CQC board meeting 15th December 2021 - Wednesday, 15th December 2021 at 11:00am - Care Quality Commission

CQC board meeting 15th December 2021
Wednesday, 15th December 2021 at 11:00am 

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Start of webcast
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Apologies and Declaration of Interests
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Minutes of the Public Meeting held on 17 Nov 2021
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Matters Arising and Action Log
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Executive Team’s Report
Urgent and Emergency Care: Update
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Board Effectiveness Review
Equality Networks Update
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Any other business
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  1. Webcast Finished

So good morning everybody. Welcome to the… Welcome to the December Public Board Meeting for the CQC. Sadly we are back on Teams, obviously following government guidance which I fully support. But it is a shame because I think we were just getting back into the
swing of being in face-to-face meetings, with the benefits that that brings. So, anyway, we are all here with the exception of Ali Hassan whose birthday it is today, and if you happen to be watching this, Happy 40th Birthday. Mrs Hassan has made it very

Apologies and Declaration of Interests

clear that Ali’s priority is not to be in our board meeting today, so that’s why he is an apology. And Mark Sutton is an apology because unfortunately he is ill. I want to welcome Taofeek Balogun who is from CQC Equality Network. He is our
network representative today – you are extremely welcome and put up your hand if you want to come in at any point during the discussions. I also want to… - Rad, I’m going to invite you to introduce yourself at this stage in order to save
myself the embarrassment of mispronouncing your name. So, would you just like to introduce yourself, and correct my pronunciation? Thank you. My name is Radojka Miljevic. I’m a partner at Campbell Tickell and I’m here as someone who has led the Board Effectiveness Review of CQC
Board. Which is on our agenda for a little bit later this morning. You are extremely welcome, both - you know for your session - but for the whole meeting obviously, if you wish to stay. I think that is the introductions. Does anybody have any

Minutes of the Public Meeting held on 17 Nov 2021

declaration of interest they need to make beyond the ones already formally made? OK, that’s good. I think that takes us then to the minutes of the meeting we had on the 17th November, are they are a true and accurate record? Excellent. I don’t think…

Matters Arising and Action Log

Executive Team’s Report

There’s one item on the action log which isn’t yet due, so we can put that on one side. Is there anything arising anybody wants to raise? OK. Ian, let’s come to you then please and the Executive Team Report. Thanks very much Peter and good morning everybody.
You’ll see in the papers that in my section I wanted just to talk about our operational stance at the moment. When we put the papers together we included in the papers a statement from the three Chief Inspectors in terms of our ambition around inspection
over the coming few months. In some respects that statement is a restatement of the sort of work that we have been doing over the past few months. However, since the papers were published, the Omicron virus has accelerated very dramatically and you have seen events
over the weekend and the early part of this week. We have therefore taken the decision to change our operating stance and some of that is potentially significant, some of which will be about continuing the sort of activities that we have been doing, but moving
our resources around, moving our focus around over the next few weeks, and possibly longer than that. I am going to ask my colleagues just to talk about their particular areas starting off with Ted, then Rosie and then Kate in terms of the three Chief
Inspectors. I am also going to… followed by Tyson who is going to talk about the way we are organising ourselves from a people point of view. And then finally picking up with Kirsty who is going to talk about registration and the changes we will
want to make there as well. And then I’ll come back to me and I will just talk about what we think our contribution might be around volunteering around the vaccination programme. So if I can hand over to Ted at this point, thanks Ted. Thank
you Ian. So, as we will be discussing later in the agenda, the acute services - urgent and emergency care is under enormous pressure at the moment so we fully support the priority being given to the booster rollout programme. The Omicron, the surge in Omicron
crisis is clearly an extra pressure on their services and I think doing everything we can to protect them from that extra pressure is a real priority. So, we very much support the booster programme and I think it is really important we do everything we
can to facilitate and encourage providers to do that as effectively as possible. In view of that we have postponed our inspections - another regulatory activity for NHS providers who are providing… supporting the booster rollout programme, also some independent healthcare providers who are supporting the
booster rollout programme. And the main criterion is they are involved in the programme and we don’t want in any way to detract them from the priority of the programme going forward. We will still monitor care as closely as we can, and we will reserve
the right to take action or inspect if there are exceptionally severe problems in any particular service. So we are not saying we won’t expect, but we are postponing our planned inspections for the time being. I should say for those services that are not directly
affected by the booster programme or involved in it, we will continue with the approach we outlined in the communication we put out last week. I would particularly stress we will continue to take our approach to inspecting and regulating mental health services, independent healthcare services
not involved in the booster programme, and we will be continuing our Mental Health Act Reviews and SOAD visits to protect people who are detained under the Mental Health Act. So that’s the plans in the Hospitals Directorate. So shall I hand over to Rosie at
this stage? Rosie. Thank you very much Ted. We are taking a similar approach to Ted in Primary Medical Services and Integrated Care. Can I just start by saying thank you to all my colleagues, working flat out in general practice at the moment, to roll
out and accelerate the booster programme which clearly is a huge priority at the moment? And they are doing that on an already highly busy and demanding day job, so thank you to everyone who’s involved in that. So, in Primary Medical Services we are also
pausing all inspections in general practice and urgent care services, except where we see evidence of risk to life or risk of serious harm. All of those decisions will be… to inspect will be signed off by myself. We are continuing in oral health and independent
health to take a risk-based approach and that work will continue, but that is under review if those areas become involved in the booster programme in any way. Our work with Health and Justice and the Children’s Services work will also continue as planned. So that
is the situation in PMS. If I could now hand over to… Kate. Kate. Thank you Kate. Thanks Rosie. So I am just going to update you on efforts in Adult Social Care. So, there are three priorities in Adult Social Care as we move forward through this winter.
The first is continuing to respond to risk and undertake inspections as a result of information we have of concern from the public, from information we hold and from people who work in the sector. So, the first priority is responding to risk and undertaking inspections.
The second priority is about an increased focus on a number of Infection Prevention Control inspections and also being ready to respond to an increase in requests for us to go out and look at the quality of potential new designation settings. So, the reason why
this work matters is good Infection Prevention Control in care homes keeps people safe and well. It also supports with avoiding unnecessary hospital admissions. Good Infection Prevention Control stops care homes needing to shut their doors, and can also support timely discharges as well. So, our
second priority is around Infection Prevention Control because it’s the right thing to do for residents of care homes, but also to ensure that those care homes remain open for people being discharged from hospital. It is us where those people need to end up. And
then our third priority in Adult Social Care is how we can take action to support the increase in capacity available in the system. So there’s two things we are going to do under that priority. We are going to pro-actively go out and inspect and
rate services that are registered with us, but are not yet rated. And we know that good commissioners do not purchase from services that don’t have a rating, so we are going to do that. And the second piece of work is we are going to
go out and re-rate services that are “requires improvement” where all the evidence tells us that should we go out and have a look and inspect the service, we would likely re-rate it as good and, again, responsible commissioners would be looking to purchase from good
services rather than services of a lower standard of quality. So, three priorities in Adult Social Care that are the right priorities to do for the Adult Social Care sector, but will also support system efforts in terms of ensuring avoidable admissions to hospital, timely discharges
and ensuring that we are doing everything we can to increase the capacity available in the social care sector. I am going to hand over to Tyson now to talk about the delivery of these ambitions. Tyson. Right, thank you Kate. We see this very much
as a cross-CQC effort, both to bolster the numbers in our Adult Social Care and also to increase our registration work which I think Kirsty will talk about. This is so that we can increase capacity across the whole of the system. As Kate said, this
involves maximising the number of people, including inspectors from Primary Medical Services and hospitals who are able to undertake our new Adult Social Care inspection priorities, as well as enhancing the registration team so they are able to bring new social care providers into the market.
Over the last 24 hours I have begun working with the senior leaders and also the planners from across the operational directorates, and also across our corporate functions, to plan this work. I hope that over the next day or so, to be able to identify
the number of additional people we can mobilise from outside Adult Social Care and registration and how we can train and deploy them in a timely manner. I am not able to give exact numbers at the moment in terms of how many people we can
deploy or how many inspections they can undertake. The situation is still very fluid. I’m hoping that it will start to crystallise over the next day or so, but I’m hoping that as a result of this work we can give the registration teams the additional
capacity they need, as well as support several hundred additional inspections across all of the priorities we have identified for Adult Social Care. Over to you Kirsty. Thank you Tyson. So, very briefly, in terms of registration what we will be looking to do is to
maintain our capacity and also focus on those applications which adds capacity into the system. So, we will be prioritising anything that enables us to do step-down care or any new models of care which will support, particularly in social care, bringing capacity to enable flows
through the system. We will also look to move some resources into registration so that we can enable us to keep ensuring that we are not letting our backlog of other registration applications creep up. So that’s fine, over to you, back to you Ian. Thank
you. Thanks. Thanks Kirsty. So, having done all of this, what we believe that we will have the opportunity to release some of our people to directly support the vaccination programme, being part of vaccination teams. As Tyson said, he is doing some modelling work on
this now so we can properly scale. We believe that the work that we do internally is… must take first priority, but we do think there is definitely an opportunity to release some people to support vaccination teams. We have, for the last few weeks, made
an open offer to our clinically-trained staff that if they wish to return to front-line medical care, they have been able to do that. We know we have a small number of people. I think there is a common misconception out there that we employ lots
and lots of doctors and nurses. And we actually don’t. We actually employ relatively few doctors and nurses and other clinically-trained staff. What we tend to do is we draw on expertise from specialist advisors as part of our inspection activity. So, whilst really… not doing
the inspections as Rosie and Ted were describing will indirectly release people back into the NHS. There are not large numbers of clinicians that we can push towards the vaccination programme. That said though, we do think some of our people can take part in other…
can take other roles in vaccination teams in order to support the wider national effort. So, I hope that Board Members and the public a sense of our approach here, and of course during the… - we had to move incredibly quickly over the last few
days so we asked Peter to give us authorisation to change our operating stance in the way that we’ve described through a Chair’s action. So, I think Peter I’d be grateful if as part of this discussion, we could agree the Chair’s action and note the
Chair’s action for the benefit of the minutes. Thanks Peter. Thanks Ian. I think - although somebody will correct me - I think this is probably only the first Chair’s action that I have taken in the six years, so it’s a mark of the emergency
that we are in. Can I just have Board approval to endorse the action I took? Good, thank you very much indeed. And Ian and colleagues, I mean it seems to me that the really big contribution that CQC can make, as an organisation, to the
emergency is all around increasing capacities you have all been talking about, and doing it in a safe way. I think this is really important that we focus on those things. I think that’s right Peter. I think one of the things that we offer, I
think, is this perspective of being able to peep over the horizon, because I think obviously everybody is worried about what is happening today and in the next week or so. Whereas I think the things that we are starting to think about is: how is
the system, how are all of the providers in the system going to fare at the end of January, end of February, because this is not suddenly going to go away in the next three or four weeks. So, I think we are trying to think
about what are the impacts for the medium to long term, hence this big focus on Adult Social Care, the big focus on capacity building so that the system has got a route out of what is, undoubtedly, an incredibly difficult time. Yes, thank you Ian.
Does anybody want to ask anything or add anything on our regulatory approach before we move on? Robert. Thank you. I am very appreciative of the action that has been taken - I think it’s obviously necessary. The question I had was really for Rosie and
is about the knock-on consequences of all this, potentially in relation to GPs. We know from previous experience that there’s been a challenge - and this is no criticism of GPs at all - of people getting access, mitigated to some extent in our much greater
use of e-consultations. But the concern has been and remains, I think, certainly in Healthwatch, that that potentially disadvantages some people in disadvantaged areas and from disadvantaged backgrounds. And while appreciating the need to withdraw inspections and so on, I wonder how at all we are
able to continue monitoring this and drawing attention to any particular issues that arise in particular places. Thank you Robert and a really important question because I think what we have to recognise as well, is there is a lot of poorly people who don’t have
COVID or COVID-related illnesses and we need to make sure that they get appropriate care. Particularly with serious illnesses such as heart conditions, stroke, serious mental health issues, early cancer and we should learn the lessons from the last… the first wave of the pandemic where
we heard about a lot of people having delayed referrals and delayed diagnosis of cancer, for example, as a result of people not accessing care. So, I think the first thing I would like to say is to the public who are listening to this, please
do -if you have symptoms that are worrying you, if you have persistent symptoms, if they’re not going away and if you’re worried about something serious - please do access care because it is important to get those symptoms checked up and seen. I think GPs
are in a very difficult position because they have a huge demand, huge demands on their time. They were already under significant demand pre this race to booster jab every one, and that was causing immense pressure on their services. Clearly now, vaccination is a priority
for them and I think the problem with… when you are a GP is that actually some things, it’s not always straightforward to work out what is a serious condition and what is a straightforward condition - a child with minor viral-type symptoms, those can to
develop into a child with meningitis within a few hours. And so it’s how do you fish out what is important and what is serious and what is not serious. I think, I understand the system is doing some work looking at how they support general
practice to prioritise during these difficult times, which I think will be very much welcome. What I would say is that this is vitally important that all parts of the system work together to deal with these challenges and that all parts of the system are
used appropriately so people get signposted to places like pharmacies, to dentists if you have got tooth ache and other places, and make sure that all parts of the system work collectively to deal with what is going to be enormous challenges. I think it is
going to be also really important that CCGs have clear contingency plans if practices are impacted by people who get sick and poorly and that impacts on the practices’ ability to deliver. So access to general practice is something we were looking at in more detail
before the last week. We will continue to follow up any concerns that are raised with us, albeit we won’t be undertaking inspections unless there are very severe concerns to risk to life. But it is something that we will want to keep under review very
closely given the level of concerns we are hearing about. Thanks Rosie. Tafoeek Thank you very much Peter. As part of our immediate regulatory response to the recent COVID-19 strain, we have now stepped away from routine inspection activity, how confident are we toward of any
legal issues that might emerge from that singular decision, possibly from key stakeholders? Thank you Peter. So I will start by making the comment Tafoeek that inspection is only one of the things that we have in our armoury and whilst we are stopping, except in
the sort of extreme circumstances, some of our on-site inspections, we are not stopping regulating and we are not stopping monitoring. So, you know, we are still doing our job, albeit in a slightly different way for a short period of time. That would be my
answer. Ian, do you want to add? I was going to broadly say what you have just said, but I think, in addition, it is a difficult balance to strike and I know that providers will be having the same conversation. It is of course possible
that we could be legally challenged or individual providers could be legally challenged, but I think we have to recognise that we are where we are in terms of the national emergency. So, I think we are in a broadly safe place, but we don’t know
what we don’t know until we are challenged. I don’t know whether Rebecca has a point of view on this. I would only add that we have been very clear that where we do have evidence of a risk to life or serious harm, we will
go out and take action. So, I think it’s just a question of striking a balance between that high risk of harm to patients and obviously the need to maintain services and not want to be a burden on providers, who are already very stretched and
at the front line of this. So, it’s just that balancing act, but I think the steps we have taken have got very broad support, so my personal view is the risk is actually low. Thanks Tafoeek. Jora. Just a question for you Ian. Previously we used the,
I think it was the Emergency Support Framework - the ESF – are we resurrecting that for a period of time, or are we using some other way of collecting data and information? We are not resurrecting that in direct terms at this point, but one
of the pieces of work that Tyson and colleagues are doing is to look at exactly how we will do our work. In broad terms, the work we do in Adult Social Care will continue to be… it will continue to be the way we have
worked over the last year or so, particularly in order to get to a rating, because I think a lot of the work is about getting to a rating. The IPC inspection methodology is a methodology in a box, if you will, and that is fairly
straightforward. So, we’re not going to do widespread ESFs at the moment, but I think it, as I said earlier on, I am concerned about the medium to long - medium in this context - of greater than, you know, post-Christmas medium to long term. I
think we may have to look at our regulatory position, sort of into January, early part of February. Again, I think we will have to keep this under review. So, we as an Exec. Team are going to formally review the position on 4th January and
we will do subsequent reviews after that. But I think we need to be reasonably open-minded and fleet of foot on this. But at the moment, I think what we’re saying is just stepping back from mainstream NHS services, but predominantly everything else remains the same.
And then redeploying people into support, the Adult social Care area and then we will see how it goes over the next couple of weeks. This is a specific response to the booster programme really rather than broader pressure. I think we will have to review
that, but you know I think it’s something we are certainly open to. So I think it’s really important that we maintain our focus on our primary objective as set out in statute which is to ensure people get safe care. Clearly if hospitals end up
being overwhelmed and people are unable to get access to the care that they need in hospitals, then that is as big a problem as an individual not being able to get safe care somewhere else. So I think if you look at it holistically, what
we’re trying to do is balance the need to try and keep the pressure off the NHS as much as we can play our part in that, and at the same time making sure that individual providers are doing what they are supposed to be doing
to provide safe care. So, I think we are doing the right things is what I’m trying to say. And thanks everybody in the Executive Team who’ve been working incredibly hard over the last few days to move us quite rapidly into slightly different operating models,
so thank you. Thanks Peter. So, if there is nothing else on the point about operational readiness, can I hand over to Kate to talk about the Adult Social Care Reform White Paper? Thank you Ian. So, I am going to talk about the White Paper
on Workforce and then I am going to talk about Out of Sight and closed cultures. So, since we last met as a Board, the long-awaited White Paper into Adult Social Care was published, and something we have been calling for, for a long time as
a regulator, which was an ambitious long-term vision for social care with the funding to deliver that vision. So very pleased that is now with us… be really interested in the focus on workforce within the White Paper. So, as you know, in State of Care
back in September/October of this year, we flagged the rising vacancy rates, particularly in care homes, that went from 6% to 10.2% between April and September of this year. We called for action to support the social care workforce who were exhausted and depleted. Around the
time of the State of Care publication, the government announced an additional 162.5 million for the social care workforce and a further 300 million was announced for the workforce last week. We are really keen to see that money flow rapidly through to the front line.
It is highly unlikely that the large number of vacancies in social care will be filled between now and Christmas and over Christmas - a time when we are most concerned about workforce capacity - but actually if actions can be taken to reduce turnover rates
in social care which is particularly high that may go some way to address the kind of significant challenges. So really welcome that we have got our White Paper. We will keep a continued focus on the impact on that in terms of market fragility and
are really keen to see that additional money announced for the workforce flowing straight through. On the topic of workforce, we have been keeping a very close eye on the social care workforce. We had vaccination as a condition of deployment for care homes go live
on the 11th of November. We have a number of concerns about how the social care workforce is going to cope through the winter. So this week we have introduced a couple of additional questions into our inspection activity. So when we go out and inspect
providers and when we have monitoring calls for social care providers, we are going to be asking them about what impact workforce is having on their ability to deliver quality care. And that will help inform us about what is going on at individual provider level,
but it will also help us aggregate the app to understand what the national picture is about the challenges around recruitment and retention in social care on the ability to deliver high quality care. We are also keeping a very close eye on deregistration - there’s
been a degree of nervousness about whether we might see providers exiting the market. To date, we haven’t seen that materialise but we will continue to keep a very close eye on that and report on it as well. So, lots of focus on the social
care workforce because it’s important for people who receive social care. We also know that if there is a big blockage when it comes to the social care workforce that very rapidly has an impact on all other parts of the health system as well. I
am just going to move on to Out of Sight and then onto closed cultures if I may. So, Out of Sight, we published our interim report in December that looked at what changes have been made since our original report into restraint, seclusion and segregation.
What that interim report found was that there has been some progress, but not enough and that people are still being subjected to restraint, seclusion and segregation in a way that we would not want to see happen. We will be publishing in spring a full
report into the findings of Out of Sight and I look forward to talking to Board more about that then. And then just very briefly to keep the closed culture thing going – we have talked about this pretty consistently over the last year, 18 months.
So we are rolling out our Quality of Life tool which, as Board knows, is our new tool designed to really understand what people’s experiences are of receiving care. We are piloting our Talking Mats Tool and in the New Year we will be formally closing
down the project around closed cultures which has been a mammoth, a kind of mammoth programme of activity, but we will also be having a conversation with Board in the new year about impact. So the exam question is has all this activity made us more
effective at identifying and spotting services at risk of closed cultures and taking action? So again, I look forward to a follow-up conversation with Board in the New Year on that. Thank you Peter and Ian. Thanks Kate. Mark Saxton wanted to come in, I think. Thank you Chairman and thank you Kate for
a very, very full report. Could I just come back to the Out of Sight Report and then also I would just like to talk a bit about the workforce survey tool. The Out of Sight Report – this continues to be really critical for us
and very, very critical for the service users. And so not to hear of great improvements, to hear about challenges around provision of community support, providers not giving the right care or providing the right skilled staff to meet the specialist needs of people is… just
demonstrates how important it is that we don’t lose sight of this. But within the report, there becomes an issue that I think is very important to us strategically - we have a strategic aim to deliver smarter regulation. And yet we learn that data from
NHS Digital is unable to tell us how many people, autistic people and people with a learning disability, are receiving in-patient care at any time which I think is a real challenge for us strategically. The report goes on to say about large discrepancies between commissioner-reported
figures and reported figures from providers. So, as I said, this has a real strategic issue for us in terms of how we want to operate in the future using data. So perhaps it is not fair to ask you this question, Kate, but I feel
that this is something we need to come back to and review and consider. And in terms of the report going forward, can I encourage that in the spring report we continue to hear those powerful stories because when you read Sally’s and Tracey’s stories, you
really get to understand how critical this issue is. So, could I encourage the report in spring to have more stories in it to help us to understand the issue more? In terms of the workforce tool, I think this is great to be asking these
questions into the sector, but is there going to be a vehicle whereby when we uncover some best practice, employment practice, could this be shared with all providers? So those are my two questions please Kate. Kate, let me bring Steven in and then come back to you Kate. I think Stephen may
be covering of the same ground or maybe different, but anyway, Stephen. Thank you Peter and thank you Kate for a really helpful report. Yes, you’re right; I did want to pick up the workforce issues, just to sort of congratulate you on the positioning of
this within the White Paper. I know it reflected a lot of effort on your part to make sure that the importance of this whole agenda was there. My question was, kind of, despite your huge energy and skill, I am not sure you alone can
get us to where we need to be in terms of, you know, the right workforce developed in the right way for the long term. Do we have the right forum for partners to sort of come together because we’ve got a range of other organisations
who really need to play a role in building the right workforce for the future? Is that forum there? Do you see our partners kind of leaning into this agenda? That was my question. Thank you. Thanks Stephen. Kate. Great. Let’s go through that in order.
So, thank you, thank you Mark. So the issue around Out of Sight. So the report we published, 18 months ago now, talked about the… it’s hugely complex. So people end up in in-patient units a long way away from the family home because there isn’t
that consistent crisis response in the community. And despite there being really good buy-in from every part of the system – NHS England, local commissioners, local government, providers, advocacy groups, us as the regulator – it has still been incredibly hard to turn the dial. So
there are still over two thousand people in in-patient units today and we know that for many of those in-patients, there isn’t that unrelenting focus on getting them back home, and often they are not receiving therapeutic intervention and they are in an environment that exacerbates
their distress rather than enhances it. So, it’s hugely complex. It is disappointing we have not made as much progress as we would like, but we will absolutely continue to focus on this agenda. And you know Mark, and the action we are taking from a
regulatory perspective to ensure that poor quality services don’t continue to deliver care if they can’t make the improvements we would expect. The data thing, when we originally published Out of Sight, the issue with data, what was interesting about it was there were many different
understandings about what constituted restraint, seclusion and segregation. And coupled with that, in social care, there was no, and is no national reporting mechanism anyway. So, social care providers do not have a current mechanism for reporting when restraint, seclusion and segregation happens and that was
something we were calling for to be put in place. I agree with you Mark. I think the person… the people stories that were woven throughout the original report really brought it to life. So it may be a smallish number of people- two thousand people
- receiving these sorts of care, but the impact on each of those individuals, on their human rights and their quality of life is so significant and that’s why this is an agenda that we absolutely won’t drop. And I will take back to the team
your request for more stories in the final report. I would also like that as well because I think it brings the topic to life. Question about the workforce tool and how we can capture best practice. So we are always really eager in all of
our regulatory activity where we see stuff is good, that we can talk about it and capture it. As to exactly what that will look like, can I come back and update Board? So the workforce tool would have been live for about a month in
January, can I just give you an update then about how we plan to do that, Mark? If that is OK? And then Stephen’s conversation about workforce and where… have we got all the right people in the room? So there are a number of very
influential bodies on this, we have got Skills for Care and Health Education England and the Social Care Institute for Excellence, to name but a few, (unintelligible) personal, etc. There are regular conversations between all those bodies so we are all busily trying to influence alongside
us about ensuring that we end up with a workforce that is valued, recognised and rewarded accordingly. So, I’m going to a meeting first thing tomorrow morning to talk about the White paper, the additional money, with all those partners to say what else do we
need to be doing next. So, I would say yes in response to Stephen’s question. Thank you. Great. I am very disappointed Kate at the suggestion that single-handedly you can’t solve all these problems immediately, but anyway, seriously, thanks very much for all you and colleagues
are doing. I mean, these are just such important areas and very appreciative of the work that is ongoing. Ted, do we come to you now? Yes. I will be brief because we’re going to be talking about urgent and emergency care in a few minutes’
time and I don’t want to cover that in this section. But just to say that we have…, we did start some inspections of urgent and emergency care systems. It was, I think, a good model of inspection; it has got good feedback from providers and
systems. We have stopped those now as part of our postponement, but we will be looking to take them up as soon as we can, without having an impact on the capacity around the booster programme. Can I just highlight one thing in my report that
I think is significant and is actually relevant to what Kate was talking about in terms of Out of Sight? And that is the community mental health services review. This is an annual review of patients’ experience of community mental health services. This is always the
review of patient experience that gets the worst results and this year’s results are worse than ever. I think it is a reflection of the enormous pressures on their services and the difficulty that people have had accessing community health services. And of course, that has
a knock-on consequence in that if they cannot get the care they need in terms of accessing the therapy they need or accessing the crisis support they need, people’s mental health may well deteriorate, they may well end up in accident and emergency department, inappropriately they
may well end up being admitted to in-patient facilities inappropriately. I think there is a real message coming out of this survey which has been present for years, but, you know, is worse in this year I think than previously, presumably because of the pandemic. But,
you know, this was not caused by the pandemic, it may have been exacerbated by the pandemic, that people cannot access the services they require for their mental health support in the community, in a timely way, and this something the system does need to address.
Thanks Ted. Eh, Kirsty. Oh, Ok Chris. Just a few updates from me. Update from October, so just a couple of areas to pull out. We continue to monitor our regulatory activity with registered providers. We have had 41.1% for the year to date, which is either a DMA or an inspection and
making judgments against 60% of registered services when you incorporate the public statements. Obviously all of this as at the end of October, so the discussions we have had are obviously going to impact on our performance for the year and we will be looking at
that in the coming months and how our reprioritisation affects our delivery. In Give Feedback on Care, last month’s part of the quarterly update, we continue to look at, kind of just diving into the information that we have had back is really invaluable and some
interesting insights. We have had 65% increase year to date which is 151% increase in PMS, 70% increase in the hospital sector and 36% increase in Adult Social Care. So, across the board increases, more specific in certain areas and quite a lot of positive feedback
coming through as well. We have seen increases in positive feedback coming through, so we continue to analyse all of that information. In registration, continue tracking well with average days to complete registration applications reducing: simple is down 7.4%, normal is down 12% and we are
reducing the time it takes us to do them, both of which we are aiming for 15% by the end of years as a reduction. That work will and does stand us in good stead to support the defaults on capacity that we talked about earlier.
And final area for me, in terms of our finances, so underspent by 9.3 million at the end of October, that is forecast to increase to 11.3 by the end of the financial year. On capital we have a 2.9 million underspend year to date and
that is forecast to increase to 3.5 billion although we are just looking at that, as I think that is probably overstated, and I think it will be closer to budget than we have indicated there. That’s it from me Peter. Thanks Chris. One day, I
will remember that you deal with this without an introduction from Kirsty. I apologise to both of you. Anybody want to… ? Yes. Mark Saxton. Thanks Chairman. And I just wanted to congratulate the Executive Team on the virtual conference in terms of for reaching out
to our people. I thought it was excellent. I dipped in and out. I thought it was a tremendous sort of second year repeat of this engagement exercise. I just wondered if you’ve had any feedback as an Executive Team on it, but congratulations anyway. I
thought it was super. I’ll take that one. So, yes, our average score in terms of, sort of, overall happiness with the conference has gone up from – I think it was 8 – it has gone up to 8.3 or 8.7 – I can’t quite
remember off the top of my head. But a continual increase in terms of people enjoying it and saying it added value plus we had, on most days, well over a thousand people on the platform and at peak times we had over two thousand people
joining, so really well-attended and really positive feedback across the board from most of the speakers and the activities that were run. Yes. I thought it was superb as well. Sally. Thanks Peter and yes, I thought the conference was excellent. I just had a query
on performance with Chris if that’s OK? And you might come on to talk about more detail Chris. But it’s about the inspection activity that we have undertaken to date. So, one of the figures talks about having undertaken review of around 14% of providers, and
obviously there are many thousands of providers, but that felt quite low in terms of what I would normally expect to see. And yet I know there have been a huge range of monitoring activities certainly. So have I got that wrong sense of whether 14%
year to date contact with providers is a low figure? I mean, we haven’t set a target for this so it is something we track throughout the year. It is probably below where we’d like it to be, so we are just looking or we were at the previous month’s, looking at how we can increase our volume of activity. We need to
just bear in mind the discussions we have had before about how that course corrects where we are at, but it, as I say, it is not something we have set a target for, but it is slightly under where we would expect it to be.
I just wanted to ask Ian a follow-up question I suppose. I absolutely support the action we’ve taken around pausing inspections, but do we have any sense of what it might look like after the first few weeks into the New Year? Or are we just
going to take it as it comes? I think we are going to have to. We are going to do a review as an Exec. Team on the 4th of January, immediately post-Christmas. I think depending on where the vaccination programme is at that point, I
think we will make a determination as to whether we can sensibly resume the work we have been doing over the last few months. I think we were already concerned about any perceived burden we were placing on providers more generally, anyway, on the run-in to
winter. So, and my sense of the moment is the vaccine programme will still be running at full chat during January. I think that would be a reasonable expectation so I think we’ll look on the 4th and then we’ll take a view then. I am
quite keen to see if we can sort of do this in a reasonably staged process. I don’t particularly like making a decision over the weekend for an announcement on Monday morning, if we can avoid it. I think it was inevitable this weekend, but I
think I want to try to get into a sensible drumbeat. I think - I suppose just linking your question to what Jora was saying earlier on - I think one of the questions for us is what can we do, what valuable work can we
do off-site, how can we maximise that? And I think we have been doing a lot of that sort of stuff behind the scenes, just in terms of reviewing regulatory history, reviewing whether there’s been any contact from the public, those things have been to be
checked on a routine basis. But we are trying to run this balance or strike this balance between a high-end regulatory contact which involves crossing the threshold and so forth versus doing things behind the scenes. We know that a number of providers, certainly in Adult
Social Care at the beginning of the provider… at the beginning of the pandemic, really valued the telephone contact we were making with providers. Because it was like we were able to identify and de-codify some of the big issues. PPE was a big issue, you
know, you recall, and we were able to pass that back to the department. My sense is we might be back into that sort of territory and we just need to think about how we can capture information quite carefully. I think that the lessons we
have learned around the way we use our systems now and the work that we have done to develop them is really powerful. Kate alluded earlier on to sort of capturing information from the workforce. Well, that is actually the way, the way that is mechanically
done is through additional questions on the new reg. platform which is essentially development of the ESF, development of the direct monitoring tool. So we are building these tool sets now, so I suspect we’ll get to January. I want to then see if we can
make a view that is probably at least one quarter long. We did this at the beginning of the pandemic. We tried to sort of adopt a regulatory stance for an entire quarter and then review it on a quarter-by-quarter basis. Because it gave our own
teams certainty, but it also gave providers some certainty. That’s a kind of broad… would be the broad stance, but I think I just want to just take the next sort of three weeks really, just to see exactly where things are and then we can
take it from there. Thank you. I wanted to set my earlier questioning context really to say, although there’s a percentage of activity, we are clearly amending our approach in using our data in the background and there has been a huge increase in terms of
patients and families providing information through Give Feedback on Care as well. So, it’s clear that we are doing the best job we can in the circumstances. So well done to you and the team. Thank you. I mean that is absolutely true. I think it
is…, the point that Chris made earlier on around Give Feedback on Care. I think… and the particularly big increase in the Primary Medical Services area, is predominantly about lack of access to GPs which is not a huge surprise on one level, but again it
does give us some quantitative information I guess to drive some of our thinking. Which is why we were intending to do some GP access inspections to try and get a sense of the sorts of things that are going on. I think Rosie has got
a few days of that and has already got, I think, some really important information. If we can keep building out those sorts of things to gather that really powerful information, I think it would be helpful. I think our overall ambition here is to be
as helpful as we can be in terms of the system, but at the same time make sure that we are being true to our purpose for the public as well. Sally, I had exactly the same thought when I read the papers as you did,
about the 14%, and had I not been distracted over the weekend by other things, I was going to try and talk to Chris. So I’ll do it now Chris. I think it would be really helpful if we could get a bit of segmentation on
this number because I suspect it is actually quite a substantial understatement. I mean, just for example, Kate, I know that you talk to corporate social care providers and so 1 conversation might well be covering 50 or 60 registrants. So I think I’d like to
unpick the numbers a bit, and see where we are having that contact and where the gaps are and perhaps we can bring that back to a future Board meeting. Yes, that’s no problem. Just to say we are following up on that with Stuart based
on the comments from the last Board meeting. So we are looking at how we can incorporate that analysis. Perfect, thank you. And Tyson is about to give us the answer. Tyson. I was just going to say we are having a look as part of
our planning for next year and for a new business plan. We are looking at all of our KPIs, including the one on regulatory contact, to make sure that it properly captures what we are doing. Sally is absolutely right about the increase in Give Feedback
on Care, which I think has absorbed the time of a lot of the inspection teams. And I think I have talked at previous Board meetings about the work that we’ve been doing to increase capacity so that we can we can spread our regulatory contact
even wider. That includes making more use of Bank Inspectors, which is being successful, and also the project to see if we can transfer some of the inquiries work to the National Customer Service Centre in Newcastle so that we can allow our inspection teams to
focus on the core activities that are really important to us. Thanks Tyson. Do you… while you have got the floor, do you have other updates you want to give or have you covered that ground now? No, I think I’ve covered it Peter. I think things have moved on since my written update. I
have kind of covered what I was going to say earlier. Thank you. Thank you very much indeed. Rosie. Just to add to Sally’s question, that figure doesn’t cover a lot of the informal work we do that gives us oversight of what happens in our
providers we regulate. For example, in PMS, we spend a lot of time regularly engaging with Clinical Commissioning Groups and sharing information that helps us identify where there is concerns and risk as well, which doesn’t get captured in that 14%. Great. Thanks Rosie. So I think there
is a bit of work to unpick that. Thank you Sally for raising it. Mark is not here. Ian, is there anything you wanted to say on cyber or anything that was in Mark’s report, or are we OK? I think we are OK, thanks Peter.
I think, yes I don’t think there’s any cyber incident I want to raise in public, thank you. OK, thank you very much. Chris Day. Just three quick points from me. First, just on the Bill and to build on what Ian was saying earlier. It
has had its first reading (inaudible) on the 7th. Peers were very supportive of our plans on local authority and ICS roles and they were very supportive of the position and outlook right across house and that was quite useful. The laws committee stage will commence
on 11th of January. We are not so far aware of any amendments that the government intends to make or indeed of their exception of any other amendments in the Bill. So we will continue to make sure that we can respond to queries from the
Bill team over the Christmas period which is when some of those (inaudible) and anything that we do, obviously we will make sure that we talk to colleagues on the Board so that we are aware of any changes in start, but we are not expecting
at this stage. The second thing… building on the conversation that Chris Usher mentioned before, we are launching the next phase of our Because We All Care campaign which, thanks to Give Feedback on care as colleagues will know, we have been targeting particular groups that
we are hearing from slightly less to make sure that we can get everybody’s experience of care throughout the year. So the next phase of this work begins on the 12th of January targeting particularly carers of people with long-term conditions, over 55s and people with
learning disability, autistic people. You will see spikes of this campaign throughout the year and it’s been a really, really useful way, as Sally said, of getting additional feedback that will help target our responsive inspections to care. I won’t go through the figures again, but
the really strong figures and increase that we have seen – can I also just take the opportunity to thank all the partners who have engaged in this work? Particularly Healthwatch who are a strong partner in our Give Feedback on Care work, but there are
there are many other national organisations as well that provide support to this. I think it’s a collective endeavour to guide and to ensure that we can reach people to get their feedback to guide our responsive inspections is vital. The last thing I want to
say – it is just… it is built on a conversation we were having earlier. Although we have paused much of our regulatory activity in secondary care, we’ve actually been invited in by some organisations to provide support to help them understand why people are accessing
urgent and emergency care in the way that they are. So the number of organisations that have asked us to support them in some research around how people and why people are accessing A&E in the way that they are. So that research is ongoing at
the moment; it will report in the New Year. That links to some of the work we did earlier on Primary Care access. I think it will be helpful for the longer term debate about why people access care in the way that they do and
how we can support better, either service provision or changes to the way people access care, so that we can move out of this particularly difficult point where we are at the moment into an area where we can improve services with providers and with local

Urgent and Emergency Care: Update

systems. And that was me. Which neatly segues us on the next agenda item Chris, thank you very much indeed, which is urgent and emergency care. Ian. Thanks Peter. We wanted to include this item on the agenda because we wanted to just lodge with the
Board our broader concerns around urgent and emergency care. I completely understand that the current and immediate context, but it was something that we raised in State of Care and we felt now would be a good time to just refresh what we’re seeing with the
Board so that you are aware of what we are seeing. But, and I will hand over to Rosie, Ted and Kate in a minute to talk about each of their sectors, but before we do that, I just wanted to set a little bit of
context. I think the obvious point is the context is incredibly complex. If we think about the moment, we think about COVID as being all-consuming, but I think if we cast our minds back to 2019, what we found was that the normal winter pressures of
winter 2018-2019 actually rolled into the summer of 2019. So actually 2019 was not… didn’t have the normal peak, then the trough, then the peak that you would normally have in a typical calendar year. So 2019 was busy, the summer of 2019 was busy, we
then rolled into a busy winter in 2020 and of course, in January/February time of 2020 then COVID became a global challenge. So what has happened is, there is an overall demand overall high demand, but alongside that the overall productivity in the health system –
and I stress health system in particular - has fallen because of the COVID safety measures. So, when we talk to colleagues in NHS England, they quite rightly say well look, in order to create social distancing we physically have to take beds out of some
spaces. Many GPs have struggled with being able to see people in their surgery, just because it was never designed for straightforward social distancing. So I think there’s a very practical productivity challenge around space. We also when we talk to front line professionals, they talk
about the taking on and taking off of PPE being something which takes a couple of minutes a patient. But it is a couple of minutes a patient times 20 or 30 patients, and those sorts of numbers start to add up in terms of corroding
the productivity of the system. When we look at Adult Social Care, I think that the rebalancing of the economy that has taken place, particularly over the last six months, has meant that people are leaving the Adult Social Care system even faster than they perhaps
once were. And sectors like hospitality, sectors like logistics and some parts of retail are also drawing people away from traditional social care roles, and that again has created just a very basic challenge around reduced capacity in the social care system. If you add all
of this together and I think, and what you get, is a system problem that manifests itself particularly in urgent and emergency care. We talked about a lot of these things in State of Care earlier on this year and things have got, you know, things
have continued to be as bad as they were, if not arguably worse than they were when we spoke about it back in October. As we go into Winter 2021, under even more pressure with the emergence of a rapidly spreading new variant in the form
of Omicron, and I think people understand that that is very transmissible, I think the deadliness or the hospitalisations is still not completely clear, but I think, you know, as I saw one of the newsreaders quite effortlessly put it yesterday, a small percentage of a
very big number is still a very big number. So, I think everybody is concerned about the impact of Omicron. I think the media will talk about lots of individual numbers, individual performance numbers, whether that be around GP access, whether that’s in waiting times in
the accident and emergency department, or the knock-on effect of waiting times if ambulances and unloading times and things. Various points have been identified in the urgent and emergency care pathway, but I think we feel very strongly that health and social care is a tightly
interconnected system and pressure in one service is rarely a result of things which can be fixed in that service, that hospital or indeed that GP surgery alone. What we found is that those places that have coped a little better are places where they have
been able to maximise all the resources in their area, whether they be public, private or indeed the voluntary sector which I think is now is an area that really has a part to play here. Those areas have coped slightly better. However I don’t think
any of us should be under any illusion that all services are under extreme pressure at the moment and there is no easy fix and we’re not pretending that there is. We thought it was important to talk to the Board around the specific impacts in
specific sectors and how they make that plug together. So, if I can kick off with Rosie and then Ted and then Kate. And then will finish off with Chris just talking about some of his perspective from some of the leaders that he spoken to.
Rosie. Thank you very much Ian. Just to give you a flavour of what’s happening, particularly in general practice in urgent care centres. So the vast majority of urgent and emergency care actually happens outside of hospital walls and the community response to urgent and emergency
care is a vital part of the urgent and emergency care pathway. What we’re hearing from providers’ practices and also GP practices, and also urgent and emergency care centres, 111 providers, out-of-hours providers is unrelenting demand which has been going on for weeks now into services.
I think some of this is driven by the backlog created by the pandemic, some of it however pre-dates- we have known for a long time that the number of people with long-term conditions is escalating, the number of people with complex problems has increased and
that there is a need for new models of care to be able to deal with this and support people in a different way with these complex conditions and multiple long-term conditions. I think one of the problems we have in primary care is that we
don’t have the same level of data that we do in some parts of the rest of the system. So we don’t truly understand what that backlog looks like in primary care and the impact that that is happening. Also we don’t have the same level
of demand figures, but I know and I’m speaking to GPs regularly who are seeing daily numbers of people that they do not feel is safe to manage in their capacity, and that is a regular occurrence. I think this is all on the background of
a very tired, exhausted workforce and significant recruitment and retention problems. I think my main concern is the impact that this is going to have on vulnerable people and people who probably find it more difficult to access services for a whole variety of reasons. I
think we need to be working and encouraging systems to really understand how all providers in their systems are identifying those most at risk of inequality and the most vulnerable, and putting in specific ways of making sure that they get the care that they need.
I think longer-term we need to really shift the system in terms of having much more of a focus on prevention, on early intervention, on things like advanced care planning so we work in partnership with people to understand where they would like their treatment, where
their goals are. I think the other thing I would mention is, I think, we would also ask the public to do everything that they can to keep themselves well, so getting a booster as we have talked about earlier is incredibly important, using - if
you feel you have something that can be managed in somewhere like a pharmacy - if you go and get some advice from them, if you have toothache to try and go and see a dentist rather than turning up at A&E. Let’s see how we
can make sure that we use all of the resources across local systems. I think the final thing I just would like to say is that this is so important, that each and every part of the system recognises the huge pressures that everyone is facing
at the moment and it’s vitally important that everyone in local areas works together to be able to address these. It is not one part of the system’s fault or another, it’s very much a problem that systems have to face together and have to come
up with solutions. I suspect the challenges are going to increase over the next few weeks and that collaborative working is going to be more important than ever. Thank you. I’ll hand over to Ted. Thank you Rosie. And just to second all you said. This
is a severe problem facing the whole system and it is a problem that we have been talking about, not just in the last State of Care but in previous State of Cares. The Board will remember that we have been highlighting our ongoing… our increasing
concerns about the urgent and emergency care system over this winter, with the prospect of this being a very difficult winter and so it is proving to be. The latest data that came out from NHS England last week shows that the whole system is still
under intense pressure, with increasing numbers of people waiting for 12 hours to be admitted from emergency departments into hospitals, for instance. Just to remind the Board, those 12 hours after a decision to admit has been made. A single patient may well have been waiting
for many hours in an ambulance outside the ED and then many hours in the ED before that decision is made. So this means that people are often delayed getting into hospital by, you know, very prolonged periods indeed. We are seeing that some of those
people are really at risk of significant harm because of that delay, despite the best endeavours of the services looking after them. And I should say, this is a reflection of the pressures on the system as much as the ability of individual services provide care,
because they are under intense pressure indeed. Many hospitals that we speak to say they have got large numbers of patients, ready to go home, who can’t be discharged. And that is… the issue here, this is an issue of flow through the system. Rosie has
been talking about community and primary medical services. It comes into ambulance services, into hospitals and then out of hospitals into the community and social care again. We need that flow through the system so that people are getting the care they need in the right
place, at the right time. At the moment the system is not delivering that. We have been doing some inspections, as I discussed earlier on. We have postponed them now for a few weeks, but the early results of those inspections of urgent and emergency care
systems has shown, as Rosie talked about, the fact that systems aren’t necessarily working together well. There has been a lack of co-ordination between different parts of the system and, really, we need in the short-term, in the immediate-term, systems need to come together and work
together really effectively to deliver this flow and increase capacity wherever they can in the system, so that the flow can be maintained. What we have seen on our inspections, and this is supported by what we have heard from our specialist advisers who are in
emergency departments all over the country, is that people are suffering avoidable harm from delays of ambulance handovers because they are held in ambulances for too long. They are suffering avoidable harm in corridors, in overcrowded emergency departments, where they can’t get the care they need.
I have been talking to staff who are really very distressed about some of the care they are having to provide in corridors to really, very severely ill people. Also people waiting on trolleys to be admitted to hospital, often very frail and they suffer harm
from just waiting on trolleys, and we have seen patients coming into hospital and getting severe pressure ulcers while they are waiting in the emergency department. For a frail, elderly person to get a severe pressure ulcer is a devastating complication. So, this is what is
happening to people at the moment in the system and there is risk throughout the system. There is risk in the ambulance service because they are being held in hospitals and cannot go out and respond to 999 calls. I have talked about the risk in
ambulance delays in emergency delays, and of course there is a risk in patients who are held in hospital too long. As we have described before, if you are frail and need to get out of hospital, staying in hospital means a further deterioration in your
clinical condition. So, holding people in hospital is not a safe thing to do. It is not good for the system. It is not good for the individual patients. Can I just speak about the workforce? Because talking to the workforce and I have been talking
to people on the frontline of Emergency Departments this week, they are really under intense pressure. I think we need to reflect on the distress they are feeling in their inability to provide the care they want to provide at the level they want to provide
it. It is having an impact on them. And, of course, workforce is going to be one of the key challenges as we go into winter because not only are there current workforce shortages, they may well be exacerbated by Omicron and the need for people
to self-isolate. I think this is a real worry going into winter. As we go into winter, Omicron may generate more activity on an already fragile system, but also it may take staff away from the frontline where they are most needed. I think those are
the reasons why the booster programme is so important. One thing that staff do want is people to recognise the pressure they are under and the problems they face in providing safe care. I think it is really important that we are honest with staff about
what we can see in terms of the pressures in the system, and they can feel that they are not being expected to do things which they know are impossible to achieve. Everyone has got to recognise that staff need support, both in terms of moral
support, but also anything we can do to improve the flow through the system. Now we said earlier on – we have talked about this in State of Care - we called in State of Care for new models of care around urgent and emergency care.
Rosie has talked about that already. It is absolutely critical, once we are through this winter, that we face up to the need to build a new urgent and emergency care system that can provide the needs for the population as it is now, not as
it was 20 years ago. I think there is a real opportunity to build on this really difficult time to bring about the changes necessary in the urgent and emergency care system, and that is absolutely essential going forward. Thank you. Thank you Peter. I’ll hand
back to Ian. So, Ted just before we go back to Ian, I just want to pick up on what you’ve just been saying because I think this is really, really important. We would have had exactly the same conversation in the winter of 2019. It is
just that this is all now, an order of magnitude that much greater because of COVID, but the pressures were all there in 2019. They were there in 2018 and this winter is… - we are in the middle of this winter now – we will
just have to tactically respond as best as possible. But there really does need to be very big effort to do exactly what you have just been saying. So that next winter we start to see some improvement in this immensely complicated but vitally important piece
of the jigsaw. I just hope we start that work really early – I say “we”, it is not actually CQC that starts the work, but the work is started really almost immediately because despite the pressures, the thinking needs to be done and the actions
need to be put in place. Yes Peter, just to come back on that. 2019 you will remember we described as the worst ever winter in the NHS and that was before COVID hit. Yes, the situation now is even worse. Last winter was exceptional because
of lockdowns etc., but we always knew that the winter coming out of the pandemic would be difficult. We didn’t predict Omicron, but there are always winter viruses so, you know, it’s not as though we can’t predict there are going to be viruses that exacerbate
demand in winter. And it always likely one of those is going to be COVID or a COVID variant. So the situation we are in is not a surprise, quite honestly. It is something that has been predicted and I think we do need to face
up to the fact that we have, as a whole system, not brought about the changes in urgent and emergency care we needed to do. If we had done that, I think, we would be in a much better place to face up to the challenges
of the COVID pandemic. I think that is a lost opportunity. As you say we were talking about this many years previously, and I think it really is important we do face up to that now and do the work to actually create an emergency care
system that is not necessarily perfect, but that has the resilience to deal with a normal winter and that extra capacity to deal with surges in demand driven by respiratory viruses. Yes, thank you. Ian. So before we finish off, can I just being in Kate
and Chris very briefly because I think you are right, this isn’t something, this isn’t a problem that we alone can solve as CQC? I do think the perspective that we bring, particularly perspective around Adult Social Care and that integration of services together is very
powerful in terms of painting the picture around what good might look like. So can I just bring in Kate and then Chris, and then perhaps open up for further conversation? Thanks Ian. I echo a lot of Rosie and Ted’s comments. I think for me, it
is critical that when organisations are under pressure, they don’t revert to just thinking about their bit of the pathway, their bit of the system, that they continue to think about hospital avoidance, timely discharge etc. So, from a social care perspective onto the urgent and
emergency care agenda. I think it’s important to remember in our State of Care Report we talked about discharge to assess and we talked about when discharge to assess is done well, people don’t make long-term care decisions from an acute hospital bed. They are supported
to leave hospital in a timely way when they are medically fit to do so, have re-ablement, rehabilitation as and when needed and then their long-term care needs are decided. So I just want to… we must all remember the benefits of discharge to assess when
it’s worked well and in the State of Care we asked, we called for a longer-term commitment around this discharge to assess to enable that long-term planning. A couple of things on social care. There is physical bed capacity in the residential nursing market. There is
physical bed capacity where maybe the issue is more about the workforce to staff those beds, but there is physical bed capacity out there in the residential nursing market. What might a system response be to using those physical beds, that would take them out of
hospital, put them somewhere they where they will be safe, either as a short-term or a long-term solution. But there would need to be a system response to look at the workforce piece. I want to flag designation settings, so this was stood up last year
where people who had a COVID, confirmed COVID case whose long-term destination was a care home, either returning to their usual place of residence or being discharged there for the first time when they had COVID. Across the country designation settings were stood up in a
number of adult social care providers, but also in some community health provision as well. Those numbers have reduced. I think it’s really important that systems think about what their need is for the designation settings, either in residential nursing homes or in community provision, pretty
urgently as we go into this winter. I would suggest that the need for them might increase as we start to see the kind of impact of Omicron. Then the final thing is, we know that there will be a significant number of people in hospital,
ready to leave. They will be waiting for a wealth of things, but one of those things they will be waiting for is home care. We know that there are particular pressures with the workforce challenge in home care. The government announced 160.5 million for the
social care workforce, followed by 300 million. As a system, how are we all collectively making efforts to make sure that that money passes through as quickly as possible to those home care workers in whatever form that might look like, that ensures that that home
care worker does not decide to leave their really tough job, tough but essential job in home care, now to go get a job in retail over Christmas. And that they stay doing their invaluable job in the part of the system we need them to
be doing so. So, just from me, a real plea that under this immense pressure, system leaders still think about what is needed from a system perspective, because in the end that is the best thing for people and patients, but also it means that things
will work a lot better for people as they move through. Thank you. And Kate, the really important thing about home care is not (inaudible). It is obviously important when it comes to being able to discharge people back to their homes, but if home care
is not there, we are going to see an increase in admissions, coming back to something that Ted was touching on. So, to me home care is probably one of the most important things right now. So, it is kind of, as you say Peter, both ends of the pathway. So it is about when people have care
needs. They get assessed in a timely way and then they get that package of support arranged for them in a timely way. Then, should they need a hospital admission, there is then the social and the community centres for them to be discharged out of
a hospital bed when they are medically fit to do so, into their long-term destination. Yes. Robert. Thank you. Well, firstly endorsing everything that’s been said by Kate and colleagues. But a feeling of being profoundly depressed because I have now been listening to this conversation
and this description of these problems on this Board for far too long. I mean ever since I have been on it. That is no criticism of anyone who is here or their predecessors, but let no one pretend that this is an issue that comes
about because of the pandemic. It was there before but it’s now been exacerbated. What has changed is that, perhaps in the early days, it was thought or suggested, perhaps rightly, that actually in a well-run, well-led place, this sort of thing wouldn’t…, didn’t need to
happen. So our outstanding hospitals, for instance, didn’t have the problem that our less adequate ones did. I think it is…, we are now in a situation where however outstanding the place or provider may be, this is a problem. Because it is not a problem
just in relation to those in hospital who shouldn’t be there, it is in relation to all those who are not suffering from pandemic-related diseases, but other things who are increasingly not getting treatment, and in many cases, increasingly becoming more ill. So, my concern is
that really we need recognition currently that we should be on a war footing and we are nearly more looking like that. But I think there has to be a more honest conversation in the system about in the very short-term, about what it is that
we can’t do and what we’re doing about it. We cannot, I suspect, any longer claim, or shortly we won’t be able to any longer claim that the NHS is performing its function of delivering free care at the point of delivery to all who need
it. It is just not on what is being described doing that. So what is… what do we then all have to talk about? We have to talk about priorities and I’m not sure we are having an honest conversation about that either. In the medium-term,
the long-term, obviously we need to change the system and we need a systemic approach and you have described how that should happen. Just one minor point, but perhaps an important point about how can anyone help now and I just wonder whether we have sufficiently
explored, as in “we” generally, have sufficiently explored the use of volunteers. We are using them to great effect, I think, in the vaccination programme. There are many wonderful volunteers in our hospital services. But I just wonder whether there is greater scope, bearing in mind
I know many members of the public are willing do their bit, where they could be used more to relieve our hardworking hospital, and NHS staff generally, to do the jobs they are really qualified to do. Chris. (inaudible) to answer Robert’s points but… Well no I…, just to go back something
Ian said that was important, what we do provide is an overview or perspective and we have been having some really good conversations with different parts of the system about this response. The urgent and emergency care we are talking about is obviously a wider system
issue. It isn’t just about urgent and emergency care, it is about the wider system issues and the sense is… When you are talking to, sort of, some of the NHS Trust about this, they described it as moving people out of hospitals (unintelligible), but then
there is a wider bit about controlling of access which comes to Robert’s point. But just to talk about movement out and to go back to what was said earlier, the reason why we want to prioritise RI to Good inspections in Adult Social Care is
precisely to improve the capacity of the Adult Social Care markets so that we can help with some of the discharge arrangements from secondary care. But if you look at the associated care homes in report today, they are saying that there are still almost half
of home care providers that are concerned about the long-term financial viability, which is why in the State of Care we talked about the importance of making sure we had a viable home care sector that could support people to move out of hospital. The other
thing, the other issue that we were talking to with both NHS and community, sorry, acute and community trusts, is what is the relative risks that people are taking. So access to community care is also a challenge as well. How do we make sure the
risks of being appropriately managed between those two sectors. In terms of control of risk in, I’m really grateful that the Patient First work that we did much earlier in the year has at least given organisations a guide of how to manage and support a
great piece of work in Ted’s team, to help guide that work. What it does say Robert, to your point, is that you can’t manage urgent and emergency care by looking at urgent and emergency care alone. The relationship between not just the wider parts of
the hospital, but the wider parts of the system are critical. The last area about control of access into hospitals - I mentioned before we were working with some trusts around a survey of A&E service use to understand why they arrived at A&E. I think
there’s some really good examples in some of the ICS areas or how volunteers have been used to support some of the admission avoidance places. I think what we should do with each of these areas is to give a sense of what the opportunities are
to move away from this crisis point for ICSs. So, we should use our data and hopefully to give not just a national perspective but a regional perspective, so that our information can be useful in the conversations with the ICSs about how they tackle the
problems in their area. In that way I think what we know nationally can help guide thinking both regionally and nationally. Rosie. Yes. To follow on from what Chris was saying is, that we can’t look at urgent and emergency care in isolation. It is not
something that will be possible for this year, but we need a cultural shift in the health and care system from something that is very reactive to something that is much more proactive; that actually empowers people to manage their long-term conditions which usually are the
driver of unplanned care, and that actually supports people to make informed decisions that are going to both support their own outcomes, but then also support the pressures on urgent and emergency care by making sure that they get the care in the right place, at
the right time for them. I think that we have significant opportunities when we are starting to look at our regulation of systems as we go forward to think and work out how as a regulator we can enable systems to consider these new models of
care that are going to help to meet challenges going forward. Thanks. Ted. Yes. Just to second what Rosie was just saying there. Remember, a few minutes ago, I was talking about the community mental health survey and the fact that we are not providing community mental
health services, not providing access to people who need community mental health services means that they deteriorate and many of those turning up in A&E - and there has been a surge in people with mental health crisis attending A&E over the last year - and
that has been one of the things that are driving the problems. But you could make the same about lots of other areas as well, it’s not just mental health. I think we need to be much better at people deteriorating so they don’t end up
in A&E just because of deterioration of a long-term condition which we see far too much of. But we also need to find better care for people who are frail and elderly who actually don’t… going into hospital is not a good thing for them to
do. But there are not sufficient alternative care available for them in the community or at home. We need to make sure they are looked after to be well, but also to be independent, not admitted to hospital and bar being admitted to hospital institutionalised so
they will never be independent again which is what the system does at the moment. There are lots of other areas as well. So, when we talk about new models of care for urgent and emergency care, it is about finding new models of care for
all these other challenges in the system. One of the impacts of the problems in urgent and emergency care is it is impacting on elective care. And, of course, people are generally worried about getting the operations they need, not because they are an emergency, but
because they are necessary for them to improve their health. That is… we saw again last week that the elective care waiting lists are now over 6 million and these are going up still. But because urgent and emergency care is competing for capacity on a
daily basis with elective care, that inevitably will get worse over this winter because of the pressures on urgent and emergency care. That is because we don’t have a model of care that protects elective care from this kind of distraction. So we have got to
look at models of care across a whole system, but the priority is getting urgent and emergency care improved. It won’t be a one year’s job, it’s a long complicated problem but we need to making progress in the right direction. And just to come back
something that Robert was saying, this is not just a problem of problem hospitals, this it this is a universal problem. Every place we speak to in the country is having this problem. It will vary and some of the local issues and local system will
vary from one system to another, but nowhere has go…, nowhere is running a service that is actually the service we want to see for people requiring this kind of care as yet. So I suspect we could spend the rest of the day talking about
this because it’s such an important topic and we’ve all got different aspects of experience, but I am mindful of the time. Ian, is anything you need to say in way, sort of, to wrap this up before we move on? No. Thanks Peter. There was
no attention to arrive at a specific action here other just I think to share with Board our overall concern. This narrative if you will, this conversation we have just had is something which informs our day-to-day interactions with a range of different system partners, whether
that is NHS England or the Department or so forth. So, we are constantly using this back story, as it were, to try and influence and talk to other system partners to make change happen. But as, you mean, as we have just said, it is

Board Effectiveness Review

a very tough environment in which to significantly change. One would argue we should have done this years ago, but I think we are where we are, so thank you. Absolutely. So that takes us to the Board Effectiveness Review and Rad, you might want to
add a postscript now to the Board Effectiveness Report saying that the Chairman can’t manage meetings to time because we are running very late, but I think we had some really important discussions which I certainly didn’t want to cut off. So can I just hand
over to you to introduce your report please. Would you, how long would you like me to speak for? As long as you want. This is also important so we are not going to cut things off just because we are running late Thank you. So,
well thank you for letting me listen to the rest of the meeting which was humbling actually, and a kind of privilege to listen to some of the challenges that you’re thinking about. I want to just set a wider frame before we dig into CQC’s
governance and just recognise that across sectors - private sector, public sector, not for profits – there is a homogeneity of what we now consider good governance and that is influenced by, you know, cross-fertilisation of different codes and checklists, and of course consultants like me.
So, in a way the kind of tenets of good governance, things around the clarity of roles and responsibilities, processes around board effectiveness, committee structures, risk management, all of those are – there is a commonality of expectations across different codes, across different sectors. There are
some areas where things like the global financial crisis for example in 2008, have an impact on governance so risk and assurance has become much more important since that time. That time also sort of started to influence governance thinking about culture because there is a
sort of exploration of the culture in banks and financial institutions. And, of course, events of the last couple of years, things like George Floyd’s murder have also influenced some of the debates and governance around diversity and inclusion, and thinking more widely about organisational culture.
So all of that is to say that governance doesn’t exist in a little bubble of its own. It is reflecting what is going on in the external world, it is reflecting the growth in new technologies, social and economic movements, climate change, you know, socio-economic
drivers. So in a way, you know, it is not a static thing I suppose is what I want to say. There is a commonality of tenets of good governance, but there are other things which shift. So, it is a dynamic set of arrangements and
relationships and in a way I would say that good governance is always about the pursuit of better, you know that it is somehow slightly restless. There will also be masses of contexts for any organisation and of course those play into your context too. So,
the areas that we focus on for improvement in these kinds of reviews, of course, reflect those wider things about the tenets of good governance. So pretty much any report, I will be making recommendations about, you know, board effectiveness or about committee structures or about
the conduct of board business. So the fact that your report has some areas of focus relate to those things is normal. So that is what I want to preface really. You know that we have engaged in a wide variety of methods because many of
you have been involved with them. Document reviews, surveys, interviews, focus groups with staff meeting observations, so our findings are really…, some of them are about you holding up a mirror to yourselves and some of them are about our interpretations of where you are. I
would say we found a foundation of really good functional governance, a really capable and strong Board and Executive Team and it is really clear that your governance and leadership - and I would say from an external view point your reputation - is in a
very different place to where it was 10 years ago. I think that is testament to the hard work of the Chair, the previous CEO the current CEO, and I’m sure an array of different board members. So there has been a lot of hard work
over the last decade and I want to just recognise that at the outset. I think I have met an organisation that has a huge commitment to openness and transparency. The fact that we are having this conversation in a public Board meeting, I think, is
testament to that, and is probably pretty unusual. I’m not sure that with other regulators I have worked with that they would have this conversation in an public board meeting. So, you know, I think that’s something for members of the public to be aware of.
I think the governance challenges for you now are different to what they were 10 years ago, of course. I think the next era and the next phase for you, as an organisation, are challenges that the next Chair will probably have to pick up, whenever
they - he or she - is appointed by the Department of Health and Social Care. Some of our recommendations are about cultural choices. So there are always cultural choices about how a Board and an Executive work well together. So, there will be some things
around good governance that we recommend and then there are things where we recognise where you are and how you might want to change and we make suggestions about choices for you. There are some matters of context that I want to draw out that influence
our thinking about where you are. The Board has had a clutch of new arrivals all at once and you probably wouldn’t have designed it in that way, but that means a bit of digesting, I think, of new people, new personalities. Of course, the dynamics
change a bit and they are getting to know the organisation, which is complicated by the fact that we are living with a pandemic. And they will also bring fresh eyes to some of the discussions and conversations, so both of those things are in play.
I think COVID and the conditions of remote working also create challenges for Boards. All Boards will feel that the absence of in-person meetings is something sub-optimal and, of course, that has come through in the review with our interviews with you. So a Board with
regulatory responsibilities and with new arrivals - it will feel doubly frustrating not to be able to get out into the field in some way, and for you not to be able to get out of the boardroom. I think getting out of the boardroom really
helps to understand an organisation, helps you engage in reality checking. It also helps you engage in some liminal spaces that I think help provoke wider thinking about the organisation and its purpose, and how you delivering that. So I recognise that that is a huge
sort of subtraction in a way that you’re trying to work against. I think some of the richness, the fluid interaction building on each other’s conversations, it is a lot harder to do that in a virtual environment, and pretty much every Board that we have
worked has said that. CQC is working on its approach to regulation, this huge transformation programme underway. These kinds of programmes, there are always challenges for boards to get to grips with. The fact that you are wrestling to get to grips with it is normal,
I think. The needs of a board may change over time in any case, so what you may have needed in relation to the programme one year ago, 18 months ago, may be different to what you may need over the next 12 months. So this
exciting, challenging work, it is going to bring systemic change to you. It will be a hugely important step change for CQC and I think it is not surprising that you are thinking about how do we oversee that well. So that is always a challenge
that transformation programmes… how boards interact with those. I think, I would expect that to come out of a review like this. Lastly, a matter for focus in any review, is about how clever people are using their time well. I know from interviewing many of
you, and my colleagues doing the same, you know there is a very clever competent group of people in the Board and in the Executive. For me, the challenges, you know, how do we get the best out of all of you? Is that delivering the
best outcomes for CQC, and through that the best outcomes for the public? And I think some of the things that we are trying to prod you towards are about trying to make sure that you really optimise the use of your time together. So the
organisation is embarked on these really important future-facing changes against this very challenging environment that we just been hearing about. I think it is important that governance moves in alignment with that change, that you have space to be proactive, a little bit agile. Remote working
in some ways has helped boards be more agile, and that you look for opportunities to work differently and efficiently. I think that that is the space I am trying to invite you in, I think. I have identified a cluster of themes or considerations and
I think they are about moving you along this sort of Good to Great journey. So some things around Board Effectiveness – the new Chair will have to develop cohesion in the new team. I think it is good practice anyway for boards and executive teams,
from time to time, to step off the treadmill of your board business and look at how you work and see whether you can work differently. I think that helps to build trust and build thinking. There are some other small suggestions about ways of tightening
up aspects of board effectiveness. A second thing is about the conduct of board business. We sometimes talk about boards having an oversight role, a strategic and tactical role and an insight or sense-making role that we sometimes call generative governance as well. I think it
is helpful to think about when you are in those different modes of governance because behaviours can be associated with those different modes. We think that board time could be better organised to allow more opportunities for that kind of generative thinking, for board members to
bring value through applying their insight. That would mean something of a reset to some of your meetings, agendas and content and I think that space has felt a little bit constrained in recent months. A third cluster of themes is around performance, risk and assurance.
I think it really helps if the strategy, the risk appetite, the performance reporting, the risk and assurance frameworks feel properly integrated, and I think you’re still on that journey. The fourth point is around Committees - it will depend on some of the other recommendations
that you pursue. But, were you progressing the work around assurance, I think there are opportunities to think about the committee structure in a slightly different way. That could help support finding discussion spaces around your emerging approach to regulation. Then lastly, I think there is
scope to think about how governance support is strongly steered, so it is someone’s responsibility to really look ahead and be accountable for the design of the board work. I know that that is probably a challenge around resources as well. So lastly, I wanted to
just put on record my thanks for the openness and collaboration that I have met with from CQC. I particularly like to record my thanks to the Chair to Laura Ottery and Naomi Pattison who have all helped in the conduct of this review. And also
to emphasise that it is an independent report. There is no fettering of the expression of our views as Campbell Tickell and I’m very grateful for that. So I think we are very grateful for the report. There’s a massive amount of food for thought in
there, so thank you. What I am suggesting colleagues is that we don’t discuss how we are going to respond to individual points or anything like that today. I think, as Rad you suggested, this is really quite a long conversation that you as a Board
need to have with your new Chair. Certainly the last time we had a Board Effectiveness Review, we had a couple of seminar sessions to get our minds around how we wanted to respond and then brought those responses back to the Board. I would recommend
that is the right approach for the future. Rad, you very kindly said that you are happy to come and lead or contribute to one of those sessions. I thought we had timed this brilliantly - I thought this was going to be my last board
meeting. So you know we just sort of hear a whole load of problems and then seamlessly next month there would be a new Chair and it would just carry on. It hasn’t quite worked like that. So it may be - and who knows it
may be a month or two’s delay - but that doesn’t mean that the points go away, they are just as important but I think it is right that we wait. So, for now, today, I just want to say are there… if there are points
that are sort of clarification that people want to ask so that they can go away and think about the report in advance of the seminar sessions, please ask them now. And excuse me, choking away, if not, I think the report is very clear and
I would like to suggest that we just receive it and it comes back to the Board – excuse me - once the new Chair is in place. Anybody want to raise anything right now? Perfect, so once again, a really good report, lots of food
for thought and oh… I was too quick. Tafoeek, did you want to come in? Was that… your hand has gone up and down. Oh yes Chair. Sorry I’ve just posted on something in the chat. I’m not really sure whether you have seen it? No.
Oh, OK. So I would like to know if we have a board succession planning in place for the planned and the unexpected? Sorry, I didn’t quite hear the last bit, forward plan for what? Sorry. Board succession planning in place for the planned and unexpected,
So… the composition of the board is only partially in our control. So all the non-executives and the Chair are appointed by the Secretary of State, not by us. So we do input to the Secretary of State what skills we think we need on the
board, and as the retiring member goes, how do we need… what skills do we need to replace to avoid having a skills gap. So that process goes on but we are not able to directly say “and therefore we will appoint X, Y or Z.
In terms of the executive directors who are appointed by us, then absolutely there is a clear plan for appointing successors to people as, you know, as they retire or move to greater things. Does that answer your question OK? Yes Chair thank you. OK, no, thank you very much indeed. Let’s… can I just suggest
that – if everybody is happy - we receive the report. We thank you very much for it, I do think it is a very good report and then it will come back to the Board with your new Chair sometime hopefully fairly early next year.

Equality Networks Update

OK and then if we can move on to the Equality Network’s update and invite the other Equality Network people who are going to join us to come into the meeting. One of the recommendations, or one of the suggestions that is in your Board Effectiveness
Report is that we allow the network representative to talk a bit about their network, and actually that is what we do in the session that is about to start. We had originally, terribly cleverly, planned this so that we would have this session and then
we would all go to lunch together and informal conversation with the networks could carry on over lunch. Unfortunately, that part of the plan hasn’t worked quite as I hoped, but we may have another opportunity in a few months to get you all back. So,
let’s… sort of five minutes each if I can put a reasonable expectation on it. I don’t know whether you have agreed on an order between you, but if not since you are already in the hot seat Tafoeek, do you want to start? Thank you
very much Chair. Sorry, could I just interrupt? I think Jo was just going to do a bit of an introduction but… Sorry Peter. If I may, I just wanted to say a few words by way of instruction. I won’t take too much time at all, and we’ve got…, the colleagues that are here from the networks have prepared their piece to talk to you around their slides, but I really wanted to do
just preface that with saying that this is the session that allows to hear about the really great work of the networks and also an opportunity for us to reflect on what we want to take into the new year, and how we want to continue
with working with Board colleagues. It is really important I think also to recognise the role the networks have all played in supporting colleagues across the organisation. This year, in particular, has been challenging and the networks have been integral in this space, as well as
delivering - as you’ll hear about shortly - a vast array of events, learning and engagement sessions across the organisation, across the year. I wanted to add my personal thanks to the Chairs for all they have done over the past year as well as the
many Co-Chairs and Deputies that have also helped in this really important space. I won’t say anymore because we are short on time, and is not me you want to hear from, it is from colleagues on the call. So, I’ll hand over briefly to Felix
who will just, sort of, I think is also going to run us through the slides on behalf of colleagues. Yes. So my name is Felix Petru, nice to meet everyone. I’m an organisation and development advisor. I am also the Chair for the Joint Network
Voice. So for those who don’t know what the Joint Network Voice is, it’s a meeting that happens once a month and it’s where the 5 Equality Network Chairs and Vice-Chairs join to feedback on work which is happening across the organisation. So they’ve also contributed
to things like the transformation of change and they are able to comment on thinks like equality impact assessments on policies. Another thing I wanted to flag which the Joint Network do is encourage the involvement of independent panel members from their networks which is mandatory
on Grade A and Executive recruitment panels. Then finally they have also been really successful in engaging the wider organisation through Ian’s (unintelligible) colleagues calls which happen weekly, which we will be hearing about after me. So, I’m just going to hand over now to the
Carers Equality Network and they will be telling us about their biggest achievements this year. Hello, good afternoon. Julia Corrigan Davis. I am the Co-Chair of the Carers Equality Network at CQC and this year we have sort of continuously been building on a safe and
welcoming forum for sharing experiences, offering advice and learning and support for our colleagues with caring responsibilities. We have done a lot of work to promote the Carers Equality Network and memberships have increase by 23 members this year, so we are now just under 200.
We introduced regular coffee catch ups - they are sort of fortnightly or three-weekly, where it is a safe half an hour’s space, just a time to chat, time to share, unload and try to normalise our world. That has been sort of really well-received. We have promoted Carers Week.
We held a range of activities and signposting support. We had Carers UK come and speak to our members, and also Carers Rights Day where we ran some promotions in conjunction with Carers UK. We have also established strong external links across the Civil Service and
other organisations so that we can share best practice, promote these support options and we have done some benchmarking, reviewing policies and practice across different organisations. This is all accumulated in us applying for Carer Confident Accreditation and I am pleased to say – I think
it was about a month ago – we were accredited with Level 1 which is Active level and that actually means that CQC is an employer that actively recognises and supports colleagues with caring responsibilities, better enabling them to fulfil their work roles. The next level
is Accomplish which will mean that we have nailed the Active. So, that is basically it from me. The collective aim is to support each other, and raise the challenges of combining a career and caring responsibilities and also influencing our working policies to drive equality
and inclusion across CQC. Thank you Julia. Paul. Good afternoon all. My name is Paul Kirby. I am the Chair of the Disability Equality Network. We have had a tough year, a lot of challenges and changes, but we have also had a positive year as well. So, we
have obviously a very successful subgroup (unintelligible) to neurodiversity. We provide a platform for personal stories for members to share their experience so there is no isolation. There’s other people who are struggling or championing access, good role models to other staff with disability. We campaign
for accessibility, for example the short e-mail signature that one of our colleagues that had trouble with reading with voice recognition of the email information and the signature. So we have actually reduced that across CQC which is successful and the NHSE has started the process
to acquire British Sign language - Sign live, so hopefully BSL users outside the organisation can contact the organisation, making it accessible. We have a quarterly DEN newsletter – the third one which will be out next week so for everybody to read, to know what’s
going on with DEN. We promoted the International Disability at Work Day on the 3rd of December. We are in the middle of doing the event of Disability History Month from the 18th of November to the 18th of December, so if you have the opportunity
to have a look at the recording of some of those presentations. We contributed heavily on the workforce Disability Equality Standard and what is really exciting, we have had 50 new members this year so that is one new member each week. We are a growing
group. We have done a great work on Mental Health and Wellbeing Workshop by the Mental Health sub groups, with Hannah Sunderland, she has done great work on that, working with the Wellbeing Team. We also try to encourage stability and diversity with self-declaration on the
ESR to show the increase of numbers of people with disability. We promote and support the use of tailored adjustment plan, accessible information standard as well as access to work, so that is a lot of work that we are hoping to do in the new
year. We have contributed to workshop training for managers and the main key is promoting disability staff (inaudible) so it is growing from strength to strength and I am proud to see the group growing and taking responsibility of showcasing their disability across the organisation. Thank you Paul. Jasper.
Hi, I am Jasper Jackson. I am one of the Co-Chairs of the LGBT+ Equality Network. So, in terms of network changes over this past year, (unintelligible) one is we have had our elections on network chairs, so outgoing we had Beth Matthews and Felix Petru,
who is of course on the call, and coming in is Becky (unintelligible) with Dean and myself. Amongst other Chairs, we do have a buy-in trans rep who is supporting particularly marginal segments the LGBT+ community and they act as point of contact for questions from
CQC colleagues. Events and achievements over this past year - we’ve been engaged with induction processes this past year so we have been helping to ensure that new colleagues are introduced to the staff networks as part of the culture of the CQC and they are
aware about how they can engage with the network, all we can do to support them, and also what they can do to support us. We have collated some network responses to positive reviews by HR and that includes prompting HR to promote a Pewsey complete
review of the guidance to support emerging staff who are transitioning while they work at the CQC. We promoted, as Felix mentioned earlier, the independent panel members initiative and we have a few members who are part of this initiative. We have created more social support
services spaces for colleagues within CQC instead of just being (unintelligible) looking. I think those worry spaces where people can talk about how they are affected by current events, how they are feeling, and a Film Culture Club to explore LGBT+-related media. We will be going
to continue this over the next year with spaces to directly discuss LGBTQ-related current events. We put on a significant programme of talks for both LGBTQ history month and Virtual Pride for the CQC, open to all colleagues here as well as colleagues of para-organisations and
these were to promote awareness and understanding of issues that face the LGBT+ colleagues and service users today. This has included sessions with external organisations including Hidayah who are a charity who serve and support queer Muslims, and Intersex Equality Rights UK looking at the experience
of intersex people in healthcare environments in the UK. Less good news, unfortunately Ray Mason who led our virtual pride social media engagement faced significant homophobic harassment and abuse on CQC channels by a vocal minority of internet users, including a wide variety of (unintelligible), insults
and misconceptions. But fortunately, the CQC worked well with Ray to support him and put out a strong message of support for our LGBT colleagues and people who use the services we regulate. I’m including that, not because I think it is an achievement, but because
I think it is important to recognise that, despite the wider support of LGBT+ people within society, there is still ongoing discrimination and abuse. Finally, we worked alongside organisational development on submission to the Stonewall Top 100 employers this 2021, which is a nationally recognised ranking
to help us ensure that we as an organisation are supporting LGBTQ staff, but it also helps us ensure perspective colleagues that we are a safe and supportive place to work for all which will obviously help us encourage the top, top (unintelligible) to come and
work at CQC. We are hoping to continue achieve a good ranking and we hope this year to get into the top 100 list in 2022. That’s all from me. Thank you Jasper. Tafoeek. Thank you Jasper. So we have a Race Equality Network. Our Executive
Sponsor is Kirsty Shaw, ably supported by Tazneem and Latoya. Our purpose to promote and champion race equality and inclusion across CQC. To do this, we focus on key recommendations from (unintelligible) report and the race report, joint network venture, Black History month, etc. The Race
Equality Network is one of CQC’s staff diversity network and is staff-led. Race Equality Network 2021 - we held 12 talks events this year, part of which was the LGBT+ History Month, the (unintelligible), owning your own career development, Black History Month. I would like to
thank the OD, our Executive Sponsor Kirsty Shaw which is (unintelligible). The range of topics - I particularly enjoyed the David talk. I’m proud to be part of an organisation that supports the types of discussions we have held and see members of our Exec Team
join in and contribute to this discussions. We held a listening event in June to commemorate one year since the murder of George Floyd, and to follow up with all the brave colleagues who spoke up about their experiences of racism and inequality at work last
year. This event was hugely impactful on us and there was some really worrying feedback that came out of the word cloud we did on Mentimeter at the event. Most of the words posted by colleagues who attended a call on what it feels like to
be a passing from a minority ethnic background at CQC among others were unchanged, disrespectful, engaged, ignored, degrading, drained, lonely, optimistic, static, excluded, tiring, soul-destroying, micromanaged and positive, misunderstood and the list goes on. Whilst we know colleagues are working hard to change the culture of
the organisation, I want to ask that you all become, all continue to be visible equality and inclusion allies. I ask this Board to approve law for positive action under section 1.5.8 of the Equality Act providing targeted employment opportunities for colleagues who clearly have an
enormous untapped skillset. So, everyone please join us and be part of this struggle. Thank you ever so much. Thank you Tafoeek and now we are going to go to Lizzie. It’s you Lizzie. Are you alright to re-share your slides? So the aim of… I’m
Lizzie and I am one of the Co-Chairs of the Gender Equality Network. The aim of our network is to improve the experience of women working at CQC, but also reduce the overall impact of gender inequality on all staff. Kate is our sponsor and she
is incredibly supportive. Some of our main priorities are providing a space for networking and peer-to-peer support across CQC. We have got around 130 members and we have also had quite a lot of new members in the last year. We have particularly focused on having
some networking and informal sessions over COVID and brought over 100 people across CQC together to talk about impact of COVID on flexible working and being able to juggle family life and of overall wellbeing. We got a lot of good feedback that those sessions were
really helpful. We also did an International Women’s Day Panel Event that we received lots of great feedback for and it had some really great speakers across health and care. Those women told their own leadership stories and talked about some of their own struggles in
obtaining quite senior positions in healthcare. We also looked at the role that networks can play in supporting women, and again leadership skills. One of the key pieces of feedback from the survey that we originally did was that women in general wanted more leadership support
and training opportunities, and they really valued senior women from both inside the organisation and outside the organisation talking about their own journeys. And that is something we have chosen to focus on and will continue to focus on. We also had the murder of Sarah
Everard which was incredibly distressing for a lot of colleagues, and we talked about that and how colleagues are feeling the impact of that. We have had a couple of changes in the leadership so Blessing, one of our colleagues stepped down as Co-Chair and one
of the other colleagues left to get a promotion at the NMC. So we have got now two new Co-Chairs, one of which is Hannah Carson who comes from working in Parliament and she set up a parliamentary Women’s Network there, and the other one is
Diane Horsley. So in the new year we are going to rerun our survey and re-check it with what the key priorities will be. That’s all for me. Thank you Lizzie. So now, we are just going to have a bit of a discussion time. So
we have a question for the Board and also the Network Chairs here today, which is going into 2022, what your recommendations on how the networks can make the most impact and how can the networks continue to involve and work with Board members in the
new year? So, can I just, first of all, thank everybody for those presentations, but more substantially I think, thank you for all the work that you do, day in and day out in the networks. I think they are a really big part of CQC and I’m really very pleased that
we have these networks. As I said at the start, my clever plan was that we would go seamlessly from this session into lunch and lots of individual discussions could then take place. That clearly is not going to be possible, but I think partly to
answer your question it may be that some of my Board colleagues want to talk to you offline, as it were, separately and outside the Board and, obviously, if you are all OK with that, I would be very pleased to see that happen. The other
sort of general comment I would make is that we are looking at the whole way the Board works going forward. So, you know, one of the things will undoubtedly be to continue with the network attendances at the Board XXX and certainly hope the answer
will be yes, and can we do that in a more meaningful way. So I think there is quite a lot of work to do. I am not sure that we are going to have time today to really get properly into the exam question you
set us. But having said that, various of my colleagues have put the hands up so… Ian, why don’t you go first, and then Sally? Thanks very much. I would just echo Peter’s thanks, you know, the work that you do, you know, sometimes it is
quite public, sometimes it’s quietly influential in the background, in terms of giving us your take on particular issues. It is just hugely helpful. I think one of the things I would be interested in exploring over 2022 is this issue of intersectionality. As I think
all of you have spoken very eloquently about your particular areas, and I know from the conversations I have had with each of you separately that it is something you are starting to think about. I think for 2022 I would be interested in how we
can link the networks together maybe, or how the networks can have a point of view on this issue of intersectionality. Because I think we have made some great progress in a number of areas, but it feels that is kind of almost the obvious next
step. But how we do it is, you know, I think is quite complex and certainly isn’t a conversation for now perhaps, but it is something I would be really interested in for 2022. Thanks Peter. Thanks. Sally. Thank you for the presentation and I echo
what Peter and Ian both said. For me I have had more contact with the Disability Equality Network and less with the others, but actually whilst your attendance is really welcome at Board, it is also fantastic just to hear more today about what you’ve been
doing. I think for me in 2022 it would be good not for you just to attend, but to come and talk to us, both about what your achievements are but also what the Board could do to help you make more progress. Thanks. Thank you.
I think there is, if not exactly an open invitation for the networks for us to attend them, there are opportunities. So as I said earlier, I think individual follow-up is good. Shall we give them the time? Shall we leave it there, but I think
there is a lot of discussion still to be had, so I don’t want to pretend that is the end of it. But I think maybe the end for today. Thank you all very, very much for coming. Sorry we kept you waiting and we will

Any other business

be talking to you again in the new year, I think. So thank you very much. That takes us to any other business, if anybody has any other business? And if there isn’t any other business from the Board, I’m going to slightly truncate the questions
from the public because we are running so, so late. So we had two questions from Robin Pike, and Robin, I am only going to take the first today. The second one, perhaps you can bring back to a future Board meeting - it doesn’t particularly
relate to anything on today’s agenda. So, your first question, which is the very topical, is how can CQC ensure that visitors are allowed into care homes and hospitals subject to infection control requirements? How is access ensured in secure units? So, Kate do you want
to start us off on that one? Yes. Happy to. Thanks Peter, thanks Robin for the question. So just a few comments on this because we have discussed it a number at times at Board because it’s such an important topic. So firstly, the majority of
social care providers are doing what we need them to do, which is making every effort to follow the latest government guidance and to make visiting happen where it is safe to do so. This is particularly… of particular importance to Christmas and over the festive
period where even more people are likely to want to see their loved ones. We have been clear throughout the pandemic. Providers should follow government guidance and if we hear instances of blanket approaches, we will take action. We had 54 concerns raised to date around
50 locations and each one of those were followed up to address that. We have done 10000 inspections since the start of the pandemic in Adult Social Care, and on our care home inspections we look at visiting as a component of each of those inspections.
We have had some examples recently about providers issuing a general policy on visiting. We expect providers to follow government guidance and things such as the essential caregiver, we would expect for them to be able to visit in most circumstances even if the care home
is experiencing an outbreak. And to just link back to our earlier conversation, as we think about how we can enhance the number of IPC inspections we will be doing in the New Year, when we do IPC inspections, we will again be having a really
good look at how providers are making visiting happen as well. Thank you. Thanks Kate. And Ted, do you just want to touch on secure units? Yes. Thank you Peter. So, as in social care, we expect providers to follow the appropriate Infection Control guidance that doesn’t mean blanket bans on visiting. Clearly, they
need to take into account the needs of individual patients, but equally they need to risk-assess visiting individually, so that all the XXX of individual patients. We discussed this actually in our recent publication Review of the Mental Health Act, which colleagues will remember, and on
that occasion we responded to patients raising concerns about visiting and made sure that the provider was allowing visiting to patients where that was appropriate to do so. So, this is something we very much focused on in our assessment of the Mental Health Act Review
and if people want to know more about it, then I suggest they look at the Mental Health Act Review document. Thanks. And the second questioner was Bren McInerney and Bren made me promise I would read out an opening statement, as well as a question.
Rather than have my knuckles rapped by Bren afterwards, I will do so. So Bren’s opening statement was “Please may I offer my sincere thanks to everyone at the CQC for all their relentless and tireless work and for consistently working with the principles and values
that you should all be very proud of. I am certainly very proud of you all. I offer my sincere thanks and wish you all well for the coming seasonal period, as I do for the 365 days a year ahead.” So thank you Bryn for
that. Then Bren went on to ask, I think, a rather important question which is: does the CQC look at the triangulation of safeguard reporting with that of, for example, speak up reporting, and how will safeguarding reporting be examined in the landscape of integrated care
systems that formally come into being in April 2022. Rosie, do you want to respond to that? Yes. Thank you Peter and thank you Bren for those kind comments and your continuous support you give to the Board. It is very much appreciated. So, we take
account of all of the information we collect which includes statutory notifications, complaints, safeguarding alerts and concerns, freedom to speak up concerns, as well as whistle-blowing information. We take all of that into consideration when we evaluate and assess risk. This information absolutely informs our decisions
about the regulatory action we take. As we develop our ICS regulation, this is something we will be considering in terms of how we look at safeguarding going forward. I know that is also a consideration with the work Kate is doing around local authority assurance.
Thank you. Thank you very much Kate. Thank you everybody. That brings the public board meeting to an end – we have finished.