CQC Board meeting 18th May 2022 - Wednesday, 18th May 2022 at 11:00am - Care Quality Commission

CQC Board meeting 18th May 2022
Wednesday, 18th May 2022 at 11:00am 









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Chair’s Opening Remarks and Apologies
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Minutes of the Public Meeting held on 23 March 2022
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Matters Arising and Action Log
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Executive Team’s Report
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Corporate Performance Report
Quarterly Transformation Portfolio Update
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Any other business
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  1. Webcast Finished

Good morning everybody and welcome to today’s Board meeting for the Care Quality Commission. This is my second Board meeting. I’m the Chair, Ian Dilks. So, we are joined by all of my Board colleagues. We do have apologies from our Legal Adviser, Rebecca Lloyd-Jones who

Chair’s Opening Remarks and Apologies

is on extended jury service. We wish her well there and I am sure we will be able to cope without her. This is, as you know, a virtual meeting. We have done that given what seemed to be a relatively thin agenda and the fact
that a number of our directors now have to commute very long ways to physical meetings, so this seemed more efficient. But I would say that we are not intending that we will continue virtual meetings and the intention is that, in future, we will aim
to do everything by way of physical meetings. I will touch on that again in a moment. In addition to the board, I am pleased to welcome Diane Horsley who is this month’s Equality Network Representative. She is from our Gender Equality Network, so Diane welcome.
I haven’t received any declarations of conflicts of interest, so I believe there are none to note. Before I hand on to the formal business, there were just a couple of other things I thought I would mention. The first is that, as was publicly announced
recently, Robert Francis will, in a few months’ time, stand down as Chair of Healthwatch England. We also have some other NEDs coming towards the end of their tenure, so appointment of NEDs is a ministerial responsibility, handled by the Department, not by me or other
members of the board. But we are working with them and they will be, probably in June, putting out advertisements for non-executive Board members, including the successor to Robert as Chair of Healthwatch England. So, that will be public sometime in June, just for your information.
The second thing is that regular watchers or people reading our minutes will know that, in December of last year, the Board received a report from an Excel company doing an independent evaluation of the Board’s effectiveness. It was suggested at that time that consideration of
the report could usefully await the arrival of the new Chair, which turned out to be me. The Board members and members of the Exec Team have been, over the last few weeks, considering the content of that report. One of the conclusions that we have
reached is that we agreed with the report’s recommendation that we needed to allow more time for strategic discussions, as well as increased focus on monitoring of our delivery against the new strategy, and our responsibilities generally. It was suggested that monthly Board meetings was probably
too frequent, so we are likely to move to a reduced frequency of meetings, albeit potentially slightly longer meetings. That would bring us in line, just to be clear, with other arms-length bodies, most of whom tend to meet about six times a year, every other
meeting. We are not going to make change immediately. We will, once we have made final decisions, communicate to everybody, so you know what is happening. But I just thought I would mention that in advance, so people are aware. I want to give you absolute
assurance that, to the extent that that means there will be less public meetings in a year, that we are not in any way intending that that should reduce the transparency of the organisation. Quite to the contrary, we are going to carry out a review
of the communication with the public at large, the people that we represent, to see whether or not everything has been done the most effective way. Public Board meetings are a very important part of the way we are transparent in what we do, but they’re
certainly not the only part. I think now is a good time to look at our overall approach to transparency, but the assurance is that whatever follows will certainly be less, and it might be more. Then I’ve touched on one response to the Board Effectiveness
Review just to say that once we have finished our conclusions, we will bring it back to the public Board some time later in the year, so people can see how the Board has responded to the recommendations. We don’t know exactly when that will be,
but it will be certainly before the end of this year, probably sometime in the autumn once we have reached the final conclusions. Thank you very much indeed. Let’s move on to the formal business. We have the minutes of the meeting held on the 23rd

Minutes of the Public Meeting held on 23 March 2022

of March. I have not received any comments on those, but could I ask my colleagues if we can approve those as a true and fair record? I’m taking your assent, thank you very much indeed. There is a matters arising log. In fact there is

Matters Arising and Action Log

only one item on it. Mark, it was down for you to report on cybersecurity in the wider system. Do you want to comment now, or do you want to pick that up in your report later on? I’ll pick that up later on, Ian, if
that’s OK? In that case, let’s move to the Executive Team’s report. We had your usual written documents, so thank you very much indeed for that. Ian, perhaps I could turn to you now and ask you to pick up the first three points? Thanks Ian and good

Executive Team’s Report

morning everybody. So, I think we can take my section of the report as written, but I think it be fair to say that the most significant thing since the last Board is the Royal Assent to the Health and Care Bill. It has now become
the Health and Care Act. Arguably it is the largest extension to our powers in a decade. It gives us the ability to use our perspective across…, right across the health and care system much more effectively. It will enable us, I think, to have a
bigger impact in a range of different areas, but particularly in areas such as health inequalities where we know that has been a challenge and it has been particularly stark during the COVID period. I have included some headline urgent and emergency care figures. They remain
a significant concern for us. Whilst there are some improving areas, we know from talking to senior health leaders that flow across systems - and we have talked about flow a number of times in the past – the flow across systems and particularly the inclusion
of social care and making sure that flow into social care services, that remains a major problem. Access, rather I should say, to social care continues to be a challenge in a number of areas and to a large extent is driven by the inability to
recruit carers. That varied enormously from geography to geography which, again, I think is an important thing to note when considering nationally national figures. We will of course continue to use our convening power to bring a range of national leaders together to look for solutions.
Albeit that, I think, we do need to recognise that this is a complex and multifaceted issue and frankly there are no simple solutions. And, equally, there is no one single entity that can solve all of these problems. Before I hand over to colleagues, there
is just one final thing that I just wanted to raise which was around the COVID-19 inquiry. Board members will remember that the Baroness Hallett had been chosen to chair the UK COVID 19 Public Inquiry. Baroness Hallett has submitted her recommendations to the Prime Minister
on the terms of reference for this inquiry. This follows a four-week consultation period and consideration of over 20,000 written responses and feedback at engagement events right across the country, including meeting over 150 people who were bereaved due to the COVID-19 pandemic and representatives from
145 organisations from a range of sectors including health, social care, education and business. In conclusion Baroness Hallett has recommended expanding the terms of reference in a number of areas of note for us. They include mental health, explicit inclusion of general practice and care provided
in the home as distinct to care provided in residential care homes. Baroness Hallett has also recommended a reframing of the terms of reference, ensuring the unequal impact of the pandemic runs throughout the inquiry’s work. I think we would be very supportive of those changes
to the terms of reference. We, of course, remain very committed as an organisation to co-operating fully with the inquiry when it commences its work and we will, of course, continue to do that, and we will keep Board colleagues up-to-date as the inquiry progresses. Ian,
that is all I wanted to say at this point. I’m open for questions before I hand on. OK. Thank you. Any questions from my colleagues of Ian’s report or comments? Robert. Thank you Ian. My question was about urgent and emergency care and really my sense is that the position
is now worse than it has ever been. But I’d like confirmation of that if we can give it. And accepting that, actually, it is an extremely complex subject as to how you solve this, I would comment that it has always been a complex subject
and the awareness that there are problems at the back door, as well as before the front door, have been discussed by people who know about it, as long as I’ve been involved in healthcare. What concerns me is that, despite the fact that those problems
are identified, we seem to have made very little progress in sorting them out. But having said that, I’m not sure, but I wonder if you are as to what, apart from our repeating what we have said before, CQC can do about this? I wondered
to what extent the use of our forthcoming duties with regard to ICSs may be of help in this regard? Yes. I think I will bring Rosie in in a second. I know she wants to just come in and support that. But, I mean I
think we are doing a number of things on a daily basis. Senior colleagues are talking to senior colleagues in both Social Care organisations as well, as talking to our colleagues in NHS England, as well as the leaders within systems. Only next week we have
convened a major event, bringing together a range of partners from Royal Colleges through to individual providers, to talk about this issue and to look for practical solutions … which I’m chairing…. … sorry, which, yes of course I had forgotten that, yes you’re right you are chairing. So,
of course, so I think we are using our convening power, I think, very powerfully, and I think we do recognise the role that we have to convene groups of organisations and groups of people together in that way. But I think the other thing that
we are continuing to do is to gather evidence, so that we can have evidence-based conversations. Because I think you are right, the basic point is, yes we all have known that this is a problem in the past. But evidencing exactly what is happening and
evidencing successful solutions, and solutions that work in some parts of the country, but maybe don’t work quite so well in other parts of the country is an important part of all of this. So, I think we are doing what we can and we will
continue to do what we can. But I think the ICS does give us this opportunity, I think, to talk more overtly than perhaps we ever done before, and also gives us an opportunity to collect more evidence and more insight. Certainly when we have been
talking to ICS leaders, the thing that does, I think, get them excited is the ability for us to benchmark and share data and information in a much more structured way than, perhaps, has been the case in the past. Rosie, I know you want to
jump in on this as well. Thank you, and Robert I think you are absolutely right. This is a complex area and it involves all of the different parts across the system, working in their local communities to be able to deliver care. It also requires
really good communication with the public to understand how to access services and how to use those services. Because a lot of what we hear from the public is, it is very confusing to know where to go in local areas. Often they don’t know, you
know, different opening times of different services, different ways of working. And a whole variety of factors mean that, sometimes, it’s quite complicated to work out which service to use for what problem, and they end up in the wrong place as a result through no
fault of their own. I personally think we need a much more proactive model of care. I think if we continue just to focus on the end of the pathway of the urgent and emergency care pathway, we will never make the progress that we need
most. A significant proportion of people who end up in the urgent and emergency care pathway are people with long-term conditions, multiple complex needs. Actually, we need to be looking at personalised care planning, we need to be looking at better advance care planning having a
much more proactive model of care. So, people are managed in a much more coordinated and integrated way. I have no doubt that through the time we are doing integrated care system reviews, urgent and emergency care will be a key theme that we will want
to look at. We need faster development of new models of care and acceleration in the pace around these new models of care. Much more focus on the out-of-hospital care models, working across community services’ primary care in its broadest sense. And looking at kind of
how we involve pharmacies, oral health services and optometrists in these pathways, as well as GPs and social care. So I think there is a lot to be done, but it will absolutely be a focus of the integrated care systems. Just in the short term,
my final point is that we will be looking at publishing, following the event you are kindly chairing for us next week, we will be publishing a report to kind of build on the work we have been doing with patient first in emergency departments. To,
kind of, give that best practice and that view of what we see that is working across those systems, so that all systems will have that available to them to be able to make changes in advance of this coming winter. Thank you. Thanks Rosie. Sally,
you had a question. I do, thank you. I may be pre-empting what Chris is going to say shortly, but I’m really interested in what Ian said about our convening role, and I wanted to ask about maternity services. So we are leading a summit, aren’t
we, later in terms of bringing more people together, just like we are in urgent and emergency care? And we did talk at the last Board quite extensively after the Ockenden Review had been published, about how we would continue to focus on maternity services. So,
I just wondered if Ian or Chris could say something more about that, and apologies if I have jumped the gun, Chris. I was going to come to it later. I’m happy to do it now, or later, whatever you prefer, Ian? Why don’t you pick it up now?
Sure. So you are absolutely right, Sally. We talked about continuing our focus on maternity services. We have actually been speaking to a number of parliamentarians as well, in a sort of set-up of the review. You will know, post-Ockenden, there has been a number of
conversations about why there hasn’t been the progress. In fact, if you go back, we started talking about maternity services needing to improve in 2017, so this is a long-standing concern that we have. We talked…, we did an end of programme inspection in 2017. We
produced a report called Getting Safer Faster. What was clear then, what the feedback we have had since, particularly from frontline staff, is that this is a cultural issue as much as it is an operational issue. So that the roundtable we are bringing together next
week will focus on groups of staff who work at the frontline of care. What we have tried to do is to help understand why services in these areas are not improving, and what are the cultural things that need to be unlocked in order to
see the improvements in frontline maternity services that we have seen in other sectors. I am really pleased to say we have got over 180 frontline staff who have, not only just registered an interest, each one of them has written a small piece to talk
about their experience of what they feel they can add to the roundtable. So, these are not just people…, they have not just registered to respond to an e-mail…, they have actually given us some information about how they feel they can support services. Obviously, the
frontline staff are an important part of this, as are people who use services and people who have experienced harm. The aim of the of the roundtable is to try to unlock some of the issues that are affecting the way services are delivered, talking to
frontline staff. And then to use that, alongside what we have got from the listening events for people who use services, to have a very clear message back to organisations ICSs and potentially national decisions about how we need to collectively support that. So, the event
next Tuesday is actually one of a series of events that will give us, I hope, first of all, in a sense of what… - because there are some organisations doing some really outstanding work here - so how do we…, why are they…, why are
they unique because there are very few of them, why they doing that well, what lies behind their work? What are particularly the cultural issues, as well as the technical issues about that, and how can we promote that both within individual services and also across
services and across systems? So I am really pleased with the engagement we have had so far, both from families that represent people using services and also frontline staff. My intention was to come back to Board with an update about what we have seen and
we will obviously publish the results in full anyway. But I want to come back to Board with a sense of where we go next with this at the next Board meeting, if that’s OK? Does that help, Sally? Yes. Thanks very much, Chris. Any other questions for Ian?
If not, Rosie, can we turn to you for a few things? to you for a few things? Yes, certainly. We have talked about urgent and emergency care, so I won’t go over that again. Just in the Board report, there is an item, just a brief update around what’s happening in our community health services work. As we know, community services
play a really key part in, both the urgent and emergency care pathway and the management of people with long-term needs and conditions in the community. They are a fundamental part of the whole health system, so just to raise the profile of what our teams
are doing in that area. Just something not in the report, but something I wanted to just flag with the Board, is my concerns about the rising level of abuse we are seeing in general practice towards people working in practices from members of the public
at the moment. Over the last two days, I have sadly heard about one practice that, because of the level of abuse their receptionist was getting, have had to stop people having face-to-face access in a reception area. I have also heard about an arson attempt
on two different practices, here in Taunton, and I think, you know, clearly these are very unacceptable. We know that people are having challenges with access and concerns about getting care, but we also know that people working across primary care at the moment are working
extremely hard and trying to meet those needs and demands. So, any form of abuse is not acceptable towards any member of health or care staff. So, I just wanted to raise that with the Board and raise my concerns that that is happening and we
are offering support to those practices that are having problems at the moment. Thank you, Ian. Well, thanks Rosie. I mean it is shocking that it should happen. Awful for the staff and last, but by no means least, clearly massively counter-productive. So, anything we can
do to lend our weight to raising the profile and making clear how unacceptable it is and stopping it would be welcome, I am sure. Any questions for Rosie? No, OK. Thank you very much indeed, Rosie. Kate, you were going to talk to us about
visiting. Yes. Good morning all. So, carrying on a theme of my updates for a number of recent Boards – a brief update on visiting and a brief update on workforce. The visiting position remains the same. We are expecting care homes to be enabling visiting
to happen. There are no longer government guidelines in place about how they should be working. We expect excellent Infection Prevention Control and we will continue to look at that on all of our inspections. We continue to have…, I continue to have a handful of
concerns coming to me each week from groups representing families where they are concerned that visiting is not happening where it should be. In each one of those instances, there will be a conversation with a local Inspector or Inspection Manager to follow up and see
whether we need to go and inspect those services. So, it is still quite a hot topic in our sector, and we continue to benefit from the public flagging to us where they think that care homes are not keeping up with what they should be
doing around visiting. That goes back to comments I have made on a number of occasions, most care homes are facilitating visiting to happen, as you would expect. Then on workforce, we are just updating you again on some rolling data we have been capturing about
high vacancy rates. The vacancy rates are still high, but they kind of remain static now, so they are remaining at around 11.5%. Turnover rates continue to be very high. We are tracking the number of care homes exiting the market, so the net reduction in
beds, which has… There has been a similar trend line around care homes that don’t provide nursing exiting the market. So I wanted to flag that to Board. And just one other thing to say. Thinking to Ian and Rosie’s comments around urgent and emergency care,
on Friday, ADASS the Association of Directors of Adult Social Services, published a survey in which they talked about 506000 people awaiting social care assessment or awaiting a package of care. They talked about 61% of councils only assessing people where there are concerns about abuse,
or people needing to leave hospital in a timely way or having gone to re-ablement. But also interestingly, they talked about 170000 care hours in the first part of this calendar year not being delivered. So people with assessed eligible needs who need to have their
care delivered, that wasn’t able to be delivered due to workforce challenges. So, there isn’t… we can’t draw a direct correlation, but if you think about that significant pressure on social care and then you think about people arriving in hospital or not being able to
leave hospital in a timely way, it just reminds us again how completely interconnected all of these components are as well. Thank you. Thank you Kate. Stephen, you had a question. Thank you Kate. The question is really a variant of Robert’s earlier question. Particularly what you are flagging around workforce and capacity,
supply capacity, these are problems that you have been flagging to us for a long time, and they are deep-seated, long-term issues. On the workforce one, yesterday’s announcement that we now have the tightest labour market since records began, in terms of, you know, there are
more job vacancies than there are people looking for jobs, is likely only to make our workforce situation worse. There will be lots of attractive jobs out there in the labour market that people working in care may want to move to. So there is a
risk factor in terms of the current state of the labour market for our workforce. And similarly, your data on supply suggests that, kind of, the market is not currently operating in a way that new entrants are coming in to more than replace the people
who are choosing to exit. So, kind of one question is, is Robert’s group going to sort this out? It is another example of some long deep-seated, really intractable problems that we keep noting. It is quite hard to know what could we do about them
and can the convening power that you have been referring to, does that help us get together the people who might have some solutions to some of these things? The second question was really back to Rosie. When we talk about new models of care and
the role of integrated care services, do you see, do we see ICSs being set up in a way that will give them the capacity and the resources to make sense of such big, wicked, long-term issues? Because there is no short-term fix for the workforce
issues and the supply issues going on in care. Really, can we expect ICSs to sort this out for us? That is a big ask of ICSs. Are they being set up in a way that gives them a chance of doing that? Thanks. OK. So
I think if I start by… I think what our data can do is remind the system why they should care about all parts of the system. So, we know that occupancy rates in care homes have been rumbling around 80% for a large part of
this pandemic. So, there are beds in care homes, physically there and available, but people can’t, for example, leave a hospital bed to go into that care home bed because the care home can’t get the staff to support it. So, there’s something about how we
can use our data to very overtly remind the system that there is physical space, which might be in the absolutely appropriate setting for people to move to, but they can’t because of workforce. I think the Government’s White Paper that published before Christmas has some
good stuff in there around workforce in terms of care workers, around passportable qualifications, around an ambition to explore a care worker register, which you know I am really interested in looking at how that may develop. Then finally, I think Rosie would say the same
thing as well. So, we are really excited about our role around integrated care systems, in the ownership or the leadership they may play, or hopefully will play, in showing that there are place-based workforce plans that can offer people who come in at entry level,
be it as a care worker or into a kind of health role, that can enable people to progress and have an integrated career pathway where they can be stretched and learn new skills and be part of the, kind of, virtual health and social care
team within a place. So there is some excitement and some opportunity that we have around our role with integrated care systems, about saying to them, how are you assured that there are comprehensive, place-based, integrated workforce plans that are providing those sorts of opportunities for
people at that level. I don’t know, Rosie, before you answer Stephen’s other question, whether that reflects what you would say about ICSs and workforce? Yes. Certainly. Because and I think we are seeing some lovely examples, albeit small-scale examples, of where some ICSs are being
really creative in terms of thinking about workforce and thinking about their pipeline, working with local, kind of, educational institutions, really maximising those opportunities to, kind of, train and develop local people and local teams, and also thinking about that flexible use of workforce across all
of the different parts of the system. Because, I think, unless there is a credible workforce plan where people are not just kind of paying Peter robbing Peter to pay Paul, if you like, and taking different parts of like a paramedic to go and work
in primary care, but then leaving the ambulance service short, for example. People need to be looking at that in totality and working out how they move people across the system in a very structured and sensible way. I think there is also something about culture
in terms of workforce, so that we drive that culture that is going to want people…, people will want to stay (inaudible) they can learn together. In terms of the other question, Stephen, that you had, I think ICSs no doubt have a challenge ahead of
them. I think that, especially with the workforce challenges, with the financial pressures and the kind of situation at the moment, there is no doubt that ICSs will find this challenging. There is a, kind of a massive difference in some of the maturity we are
seeing across ICSs at the moment in terms of how they are thinking more broadly about the four I aims of the ICS, particularly around inequalities, particularly around that (unintelligible) of social and economic kind of development. I think the best ICSs will be the ones
that really kind of use this as an opportunity to work with their local communities, to understand their population needs, to build and collaborate with not just people in the health and care sector, but with, you know, education, with people involved in jobs with local
businesses and local industries to see how they can really drive those improvements forward. I think in terms of the way they need to work, they need to be collaborating, they need to be thinking about how are we creative, how we bold, how are we
really challenging the status quo in terms of how we have always done things? Because I think we know that the current ways of working are not delivering the care that we like to see for our patients. I don’t think there is going to be
huge amounts more money. I don’t think there is going to be huge amounts more workforce round the corner. So, we are going to need to see levels of innovation that we have not seen across health and care in the past, and really seeing that
rapidly. The CQC, just for any ICSs listening out there, please come and talk to us about those innovations. We don’t want to be a barrier to those, we want to enable those and often we hear the reason that people say we can’t do it,
is because of the CQC. That is not the case. We want to work with systems to be able to enable them. I think that there does need to be much more of a focus on inequalities if we are going to, really kind of deal
with those challenges. I think there is going to be some very difficult questions for integrated care systems, about things like how do they fund services to make sure that people who are subject to the worst inequalities actually get better care? So, we can really
start to change that model, that kind of inverse care law that we see. So I think it will be very challenging, I think there is that opportunity but it’s going to require very different ways of working than we have seen to date. But with
a big prize, Rosie, so… Ian, you wanted to comment. Thank you. Just to build on the comments of Kate and Rosie, and to add to Stephen’s question which, I think, is a really good point. At the moment, if you think of the reason workforce
is a particular challenge in social care, is because though the jobs are paid at the lower end of the pay scale, that relative success of other industries, notably hospitality and the inclination to holiday in this country, rather than holiday abroad, is making the situation
worse. I guess in times past there has been a sense that, you know, there were 14000 registered care home… 14000 social care enterprises, there was 14000 responses to the workforce problem. What ICSs have the potential to do is to give 42 responses to a
problem that was, otherwise, 14000. One could argue though, that there is a broader strategic question for, I guess government, is the degree to which social care is perceived as a piece of critical national infrastructure, and if it is, what is the national, the single
national stance around workforce in social care? I think the same argument probably applies to the digital component, additional digital dimension of social care, and cybersecurity and so forth. But, certainly in terms of workforce, you know, 42 versions of response is better than 14000 responses,
but probably one response is even better. So the question I get is how do you cluster the different ICSs together in order to have a much smaller number of responses? I think we potentially have a role to play there, where we can start to
bring ICSs together and start to point out similarities of demography and local challenge. So, I think there is definitely a role for us to play in that, in that area, and Rosie and I are on a bit of, a sort of virtual roadshow to
meet many ICS leaders. It is striking that some of them will naturally group together and I think that could lead to some really important innovation in the way that Rosie was describing. Thanks Ian. I think that was the end of the comments, so thank
you very much indeed. Tyson. Thank you, Ian. I don’t have much to add to my written report. I think it is fair to say that the performance we saw in April was more or less as predicted, as I trailed at the last Board and
for the reasons that I set out then and I set out now. I think particularly the increase in the…, the tendency to do more complex inspections in Adult Social Care, and we have done over January and February. The only other point I was going
to make is that, now that we have come together as an operations group, my senior team and I are very focused on removing barriers to performance for our teams. I think by having a bigger group with all of the operations together, there are certainly
economies of scale we could have when it comes to trying to drive improvement. A couple of examples I would give would be around taking a different approach to the way that we deploy specialists, advisers and also Bank Inspectors, which can be a big issue
for some of our inspectors at a local level, and also whether there are different and innovative ways we can look at for answering Give Feedback On Care or dealing with enquiries. So, just part of an ongoing rhythm of how we will continue to look
at ways of removing the barriers to performance, maybe in place for our teams at the moment. But that was all I was going to say. Thanks Ian. Thanks Tyson. Any questions for Tyson from my colleagues? If not we will carry on. Kirsty, you just
had one thing you were going to comment on. Yes. Just to bring to people’s attention, the public bodies review programme, which has been in the media recently, as a Cabinet Office initiative looking at ALBs and NDPBs of departments. We have recently received a letter
from the Perm Secretary to the Department saying that we will be working more closely with them to look at what that means for us as CQC. And we will keep you updated as that develops. Thanks very much, Kirsty, As you said, this is a government-led review, not much having flagged
it, not much more we can say at this stage. Mark. Hello. I think the… on cyber we have got no…, sorry, significant security issues to report, from a CQC perspective. We are aware and have been made aware of a new ransomware threat that is
in circulation which is called Shimoc that compromises remote access accounts. There is some detailed guidance for organisations on how to protect against this. I am pleased to say that we can confirm, we comply with all of those recommendations with our improvement work that we
have completed already. Ian, you asked me the question about the wider Health and Social Care cyber position earlier on and we have consulted with colleagues across on Health and Social Care and NHSX and I think the consensus is that there is, you know we
are currently in three-year cycle of investment around cyber which starts this year, to improve cyber protection services across all Health and Social Care services, which is based around trying to reduce the risk of a successful cyber-attack. Indeed, if you look back over the last
years, since 2016 there has been around 300 million invested, but the sheer size and scale of the sector means that there is a lot of work to do and so, there is still a significant amount of improvement that needs to be made. I think
in addition to that work that is ongoing, there is also readiness being made to improve cyber resilience across the sector, to work to mitigate the impact should there be a successful cyber-attack, which includes things like dry-run cyber exercises and ensuring that all providers have
got effective backup systems in place. I think for us, we have got a role as a regulator to play in in supporting that improvement, in highlighting areas that there…, that there are areas that need improvement and also providing an evidence base that supports what
the digital and cyber maturity levels are across the system. Thank you. Thanks so much indeed, Mark. Any other questions for Mark? I mean if not, then thank you very much Mark. Just concluding the Executive Team’s report, Chris, a couple of things for you please.
Yes. So I’ve talked about the maternity Services. I just wanted to flag one thing that wasn’t in the report because it is subject to a go-no-go decision after the Board papers were submitted, which is the update to the CQC website. This is a service
that is used by thousands of people every day to access information about how services are performing. I am delighted to say, thanks to Mark’s colleagues and colleagues from mine too, we have made some significant improvements to the way the website operates. For the first
time ever, it will adapt to phone and, as you know, more people now are accessing their devices on a non-PC systems. We have seen in the first week an 18% rise in the number of people accessing our sites on the phone which is dramatic.
The other things that we have made improvements to are our accessibility of the site, more generally for all groups of staff. We now fully comply with the WCAD, sorry, WCAG website consensus, with the guidelines set out by the HSE. So I just wanted to
highlight that has happened. There are some other simple changes that we have made so people can now compare sites with each other, so if you are looking to access a particular service, you can compare and contrast one service with another. There are improvements to
e-mail alerts and there are almost always improvements to the way providers share their information with us. So, I am delighted by this. It is the first in a number of changes that we want to make to our engagement with both people who use services
and providers. But it is an important and useful first step, so I just wanted to bring that to colleagues’ attention. Yes. Thanks very much Chris. I mean it a work in progress, but for anyone listening who has not looked it is a major step
forward. So, thanks to…, please pass on our thanks to everyone involved. And although it’s not quite the openness point I raised earlier, I think it’s a good example of how we recognise that we are responsible as (unintelligible) the British public using services. This is
a significant step forward in the way they can use what we do, so thank you. Any other questions for Chris? If not, that concludes the Executive Team report. Let’s move on to the next item which is the Corporate Performance reports. I think we are

Corporate Performance Report

going to be joined here by Chris Usher who is the Director of Finance. Hopefully, you are on the line, Chris over to you. Yes. Thanks Ian. So, as you say, this is our Performance Report. It is for the year 21/22 which is obviously closed.
We have included a year at a glance in the pack, so pages 46 to 48 in Board’s pack. I don’t propose to go through this each line by line, but hopefully it illustrates what we have managed to deliver across the year, and it gives
some good information around that delivery. In terms of actual Business Plan performance, I’ll just pull out some the highlights and key points, and then open it out for questions from Board. So in terms of our objective to analyse data we capture, to identify…, to
interpret it to identify risk, in terms of managing risk to people we have carried out monitoring calls and inspection activity with just under 30% of registered providers in the year. This is on Slide 4 in people’s decks. Alongside this, we have also published statements
regarding band one services, as well as received safeguarding alerts, whistleblowing and complaints. Taking all that into account means that we have…, that 75% of registered locations have had some form of regulatory contact with us across the financial year. I have mentioned the short statements
we publish. It is important that as we undertake Quality Assurance Inspections, to test our approach and findings. Slide 5 shows that we have undertaken 243 of these Quality Assurance Inspections across the year. The vast majority are coming out good or outstanding which assures our
approach. However it is vital that we gain this feedback to test and learn on our approach. It also shows we have undertaken just over 10000 inspections in response to risk. 60% of these were rated as “requires improvement” or “inadequate”. In terms of registration, which
is on Slide 6, it shows we have improved our timeliness in year with time taken to process simple applications reducing by 4.7% and normal applications by 8.1%. However, both areas and complex applications, which saw a slight increase, were below the target for the year
which we set which was a 15% reduction. In responding to concerns, safeguard and whistle-blowing, we aim this year to increase the volume of people giving us feedback. And in year, we have had a 52% increase to Give Feedback On Care from people, which is
on Slide 7. This is incredibly insightful information and what we do with this, depends on the information received. It is worth noting some of this is positive and some is negative, but our responses can range from contacting the provider, being used as intelligence for
inspection planning, or in some cases a referral to Safeguarding Adults local authority teams. There is a significant increase in Give Feedback on Care year on year. Some other areas to pull out, so Slide 10 shows the major publications we have issued all being delivered
on time, collectively with 42000 views, and Slide 12 you can see across our transformation, all current milestones were either completed or are on track where they run across financial years, where we would expect them to be. In terms of managing people and resources, the
deck includes various people data and metric, Slides 14 to 19, in addition to our Business Plan measures. In terms of actual measures for the year, 57% of colleagues would recommend CQC as a good place to work and this was down from 67%. 66% of
colleagues think CQC supports their wellbeing which is up from 60%. We continue to pursue a more diverse representation across our workforce. We see Black and Minority Ethnic colleagues represent 14% of our workforce and colleagues declaring a disability represent 9% of our workforce. In the
year, one of the things we really aimed to do is ensure that all recruitment panels have an independent panel member for senior recruitment. We have done this in 100% percent of instances. Finally, in terms of finances, at the end of the year our revenue
budget was underspent by 9.9 billion, so 4.2. Our underspend is across pay and non-pay, largely due to adapted ways of working as a result of the pandemic. For example, significantly reduced travel costs in year. A (unintelligible) budget ended the year 0.9 million underspent, which
is 6%. So, that is it from me, Ian. I’ll open it out for comments and questions. Thanks. OK, thank you Chris. I have some questions. Well, let me start with my colleagues. Mark Saxton. Thank you Chairman. Chris, thanks again for another very thorough Performance Report. Page 2 of the Business
Plan overview, we have several activities there that are either on hold or in development, and as we know those are two different things, so slightly unclear. But I suppose my concern is, if something is on hold for a very long time, then it is
inevitably going to fall into a red category. So, I just wonder whether you have any view on whether we should try to split that out, as the difference between being on hold and being in development? In terms of the people charts, it is a
nice new first chart, first page of that chart showing the RAG rating of the KPIs that we look at for people. So I was pleased to see that. Looking at the absence rates and sickness and wellbeing, it is slightly concerning to see Grades B
and F running at 17.7 and 16.8% stress, absence for stress, versus a corporate percentage of absence rate for stress being 11%, but that’s something I will take up with Gill. In terms of employee feedback, it’s still people joining us and not inputting their data
onto the ESR which only goes to compound the fact that we don’t have full accuracy on our data. But you mentioned quite clearly our performance in terms of our recruitment of ethnicity, ethnic background of employees, it was very encouraging to see that at 19.5%
starters coming from an ethnic background. Finally, could I just say on the turnover and movements in the charts, I really feel it would be good for us to be looking at promotions, making ups or acting ups and secondments, across both the disability and ethnic
groups in our organisation. But I think that most probably falls more into Mark’s area, Mark Chambers’ area, in terms of sponsorship of DNI, but I would just make that point, and I think that you know be good to be looking at. But thanks for
a very thorough report and I thought there was some very good data in it. Chris or Ian, I don’t know if you want to respond to any of those. Most were observations perhaps rather than questions, but then I’ll go to other questions afterwards. Yes. You know
all of that information is something that we look at from an executive point of view, so we will… I think we can take that away and look at additional things to add into the report. That’s fine. Thanks Ian. Sally. Thank you and thanks for
the comprehensive report. It is always good to review at the end of the financial year. I just wanted to pick up on the inspection activity or inspection and monitoring activity, because it is kind of buried in there, Chris, but we have seen a substantial
increase in all of the activity that CQC has delivered. I just think it is worth pausing at that point to say, I think there have been press articles or articles written to suggest that CQC weren’t quite monitoring or regulating in as much detail, or
to as many providers as possible. These statistics would not bear that out. So I think it is perhaps just worth Ian or someone explaining, perhaps for members of the public who don’t quite understand that crossing the threshold isn’t the only thing that we do,
quite how our activity is ramped up and what our staff have been able to deliver. Thank you. Ian, do you want me to take that? Yes, could you? Thanks. I mean, I think it is a good question, Sally. I think your point is well made. Right at the beginning of the pandemic, we made
a conscious decision, as a Board, to move to more of a risk-based stance and we stopped doing routine inspections. I think, as you rightly say, the press articles were largely driven by that sense that we needed to be continuing to do some kind of
routine-based inspection. But, as Chris identified, there has been a significant increase in Give Feedback on Care and that has been particularly pronounced in some sectors, particularly the feedback we have had around general practice there has been an even bigger increase as a percentage. That
has meant that we have continued to develop our approach, that we have had a range of different, quite specialised reviews sometimes, so we have done things like Infection Prevention and Control reviews where we have particularly focused on a small number of questions, but go
and see a lot of people. We have also developed what we call a direct monitoring approach which is, again, it is a sort reconnaissance approach, if you will, where we are making structured telephone calls to providers and also we are doing a structured review
of the data we hold on those providers are we are blending those two things together. And if we then have further concerns, that is then triggering an on-site inspection. We have also been doing some work on looking quite deeply at the way in which
we do rating-based inspection. So, we have done a lot more in the way of focused inspections and moved away from the larger, long-form ratings inspections that we have been doing. So, a range of different responsive approaches that are focused on risk, focused on trying
to cover as much ground as we can, given the complexities of the COVID situation that we have been in. Of course, I think, as we sat here a year ago, we were all hoping that COVID was very much on the wane and I think
we have…, this data does very much reflect another very COVID-focused year which we had all hoped we would not be in. And, of course, you know, we have talked about our transformation approach which would deliver, again, a very different and revised approach. But it
will be very much building on the lessons we have learned over the last couple of years around remote monitoring, ability to reach into GP systems and do remote clinical searches, a very much focus on a deep assessment of real risk and the things that
are going on, and then respond to that risk appropriately. So I think we have tried to move away from the kind of big, long-form report, but at the same time, I think the public should be absolutely assured that crossing the threshold will remain an
absolute core part of what we do. But there are a number of other tools that we can use and we can deploy to make sure that we are discharging our overall duties, to provide the public with assurance around their healthcare services, but thanks for
the question, Sally. Thank you. Thanks Ian. Stephen Marston, you had a question. Thanks Ian. I wanted to pick up – it’s page 30 of the Pack -which is the Give Feedback on Care data. Firstly, it seems hugely positive and, congratulations, that there has been
such a rapid increase in the number of people using the system. Hugely powerful and important data on people’s experience of different services. But it then kind of prompts, at least for me, a number of questions. Firstly, if this is both good experience and bad
experience, this could be pointing in a number of different ways. It could be pointing up a greater level of risk, or it could be pointing up a greater level of satisfaction, is it possible to disaggregate these data into positives and negatives? Because, as I
say, they kind of point in very different ways in terms of the service performance. Second one is, that massive increase between December and March, I’m assuming that is more down to your success – congratulations - in making people aware of this opportunity to Give
Feedback rather than any measure of growth in underlying public concern about systems. But is there any way of kind of tracking that underlying concern level, which is different from your success in the getting people to fill out a survey instrument? Final one, if I
could, the biggest single increase is in primary medical services which got me wondering whether this is kind of aligning with what Rosie particularly is hearing. Is this warning that there is a disproportionate he level of concern going on in primary care, compared with transition
in other sectors? Is that what we are hearing from other sources? Thanks. Ian, I don’t know whether it might be easiest to pick it up in general comments, and ask others to add as necessary. I think Chris and Tyson can probably come in on
both of those topics. Shall I kick off then? To say, some Board members will remember we changed the Give Feedback On Care process now, almost 2 years ago. And a lot of the changes that we have seen since are actually a function of the
fact that we have got a Give Feedback on Care service that works more for people who use services. So that is thing one. We have had a number of spikes where we have deliberately targeted groups of people to give their feedback over the last…
well for each year, and some of the increase reflects the fact that we’ve worked with Healthwatch, we have worked with Age UK, we have worked with other organisations to target particular groups of people. In terms of the good and bad, often people provide both
in in an individual Give Feedback on Care. So, they may give some information which is either positive or neutral, and some areas of concern. Because people are not the same thing as locations, they may give information about their community care experience, their secondary care
experience and possibly their adult social care experience. So, they are giving their perspective which I think is really helpful to us, not just in our regulation of locations and organisations, but our thinking about systems moving forward. So, we can disaggregate it, and often it
might relate to one or more different services when we do. Finally, on your point about- I probably kind of know Rosie will want to come in - I think that a significant proportion of that rise has been connected to access to primary care services
over that time period. I think that the post-pandemic pressure on primary care that we have seen is reflected in some of the information that we have seen in Give Feedback On Care and that is a help. The last thing I wanted to say is
that group that have been responsible for doing some of the monitoring activity have actually encouraged providers to gather that feedback themselves, of from organisations across all sectors, and that has also helped in improving and maintaining the rise of Give Feedback On Care in the
last six months. Hope that helps, Stephen. Tyson, do you wish to add to that? Just a couple of things to add, Ian, if I may, to Stephen’s question? One is to do with the volume and Ian mentioned the direct monitoring approach that has really…,
we have been ramping up over the last few months. Part of that approach as the team prepare for the monitoring call is to seek feedback on care from the provider that they are doing the call with. If whether a GP practice or an adult
social care home and we are seeing quite an increase in Give Feedback On Care as a result of that, which I think is a really, really good thing. Clearly you will have seen that the volumes have gone up considerably over the last few months
which, as you know, which has been an additional amount of work for the teams to deal with. I am really grateful to the teams for the professional way in which they have they dealt with the feedback because it’s really important. I alluded to it
earlier, but we need to get, I think, smarter at how we triage the feedback. So that where we get feedback, we make sure the Inspectors see it and they are able to reflect it in the way they deal with the provider, but particularly making
sure that where risk is identified in feedback on care, that is also highlighted to the Inspector so they can take remedial action if they need to. So, despite the volume of feedback on care, we are still taking the right action with it and will
make sure that our inspectors are always aware of what it says. Thanks very much for that, Tyson. Diane Horsley, our Network Representative who joined us today, you have a question. Yes. Again it’s on the Give Feedback On Care. I noticed that when you look
at the hospitals data on Slide 7, there’s two particular spikes - February and March 2021 and then again February and March of this year - but in between those times, it settles down into quite a regular pattern whereas… So, I was just wondering is
first spike down to targeted approach on Give Feedback On Care, Chris, for that period, or is it possibly COVID? And because of the settling and it kind of being having quite a consistently lower rate compared with the others, are there any plans for more
targeted approaches to get more feedback on care from hospitals? There are. So, first of all, we look for people, not institutions. So, we will look for people, as I said before, they may work with or use a number of different organisations. So, there are
particular groups of people that we want to hear feedback from. Often the spikes relate to some of the activities that we do at the time of a big report coming out, so we may do some focused activity, either in geography or with a particular
group of people. So, for example, recently we have done some work on maternity Services in light of the work we’re doing, and also on urgent and emergency care. So, that can often prompt spikes in feedback that we received, but a bit we are acutely
aware of, where we need to gather more feedback from particular groups of people. And a lot of the spikes working with our partners who represent people who use services in different areas are geared towards trying to make sure we are hearing from all or
parts of the community in all areas. So that, as I say, the spikes often relate to some of the work that we do that pre-empts that. But my aim is that we can hear from all parts of the community to make sure we have
got a really accurate picture of how people are receiving services. Has that answered your question, Diane? Yes, that is brilliant, thank you. Chris, I had a number of questions for you myself, probably because I am the newest member of the board. It’s my first
review of year-end. Quite a number have been addressed by my colleagues, and I do particularly pick up on Mark Saxton’s point about the plan overview distinguishing between what is on hold. That (unintelligible) grey box of what is on hold, I think that would be
very helpful. I had three other questions which I will pose to Ian initially, but he may wish to ask others to do it, to comment further. One is on the registration. We had a target of reducing time. The good news is, despite the increase
in volumes, that we have been successful to a degree, but not as successful as we would have hoped. I just wondered if there is anything to be said about the barriers to making further progress. Were we just over optimistic or is there a barrier
that we can deal with? And I suppose that leads into whether we think we’ll do it more next year? The second is you commented on the reduction in travel costs. I mean we have seen changed ways of working, which we would plan on being
sustainable. We have also seen the impact of COVID, which is changing, and I just wondered if you could comment on how much of the reduction falls into each of those buckets. I don’t need precision, but I suppose, again, behind that question is what is…,
would it be likely to see in the future for having achieved some sustainable reductions through different ways of working, but at the same time, the now ability to do more inspections as we are out of COVID restrictions? My third question is around people. You
did specifically comment on it, but there was a reduction in a – I have forgotten the exact question, that people’s views about CQC - and it has fallen from 67% to 57%. I just wondered if you could comment on why we think that happened
and what actions are being taken? So three very different areas, so, Ian, it might be easiest if you have any additional high-level comments and then ask others to add, if you think that is necessary. Thank you. Sure. Thanks Ian. So, in terms of registration,
I think there is two areas just really to raise there. One is a straightforward recruitment one. We have done lots of work in terms of leaning processes, making them more efficient. I think the team have done a really good job of doing that. And
Kirsty can come and talk about detail, if necessary, in that area. I think we did see a big improvement. What we did see, particularly sort of around Christmas time, is an increasing difficulty in recruitment and so there are just simply fewer people. We are
continuing to try and address that, as we are with recruitment more generally. The second factor, which I think is relevant overall in terms of our overall rate of improvement, has been the prioritisation process that we put in. We, unapologetically, were prioritising applications that were
going to add additional capacity into the health and care system during the COVID period. So, if you were approaching us looking to build a new care home and open a new service, which was going to add that particular capacity in a particular area, we
would prioritise that activity over perhaps services which perhaps were not going to add direct COVID capacity. So, we tried to make a triaging judgment quite early on. That again, I think, has somewhat made some of the figures slightly odd-looking in places where some applications
are dealt with incredibly rapidly as a result of the work that we have done, and others take a disproportionately long time. So there is a bit of a range in places. So, I think recruitment and prioritisation are probably the two registration points. In terms
of sustainability of our overall cost base. It is something that we have continued to put work on more generally. I think changed ways of working has made a difference in the short term. I think we have got services like the direct monitoring approach, that
I talked about earlier on, which does mean that we will be doing more work remotely. That said though, I think we will continue to be travelling, and I suspect some of those travelling costs may come back as we do more travelling. The other thing
that we do is we do use specialist advisors and experts by experience to accompany colleagues on inspection and, obviously, as we have been doing fewer long-form inspections, we have needed to use fewer of those colleagues and for less time. But having said that though,
I know Tyson and his team are looking at how we use specialist advisors, how we use experts by experience, can we use them in the most effective way? And we have seen some success in that area if I look at, a good example of
that, would be our second-appointed…, our second-opinion appointed doctors where it is a service that we offer on behalf of the Department of Health and Social Care. In that area we have managed to move to a service which is a lot more remotely-delivered as a
first way of doing things, rather than the traditional approach of people travelling and often spending a significant amount of time on the payroll, as it were. So, I think there are a number of examples where we have made changes. Some of them, I think,
are sustainable and some of them probably will start to come back, as we as we move to a more in-person approach to things. Finally the people point. I think, I guess the short answer on the people point is, well, there are probably two reasons.
One is we are making significant numbers of changes. We have talked at length about transformation, which again we know, it causes people some uncertainty. But I think the biggest, probably the single biggest reason is pay. We have talked a lot about pay and we
have noticed, particularly in the last couple of years, our pay is becoming increasingly uncompetitive in comparison to the places that we recruit from. We recruit traditionally from adult social care, care home managers and from the NHS. We are finding that we are increasingly uncompetitive
in that area. Although, we are putting together a business case to Treasury to look at how…, to look at our pay scheme in the broader sense, with a view to improving our pay scheme. Because, many Board members will know that our pay scheme is
linked to the civil service pay rise process and civil service pay remit, even though we have a sort of somewhat hybrid pay scheme, in the sense that we have an NHS pension, but we have CQC terms and conditions. But any pay rises are linked
to the civil service pay unit, which is a slightly awkward combination of things which we are looking to fix. We will be bringing forward a business case to our remco later on in this year, with a view to resolving that pay position, ideally before
the end of this calendar year if we possibly can although I think that will be largely dependent on progress through the Department of Health and Social Care Cabinet Office, and so on. So, I think that is probably…, they are probably the areas that that
I look at as being the reasons why that particular number has decreased. Thanks Ian. Thank you very much Ian. I have no more questions and I don’t see any others, so thank you very much Ian and team for that very helpful update. Let’s move on to the next item then which is

Quarterly Transformation Portfolio Update

the quarterly Transformation Portfolio update. Kirsty, I think you and Mark are going to pick this one up. Yes, we are. Thanks. So, I will just kick off and then hand over to Mark to pick up a few other areas. I am going to take this paper as
read, but just draw out a few highlights for you. We are now at sort of year-end and I think it is just worth the opportunity to have a little bit of a reflection on the year that we have had to date. We set out
at the beginning of the year to deliver our Interim Operating Model State 1, and I think we are in a really good place in terms of what we have achieved around that. Just a few of the highlights around that is we launched our Digital
and Intelligence Unit at the end of March which was on track, as we intended. That is the piece that is giving us our real insight capability and enabling us to really transform into that insight-driven regulator that we aspire to. We have appointed all of
our senior leaders across our regulatory and operational functions as on time and as we intended. We have also developed our new Single Assessment Framework and the scoring that goes with that and that is bringing all of our regulatory activity into one single assessment framework.
So we are able to really take that into an approach in terms of how we are going to regulate and really start to set out that as a codified piece of work. It has been a huge piece of work and I am glad to
say we have managed to do that within the year as well. We have done all this as intended on time and on budget, which I think is a fairly major achievement. And I would just like to take this opportunity to say thank you to
everybody in the teams and CQC have been working really hard over the last, well not just last year, last couple of years, to get this huge piece of work landed in such good order. That is the early stages of our transformation. We are now
starting to get really into the meat and bones of what we are doing. Our focus moving forward is now on implementation and, particularly, as we start to roll out and implement our new methodologies into our operations and really start to look at how we
can bring both the people changes, the system changes and the regulatory changes together into a coherent whole. What we are planning to do over the next month or so is to pilot and test our new methodology. We have done some work doing that in
a virtual environment to test out the functionality of our systems and we are now looking to put that into place in a small way, to test that in pilot stage and then looking to roll that out. We are using a sort of early adopter
approach and then, so that we can really test our activities, making sure it all hangs together and it works properly before we look to scale out that into…, across the rest of the organisation, with a view to landing that within this next financial year.
We are working, as well as part of that, to look at how we implement our multi-disciplinary teams. This is moving away from our work where we are currently brigaded in sort of specialist silos, such as hospitals or Primary Medical Services and Adult Social Care,
but moving into more geographically-based workforce with a multidisciplinary team approach. We are looking at how we start to put that into place as well, over the coming months. So, I think in some way, a pretty good progress we have made, lots of work still
to do and lots of difficult things still to come, but I think we have built some really good capabilities within the organisation now on delivering and managing our change. I am confident that, as we move forward, our Interim Model States 2 and 3, we
will make good progress with that. So Mark is there is anything you particularly wanted to pick up. Well, just a little bit of extra detail on the technology, the data and insight pieces. So in our regulatory platform work, we’re on track for this, building
up towards an autumn release of new digital services. We will start to roll those out with providers, and for our internal colleagues who are managing registration, managing assessment and the publication of our new up-to-date ratings. We will be phasing some of those services in
them, carefully, with providers and with the public in the summer. We have launched our new Data and Insight Unit, so an important part of that is the new enterprise data platform. The aim of that is to build a new core repository of quality data
and tools and we completed the recruitment of a new senior team in data and insight and the next six months will see us really mature and establish that unit to support us to become an insight-driven organisation. Then just finally, in our financial transformation work,
we have procured and onboarded a new implementation partner. We are nearing the completion of that that design phase and we have also completed the implementation of our new portfolio management tour and transitioning that now into regular business practice. Thank you. Thanks very much Mark.
And to Kirsty. We will go to questions, Mark Saxton. Thank you Chairman and Kirsty, thanks a lot for this report. A couple of observations around the People Strategy update. Really good to see the work rolling out on culture. This, as you know, came to
ACGC and we were very supportive of it. Also good to hear about capability-building and I am sure that you are demonstrating a lot of success stories there, because I think that would help us convince our people and reassure our people that we are travelling
in the right direction. But, can I say…, ask a question about the really good news in here about - and congratulations on the rolling-out of the regulatory and the operations leadership teams and also the data and insight unit. So, that is a really big
step forward and so, well done to the whole team on that. But my question is how are we capturing what went well in that process, and perhaps what was tricky in that process, so that so we can learn from that and apply those learnings
for future rollouts? Yes. In response to that Mark, we have just, I have just seen a draft report which is basically what we have done at the end of IOM 1, is we have done a whole lessons learned review piece of work which is
basically looking at what went well and what could have gone better, and make sure that we are taking that forward and applying that to the next stages of our transformation. It is part of our continuous learning approach. So we have got areas from across
all of the portfolio, including some of the stuff around (unintelligible) change and our people activities that we are feeding into that. So, it is not quite complete yet, but once that is done, we will be able to really look at that and then put
some actions against those, so that were able to track those. And I suspect that might get picked up as part of our internal audit process going forward as well. Thank you. Thanks Mark. Thanks Kirsty. Any other questions for Kirsty or Mark? Well, I have
no questions, but again I am still the new boy here, but it did occur to me, we’ve made much of the transforming data and insight work, and it is clearly a strategic change in what we are doing. So, it would be helpful I think
on future reports if we could bring it alive and talk a little bit more about…, give some examples maybe of how it has informed a different way of doing things. Certainly of interest to the Board, and I think to members of the public who
may be listening as well. If there are no more questions on the Portfolio update, thank you very much indeed for that. We have a couple of questions for the public to adjust, but just before I do that, I should come to any other business.

Any other business

Any of my colleagues wish to raise any other comment? I see them shaking heads, OK, thank you very much indeed. As you know we do give members of the public an opportunity to submit questions in advance, and we do have a couple from Robin
Pike in fact. I will take them separately. I’ll read them out and then ask – pardon me - somebody to respond. The first question was how will CQC regulate patient access to Primary Medical Services when the GP contract changes in October? Rosie, it is
probably best if I could ask you to respond to that? Yes, certainly. Thank you Ian. In terms of how we work and our methodology, the contractual changes which are looking at extended hours are not going to change what we do in terms of looking
at the quality and safety. Access is something we have had a focus on throughout our methodology, through our responsive key questions, and it’s something that’s very important. We don’t just look at access in terms of appointment availability and what is offered, but we also
look at the appropriate methods and modality that appointments are offered in, and also how people who might find it difficult to access services are able to get access. So, the contractual differences won’t make any difference specifically in terms of our methodology and we will
still be wanting to make sure that people have good access to all Primary Care services, however long their open for and whatever form they are open in. Thank you very much Rosie. The other question and I might take this one myself and see if
Ian or others wish to add. The question was how do we, CQC, find children and adolescent mental health services performing following the COVID pandemic? We did give some thought to that. I mean in our provider collaborative reviews last year, we did look at mental
health of children and young people in a number of areas of England - 7 I think. That gave rise to a number of findings, including challenges in ensuring the availability of staff and the right skills - no surprise there. But recognition that health inequalities
have been exacerbated by the pandemic is something that has clearly been on the board agenda, even since I arrived and certainly before. Through the regulatory work that we do, we have identified a number of common themes. That includes an increased demand for continuity of
inpatient services, touched on earlier, with more children and young people being referred, and challenges in children and young people being able to access the appropriate inpatient mental healthcare and treatment. Many of those existed pre-pandemic, they are not new. But while we know the inequalities
people face have been exacerbated, I think it is too early to understand the full extent of the impact post- pandemic. We are still - we’ll be optimistic here - just coming out of the pandemic. I think the important thing to say is we do
recognise we have a key role to play in regulating child and adolescent mental health services, but they are only one part of the wider services required to support children and young people to be safe and to live well. Our work to develop an approach
on the ICSs, the review and regulation, will give us - I think this is pretty crucial – an opportunity to highlight issues faced by children, young people and their families. So, thank you very much indeed for the question and it is far-reaching and we
will, therefore, also send a more detailed response to you following the meeting. But we did want to flag the fact that it had been raised and that was our initial thoughts. I thought it was easiest if I responded to that (unintelligible), but, Ian, I
don’t know whether your colleagues wish to add anything. I don’t think so, other than to just simply to loop back round to where we started. I made the point at the beginning of the meeting that the new Health and Care Bill will give us
probably the largest extension to our powers in the last decade. I think Robin’s question is very much one of how is the system working for children and young people, and I think whilst we can look at how individual providers are performing at the moment,
our extension of powers gives us an ability to start to have a much more comprehensive view of that question than we can at the moment. So I think it’s a good question, Robin, but I think we really won’t be able to fully answer that
question until we really get into the ICS work over the next few months. Thank you. Ok, Thanks very much Ian. So, those were the only questions we received, so can I just thank my Board colleagues, thank those who may be listening in and thanks Diane on behalf of the
CQC networks for joining us today, and some good questions. I think on that, I am going to formally close the meeting and the webcast. The next meeting, just to confirm will be streamed, but the Board meeting will be a physical meeting from our office
in Stratford. Thank you.