May 2018 Board Meeting (Wed, 16th May 2018 - 11:00 am) 

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Chief Executive's report

the tests that are set so that we can take that forward and on the

[ Andrea Sutcliffe - 0:00:07]

Civil enforcement side one of the things that I think sits underneath the radar for people is the amount of activity that’s going on in civil enforcement which we cannot make
public because we cannot kind of share that information until it’s all

[ Andrea Sutcliffe - 0:00:21]

been completed and if there are representations so providers query what we’ve done or if there are appeals to the first-tier tribunal, you know this can spin this out for quite some period of
time. And that that is an impact and it’s one of the reasons why we would really like to have the regulations change so that we could make that public so that the public could see that we were taking action even though it was not
complete. There is there is controversy about that as I’m sure you can imagine from providers but there is something about us being able to be a bit more transparent about that. The second point around progressing through the warning notices in particular and making sure
that we’re doing that in a speedy fashion. We have been improving our data collection and data analysis around this but there is a problem that on some occasions we are not closing off the enforcement actions in the system so that we can demonstrate that
it’s been done. When we’ve gone in an done our quality assurance we are finding that actually things have been done in a timely fashion

[ Andrea Sutcliffe - 0:01:30]

but we’re not actually demonstrating that in terms of the way that we’re managing the system. This is something that Debbie
in particular has recognised has raised as part of the enforcement oversight board. There’s a whole series of work that is going on to validate that information and to follow up on it and we’ve had a conversation with Gavin Kennedy who does all of the
kind of hard work behind presenting this report and we will be able to bring for the September report a more detailed breakdown of some of that information which I think will help. The bit on the breaches again we, what’s reported here is that we
were at 10 percent and there’s been further work done and I can tell you that we’re down to 4 percent of those services that are in breach for more than four quarters that don’t have an action plan against them and there is work that
is going on to address that. Some of that is data issues you know we had services in there which were actually adult social care services so you know hospices because we transfer those across to hospitals. There are still again some issues around us closing
things off in CRM but there are issues that, I mean in MPS they have identified a number of services that are in the process of de-registering and so that’s a category that is included in the PMS. We decided not to do that in adult
social care because we get an awful lot of providers telling us that they are de-registering and then they don’t and there’s a kind of you know a bit of a recycling of that going on so that we don’t kind of think that that’s all
fine and dandy. We’re keeping on top of that but there is at least one of the cases up in the north where we have identified the location is vacant we are actually progressing to cancel that registration. So there are things that are going on
and the heads of inspection and deputy chief inspectors are all over it. The final point which is linking all of this in terms of impact. I do think this is maybe something that we could think about for a regulatory governance committee session Lewis which
is obviously in your gift as Chair, to actually think about how can we do some of that more rich connecting of the dots to think about both what’s the impact, what change is produced. You can see in one of the other slides that when
we go back to services that we’ve rated as inadequate you know the vast majority of them do improve and an awful lot of those will have had breaches will have had enforcement action taken against them. We do still see improvement but at a less
high rate when we’ve rated services as requires improvement. But I think you’re right something that helps us to join all of those things up and really explore that further would be helpful. So I think what I heard you say was that you do have

[Mr Peter Wyman - 0:04:35]

confidence that our teams know what is happening in response to either a warning notice or a provider that has been in breach for a long time but somehow somehow some of that isn’t getting recorded so it’s primarily or entirely a recording issue. If I

[ Andrea Sutcliffe - 0:04:56]

heard that right. Yes and what’s been great has been that the improvement in the data-collection imprint presentation of information to the dashboards and then the kind of performance reports that are coming through to inspection managers, heads of inspection, myself and my senior team you
know has improved immeasurably over the last couple of years. And so even if the, you know the individual inspectors weren’t picking it up there is a process in place that means that we are seeing that and that’s one of the reasons why the 10
percent has gone down to 4 percent because people have gone back and asked those questions. So you know pay tribute to the team that’s been developing that to help us manage that in a much better way. Thank you, I don’t know if you were

[Mr Peter Wyman - 0:05:42]

offering to provide the answer or whether you were raising a separate point. No I was just going to say in response to Lewis’s challenge

[Ms. Kirsty Shaw - 0:05:49]

about putting the data together as we have already started a piece of work to, and it’s not just around enforcement
as a whole, a whole load of other areas where we can start to be a bit more intelligent in how we use this information to present the sort of so what questions, so Gavin is doing that as we speak. And the other piece is
actually trying to look at how we use this information more effectively so bringing back some deep dives into certain areas to really drill down but give you the information in a way that prompts the questions that does the analysis for you as opposed to
having you having to put all the bits together to ask the questions. Good. Paul and then John. Just a point that Andrea made about the

[Mr Paul Corrigan - 0:06:33]

delay caused by the transparency problem and us not being able to say about it and saying there needs to
be a change in regulation. I think this is quite an important issue because you know the transparency is what we’re about and if there’s something getting in the way of and there is and there seems to be a perverse incentive on the provider to
elongate this because nothing will be seen by the public while this goes on. I think we do need to talk to the Department about those regulations and I think it’s something that the Health Select Committee will be interested in because you know in a
sense the whole burden of where the whole system is going is around transparency and something getting in the way of that is a problem. To

[ Andrea Sutcliffe - 0:07:17]

reassure you Paul and we have indeed raised that and there are ongoing conversations not just about that specific regulation
but others but if I had my top 3 preferences of what we might want to sort out that would definitely be in it. Sorry very quickly Peter.

[Mr John Oldham - 0:07:38]

Building on what Kirsty just said 21 percent of services perviously rated good deteriorated and I wonder if
you’re doing any analysis that would give us some red flags that would help inform an intelligence led strategy as to who might be wobbling. Malta. Thanks John. I can’t give you the answer whether we’re doing it but I’ll explore and get back to you
on it with a team to do that also just because it’s important that

[Mr Malte Gerhold - 0:08:06]

we’re clear, its 21 percent of services that we re-inspected who were previously good not 21 percent of all services. Yes. In the country sorry it’s an important distinction but I will

[ Andrea Sutcliffe - 0:08:15]

take that away and answer the question. And if I can add in some ways it’s a testament to our intelligence driven approach because it is a reflection of the information that we are getting that is alerting us to a level of risk in those
services which is meaning that we are going back out to them earlier than we might have done, given that we’d rated them as good and therefore are picking up those problems at that stage. So I think you’re right that we need to be getting
underneath it and one of the things that we’re going to talk about later which is the work that Helen is doing specifically around registered managers that’s absolutely a flag. But it is a response to risk being raised with us that we’re going back out

[Mr Peter Wyman - 0:09:06]

to those services. Andrew, can I just raise one other, Timmy just surprised me really. We, on the risk register we have an amber risk rating after mitigation that we would fail to have spotted a hard to replace provider. Now I presume that this is
since we only have the responsibility for that they’re, and anyway hard to replace would be in the market oversight scheme, and I have huge confidence in our market oversight scheme to spot things. I mean we may or may not have issues around exactly how
the regulation is scoped but that is different from a failure to spot it. Am I missreading this or are we doing ourselves a disservice by

[ Andrea Sutcliffe - 0:10:08]

having this amber I think it’s probably a green. If you look at the way that we’ve rated that Peter
the likelihood is in terms of after mitigation, the likelihood is low but the impact remains high. And that, you know so I think that there is, we are taking into consideration that we don’t think the likelihood is low but clearly if it did happen
the impact would be high. The other reasons that kind of lead to that is that you know we have documented our processes. We have, there are various things that we are doing and that we have done and we’re going to report on when Stuart
joins us later for the market oversight I term. But in terms of fully testing the whole system and going through that then I think that applying a level of caution around that is appropriate and as Stewart has identified in the report that we’re bringing
to you later in the agenda, we do still have a significant resourcing challenge within market oversight given the pressures on the team and we have now got the permission to increase our establishment so that we can cope with that so I think those are
the aspects that are guiding our thinking. The other aspect of it although you know in some senses this is a risk which is not our risk but there is a risk around sort of what then does the system do about all of this and
the contingency arrangements being led by the Department of Health and Social Care and other appropriate bodies is something that again is not completely fully tested. So I think it’s right for us to have a level of caution but the after mitigation we would be
expecting the likelihood to be low. But it would still be a high impact. I can’t argue it would be a high impact. I just, you might

[Mr Peter Wyman - 0:12:11]

like to look at the words to spot as, yeah Happy to do that. Thank you. Make be happy.
Steve. Because I haven’t said anything I’d like to just say something.

[Professor Steve Field - 0:12:21]

It’s not compulsory to speak. No, I was sort of feeling a bit sad we hadn’t said anything about primary care. Sorry our performances has gone done pretty well on the this year on
report publication whatever. But I just want to, we don’t focus in the qualitative side of this discussion which always on quantitative and on data. But we’ve got a number of GP surgeries which have done exceedingly well to go from inadequate to good in a
year in the past year and as this is the forequarter review, there’s one today that’s come up called the Droylsden Road Family Practice in the Newton Heath where Man United were created as well. They’ve gone from inadequate to good in a year and I
think that’s down to superb leadership. And I think sometimes we should mark a performance by reflecting the performance of providers which have turned round care in really difficult areas. I can’t

[Mr Peter Wyman - 0:13:22]

disagree with that. But don’t blame us for spending most of our effort commenting

Performance Report Q4 and End of Year

on the data that you’ve supplied us with. So anything else on the performance report that anybody would like to raise. Excellent. So we’re in good shape. Yeah. Let’s do the money. So we’ll do the money. Kirsty. Okay thank you. Because you asked for the
performance data, you asked for this data as well so Yeah, yeah, yeah I know we get it So just in terms of the money. The headlines are, because this is the final quarter report, that we drove down costs in

[Ms. Kirsty Shaw - 0:14:00]

2017, 18 and we are
continuing the trend that we started in the previous year. Overall we are underspent against our budget by 6.3 million pounds. That’s 8.6 million lower than our budget and then which was reduced by another 2.3 million due to under recovery on fee income. So what
we’ve done is we’ve, our reserved for retained earnings has now increased to 15.5 million pounds. So overall pretty good performance in terms of finance for the last financial year. In terms of finance position I think we’ve been looking at the underspends and where they’ve
occurred and what we’re going to do about it in future years if that happens again. This year we took money off in year as underspends occurred and held those in a central fund which is why if you look at the Finance Performance Report the
other looks quite significant in terms of the variants in underspend because that’s where we held the money that we’d retained and then we held it and put it back out to the business where we had a need to spend. So in terms of this
year moving forward we are slightly overspent on our first results for this year. We will do a full forecast at the end of this, when counts close down for this month, to have a look at what that means moving forwards. But at the moment
we’re not worried in terms of where we are but just to say I think the overspend has come from a few things that have come forward from the last financial year and into this one so it’s not looking too bad at the moment. So
overall it’s a very positive picture. We are now starting to think about how we budget, how we allocate our funds and business plan for next year and what we do around that in terms of having a more robust process around managing money to try

[Mr Peter Wyman - 0:16:04]

and avoid us getting into the underspend situation in future. Just to

[Mr Paul Rew - 0:16:10]

pick up Kirsty on what you’re saying. You mention about the 15.5 million retained reserves, I think it’s worth pointing out, I think I’m right in saying that those, that is really just a
timing feature in that where we are collecting more money than we are spending because, and we’re not, we’re doing that partly because we’re driving down our costs but also because there are other costs coming through that we will be wanting to spend that on
in order to improve our services. So it’s not that we’re building up things to you know pay dividends or something to people we’re building this up because we’ve got some costs that are coming through. As you said maybe some of them slightly delayed from
last year, some of them to do with the strategy implementation where we need to deliver some kit and systems and stuff like that which is coming through in this year and beyond. Is it, that’s right, am I right. I’m right in that. That is
absolutely correct yeah we’re not, as I say we’re not stash piling up a big pile of cash. It is to fund all our digital improvements to

[Ms. Kirsty Shaw - 0:17:16]

drive efficiencies further forward to help us not have to put up fees in the future. Yeah. Good. Thank

[Mr Peter Wyman - 0:17:20]

you. Anything else for Kirsty. So unless we’re going to spend half an hour talking about the ACGC report... well be careful what you wish for Paul. It might be helpful if you could get a message, if you haven’t already done it to Imelda that

Audit and Corporate Governance Committee - summary of meeting held on 11/04

we miraculously running ahead of schedule at the moment. So Paul back

[Mr Paul Rew - 0:17:57]

to you. Thank you Peter. This meeting, there’s a synopsis of what the items were that we covered in here and I suppose I’ll pick out a couple of points which are worth just
emphasising this. One is looking at the NAO and public accounts committee action plan. We spent some time particularly here around something I addressed it earlier with Ted around the hospitals, the issuing of reports on hospitals within a timely fashion. And because that’s one of
the areas that I think that both NAO and PAC have highlighted. And it was quite a useful discussion. As Ted reflected I think we think it’s a pretty tough ask to get all the way to our target within the next year but we need
to make significant progress around that and I think that’s quite a useful discussion that we had about that. And then we spent a fair bit of productive time I think on looking at the governance and control and management really around the, particularly around the
agile projects within the IT function, there are different aspects of systems and data and information technology that we need to separate out butt particularly when looking at the agile projects where we’ve started, you know, we are building up a capability within that. We’re starting
to build up one or two products that we’re actually producing around that but it will become a way of working for us in the future around the development of new digital capability and we need to make sure that we’ve got in place the right
structures to both enable that capability to be done quickly and agiley and in the right way but equally to make sure that we are on top of what’s happening and we are managing and governing and controlling that in the right way as well and
we’ve learned quite a bit over the last couple of months in terms of what we’re doing there. Some if it is good. We had a review by the internal audit by some specialist within internal audit to look at this to give some pointers as
to what we might do better and I think that was a very valuable review that was done there. It’s not an audit as such it’s a review because its an early stage thing to help us with those controls and out of that I think
has come a number of areas to look at. And I’m glad to say that you know Kirsty is picking that up with a view to actually looking at you know what are the, defining what we need to have in there and making those processes
as agile in their own way but also as automatic as we would want to have so that we are, we can assure ourselves that we are on top of what’s happening there. And that we spend the money wisely, that we get the results that
we want out of it and we get it out on time. So that’s coming back. Kirsty’s in the process of looking at that will come back to our June meeting of ACGC. It won’t be complete there but it will be, the challenge was for
Kirsty to show us progress along that line by June and I’m sure she will. So those are the two points that I have. Thank you. That’s

[Mr Peter Wyman - 0:21:36]

really good. Anybody want to raise anything. So thanks Paul and thank you in advance Kirsty for what you’re

Healthwatch England Update to the CQC Board and Business Plan

obviously going to be doing. Fantastic. Good. So we move on to the Healthwatch England update. Welcome Imelda. Nice to see you. Jenny you say anything by way of an introduction. If I might yes please, yes

[Ms. Jane Mordue - 0:21:59]

thank you. If you turn your microphone on you
may. Thank you chairman very much. And first of all just to remind ourselves of the rules of engagement which of course is that Healthwatch England has its own independent statutory powers but we are as a subcommittee of the Care Quality Commission. David Behan is
our Accounting Officer and Imelda is the Accountable Officer. And having done all that formalities I think I would like to say thank you very much indeed because this relationship could be one where we spend a lot of time going while you’re telling us what
to do, but in actual fact is incredibly helpful not least because around this board you spend a lot of time doing governance which means that Healthwatch England we can get on with the job and spend our time mainly looking at what people say to
us and what we can, how we can best pass that on. So thank you very much indeed. The paper comes in two parts. One is an update on the second is the strategy. Just very briefly on the update you’ll see there local Healthwatch funding
looming large there. It’s a very interesting debate at the moment because it’s about, this isn’t about local authorities it’s somehow the fault of local authorities or is there something else going on out there. And just we were talking the other day about what’s happening
up in the North West where Healthwatch Cumbria has now taken on the contract for Healthwatch Lancashire and they have found interestingly but whereas Healthwatch Cumbria is very strong on strategy and partnership and you know meeting and talking with the big beasts up there. Healthwatch
Lancashire is actually very very good at engagement and so although it feels like maybe it felt like a takeover they’ve actually, they’re going to benefit each other so there’s a lot of churn going on in the marketplace out there in local Healthwatch. Some bits
do with local Healthwatch funding but a lot of it’s do with actually strengthening, coming together to strengthen our offer. I’ll let Imelda talk more about the mandate and our mental Health Watch, mental health programme and I would just like to draw your attention to
the Healthwatch England’s staff survey where I am pleased to say we have a very happy ship. We also though have, I’ve just introduced seven new committee members and that’s providinbg an additional level of challenge and we’re going to be working. David’s very kindly offered
us some some help to make sure that we sort of really get the best out of some very interesting people with lots to offer. But it’s finding a way of how to make sure that they can offer their advice and work happily with all
our wonderful staff. So that’s the update and I’ll hand over to Imelda if I may. Thank you Joan I think I would just spend another moment if it’s ok on the funding of local Healthwatch. Just to remind you the money comes from Department of
Health through then to local government and obviously isn’t ring-fence. We’ve seen a 37 percent cut in funding since the Healthwatch was first set up and the funding that was originally put in place was, there was the amount that went for links that, which was
the body that went before Healthwatch. And then there was additional money put in so that we could take on the additional statutory responsibilities. From this year now our overall funding is lower than the links level so I think we’re actually at a real crunch
point about what we, you know how we handle the issue around funding. There are 81 Healthwatch which are now receiving less money than they were when they were links or when the predecessors links. We are raising it with the Department of Health with the
sponsor team and next week have a meeting with the Ministers, 2 Ministers that have responsibility for Healthwatch on the basis that this is the department’s way of making sure that the views of people are at the heart of health and social care and I
think we’re at a very precarious position at the moment. So I just thought you should know that. The rest of the report I am very happy to answer questions on. I’m assuming you’ve read it. Definitely

[Mr Peter Wyman - 0:26:31]

guarantee everybody’s read it. Robert. Just taking up your

[Sir Robert Francis QC - 0:26:34]

point about funding Imelda. Is there any prospect or any consideration being given to changing the route of funding. There seems to be that what’s happening is that the reduction may not be so. I don’t know how much the reduction is from what comes out
of the Department but it’s actually seems to get filtered away from HealthWatch once it gets to local level for reasons which are pretty obvious when you look at your council tax bills. Yes exactly, exactly. We understand exactly why it’s happening. But nevertheless there is
still a commitment to putting people’s views at the heart of health and social care. There are lots of people within the network who would love to change the funding model but that would need legislation and it’s just not a runner. I’m not having those
conversations at the moment. We’ll have conversations about whether there are other funding streams that can support the work because it’s entirely from local government at the moment. So Imelda you say it’s

[Mr Peter Wyman - 0:27:35]

entirely from local government and that’s entirely as far as the statutory fundings
go. Yes. But am I right in saying that at least some of the local Healthwatches also raise money locally. Yes they do. Yes that’s quite right. So some will take on additional contracts. Some take the advocacy contracts. Some have complaints contracts. Some will take
on contracts for specific pieces of work and their core funding that sustains them and their statutory responsibilities is the local

[Mr Peter Wyman - 0:28:05]

government grant. That’s correct. Good. Thank you. Lewis. This is not

[Professor Louis Appleby - 0:28:10]

about funding this is about ####. I’m sure I should know this already but
when there’s a report which says, as this one sounds like it will say that there is a problem over GP access, and also there are some interesting points made in the mental health section about, actually something I’d not heard before, which is people saying
that they feel that primary care general practice has become a very useful resource, the go-to place I think your refer to it as in mental health whereas actually the story out there in mental health is that you know secondary services are asking primary care
to take over the care of individuals a little bit too quickly. And so if what you’re hearing is something different that’s quite an important message. But my point is what then happens. So you if your report says you, you know that there is, you
have evidence, you have information, you have reports about poor access to GPs, a very, very familiar theme, I suppose one of the most familiar themes. Is there a requirement to respond, is there, what’s the impact of that. Is it just go out there so
that people read it or what’s the actual mechanism through which that might influence practice. Well I’m gonna let Imelda give you the substantive answer. But the initial answer is that it’s our job to

[Ms. Jane Mordue - 0:29:36]

provide this evidence and then it’s our job to just offer
it out there and to make sure that we offer it in a way that the right people get to hear it. We don’t to sit on this evidence. We pass it on. But Imelda will know who we pass it on to and how. Because
we do it in a myriad of different forms and at a myriad of different levels. And I think you’re asking a really important question which I’ve been asking the team myself which is the so what, so we know this so what. And I think
there’s two things that we need to do and is, we know that people are finding it difficult to get access to their GPs but that’s not everywhere. And that’s not everyone. So where is it the problem. So then how do we get that piece
of information into that part of the system. Then there are the other overarching themes. Or some of them actually tell us a different message like the mental health one. And what we’ll do from this, because this is the first time we got to a
place of what do we know, from this will come a plan of, so now we know it what do we do, who needs to know this, how do we get embedded into different parts of the system so that change happens. An that’s what the
team are working on right now. Then we’ll meet with mental health policy leads, we’ll issue papers on it to the sector. Yes but does anyone have to do anything about it, is that the ... Well I suppose I’m thinking that there are, you know
we’re in a world where there are quite a lot of reports and one or two

[Professor Louis Appleby - 0:31:09]

of these issues are incredibly important but I suppose I’ve highlighted one that isn’t new and therefore the implication is that the response has only been partial until now and
that might be putting it generously. And one of the messages is new. But either way there’s something for people to respond to and, you know, sort of, there are certain sorts report that require a response and there’s a, you know a sort of duty
to respond and there are others which are just sort of, you know respond if you want, they’re quite interesting to hear about. And given the status of Healthwatch and the importance I suppose of where it’s getting its information from. Yes. There is just a
question which I’m admitting I maybe should have known the answer to already but about what should happen. Not what could happen if people have kindly disposed towards it but what actually should happen. I mean. Well two things. One is, with your permission chairman, one
is that the mental health we got a big focus on that at the moment led

[Ms. Jane Mordue - 0:32:08]

by Liz Sayce and that’s absolutely to make sure that we have a focus on what is, what people are telling us and making sure that their voices are passed
on. But the other thing is the sort of information that way we’re sharing are stories and in a way we’re hoping that and it does seem to be the case that if you present to people a real-life story they are more likely to react
to it and more likely to go “ah right. That’s a problem. Yes I know I can do something about that”. So I think where we’re different is that we’re not just about reports and statistics and graphs and diagrams. We are very much about stories
of real case histories which people in the system providers can react to and perhaps do something about. ...up on that very quickly. It depends on the type of report it is and where it goes to whether or not they have to do something with
it. So in, with the local Healthwatch reports particularly around the enter and view and the reports into the local government. They have to respond within a period of time to acknowledge it and to say what they are going to do. For ours there are
certain things that they have to respond. We are one of the statutory consultee so like on the mandate and they have to respond to it. It’s a very good question to ask whether they have to respond when we send in a paper on let’s
say what we know about mental health as a particular briefing. I’m not talking about the big reports but at the end of this year this is what we know. I don’t know actually. I have to go and ask. Do you know David. Do they
have to respond. No. Just the mandate stuff I think, just the, yeah.

[Mr Paul Corrigan - 0:33:54]

One of the ways in which you’ve been phrasing it is “they” have to respond. Yeah, yeah, yeah, yeah Now what about “we”. Yeah. Have to respond. So if we’re going to give
you legitimacy Yeah. We as the CQC should respond to your report. Yes. Not because we have to but because we should. Yeah, yeah. Go on Ted.

[Professor Edward Baker - 0:34:16]

Well first of all thank you for the feedback that you supplied to us which is very valuable in
terms of our role ..... but can I just ask a question about our reports and how Healthwatch, how useful Healthwatch finds them. Because we sometimes get a lot of engagement from local Healthwatch when we publish a report. Sometimes we don’t and the kind of
sense is, is it helpful in terms of Healthwatch taking its agenda forward locally when we have reported on a local provider say and is there something we could do differently either in the report or the way we present the report that would actually help
you be more effective locally. That’s a, there’s a complex answer to that. One is that at Healthwatch England level and CQC at national level I think we work really well together and particularly in early of reports and that I think is improving all the
time and so it’s incredibly useful to us. The work that we’ll be doing on mental health will be a lot framed by the work that’s already done within CQC. At a local level its various. It depends a lot on personalities. We’re doing quite a
lot of work at the moment with the engagement team to help streamline the way that inspectors can relate to local Healthwatch, knowing the pressure they’re under and knowing the pressure that local Healthwatch are under. And some places it works really very well and there’s,
you know there is a monthly meeting where they share reports or what’s coming up. In other places they have to go find that work, that they know when the public knows. But we’re trying to, we’re trying to make it more systematic. So, so I
suppose my question is is there anything we can do that will help local Healthwatch do that better. I think just sending back the message through your teams that it’s important that we work together and that we find a way of systemising it so that
it happens all the time in the right way. Andrea. Sorry excuse me.

[ Andrea Sutcliffe - 0:36:21]

Thank you every so much and thank you Jane and Imelda for the report. I just wanted to pick up on one aspect of it which was as you might imagine the work
that Healthwatch are doing on quality matters in social care and the leadership role that you’ve got around priority one which is around improving complaints handling in social care which is mentioned on page 5 of the update report. And, you know, thank you for the
work that you’re doing on that and it’s been great to be a part of that with you. But I was just reflecting that it doesn’t seem to be in the business plan for the coming year in terms of there being a deliverable around that.
I’m just wanting to kind of understand what it is that you’re expecting will now happen with that particular aspect of your work and how we can be assured that it will be taken forward. Yeah I can assure you it’s been taken forward and it
is a priority. It isn’t in the business plan but it is in the work plan that sits underneath it. There is a broader heading about partnership working and a broader heading around working across the system. And under that there are lots of plans one
of which is Jacob leading on quality matters and complaints. It’s in his work plan specifically. Thank you I shall look forward to it then.

[Mr Peter Wyman - 0:37:45]

Imelda could I, I’m not sure I’m asking a question or just raising a point but I have difficulty at times
in contextualising some of that data that you’ve got because by definition this is just what you have been told and that is a self-selected group of people that tell you. And I am having difficulty knowing, in some of this, whether there is a significant
deteriorating or improving situation or whether it’s just a bit of sort of random feedback. So if I just give one example. Under the secondary care key themes you say people who continue to tell us about poor quality of care provided in A&E departments. And
I’m sure they do if that’s what you say. But if you just read that at face value you would think Gosh that means that you know the whole world thinks that A&E departments are looking after them badly. My, probably even less scientific personal experience
from talking to patients in A&E departments is that mostly they think that the doctors the nurses there are great whether Ted and his team would agree or not most patients that I talk to are really happy so it’s this contextualisation. I don’t know whether
there’s anything we can do about that. But so it may just be a statement but if you’ve got anything to add..... No that’s great. I think that’s very helpful. This is the first time that I’ve had a look at a whole year of data
and my honest view is that we need to do some serious work to look at the context of it, what it’s telling us and where, and is that the right place to look for the information or is it somewhere else. Because actually in the
reports that local Healthwatch produce there is far greater depth, you know so if I give an example of Worcestershire, went and spent quite a considerable time in their A&E department so the report that came from it has huge amounts of depth. Enfield spent a
whole week in their A&E departments so again you get much more nuanced debate whereas if you’re just getting the, what do the public say then you just get a “we’re not very happy we’ve waited too long” or actually you get quite a lot of
“it’s great”. So I think that, you know it’s about how do you get to the stuff that helps change and I think that’s often in the reports rather than the individual feedback. So I think we’re gonna have a look at how we shift the emphasis
on to some of the reports, the findings of reports as much as

[Mr Peter Wyman - 0:40:21]

individual feedback Really interesting. Thank you. But also how it

[Mr Paul Corrigan - 0:40:25]

fits in with other data Yes, yes So like Lewis I think it is really interesting that you are saying you are getting
people saying we’re getting better access to GPs and mental health services. Now, you know, there may be other bits of data saying that I’ve not come across it so this, so either you’re the beginning, because probably your relationships, your information coming in will be
new, will be sort of nearer the front end of rather than actually a lagging information and so that could be really quite useful. You’re getting newer information in. Yeah. But there will be a lot of information about that out there and you saying we
found this, others have said that Completely agree and so in the new strategy we are clear that we will be using a lot of other people’s data too and will be setting out alongside that so it can tell us, it can tell us what’s
difference or whether we’re just, if we just agreeing with what everybody else is say then that’s just a sort of an add-on isn’t it really. But completely agree. So yeah that’s a major piece of work in

[ David Behan - 0:41:31]

this coming year. Just pick up on these
points. And the point that you’ve just made Paul and Lewis, we were talking earlier about subjective truth and then there’s this point about triangulation add it seems to me that the relationship between Healthwatch and CQC is a hugely important one and this flags it
in that sense and I’m struck today about the news from the Professional Standards Authority in relation to the regulation of NMC and Morecambe Bay. If I remember the James Titcombe story and I think I do. It was something like a 96 percent satisfaction of
maternity services at Morecambe Bay. The question was what was in the other 4 per cent and those individual stories are often what’s in the other 4 percent that they needs to be triangulated against the 96 percent that are satisfactory. And I think Karl Hendrix
and whose story was on the Today programme this morning talking about the loss of his wife and a baby bring these out for me which is why you need the individual stories subjective or other truth alongside the data that comes along and that’s where
I think we’ve got to ask the questions what does this mean, just to put the point on. So it’s not just the data that Imelda and her local Healthwatch teams generate it’s also a contextualising that add beginning to draw it together. And I think
that’s the conversation we’re gonna have later today about intelligence and how we draw data together is how we do draw those different data sources and begin to make the connection with our assessments and there’s a, as I say I was, I’m struck by the
poignancy of the stories from James Titcombe and Carl Hendrickson this morning being told which remind us of you need multiple sources to arrive at assessment about whether something’s ok. Some of them will be picked up locally and some of them will be picked up
through our inspectors operating locally and it’s that relationship that’s a critical one in my view. Lewis. Yeah. One brief point. I was

[Professor Louis Appleby - 0:43:26]

interetsed in just one line in the, of the Work Programme which is about making sure you heard from young people and I’m
slightly paraphrasing but there’s an emphasis on young people and I suppose it relates to what we’ve just been talking about, but a slightly different aspect which is the need to have a balanced demographic in, when you’re, you know hearing from people and translating what
people tell you into something which is a broader message. You have to understand who it’s come from and who is not there and as well as who is. And young people I supposed are a very good example. And it would be very surprising if
ethnicity is not also an issue because it usually is in questions of representation so there’s, there are two groups, I mean young people, you might say older people as well. I don’t know there’s, you know there’s a certain demographic that puts themselves forward and
at either end of the age scale you tend not to get that. And, so, first of all I think that’s a good thing. I wonder whether it should be a wider thing about the broader balance rather than, I mean young people is great, I
strongly support that, but the broader balance because there are other groups too that might not be there. And whether or not there’s a way of formally checking. You’ve obviously got a number of KPI’s which you are following, and I might have missed it, but
that doesn’t appear to be one of them even though that’s a really a good thing for you to be doing and I just wonder whether that’s something that could be given more strength more impetus. Just very

[Ms. Jane Mordue - 0:44:56]

briefly. It’s a very good point. What we,
what has always been the mantra of Healthwatch England has to be, has been to look out for the hard to reach groups on the basis that we could solve problems for them problems for them we’d be solving issues for everyone so we do yes
we do look at all across ethnicities all their protected characteristics and we have several members of our committee who are particularly strong on making sure that we do so. I think the bit about young people was just that young people have particularly at the
moment are coming up with, all over the Healthwatch all over the country have some have youth champions, some have people out there doing films, doing all these wonderful social media things that people do. So I think they are a particularly interesting group for us
to latch onto. Especially because they’re coming forward very strongly to say that they, on this prevention business that we were talking about earlier, they don’t want to get ill in the first post particularly on mental health. They don’t want to get ill. They want
to be helped to stay healthy. So I think that was our particular link in for young people. Sort of to stop them becoming you know customers of the future basically....KPI ghosh we’ve discussed KPI’s, we’re not there yet on KPI’s but Imelda do you want
to comment on that. KPI, what we’re doing, which might be of interest to you is that by July we’re going to have got, taken all our data and started looking at it in terms of different representative groups. I think what we’ll find is that
we don’t know a lot to be honest in the individual pieces of information that come from the public because you have to fill in a lot of detail you know. But the reports again I think will be where we’ll find our nuggets of gold
we very happy to bring back the exploration of equalities report to hear if that’s suitable for you and then from that we’ll know what we need to be doing for the future. At the moment we don’t quite know but we could put it in
as a we don’t know baseline couldn’t we. That’d be alright. I’m very

[Mr Peter Wyman - 0:47:02]

happy to do that. So Imelda firstly congratulations on all you’ve done on the first year you’ve been at Healthwatch and secondly it looks like you’ve got a busy year ahead of you

Market oversight update

but it’s really great so thank you very much for the update but more particularly thank you for all you’ve been doing. Thank you. I’ts really good. So we move on to the market oversight update and Stewart you’re extremely welcome and you might want to
move into Imelda’s chair so you’ve got a microphone. Andrea are you going to say something by way of introduction. I’m just going to kick

[ Andrea Sutcliffe - 0:47:36]

it off thank you. I want to just say a few words before I ask Stewart to present the report. Just
for the board, the purpose of the report is to ensure that you’re aware of what the market oversight team is doing as much of it is necessarily because of the commercial sensitivities remains very much below the radar. But in doing that I did want
to pay tribute to and say thank you to Stewart and the whole of the market oversight team for their hard work and frankly diligence in what can be a very difficult job and under some very pressurised circumstances at times. So thank you and sparing
you any further blushes you can start to present the report. Thank you. Prior to responding to any questions that Board members may have with regards to the update paper I just wanted to take the opportunity to make board members aware that market oversight issued
its first stage six notification on Monday of this week. As you are aware we make such notification once we have satisfied ourselves that service cessation is likely as a result of likely business failure and that the purpose of that notification is to allow local
authorities to ensure continuity of care for all impacted people using services. Yesterday administrators were appointed over to Orchard Care subsidiaries. Monday’s notification was only to Darlington Borough Council and related specifically to a single location called St George’s Hall and Lodge which is an 83
bed nursing home operated by Orchard Care. Our notification was therefore proportionate and focused since it related to the single location and one impacted local authority. The intention is for the other homes operated by those subsidiaries to be transferred to an alternative operator shortly. No
other homes operated by Orchard Care were impacted by the notification and we’ve since confirmed with Darlington Borough Council ensured ourselves that all parties are sort of engaging in the sort of process to preserve continuity of care. If I now turn to the sort of
accompanying paper that we’ve sort of provided that obviously relates to the May 2018 quarterly market oversight governance process. If I sort of pick out a couple of highlights. Clearly activity levels have increased. The drivers of that have been twofold. There’s been an increase to
the number of names covered by the scheme as a result of providers satisfying the entry criteria and secondly there’s been a general increase in risk across the portfolio. That sort of increase is again twofold. One is a sort of general increase and the sort
of second is that we have a number of names which are sort of currently operating at an elevated level of risk within the portfolio. We will therefore,or the intention therefore is to take the opportunity to review the sort of guidance sort of legislation that
we sort of operate within both on the back of now having made our first stage 6 notification but also having sort of run through the continued sort of live elevated risk situations. I wasn’t going to sort of go into further detail on the paper
but instead use the balance of the time to take questions so without further ado if anyone has any questions I’m quite happy to field them.

[Mr Paul Rew - 0:51:57]

Paul. Thank you Peter. Thank you very much Stewart. Thanks for the work that the other guys are doing cause
I know you’re working really hard on all this stuff. The question I’ve got is around the direction of travel if you like and where we are in terms of, we’ve referred in reports in the past of tipping points, and you know what the dynamics
are going forward. You mention the number, the increased number of operations that are within the portfolio and the increased level of risk within there. You also note the potential risks rounds sleep in catch up payments than might be, you know and just the timing
of when those might happen in future. I just wonder whether you would give us a sense of what direction of travel and the dynamics might be around at the market place as a whole and whether it’s the market place as a whole or just
a few providers within it. So, there is no doubt that we are now seeing the consequences of the sector having being funded at a level that allows it to limp along actually manifesting itself and I sort of say that not only because of sort
of a number of elevated risk situations that we are sort of currently dealing with but also certain behaviours that are sort of obvious in the market and I have in mind there wholesale corporate sort of exits, contracts, sort of hand backs but also business
being taken on on a marginal cost basis. So what that sort of means is the operators are taking sort of decisions that in other circumstances they wouldn’t be inclined to do and they are only doing that to try and sort of bolster the economic
viability of an existing operation. The final related point that I would make is that if one focuses solely on sort of local authority facing services for care homes for instance the market has not seen any significant investment in that sector for a number of
years because sort of the economics don’t work and there has been sort of increasing concern amongst operators and investors given sustained austerity that the importance of that point is that if one looks at the CQC bed data then whilst that has been evident seeing
some decline and it may have sort of flattened out it’s difficult to be definitive on that point given the of lag in our registration data but even if one assumes that sort of the bad data has flattened out that masks the fact that the
beds coming into the sector are heavily biased towards self-funded provision and those leaving the sector are heavily biased towards local Authority provision again for the reasons that I’ve articulated.

[Mr Paul Rew - 0:55:35]

So the impression of that is that it is continuing to get tighter and tighter Correct
In terms of the risk and tipping point we refer to is still very much coming at us rather than going a or receding. Correct. That would be

[Mr Peter Wyman - 0:55:56]

my assessment. Other questions or comments. You weren’t here earlier Stewart when we were looking at the risk
register and I made a point and I won’t repeat the point but in making the point I said how the great confidence I had in you and your team in exercising the market oversight role and I’d like to repeat that now you’re in the
room to hear it Thank you And certainly from what I see and I think, you know David’s nodding, I see him next me as our, and our governance role we see what you do and it’s really impressive and thank you. Thank you and I
will message that to the wider unit. So are we, are we done on that. Excellent. So thanks again Stewart. Imelda don’t go because David pointed out to me that when we were going through HealthWatch we, I not we, I failed to ask you to
note the budget and business plan which we didn’t discuss. I’m assuming that we didn’t discuss it because nobody had any points to raise but can we please formally note the business plan and budget. Good. Thank you. Governance is working well under my chairmanship. Excellent.
Yeah. I’ve got friends on either side to keep me on the straight and narrow which is just as well. You’ve got 14 but anyway. So Helen is about to come in. Helen welcome. I’m glad your intelligence is so good that you knew we’d be
running nearly half an hour ahead of ourselves which just proves how good you are....Oh really..... So seriously. Extremely welcome Helen and I think we just go straight over to you if that’s ok. So thank you for the opportunity to provide an update on the
work that we’re doing within intelligence. So this session is designed to give the board an update on the progress of the work that we’ve been doing within the intelligence team and just I guess a recap that the development of the work that we’re doing
and the team overall is really central to our ability to deliver against our intelligence driven strategy within CQC. And making sure that we’re putting the right information into the hands of the right people at the right time to make decisions internally it is going
to be key as we move forward to make sure we can maximise the work, the impact our work has on people who use services. So the work we’ve been doing over the past 6 to 8 months has really been about focusing on some solid,
laying the solid foundations and I think the work that will come and we’ll talk about this is really going to be about the impact now that the benefits those foundations will already have for us and the impact we can have with that work. So
if I quickly move to slide 2 which just talks about what we’re going to cover here today. In the autumn we came to the Board to describe the framework for the work of how we’re going to develop the team overall and then in February
I gave an overview of the work underway in the data science space. This is revisiting both those and a bit of an update on progress and also what I want to do is give some examples of the actual work that we’ve started to do.
Some tangibles so you can sort of see some of the impacts that some of the things we do will actually have. And a little bit of a view on how alongside digital we are now starting to engage the wider organisation in some of this
work as well. So onto slide 3. I start on all of my presentations that I’m doing with the board with this slide so hopefully this is a bit of a reminder of the framework that we’re thinking about how we’re improving the outputs that we
deliver. Making sure there’s as much consistency as across sectors as we can and sort of driving that consistency across the operating model in the way describe our intelligence. We will only be able to do that if we the three enablers right so the data
and technology that we use to drive those outputs. Improvements to the culture and ways of working within intelligence and the development of the team. And obviously the impact that all of that will only be really fully realised if we’ve got the right cultural ways
of working across the organisation to take advantage of that. So onto slide 4. This is describing I guess revisiting the work that we spoke to you about in February. We talked then about some of the external procurements that we were undertaking alongside some of
the more experimental work being carried out internally. Some of the examples later we’ll just show you some of the data science work we’ve been doing internally ourselves but here’s a bit of an update on where we’ve got to with some of the external pieces.
So firsty the expert systems work. This is really, sorry expert systems are attempting to emulate the capabilities of expert decision makers using artificial intelligence and we’ve been running a scoping project with an external provider to help understand the benefits that that type of approach
could bring to CQC and what what things would need to change. What neighbours would be required to really make that effective. So they did a series of interviews across adult social care. We used that as our sort of focal point for the scoping piece
and and there was a follow-up workshop which was attended by members from across the sectors and I had some anecdotal feedback from that that was a really sort of inspiring session about what the possibilities of this could bring which is fantastic. We are expecting
a final report in the next couple of weeks on that and would be very happy to speculate that to the board members to then allow us think about what really we could do with this next and how we can take that forward more formally.

[Mr Peter Wyman - 1:02:05]

Helen this may sound like a rather silly point but I’m just intrigued I mean you, throughout the slides you are describing a problem and then how are you going to solve the problem and I can understand from your point of view that’s how you’re
thinking about it but actually it isn’t a problem is it No It’s a huge opportunity Yeah, yeah that’s right. It’s an intellectual problem Yeah no I ...I understand that Not an organisational problem as such but yes But I think it’s quite an important, you
know it’s not just a semantics Yes I think these are huge opportunities for us Yeah That you’re describing Yeah. Noted. Thank you. So that is the expert systems piece. The other thing I think that will give us is some of the conversations they’ve had
is really about how decisions are made today but also what data are underpinning current decisions and I think that piece of work will be a really good head start for the data strategy work to come that we’re going to do,start in the next few
months. On the data science advice that piece was all geared to training some of our more sort of statisticians some of the more advanced analytical members the team in new coding languages and given advice and support as we undertake the GP predictive model work
to make sure that we are using those new, you know we’re applying techniques that we know about in the right way with these new coding languages so that training has been done and the support is now starting as we, as we are starting the
modelling piece of that work. And the text severity piece is going to be, we’re going to see the first sort of version of this, of early results from this in the next few weeks but this is about, can we, what we want to get
to a place where as we get information coming into the organisation can we quickly tag or identify those pieces that we’re most concerned about. So it’s an automated way we can do that so obviously all inspectors already get all the information as it comes
into us. But is there a way we can really flash up and highlight the ones that we should, you know are most concerned about where it might not already be flagged in that way and also allow us to look at items that are identified
to high concern over time and across services to see what information we can learn from that and what, how that might help us with our risk assessments. So all of these pieces are not end results in their own right but they are really going
to enable us to do better things in the future if we can apply them in

[Mr Peter Wyman - 1:04:36]

the right way. Ok. I’m ok. I think this is really great yeah And just to back Helen up on this I mean the people from adult social care that

[ Andrea Sutcliffe - 1:04:43]

have been involved in it have been you know, are very excited by the possibilities so it’s kind of, it’s been really good work so thank

[Mr Peter Wyman - 1:04:55]

you. And I suppose I was going to make the point later but it’s perhaps right to make it now.
I mean this is not going to be a straight line of unremitting success is will not quite deliver what you thought they were going to deliver and we need to be very prepared for that and actually regard that as a success in its own
right because that’s where you learn and move on so you’ve got dates by which things will have happened and it will be really interesting to get the reports coming back but we shouldn’t be dismayed if on some of the things you say we didn’t
quite deliver what we hoped it would deliver and we’re now adjusting Yeah absolutely and the important thing for us is to learn that and apply that as we go forward Yeah, yeah. Good. Paul. And just on the

[Mr Paul Corrigan - 1:05:46]

last one on tech severity which is
a frightening phrase. What we’re doing, if I understand it right we’re learning what are the words that are used that actually provide red flashing lights for us. There should be a feedback back to the public about shouldn’t there. So that in fact if we
get that light then actually they need to know what those words are. So that it’s not just an internal thing that we then have found out what they’re trying to tell us but we feed back to them saying if you tell us this then
actually we know this is very serious. Rather than just us, it’s as if the tech severity gizmo is trying to double guess the public and I think I’m suggesting that if we say to them actually this is what, then we don’t have to double
guess them Possibly We’ll probably still have to double guess them

[Mr Peter Wyman - 1:06:42]

[Mr Paul Corrigan - 1:06:44]

because... Well we still have to, but they can assist us Yes They can assist us by saying the phrases and words that we think are red flashing lights Yeah and there’ll always need be
a level of validation That’s right As there always is around all of this. So that you know we have to make sure that we’re following up in the appropriate way from whatever piece of information we’re getting But this is not private stuff No Because
it’s scraping public data Some of it would be things that we’re, a lot of it will be publc data. Some of it will be things that we’re directly notified of It’s private data from the public Yes, yes. With things people are telling us. Yes.

[Mr Peter Wyman - 1:07:23]

In one way or another. Great Ok Onwards. So moving on to slide 5 I’m just going to give a bit of an update on some of the data and technology enablers. So we continue to work with digital to ensure our data and tech foundation
is being layed to allow us to generate the high impact timing intelligence for the organisation that we need to. Going forward these key pieces are going to be governed under the monitor programme board to make sure we’ve got the right governance and assurance on
them because they are so crucial to us within intelligence being able to do the work we need to do and help us overall deliver a strategy so that’s something that is going to happen going forwards. In terms of the individual pieces so my personal
belief is that the qualitative text data is probably going to be the biggest thing that we can do this year. We’ve got a lot of information in the organisation but it’s not available to analysts at the scale that we’d need to be available for
us to use it appropriately you know in an automated scale way. And so really unlocking the value from that and presenting the intelligence from that to our inspectors to help them with their assessments of risk and ongoing monitoring is going to be I think
crucial personally. So I said they already action that information but the ability to really wrap that into ongoing monitoring and use that. You know look at that across time is going to be, it’s going to be really important. So pieces of work we’ve got
going in the spaces. We’ve got some excellent providers helping us basically create the right interfaces and API’s to pull data between different systems so that we can really build it all into our one intelligence platform and am make it available to our analysts to
use in its entirety rather than individual items which is where we’ve

[Mr Peter Wyman - 1:09:02]

been thus far. So is the ambition, it says the progress remaining 8 planned by the end of June so at the end of June is the hope that you’re then able to get
the whole lot to analysists or ... Yeah Is there a subsequent piece that So the, getting 12 data sources means that it’ss sitting in a data system where our analysists can access Yeah And we are, as we go forward we’re testing different ways of
using that now so that’s as quickly as we can once all of that’s available we can start to roll different sort of solutions out off the back of that data. Yeah. There are more than, so there are the 12 priorities, there are further sources
that we want to get our hands on so we’re just trying to go about getting, securing that external source so a little bit longer to get us the extra pieces that we want to, that will take us probably through to September or October time
but the 12 most important ones are the ones that we believe we’ll have by the end of June Paul Could you say a little bit more about the

[Mr Paul Rew - 1:09:58]

sources Yeah What they are So things like notifications that come through to us, complaints, whistle-blowing, inspection
reports. So it’s basically anything that we’ve got in the organisation that’s tech data that’s either we’ve generated ourselves or that have come in to us. So and there are less, other sources like that, so all of those text pieces. It’s about trying to build
relationships between all those in order to be able to derive messages from it. Yes. Which give us something we can then use to act upon. Yes so today, for instance where notifications come to us they are stored as PDF attachments against a specific location.
And they’re stored in our CRM database. So they are PDF documents and they are not in a system that our intelligence team can access. And they’re not stored in any logical way where you could read through all of those. So part of what we’re
trying to do here, and what we’re trying to do here is basically read those pieces of information and then store them in a logical structure so that we can look at that stuff. Just the one source and then we’ll be doing that across sources
so that we can use all of that together as you say. Yeah. Okay. Then the next piece is around the I-Hub. I’ve talked about this a little bit previously. One of the big things that we need to do is make our work more efficient
and part of that is about bringing all of our data into one place and it doesn’t necessrily mean all in one big place. It might not be a huge data lake but the I-Hub is at the outset a place for us to store all
the standard data that feeds our current automated reports. We need the ability to link all of the data that we have around the different locations around providers together and the I-Hub is the place that we are really starting to do that. So as I
said we’re bringing together standard data that supports our current products and our plans for the future will be to allow us to easy link that all the other data sources that we have to make sure that we can do the analysis on the biggest
and most richest set of data that we have. This is something that’s been in progress for quite some time and the PMS and the acute datasets have developments. The development itself his completed and we’re now in parallel testing. So we’re testing the outputs that
we get from the analysis that we are doing on that data to make sure it matches up with the way that we do it today and that we haven’t lost something in translation in building this new solution. So our hope is that that will
be complete by the end of Q1 for those two sectors. And then the remaining sectors will go through, we’ll literate through them through to probably early autumn time. Jane. So a simple question. This is all

[Ms. Jane Mordue - 1:12:42]

sounding really good. How can Healthwatch help you. I’m
presuming that you and Amy are in contact because we’re collecting lots of data. Do you want to have access to that. Or, you know, how can we help. Yes. So I think the Healthwatch is one of the qualitative sources. So informational help is one
of the qualitative sources that we’re talking about. We are in discussion around what is possible to share from an output perspective in terms of the intelligence as well between us and Healthwatch so we’re actively talking to Amy around all this. John. Thank you very

[Mr John Oldham - 1:13:14]

much. A huge amount of work that you’re doing internally and trying to create this thing. I just wanted to ask because it isn’t here. How much, or is anybody allocated in your team to look outside. I know you’ve got connection with the ##### Institute,
you told us about that before. But Juro gave us a brilliant example last time. Has anybody been to see it. Are there other organisations outside healthcare that are doing this that the learning could be imported the aim being just to create a gearing effect
on your implementation. Yeah. So we know we haven’t got dedicated individuals but one of the things that we’ve been really trying to encourage over probably last 12 months and we’re reiterating it is the need to be curious and innovative and find out what others
are doing and you try and bring that in to, you know learnings from that and bring that into the work that we’re doing. So there are probably I would say 5 or 6 individuals across the team who are starting to have conversations outside. I
mean we honestly haven’t got a formal plan around #### the specifics that we want to go and talk to. I know David and I went to the Met Office recently. I’d contacted the folks that Juro put us in touch with after the last board
meeting. A number of us have different contacts from past lives that we are starting to talk to. Yeah. So I guess that’s where we’re at with that. I guess what I was prodding is whether it should be formally part of your strategy. I mean
we’re doing it. It’s not a business plan deliverable that we, you know we’re actually building all of those pieces in but I mean I think we’ll take that on board yeah for sure. Ok. Onwards. On to slide 6. So a couple more pieces on
the enablers and then I’ll get into the exciting pieces which is the work that we’re, you now the actual tangible work that we’re doing. So one of the other pieces was around the automation of intelligence outputs. I think a key principle for having one
work going forward is that we automate, we look to build automation in as early as we can to the work that we’re developing. We run a significant number of manual processes today. For good reasons. Partly because of the data platform. Partly because the technology
that we’re delivering it in. Partly because of just the inconsistency with that data that we’re using. But we have real strong ambition to make sure that we can automate all of the standard pieces as far as we can. It has proven challenging because in
particular some of the pieces that take the longest time for us to deliver are the evidence appendices to support different sectors within the acute sector, different providers in the acute sector. In part because the data, because we don’t have a digital collection for some
of that information that comes to us. The data is in slightly different formats when we get it every time and so it’s actually quite hard then to automate a, you know, production line around that data. So we haven’t made as much progress as we
would have liked in the automation space. We understand why but we’re really keen to make sure lots of key focus continues to be a key focus for us going forward. And then the final piece here is around an analytical environment. So we’ve currently got
analysts trying to process large volumes of data using their sort of laptop processes and with poor network speeds of data being transferred around and processing in systems that aren’t necessarily up to speed just creates real inefficiency for us. So we’ve been talking about the
need to create an analytical environment. A space, dedicated server space where we can basically do all of this work and we’ve actually been in discussion with DH as part of this. They are running a proof of concept for analytic environment in June, July and
we’re basically, they’ve invited us to be part of that which is great and that will help shape our requirements for this as we go forward. I mean I’m really very excited about this work automating the evidence

[Professor Edward Baker - 1:17:07]

appendix. Because that is the heavy-duty report writing
that is taking so much time at the moment and I think that relates back to what we were talking earlier on in that, that our reports are made up of a summary of report which is about judgment and the evidence appendix. And the evidence
appendix at the moment still is a very manual maually driven process so I think there’s a real opportunity to drive improvements in consistency to make sure the evidence we’re looking at is consistent between providers but also improves in productivity with the automation. So that’s
really a very exciting project that which hopefully can deliver you know fairly soon for us because I think this is, it’s one of the things that’s holding back the speediness of our reports so I’m very excited about that. Yeah. There’s the speediness of reports
and then there’s our ability to innovate further because we’ve got people doing lots of manual work we don’t have the capacity for the innovation that we want. So I suppose following on from that the

[Mr Peter Wyman - 1:18:01]

question is, are there things that the organisation as a
whole needs to do to help you make the progress that you want to make in the timescale that you and everybody else wants. And if there is and if there’s anything the board can do to support that. And I suppose linked to that are
there things the system should be doing. Right so presumably the system is moving in the direction of sending as digital information, more digital information. And the quicker it does that I think the more time they’ll save but the more time then we’ll save. So
it’s actually how they can be encouraged to do that because at the

[Mr Paul Corrigan - 1:18:43]

moment it’s a burden and it will be a smaller burden. I think that’s

[Professor Edward Baker - 1:18:46]

right and one of the, some of the feedback we’ve had about the private information requests is that they
are burdensome even though we’re asking for less information. But we’re asking for it in a very specific format and I think we’ve had to be flexible with providers too about the format they submit it in, in order to reduce the burden. But equally over
time I hope they’ll be able to collect that data internally in a format that can be rapidly transmitted digitally into our systems so save work both for them but also for us. And I think it is part of our learning and our relationships with
the provider sectors to do that really well both for their benefit and ours. And that certainly then kind of passes the focus of the work that we’ve been doing on the adult social care provider information return, you know clearly we’re expecting that to help
us internally in terms of the use of the information. But one of the significant benefits will be to enable providers to have a digital relationship with us which enables them to own the information and use the information as well. Rather than it just feeding
our beast it’s something that encourages improvement within the service as well and potentially in the long term future and enables us to share that information with others so that they can use it too which again will will have an additional reduction of burden on
providers so there’s a whole circle of benefit which we can be kind of

[Mr Peter Wyman - 1:20:19]

achieving there. Right. Yes? No? Good. Onwards Helen. Ok. So into some of the examples of some of the work that we’ve been doing. So the first one is around our ability
to identify where we think there has been, there is an absence or a change in registered manager adult social care locations. We know that the absence or change can lead to a risk in the quality of care at those settings. And the providers are
required to notify us when that changes. But we know that doesn’t always happen and so one of the pieces of work we’ve been testing out is can we identify beyond the notifications that come to us whether we think there’s been a change or there
is an absence of a registered manager. So what we did in this sort of test project, was to manually look at job sites to see if we could identify where there were adverts advertising registered manager posts. And use that information to create some flags
with, alongside our inspecting colleagues to understand what we think would be something that would give us cause for concern and what would actually be quite comfortable with given some of the information we know already. And those pilots were quite successful and we developed some
flags from the back of that and so we’ve progressed from there now. Going through all of the appropriate approvals internally around the data, that I needed to sort of minimise any data concerns around this and in line with the website commissions, there are a
small number of websites that we’re now starting to basically automatically look at to see if there are any of these adverts posted, which is a big step forward for us. We’re using our new text analytics tool to do that automatically. So we started that
process. The the data is starting now to come into the organisation but I talked about the I-Hub. In order for us to be able to use this at scale we need the I-Hub adult social care instance to be up and running so that that
data can flow into our data store and we can generate the flags from it and push that into our standard inside products. I don’t know if you’ve got a comment Andrea about this within the team. Just to say that, I mean one of the

[ Andrea Sutcliffe - 1:22:45]

reasons why this one is so helpful or potentially so helpful is that we know that a change of registered manager, you know, in any type of service but in a good service could be a precursor to a lack of grip on quality and a
deterioration in the level of service. In the vast majority of cases we will get that information and know that information in the right and proper way but this gives us an added benefit of being able to flag up the potential that our existing rating
can’t be relied upon without further investigation because of that change. So if there is a change and we’ve not been told about it then actually that would be a significant flag and being able to feed that through into inspectors so that their portfolio management
of individual locations can be more intelligence led will be incredibly interesting to see whether it then has an impact on, do we go out and if we go out what do we find and you know so is there a kind of new evaluation loop
back that demonstrates that it’s actually done the thing that we

[Mr Peter Wyman - 1:24:04]

expected it to do. And presumably this is just an example, I mean a very important one, but only example of probably what are a whole lot of other indicators across the sectors in due
course that we’d want to flag so Steve you know a change of practice manager might be a, I don’t know but it might be something we’d want to be sure we knew about. So if you get, make this work for the registered manager we
can make it work for other areas. Possibly yeah. Yeah. Only possibly. Well it, we can make it work whether it gives us useful information or not is another matter. Ok. Fair challenge. It back to what you said Peter which is that we can have

[ Andrea Sutcliffe - 1:24:40]

a hypothesis about what potentially would be really useful for us to have. We need to test that out both practically but then also in terms of what does it actually mean because you know clearly what we don’t want to be doing is kind of
you know taking information into, I mean don’t think it’ll happen on registered managers to be perfectly honest but we don’t want to be kind of giving inspectors information which is a false negative and takes them out to do inspections which actually are not required because
you know our inpsection resources are very precious resource and we need to make sure that we’re using it in the best possible way which is what all of this is designed to help us to do. Yeah well. Just on the web scraping which it

[Sir Robert Francis QC - 1:25:26]

sounds almost worse than text severity. I’ll change the words that we’re using. I can see the importance of what you’re seeking to do but wouldn’t a lot of homes be seeking to recruit managers through recruitment agencies with ads that are anonymous and does that,
that might not help you, you’re proposing to web scrape as it were the home’s own website assuming they have one and presumably some of the worst ones don’t so I mean how do you discriminate on that basis. Yes. So I think this is, if
you think about what it will give us, it will give us a view of when we think there’s a change so there’ll be things, there’ll still be things that we don’t know about but this is something that we do know about that we can
actively manage. This is our first foray into web scraping and so I think there’s lots for us to learn around is it going to be possible to go to, sorry I won’t use that term, automating the ability to access information on the internet, shall
we use that No that’s too long So I think yes absolutely there’s all sorts of ideas that would explode as we go forward but I mean this is sort of the first time we’ve tried that but absolutely we could look at that. And I
think Robert if you go back to what Helen identified on slide 3 in

[ Andrea Sutcliffe - 1:26:44]

terms of, you know we’ve got the intelligent products and services but those 3 enablers and you know clothed the data and technology, what websites can we go to, what can we
actually find, you know the support that we might get from the intelligence team. But absolutely critically what do we then do with it out there in terms of the registration and inspection teams. So on this one what we need to make sure is that
we don’t kind of give ourselves a sense of false security that because we haven’t been told that there’s a problem that absolutely the reasons that you’ve just described we don’t kind of give ourselves a false assurance that everything’s ok. But where we do have
that information and it’s an added insight that will help and what is it that we’re going to be doing with our teams to enable them to use this information in a way that actually helps them do the right thing in a timely fashion which
is the reason why the evaluation of this is you know the practicality of it is really important but the evaluation of what we do with it and that any impact it has is perhaps even more important Yeah. Ok shall I

[Mr Peter Wyman - 1:27:55]

move on. Yes please.
So the next one is around, this is, we talked about this briefly at the Board dinner last month so I have included this, this is the topic modelling piece that David mentioned. So we’ve had, actually we’re trying this in two different ways, 2 of
the analysts in team have been trying to look at, can we identify the topic that’s being discussed when we get information. And through things like NHS choices and sheer experience so NHS choices is the piece that we’ve looked at at the outset. And we
are attempting to build different algorithms that allow us to identify topic based on information so the idea would be as information comes into us we can effectively tag it with a topic that is like, you know with a level of certainty as to how
likely it is that that topic is as we define it, so that we can again pass that information to inspectors and they can see when a notification or something comes in, motivate is probably a bad example, when some choices information is now available to
us without having to go in and read all of the different pieces they can quickly see what the topic is and then decide if that’s something we need to look at now or something they can come back to a later time. We don’t today,
in the intelligence team, do any of this manually so we don’t create manual topics from any of these pieces of data largely we don’t do that. And so these data sources have got huge volumes in them so the ability to automatically identify or tag
a piece of information will be really valuable. So just a brief example on the next slide, so this is slide 10 just what that might look like. So all the different blobs are different topics. In some multi-dimensional space so we won’t go into that.
But you can see this is an example of maternity services that says for the topic we’ve identified you can see the red blobs, the red bars are the importance of that word within that topic. So within maternity services, baby, midwife and birth and the
word experience, those are words that really help us identify that as a topic around maternity. The blue bars are words that are actually quite important across lots of topics you can see so they’re not necessarily the differentiator. So you know you can see some of these there’s quite a bit of overlap
with some of these bubbles so we haven’t quite got this right yet. We’re still working through it. This is our first attempt at trying to dissect some of the topics that are within the data. So the next stage around this is really to get
to a place where we’ve identified the approach that we want to use and we’re comfortable with the accuracy of that. So that we can then start to tag that data coming in, helps create some national views and then work out how we present that
information at the location level for our inspectors to understand. It all sounds so fantastic. I’m just trying to understand what this giving you. So when people write something which includes the word baby that means they’re probably talking about maternity services. Probably. Yeah ok..... But
it’s a combination .... Yeah ok. Now I think I could have told you that. Yeah of course. So I’m just wondering what the development of it is. Let’s takes something that’s a little bit less, sorry I don’t mean to be so. But you say
mental health for example where people might, the language people use might be not quite directly, it might not be so explicitly linked to the kind of service that they’re referring to. Yeah. And it’s the combination, it’ll be the combination of words together that really
help us to differentiate that topic. So even if you took baby out of it I mean midwife, birth, I mean I think those ones are, this is probably quite a polarising topic. It’s probably relatively easy to identify but it’ll be the combination of words
together that really helps you effectively cluster those words together will identify what the topic is. So you’re right in mental health it might be that there are you know more words that, and different combinations of those words that might identify that topic. So what
it allows us to do though so while an inspector might, you know quite easily read one piece of text and identify very quickly what that looks like, what that won’t allow us to do is if you can identify over time what those topics look
like for a location. You know if we’re getting sheer experience or complaints coming through actually if over time the number of bits of information relate to baby is more than we’d expected for one service compared to another or maternity or mental health or whatever
it might be that gives us intelligence that we didn’t have previously. So again we can identify, as these pieces come into us from an inspector’s perspective what that looks like, but our ability to analyse that across time and across services and create benchmarks and
things that is limited today. Joan. Just following on from Lewis’s

[Ms. Jane Mordue - 1:32:37]

comment I think actually what I would encourage you to play with some of this stuff because it’s not, as Peter said, it’s not all going to work is it. Absolutely. But this looks interesting
and some of the earlier things you were talking were really really good. I think we should celebrate this. It’s very innovative and it’s flexible and you’re trying stuff and some of it will work and some of it won’t, so. Yeah. Good luck. Thank you.

[ David Behan - 1:32:59]

If I may I think your question is a really good one Lewis and I think the significance of this is, this is looking at the data the others hold about health and care which can get made available to us in a way that our
inspectors can sort. So where I’d go with your question on mental health is, let’s for the sake of argument Healthwatch gets stuff on detention and restraint in a particular unit and this allows us to look at the way that that tax is coming at
us and understand that and that then can get converted into evidence that might not otherwise be available to evidence. I can’t think of the example now but we were in a meeting yesterday where the elision between some words and some phrases where the actually,
the same word can mean completely different things in different settings means that the precision of which you set these words becomes important. So I think the skill that’s being used here and that’s why I think maternity services is easy. You can say babies will
be involved in every maternity services but there’s other words that we know just to go back to some of the things where we know maternity services don’t work that you’d want to know as well probably. So I think the skill of this is building
on this base skill about what are the questions you need to interrogate this to begin to convert what is just a bunch of text basically into intelligence. So I think the point that this is exciting it’s absolutely well done and the organisations that are
using this, the skill comes in how you construct the questions you ask to be surged and then that gives you the data. So this will never replace the experts as a mental health expert this is a question I’d like to ask. It’s that combination
I think of experts asking those questions and the machines that come through. But I think that whether we do maternity services or not I think what’s on demonstration here is the skill and techniques and tools that are available to allow us to actually get
a richer understanding. And I think it connects the earlier conversation we were having about how do we take subjective truth and begin to combine that with the statistical evidence #### that we have

[Mr Paul Corrigan - 1:35:18]

as well. And again if this becomes, if this becomes explicable to
the public like I was saying earlier on about what we’re doing, then they can see their subjective truths being part of a wider discussion. Rather than us simply saying that’s all very interesting but what we do is what matters. And this is how we
make that connection. Yeah. And you can play back to them the nature of the things they’re saying and how that relates to our, it doesn’t tell us what to do but it informs us about what to do and then the loop needs to go
back to them which says because you’ve told us this we came to this. Yeah. Because trying to keep a thousand stories in your head as an inspector of a service is impossible. This actually means that something becomes more accessible. I’m not sure it makes
it more possible. Yeah and I think also not forgetting the ability to actually use it for our independent voice. If we can have that national picture which we’ll never get from you know inspectors using this information day to day as they are already. It
doesn’t allow us to capture that effectively. OK. The last one on the show and tell is around the local area portal. So what we are trying to do with this is to enable staff to work better across sector and to really understand what’s going
on in their local area. So this is a visualisation example of something we’re trying to develop to help better cross sector working. And it’s come through the better cross sector working group but it’s really about how do we make information that we have in
CQC around the different providers within a location really accessible to everyone who needs to have that information. And I’m really excited about this because I think this potentially could be a really important way of creating the bottom up cross sector connections that we want
to generate amongst our inspectors. You know we will talk about the need to get out there and find out what’s going on in your area but it’s very hard when people have got day jobs and they’re really, really busy. Actually there’s some really simple
information that people can access for themselves and create a pull off that rather than sort that push which is perhaps where we have been. So I’ll just show you some examples of this. If you, I’d be really, I’m sure the team would be really
keen to give you more of an actual real life demo of what this looks like at some point if that will be useful. I can talk to it, they can talk to it much more exciting and much more enthusiastically than I can. So we’ll
say yes to that please, Excellent. So we start with, the first on slide, what slide are we on, 12, this is just the first view that you would see when you log into this. So this is the map of all of the services that
we regulate across the country and where they have a ratings they are flagged and colour coded on this map. So then you can basically drill into different areas that you’re interested in. So if you move onto the next slide you can see what that
might look like. So you can either drill down from that high level map view or you can do a specific search on a provider or postcode or whatever information it is you want to search on to find the location that you’re looking for. You
can filter it based on different types of layer so you can just look at adult social care, you can look at PMS for instance, you could look by, and you can have different views of the boundaries. So you can have a view around local
authority boundaries, you can have a view round CCG boundaries etc. And when you click on a location then you get this pop-up box which basically gives you some information around that location. So it will take you through to the CQC web page so all
the information we hold there. It will give you the rating if you’ve got it as you can see on the image there. It will also allow you to link through to insight so it will show you, you can go straight through to the insight
product that gives you the information, the more detailed information about the monitoring information we have for that location and also there’s also a separate link through to the relationship owner. So say on the adult social care inspector in a certain location and I go
on here and I can see that there’s some interesting GP practices or there’s an interesting ratings for GP practices around that care home that I look after. You can basically kick in to see who the relationship manager is. Who the inspector is for the
particular GP practices that you’re interested in. For instance it will give you their contact details and you can basically get in touch with them, have a conversation about what might be going on that might be impacting the services in that local area. And then
it will also help you link through to other locations that particular provider runs as well. So that’s where you can get information at individual location level and then if you flick onto the next slide it also allows you to access the area level information
that we have for that specific CCG or local authority for instance as well. So some of the work that we did that support the local system reviews and the reports that were generated that were generated out of that. It will allow you to get
access to that information. So I’m quite excited about this and it’s really early days so I’ll say I think the analysts that built this took about 4 or 5 weeks to do it. A lot of the information is already there. It’s about just collating
all of that information together. This was presented to the pit board a couple of weeks ago and I think some of the comments were a leap of imagination and a methodological game changer. So I think some of the people who are starting to see
this are getting really, really excited about what it can do and really there isn’t new information here it’s just about bringing this information together in a way that makes it really accessible that we’ve just not been able to do previously. So really, really excited.
In terms of where we go with this. So we’ve been demoing the prototype to various groups. Next quarter we’re going to do a soft launch with a small number of users so that we can really evaluate it, make the tweaks that we need to
make and then we will be ready to go with a big sort of launch to everyone from from September onwards. And obviously we’ll continuously improve and iterate that based on user feedback. Well I think it’s

[Professor Louis Appleby - 1:41:14]

fantastic and one of the, I mean I think
it’s right that the potential is enormous for this so if I’ve understood it correctly you’re starting now with the potential to show let’s say all the services within the area of a particular CCG and how they’re doing so that’s available, it’s the kind of
thing that we talked about even this morning because we were talking about something very similar. But the real prize is that you would, because I think you’ve talked about it mainly as being something that will help our staff work together with each other, but
the real prize is informing the public about the same thing. And not just so that, obviously at the moment you can go on our website and you can see how good the care homes are where you, you know near where you live. But this
would create a much a more comprehensive information. But the better development of that thinking of the local system reviews is that you could imagine the next step would be, where you might take maternity services actually, or it could be something else like diabetes care,
and instead of just doing the rating for an organisation as a whole, you would know about the core service ratings. So that if you are a patient who had let’s say diabetes or somebody who needed maternity services you would be able to say ok
I want to see how good my local provider is, my local maternity unit or how my acute provider performs on diabetes care alongside how well my local community services provide. So if we take maternity services you’d want to know about your maternity unit, you’d
want to know about your health visitors, you might want to about your GP and all of that would be part of the, how you would picture your care. If you wanted to take diabetes you’d want to know about whether the community district nurse or
the community diabetes service but the podiatrist and all the other people who might be involved that the ability to pick up the pathway of your care for your specific condition through this kind of model is fantastic. But I would say that is the real
prize. That’s the, I know that’s the next stage but if they can do this in 4 or 5 weeks just add another couple, you know another couple of weeks and you can do the rest well. Well this is a game changer. This is a

[Professor Edward Baker - 1:43:22]

really exciting bit of work. Just to, and I, to support what Lewis is saying I mean a public facing version of this would be really very exciting and I think it would be highly appreciated by the public who you know I think have difficulty
accessing our reports through our current website. But you know accessing it through this graphical interface based on geographical areas I think would be very interesting. But for us internally it would be very interesting. I think one of the key things that is going to
be important about this is accessibility. I mean this is something we need our teams and the public to be able to access fairly easily and not jump through lots of technical hoops to get into. Yeah. So, can we just think about how easily people
could access it because if you can access it from any PC attached to the internet that would make a big difference both to the public but also to ourselves as well. Rather than through some networks protocol that makes it much more difficult to access.

[Mr Peter Wyman - 1:44:18]

Yeah. Currently its, the sort of the first layer that you see is accessible but to click into insight or to click in to get the information about relationship manager and insight that’s all through CRM so absolutely those are things that we need to develop
over time. And presumably there are layers you could make a lot of it accessible to the public but also have some of it only accessible to employees when it’s information that only really for our staff. Yeah, yeah absolutely. But all this information is public.

[Mr Paul Corrigan - 1:44:42]

So we’re only recollating public information. So therefore the whole thing’s public. So perhaps the relationship manager but who cares right. But actually the ability to drill down into a diabetes pathway it’s only we’re reorganising existing information that we’ve given to the public. So I
think there are parts of CQC insight which on,I think I’m right in saying some of it isn’t public so some pieces I think may need to not be. But our view is to be as transparent and open with all of this as possible. So
as much as we can make this available to public we absolutely should. And just building on Ted’s point for accessibility then the language

[Mr John Oldham - 1:45:28]

that you use and the designations will need to be public friendly. Absolutely. And maybe our colleagues in Healthwatch can help you
out with that. Yeah. I think the approach with all of our products going forward is that we really involved the users, the end user in the development of those so as we go forward to creating a potential public version of this we would absolutely
need to involve the right user groups to make sure we were making it as accessible as possible in that way. Helen could I just ask you.

[Ms. Kirsty Shaw - 1:45:58]

Some of this stuff is really good suitable for making into apps and obviously that’s probably not our remit.
But how we are, once we’ve got it are we thinking about engaging wider with app developers to actually being able to get this information out there into a really user-friendly way which is without us having to do it but really sort of engage in
that space. Yeah. I mean it’s not something we’ve actively being sort of pursuing at this point. I think we’ve had lots of conversations so there’s a relatively new head of architecture within the digital team. There’s new digital heads of sort of coming through now
as part of that restructure so I think this is all part of how are we making all of our information as accessible as possible in future.

[Mr Peter Wyman - 1:46:43]

Absolutely we should be thinking about that. Anything else. So Helen I think this has been a story of
good news and bad news. So the good news is everybody’s really, really excited by everything you’ve said. The bad news is that we want more of it within a few days if not weeks. Seriously I think this is very, very encouraging and you’ve been
brilliant over the last year or so since you’ve been with us and getting the foundations in place patiently. Thank you. For this to happen so on behalf of the board thank you but would you also pass our thanks onto your team because this is

Recognising Outstanding Contribution Award round 1

clearly a lot of people doing some very clever and potentially very, very valuable stuff. So thank you. I absolutely will do. Thank you. Good. Right. So talking of good people doing good things I think that takes us on to the recognising outstanding contribution award.
And I think, have I missed something out. No, no Sorry, I thought I was being told I’d done, I’d made, no, right. So what I was going to say was you know one of the good things about my role is meeting a lot of
our people who do fantastic things and one of the disappointments is that I don’t actually get to meet everybody that’s doing fantastic things around the patch. But having the Rock Awards and having the winner comes here at least gives all of us a chance
to meet some of those people. So I’m going to read out what Richard Magee has got this award, what citation says because if I try and paraphrase it I will just not do it justice. So forgive me if I just read this out. So
Richard works in the information sharing team that deals with all of

[Mr Peter Wyman - 1:48:48]

the hard copy information that is sent to NCSC. And this includes roughly 1900 notifications each day. Local authority concerns, outcomes, meeting minutes and so on which were another sort of 200 a day.
So you’ve got, you get a picture of a large volume of hard copy information. So Richard was nominated for the Rock Award following his identification of a number of issues which he believes should be reviewed to make the process more efficient and lean. So
something that we talk a lot about how do we get more efficient. And the idea was then, his idea I should say was then taken forward by developers who as a result of his creative thinking took his idea a step further and as a
result CRM now with a click of a button auto renames attachments within enquiries. And this has not only benefited Richard’s team but those who process information within NCSC and also anyone within CQC who is required to rename documents received within an inquiry. Now you
may not get, even now quite the picture of the sort of volume of what this is all about but Richard’s team alone processes around 26,000 enquiries a year which recreates, equates to a minimum of 52,000 times of opening, renaming and closing documents. So you
get a picture that Richard’s suggestion based on his knowledge of what he was doing day-to-day has now come up with a recommendation for improvement that has had phenomenal impact. So I think it’s just really great and I’m sure you all join with me in
congratulating Richard. I should also say one of the other great advantages of being chairman is from time to time I get to be Kirsty’s sidekick or bag carrier or anything else so I have Richard an award to actually hand you. Although I see that
it’s signed very nicely by Kirsty not by me so. Sorry. Richard come and ... Thank you. Did you get it. Wait a minute. Yeah. Can we sort of do a photo. Shake hands and hold the thing and do all of that. Got it. Perfect.

Any other business

We’ll talk to you in a minute. Thank you Richard. No thank you. Fantastic. Great. So board is there any other business. Yes. Malta.

[Mr Peter Wyman - 1:51:37]

While we’re on congratulations I just wanted to mention that our director of policies and strategy’s baby daughter was born this morning
while we were meeting as a board. No correlation. Everyone has well and healthy and I thought we all congratulate her for the birth of her daughter. So her strategy, she hasn’t lost her touch on the strategy coincide with the board meeting. Fantastic. So it’s
a calendar baby. Important piece of information. Just following Lewis’s tradition. It’s not just baby you needed. ..... You’ve got to scrape the website Paul. So no doubt even at this minute she will be watching the live, or at least not live, but she will
be watching the board as this goes out and so very many congratulations to her and thanks for the update. Good. Any other business from anybody. So I said we were not going to have time for questions from the public but if there is anything
and we haven’t been notified about anything but if anybody wants to raise anything we’ll have time for it. David. One question. Although I thought between Andrea and I we actually answered your question but anyway perhaps you’ve got another one. David Hogart Neighbour Care St
John’s Wood and Mayvale. We are a befriending organisation in north London. We were having a meeting in April and one of our befrienders reported that the person she was befriending was going into a home in what used to be the Triborough area. It was
home which I had visited, an interim view visit for Healthwatch a long time ago. I hadn’t been very happy with it and none of us in fact had been very happy with it so I was alarmed. Therefore I said I’d go to the CQC
website and I did go to the CQC and the very first thing I saw was that a whistle-blower had reported that they were, that this home had recently been getting up people at 4 or 5 in the morning in order that the night staff
could do it and not the day staff. And I passed this on to the befriender who passed it on to the person’s son and as a result of this the person is not going into that home at all. She is staying in place she
likes where she is receiving respite care but they also have a long stay facility. And she’s, everybody so far, is very happy about this. And I’m telling you the story for two reasons. First of all I would like to thank the CQC for two
reasons. First of all for putting this on the website. Putting it into the report, being transparent about it because in the past it might, they might just have said that we heard had concerns and that wouldn’t really have been enough. And secondly the CQC
went in, this was one of the 6 percent of whistle-blowing reports that actually brings forward planned action and they went in at 6.20 in the morning and discovered, they didn’t discover anything, they discovered everything was well. Nonetheless I didn’t entirely trust that nor did
the son nor did anybody else. We thought probably the whistle-blower was telling the truth truth and that’s why we had the outcome we did. So I’d like to say that that is one thing I’d like to thank the CQC for, for that. But also
I think the fact that you didn’t find it when you went in I think does highlight the thing which I keep saying and I have the same worry about saying the same thing twice as Lewis’s is that ... is that you weren’t able to
discover that this was happening I’m pretty sure that it was happening. And I’m hoping when I get my head more round intelligence that perhaps intelligence will help with this but also of course my own thing is cameras and particularly two-way audio cameras where you
can communicate with the resident as well as surveying or monitoring what goes on. That if those cameras had been there if the CQC had known that those cameras were there you would probably not have had to go there at 6.20 in the morning at
all you could just have had a look and see if this was general practice or not. So I keep saying the same thing I’m just hoping that somewhere you will think of other ways than inspection to find out the truth about what is going
on in these places. So it’s a bit of a mixed bag. So I think. Thank

[Mr Peter Wyman - 1:56:32]

you. Thank you David I mean I think a lot of what you said plays in really well to the conversation that we’ve just had with Helen and comments that
various board colleagues have made about the importance of not only getting intelligence but making that as available as possible to the public so I think that’s great. And on your point about cameras and other devices we’ve already said we’re having a report back in
the July Board so noted and we’ll see where that takes us. So thank you very much indeed. And with that ladies and gentlemen we bring the meeting to an end. Thank you very much indeed.