February Board Meeting (Wed, 21st Feb 2018 - 11:00 am) 

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Apologies and Declarations of Interest

[Mr Peter Wyman - 0:00:00]

Right, a good morning everybody can we get started please, so Sir Robert can get started thank you. Great good, so welcome everybody to the February Board meeting and we have an apology from Lewis, is there any matter anybody needs to declare an interest in

Minutes of the meeting held on 17 January 2018

Matters Arising and action log

before we go any further? Okay that’s good, we have the minutes of the meeting of the 17th January are they a true and accurate record of all we discussed? Excellent thank you very much we will approve those. On the action log there are various
things either already dealt with or on the agenda the today, the only one that isn’t is the report on enforcement and that’s coming to The the RGC next month so I think everything on the action log is okay, agreed. Was there anything arising from

Work of the Health Safety Investigation Branch

the last set of minutes that anybody wanted to raise that isn’t either on the action log or otherwise on the agenda? Great, good so we then move to the work of the Health Safety investigation Branch and and Keith a very big welcome to you,
thank you very much for coming this morning we are obviously extremely interested as a Board to understand how you see the branch developing and working and the interaction with us so thank you and can I just hand over to you please? Yes of course,
thank you very much and good morning to everybody. So I just want to give you a sort of a five minute overview of the background of the HSIB the Healthcare Safety investigation Branch and what we are currently upto so we really have one aim
that’s to improve patient safety by getting the most out of learning from all the incidents that take place and there’s four ways I think that we are looking to achieve that, we want to introduce safety investigations that don’t apportion any blame or liability, we
want to raise the standards of Local Trust investigations and overall what I would like to do is to try and professionalise Safety investigations so that we’re introducing if you like the art of Safety investigations as a discipline in its own right so looking at
full time fully trained safety investigators that’s what they do it’s not in addition to a day job, and fourthly I guess the output from the investigations will be public reports and safety recommendations and in my view the vast majority of the safety recommendations that
the HSIB will make will go to the national bodies the idea is that they aren’t made to the local trusts we are looking at going to a professional regulators colleges perhaps even the CQC. The way we will go about this is that anybody can
make us aware of an incident that they may think that we would like to investigate we have a website where we have publicly stated what our criteria are for investigating and very briefly there are three criteria will there are four, the event has to
have happened after the 1st of April ‘17 when we kept became operational, secondly there has to be harm or the potential for very serious harm, thirdly there needs to be an underlying systemic issue to make it worth us looking at it, we’re not interested
in a single event, in a single trust that isn’t potentially replicated elsewhere, we’re looking at systemic problems and fourthly we want to make sure that we can add value there is value in the HSIB during the investigation where only funded for up to 30
a year so we need to pick and choose fairly carefully where we place our resources and it is important that to understand that we are not replacing anything else in the system we are in addition to the local serious incident investigation and whatever else
may be going on and we might not necessarily be the only investigation in town. If I just comment onto that, we don’t apportion blame as I said it’s a fundamental part of our type of safety investigation that we don’t apportion any blame or liability
and we see ultimately a change in the culture by looking at actually what could the system have done to have prevented this issue happening not what an individual could have done to change it and what we also bring is through our investigators is a
wide variety of background so there are clinicians, there are engineers there’s even the odd pilot or two but in particular we’ve got a lot of focus on human behaviour so we have a lot of human factors specialists to look at the behaviours that perhaps
led to the incident taking place. So that, if you like you are the principles with which we work we have undertaken so far, I think we started 10 investigations we’ve published five or six Interim bulletins to date we haven’t got as far as a
final report as yet and we will continue making Interim bulletins until we get to the final report stage. The other thing just to add is that we’ve also been asked by the secretary of State to undertake some maternity investigations and I think we need
to recognise these are different type in investigation but only in the size and scale the basic principles will remain the same they are not investigations to apportion any blame or liability. But what we have been asked to do is to investigate all the incidents
that currently the each Baby counts criteria apply to so that tends to be babies that at term are still born or there are brain damaged or this is recognised or they die within seven days of being born and we’ve been asked to do all
those investigations in England so last year that would have been about a thousand investigations. So that’s quite a big change for us to try and take on this work so we’re working up to start this work as of April/May this year and we will
start to roll out teams in various parts of the country to undertake these investigations now these are are the same principles but one of the big differences is that these will replace the Local Trust serious incident investigation and so the recommendations from these each
investigation will be into an individual incident and so there are more likely to be recommendations at local level and then we will use the National HSIB to aggregate some of the findings some of the data and then look into some of the the the
themes from that into some of our larger national investigations so hopefully that gives you an overview of the type of work that we are looking to do in the future. Thanks Keith, I mean it’s really interesting because your role and ours are very different
but there is a massive overlap in the objective of improving the safety of services through learning from what’s gone wrong in the past and how things can be improved so I think hugely welcome the fact that you’ve been set up and that you’re here.

[Sir Robert Francis QC - 0:09:07]

Does anybody want to raise some questions? Robert please. You being set up and the question I have is this, the techniques that you described which include in my view a very welcome focus some no blame but also human factors and systemic explanations is something
that clearly you will be deploying in your maternity service, single incident investigations as well as your national level ones, how would you suggest that those skills get applied more readily assuming it is thought that they are good skills and I believe they are to
the wider range of investigation that is currently undertaken often internally by providers some would say often without those skills and without the resources to have them. Well I think first of all we are still in a development phase as we actually work out how
our techniques actually go down in the various settings and I should say we are not just in into acute care, we will be looking at primary care and anywhere where NHS money is actually spent within England but I think as we develop the model
we are working with higher educational authorities to actually help with the training, we’ve been working particularly on maternity with various maternity units to understand how again we can get the training in what we do in the process and the methodology and I think once
we’ve established that the aspiration is that we would have, publicly we could explain how that works, what we do and then we could encourage the local Trust to follow the same route and potentially we could even work with higher education providers to actually offer
various training packages that meet the same standards that we are setting ourselves because I think if we’re going to professionalise investigations having that dedicated training, not just a day or two but a dedicated training courses is fundamentally important. Keith thank you very much for

[Professor Edward Baker - 0:11:35]

that. I very much welcome your leadership and the HSIB’s leadership on improving investigations when things go wrong in healthcare it’s something that I think healthcare generally has not got right, making sure that we learn when things go wrong and make changes for the better
and this is a great step forward so we look forward to working with you going forward as Robert was indicating I hope this will be the beginning of an improvement in investigations across the board and you will be seen as exemplar that everyone could
learn from we have been critical in the past about serious incident investigations that we’ve observed in Trusts and there’s plenty of room there for Trust to to improve their local investigations and I hope they will be able to learn from your investigations in doing
that that but I suppose what I really feel this is about, is about changing the culture of the NHS or healthcare should I say because it’s not just an NHS problem and moving away from the very defensive culture when things go wrong to a
culture of openness transparency where there isn’t incrimination but there is a genuine desire to learn and improve services and use if you like the things going wrong as an opportunity to drive for safety improvements rather than see them as a threat to the system
so I hope we can be both be part of that change of culture going forward. I absolutely agree and I think by demonstrating consistently that actually this is what we do that we are sensitive with information that is given to us and that we
do actually get the most out of an incident without apportioning any blame or liability time and time again then slowly we can achieve the same culture change that you want to do as well. So Liz and then Andrea. Yes I just want to really

[Ms. Liz Sayce - 0:13:19]

build on what Ted asked. So I mean, I think from the point of view of individuals and families who are affected by these safety incidents, two things particularly matter often, one is accountability and I think that you know, that’s not what your part of
the whole system is going to be pursuing and the other is that kind of sense that you just don’t want this to happen to somebody else and that’s the point that Ted was making about real learning so you know it’s not enough even just
for somebody to be found accountable or people to be found accountable if the learning doesn’t actually happen and I suppose that, and we know that people, that learning happens better in that environment where you separate that out from the processes of accountability and justice
etc. where people feel they can speak openly and really learn not defensively. But I just really wanted to ask you how you think that your findings will help feed into that culture change, so you would be producing the reports, what might you be able
to do perhaps working with others to make sure that that learning really gets embedded and taken up? Well I’m pretty new to the whole system but I’d like to think the fact that we’re making recommendations to the regulatory bodies to the national bodies will
be quite a difference from perhaps what’s gone on before and I understand a lot of the local investigations can only really focus at the local level I would like to think we are not going to go down that route as I say I think
very rarely will we make recommendations there, but if we can make recommendations to people like the GMC and go actually have you thought about this, you know what about this area and try and focus the attention there, I think there is more potential to
make changes that will actually stay and they are not short term,

[ Andrea Sutcliffe - 0:15:22]

short gaps. Thank you very much Keith and it was good to have the presentation and really welcome the idea of making these investigations more professional. I remember doing them as a jobbing General
Manager 20 years ago and it doesn’t feel like things have moved on since then, so it will be good to have that. Just picking up on the point that you’ve made which is that your powers extend to anywhere where NHS money is spent in
England which does of course include adult social care services particularly in respect of nursing homes and I’m not sure that that’s wildly understood in terms of that reach that you’ve got so I think that there’s two important things for us, one the joint working
between our organisations is not just kind of through the hospitals and primary medical services directorate but with Adult social Care as well and recognising our independence, both of our independence because as a regulator we’ve got criminal enforcement powers to take into consideration when harm
has happened as well as kind of what you want to do around learning from that. But also to make sure that we’re making the connection with local authority safeguarding and the reviews that happen there when when things go wrong so it’s just to kind
of flag that up and to emphasise the point that you will have that reach into Adult social Care which as I say I don’t think most people really understand. Yes and actually it’s worth emphasising, we are really trying to develop our techniques I think
as I said earlier and we would welcome more people making us aware of different events in the different settings so that actually we can test ourselves and see do our techniques work in all these different care setting so our website has the opportunity for
anybody to raise an issue with us and I would really ask people to do

[Mr Peter Wyman - 0:17:20]

that. Thank you. Keith, I think it is really really interesting as I said a few minutes ago I mean I think we have an overlapping objective around improving quality and
safety so, really interesting and I hope that we can not only just continue a dialogue with you but if there are things that we at CQC can do to help you as you establish and develop please feel free to come back to us at
any time I am sure we would all try and help if we can. Unless anybody has anything else, David do you want to add anything? No, Keith and I

[ David Behan - 0:18:06]

have met on a number of occasions since he came into post and I think the
theme of the meeting is just how important that relationship is. We’ve got as Andrea was saying a an independent role that we need to play where we do have some investigative powers when the organisation that Keith now runs and leads was been set up
there was a debate about whether that should come to CQC if you remember the decision was taken no it needed to be independent of CQC for the reasons that Keith has set out and I think there were the right reasons but this interface I
think between what Keith and his team’s all do and what we do is an important one and we just need to keeep the right distance I think in relation to this and work at that relationship and I think I’d be confident we can continue
to do that just by continuing to talk on these issues we can do a memorandum of understandings and all those kind of architectural things but actually the most important thing is the conversation. I think the other thing I’d pull out and Andrea in a
way touched on this which is a number of our inspectors needs to deploy investigatory skills and as Keith begins this journey to professionalise investigation I think we need to be open to the learning that we can take as well so I say the relationship
is being completely reciprocal in that sense. I think the learning that can come out of this can help people that are running and delivering services but I think those of us have a responsibility to scrutinise from the outside services can acyually learn together how
to do that as well so hugely important and I’m just really pleased to see Keith now got 10 investigations under way and beginning to get that product underway and I think it’s a great achievement and something that we need to keep close to him
on without each other crowding out each others space and just getting the appropriateness because there will lots of people that will have a view on us getting too close and too far away and I would have a view on that quite frankly we need
to just to curate that in the best sense of curating it but well done to Keith for the work that he has done to date and commitment from us

[Professor Edward Baker - 0:20:26]

to work closely with him. Ted you wanted to come back? Can I just come back
just one other comment, we were doing a review of never events a as you are aware and we are focusing very much on what appear to be barriers to implementation of guidance and I think there is an issue which I’m sure you’ll come across
with your investigations is that there is a lot of guidance out there but actually reliably making sure it’s implemented on the ground is sometimes a real challenge for the system and we are trying to explore through our never events review why guidance isn’t always
implemented effectively and why never events continue to occur and I am sure this would be a theme that comes through some of your investigations as well and I would be keen to hear your views on it as you take forward investigations. So Keith thanks

[Mr Peter Wyman - 0:21:16]

again, you are very welcome to stay for the rest of the meeting, I think though you said that you have other things you probably ought to be doing so we fully understand if you decide, riveting though our meeting is, you need to do something

Chief Executive’s Report

else, but thank you very much for your time and every success in your endeavour, thank you. David we need to move on then to your report please. Thanks, so the performance report is covered separately where we’ve got the quarterly report to the board so

[ David Behan - 0:21:55]

I’ll not touh on any of that during this particular briefing. Paragraph 2 really does pick up the learning from when things don’t go as they should do and go wrong in a sense and draw attention to a Mendip House and the fact that there’s
been a serious adults Review, safeguarding review published and produced on Mendip House which I’m a I think the Board members would have seen in the media we have welcomed the review, published the statements by way of response and we’ve also, since the incidents that
led to the review, have change the way that we’re registring some of these services which the Board have taken close attention to as that’s been discussed and debated and then agreed as a position statement so there are things that we need to take away
as safeguarding adults Review suggested that the responsibility and accountability for what went wrong needs to sit with the provider but I think we are also reflecting on the findings from the report about whether we acted quickly enough and Andrea and the team will continue
to take that into account learning was also one of the themes that came out of the Kirkup review into Liverpool Community Healthcare Trust and I will pick this up with the next item Peter which is the review of the fit and proper person regulations
if I may. So what we’ve tried to do in this report is just reflect on a Dr Bill Kirkup’s report he was commissioned by NHS Improvement to look at the Trust not trist, apologies for this, it probably was a trist as well actually, but
the oversights of Liverpool Community Healthcare Trust I’m from a period 2010 onwards in his report Bill made and I think it was 10 recommendations a number of them are directed to us but they are also directed to NHS Improvement and NHS England in considering
those recommendations we’ve accepted all of those recommendations and will respond to them some of that response will be done jointly with other agencies I think he’s deliberately given them to, as Keith has just been taking us through a lot of these recommendations are not
to the local services to the national agencies about the oversight which is I think one of the themes that Keith was developing. There is a specific recommendation, there are specific recommendations to pick up on, a fit and proper person a regulation which is directed
at the Department of Health and I would like to comment on a on that if I may Peter, the recommendation talks about CQC’s fit and proper person test and I just want to make what seems to me to be a pretty important point that
we don’t have a fit and proper person test what we’ve got is a regulation which was agreed by parliament which was proposed in response to Roberts report when he produced his report on Mid Staffordshire in 2013 just over five years ago now we, and
I think one of the issues in Roberts reports is and I went back and reminded myself of this when Bill Kirkup’s report was published, here it is, just in case you don’t know what it says on page 109 Robert, but the serious point is
on this issue of fit and proper person I think you should speak to this, your recommendations were about the development of a code of conduct about having some code of ethics, having some standards which people should support in the delivery and you raise this
question of whether there should be a register and I think the regulations that were passed that we’ve been operating in we’re based on your recommendations but this stops short of those full recommendations and what we were left with the responsibility which is placed on
trusts for trusts to satisfy themselves that their appointments are of people who are fit and proper and the CQC role was to assess whether the trust had applied that regulation in the way that they operated. I think there is a narrative that says that
CQC should actually determine whether people are fit and proper and whether that determination should then result in whether they should be able to be employed in other places. I understand why people would say that but that’s not the regulation that we think we’ve been
given to operate so when Bill Kirkup’s report was published the Minister for State for Health, Stephen Barclay made a statement to parliament and in that statement he talked about a review of again CQC fit and proper person test and as I say it’s not
CQC’s test it’s a regulation that was agreed, proposed by government and agreed by parliament but what he did talk about was a review that will address the operation and the purpose of the fit and proper person test and I think that scope is important
so I think the purpose of the test is an opportunity for the review to consider whether the response to Roberts recommendations and the regulation that we’ve been operating in is the scope that people want to see. One of the issues that came out in
the Minister’s statement to Parliament that day was around an individual moving from the NHS in England to another part of the NHS in the United Kingdom it is this sense of people who are seen to fail can they go somewhere else and that should
be employed by somebody else which is akin to some of the issues which I think that sit behind the idea of a register of do we know where people are? Can they be struck off? and I think it is true to say that part
of the tension we’ve been operating in Peter is this issue about the people that wanted to see a register where people could be held to account and that would include being struck off the register and what it is that we’ve been asked to deliver
through the application of fit and proper person regulation and that’s a bit about scope I think there is something that we as an organisation need to be open to which is the operation of the regulation that we have been given to operates and again
I think there is an important issue about whether we’ve operated that regulation or in way that has been consistent my personal view is I think we, that is exactly what we’ve tried to do the Board will know that since a regulation came in 2014
we’ve carried out a review of our implementation in 15/16 we’ve had action plans to improve the way that we’ve implemented it we’ve undertaken work to more carefully and clearly define serious management and conduct and in the summer of 17 we published a new consultation
document that went through how we could strengthen that approach and then in January of this year we published our new guidance which really had strengthened definitions about serious mismanagement and conduct which was based on our learning from what effectively two and a half years
of applying this test, we didn’t know when we published that guidance that Bill was going to publish his report in February or make the recommendations that he did but I think we genuinely welcomed the fact that another set of eyes, other independent person would
come to look at the fit and proper person test which is I think why we’ve welcomed the test, the review that was announced by the Minister we will co-operate fully with that to the best of my knowledge there’s been no announcement yet of an
individual that will lead that that work, so that’s obviously something that is still ongoing within the Department of health but once that person is announced then we will seek to work constructively with that person. The bits that I want to stress Peter is this
important issue about scope this has been contested territory since we started on this regulation and trying to settle this will be incredibly welcome for all of the staff in CQC that are trying to implement this but I also think as an organisation we should
be open to a further reflection on the way we’ve operationalise this, as I say with good intent we’ve tried to do this in both the spirit and the letter of the regulation but again having an independent review in the way that we’ve operated I
think we should embrace that rather than actually be concerned and worried about it and that will be the mindset that I would want to

[ David Behan - 0:32:18]

take. There is more in the update and I’m sorry it’s in two paragraphs I think I probably should have overseen
drawing this all together in one paragraph rather than two a the responsibility for that rests with me but I think the key point is a really about the substance of the review and how we should position ourselves with it. Is it worth just pausing

[Sir Robert Francis QC - 0:32:41]

at that point, I don’t know whether Robert wants to speak on this? Well, I’ve got to haven’t I, being five years to the month that my report was published and all the recommendations that David has mentioned were said to have been accepted and can
I say I have never felt any proprietary rights in relation to how any of those recommendations or any of the other recommendations for that matter should be implemented because implementation is always in a sense a much more challenging business than making the recommendation in
the first place. One point perhaps David didn’t mention was that amongst those recommendations and that group of recommendations was the idea that if the fit and proper person test or regulation was to be used that its operation should in fact be kept under review
in effect to whether it was an adequate answer to the concerns that were raised in the report so for that reason and in addition to the fact that it is well known that many people have not been satisfied rightly or wrongly with the way
in which that regulation has worked, I welcome a review at this time I think it’s the right time for such a review there’s been experience since my report which can inform such a review and what the outcome of that is will be anyone’s guess
but clearly is the right thing to do at this time. Alright, thank you

[Mr Peter Wyman - 0:34:13]

[ David Behan - 0:34:18]

Robert, David back to you. Thank you, and then the remaining paragraphs of the report are really updates, there’s been a lot of media publicity about and speculation in relation to the
future of Four Seasons Healthcare and we’d previously briefed the Board on the engagement that the Market oversight team have had with Four Seasons Healthcare and some of this material in these short paragraphs was in the public domain in that second week in February and
I have just repeated it here Peter. Basically this is a group which is going through a restructuring, there’s certain milestones in that restructuring which we’ve laid out in the report and Stewart Dean the director of market oversight and his team are along with Andrea
are all very carefully and closely engaged, some of this work remains confidential which is why, commercially confidential, which is why we don’t want to say a lot in the public demand but this is all information which is now public so we can repeat it
. The opportunity here I think he’s just to a state how important this work is and just how engaged the Market oversight team actually are in relation to this and it, I suspect can be anticipated to be further publicity in relation to this as
we get up to some of these milestone which are set out in the report in March/April and then again in June. And then paragraph 5 I want to just draw attention to some important work again which is underway within the organisation in taking forward
the local system reviews Steve and Andrea are heavily involved in participated in these reviews themselves but we have teams on the ground, very very good changes in my view that are leading this work and this week we’ve published reviews in the, well in past
few days we’ve published reviews into Bermingham, Coventry and no let me get this the other way around, we have published some of the reviews into East Sussex, Plymouth and Oxford and we’ve got reviews which have been underway in Liverpool this way but just completed
Birmingham, Coventry and Bradford reviews. I think the significance of this work is just the importance of some bits of the oversight system, in this case so it’s us able to look at the system I think as the focus and reorganisation of the NHS in
particular begins to look at the way systems operate at a local level, this is hugely important work hugely important work for CQC both now and in the future and we will continue to complete these reviews and I think we’re on schedule to do that
by the spring with a view to publishing a report in early July on the outcome of the reviews and the learning that can be taken as I say I think one of the key issues is the importance of that oversight of the whole system
and no other organisation is doing that and we are uniquely placed to be able to do that. And then in paragraph 6, I am really drawing attention to three reports we are going to publish over the next few days, one on children and young
people’s mental health services which is due to be published on the 8th of March, a report on mental health rehabilitation units and then our Annual report which will be later this month on the operation of the mental Health Act. Thank you Peter. I think

[Mr Peter Wyman - 0:38:17]

David, just listening to talking it just reinforces just how many of our people are doing some really great things and it is just worth noting and thanking them here I think that the market oversight team are like privy to some of the work they’ve
been doing, been phenomenal in what they’ve been doing recently the local system reviews have been really superb and the teams involved in those have been excellent and the reports that we’re about to publish along with reports that we’ve been publishing over the last few
months again are all really good so I think just a big thank you to everybody that’s involved in all of those as well as the other activities that aren’t in your report today but often arise. Is there anything anybody wants to raise in relation

Performance Report Q3

to David’s report? Wow, right good. So on we go then, Walter to the performance report and you won’t get away quite that lightly I don’t

[Mr Malte Gerhold - 0:39:15]

suspect. Thank you very much Peter, in a moment I will let Kate Harrison Director of Finance talk to the
budget over the last quarter and my Chief Inspector colleagues about the the operational performance let me focus specifically on the points around our business plan at our risks which are included in the report and in terms of the deliverables that we set out in
the business plan for 2017/18 I’m quite pleased to report that the majority of them is on track, there is one that is rated amber at the moment because we have to change the delivery timetable for the development of the provider information collection for adult
social care services which is a core part of the beginning of the changes that we are making to how we use digital systems so while we’re behind on that it’s an important thing to get right and we continue to have conversations, of course with
the sector about how and when we roll this out. Secondly we have reviewed the current risks to the organisation and wider delivery and there’s no changes to the risks that are set out in the business plan there are currently no high risks listed and
finally we continue to track and monitor the progress that we are making on any recommendations made by internal auditors through the accountability and corporate governance committee which is chaired by Paul Rew and where we have made progress on most of these but with a
focus on a number of actions that were flagged by Internal Auditors is high priority but that as you can see in the report are currently being actioned so there’s no things of recommendations that were not following up though there are two or three things
were the time it takes for example to make some of the changes to a governance or the benefit realisation simply takes time to develop properly which is why these sections haven’t been closed and quite rightly so until we are confident. So those are the
issues I wanted to highlight from that perspective. Kate I will hand to you on the budget. That’s Fine, thank you Walter, just briefly, we at the end of Quarter 3 we were underspent, had a net surplus of 8.1 million which is made up of
an underspend of 10.2 million offset by an under-recovery on income. We are forecasting we still are forecasting beyond quater 3 a surplus of around 10.2 million that’s largely on pay although some still on non pay due to the continued drive of efficiency in the
non-pay area and linked to that is that we and colleagues in the people Directorate are moving or have moved to and always on recruitment model so next year we are hoping that that will enable us to have a steady stream of people coming in
and that we’re not underspending on pay and just to finish off on that, any underspend that we do have will be taken into a reserve that will be held by CQC and used for the benefits of fee payers, I think that’s all on the

[Mr Peter Wyman - 0:42:26]

finance. Any questions on that for Kate? John. A question for Walter

[Mr John Oldham - 0:42:36]

if I may, I noticed the distribution of ratings has remained static, maybe not necessarily yourself but maybe colleagues who chief inspectors, is there a census to why that is or is this just
part of the normal distribution over a period of time? Should we pick

[ Andrea Sutcliffe - 0:42:55]

that up as we go through the comments that Chief Inspectors are going to make on the performance report and if we haven’t answered it properly then you can come back to us

[Mr Peter Wyman - 0:43:03]

John, would that be OK? Because it’s not an insignificant point so, we will do that OK. So don’t let us forget John. Alright, sorry Paul?

[Mr Paul Rew - 0:43:19]

Sorry can I ask one question on the of risk register, apologies on strategic risk register which is on the
last slide, I think I’ve got it here, Kate I think this is one for you probably, there our 14 we are unable to reduce our costs in line with reduced budget or fees that are not received in a timely way the confidence level seems
to have gone down and I was perplexed by that because we seem to be, we are reducing our costs we are underspending if anything, I just wonder what the, whether there was an issue there? I don’t think there

[Mrs Kate Harrison - 0:44:08]

is an issue, I think its
recognition of the fact that we need to, we still have a need to reduce expenditure next year in year so we get down, we will have a budget of 223 million next year the following year we will have a budget of 217 million so
we still need to take money out of the system and we need to obviously achieve quite a lot of change as well during that period in investments so I think it’s just in recognition of that. When you look at the underspend, is that a
reflection of timing of spend or is it a reflextion of absolute efficiency if you like. I think some of it, as I said the pay underspend is very much due to recruitment hasn’t gone as well as it might have done we’ve had, there are
timing issues there has also been SPA usage etc that we have maybe over budgeted for. In terms of the non-pay, I think that is a continued drive in terms of efficiency, getting better value out of contracts, keeping a good handle on what we are
doing in terms of travel and subsistence etc so I think it’s a

[Mr Peter Wyman - 0:45:29]

[ Andrea Sutcliffe - 0:45:35]

combination of the two. Okay, so Andrea? OK, so each of the chief inspectors is going to comment on the performance report from our perspectives and there were four points that I wanted
to raise from a registration and Adult social Care point of view just to highlight the issue and what we’re trying to do about it. So on registration you will see from paragraph 5 and slide 5 that activity has been increasing by an increase of
10 percent the first nine months of this year compared to the first nine months of the previous year and despite that increase in activity we have improved our timeliness from 79 percent last year to 84 percent this year in terms of our target and
that is absolutely down to the hard work of staff really really trying to make sure that they are doing things as quickly as they possibly can but as effectively and as thoroughly as they possibly can, but we do need to do more to get
to the target of 90 percent which is the key performance indicators target that we’ve got and key to that is the Registration transformation programme which is looking at three things but two things that will impact on this. The three things are, one, changes in
policy which fit in with our strategic direction but also to streamline our processes and procedures as well as taking advantage of the digital developments to improve our efficiency and those things are starting in this year but we will see them going into next year
and hopefully beginning to have some benefit as we move forward. The second area was on unregistered providers and in response to the questions that Board members raised last time we provided a little bit more detail on unregistered providers and as you can see we’ve
had over 1000 reports with nearly 600 requiring an investigation as a management review, many won’t actually require that review because it’s blindingly obvious that it’s not a regulated activity and there are some interesting things that people do refer to us as unregistered providers which
actually have nothing to do with adult social care or health services in any shape or form. But of course there are some that do and the issue for us is that we don’t have the, one of the things that board members wanted to know
was what were the services that were coming through as unregistered and therefore where was the risk, clearly if they are not registered they are not on our register so you don’t have the information in quite the way that that we have for services that
are registered. So we’re giving you an indication of the percentages of the types of services and what you could see is that the majority are in the healthcare community services area with a substantial number in Adult social Care on the community side as well.
The issue for us I think is that this is activity that is increasing both in terms of people referring information through to us and those referrals being areas that we’ve got to do work on and so we are looking as part of the whole
registration transformation project at how we can better record what were doing so that we can reflect that both on our workforce planning and management of the activity but also so that we can report that better to the Board in terms of what we’re doing
and what the outcomes are, so there is more work to be done on that one. Sorry to interrupt, is there also a communication issue here, I

[Mr Peter Wyman - 0:49:10]

mean both that there are people reporting unregistered activity when actually the registration is required, so they were missing
form but I guess that quite a lot of those people who have carrying on services that should have been registered aren’t, ahve done that in perfectly good faith they just didn’t realise that they were doing the registered activity. So is there a communication process

[ Andrea Sutcliffe - 0:49:32]

we need to be thinking about as well? There is indeed and I think that one of the indicators of our improved profile is the fact that we’ve be getting increased numbers of referrals. Two or three things that we’re looking at on that, one, a
very particular issue is what are either local authorities or Clinical Commissioning groups doing in terms of commissioning services from providers that should be registered with us and may not be registered with us and making sure that that check at that stage is happening in
a way that is appropriate and so the work that all three of our teams are doing with colleagues in the health service and in local government to ensure that we’re sharing information and sharing risk and all of those kind of things is a really
important part of making sure that that happens and I think the other thing is being just clear and work is happening on what our website looks like and what information is there, being clear about what is a regulated activity and therefore what people should
be identifying as either they are going to be doing it so they should be registering with us or indeed people are seeing it happen and it needs to be registered with us so you know Chris Day as our Director of engagement is very cognisant
of all of that and taking that forward. Shall I move on? Yes please. Okay so I then wanted to move on to inspection which is paragraph 7 and slide 10 and just to highlight that we and this kind of comes a little bit to
what Kate has been saying about the impact of our vacancies on the expenditure that we’ve had but also obviously it impacts on our ability to deliver on our activity and in Adult social Care we’ve been at 87 per cent of our inspection establishment and
although I have to say people are working extremely hard to deliver on our inspection commitments we’re actually only 85 percent against 90 percent target of inspecting within those published commitments. But what I’d want to kind of assure the Board about is that we are
focussing our activity on those services that present as a risk either because we have already rated them as inadequate or requires improvement or because of the intelligence that we’ve had from staff people using services notifications that we get that suggest that we should bring
forward our inspections and managers have been working very hard with the recruitment team and paid tribute both to Ruth Bailey’s team in the people Directorate but also to my managers for the amount of work they are doing to try and make sure that we
get ourselves back up to full establishment and that we recruit into next year so that we can improve that possession but were also monitoring what’s happened as a consequence of this to make sure that we are going back to the right places. And then
last but not least is on the ratings slide which is page 11 of the slide deck and paragraph 8 and I just wanted to correct a sentence in the report and apologies for this not been correct in the first instant, what it should have
read at paragraph B is that 23 percent of 4847 good locations that we’d gone back to not 715, I’m not quite sure how 715 got in there because it’s not figure I recognise at all but 23 percent of nearly 5000 good locations we’ve returned
to have deteriorated so this starts to come to John’s question about what’s happening out there in the services and what we are seeing is a number of things, one is we reported in the State of Care last year that we were concerned about the
fragility of the adult social care sector and the difficulty of sustaining good quality care and you know, that concern remains a worry and we are continuing to see that as a problem. When we go back to requires improvement services we see a greater level
of improvement because they can go up to good but we are now going back to a lot more good services and we are rating about 78 percent of services as good not as many of those improve to outstanding we are seeing some improvement to
outstanding which is fantastic and all due credit to the providers who are doing that but we are seeing that deterioration and the more good services we go back to the more deterioration in terms of numbers we will see because of that kind of quirk
of the statistics but what it does mean is that we are seeing a real challenge to sustain in good quality care in adult social care and it means that we have to be very vigilant and that’s the reason why our inspection programme is really
focusing on making sure that we’re returning to services where we think there are risks and responding when those risks are flagged up to us by others so I just wanted to draw that out, which I was going to do anyway but John kind of

[Mr Peter Wyman - 0:55:10]

led us into it with his question. So I don’t know John if you want to come back? Or whether anybody else wants to raise anything with Andrea

[Sir Robert Francis QC - 0:55:19]

before we move on? Okay. Is mandatory safeguarding alerts your

[ Andrea Sutcliffe - 0:55:23]

departmetn? Mandatory actions rather? All three of us
have responsibility for budgetary safeguarding because they could happen in any of our three directorates. That’s got a red flag by it and in terms of the KPI’s and.. Yeah, and we have, I had a conversation on Monday with my team about this because the
numbers are small but they are obviously absolutely critical and some of this is people frankly not completing the bit in the, in our customer relations management systems to say actually they have completed the mandatory action I’ve had reports back of areas where they followed
up the safeguarding alert with the individual but actually you know, needed more information and so it was taking a longer time so they didn’t tick the box to say that they had actually followed it up and passed it on to the Local Authority which
is what we require them to do because they were getting that further information so again it went out beyond. The bit that I am really asking managers and teams to look at is that where inspectors are getting those notifications when they’re out on inspection
and then they’re coming back and they’ve missed a day or two days to be able to respond to it, that shouldn’t be happening we should be having a system which makes sure that if staff are on inspections the notifications that are coming through they
are getting picked up by somebody else so that we are responding appropriately and there have been some areas where we’ve missed out on that so there’s work that’s going on at the moment as a consequence of us looking at this to make sure that
we are on top of that. When you say that the numbers are small, we are talking, if I am reding the chart right , hundread, I mean they aren’t necessarily one area... I mean, I can tell you my figures, the breakdown we have 46

[Professor Steve Field - 0:57:35]

alerts were 96 percent within target. SO you are above target? Above target yeah, with 96 percent not a hundred we would like to be a hundread, the numbers for us are very small so we would only have a tiny number compared with Adult social

[Ms. Jane Mordue - 0:57:59]

Care. Kate. Thank you, I’ve got a point about whistleblowing, a pie chart, but before that can I have a little bit of fun because on the Health and Safety reported accidents what are all these dangerous objects there is somebody crushed against object, somebody struck
by moving object, somebody striking against stationary object, oh and there is a near miss, I just, I got some enjoyment out of reading that but I just, there is obviosuly some dangerous objects around the CQC world, but that’s not the point I want to
two major on. On whistle-blowing, what would it take for the circle, it’s on page 4, the accidents, on page 7, whistle-blowing trends what would it take for the little grey circle to turn red or green are we simply just counting up people who, I
don’t know why I’m looking Andrea but you may know the answer to this, what would it take for the a grey circle which I either would fly green or flag read is it just, would it ever go one way or the other are we
just counting and just noting the amount of whistle-blowing activity? I’ll try and answer your question so The Grey circle says that we don’t have an explicit KPI against the number of whistleblowing.. It might be ..concerns that we received less the simple explanation for that.
So in terms of it going green or changing that would want to have a target it’s not a conversation we’ve had, personally I’d say we are interested as many people talking to us as possible because we are interested in everyone raising issues of concern
so highlighting good quality care I wouldn’t want to put a number on that because it be very hard to say what would be good or what would be bad I think as many people as possible who feel open to talk to us because of
the huge value of those conversations to us is the right thing so that explains why it’s a grey circle rather than green or red, did that?

[Sir Robert Francis QC - 1:00:04]

Yeah that’s OK. The vast majority in terms of the section of whistle blowing reports are said to be
native for future reviews could I just suggest, certainly from the mail that ends up in my inbox there is a degree of frustration I think amongst those who communicate to us in relation to what they get fed back which is a rather standard form
letter which says your information is very important to us, it has been ###INAUDIBLE### for future response and I suspect a lot of people aren’t terribly satisfied with that response, I’m not saying it’s the wrong thing to have done but there is something of a
gap in terms of the relationship with the whistle-blower about that because some of them will have plucked up a lot of courage to do what they have done and they are told thank you very much information it’s important to us in brackets goodbye and
I just wonder if we could think a little bit about how we manage that.

[Mr Peter Wyman - 1:01:08]

So we’ve discussed that particular point before and I think one of the things that we were trying to do better was to close the loop when we report so if
somebody’s raised an issue with us we have taken it into account in an inspection and either we were satisfied there wasn’t an issue or we’ve taken some action or whatever but we don’t always reference in the report that that information was used so certainly
when we discussed it before there was an intention to reference back, sorry, reference back at that point where we can, maybe other ideas. Jane as somebody who trips over things from time to time I don’t think the necessary dangerous stationary objects, I think it’s
dangerous people walking around, but more seriously and of course this is not just within CQC premises, I mean the serious point is this is people being out on inspection and some of our people do operate in environments which I don’t think are necessarily as
safe as they should be from a personal point of view. OK we are happy to move on, Steve as it you next? I am very happy to, Chair. Go for it

[Professor Steve Field - 1:02:27]

Steve. On the whistle blowing it again is very difficult sometimes for us to
report in reports because if it’s a single-handed GP or dentist and the whistle blowers the only other person working in the practice to identify that information for whistleblower helped actually identifies the person so it’s it is actually quite tricky in our sector and we
have certainly had some, I have to be careful what I say, some interesting cases where it has helped us with our judgment. I will I promise you be brief, the good news for us is that we’ve had full recruitment of all of our staff
for some time now for some months and I think that has contributed to the very good showing in the staff survey which is later on the agenda I do lead on the local systems review I spend most of my time at the moment on
them and out and about and Andrea has been fantastic actually in providing support particularly for one report where I couldn’t be involved myself because where I allegedly live and work but the, and we’re learning a lot but I wanted to put it as performance
because it’s not in the performance chart but we are on target for all of what we set ourselves on the local systems review both on the report publication as well as the a scheduling of the inspections which over a 14 week period for those
new members to the board. We do have an issue with purdah and not being able to do some things because of purdah during the local elections which will push some things as some report publications back slightly and I just wanted to note that. As
far as PMS and integration the Directorate go, I’d like to again congratulate our staff on tremendous work particularly since April on the median days to publish reports we are consistently at 26 days which is superb, given that the National Audit Office were concerned about
report publication the KPI that we declare does show us still at below where we would like to be in that it’s at 84 percent but they are a backlog of reports from before the pre April period and include a number of reports which we
publish as part of the KPI but are not in our hands these are joint reports published with Ofsted, HMI prisons and HMI probation, those reports are part of our target but their out of our hands when those reports are published but the performance is
really good. And the final one I would like to just mention is the 4 Court and non-compliant graph which has improved a lot and it shows on our chart which is C, I can’t remember the page now, page 8, 41 that don’t have an
inspection we’ve actually got that down under the current data to 7 and we do take this extremely seriously the graph sort of lags behind slightly where the work is of course the focus is on the third quarter rather than the fourth-quarter because you need
to prevent them going into the fourth quarter and some of those just like in Andrea’s, well and Andrea has made excellent progress as well is how people who are non-compliant in one area and then non-compliant in another area a different one as they go
through, that’s all I wanted to say thank you. Thank Steve, any

[Mr Peter Wyman - 1:06:12]

questions? Oh well you’ve got off very lightly Steve. Ted see if you

[Professor Edward Baker - 1:06:19]

can do as well. I will do my best Peter, thank you. Can I just a just come back to a
couple of questions that have been raised, whistle-blowing I have said here before and I want to say again how important whistle blowers are to us to identify risks in services and you know on a virtually weekly basis we are looking at our inspection schedule
and we are using whistle blowing information for that so it is vitally important. So when will it says in the pie chart below refer for future review, essentially that saying is going to determine our inspection Schedule going forward and I’ll come to in a
moment our new processes of inspection but we feel that we have built a flexible inspection approach in so that we can target those areas where concerns arise and those concerns may be because of winter pressures or they may be because of whistle-blowing and over
the last few weeks we have had occasions of both those whee we have managed to change our inspection schedule at short notice because of concerns being raised so I think it’s important to emphasise how important they are to us, I think Robert’s point is
do the whistle blowers get that message back and I think it’s an important challenge, I hope they see our reports when they eventually come out but of course the reports often come out a long long time after they have blown the whistle and for
the reasons that Steve raised it’s sometimes difficult at the time to link them in because clearly there is the danger they’ll be identified if they get linked into what’s going on and I think it is a very big challenge for inspectors to make sure
they use that information effectively but don’t, if you like, reveal the identity of the whistle blowers and I think that’s a big challenge for them and they are, I think work very hard at that. Can I come back to safeguard issue again we do
monitor those alerts and concerns very closely in the Directorate there aren’t a lot in hospitals and generally we are within the KPI but occasionally we fall below it and we investigate that when it occurs so it’s something we are very closely focused on just
to emphasise. I think the main point I wanted to make is if you look at the charts on page 10, left hand side of page 10, and is carried out under section 7 of the report as well it just shows you how the pace
has picked up in hospital inspections since we launched the next phase of inspections which we’re now several months into and this is very clear that the teams out there are working very hard to deliver this programme and we are on target for the time
being and I’m really very impressed with the way the teams have taken on this new approach to inspection so vigorously and are driving it forward so effectively. The graph at the bottom left on page 10 shows that we have to do 235 units of
inspection a month and we are achieving that except perhaps in December when clearly that was holiday time but we are overachieving it in January, January has proved to be a very busy month and that’s a unit of inspection by the way is the equivalent
to a core service in hospital inspections so that is a lot of inspection activity, it’s on average 20 trusts inspected every month that we are doing and we are delivering on that timescale at the moment. So just tribute to the staff who are delivering
that, they are working very hard and I have to say with the new introduction of next phase there have been some IT glitches and will be coming back to that under the staff survey, I think about some of the frustrations with IT glitches and
they have been really managing that very well indeed and kept the programme going so tribute to them. The other important aspect of what they are doing at the moment is it isn’t just inspecting is also building a new form of relationship with providers, and
certainly I have been on some of the meetings with them when they have been to see providers as part of the relationship management and the feedback I’ve had from providers so far has been really very encouraging I think they are finding it very positive
the relationships that are building that and that makes up about 30 percent of their time so it isn’t just an adjunct to inspection it is a very important part of the regulatory process. Perhaps go over to the next page, page 11 where we look
at some of the rating improvements, the situation in hospitals is that there is generally improvement in ratings and that’s continued this year we’ve, I think the figure I’ve got in my head is 16 hospitals, sorry trusts moved from requires improvement to good during the
financial year and this is in a setting where those services are under enormous pressure and I think we need to recognise that very good work is being done by services under pressure in improving their care. Having said that, there are some services that have
deteriorated as you will be aware, not nearly as many as have improved but I think the fact that there is some deterioration is recognition of the fragility of the improvements to services under pressure and the need for us to keep focus on the risk
out there in the hospital sector. And just going over the next page, page 13, we look at timeliness of reports, you’ll see at the bottom left that we are was still not achieving the KPI consistently but the median time to report writing is falling
fairly consistently coming down and I think there’s a lot of hard work going into turning around reports as a bit of a backlog which I think Steve referred to as well in his sector and once we have cleared the KPI won’t be reflecting the
current activity as much as we’d like it to. We are monitoring the next phase of inspections very carefully to make sure they’re coming in on time again some IT issues around the data means that we haven’t got the full data on that yet but
the initial data looks very encouraging on that, so I think that will improve over the next few months and we are also doing some work to make sure we’re up-to-speed doing these independent health inspections and again that work has improved a lot over the

[Mr Peter Wyman - 1:12:10]

last few months so that’s all I wanted to say, any questions? John.

[Mr John Oldham - 1:12:15]

It’s just me asking a dumb question again Ted I’m afraid, slide 10 the one you refered to, hospitals activity, I may just not be understanding this properly but I can see the
Green undertaken and the blue scheduled most of which are below 235, how do you get to the 235? Well the next phase, sorry the next phase

[Professor Edward Baker - 1:12:40]

started in September/October as you see we’re over the 235 there.. Yeah, but then it goes that the schedules
are Well the schedules are the ones booked in so far No I get that but we will do more than the schedules, are not a prediction of the actual activity, because the flexibility of the system some of the schedules are not filled until late
Okay Ted, I think is worth just saying that some of the some of the informal feedback I’ve had from trusts on the new approach has been really positive because the sort of general feedback is that they have found your work and your reports more
more useful and you know obviously we have a sort of joint destination here that the Trusts improve and if our work, your worker is helping them do that more than ever before then I think that’s really positive, so it’s early days and this is
informal feedback but I have been very encouraged by the feedback I’ve had. I say it’s not just an inspection it’s the relationship between inspections where we are trying to build a really constructive relationship in those meetings between inspections where we share areas of concern
with trusts and if you like work with them to make sure they’re taking action on them and I think that that’s proving very positive for instance our data analysis we share now with trusts and they’re finding it really helpful I think in identifying risks
themselves And I think also through that ongoing dialogue our understanding of the Trusts objectives, aims, issues and everything else actually makes, it doesn’t probably changed inspection findings but it probably does sharpen some of the recommendations and makes them more in a context therefore more
helpful, I don’t know, I mean I’ve just had some positive feedback.

[Ms. Liz Sayce - 1:14:49]

Anybody else want to raise anything? Sorry Liz, I beg your pardon. Just a specific point, I just want to ask about SAOD, Second Opinion Appointed Doctor visits so it looks like the numbers
are going up and indeed exceeding target in relation to CTO’s but they are still quite a way off target in relation to ECT and I just wondered whether you are confident that we will be able to get to

[Professor Edward Baker - 1:15:12]

target on that? Liz this has
been a long term problem, it is much improved there was a real problem recruiting these doctors so we’ve changed some of the remuneration and the recruitment processes we have now recruited a lot more so should be able to improve on that performance quite considerably
but we do need to keep closely monitor it. David. Can I just come back

[ David Behan - 1:15:36]

on John’s point about the distribution of ratings which he said at the beginning and this has been a really important conversation which has been taking place with some earnestness over
the past two or three weeks with some of the policy people and the analysts and the issue about this is about how those results are driven by our approach to targeting inspections they are not necessarily an underlying reflection of quality and how we both
analyse and explain that publicly because the risk is people will see deterioration and think there is an overall deterioration in quality so I just think we need to be quite careful about how we present this, I don’t know whether this is behind your question
so the very end of paragraph 8 I think it is, I’ve had to go on to just look at some e-mails I was sent in relation to this just to make sure I get this absolutely right, is talking about something will bring back at
the end of Quarter 4 when some of that analysis has been undertaken because I think it is a hugely hugely important point because if we target based on data the conversation we had earlier your bias the sample to it so if you’re going back
it’s a good because there’s risk you’ll see more deterioration in that and the risk is that people will go to there is an overall deterioration and we just need to be careful we’re not saying that but we do need to understand the subtleties and
nuances of why those that were good have deteriorated, by the same token for Steve we need to know why people are staying at good and outstanding if some are coming down from that what is it that’s happening there as well. So both the snake
on the ladder of the rating needs to be understood and the risk is there’s an oversimplification of what’s happening because it’s quite a complicated story to tell and in The please answer yes or no is getting better or worse which is a kind of
question that I’ve certainly been asked in formal committees of parliament’s, looking at Sean Linton that a journalist would answer actually there isn’t a simple yes is it or no it isn’t, what’s going on here is actually quite complicated and there was a bit when
we were doing the press stuff for the care report where people were saying please answer yes or no is just getting better or worse and I said I’m not going to answer that question because what we are doing is assessing something that is very
complicated and complex and we’ll tell you our assessment and we’ll tell it in a simple way but we will not over reduce it so can actually be misused. So what we’re trying to do is just get a rich and full understanding of the data
if that’s what was behind your question and then we can tell this story in a way, and that works going on and is not yet to a place where I feel I could do an interview with Sean for instance and say this is exactly
what’s going on, but we do need to be able to do that, but I’m not going to give you that interview, no seriously, we would need to be able to tell this to the man and woman on the Clapham omnibus quite frankly and we
need a lot of paragraphs to explain this clearly and we need to get it better than we have actually got it at the present, so right question

[Mr John Oldham - 1:19:09]

I think, John. Thank you, that’s exactly what I was getting at. Good, anything else on the performance

Audit & Corporate Governance Committee Summary report of meeting on 31 January

[Mr Peter Wyman - 1:19:12]

report anybody wants to raise? Excellent, thank you very much indeed.

[Mr Paul Corrigan - 1:19:23]

Paul I think we come to you then on the ACGC report. Just to pick up a

[Mr Paul Rew - 1:19:28]

couple of points on this, we spent some time at beginning of the sesion on the National Audit
Office value-for-money study which has been published and commented on in board meetings previously, it was a chance for us to talk to the people who actually wrote it and get behind the report and get some of the sentiments in there and there was nothing
that came out of that discussion that was not in the report, it basically confirmed that the organisation has made, CQC has made some good progress over the course of last couple of years and indeed before that but it was a very positive broadly positive
assessment and broadly positive meeting as well and we went through the I think it was 5 recommendations which they had made and the intended responses from management as to what we’re going to do about that and again they were supportive of what we were
saying, that indicates that we are in the right direction of travel on this so that was a useful session. Moving on to the internal audit reports 8 issued only one of those had caused any sort of discussion around some risks in there that was
around IT disaster recovery, generally IT disaster recovery is fine, there are a couple of specific areas where we need to go away and look at this where we are dependent upon third parties resources and we need to look at whether we’ve got what we
want to do in those particular areas. And we also looked at health and safety where we’ve had some problems within the organisation in the past on Health Safety and Internal Audit reports around health and safety and we were really pleased to notice that Internal
Audit were upgrading our degree of assurance there too to moderate and at that we made some good progress on that. And then we looked at a number of areas of Risk and Assurance, one to pick out was around the developing IT technology and data
areas of the strategy and looking at the governance and assurance processes which go with them, the agile approaches which are going on in there and a commitment by management to come back with how we are flexing our assurance well our governance processes and the
right assurance processes to go with those so that we make sure that we are on top of that and making sure that we’re making the right progress there. Generally I think that was the main things. So that’s

[Mr Peter Wyman - 1:22:08]

positive and encouraging thank you Paul, any

HWE Update to the CQC Board - HWE New Strategy

comments or questions for Paul? Good, Right, we’re doing well everybody he said tempting fate. I don’t know Jane, whether you’re phoning your friend again or, we are early so, but are you happy to start? Shall I start, yes? Would you mind? and of coures

[Ms. Jane Mordue - 1:22:31]

Liz is here as well who is leading on a very important piece of work for us so if we can, you know we might do a little bit of a double act, it’ll give me some support. So Healthwatch and Healthwatch England, local Healthwatch, we
have laid our report for Parliament called Speak Up and I think my overall assessment will be that we are in a much much better place but there is still a long way to go. I think David was talking just now about how CQC has
got the overview of the whole systems and I think maybe you might say that local Healthwatch got the underview, they stretch across, they really gripped their local local communities so this report is really a sort of showcase, I think the conclusion I’ve come to
after three years is that the, in a way the strength of the organisation is what is happening day by day blow by blow on the ground so all those myriad of local changes that Healthwatch are making out there on the ground that’s where the
real impact of the organisation is and then that then feeds into what we can do nationally and the secret of getting more of a grip on all this has been for us, to professionalise and I think we have done that now our own intelligence
handling and not only are we doing it in a more professional way but we’re also, we have are a desk, a support desk to help local Healthwatch with all their research work so a really, a good growing picture, still a lot to do and
we can talk about that under the strategy, but, and it’s quite a big but we have been constantly bedevilled by the issue of local Healthwatch funding and on the second page of our report you’ll see we finally came up with a picture that really
expresses this and I have been asking for the, what is the so far but no further moment on this this picture really, I think says it, you know we were initially handed by Department of Health...hello, welcome... don’t worry Apologies Imelda, It’s just to keep
you on your toes that’s all, we will be half an hour late next time don’y worry. No no, we work them hard at Healthwatch don’t we? I am just talking about the funding and this picture which shows that originally 40 million pound was provided
to fund local Healthwatch and you could see if it was adjusted for inflation we are gently going up, it’s gone out through the, they’re all commissioned through Local authorities and that figure has gone down now to, it’s gone down now to 27 million that
masks huge variation, some local Healthwatch are getting the same amount someone getting slightly more and some have been substantially cut and there are now down to the level of funding of the previous organisation which had far less to do with us the Local Links
I think they were called. So we got a little group, I have asked them to look into what exactly, where the levers, what can we do about this, if anything so they will be coming back to us in March because this is now a
matter of urgency. I am now writing, I have had to write letters to Staffordshire it all seems to come back to Staffordshire, to say that what they are proposing to do was it was ultra vires they have come back to say no they will,
they will stick to their statutory requirements, we’ve queried that I’m going to keep that under strict review and each year I write to the secretary of State to give him the run down on local Healthwatch on the funding and we’ve told them this really,
we have reached I’m sure, Andrea’s point tipping point but this is you know a very serious situation so a lot of good work going on but it’s rather like standing on the sandy beach when the waves come out and you feel the grains of
sand relentlessly coming away from underneath your toes that the money is being pulled away and you can understand it’s you know for Local authorities they are in a very difficult situation but we don’t want to be funding their other activities. So two other points
if I may on this paper, one is we’ve been very pleased to refresh my Committee I’ve got three or four people who are standing down at the end of/middle of May we have just recruited seven new members who bring with them a wonderful cornucopia
of skills in terms of consumer, change, digital, local Healthwatch, social care, public health, mental Health, Research, and the other six are quite good as well, so we got a nice, and I would say a thank you a big thank you to care of quality
commission because the fact that a lot of you know, the heavy lifting on governance and you know the running of, we don’t have to worry about that I’m able to have a really exciting Committee of people who are more of an expert Advisory obviously
there are some governance responsibilities but it works really well from our point of view, so thank you very much. And the big focus going forward is on mental health and maybe I can ask Liz to talk about that a little bit and then we’ll
move on to the strategy and Imelda. Liz did you want to talk about

[Ms. Liz Sayce - 1:28:16]

mental health at all? Yes sure, so I have been on the Healthwatch England Committee for a little while and we are just at the very early sort of scoping stages I
think just to add to what Jane said about the development of Healthwatch generally I think there’s been a welcome kind of shift to doing more sort of proactive solutions focused work so not just what are the public’s experiences of services as they are at
the moment but how is the public effectively engaged in what the new forms of service may be, such that we’re not just repeatedly hearing about the same issues about, access difficulties or whatever but actually looking at Service redesign, new models of care and all
those sorts of things and some local Healthwatch have done very good pieces of work including in the area of mental health engaging for example, groups of people who don’t traditionally have a voice so you know things like, veterans experiencing mental health difficulties, deaf people
experiencing mental health difficulties and on so pulling some of all that together we are at the scoping stage in the work on mental health so we’re going to be looking at particular points in the life course where we’re both getting high demand on the
issue from local Healthwatch but also where we think you can make an impact if it’s Healthwatch’s niche where there are serious issues for particular groups of people but particularly tricky transition or intersection issues across the system so very keen not to duplicate the huge
amount of work that’s been done on mental health and is being done on mental and I think just to also say that it’s very I think has been very good to see how Healthwatch and Healthwatch England and CQC have been working together and will
do certainly on this area I know there’s been some linkage on the Child and adolescent mental Health Service report that CQC is about to publish and indeed on quality matters that we may talk about later so watch this space on the mental health piece
but we certainly won’t be duplicating but we want to bring the voice of people using services into what could be kind of better solutions

[Mr Peter Wyman - 1:30:42]

for particular tricky areas. Thank you, do you want to pause before we go on to the Strategy’s anything anybody wanted
to raise or ask about anything either Jane of Liz has just been saying before we go on to the strategy? Right, Imelda. Thank you very much. You had in your papers are a summary of our our Strategy it is here for you to endorse
its already been through Healthwatch Committee who have approved it if I take you on to the first slide it just takes you quickly through the process that we have been through in order to arrive at our strategy we did a very thorough piece of
consultation work both with the network and with key stakeholders right across the sector, that piece of work was really kicked off last March by our Committee who set the parameters and we’ve been working on through that. We now have a vision that is health
and care that works for you and our purpose is to find out what matters to you and help make sure your views shape the support you need so we’re really pushing it, when we’re talking about our strategy were talking about the whole of the
the body that is Healthwatch not just Healthwatch England so when we talk about you we mean the individuals and we also mean local Healthwatch. So our strategy in brief is then to ensure that your views are used to help improve health and social care
so we want to have that impact we want to have more people having their say and at the end of that we want to make sure that you experience high quality health and social care services. We have three broad strategic aims the first one
is support you to have your say we want more people to have the opportunity to make decisions about their care and their wellbeing and have a say in the services that support them. We have been doing significant amounts of work on identifying people who
are least heard within the system and making sure that we get their voices heard, we’ll be providing information directly to the public to help them act on improving health and social care and we’ll be looking at the use of Partnerships right across the board
to make sure that we can deliver within, we have our resources but actually there are far more resources out there if we think about the whole community of organisations that are there to improve people’s health and social care. Our goal by 2023 is that
we’ll have over a million people sharing their views with Healthwatch England, I know that you’ll think that’s not a very big number but we’ve done a lot of thinking behind the scenes about how we arrive at that number were currently about three hundreds and
60 thousand and we’re looking at what does the data tell us about how likely it is that the public are to share information and so will have a stepping stone to get us there we also have to put that within the back drop of
the reduction in funds to lots of the local Healthwatch who are the main contributors of this data, though we will be going directly to the public ourselves. So second strategic priority is provide a high quality service and our goal here is to ensure that
wherever you are in the country when you get into in contact with the local Healthwatch you will receive a high quality service we want to make sure that we put a lot of effort into really supporting local Healthwatch to be the best organisations they
can and we’ll be delivering a very clear offer of support to them within that first year which will include things like training and support, we’ll also be doing support round research skills engagement skills a whole broad range of offers to them that will help
them improve. And then what we hope by 2023 is that when somebody shares their experience with Healthwatch that we’ll be able to come back to them and tell them what difference that has made. Our final objective then is to ensure that your views help
improve health and social care so that’s the gathering information from the public gathering it through local Healthwatch and then ensuring that that has a big impact on improving the design and delivery of health and social care at a local and national level and success
for us in this field will be that twice as many of our recommendations that are made at a local or national level are implemented by the services that we make those recommendations to. What we have done in your pack as well is that you
have a top line one page summary that describes what we will be doing across the next five years, where we are at the moment is as I say it’s been approved by Healthwatch Committee we’re working on the detailed business implementation plan which will come
back to your Committee I think in April or May, I think it’s in May so that’s a quick trot through our new organisational strategy. Which is exciting It is quite exciting yes And to get it on a page, I for one valued so thank

[Mr Peter Wyman - 1:36:08]

you Oh you’re welcome Other questions or comments from anybody? John

[Mr John Oldham - 1:36:13]

Less on the strategy which I like also the presentation of it thank you, but more on the activity to deliver on it and in particular the ensure your use help improve health and care,
I just wondered if a Healthwatch is using its network to get actively involved in the what matters to you day or if you know about it Good

[Mr John Oldham - 1:36:44]

question, I don’t know Can I just describe what is, it’s somebody that started off in Norway in
2014 and it’s about getting a whole series of clinical professionals on one day of the year to instead of asking what is the matter with you ask what matters to you in the individual interactions that they have on that day and now is spread
through 20 odd different countries and they do do one in NHS England it’s a much bigger deal up in Scotland where it’s massive, but it struck me that is the sort of simple question that if the mass of clinicians on that day and its
June the fourth or sixth I think, ask people but instead of it being a push down on the clinicians equally Healthwatch could create a pull a from individuals but it would also help you move towards that aim a of a people not having the
opportunity to have their say because there’s the attitude of professionals, it just struck me as an idea that you might want to think about Thank you I shall pick it up, thank you Andrea Thank you and thanks every so much for the papers and

[ Andrea Sutcliffe - 1:38:00]

the presentation Jane and Imelda at. The one thing that I just wanted to pick up was the link between what you’re doing currently and what you are doing in the future with quality matters because it doesn’t get mentioned in any of the papers I
did a word search and actually I think you’re underselling yourselves frankly because the work that you are doing together with the local government and social care ombudsman on the priority action number 1 in quality matters is really very important which is about to creating
a much easier way for people to understand what complaints in adult social care system is and being able to access it. So I just wondered how and obviously that’s the specific area that I am interested in some senses it links to what John said
which is how is Healthwatch kind of connecting and making the most of those other things that are happening across health and social care that can make a difference particularly as Jane is highlighting the pressures on resources so kind of, you know creating something that’s
more than the sum of its parts is part of the the Strategy I would have thought so just to really kind of link those thing those thoughts together Thank you Andrea, the downside of reducing it to one side of A4 is that you lose
the activities that will take place one of the things that we are very clear about is the partnership will be the major way of delivering a lot of this and therefore quality matters as a partnership initiative will be a high priority so I think
once you get to the business plan that lays out the activities it will

[Mr Malte Gerhold - 1:39:49]

appear in there Malta Thank you, Imelda this is the question again about the third aim about ensuring your views help improve health and care you say very politely that a challenge
to that is the attitude of some professional defaults involving people in their care and I was wondering whether you could say but more to what extent these are professionals not just in care services put potentially also in any national bodies including our own and
what that means for the way that we work together but also that you work with other bodies to make that happen, and then related to that in the enablers you mentioned digital and investing in a unified system together understand or share people’s view of
care and I’d be interested to hear a bit more what your plans are on that if you say that the very beginning of the plan because you just putting out the strategy that’s totally fine Okay Thank you Thank you Malta, I’ll start with your
last point first which is we are currently going out around the country doing a sort of user requirement piece of work around the digital future but one of the things that we see is that a lot the local Healthwatch are now very tiny some
with very little resources to run on so we’re looking to see how we can create and generate information here and then syndicated out to the 152 Healthwatch so that they are getting quality information out at a local level and we’re also getting it back
so were at the early stages of doing the requirements around that, but that’s one of our aims. The first point you made which was about professionals attitude, well in the scoping of the strategy we went out and spoke to lots of the professional organisations
royal colleges, professional bodies and they are keen to work with us again this is part of the partnership piece to help their membership understand why it’s important to put people’s views at the heart of what they do and so again if you think about
the first year of the strategy being very much a transition year we will be developing partnerships across a whole range of bodies that work directly with professionals, Royal College of Nursing, Royal

[Professor Edward Baker - 1:42:13]

College of Physicians so on Sorry, Ted Thank you Peter, Thank you Jane
and Imelda it’s a very clear strategies it’s very nicely laid out so thank you, I Lord strategy on a page it makes very clear. I suppose the other thing I just want to say before I ask my question is a big thank you for
all the support you give us on our inspections in terms of all your local Healthwatchs feeding in, it’s really very important that we hear the voice of the local population and the patients using services and you’ve been very supportive in that. Can I just
come back, because you say that you’re purposes is to find out what matters to you and help make sure your views shape the support you need, the NHS and health services need to go through a lot of change to meet the needs of the
changing population and is there a way in which, and I think it’s a big challenge for people because people always worry about change so is there a way in which you can help people understand the change you contribute constructively to it rather than just
if you like feel worried by the change, I mean I think interacting with patient groups sometimes there is a great fear of change when in fact change is necessary for them for their wellbeing or so professionals think and we just don’t get that kind
of positive interaction of everyone working together to build the best is there a role for Healthwatch in that or is there bigger role for

[Ms. Jane Mordue - 1:43:35]

Healthwatch in that It’s something we absolutely feel is part of what we’ve been doing, Healthwatch local Healthwatch in particular but
Healthwatch we have already made it our business to make sure that the conversations and the listening that we do is absolutely done in that way that people are able to say what they think and to get used to the fact that things will change,
one example, I think it was a couple of years ago now but when up in the North when there was problems about maternity services we were able to get people in the room away from placard-waving or being angry and asked them what would a
good service look like for you at which point they start to come up with some really useful and helpful, and raised a rich source of information so that is exactly the area we hope to mainly be in although obviously we do just take in
stuff on spec from whatever anybody wants to tell us which could be my doctor was really brilliant because sometimes, quite often it’s things that are really complementary to that service was really difficult and that didn’t work for me at all well so we do
have a space, quite a large space I hope when we are talking and listening to people in a very positive way Just follow up with that, again what’s hidden within the word partnership is something that we will be doing with many organisations and that
is working with them to produce high-quality briefings that are properly evidenced to send out to local Healthwatch so if for example there is a discussions going on locally about A&E or all stroke services then within this library of information we will have worked with
the College of emergency doctors or The stroke Association to have resources therefore local Healthwatch to say OK what does good look like and then they can hold the ring about what does good look like rather than be battered by the public or battered by
the professionals and I think that’s the space we’ve to create for local Healthwatch is to be the sort of honest broker with the evidence

[Mr Peter Wyman - 1:45:54]

of of what good looks like. Excellent, thank you very much Imelda, Jane, thanks to your colleagues for all your doing
thanks Liz as well for what you’re doing there. It’s great and you ask us to endorse the strategy are we happy to endorse the strategy? Anything on a page gets endorsement here, there you go. Thanks Imelda, good. Right so we need to move on

Staff Survey Results

Apologies and Declarations of Interest

Audit & Corporate Governance Committee Summary report of meeting on 31 January

Audit & Corporate Governance Committee Summary report of meeting on 31 January

Any Other Business

Audit & Corporate Governance Committee Summary report of meeting on 31 January

Staff Survey Results

to the staff survey and we are running ahead of time so we may not have the key people here yet. I think we need to bring forward the other people as well Yes, ah ha, greetings. I hope you are impressed with delivering ahead of
time ha ha. Absolutely so, welcome to you both, I don’t know, Ruth or Helen who’s starting? Helen, excellent good. Thank you very much for the opportunity to address really the results from now the 2017 staff survey, you will see from the paper that’s there
was a lot to say and we’ve reflected I’m not going to go verbatim through the paper but there were just a few comments that I wanted to kind of put out, we’ve made reference in there that there was quite a lot of results that
were static and when you look at an overall level it appears that we haven’t really moved on year on year and in fact the biggest improvement and were in questions that have gone up by about 3 percent so and yet our fallers have fallen
by between 7 and 10 percent so the most important thing to note when we’ve crafted the paper and our response was about looking at the variance within that so there are questions around health and wellbeing and around work-life balance that have a high degree
of variance that have increased rather than decreased year on year so the variance within the schools of health and wellbeing between the highest performing team and the lowest performing team is 77 percent so we’ve really got a lot of learning that we can do
within the organisation about how we are managing this well for some staff and not well for others and that has increased that variance over the course of the year which means that we also have made a difference within a year in some places which
is important learning for us. It’s also important just to recognise that actually is not also a bad news story, that there are a lot of good scores within our staff survey and that the overall perceptions of staff in all of those questions whether it’s
around values, the purpose I believe in the work of CQC they all feel relevant to people’s work and that’s a very good basis on which to work and they are very static results so having a static set of results isn’t also a bad thing
in itself either. My final comment is that a we did a lot of work last year on shaping our future where we got a lot of the views of staff about why they would be excited to work in CQC and what it felt like
to be part of CQC and building on the work that we did a few years ago on values which still remains one of our strongest results in the staff survey people said that they felt it most excited when they were recognised, autonomous, connected, supported,
knowledgeable and curious and if we focus on those 6 feelings within staff and kind of focus on developing those then over the course of the next year we will see incremental improvements in the areas that we perceive to be stubborn and building on the
work that the inspire programme has done and enabling a kind of positive conversation rather than a negative conversation about those areas of learning I think we will really make some significant strides forward and it was on that basis around appreciative Enquiry and focusing on
the positive that we have constructed what our response is going to be which is around digital and technology workloads, Resources and wellbeing and around communications. I have brought with me a variety of experts on each of those each of those areas of responsibility because
the staff survey is mine but it’s important that the rest of the organisation obviously picks up the responsibility for those areas of

[Mr Peter Wyman - 1:51:53]

focus. So that was all from me. It does seem to me that this is a mixture of really good news and we
should celebrate that and not really bad news but some areas where we really have got to sort something out, we want to be a great place for people to work and we are in some respects and we clearly are falling short in others so
a lot of the focus Ruth I guess and colleagues going forward has got to be to, as you say maintain the good things but actually then really make a difference on the things where people are not happy that’s as I read it very much
what you’ve got in terms of your sort of recommendations going

[ David Behan - 1:52:44]

forward. David you want to say anything at this stage? So I think is to our credit that we continue to do this and make it public, I thinke as Ruth has said it’s been
pretty static it’s been 64, 62 and around that area but these have not been improving scores and I think the key point as Ruth pulled out, Helen pulled out to focus on is this issue about variation part of the answer is within the organisation
of 70 odd percent variation between teams that are highly performing and others gives those high-performing teams gives us a clue about what it is that’s required and I think the way this has been broken down to look at issues which are effectively about how
staff feel valued and supported these issues around we touched in the performance reports about work load about people feeling that the work life balance is completely out of kilter but it’s important that stuff around just attending to people’s wellbeing this issue about if you
feel your work life balance is out you don’t feel in control of your workload that’s where stress and anxiety comes in the beginning then to actually address the work load should be leading in its own right to addressing those feelings of feeling out of
control I know when my stress and anxiety levels are up its when I feel a bit out of control there is things happening around me that I can’t get traction on and purpose on so I think first chunk of work about supporting wellbeing and
so the point I think Steve mentioned this earlier about just the effort that primary medical services directorate have put into a focus on wellbeing is pretty clear to me and Steve has made this points on a number of occasions that the improvements that we’ve
seen in the staff survey around PMS are in my mind no doubt due to being fully staffed work life balance is probably slightly better and that there has been a attention to people’s mental wellbeing campaigns. I’ve been to two meetings just recently the dental
team where part of their conversation was about mental wellbeing so it’s about how can we do a bit more of what some teams are doing. It’s not to say how the changes have been getting it wrong but we talked earlier with Keith Conradi about
how you can spread learning and it seems to me that is one of the things that we need to do. I think the equipment and technology this is why Helen I think was dodging some of the bullets in relation to this, in saying she’s
brought her friends with her, but she’s absolutely right. This issue about whether our technological platform has been supportive of people hs been stubbornly resistant they’re the words I would use for five years now and we’ve not shifted these, we had a really good go
I think earlier with Helen in the seminar about the potential for data and its use to help us but how critical our ability to do that is dependent on changing some of the platforms we’re on. I think the good news is we’ve agree the
priorities for that, we’re beginning to invest in the not so good news is that’s gonna take two or three years to see through. So there’s sense of, we’d need to be a patient about some of those things but continue to be focused. The other
stuff that’s been stubbornly resistant has been communication and change where our staff don’t feel we communicate well and don’t feel that change is managed well and when we’ve compared that against other benchmark organisations that again shows what we need to do so there work
going on by internal comes colleagues about how a we can actually just reflect and think differently about how we can do communication. I think we’ve done a lot of work on can we engage people more in the changes we’re making, there’s no external pressure
now on us changing, there’s no programme that needs to be completed by a date and we’ve got through that period my personal view on this Peter is that I think there is a lot of communication in the organisation I think in some areas we
almost over communicate, there can be Fridays when a my message, Chief Inspector’s message repeat the same thing and that’s an issue that needs to be sorted out but then there are other things where people feel they don’t know what’s going on and my personal
view is this is less about communication and more about whether people feel they are engaged in the changes are taking place, things are being done to us rather than we are involved in shaping those things. So I think well Helen and teh team have
pulled out are some important actions which are taking place which will allow us to I believe Mat progress under those three big headings but also paying particular attention to somethings that we’ve also discussed the just looking at the issue about recruitment and retention and
reward about whether our learning development offer is a good one is a lot in there, the staff survey where people are concerned about that and then this big push that we’re going to have on the Quality Improvement which are think does actually provide a
route to engaging people in a slightly different way and importantly is this paragraph 3 point seven which says Well we’ll actually look about how we measure this and actually not there will continue to do the best staff surveys but measure through the year about
whether we’re making progress on this rather than what we end up doing is having an annual conversation about this a moving it on. So I think we are being very open and honest in the work that we’ve done I’d commend Helen and her team,
I see Paul Sumner has done a lot of the analysis, went and sat on the back row, because he’s very shy is Paul but has done a fantastic job for us in getting under this and there have been good conversations across the organisation so
I think where we are well placed to actually push on this and we have already published the raw results on this but this we said we bring back the actions that we are putting in place so I think what will be helpful, particularly from
a non-executive director colleagues is whether you think we pulled out the right issues and we’ve got the right actions here the Executive Team have had a good go at this Hele and the team have had a good goal. I just want to echo the
point this isn’t Helen’s job to get this sorted it’s a senior leadership teams and managers within the organisations to get this sorted and it is a hugely important issue I think our future success is predicated on how well engaged our staff feel that’s a
level that we take to NHS Trust social care and PMS organisations and it’s absolutely right that that’s the level we take to the way that we operate as well but I do want to say this, there are other organisations that would die for 94
percent positive on our direction, our purpose, our values in the way that we operate there is a fantastically strong and good story to tell in this and by looking at what we need to improve we shouldn’t in any way dilute or diminish what is
a fantastic fantastic set of data in relation to what we’re doing well , and that echoes the point that you are making. So I’m sorry if I’ve repeatedwhat Helen has already said but I just, I often think this is my as chief executive, single
most important performance indicator is the staff survey and so I just welcome opportunity just to say what we’ve got here and why this is

[Mr Peter Wyman - 2:01:12]

important, thanks. It is really important so thank you. Steve you

[Professor Steve Field - 2:01:15]

wanted to come in? Yes thanks, to a sort of
echo David’s point but just specifically about PMS and to be clear this was our busiest time we’ve ever had in our Directorate on delivery of the GP programme under pressure so the staff survey in the individual teams in PMS the feedback has improved despite
the fact it’s the busiest time we’ve ever had despite the fact we were working under extreme pressure to deliver a series of programmes and what we were doing, this started about three years ago where we started to focus on this isn’t last year’s plan
in order to improve results in a survey no matter how important the survey might be. This is about looking after our most valuable asset which is our people a focusing on getting recruitment up but also being quite hard as well on making sure that
the staff we had all perform to the best of their ability because when we started with turning around CQC we had a hugely variable, in all directors performance of some staff and we’ve had to make some difficult decisions about some stuff that didn’t perform
so it’s about encouraging people as well as ensuring performance is there. We have in the last 18 months now spent quite a lot of time on on wellbeing and we do have the benefit in PMS it’s not about general practice it’s we’ve got lots
of individual teams doing really focused work within it and the best feedback we get our in our smaller teams, focused on clear objectives such as the prison work we do, the child safeguarding work we do, the medicines optimisation work so what we did was
look at what was going well with those teams and try to roll that out as well. We introduced a marker for this area of well-being in our performance Management so that everybody was encouraged to look and what we’re looking at now is the enrichment
of the roles and the feedback that is coming which isn’t in any survey but the feedback is our staff like working with people in other directorates across CQC and when they’ve got the opportunity to work in cross-directorate work with the clear objective of the
working to improve the care of people whether that’s in PMS hospitals Adult social Care that comes back as a very positive thing for them which supports the direction of travel to much more cross CQC one CQC working rather than in silence. Liz Thank you

[Ms. Liz Sayce - 2:04:15]

yes, I would echo David’s last point I mean I’ve known organisations where you get low scores even on where the people understand the purpose on the values of the organisation so I think this level of commitment is to the values and purpose is really
to be strongly noted really. You mentioned the variation by team I just wondered has the data being cut in other ways I’m thinking about are there big differences for instance between more junior and more senior staff or according to different equality characteristics, I would
just be interested to know that whether there’s anything else lurking in the data that needs to be sort of attended to of particular groups of people. And I suppose the other thing was what came out to me particularly strongly was this point about whether
people have a say and a voice and your point Steve that sometimes even when workload is high if you feel you’ve got that say in some sense of control you can still have sort of a decent wellbeing and I just wondered whether there are,
sort of how that’s going to be kind of mainstreamed into business as usual, so I know there’s a leadership programme going on for example, so as well as sort of initiative that comes out of this staff survey is there any, are there ways in
real business as usual activities that that key point about people having a voice and a say and being able to come up with solutions and having autonomy appropriately can be just really really sort of built into that and my final question is just, there
is obviously workload issues and we know in Adult social Care for example, how confident are we that we are on track to get those right across the organisation because there is differences there in terms of

[Mr Peter Wyman - 2:06:04]

workload. So several questions, probably several different people are
going to answer them. I am going to take the first point and then I’ll hand over to Ruth . So in terms of how we’ve cut the data we have analysed it by grade, by work base so differences between home and office and all
of them have interesting characteristics we floated to the top the ones that are the most significant, that’s not to say that though there isn’t learning to be had from some of those differences and certainly the inclusion metrics so for all of our protected characteristics
plus Home and Office etc are coming back to the Board in March so I am that will be pooled as part of our inclusion session. So just to say that overall these are the things that were considered to be most significance there are great
differences actually there’s not a consistent message about grades lower down the organisation versus grades higher up the organisation feel differently you cut the data in different ways you would get a different, so certainly at a senior level there is marginal difference about how they
feel attached to the purpose but you would expect that and other people more lower down the organisation feel a greater sense of well-being so there is learning to be had but there certainly wasn’t enough of a difference to pull them out in that paper
here but the inclusion or the inclusion matrix will be part of our conversation, a longer conversation that we have in March. Ruth So, Liz I think your point ###INAUDIBLE### I say in a voice in the in the way people work and what they do
is absolutely essential and that is a critical part of the work that we’re doing around quality improvement within the organisation so leading on from the really large investment that we’ve made in developing leaders within the organisation the next stage is around developing quality improvement
capabilities and that will be done across the whole of the organisation so it will be a very systematic approach that we will take where we will have a consistent methodology that we will use but that will very much give staff the opportunity to have
a say in how things are improved in their particular area and we’ve already got quite a lot of work that’s been taken forward alongside this whilst we bring in some partners to work with us on this and the excitement that generates within those teams
that are taking forward some of these quality improvement tests and pilots it’s just really exciting to say it is fabulous to see how staff respond when given the opportunity to have a real say. Can I

[ David Behan - 2:09:07]

just add to that. So I think your question,
so I think there is having your say and then ther is feeling listened to and I think what the staff surveys shouting at us on is feeling listened to not having your say so I think that’s the trick so on the equipment there will
be new equipment made available to people which is an endeavour to address immediately some of the issues about equipment albeit that some of the underpinning systems will take a couple of years to actually introduce themselves so it’s just trying to get that balance. The
other thing I would say to your question Liz which I have to say it’s very apposite is I think part of the variation particularly in teams is feeding back whether people feel that they can both have their say and they are listened to immediately
and I think that’s one of the issues why we need to look at those higher performing if I can do that in that way higher performing teams from the other teams is are there some teams just get in this balance between letting people have
their say and listening to them and then doing something about those issues within the local control and I think there is some evidence that some teams have a better culture and tradition of both raising these issues, supporting each other and addressing which attends then
to people’s wellbeing and actually having a vacancy doesn’t explain that. There’s something about the leadership the culture of those teams and I think that comes through this as well which is why I think part of the answer is within the organisation not outside of
the organisation. I think the other bit that I would pull out is and I don’t know a home based work force as big as ours that then gets people working in teams so again how do you, who do you look to and who do
we reach for to get those benchmarks of how we take this forward and that’s not an excuse that’s the challenge we’ve got I think as an organisation about how do you create a sense of identity where your right, the work on perhaps an values
is hugely important but how do you feel connected if you work in on a big hospital inspection and you’re part of a team of another 10 people and you feel connected, if you’re a single inspector there in a three bed care home for people
with autism and you doing that by yourself do you feel as connected and so there are some really important issues that need to be teased out. Ones not right and ones wrong but there is a sense of the challenge and I think that’s why
some of this stuff has been resistant and is not that people haven’t wanted to get this right and I don’t believe anybody in CQC gets up to do a bad days work but there are some really tricky issues we’re trying to deal with. Andrea,
the last of the compendium of questions from Liz was to you, wasn’t

[ Andrea Sutcliffe - 2:12:06]

it? In some senses although, in fact some of the issue of variation kind of applies into Adult social Care quite significantly and registration so I wanted to pick up the point about
people feeling that they have had a say, had a voice, I absolutely agree with David it’s also about whether they feel that they have been listened to and responded to and there is quite a lot of work and it goes on in all of
the Directorates around internal co-production, people being engaged in the development of their areas of interest, using their expertise to apply a across and understanding some of the kind of solutions that staff have got to some of the problems that we’ve got. One of the
things I don’t think that we’ve done as well as we could have done is actually share back with people when that has shaped the solution and I manage a thousand people, a thousand people are not going to be involved in every single decision that
we make an adult social care somebody will have been but how have we kind of shared with them that that’s actually how the decisions that we’ve made have been shaped. So I think there’s something really important for us about kind of completing that loop
and it goes back to the point Robert was making earlier if people are bringing information into us from the outside and we don’t complete the loop it makes them feel dissatisfied exactly the same thing happens to us internally as well so I think that’s
a big message for us. The second one is around sorting out some of those problematic issues and really understanding how that plays out in an organisation that runs as David’s quite rightly said with over 60 percent of our staff living at home, working from
home sorry and that’s nearly all of adult social care team and is based at home and then working in teams which are not kind of big teams they may be singly or or perhaps the only other person in the team is an expert by
experience and and so therefore somebody is different every time that they go out and I think that one of the learnings I take from all of this and my conversations with staff is that when you are working in an environment which is high pressure
lots of expectations and people are passionate about what we do so they want to get it right they really really want to get it right and then your computer breaks down or you don’t have a printer or whatever it may be actually if that
happens to me here I go round the office I kick a few things, you know, somebody makes me a competition I feel an awful lot better that’s really quite difficult to do if the only thing you can kick as your cat so you know
we’ve got to kind of think and I am noadvocating people kicking cats just in case anybody wants to suggest that, but you it environment. And then last but not least is the thing about workload and we have really tried to address that both in
terms of the work that Ruth and her team are doing to support us on always on recruitments so we are planning in advance, I mean I’ve got a lot of people who will be retiring this year absolutely making sure that we’re not waiting until
they walked off the premises before we start recruiting because we know that’s going to happen so actually making sure that we’re doing that are in advance looking at the investment that we’re making next year to make sure that we are recruiting to that but
also thinking about the skill mix of our staff because we have had some difficulties in recruiting the people that we need to be inspectors how do we grow our own, by recruiting people who can be Assistant inspectors so that we can develop them and
use them in the future. I’m not saying that we’ve got this cracked yet I really wouldn’t want to make that claim but I think that there’s a good understanding a good recognition of what those issues are and real commitment from the manager’s throughout the
organisation and across into the other directorates who are working

[Mr Peter Wyman - 2:16:09]

with us to try and address it. So in the interests of time and I would like to allow some time for questions from the public, I’d like to

[Sir Robert Francis QC - 2:16:20]

move on. Robert, yeah? Very briefly it’s
about being covered, the business about home working and the very valid point it seems to me that we are not necessarily unique almost unique and I wonder whether it would not be helpful if I need recognition of the huge contribution that the homework has
made to what we do and to the public generally we couldn’t perhaps have a seminar session with the board about that specific issue about what it is that we as an organisation are doing in relation to the Wellbeing and so on of our home
workers the only reference in this document and it’s not a criticism is good news they are going to get higher speed broadband, hallelujah could we all have a bit of that if possible but there is so much more of a challenge in relation to
wellbeing and the softest points that Andrea has just mentioned that I

[Mr Peter Wyman - 2:17:14]

think deserve a bit of consideration. Thank you that’s a really good point, I was going to go on and say Pete we are going to let you off today you are so much
a part of the solution but you come regularly the Board anyway to update on that but could I just ask Helen or Ruth you are going to be doing periodic reviews so we are going to wait a year then find out we haven’t made
progress when do you think, well when are you planning the next sort of reviews, so what’s the next point at which the board can be updated on whether we appear to be making progress So the first what we’re calling a pulse check, so 2018
is a transition year for us in terms of staff survey were using it as an opportunity to test how we approach pulse checks and is the final year of our current annual staff survey contract so we are going to use April May and June
as our ability to kind of pulse check the areas of detailed research that we’ve outlined in the paper so I suggest we come back in July and update you about what that’s saying before we go back out again in 2018 on the Annual Survey

[Mr Peter Wyman - 2:18:32]

Sounds good to me, alright everybody? Excellent, thank you very much for all the work has gone into this and all the work that’s going to go into making sure that this time next year they are all excellent results throughout this variation and everything else

Recognition of Outstanding Contribution Award Presentation

fantastic thank you. So the last item of business before we get onto any other business is to embarrass Katie Allen and I can’t do that Katie if you sit behind the lecterns, come, welcome. So this is a to recognise outstanding contribution to CQC now
there are many people who do outstanding things which I am not aware of but in your particular case Katie I am aware of what you do because I’m part of the problem that from time to time that you have to deal with so we
actually earlier in the in the Board meeting were commenting generally on the quality of publications and reports and thanking people for doing it but your particular role and where I’ve been involved anyway has been primarily around both state of care which I think everybody
in the room thinks is a really excellent publication and our annual report and accounts which at least Paul and I think is an excellent publication even if everybody else isn’t as excited by it, David thinks it’s OK as well, maybe as the acconunting officer
has a sort of view on that but can I just read out the nomination because it’s not just from, the nominations isn’t from me at all but those are my personal observations but the nomination said that you were the the editorial linchpin that held
everything together in relation to the state of care and made sure everyone involved was kept fully informed up-to-date Katie was unwaveringly hard-working professional and enthusiastic as the lead content coordinator, as well as writing articulate an informative chapters Katie worked tirelessly to keep the editorial
Team updated on all key areas and guided us through the very complex and ever expanding world of state of care. So that’s the official citation, I think David you and I would add to that keeping you and me happy as we got increasingly into
the editorial drafting so Katie very many congratulations one day somebody will actually give me something to hand to somebody can you just accept the metaphorical handing of an award because it’s hugely well-deserved and thank you very much for all you have done and hopefully

[ David Behan - 2:21:08]

will be go on doing. I think what you won’t know is that she is a brilliant violinist too often turns up at open mic nights and gets Andrea dancing For which many thanks as well One woman of many talents So I used to be
on the Board of an orchestra and one of the things we used to do at the board of the orchestra was we would always invite one of the players to come to the management meeting which was the board so we link up the management
and the players but we always got whichever the player was to come and actually spend the first five minutes every board meeting just to talk about their instruments and playing a little so and it does get you in the mood I have to say
Katie so you may have another job as well I should have brought my violin You should have done, so I am not giving you an opportunities to play but do stay and have some lunch with this in a moment thank you. So shall we

Any Other Business

move on to just check is there any other business from the Board itself anybody wanted to raise that we haven’t covered? OK so then let’s move on to questions from the public and I think Robin you were probably the first that I’ve got anyway
here so would you like to come to the microphone for the record say who you are and ask your question. Thank you chairman ###INAUDIBLE### just a question about primary medical Services inspection and their ratings, what does a practice have to do generally to improve
its rating from good to outstanding and do practices understand what they need to do to improve their overall rating because there is some criticism I think from general practice and possibly from some patients that their practice they think is jolly well outstanding but the
CQC rating is good. Steve. I guess that’s for me unless Andrea wants

[Professor Steve Field - 2:23:36]

to answer it It’s all yours Steve Thanks very much, I mean most practices are good or outstanding which is a which is superb for patients across England because they will know that
they can get really good care and I’m going round the country at the moment looking at a number of our outstanding rated surgeries in the last few weeks I’ve been upset to Liverpool to look at Brownlow which is extraordinary I’ve been to Manchester to
Ancoats to look at the urban Village surgery there and I saw three in Devon two weeks ago. The characteristics of outstanding are very similar to actually adult social care in hospitals it’s about the leadership and about the vision and the focus on the local
patients whether for example in Liverpool they were students and homeless people or in some of the other surgeries where they have a much more elder population what you find is fantastic leadership focusing on the needs of their particular population and getting staff to own
that vision and really value it and we just had a very good discussion about our own staff survey if you go into an outstanding practice the teams as soon as you walk through the door you get a feeling for the fact that it’s outstanding
they know what they’re doing they care about their patients they really want to go the extra mile for their local population all of our KLOE’s is the key lines of enquiry all of the standards are all written down and a lot of it is
in our end of Programme report that we published because every practice in England for the first time ever and probably the first time in the world were rated last year and now we’re going back to them and the great thing is that we’re going
to a number of these outstanding practices and they’re saying that it’s actually helped them with the recruitment of staff and of doctors and we’re seeing many other practices get even better broadening what they do and focusing, what we’ve got to make sure is that
they maintained the standards when there are outstanding and we want to do whatever we can to encourage the good practices to be even better, but going round the country looking at them high feel really really optimistic and it’s a fantastic feeling and you can,
I mean if you follow me on Twitter you’ll see some of the journey as we go round it’s great stuff. Steve it might also be worth adding that

[Mr Peter Wyman - 2:26:19]

we are doing more and more to give examples of outstanding practice whether that’s in primary care
or wherever else and indeed Katie while you are still in the room we know quite a few examples in state of care of good things and other places I think for both practitioners and for the public to understand the characteristics of outstanding seeing examples
of outstanding whether its practice or adults social.. Yes that’s well

[Professor Steve Field - 2:26:50]

said, we are we using our website we go round and work with lots of of meetings with the CCG’s with the BMA and the college we all want to improve the quality of care
and of course being able to say that the vast majority of care provided in this country is good or outstanding reinforces the public messages from the college the BMA and others that investment in general practice is a good thing. We know from evidence around
the world that if you invest in primary care and you have really good primary care led services the outcomes even from hospitals are better and it’s reinforced in our local system reviews that prevention keeping people out of hospital which primary care general practice has
a really core role working with social care colleagues and with hospitals that’s where the services are at their best Great, thank you for the question. David I’m David Hargroves I’m a coordinator of care St John’s Wood ###INAUDIBLE### befriending organisation. When I was in the
Link which you will remember was the predecessor of Healthwatch we did a lot of work surveying the effectiveness of the monitoring activity of social care department of the Council which of course funded us and I wanted to ask Jane as a quick one not
immediately but later how for Healthwatch’s local Healthwatch do this sort of thing because there’s a great deal of surveying I think all providers but not necessarily of those who could use the money but my main point is really about inspecting just over a year
ago there was an article in Nursing Times reporting some research by somebody called Steve Moore he was a Commissioner of social Care in Dudley and he asked quite a large number of care home workers if they’d ever seen abuse or neglect in their previous
job that was a good point get interference from those old whistle-blowing worries and that kind of thing and he 138 responses 109 that’s 79 percent of those said they had either seen abuse or they had actually suspected it. Of the 109 who responded the
largest number were psychological and he asked them also to give some examples two of the ones which he chose to highlight were some nursing staff including the seniors who thought it would be enormous fun to give everybody all your residents the wrong set of
false teeth because then wouldn’t it then look funny, and well that’s just one I will give you for the moment,the other one is gone out of my head. Now he at the end concluded that this sort of abuse and neglect was not really possible
for a regulator to discover through inspection I would like to qualify that because I mean I’ve read quite a lot of inspection reports and I think that some inspectors do an excellent job in picking up on clues but on the whole they are clueless
but I think his main point does stand that there is just a limit to what you can do on inspection and I was therefore a little bit disappointed to learn that the round table on technology which is coming up with also includes surveillance would
not actually necessarily have any effect on the inspection process in adult social care and also that there was no plan that whatever it produced, whatever the guidance resulted from it said this would not be enforced so it would seem that the guidance would be
the same,I have to say ineffective guidance that we had about eviction banning and also the guidance on cameras that came out in 2015, it was open to care providers to pay attention or not pay attention as they wished so I am still hoping, of
course, it may well be that you are thinking about how to inspect rather how to investigate and that that is not connected to this round table I hope that is happening and perhaps I will in future learn a little bit about what is being
done but I do feel like Steve Moore felt that there is a real need for something which is more penetrating and digs down deeper and gets out this thing this abuse that is happening quite widespread and which will make the ###INAUDIBLE### that you always
talk about come true. Thank you. I think that is the ###INAUDIBLE###

[Mr Peter Wyman - 2:32:43]

decoy isnt it because the first part of your question was certainly not something that I didn’t know coming anyway but Jane Are you able to answer that or do you need notice? Well

[Ms. Jane Mordue - 2:32:57]

notice would be nice but I will get you an answer I mean as far as you know, Adult social Care department is concerned we will most likely be working with them and holding them to account through the local Health and Wellbeing Boards that’s where
our sort of, you know institutional link might be but basically we stick to the task we have been given which is what people tell us and whether people will comment to us on what the Adult social Care Department doing I don’t know I would
more like to comment on the quality of care they are getting, but let me look into that the point about false teeth is something that I remember coming across at Healthwatch Coventry it is not so much done as abuse is just a, the terrible
is it not necessarily done as abuse is just something that you know heaven forfend if you do go into a home somebody said to me at Coventry the trick is to get your postcode engraved onto your false teeth because they go into a bucket
to be cleaned and you don’t get the right ones back and it is not done as abuse, just on us thoughtlessness I think would be the nicest thing

[ Andrea Sutcliffe - 2:34:07]

I can say. Thank you, Andrea. It’s just not acceptable lets just call that for what is
our expectation is that people are treated with dignity and respect and all aspects of their care needs to kind of be consistent with that and if somebody has got false teeth then they have every right to have the right false teeth for goodness sakes.
So Get off my little soap box on that one. Just to to clarify a couple of things David and thank you very much for giving us advance notice of the area that you wanted to cover, as you quite rightly say three years ago we
published information about the use of technology and surveillance techniques both for providers and for the public and we have committed to looking at that and to taking that further forward given that we are now three years on and obviously an awful lot of things
have changed since then. One of the things that has become really very evident to me in the last few months while we’ve been preparing for that is that there has been a lot of change in terms of the sorts of things that are available
for people to use and also there’s been a change in terms of how these things are being used by providers and the public now as compared with three years ago. There is also quite a lot that’s going on within CQC in DIFF and all
three of our directorates and looking at the use of technology and how technology is improving the quality of care and that might include surveillance but it’s other aspects as well. so actually yesterday I was part of a meeting trying to bring together some of
the different strands of this so that we could be much clearer about what the round table that you referred to can focus on and one of the things that we felt was going to be an important thing for us to do is to bring
everything together into one place so that we have a resource that is available for the public for providers but also for our inspectors in terms of what’s the best use of technology how it can improve and support better quality care and what our expectations
would be of services but also of our inspectors in terms of how they use that. I think that what we’re doing is shaping the Round table a little bit further on from the conversations that we previously had to make sure that it’s a cross
sector round table that we look at all aspects of what we’re doing that we do think about creating, what I’ve got in mind is those of you have had a look at the equally outstanding resource that we produced last year which was on the
website and kinda had links off into various different places was a repository for information that everybody could use was very accessible and I know has been welcomed by people out in the sevice as well as others that that’s the sort of thing that we
can create and that we can use that to actually try and move things forward. We are still going to be in a position where as a regulator we’re never going to know absolutely everything because we’re not going to be there all the time which
is one of the reasons why, as Ted said earlier the information that we get from people who are either using services or working in services continues to be really really important but what also continues to be important is that our staff are trained and
supported to identify those clues and to dig deeper when those clues manifest themselves and that’s something that we will continue to do as well but you and I have got time to speak about this later on this week David so we can go into

[Mr Peter Wyman - 2:38:03]

it in more detail then. Great, thanks to Andrea. Can I just check who else wants to ask a question? Right so we’ve got three and we are nearly now at twenty to two can we take your question quickly thank you. My name is Joyce
Obaseki and I am the founder of the social enterprise known as granted smile I started this initiative in October last year, what we do is we basically going to the homes of chronically ill parents, parents with chronic illness and mental health conditions and we
clean their homes and do other practical House chores for them for absolutely free. By December last year we got picked by the press and we were on the ITV News, BBC and all the others and so far we’ve just had so many referrals from
parents referreing themselves to us. I have written to CQC and the GPs and other bodies to try and support what we do as a result of the the surge the parents coming asking for support and I haven’t had any so I started to think
maybe they there are other practical services out there that I am not aware of and that’s where I haven’t had the support that we should have so my question is basically is kind of just checking, that’s why I am here today because our research
shows that 1 in 4 children have families who have parents who have chronic illness or medical condition and I’m thinking why are we not supporting these children because this is where the mental health starts this is where the emotional well-being and psycholgical needs are
not met and I am just wondering what practical Home support Service are out there for these families outside of the hospitals. I’m not

[Mr Peter Wyman - 2:40:06]

sure we’re the right organisation to answer the question Andrea have got anything you want to say No no I mean it

[ Andrea Sutcliffe - 2:40:13]

is unfair You can ask me but I am not sure that I am the right person either. I think that the right place to go is where is that support being commissioned from so I think that there is an important focus on this in
NHS England and NHS England have a director of mental health services, a woman called Claire Murdoch who I had the pleasure of working with many many years ago and what they are doing and through the Five Year Forward View that they did on mental
health services actually identifying the things that they want to do to kind of ensure that there was better support out there in the community as well as in terms of what was happening in hospitals, there is also what local authorities are doing with regards
to the services that they are putting in place and it’s something that, and Steve may want to kind of touch on this whilst our local system reviews have been picking up on what’s happening for people over the age of 65 in terms of the
use of services between health social care and back into the community one of the things that we have picked up which I think is a theme that applies back into what you’re asking about is that because of the restrictions on funding and resources an
awful lot of focus has been on the kind of crisis intervention or support when people are really struggling but not on prevention and I think that that’s really what you’re your highlighting is where are the preventative services were the services that support people and
I think that our message from the local system review is that you’ve got to concentrate on that as well as that the heavy end is important and last but not least I don’t know whether Multer or Ted will pick this one up but the
children and Young people mental health thematic review that we are doing again I don’t know whether that’s picking up on some of the preventive supported mechanisms that need to be there because you are quite right you know, young people supporting their parents who have
got problems end up with problems themselves and you start that cycle

[Mr Peter Wyman - 2:42:27]

so I’m kind of basically passing this to other people Peter. So rather

[Professor Steve Field - 2:42:32]

than, go on Steve I am really happy to have two minutes on this I think it sounds like what you’re
doing sounds really helpful and really good so so thank you from me not particularly from CQC but from me and the work we do with the voluntary sector in health and social care is so important and as Andrea said one of the themes that
are coming out with our local system review work which is over 65’s but it but you can talk about the whole population is the importance of the voluntary sector and those areas where like Bradford where they really engage well with the voluntary sector support
carers at home that releases pressure from the health and social care system and so the best areas really would want to engage with organisations like yours but it’s at a local level where the engagement would be made and in Bradford for example, the Leader
of the Council is really up for the approach with voluntary sector working very closely and and most of the good areas are so I would encourage you to talk as Andrea said to the local areas to the CCG’s to local authorities but it sounds

[Mr Peter Wyman - 2:43:53]

great. So you’ve said you have written to us not had a reply let us try and find out what’s happened to your letter and make sure you do get a reply which will help you anyway I echo what Steve just say well done for
what you’re doing Thank you very much And thank you. Andrew given we’ve had quite a long discussion about the review of fit and proper are you happy to leave your question. Charles I am happy to leave it if you do, I dont know if
you have had the chance of if you’ve seen what I sent through and there is one outstanding question can I respond to you after the meeting. Lovely thank you very much Bren the last word goes to you then very quickly thank you. Very briefly
to have the last word really it is just as you started off really celebration really and I just want to offer my thanks and the thanks of a hundreds more community groups in Gloucestershire that were part of the national pilot that we brought down
to have that conversation on not just what matters to those groups but why aswell is not just what matters have got to understand the why aspect as well and Peter you’ll know that we had that fantastic opportunity on the 31st January at the House
of Lords with Earl Howe to host the the opportunity to do exactly just that celebrate and I think the key thing for me is that we’ve got to make sure that we involve those small community groups all the way through so isn’t just coming
down saying what matters to you and why they’ve actually got to be part of that celebration of the House of Lords and onwards with us as well or else actually does becoming a bit of a tick off box really and we disengaged those people
really well a no surprises with Duncan Selbie is the Chief Exec of public Health England galvanising the conversations that I am sure there will be further developments from that and whenever and thank you to Chris Day to Paul as well for coming down on
the 7th and for other people who couldn’t make it on the day as well. Thank you for closing it as well with all these things sometimes you are damned if you do and damned if you don’t but I made very clear conscious decision about
the biggest part of the conversation on that to our two and half hour day, went to those small community groups but I also made a very clear conscious decision Peter that you would close that and there was a reason for that and the reason
is and hopefully you like it really, but the active involvement of the Care Quality Commission all the way through on this work not only the Care Quality Commission but other arms length bodies public Health England for example has been really exemplary so the work
was done slightly outside of the system so independently I don’t work for an organisation per se I just give a little voluntary time where I can amd whatever and knowledge of the system but also keeping the absolute focus on people and communities. It isn’t
surprising that a number of invitations have come my way to say actually can you tell us the how bit I have you managed to do that and any whoever is in Whitehall or beyond always get the same reply it’s not about Bren it’s about
the we, how do we do it so thank you Peter for closing it but much more and whatever but thank you to the whole of the CQC for that belief that commitment and above all understanding the purpose. So

[Mr Peter Wyman - 2:47:41]

other people make their name by
opening events I am obviuously making mine by closing them then we let me close this one Bren by saying it was a fantastic afternoon in the House of Lords and it is a great pity that everybody couldn’t see what you did that afternoon for
those groups of mainly disadvantaged people doing fantastic things in their own communities and it was really uplifting just to sort of sit and watch it so congratulations to you and and long may you be able to carry on doing such great stuff in Gloucestershire.
And with that we are finished thank you all very much indeed.
  • Professor Edward Baker

  •  David Behan

    David Behan

    Position Chief Executive

  • Mr Paul Corrigan

    Position Board Member

  • Professor Steve Field

    Professor Steve Field

    Position Chief Inspector of General Practice

  • Sir Robert Francis QC

    Position Board Member

  • Mr Malte Gerhold

    Position Interim Director of Strategy and Intelligence

  • Mrs Kate Harrison

    Position Director of Finance, Commercial & Infrastructure

  • Ms. Jane Mordue

    Ms. Jane Mordue

  • Mr John Oldham

  • Mr Paul Rew

    Position Board Member

  • Ms. Liz Sayce

  •  Andrea Sutcliffe

    Andrea Sutcliffe

    Position Chief Inspector of Adult Social Care

  • Mr Peter Wyman

    Mr Peter Wyman

    Position Chairman