CQC Board Meeting 20th July 2022 - Wednesday, 20th July 2022 at 3:00pm - Care Quality Commission

CQC Board Meeting 20th July 2022
Wednesday, 20th July 2022 at 3:00pm 









Start of webcast
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  1. Mr Ian Dilks
1.1 Chair’s Opening Remarks and Apologies
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  2. Mr Ian Dilks
1.2 Declarations of Conflicts of Interest
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1.3 Any urgent business
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2.1 Equality Objectives
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  1. Mr Ian Dilks
  2. Mr Mark Saxton
  3. Mr Jora Gill
  4. Ms. Rosie Benneyworth
  5. Mr Ian Dilks
  6. Mr Ian Dilks
  7. Ms. Rosie Benneyworth
  8. Mr Ian Dilks
  9. Mr Ian Dilks
  10. Mr Stephen Marston
  11. Mr Ian Trenholm
  12. Mr Ian Dilks
  13. Mr Jora Gill
  14. Mr Ian Dilks
  15. Mr Mark Saxton
  16. Mr Ian Dilks
  17. Mr Ian Dilks
  18. Mr Ian Trenholm
  19. Mr Ian Dilks
  20. Ms. Rosie Benneyworth
  21. Mr Tyson Hepple
  22. Mr Ian Dilks
  23. Ms. Kate Terroni
  24. Mr Ian Dilks
  25. Mr Mark Saxton
  26. Mr Mark Saxton
  27. Mr Tyson Hepple
  28. Mr Stephen Marston
  29. Ms. Rosie Benneyworth
  30. Mr Stephen Marston
  31. Ms. Kate Terroni
  32. Mr Ian Dilks
  33. Mr Ian Dilks
  34. Ms. Kate Terroni
  35. Ms. Rosie Benneyworth
  36. Mr Ian Dilks
5.0 Board and Committee Matters
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5.3 Audit and Corporate Governance Committee Annual Assurance Report to the Board
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  2. Mr Mark Saxton
  3. Mr Ian Dilks
  4. Mr Ian Dilks
6.0 Any Other Business
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  1. Mr Ian Trenholm
  2. Ms. Rosie Benneyworth
  3. Mr Ian Trenholm
  4. Ms. Rosie Benneyworth
  5. Mr Ian Trenholm
  6. Ms. Kirsty Shaw
  7. Mr Ian Trenholm
  8. Mr Ian Dilks
7.0 Other Information:
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  1. Mr Ian Trenholm
  2. Mr Ian Dilks
  3. Webcast Finished

Well, good afternoon everybody and welcome to the Board meeting of the
Mr Ian Dilks - 0:00:09
Care Quality Commission. This is the first of the new times of these in the afternoon, I hope it is convenient for everybody. I just wanted to make sure – it would probably be
useful to explain where everybody is - we are here in Redmond Place and the majority of the board is here. One member was unable to get here because of problems with the trains yesterday. And we have also a number of our presenters are actually
dialling in online which seemed the only sensible response to the difficulties of travel yesterday. But I think in the circumstances, we have got a remarkably good turnout here, including a very long bus ride by one of the members to make it, so congratulations to
them. We are also joined by Karen Hill who you may see on the screen. Karen is our Equality Network Representative from the Disability Equality Network, so welcome Karen. One or two apologies, Robert Francis one of the Board members is unable to join us today,

1.1 Chair’s Opening Remarks and Apologies

so apologies from him, but also Chris Usher and Chris Day from the Executive Team who often join us are not able to do so today. And
Mr Ian Dilks - 0:01:22
lastly in terms of faces, I should welcome Sean who – Sean, thank you I can’t even find you.
Sean, of course, joined the organisation a little while ago, but this as his first public Board meeting since he joined the board, so Sean,
Mr Ian Dilks - 0:01:36
thank you very much indeed for joining us. Let’s move on to the formal business, then the presentations. Are there any

1.2 Declarations of Conflicts of Interest

1.3 Any urgent business

conflicts of interest or new conflicts of interest to note? I don’t see anybody. I had no urgent business to pick up. One point I would flag, which is not urgent, that is to say that we are in due course, as is public, going to
be losing a couple of our Non-Executives. They will be here for the next meeting, so this isn’t urgent. We are in the process of working with the Department, and I have mentioned this publicly before, to find successors. I greatly appreciate that, at the moment,
that can be a challenge, but we will keep you updated in due course as things progress. I think, having said that, then let’s move on to the formal business of the meeting and the first item is the equality objectives which we are to consider

2.1 Equality Objectives

and approve. Lucy Wilkinson and Gill Nicholson, can I hand over to you? Thank you Ian. It’s Lucy Wilkinson, I’m Head of Equality - Health Inequalities and Human Rights. Just a few introductory remarks, the first being that the equality objectives were published in July 2021,
just two months after we published our new strategy. So published following Board approval, so they are very closely aligned to our strategy we have for regulatory equality objectives which relate closely to our Strategy theme about reducing inequalities in access experience and outcomes for people
using health and social care services, and one equality objective relating to equality diversity and inclusion for CQC staff. I’m joined by Gill Nicholson who is a director of People to address any questions relating to that objective. The first year has been very much a
kind of foundational year where we have focused on ensuring that the equality objectives are reflected in CQC’s priorities in various, important pieces of work like our Data Strategy, our Independent Voice Strategy, our research priorities and so on. And also the opportunity that we have
had in embedding, tackling inequalities in our new regulatory model for both providers and local systems. We have also been doing quite a lot of work engaging internally, including with leaders and with other staff and externally, including looking at opportunities for cross arms-length body working
on advancing equality through the topics in our equality objectives. Then finally we have been trying to accelerate some specific pieces of work, which are covered in the paper and I won’t go into in detail. A couple of minor amendments to make in that we
were working on the appendix right up to the last minute and I did notice that we haven’t quite got the overall distributions right in the main paper about the deliverables and the success measures. So I need to correct those for the record. So, on
the deliverables 22 are on Green, 6 are on Amber, none are on Red and 6 have not started yet. And they are just deliverables for this financial year though the equality objectives do cover a four-year period. The success measures are more long-term. There are
some challenges in measuring them yet, particularly the ones where we need to build up our capacity to disaggregate data that we gather, for example in surveys and so on by equality characteristics. The distribution of them is that 12 out of 29 are not yet
measurable because they are too early to be able to do that. Then, 9 are Green, 7 are Amber and two are Red. It is quite challenging to design success measures for equality objectives. I know that that has been an issue raised by both the
Board and the Executive Team before and we are working on that, particularly linking with the strategy assurance work. It may be easier to do the success measures on the Internal CQC Workforce Equality Objective because we have like a whole data set about our own
staff, but it is harder in relation to, for example, people who use services. Just a final point is that the Board reporting doesn’t yet align really with we how we plan the priorities. Because we are an annual work planning cycle, along with the rest
of CQC because it is embedded in CQC work, which is kind of April to March, but because we published the equality objectives in July, you are getting kind of quarter of the way, you know for months through the year, a view of how we
are doing. So the proposal is that the next report would come in February where you could have a full year review and also some input into what that means about next year’s delivery. That is all I wanted to say at the start. So, thank
Mr Ian Dilks - 0:07:05
you very much. Can I ask colleagues if they have questions for Lucy? Mark. Thank you Chairman, and thank you Lucy for a very, very good
Mr Mark Saxton - 0:07:18
report. Really excellent to see the work on Executive Engagement in this area, the oversight and rigour of the oversight
of our progress, and some changes in our processes as well. Also really good to see collaboration with other ALBs and our own work in terms of the independent panel members and the appointment of our Diversity and Inclusion Coordinators. Very good to see the work
around Inclusive Leadership Pathway. So, this is all great. As you have said, there still needs to be some work done on measures, and obviously still some work to be done in terms of training of our staff in measuring data and how we influence providers
through our well-led framework. Did have a couple of questions Lucy, if I could? One, why the second iteration of the Reverse Mentoring Programme is not Green, it’s Amber, it seems to me we could be ready to go on that straight away? And I did
wonder in terms of selection processes – you have demonstrated there that we are going to be looking to make sure that our advertisements and our processes are not exclusive, are inclusive, but I just wondered whether you, as a team, have looked at the use
of AI in selection and whether we are… if we are using AI at all in our selection, whether we are ensuring there is no exclusivity there. And then finally, sorry it’s a long question I know… That’s OK, keep going… I just wanted to say
in terms of the shortlisting buyers for promotions and acting ups, we have asked for that information to come to the public Board and I am very hopeful that that comes and that is something that gets a lot of visibility at the Board, but thank
you very much indeed for the report. I will ask Gill to answer those because the People Directorate lead on the detail of the delivery of the Equality Objective 5, so I’ll pass over to Gill. Thanks Mark, really helpful reflections and questions, so I will
take them in the order in which you made them. So, the Reverse Mentoring - I think probably it was Amber at the time that we pulled this paper together. We had a People committee meeting shortly after we concluded and finalised this paper which confirmed
the approval to go live with the next cohort of this really important initiative. As you know…, you will know, all of you at the Board, for those of you who were actively involved yourself within our first cohort of Reverse Mentoring, it was a very
powerful thing for all concerned. We took some good time to make a proper evaluation of the activity, so that we could be really clear that we were building on strong foundations for how we roll this out further. Obviously, the paper indicates that we are
expanding this out to colleagues with a disability, as well as those with an ethnic minority background or black or Asian background. So, we are… we wanted to make sure that we were really ready to roll this out well. We, as I said, agreed this
at the People Committee earlier this month and so our plans will be in place to roll this out in the autumn time, so that we can actually properly manage that with colleagues across the organisation. So, that was that one. On the selection processes, I
think it is a really good reflection. I can take that away to the team. We are looking at a whole raft of activity under our QI project so there is no reason why we cannot build AI into that, sort of in terms of a
scoping and a review point. So happy to take that away. And then the shortlisting buyers’ information, I think we can probably bring that…, we, as I will share later in the People Plan session, planning to come to board on a twice-yearly basis, then more
than happy to bring that at our next opportunity to Board. So always happy to share that. Thank you Gill. Thanks Gill, Mark. Other questions? Jora, go next and then I think Sally (unintelligible) the
Mr Jora Gill - 0:12:24
screen. Just on Mark’s second point, I noticed in the Board pack that the technical data
issues, technical data risks were highlighted. I wasn’t quite sure is that we are not collecting quality data, or is it more of a technical issue? Could you expand on what was meant by technical data risks? Yes. I can take that one. This is largely
relating to regulatory data, not our HR data. So this relates to issues particularly with qualitative data, about how we can disaggregate that by equality characteristics. So, for example, information that comes in to us through Give Feedback on Care from members of the public and
people who use services, where we might not be aware of their equality characteristics or the way that things are phrased, might not be easy to work out whether or not there is an equality dimension to the issues that they are raising with us. So,
there is something about how we use and score qualitative data. There are… other issues are that most of the data that we collect, that we use in datasets around quality of care, so that is equality data around patients and people who use services, we
don’t collect directly, but is collected by other bodies such as NHSEI, NHS Digital, individual trusts and there’s even less in GPs and in Adult Social Care than there are in the larger services. So, that is one of the areas that came out very strongly
in terms of joint work with arms-length bodies about aligning and strengthening data collection on equality, so we can look at the quality of care for different groups of people. Obviously, the primary responsibility for that is on the care provider, so the other thing that
we are doing is writing into a single assessment framework quality statements around how they are looking at the quality of care that they provide in terms of equity in access experience and outcomes. So, we are not expecting to do all the data analysis across
the whole of health and social care to uncover equality issues, but we do come across difficulty when we are trying to use data sets by others that are not yet good enough on equality. Yes, I was just wondering if we are levelling up to sort of equality of everybody having the same quality of care, who are not collecting the data. What is
the mitigation? I wasn’t quite clear on, are we saying that it is up to the providers to improve the quality of data they collect? Or are we sort of holding them to account to improve the data that they are collecting so we can assess
that, you know, individuals, you know, who may have a disability aren’t being penalised by having a disability? Well, we are doing two things really. The first is that we are working naturally to improve data collection and you have picked a very good example there,
Jora, because there is not yet, for example, the NHS Accessible Information Standard doesn’t yet have good data collection and one of the things that we have been asking as part of the Accessible Information Standard Review is about whether or not metrics can be improved
at a national level. So that there is a framework for providers to actually collect and more importantly analyse and use that data. The second thing is where data is already collected, that we look at the quality of the data as part of our assessment
of equality and we have done a piece of work specifically looking at ethnicity data in mental health because there is the ability to collect ethnicity data in mental health data sets and so we are actually using the quality of that data, looking at using
that as a measure because it is comparable across all the organisations that are expected to use the mental health standard dataset. So, where it is a provider failing to collect or to use, then we will we will build it in there. And where it
is providers maybe would like to, but there isn’t the national framework to do that, then we are trying to work with others to develop that. Thank you. Sally, you had a question. Thanks very much Ian. And thanks to Lucy and Gill. I had a
specific question on 5.4 which is around diversity data as well, and then a more general point about Section 3 working with others. So on 5.4, it is rated Green, but we have a target of 95% of data collected, and all of those figures are
below 95. So, whilst I appreciate it is a positive trend, I think we need to decide whether it really is Green and what more we could do? And under Section 3 around working with others, a lot of the measures are about us asking providers
or stakeholders how they think we are doing. I wonder going back to the GPs’ Report - that Rosie might want to comment on last time around perceptions of equality in our own regulation and the need for us to work with other bodies like NHS
England on some of the issues there - although this is Year One, perhaps over Year Two I would like to think about not just asking providers for their comments, but to think more proactively and strategically about how we work with other bodies in health
to be able to push this agenda forward and make a real difference for people who use services. Thank you. Should I just comment on the GP
Ms. Rosie Benneyworth - 0:18:44
aspect because for Board members who may not have seen this, we did a large piece of work looking
at inequalities faced by GPs of black and minority ethnic background and the potential inequalities that they faced, and the impact of our regulation. Some of the findings very much highlighted the need for good data collection that actually none of the system had really in
terms of that quality of data. I think it is really important that we work and we continue to work with other parts of the system, so that when we are looking at data collection we are not all going into providers collecting data in lots
of different ways, but we are doing that in a sensible way that doesn’t kind of create impact, but enables to understand the issues. Also, I think it is really important - one of the things that was flagged in that report - is that we
found that there was a lot of practices led by GPs from black and minority ethnic background who were working in environments where they would just not getting the support that they needed, in very deprived areas and areas with less funding and a whole range
of other issues. So, it is vital, and I completely agree with Sally, it is going to be vital for us to work with other partners and we are doing that to look at, actually, how do we make sure that people get the support, get
the resource that they need to be able to give good quality care and thrive. I think integrated care systems, as we go forward, have a really vital role in looking at the inequalities that exist potentially across their areas and being able to address them.
So I think part of our ICS regulation needs to be looking at actually how are integrated care systems understanding that and putting plans in place to be able to address those inequalities, and making sure that people get the support they need to be able
to deliver good care. Thanks Rosie. A really important point about the
Mr Ian Dilks - 0:20:42
role of ICSs. Lucy, there are other questions… you respond to Sally. Yes. So, I think Gill will need to pick up the one on 5.4. So, just to say that… it is a really good
challenge over the measures for three. We can go away and look at… so there is the activity, the activity report at the front of it gives a bit more detail on what we are doing. Getting good measures for how the impact of what we
are doing, I think we need to develop over time and I think that is a really good thing that I can take away. And I think on 5.4, so we have probably been, perhaps, optimistic in our… or a bit positive in our rounding up
and I’m looking on balance that whether or not we felt that all of the indicators were sufficiently robust that we could give ourselves a Green, a Green score on that, I think, you know, we have got…, in terms of rounding…, we are…, if we
rounded up when then our disability declaration rates are on target, we are not that far off with the ethnicity declaration rates. Slightly lower than we would want to be perhaps on the sexual orientation and religion, but if people feel strongly at the Board that
they should be Amber rather than Green then we can happily change that. I don’t think you actually need to change this report nor… - I am not suggesting either a category of Almost Green -, but I think as a general rule for future reporting
we just, as Sally said, you ought to be clear we either do or we don’t achieve it. Or we find a slightly different way of measuring it, not an Almost Green but something that flags what is going on. I mean, an indicator of direction
of travel once we are into a second period would also be quite helpful, because often that is as interesting as the level status. Any other questions for Lucy or Gill? I just want to follow the one from me then Lucy, and this is probably
Mr Ian Dilks - 0:22:54
an unfair question at a public meeting, but I’ll ask you anyway. I mean this is us and clearly we are interested in what we are doing, but you have talked about working with other ALBs as well. So, I am not asking you to comment
on others - this is a report about us - but do you have any observations from working with others as to where we… Well, two questions actually, one is where we stand, anything to learn from others where we are more successful or perhaps less
successful than others? And why that might be? And a second question is, to what extent are these things all within our control? Are or are some of these to some extent influenced by what is going on in the wider system and therefore we don’t
have complete control over it? A really good question, thank you. So, in terms of where we are at, I think one of the things we have got is we have got a new research… - I am going to fudge this slightly – we have
got a new research budget in CQC and one of the themes on that is about tackling inequalities. Among the things that, as the sponsor for that part of the research budget I want to do, is an actual kind of assessment of what we can
learn from other regulators in other sectors, and also in other countries about how they have - not what they are doing - but how they have actually made an impact on tackling inequalities. I think generally speaking, we have got a level of clarity and
the level of commitment and the level of the kind of development of the programme that quite strong compared to many other organisations. I wouldn’t like to say where we would rank compared to other organisations, but I think we have got a high ambition so
we want…, it is key to our core purpose because we are here to regulate that care quality is good, and that care quality is good for the people that are more likely to have poor care is really, really important so we need to keep
on with it. We have got good foundations in place, we need to kind of not rest on our laurels, I would say. So what is in control? The activity is definitely in control. There are sometimes confounding factors in the success measures is what I
would say which we need to be aware of. So, everything that is in the deliverables is within our control, but the success measures might have confounding factors. Rosie. Can I just add to that? I just want to say well done to Lucy because I
Ms. Rosie Benneyworth - 0:25:25
know Lucy has built very, very constructive relationships with arms-length bodies across the system and those relationships are really growing and really productive and we are working particularly with people like Bola Owolabi from NHS England, the Director of Inequalities. So, I think we are positioned
well to progress this and to play our part across the system and I think Lucy has brought this agenda forward massively in the last year or two. What I would say is I think all of us as arms-length - all the arms-length bodies -
have so much more to do in this area. I think we are only being…, really starting to understand some of the inequalities that exist. If you look at the work we have done around general practice, if you look at the work around maternity and
outcomes for black and minority ethnic women, if you look at some of the DNACPR work we did last year and the impact on people with learning disabilities, for example, there are huge inequalities that exist. And I think all of us as arms-length bodies need
to be challenging ourselves to do more and do it quicker really. Thanks Rosie and thanks Lucy as well. I was pleased to hear you’ll be
Mr Ian Dilks - 0:26:38
looking at what others do. They support and protect the focus here, but equally nobody has all the wisdom, so
seeing what we learn from others, including international (unintelligible) was interesting, so well done. If there are no other questions – there don’t seem to be looking around the table, so Lucy, thank you very much indeed. Good report both in terms of its comprehensibility and
its content, so we look forward to meeting you again and having at least equally as good reports for you. Thanks Thanks, see you in February then. If we move on, we now have the People Plan, so Gill, I think you are remaining with us
and this one is down for you. Yes. It certainly is. So, I have shared with you our sort of Draft People Plan. Just by way of context as to why this is with you, we have reviewed and refreshed our existing People Plan which was launched in March 2020,
running for three years, but we felt that it was probably time to actually give it a bit of a refresh, at this stage, before we reach the end of the 3-year period. The reason why we wanted to do that was: 1) to reflect what
we had achieved so far, but then also where we needed to focus in the future to support our transformation journey, so, really tying our People Plan into the transformation journey. You will see from the draft plan that I have tabled for you that our
overall ambition is to create a great employee experience for all of our colleagues, every day. I do recognise that the organisational changes that are underway can be unsettling and can have an impact on how people feel and experience working with us. So we need
to be mindful of the here and now, but also still striving for our ambition for the future. We also know from previous surveys that we need to really continue our focus on how colleagues understand and experience change. So, our leaders at all levels are
critical to this point. The People Plan that I have provided for you provides a focus on our core People activities and the key touchpoints for our colleagues which all contribute to create a great employee experience. You will see from the plan that the role
of the line managers is critical in all of these touchpoints right the way through from attraction and on-boarding, to how people feel developed, how performance is managed, how the people feel and our colleagues feel connected to the organisation, so that they feel engaged and
motivated. So, management activity really critical to all of those key touchpoints in the employee journey and lifecycle. There are also within the plan three specific areas for focus. One is the diversity and inclusion agenda. So we have achieved a huge amount since we launched
our D&I strategy in June 2020, but there is still more to do. We have some work underway now to review the achievements to date and really focus on where we need to add our focus and value going forward, and our activity. The second area
for focus is people’s experience and insight so I really… Given that all of our strategy across the organisation is about being a data-driven and insight driven organisation, we really need to continue in our People agenda to look at how we use People data effectively
to inform our priorities and our actions. So, really get into the heart of how people experience working with us, but also how people…, what insights people can share with us and the various different mechanisms for doing so. And then finally leadership and change, I
said this just now. It is really important that we embed leadership skills at all levels, now and for the future, for the organisation So, this is the high level delivery plan attached to the overarching plan. It is supported by very detailed project plans, which
obviously are of a detail that I wouldn’t share necessarily with the Board. But we are reporting on that progress to the People Committee on a quarterly basis and we will bring a summary of our progress to Board on a twice-yearly basis. So, the People
Plan finally has been approved by the People Committee and also by the Executive Team, so I am bringing it here to Board ahead of sharing it with the wider organisation in this period of August into early September. So, I will pause there as a
sort of summary of what I have brought you and happy to take any
Mr Ian Dilks - 0:31:34
Mr Stephen Marston - 0:31:38
comments or questions. Many thanks Gill. Stephen, are you up first? Gill, thank you so much. I think this is a really, really terrific report. You have clearly made a huge amount of
progress and thought really hard about what you need to do next. Could I pick up the comment you made - because I strongly agree with it - about the importance of line management. You are absolutely right how important it is, could I sort of
push you a little to give your assessment of how good it is currently? Well, how would you rate the current sort of quality confidence of managers? We are setting them a huge task of change management and culture change management - you know it is
a lot we are expecting of our managers. How do you rate current capability? Could I then ask a different a second question? I couldn’t see anything in the report about the consequences of two years of working from home on what you want future working
practices to be It may not be true here - in many organisations, I mean I think people are now wrestling with what is a future, more sort of hybrid, more agile way of balancing individuals working from home, from the office, from third places. Is
that an issue for you in terms of People management? Thanks. Thanks Stephen, so I will take those in the order in which you have shared them. So a good challenge for me - how do I rate our line managers? If we look to our
survey data, I think our colleagues have a very strong connection with their line manager and they are…, they rate them really highly and I think that is relatively unusual, certainly in the organisations in which I have worked previously. I think we have pockets of
really excellent line management practice, as you’d expect in an organisation. I think we have some colleagues in line management roles who, perhaps, do lack a little confidence and so I would say it was probably patchy. We have some really, really brilliant by managers and
we have some people for whom actually some of the interventions that we have available in terms of our line management learning offering have been really helpful for them, and we have now got quite an established cohort of internal coaches who can offer specific coaching
to line managers. So, it is a work in progress. I think we have got some great people. What I really want to do is make sure we are role-modelling the really great people management skills that we see in (unintelligible) people and our colleagues’ experience,
as well as making sure that we have got the tools available for all of our colleagues who have got a line management responsibility, to be able to feel confident to work in that way. Much of that is to do with how they are coached
and supported by their line managers up the chain. So you know, right from the very top, all of us as line managers need to be really, really demonstrating great line management skills and that includes giving constructive feedback when it is required. So, I think
without willing to put a marker on it, Stephen that is kind of…, that is my summary of what I think…, what I see and experience. I think then on your second point, I think unlike other organisations, we entered into the pandemic with 67% of
our workforce already home workers. So, we already had this as an established way of working. I think we have proved over the last few years that we can actually function really well as an organisation with a high degree of home-working in our midst. So,
our technology platforms support that entirely, our ways of working, our colleagues are used to travelling to connect with their colleagues. I think we have made great…, there has been a huge amount of activity going on which is probably completely unreported at Board around the
sorts of social interventions that people have initiated within their teams. You know, bringing children in, Christmas carols, story-time for those when - well you know a great number of our colleagues were home schooling, had their children home schooling. So, some really brilliant initiatives and
I think that actually it is not an issue for us. I think we can manage well where we are. We currently have 91% of the organisation now on a home-based contract. That feels comfortable. It has not diminished our ability to deliver our end performance
and so we are open to considering home-based contracts on an ongoing basis. I think it is certainly something which I think we have proved that we can do well. Can I just add to Gill’s comment? I think we can
Mr Ian Trenholm - 0:36:49
really turn that around and
say actually, we are turning that into a positive in some areas. In some teams we are able to recruit hard-to-recruit skills because we can offer that flexibility and because, as Gill described. It was not a cultural shock to move to home working. We already
had a national footprint, we had a significant number of people in the field force and a significant number of people working from home anyway. So, I think what we have managed to do is to is to build on and, as Gill described, we have
made some investments in technology platforms as well which, again, put us in good stead. So, I think that combination of culture, national footprint and technology meant we were really well-placed and we are now attracting some really talented individuals who, maybe, that we wouldn’t otherwise
Mr Ian Dilks - 0:37:42
have got. So I think it is a real positive actually. Any other questions for Gill? Jora. Just a quick one. Gill, on the Delivery
Mr Jora Gill - 0:37:49
Plan, Slide 48 of our pack, it talks about sort of increasing, you know, maybe having more diverse individuals as part of the Executive Team
and decreasing others. Would it be worth, or would you feel comfortable putting a range in, like increased by a percentage of X? Because, how do you measure success? Because it seems a bit vague. Yes. So, I think this success measure is actually in the Diversity
and Inclusion Strategy which is where these all fit together. So, our ambition and our target is to effectively map against the economically active population, for both ethnicity and disability. So, overall, I think for ethnicity it is currently 14%, and we are overall, I think,
at 14.1%. But when you look at that an a grade spread, we are not quite there. So that is our target, is to continually meet that so that we are representative of the economically active population that we serve. We are not quite there with
disability, but that certainly is there, but we can, you know…, it is there in another part of this interconnected strategy, so the D&I strategy has that very, very clear. Mark, I think you had a question.
Mr Ian Dilks - 0:39:10
Thank you Chairman and thanks Gill for a very
Mr Mark Saxton - 0:39:16
good report. I certainly want to endorse the good progress that you have made so far in terms of recognition, leadership development, independent panel members and the diversity, inclusion and wellbeing focus and actions. So, I really do applaud you for that. I am going to
say I am going to miss your old People Plan, People Plan diagram. I quite like the old 6 pillars, so I am going to get used to your new diagram. But I just…, in terms of the actual attachment to the Plan, I wondered whether
actually on Page 54, the employee experiences and insight and move to peer-to-peer recognition, I wonder if that is actually an example of a post-pandemic People action as people became very much influenced by social media in that times. So that is one question if I
could. And then on Page 55 of our Pack, the employee experiences and insight and building engagement approach establishing our regular survey rhythm, and the expected outcome is to be confirmed in this Pack. And I would have thought we already have some measures that we
would want to use in terms of evaluating our performance in that area. I mean sort of areas such as we survey, in terms of people recommending CQC as a place to work, people feeling that CQC, you know, has a concern for their wellbeing. We
have some measures. I was a bit surprised to see that not having any measures confirmed at the moment. I think…, you know I draw your attention again to the one below that, about developing and producing informative and relevant People Data Packs. Again, the expected
outcome is to be confirmed, but I would have thought that the outcome there is sort of improved resourcing effectiveness and improved shaping of our workforce. I just ask you why those outcomes have not yet been determined? Thanks, Mark. So some really good questions. I
think where we have got the “to be confirmed”, certainly in the context of the People survey, is to do with the fact that we have are just on-boarding a new survey provider. So sort of…, I expect us to continue to ask the questions that
we are broadly asked in previous years, so that we can maintain our trajectory and make our important trend analysis work on where we see things improving or dipping, and where we need to pay particular attention. So, the “to be confirmed” in that context relates
entirely to that. I think we are also just then, on the back of that, looking at really, because what we want to do is ensure constantly that we are providing colleagues in the business and leaders in the business with the right People data, that
it is a good opportunity for us to really reflect on the People data that we that we provide to our colleagues. So, is what we have in our extensive People Pack helpful? Does it contribute to the right conversations? And so can we actually…, is
there a point at which we can refine that? That perhaps we can tighten that up and happy to take that away, we can bring it back to Board in February. Gill, the peer-to-peer… Could you just talk about a little bit please? Yes. Of course.
So, we know from our research that actually peer-to-peer recognition can be really powerful, and so we have never really had a mechanism for doing that before. So, this is an opportunity and it is in train now. We have a platform which allows peer-to-peer recognition
and recognition up the line. It is not as sophisticated as we would like and so it gives… What we really want to do is give, is provide a really easy route by way that colleagues can actually recognise their peers, say thank you for something
if that is to do with any of our values, you know whether they have been the experience…, had really great experience of team working in collaboration with a colleague, whether they have seen some really excellent inputs, or whether they have demonstrated integrity or caring.
So really wanting to make sure that we have got a mechanism which is a bit less clunky than we currently have, which is essentially where we have to route everything through the line manager in order to trigger the sort of the recognition award. So,
the objective around that is to make sure that we are building on the ethos and culture of recognition in the broadest sense. And then do so
Mr Ian Dilks - 0:44:47
in a way where we have got a platform that supports that. Thank you. Any other questions from people? Gill, I have a couple which
have sort of been touched on already, so I won’t ask you to repeat, but I may just try and tie them together. You talk about the need for everyone to be leaders, the training of requirement of that, the tools etc. I would just be interested to get
a better feel for the resource required to do that. Whether we actually have that in place already, or whether that is something that has got to be found, in the more detailed plan you referred to underneath. And then secondly, home-working, as Ian I think
said and absolutely, you know, I have seen this myself in my time here, it does work successfully, I think the organisation is doing a good job of using what was almost a slight advantage when even better competitive advantage to recruit people in. But home-working,
or at least collaboration by things like teams, works really well for people that know one another, it’s much less effective if people don’t know one another. I just wonder how we are being able to induct people and bring in the people you’ve talked about,
and then train and develop the people we are talking about in an environment where 90% of the people are not in the office in the first place. OK, so on the first point, yes, we do have the resources identified for all the learning, including
all the learning that is related to our transformation activity. So we have got a…, I have got a very skilled bunch of learning professionals in the Academy. We have identified the funding that we need for the various different programmes that we are about to
launch, including our inclusive Leaders Programme which I am really proud of, and I am hoping is going to be really effective in the organisation. A broader Leadership Programme is resourced and will be able to roll that out. So, I think there is also…, we
mustn’t underestimate the power of really, really strong role models in the organisation. So, as well as investing in training and learning and opportunities for people to develop, I do think we also need to recognise our leaders themselves are really powerful advocates for what good
leadership looks like and what good change leadership particularly looks like in the organisation. So, I think a combination of training people, of some of our sort of strong advocates, some of our really powerful role models, I think will get us to a point where
we have got a kind of sweet spot in terms of our resourcing for that. On the home-working, we are now able to bring people together and so what I see and I hear from colleagues is a lot more of collaboration happening because people are
coalescing around a particular place. So, more team-based activities are now happening as people are able to move out of the restrictions that we had for the vast majority of the last two years, and so that is starting to self-manage itself again. It has always
been our way of working, so our teams have been really used to coming together for a purpose. And we are inducting in the way that we had previously so we are looking to bring people together. Line managers I know are always really keen to
meet people face-to-face as soon as they can. I know that from my own teams when we have brought new people in. The fact that this is a…, that our organisation has caring as one of our values, I do believe that actually means that people
are reaching out to colleagues. We see a lot of that through the regular communications, but there are certainly mechanisms in place which means that, you know, we are able to establish relationships with people who are new when they join us. Thanks. I mean there is no
doubt that technology, the collaborative element of the technology has improved dramatically over the last couple of years, so I agree it is much easier than it was. Any other questions for Gill? If not, well Gill, thanks very much indeed. I am sure Mark will
get over the fact that you have taken away the picture he liked. I’ll send him the picture so he can keep it for posterity. I already have it Gill. Thanks very much indeed Gill. We look forward to a future update. Thanks for joining us.
Mr Ian Dilks - 0:49:34
OK thanks everyone. Bye. OK. Well, thank you for that. I think the next item up is the report from the Executive Team, so there will be a number of contributors, but perhaps, Ian, if I could hand to you? If there is anything you want
to say and then we will hand it on to the others. Thank you very much
Mr Ian Trenholm - 0:49:51
Ian. So, I think there are four items from Sean, Rosie and Tyson which we will come out…, come off…, talk about in a second. So, please take the report
as written and we will have an opportunity at the end of the meeting to formally thank Kirsty and Rosie for their contributions to the Board as well. So if I could hand over to Sean in the first instance to talk about urgent and emergency
care. Thank you. Thank you Ian. Just to confirm to the Board that the Ambulance Service remains under intense pressure, with a number of key performance indicators including call response times across all four categories of call including 999 call answering times and including ambulance handover
times, have all either lengthened or increased over the last month. This may be due to, partially due to increased demand - there is evidence of increased demand over the last month -, but also due to the issues around preserving or improving patient flow through
the emergency and urgent care pathway. So that is all I wanted to
Mr Ian Dilks - 0:51:04
mention on that one. Thanks Sean. Why don’t we perhaps take all other reports and then come back to questions on any of them, if that is OK, it might be easier? OK, thank you
Ms. Rosie Benneyworth - 0:51:15
Ian. Just a couple of things for me. Firstly I just want to take this opportunity, it is my last Board, just to say a huge thank you to all of the CQC teams have been working with in public. I have felt very privileged to
work with a group of people who are so dedicated about improving care for people using services. I think many of our teams, particularly our inspectors, have very difficult jobs and they go about them with huge dignity and professionalism and are hugely patient-centred at all
times and so, just as a big thank you from me and good luck with all of your future work. Two things - the first thing I just wanted to mention was about the Fuller Review. As you might have seen in the report, we have
seen Claire Fuller’s report which sets out a lovely vision for the future of Primary Care. I think over the last few years we have seen…, I have been increasingly concerned about general practice particularly since I have been in this role. We have a workforce
that has recruitment problems, that is struggling with enormous demand and that has just got more and more difficult during the pandemic. I think that the workforce in Primary Care is tired, it is exhausted and in some places really struggling to manage those demands. At
the same time we have also had increasing Give Feedback on Care and increasing patient feedback that says they are not getting access and they’re not getting the care that sometimes they expect. I think that points to the fact that the current model of Primary
Care and the current model of general practices is not sustainable. We need to look at how we can develop new models of care in light of the wider integrated care system and all of the services. So, I think it is going to be…, Primary
Care is fundamental to the future of the NHS, it is fundamental to be thriving, it is fundamental for patient care and I think we need to ensure that all people work with Primary Care to ensure that we have a thriving and good service for
patients that is sustainable for people working in the services. So, I can really welcome Claire Fuller’s report and very much keen to support it as we go forward. Can I just also take this opportunity to thank all my colleagues who are working incredibly hard
in all Primary Care settings and dealing with very, very challenging situations at the moment? So thank you for all you are doing. Just a few things to mention about oral health as well. One is that oral health and care homes, the Board may remember
just over three years ago we published a report looking at oral health and care homes. That has not gone off our agenda. At the time we found some fairly shocking things about the lack of oral health and care homes. It is so important for
people’s dignity, people’s wellbeing, people’s health to have good oral care healthcare and we are reviewing the progress that we made since that report was published three years ago, and the findings of that will come back to the Board. Couple of minor things just to
mention. One is that we, as you know, well they are not minor, they are very important, but brief things. We have had longstanding problems about access to dental care. Just to flag that NHS announced yesterday new reforms to the dental contract to improve access
to dental care. I think we welcome anything that is going to improve access to care for people’s dental health. Also, just to flag also, we will be responding to the General Dental Council Consultation that has just been launched about their new strategy. We work
very closely with the General Dental Council and other dental stakeholders and continuing to work with them. So, we will be responding to that in due course. Tyson. I think it is me next. I will be very brief. Thank you Chair. I just wanted to
give a couple of updates on my written report. In my written report I
Mr Tyson Hepple - 0:55:38
say there were 870 inspections in June. We have now further validated much of the data and the figure is now standing at 924, which is closer to May’s figure. There are
still 42 inspections to be validated, so I am hoping that the final reckoning will be closer to 950. Very briefly on registration, things remained stable despite vacancies in the team, and the overall amount of work in the system it is pretty much the same
in June as it was in May. One thing we have been focusing on is the very old…, are the very old cases, the very old applications in the system. As of March this year, the oldest application was November 2020. As of in my in
my written report, I talked about the oldest application being April 2021. I am really pleased that, today, the latest figure is the oldest case in the system is January 2022, so we brought the tail into almost within six months and I think that is
a sign of good health in the system. That is all I wanted to update
Mr Ian Dilks - 0:56:43
on. Kate, do you want to add to your written report? I can just very
Ms. Kate Terroni - 0:56:50
briefly flag to Board that we are doing some active engagement with health and social care
providers about our up and coming role around assuring local authorities and systems. There are two pilots for local authorities that are underway and are going well, and we are about to start our piloting with ICSs. So, very brief, right. I thought it might be
Mr Ian Dilks - 0:57:11
easier to take all the reports together, but questions from colleagues on any of the areas? Mark, you were going to go first, I think. Thanks
Mr Mark Saxton - 0:57:20
Chairman. The first thing I would like to say is, you know, you really get a sense, as a Non-Exec.
Director here, of the work that goes on, on a month-to-month basis, so thanks very much to the Exec. Team for these reports. Sean, I was just wondering in the ambulance sector, I was reading somewhere that there is a perception perhaps that people feel they
get treated quicker at A&E if they arrive in an ambulance than if they don’t. Is there a strategy to try to address that perception, to take pressure off the Ambulance Service? I am not aware of any figures myself that indicate that patients do get
managed more quickly if they arrive by ambulance than if they arrive themselves. I think it is, you know, patient disposition at ED will be a function of triage processes and the their clinical need. I would have thought that that would be the thing that
we would want to make sure was always present and preserved in emergency department function. That patients are managed and seen on the basis of clinical need rather than any, you know, any conveyancing. I totally agree with you. I was just saying that I have
Mr Mark Saxton - 0:58:49
read this perception is out there and that is what is putting the pressure onto the service. So, if you could dissipate that idea in people’s minds, that you walk in and get treated as quickly as ambulance arrivals, might take some pressure off the system.
Could I ask another question please, Chairman, and it is to Tyson. Tyson, thanks a lot for your report. Just looking at the DMA performance in June being down on May, I think you said to us before that you were using the Bank to try
to give more resource to the DMA, is that still part of the process or, you know, has that actually stopped now? We are still using a number of Bank Inspectors in the DMA Team. I think the DMA team is
Mr Tyson Hepple - 0:59:53
currently about 59 strong and
there are 17 FDE who are Bank Inspectors. We have lost a number of Bank Inspectors since the team started in February. I think it’s 12 Bank inspectors, FDE equivalents, and 7 of our colleagues, so from size of the DMA Team is smaller than it
was. We’re not looking to recruit new inspectors at the moment given the pressures on the other inspection teams, but I think the main reason for the figures of DMA as being lower in June than May is because of the vacancies that have come about.
The Bank Inspectors who have left, left for a number of reasons. We are using Bank across the operation, we are using Bank Inspectors more generally. We still have around 160 on the books, and over the last month or so, we have been using them
to fill other vacancies we have got and that we are also looking to recruiting. OK, thank you. Stephen. Thanks Ian. Two questions if I
Mr Stephen Marston - 1:00:53
could? One to Rosie, very interesting comments to us, particularly about the current challenges in the whole Primary Care system and
the need for a new model of Primary Care. Feels like quite a big issue. What is your advice to us on how would we or others working together, how do we generate such a thing? You know, how do we get to that new model
of care if you are, you know, with all of your expertise and experience, you are saying what we have got is not working, we need something different. It is a good question. I think the first thing to say is I don’t think there is
Ms. Rosie Benneyworth - 1:01:33
one model that fits all. I think it will depend on the population needs, it depends on the environments that people are working in and the local set ups. I think the system has become very fragmented and I think we need to encourage with our
ICS regulation, how systems are working together. I think Primary Care is dependent on how systems and providers around it work as well. So we need to see much more integration with Primary Care and Community Care, we need to see much more integration between the
Acute Trusts. We need to really hold on to the things that we know are important in Primary Care like continuity of care. Huge amount of evidence that continuity of care improves outcomes for people using services and particularly people with complex needs. So, we need
to look at the important things in Primary Care and the things that we know are fundamental to good patient outcomes, but then think about how do we design services so they really support sustainability and deal with the workforce challenges that we are seeing across
Primary Care which are significant. And really think about what is going to deliver best outcomes for people using services. So I think there is not…, I don’t think there is a specific model. I think that different places are trying lots of different idea. We
have got vertical integration with Acute Trusts, we have got some great examples of where practices are working together with their local communities and providing good care. I think there are pockets of really exciting things happening. I think the question is how do we support
those, how do we share that best practice? I think we have a role with that. How do we make sure our regulation is enabling, so that we encourage that innovation and we encourage those new ways of working. How do we work with national stakeholders
as well to make sure that we help systems nudge in the right direction, I guess. So, I think there is lots of things we can do and we have been doing, working with other partners in this area. But I think that there is no
doubt that…, I don’t think people using services or people working in Primary Care, it doesn’t seem to be working in a lot of places. I am sure there is some places where it is working, but in a lot of places there is huge strains
and that makes me think it is not down to the people, despite what the… There has been a lot of negative media about Primary Care which I think has been very difficult for people working in services to deal with and it has been quite
demoralising for them. I don’t think it is…, I think it is not because people aren’t working hard. People are working extremely hard at the moment and I have been out to lots of practices and seen the pressures that they are under, working extremely hard.
So, I don’t think it is due to anyone’s lack of dedication or commitment. I think it is more that the way the environment…, the way they are having to work and the challenges they are having to face
Mr Stephen Marston - 1:04:44
need new ways of thinking about them.
So, does that answer your question? It does. I don’t know if you agree, Chair, I feel Rosie has laid down quite a challenge for us and we might want to sort of think, well, how would we come back to that one? Could I ask a second question which is…, Sorry my IPad has just gone to sleep
again, it is Page 64 of the Pack. It is the bit about Adult Social Care Funding Reform. I was really interested, the second paragraph seems to be signalling an issue that potentially Section 18, Brackets 3, might change the way the market works. If I am
understanding it, I think it is because if people are given the…, sorry if self-funders are given the right to pay no more than the local authority pays, does that change the business model for private care homes dependent on self-funding? And how big a risk
is that to our sort of market oversight and market shaping? Shall I come in on that? So we need to watch this really closely. So the
Ms. Kate Terroni - 1:06:08
guidance that was published about a week or two ago from the government was on how they intend to
operationalise this part of the Care Act. What this means is, as you say Stephen, if you are a self-funder, this gives you the opportunity to go to your local authority and to have your needs assessed and potentially get access to equivalent cost to what
that local authority might be paying for a placement. So big implications. What was important about the operational guidance that came out last week was how the government intends to introduce this, in this kind of staggered approach, that from October of next year new people
coming into, moving to a residential service have the opportunity to apply for this. Then up to April 25 where people who have been living in residential care for a longer period of time could also apply to local councils. This will have an impact on
the sector and, as you say, through our role in market oversight where our major focus is on about ensuring continuity of care for people, we need to observe very closely the impact that this has. However, the approach of kind of staggering its introduction should
go some way to mitigating the impact on the market rather than it all going live on the same date, but everyone who is currently resident in residential nursing homes and all new applicants for it as well. So, watch this space, Stephen. On your previous
Mr Ian Dilks - 1:07:35
observation, I mean I take the point, Rosie has put down the challenge. Stating the obvious for particularly the benefit of the public, I mean we are not responsible for the quality of care that is provided by another provider, but we do have an overarching
obligation to see that we can do, conduct our affairs in a way that encourages improvement, so I think that in that context the question is very fairly left out there. Are any other questions for the management team from anybody? I mean the feature benefit
Mr Ian Dilks - 1:08:09
or disadvantage when going last it that usually your questions were asked by others. So, I had two, one has already been asked. Actually this is a request rather than a question, and it is probably for you Kate, unless Rosie wants to pick it up.
But under ICS, you did mention that the questions we are dealing with indicate misunderstandings about our role and the example you gave was enforcement powers don’t apply to systems or local authorities. I agree from meetings I have had as I am inducting myself the
organisations, it is a common misunderstanding. So given the fact that this is a public meeting, I don’t know if you can just say a few more words about that. Yes. Happy to and this is feedback that has come from our meetings with health and
Ms. Kate Terroni - 1:08:53
social care providers, so supporting them to understand what our role will be around local authority assurance and an integrated care systems. So this is very much about providing transparency opportunities for local authorities and integrated care systems to improve, and the ability – Rosie was
talking earlier about how there will be excellent examples around the country of where health and social care providers are doing really innovative work together. This is the opportunity for us, as the independent regulator, to spotlight that, to encourage that improvement elsewhere. So, the purpose
of this is around transparency, driving improvement and supporting ICSs to deliver the ambition I think we all have for them, which is that they tackle inequalities in their area, they drive improvement and they support people to get better outcomes. Do you want to come
in on anything else, Rosie? Yes. Just to say that while we won’t have
Ms. Rosie Benneyworth - 1:09:43
enforcement powers in ICSs, we will continue to have the enforcement powers with providers, and I think that there needs to be a very fluid relationship between the ICS work and the
provider work so that there is a two-way process. Certainly, you know, if providers are not taking part in their local ICS work, I think that is something we will need to very much look at with the provider regulation that we do. There will be
routes of escalation though if we are aware of concerns that emerged through the ICS work. We will be working with partners like NHS England, like the LGA and others, just if there are concerns being raised, we need to make sure that those are addressed.
Ultimately if we are not confident and in the last case scenario, we will have a route of escalation through to the Secretary of State if we are not confident that concerns are being addressed and improvements are happening. Thanks Rosie. Your last point is really
Mr Ian Dilks - 1:10:43
important by way of reassurance. I have to say I find it difficult to see how we would design enforcement powers for local authorities or ICSs. But as I say, it is something that has come up with some of my discussions and if you are
finding it come back, it probably suggests we just need to make sure that we are proactively communicating what we are doing, but the limits of what we are doing so that we can to try to head misunderstandings off. Any other questions from people? If
not well, I will thank the Executive Team or members of Exec. Team for their response. So thank you very much indeed for that. We have a few final matters on the agenda, most of which are by way of formalities to approve. The first is

5.0 Board and Committee Matters

the minutes of the previous meeting that we enclosed in the Pack. Can I take those as agreed or any comments? Everybody is nodding so those
Mr Ian Dilks - 1:11:42
are approved. There is an action log which I temporarily cannot find. There was only one item on it which
was something that is on track and we will pick it up in September. So, unless anybody wishes to comment or add, I think that is correct and self-standing. I think the final item on the agenda before we go to AOB is a report from
Sally on the conduct of the Audit and Corporate Governance Committee, so Sally over to you. Thanks Ian. There is a report in the Pack so I won’t go through (inaudible). I have got really bad feedback. Is that better? Good, yes, thank you. So this
is our Audit and Corporate Governance Committee’s Annual Assurance Report to the Board. It is the 11th one. Several of our non-exec colleagues serve on that committee, along if two independent members from outside. So, I would like to say thanks to them for being so
diligent and committed during the year before we start. We also have regular attendance from our Executive colleagues to be able to both explain improvements they have made and respond to the Audit Reports that we have. I am pleased to say that in terms of
the Annual Report and Accounts, there are no key issues to report at the moment and we are expecting a clean report, although a slight delay to laying that report because of the work that the National Audit Office need to do around Local Government Pension
Schemes, so that is probably autumn. In terms of internal audit, we have a positive opinion from PWC - our Head of Internal Audit. They have given us a rating of moderate, same as last year. It sounds underwhelming, but moderate actually means generally satisfactory with
some improvements to be made, as is inevitable in an organisation that is as complex as ours. They produced 13 reports during the year of which only one was high-risk around consistency of our regulation, which we know is the key point of our transformation programme.
Management have responded and as the Transformation Programme delivers, then we will be able to improve that consistency. We have a number of agreed actions. Just to give you a flavour of the type of work we do, we obviously oversee the risk register - strategic
and high level operational - and we have overseen quite a few changes to that risk profile that CQC has this year. We know it has been a challenging year, but that is very live and current. We have also done a number of deep dives
into different topics and we focus very much on assurance around CQC’s Transformation Programme. We did have a sub-committee which looked very closely at transformation business cases and delivery of our overall portfolio. The place that we have got to now is as we are implementing
our new structure, our new ways of working, transformation reporting in future will come to the Board directly, and we have decided to close that sub-committee. We faced also on cybersecurity and IT disaster recovery. There is a quite a large and specific programme in place
to ensure we have as few cybersecurity incidents as possible. That work is progressing well. In terms of counter-fraud, we only have very few cases that are investigated and none of those have led to further action. It is important to say that we also oversee
risk for the National Guardian’s Office and Healthwatch England. We were delighted to have two really in-depth and impressive presentations from the leaders of those organisations, not about their overall governance but about their risk and financial management. There are some funding issues around Healthwatch England
in particular, but we have confidence in the people leading those organisations. We have played our own part in the Board Effectiveness Review. The feedback for ACGC was largely positive and we have a few minor things to improve around additional assurance. I think in conclusion,
unless people have got questions, ACGC are assured by the governance and risk management and audit processes that we have in place, and content that that assurance is reliable and comprehensive for the purposes of the Board. So, it is a positive report and, again, I

5.3 Audit and Corporate Governance Committee Annual Assurance Report to the Board

would just like to say thank you to all of our colleagues, Non-Exec. and Exec. for the work they put in, particularly in providing that assurance. Thank you. Thank you very much indeed, Sally. Very
Mr Ian Dilks - 1:17:02
comprehensive and I emphasise the importance of the report. A huge
number of our key responsibilities as a Board are delegated to that committee, so it is important to all of us that its affairs are conducted well. Has anybody got any questions for Sally on her report? Mark. Well, not a question Chairman, but as a
Mr Mark Saxton - 1:17:20
member of the Committee I would really like to thank Sally for her hard work and leadership and producing such a strong report as this. I would also like to thank the Exec Team, especially Kirsty and Chris for their engagement with the ACGC governance process.
Thank you. Thanks. Well, we will continue with that theme. I was just
Mr Ian Dilks - 1:17:46
also going to add thanks to those members of the sub-committee specifically. Sally mentioned that it has been closed for the benefit of the public. It is not that we are spending less
time monitoring what is going on, but the world has moved on, the project is up and running, it is a long way down the track and the things that are outstanding, as we transition to business as usual, I think are matters for the full
Board. But a huge amount of work went into that sub-committee - there are some figures on meeting attendance here, but they do not do justice to the amount of work that individual NEDs (unintelligible) outside of the meeting. So, we have reported to this Committee
at a very high level progress on really quite a major transformation programme, so my thanks to everybody there - a lot of this predates me, but even so I do see the huge work that was put in. Any other questions for Sally on her

6.0 Any Other Business

report? In that case, that is the end of the items on the agenda. I
Mr Ian Dilks - 1:18:47
should ask colleagues if they have any other business they wish to raise? Yes please. Are you going to pick up the reporting? OK what it looks like we are going
to squabble over who is going to say this. You go, Ian. I just…, Board
Mr Ian Trenholm - 1:19:08
members can join me in thanking both Kirsty and Rosie for the fantastic contributions over a number of years. I think in Rosie, we have had a fantastic Chief Inspector who
Ms. Rosie Benneyworth - 1:19:23
has been able to support the Board, but more importantly support the sector through what has arguably been one of the most trying times in
Mr Ian Trenholm - 1:19:33
our history as a nation actually. Rosie, being able to build relationships and improve relationships, despite that complexity across some pretty
complex sectors in general practice, in dentistry, with the military,
Ms. Rosie Benneyworth - 1:19:49
with prisons, all of which will, of course, have been particularly stretched. So, an enormous thank you from all of us. Rosie has also
Mr Ian Trenholm - 1:19:57
been a real staunch advocate for integrated care work and I think
we have talked a number of times in our meetings recently around the work that we are aspiring to do around integrated care systems. I think Rosie’s leadership and advocacy all the way through her tenure here has been fantastic. So I think, you know, we
really would want to thank Rosie for that work. And in Kirsty, you know, we have got somebody who has been really the architect of our
Ms. Kirsty Shaw - 1:20:23
transformation work and has talked many times round this table around the work we have done on change. And that
has been fantastic and that will enable us, it has given us the
Mr Ian Trenholm - 1:20:34
vehicle, I think, to transform as an organisation. What we don’t talk about very much, of course, is Kirsty running, you know, a large piece of our organisation. Got some really effective support
services that quietly, behind the scenes, do their thing and we have seen some examples of that, just in this meeting alone, in terms of things like the People Plan. That has been incredibly powerful and gives us the basis for doing the work that we
want to do in future. So, an enormous thank you to both Rosie and Kirsty on behalf of all of us, for the fantastic work they have done. Thank you. Thanks Ian. Thanks Ian. I don’t want to repeat that. You have known both much longer
Mr Ian Dilks - 1:21:17
than I have. I have only been here three and a half months, but much of that reflects their executive experience, but, I mean, you have also been members of the Board in my limited period here. So, even in the very short time, I have
enjoyed working with you. What I think is, it is always sad to see colleagues go, but also I think is a testament to the organisation when people go on to be very significant elsewhere in the sector. Particularly with you, Rosie, we look forward to
continuing a close working relationship, so I’ll add my congratulations. But thank you for the longer version Ian, that is good. So that concloses the…, sorry, does conclude, it closes the main business of the meeting. As you know, we do ask members of the public

7.0 Other Information:

if they would like to submit questions and we say that after the conclusion of the meeting we will address them. We do have a couple from Robin Pike, so I am going to take the first and the other Ian is going to take the
other. Robin’s first question was How can - I’m using his words – how can CQC adapt its business at public Board meetings to include a patient’s safety story, sorry patient’s story, as it did in in June? And I guess that reference is to a
very emotional presentation from Alexis Quinn. Robert, I think let me answer that in two parts. I mean the public Board meeting, we believe, serves two purposes. It does allow public account for CQC’s performance as an organisation, and it also shows some of the processes
we go through for things to be approved. It also gives us the ability to listen, debate and respond to challenges in the wider and healthcare environment. And there are aspects of that like horizon scanning. For the latter, an important component part of that, I
think, is the voices of lived experience of people who use services which, I mean, ultimately is what we are here to serve. And also of frontline staff in the health and care systems. So I think doing that helps the Board focus on the right
issues. We do keep our focus therefore on the public at large, rather than simply care providers, important as they are. So, you know, we do aim to listen and act on the voice of the people in that way, in a number of ways and
invitation of the board is one of them. But bearing in mind that is the agenda of the Board, I think there is also a limit to the amount of time we can spend simply on patient stories, and you will appreciate that there are many
other ways in which we do listen to patient stories, both the organisation as a whole, at the executive level, but opportunities for non-executives to attend. So, I can assure you that, from the point of view of the non-executives and the way they conduct their
business, and particularly the executives, that we do try to make sure that we keep an eye on and listen to the patient stories. But you are absolutely right that the public board maintains a role as well, so you make a good point. Clearly Alexis
struck a chord with a lot of people and it is something that we will continue to keep under review. Thanks Ian and the second question from Robin was how effectively does CQC find the providers of NHS and social care are adapting their care to
accommodate the current heatwave? So again, I think it is a very
Mr Ian Trenholm - 1:24:37
pertinent and very current question - we speak on the Wednesday of the week when the Monday and Tuesday are the two hottest days of the year, and arguably ever. So, I think it
is too early at this point to make a definitive judgment in terms of an evidence-based judgment, but I think it would be worth just sharing a few of the things that we are doing to look at the way that providers are responding. We use
information from providers to ensure that systems and processes are in place to ensure that the risks associated with the current heatwave are mitigated. Through our inspection of the well-led domain in particular, we review contingency plans to ensure that risks are mitigated. We work with
other stakeholders, such as NHS England, who provide direction and support for the NHS. Through this we are aware that NHS England have asked trusts to ensure that patients who have completed their medical journey to be moved out of the emergency department to an observation
area or a ward before admission to their ward bed. This is obviously to help create capacity within emergency departments and thereby facilitate the more timely offloading of ambulances before patients become exposed to the risks associated with a prolonged stay in vehicles, not really designed
to protect them from extreme heat. We do expect care providers to have contingency plans more broadly for adverse weather events of all sorts. If we receive information that suggests that the provider is not taking reasonable steps to reduce the impact of the heatwave on
people who access this service, we would treat this in the same way as any other information of concern and use it to determine our regulatory response accordingly. The government has provided guidance to health and social care staff around the support for vulnerable people during
the heatwave. When speaking with providers we will continue to signpost them to this guidance. However, we will continue to inspect and monitor plans in place where we believe that there is a significant risk. We ensure that we share guidance with providers and on the
14th of July we shared the UK Health Security Agency Heatwave Plan for England and other guidance, including support for health and care professionals and supporting people living in care homes. So I hope you will agree, Robin, we have been reasonably proactive in terms of
sharing the guidance that is out there, but of course, as I say, a bit too early to tell in terms of exactly how the last couple of days have gone. But of course we will keep that under review over time. Thanks
Mr Ian Dilks - 1:27:11
Ian. Sorry, I
hadn’t got the mike on. With formal business finished, we have answered the questions from the public, so on that I will close the broadcast. Thank you very much everybody.