CQC Board Meeting 19th July 2023 - Wednesday 19 July 2023, 3:15pm - Care Quality Commission

CQC Board Meeting 19th July 2023
Wednesday, 19th July 2023 at 3:15pm 

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  1. Ian Dilks
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  1. Mr Ian Trenholm
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  1. Ian Dilks
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  4. James Bullion
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  1. Mr Sean O'Kelly
  2. Ms. Jillian Marsden
  3. Ms. Jillian Marsden
  4. Ian Dilks
  5. Christine Asbury
  6. Stephen Marston
  7. Ms. Jillian Marsden
  8. Ian Dilks
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  10. Chris Day
  11. Ian Dilks
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  1. Kate Terroni
  2. Ian Dilks
  3. Mark Chambers
  4. Mr Mark Sutton
  5. Ms. Jillian Marsden
  6. Kate Terroni
  7. Ms. Jillian Marsden
  8. Kate Terroni
  9. Mr Mark Sutton
  10. Stephen Marston
  11. Kate Terroni
  12. Mr David Croisdale-Appleby
  13. Kate Terroni
  14. Mr David Croisdale-Appleby
  15. Mr Mark Sutton
  16. Ali Hasan
  17. Ian Dilks
  18. Christine Asbury
  19. Kate Terroni
  20. Mr Mark Sutton
  21. Ian Dilks
  22. Kate Terroni
  23. Ian Dilks
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  1. Mr Jeremy Boss
  2. Mr Jeremy Boss
  3. Ian Dilks
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  1. Mark Chambers
  2. Ian Dilks
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  1. Ian Dilks
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  5. Mr Sean O'Kelly
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  7. Mr Sean O'Kelly
  8. Ian Dilks
  9. Webcast Finished

Good afternoon, everybody and welcome to the Public Board meeting of the Care Quality Commission on the 19th of July. Obviously, this is a slightly later and shorter meeting than usual. Just to clarify, this is not the intention of a one-off shift, it just reflected
the availability of people and the extent of topics we had to discuss at the public meeting today. I would expect that going forward we will revert to the more normal…, starting early afternoon and perhaps a slightly longer agenda. A number of administrative observations to

1.0 Opening Matters

make, in no particular order. Firstly, we are delighted to welcome – we have appointed to the Board - three new non-executive directors. You should, if you’re watching on screen, be able to see Christine Asbury in the striped top sitting opposite me, David Croisdale-Appleby over
there and Dr Mark Chakravarty also joined us. However, that leads me on to apologies, Dr Chakravarty can’t join us today. Obviously, he was only appointed a few weeks ago. He had another board meeting in his diary for today, which he had already committed to
Mr Ian Dilks - 0:01:21
so he can’t join us, but he is available for all future meetings, so it’s a one-off. Then, one of our continuing non-executives, Belinda Black, is also, unfortunately, unable to join us today through a combination of family circumstances. I also have a semi-apology for Tyson
Hepple who has a minor injury and is having to stay at home. We were expecting him to join us by video, but we seem to be having some technical problems which was the reason we have actually started this slightly later than on the programme.
We were trying to connect him and can’t. So, hopefully, he will join us but if not, I will ask other colleagues to pick up the areas that he would have covered. Last, but by no means least, can I welcome James Bullion sitting over there.
James is due appointment as, excuse me, Chief inspector of Adult Social Care and Integration, so welcome James. I think finally we, as regular watchers will know, we always have somebody from our Disability Equalities Network, I’m delighted to welcome Jillian Marsden who is here with

1.3 Declarations of Interest

us today, welcome Jillian. Do we have any declarations or new
Mr Ian Dilks - 0:02:45
declarations of interest from anybody? No, thank you very much. Any urgent business that people want to put on the agenda that we don’t already have? It looks like not, thank you very much indeed.

1.4 Any urgent business

So, perhaps we could just move straight on to the reporting. Ian, I don’t know if you want to kick off and then we will pick up with your colleagues as necessary. Thank you. Thank you, Ian. Good afternoon colleagues. We have got two reports, one

2.0 Reporting Updates

Mr Ian Trenholm - 0:03:13
is the regulatory report, one is the operational report and the organisational report. So, I will run through both of those relatively quickly together and then we can pick up questions at the end of that. Firstly, the National Maternity Programme. This is a programme of
work we have been doing to run inspections across the whole of maternity services across the whole country. It is designed to do two things, one is to give us an up-to-date picture of what is going on in in each of the individual services but
also, probably more importantly, to capture good practice. It is really important to us that we can both look at what is going on positively and negatively, but also capturing the good practice and then play that back to the sector through a series of reports
and a series of other products. So, for example, Carolyn Jenkinson, one of our colleagues, has written a blog recently which covers some of the things that we have seen. The second item I wanted to draw attention to was urgent and emergency care. We are
continuing to look at high-risk services, examining pathways, because what we recognise is people’s experience of care is as much to do with the way they transit between services in an area as it is about the service that they receive from an individual service. So
again, we are doing some work in the East of England in that area as we are starting to think ahead to this coming winter and how we can be as supportive as possible as a regulator to providers as they move into what will inevitably
be another very challenging time period. Local area, sorry, local authority assurance and integrated care systems, our pilot work in those two really important new areas continues. I am going to ask James in a second just as to talk about, in detail, about the detail
of where we are with that, but the pilot work is going well. We have had some good constructive conversations with colleagues at the Department of Health and Social Care. We have listed in the report some really important reports that are coming up. One is
the Defence Medical Services Annual Report. As many of you know, we support the Defence Medical Services in their regulatory role, carrying out regulatory activity on their behalf, looking at the quality of care that is delivered to people in our armed forces. We are also
issuing reports on safer management of controlled drugs, as well as publishing the urgent and emergency care survey from 2022 at the end of July. That is a survey that we carry out on behalf of the NHS. In terms of organisational matters, the overall operational
performance continues to be strong. I would like to take the opportunity to publicly thank our colleagues and Tyson Hepple and his team for the efforts that they have been making over a number of months now to engage in training activity for the significant go-live
that we had with our new future regulatory platform. The regulatory platform is our new system that replaces our customer relationship management system. It is the culmination of a couple of years’ work within our transformation programme and although, from an external point of view, it
won’t have an obvious impact, internally it is a much more consistent, reliable way of looking at inquiries and making sure that we can deal with them in the most effective way and also to report on them and place some of those inquiries back to
providers. That is a build on a go-live that we had earlier on in June where we opened up our provider portal and it is now possible for providers to cancel their registration online. Again, there are a series of go-lives as the portal opens up
between now and the latter part of this year. Our next major go-live which people will be interested in will be towards the end of October into November, as we as we start with our new Single Assessment Framework. But I think the big important news
internally is that colleagues have managed to keep a good operational performance whilst engaging in training activity as well. Initial reports are that that has gone well and we are confident that we can continue on track with our transformation programme in the latter part of
this year. I would just like to note that there is a fair amount of parliamentary engagement which is noted in the report as well. I’m going to ask James just briefly to come in on ICSs and Local Authority Assurance and then open up for
questions. Thank you. James Bullion: Yes, thank you and good afternoon. I’m really delighted and proud to have joined CQC in this role. So in terms of both of the new programmes, the Local Authority Assessments have begun, it’s a really good moment to, as it
were, note that we are now into the work in detail. We are working with five pilot areas, so work has already commenced in Lincolnshire and now in Birmingham, and then we’ll be moving on to North Lincolnshire and Nottingham City and Suffolk. We had been,
in the run-up to operating these two pilots, collecting some national data around access and around care services, and we’re now road-testing the full framework, the full quality framework, with the five pilot areas and we will be issuing a report and an indicative rating for
those local authorities who are taking part in the pilots. We are grateful for those LAs taking part in the process with us, but I can report from dipping into the programme that it does feel very real for those local authorities. They are participating and
are taking this very seriously. We can see evidence beyond the five pilot areas of preparation across all local authorities actually limbering up and getting themselves familiar with the assessment framework and getting their information ready to share with us. Once we have completed the pilots,
we will be reporting on that and confirming, as it were, our final methodology for assessments before rolling those assessments out to a group of wider councils in the new year. On the integrated care systems, similarly, we have shared our initial methodology and we are
now in a position where we can confirm that we are piloting this assessment process with Birmingham and Solihull ICB and with Dorset ICB. It is good actually to have an overlap between the local authority insurance assessment and the integrated care system assessment in the
form of Birmingham and Solihull. In these assessments we are looking at quality and safety, we will be looking at leadership, we will be looking at integration arrangements, particularly focused on what are the outcomes for people in in those areas and how are relationships working.
again. We will be piloting aspects of our framework and eventually moving from the pilots into assessments, and that will be in the spring of next year for ICSs. We anticipate probably takes about eight weeks to do an LA assurance and about 10 to 12
weeks to do an ICB, so it’s not just a question of when boots are on the ground in fieldwork. Actually, we are engaging with all, have been engaging with all local authorities and all ICSs to gather data, in addition to the fieldwork week as
it were with them, so very pleased to have begun. We are in a learning phase though as a commission before we roll out in earnest, thank you.
Mr Ian Dilks - 0:11:21
So over to colleagues, any questions or comments? OK well I have… Mark, I beg your pardon. Yes,
just an update from Ian, if we could, on the discussions around pay, could be helpful to hear. Yes, thanks Mark. Yes, we have been having
Mr Ian Trenholm - 0:11:42
some very constructive conversations with our trade union colleagues on the topic of pay. As you recall, we are subject
to the civil service pay remit and this year the civil service pay remit had two components to it. One component was around a salary increase. Another component was around a one-off, non-consolidated payment of 1500 pounds. So, we have confirmed to trade union colleagues that
we will be paying the one-off 1500 pounds payment to all full-time employees who were employed with us between the 31st of March and the 1st of August, and we will be pro-rating our payment for part time workers. Our trade union colleagues, of course, are
very supportive of making that payment, but we haven’t been able to reach agreement around some of the detailed eligibility criteria. They in particular would like all employees to receive the 1500 pounds, regardless of whether they work full or part time, and they would also
like us to change the eligibility date as well. That is not something that I think we can do. It would fall outside the pay remit. So, they are supportive of making the payment, but recognise that we have had to make the payment without their
explicit agreement. However, that said, I think we understand each other’s point of view on this, and I think there’s been, as I say, constructive conversations. We are now talking to them about the salary increase for the 23-24 pay year. Again, as you know, we
pay our salary increase on the 1st of September each year rather than the 1st of April, so in line with the civil service pay remit. That is the basis on which we are having on our conversations. We are both very clear. There’s a real,
shared ambition, I think though, to make sure that we can conclude those discussions in time for the 1st of September so that we can make sure that our colleagues have the salary uplift in the September pay which is on the 19th of September. So,
I think bringing those two things together is really important and I think we are moving in the right direction. A number of the unions who had talked to us about strike action have withdrawn those strike action notifications, so again, that’s a very positive development.
I think it is worth saying though, the obvious point, that a salary increase and a one-off payment of this magnitude does represent a financial challenge for us as an organisation. The 1500 pounds payment on its own is about a 5-million-pound cost which, obviously, we
and all the other organisations in the public service were not budgeting for. So again, that’s something that we need to be on top of over the course of the remainder of this year. But as I say, I think that the general direction of travel
is a positive one and I am very optimistic we will be able to deliver a good pay increase for colleagues in the September salary, thank you. Thanks Ian. Actually, just picking up on a couple of things – thanks for the update. Just going back
Mr Ian Dilks - 0:14:50
a bit, I think it is worth noting that the NEDs obviously are being consulted at high level on this. I think the overall objective is to get money in people’s pockets as quickly as possible, so thank you for doing that. You did mention this
point about pro-rating pay. I understood from talking to some of my colleagues elsewhere that pro rating for part time was the normal practice, so what we have done is in line with others. Perhaps you could just confirm that… or not? I can. The civil
service pay remit is quite clear. It says you should use the policy that you normally do for these processes, our normal practice is to pro-rate. One of the reasons that we’ have been debating this for a few weeks with the other arms-length bodies within
the Department of Health and Social Care family is we have been having exactly this conversation. I am confident that we are entirely consistent with the activities of other ALBs in the DHSC family and indeed the DHSC themselves. Thank you. Thank you. Other questions or
comments for Ian or colleagues? I have an observation and a question, just to build on what James said for the benefit of other Board colleagues. I attended a big chunk of the Local Government Association meeting a couple of weeks ago. Ian and a number
of his team were there. In fact, one of your team was presenting. It was quite obvious – I mean, it was a huge event and a lot of big agendas out – I don’t want this to be overstated, but nevertheless it is quite clear
that our work in this area carries a lot of significance for people. There were a number of dedicated sessions. Certainly, the feedback I got talking to people was yes, it’s important, and I was getting some very positive feedback about the way we have gone
about putting the assessments in place and the way we have worked with people. So, I suppose I would like to thank… the team, you have inherited James with due respect, rather than you, but thank the team for doing that. I mean, obviously, it is
easier to agree with the process before you see the outcomes. It may be inevitable that some people won’t necessarily like the assessments we come to. It seems to me as a heck of a good start that if people at least think we have gone
that extra mile to get the right process and allowed people to have input to it, then the outputs ought to carry greater respect from people who receive them. So, I just thought I would add that, but thanks to the team, James. My question actually
is a detailed one, but Ian, in your report on the ICSs there’s a statement right at the end that DHSC has yet to decide on ICSs being rated. I don’t know if you could just expand a little bit more on that, or maybe that’s
one for James. One for James. Yes, certainly. So, we have had, we have built our assessment methodology on the basis that we have the capability to rate built in. However, since doing that work we have had the Hewitt Review which has taken a look
at this issue and has reported and made some recommendations to the Department and the Department have responded. They would like us to look at sector-based ratings as part of our work. So, we had not particularly planned for that particular flavour of rating in the
work that we are going to do. So, we are taking that into the pilot process and looking to see what that means and what is feasible. So,
Mr James Bullion - 0:18:35
we are building up options now which we will report back to the Department, but we have got
the capability - because of our methodology - to issue a report and certainly a narrative, and potentially a rating for the whole system, but it is not finalised yet. I appreciate this isn’t within our control, but do you have any indication of likely timelines
Mr James Bullion - 0:19:02
for this? I think there is still more to emerge on that, but certainly we are timely enough to be looking at this in the pilot process. OK
Mr Ian Dilks - 0:19:10
thanks. So, if there’s no more questions… We should also thank, Ian, your colleagues, for the recent successful

2.2 Research Programme Annual Report

delivery of some of the system so far. So, our thanks back, Mark, you and your team should formally note that. If there’s no more questions on the operational performance, let’s move on to the Research Programme Annual Report. Sean, I think you’re going to lead
off on this. Jillian may join in. So, you might, for the benefit of people, just give a little of the background or context on why we are doing this and then give us an update. We have your paper, of course, but thank you. Thank
you very much and yes, Jillian and Zoe I think will be presenting the
Mr Sean O'Kelly - 0:19:59
report. This is the first Research Programme Annual Report which I think is Programme demonstrates the commitment of the CQC to being an evidence-led and learning organisation. I think the report itself
demonstrates how our research is aligned to our strategic priorities, for example, safety through learning, reduction of inequalities. It also demonstrates how we worked in collaboration with research partner organisations and some of the leading academics within them, and also gives a flavour of the breadth
of research that we’ve engaged with in the first year and how much has been achieved in the first year. So, I will let Zoe and Jillian take us through the report. (inaudible) Thank you, I’m Zoe Fyffe. I am one of the Heads of Strategy
and the Research and Evaluation Programme falls within my remit, but Jillian, who has been joining you all day today is going to lead presenting it, and then I might add a few things at the end. Jillian Marsden: Thanks Zoe. So, I think, as Sean
was saying, the Research Programme is designed to support our strategy and it’s about us making sure that we have the right evidence base to deliver our strategy well. Therefore, all of the research that we have done and in the way that we’ve designed the
research programme, we have been thinking about the practical application of that research all the way through. So, how are we going to use it to inform our Single Assessment Framework and to form our own independent voice, in particular. I think in terms of what
we’ve done in the first year, we wanted to ensure that we started with what was already known. When we looked at the questions that we wanted to answer, we recognised that there was evidence available out there in the system, but that evidence was quite
disparate, and it was quite poorly connected to what we do. So, what we have done is kind of a series of literature reviews that have been really designed to make it tangible and applicable to our context so that we can use the evidence for
Ms. Jillian Marsden - 0:22:38
our work. So far, we have completed seven research projects and the priority now, as well as obviously to deliver more research on areas that we need to know more about, is really to ensure that the research that we have done has an impact, as
Sean was saying. I think that it is about things like the specific implications for kind of what the evidence that we use is against our Single Assessment Framework. Things around how we use the research to inform training and development for our own colleagues particularly,
for example, on a safety learning curriculum for our colleagues. Also, how we are going to use the research to inform our improvement campaign so that we can deliver our ambitions to accelerate improvement. I think one of the advantages of the Research Programme is that
it allows us to be adaptable to the external environment and ensure that we are kind of knowing what is out there and we are being kind of, therefore, dynamic and effective in our approach. I think that, as again Sean said, we have really kind
of tried to do this in partnership with others. We want to collaborate on research, we don’t think that we are the best place to do everything. Also, we don’t want to think we are the best place to fund everything, so we have been looking
at how we work with others. I think that we have started to signal in the work that we have done in the first year that we are in this space and that we want to collaborate with others. I think that by doing that, we
also increase the potential kind of impact and influence of the research we do and hopefully improve the impact of our regulation as well. I think that’s all I wanted to say. I don’t know, Zoe, if there is anything you wanted to add. Zoe Fyffe:
I’ll just add a couple of points. One of the things Jillian mentioned is really building our work with partners. There is something we need to do, and that we are working on as well, is how to make sure that we are a good research
partner. We have got lots of people really interested in working with us. There is some logistical and practical things like making sure we have got the right procurement frameworks, the right access to all the right sort of partners, and that we can work with
them well and that we can attract really high quality researchers, academics, people from various fields to work with us to make sure that we’re really doing things that have impact and are meaningful for us. Then, also just to mention we spoke to some colleagues
a few months ago about where we were up to with this, and we said at that time that we’re expecting quite a lot of projects to complete over the summer. That is happening. We are pleased to update that we are seeing that coming through.
I am in a workshop all day today, just kind of across the hall, reflecting on the improvement cultures research and thinking about how, not only can we use that to think about how we look for improvement cultures in providers and in systems, but also
to think about ourselves. How are we using that research to make sure that we are an improving and a learning organisation. So, I think from that conversation - I think it was May - continuing as planned. Sorry, I should just add, just a very…,
Ms. Jillian Marsden - 0:25:39
it’s a kind of procedural note. The version of the report that was shared with the Board has a very slight amendment to what was published. That was just the inclusion of another research project that we were getting funding for from NIHR and we needed
DHSC approval that came after Board’s circulation of papers. So just to note that that is a slight amendment. Thank you very much indeed, Jillian and Zoe. Questions or comments from my colleagues? Christine
Mr Ian Dilks - 0:26:06
Thank you. I found this a really helpful report actually and I
thought the focus and priorities were spot on, but my interest really - I’d like to understand a bit more - is about how the impact of that and the dissemination of it… How will that dissemination, how will that disseminate down to teams and how
soon is that going to happen? Is it going to be a very sort of slow and long process, or is it can be something that has impact within
Ms. Christine Asbury - 0:26:41
months? You will be pleased to hear it is already happening. So, we’ve been having seminars and workshops
with our colleagues. We are working with Chris Day’s team on further dissemination and we’re trying to think about, you know, it’s not just about putting out information, but actually engaging our colleagues in conversations so that they understand kind of applicability to them and that
we make it relevant to their context. So, we have already started that work, but absolutely we will be continuing to do it. Just a supplementary on that is how will you analyse that impact? That is a very good question. I think that there’s kind of
some kind of hard and soft kind of elements to that. We have formal recommendations which are kind of working their way through. We are going to measure and kind of look at the implementation of each of those recommendations. So, how exactly we measure it
will can be dependent on the individual recommendations but we are actively thinking about measuring so that we, certainly in future annual reports, will be reporting not just on what research we found but what difference that research has made. So absolutely, as you would hope
to expect from research and evaluation colleagues, we are very much thinking about that. If I could just add to that, sorry, there’s also something around one of the things that the team does is really build a network of people interested in research and evaluation,
and kind of have things like an internal site that allows people to access some of this easily kind of support, conversations about research and evidence. They are the things that are a bit harder to track, but I think are really important in getting us
to have the right culture so that we are really using this. So, yes, more difficult to track, but we’re focusing on that too. Thanks very much. I think it was Stephen and David, let’s take them in that order. Zoe and Jillian, thank you very much indeed, really
helpful paper and a very interesting programme you have got. Ian
Mr Stephen Marston - 0:28:34
mentioned in presenting his report that the CQC has released just this week, sort of the new approach to collecting data which, over time, will build a huge, complex, powerful dataset. Is it part of
our own research programme to be thinking about well, how do we best make use of that to start answering some interesting research questions? Might there be a case for a call out to the academic community to say this is what we have now got,
who out there would be interested in working with us to analyse what it is telling us? Yes, so I think again, it is a really… I don’t think
Ms. Jillian Marsden - 0:29:26
we have got a full answer to that question yet, but I think we are developing that
answer. I think that we absolutely want to – again I think you kind of hit the nail on the head there - that we don’t want to be just thinking, how do we answer all of these questions? What we want to do is develop
stronger relationships with the academic community so that they know what questions we are interested in. We are already having a larger and larger number of kind of meetings and workshops with different academic groups to kind of share our questions. The areas of our research
interests are on our website, and we are directing people to that so that we are trying to communicate what we are interested in finding out so that, actually, we are encouraging kind of discussion and investigation of questions that we’re interested in, as well as
obviously proactively trying to answer some of them as well. Just to add to that, I think ultimately the answer to your questions is yes, we absolutely need to do those things. We have started them, there’s further to go, but certainly the new approaches we
have to collecting information put us in a much stronger position to do that than we were historically. We know that our historic data is very difficult to use, but actually we know we have got the foundations of something that really could support this having
much more power in the future. Thank you Chair and thank you for the report. I was just aware when you were talking about the headlines of this that there is a lot of information at the moment coming out from UK R&I, from the research
councils, from Innovate and from Research England that is indicating the new approach that is being taken. This was all developed when we were still in the negotiations over Horizon Europe, as you are probably aware. The other source of information that is coming out is
the guidance for the next REF, which talks a lot about how impact, of course, how knowledge exchange and how sustainability are going to be looked at. I would recommend, if you haven’t done so already, that you take a look at that because I think
that will give you a very modern perspective on how we might develop our Research Programme over the next two-three years. Brilliant, will do. Thank you. Ian Dilks: Any other questions or comments? I just an
Mr Ian Dilks - 0:32:02
observation and one very simple question I mean, firstly, just
a compliment on the approach. I mean there is not a lack of research on the health and care system, so it was easy to say that we needed to do something. But I think the approach we have adopted of seeing what others have already
done, it is an obvious step, but often missed I have to say. So, the logic that said let’s look at that and then work with others for a whole bunch of reasons, not less co-funding, I think it is to be commended. So, coming into
this organisation a year or so ago, I was quite impressed to see us doing it that way. Just a very simple question. I mean this is looked at through our eyes as to what we are going to do, and I take it from that
that we are approaching others to help put this together. to what extent are we becoming a sort of convener of things and maybe people approaching us, or not? I think we absolutely are. So, I think there’s
Ms. Jillian Marsden - 0:33:04
two kind of parts to that answer. First
of all, in terms of developing the questions that we are seeking to answer, we have not just looked at that from an internal perspective. We held workshops where we kind of convened external colleagues to actually help frame and shape those questions in a way
that would be most useful with the external evidence, so that not only was… and also to make sure that it was not only useful for us, but that the research would have maximum impact by being useful for others as well. Then the other thing
is that we are increasingly, I mean it’s increasing exponentially actually, as people start to understand that we are in this space. They are coming to us and they are saying, you know, how do we work with you and we are then kind of trying
to… we are now starting to be able to join up kind of different people who are interested in the same kind of research areas and I think that will continue to grow. I think that we have got a level of maturity in terms of
exactly how we make that happen in a kind of smooth way, but absolutely the appetite is there. I think we’re starting to kind of build those relationships and kind of act on them as well. I think that applies with kind of some of the
obvious partners, things like academics. We have also had conversations with kind of our equivalent bodies in Europe and elsewhere about potentially shared research questions or places where we have got already shared interests, where actually some of the findings would actually apply to us all.
Perhaps we are at risk of everyone doing everything in silos, or we could really join up as well. Chris, you wanted to add… Just one example of that has happened this week. So, some of the information -
Chris Day - 0:34:42
so Jillian is absolutely right - part of the rationale for
this was to demonstrate to a wider group of organisations and people that we are interested in this work. This week we held an innovation seminar, I think it was a couple of days ago – my geography for time is missing. But what that began
to do is say, well, what data information do we hold, that actually might be useful, not just to academics, but actually to business partners and those who are seeking to provide new and innovative solutions into health and care? So, I think there are a
number of different avenues that we can explore with this, and I think it is really great that we could corral that information in new way and it will lead to new academic partnerships. It will lead to partnerships with organisations, and I think it will
also lead to driving innovation and improvements in the wider health and social care system from what we know. And that is an important outcome as well. Ian Dilks: Good point. OK, so if there are no more questions, thank you very much indeed. It was
Mr Ian Dilks - 0:35:41
down for noting or discussion, we don’t need to approve it per se, but I think you can take away from the discussion a kind of big approval for the approach, so thanks for doing it, with a couple of suggestions, in particular David’s comments. So,

2.3 Quarterly Assurance on People and Culture

Zoe, thank you for joining us. So that brings us on to the Quarterly Assurance Report. Kate, I’ll hand over to you. You might clarify, Jackie was supposed to be here, I gather she couldn’t be here, so you can explain how we are handling that
as well. OK. Good afternoon colleagues. So, I am here today to share
Ms. Kate Terroni - 0:36:17
with you our Quarterly People Update. It’s got a different format from the People Updates you have received before. Our goal with this update is to kind of bring together the stats -
so what do vacancy rates look like, what are turnover rates, why are people leaving, along with some programmes of activity that we are quite proud of. So, looking forward to talking to you briefly about our inclusive leadership programme, as well as trying to bring
out a bit of sentiment as well. So, you will notice in the pack, and I hope to do more of this depending on feedback, that kind of blend of what do the numbers tell us, but also some quotes from people receiving the kind of
services and programmes that we’ve got underway at the moment. So, at the end, happy to take questions, but also would really welcome feedback from you all about is this the sort of format and content that you were expecting for these updates. So very briefly,
I am going to start on talking about recruitment. There is a huge amount of recruitment activity happening in the business at the moment. We have got real ambitions to have a really inclusive and effective way of recruiting people into CQC. You will remember from
our Listening, Learning and Responding to Concerns Review, there was work to be done around reasonable adjustments, and there’s been some really good progress on that. I think it is really positive our work around our independent panel members, so you will note in the pack
that 100% of recruitment interview panels, whether recruiting at Exec Grade or Grade As which is for managers, have an independent panel member sat on that recruitment panel. You may remember Blessing, who was our Network Rep in the last Board, asked me what our plans
were to expand that pool of IPM’s -independent panel members - and that is something we are planning on doing as well. We recently held a recruitment workshop with colleagues from the People directorate and those from and our networks to look at what more can
we do. So, currently our recruitment process often ends up with a kind of panel recruitment where people are asked questions on the spot and are expected to answer, unless they have got reasonable adjustments and we have done something different for that. What is the
best practice internationally when it comes to getting the maximum out of people when we interview them and what might a different approach look like? So, that work is underway at the moment and we look forward to talking to Board about what the outputs of
that look like as well. Again, you will notice in the pack we have got a slightly higher turnover rate than we usually have, and I think if you look at the turnover rates and you look at the kind of organisational changes we are going
through at the moment within operations, that might be expected. However, we hope to see those turnover rates come down. Again, when you look at your pack – your information pack - we do exit interviews for colleagues, colleagues leaving the organisation and if you look
at the word cloud and the largest word is that people are leaving because of career progression, which is fantastic, the second largest word is around higher salaries and benefits. Ian has already talked to you today about where we are on the pay front as
well. Very briefly on diversity and inclusion, we are seeing an increase in colleagues reporting whether they have a disability or they are from an ethnic background. We have more work to do to close the gap on that. So, we are about 4.7% underrepresented on
colleagues with disabilities when we look at the wider employment market and less than 1% for colleagues from an ethnic minority. Diversity and inclusion was a focus of our recent Pulse Survey. So, we undertook a Pulse Survey in the organisation through May, had great engagement
as we always do with our Pulse Survey. So, 74% of our colleagues responded. There was a real focus on disability inequalities that came out of that survey. That will inform our workforce Race Equality standards and our workforce Disability Equality plans that Board will be
seeing later in autumn. We will look forward to sharing with Board the full findings from the Pulse survey in September, once the Exec team have had a chance to fully digest them and to share them with our networks to get those kind of insights
we need ahead of that. Just a few final points around culture. So, we have been doing workshops in our operational part of the business around good endings and good beginnings. There will be three modules. We have recently evaluated the first module and 96% of
colleagues who went on that module reported being satisfied or very satisfied with the training. There were clear objectives within that training around supporting leaders to feel confident with changes around transformation and how to support colleagues going through changes as well. Then two other things.
We have got our new Inclusive Leadership Pathway that has launched recently - a programme that we feel really positive about. I am on it and am working with a colleague in the organisation as well. This is about working with colleagues from ethnic minority backgrounds
and colleagues who are disabled who have ambitions to progress within the organisation. The vision of the programme is they are matched up with someone more senior to help kind of dispel the myth of what these more senior roles look like, to invite them into
forums where they wouldn’t have been in before - so observing an Exec meeting, for example - and to help support them gain those promotion activities… promotion opportunities. You will see in the report, so 49 colleagues started out on the programme, so far seven have
got promotions. Again, you’ve got a couple of quotes in there about people’s experiences of being on the programme. As ever we will evaluate that, but that feels like something we might want to do more of going forward. Then, lastly, reverse mentoring. So, you might
remember Belinda Black, our colleague our NED colleague who is not here today, asked a couple of board meetings ago, where did that programme get to? We did it a couple of years ago and that is where senior members of the organisation are matched up,
are mentored by colleagues from ethnic minority backgrounds to gain insight and to increase learning around race. We did the first programme, we evaluated it and there was learning from that first programme that we needed to digest before moving into our next episode of that.
We are looking forward to launching that in autumn. The very final thing is we are pulling together a People Handbook. So, you may be aware, we have lots of policies in the organisation and you’ll remember in the Listening, Learning and Responding to Concerns Review
that there is a need to place people at the centre, rather than process. I think we all agree our policies could be more accessible and more people-centric rather than process-centric. So, work is well underway with that People Handbook. When it is in a good
enough draft, it will be shared with the networks to sense check around accessibility. Have we got all the information you need in one place to help you do your job? Again, we will come back to Board in due course with that. So that’s a
bit of a flavour of what’s in your pack. Really happy to take questions from colleagues. Thanks Kate and very well done on handling
Mr Ian Dilks - 0:43:26
that without any support. So, I will take questions in a second. Just to be clear. I mean that is a big update on things,
but really there’s two things we need to address. One is any questions on the detail, I’ll take those, but also the Executive asking for guidance on whether the pack in front of you now responds to the questions posed. It would be nice to answer
that. We can take detailed drafting offline, but if there’s any general gaps in what’s here, can we kind of identify them at this stage? You also posed the question on frequency. I might turn that round slightly and say what do you think is appropriate?
Although maybe I shall half answer my own question and say, you know, every meeting sounds an awful lot. Quarterly doesn’t work for six meetings a year, so six-monthly, I guess, looks like an obvious thing, but you may wish to add, when we finish some
questions, whether that’s right and colleagues will agree. So, there are two broad areas, but I don’t think we have to take them one-by-one. Just take any questions or observations. Mark, it looked like you wanted to add before we go any further. Thank you. I
Mr Mark Chambers - 0:44:34
think fantastic, I love the new report. I just wanted to say second your comments about the Inclusive Leadership Pathway. I am one of the sponsors on that pathway and I think it is absolutely a fantastic
Mr Mark Sutton - 0:44:42
opportunity and a really great programme that we are
running for disabled colleagues and colleagues from an ethnic minority. I also wanted to bring out the networks that we have in CQC. I think they contribute to a huge amount here. I am the Exec Sponsor for the Disability Equality Network. Jillian is one of
our new co-chairs on the Disability Equality Network and doing an absolutely fantastic job. It is a really vibrant community, it is supporting disabled colleagues across the whole organisation and their focus is on not only supporting colleagues, but also making demonstrable improvements on how we
can make CQC a great place to work and a great place for us to recruit and attract great talent as well. There is some really wonderful work going on this year, looking at how we can deliver innovations to radically improve things like reasonable adjustments
for disabled colleagues. That is a collaboration across the whole organisation, so it’s not just the Disability Equality Network, it’s people from the People area and Technology colleagues as well. I just wanted to echo the positivity around the People Pulse Survey. Really looking to seeing
the results of that because that is really focused around diversity, diversity and inclusion, and there is some specific work in there that is looking at trying to delve deeper and understand what colleagues need to help support them and make this a great place to
work, particularly disabled colleagues. So really looking forward to that and the wider improvement work. Thanks Mark. So, there is a good number of hands going up fairly quickly. Actually Jillian, I’ll let you have first go as a member of staff and then I think
Ms. Jillian Marsden - 0:46:23
Stephen and David I saw and anyone else I have missed after that. Sorry, Ali as well. Thanks Ian. I guess there is a kind of reflection, and then from kind of my experience and then a couple of questions, if that’s alright? Just to say
Kate talked about the workshop on looking at recruitment. I just wanted to say that we were involved in that. How that worked was that we were given kind of a set of questions that we went out to all our networks with which asked them
kind of what their perspective on how recruitment currently works, and then we brought that together into kind of a workshop across all of the networks, along with our diversity and inclusion colleagues and our recruitment colleagues. I think what we have done there is a
really solid piece of discovery. I think we are now going to be moving onto the next stages of identifying the best practice and the solutions, but I think it is a really positive start. I just wanted to kind of note that that’s a really
good thing from the perspective of our equality networks. In terms of…, just a couple of questions Kate, you talked about the kind of 4.7% gap. I guess I was interested in kind of what further work is planned to kind of reduce that gap and
also, that’s in terms of disability, and also kind of just in terms of understanding about variation across grades and how we kind of help to reduce that variation as well. So that’s kind of the first thing. Then
Ms. Kate Terroni - 0:47:55
the second thing was just in terms
Ms. Jillian Marsden - 0:48:01
of it talked about kind of tailored adjustment agreements and I know from kind of our colleagues that they really welcome having tailored adjustment agreements. But what happens is that as they move around the organisation, they feel like they have to kind of redo those
tailored adjustment agreements every time they get a new line manager and that can become really distressing. I know that in operations there was kind of the stable work initiative, and I just wondered, is there options and work going to be done to kind of
ensure that kind of that experience of having to kind of reset adjustments with every manager is something that all colleagues no
Ms. Kate Terroni - 0:48:37
longer have to face? Thank you, Jillian. So, thank you so much for the feedback on the workshop and as ever we started well,
but the proof will be in the pudding. So, we need to keep up that, following on from the discovery that needs to lead to tangibly different ways of doing things. If I start and then maybe hand over to Mark. So, I think there is
something about increasing reporting and Mark has been involved around Count me in and really trying to encourage colleagues to disclose and to share their information around whether they have a disability or other protected characteristics. I think there’s something about, you know, it would be
really good for us to accurately reflect the colleagues that we have in the organisation. The variation across grade, so that is something, again, if there is an appetite for it, we can get into in these reports going forward because there has been a notable
increase in bringing colleagues into the organisation from different backgrounds. But we need to see that at every level of the organisation and the data will show where we are with that. I mean initiatives such as the Inclusive Leadership Programme is about working with colleagues
to actually see the outcomes, seeing them being promoted up through the organisation. Certainly, I am matched with a colleague who has recently been promoted to a kind of grade A level, so they are now at the manager level, and then successors, let’s get them
up into that kind of Head Off. level as well. So, that is something we are doing on that front. Then on the reasonable adjustments, there has been lots of conversations. So, I may not use the time right, but there’s been a load of work
around kind of passports. You know, so the idea that you don’t just have a conversation about what keeps you well at work if you have got additional needs. You know part of having healthy, good conversations as a line manager with your direct report is
what do you need to keep well at work? You know, what does your work routine look like, what do you need in terms of support, etc and I have got a real aspiration that we move to a point that everyone in the organisation has
their own kind of wellness passport. So that it is not unique for colleagues who have additional requirements, it is just how we do business. But if I could just pause and just check with Mark whether there is anything you would add or anything that
Mr Mark Sutton - 0:50:47
I’ve not stated correctly. Yes, thank you. So, I think two things for me to supplement that. One is there is a specific piece of work as part of our workforce Disability Equality Standard improvements around recruitment for disabled colleagues. The specific, we are seeing once
people apply an effective success rate, but we’re not seeing enough applications, so I think we need to do more to publicise and more in terms of our recruitment, specifically in those in those areas. I agree around the Inclusive Leadership Pathway, I think that would
be a good start. We need to see that expand and be more successful. I do… I think the passport concept is really interesting and that is part of a reasonable adjustments process that works really well. I mean I am leading on the reasonable judgments
work very closely with Jackie who’s our People Director. What I would really like to see is quite a radical approach to us improving radical adjustments, reasonable adjustments, maybe we should call them radical adjustments. The quote I really like – someone, one of our Disability
Equality Network co-chairs - describes this, the change that we want to see, I want to see, applying for a reasonable adjustment as easy as it is for me currently to order a printer cartridge on the tech portal. I think it is a lovely way
of describing it and we want to make it as easy and simple for the colleagues to get the support that they need in the organisation and to understand what support is available as well. So, I think that is a two-point thing and we will
do that this year. Thanks Mark. Can we go Stephen, David and Ali which was the order I saw the hands? And I have obviously got to add Christine now as well, so let’s take it in that order. OK, thank you very much indeed. I
Mr Stephen Marston - 0:52:41
mean I very much welcome this because I think it was at a recent meeting of this Board in, light of the LLC report, that we said we really, really need just greater visibility of people in these Board discussions and I think you’ve delivered in
this report really well on that. So, I would just like to say thank you. I think this is a good follow up to some of the discussion we had. A point you do make in the paper going forward, getting regular reports. It will be
really important to balance the metrics and the demographics, which are represented well here, with the sentiment, the mood and the morale which we don’t yet have, because we haven’t done the main survey and we have not yet been able to analyse the Pulse Survey.
But in future reporting, making sure that we have got full visibility of those issues around sort of morale, engagement, sentiment, I think
Ms. Kate Terroni - 0:53:42
will be really important and very welcome. Thank you. Kate, thank you very much for that. Two points I wanted to make. The
Mr David Croisdale-Appleby - 0:53:51
first word was a context point, and the second was a content point. It was to look at the…, I think it is important in this that we look at the future of work to include an AI content and the context in which future of
work will be developed. We could be leaders in that field, in my view, so that was my context point if I may. The content point was really specifically one about job sharing which, again, is something I think that perhaps could be developed very considerably.
Some of the experiences that I have had have been unusual job sharing from the standard 50-50 kind of job sharing, particularly putting together a very experienced and a less experienced person in that job sharing which I’ve seldom seen done. Unequal in the sense of
not being fifty-fifty in terms of time, but being different to that, and finally a job sharing that takes positive account of one or the other, or indeed both participants’ disabilities or other protected characteristics. I think job sharing gives an opportunity to move ahead more
quickly on that than just the normal job recruitment and indeed the retention things that are put in place for that. Thank you. Thank you.
Ms. Kate Terroni - 0:55:20
So again, that’s not data that I have shared with you before. I would need to check that, I could get
that data, but I think the starting point for me would be how much job-sharing do we have in the organisation? I know we’ve got a relatively senior arrangement in Mark’s areas of business. That is quite a new arrangement, maybe about six months old, and
not that long ago I was having a conversation - I think with the Gender Equality Network - about what would it look like if on our job adverts, we said job share welcome? What if we just said we are an organisation that would be
friendly or receptive to job-sharing, rather than it being on the individual to kind of put forward that request, not knowing where it would land. So, I think it is an area we haven’t massively focused on to now, but I am more than happy to
take away an action that says, if we are already capturing that data, let’s share it with you. If we’re not, let’s start capturing it and then let’s fold it into the conversations we’re having around recruitment with our Equality Networks around what would it look
like if we, more positively and proactively stated, we would be really receptive to job shares. Because, ultimately, from my perspective, you are getting kind of two brains, two different perspectives, two brains for the price of one. So, I think that is an area we
haven’t really explored fully, and we could do. A quick response, if I
Mr David Croisdale-Appleby - 0:56:30
may? I think the other thing is, of course, it opens up the opportunity of a kind of mentorship relationship to some extent which is often very valuable. Thank you. I’d like to come
Mr Mark Sutton - 0:56:44
back on both those points, actually. So, job sharing I see…, I like that innovation that you just described there, and I think there’s something we should explore, but I do think in our world of technology and data and insight, recruitment and retention is a
challenge. It’s a hot market out there, so whatever approaches that we can take that engender some innovation and create a great place to work for colleagues is a really positive thing. We have had some success with working through some job share, for some experiences,
for some very senior roles, and that has enabled us to get access to great talent that we wouldn’t have otherwise been able to get access to. So, I think that is a really positive way forward. On AI, I think we’ve got a strong role
to play here. We have just delivered and are extending our enterprise data platform. That is going to be used to support our Single Assessment Framework and how we use data in a really constructive way to generate superb insights that support our assessment of risk
and our assessment of opportunity and how we structure and manage our work. It will also be an opportunity to use large volumes of data to be very constructive and, I think, allow us to innovate in ways that we haven’t been able to before. I
think we have got another role to play in terms of supporting the effective use of AI out there in the wider provider community. Because I can see innovation in AI when used safely and managed well is going to be one of the ways in
which providers are able to meet overwhelming demand with scarce resources. So, I think we have got a dual role to play there with emerging AI technology. Thanks. So, Ali, I think I will come to you next, and then Christine. Thank you. Kate, as others
Mr Ali Hasan - 0:58:42
have said, this is a really helpful report and really presents a lot of information well. You asked what other kind of information might be helpful as we evolve and continue to develop this report, three brief ideas. Firstly AI, not just in terms of our
regulatory work, but actually in terms of how that’s evolving and shaping the workforce over the short- to mid-term, recognising that it is providing new ways of helping make people more efficient, more effective, but has to be taken with the right governance and guard rails
around as it continues. There are other areas in which we could potentially take employee sentiment as well, colleague sentiment as well, so however we do that would be helpful. Finally, whatever we can do to, I suppose, benchmark some (unintelligible) metrics against other organisations while
recognising that we are quite a special organisation and there probably aren’t many around like us would be helpful. Thank you.
Mr Ian Dilks - 0:59:38
Christine. Thanks. Yes, I was interested in the Pulse response rate
Ms. Christine Asbury - 0:59:41
around it being safe to challenge the way things are done. I just wondered
if you could say something about that metric, but it’s up 7% to 36%
Ms. Kate Terroni - 0:59:56
positive on what underpins that. Kate Terroni: Thank you. So, we will definitely get into this more when we have the full Pulse Survey in September, but also the review we did
- our Listening, Learning and Responding to Concerns Review - highlighted there was a whole chapter around how we had disinvested in our Speak Up arrangements as an organisation; that we didn’t have enough Speak Up guardians and that there was a lot more we needed
to do to support colleagues to feel comfortable speaking up and to feel confident something would be done in response to that. Again, though, there will be a specific Speak Up item, an update coming to a future Board. I think it is positive there is
an increase. It is still far lower than we would want it to be. I mean in an ideal world, you would almost want all your… in an ideal world you would want all your people saying that they feel safe to speak up round here.
So, it’s, you know, little green shoots, but a whole lot more work to do, and a lot of work is underway that that Mark is leading as well. What is also important about this Pulse Survey, Christine, when we get into it is, we will
be able to see, does it feel easier to speak up as a white colleague versus a colleague from an ethnic background, or a disabled colleague, or a colleague with a number of protected characteristics? So, we ask this question often, but this particular Pulse Survey
will enable us to look at it through the lens of, does it feel even harder if you have different characteristics as well, but Mark, do you
Mr Mark Sutton - 1:01:24
want to come in? I think, just to supplement that. I think we need to know a bit more.
So, I think what we’ll be doing…, in fact we have spent a bit of time recently with the National Guardian’s office, taking some advice from them on how we can approach evaluating what our Freedom to Speak Up current capability is and what can we
put in place to develop a “best in class” Freedom to Speak Up service. I think the Pulse Survey also, as well as Diversity and Inclusion, has got, hopefully, some interesting qualitative information that will enable us to understand a bit more about how people feel
in the organisation about that. We are going to go out with some specific engagement in the organisation to really kind of tap into and understand how people are feeling. When we devise our plan about how we’re going to engage with the organisation and make
improvements, we will make sure we properly engage and get feedback from everybody on that. Thanks. I will try to summarise in a moment if
Mr Ian Dilks - 1:02:30
I can, but any other questions or comments? OK. Firstly, thanks very much indeed, Kate, as everyone said. It is clearly,
as Stephen said, your response to a number of requests from the Board and the very fact that we have had so much discussion - you know way over the time allotted - I think shows the absolutely right interest for the Board, should have been
right anyway and we, I think, learn from some other events. In terms of the sort of questions you have addressed to us on content, I think, well-affirmed it has come a long way, we like the format and what’s there. Not asking you to…, and
I would say actually it’s not a bad template for some other changes as well, just more widely. In terms of its length and clarity and telling us on flannel you know information on a page, it is actually quite a good template we might consider
using elsewhere. Just coming back to this one, I haven’t heard any specific requests of things we know we have, but there are one or two things you need to see like job share, whether we have it. You obviously gave absolutely the right response, if
we have got it, we will share, and if we haven’t got it, we’ll see if we can get it, for some good reasons, it’s not just a trivial point for a very important issue. Then, I think both David and Ali have made some observations
of things we might consider. I don’t think it’s a die-for, we must have it now, but things we might consider as part of a gradual process of improvement. Is that fair David and Ali? Then the other question you addressed or else consider is the
timing of this. So, you know this has got to be relevant to the Board, but not over duly burdensome to the management. So, what do you think? Yes, so can I make a bid for three times a year? I think twice a year doesn’t
Ms. Kate Terroni - 1:04:15
feel enough. I note your point that quarterly wouldn’t work. So, if we could go for three times a year, but obviously dotted between that will be a conversation about the Pulse Survey and there will be an update on the Listening, Learning, Responding to Concerns
Review. I think if we are getting our balance right, every Board should have a People component, but the full suite of information maybe we go for three times a year. If I may just finally say, I’m here representing this paper, but obviously Jackie Jackson
and all of her team are the people who wrote it and put the content in, so thank you for the positive feedback and I’ll pass that directly back onto the team as well. Thank you. OK, that is fine. Every other meeting, we will capture that as
Mr Ian Dilks - 1:04:49
a standing item. I mean I have perhaps slightly glossed over one other point Stephen made absolutely rightly. This is great hard fact, but the other thing is we need the sentiment of our…, I think whether that is formal or whether that is a golden
thread through all of the reporting, you know we can see, but it is an important point to make. But thank you very much and thanks for passing the comments back. We have got a couple of more formal matters now. People will know that we

3.0 Board and Committee matters

have some important Board Committees, one of which is the Audit Risk Assurance Committee. So, as we saw earlier, joined by Jeremy Boss who is the sort of Acting or Interim Chair of that committee, so Jeremy, I will hand it over to you. I think
in the first instance we have got a more formal report. We have read it, but there may be some points you want to highlight, and we’ll take
Mr Jeremy Boss - 1:05:46
any comments. Thank you Chair, I think first, just give a little bit of context to the first
and longer report which is the annual report from the Audit Risk Assurance Committee. It is tailored to support the Accounting Officer and the Board, in particular in relation to the annual sign-off of the annual report and accounts, so just specifically relates to the year
22-23, i.e., the year ending on 31st of March 2023. It is intended to demonstrate the committee has discharged all its duties in order to give the Board and the Accounting Officer assurance about governance, risk and financial controls within the CQC. I will start with
the external audit and the first thing is there is some sort of good news, well good and bad news. So, the good news is that our accounts for 2021-22 were laid before Parliament yesterday. This has turned into somewhat of a marathon rather than a
mid-tier run. Unfortunately, that is largely caused by things outside the CQC’s control and is all driven by local government pension schemes, which really are very large numbers in our balance sheet. But historically, there are historical matters, and we are underwritten by the Department for
any impact of that, so actually it doesn’t change our performance very much, but it can change the accounts. The NAO were unable to complete that work until we had received all the information from the local government pension scheme auditors. So, we now have that
and that’s now done, but we are a bit out of sync – quite a lot out of sync - as normally we would be expecting to do our accounts about this time of the year, so it is a year later. There is work at
national level to try and minimise these delays for future years although I have to say none of us are very confident that will make much difference. So, we are in a situation where external audit reports will be formally laid some time after the year
end, which is not ideal for transparency purposes, but is the reality given these wider sector delays which impact on a number of organisations as well as ourselves. But the good news is the NAO have issued an unqualified audit opinion. So that gives us some
assurance. It is also worth mentioning that they have already started work on this year, but we purposely delayed it slightly, because we know we can’t complete the work in the same timescale. So, we are doing it in the most efficient way we can rather
than trying to revisit things. Alongside external audit, the other main or one of the other main sources of assurance is internal audit and our internal audit programme. Again, we have an assurance and opinion from our internal auditor which is that we are substantially under
control. That doesn’t mean there are not things we need to do, there always are more things we can do, but again that is good news, and the audit programme was completed. We do get some other assurances more from internal processes and committees around risk
management, fraud and, in particular, our transformation programme, and then finally, cybersecurity and information security incidents. It is worth noting that those assurances have been provided. There are no significant matters, I need to draw to the Accounting Officer’s or the Board’s attention and more detail
is in the report. So, I will leave that for questions if people want to raise them. So, the conclusion is that, whilst there are some improvements which you will always expect actually – I would be rather worried if we didn’t find anything in our
audit programmes or very worried. So, there are things we need to do, things we need to improve, but we are content that the governance and control process continue to be effective and that assurances provided are sufficiently reliable and comprehensive to meet the needs of
the Board and the Accounting Officer. I shall pause at that point for any questions. Questions anyone? Seemed pretty comprehensive to me,
Mr Jeremy Boss - 1:09:56
Jeremy. I think we should just give a bit of credit to those wide number of people across the organisation, but particularly in finance,
around getting through those accounts as it has been a bit of a marathon. It has required us to go back over several things, several times which is never helpful, and also indeed our auditors, for doing the best they can to try and make that
process as smooth as possible. Any questions and comments? Anything
Mr Ian Dilks - 1:10:25
else you want to add, Jeremy, from conduct of the ARAC agenda. That was a very formal report on last year, anything else to add? So, in in
Mr Jeremy Boss - 1:10:31
June we considered a number of issues, none
of which are likely to drive any particular things I need to draw attention to the Board. It was noted that we have had our financial settlements, which is helpful, from the Department for Grant and Aid. As I said, we have set a new internal
audit programme. We were a bit behind most of last year with our internal audit programme, which was not ideal, but we have done some work to bring that forward. So, the work has started earlier and we did indeed receive three reports in the first
meeting, one of which was low-risk, two of which were medium-risk, which means there are some things and recommendations we need to do, but again nothing dramatic to report to the Board. Any questions? OK.
Mr Ian Dilks - 1:11:20
Thank you very much indeed, Jeremy, and thank you for standing
on this role as well. You will be doing that for a little while. Just for the avoidance of doubt, advertisements for a full-time replacement were undertaken a few weeks ago. The time period has now closed, so the next stage is for the Department and
ministers to work out interviews, conduct interviews, which is likely to be after the summer because of the intervention of recess, and appointments will follow. So, the timing is not within our control, but I would estimate that it is probably going to be later this
year, but the back end of the year, not before. The other thing, another important committee, yes, this is unique to CQC, it is the Regulatory Governance Committee. It does fulfil a very valuable function, and it’s kind of been getting up and running in the

3.3 Assurance Report from the Regulatory Governance Committee meeting on 05/07/23

last few months. I think, finding its feet and doing it very successfully, but Mark do you want to just give us some comments about the recent meeting and what you’re dealing with? Very happy to do that, Chairman, and thank you. For those joining the
meeting who are new to this, the RGC is unique to our organisation. It focuses on assurance in relation to the policy and methodology of how we regulate. So, we look at design and we optimise and deliver on what is required of us as a
regulator. We look at proactive improvement and improvement that we
Mr Mark Chambers - 1:13:04
are making in response to developments. We look at the operational measures of how well we are actually managing to deliver on that design, are we operationalising what we set out to do? Then, we look
at sources of insight from our stakeholders as to whether we are proving to be effective. Is this delivering what we intended? We also conduct a series of deep dives on areas that, in an ideal world, we would probably like to do it at Board,
but the Board agenda does not accommodate that. So, we had a meeting a couple of weeks ago. Things of interest that that came up as we went through it - we got an update on proposals for a more structured and evidence-based methodology for mental
health inspections with more focus, a more structured focus on observation and understanding cultures. This is going to involve greater input from staff, greater input from patients and greater input from experts by experience. I think that, you know, the early signs from the pilot work
are showing encouraging results and the learnings from that will be widely shared across our portfolio. So that was very encouraging to hear about. It segued into a discussion about our Single Assessment Framework and we had a discussion, which we will most definitely come back
to, about how we balance the desire for greater consistency in terms of our approach to regulation, with the absolute necessity of retaining, and the application of professional judgement in what we do. If something doesn’t feel right, it isn’t right and the best people to
assess whether something is right or not, are the experienced clinicians that we that we use and the experienced inspectors that we use to do our work. We have got an update on good progress in relation to moving towards an increase in our capability to
do, you know, genuine out-of-hours inspections, inspections that are not intended to take place during regular office hours. That is an important part of our capability, and we are going to grow that. Another part of our tool kit that we talked about, potentially exercising some
of our powers under the Regulatory and Investigatory Powers Act in relation to…, which relate to covert surveillance. We are happy with the plans in relation to that, we are happy with the controls that have been put in place in relation to that. We should
be ready to start a pilot, which will be largely at this stage around open-source information but start a pilot later in the year. I think, you know, having this capability as part of our toolkit ought to have an important deterrent aspect as well as
allowing us to target potential abuse where we become aware of it, or have suspicions around it. One of the things that, you know, we are pleased that we now have a much better view of; it’s really important that we quickly update the public in
relation to concerns that we identify so, you know, our reports need to get out in a timely way. We have had a good look at the tail, you know the averages have been coming down, but it is variance that was concerning us. We have
had a good look at the tail and, actually, that is pretty clean so there has been very good work to work through that. Another thing in our toolkit which, as a committee, we have encouraged the organisation to use more proactively, has been our ability
to suspend the rating of a provider. We have used it on a relatively small number of occasions. I think it is important that we do that when we come across information that warrants it. So now we have, I think, that encouragement is reinforced by
empowerment at the right level in the organisation, encouraging people to have the confidence to do that when the circumstances warrant it. In terms of external engagement, I think one of the very encouraging things that we heard about was evidence of very good levels of
awareness and understanding amongst those we regulate in relation to our plans for our future regulatory model. The scores are really very good and it reflects well on a huge effort to engage proactively with providers about what is coming. So, the team are to be
commended in relation to that. We are also going to use the RGC as a sort of collating ground for a large number of recommendations for improvement for the organisation that come in from for a range of sources that we have, I think 211 on
our list. We haven’t seen the full list, yet that will probably be for a future meeting, but we want to try and track this from two or three angles. We want to do it from an audit action, you know, of the things that we
agree to improve actually getting down on time. We want to look at the qualitative perspective, what have we learned, what insights have other people had that we hadn’t really realised ourselves. We also, certainly, want to have a look at the recommendations that have not
been accepted. Why do we think other people’s insights and views were not right? Then, our deep dive this time was in relation to complaints, and we also looked at our ratings review process which is a particular type of complaint. Complaints are tremendous learning experiences,
as you know, as I’ve said before, you know, you learn more falling off a ladder than you do when climbing up and down it 100 times. So, when things go wrong, when there is a either a partial or fully finding of fault against the
organisation, it is a great opportunity for us to learn. One of the things that we talked about at the committee was how joined up we are, where we are seeing repeat failings. We want to make sure the lessons are not just local, that we
are learning across the organisation, and we are joining up insights which could be for improvement which could be applied elsewhere. So, it was a good meeting. At our next meeting we are probably going to spend some time looking at what we’re talking about, (unintelligible)
silent services where we are not getting a lot of feedback in relation to a service, perhaps sectors where we have fewer triangulation points in relation to other sources of insight into a provider; how we are assessing risk in relation to those services that will
be for the next time. Thank you very much indeed, Mark. As you said a busy agenda and probably (unintelligible) explanation, but the ARAC
Mr Ian Dilks - 1:21:58
Agenda is, to some extent, relatively similar between organisations. This is unique to us. Just ask questions in a moment, just to
pick up on one point you mentioned about the (unintelligible) recommendations and things to look at, and those that are not implementing. Probably just worth highlighting - at least I stand to be corrected - but basically what I’ve seen. Quite a few of them, the
answer is quite simple, that people have considered we might like to do something that is not within our powers. So, it’s not something that we’re refusing to do, it’s just that government will need to decide if they wanted to extend our powers. So, that
is probably quite a big chunk of our third category, I think, isn’t it? Any questions or comments for Mark? No. I think there’s an open invitation - I know he has got a busy agenda - an open invitation. If there are things that the
Mr Ian Dilks - 1:22:51
Committee thinks ought to be dealt with within the terms of reference, then please do let Mark be down, and we will work it out on the template. Thank you very much Mark. Just a few final things. The only item we had for approval on

3.4 Minutes of the previous Public Board meeting on 24/05/23

the agenda today, slightly unusual, was the minutes of the last meeting that were circulated before. I won’t ask those who weren’t here to comment, but for everyone else, are you happy that it’s a fair record of the meeting? My colleagues seem to be, so

3.5 Review of the matters arising and the action log

we will approve those. There are no outstanding actions on the action log, so there’s nothing to mention there, so in terms of the formal meeting, it brings us to Any Other Business. I have one I want to deal with before I do with that,

4.0 Any Other Business

can I just look around the room and see if anybody else wants to raise
Mr Ian Dilks - 1:23:42
anything? OK. Just what I wanted to deal with, and apologies, I couldn’t get a paper in the pack, time didn’t allow it. But we have three committees of this Board,
two of the (unintelligible) membership is determined by our regulations, but the other two, they do important work for the Board, but I think it is up to the Board to make sure it’s happy with the people on those committees. We have just had reports
from the two Chairs. Obviously, we have been running very light on non-executive directors for the last six or nine months, but we would like to take the opportunity of bolstering the main committees with the changes. So, although it wasn’t in the public papers, I
have spoken to colleagues outside the room, but this is a request for approval for two additions. One is that Christine should join the Regulatory Governance Committee, sorry, excuse me, and the other is that Mark Chakravarty, would join the Audit and Risk Committee. There is
a slight complication on the latter in that, having had a quick look at the dates, he may have problems attending some in the near future. So, what I would ask, two approvals, one is that Christine joins ask RGC with immediate effect, and the other
is that Mark joins the ARAC, but at a date to be determined when we can clarify his availability. It wouldn’t be fair to ask him to be a member when he can’t turn up for any meetings. So, can I have my Board colleagues’ approval
for those guys? Thank you very much indeed. I think on that we will
Mr Ian Dilks - 1:25:18
close the meeting officially, so thank you to my Board colleagues here, and thank you very much to those listening in. However, regular observers or listeners will do say if people would
like to submit questions, we will happily submit them to the Board. We have to do that in advance, given the fact that this is livestreamed, but we don’t have (unintelligible) in the room. So, I do have some questions to address. I think they’re all
from Mr. Robin Pike. So, there are three. I will take them in turns. The first is how can CQC improve its service to whistleblowers? Mark, it might be best if I asked you to pick that up first. Thank you. So, we are committed to
Mr Mark Sutton - 1:26:06
effectively handling concerns from workers of providers registered with CQC, including when they make protected disclosures or whistleblowing. We looked again at our current practices during the Listening, Learning and Responding to Concerns Review which was published in March earlier this year. This Review identified opportunities
for improvement, and we have agreed the action plan is underway now. These include the implementation of new technology that supports the improvement in collecting and monitoring concerns that are raised with us. You mentioned, Ian, earlier about the successful release that we had yesterday. That
was our contact service as part of our regulatory platform which is the foundation of how we can start to improve that monitoring. I particularly wanted to thank again operational colleagues, national customer call centre, service centre colleagues and our technology colleagues as well for a
fantastic start of that technology roll-out. We are also making improvements in how we collect equalities data and improvements in our standard operating procedures and training and support to colleagues to help continuously improve our service. Thank you very much Mark. As
Mr Ian Dilks - 1:27:21
you say a fundamentally
important part of what we do. Sean, I think this one is probably for you. How does the CQC decide when to inspect independent hospitals,
Mr Sean O'Kelly - 1:27:33
and particularly those that are newly opened? Thanks very much. Well, our inspection process really begins with the registration of all
providers. When new providers register with us, we undertake a very robust and thorough assessment of their quality. Once that has been completed, we continuously monitor the performance of providers with data that we receive, information we receive, feedback we receive from patients, from staff and
hard data we can obtain for that provider’s performance. Through that process we develop a picture of risk for that organisation, and we can choose to inspect when we think the risk, you know, warrants that inspection. So, the answer really is we choose when we
inspect providers based on the picture of risk that we have built up through the data and intelligence processes that we operate. Thanks.
Mr Ian Dilks - 1:28:42
It is probably worth saying the one of the things that Mark’s RGC has been doing is looking at ratings from first inspections
from newly approved bodies. That’s not just independent hospitals, but it is something we do generally. And protections for whistleblowers as well is on our list. Then, the last question. Actually Sean, looks like it is another one for you as well. What processes does CQC have
Mr Sean O'Kelly - 1:29:12
for reviewing and improving its inspections of dental practices? There is an (unintelligible) on improving, I don’t know if that means continuous improvement or other things, but perhaps you could answer from your perspective? So, what processes do we have for reviewing and approving inspections of
dental practices? Others can add if they wish. I think the first thing to say probably is that we do a lot of these inspections. In the last financial year we have done over 1000 inspections of dental practices alongside over 600 monitoring calls, so we
do a lot of them. We also frequently review the processes we operate and ensure that we are using the feedback we have received from providers in ensuring that we are doing things like reducing the burden of inspection, making sure that our reports are accurate
and well written. We’ve just recently completed a review of assessment reports and templates that are used in these inspections. Again, in a way of responding to feedback we’ve had. So essentially, they are under continuous review and we operate a lot of them so we
get plenty of feedback and plenty of opportunities to make sure the inspection processes are responding to the feedback we received. OK, thank you very much. If colleagues need to add? I think that brings us the end of the questions, so thank you, Mr. Pike,
Mr Ian Dilks - 1:30:51
I hope you find those responses helpful. So, end of meeting and the questions. Thank you to my colleagues for joining us here today. We are meeting again a couple of months for those listening. Thank you very much for joining us.