March Board Meeting (Wed, 21st Mar 2018 - 11:00 am) 

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Good Morning everybody welcome to our Board meeting which earlier this month is in Birmingham in our office in Birmingham which is great, can

[Mr Peter Wyman - 0:00:17]

I particularly welcome first of all Kirsty who has joined us as chief operating officer Kirsty you are extremely welcome and then

[Mr Peter Wyman - 0:00:26]

secondly Mark Saxton who’s joined us as a non-executive director so you’re both extremely welcome. I dont think we have any apologies so we can deal with that is there any declaration of interest that anybody needs to make which is excellent. We then have the

Apologies and declarations of interest

Minutes of the meeting held on 21st February

Matters arising and actions log

minutes of the 21st February Board meeting they are a croon accurate record of everything we discussed, good thank you very much indeed there’s nothing on the action log that has not been completed which is really good is there anything arising from the minutes that

Chief Executive's report

were not otherwise covered on the action log or otherwise on the agenda, fantastic and welcome to the members of public who just arrived I’m sorry that for whatever reason you were probably held up somewhere but you’re very welcome so David that takes us to

[ David Behan - 0:01:27]

the Chief Executive’s report please. thanks Peter, so there’s rather a

[ David Behan - 0:01:33]

lot in this a significant proportion, is for information only so I’ll do the performance material with colleagues and then we will pause through on that and then I’ll take the rest of it a
gallop so what you’ve got in the first paragraph and the annex is the performance summary for January and you can see we’re trying to present this in a crisper way so I’m at the top of page 2 a brief summary of the performance it’s
on track I will not repeat them and then more analysis of those were a performances under the KPIs under what we would hope it to be and as an analysis there are the detail of the work that is taking place on report time in
a safeguard in reports and the inspection programme to date. I don’t think there’s anything new in those paragraphs and then at paragraph 2 we’ve got financial performance where the position is at the 31st January is laid out and an explanation of why that is
the case, I suspect the questions that might arise are more driven by the performance on X which has a more detailed breakdown this is a summary of the report you get on a quarterly basis but as a key headline so if a pause there
Peter and invite questions and I’m sure my colleagues around the table will come in and answer specific ones which are coming in their direction if it’s around I’m inspection directorates and if there is anything there about money care will pick that up. right so

[Mr Peter Wyman - 0:03:34]

anybody want to raise anything. you might be on a winner here David,

[Professor Louis Appleby - 0:03:46]

Lewis. You did that so quickly David, are we now talking about the annex as well, it’s very helpful information as always complex condensed. I was struck by the, maybe I misunderstood the
apparent rise in the number of whistle-blower notifications to us to which is on, if I can find it so this is about volume received although the there’s obviously got a lot of month on month fluctuation leading to an apparent peak in January but I
think the message of the slide here is that there is a general, despite the fluctuation, there is an overall trend towards an increased number of notifications and I suppose that’s surprised me because of how much has been done to create across the NHS an
alternative way of allowing people to speak up through the Guardian system, so a national infrastructure if you like a national message about the importance and yet we’re getting more more cases notified to us or more people coming forward let me put it that way
do we understand why that might be. starting with the NHS Ted might

[ David Behan - 0:05:15]

want to come in, social Care Andrea might want to come in so these are all whistle-blowing this is right across the piece I think what you’ll find in this is a significant
proportion of these relate to adult social Care not just to the NHS, whereas to your point a national guardian role is specifically directed at the NHS acute hospitals it’s not yet offered in terms of general practice or in relation to adult social care so
some of the mechanisms referred to Lewis are partial and they do not go across full score but I think this is one of the issues that came out in the public accounts Committee hearing which is and how do we do, as we become more
well known as people understand who we are and what we do and that’s the survey what we do about prompted an unprompted recognition of us and who we are and the more successful we become people feel more confident in refereeing issues to us, I
would offer that I think some of these figures are an artefact ofthat phenomenon, but we continue to work to understand this I still worry about the accuracy of the figures in relation to all people who are employed are raising concerns in relation to their
employment and the quality and safety of their employment and all the whistle-blowing cases which related to quality and safety in relation to what’s going on, so we continue to do work to actually understand the accuracy of the figures and I think we do need
to break them down. I think what is possibly behind your question is where are they from and what do they tell us and we can have a better understanding of whether this is more people expressing concern or whether this is more reporting coming through
to us and these figures are an artefact of that. I personally think this is more reporting coming through to us but I think the truth be told I wouldn’t want to be definitive about what we think is going on here. Ted and then Robert.

[Professor Edward Baker - 0:07:20]

well very much with those caveats about the figures that David was just highlighting I should say that from an NSH perspective I very much welcome this inquiry. I think it is a sign that people are willing to talk to us and as I’ve said
to this board before the value we get from members of staff raising concerns in terms of identifying risk and helping us target our inspections where necessary is immense and I think we owe a great deal of gratitude to the people who do raise concerns
and they give us really very variable information. We are trying to change the culture of the NHS here we tried to create an open culture in which whistleblowing would no longer be necessary because there’s so much transparency, we are a long way off that
yet and I think the work that the national guardians office is doing and the work we’re doing is encouraging people to come forward I think that’s right and proper and I think it is going to be quite a while before we see the improvements
in culture driving down the numbers because people don’t know they

[ David Behan - 0:08:21]

dont longer feel the need to I think we’re way off. firstly the same point which is that increasing numbers is probably a good thing rather

[Sir Robert Francis QC - 0:08:27]

than a bad thing i’d rather like complaints and
more complaints you have the more learning you can have. The question that I have which is about the research the pie chart next to it and I may have mentioned this before but it is that i’m not sure we’re digging down and getting information
about exactly the point that Ted has made, which is how useful the information is to us, so we are told here that a certain percentage has brought forward a review and one on the whole we think that means that’s a really useful piece of
information then there is the majority in terms of this pie chart that are noted for feature reviews and that’s what goes out in letters most of the time which if I were a whistleblower that summed up the courage to say something I regard it
is important I would get a sense of anti-climax about that and worry about what that really meant and I worry as a Board member what it really means here so for instance when the review eventually takes place do we in any way have a
measure of the extent to which the whistle-blowing information intent

[ David Behan - 0:09:40]

was confirmed or not. some on that so when we receive information is categorised as a priority categorisation, where priority one is if there’s a risk to health and safety and that will get a pretty
immediate response and at the other end priority four for example might relate to a breach of environmental regulation where others have already been notified and they’ll get different so we continued to apply that approach and we are currently updating the guidance to all inspectors
in relation to whistleblowing which will again confirm some of the issues around what action needs to be taken and so I think this is something that receives a fair bit of attention at a senior level in terms of how can we be assured that
we got consistency at the front end which is behind both your questions and pulling out the data and the data does open up the need for us to be constantly on that just use one of the phrases from the last session about being constantly
curious about what is this telling us on what do what do we know. you know we have driven inspections, one that immediately comes to my mind is the Marie Stopes International inspections which were done in 16 through to 17 which were driven by concerns
from our inspections and by whistleblowers but we also know my inbox, and I know Robert yours is as well, we will frequently get people who have blown the whistle who feel that we’ve not listened to them adequately, we’ve not taken the appropriate action as
quickly as we should do and we actually need to listen to both of those we need to listen to the challenges which come in as well as actually building on the successes we get very little media coverage when we do an inspection and then
take enforcement action based on a whistle blowing concern that comes through the Board is an opportunity to raise some of those issues, but we do get challenged quite properly if we’re not seen to take actions efficiently, so I think they review the data making
sure we’ve got clean data, that the data is up to date, we can be absolutely clear about it the issuing of guidance to inspectors making sure we are not conflating safeguarding concerns with actual whistleblowing, the true legal definition of whistle-blowing are all part of
the depth of cleansing that’s been going on so, I wouldn’t want to come over as being in any way shape defensive about what we’re doing but I also want to be clear to the board that we are constantly reviewing the approach and I think
just to pay tribute to the National Freedom speakup Guardian Henrietta Hughes who I think has done a fabulous job a in terms of setting up the National guardian’s office. I think the quality of the work between inspectors and national guardian’s office about exchanging information
to make sure we are picking up I think was evident when Henrietta came to the board and shared her annual conference about three or four weeks ago were we were able to go through a number of these things I was able to say a
few words but there was a whole day conference where we got inspectors really who were present to really look at how we work with the national guardian’s office in relation to their role and responsibilities so I know that in terms of the inspections is
something that Ted’s team, when they’re out in the hospital there is a big component of the inspection methodology because let’s face it that’s where a lot of the publicity around whistle blowing comes from, rather than in care homes where the volume of our whistle
blowing comse from that needs to be attended to as well and at one level we worry considerably about the ones are coming from adult social care because they are more closed institutions without getting into the sociology of all of this, because hospitals are pretty
public places with lots and lots of people going in and out every day I’m not sure care homes are necessarily as public with that degree of scrutiny and as you were showing what this is about your personal experiences of the other day so yeah
going to stop repeating itself and we’re not complacent yeah. Can I just bring Andrewa and then come back to you. Thank you very much I

[ Andrea Sutcliffe - 0:14:29]

just wanted to make a couple of points the first is that this is really important information for us and
as Ted has said I am personally, and I know that my team are very grateful to people who do step forward and share that information. I was going to say the same thing as David which is that very often we are the people that
they would want to turn to because if you are working in a small care home you are blowing the whistle on people who you may be living very close to, bumping into at the supermarket you know they are very often small enclosed environment where
it could be very difficult to raise your concerns within that environment and therefore coming to us is very important. I do think though that we have it’s not just about kind of immediately going out we do indeed have experience of people raising concerns with
us and that has triggered a responsive very quick inspection and going out and monitoring what’s happening on the ground, but we are constantly monitoring these services, every single adult social Care location sits on the portfolio of an individual Inspector, they are gathering information together
on a regular basis, this is part of that building up the picture that helps us to ensure that were scheduling inspections correctly and that when we go out on inspection we’re asking the right questions and we are really focusing our attention in the right
way. the final point is and I welcome as David has said we’re doing this additional guidance and support for inspectors to help them to do the right thing and part of that is about the response that we make to the whistle-blower. Sometimes we can’t
make a response to the whistle-blower because its anonymous to us and therefore it’s difficult for us to do that and closing that loop can be difficult, but very often we do try to go back to people but increasingly you will see in reports that
the reason why we have undertaken the inspection is in response to concerns being raised with us and I think that that’s another way for us to demonstrate that we are valuing this information, that we’re taking it seriously and that we will do something about
it. Thanks, Louis. Well first of all thank you very much for all of

[Professor Louis Appleby - 0:16:55]

these comments they are very very helpful and I think getting behind the data I think is key here without difficult idea. I absolutely accept the idea that that as with complaints
a rise can signal a change in the culture towards openness and we want to welcome that, but I just want to caution against relying on that interpretation. There is a danger for us without disputing it I was wanted cautioned against being too confident of
it because there is a danger that we fall into the the sort of culture of positive news which runs around national organisations at times and so you know when the figures are going up we think that’s good and when they start coming down we
will think that’s good as well so we can’t lose and sometimes the figures are going up because don’t forget when we’re talking about whistle-blowing figures we are not simply talking about openness in the system we’re talking about failed openness locally, and so we can’t
be too happy that that’s the situation though we might welcome the fact that our role is then being so recognised and responded to. David you are absolutely right that my concern is partly about social care and care homes and I’m not going to pursue
my own sort of personal case in the board here but just care homes are as you say a different environment, they are smaller in various ways they’re are small in terms of number of staff, they’re local the adverse news that a care home might
generate has great potential commercial impact and so the the reluctance I would suggest at times for care homes to respond to legitimate concerns of staff I think that there is an incentive not to respond and in my own case the handling and harassment of
whistleblowers was quite evident but concealed for quite a long time so I think that we just need to have an open mind about what these figures might mean and make sure that we don’t lose sight of the human and the effort that goes into
being a whistleblower and the tremendous commitment that whistleblowers are making to the system because they are often not making any commitment to themselves it’s very stressful for them and the commitment they are making to the values of the system that we regulate that when
they do speak up locally and to us and making sure, Andrea as you say, that we respond properly to them I think responding to them direct whenever we possibly can, talking to them, understanding what they are really telling us and making sure that they
feel that they are having taken this step are being listening to that that’s incredibly important so I think these answers has been very very helpful, but can we just continue to keep our eye on this very important issue. So I think when I first
came to CQC one of the things that quite a lot of whistleblowers were

[Mr Peter Wyman - 0:19:52]

writing to me about was not that we had failed to go back and say we’ve received your concern and it wasn’t that in the main that they were unhappy when we
were saying and we will look at it when we next inspection so it was, what they were unhappy about was that they never heard what had happened when we done the inspection and I think we’ve discussed it in the board before I think since
then we’ve got much better in our inspection report in closing the loop saying we did have information about whatever and this is what we found on the inspection I think it’s really important we don’t lose sight of that in our inspection reports because that
does close the loop for a lot of people to get to your point good we

[Mr Paul Rew - 0:20:49]

happy to I’m sorry, no Paul go on. Can I just ask about a report production and what we can expect in terms of when the improvements to the timeliness
of report production and I guessed services particularly aimed at hospitals as well because I’ll just point out that this is something which has been a problem for forever it seems, that I dont think we ever hit our targets on report production that’s been picked
up by PAC and others and in that respect and in the commentary that we got within the David’s report there’s a bit that says well actually we brought something, some analysis to the executive team in January and we’re going to do some more work
and we can expect something to come back to the Executive team and then in the next few months and that doesn’t sort of feel to me like we’re really getting a grip of it and if you look at our business plan for next year
it has the same KPI and unless we do something about it the KPI is gonna be missed by a mile again so it’s just a little bit of questioning about when or whether we get to see the improvement come through Steve looks like he’s

[Mr Peter Wyman - 0:22:06]

[Professor Steve Field - 0:22:11]

going to answer the question. it’s actually Ted’s bit which is the most. Well the real world report time is important for all of us actually the problema with the KPI is that it is like a rolling sort of average and we had a problem
when we were coming to the end of the programme and trying to get through the volumes and if you look at the graph which you can see, our improvements really kicked in April of last year we think that the KPI will be met in
April or May of this year because the backlog of long reports, some of the complex enforcement action which meant some reports took many many months, that has now passed and if you look at the PMS graph where since May of last year 26 days
and whenever 31 days and that’s because we’ve introduced a lot work looking at lean methodology working on each step in the process because we believe it’s important. Unfortunately KPI is about 10 months behind where the actual action is. Yeah I share your concern Paul

[Professor Edward Baker - 0:23:33]

and thanks for raising it has a as Steve says some of these are dealing with backlogs of reports and we have improved the processes and if you look at the rate of the a graph at the bottom of page 10 on left-hand side the
the average length of time of producing report is coming down but it is still not achieving the KPI are and I think that is a reflection of the complexity of issues in the next phase inspection, at the same time as as clearing the backlog
from independent healthcare inspections which have been taking place, a lot of work is going into managing the process of next phase inspections to make sure they are coming out of time we are getting closer to it all the time so I hope this is
going to turn round quite radically soon but there will be a bit of a backlog of Independent healthcare which keeps the average down what you’re seeing in the in the KPI on the right-hand side is the kind of long term situation which inevitably takes
a long time to change because it is data over a very long period and I think probably and John mentioned this I think that the last board meeting we probably do need to move to where monitoring this through a timely process of statistical process
control rather than just the the annual KPI which I don’t think really very helpful in that we can’t really turn that round in short order so it’s very difficult to demonstrate progress going forward the work we’re doing around quality improvement I think has to
be the focus on getting this better this is very important we direct our quality improvement initiative starting out in these areas of difficult performance and that’s what we are determined to do. so the

[Mr Peter Wyman - 0:25:10]

risk of upsetting colleagues and I don’t think in with great
respect in hospitals where they are large and complex we will actually get to the turnaround time that I think is necessary whatever the KPI is, while we are essentially a pen and pencil operation the technology that were working on will be the game changer
and that in my view when we get that in place the report will come up much more quickly, the quality assurance around that will be a much easier operation, so I think it is technology and we are at that point yet others may disagree.

[Professor Edward Baker - 0:25:52]

Ted. Just to come back on that Peter I totally agree with what you’re saying but actually I think we can improve a lot of where we are at the moment before that technology comes in and that’s what we’re doing at the moment. I’m sorry

[Mr Peter Wyman - 0:26:01]

I didn’t mean to imply otherwise but I just think there is that there is a bit of change that you’re making the moment the quantum leap comes with the technology I think. David. So just not to have the last

[ David Behan - 0:26:15]

word on that but so
am I’ve asked every year for the past three years do we want to change this KPI and we did it again for the business plan that you’ll be

[ David Behan - 0:26:24]

invited to agree in a few minutes time and the executive team were consistent decision to keep
the KPI where it was so that it becomes a public declaration of the target we should be working so and the expectation I think is that the board and members of the public is that we should be working towards that. I was asked specifically
at the public accounts Committee because this was a big thing for them when did I think the politics of this was all about the NHS when did I think the NHS will begin to improve and, rather put on the spot, my answer was we’d
expected to hit 50 percent during 18 19 so that’s what we’re on the record of saying within an agreed target of and I think to Steve’s points about a rolling average I think if you look at where Andrea and Steve are going to hit
that, what Steve’s working his way through is a backlog because it’s a role in Ambridge to keep that going so I think we’ll get there and you’re right, the challenge is going to come from a mixture of improved systems of productivity we’re going to
start distributing laptops which will go to inspectors which will allow them to have a tablet that they can write on which would then convert into scripts I think as we begin to ensure that kind of technology the productivity improvements will be considerable as it
works its way through I think Steve’s point about end-to-end process and constantly reviewing those outweighing processes is right I think some are Ted’s team probably can do it I think it’s a mental health reports on a big mental health trusts that was done in
30 days so it is possible to do this we know it’s possible to do this, the issue is about how can we work in a consistent way right across the organisation to do that. But you are right and Andrea and Ted have to work
very very hard with their teams over this next 12 month period but and I just don’t want to pre-empt the next discussion Peter, but it was a very conscious decision taken to propose a business plans at the Board which kep it at 90 percent

[Mr Peter Wyman - 0:28:33]

[ David Behan - 0:28:36]

the next I’m already in part referred to the public accounts Committee report but this is the first public meeting of the board since the public accounts committee published their reports are on the 9th March of the hearing which took place last week and they
reflected on the progress that we made and they referred to substantial progress which built on what the public accounts committee talks about improved significantly. They also focus quite heavily on the issue that you’ve just been discussing which is Report timeliness amongst other things and
interestingly enough Lewis, your question about whistle-blowing about what impact would greater recognition have if we get more work coming through in terms of how we plan and the allocation of resources to make sure we’ve got sufficient people to do the job we’re asking people
to do as well so it’s interesting Peter how a two of the conversations this morning reflected the conversation at the public accounts committee. which proved the public accounts Committee report on the case I can do that as sly irony that five months after my
appearance they published their report and one of the issues and challenges that always report publicity so I can’t resist the deliciousness of pointing that out in a public forum so thank you very much I promise as we towards July but a rather importantly though
in the public accounts Committee reports was the attention they brought to the value of the work that we do on local systems reviews and this important issue about looking at the system as a whole not just our individual systems and I think that was
from the perspective of wanting to encourage some longer term solution about being able to look at the way that systems operates so it is a helpful opportunity to both review our progress Peter and just to a acknowledge the reports from the public accounts Committee
itself. Interestingly they want us to report back by virtue of a letter in April 19 which hopefully means that there won’t be another NA or review within the public accounts committee hearing so I thought that was a significant step. We’ll bring forward an integrated
action plan which we will bring to the board which combines the National Audit Office’s action plan and our response to the National Audit Office reports as well as the public accounts Committee reports and that will go to Paul’s audit and corporate governance committee in
April. Moving on, competition and markets Authority published a report in December 17, a very important report I’d thought an excellent report as well in terms of its content and the quality of their research and the evidence that they are brought forward and they’re focused
on capacity consumer protection and consumer information the government published on the 5th March their response which accepted the recommendations in principle and in full and stated that a significant component of the government’s response will be captured in the green paper and I think this
was talked about over dinner yesterday evening but the secretary of estate yesterday a made a speech on the seven principles that would support a green paper in the summer and I think you can see in that speech some of the principles that were flanked
by the CMA in their report so I think a a pretty significant reports a from the CMA. Paragraph 5 is about the Kirkup review this is a review that Dr Bill Kirkup was asked to undertake in Liverpool Community Health NHS Trust and published report
that had a number of recommendations we’ve accepted those recommendations where they were directed to us and attached to this report is an annexe which picks up on some of those recommendations. A significant one that relates to us was directed to the Department of Health
which is on the fit and proper person review where the Departments of Health and social care said they would identify an independent person to carry out a review of both the scope of what did they cover and Operation how are they being applied, a
fit and proper person regulations. We are awaiting an announcements of who will lead that review. In terms of the challenge to us from a Bill Kirkup’s reports, he was clear that we failed to identify the extent and nature of the problems back in our
pre 2013 recommendations Rosie Cooper was the MP who championed these issues and contacted the local head of hospital inspection and also myself and she is a pretty indomitable spirit Rosie Cooper I have to say and we undertook some responsive inspections where we picked up
on some of the allegations around bullying interestingly going back to the early conversation the closed culture in the trust and as a consequence of those staff did disclose their concerns around a culture and the way that people were treated. We then took enforcement action
and a a new leadership team was introduced with some people leaveing so whilst we didn’t get underneath the skin of this organisation in those early inspections we have subsequently and of course since that first inspection we have changed the way we inspect and it’s
a different and new methodology which is more rigorous and there’s a set of recommendations which are directed at those and are set out in Annex 2 to this report today so a very important piece of work. does anybody want to come back on that

[Professor Louis Appleby - 0:35:23]

now keep going, sorry Lewis. yes well just maybe to pick up this is a very important piece of work is a very important report and it has had quite a high profile in the north-west of course, maybe higher than it has had nationally and
you’re right because it relates to a period a few years ago just before actually the methodology was changed so that the whole ###unclear## allows us to say something which is I think is genuinely true which is that it is less likely that this would
be missed now I think we have to be able to reassure people that our new methodology would pick up some of the sort of flags and warning signs there and in some ways the interesting bits about the report is of course the meat of
the report when you read about what actually happened and some of the things that we might be finding and the requirement therefore on us to put together the this this string of things that was going wrong that could have been tied together at the
time, for example the fact that we knew there was a new board actually that was one thing New and The Bill Kirkup report specifically said that a new and inexperienced Board that provided insufficient challenge to the top of the organisation so in terms of
our well led inspections there is a clear message about what we are there to look for and the bullying of course which went unpunished and unreported largely, but other things like unrealistic cost-saving targets you know that that was a sign that this organisation was
running into trouble and I suppose because it made specific reference to prison health I suppose I’m because of my interest in that area picks up on that there was a suggestion that some of the these areas which can sometimes be on the margins of
an organisation that they tend to suffer more and that neglect of the peripheral specialty could also have been a sign and so I think quite a bit behind that the actual wording of the recommendations which is very much in the style of reports, the
actual detail of what they found and what the signs really were, I

[ David Behan - 0:37:46]

think it is a really helpful report for us. I agree Lewis, I think there’s two people come out with a managed credit one is Rosie Cooper for championing the issue and doing
her job as an MP and a I have to say it is invested in us and given us the confidence we have to respond to what she raises and she doesn’t always do it in the most comfortable of ways and she’s absolutely focused on
the quality and safety of services and as you know she has raised the issue around prison health as well on the bucket list. But I think Bill Kirkup report should be compulsory reading for every inspector of actually said this because I think it’s a
fabulous analysis of what the issues are and that combination of factors are within experience both in an experience management ##unclear### into one realistic savings targets which is what ended up driving into the background a over this period with all the consequences that come from
that and I think our challenge is to build that into the way that we inspect, and not into our systems and processes our key lines of inquiry but in terms of the appreciation the inspectors have got when they turn up on a wet Tuesday
in February at trust acts or a sunny day in July Trust why how far are some of the responses which have flagged in Bill’s reports to the front of their minds when they’re actually carrying out the inspections and doing the interviews looking at the
data I think again it goes back to what weight we give two concerns which are raised by people sorry and I think we shouldn’t be complex and this was the old methodology but we should we should be constantly saying to us this could happen
again how do we ensure this isn’t going to happen again rather than with changed the methodology thank God for that. This is something we need to be constantly on too and I’m I think we have given this a profile by bringing it to the
board in an open session in this way about position our action plan in relation to what Bill Kirkup said in his report is just one way of doing that and of course it is why as a Board of non-executive directors to ensure that we
keep we keep true to this and I’m something by combining those forces a hopefully we can actually do justice to the work that Rosie Cooper

[Professor Edward Baker - 0:40:18]

and Bill Kirkup has done for it. So Ted and then Robert. I mean this is a very important report
for us because as you say it does describe how we fail to pick up these problems in our previous methodology but he does I think stressed the importance of keeping focus on leadership culture in organisations and that’s something we’ve learnt over the last four
years when we’ve been doing all these inspections and I think the emphasis we put it on in our current methodology and well led is absolutely a reflection of that and I think the lesson for us is we need to focus very clearly on well
led and doing well led really well to understand the culture in organisations that can lead to these kind of failures that were so bad in the ##unclear### it is a deeply shocking report to read, I mean our inspection reports on this trust was shocking
as well and I think really it is very important for us to pick up if you like the leadership keys this from our well led that points towards real problems on the front line and one of the things we’ve got to do and I
think it’s really very important is we don’t focus just on what happens around board tables but actually correlate that with what we’re seeing in frontline clinical services because I think that has been the real power of our inspection so far and I think this
is an important reminder to look at both aspects of the work in

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

trusts. I can’t tell you how often after I done Mid Staffordshire report I was asked was that that was a one in fact it was always a leading question, usually by people
who should know better wasn’t, that was a one-off and I continually said No it wasn’t because look at the Keogh review this is another example from the same time of almost exactly the same pressures producing the same terrible results and I agree that we
should not be complacent about our methods have changed these things are more likely to come to the form and I think one thing perhaps hasn’t been mentioned it’s one thing for this to be a case study as I really think it should be if
only because Bill Kirkup managed to put in 50 or 60 pages what it took me three volumes, but I did get a first if not the most serious point is that it’s not just the inspection a lot of the facts as he mentioned here
are still present in the system but happily one would like to think they’re being managed better in most most places but actually these factors mentioned in recommendation too plus the stories behind them and I seem to me are very valuable indicators to what our
intelligence should be looking at in terms of showing up an assessment

[Mr Peter Wyman - 0:42:56]

of risk. I think I think a useful discussion and in important stuff in

[ David Behan - 0:43:03]

there David lets go onto the next one. so the next item is about

[ David Behan - 0:43:08]

something called care rooms you may
have seen some publicity around this and I’m this report is an opportunity just to provide a clear public statement of how we’re addressing the issue. This is a novel service and a great deal of thought has been given by registration colleagues about what are
the implications for CQC of this service being developed. So effectively it is a service where people recuperating after a hospital stay go to stay and the question has been raised it should these services be regulated but on the basis that these services are provided
in accommodation they not providing care, the decision has been taken i.e., carrying out a regulated activity which is the basis of legal basis for registration. At the minute our judgement is that they should not be registered, the provider has been quite open with the
CQC and we have been open with him and as you can see from this paragraph we’ve been keeping that situation under review and if those services do expand, the service operates changed and there is the offer of a regulated activity is defined by the
regulations then registration would be considered this is effectively about school and one trust does have a contract with care rooms and what we are saying in the second bullet point here is that we can actually use and how we regulate the trust and similarly
look at how some local authorities may use care rooms and how local authorities can use their powers to look at care rooms, if that indeed is something that’s required but the important bit from this paragraph is just to provide some clarity about what our
current position is in relation to whether these services should be registered as I said there’s been some some press coverage saying that we should be registering these services so this is an opportunity just to make a public comments in relation to this and again
will continue to monitor the situation and continue to have discussions with the provider, who has made contact with us and wants I think to do the right thing in relation to this. Just interrupt you

[Mr Peter Wyman - 0:45:48]

David, I think this is exactly the right approach and
while it is effectively a hotel operation and there is nothing to register, but your point about monitoring carefully the there isn’t a mission creep that suddenly the service doesn’t change into effectively been a care provider and I think we will need to be very
careful to make sure that the people that are registered that are using this service are very clear what’s happening and we haven’t got something different to me in a year’s time but it is still unregistered so I think this is something we need to
watch. Robert sorry yes. I don’t know about anyone else both in terms

[Sir Robert Francis QC - 0:46:30]

of where these dividing lines are absolutely endorse the idea that what is happening is a room and that’s one thing but if it goes further and some form of care or rehabilitation
is being offered with would that trigger interest and the other thing is even if that’s not happening how do we ensure that the public are aware of the difference do you know what I mean, in the sense that somebody else might be provided for
instance or care in that room but it might look as though it’s all under one envelope when in fact it isn’t and I just wonder whether we’re in a position to cope with with that because all sorts of things could be happening around an
apparently in the provision of a room and nothing else with but in cooperation with other people it all becomes the same thing. This is

[ David Behan - 0:47:25]

why this is an important and sensitive issue and sits at the Board today so if it did change so,I can’t
remember the number Andrea, I don’t know whether you can but we’ve got a large number of supported living accommodations which are effectively adult fostering schemes where the care is provided is defined by its as a regulated activity, the treatment of and support of people
and they will be registered so that’s a somebody else’s house that people live in and they are supported to do that and that will be deemed as I say a supported living and that’s been a situation which is endured it for what coming up
for a decade I think in a that formal way but it’s why it’s important that the registration saying continue to work with the provider relations that we don’t think the provided he’s got an innovative approach is new it is different, but I don’t think
that right is trying to game the system in that sense he wants to do the right thing so I think that’s important and I think really does underscore the importance of at that point grabbing discussions with providers about registration and the importance of that
conversation that discussion going on to make sure that we understand what the offer is and what the risks are, and I think it’s your point I think if this is what you meant Robert my understanding rather than

[ David Behan - 0:48:54]

whether you’ve presented it and we think
there is more going on than he’s been offered I’m not saying in this case with care rooms then the registration saying there was significant amount of work on a referrals of what looked to be unregistered providers because if somebody is providing regulated activity and
they are not registered with us they are actually breaking the law, so that’ll be something that the registration team would investigate with a view to correcting it i.e., they do become registered or there is some enforcement action that we can set this prosecution that
we can take in relation if people continue to do that knowingly. So that’s broadly where we are, I think what we need to do as we begin to understand what this particular providers offering much more and what the service model is particularly the service
model stays the same it’s that we need to use our website just to actually make sure that people who are thinking of applying to us to register can be clear up front. I joined Andrea in Birmingham, it was Birmingham wasn’t it last week for
the registration conference and I was fortunate enough to be able to spend a day and there was quite a lot of conversations with went through the looking at the various bits of looking at the way that we register any service that applies to us
but the table that I sat on and spend pretty much most of the morning with, they were focused on what our pre contract offer is to people who are considering providing so people can self-select, and I don’t think we do enough to explain what
people need to get in place so we have a lot coming to our door for registration of people they want quite clear and then the fallout rate is quite high people that eventually go through to registration particularly around domiciliary care. so something I used
to work for domiciliary care agency and I’m thinking of setting up my own business will be a frequent cause of this be a single person who wants to do this and have given no thought to some of the detailed systems and processes you need
to get in place to keep people, safe so that takes a lot of time pitches often referred to as Digital and I think for those of you that were there last night, Andrea’s slides on the regulatory governance Committee there was a couple of those
coloured boxes which had the importance of developing a digital offer, for those of us do tax returns or do our car tax you can’t go on to the next box and complete it unless you finish all the boxes we haven’t yet got a system
for this so we’ve got people that send in an application form it’s not complete so we send it back and this is all paper to go on to this issue they then send it in again is still not right so we send it back
again so to streamline this process so we don’t have to do any of that is really what the objective is and that’s what people are working towards so it would be a bit like tax returns, tax in your car or any of the other
things that we do where it helps for people to get it right before the apply to us but it also helps us in terms of our processes when they can throw so that’s the aim, and the prickly work and so the first stage of
that was to do the business process mapping to make sure we have got the cleanest and simplest system and that’s one of the ways will root out people who are applying in the wrong way and without the full information and putting our information up
front so that’s pretty much the approach that’s been taken, but that’s probably gonna take a couple of years to get through all of that and get a that through. Peter just sighed for the record. I am sighing only because I was looking at the

[Mr Peter Wyman - 0:53:09]

time and just how far behind we are on the timetable but that was OK. So the gender pay gap we’ve already had something on those suffering

[ David Behan - 0:53:16]

disease and a good news it doesn’t mean that we haven’t got issues that we need to address but
in terms of recruitment and retention it’s a big part of the offer I want to draw the Board’s attention to we’re collaborating with a mental health safety improvement programme and also wanted to make the border aware that some were in discussions about joining the
defence employer recognition scheme and the armed forces Covenant largely on the back of the work that Steve and his team have done with the armed forces in relation to our inspection of defence military services and staff from CQC will be contributing to the 70tha
anniversary of the NHS and they may add up the 70th anniversary of the National assistance Act. Paragraph Eleven is or just an opportunity to flag the work we did on recent adverse travel where because of the severity of the weather particularly in Newcastle, the
Newcastle office was closed and the consequences of these two issues that we’re looking at further one is what do we do when we close an office and the other is do are technology systems actually support more of us working remotely when people can’t get
into the offices are key issue about closing the office was safety there were red weather warnings in the north-east and the south-west which was a risk to life and limb, so we took the decision to close the offices and will further review that and
in paragraph of our reports that we published and a significantsequence of publications on mental health and then lastly reports which are due to be published phase in a state of independent acute hospitals and the Programme report and the last I think in the sequence
of reports we have been producing on mental health that’s the report Peter. thank you David. Malta. There is one small correction to be

[Mr Malte Gerhold - 0:55:14]

made at the bottom of page 9 says that the state of online providers of primary Care report has been published that’s
actually due on Friday this week so this was corrected the writing of this last week but the scheduling changed so expect it rather than welcome it thank you. We will welcome the expectation thank you.

[Mr Peter Wyman - 0:55:29]

Anything anybody wants to raise on David’s report we haven’t

Business plan and budget 18/19 sign off

covered. OK, let’s move on to the business plan we have of course looked at the business plan in its various earlier drafts sorry this is not to give the impression that a quick sign off is that we’re not very interested in all the work
that’s behind it. I dont know if it’s Kate or Malta who wants to start

[Mr Malte Gerhold - 0:55:53]

on this Malta. I will briefly start so I commend to you our business plan for 2018-19 which is the public commitment of what we’re going to do over the year
and that has been used to hold us account with the Department of Health and social care as well as parliament and sets out our performance indicators as well. this year sets out nine priorities particular that we’re working towards in particular including two investment priority
areas for digital development on our current group implementing a quality improvement culture internally for all of staff. The two things then I just wanted you to be aware there is some final refinements before the final report is published on some of the delivery dates
following the discussion today which is underway and then finally that the subcommittee of the board considered the risk tolerance statements and risks set out in the report and made some changes to the tolerance of a risl particularly the developmental phases around digital services as
well as some of the exploratory analysis but also being clear that that risk reduces as we make those systems and analysis operational

[Mrs Kate Harrison - 0:57:03]

and on a wider scale. Kate anything on the Finance. Just say that at the end of 17-18 we will have achieved our
regional spending review target for the end of the spending review period of 270 million which is two years ahead of target but we have set our budget next year at 223 million to allow us to invest and to bring costs down further and introduce
efficiencies in future years so that’s all built into the budget in the business plan. So just to clarify that’s two years ahead of target

[Mr Peter Wyman - 0:57:31]

not behind target, you said out of target I just want everybody to shbe clear its ahead. Good so I just
say we are this is not the first time the board has seen any of this

[Mr Peter Wyman - 0:57:43]

but is there anything anybody wants to raise. Excellent so we can agree the business plan and budget are as presented an absolutely we’ve noted the work of the audit

RGC - Oral update from meeting on 20/3

and corporate governance committee and looking at that, thank you. Right Lewis I apologise I wasn’t at the RQC last night I was in London with our intelligence away day which was really interesting but that in a couple of things that I could not get

[Professor Louis Appleby - 0:58:18]

back in time so sorry so tell me what happened. Well this is a summary of what you missed. We had two topics for discussion mainly one was about CQC’s Rollers prosecutor as well as regulator and how these two might fit together I suppose it’s
fair to say we had a very good presentation very good discussion but it is still work in progress and so there will be further discussions about it at RGC, I suppose one of the discussion was about how we might how we decide who to
prosecute or on what grounds we might prosecute and that led to the need for consistency of decision making so there are training and workforce questions there, and also with what are our priorities given the potential number of cases that might be prosecuted how do
we decide what the priorities might be and so further work might be needed on that decide how CQC should reflect its own strategic priorities in those decisions but also of course public and patient priorities too, and there’s a wider question here which is how
that part of our enforcement sort of capacity our enforcement and our the material how it fits in with the with other things that we do this Civil enforcement and so on. So it’s a very important subjects and a it will come back. The second
topic was a presentation of adult social care so as you know we have a rotation of presentations from different different sectors within CQC, this was adult’s social care’s turn and we had a very full presentation about progress in adult social care it just Andrea
if I could just select one or two of the things that you said, one important one was that 81 percent of the adult social care providers are now rated good or outstanding, 81 percent, and that on reinspection the general trend on reinspection requires improvement
organisations too for a number of them at least to become to get higher ratings, so there was a positive message about the direction of inspection ratings. We also talked about the future for adult social care and just to summarise the future, it’s a very
important part of determining where we place our effort and energy in the future and it’s worth saying that the future can be looked at in different ways what one is still what is what does the sector concerned about and I think the sector is
concerned about money, but it might also be concern about quality but also the lack of improvement infrastructure in the way that we have in the health service, but money is the dominant concern there. The concern for CQC itself and for social care, a bit
of CQC, is perhaps equally about responding to concerns how we identify where risks are in the system, how we respond to particular incidents and then how we use our enforcement powers so there’s more but how we do our job well and of course all
that sits alongside the public concern and the public concern is poor care and not only that but how because of poor care in the system how do members of the public make decisions about where a relative might live, the difficulty of those decisions and

Any other business

the question is how we might support them, so it was that it was a

[Mr Peter Wyman - 1:01:55]

very good and wide-ranging discussion. Great thank you Lewis. Is there any other business in the body around the board wants to raise, so we have a couple of minutes David

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you were the only person who notified me of a question. David we probably answered quite a lot of your question but maybe prompted some further questions so David. I’m David Hogarth a co-ordinator of a small befriending charity which brings us into contact quite a
lot with registrable care ofall sorts, as you say the question I asked was really asked by Sir Robert it was about the pie chart about whistle-blowing and also well answered by Sir David and buy Andrea ,but I think the point the point you are
making I think was how the whistleblowers who are doing something very very brave usually particularly in care homes, need perhaps a little more than just to be told something is being put on file and that is a very good point. But the other thing
is I think that Andrea has very often said when a case arises where a CQC has said that some care home is good and then there’s some awful abuses discovered by Panorama or something like that, Andrea very often says Well there is just so
much we can do which I take to mean is there is just so much that inspecting can achieve, because frankly you are not there all the time and these things usually happen when you’re not there and so there is a sort of gap in
your knowledge about everything that you inspect, and it seems to me that whistleblowing is desperately important because that is the only way of filling up this gap. So I very much hope then that you will be looking hard at whistle-blowing and how you can
encourage whistleblowers more than perhaps has been done at the moment. David thank you. I would take a slightly different view on one

[Mr Peter Wyman - 1:04:25]

aspect of what you said at any one aspect which is that any whistle-blowing is the only thing that is available to us.
I think it is really really important I don’t disagree with anything that you were really is central to what you are saying, but I think there are lots of other things we need to do our strategies you know is to be intelligence lead there
are cameras. I don’t know why you never thought of that to mention it before there are lots that there are lots of things we need information we want to be intelligence lead it’s at the heart of our strategy. Whistle-blowing is just a part of
a really important part is just a part of what we need but thank you for raising it I think with that and miraculous speeding up towards the end of David’s report I think that brings to an end the meeting, so we are only six
minutes late which isn’t too bad thank you all very much indeed and we started. It’s Kate’s last meeting as I hadn’t forgotten it is written here, no no no no no no how could I forget it’s absolutely here, but thank you just in case
I had but I hadn’t. Kate you looked after our finance is brilliantly well the fact you delivered our target, I mean you may have gad a bit of help from other people in doing this but on your watch we’ve hit our target two years
early which is fantastic and all I can say is that the MAD is gay and it is absolutely our loss so very best of luck to you in the future and thank you very much for all you have done for CQC in the past.
And with that as a board we start again one o’clock so thank you very much indeed.
  • Professor Louis Appleby

    Position Board Member

  • Professor Edward Baker

  •  David Behan

    David Behan

    Position Chief Executive

  • 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

  • Mr Paul Rew

    Position Board Member

  •  Andrea Sutcliffe

    Andrea Sutcliffe

    Position Chief Inspector of Adult Social Care

  • Mr Peter Wyman

    Mr Peter Wyman

    Position Chairman