CQC Board Meeting 20th April 2022 - Wednesday, 20th April 2022 at 11:00am - Care Quality Commission

CQC Board Meeting 20th April 2022
Wednesday, 20th April 2022 at 11:00am 









Start of webcast
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  1. Mr Ian Dilks
Apologies and Declaration of Interests
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Minutes of the Public Meeting held on 23 March 2022
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  1. Mr Ian Trenholm
Executive Team’s Report
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  1. Sir Robert Francis QC
  2. Mr Ian Trenholm
  3. Chris Day
  4. Ms. Sally Cheshire
  5. Mr Ian Trenholm
  6. Mr Ian Dilks
  7. Mr Mark Saxton
  8. Mr Ian Trenholm
  9. Mr Ian Dilks
  10. Ms. Kate Terroni
  11. Sir Robert Francis QC
  12. Ms. Kate Terroni
  13. Mr Ian Dilks
  14. Ms. Rosie Benneyworth
  15. Mr Ian Dilks
  16. Mr Ian Dilks
  17. Mr Tyson Hepple
  18. Mr Ian Dilks
  19. Chris Usher
  20. Mr Ian Dilks
  21. Ms. Kirsty Shaw
  22. Mr Ian Dilks
  23. Mr Mark Sutton
  24. Chris Day
  25. Mr Ian Dilks
  26. Mr Ian Dilks
  27. Ms. Sally Cheshire
  28. Mr Ian Dilks
  29. Chris Day
  30. Mr Ian Dilks
Out of Sight Follow Up Report
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  1. Ms. Kate Terroni
  2. Mr Ian Dilks
  3. Mrs Belinda Black
  4. Mr Ian Dilks
  5. Ms. Kate Terroni
  6. Mr Ian Dilks
  7. Mr Stephen Marston
  8. Sir Robert Francis QC
  9. Sir Robert Francis QC
  10. Ms. Kate Terroni
  11. Mr Ian Dilks
  12. Ms. Sally Cheshire
  13. Ms. Sally Cheshire
  14. Mr Ian Dilks
  15. Ms. Kate Terroni
  16. Mr Mark Chambers
  17. Mr Ian Dilks
  18. Mr Ian Dilks
Healthwatch England Update
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  1. Sir Robert Francis QC
  2. Sir Robert Francis QC
  3. Mr Ian Dilks
  4. Ms. Rosie Benneyworth
  5. Chris Day
  6. Ms. Sally Cheshire
  7. Mr Ian Dilks
  8. Mr Ian Dilks
Summary of Audit and Corporate Governance Committee
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  1. Ms. Sally Cheshire
  2. Mr Ian Dilks
  3. Mr Ian Dilks
Any other business
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  1. Mr Ian Dilks
  2. Webcast Finished

Mr Ian Dilks - 0:00:43
My mistake… Welcome everybody to this morning’s public board meeting for the Care Quality Commission. To introduce myself, I am Ian Dilks. I’m the new Chair of the organisation. I took over on the 1st of April so it’s my privilege to be chairing these meetings
for the next little while. I would, of course, like to say thank you to Peter Wyman - my predecessor. There were many thanks for him at the last public meeting, as those of you listening will know. I am very grateful for what I have
found since I arrived, so thank you to him. We have a full representation from our Board here this morning. We also have full representation from the wider Executive Team except that Rebecca Lloyd-Jones, our legal adviser, can’t be with us due to jury service, so

Apologies and Declaration of Interests

there is a vacant space there on my right. We have had no new declarations of interest, so I think on that basis we can proceed with the business of the meeting. We have some minutes of the last meeting which I was interested in listening

Minutes of the Public Meeting held on 23 March 2022

to, but I wasn’t here. So I will ask my Board colleagues whether they think that is a fair representation of the meeting we can approve? Approved, thank you very much indeed. There were in fact no matters arising so there is very little to discuss
there. And everybody happy that there are no matters to be followed up, so thank you very much indeed. So, on that basis we’ll move very swiftly on. So, Ian can I pass on to you to handle the Executive Team’s report? Thank you. Thanks Ian
and good morning everybody. I want to kick off and talk about the
Mr Ian Trenholm - 0:02:23
Ockenden report which was published at the end of March. The Ockenden report, as you know, was a report that was done by Donna Ockenden into Maternity Safety at Shrewsbury and Telford Hospital.
It was the final report of a report which was done in two stages. There was an interim report published in December of 2020, and then of course the final report in March of 2022. The report was originally set up to review a relatively small

Executive Team’s Report

number of cases of potentially avoidable harm, but it then reviewed in detail some nearly 1900 maternity cases, specifically at Shrewsbury and Telford NHS Trust. It looked at potentially avoidable neonatal and maternal deaths over a period of some two decades, although there were some cases
that went back even further than that. The report made a series of detailed recommendations for a range of national bodies, including CQC, as well as a number of local actions. We have been raising concerns about Shrewsbury and Telford and the maternity services there for
some time now. We downgraded the Princess Royal Hospital from “good” to “requires improvement” in 2016 following reviews of cases going back to 2014. We raised, at the time, specific concerns about embedding a robust safety and learning culture in those reports. Subsequently, inspections in 2018
and 2019 found repeated failure to address those concerns and wider leadership and governance issues across the Trust. We therefore used our urgent enforcement powers and the trust was put into special measures. We are starting to see some improvement and continue to monitor closely, but
it does remain a challenged trust and a challenged service. I think it’s also worth placing the report into a wider context, a wider context of maternity, because I think we do have wider concerns around maternity services across the country. I wanted to flag two
recent reports - the links of which are in in the paper - one of which is Safety, Equity and Engagement in Maternity Services and the other is Getting Safer Faster. We have tried to escalate these broader issues in services and particularly flag inequalities in
care. Inequalities was not something that was necessarily a big issue in in the Ockenden Report, but it is something that we are flagging more broadly in maternity services across the country. We have made a number of changes to our methodology over the course of time. And you
would expect that as we have talked to the Ockenden team and we have seen the various reports, we would of course reflect on our own methodology and the way that we have conducted our business. We have also built a number of relationships with patient
and advocacy groups to make sure that we are able to reflect the voices of women in our reports, and also reflect the voices of women in the national picture. We continue to work with other national organisations to try and improve the quality of care
and use the power that we inevitably have as a regulator, as a convener of people, to come together to make sure that the answers to some of these challenges is about people coming together as a system. We can use our powers to help contribute
to that. But having said all of that, I think it is worth just finishing with the important point that over 40% of services, of maternity services, remain “requires improvement” and “inadequate” in the safety domain. I think it’s important that we and others across the
system continue to work hard to improve the quality of care for the women and families that use these absolutely vital services. I am going to pause there Ian for questions, thank you. Any questions for
Sir Robert Francis QC - 0:06:43
Ian? Robert. Thank you for that report and that reflection.
One of the things that struck me, reading the Ockenden Report, was the very concerning history of a Trust downgrading incidents from being ones which required investigation as serious incidents. I wonder what, if anything, there is in our inspection or regulatory activity that would bring
that sort of behaviour to light? I think it is something that we
Mr Ian Trenholm - 0:07:19
identified some years ago, but I think it is something we will continue to look out. We do look at individual cases on a sample basis, but I think one of the differences
between what we would do on a regular basis and what the Ockenden Report, the Ockenden Team have been able to do is they have looked in somewhat forensic detail at a large number of cases. Whereas we would tend, by definition, to only look at
a small sample. So, I think there is definitely a reflection point for us. So, how big are those samples, are they big enough what are the specific things that we would we would want to look at? So, there’s definitely some detailed reflection points for
us there. I think Chris wanted to add to that. One of the pieces of
Chris Day - 0:08:06
work that is ongoing at the moment, supported by James Titcombe, is looking at how we access more in real time the voice of frontline staff. So, we are doing some
work which will begin in early May, working with groups of midwives in services. You will know from the Ockenden Report, people have often felt worried about raising concerns to the course of their own line management. So we are doing a piece of work with
James, and with NHS Horizons and other organisations and regulators, to try to have a way of gathering the voice of nurses, midwives and others who provide health and care, all the time. So that it is not just at the act of a particular inspection,
but it’s an always on view, a bit like the Give Feedback on Care is for people using services. I think this might help, to your point, it might help unblock some of the things that you may not pick up from the act of an
inspection that happens over a period of time, looking at a particular issue. So I think, it’s not a perfect answer to your question Robert, but I think it’s an important ingredient moving forward, of how we give confidence to people in midwifery positions, in different
line midwifery positions, to allow us to use their information to drive improvement and change. Thank you. Any other questions for Ian?
Ms. Sally Cheshire - 0:09:45
Sally. Ian, thank you for the report and the reflections. I suppose the stark fact is the one you said at the end that
40% of maternity services are still “requires improvement” or “inadequate”. And in maternity, of course, there is no pandemic backlog as such because babies are born when they are born. But there is an impact on maternity services from COVID more generally in terms of staffing
and workforce. So, whilst it isn’t just CQC’s responsibility to pick up the recommendations from the Ockenden Report, how much positive change do you think we can have on what is our role in that, as we try to recover from the pandemic? Is maternity services
able to be something we isolate and focus on as a set of services, or is it just going to be part of the general improvement we want to see? Does that make sense? It makes a lot of sense, but I’m not sure I can
Mr Ian Trenholm - 0:10:40
give you a completely coherent answer. But, I think a couple of reflections just in response to that. I think when we look at Shrewsbury and Telford as an example, although the Ockenden Report focuses on maternity services, we have broader concerns around that hospital trust.
So, there is a position where the Board, the senior leadership team will be looking across a number of different services, and they will inevitably split their time and dilute their time, perhaps. So, this is not as if this is a single service in an
otherwise high-performing trust. This is a broader challenge. Alongside that, there will be very practical workforce recruitment challenges and some of that will be related to geography, and so on and so forth. I think there is a broader question around… maternity services are effectively unplanned
care to some extent. As you say babies come when they come. In the same way there is similar challenges in urgent and emergency care. I think we often see trusts that are struggling, do have challenges in maternity, they do have similar challenges in urgent
and emergency care. I think in terms of… so, what can we what can we do about that? What we can do is, we can use our convening power. We can bring others together and I think we have been doing that over a number of
years and we will continue to do that. But I think, you know, the very practical levers that we can pull in a sort of hard way tend to be around limitations on practice in some way, placing limitations on registration or ultimately closing locations. Of
course we have not done that, but what we can do is we can call for actions and we have done that to some extent in Shrewsbury and Telford as well. So, I think, you know, my broader reflection around the Ockenden report is what more
could we do? And, of course, there are other locations. There is inquiries going on in East Kent at the moment, and we will be reporting on other maternity services. There is a question for us around the degree to which we escalate some of those.
Whether we escalate them more than we have traditionally done and, if so, how best to do that. But, again, we need to do that with NHS England, with the Department, with the Royal Colleges and so forth. So, I think there’s a number of things
we can do, but I think one of the things it has exposed probably is that, in extremis, our powers are quite limited to closing places or placing limits on registration. There isn’t an investment power that we have. I think, you know, we need to
reflect on that in the long-term. Thank you. An important subject
Mr Ian Dilks - 0:13:34
clearly. Any other questions? Well, I think the risk of… Sorry, Mark. If I could… Thank you Chairman and Ian, thanks for this report that
Mr Mark Saxton - 0:13:42
you have given on the Ockenden Report which is very
challenging report to read and lays some responsibilities to us, as well, going forward. I just wondered… We are a member of the Maternity Transformation Programme Board and I wonder whether we can be assured that the contributions that we make to that Board are brought
to this Board, so that we can see how we are trying to influence an improvement in this area. Yes, I am certainly very happy to do that
Mr Ian Trenholm - 0:14:23
and I think, you know, it feels to me this area is a is a very important area,
both nationally and in relation to Shrewsbury and Telford. So, my inclination would be that we bring regular updates on maternity, that would seem to make sense to me. Thank you. OK. So, actually we should probably move on, but I think that the clear message there
is that even though our inspections highlighted the issue and we did
Mr Ian Dilks - 0:14:48
what we were required to do, the fact is problems persisted. So, we are certainly not sitting on our laurels and I agree with you. I think it is something that should come back
to the Board, so thank you very much for that. If we can move on, Kate, could I ask you to pick up your piece, thank you. Thank you.
Ms. Kate Terroni - 0:15:04
Good morning all. So, liberty protection safeguard. Board will remember that this is about the expansion of
safeguards to people who may have their liberty deprived in the community. This is also about expanding those protections to 16 and 17 year olds. The consultation has gone live and we are in the middle of preparing a response that will go back to the
Department on that. So, just to flag long-awaited consultation is now live and we are engaging with it, as you would expect. On visiting - a topic we have discussed at every Board meeting for a long while now, the incredibly important issue about people in
care homes having access to see their loved ones. As of the end of March, government has ended their guidance around visiting. So, the expectation now is that care homes should be enabling visiting to happen and that they should be following excellent Infection Prevention and
Control. We continue to look at visiting on every care home inspection and we continue to invite the public, people who live in care homes’ families and the workforce to get in touch with us if they believe that their care home is not following…, not
enabling visiting to happen in the way that it should be. We have examples where we have issued warning notices and taken regulatory action against a small number of care homes where we have not been confident that they have been making visiting happen in a
in a person-centred way. Two other briefings for me. Local authority assurance - we are very excited with local authority assurance and with our integrated care system work to be getting on with some piloting work between now and July where we are testing out our
new Single Assessment Framework methodology. We are going to be doing it with a couple of local authorities and the same efforts are happening with a couple of integrated care systems. So, that will give us an opportunity to test out the methodology and to think
about any changes we may need to make ahead of it going live in April 23. Then, the final thing for me is around workforce. We have had a really sharp focus on the impact on the challenges around recruitment and retention of the social care
workforce and its impact on quality and stability in the sector. Workforce vacancy rates in care homes still remain high, so they are remaining at 11.4%. That has plateaued, but it is still not… even though it has plateaued, it is still critical that we recognise
the significance of that vacancy number, which is significant. We have also been looking at when providers leave the market. So in your papers you will see a net reduction of about 2000 care home beds over the period of six months between October and March.
The majority of those beds, those care homes that have left the market are those that don’t have the nursing component. So, they are what we would call residential care homes. We have introduced exit interviews to try and establish what is prompting those providers to
leave the market. It is early days, but those exit interviews are generally showing us that these are planned exits from the markets. So, these might be care home owners that are coming up to retirement and as part of a plan that they have had
for a while, they are exiting. But we are seeing workforce being excited as a reason for some providers leaving the market. So we are going to continue to focus on that, and that will feature in our State of Care Report that will publish later
this year. So we are going to continue to look at the impact on recruitment and retention, on continuity of care and quality. And we will continue to look in terms of market stability and whether the challenges around workforce are prompting more providers to exit
than we would anticipate. Thank you. Any questions for Kate? Or other observations from colleagues? Robert. Thank you. Thank you for the
Sir Robert Francis QC - 0:18:53
report. I actually wanted to ask you about something that wasn’t on your list. But a matter, I think, of some importance, which is
what progress we are making, or is being made generally, in relation to the placement of young people in institutions far from home and in unsuitable circumstances. I know that we have been doing quite a lot about that, but I wonder what impact that is
having. So, that is a really important topic, Robert, and I’m happy to
Ms. Kate Terroni - 0:19:23
answer it now. We could also pick it up under the Out of Sight Report that we are going to cover shortly, which will show, reflect on the collective efforts made across all
different stakeholders and the fact that there has been lots of effort, but that hasn’t yet translated to consistent improved outcomes for individuals. So if you are happy, we can get into a bit more detail on the Out of Sight Report if that’s OK. Thanks Kate, and
Mr Ian Dilks - 0:19:49
Robert. Any other questions for Kate? OK, thank you very much indeed. Rosie, over to you. Thank you very much. So three brief updates from
Ms. Rosie Benneyworth - 0:19:57
me. One just to update the border around our clinical search work, and it’s great news because now we are able
to develop these searches in all practices. Before, we could only work with two of the big suppliers - EMAS and System One. We are now able to make those searches available for practices using Vision, so we have now 100% coverage of all practices across
the country, which is fantastic news. The second area, I just want to touch on the Ukraine crisis. I think we are all very, very distressed about what we are seeing in Ukraine. We have particularly had a focus on refugees and making sure that refugees
coming into the country get good and appropriate care and treatment. We had done some work prior to the Ukraine crisis, looking at care and treatment expected for refugees, and had already an existing myth-buster in place on our website. We have reviewed that and we
have recirculated it to providers to ensure that everyone is aware about what we expect from providers when they are looking after refugees, and to make sure that people get the appropriate care and treatment. We have also been working with the British Red Cross and
we are working with our inspectors so that we can make sure that any themes or any concerns, any feedback that we hear, we feedback and we are aware of quickly so we can take appropriate action. So, please, if you are a provider listening to
this, please do have a look at that information and have a read of it. Because it is really important that this group of people who have specific needs, get the care they need. Finally, we… some of the Board will remember we published a report
called Smiling Matters a couple of years ago and this looked at the oral health provision in care homes. As some of the Board will remember, at the time we found really quite shocking things. People with no access to dental care, some with no access
to a toothbrush and clearly this has a major impact on people’s dignity, people’s symptoms, from oral health problems and also from their general health and wellbeing. So, if people can’t eat, they lose weight and often they have problems as a result. So it is
a really important area and we have been working with a group of stakeholders across the system to look at the recommendations that we made in that report. We want to make sure that action has been taken as a result of those recommendations, so we
will be looking and reviewing those recommendations. So, we are just about to start that work, working very closely with Adult Social Care colleagues. Thank you. Thank you very much indeed Rosie. Any questions
Mr Ian Dilks - 0:22:59
or further comments? OK. Rosie, thank you very much indeed. So, I
think that deals with the main inspectorates. Let’s move on to one or
Mr Ian Dilks - 0:23:11
two other areas. So I think next up is Operations. Tyson. Thank you.
Mr Tyson Hepple - 0:23:21
Not much to add to my written report Ian, other than to say that I have flagged up last month
for the reasons set out, particularly the shift in Adult Social Care from the more straightforward Infection Protection Control inspections to more complex Risk and Improvement inspections. The overall number of inspections have gone down in March compared to February. However, when we look at the
performance of the Direct Monitoring Approach team and the Registration teams, the performance has been stronger in March than it was in February. So, very much as was trailed last month, and I think more or less for the briefings I set out then, but covered
in more detail and with all the figures in in my written report. Thank
Mr Ian Dilks - 0:24:01
you very much indeed Tyson. As you say, there is more in the document, but any questions for Tyson? No, we are going through very quickly this morning. Tyson, thank you very
much indeed. Chris, over to you, I think, for comments on Operations
Chris Usher - 0:24:20
no sorry Performance. Yes, this is the February update. We have got a full review of the year for next month as part of the year-end close. So, just three areas to pull out
for this month, as well as a finance update. So, building on Tyson’s point about delivery and what that means in terms of business plans. To the end of February we had either inspected or done a direct monitoring call with just over 25% of registered
providers. The two other regulatory approaches we have in addition to that, so a public statement where there isn’t a concern about the information we hold, or information of concern we receive through safeguarding, whistle-blowing concerns and complaints. Factoring those two regulatory approaches in means we
have had regulatory contact with over 75% of services this financial year. In registration, we have a target to reduce our timing lists by 15% this year. That’s the end-to-end average completion time. The performance continues to fluctuate during the year with timing lists for normal
applications reducing by 17.6%, so exceeding targets, complex by 2.1% whereas simple has increased by 8.6% to the end of February. So, it is variable across the year which is partly due to being a demand-led service. Alongside that registration, we have completed and processed over
30000 registration applications this year, so in terms of recognising the volume we are dealing with. Then the last area. Just in terms of key publications, we continue to monitor how our publications are accessed in the first three months after going live. With State of
Care it has received over 24000 views in the first three months since publication. Surveying of stakeholders shows that there has been positive feedback received to date which is good. And finally for me, in terms of finances at the end of February we underspent on
our revenue budget by just over 15 million. This is forecast to reduce by the end of the year to 12.8 million. And on capital, we are 2.5 million underspent to the end of February, which is forecast to reduce to 0.8 million by the end
of the year. Ok, thanks Chris. Obviously the figures you are quoting
Mr Ian Dilks - 0:26:36
are to the end of February, so I think you are right in saying a full year-end report will come to the public Board next month. OK, thank you, So, any questions for Chris on his
comments? No, Ok. Kirsty, People Plan. Thank you. So, we launched our
Ms. Kirsty Shaw - 0:26:59
first People Plan back in 2020 and we have made some really good progress against that. So, we are now in the process of refreshing our People Plan to really make sure we having
a holistic approach to making CQC a really great place to work. This is a comprehensive plan which will cover capabilities, culture, pay and reward, talent, diversity and inclusion, as well as our structures and processes around how we work and run our business. This plan
is in train at the moment and what we intend to do is bring that back to this Board on a quarterly basis to review our progress. The new refreshed Plan will provide us with a baseline against which we are managing and monitoring ourselves. So,
it was just to basically update that that work is in train, and then from, I think, next month we will start to bring that forward quarterly for a more detailed discussion on People. Thank you. So, flagging more to come, thank you very much. Any
Mr Ian Dilks - 0:28:00
questions for Kirsty? No. OK. Mark, information on the cyber-risk
Mr Mark Sutton - 0:28:13
security. Thank you Ian. A short one from me. We have no cyber security or information incident reports in the last month. We continue to follow the guidance from the National Cyber Security Centre and continue
to make good progress in our ongoing cyber security improvements and our internal information security training. Chris, you wanted to
Chris Day - 0:28:40
Mr Ian Dilks - 0:28:42
comment. No not on that. I was just preparing for… I’m next. Red buttons flashing around here. OK, any questions for Mark? Mark, just a quick
Mr Ian Dilks - 0:28:58
one. You talk about our sort of benign experiences, probably the best way of putting it is, to the best of our knowledge is that what is happening in the rest of the system. Or are we faring well compared to some others, do we know?
I would probably need to come back to you on that, Ian, to get a system view. Certainly we, as with other all other organisations have a constant level of cyber security threat and attack, but again, as with other organisations we have appropriate mechanisms in
place to protect ourselves against those. That was probably a bit unfair asking you a systems question. Sally. Thanks Ian. Just to
Ms. Sally Cheshire - 0:29:42
reassure you on that point, given that you have just joined CQC. We do take cyber security and disaster recovery very seriously, so we
now have a quarterly report that comes to our audit and governance committee. And there is an internal audit programme which is looking at how we can continue to improve even though Mark is reporting no incidents. Thanks Sally, very reassuring. Any other questions for
Mr Ian Dilks - 0:30:03
Mark? OK. Chris, you can now hit
Chris Day - 0:30:11
your red button and over to you. If Mark ever has a loan of one of those, we are in a lot of trouble. Probably out in the room, in the corridor. Just three points from for me. As colleagues will know, the Health and Social Care Bill has completed its stages in both the House of Commons and House of Lords. It
is now at the Consideration and Amendment stage which is the final stage before Royal Assent. A couple of the amendments, just for note, that are important to us in particular. An amendment that requires staff to receive the appropriate training around learning disabilities and autism
was accepted by the government, in the House of Lords stage. There’s an important element to us, obviously that will feature in terms of our regulation of those services. And there is also an amendment requiring the Secretary of State to produce a Code of Practice
with regards to training on learning disabilities and autism. So those are just two things of note that have come in at the final stage. There is continued engagement with peers, the Department of Health and Social Care and also with colleagues in the committees. We
expect the Bill to complete the parliamentary process by the beginning of May, and certainly because the Queen’s speech is, I think, on the 10th or 11th May. So, it has got to be through that process before then. The second point just we… as colleagues
will know… we have an external Advisory Group and in the recent months we talked at that committee about both the Single Assessment Framework and also our oversight of systems. We have already begun to talk a bit about how the data and insight will change
both for providers and persistent partners. I just wanted to convey to Board the excitement that both providers and system leaders have particularly around the ability to capture and use information to benchmark themselves against other services. Mark gave a great presentation at the last (unintelligible)
meeting talking a bit about how the data we hold will be able to give providers an early indication. We talked about this earlier. The early indication of how they perform against services like them. I think this is a tremendous element. It isn’t just about
the act of regulation and what we do, it is also about giving providers the ability to see the things that they need to do to improve their service. There is lots of support for that, lots of support for that for that opportunity. I think
there is also a strong support for the ability for us to take both a system and a service view. The idea of a Single Assessment Framework that is able to bridge between individual organisations and also between ICSs and local authorities, again, had strong support
and both Rosie and Kate came to a conversation where that was discussed in detail. So I just wanted to give a flavour of the support there is in both the organisations that represent people who use services and providers for that work. Actually, a lot
of support for people being part of the testing regime that will need to be supporting both. So, I just wanted to make people aware of that. And just finally to round up, we talked about this earlier, but the round table that will take place
on the 5th of May - which is International Day of Midwives - which has been put together by people who use services and by sector partners sponsored by ourselves. It will give, I think, an ability to bring together what we know about how services
are working at the moment to Ian’s convening point, but also try to share both good practice and also why in some areas we haven’t been able to unpick what lies behind some of the issues around maternity services. Why some are struggling to improve? I
hope that round table will spark a further conversation, particularly with front line staff, about their approach, what could change. We did this in in urgent and emergency care which led to the Patient First document. I hope for something similar with maternity services as a
result of this, and also obviously I will keep Board apprised.
Mr Ian Dilks - 0:34:27
Thanks Chris. Presumably you will report back to the Board after that round table. Indeed, will do. Any questions for Chris? No. So, that seems to bring us to the end of the Executive Team’s report.
I suppose just before we move on, any other questions people want to ask Ian or any other member of the Executive? No. OK, well thank you very much indeed Team. We will move on to the Out of Sight Follow-Up Report. Kate, I think you’re

Out of Sight Follow Up Report

going to lead this, but also we welcome Debbie Ivanova and Alison Carpenter. I don’t know if those watching on video can actually see people at the end of the room, but we have been joined with them, but Kate I’ll hand this over to you.
Thanks. Fabulous. Thank you Ian. And thank you for the opportunity to
Ms. Kate Terroni - 0:35:16
talk about this really important topic. So, I will shortly be handing over to Debbie Ivanova who is our Director for people with learning disabilities and autistic people, and Ali who is our Delivery
Manager for Out of Sight. But before I do, so just a couple of words from me on this, if I may? So, since last Board we published our Progress Report on Out of Sight and this is our follow-up work to the Out of Sight,
Who Cares? publication that we published back in October 2020. You will all remember, it is a fantastically well-written report that really benefited from having people stories throughout it, which really brought to life what it meant for individuals to be placed a long way away
from their family home and to experience restraints, seclusion and segregation. So, we published what I think was a really hard-hitting report back in October 2020, that called for very specific action from a whole wealth of system partners, including ourselves. The Progress Report we’re going
to talk about today reflects and acknowledges that we are all on the same page. We all want to do better for this group of people. We have the same ambition. There has been a huge amount of investment and financial investment and focus on this,
but ultimately, has all that effort led to consistent improved outcomes for people with learning disabilities and autistic people? The answer is No. So, I think it is really critical that we recognise the amount of effort and work that has happened over the last 18
months. But that effort in itself isn’t good enough because it has not yet translated to things being better consistently for that group of people. That is what this Progress Report talks about, so without further ado, I am going to hand over to Debbie to
draw out for you a couple of the key components of the report, and then we will open it up for questions or comments. Over to you, Debbie. Thank you. It’s a really important report because when we first published the report, we promised that we
would follow up on those recommendations and talk about the progress that had been made. But what we have found is that there are still too many people in hospital. They are staying there for too long and they are subject to many restrictions. There is
not enough support in the community, and when people do get that access they have had to already reach a crisis before they do so. So, the whole system is not really working in the way that is best going to meet the needs of people
with a learning disability, autistic people and people with mental ill health. This is about people’s lives, it’s about people’s rights, it’s about their expectations and their aspirations. In many of the reports what we see as a shocking lack of ambition for people. The focus
is very much on these are supposed to be services where people go for assessment and treatment, but that isn’t what happens. They end up living there for many years. When we worked with families and people with lived experience to publish the first report, they
took ownership of that report. But they were very clear with us that there was more that CQC could do as well. That is why I wanted to have this discussion today, because we have a really important role in making this happen and making the
changes occur. We are in a position where we can hold people to account, hold our partners to account, where we can continue to leave a pressure on the system to make those changes that need to happen. We also, I think, have a responsibility to
change the dialogue around this. The families that I was speaking to yesterday were talking about reimagining the system, thinking about people not services, actually starting to change the dialogue from conversations about challenging behaviour to people whose communication needs are not being understood or met.
I think CQC has got a really important role to change some of those perceptions. We also need to follow through on what we find in our inspections of services. We cannot accept unacceptable practice and we need to be both saying people cannot move into
these services because they are not safe, and people can cannot continue to live in these services when their needs are not being met. So, we need to do that, but we also need to support improvement, looking forward at the work that we can do
to try and change the system. Fundamental, I think, to a lot of this is both commissioning and funding which are areas that are difficult for us to get involved in directly. But with our work moving into looking at local authority assessment and ICS assessment,
we should be able to also look at how we can support change for this group of people to happen. In 19 - I’m going to just read this to you - because in 1988 the King’s Fund talked about people living in ordinary houses in
ordinary streets with the same range of choices as anyone else, mixing as equals and being treated as citizens. That was 1988. We are still going round that same circle now and it really is, I think, we are in a great position to be able
to try and make some of those changes happen. Thank you very much.
Mr Ian Dilks - 0:40:26
Turning to my colleagues, any questions or comments? Stephen. The Report is really good, it is very hard hitting, I completely agree. It
Mrs Belinda Black - 0:40:41
clearly outlines what needs to be done. So, what sort of leverage do
you think CQC can do to 1) speed up change and influence other agencies, and keep it, you know, there in focus all the time? Well, I think one of the things we can do is keep it in the public focus. I think that’s really
important that we keep returning to this and talking about it publicly. But it is both through our enforcement action and the action we take where care isn’t good enough, but also using Right Support, Right Care, Right Culture – our policy that outlines the model
of care that we expect and, therefore, as things come through registration making sure they meet the right standards of care. That does leave us in a slightly uncomfortable position because at the moment, we are in a position where we are saying no to services
because they don’t uphold that model. Some of those services are being created for people to come out of hospital to, but they are recreating mini institutions in the community, or on the outskirts of communities, which is just not what should be happening for these
people. So, it is sometimes quite an uncomfortable line we are taking because it feels like we are restricting at both ends of the scale. But that pressure is the only way that commissioners – I am working with commissioners constantly, I’m talking to commissioners about
what they need to be thinking about when they are looking at the services that they want to offer. So, it is it is very much using our improvement arm, as well as our regulation arm, to be able to take action from both sides and
support the sector to improve. Kate, I think you wanted to add to
Mr Ian Dilks - 0:42:15
that, and Stephen, then we will come to you. Thank you Chair, and
Ms. Kate Terroni - 0:42:19
thanks Belinda. So, as Debbie says, we are shaping the market through our approach to what we are registering and
we are holding established services to account for delivering, kind of, high-quality, person-centred care. Debbie and the team are working really closely with commissioners. I think we are doing everything in our power and we will continue to do so to drive this agenda forward. I
think it would be fantastic if there was a commitment from all commissioners, so for everyone who purchases services to commit to not buying new services from inadequate provision. So, a number of years ago in local government, ADASS, the Association of Directors of Adult Social
Services, made a public statement that they would no longer buy new packages of care from inadequate home care providers, inadequate care homes. Wouldn’t it be fantastic if there was a similar commitment that says, actually, we are not going to move someone from a service
that CQC has closed down because it is so poor into another service that we have rated as “inadequate”. That feels like quite a reasonable thing that as a system that should be committed to. So I would like to call for that. If there are
any people listening to whom that applies, it would be interesting to
Mr Ian Dilks - 0:43:35
hear. Stephen, over to you. Thanks Ian. Debbie, thank you very much
Mr Stephen Marston - 0:43:37
indeed for the Report. I wanted to pick up your comments on Page 24 of the Pack about the staffing position, because
you use the language of “we have seen a staffing crisis develop”. In my part of the country, recruitment to learning disabilities nursing is the hardest thing to recruit to of all of the medical nursing allied health professions. People just don’t want to do it.
So, all the way up the supply chain of skilled staff, we have got a problem. Not enough people want to do it, they may not then be getting the right training, they are not then going into cultures where they are sort of supported to
be doing the right thing. That is quite a big set of issues just in itself. Do you think… I mean which organisation or organisations should we be looking to try and sort that bit out? Because without the right supply of skilled staff, we can
or can’t get that increase in high quality supply that Kate was just talking about. Yes, that is absolutely right and I think there’s two big issues. It’s attracting people into the sector, getting people to understand the value of this work. I started as a
care assistant and, you know, I wanted to do this job and I wanted to have a career in social care. Many of my colleagues are the same with nursing and starting off in this job, because you want to do it, because you have got
the right values, because you actually see it as a career, I think, is incredibly important. The other bit, it is about those terms and conditions and people being valued in their job for their pay, and being able to see that there is that progress
available. And, the training that staff have has to be right. I think Ali would be able to confirm that the most difficult situations that we have seen have often been where there are a lot of temporary staff, bank staff, coming in services. They don’t
know people, they don’t understand how to work with them, they’re not properly trained. They use restrictive practice as a way of operating because it is the only way they know how to deal with people, rather than actually understanding what is going on in that
service. I don’t have the answers to the staffing crisis, but I do think we have to start thinking about this as an incredibly valuable occupation and that isn’t the way that it is seen at the moment. Thanks. Sally, or Robert? Pointing at one another and no red buttons. Robert.
Sir Robert Francis QC - 0:46:19
Thank you. And thank you very much
for this frankly shocking report. When you look at the cases, we have kids who have, in effect, spent their entire life as children in the wrong place, not being treated well and with no apparent provision elsewhere, more satisfactory provision being available. Firstly, I would
presume that people in this position are being, in effect, actively harmed by the care they have been provided with. Secondly, if that is the case or maybe the case, then clearly this is not just something that needs talking about, as we do, it is
actually an emergency. Do you see any evidence that those who are responsible for commissioning services are treating this as an emergency? And if not, when we talk about accountability, who is accountable and how are they held to account? So, I think there is a
growing sense that this is an emergency, and that if things aren’t changed this time, then, you know, we cannot continue to go along this path and there needs to be those changes. Certainly the people that I talk to who are commissioners in parts of
the NHS, for example, do understand that it is different, things have to be done differently. I think the problem is moving people along quickly and getting people to really see this fast. And families, what families are telling me is the only way to get
fast movement is to go to the media, which is dreadful to have to tell their stories publicly being the only way that they can actually get that urgency to it. However, there is… if you want to do this well, it sometimes does need a
bit of time. So there are organisations, for example, who set up small supports for people coming out of hospitals. They are also under pressure at the moment because commissioners are saying to them, we want you to provide these services but we want it next
week, or the week after. It actually takes a little while to develop it. So, it has to be done at the pace that people can be moved safely with, but I think what we need is an increase in providers who want to take on
this work, who are coming forward to say we can provide this care. This is the model, this is the right model to do it. And the funding needs to follow those people and the commissioning needs to reflect that, actually, as this person moves around
the system, the funding that they were being used to pay for in hospital should be available for them to be able to have that right accommodation in the community. That is often where there is a problem because the local authorities, when they take the
person back out of hospital, aren’t able to actually have that funding to travel alongside them. (inaudible) Robert? I mean I hear what you
Sir Robert Francis QC - 0:49:25
say and I quite understand why you said it, but we have been saying this, you have been saying this, Debbie, now for
a long time. In the meantime some of these children have been actively harmed, so I wonder is there no more we, as a regulator, can do in those circumstances? I appreciate we are refusing to register places that offer the same level of care, but
we are still registering places that are in existence because that’s the only thing available. But I am beginning to wonder whether not taking any specific cases, some people would actually be better off having no care at all than what they are actually getting. But
that is probably a dangerous thing for me to say. So, it would be, it would be accurate to say that we are also closing down
Ms. Kate Terroni - 0:50:11
services that are not. So, we are shaping the market by what we are registering, but also where we are seeing people getting poor outcomes and providers not being able to improve, we also taking
action to close down services. In the middle of that we are placing restrictions and requirements on providers to do better. But in doing so, as Debbie said, we… because of the action we are taking to reduce the capacity of the wrong type of care
or the care that doesn’t get the best outcomes for people, that is increasing the pressure on the clinician on a Friday afternoon who is trying to support someone at the point of crisis. What we are saying and what we said in Out of Sight
is we need a comprehensive crisis response across the whole country. A consistent opportunity for people to access crisis support in their own place of residence before it escalates to the point that someone would even consider a placement 200 miles away from home as the
right outcome for that individual. So, we are shaping the market, we are closing services and we are also placing restrictions or requirements on services to change in the meantime. But in doing so, we are putting pressure on a system that is already pressured. Thanks
Mr Ian Dilks - 0:51:21
very much, Kate. I think Robert’s question, to some extent, remains on the table though. You know, we have identified the problem, we have told people, but things are not improving, as you said right at the outset, the way we would wish. So, I think
it is an open question, just to think about it. Is there any more that could be done, or should we be shouting more loudly? Robert, thanks for the question. Sally, now over to you. Thank you Ian. And thanks to Kate and the team for
Ms. Sally Cheshire - 0:51:45
your report which is quite shocking, isn’t it? Just by way of context, although the Out of Sight Report specifically talks about people with a learning disability or autistic people, there is a wider context in children’s social care that people may be aware of around
placements a long way from home for general mental health segregation, and also for children in care. So, it is part of a wider context which does raise some questions about commissioning and funding more generally. Just to follow on from what Robert said about accountability,
I think it is the same point I made about maternity services before. CQC, well for Kate and team first of all, because a lot of our services for people with learning disability or who are autistic are rated “good” or “outstanding” now, is there any
work we could look at between those overall positive ratings and the improvement that we have seen versus these individual cases? I don’t know whether there is a mismatch, whether all of the individual cases are actually in institutions or providers who aren’t rated “good” or
“outstanding”. Or, whether there is a bit of mismatch, does that makes sense? I think some more information would be good on that. But in terms of accountability, CQC are limited, aren’t we, in terms of what
Ms. Sally Cheshire - 0:53:08
we can do? We can raise the issues, we
can convene providers - exactly what you said about maternity - but we wouldn’t want this to be a similar case to maternity that we have talked about before, where we raise it and we raise it and there is no action. So, I think Robert’s
question is still on the table and it will be helpful to think about what we do, as part of a wider group of people, to try and effect a
Mr Ian Dilks - 0:53:36
bit faster improvement. Thanks. So, I think they are absolutely the right questions. What we have
Ms. Kate Terroni - 0:53:39
seen is a 25% increase in the enforcement action that we have taken against services for people with a learning disability over the past year, the 2020-21 year. That will continue. I mean obviously we are focusing on services where they are at risk and that
is what we are going out to see and that is seeing some of the ratings change. We are getting more information from people about the care that they are receiving which is helping to direct us into the right services to go. We do need
to go out to a lot of others as well to see what is happening. We are also channelling a piece of improvement work and looking at supported living services which is where a lot of the people are moving to, out of hospital, and looking
at how we can support the sector to really improve and identify what are the key fundamental issues that make a really good supported living service. That is work in progress at the moment that I would like to talk to you all about, on another
occasion, in a bit more detail. There is some really good practice out there. We do include that. We have the Home for Good Report that was published earlier this year which talked about some of those particular services, and what fundamentally makes that good service.
But the bottom line is that the right services are not available in the right place, and so people are having to travel, people are having to move to areas outside of where they need to be. And it does need the integrated care systems to
really think about what is the needs of their population, and how do they meet the needs of all of the people who live in their area. How do they bring back those people that are outside of their area? And how do they have a
plan for those people that may be coming through the system, those young people who, when they get into adolescence particularly young autistic people, who may require support to be able to stay in their own communities? I think this is the big challenge, and this
is the big challenge to make it happen quickly. Because, I think you know, to get into the integrated care systems working really well and functionally, that is going to take a bit of time. But this needs to happen now, which is why we need
to, kind of, continue to keep that pressure on. OK. Thanks very much. Mark, we should probably make this the last question but… I think it
Mr Mark Chambers - 0:56:06
is a tremendous report, I think… the lack of progress is stark and you are right to paint it as
you paint it. Some of the personal stories that are in there are shocking and shameful and it clearly demonstrates the impact on the individuals involved and their families. I think that is why we should look sort of wider than this. The impact goes beyond
those using services and their families because there are a large number of families and carers who will be not prepared to put their loved ones into a situation like this, and are not currently confident enough - and rightly not confident enough - to take
advantage of the services that should be available to them. So, this is… it is not just those directly caught up in it. Any further
Mr Ian Dilks - 0:57:14
comments. Debbie. I think that your comment you just made there was really vital because there’s lots of families, you know,
with children that are growing up now and they are not able to get the support. They are the people that are going to be admitted into hospital in the future, and so changing looking at the whole system is what is needed and absolutely vital.
Mr Ian Dilks - 0:57:40
Well, thanks very much indeed, Kate, Debbie and Alison. Thank you very much from that. I think you got from the questions and (unintelligible) taken, I think clearly you have rightly said we need to keep on those, but I think there’s some questions left on

Healthwatch England Update

the table as well, for us reflect on. So, thank you very much indeed for all the work you’re doing. We look forward to hearing from you again in due course. Thank you. Time to move on. Robert - Healthwatch England. We would like to hear
from you, as to what is going on. Are you going to be joined by Louise? I am rather hoping Louise is here to present her report, he said emphatically. There she is. Louise, welcome. Have a seat at the end. We have just moved on
to the Healthwatch update, so Robert and Louise, over to you. Well, I think everyone has met Louise. She been to the Board once before to introduce herself, but this time she has had the opportunity to get
Sir Robert Francis QC - 0:58:36
stuck into the work and she has a
report to present. Over to you, Louise. Thank you Chair, and thank you Sir Robert. It is a real pleasure to be here. So, in the detail of the report, you will see achievements which predate me, so those are all down to Robert and the
team. They should take the credit. So, I have been the National Director of Healthwatch for just over a couple of months. I feel like I have inherited an incredibly strong organisation, a very influential organisation that achieves really a huge amount of impact in bringing
to bear the voice of people and patients to improve health and social care. Some of the great examples in the report, that you will have read, include any commitment on dentistry, including a fund of 50 million pounds to support access for children to NHS
dentists, a commitment by NHS England to review the Accessible Information Standard and some really strong policy influencing and messaging and advice for providers on the Elective Care Recovery Plan and waiting times. I was on the BBC News last week emphasising the need for people
to be supported with better communications, better pain relief and better support for their mental health whilst they wait, given that waiting seems to be a fact of life now. So I see in Healthwatch England an organisation not just shouting into the ether, but being
very clear about the change needed. I see a very strong line of attributable impact in terms of system change, but much more needs to be done of course both by Healthwatch England nationally and by the network. But to be able to do this, we
have got to overcome some challenges and in the paper you will see reference to the State of Support which is an analysis of the funding for local Healthwatch that the team have undertaken. Now funding for local Healthwatch network is, in real terms, around 50%
less than it was in 2013-14 when it had its original allocation. It has around 24 million pounds now to be shared between 152 local Healthwatch. And the complexity of how local Healthwatch are funded is also, I think, a problem in some ways. Only 74
out of the 152 local authorities comply with the direction of the Department of Health that the majority of funding for local Healthwatch should come from the local government settlement, as opposed to the local reform and community voices grant. So, there is some change needed,
I think, in terms of the way money flows through the system and to local Healthwatch and how its commissioned, notwithstanding obviously the pressures on local government. The Healthwatch Committee and all of the team are looking at longer-term solutions to the issue of financial sustainability
for the network. Then the second big challenge, although of course it’s also an opportunity, is how local Healthwatch work across integrated care system footprints; both from a governance point of view so that is how they can feed in public views and how those need
to be taken into account across ICSs, and also how ICSs might fund groupings of Healthwatch to do engagement work. So, we are providing support on both of those fronts and I am meeting a number of Chairs and Chief Executives of Integrated Care Systems, building
on Sir Robert’s meetings with some of the new appointees. So I have only got very brief comments and I am going to end them by reflecting on the Secretary of State’s speech on the future of health and social care that he made on the
8th March, and that I was happy to have been able to have some input into. We worry sometimes that the voice of people slides down the policy ladder in health and social care, but he said “I want to put power back in the hands
of people and their families to improve their voice within the system. We have taken bold steps in response to scandals, like the Francis Inquiry, but these kinds of scandals were because people were not listened to earlier. We need a new approach that is about
more than individual experiences and complaints. It must be about continually listening to patients users and their families.” We were quite heartened by that. You know it has been a long time since a Secretary of State has said something like that. So, obviously we will
continue to work to make this a reality, at both a national and a local level. So thank you and obviously I am open to questions. So, Robert, do you want to add anything or shall we go straight to questions? I would just emphasise the
Sir Robert Francis QC - 1:03:40
importance and significance of what Louise said about the state of support. One might actually call it the lack of support. I write to the Secretary of State once a year reporting on that, and it’s received usually with some concern at the Department of Health.
But because of the byzantine way in which money is filtered from the Department of Health through to local Healthwatch, no one seems to have the levers with which to do much about it, and that concerns me. I have done my best over the years
and I will continue to do so. But if something doesn’t happen, then the voice of the people will not be properly listened to. In fact. I’m sure Kate would wish to remind me, of course, it is the Department of
Mr Ian Dilks - 1:04:25
Health and Social Care. Rosie.
Ms. Rosie Benneyworth - 1:04:33
Yes thank you, and thank you very much Louise for your report. Just a couple of points from me. One is to say we continue to have really good relationships between our inspectors and local Healthwatch, and that is very important in terms of that information
sharing and hearing about local services. So thank you too to all the teams involved. A couple of specific points, I was really pleased to see the focus on dentistry. I think it is an area we have been very concerned about as well. We published
a report last year about access to dentistry and hearing very distressing stories of people not getting dental care, and particularly around children as you highlighted in your report. It is going to be a theme as we look at integrated care systems because I think
it is a commissioning area rather than the individual providers’ quality very often. So, it is going to be a theme that we need to think about in terms of integrated care systems. So looking forward to working with you on that because it is very
poor at the moment. The second area, just to say really looking forward to working with you around the integrated care system regulation as well. I think it’s absolutely vital that local Healthwatch has a really strong voice and that people are fully involved in integrated
care systems. It is something we will be looking at when we assess integrated care systems, is how people are being involved by their integrated care system in development of plans and delivery of services. So looking forward to those discussions. Thank you. Chris. I just
Chris Day - 1:06:14
wanted to thank you and the team for your support on the Give Feedback on Care campaign and sort of echo Rosie’s point. I think the challenge moving forward is how do we make the act of giving feedback something that is always on, that is
constantly providing the feedback. Not just so that we can understand how individual services are performing, but also people’s experience of access and system performance through an area. So, I know your part of the work will do on the 5000 voices and the work we
do on systems moving forward. I think that is a real opportunity to ensure that we embed the voice of people in the way in which we regulate ICSs and local authorities. I know we have built up a strong partnership over the last years in
that space. I think it is important we can go back out with a collective, united voice to the systems, that this is something that will remain our focus. But thank you. Thanks Chris. Any other…? Sally. Thanks Louise. It is not a question, but just a comment really. I
Ms. Sally Cheshire - 1:07:22
think we have expected someone to say it, but there’s a huge range of work that you have done in this report. It is actually quite a lengthy report. So well done to the team, even if that only included you latterly, for the whole of
the whole range of things that Healthwatch look at which, I think, is a really valuable strategic report back to us. Just in my role as Audit Chair, you will be aware as well that Healthwatch England come to the Audit Committee once a year, not
to report on these plans and accomplishments, but to report on finance risk and governance. We had that meeting in January. I just wanted to reflect for the public really. My colleagues and I were all very impressed by the depth to which that those risks
around, not least finance but lots of other areas were recorded. So compliments to the team about that. Given what Robert said about funding, we do still see that as one of the major risks and we will just keep it in view. Thank you Sally. Any other questions
Mr Ian Dilks - 1:08:29
or comments for Robert or Louise? No (unintelligible). OK, well, look, Louise, thank you very much for joining us. Well done on – I think as Sally said – a very long piece of work, so well done to you and to the team. Robert, thank

Summary of Audit and Corporate Governance Committee

Mr Ian Dilks - 1:08:49
you very much for introducing, I appreciate it. Thank you Chair. If we… almost the last item, I think, on the agenda. Sally, we will turn to you for an update and summary of the activities of the Audit and Governance Committee Chair. Thanks Ian. So,
Ms. Sally Cheshire - 1:09:09
as you know, for reasons of assurance we report back to the Board on our Audit and Corporate Governance meetings. The last one was held on the 30th of March and there is a report in the pack. Just to bring out some brief highlights. So,
we clearly look at our internal audit programme and I am pleased to report that we have received the vast majority of the reports in the programme, with the final two going to be received in June. So, we looked at progress and management’s actions to
address all of those points and we also looked at what we hope will be a positive Internal Audit opinion for the year. That also comes in June, we haven’t finished the year yet. In terms of risk, we always look at our high level CQC
risk register and discuss the changes to that. We also had quite an extensive report on management assurance. So CQC complete an annual management assurance process that looks at improvement across the organisation in a number of key areas. We received assurance about that. That ties
in the internal improvements we have identified with the improvements that our internal auditors identify we should make so that CQC continues to be a more effective organisation. Our Committee expressed confidence in that process and also in the specific item we looked at for the
National Guardian’s office. So a few minutes ago I just complimented Louise on the fact that we believe Healthwatch England has quite a substantial and comprehensive risk management approach. At our last meeting we also looked at the National Guardian’s office and concluded the same. My
colleagues were allowed to and did express a few minor improvements that could be made, but thanks to Robert and Louise and Jane, the new National Guardian, for the work that they have done on that. We will to monitor risk across CQC and in those
two organisations as we go forward. As you know because Kirsty reported before, we have a transformation programme and we look at that in more depth through a sub-committee We have seen a lot of progress in that area in recent months and that sub-committee continues
to monitor the progress of the transformation programme. Just in terms of external audit and our annual report and accounts, the National Audit Office, who are our external auditor, are currently starting year-end processes. It is reassuring that they haven’t found anything concerning to date. We
have a programme and timing for the production of our annual report and accounts which will have, obviously, Committee, Board and Non-Exec input. We will face the same delay this year probably in the assurance of local government pension schemes, but that’s a broader public sector
issue that doesn’t just affect CQC, it affects many bodies. Finally, we look at any counter-fraud allegations, not cases, but allegations against our staff. I am pleased to report there are a very low number, but the committee is keeping an eye on that anyway. So,
all positive from my point of view unless my colleagues want to add
Mr Ian Dilks - 1:12:45
anything. Thank you very much Sally. Any other member of the Committee wish to comment or questions from anyone else on the Board? No. it seemed pretty comprehensive Sally. You have a huge
Mr Ian Dilks - 1:13:00
agenda, so thanks very much indeed for taking the Committee through its task and them all through the conclusions. Appreciate it. I think that is bringing us almost to the end of the formal business. A few closing remarks, but I mean, firstly, I should ask

Any other business

if there is any items of any other business. So I will sort of look around the table, any other business that people want to raise? It appears not. OK, well I think… we seem to be running slightly ahead of time, but I would just
like to thank my Board colleagues. This my first meeting, but thank you for your support in taking through. Thanks to those who joined us. I should at the beginning - my mistake – introduced Taofik Balogun who joined us from our - excuse me –
one of our networks representing all the networks, so thank you very much for joining us. And, of course, to Debbie, Alison and Louise who presented. If there were been any questions from the public, we would have taken them at this stage. In common with
Mr Ian Dilks - 1:13:58
many other public bodies, we are continuing with this virtual way of working for the present time. We will let you know if that changes, but in fact we have received no questions from the public, so there is nothing to take at this stage. So,
I think it just leaves me to close the meeting down. So, for those watching, thank you very much indeed and we will see at the next meeting. Thank you.
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Non-Executive Board Member
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Chief Operating Officer