organisation what we are doing is something we have not experienced and therefore
I think it is quite disruptive already.
So in answer to your question, I'd say yes.
Ruth then Toli.
Kay Boycott - 1:13:46
Chris, it's good to see that we're working
with the networks and you're meeting up with them.
Ruth Owen - 1:13:51
I'm really pleased to hear that, so thank you.
No, thank you, Chair.
Dr Toli Onon - 1:14:01
I'm just reflecting on Chris's response
and the feedback we had from our
staff side representatives as well,
which has been really valuable.
And I think the point Chris makes about
it being a new thing in the organisation
in response to David, I think that's the key point.
So every public sector organisation we regulate,
local authority, every local authority,
every NHS trust is used to a cost improvement programme.
And they will all be very familiar with that.
But that's not something, as Chris points out, that we have been regularly used to.
And I think the reflections we've heard from our staff side just show how that has to be
communicated across, you know, more strongly and better than we have done.
But therefore, I'm absolutely with Chris, I don't think we could be more radical at
this point in time, because it's just new.
So it, although I recognise, you know, there may be partners, there may be people we regulate
providers who think you know is that it? It has to be different here for the
reasons we've heard but doesn't take away from the fact that we've had really
valuable feedback on how we communicate but I'm obviously in agreement with
Chris on that so I understand the point you're making, David, but I think so. Thank you.
Kay Boycott - 1:15:19
Alex Kafetz - 1:15:24
Alex. Yeah thanks and thanks Chris. I mean I think we're probably going to be in a
building on I think something David said, you know we're going to be in a constant
flux for a long time you know I think politically that there's lots of
discussions first of all across all governments about how much the role of
ALBs versus you know ministerial accountability and that comes up in
some of the other ALBs I'm involved in there's there's the kind of devolution
challenge and then there's the kind of public finance challenge about just doing more for
less and then there's the artificial intelligence challenge and I think there might be further
challenge from government about how much we can do with artificial intelligence and how
does that affect the skill mix in our staff.
So there are quite four big challenges which I think are going to go away.
So I suppose from valuable feedback from colleagues here and everyone else, there's perhaps something
for our incoming chief people officer
when he or she is appointed to think,
how do we build resilience within our staff
that I don't think there's going to be stability
in CQC or actually any other ALB for a period of time.
And so how do we kind of keep the focus on our BAU,
but keep our staff resilient with those four big challenges?
Kay Boycott - 1:16:48
Well, that's a big question for a board meeting.
Did you want to come in, Arun?
Arun Chopra - 1:16:57
Just very briefly, alongside all this other work, like other organisations, we are embracing
innovation and we are thinking about how we might deploy AI within the organisation, across
the organisation, and with our frontline teams to boost productivity.
So all of that work is happening together.
So we're embracing innovation at the same time of delivering change.
I'm very mindful about what Dee and Alexia where saying earlier about colleagues who've been
through quite a lot of change, have remained productive,
care deeply about the mission of the organisation,
and it's balancing the change that we're making
with also using technological innovations at the same time.
Thank you.
Kay Boycott - 1:17:33
Could I just ask one question?
So we've heard about the impact
of the current regulatory platform on colleagues,
and we've also heard about the impact of impending change
in terms of rebuilding our organisation.
how are we making sure that we protect the absolute requirement to deliver a
new regulatory platform with potential change going on in the organisation? How
are we managing that trade-off? So I think there's a couple of things, Chair. So one of
Chris Usher - 1:18:08
which is recognising that and we have spent time as an executive looking at
our principal risk around strategic change and acknowledging that we have
two big pieces of work running at the minute and that is a lot for an organisation and
how they interact. I think in the work we've been doing around the cost improvement, it
is making sure that it is highly cognisant of the rebuilding regulated services work,
any risks that anything we're doing in that work flush out clearly so we're not making
Kay Boycott - 1:18:49
any changes that will impact or detriment on that programme. Thank you.
I think, sorry, Arun? Just to add to what Chris was saying, I mean we're taking both of
Arun Chopra - 1:18:57
these items, both the rebuilding our regulatory services and rebuilding our
organisation together at our exec committee meetings. There's also
challenge panels where we're asking each other the same question that you've proposed
just for assurance to the board that is very much on exact mind about balancing these things.
Kay Boycott - 1:19:16
And I wanted to do that because you're now going to talk, Chris, about more change and
people will be wondering about the interrelationship. Could you introduce the Rebuilding and Regulatory
Services programme, please? It's an update at this stage.

4.3 Rebuilding our Regulatory Services Update

Chris Badger - 1:19:35
Thanks, just as a reminder to colleagues and those tuning in, rebuilding regulatory services
covers a number of related issues which seeks to improve and develop our capability as a
regulator, one of which is around our future assessment approach.
That includes the work that's been going on over the last year on new assessment frameworks
for each sector that we regulate and thank you to the thousands of colleagues across
health and social care that participated in that exercise to get those right and that
work is coming to a conclusion. It also includes how we use data and that's come out of a number
of reports into CQC about the privilege of the data that we hold on health and social
care services but then our duty to use that data effectively to become as good a regulator
as possible and finally and this is when I turn to Dee and Alexia about the
important role around technology to deliver that future assessment approach
and that's in in terms you articulated technology to replace the regulatory
platform and I took on board and have know that the team have been working
really closely on solving some of the problems that you've articulated today
and that's one of our key missions to do that.
One thing I think generally is a working principle on that
is to simplify a lot of our approaches
and that will make things an awful lot easier
both for us but also for providers that we regulate.
So a couple of updates on how we're progressing
with that programme.
We've been working very closely
with the Department of Health and Social Care
as has been mentioned on seeking approval
for an outline business case
and we are in active conversations
and really constructive dialogue
with the Department of Health and Social Care.
On that we've appointed and procured a partner to help us on the technology.
We are working now very closely on a sort of clear plan and phasing of the work that we want to do that crosses both the data approach, the future assessment approach and the technology.
being clear that those must be done interdependently and they were all
contingent on one another with the kind of form follows function mantra running
through that that work is progressing this month so we hope to be able to
share a plan detailed plan in October which will then help in terms of people
holding us to account on on that progress we'll be taking clearly updates
to the regulatory governance committee which obviously subcommittee this board
as well as this board, but clearly we are meeting weekly
in terms of the work on that.
And the final thing I wanted to say on it,
Chair, if I may, is on one of the approaches
we sought to take.
Clearly, previous transformations haven't worked,
have not delivered as was intended.
That's had a damaging impact on
colleagues across the organisation
and indeed providers that we regulate.
So one of the things that I'm driving
as the senior responsible officer
is an approach that seeks to put people that will be using our assessment
approach, our data and our systems at the centre of what we're doing so very
much user-centred design, making sure colleague voice is heard and indeed
securing people into the programme that are subject matter experts that work
operationally and will be using the systems and also can pretty well
articulate some of the concerns and issues that we have now that you raised
earlier that we'll need to make sure we address in the new approach. So a quick summary, chair,
I hope that's sufficient now to answer any questions.
Thank you. Mel.
Kay Boycott - 1:23:16
Melanie Williams - 1:23:20
Thank you, Chris. So we know that we moved to sector-led teams because of the really strong
feedback from providers and partners, and we could evidence that. With the new assessment
framework, equally we heard really strong evidence from stakeholders about the need for that.
and you mentioned this drive, I'm sort of waving over there as if they'd represent all staff,
but this drive to put people at the centre, so how will we have assurance as a board that
Chris Badger - 1:23:44
we've achieved that, what have you got in mind? So I think one of the things on
is regular capturing the feedback as we go, so we're looking to run the programme on a
forgive the jargon colleagues - of an agile approach, which means we shouldn't be afraid to stop and reflect
and if we need to change direction on something because we're getting feedback that says it's
not working, that we do that.
I'm not too proud to adjust course if we need to.
With our overall mission clearly still at heart and that means crucially engaging with
colleagues in the organisation and the sector.
I mean a good example is on the assessment frameworks we're you know already undertaking
a lot of pilot assessments using the proposed assessment frameworks, using inspectors to
do that but working closely with providers on that too to get that too, to get that
understanding right now and looking to make adjustments on that based on that
feedback. I think one of the problems last time that I've heard from
colleagues testing whether it be assessment frameworks or indeed
technology wasn't as comprehensive as it should have been and therefore mistakes
were made I'd rather spend a bit more time on some of this work but get it
right. Pacey of course but purposefully reflective of the need to keep testing
both with sectors themselves and old colleagues.
Kay Boycott - 1:25:05
Chris Badger - 1:25:06
CQC Networks Rep. - 1:25:09
Hi, it's more a comment than a question. It's we hear a lot, I'm sure Dee will say the same
thing with staff that we communicate with, that they are under immense pressure on the front line. I'm not just talking inspectors
on the front line, the cons teams, how will you ensure if they are meant to be
co-producing this new work that they will have protected time away from their
day job so that they're not actually adding to the additional
stress that they're under because I think a lot want to be part of it but
they are so under pressure they don't know how to be part of it because they're not getting
the the support should we say to be free to help with the process.
That's really a really good question. A couple of things that we're doing I just used to illustrate
although we'll need to keep that under review and keep getting feedback about whether we're getting
that right number one when we're looking to sort of seek views and support let's
Chris Badger - 1:26:22
get enough notice in so people can plan in some of its about make sure we don't
have so come we have can we talk to some colleagues tomorrow about it you know
when do we think we know that will be in working to plan that in crucially on the
programme we've got representatives from each inspectorate operationally in people
from different levels operationally in and they they kind of keep our mind on that
and indeed my role is overseeing a significant operational area and I've
just as much desire to get that right as anyone else.
Secondly, we've looked to carve out some subject matter expert roles who are people
who will be working full-time on this who have that operational experience.
They will not be the only source of that insight but they will be able to
guide us and give us that expertise to help us then
engage sufficiently and effectively with colleagues around that while
keeping an eye on the business as usual so to speak.
But we want to keep an eye on that, let's see how we're getting on and we will
need to review that and if we're not getting it right let's take a step back and see if
we can do anything different.
Thanks staff, we appreciate hearing that assurance.
CQC Networks Rep. - 1:27:28
Dr Toli Onon - 1:27:30
Thank you chair and I think it's just a great point you've raised Alexia and aligned to the
query that Mel raised and Chris' response.
Absolutely we need our frontline staff who use this system to design it.
So people like chief inspectors and even directors don't have that same knowledge.
It's absolutely critical.
The people who use it have a key voice in leading the design of it.
And that's why they do need dedicated time in which to do that.
A couple of things I would say in response to that.
First of all, it does have to be specific people who represent their teams.
This is not, like I say this tongue in cheek, this is not a democracy.
It's not one person, one vote.
3,000 people can't design this, but people will represent their colleagues in their view
of how parts of the system should work.
And that's just how a provider would implement an electronic patient record, for example.
Secondly, the discussion we've had about business planning and discussion we had earlier about
our activity targets within that.
We have agreed it's not the most ambitious set of activity targets we could have gone
for but that is because we recognise we have to implement this at the same time
as doing that activity. So you're absolutely right Alexia we can't expect
people to do everything and I think we're being realistic in saying over
this 18 month period it isn't you know the biggest number of target of assessments
we could possibly obtain for because we need to do this work as well. So I hope
that's a fair representation of it and as Chris says we'll keep monitoring that
and thank you Chris for leading this for us because I think you've been really inclusive
with all the inspectors as well and we appreciate that.
Kay Boycott - 1:29:15
Chris, if I may, I've got a couple of questions and I'm sort of using the board privilege
of the, this is a supportive challenge question, but there might be people who are sceptical
out there. I haven't gone back and looked at board meeting recordings from three years
ago, but you might have had a little four years ago, but people will have said, we've
got this great change thing, we've thought about all of this and then we ended up with
Peter Gill report. So what assurance are we getting that's not purely the exec coming in
Chris Badger - 1:29:52
and saying this is how it is and this is going to work? Thanks Kay, yeah that's a challenge
I'm dealing with every day really to make sure we learn from the past but I'm afraid and confident
to move forward but to do that I think seeking an external assurance is really important.
We've had helpful input again from Peter Gill to look at our approach. Clearly the work
with DHSC involves a significant amount of assurance from experts, ranging from technology
all the way through to the finance commercial side of what we're doing. Clearly securing
commercial partners with the more I think approach this time thinking about a much more
intelligent client approach, thinking about a hybrid model where we're looking to make
we take the ownership of decisions we need to own and an assurance framework in the programme
that builds in assurance as we go rather than simply at the end when decisions have been made.
Look the only way we'll show that that has worked is when we deliver that will be there that will be
what makes makes that difference and gives people that confidence all the way through though we need
to build in those checkpoints around seeking external assurance around how we're doing what
we're doing. I think that's what I'm sure comes from colleagues who are going to be
best placed to know what's going to work and what isn't from providers and
they've got that history from the past as well which they can play in.
So I think we'll need to keep that as a process as we go through and I'm really
happy as SIO to be held to account if that's not happening and would welcome
the feedback so that we can make changes.
Kay Boycott - 1:31:29
David and then I'll come with my other one.
No, you go first.
Chris Badger - 1:31:32
David Croisdale-Appleby - 1:31:39
Okay. Forgive me for repeating this because I've said this at previous meetings, but I
constantly hear the fact that from several colleagues, you know, that people on the front
line are really stressed with the amount of work they're having to do, they're having
to do additional work, they're having to do this. The leg of the stool that I never hear
mentioned is what we're stopping doing. I never hear that. That never appears in the
reports that I see. Now, most organisations like ours, as things change and there's no
area that changes faster than the environment that we sit in, then you stop doing certain
of the things that you did before and I don't hear that. I don't want a response now, but
I would just like to make the point that one way in which we could increase the capability
of the organisation as being really quite ruthless about looking for things that are
nice to have, that we used to do, that were important, are less important now, perhaps
not so nice to have, etc., etc.
Because that way we will release this people from this constant fear that I keep hearing
that everybody on the front line is stressed doing this, we're piling on work to people,
we're changing this, etc.
So again, I'm not asking for a response.
I'd just like to make a point, as I've made before,
that that's something that I detect is missing
at the moment in this organisation.
Questions or response?
No, you didn't want to respond today.
We'll go ahead and give you one.
Chris Badger - 1:33:04
So I think there's something about,
some of this is around everyday management
Chris Usher - 1:33:09
and the work that, self, but more importantly,
probably chief inspectors are doing
in terms of discipline and ways of working
and things that don't need to be focused on.
But from a more strategic level,
we have looked as an executive team
around a strategic prioritisation framework,
which we are about to bring in and introduce,
which will be a process for prioritising
all of the work that we deliver,
which will sit kind of underpinning our business plan,
making sure that the work we do
is entirely focused and prioritised.
We haven't had that before, so we do a lot of things,
and we've never prioritised and looked at
through that kind of a methodology and a framework.
So we'll be bringing that in, we'll be looking at that.
That'll create tough conversations, I anticipate,
and things that will fall out of that,
which will probably mean that we stop doing some activity,
or we defer activity, or we delay activity,
but I think we've missed that,
and I think you probably recognise that with the question.
Thanks, Chris.
I may just respond very quickly.
Chris Badger - 1:34:12
I'm very pleased to hear that, Chris.
That's splendid.
David Croisdale-Appleby - 1:34:18
When we finish up with our, I don't know how many, but you know, our list of 14 priorities,
whatever else, the point I would make is we've got to draw a horizontal line at some point
in that priority list and stop doing the things that are below that list.
If we don't do that, then okay, it becomes a priority list, but we still do all those things.
So I think a concomitant of what you're saying is the fact that we look for those priorities,
that then have to take a board decision about where we draw that line and drop the things
below that.
Chris Badger - 1:34:52
Thank you David and just to comment and that's in a changing environment where sometimes
Kay Boycott - 1:34:54
we're asked to do new things as well and we need to be very clear that new things need
to come with the resources to do them or it's potentially affecting everything else. Yes,
Absolutely. I've got the final question Chris. We've spent a lot of time, I mean
whenever you talk about programmes like this and it's not a criticism view, we
talk about frameworks and technology and assurance and there's this sort of big
big beast of a huge amount of effort going on and we've talked quite a lot
about how we're going to make sure colleagues needs are incorporated into
this but I'm wondering how we're going to make sure that provider needs, the end user needs, front and centre,
The dentist who's having a problem with registration or the person who's reported information of
concern and hasn't been responded to, or a mental health provider who doesn't know what
the new assessment framework is going to be, how are we going to make sure they are absolutely
in the room with us and how are we also, because some of them may be watching this, how are
we going to be communicating with them when things are going to get better?
they don't know the ins and outs of a technology programme
or a new framework or anything like that.
Chris Badger - 1:36:12
Thanks, just to break that down,
I think first of all,
we're talking about the future assessment approach
and the assessment framework,
I'd like to reiterate again my thanks to all those
colleagues across the system
that have engaged really strongly with that.
I think when those, when the assessment frameworks
for example come to be agreed,
I think it'll be really clear
what we've heard and what we've done which hopefully will give people confidence that we're really keen to
listen and engage that. When we come up with a plan we'll be really clear
when we think certain changes will come into effect whether it be around the assessment frameworks or changes to
registration and so forth. We'll try and build those milestones so we're clear on what people can expect when.
On certain elements of course I'd reiterate what Chris has said about things like registration where we've made significant improvements
One, I think, bit of discipline we need to have is when we're putting a new, whether
it be a new technology system or a new regulatory approach in, what we can't do is if we see
that we've got an inefficient or poor process now, not replicate that in the new world and
spend money putting that into a new system.
Now is the opportunity to simplify, to reduce duplication in assessment frameworks, and
that's feedback we get because where something is causing us inefficiency,
it's likely causing providers equal levels of inefficiency in a very tight
fiscal environment where people are busy trying to deliver great care. The last
thing they need is an inefficient process from us. So that discipline
around how we meet those challenges both internally and externally has to be at
the heart of what we do and you know one of my goals is to make sure it does that.
Thanks, Chris.
Arun Chopra - 1:38:01
Just to add and for assurance, at a systems level, we are discussing the approach we're
taking to assessment frameworks and how they engage providers at the National Quality Board
later this month.
So we'll be talking about our approach to assessment frameworks and how we bring all
the information together with stakeholders.
Thank you.
Kay Boycott - 1:38:28
Sorry, didn't follow my own rules then.
If there's no more questions on that, I think obviously these are going to be things that
we return to again and again.
And thank you to everyone for the work that's been going on over the summer.
I know a lot of this has been done at pace.
huge amounts of hard work from colleagues in this room and outside and
so thank you. Right, I think it's shortly going to be over to Bola and
we've got the very important quality objectives annual report. I'd like
Bola you to highlight the key achievements areas of focus on what you
think the board should be aware of in this, please?
And you're on mute.
I'd like to.
No, you're back, you're back on, don't worry.
Just to say my wifi is not the greatest,
so hopefully you can hear me.
Thank you, Chair.
I want to first of all record my thanks
to the board and to colleagues across the CQC
for the progress that we are making
in advancing the commitments that we published
in our equalities objectives,
which the board approved late last year.
And the annual report is here to reiterate
what those objectives are, the progress we've made,
and where we're hoping to get to in the coming period.
So just by way of reminder,
you'll find that the objectives actually align
to some of David's updates
in relation to Healthwatch findings,
and also what our staff side and equalities networks have been saying earlier.
First of all is to amplify the voices of people who are more likely to have a poorer care experience or outcomes.
Our second objective is to develop the systems to gather equality data so that we can better understand and respond to risks.
Thirdly, to improve equity by using our actual regulatory and monitoring activities.
And finally, the equalities as it pertains to our workforce
in terms of equity, diversity and inclusion.
And just very quickly in terms of what we've achieved
over the period, in relation to equality objective one,
we have two contract in train as I alluded to earlier,
the public engagement network led by National Voices,
and we further strengthened our experts by experience,
who take part in our inspection activities
to make sure that we are using the insights
from people with lived experience
as part of our regulatory work.
Secondly, the quality objective two is to highlight
that we are now disaggregating the feedback
that we receive from various channels
by population demographics,
so that we know who we are not hearing from.
as David was saying earlier on,
but also to establish the differences in experience
by different population groups.
In relation to Equality Objective 3,
we have developed our population health inequalities
improvement plan, which we look forward to publishing
imminently and implementing over the life

5.1 Equality Objectives Annual Report 2025-2026

of the business plan.
And finally, Equality Objective 4,
we commissioned an anti-racism research
which has fed back and we've put all of the ways that we're taking forward the recommendations
from that research as core work rather than a separate tram line of work because we believe
it's everybody's business rather than a niche project for the CQC in terms of how we become an
anti-racism, an anti-racist organisation. So these are the progress that we've made over the last
period. And going forward, we've set out in the report the specific things that will be
taken forward now under each one of those equalities objectives. We are assuming that
the paper has been read and chair, I'm very happy to receive any questions, observations
or reflections from the, from board. Thank you.
Kay Boycott - 1:42:47
CQC Networks Rep. - 1:42:56
Thank you, Bola. Questions or comments? Yes, Alexia. Thanks, Bola. What are the boards
and executives' expectations for closing the remaining gaps in senior representation
and career progressions for protected groups within CQC?
I think that's an excellent question and you will see that we set out the data and that
Kay Boycott - 1:43:17
CQC Networks Rep. - 1:43:18
whilst we've seen progress, for example, in representation across the organisation in
terms of colleagues from ethnic minority backgrounds, those with disabilities and LGBTQIA, we've
referenced in the report that we do still have some distance to cover in terms of representation
at the executive level and therefore that is one of our key priorities as we go forward
through the life of the equalities objectives that we actually put in place interventions
to make sure that whether it's through the independent voice on our panels, on our recruitment
panels and other efforts that we are going to be making to make sure that we actually
see better and improved representation at senior levels across the organisation as a matter
of priority building on the success that we've already seen in relation to representation
more broadly across the CQC. It's a great question. Thank you.
Kay Boycott - 1:44:18
I think Chris wanted to come in and then Alex.
Chris Badger - 1:44:24
Just to flag that through the People Committee work is coming to conclusion on the new
equality and diversity action plan for which the recruitment,
Diversity of recruitment at all levels, particularly at those senior levels, is one of the key
actions and includes a number of commitments that Bola has just outlined in terms of actions
that we can take.
So, understood and agreed with.
Thank you, Bola.
Alex Kafetz - 1:44:53
This is an excellent piece of work and I know a lot of work has come in tonight and it's
great to see the progress.
I'm looking at page 37 of the pack, I really, please see the priority and an explicit focus
on people most likely to have a poorer experience of care
as we rebuild our assessment approach and systems.
And again, I think this is something as we think
through our data strategy, we can focus on.
And I've made the point before that at the moment,
and we talked about this earlier in terms of Thirlwell,
CQC's strategy at the moment is curating other people's
data being produced by rural colleges,
NHS England, social care institutions,
and using that to prioritise.
and there's absolutely no problem in that.
But there's a discussion for us to have about the right time
at taking that raw data at patient level
and building our own analyses that are right for CQC
with our own right methodologies
rather than using other people's methodologies.
And this would be a key argument
to suggest that we could do that
because national data by its nature
is created by consensus with different kind of
risk adjustment methodologies or whatever.
But if we really wanted to do that,
we could build our own data with our own
kind of statistical analyses that were focusing
on people most likely to have a poorer experience,
which as David has showed us in his work,
that's very different populations everywhere we go.
So, you know, I know we're not quite right to have that,
but I'd love us to have that curation
versus bespoke analysis discussion at the right point over the next 18 months
and this for me would be a key argument why we should start to build our own
Kay Boycott - 1:46:41
expertise in-house. And to provide assurance of that if I may Chair? I think
the microphone is muted. So Bola you go and then Arun wants to come in as well. Thank you
Alex, that's a really important observation. I just want to draw attention to page 44 of the pack.
One of the things that we have done is we've developed our GP metrics on health inequalities
and it is disaggregating our data across the Core 20 plus five framework. And so going forward
in relation to general practise inspections, we are piloting this new GP metrics on health
inequalities to look at the differentials in outcomes by population groups. For example,
how quickly we are picking up hypertension, i .e. high blood pressure, whether that is
being managed optimally. We know, for example, that even though the incidence of stroke,
heart attacks is higher in some of our populations, for example, black communities, they are less
likely to be treated to the optimum level in relation to their hypertension. So we've
We've built in partnership with Esther's team,
who have been incredibly supportive in this area.
We've built the GP dashboard,
and we're going to be building that into
how our inspectors look at the data
before they actually go out on inspection.
That is being piloted over the next few months
with a view as we go forward in the life
of the qualities objectives to mainstreaming
that sort of approach that gives us the sort of insight
that you're talking about there, Alex.
So this is a start, completely agreeing with you
that that is how we must use the data
for actionable insights as part of our regulation.
Thank you.
Kay Boycott - 1:48:36
I think that's it.
Arun, last word from you.
Well, and then me.
First of all, it was just to say thank you
to Bola and her team for the leadership in this space.
Arun Chopra - 1:48:49
It's been really, really welcome,
and it is fantastic that as a regulator,
we're now reaching the point where we're going to be able
to build up our evidence to make sure
that we're hearing from all communities.
So, fantastic, and just wanted to recognise that
and the teams that have been involved in that.
And then Alexia, I think your question's excellent,
and I think one of the things that we will consider
as an exec team is the internal pathways that we have,
such as the successful managers programmes.
We'll have a think about how we can consider,
how we monitor the protected characteristics
of people who are going through those processes.
So thank you for your question, that was really helpful.
Thanks.
Kay Boycott - 1:49:29
Yes, I was just going to say thank you to Bola as well.
So we look forward to seeing that again.
We've got our last substantive item.
We're just waiting for Prem to join us, I think.

5.2 Annual Responsible Officer Report and Statement of Compliance

Hello Prem, sorry we're a little late but we're getting there.
It's okay thank you.
So this is the annual responsible officer report and statement of compliance.
It would be great if you could introduce the report and highlighting any matters that require
board attention and that is apologies I've missed them from the last item.
I'm so sorry. Are we happy to approve the previous report, the Equality Objectives
Annual Report? I'm just looking around. Terrible chairing, terrible chairing.
Right, so because we are being asked to approve the annual responsibility,
Responsible Officer Report and Statement of Compliance. Well, it's gone dark as I've,
as I started to mess up my chairing. I don't know whether that's a statement.
Those of you online won't be able to see that. But over to you Prem.
Thank you, Chair. Can you hear me? Yes. Yes. So I'm Prem Premachandran. I'm the National
Professional Advisor for Urgent Emergency Care and also I'm the responsible officer
for CQC and I'm also currently an Emergency Medicine Consultant. Thank you for thank you
for the opportunity to present the R.O. annual report and statement of compliance 25/26 to
The background actually is this is a statutory report that is required by NHSE and Department
of Health of the regulatory function of every designated body in England.
So CQC is one of the designated body.
Therefore my ask is for the board to note the assurance provided in my report and also
approved the annual R.O report when CEO to agreed to sign the statement of compliance. So it can be
submitted to the NHSE and Department of Health. I think the key message in that report is that
quality CQC remained compliant with the Responsible Officer Regulations and GMC
revalidation requirements throughout the reporting period.
This year end, CQC had three doctors
with a prescribed connection to a Responsible Officer,
that's me, all doctors completed
their annual appraisal requirements,
one positive revalidation recommendation
and submitted to GMC.
There were no missed appraisals, deferrals,
non-engagement referrals, appeals,
or responsible officer concerns. We had a strong assurance of all the
professional governance arrangements as well. We have done several improvements during the year.
I think it's already in the report. I didn't want to go into details, but I just want to highlight
only just one thing. We also have now strengthened our approach to managing concerns about doctors
identified through CQC regulatory activity.
During the inspections, they come across some concerns
about the doctors, because that is a serious
patient safety issue.
The new process is actually, it's been agreed now
to ensure that appropriate concerns are revealed
through main responsible officer function.
And if it's necessary, I will discuss with the GMC
relevant responsible officers as well because before it's a direct referral from CQC to
the GMC that has got serious or some haphazard, not the request being not been properly managed.
So now it's all come through me.
So it has a more structured process.
So it won't be anything missed actually.
For the looking ahead, I think we normally use the NHSE medical appraisal policy, but
now the NHSE is merging with the Department of Health.
I want to develop a CQC specific medical appraisal policy and also want to have some external
peer review.
That's usually it's, it consolidate our activities.
peer review to our appraisal evaluation process that's already on the on the card
so that's one of the things I want to do this one and also strengthen our EDI
monitoring and assurance with professional standard process so that's
another things I want to make it more robust in the next year. So in conclusion
I'm able to provide substantial assurance that CQC has an effective
system and control in place for appraisal, revalidation and professional governance and
no material compliance or governance or concerns identified during the 2025-26.
So my ask is to the board to note the assurance provided and approve the annual
Responsible Officer Report of Statement of Compliance and support the
the identified improvement I have suggested for the next year. Thank you. I'm more than happy to
Kay Boycott - 1:55:21
answer any questions. Thank you Prem. Thank you for a comprehensive report. I'm seeing a lot of
nodding heads so if there are no questions are we minded to approve that. I think you were asking
and then Arun will sign on the organisation's behalf. Yes. Well thank you for your work on this Prem,
and that is approved. Thank you very much. Thank you very much. Thank you.

6.0 Any Other Business

And with that I'm going to move on to any other business. We have had three questions from the public.
One of these questions which is when CQC inspects GP surgeries how do
inspectors assess the availability of GP appointments for patients. This was asked
previously and the material position is unchanged so we would direct the questions for minutes from
the June 2026 meeting. And then we have a couple of questions around mental health which I'm hoping
Adrian will be able to answer. So the first one, when CQC inspects secure mental health hospitals
how do they assess the systems for discharging patients who have been sectioned? Thank you chair
and I speak not only as Chief Inspector of Mental Health,
Adrian James - 1:56:33
but I'm a forensic psychiatrist myself.
And this is really important to primarily patients.
Patients want to know when they're going to leave hospital
and what the plans are,
but it's also important to systems
because by discharging patients efficiently,
we can admit new patients.
So this is of overwhelming importance.
So first of all, we would look at board papers
to see what the policies are around discharge. We would look at data, so we would look at
things for example around delayed discharge and length of stay that are relevant. I think
most importantly we would ask patients when we visit wards, we would ask them are they
aware of their discharge plans? Have they been involved in co-producing plans? Because
these plans shouldn't be placed before patients, they should be drawn up with patients and
My view is that discharge plans should be drawn up the day the patient comes to hospital,
not at the point that they are about to be discharged.
We would also speak to teams and we would look at care plans to ensure that there is
a discharge care plan for every patient.
We contact care coordinators who are in local areas who will be in contact with patients
to make sure they are in contact.
We also speak to advocates to ensure that they are aware of systems and processes and can advise patients.
In the mental health world we not only do the inspections around ratings but we do specific inspections around the Mental Health Act.
And within the Mental Health Act under section 117 there is a duty to provide aftercare for all patients who have been detained.
And that includes discharge planning.
So we would look at the 117 aftercare arrangements,
the details of those plans.
If there was a 117 meeting that was occurring
during the inspection, we would attend those meetings
with the permission of the patient.
So this is of overwhelming importance
and we look at this in a variety of different ways,
putting the patient at the centre of all that we do.
Kay Boycott - 1:58:51
And apologies for those watching, we started a little late so we're running a couple of
minutes over, but another very important question which is how does CQC assess the performance
of mental health trust provision for treatment of young children and adolescents?
Adrian James - 1:59:05
Again a really important area and the data shows that there are more children coming
forward for treatment and the system is responding but is certainly under strain.
So again first of all we would look at board policies around what treatments
are available, what services available for children and young people, what is
their data around for example waiting lists but also the numbers of people
receiving treatment, what are their policies around implementing evidence
based practise. We would then look on the ground, most importantly again asking
children and young people but also parents to ensure that people are
receiving the treatment that they need. We would look at care plans to ensure
that there is evidence-based treatment that is going on. We would also, we would
look at advocacy and again ensuring that they are involved in making sure that
children and young people get the care that they need and that it's evidence-based.
CQC also have a national children's team and there's a very important link to
other regulators such as Ofsted because in a world where we are moving treatment
into for example mental health support teams in schools it's important that
Ofsted have a look at that. And moving forward we're being proactive as an
organisation, we're involved in the development of modern service frameworks.
They will set the standards going forward for what treatment everybody
should receive. There's a modern service framework in relation to children and
young people and one involving serious mental illness. I co-chair that and that
actually dips into children and young people's services
to ensure that there is seamlessness between transitions.
So we're actively involved in drawing up standards
going forward and ensuring that as a regulator,
we can go in and monitor the delivery
against those standards.
Thank you very much.
Is there any other business?
Kay Boycott - 2:01:26
Thank you for bearing with us.
Apologies for running a little bit late because we started a bit late.
Thank you everyone for your contributions today.
A lot was covered and we will see you at the next public board,
which is on the 24th of November.
Thank you.