CQC Board Meeting - May 2024 - Wednesday 22 May 2024, 2:00pm - Care Quality Commission

CQC Board Meeting - May 2024
Wednesday, 22nd May 2024 at 2:00pm 









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  1. Mr Ian Dilks
  2. Mr Ian Trenholm
  3. Mr Ian Dilks
  4. Mr Ian Trenholm
  5. Mr Ian Dilks
  6. Ms. Christine Asbury
  7. Mr Ian Dilks
  8. Ms. Kate Terroni
  9. Mr Stephen Marston
  10. Mr Ian Dilks
  11. Mr Ian Trenholm
  12. Mr Ian Dilks
  13. Mr David Croisdale-Appleby
  14. Mr James Bullion
  15. Mr Ian Dilks
  16. Mr David Croisdale-Appleby
  17. Mr James Bullion
  18. Mr Ian Dilks
  19. Mr David Croisdale-Appleby
  20. Chris Day
  21. Mr Ian Dilks
  22. Mr David Croisdale-Appleby
  23. Mr James Bullion
  24. Mr Ian Dilks
  25. Mr Ian Trenholm
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  1. Mr Ian Dilks
  2. Mr Stephen Marston
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  4. Mr James Bullion
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  7. Charmion Pears
  8. Mr Ian Dilks
  9. Ms. Kate Terroni
  10. Mr Ian Dilks
  11. Mr Ian Trenholm
  12. Mr Ian Dilks
  13. Chris Day
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  15. Mr Mark Sutton
  16. Mrs Belinda Black
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  1. Mr Ian Trenholm
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  4. Mr Tyson Hepple
  5. Ms. Joyce Frederick
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  7. Ms. Kate Terroni
  8. Chris Usher
  9. Mr Ian Dilks
  10. Mrs Belinda Black
  11. Chris Usher
  12. Mr Ian Dilks
  13. Mrs Belinda Black
  14. Mr Tyson Hepple
  15. Mr Ian Dilks
  16. Chris Day
  17. Mr Ian Dilks
  18. Charmion Pears
  19. Mr Ian Dilks
  20. Mr Tyson Hepple
  21. Mr Ian Dilks
  22. Mr Stephen Marston
  23. Mr Ian Dilks
  24. Mark Chakravarty
  25. Mr Ian Dilks
  26. Mr Tyson Hepple
  27. Mr Ian Dilks
  28. Mr Mark Chambers
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  7. Webcast Finished

1.0 Opening matters

Mr Ian Dilks - 0:00:00
Let’s start, we have a problem with technology, I think. OK. Seat 34 is also working. Can you… is that OK? Right, we will start the meeting again. Welcome to everybody dialling in, and my apologies for the sound problems. Welcome to the public Board meeting
of the Care Quality Commission, 22nd of May 2024 for those live or as a record for those watching it on catch-up. We have a meeting of about two and a half hours. We would like just to give a few apologies and welcome a few
guests that we have here today. Sean O’Kelly, our Chief Inspector of Healthcare is, regrettably, still not well, so he won’t be with us today. We have four people who are joining us, predominantly as observers, so sitting at the back of the room and people
on camera may or may not see them, but I shall mention their names anyway. We have Mary Mumvuri from the National Professional Advisor for Mental Health Nursing, she is part of a shadowing programme joining us today, Elaine Mullen (unintelligible) who has joined as the
new Governance Manager and as part of getting into her role is sitting in on a number of important meetings, including Board meetings. And as among guests, Thomas Bentell, we are conducting a Board Effectiveness Review at the moment and we have an observer from the
organisation we have appointed to do the work for us, so welcome to them. And then actually joining us at the meeting, but online is Hannah Sturland who is our Disability Equality Network Representative, so Hannah thank you very much indeed for joining us. Could I
ask my colleagues if there is any new declarations of interest to note? OK. I have no planned changes to the agenda, nothing urgent has come to my attention. Is there anything else people want to flag that we should be doing differently? OK. Well, if
not, let’s move straight on to the main business of the organisation, perhaps I could turn to you, Ian, to add to the report from the
Mr Ian Trenholm - 0:02:51
Mr Ian Dilks - 0:02:53
Mr Ian Trenholm - 0:02:54
Executive? Thanks, thanks Ian. So, just going through the report and I will just do what I usually do and
briefly step through the report and then take questions at the end. Kicking off with… does the microphone sound weird, or can you hear me. I think Hannah has indicated she can hear me, so I will carry on. So, kicking off with culture change and
people, kicking off with culture change and people. We have committed an important piece of work to refresh our decade-old values. Now is a good time, following the sort of drawing to an end of our transformation programme, to start to look at our values. We
have had 1,200 colleagues who have been part of the work so far, through a series of (inaudible) continue through the rest of May and into June, and there may be some follow-on activity in the early part of July as well. We will be coming
back to Board with the recommendations that encompass all of the voices of our colleagues in terms of what values we should have. We have also continued with the successful Manager Pathway. 147 colleagues in two cohorts have started the programme which has helped to develop
our first-line managers and give them the skills that they need to operate in our current working environment. In terms of race and inclusion, we made a clear commitment at a Board as part of the Listening, Learning and Responding to Concerns Review a year or
so ago, and we have continued to do a couple of sessions. We had one which was focused internally and one which was focused externally, and the way in which we regulate and the way we talk about inequalities through the voice of regulation. That work
will continue, including cascading the work to senior leaders as well. In terms of technology, data and insight, there has been a big focus on supporting colleagues in bedding down the new platform along with streamlining the assessment service, our contact centre contact services and, of
course, the registration service, and I will talk a little bit more about some of that work later on. Our new portal has been updated and we now have over 11,000 people enrolled on the portal. It is being extensively tested and monitored in the live
system at the moment, so we have got a small number of providers who are in the live service. We have not yet commenced marketing that more widely, but we will be doing that in the next few weeks when we are confident that all of
the services that support the portal are all working well in order to make sure that providers have a good experience. Our new intranet titled Home is now live and performing well. It is available for the first time on people’s phones which means that colleagues
will be able to access intranet, the intranet directly on their phone. It means that when they are out and about on inspections and so forth, they can get access to guidance and so forth which, I know, colleagues have wanted for quite some time now.
Data and insight teams continue to support and import external publications alongside supporting work on the reports coming out of our national maternity inspection work, and that is all due to publish in July. In regulatory, within the Regulatory Leadership Team, we have got six current
areas of focus: Dementia Strategy, Inequalities in Health and Mortality, Mental Health Mortality, Mental Health in Black Men, Children’s Health and Deteriorating Patients. These are our priorities which the Regulatory Leadership Team have picked up from our regulatory work, and they are going to do more
work to work out what we can do from a regulatory point of view to positively influence all of those topics. In terms of local authority assurance work, we have got…, three reports were published earlier this week and they were well received by the councils
involved, and work is now ramping up with a number of new colleagues to do that work at pace. In terms of our integrated care system work, we continue to discuss with DHSC the detail of the rollout of this work, and James has been leading
that personally and will be able to talk to that, if anyone would like to follow up on that. We will publish our consultation on the fee scheme once we have had the necessary government approvals for our work, but in any event before we commence
ICS assessment. And of course, the work on Maternity Services and Urgent and Emergency Services continues at pace as well. Our colleagues who joined us in last October from MNSI are now getting much more integrated into our core teams. We have included the team in
our regular performance reporting for this year, so again we will be talking about the performance as we go throughout the year. I wanted to flag the publication earlier this month of the report that MNSI have done on birth centres. That is a thematic review
that they did, learning from 92 MNSI investigations that they did. Then finally, engagement, we continue to actively engage in a range of topics - they are listed on Pages 17 and 18 of the Pack - both with parliamentarians and elsewhere. So, that is all
I have got to say for now Ian, and I am happy to take questions, thank you. OK. Thanks Ian, just before we move to questions, Kate, I think there was a People update you were going to mention. Yes, thank you and good afternoon everyone.
Mr Ian Dilks - 0:08:43
So, just to let you know, we have made an appointment to our Director of Governance, Performance and Assurance, a colleague called Sean
Ms. Christine Asbury - 0:08:51
Cornall will be joining us on the 1st of July. So, Sean comes to us from a Natural England, where he is currently
Director of Assurance and Corporate Governance, so we are really looking forward to welcoming Sean. When Sean arrives, so the 1st of July will be the point that we establish our two new directorates. So, you will know at the moment we have currently got a
Director of Governance and Legal Services. Following the work of our Corporate Services Review, we are going to be moving to a Directorate of Legal Services and a new Directorate of Governance, Performance and Assurance. So, just to let you know that Sean is arriving and
at that point we will be establishing the two new directorates, thank you. Thanks Kate. I mean it is good news we have managed to recruit, but also a welcome development of continued bolstering up of our governance and assurance side, so thank you for that.
Mr Ian Dilks - 0:09:33
I will turn to my colleagues for questions on anything Ian said or the papers. Stephen. Thank you, Chair. Could I just pick out and warmly welcome what was said about maternity, because it feels hugely
Ms. Kate Terroni - 0:09:52
important when the safety and quality of care in maternity
units is still a matter of widespread public concern, that we keep our focus on it. I know some really important work is being done to take the learning from the great work that our own teams did, to go out and inspect maternity units, so
that we can be clear about what are the contributing characteristics of poor and good performance, so that the whole system can learn from it, including our own teams on future inspections. So, I just wanted to sort of warmly welcome the profile we are giving
to that follow up work on maternity. Thanks Stephen. I think we are
Mr Stephen Marston - 0:10:38
doing follow-up work in two broad groups. One is to summarise the
Mr Ian Dilks - 0:10:40
things we found on those during the overall programme, but also I
Mr Ian Trenholm - 0:10:43
think, more importantly, working and collaborating with practitioners. There
certainly are a number of other organisations and people who work in these services who are really keen to improve and to learn lessons, and we want to try and be a rallying point for that. So again, we are trying…, we are delivering two final
reports there, one, a sort of summary of what we found, and the other one is really starting to summarise that and say what extra services if you will, can we help people improve on. So, it is a good point, thank you. Any other questions
from colleagues? You did flag - (unintelligible) others, so thank you
Mr Ian Dilks - 0:11:24
– you did flag, James, my comment on where we are in ICSs. James, are you able to say anymore? Yes, thank you. Thank you Ian and good afternoon everybody. Yes, I mean it is
probably worth reminding ourselves, at the Board, that our ICS approach, much like the local authority approach, is particularly
Mr David Croisdale-Appleby - 0:11:39
determined by the Minister and the ministers under the Health and Care
Mr James Bullion - 0:11:43
Act, so it is a slightly different arrangement that we have than our regular inspection
powers. We are in fact making progress in our discussions with the Department, so we are still working through with the Minister and with the Department the finalisation of how we will report. I am very conscious that that is holding up the publication of the
two pilot reports that we completed with the two systems in Birmingham and Solihull and Dorset. We are ready, as it were, for the publication of both our evaluation, the consultation on fees and those two reports, and we are committed to publishing as soon as
we have agreed the overall methodology with the Department. I anticipate that, following a further inclusive event with partners in the NHS and with the Department in early June, that we will be hopefully coming to a conclusion in June and back at the July Board
with the conclusion, as it were, of the process. Thanks very much. Just to clarify a couple of things, we did discuss or request, I think at a previous meeting, to make sure that we had written to ICS leaders to update them. I think you
Mr Ian Dilks - 0:12:59
said in your paper we have - I suppose I am asking you to confirm what you wrote but I will ask anyway. And the other is, we did a consultation on our fee arrangements, and my understanding is we should have published that by now,
but I guess that is being held up while this continues. So, we probably have to fail to comply with something, whatever we do now, but where are we on compliance with the general rules of publishing the response to that consultation? Yes, as you say,
we are beyond the good practice and requirement for us to publish that. So, I think we are now around, well over 20 weeks since we
Mr David Croisdale-Appleby - 0:13:39
concluded that, so we do need to be aware of that. I suppose though,
Mr James Bullion - 0:13:41
we have been public, as it
were, about the position and our intention to be very clear about that, and as soon as the methodology is applied, we will prospectively then implement that. Just on the point of engaging with the ICSs on this question, so myself and Chris Day are engaged
with the ICS leaders formally convened by the NHS Confederation. We have got a meeting coming up with ICS leaders to give them a further update on our position, and indeed to engage them as well in our potential proposals for amendments to our way of
reporting going forwards. Thank you. Any other questions from colleagues? David. Chair, if I may, a question following what James
Mr Ian Dilks - 0:14:31
has just said, and partly to Chris, in terms of our relationships with
Mr David Croisdale-Appleby - 0:14:37
the integrated care systems which James just referred to? Have we got in
place speaking events at their various conferences and collection, regionally and nationally? It is a great question. So we have been really fortunate in our conversations with NHS Confederation to be able to work with them to do exactly as you say, to make sure that we are able to have good conversations
Chris Day - 0:15:08
with them. We have also been working with the pilot sites to try and ensure that we can bring them with us into a conversation about what happens. Clearly what they are looking for is a relationship between what we intend to assess as part of
our ICS framework and the Oversight framework that NHS England has in place as well. So what we are trying to do is to show the links between the two, but to show obviously what they are doing that is complementary to each other. But as
James said, NHS Confed, we have been in conversation with them for some time now and they are really keen to act as a bridge for those conversations into the ICS networks. And in terms of speaking events, Chris? Yes, well, for example, we will be
talking about this at NHS Confederation this year, we will be using…, there are a number of both national and regional speaking events hosted by both NHS providers, NHS Confederation, and the ICBs themselves. Our aim is to make sure that we can talk with confidence
about our plans working alongside NHS England at those events. James, sorry, another one from me then. I mean we talked about the work at
Mr Ian Dilks - 0:16:20
ICSs, obviously we were able to start the work at local authorities earlier in April, so it is very early days,
but any feedback on how that is going? Well, as Ian referred to, we published the three first reports last week, last Friday, and to some
Mr David Croisdale-Appleby - 0:16:38
interest, both in terms of those local areas, but more broadly across
Mr James Bullion - 0:16:41
local government. They were three “good” reports, but
we were demonstrating in their publication the range of differing findings relating to, as it were, the score, the way our scoring system works, and in producing a “Good”. So, we continue to find the common issues that we had begun to discover in the pilots,
including issues like waiting times for services and the impact of people’s care on their lives, and also the commissioning arrangements, particularly with the fragility of the social care market. So, those are common themes that are coming through. It might seem that three reports are
few in number and, as our papers show, we, as it were, completed six site visits. In fact, the way we work is that we announce in the next quarter who is going to be in our sights, as it were, for assurance and then we
write to them six weeks before we are coming. So, in fact, the numbers mean that we are now in touch with 35 councils for that process and that number will begin to build. We will be in the 40s in July, and so on, to
get through the 153 over two years. The point of raising that is that this has an anticipatory effect for the 35 and then for the other people who are, as it were, waiting for our process to appear in their (unintelligible). So, I think as
well as what we are finding, we are also finding that local authorities are, as it were, making themselves as best prepared for our process and in doing that are making improvements in their delivery of services. Yes, I must admit, I picked that up from
other sources as well, people I have been speaking to that, it has led to change, and indeed therefore some improvements. So, it is a bit like doing a lot of these Community Speedwatch things, isn’t it? I
Mr Ian Dilks - 0:18:34
mean is success not catching people or catching
people? Anyway, thank you very much indeed for the update. Any other questions from colleagues? No, OK, well Ian, thank you very much indeed for that, obviously the paper is very comprehensive. We are going to move on to the Single Assessment Framework implementation. So this
is verbal, we don’t have any papers for it, but I think probably over to you and you can update us on where we are. Thank you. Thanks Ian, quite a lot to update. So, I think, just by way of background, over the last few
months we have been working hard to roll out a new approach to the way that we regulate and this has involved changes to how we organise ourselves, new policies and a total replacement of our overall
Mr Ian Trenholm - 0:19:25
technology. This has been incredibly ambitious as a programme,
and we, of course, have met a number of challenges as a consequence of that. I think we have now got to a point where all of our assessment services are live, with the most recent turning on of assessment services for dentists and a range
of other providers who we do not rate. We often call them other assessment services. I want to pay tribute to begin with to all of our colleagues who have been working incredibly hard to get us to this point, and specifically to manage the old
system whilst moving on and training on the new system. That has been a particularly difficult journey for a number of colleagues, and they are doing all of that in the context of a very challenged health and care system. So, they are trying to make
sure that we can protect the public, manage the risks…, help manage the risks of those services, whilst at the same time, getting ready to move on to new services which has been a huge undertaking. As we have been rolling out the new approach in
phases, we have been doing that deliberately so that we can make sure that there isn’t a big impact all in one go. It has also meant that we have also left old services running at the same time as moving on to new services, and
that obviously creates a whole set of risks and all sorts of challenges. On balance it was probably the right thing to do, but it doesn’t alter the fact that there are some real and significant challenges. It means that providers and the public have always
been able to contact us and continue to be able to contact us as we are rolling out our new services, but it has meant that there has been some confusion. I know some providers have asked what is the was the right thing to be
doing at the moment, and particularly there was a point where providers, who had a national footprint, were doing one thing in one part of the country, and a slightly different thing in a different part of the country which, obviously, is a challenge. That has
been a real challenge, to communicate that level of complexity consistently and well all of the time. So, based on feedback that we have had from our own teams and from providers - we have been doing lots of work with providers directly or through provider
groups. We have also been talking intensively to our own colleagues, internally, getting feedback through in-house meetings, conferences and so forth. It means that we are now working on a number of specific areas. The first one is addressing the backlogs in registration. We know that
the registration team have been under enormous pressure over the last six months in particular, but probably a little bit longer than that. We have had some of the highest levels of inbound registration queries that we have ever had over the last few months. That
has meant that the backlogs had built up in registration before we started to go live on the new system and I know that is a challenge. A big thank you to the registration team who have been working incredibly hard to address those backlogs, and

2.2 Single Assessment Framework implementation update

also a big thank you to providers for their patience. I know a number of providers have rightly raised concerns with us that they are worried about the backlogs in the time it takes to get things done. We have got a fast-track process for those
providers who are supporting, at the NHS in particular, but also where there is particular challenges in social care in a particular area. We can fast track Applications and we have done exactly that, but I think, in general terms, for a number of providers they
found it quite frustrating and I am hoping that, with the advent of having increased the number of people in registration by over 40% and an ongoing recruitment campaign plus the go-live on the new system, that should start to make a difference over the coming
weeks. Designing a new approach in the way that we manage relationships is the second area that I want to just flag. It is one of those things, that we were always concerned that the individual inspectors were having untenable workloads in our old method, and
they weren’t always able to offer providers the sort of the sort of relationship management, the sort of service that we want. Equally, it meant that there were times when we needed to understand how risk was being managed in a provider, and that wasn’t done
as well as it could have been done. The new method…, the new system offers us a number of pieces of functionality which are helpful but, more importantly, the way in which we manage the relationship with providers is something we are doing some work on
at the moment. We are hoping to be in a position to start to talk to providers openly about that in July, and talk to them about how we are going to manage those relationships which addresses the concerns that both providers have had, but also
our own teams internally, to make sure that that relationship management approach is manageable. We have also been doing some work internally around ensuring that our managers have the flexibility to deploy their teams and to get specialist support in the most effective way. What that
means in turn up from a provider point of view is we can be much clearer on what is planned and what is responsive work. We want to be much clearer about the fact that we are still doing a significant amount of work based on
perceptions of risk, but we also need to give providers confidence that that we will come back to those providers that have not had an inspection for a while, those providers who, perhaps, have got an aging rating. We know in particular that providers who are
rated “requires improvement” in social care have had some real concerns about how frequently we are going to come back. We want to be in a position over the next couple of months to, again, talk openly about when we are likely to return. The work
we are doing internally around productivity gives us that sense of what our capacity is and how likely we are, or when we are going to come back. We have also got a very significant programme of work and investment to learn lessons from the first
few months of the new system, to fix the issues that inevitably are going to appear in new systems, and to make changes to offer our teams and providers a better experience. We know that as soon as you start using a live system, a number
of things which couldn’t possibly be predicted start to become obvious. Again, we want to be in a position to rapidly respond to that and make sure that we can link services together. This, in turn, drives up our ability to get to more providers and
offer the public the most up-to-date picture of ratings. We are also continuing to review how we communicate all of this. I recognise that in doing this, there’s a number of things which will have gone very well for people, equally, there will be a number
of things that haven’t gone well for people. A lot of the reasons for this are quite detailed and in some cases quite technical, and communicating that in a way that is clear both to our internal colleagues and also to providers and is up-to-date remains
a challenge. We are trying to balance too little communication with unhelpful and complex communication, and I acknowledge that sometimes we get that right and sometimes we maybe don’t, but we have been working with providers directly, with provider representative groups and others, and we have
been doing the site internally as well. We have got (inaudible) work that is fixing these issues a long time, alongside a longer-term programme of work to develop new functions and to make the system much easier to use, both for providers and for our internal
people. We are also looking at our policy. We know the Single Assessment Framework as a concept, as a basic frame, has been well-received, both internally and externally. The idea of the Framework seems to make sense to people, but are there some specific rules within
it that in terms of how we execute on it, that we need to change? Again, we are actively looking at that to see if there are small tweaks and changes we can make over the next weeks and months to make the system easier to
work. I am particularly concerned about making sure that the new system and how it interacts with the old system works really well. I think the Single Assessment Framework on its own makes complete sense, but that transition from old to new is something which I
know some providers have really questioned, whether there is anything we can do to make that clearer and obviously fair. Because I think there is something here about making our work clear and transparent to providers, so they understand how we go from here to there,
and they see any ratings as being fair. Equally those ratings are as up-to-date as they can be and they make sense to the public. We are also looking at internal work, to look at the way in which internal teams collaborate with one another, whether
we need to make some small changes and tweaks to job roles to make sure that all job roles are achievable. We do know that some of our colleagues have really raised concerns about volumes of work as part of this process and, again, that is
something which is being actively looked at to try and make sure our front-line managers can do the work that we want them to do. I think all of this taken together means that it will, I hope, start to drive up our ability to cover
the ground in the short term. That, in turn, gives us the capacity to make sure that we are going to the right places which, in turn, gives us the ability to give the public the assurance that they need around the safety and quality of
the care that is delivered in this country. If I pause there Ian, I know a number of colleagues will probably want to come in and pick up individual details, Thank you. So, some questions, but we will turn over to colleagues first and Hannah, if
you wish to check-in as well. I won’t come to you for a question, but
Mr Ian Dilks - 0:29:52
if you wish to chip in, please feel free to do so, though I can’t actually, necessarily, see your hand on the system. So, wave or something and I will know
to bring you in. Colleagues, questions, comments? Stephen. Firstly, I would just like to pay a huge tribute to all colleagues across the whole organisation for the immense amount of work that has gone into this whole transformation programme. It has been big, it has been
Mr Stephen Marston - 0:30:26
ambitious, it has been very challenging, and I think colleagues have worked incredibly hard to implement it effectively. We are just in that phase where, I think, for many colleagues it is feeling very challenging indeed. You know, they are trying to get to grips with
new ways of working where many, many moving parts are all changing at the same time. As Ian described absolutely rightly, we need, as a Board, to own the programme that now helps colleagues come back up the other side and feel confident that within these
new ways of working, amended, tweaked, adjusted as they need to be, they can see a way to delivering their jobs effectively, efficiently professionally, to give the results that they are all highly motivated to give, which is reliable, accurate ratings that promote safety, promote quality
of care across the whole system. So, it is trying to sort of now identify the adjustments and the changes that we need to make to address the frustrations, the unexpected consequences of what has been put in place so far, to give our colleagues that
reassurance that, you know, we can get to the end of this transition phase and they will be able to deliver their roles in the way they want to, professionally and to high quality. I think that is a responsibility on all of us as Board
members. Thanks. Do you want to comment Ian? I mean I was going to make a similar point Stephen, so thank you for doing it, but do you want to respond? Yes, thanks Ian. I think that is exactly right, I think a number of us,
Mr Ian Dilks - 0:32:25
including a number of non-exec colleagues who have been to various conferences with Ops Group colleagues over the last few weeks, time and again, that real visceral sense of wanting to do the right thing and wanting to make a difference for the people who use
services, comes through time and again. The question for us really is, how do we get to a point where we can offer people the tools and techniques that they need to deliver the great job that I know they want to deliver? As I say,
we have got a lot of work in the background which, in detail, covers this off. It is the single, most important focus of everyone round the Exec. Team table and I know Board colleagues share the importance of that work. So, I am confident that
over the next few weeks, we will start to put in place some really significant changes which are going to…, Well, in some respects, they are significant changes in the sense of the impact they are going to have. They are not necessarily a significant change
to the system, just to stress that, it is about looking at things which maybe haven’t worked in the way they should have done. I also think that providers will also start to see a significant uptick in things like the ability to do things on
the portal. We are already starting to see that coming through, but I know Mark will probably want to talk about that in a minute. I think each day we are putting in small fixes, and there are some pieces of work which is being done
with colleagues, and I think that is a really important point to stress, that a lot of the slightly bigger changes are being done as
Mr James Bullion - 0:34:00
part of a co-design process with colleagues so that their voices are embedded in any changes we are making which is
Mr Ian Trenholm - 0:34:07
really important. So, thank you, I am sure colleagues will appreciate the sentiment you express. Thank you. Charmion, I think you were going to comment. Chris, you had your hand up as well. Let’s start with Charmion. Thanks. Just building a little bit on Stephen’s comment
earlier. I am just wondering - we have seen a lot from colleagues at
Mr Ian Dilks - 0:34:24
many conferences, a lot of us have sat on calls - and I wondered,
Charmion Pears - 0:34:28
given how stressful this has been for colleagues, both in terms of, some of our IT colleagues, in
terms of volume of work, our operations, colleagues, in terms of new ways of working that haven’t necessarily fallen right, what are we doing to offer them support for wellbeing? It is my first question and I guess, what would be really useful to understand as
you have sort of talked a little about timing, is sort of a bit of a view on co-creation versus decision making timelines, because I think there is that balance, isn’t there, between wanting to hear from colleagues as to how we resolve, but also colleagues
desperately wanting decisions, so just a bit on that would be great. Can I point to Kate to do the wellbeing question and then I’ll come in on the on the decision-making question. Thanks Charmion. So, as you say a number of us have been at
operational conferences across the country over the last month or so.
Mr Ian Dilks - 0:35:21
We spent time with colleagues asking them what would make their lives easier in work in six months’ time, and therefore support their
Ms. Kate Terroni - 0:35:27
wellbeing, and we have got some really clear messages that have come
from that. We had heard it through the People Survey, but this really solidified what people want to see, and it’s issues around the assessor and inspector ways of working, the relationship manager, the technology, the methodology and also how we have established these teams. So,
the kind of challenge around some specialist colleagues not feeling like they have got the kind of infrastructure and support around them. So, we have got real clarity about what people need to improve their wellbeing. There were already some actions in train to address that,
but now we have got a real clear view on what order to be addressing it. We will now be communicating much more frequently with people about what we are doing in response to that. So, I think the most important thing we can do to
support people’s wellbeing is to show that we are listening and then doing something with that feedback which they have given us now loudly and clearly. We do have a suite of offers around wellbeing that have been in place for a while that colleagues…, I’m
confident that they will be clear how to access through our intranet when it comes to employee support and obviously in regular conversations, one to ones with their line managers as well. So, and we are particularly aware, as I say, it has been a difficult
time for our colleagues in Operations, so that extra support that operational managers have been providing. Again, when we look at our People Survey, we have had positive feedback about the support colleagues have got from their Line Managers on the front line as well. So,
there is two things, I think, it is about reminding colleagues of the support that is there and signposting them to that, but I think the most critical thing we can do as an Exec. Team is all this time and investment colleagues have taken to
tell us that they need to see change, to demonstrate that that change has happened and to let people know that a lot of it is happening in response to what they have told us as well. Just my final comment would be actually, what some
of our colleagues want to see changed, are a couple of a kind of key things that we now our providers want as well. So, we know our providers want to say something meaningful when it comes to relationship management, they want to have a smoother
experience when interacting with us through our systems as well. So, in addressing what our colleagues want, we are also addressing some of the key issues from our providers. I know there are other questions, and Chris, you wanted to come in, but I can see
Hannah’s hand is up, I suspect she is wanting to come in on that, so, Hannah, let me come to you first, and then we will come to others in
Mr Ian Dilks - 0:37:40
the room. It really is lovely to hear all the work that is going in, and
all the thought that is being put in around supporting our people and the recognition that it has been a really difficult time. It feels like we have had change upon change upon change with, you know with the pandemic and then systems and structure changes.
Actually, I think, what we hear in the networks is people are sort of changed out, you know they need time to settle and that stability to kind of settle into new ways of working with that support of being heard when they raise issues and
then action being changed…, action being taken, sorry. We just need to give people a bit of breathing space and time to adjust with that sort of (unintelligible) of support around it. So, it is really wonderful to hear that people’s feedback is being listened to
and action planning happening, and just a plea really for a bit of stability. Yes, fix the issues that we have talked about, but also just give people a bit of breathing space to get used to the new ways of working. Thanks Hannah. It echoes
a message we have had from other sources. I mean we appreciate from the Board’s point of view, we are trying to get a sensible balance between people that want things done yesterday, or the day before yesterday, and an understandable desire. We are all human
beings, none of us like changes is a basic premise, and getting that balance right, I think, is one of the biggest challenges for the Board. Ian, do you want to come in? Can I just come in, just picking up on Charmion’s second point and
I think linking it to what Hannah has just said. I mean my ambition is that we fix the things that need fixing, and we can debate the definition of fixed versus enhanced and that is probably a slightly
Mr Ian Trenholm - 0:39:24
unhelpful conversation. We can fix the things
that need fixing, both for providers and for colleagues internally, but then I think that is the point at which we then start to say, having used the system, are providers asking us for a new feature, are colleagues internally asking us for a new feature?
If that is the case, then we can start to think about building that, but job one is make the system as smooth as possible internally and externally, and therefore to make it as effective as possible. You know, and the same when we look at
job roles and indeed policy, there is no ambition to start to massively change those things in terms of a change programme, but it is about addressing where people are saying, look this doesn’t work or that doesn’t work, or wouldn’t it be better if… Then
if people who are working in the system are asking for change, then address that constructively, but I 100 per cent agree with you Hannah, that it is not something we want to do. But I think to Charmion’s point, I think I am really keen
that if we can just fix something because a form doesn’t work and it needs a field moving, which is the sort of level thing that we are doing in some places, we should just do that. But, equally, we should create the space for where
things do need co-designing, we create…, we give ourselves an extra couple of weeks us to do exactly that. I know Mark will want to talk about some of the work he is doing in a minute on exactly that topic. So, I think you are
absolutely spot on. It is a question of giving ourselves a little bit of time, but not letting an issue run ad infinitum. So, because we have now got, I think, a good mechanism for getting colleagues into the mix more frequently than maybe we had
done before. That is not to say that colleagues weren’t involved in co-design in the first place because they were. So, thank you So, Chris and Mark, if you can keep it brief if you could? Chris, do you want to go first? Yes, thank you.
So, just to build on Stephen’s original point and couple of comments
Mr Ian Dilks - 0:41:33
that have been made, this is, I think that we owe thanks to both colleagues and to providers in the way that they have engaged with us
Chris Day - 0:41:40
as we have launched the new approach
and the technology around it. I think the challenge for us is to make sure we have heard the insight that we have got, and turned it into action as you talked about, Ian. I think there is some things that are, in a sense relatively
easy and binary to fix, there are some things that we need to consider what the right solution looks like. One of the things that we have heard from both colleagues and providers is some things are quick, but where there is a consideration of what
to do, making sure people are involved in a journey both internally and externally. I think part of our challenge is to make sure that we are involving people in the development and the testing of new approaches that we take and there is ongoing support
for both colleagues and providers. Then lastly, just in terms of the way in which we communicate this internally and externally, I would be very grateful for colleagues that work internally, and also organisations that represent it externally, for support in the development of the communications
around the sort of insight into action work. So that they can help us make sure that works well and that we can get further feedback on how the messages are landing internally and externally. That will be really important not just for the next few
weeks, but as we build confidence and trust and develop longer-term solutions that we have talked about earlier. Mark Sutton: Thank you. So, I wanted to echo Stephen’s comments about thanking colleagues for the enormous hard work they have done in adopting new systems and new
Mr Ian Dilks - 0:43:14
ways of working, and particularly colleagues across the change functions who have worked incredibly hard, tirelessly, often weekends and late into the evening, supporting the change work that we are
Mr Mark Sutton - 0:43:23
doing. At the moment there are a number of key areas that we are supporting change
in, specifically focused on registration, on contact, on streamlining of assessment, portal work and some performance issues. We are working really closely with our colleagues in different sectors, in different regions, to make sure we get a balanced view in feedback, and that there is real
Mrs Belinda Black - 0:43:44
Mr Mark Sutton - 0:43:45
co-design going on at the moment. Just to give colleagues some insight into some of the things that are coming, some of these things are at various different stages, and as Ian says, some of these take a bit longer to design and we should take
the time to make sure we get full colleague input into making sure that those things are, when we deliver them, are the things that make a difference for people. Some things will deliver very soon, so for example the ability for colleagues to see everything
on an assessment once it is closed. It might seem like a small thing, but actually that is a big deal for colleagues. Others will be more dramatic, an ability for us to be able to significantly streamline the evidence process when we are uploading evidence
and the ability for us to do a lot of that in one place rather than the system having to do many activities. And the big one around assessment review processes which, I know, colleagues find particularly onerous at the moment, for us to have that
reduced down to a single page where colleagues can review things by exception, it is a leaning of the process and a real kind of user research-centred design which, at the moment, has lots of colleagues from across the organisation, as I said from different parts
of the organisation, really embedded in that design process. And I am excited for colleagues to be able to see that once that comes to fruition, I think that will make a big difference. So, make this the last couple of comments, I think. Christine, I
think you had a question, and Joyce, did you want to come in as well? So, Christine, and then Joyce. Thank you. I wanted to - Chris may have
Mr Ian Dilks - 0:45:21
started to answer this question - I wanted to find out a bit more about the Insight

3.0 Reporting updates

into Action Group, and particularly what is its membership, and how are the channels of communication working both ways, so how are you consulting with external and internal groups and how are you communicating what is happening? I am not quite sure who will answer that.
Insight into Action is an internal group that I chair, which contains the Exec. team, plus a number of other people who are involved in direct delivery of particular work streams. We have divided the work,
Mr Ian Trenholm - 0:45:54
the short-term work, into a series of work streams and
we have oversight on a weekly basis of what was delivered last week, what is being delivered next week and the meeting begins with what are we hearing from providers, what are we hearing from our colleagues internally and then we work through the specific action.
So, it is an action tracking group if you will, and then at the end of that we work out whether we need to change our overall communications plan, both externally and internally. So decisions are being communicated back to those groups? How? So, we use
the start of the meeting to talk about the new insight we are getting. We talk about, as Kate said, there are some four or five areas of work that we are particularly focused on. At the end of the meeting we agree, therefore, what are
Chris Day - 0:46:41
the messages for now and what are the actions for next. Then, we take that away and test that, with both colleagues internally and also with providers and provider representative groups externally, before we then update the communication. It goes differently to different groups. It might…,
what we send to managers and colleagues internally might have a flavour slightly different to what we talk to providers about, but essentially built on that core script of what are we doing this week, what are the plans for next week and the following weeks?
So, people get, hopefully, a drumbeat of things that we are trying to make changes on. Can I come back? Joyce. We do need to move on, Tyson, so by all means comment and then, Joyce, and then we will have to close it down. Sorry to jump ahead of
Mr Ian Dilks - 0:47:27
you, Joyce. I just wanted to add to what Chris said. First of all to also underline what Stephen said, about the incredible commitment of all my colleagues over what has been a really challenging period.
Mr Tyson Hepple - 0:47:40
Thank you. We have also developed, Christine, in the Operations
Hub, a “you said, we heard, we did” mechanism which is an actual live share point site where we are taking all of the feedback we are getting, including from the operation conferences, and giving people in real time feedback on what we are doing with
the information we have given them. I think that will really help to give colleagues a sense of what we are doing with their feedback, with their concerns. Thanks Tyson. Joyce, you wanted to come in. Sorry, thank you. So, I wanted to say thank you
to the actions and commitment that our colleagues have demonstrated. I
Ms. Joyce Frederick - 0:48:21
also wanted to say sorry, actually, that it has been such a challenging time, and we are asking people to balance hardship and hope. So, I just wanted to mention that we talked earlier about
lots of people want us to do things really quickly, but we also want to be evidence-based and also want to co-design, because doing things with people in consultation with people is also really important. So, I think there are lots of activities going on, but
we have got to give people an understanding of what is our plan, clarity of what do we want to achieve and by when, and to keep people up to date within that plan in terms of our communications, and our communications are really important. First
of all, it is like the three aitches to me. People want to be helped - let’s sort out the problems that people have -, they also want to be hogged - let’s speak to the emotions that people said that they are feeling now and
try and improve where people are -,and people want to be heard. So, just to Tyson’s point that you said “we have heard” is really important, but we have really got to hear and we have got to feed back, in terms of our understanding, what
people have said to us so that they know then that they have been heard. So, we are thinking about the different types of communications, that is really going to be important to take people through this process, because it is an endurance and it is
challenging and we just need to really support people through that. OK, thanks Joyce. Perhaps we could (unintelligible) the discussion, but I mean firstly thank Ian for the summary and I think there is a lot of recognition. I hope people listening, understand that the Board has got
the message about the challenges it has created both externally and
Mr Ian Dilks - 0:49:53
internally. So, at the risk of repeating, thanks to providers for sticking with us, but also for those who volunteer to help us do some of the pilots, that is appreciated. Colleagues, internally, I think
one of the most common questions is do we really understand the impact, and I would like to think today we do. Nobody is under any illusion. There is a vast amount of work going on, the challenge, really building on what Joyce said, to make
sure that people understand that, but more importantly, what it means for them, and they can see where the improvements are going to come and over what timeframe. We have got that message, I think fairly clearly, so it is something the Board needs to do,
but thank you very much indeed for that hugely important priority for the Board. If I could move on…, the reporting update, Kate and Chris, I will hand this over to you. This seems odd to be talking to Q4, but the back end of the
last financial year, so over to you. Thank you. So, pleased to present to Board the performance reporting for end of Quarter 4 of the last financial year, and in your summary sheet, you will see that we have drawn out some key performance areas that
we might wish to discuss today, along with some changes when it comes
Ms. Kate Terroni - 0:51:03
to risks. So, some new risks and risks that have changed in terms of action that we have taken. So unless Chris or Steph have anything particular we want to draw out, I
will hand over to Chris now for just a couple of key reflections, then we will go to questions. So, Chris. Thanks Kate. I will just summarise what is in the deck. This is, as said, the last position of 23/24, we have got a later
Chris Usher - 0:51:29
item on business plan for next year which will have a new set of measures and a performance deck to support that. Just in terms of summaries, there are a lot of areas where we have shown “green”, we have met our targets, but there is
probably three areas that I would pull out as standing out as an area of discussion, similar to areas I have pulled out in previous months, and probably been the story of the year. Just to run through them, the first one would be safeguarding alerts
and whistleblowing. Just a bit of context to this, we had a previous measure that brought together all whistleblowing with a 95% target and what we have tried to do this year is break that out, based on priority, to a) give a bit more focus
and a bit more transparency. For the Priority Ones, we kept the target of 95%. I think you can see from the deck we have struggled to achieve that throughout the year. We have struggled to achieve that 95% aspiration. We have responded to the whistleblowing,
it is just we haven’t done it in the one-day target that we have set ourselves in all of those cases. More generally, for safeguarding and whistleblowing, performance dipped in the year as we launched our new Contact Service in Quarter 2 which has impacted the
year KPIs and performance continues to be monitored closely for safeguarding and whistleblowing. Another area to pull out would be NCSC response times. We track four types of call and you can see from the dashboard summary, that all bar general enquiries are just short of
the target. Performance has been largely unchanged from the previous quarter, and again we have had challenges as a transitional period with our regulatory platform in-year, but also resourcing challenges in the centre. Again, response time continues to be tracked closely, weekly internally, as we track
through that and you can see the performance is improving in most areas based on live data. The last one to pull out would be registration timeliness. Currently 54% of our registration applications are over 10 weeks old, which is an increase from last financial year
and the previous quarter. We continue to see an increase in volume of applications coming in to CQC, that has left resourcing challenges, we have addressed those resourcing challenges. I think what is worth noting is, whilst the age of our applications increases, and the volume
coming in is increasing, the overall volume of applications in the system has gone down in recent months, so an area of an improvement there, but continue to focus on registration incredibly closely. Lastly, on the finances, we finished the year with a 0.5 million surplus
against our budget, which was an improvement on the previous forecast we had. That is made up of favourable variants on our fee income of 2.1 million, which is largely due to small variations in what we planned to bill, based on a register, versus what
we have actually billed in year, based on the actual register, and a deficit on our grant-in-aid of 1.6 million, which is entirely down to our response to the COVID inquiry which we have not had any funding for and is currently unfunded. Capital budget ended
the year with 300k underspent for the year. So, I will pause there and happy to take any questions. Thanks Chris. Questions for Chris? Belinda. Thanks Chris. So (unintelligible) point out about the whistleblowing, the Priority Ones, just deteriorating through the
Mr Ian Dilks - 0:55:17
year. But, I wondered if
Mrs Belinda Black - 0:55:20
you had a feel for…, if they are not getting heard within 24 hours, how long are they actually taking? And also, you know, what steps are we taking to improve that to get back to target? I will take that if that is all right, Belinda.
So, we are delivering against our old KPI which was around 95% within five days, it is just the one-day and three-day that we are not
Chris Usher - 0:55:42
meeting. So, when we look at that delivery overall, we are seeing that we are hitting the majority of whistleblowing
within the five days, and all remaining have action within a two-week period. So, it is just the timeliness within the one-day and the three-days. We do do exception reporting internally, as an organisation, to look at any that fall beyond that period and just to
flag them up in case that has been a kind of recording omission or anything like that. Thanks Steph. And steps to get back on track? There is a programme of work being led from a colleague within
Mr Ian Dilks - 0:56:23
regulatory leadership which will include development and support for
Mrs Belinda Black - 0:56:27
people working in Operations. It is quite a comprehensive programme
Mr Tyson Hepple - 0:56:33
which maybe we can discuss at a future Board meeting. Chris. Just wanted to say that, as ever with these figures, they probably don’t play to the effort that the NCSC colleagues and national Operations
Mr Ian Dilks - 0:56:48
Chris Day - 0:56:50
are going to manage what is…, we just talked about the issues around…, the challenges of the introduction of the new approach. There is a lot that sits behind these figures about people working very hard to try and manage the volumes of activities, both in
terms of information that they are receiving, whistleblowing and elsewhere in registrations, but also the conversations and the information coming through on the national enquiries line. So, I just want to say, particularly to those colleagues, that…, to thank them for the way in which they
have approached their work, because it has been an important part of our response to providers and to the public. Charmion. Thanks. I just want to compliment the team on the work, because I think what we have got now is a really great degree of
Mr Ian Dilks - 0:57:41
transparency, which makes it very useful for us to have some very
Charmion Pears - 0:57:44
meaningful conversations. I am really keen, as we go forward, as we have discussed, to sort of look at the “so what” and then to the points that have just been made, how do
we move back to sort of looking at what corrective actions are required. Likewise, I was just interested in relation to a matrix such as the proportion of services requiring enforcement following a regulatory activity or the percentage of services requiring action after first assessment, how
are we looking at those in terms of “Listened”, “Learned”, to beckon to sort of the initial processes. I am not sure if it is one for you, Steph. Sorry, I was just going to answer Charmion initially and then hand over to Tyson. So, in
terms of the way that we review that from a performance perspective,
Mr Ian Dilks - 0:58:34
naturally, we can’t create targets around that because of perverse incentives, but what we do look at is where there is variance, so regional variance, sector type variance, and we do monitor them for
the volume of applications that result in breaches or impact. What we will have the functionality to do in our new platform, which we weren’t able to do previously, was get a lot more granular detail of the types of breaches and the types of activity
that we will be taking. So, we will then be able to look at more information around any statistical variance of, is it safe care, or is it good governance and staffing, things like that? So, we can start to look at those kind of patterns,
but Tyson and his team look at that data more regularly, in terms of reactive approach as well as performance. I mean, thank you Steph. The only thing I would add is that we do look particularly at regional variations and then map that against our risk
factors. And if we are seeing more enforcement than we would expect,
Mr Tyson Hepple - 0:59:31
then we would want to look into that. This is an area where, I think, consistency is important. Thank you Charmion, if you could take your mike up. Stephen. Again, thank you, Chris, thank
you Steph. I think this is a really good report and it gives us much better insight than I think we have had in the past about performance,
Mr Ian Dilks - 0:59:50
Mr Stephen Marston - 0:59:54
but of course that then brings the consequence that it allows us to spot where performance really needs
to be sort of interrogated. I am looking particularly at Page 29 of the Pack and the Inspection and Assessments graph because for me this is the organisation’s core business, the generation, the whole pipeline of inspection and assessments and the reports that go with them.
I think as a Board we can’t be happy with the latest reported actual and the trend that it is showing. Now, we are where we are because of we were discussing under the previous item about, you know, being in a transition phase, of everybody
getting used to new ways of working and that inevitably slows people down. But I do think we will need to keep on top of that particular metric because, currently, performance is not where it needs to be, and by quite a long way. So, we
need to see that turning back up again as a result of all the work we were talking about previously in helping colleagues get to the point where they can efficiently, effectively, swiftly, you know, move through the whole pipeline of generating valid and professional informed
reports and assessments. Anybody want to respond to that, or shall we go straight to Mark? Mark, you pick up your comment and if there is any (inaudible) Mine was just in addition to that, which is the
Mr Ian Dilks - 1:01:26
massive benefit of having that transparency. At the moment, quite
Mark Chakravarty - 1:01:32
correctly, this position is looking backwards across
the year that has just gone by, we need to turn that into a prospective view including particularly focus on those areas, on those hot spots where improvement is required and required quickly. And seeing what we are anticipating month-to-month, or quarter-to-quarter, with an ability to
hold ourselves to account when we are not meeting projections that we hope to meet, what interventions are we taking to make sure that we are actually continue to accelerate in the right direction and be open to continue to make those changes as needed? Do you want to pick that up, or Tyson?
I’ll start, shall I? I mean Steph can come in with the figures, as the owner of the data, but I think that over the last few weeks we are
Mr Ian Dilks - 1:02:23
Mr Tyson Hepple - 1:02:26
starting to see quite a good uplift in the amount of assessment activity that the teams
are doing. I think that is sort of right across the different areas of assessment, including publishing reports. I think that is still very early days and still very small green shoots from the point of view of what you have been discussing plastic, but I
think that is starting to show, I hope, a good direction of travel. You are absolutely right, Mark. We have an overall target for the year at a national level, we can work that out by quarter, by quarter and Steph is monitoring where we are
for Quarter 1. But that uplift, if it continues, I think will start to see us doing more assessments than we did last year, but we will be able to update the Board on a regular basis. If I could just add, I mean I think
when people are transitioning from one way of working to another there is inevitably a slowdown as people lack familiarity, so it is
Mr Ian Dilks - 1:03:21
inevitable that as people become more familiar, things will start to get better. What I think is important we understand is there is
a finite life to that, they just become more familiar, but at that stage impediments kick in which brings us back to the sort of things Ian was talking about earlier on. So, I think in terms of projections, we need to be clear we don’t
just extrapolate the benefits of learning so far because that could plateau quite quickly. We need to understand what needs to happen more structurally to enable people to achieve a higher level. I am stating the obvious but I think it is important that it plans
to do that and also for the benefit of our colleagues as I know many will listen to this call, that we understand that. Mark, you wanted to come in? Yes. Thanks. Thank you Steph and Chris for this which is just a level of transparency
that is terrific and enormously helpful and, and thank you also for your help in supporting the information that we see at RGC because I
Mr Mark Chambers - 1:04:27
think, you know, we are getting there in relation to RGC. One common area of ground is on Page 38 of
the Pack and it is the, as if didn’t have enough to do we have also accepted 245 recommendations from other people about how we could do better, because these are recommendations that we have reviewed and decided to accept. We do need to track them
through to completion. I think we have got the same problem with this, with the metric as presented here, as the equivalent metric we see it at RGC and that it talks about progress, whereas actually it is quite hard to understand whether we are really
on track in relation to this, because obviously those 245 are prioritised and some of them we, quite deliberately, will not have started yet. So, if we can try and get a lens on this which is more about, well, where did we think we were
going to be and where are we in relation to the 245, that would be enormously helpful. Thank you I think it is important to add that we treat with respect people who make suggestions to us about what we could do. It is also true
Mr Ian Dilks - 1:05:42
that not all them we can do. Sometimes people recommend things that are beyond our powers, don’t they? So, an important part of this is making sure that we are identifying what we can and can’t do, as well as then managing how we progress against
what we can do. Yes, these are the ones that we have accepted, so these are the ones which we reviewed and said, yes we should do that, but they have various degrees of priority, and it is reflecting that
Mr Mark Chambers - 1:06:06
priority I think, that we need to try and do
here. Steph, you wanted to…? So, just to provide some clarity on that,
Mr Ian Dilks - 1:06:19
so we do have 254, 245, sorry and those 245 are both external recommendations and internal and there are previous publications where we have committed to change in our methodology. So, some of them are like
Out of Sight, Who Cares and things like that where we have committed to change, and part of the Single Assessment Framework is around that, and about kind of change in our methodology. What we can do moving forward is split this up because it is
made of three camps, it is where we have published documents, the Listening, Learning, Responding Review and then those recommendations that we have had from external sources where we need to change our methodology to support. There is a number of those whereby they are with
partnerships and external agencies where they are not progressing to a point that we can deliver them, as of yet. So, I think we need to be more transparent in this reporting, Mark, and I think it is a really valid point to make because, actually,
we may be far from target because that is the furthest we can get at the moment. I think we need to provide that transparency in this reporting so that you have sight of that and therefore that the questions can be on the ones that
we can progress, and potentially have prioritised other things in addition to that. James, you wanted to come in earlier? Beg your
Mr Ian Dilks - 1:07:41
pardon, just to add a final codicil to what Steph was saying there around the recommendations, we do have a dashboard and report and
the Regulatory Leadership Team do delve into the detail of where
Mr James Bullion - 1:07:52
performance is at in terms of where we are taking action on recommendations with Executive, but also ones are, as it were, parked or queued for further works. So, there is more detail, if the
Board would find it helpful, we could supply that, certainly. I wanted to make the broader point about, of course, this report is really helpful, it gives us the transparency on the numbers and as Tyson was alluding to earlier, there is an issue of quality
of the work we are doing, as well as the number of assessments that we are doing. So, there is action underway in particular areas, for example, on safeguarding or information of concern and the standard operating procedures. So, we both need to look at the
impact and the quality of the work we are doing, as well as just tracking these numbers, because behind the numbers there are issues around how good is the work that we are doing. So, Regulatory Leadership have got a key role alongside Operations and Policy
colleagues in doing that. Thank you. OK, thanks. Are there any other last questions or move on? Look, if there are no more questions, can I just repeat something I think something Stephen certainly said, and
Mr Ian Dilks - 1:08:56
maybe others? Thanks for the way you have continued to
develop the reporting, even accepting the consequence of the more you give us, the more questions we ask, that Stephen did not mean to interpret as we want to go back to the old ways! That it is really helpful and the other thing is, as
Chris was stating the obvious, the data is helpful but we have been asking that if something looks odd, you comment on it, and more importantly what you are doing about it. Because if it is clear that you are on the case and doing something
with it, I don’t think we need to spend too much time at the Board. So, I think we are progressively spending a bit less time on this simply because we are discharging obligations by saying you have identified the problem and have a plan. Nevertheless,
of course, there are always questions that we bring, but thank you very much indeed for that, Steph. Let’s keep moving on then if we could, Joyce, I think probably over to you, I don’t know if Becky is joining us, hello Becky. The Cabinet Office
Review, there is a brief paper in the Pack, take that as read. I mean it is what it is, but you might want to give some additional comments and then we will see if colleagues around the Board table have any questions. Thanks. OK, thank
you Ian. The paper just points to the Cabinet Office and Departments of Health and Social Care Review, which was launched in May, and the Chair of that Review is Dr Penny Dash We have said that this is part of the Cabinet Office Public Body
Review Programme, and the aim of the Review is to look at the duties that are given to us as a regulator, and also then how we fulfil those duties. It covers definitely our Single Assessment Framework, but it also looks at our leadership and staffing
for our new regulations on Local Authority and ICS assessment. How we use people’s voices in our assessment and our work, our work with partners, for example NHS England, and the impact of our work on providers, as in do we drive improvement, do we encourage
providers to do the right thing, are we focused on innovation and productivity and are we, ourselves, prepared in terms of digital healthcare and the data metrics we use around that? If I just point, in terms of our approach, as I think and we have

3.2 Cabinet Office/DHSC review of CQC’s operational effectiveness

said that we do welcome this review. Independent assessment as a public body is very important to provide assurance about the effectiveness of our work and our approach. We have just talked earlier about this review has come at a time of significant change, a transformational
change as an organisation. The review is not asking questions that we are not asking of ourselves and actions that we are not taking of ourselves, but we do see it as a really good opportunity to understand where we are in terms of the regulation
that we do but also to learn and improve. It has just started, so if there are questions which are far more detailed, I probably won’t be able to answer having just spoken to Penny Dash on Monday of this week. I am stating the obvious, this is
a private review, so we cannot control, or even probably have much
Ms. Joyce Frederick - 1:12:00
influence over what the Chair will ultimately write, but in the report the Board are made aware of where we are. So any questions? Christine.
Mr Ian Dilks - 1:12:08
Thank you. I just thought that I have seen
quite a lot of comments externally, particularly from people who see
Ms. Christine Asbury - 1:12:20
this as a reactive inquiry, as a result of the transformation agenda, and I just wanted to clarify, is that the case, or is it part of a programme of public bodies being reviewed? So
from what we are aware, this is part of the programme of the Cabinet Office Public Reviews Bodies. There are thirty others going on this year and we are part of that, and what our sponsorship is the
Ms. Joyce Frederick - 1:12:42
Department of Health which is why it is
a Cabinet Office and Department Review. Just add to that as a statement of fact, we became aware of the intention to do this had initial discussions about the prospect of it before SAF was rolled out, so, yes, you are right, I think there has
been a number of media commentary, some of which is probably ill-informed. Now, ultimately, the Chair will decide but it seems to me that, I would tend to look at this in really two blocks which were touched on in the papers. If we look at
Mr Ian Dilks - 1:13:14
how effective is CQC, one block is what are we being asked to do, do we have the right regulations, the right powers, all that kind of stuff? And any recommendations coming out of that are not for us, we may have a view on them,
but they are not for us. The other bit is given those regulations, how effective are we, of which SAF is clearly a component part, but recognising that SAF is literally only in the process of being rolled out? The vast majority of (unintelligible) providers have
not seen SAF yet. So, I am sure the Chair will look at SAF and what it is rolling out, but the evidence that is available on our effectiveness is largely available from what we did before. I mean, if not, I mean it is not
surprising there aren’t. I mean, as I said this is an independent review and we don’t control anything, so no point in speculating. To the extent that we can, we will keep the board updated, but again I don’t know how much feedback we will get
from the Chair in any event, I mean it is up to her to report, not for us to report publicly, so we will do our best to keep people informed. If you hear any other observations outside as to what is going on, please do
let us know, but equally, I think, Christine, to your question and hopefully, that is a helpful response, because I think there has been some unhelpful reporting. OK well, Becky, thank you very much indeed for coming in briefly and nice to see you again. Joyce,
thank you for dealing with that. Moving on again, we have…, it is down to note, but we need to make - we haven’t got the form there for approval- but we need to make sure we are happy with the equity, diversity and inclusion strategy.

3.3 Equity, Diversity and Inclusion Strategy 2024-2027 and Action Plan 2024-2025

So Kate, I think this is yours, but we are going to be joined by Jackie, hopefully. I hope so, because I would like to address some of this to them, they are walking into the room, so I will just fill for two seconds as Jackie Jackson,
our Director for People and Culture and Nadia Rahman join us. So,
Ms. Kate Terroni - 1:15:13
colleagues, I am really proud to present this paper to you today which is our proposed Equality, Diversity and Inclusion strategy for 24 to 27. This has been quite a long time in the
making, and the reason why it has been a long time in the making is the amount of work that Nadia has done externally, but internally with equality networks and many, many other people, to ensure that we came up with a strategy that was suitably
ambitious, but also boiled down everything we wanted to do to three concrete priorities with clear deliverables and then a kind of timeframe about when that is going to be delivered by. So, I wanted first of all to say thank you to all our colleagues
that have been involved, but before I hand over to Jackie and Nadia, I just want to say a personal shout-out to Nadia and her leadership on this piece of work. Because I hope, and we will see, what are our Board colleagues think, but I
hope it is a piece of work that we can feel really positive about getting behind. It talks about things such as belonging, and the final thing I would say is the format of this, hopefully, feels really accessible, but we also have it in a
number of different versions that again, Nadia, will talk to, to make this a document that everyone can engage with and is able to use. But without further ado, I will hand over to Jackie. Actually before you do that, my apologies, Nadia. I said we
were due to be joined by Jackie and I introduced Jackie, and I didn’t introduce you because your name was on the next page, so my apologies for that, for those watching online, and Nadia has joined this as well. So, over to you. Thanks Kate.
Mr Ian Dilks - 1:16:41
Just to build on that, I will just like to take the opportunity to publicly to thank a number of colleagues and external stakeholders who have given up their time generously to help with production of the strategy and worked with Nadia and Karis, and my
wider People team, really to bring us to the publication you have got in front of you. So, Equality Network Chairs, members for the advocacy and leadership in this work, trade union colleagues, Equity, Diversity, Inclusion Coordinators who are going to be absolutely integral in how
we take this strategy forward and live and breathe it in the organisation, Data and Insight colleagues, colleagues round this table, (unintelligible) and sponsor and Joyce for your invaluable contribution. This has been a really collaborative approach and I think that really bodes well and provides
a really sure foundation about actually what happens next. Because this isn’t a standalone piece of work, this should be in everything we do, everything would consider, and actually it isn’t a bolt-on. This is who we are and this is about belonging. So with that
in mind, I think it is worth to say this isn’t about additional resources needed, or colleagues feeling overburdened by this. This is about recognising the links that this strategy will give us, so our Inclusive Leadership Pathway, our Talent Management, how we recruit, how we
support and develop. Colleagues, all of this has an integral part in the talk to each other on a relationship basis. You know, I could go on for a long time with all of the work programmes that actually talk to the strategy and they will
sustain each other. I want to give some assurance in terms of resource, this is in my work programme in the People directorate, in terms of how we support, guide, challenge, hold to account. What we don’t do is exclusively own this, this is for everybody
to own and be proud of and take responsibility, whatever role we have in the organisation, to bring this to life and make ourselves proud, and also be an employer of choice, that people want to come and work with us when they see us living
this. So, I think that is all I want to say. I am absolutely passionate and believe in everything we have in this strategy. I am compelling the organisation to get behind it, own it and work with us. Nadia, you have got a couple of
things to say, and just to echo Kate Nadia and Karis and my People team have been absolutely phenomenal and I am really proud of everything we have done to get us to this point, so thank you. Thank you, Jackie, I just have a couple of points. We acknowledge the plan is comprehensive
and there is a lot of activity in there but for assurance, a lot of activity is underway already, and then we will use a phased approach, agreed with key stakeholders, so we can build on that activity. So, for example, the recruitment review is already
underway and that speaks to one of our key priorities. We will build on that later this year once the recommendations come through from the external consultant company. We have already started work to support our activity on bullying, harassment and discrimination. So, for example, the
successful Manager Programme was launched earlier this year that will be iterative, it will equip leaders to have those conversations on inclusion with wider skills like in terms of interpersonal skills. There is also our work on culture and values that you are aware of, that
creates the foundations for the activity on bullying, harassment and discrimination, any targeted interventions to actually succeed. There is also work underway, that leaders are aware of, on talent in terms of career conversations that speaks to another priority within the strategy. So, you will see
that there is activity already underway that has the thread of inclusion throughout it. It is such a priority for the People directorate. It is woven through all of the key priorities that we are working on from a from a number of teams, and we
want to bring that all in one place so it is focused for everyone in the strategy, so they can see that it touches all of the work that we do. Another specific example of activity that is already underway and there will be a phased
approach, is our learning on race. So the LLRC recommended that it was academically-based, it was evidence-based and we should start as a priority with our leaders and you have been a part of that. So, we have started that with our Board and Executive Team.
We will continue that this year by rolling it out for wider colleagues, and we will use a learning needs analysis to support that, so it is tailored for individuals, and we will aim to ensure that it is aligned to what we have started for
our Executive Team and our Board. To build on Jackie’s point on governance, so it is important that we have these committees and that we are transparent using these platforms, to share updates with our colleagues. What we learned last year with our engagement is, a
part of our governance or a significant part of our governance is to be accountable to our colleagues and one way that we will do that is to work with our valuable Equality Networks, our trade union representatives, our Equity Diversity and Inclusion Coordinators and our
leaders to share our progress regularly and gain their feedback regularly as well. So, if we do need to change tack, if we do need to change our approach based on what people feel, then we do that and they feel part of the journey, because
that is very important to them, that it is not a paper written by me or Jackie. From a corporate perspective, they have shaped the way that we feel inclusion at CQC, that was very important for them and we want to listen to that feedback
and make sure that we do that throughout the course of our strategy over the next three years. We will start to do that as part of our engagement plan for embedding the strategy. We will go back, close the loop, explain to them how their
contributions from last year have been incorporated into the strategy. Hopefully that gives them reassurance that we have listened and we do listen, and we will continue that dialogue with them. We will use feedback from those sessions to tailor, directorate to directorate, how do they
want to hear about future updates. Is recruitment more of a priority? We will come back and give you more of a comprehensive update following the Recruitment Review, for example. So, we will work with our internal engagement colleagues to make sure that engagement plan is
more than our publication of the strategy documents, which is very important, but they really want us to go back and speak to them and be transparent, and we will make sure that we do that. As Kate mentioned, there are a few versions that will
be available, and that is to ensure accessibility for all, so there will be a Word version and an audio format version, in addition to perhaps a little bit more of a colourful version, and we have engaged with our Assistive Technology and Accessibility lead, the
Business Disability Forum, our Equality Networks and our Equity, Diversity and Inclusion Coordinators to make sure that the products are accessible for everyone, because that is a key priority for us accessibility inclusion. People need to feel that they can access the CQC, so it goes
to the heart of the strategy and what we want to build at CQC in terms of inclusion. So, I hope people are able to read the strategy and we hope our leaders will provide them protected time as part of the learning and development priority
that we have in investing in our colleagues. So, they have time to really digest the strategy, have time to reflect on it and they can understand how they can support us to deliver the strategy. OK. Many thanks Nadia. I mean, look, it is…, clearly
a huge amount of work has gone into it. It seems pretty comprehensive and cohesive to me, so thank you for that. I have got a couple of
Mr Ian Dilks - 1:25:36
quick comments, but I should turn to others, first of all. I think, Mark Chakravarty first, and then
Mark if you want to add. So, thank you. It is wonderful to see the sort of the breadth and depth of the work and the comprehensive nature
Mark Chakravarty - 1:25:56
of it, and it is also important that we have got a real plan against this ambition, across
a three-year time period with a very strong action plan for the coming year. One request and one observation. The request is that in the action plan, the actions are clear, the measuring progress is rather a monitoring statement, monitoring comes up quite often, the ambition
level of where we want to reach and what are we setting as a target is not there in most of those at the moment. So, I can understand that, this is an area as you are learning, as we are learning our way as an
organisation is hard, but the request is, can we have a specific ambition that when we get to look at Action plan 25 26, we have learned more about where we should be setting targets so that we are actually very deliberate about what does improvement
look like? The observation was, there is a natural tendency to go to where we have got opportunity areas, and that is definitely a good way of driving focus, but what it might miss is where do we have strengths in our organisation that could be
used to accelerate those improvement areas and visibly calling out some of those strengths. So, making it not just focused on gap, but on where can we use the strength of what the CQC does and the CQC people to accelerate this journey? There are two
executives in the room who want to comment and also Charmion, and that is probably about all we have time for, but before we do that, Hannah, I can see your hand has been up, so it would be helpful to have you comment first and
then I will go to James and Mark which I think was the order, and then
Mr Ian Dilks - 1:27:47
a question from Charmion. Thank you, and again, just echoing the massive thanks to Nadia and team for this fabulous piece of work. As Network Chairs, we are really excited to be
involved with this, and I think a couple of points that to build on is that this does kind of…, we have got a really strong foundation of collaborative working with Nadia and the team across the networks. The work that we have already done around
accessibility, access to reasonable adjustments, helping people to access the support they need without stigma. We have worked really collaboratively on this already, and so we are looking forward to continuing when we are looking at the actions in the strategy, particularly around recruitment, for example,
that is something we are already involved with. But I think my biggest question is about how we create the capacity for people to engage with this work, so not just Equality Networks. We already spend as co-Chairs quite a lot of time outside of our
working hours, working on things for our network members which is often not accounted for in workloads, but wider organisational colleagues, who are equally like fully-accounted for, minute by minute throughout their day-to-day work. So, often workloads don’t account for that capacity planning in terms of
time spent on line management, time spent on these additional things that we really don’t want to be additional. As Nadia said, we want them to be part of our everyday, so it will be really difficult, I think, to achieve our aims here if we
are not intentional about creating a space for people to develop and focus in these areas. So, that is my plea, if we could have a look at that please. It was a plea more than a question, but can I perhaps, I know Mark and
James wanted to comment, so let them comment, if you want to pick up on that, fine, and then we will come to Charmion. Thank you. I just wanted to add my huge congratulations for this piece of work which, I know, was a vast amount
of work with many people that you led on. The collaboration is what I think was really struck out for me and the huge attention to
Mr Mark Sutton - 1:29:45
accessibility. Three things popped out for me from this report: the body of work around accessibility that we have already
achieved and our aspirations for the future, particularly on the technology side with the accessibility hub, I think is wonderful, the Inclusive Leadership Pathway, which has been an enormous success in terms of promoting colleagues and then finally that workplace adjustments work which I think is
something to be incredibly proud of, which will help colleagues across the organisation to really enable them to bring their best selves to work. James. I wanted to welcome it too. I think it is really clear and accessible and practical, and I like the fact
that it goes into, what does it mean for me, as it were, so you can really relate to at an individual level. I wanted just to mark that, I suppose, this takes it down into work objectives, and it is at that
Mr James Bullion - 1:30:34
point around the
development discussion and making that space, managers and leaders making space for people to actually engage with this and to do it, has to be at that individual objective level, as well as the collective statements that we are making. The real point I wanted to
make was just to mark the anti-discriminatory ambition aspect of this and anti-ageist, anti-racist, it is a really proactive and positive statement. It is not just outlawing discrimination, as it were, and I think that gives us a platform externally. If we can improve internally, externally,
it will be much more effective at challenging the discrimination in others. Thank you. And I mean the Board, for the benefit of those in the room who did not know, and Hannah, I know you are listening, I mean the Board spent a third of
Mr Ian Dilks - 1:31:27
our sessions on race and equity yesterday and questioning what more support we can do. I think it is a bit premature given time to get into that now, but it is something that we are keen to do. Charmion. Thanks. Just again echo that is
great to see it being a combination of the teams’ works. Just a couple of things for me and it builds on Mark’s point, but a different level.
Charmion Pears - 1:31:48
I wondered if a sort of a bridge between the end of it and the detail was to
say, really, how are we holding ourselves to account? I am talking about the leadership of the business, how is the leadership holding themselves to account for delivery? So what kind of things are you going to look at? If at the end of the year
we are successful, what is that going to look like, and I am talking four or five really key deliverables. I mean, has everyone been EDI training, which we are seeing is quite low in terms of mandatory training update. Where are we with some of
the, you know, with some of the colleagues’ survey metrics versus where we have been. So, I think, understanding that holding ourselves to account at a high level would be key. The other one is we talk about zero tolerance stance to bullying and harassment which
I’m totally supportive of, but I think we really, well as an Executive Team, it would be really good to see the team challenging themselves as to what that actually means in practice. Whether it is the Health and Safety policy or the EDI policy, zero
tolerance is a high threshold which I totally support, but everybody needs to know what that that means, that everybody is signing up to, because it is a high threshold which is important, but it has repercussions that sort of need to be followed through with.
So, they are kind of my key points. Thanks very much. I just had an observation and a question. The observation is we are, as we know, we
Mr Ian Dilks - 1:33:17
have talked elsewhere, doing work on values and culture. I think this is obvious, but I would have
expected that when we articulate the behaviours that we expect out of our values, that somehow this is picked up. I mean I am not quite sure how, everyone seems to be nodding, but I think it is important to log that, but it would be
inconceivable to me that we would come up with a set of values and behaviours which did not link in to this, I mean we have to be an inclusive organisation. My question and this is in danger of sounding picky, but I want to make
sure I understand. If you look on page 19 of the Pack, which is 69 of those who have the full book, on the question on bullying, harassment or abuse, we restricted to CQC colleagues, but on the scores on determination of discrimination, we say at
work which has a much wider population. So, quite a lot of that could happen, particularly for Operations Colleagues out at providers, do we have any sense when people answer that question whether the discrimination is taking place in CQC, or whether it is happening in
the workplace? I mean it is equally unacceptable, but the levers we have to pull are quite different. So, do we know how those figures would break down, and if we don’t, actually I might suggest that we distinguish in future surveys so that we understand.
Sorry, we don’t have a great breakdown, but I think that is a really valid point, because you are right It is not acceptable in any form, but the approach will be different depending on which category it falls into, but I will certainly take that
away because I think it is a really valid point. OK, I will leave that as a thought, but I mention it and I think we should look at it, but I mention it because I came across a situation the other day internally where somebody was stressed and upset because of
Mr Ian Dilks - 1:35:19
the discrimination that she had suffered went out at a provider. And it wasn’t clear to me from the discussion whether she felt we had supported her sufficiently in dealing with the problems she had with a provider. That is why I say I think the
method is different, so if there is any colleagues listening, let me make it quite clear. The Board stands stamping this out, and if it happens at a provider level then maybe you need to do something differently, but we will stand behind you and take
that into account. Mark. Sorry, just two thoughts on this one which might help in relation to that. I think if we are wanting to achieve
Mr Mark Chambers - 1:36:03
the culture that we want to achieve in relation to our institutional intolerance for the behaviours outlined here, then we
need to make it psychologically safe for people to call it out. And an area where I don’t think we are any better or worse than anywhere else, but where best practice really differentiates itself, is protection for people from retaliation and victimisation for people who
do speak up and speak out. So, I think there is, that is an area that we should focus on, what can we do in terms of risk assessments for people who speak up, following up with people 3 months, s6ix months, 12 months later, having
a look at their performance reviews at the end of the year to make sure that they have not been dinged at the end of the year. There is quite a few good practices there, they are not easy, but they are impactful. The second thing
to flag, which is something I mentioned in RemCo. yesterday, that I think on recruitment, some of the barriers, one of the barriers that we could definitely be ahead of the pack in reducing is this sort of Catch 22 situation that you look at a
job that you aspire to do and then you read the required characteristics and you have got to have done the job already. You know, if we focus on cultural (unintelligible), we focus on transferable skills, communication, skills, leadership, skills, people skills, if we are clear
about the role and assume that somebody who is applying actually has the appetite to learn and grow into it, and then we test how much potential we think there is there, you know that is the sort of thing that will allow us to significantly
broaden the pool because it is not a terribly diverse pool for a lot of the jobs that were that we are recruiting for. OK. Thanks Mark. So Nadia, Jackie, thanks very much indeed. I think you have got the message, we are all very impressed
Mr Ian Dilks - 1:38:21
with this. And I like the fact on governance, we will see the results of this as it plays out, so a number of thoughts to think about, we appreciate it, so thank you for joining us. Let’s have a comfort break, we have only scheduled


seven minutes, so it will be brief. We are slightly behind, so if we could keep it to that, please. I suggest we convene absolutely no later than ten to four, if that’s OK thanks. Welcome back everybody to rejoining the public Board meeting for the


Mr Ian Dilks - 1:38:54
Care Quality Commission. The next item we have got is a Paper, it is ready for note or discussion, on Modern Slavery. and Unethical International Recruitment, so, Tyson, I think you can lead off on this. We have a paper which we have read but anything
in particular you want to highlight or update us on, and then we will go to questions. Thank you, Ian. I mean we clearly have a role to play when it comes to defeating the scourge of modern slavery and unethical international recruitment in health and
social care. We are not a first responder, but we do have an important
Mr Tyson Hepple - 1:39:29
role working with other agencies and giving them the information they need. So, Clare and Hayley are going to give us an update on the actions we have taken over the last
few months as part of our contribution to the overall team effort, but before I hand over to the team, I think James wanted to give the Board a bit of an update on some evidence he gave to a parliamentary select committee recently. Thank you,
Tyson and yes, so just to let colleagues in on the detail, but I did want to let the Board know that we were able to give some evidence to
Mr James Bullion - 1:40:03
the House of Lords Committee on the review of the Modern Slavery Act. So, the act,

4.0 Policy matters and external environment

as it were, that we don’t have any formal responsibility for enforcement against, but do obviously, as Tyson says, we are one of the key players. Other than giving them the detail of what we do, which is covered in the paper. I think we were,
we are strongly of the view that the Act itself needs modernisation. It does not sufficiently reflect the modern conditions that people find themselves under exploitation for, particularly around the financial aspects of exploitation, which the evidence, you know, is, pretty overwhelming in the adult social
care sector for. Then secondly, the visa system and how that operates, and particularly our principal concern, of course, is people’s continuity of care and the impact when the application of the Act and the application of the visa changes takes place, and often staff members
are finding themselves in a six-week period of having to find a new employer and the impact of that on people’s care. One of our recommendations to that committee was that that period, the length of time that that is operating for, needs to be looked
at and would be, ideally from a local authority’s point of view, probably a three-month period of the right time to transfer someone’s care from one setting to another or letting a new contract to a new care provider where international recruitment was a heavy aspect
of that. Then the second sort of policy point that we were putting forwards as well to the Committee was that any consideration of changing the shortage occupation framework around social care would be a negative from our perspective. We observe the huge dependency on international
recruitment in social care. Of course we would want to outlaw modern slavery and spot it, but actually any impact on international recruitment per se would be negative from the point of view of the availability of care, as well as the quality of care, as
well as the diversity of care as well. Thank you. Thanks James and we are joined by Hayley Moore and Clare Bell. Sorry, I forgot to welcome you earlier, but thank you for joining us. So, Tyson, thanks for the introduction and James for the contextual
Mr Ian Dilks - 1:42:27
comments. So we have read the paper, any questions from colleagues? Ali. Thank you. I thought this was a really helpful and clear paper that set our position and the direction that we are going in. I would be keen to understand what our experience has
been since we published our regulatory policy position in 2023, in
Charmion Pears - 1:42:53
terms of what we have seen in the field and what feedback we have had from colleagues. Thank you. We have been doing a huge amount of work externally on which Clare is our Lead
Mr Ali Hasan - 1:43:06
for Modern Slavery and Unethical International Recruitments, and we have been attending a huge amount of round tables and different
Mr Ian Dilks - 1:43:11
contact with external stakeholders because we are not a first responder organisation. It is about how we support our colleagues to be able to identify these
issues and to make appropriate referrals outwards. So, to do that, we have been working on things, for example, like a memorandum of understanding with UK Visas and Immigration, and you know, we will be doing, for example, a data protection impact assessment on how we
receive notices through from UK Visa and Immigration. I think some of the round table conversations have been really helpful too with, for example, the GLAA, because a big gap in all of this is the fact that the labour market itself is not actually regulated
in the same way, because we look at care providers, we don’t actually look, for example, at all the people who were actually sourcing people through international recruitment and acting as middlemen. And because of that, it really opens up the chances of exploitation and the
impact for the people who were then, in some cases, might have, you know, sold houses, you know set out to build a life and then arrived in England believing they have a job to find that there is actually no work, for example. So, you
know these sorts of situations that erupt are absolutely heart-breaking, really, for the people that experience them, but this is all about partnership working to take it forward. Can I just come in there? For us, as regulators, this is a new and emerging area and
we are learning what our role is in all of this, and part of that is then building the knowledge and understanding of our own workforce so they can identify those indicators and then take the appropriate action, which predominantly is to make that referral to
the appropriate organisation that can take that action to get people safe and hold people to account. But then we can look at that information through the lens of our own legislation and go, is there anything we need to do, are there breaches of our
regulations, what can we do to make sure that the people using those services get good quality care and are safe? Comments from anyone else? David. Thank you, Chair. In one of the fields that I work in,
Mr Ian Dilks - 1:45:40
which is with the medical Royal Colleges, they
are concerned, obviously, about this whole area of unethical international recruitment and, of course, also in terms of nursing, professions allied to health, et cetera. My question to you was, when you talk about the round tables that you have attended and participated in, are those
round tables with employers like ourselves, or are they roundtables that include professional organisations? There has been quite a variety of organisations that have arranged round tables. The most prominent one was organised by the Department of Health and Social Care, and that was multi-agency, as
well as provider organisations were represented. From recollection, I am not sure that there was any regulators of health professionals that were present at that time. The reason I asked is that, having attended a number myself, I have not seen CQ…, just a number, not
all of them, obviously, I have not seen CQC represented there, so I
Mr David Croisdale-Appleby - 1:46:58
just wondered what your locus was really for the interactions that you have. Is it from, I am assuming it is from, much more from a provider point of view, or, sorry from
an employer point of view such as we are, or is it from the viewpoint of the providers whom we regulate and serve that have been present in those groupings? A lot of the viewpoint has been, or the approach has been about, how can we

4.1 Modern Slavery and Unethical International Recruitment

work collaboratively to develop preventative approaches? What safeguards can be put in place? For many of the international workers, the actual exploitation starts in their country of origin. So, it is what can we do to educate them about their rights when they come to the
UK? What preventative measures can be put in? One of the proposals is through gang masters, about their licence for the labour recruiters, the labour market there, so it is multifaceted, but it is still early days. James. Thank you. It is, in a sense that
conversation what it illustrates is that one of the points we were making to the House of Lords Committee, is that there is no single organisation that is, as it were, taking an overview of all of this.
Mr Ian Dilks - 1:48:22
And one of the debates I think going
Mr David Croisdale-Appleby - 1:48:25
Mr James Bullion - 1:48:28
on does a single agency need to have that enforcement power right across all of the agencies? In some senses the answer, structurally, is probably no, because there are a number of enforcement powers laid across professional bodies, or ourselves as a regulator or the police,
and so on. It is very hard to get a single view, but because nobody is taking a single view, we are edging progress forward in partnership and collaborating as is described, but actually speed of response is probably what is required here. I daresay, at
some point, somebody needs to bring their in together in a stronger way and also to give voice to the migrants in this. There is no organisation that is representing that voice effectively at all, actually. As is outlined, people are paying thousands of pounds through
a legal migration route, as it were, and are being exploited in the process without anyone really giving that proper voice. I am not calling for CQC to have that role of course, that is our position for that not to be us, but there is
a bit of a gap in coordination. Thanks James. Clearly, is not for us to stand in and take that view, but, given the point you raised, it probably puts the onus on us to make sure that, as we learned, as you said earlier, that we
Mr Ian Dilks - 1:49:51
are have a voice and feed that in at the right place. People seem to be pretty comfortable there, so no other questions. Thank you very much for what you are doing. I don’t think…, it is not an issue where we need regular updates and say come
back in July, but clearly it is an evolving field and it is a sensitive one about the personal level of people involved, and politically as well. So I think it would probably be helpful to schedule a further, even a very brief session at some
stage in the future, just to get an update on what we are seeing and what we are learning if that is OK? So, thank you very much indeed for joining us. We have got a paper now on Martha’s Rule. Actually, I think we have

4.2 Martha’s Rule Update and Role of CQC

seen this twice, it was in the Board papers, I believe, a little while ago and then we were running behind schedule, so we said let’s defer it. So the paper is…, you have actually seen before, really for information, but an opportunity to see if
people have comments on the way we are thinking about it. So, Joyce, do you want to give any further introduction to the paper and then we will go straight to questions. It was deferred from the last Board meeting. Can I just briefly summarise because
it might be helpful? So, in February the Secretary of State published a statement on supporting Martha’s Rule to roll out in England, which
Ms. Joyce Frederick - 1:51:14
has been led by Henrietta Hughes, Dr Henrietta Hughes, as the Patient Safety Commissioner. Martha Mills, as you know, was 12 years
old and had died because her condition was not identified, her deteriorating, condition was not identified and the voice of her parents had not been listened to, which is an example of epistemic injustice. So in October last year, several arms’ length national bodies met in
October and we, as CQC, were contributors to this to support Henrietta Hughes in developing Martha’s rule and what it would look like in England. There is an example in Australia and sometimes in other countries, and there are three bases by which Martha’s rule will
be rolled out. It is a structured approach to obtaining information related to a patient’s condition directly from patients and their families, at least on a daily basis. Trusts must have a 24/7 access to rapid review from a clinical critical care outreach team and/or patients,
their families and carers, and advocates must also have access to the same 24/7 rapid review from a critical care outreach team, and this is Martha’s Rul. So the NHS have started from April, and are asking volunteers for at least 100 trusts to participate in
this first year. They are looking at applications now and considering the various trusts who want to participate in this. It is part of a longer-term plan to roll out Martha’s Rule over the next few years where it becomes commonplace as part of the NHS,
and in the NHS constitution. Our role, as I said, was first to be involved in those groups where Martha’s Rule was developed and working with the Patient Safety Commissioner. We have supported this and we did produce a joint statement with the GMC and NMC
about our support of this and how we would assess and regulate. Certainly in the first year, I think we would want to be seen to be gathering information and roll-out, supporting good practice, but it would eventually be part of our assessments under our Single
Assessment Framework. We have been asked and it is in the paper, would you enforce against Martha’s Rule? Martha’s rule is not a regulation. We would assess it under the Single Assessment Framework. The regulation that does exist around safe care and treatment would be one
that we would look at should there be an impact, as a result, not directly of Martha’s Rule, but as a result, on people’s care which may not or may be linked to epistemic injustice or safety concerns. So, it not being a regulation means there
isn’t a direct line to enforcement, but it would be part of our assessments and our view on regulations on the safe care and treatment. Thanks, Joyce and someone was speaking very positively the other day about our engagement on this. For our engagement, read Joyce’s
Mr Ian Dilks - 1:54:09
engagement, so thank you for that. Any questions for Joyce or comments? Belinda. Just a quick one from me. Do we have any indication on how often it is used in other countries like Australia? it has been quite long-standing in Australia. Oddly enough, we talk
about Australia and I did myself, but it’s actually one state, New
Mr Mark Sutton - 1:54:25
South Wales I think where it is Ryan’s Law, and there are different
Mr Ian Dilks - 1:54:31
states that have different ways of interpreting. I think what we want to do in England is have one process, the
Ms. Joyce Frederick - 1:54:35
three points that I raised, so it is commonplace across England. In other countries like in America, maybe it is federal as well, federal states, rather than across the entirety. But when it is used, it is used well and it is not misused. People advocate
on behalf of their relatives or their carers, and they use the rapid review. It is usually a line. We have talked about a second opinion, this is not just a second opinion, there is a formal process by which you can get a rapid review
and people use that process. They feel empowered to use that process and they have actually improved, where they have looked at outcomes and the impact it does improve care for people. Just one question for me then. I mean as a regulator, it is something
Mr Ian Dilks - 1:55:28
you explained what our role is, does this require any additional training for support for our people as this gets implemented across the NHS? Yes, I think it would be worthwhile for us to support colleagues with the increased awareness and knowledge around Martha’s Rule itself,
but epistemic justice. We have started that because we published a
Ms. Joyce Frederick - 1:55:49
Human Rights Approach last year, and that includes what we mean by epistemic justice. I mean the word itself puts people off, isn’t it? But it is about listening to people’s voices and valuing those
voices as much as you would a professional. It is the weight at which you use people’s experiences in our work, so there is more we need to do to support colleagues in that understanding. But I also think when we start to assess this more
formally, more formally than in a descriptive sense, we would probably need to put some guidance out for providers as well. So if I could just leave it as- I won’t caption an action of the committee, it is not the committee - but I think
I will ask management to make sure that the training and support has been put in place. I mean, apart from anything else, well, sorry, that
Mr Ian Dilks - 1:56:34
is the main thing, but in addition, perhaps by the way of phrasing this, I mean this is a measure
designed to improve safety. So I think there are bound to be questions about how effective it is being. It is not up to us to implement the rule, that is somebody else, but I think we should reflect now and recognise that at some stage,
we will be asked our view on how effective it is being. So, without getting it out of proportion, we need to recognise we need to do that. If there are no other questions, thank you very much indeed for that Joyce, sorry to bounce you
last time. Let’s move on to the business plan. Chris, it’s probably easiest if you lead off on this, although I guess Steph will be coming back in, is that right? Steph, you are being like a jack-in-the-box today, in and out. Thanks Charmion. So, this
is down for approval. I think I am right to say we have seen it before, but a lot of the bulk of it we have seen before and I suppose, approved by implication, but there were some things that we wanted adding or to change.
So, perhaps you could briefly introduce the paper, explain what has changed or anything you want to highlight for us, and then go to colleagues to questions. I say, bear in mind we are being asked to approve it. Thank you. Yes, thanks, Ian. So, we
had the draft of this at the March Board, but it was the measures that we would be tracking. I think at the private Board we had a draft of
Chris Usher - 1:58:20
it. This is the first time we have brought together into public our draft plan for

5.0 Matters requiring Board approval

24 through to 27. So, colleagues will have seen it, but this is the first time of this final draft. What we have done is, we have taken away comments from last time, which was really around strengthening reference to our people in the opening content,
the fact that we would be looking at a strategy and just sense-checking our strategy. But also, we had quite a few TBCs around targets and measures, so we just been looking at them and strengthening them up, and trying to fill in most of the
blanks that we had previously where we were waiting on data to be gathered. So, this is the final version, ready to sign off to track performance against for the coming year. So, that is all that was planned to into and take any comments or
questions. Thanks Chris. So, colleagues, questions, comments? Mark. So again, thank you, it is wonderful to see this and its evolution of it.
Mr Ian Dilks - 1:59:28
It means that we are definitely maturing in our understanding of data,
Mark Chakravarty - 1:59:33
but also how data drives our management decisions. One request for
disambiguation. Very nicely, you have put some target increases for specific targets. At the moment I could say that they are ambiguous, because we have something like a 5% increase. I’m not sure whether it’s a 5 percentage point increase or 5 percent of the baseline,
so just so that no one criticises us afterwards, I would suggest that we are very clear as to whether it is a percentage point increase or of the baseline, so just a disambiguation. There are a few where we still have “improve on”, so just
a directional goal which could be OK, but again the same request that we made before, which is can we learn during the next year as to whether there is a target or a threshold that we should be above, that would have an impact, that
makes a difference? And linked to that, there are somewhere, we can’t year-on-year at some point when we are getting into the 90 percentages of things, we have to sort of say that actually is above a threshold that we are comfortable with, and it becomes
a “maintain” rather than an “improve”, so it is really getting into that mindset. Then my last one, which is a little bit nitpicky, I could not understand under…, on Page 127 for us, Page 10 out of the report, under the cases and timely triage,
I can’t do the maths that says if we hit 90% within 48 hours for low-risk and 90% for high-risk within 24 hours, how do we get to a target for overall of 70 within 120 hours? So, there may be some…, I might be flawed
in the maths. Can I come back on that? So, I think that is our…, I think we have missed some wording out to add clarity in terms of that,
Mr Ian Dilks - 2:01:35
so there, Point A is cases overall, so all information that we receive
Chris Usher - 2:01:39
as an organisation, whereas B and C are specifically around our information of concern, so
that is high priority but some of them, even though it is a whistleblowing, it doesn’t contain a suggestion of abuse. So, we just need to add that wording in, and hopefully that will then provide that context. Just on the first point, I think I
really agree with your points, Mark. I think the bit about clarity, we will absolutely take that away, we don’t want any ambiguity. I think
Mr Ian Dilks - 2:02:08
the thing with this plan we have tried not to do is see perfection as
Chris Usher - 2:02:09
our enemy here, and go with
what we know, especially when we have got new systems, new data. So, we probably will see more “improve” than you would necessarily want to see in a normal year with a target, and I would suggest we go with that and we monitor that through
the year and then decide if we think we need to set some targets around any of those things, let’s review them in year and we can do that. That would be my suggestion if people are OK with that, and challenge ourself about what “good”
looks like where we are seeing something that we are monitoring, or just setting an aspiration of “improve”. I am not saying it is pragmatic, I mean the Board is both asking for more insightful data, and new systems have the potential to give us that data,
so I wouldn’t want debate over exactly what the target should be to
Mr Ian Dilks - 2:02:57
hinder giving us the information and we will refine it as necessary. So I think that is fine. Any other questions? Charmion. Thanks. Yes, great to see where we have got to and
that we have added the section in on colleagues, which is good to see that that piece being added. Just on risk, I am taking it that the appendix (unintelligible) is all we are going to kind of cover in
Charmion Pears - 2:03:18
relation to that, we are not
going to put in, sort of any kind of static point view of a risk register or…? Our intention was, in the business plan, to capture how we do risk management in the organisation, and then in our quarterly performance reporting of the business plan, we
will talk about how we are dealing with risk, the controls and
Mr Ian Dilks - 2:03:38
mitigations. Perfect, thank you. Any other questions or comments? I mean, just a comment and a question. Just building on comments that have already been made…, Yes, I was thinking it would be useful
if you are closer to the mike. Building on comments made, I mean, thank you for adding in the reference for People, I think it was something that was essential. It is, I think, an acknowledgment rather than, this does not contain a specific plan we
have talked about to deal with the current issues. This is a three-year plan and we are taking it as read that in the very short-term, there are things to be done to address the bedding in of the Single Assessment Framework. So, the fact there
is not more in here does not mean it is not important, it just means that it is a more immediate thing within a three-year plan. But we do just need to make sure that, given the starting point on some of the metrics, we talked
about earlier, things like the volume of assessments, whatever, that we are realistic about what goes into the plan. So, that is not a licence to say we can set extremely low targets because we have to deliver the right sort of performance for the market
and to meet our regulatory requirements, but at the same time, if we are having difficulty operating at the levels we would like because of the pressures on people, it is essential that we don’t introduce undue pressure as a result of setting unrealised targets. So,
I note the observation but that is not to question what is in here, but I think when we come to looking at performance against the targets, we just need to be understand what is going on and respond in the right way. Question, this is
down for approval for the Board, it sounds like people are comfortable with it, where does this stand in relation to the Department? We have issued it to the Department in draft, so just awaiting final approval from the Department. Usually, it is not unusual we
wouldn’t have that at this stage in the year, we got it quite late
Chris Usher - 2:05:42
last year from memory. So, it is with the Department parallel to Board approval. So it was with the Department, so if we approve it, then you just tell the Department this
is now an approved plan, not a draft plan. Are people comfortable to
Mr Ian Dilks - 2:06:01
approve it? Yes, OK, thank you very much indeed. Chris, you rarely get such an easy ride. Steph, I think that is the last time we are going to ask you the shooter.
A few final points, we don’t have a Caldicott garden, Guardian at the moment, so Sasha, do you just want to comment on the proposal? Yes. So, basically, in accordance with 1997 Caldicott Report, we appointed Sean O’Kelly, Dr Sean O’Kelly, as Caldicott Guardian and he
Ms. Sacha McInnis - 2:06:36
is registered with DHSC as such, but given his continued absence from work and given the importance of this work, we are looking at making a temporary appointment until we are in a position to sort of take longer-term action. So, essentially, what this role covers,
it is about overseeing our responsibility for addressing information governance matters, particularly in relation to patient identifiable information, and making sure that we have an accountable board member that can oversee this work at a strategic level. So, I think what we are proposing is that
we appoint James Bullion to step into this role temporarily, and so we just wanted to note this at Board. Just one addition to what Sasha said, the individual should not normally be the Head of ICT or associated with the ICT function specifically, hence James,
Mr Ian Dilks - 2:07:42
rather than Mark. Thank you. Well, it’s obvious from discussions that
Mr Ian Trenholm - 2:07:44
James has nothing else to do at the moment, so I am sure you welcome this additional appointment. But can we approve James as a temporary
Mr Ian Dilks - 2:07:54
Caldicott Guardian? OK, thank you very much, congratulations James,
bunch of flowers afterwards. We come onto a few Board and Committee matters. Mark, perhaps we could ask you to give a commentary on the RGC? Thank you, yes, very happy to do that. As you know, for those who are not familiar with the RGC,
it is the committee that looks at the design, delivery and
Mr Mark Chambers - 2:08:21
effectiveness of our regulatory model. Our last meeting was on the 17th of April, which now feels like a very long time ago, and I don’t think it would surprise people to hear that our
focus at that meeting was on delivery. We heard a lot around the challenges around delivery of the new regulatory model, the challenges with the provider portal, the backlog of registrations, the knock-on effect in relation to notifications, and we explored some of the drivers of
that, acknowledging that this was despite the very, very best efforts of our people who are, as we have seen throughout this, consistently trying to do exactly what it is right and everything possible to deliver on the purpose of the of the organisation. You know,
we identified, obviously at that meeting, the need to fix some of the identified issues and to solve, together with our frontline colleagues, some of the more difficult issues and difficult decisions. That work has continued and many of us have had the opportunity to attend
some of the Operations conferences and other sessions with colleagues where we have heard more about the way forward. You know one of the things we emphasise at the committee is, you know, the importance of listening very carefully to the feedback of the experiences from
our colleagues. We also talked about the provider voice and, particularly again, emphasised the importance of making sure that we have good engagement channels with small providers, as well as the well-established channels that we have to hear the views of our larger providers. So, you
know that, that work continues and I think, since the Committee, it is work that has very much been taken up as the key topic of conversation at the Board meetings that have happened since then. We also heard about the challenges for our colleagues in
the NCSC, emphasising the importance if we can of continuing to prioritise inbound calls continuing to prioritise safeguarding calls, but also in relation to the impact on notifications of the difficulties with the provider portal, the importance of supporting our colleagues dealing with large numbers of
calls, and dealing with calls where inevitably some of the people ringing in are pretty fed up, and they are quite difficult, challenging calls for people, so we need to continue to look after our people. You know, we talked, I mentioned earlier, of the need
for us to have a clearer view in relation to the many recommendations that we have accepted from various sources about how we could improve, of making sure that we understand the prioritisation of that work, and we understand the path to delivery because these are
all things we have committed to do. We focused in particular in that meeting on the status of the actions relating to Freedom to Speak Up, those are of particular importance to us at the committee. We did manage to have time for a deep dive,
this one was on innovation. I think, you know, some of the themes from that were again unpacking this point that innovation is not synonymous with technology, and when we are seeing technology applied as an innovation, it is not the technology that we are judging,
it is the application of the technology that we are judging. I think a really important point that again was emphasised in the discussion is that innovation is not something that is restricted to our outstanding providers, because we see it, we ought to be looking
at capturing innovation in every interaction that we have with our providers. You know, the key thing for us in relation to the new model is to make sure that we are not inadvertently driving conformity and stifling innovation by our new, more structured technique. That
is not the intention, it is something that we will need to keep an eye on and make sure that actually it is surfacing and driving innovation and allowing us a framework for sharing best practice. So, that is pretty much what we covered. Okay, thanks
very much Mark. I mean some of us, quite a few in the room are either members of the RGC or listened in last time, but not everyone. So, any
Mr Ian Dilks - 2:14:36
questions or comments for Mark on that not update? No? OK, well, thank you very much
indeed Mark. Increasing your agenda, but I think the RGC has got its straps now, so thank you for that. The minutes of the last public Board meeting, we didn’t manage to get these to you in advance last time, so the first time you saw

6.2 Minutes of the previous Public Board meeting held on 27 March 2024

them in this pack. They are quite long, but we seem to have ever longer discussions, but hopefully you got through them. Are you happy with them, can we take those as approved? Yes? OK, thank you very much. There is an action log, there are

6.3 Review of the matters arising, action log and decision log

three items on it, all shown as green. Items 2 and 3 are due in September, and therefore are green. Action 1 is not, because what it says here is that this will be presented to our private Board meeting today, but it wasn’t. I think
there is a slight misunderstanding perhaps, but what the action was aimed at is where LLRC actions are overdue, understanding better what the timeframe is for dealing with them. Well, I won’t say overdue, that is part of the point, where they are not done and
we understand - we always said at the outset not everything can get done immediately - but we need to understand what is going to be done and when and make sure we are comfortable with it. There are some milestones in there, so I guess
that is red rather than green, but we will find a way of picking that up at either the next RGC, or the Board meeting depending on timing. We are told there are plans, it is just that we would like to see them to make
sure. James do you want to add anything to that? Well, just to let the Board know, so we undertook and carried out a review of LLRC, and brought back to the Strategic Oversight committee. So it has been completed, and including the external evaluation of
Mr James Bullion - 2:16:29
progress by our existing external partners to the process. It has gone through the SOPIC process and is due at the ET, but was postponed there, and given the very heavy agenda today at private Board and public Board, it was postponed from there to our
July meeting, but happy that it is on progress for review, albeit we did put it back from today’s agenda to July, to give it better consideration given all that we have discussed today. Alright, thanks very much, James. Any other business from colleagues they want

7.0 Any Other Business

to raise? OK, well, if not, we do have some questions from the public.
Mr Ian Dilks - 2:17:14
Before it goes to those. I will just close down the formal meeting, so thank you to colleagues for being here today. Super impressed, it is (unintelligible) ahead of schedule. Hannah, thank
you very much indeed for joining in and listening in on your observations. I know it is not easy listening on for hours on end on the screen, so on that I will close the meeting. Our next public meeting is on the 24th of July,
currently scheduled for 2 o’clock. As usual though, we have agreed to take some questions from the public and we do have three. So I hope, I will briefly read the questions for the benefit of listeners and then ask colleagues to address them. The first,
I believe, you are going to pick up Tyson, and that is how does CQC plan to further develop its protection for whistleblowers? Very topical question at the moment. Thank you, and thank you for the question. The CQC’s role as a prescribed body is to
provide employees with a mechanism to make their public interest disclosure to an independent body where they do not feel able to disclose directly to the employer, and the independent body might be
Mr Tyson Hepple - 2:18:23
in a position to take some form of further action on the disclosure.
In our Listening, Learning and Responding to Concerns Review, we have identified variation in how we handle concerns from employees and have committed to doing more to improve their experience in order to deliver on the recommendations of the review. OK, thanks, Tyson. I say, very
topical question at the moment. The second one, I think, actually you are also going to respond to, which was during its inspection of GP
Mr Ian Dilks - 2:18:54
surgeries, how does CQC ensure that practices are complying with the requirements of the NHS constitution? Thank you and thank you
again for the question. We don’t actually map our methodology to the NHS constitution, but we regulate against the specific regulations. We
Mr Tyson Hepple - 2:19:14
cover both NHS and non-NHS services and while they are likely to be many synergies between the fundamental standards and regulations and the NHS
constitution, it wouldn’t be appropriate for us to require different standards from different sectors. OK, thank you. One third question, we will give you a break from this, I believe this one is for James. What is CQC’s view of the financial stability of the providers
Mr Ian Dilks - 2:19:39
of social care services? Thank you, and thank you for the question. So, we have a statutory duty as a Commission to, within our Market
Mr James Bullion - 2:19:54
Oversight scheme, to monitor progress of financial stability, that represents about 30% of the market. Whilst you can’t entirely extrapolate from
that 30% to the whole of the market, given the complex makeup of a large number of small and medium enterprises, it nonetheless does give some insight as to what our perspective might be. We said in our State of Care, last State of Care Report
that the EBITDA, the rough approximation of profitability, our measure of that through market oversight remained at the lowest level since 2015. The key factors for that measure are the increased labour costs, as we all know, despite progress on inflation, actually for social care providers
that has led to increased labour costs and increased costs of running the business as well, and particularly for utility prices. So, there are external factors, as it were, driving costs, as well as the commissioning activity as well. Whilst our Market Oversight data suggests there
has been a modest increase in profitability from March 23 to December 23, as some workforce challenges have begun to ease. However, a number of providers saw a reduction in their financial reserves during the same period which makes their financial position less robust. Providers are
telling us their key current concerns are whether increases in local authority commissioning rates for 24/25 will be sufficient to cover their costs, and this is especially in relation to the national living wage of 9.8% that took effect from April 2024, which could further erode
profit margins and present some additional risks for financial stability. Thanks very much James, and a very comprehensive response for something that goes beyond our responsibilities, but I hope that was helpful to the questioner. So, that was the last of the questions, so for anyone
listening, I will say goodbye,