CQC Board Meeting - July 2024 - Wednesday 24 July 2024, 2:00pm - Care Quality Commission

CQC Board Meeting - July 2024
Wednesday, 24th July 2024 at 2:00pm 

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  1. Ian Dilks
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  1. Kate Terroni
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  1. Ian Dilks
  2. Stephen Marston
  3. Ian Dilks
  4. Stephen Marston
  5. Kate Terroni
  6. Ian Dilks
  7. Tyson Hepple
  8. Ian Dilks
  9. James Bullion
  10. Ian Dilks
  11. Christine Asbury
  12. Ian Dilks
  13. Chris Day
  14. Ian Dilks
  15. Charmion Pears
  16. Ian Dilks
  17. Mark Chakravarty
  18. Kate Terroni
  19. Ian Dilks
  20. Joyce Frederick
  21. Ian Dilks
  22. Kate Terroni
  23. James Bullion
  24. Chris Dzikiti
  25. Ian Dilks
  26. Christine Asbury
  27. Ian Dilks
  28. Jackie Jackson
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  1. Ian Dilks
  2. Charmion Pears
  3. Ian Dilks
  4. Network Rep.
  5. Ian Dilks
  6. Jackie Jackson
  7. Ian Dilks
  8. Kate Terroni
  9. Ian Dilks
  10. Kate Terroni
  11. Jackie Jackson
  12. Ian Dilks
  13. Presenter 1
  14. Presenter 2
  15. Presenter 1
  16. Ian Dilks
  17. Stephen Marston
  18. Presenter 1
  19. Ian Dilks
  20. Mark Chakravarty
  21. Ian Dilks
  22. Presenter 2
  23. Ian Dilks
  24. Charmion Pears
  25. Ian Dilks
  26. Kate Terroni
  27. Ian Dilks
  28. Mark Chambers
  29. Presenter 1
  30. Ian Dilks
  31. Presenter 1
  32. Mark Chambers
  33. Ian Dilks
  34. Chris Day
  35. Ian Dilks
  36. Kate Terroni
  37. Ian Dilks
  38. Jackie Jackson
  39. Ian Dilks
  40. Joyce Frederick
  41. Ian Dilks
  42. Network Rep.
  43. Ian Dilks
  44. Presenter 1
  45. Ian Dilks
  46. Gemma Skipsey
  47. Ian Dilks
  48. Joyce Frederick
  49. Ian Dilks
  50. James Bullion
  51. Ian Dilks
  52. Stephen Marston
  53. Presenter 2
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  1. Ian Dilks
  2. Ali Hasan
  3. Ian Dilks
  4. Network Rep.
  5. Ian Dilks
  6. Belinda Black
  7. Ian Dilks
  8. James Bullion
  9. Ian Dilks
  10. Mark Chambers
  11. Ian Dilks
  12. Jackie Jackson
  13. Ian Dilks
  14. Presenter 2
  15. Ian Dilks
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  1. Ian Dilks
  2. Joyce Frederick
  3. Presenter 1
  4. Presenter 2
  5. Ian Dilks
  6. James Bullion
  7. Ian Dilks
  8. Ali Hasan
  9. Ian Dilks
  10. Belinda Black
  11. Presenter 1
  12. Ian Dilks
  13. Chris Day
  14. Chris Day
  15. Ian Dilks
  16. Ian Dilks
  17. Presenter 2
  18. Ian Dilks
  19. Joyce Frederick
  20. Ian Dilks
  21. Chris Dzikiti
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  1. Ian Dilks
  2. Chris Dzikiti
  3. Belinda Black
  4. Ian Dilks
  5. Chris Dzikiti
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  1. Ian Dilks
  2. Chris Dzikiti
  3. Stephen Marston
  4. Ian Dilks
  5. Chris Dzikiti
  6. Ian Dilks
  7. Presenter 1
  8. Presenter 2
  9. Ian Dilks
  10. Charmion Pears
  11. Presenter 1
  12. Ian Dilks
  13. Presenter 1
  14. Ian Dilks
  15. Ian Dilks
  16. Presenter 1
  17. Mark Chambers
  18. Ian Dilks
  19. Presenter 1
  20. Ian Dilks
  21. Presenter 1
  22. Ian Dilks
  23. Presenter 1
  24. Charmion Pears
  25. Ian Dilks
  26. Charmion Pears
  27. Ian Dilks
  28. Mark Chambers
  29. Ian Dilks
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  1. Joyce Frederick
  2. Ian Dilks
  3. Joyce Frederick
  4. Ian Dilks
  5. Tyson Hepple
  6. Ian Dilks
  7. Chris Day
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  1. Ian Dilks
  2. Kate Terroni
  3. Ian Dilks
  4. Mr David Scutt
  5. Ian Dilks
  6. Webcast Finished

Ian Dilks - 0:00:00
Well, good afternoon, everybody and welcome to the public Board Meeting of the Care Quality Commission on 24th of July. It is 2 pm on the 24th of July for those of you watching the recording. We have a full room today and a reasonably full
agenda, but we will try to get through everything on time and we do have some questions to the public which, after the meeting is finished, we will take as usual. Again, I will try and do this briefly, but there are a number of apologies,
new people I should introduce in different ways, so in no particular order, continuing apologies from Sean O’Kelly, our Chief Inspector of Healthcare, who remains unwell, we will update that at a future meeting. Among the NEDs, David Croisdale-Appleby is unable to attend, he has a

1.0 Opening matters

longstanding prior commitment somewhere else. Then we are getting into holiday season, so two of our colleagues who are normally here, Chris Usher and Nimali de Silva are both away. Gemma Skipsey, over on my right down there, left I guess for people watching on the
screen, is standing in for Chris, and David Scott, to my right, is standing in from the legal team, on behalf of Nimali. This is, of course, the first meeting we have held since we announced that we had appointed Kate Terroni as the Interim Chief
Executive of CQC, so Kate will be familiar to you from her previous roles, most recently as the Deputy Chief Executive, but Kate welcome, and our first item on the agenda will give Kate a chance to make some observations. But not to exclude others, Chris
Dzikiti down at the far end, you will have met him before, but it is the first time he, I believe, has attended one of these meetings since we appointed him as the Interim Chief Inspector of Healthcare. We welcome Diane Horsley, just to my right
here, who is the Gender Equality Network representative, so from the Gender Network but representing Equality networks, thank you very much for joining us, Diane. I think that is probably it. There was one other colleague I was expecting, but is unfortunately ill today, so I
don’t think there is any more to say. Declarations of interest? There is just one point I would mention that was notified to me. Stephen Marston, one of our Non-Executives, has been asked to take on a non-executive role with an NHS Trust. A very recent
appointment, hardly stepped through the door. I have to say we don’t regard that, given the nature of the agenda for this board, as a conflict, but often these things are based on how others see them, so it is something we need to look at.
Obviously, NEDs are appointed by the government, not by me or the rest of the Board, so that is something that they need to consider. But as I said, to be absolutely clear, I mean Stephen really has not started his role and we actually don’t
believe there is any real conflict at all. Any urgent business from people they want to put on the agenda before we kick off? No okay. Well, look, as I mentioned a moment ago, what we thought would be helpful is to give Kate the opportunity
to give an update on her first period and summarise some of the changes that we have already announced. I should say, for the benefit of anyone listening, given the nature of these topics, I hope you would expect that the whole Board, certainly all the
non-executives having regular contact with Kate. So what follows over the next 15 to 30 minutes or so is not the only opportunity we have had to discuss things with Kate, this is part of an ongoing dialogue, but this is the first Board meeting since
she was appointed, so Kate, perhaps I could ask you to give a summary of a number of points thanks. Thank you. Thank you, Ian and good
Kate Terroni - 0:04:20
afternoon colleagues. So, the first thing I want to say is, that it is an absolute privilege to be
taking on this Interim Chief Exec job at what feels like a pretty critical point for our organisation. So, I am really honoured to be here and I am going to work as hard as I possibly can with my key partners and colleagues to take
the action that we need to get us back to being the strong regulator people who use services require us to be. So, I just wanted to set out for this group some of my reflections on where we are and to share with you my
three priorities and some actions that I am taking and then really keen to hear colleagues’ thoughts as well. I want to let Board know, and you will be aware because I know you have joined some of my all-colleague calls I held in the first
couple of weeks of joining this role, is I have started off my work in this role to our colleagues, and externally to our providers, by issuing an apology for where we find ourselves as an organisation. I think it is really important that, in order

1.1 Chair’s opening remarks, Apologies and Forward View

to move on, we have a frank appraisal of where we are at the moment and I will be sharing some of that with you as I go through. But I just want to let Board know that my first message to our people and to
providers and people who use services is that we have not been the regulator that has been needed and we need to do better. So if I can just talk you through a few areas where I think we need to do better. So, I think
about our strategy as being our North Star as an organisation, and I think our strategy about being a proportionate, flexible regulator, regulating through the eyes of people who use services, is still the right strategy. We very recently, as a Board, had the opportunity to
come back together to kind of reaffirm that that is still the direction that we need to be heading in. To deliver that strategy, we have had kind of three big pillars of work. We have had a pillar of work around designing our Single Assessment
Framework. We have had a pillar of work about our regulatory platform, which is our technology, and we have had a pillar of work around our ways of working. So with our Single Assessment Framework, often shortened to SAF, so I will use that if people
will forgive me for the abbreviation, the idea of having a quality framework that is based on the voices of people who use services feels the absolute right thing to do. That is what the public has told us, that is what providers have told us
as well. So I believe that the concept of our Assessment Framework being based on user voice, patient voice, people’s voice, is absolutely right. I think the challenge we have had with implementing our SAF is that we have had to put in some age ratings
into our new system, and then we wanted to make a commitment that when we were going out and seeing services, that we would re-rate them wherever possible. But in order to re-rate a service, it actually ended up being a pretty extensive piece of work
for our frontline colleagues, not only in terms of the number of quality statements they needed to look at, but also some of the challenges we have had with our technology in terms of the amount of time it takes for our people to upload evidence.
So, I think the SAF is the right model. I think we have had challenges because of the fact we have put in age ratings, but what I think we do need to do, and we were always planning on it, is we need to do
an evaluation of the whole Single Assessment Framework. That will take time to do it comprehensively, but in the short term, we need to bring in expertise now to look at how the SAF is working, particularly for hospitals. So, that is something that I am
going to be really keen to pursue very rapidly is that expertise looking at how the Single Assessment Framework works for hospitals. I am going to move on to the regulatory platform. So again, legacy systems. I think we all agreed that there was a need
to have new, modern technology that enables us to understand the themes and trends in how we inspect, enables providers to see the kind of granular detail about how we are making our judgments, and actually the ability to look at national trends. So again, the
ambition is right, but I think we went live, for a whole variety of reasons, with a system that we had not comprehensively tested end-to-end. And the consequence of that, along with needing providers to interact with us differently without taking providers on the kind of
cultural journey, cultural change that was required, has meant for many providers, they have felt kind of pretty extreme frustration with dealing with our provider portal. So, things are getting fixed on a daily basis, but again we have got lots more work to do to
get that provider portal working in a way that makes our providers’ lives easier and gives us the information that we need to do our jobs. Then finally, on our ways of working. So, our ambition was to bring together specialists, inspectors and assessors across mental
health and adult social care and primary and community services and secondary and specialist care into integrated teams where that group of colleagues could understand quality and risks within a place. So again, the idea, the concept was right. I think we have made some errors
along the way. So, a couple of years ago we made a decision to split out the Inspector role to create inspectors and assessors, and we made that decision at a point where most of our frontline colleagues did not think that that was the right
answer. That has continued to be a decision that our people have cited in People Survey results over pretty much the last three years where they have said to us, you haven’t listened Exec Team. One of the main things they have pointed to is, you
made the decision about the inspector/assessor split where we did not think that was the right answer. We have been doing an evaluation, we have asked Ipsos MORI to do an evaluation of how that role split has worked, and we will be getting the conclusions
to that next week. So, I will be looking at that evidence with my colleagues, but I suspect that that evidence might give me enough to be able to bring forward a decision about whether we continue on with the inspector/assessor split, or whether we now
make a decision to do something differently. Clearly that would be a decision I would make in very close consultation with our unions who were there at the start, when we made the decision to evaluate the splitting out of roles. So, I just want to
let Board know that that is a decision, potentially, I will be bringing forward. A couple of other things on ways of working. So, I believe we have moved a bit too far away from specialist colleagues working in our business. So, we have lots of
fantastic people in Operations from a wealth of different backgrounds that we value incredibly highly. I think we need to slightly shift the emphasis for a period of time, to look to proactively recruit now new people into our organisation who have worked in the sectors
that they are regulating. So, again I will be working with the unions, Equality Networks, et cetera, to look at what that might mean, but again I just want a kind of signal to people listening that we need to do more to bring specialists back
into the business. Then two other things on ways of working. We are looking at the Operations Manager role, so we brought together these specialist frontline colleagues who are now line-managed by Operations Managers who clearly can’t be sector experts across the four areas. So, the
consequence of that is often inspectors and assessors are talking to line managers who maybe do not know their sector as well, and we offset that with the role of Senior Specialists. But we often will have a situation where an Operational Manager might be going
out to meet a Chief Exec of an Acute Trust or Local Authority where maybe that is not their area of expertise. We are going to do a bit of a pilot to pose the question is that still the right model at the Operational Manager
level. Then finally, in ways of working, we established a regulatory leadership function and an Operations Directorate, but actually, I think on reflection, our Chief Inspector roles have become a bit too removed from supporting operational colleagues to be focusing on what they need to be
focusing on. So, I am minded and again this needs a bit more thought and engagement, but in our statute, in our legislation, is that we should have three Chief Inspectors, for a little while we have been down to two, and that is the decision
I want to revisit again. Because it is absolutely critical that at the top of our organisation we have got credible experts in the fields that we are regulating as well, so, I just wanted to signal that. Then, just very briefly, I just wanted to
update Board on my three priorities as I move into this job. So, my three priorities are supporting colleagues to have more good days at work, driving operational performance and increasing our credibility. Now, as I sense-checked my first priority, externally actually, it is really interesting
my response from providers - I didn’t know how well it would be received that my first priority is our people externally - but actually providers really recognise that when we when we got out and regulate, we know that a happy workforce equals high-quality care.
So, actually the fact that we have not had a largely happy workforce for a while in CQC, there seems to be a really good recognition that that is the number-one thing that I need to be focusing my effort on, which is brilliant. So, very
briefly on some of the things we are doing around that. I intend to work very closely with the unions, our staff forum and our equality networks, who are really key partners for me in terms of understanding what the organisation needs from a people perspective.
There will be a series of other things we will be doing around wellbeing and making sure that we have a very different way of communicating with our people. You know, gone are the days of Broadcast to kind of having really full exchanges, and very
briefly, for the three all-colleague calls I did at the start a couple of weeks ago, we had 1,346 colleagues on the call, we had 400 comments and we have 37 colleagues who came on camera to directly give me feedback on my priorities, which was
just wonderful, so a lot more of that. So, that is my first priority. Second priority is around operational performance, so we need to remember that we are here to assess, inspect, rate and publish our views on the quality of care out there in providers.
We do lots of extra things, lots of really important things in addition to that, but we have got to get our fundamentals right. We have got to be going out to the right places and undertaking enough assessments, inspections and rating services to give the
public confidence about the services that they are receiving. So, everything that we are going to be doing now is going to be challenging us to say, will that activity, will that streamlining, will that technical fix, is that going to translate to more activity, more
operational performance, so that is an absolute critical priority. Then my third one is, I think our credibility has been eroded as an organisation because of some of the challenges we have had around the transformation we have been on, because our inspection numbers are lower
than they should be and because of some of the changes we have made around our people. So, there will be a third priority around making sure that everything we do drives up external credibility as well. So finally, and then really keen to hear colleagues’
reflections on this, the final thing I want to say is professional judgement, professional expertise. You know, we employ a really skilled workforce and they need to have the tools, they need to have the technology and the tools to do their job well. We just
need to shift the focus a bit to really emphasise professional expertise as being in the foreground of how we work with the tools merging more in into the background. As we make that transition, along with transitioning our focus away from what has been quite
internally-focused as we have gone through this massive change over the last couple of years, to getting back out there so that our focus is on shaping and influencing the health and care landscape. So, very final thing, thank you so much for the response I
have had so far from our people and from external providers. We have got a big hill to climb, but I am confident that with the passion and the energy that I am surrounded with, with fabulous colleagues and great providers and stakeholders, I am confident
we are going to get there, but it is going to be a hard slog for, certainly, at least the next six months. Thank you. Thanks very much
Ian Dilks - 0:16:22
Kate. Just to remind you Kate has been in the role for three weeks, so there is an
awful lot to cover there. Clearly the Board, at some stage pretty soon indeed, will need to see what that looks like when it is written down, to make sure we have got appropriate timelines, we have got the resources to do it, etc. So approvals
to follow, but really helpful to have that overview. Before we move into discussions on organisational matters and regulation. any responses or observations from colleagues to what Kate had to say?
Stephen Marston - 0:17:05
Stephen. Kate, I would just like to say a big thank you. What you have
just said, and all of your messaging to staff and to providers, colleagues since you took up the role, I think, has been positive, well-received. Not just because of its content, which I think does pick up very skilfully the many concerns that our colleagues have
been raising over quite a long period now, but also the tone of it, the honesty of it. I think that needs to include, for us as a Board, also being honest about our own role and the length of time it took us to fully
understand the depth and range of concerns that our colleagues were raising. I think it is important that we too are honest about that as a Board, and we learn the lessons from that. Colleagues know, I mean I have some role in the Speak Up
area and I think the delivery plan, recovery plan that you have summarised there does pick up the concerns that I have heard from colleagues, so that’s a big plus. But it is hugely important now that the way we take forward the recovery plan also
picks up some of the current concerns that colleagues have been raising, specifically that from now on, and I know this is a commitment that you have made, we take huge care to listen to our staff and learn from their experience of trying out new
ways of working. So that there is a regular feedback loop, coming back from our staff on the front line saying well, we are trying this way of working, this is our experience of it. We need to learn from that so that we keep adapting
and improving what we have got, but that that crucial point about listening really carefully inactivity to what our colleagues are saying about their experience of trying to make all of this work. Secondly, a point you make, that we don’t again slip into understanding the
recovery plan as just a set of operations, processes, system fixes because, at the end of all of this, where we need to get to is all of our colleagues feeling their professional expertise and skills are valued. It is being deployed well and that they
now have a set of tools that they can use to go out and deliver their own professional personal mission, which is about developing ratings and assessments that will keep vulnerable people safe. So, it is constantly looping from the new operations and ways working in
systems and procedures back to that critical outcome: do our colleagues feel they can do the professional job that they have always wanted to do in keeping people safe? And is that feedback loop above all, that I hope we can now build into the way
we take the recovery plan forward, but overall I think you have really hit the ground running. I think you are doing all of the right things, at least from what I have heard from colleagues, so thank you. Thanks
Ian Dilks - 0:21:07
Stephen. I think in your opening
comments, let’s be clear, you speak for the whole of the Board. I mean [inaudible] people, if we all speak we will be here all afternoon, but I am absolutely certain that in your opening comments you speak for all of us. Kate, do you just
want to quickly comment on [inaudible] point? Very briefly. I am
Stephen Marston - 0:21:25
conscious of a few other hands up as well, so Stephen, it is
Kate Terroni - 0:21:31
absolutely critical that in this time, where there is a real sense of urgency, that we are also really thoughtful in the
changes that we make. So, for example, you know, having an operational manager span four areas, is that the right answer? I don’t know, but we are going to be piloting, testing out in one part of the country what it looks like to go back
to kind of specialist line managers and then we are going to evaluate it. So, we are taking a quality improvement approach, taking a similar approach with relationship management and then a similar approach with some work that is happening at the moment around the Single
Assessment Framework and supporting colleagues to have a way of uploading their evidence that takes less time. So, we have kind of got three quite key pilots, but all of them will be evaluated and we are going to be constantly, not only be hearing from
our people, but hearing from providers, has that approach worked for you as well? Thank you.
Ian Dilks - 0:22:21
Any other comments? Ali, did I see your hand go up? OK, James, actually I think you were first, James and then Christine. Do you want to comment on the last point, or do you want to add another point, Tyson? [inaudible] OK, why don’t you speak first, and
then we will go to James and Christine. Thank you, I mean what I
Tyson Hepple - 0:22:38
wanted to say is I clearly played a big role in the transformation programme and I wanted to add my own apology to the one that Kate gave on behalf of the
Executive Team, both internally and externally. I want to say sorry for the role I played in the situation we are in and any of the decisions that I took, but also picking up on Stephen’s point I want to say sorry for not listening well
enough and not acting soon enough. But I thought I would like to say that, I have said that to some colleagues internally already, I would
Ian Dilks - 0:23:10
James Bullion - 0:23:13
like to say that more broadly. Thank you, Ian. I would add my voice to Tyson’s in our collective responsibility
as an Executive Team for the position we are in and our sorrow about that. But what I wanted to say was just recognise what Kate has said about the needs to make these changes. I have been talking to many social care providers who have
been raising concerns about us fixing the basics and getting back into a higher volume of work, and these changes are really crucial to us to try and address those concerns. I thank those providers for raising that and to continue to give us feedback and
raise those issues, and I welcome what Kate has said too about the role of the Chief Inspector. Actually, it has been my observation over the past year that strengthening that connection between the operational delivery and the Chief Inspectors is a really important part of
us raising our own quality. That is not to devalue any colleagues who have got a different skill set that may be not in social care or health, you know, the regulatory skill set is really important, but it feels to me like the core basics
are getting back to a focus, as Kate has said, through health and
Ian Dilks - 0:24:32
through social care. Thank you. Thanks James. Christine. Thank you. I
Christine Asbury - 0:24:34
would like to add my sort of support for Kate and the team for what you have done so far. It seems
to have been very well-received from the feedback I have had both externally and internally, and that is really good news, but just to say we are still at the start. I am still hearing feedback both from colleagues internally within CQC, and also from providers
that there are still problems of all sorts. So, you know we have still got a long way to go and I just wanted to emphasise - I know you recognise this because we have talked about it before - but the importance of working in
partnership, both internally with our colleagues and also externally with providers because the impact of the changes, particularly on social care providers, is massive. It has been so far, and you know, what I have heard is how hard it has been for them to try
and keep up and understand what they might have to do differently. That is going to change again now, potentially, so we just need to make sure that we do work in partnership with them. Then finally just to emphasise really, as a Board, the whole
of this has to be a priority for us, and we recognise that we have got a long way to go, and as a Board we really have to be very, very
Ian Dilks - 0:25:50
focused on it. Thanks Christine. Chris. Can we keep it brief please? Yes. Just
Chris Day - 0:26:02
in response to that point in particular, and to say to colleagues, both internally and externally, to express my thanks for their continued work with us on getting everything back into a space where we can talk about what good looks like in services and how
services are working. We have done some really important groundwork with providers of all sizes, stakeholders and colleagues, and people who use services, to try and ensure we understand in this new environment what good looks like in each sector. I think that is totemic in
terms of the start position that gives our colleagues the security that they can go and do their excellent job with the qualities that they have. It also gives providers a sense of exactly what they need to do to drive change and improvement, and it
gives assurance to the public that we are in a common space. I think that first piece of work on what is called [unintelligible], really is about what good looks like in a service will be very important and will help, I think, reset some of
the conversations in the relationships we have with providers, with colleagues and with people who use services, and for me, it is a very important start point to rebuilding our credibility. Charmion, I think
Ian Dilks - 0:27:15
you want to comment, and then Mark, I don’t know if we
Charmion Pears - 0:27:21
could move on, please. Thanks again, thanks Kate. It is great to hear what you have said today, Couple of things, just on the People side of it, I think we all would support the view that colleague engagement is key to successful delivery of strategy, so
advocate it being right up there in neon. There is some really important information you have referred to in terms of spending time to hear from our colleague-led groups, etc. I would encourage also using some of the other people data are we going to talk
about later today. You know, we have got 42.5% of our people off on sick due to stress and anxiety. We have got people leaving with 59% was avoidable, we should try and bring in some of those data sources to the work. In terms of
the increase in focus on operational metrics, I think we all support getting back to basics, which is great to hear. I think, important, as well as the activity is the outcomes and the quality of those outcomes to the activity. Then finally just a plea,
as you would expect from the ARAC Chair, this time round, can we really focus on the risks associated with the next recovery plan and what controls we are going to put in place to manage those? Thanks.
Ian Dilks - 0:28:33
Mark Chakravarty - 0:28:38
Thanks Charmion. Mark. So again, adding my thanks. I
think, out of all the conversations we have had this one feels where we have got a very reality-based conversation, where we are already embracing the reality that people have been feeling, whether within our own organisation at the front line, or actually within the provider
community. So, the fact that we have that now and as a starting point and a foundation to drive a turnaround is great. I think there is probably just two things that I just wanted reassurance on, and maybe they are just making sure, I will
make two observations and see whether Kate on behalf of the team you agree. One is the fundamental reason why we embarked on the transformation has not changed. As you said, it is about that user voice, but it is also that many of our systems
were stuck in an analogue world and way of working when the outside world had become much more digital. So, we were static and the world was moving in real time and that need has not gone away. You know a requirement of a regulator going
forwards into the next 5 to 10 years is to be more real-time, more database, more digital, so we must deliver that. The other part is, just again, it is the transition that we did not get right, not necessarily when that end state is implemented.
I think we have heard, at least anecdotally, when it is working as it should work, it has the ability to fulfil some of those goals. With that, it is that sort of conclusion that we really just not let the brilliance of our people shine in that space,
because we have not got the transition right, we have made it just too complex, too hard to get to that next stage. Is that a fair reflection, something you can assure us on that we are correct on that? Thank you Mark. So, I think
Kate Terroni - 0:30:29
it is really critical that everything we have done, every decision we made, we are prepared to really challenge ourselves that it is still the right thing. So, from my perspective at the moment, the Single Assessment Framework based on user voice still absolutely feels like
the right framework. We need to evaluate it, we need to understand, is it working for hospitals? So, as I sit here today, I still absolutely believe that it is the right framework and we are going to evaluate it to have that confidence. The changes
around technology, as you say Mark, you know, we could not have stuck with the kind of creaking old systems that we had, and the vision for what regulatory platform will give us. So, that ability to see what another provider scored, and what are they
doing differently to how I am doing it, and how can I improve etc. You know, what became so stark to us during the COVID pandemic, was the focus on asked to talk about particularly what was happening in social care at a national level, and
we absolutely were not set up at that time to do it. We made it happen through lots of manual activity, so having a regulatory platform that can enable us to kind of aggregate, look at themes and trends, still is absolutely the right ambition. But
as Christine said, you know, particularly on some of the changes and fixes we need to do around technology, we have a road to travel and we are working on it rapidly, but I absolutely acknowledge, as we sit here today, there will be providers experiencing
frustrations as they work with our system, but my ask, is, you know, is that people stick with us as we as we go to where we need to be with these things. Because I still believe the strategy, the Single Assessment Framework, the regulatory platform
are the right ingredients, but we need to address some of the issues
Ian Dilks - 0:32:12
we have come across. Thank you. Thanks so much Kate. Joyce, OK, last comment please. Thank you. I don’t want to repeat what everyone has
Joyce Frederick - 0:32:16
said, and I think Kate you brilliantly summed
up where we are as an organisation and the things that we have to do with that sense of urgency banner. I just wanted to reiterate the sense of urgency is because health and social care needs a strong regulator. The end of this, actually, is
people who use services and the absence of regulation because regulation does make a difference in terms of the quality of care that people receive, and it is the absence of regulation that has been the problem. We will do all the things we have to
do internally. We will build that trust and confidence internally, and with providers and our stakeholders, but we still have to make sure we manage the care and the risk and prevent the harm that is happening. So, getting the basics right is important, doing this
with a sense of urgency is important. And the third thing for me is that level of accountability, that we have got into a position, that none of us would have wanted to be in, and we need to make sure that we do the learning
to make sure it doesn’t happen again because the strong regulator is the emphasis that we need going forward. I just want to emphasise again our strategy is the right one, and the Single Assessment Framework is the right one, we just need to make it
work in practice. We have had lots of feedback, not just from providers and stakeholders but from people using services as well because we have consulted and engaged and co-produced. We are going to do the right thing on behalf of people, but we need to
make sure that we can do it in the way that we want to do it. Thank
Ian Dilks - 0:33:38
you. Thanks Joyce. Look, I appreciate everyone’s input, two quick comments from me, one for the benefit of anyone listening in. We didn’t allow time and we haven’t got
time for everybody to speak, but, as I said earlier, I know Stephen spoke for, certainly for all of the non-executives including me, and I think others as well. So, I did not want the lack of everyone, contributing and making the same comments to be
misunderstood. On the other thing is, just to be clear, I mean Kate on the behalf of her Executive Team, presented the case, but absolutely there have been discussions in other for a – we meet regularly - and the Board is foursquare behind what it
is that we are talking about. I think that’s an important point to make and particularly we like the way you have continued to focus, or re-establish the focus on, firstly, the patient and the patient voice and secondly, we have a great strategy, but there’s
also, at the moment - I will be using different words from Joyce - but we need to get the basics right, so we will do that. If we could move on, not surprisingly given the nature of that discussions we are running behind time. So
other operational matters in your report, there are only a couple of pages, I mean can we take the papers as read unless there is anything you particularly want to highlight, and then go straight to any questions on People? And then we will come separately
to the regulatory section. Anything you wish to add on People? So, any questions from colleagues on People, we are coming back to People obviously more generally in a few minutes’ time anyway with the report? Can we take that as read? OK, thank you very
much. I would, the only thing I would add is that we have put in there the inclusive mentoring programme. There seems to be quite a lot of enthusiasm for that. Certainly, I signed up, looking forward to it. I met my mentor the other day.
This is a new experience for me, but I think it is a great initiative, so well done. On the regulatory insights, again, could we largely take the paper as read? But anything you want to highlight? What I would actually like to do is ask
James and Chris as our Chief Inspectors just to highlight anything they would wish to. You have a Chief Inspector’s update written in here, James, you might want to talk about some of the winter planning stuff Chris, but anything you wish to add Kate? No, I would just like to
Kate Terroni - 0:36:01
hand straight over to my chief inspectors, so thank you James. Thank
James Bullion - 0:36:06
you, thanks, Chair. Just a couple of points from me, the first is fairly unusual actually, the launch last week of the Skills for Care, Adult Social Care, Workforce Strategy on the 18th of
July. It is fairly unusual for the sector itself, as it were, to come together and published document. as it were, about what it believes should be the strategy for the social care workforce. CQC had been a participant around the table, alongside the Local Government
Association, alongside ADASS, the Care Providers Association other partners, Skills for Care and Sky. The report is, as it were, aspirational and directed at the new government and there are commitments in there about what each partner should be contributing towards the development of a workforce
strategy for social care. Clearly, CQC - we have previously said that we welcome this leadership from Skills for Care and that we support, as it were, the notion and the need for social care workforce strategy - CQC has mentioned, with potential commitments for a
future approach by governments. Of course at this stage it is not a commitment from CQC. It is our expressing support for the conversation which would get taken up the government or not. There are some quite significant implications for such a strategy, particularly around pay,
but there are many things in here that are recommended around, for example, presenting a picture of what good looks like when it comes to workforce that don’t actually have a great deal of cost attached to them, but are potentially collaborations between CQC and Skills
for Care which could arise from this ongoing partnership that we have developed with the sector itself. I think it is a good example of improvement and improvement mentality and self-improvement by the sector itself, and I really wanted to express warm, welcome support for it.
When it was launched, we put out a formal statement which I think is on our website, as it were, in terms of what we what we wanted to say. Then, the second comment relates to our Integrated Care System assessment. So, as the papers say,
we are still in discussions with government about where we will go in the future with that work, and clearly a new government will take time, perhaps come up with an approach. In the meanwhile, the capacity that we have for our ICS team is being
gainfully employed elsewhere within the Commission, and given what Kate Terroni said about the need for us to get our performance back up, and that might signal, you know, a welcome extra capacity in relation to that. I will hand over to Chris for the remaining
Chief Inspector updates. Great. Thanks James, thanks Ian. I have just
Chris Dzikiti - 0:39:12
got a few updates, the first update is on the national maternity programme. I suppose this is just a reminder because we completed our final on-site inspections in December 2023, and we shared our highlights
of our key findings throughout the programme, but at the end of this year we are planning to publish our end of programme report In this part of that report, we have some improvement resources that we can share across the country to health providers to
continue with their improvement journey. The second update is on urgent and emergency care. Last week, on the 17th, we hosted an engagement session for about nearly 150 senior leaders who work in emergency departments, and the focus was really to think about winter is coming
- and we know winter is coming - and some of the conversations we have had with colleagues and providers like chief executives, it’s the challenges they are already facing in emergency departments now, before even winter. So we are trying to think how best can
we work collaboratively with our providers, thinking about what else can we do? We had some areas of concerns around length of stays for people with mental health needs in ED departments and then also thinking about, you know, people being supported in corridors and at
the back of ambulances. And actually everyone who was on that call, including all the providers, we all agreed that we should never accept having people being supported in corridors, so we need to think about what else to do. But in terms of some of
the solutions which came through was actually thinking about prevention rather than letting people come to ED. For example, you know, crisis support in the community, thinking about other ways of supporting people in the community instead of just coming to emergency department. Something I think
which was really interesting to take away in that conversation, which was in and around, collectively as a healthcare system, do we now understand the behaviours for our public who access services because it seems as if now the public when they need services. they need
services there and then and they will come to ED as a default position. Then the last thing I suppose I will just mention, as part of the object, is around our Maternity and Newborn Safety Investigations Programme. We completed a total of 3,614 investigation reports
and with 350 live investigations going on at the moment, and there is a lot of work coming through and there is a lot of learning also coming through. Those are investigations. Then we also have the Community Autism Support Services, which is the casework and
group, which is looking at actually establishing the plan to oversee some of the actions from the case review, and actually what we need to do from a regulatory point of view. I think, taking some of the feedback we got early in terms of actually,
when there is a report coming through, do we to take a moment to just think about actually, is there anything else we could have done or we could do to improve the experience of people who access services? I will leave it there and let
Ian Dilks - 0:42:22
in other questions. Thanks James and Chris. Just quickly going back to your point James, I attended the launch of the strategy you talked about and you’re right, we got a lot of entrance, clearly very grateful for the input, but there is quite a lot
of things that they said CQC needs to do or will do. So, we just need to make sure that long goes on the thing that the RGC reviews of commitments. Christine. Thank you, just to pick up on that exact point
Christine Asbury - 0:42:50
as well. I mean
I read the strategy and I welcome it very much. I just think it is important to, when we think about what future role, potential role CQC could have, to see it in context and to be proportionate. I have mentioned to you before about our
local authority assessments looking at how they are approaching paying for the fair cost of care. There are providers I know about who this financial year have received no uplift at all from their commissioners despite the national living wage having a significant increase. If we
are going to be looking at how providers are doing workforce planning, and particularly about how you know, if we ever get to that wonderful moment where social care workers actually get paid what we believe they are worth, or anywhere near what they are worth,
we need to look at how commissioners are funding that. So, we need to remember that we have got to be even-handed in how we are looking at
Ian Dilks - 0:43:57
that and how we are regulating that. Sorry, thanks Christine. Any other questions or comments on either the
papers which we took as read or anything James or Chris has said? No, OK. Well look, thank you very much indeed both of you. I mean there is a lot going on, but obviously it is all in the context of the opening 20 minutes.
So I think we have the People report next. Jackie, I should have thought to welcome you earlier, but I will do it half an hour late, welcome to join us. So, we have your report, assume we have read it, so, but it is important
so it would be helpful if you have anything you particularly want to highlight, and then we will go to questions, Thank you. I think before
Jackie Jackson - 0:44:46
I start to talk about the report and actions coming out of it, I think it is important that I
also recognise that I am in a position of privilege, as are my team, as to the part that we play in the good day at work, in our colleagues’ lives and the importance of the small activities equally to the big strategic pieces of work.
It is important to me that colleagues are paid on time, we deliver in terms of timescale. So in terms of this report, I will be talking about some of the maybe smaller things, but actually to me equally as important in that good day at
work and allowing our colleagues to move forward to discharge their duties, so we meet our core purpose. So, instead of going through the pack, page by page, because I assume that you will have read through it, what I want to do is share with
you some of the work streams and actions that we can track going forward in the pack, and also have resulted from the data received in the pack and also colleagues’ feedback, leadership feedback, and also wanting to be current and modern in an employment climate.

1.2 Declarations of Conflicts of Interest

So the first thing I just wanted to see was, internally, we have talked a few times about the stability of the structure and I think I have referred to the fact that when we started transformation, the decision was taken that most of the roles
would be fixed-term contracts until a structure was known, and we were clear about the direction. I think that brought challenges in terms of stability for workforce, stability for leadership and also being able to plan the future, because we introduced more uncertainty than was maybe
necessary. So I think the positive I think we have seen is that in 21/22 our workforce was 75% fixed-term contract. We are now down to 23%, it will probably go down even lower when we get completely through corporate service transformation. I think we really
have to learn from that, about what was thought to be a good idea at the time was then a problem, as we moved through trying to manage structures, expectations, opportunities for colleagues. So for me that is around absolutely recognising there will always be the
need, whether it be budgetary or specific pieces of work or niche skills, a fixed-term contract element, but we need not to go back to that point because we are emerging through that in a positive light. I think for all colleagues that will bring stability,
it will bring opportunity and it will bring job security depending on what colleagues are looking for. So working through the pack, what we have tried to do is look at how we can put work streams that can be tracked against the data that we
produce. So the first one I wanted to show was the leavers pilot. So, we have had feedback from this forum, and other forums about the data that we collect from leavers and how we can positively impact the future by colleagues, who are leaving for
a raft of reasons, can share with us. So, one part of our offer is the on-boarding scheme where we have a peer that works with anybody coming into the business. It gets rave reviews, and what we are going to do is replicate that for
leavers. So as soon as we are notified somebody is leaving the organisation, they would be supported throughout that, with one person who will work with the manager and the colleague and be able to get the data for exit interviews, feedback and make sure those
colleagues who have contributed to CQC are supported in their exit. So, that will be tracked through our exit data and we can review the pilot after six months. We have worked closely with David Croisdale-Appleby on that, who was been really supportive of trying for
a pilot, because I know he was really keen to see an improved data set from exit interviews. So, we have based on what we know works, and we will see how we go through the six months. The second work stream is our recruitment review.
This has been born from feedback from leadership, hiring managers, our staff networks, colleagues, the need to be more current, and it is something that we haven’t done for some time. So, working with a recruitment partner and a recruitment psychologist, we commissioned a report looking
at the end-to-end recruitment cycle, including, you know, diversity, demographic, geographic, routes to market, job boards, jobs forums, the [unintelligible] we would be recruiting to. The draft is just about ready, so we will be reviewing that, and what that tells us about our current recruitment
process, and without even reading the draft, I know that there will be a significant number of recommendations in there which I suggest I bring to Board at a later date, in terms of what the proposals are. You know this is about our candidate experience,
internal and external, how we can improve our data, how we can improve the expertise of our hiring managers, independent panel members, and at what point we actually ask for feedback to improve the process on an ongoing basis. Again, that can be tracked through all
the recruitment data that we provide in the pack. The second work stream is our employee voice work stream, and I think many colleagues around the table know Hannah Stirland who has come to work for me, working on employee voice and wellbeing and mental health.
I will take employee voice first, I think this speaks to the good day at work and also some of the conversations we have had as to how we listened to hear and then act upon what we hear. Again, we need to work with our
staff networks, trade unions, our Speak Up guardians, so we can provide forums, we can provide channels, we can provide a fair and consistent way that our staff forums can meet, can share best practice between the groups, and really give this some focus because I
think this does talk to a lot of the discussion we have already had. Hannah is also going to help working with wellbeing and mental health. We have got a raft of support for colleagues’ wellbeing. I think the challenge we have got is socialising this,
making it accessible and making it easy to interpret. So, I think there is going to be a bit of an audit on our existing work and what that tells where the gaps are and how we can make sure we socialise it, and also look
at best practice externally. Mental health is really key to our wellbeing offer. I think you mentioned, Charmion, you know, that the stats regarding is our highest statistic for absence. I think it is fair to say that the transformation will not have helped that, so
you would hope that from three weeks ago the messaging, the engagement, the authenticity of how we want to move forward, should give a really positive message out. That combined with avenues to speak up, avenues to be supported and what else we can do in
the mental health arena, and also reaching out to colleagues in CQC with that mental health expertise to help us think about what more and what next. Excuse me, and then, lastly, just also thinking about the data pack. We have had this in the same
format for some months now and I think from where was started to where we are now, I think it has been a really positive journey, but we are going to bring it back to our People committee just to see, you know again, to think
about good days at work, what do we want to track, what do we want to be really, really transparent about? So, are there any amendments we need to make in the park? Is there anything new, or you know, is something not working? So, we
are going to do that at probably the next People committee, so we can again come together to review that. So that is my thoughts on the
Ian Dilks - 0:55:44
People and Data Pack. OK, thanks Jackie. I mean the combination of the paper, and your comments, pretty comprehensive.
Kate, do you want to add anything? Go straight to questions? OK, we have a few minutes for questions, if there are any? Charmion? Thanks
Charmion Pears - 0:55:59
Jackie. It is another great pack and great to hear some of the things that are going on. Just a couple
of things, one, you mentioned other things in the pack, one of the things that would be quite useful, and I will touch on later when we talk about the policy, is coordinating with Max’s area to look at some of the health and safety data.
So, it would be useful, I think, for the Board to see that on a quarterly basis, you know have there been any [unintelligible], what the incidents are and how they are being resolved? I think a triangulation of that data will be beneficial for your
mental health work. So, we are seeing, or we did see, a spike in verbal abuse incidents for colleagues and which can, if it’s not are supported in the right way, result in mental health issues perpetuating. So, I think some of those triangulations will be
useful, and useful for the Board to see. I was interested in also the sickness data which you break down in a really useful way, and actually, you know, 4.6 was a reasonable number, but when we look at the breakdown you provide, we have still
got 242 colleagues who are effectively taking one month out of six as sick, that is a very large amount of sickness. It would be really useful at some point to get a breakdown to understand, is it that we are not able to help resolve
that, or is it a management issue, because it is quite extreme? So,
Ian Dilks - 0:57:26
there would be a couple of things I would be interested in. Thanks. Any other comments? Diane, you have done that the second time today, I was going to ask if you had any observations? So,
Network Rep. - 0:57:41
thanks for the report, Jackie. it is really heartening to hear that you have mentioned the review of recruitment which me and my fellow Network Chairs have been involved in. But, looking at the pack, my fellow Network Chairs were concerned again about the absence figures,
particularly as the Disability Equality Network did point out, that you splits the figures between stress and physical disability, and they felt that an issue with this is that for those people with long-term conditions, if they had gone off and cited their physical condition for
reason for leaving, it is not acknowledging that it can actually be stress that has exacerbated that condition for them. Particularly for Ops colleagues and for those going through management of change, it has been an extremely stressful time and there is a massive connection between
stress and physical health for those people with long-term conditions. So, we would be interested to know how you are tracking that really. Another point that a colleague made is that there is mention in the report about turnover and retirement being labelled as unavoidable leaving
reasons, but we have information within the Equality Networks that notes that there are several staff members who took retirement earlier than we would have had anticipated them taking retirement and them citing transformation and change being a large part of that. One of the concerns
for the organisation is that they take huge amounts of skill and experience and knowledge with them, and we have lost a lot of that through stress and management of change. And because of the prolonged nature of management of change, we are hearing that it
is leading to things like burnout, which is not necessarily being recorded very well, and the Disability Equality Network is hearing and the other networks are hearing that there are several members of staff who, because of their commitment to the organisation and to patients and
people, to protect them from risk in services, they are remaining at work when, ideally, they should not be at work, because they are
Ian Dilks - 1:00:37
overly stressed. Ok. Thanks Diane. Two very different points there, I mean the first, Jackie, I don’t know if you have a
quick response, but if it is a detailed one I suggest you take it offline, rather than [unintelligible] the Board going through the mechanics as [unintelligible]. The second one is something we have talked about elsewhere in relation to the impact on people of the new
ways of working, and some of the changes, so I might ask Kate if she has any observations on that, if that’s okay? But, do you want to respond now on the first point, or do you want to take it offline? Because that does come
Jackie Jackson - 1:01:10
down to how it is reported, but we can maybe think about if there’s something else that we put in there, to put in there as a category,
Ian Dilks - 1:01:20
Kate Terroni - 1:01:24
yes, fine. OK. I just want to acknowledge, one of the key things our people will say is,
we have lost some amazing people because of them being unhappy with the direction of travel or frustrated or a whole wealth of reasons, Diane, and that is all that is a real loss for us as an organisation. I have got a little secret hope
that, maybe, when we start getting things back on track in the coming weeks and months, some of these fabulous colleagues might have a second thought. They may not. They may be loving another job, but I am aware that some colleagues left CQC without another
plan, so that is not a specific plea, but I’ve got, as I said, a little secret hope that as the months go by and our colleagues hopefully start talking about it feeling very different in CQC and that we are more able to get on
and deliver our purpose, some of those amazing colleagues might have a second thought about whether they want to come back. Because we will be needing to look at the numbers of people, particularly in Operations, because we haven’t got the right numbers at the moment,
so there may be opportunities for those colleagues who have left, if we can convince them that this is an organisation they want to return
Ian Dilks - 1:02:27
to. Thanks. Thanks very much Kate. As I say, your point is noted as a big business issue for us, so OK, well look, Jackie, thank you very much indeed for
that, helpful. And I mean, I think we may have said it before, but the quality of reporting, analysis and everything else, the interpretation and then, more importantly, so what are we doing about it, and it has just improved immeasurably in my time here, so
well done. Can we just keep on the pace and move on again. We have got a session now on an update on the values, behaviours and leadership work. So, Jackie, I think you and Kate may want to lead off on this, but we are
being joined in by a couple of colleagues, I believe, Shelley Hallam and Mehjabeen Jagmag are they joining us? So, thank you very much indeed for joining us, and I only clocked this morning at some point at quite how intimidating it is with this great,
long room and you sitting at the far end, so we, perhaps, need your advice on how to fix that, but for the day this is where are. We have a crowded agenda, so we do need to keep to time. We have a rule, we
take papers as read, so there’s no need to talk through papers, but it is always helpful if there are any particular points you want to highlight or draw attention to, so we get questions, focus on the right areas. Kate, do you want to say
anything by way of introduction to this? If I may, I just want to say
Kate Terroni - 1:04:11
this really matters. So, this is a key component of a whole piece of work around the kind of culture change we need to do as an organisation, but having the
right values and associated behaviours has been critical and it has been a fantastic piece of work that Shelley and colleagues in our People team have led in terms of getting a huge amount of engagement, and then colleagues in Data and Insight who have done
a fantastic bit of analysis. So, we are hoping that we can briefly here from Shelley and Mehjabeen about the work they have done, but we are asking Board today to make a decision on the top three values, so I know the organisation will be
waiting in anticipation to see the outcome of this discussion. So, Jackie, unless you want to say anything… if you are happy Chair, I will hand over to Shelley first. I’ll just go first if that is OK?
Jackie Jackson - 1:04:57
Yes. So, paper sets out the update on
our values and behaviours, just to take colleagues back a few steps. When we started first talking about our cultural plan, you know, we recognised that the first part of that was refreshing and reviewing our values and also thinking about the behaviours. Our values have
been in circulation for 10 years and are loved and cherished, but it was still the right time as part of the first step of the cultural plan to look at that. So today’s update, we have split into three parts. Shelley is going to talk
about how we approach this, Mehjabeen is going to talk about the data and insight in the collaborative working we did with it and then we can come back and I can just sort of talk about next steps in the
Ian Dilks - 1:05:47
cultural plan. Thanks. Thanks, so
Presenter 1 - 1:05:59
to follow on from Jackie, I will share some brief details around how we have carried out the cultural work to date, and how we plan to arrive at our full set of values in September. So, in March, in line with Phase 1 of delivering
our cultural plan, we started to engage with the organisation to begin the process of revisiting our values. Our existing values, as you know, are 10 years old. Many changes have taken place within the organisation and, before processing with our cultural plan, we needed to
start a conversation with our colleagues to consider the organisation that we want to be and also what the values and behaviours are that are going to get us there. So, before we started we considered what was the best way to reach maximum coverage in
terms of our colleagues, but also to collect the right rich data to inform this work. From April to the end of June, we have delivered 27 Values workshops. The range of engagement opportunities offered to our colleagues to participate have been both face-to-face and online,
and covered a number of delivery options. So, workshops were delivered in conferences, in directorates, open sessions to sign up to, and in smaller, dedicated sessions for the Tus and Equality Networks and some one-to-ones, as you know, with Annette. So through these workshops we have
engaged with 1,402 colleagues, which represents about 42% of the organisation. All directorates were represented and we got a good representation from all protected characteristics. We acknowledge that some colleagues will have chosen not to attend, and we also acknowledge that some colleagues will not have
been able to attend, and we are hoping that the next steps will allow for further colleague engagement and influencing our final outcomes. So, the review work is on track with our timeline and up-to-date with Phase 1, and we will be ending that in September.
So, the workshops were designed to give colleagues the opportunity to have their individual reflections, share their thinking and then collaborate in small groups of up to 6, using dialogue mats and supported structure to get to an end result of a combined set of values
and supporting behaviours, and these were submitted through Microsoft forms. The data was then analysed and we handed it over to internal expertise, and I am going to hand over to Mehjabeen who is practice lead for qualitative research and she will talk you through how
the data was treated. Thank you, Shelley. Can you hear me OK? Thank
Presenter 2 - 1:08:35
you. So, the data, as you can imagine, was really rich because we were looking at what colleagues had said across several groups. Our first approach was to think about what is good
practice, so how do we approach something that is this varied? And we thought we would zoom out first, so we looked at all of the values and tried to organise them based on their thematic interest, so teamwork and collaboration, for example, or the fact
that colleagues may have used other words for collaboration, and try and pull these themes together. Once we had these themes, we kind of plotted them on how frequently they recur and there were quite clear winners. We had the first three, which are in your
presentation pack, are integrity, collaboration and caring, and these were…, they came out as emerging values that were recurring across lots of different groups. There were four others, excellence, inclusive, respect and innovative. These had lower recurrence, but were still really important for colleagues, so still,
you know, emerging as values that were important. Then, once we had these seven values, we looked into all of these details. So, we use qualitative good practice which is reading the data until you reach saturation which is where it is not telling you anything
new anymore. Once we did that, there were these supporting statements that emerged that are associated as I and we statements now. The presentation of these statements is not necessarily what colleagues may have told us verbatim, but really a narrative form that helps us understand
these values better, and they really have gone through a rigorous analytical process before we can present it to you today. I will hand over back to Shelley who can take you through it. So, immediate next
Presenter 1 - 1:10:21
steps for us are that we are looking for
approval for the recommendation of adopting the three clear leading values, that we are able to invite our colleagues to take a vote on the remaining ones, two values from the four that were following behind, and that we are seeking to clarify how we want
the values to be expressed, either a single word or an active statement, what is the preference there? We will then review Phase 2 of our cultural plan in line with the priority areas of increasing the number of good days at work for our colleagues.
We are confident that this values and behaviour work wholly supports that, and we are also confident that the Phase 2 work centred around our four enablers will ensure that we move forward with good and well-organised actions to enable this for colleagues. In September we
are coming back to you with those final values, should we get our approval, and that will be able to relaunch our values then, and we will move forward with Phase Two of our cultural plan. Thank you.
Ian Dilks - 1:11:16
Sorry I switched it to off, still get
it wrong, Kate, thank you very much. Thank you very much for that. So, we are being asked to approve something and there is the opportunity, I suppose, to give direction on other things. Any questions or observations on what has been done before that. Stephen.
Stephen Marston - 1:11:41
Thank you, and I really welcome the work. I think it’s important and good work. The reflection I would offer though is that in terms of working out an action plan now to take all of this forward, that can’t kind of sit in a box
that is separate from the way we each behave and the way we treat each other now. Fundamental to the success of the recovery plan is that we are living these values kind of now, that colleagues feel respected, cared for, listened to, included, all of
these things that are there in the values. Yes, by all means let’s have an action plan for rolling them out, but shall we also start
Presenter 1 - 1:12:27
doing them now? Would you like a response? Absolutely, we are working with our engagement team and we have appropriate
steps to take once we have got this signed off to make sure that we all are clear about what those values are, and how we can live them
Ian Dilks - 1:12:44
Mark Chakravarty - 1:12:49
going forward. Mark Chakravarty. So, I think it is great to see the work, great to see
that it is actually from the organisation up, and that is a reflection of what we are hearing, the values that they would like us to aspire to. A little bit to Stephen’s point. I think alongside of these, it is also looking for, if this
sort of organisation tells us, it is quite good to get some external sense-checking to say other organisations that have dealt with this and how they have translated that into behaviours. So, we are not the only organisation that will pick integrity as a value. So,
it is good to see how people operationalise that, how do you put that into our recruitment, or even how we attract talent, how we recruit talent, how we evaluate people during their performance and, critically, what behaviours then we do not tolerate in an organisation
that says this is the expressed value? So, I think there is an opportunity to use this as a launching pad. The other one, and I think it’s through conversations that we have had as we read these papers, is thinking about again, would these values,
had they been fully expressed, have prevented the challenges that we face in our transformation? So, it is actually thinking through, will they help us be that sort of assurance that we would get that right? And there are elements here that definitely do that, integrity
and always doing the right thing, the ability to have those candid conversations, respect and collaboration. I think there are those, if we had expressed them fully, might have helped us avoid some of the challenges, but the one that is not necessarily here is that
sort of openness, the sort of curiosity - I think we have had it labelled in different conversations - that says we are really, really keen to hear the truth, regardless of whether that is painful, whether that is challenging and to accept that. I think,
given our role as listening to people’s voices, that doesn’t quite come across. I know that may be, you know, just either it didn’t come across through the organisation feedback or we haven’t found a way of representing that into one of the core boxes here.
Ian Dilks - 1:15:01
Presenter 2 - 1:15:05
May I respond to the methodology? I think you are right in that there is definitely…, in the richness of the data, curiosity is one of the things that came out. They are represented in different ways, and I think when you surface to the top
what came up the most is what do you see here, and it underpins a lot of the behaviour, so it comes out, perhaps, in a behavioural statement or is supporting another value. There was also a lot of overlap, so I think what be read
from this is that there is a narrative throughout these four or five words that probably lead to something. So, you know I don’t disagree with you, but I think if you just looked at the data, this would not have been one of the first
Ian Dilks - 1:15:48
words that came out. Thank you. Charmion. Thanks. I totally support
Charmion Pears - 1:15:51
the way the exercise has been done and hearing from all our colleagues, I was just going to throw a counterview, I guess, which was, you know, inclusion is one of the ones we are
going to vote on and I am not sure any of us around the table would feel happy if it didn’t get voted on, so I would just question as one, whether or not the inclusion and respect could be looked at as one and the
same because they are quite similar things. And whether you need to go out to vote, because I do concur with my colleagues that we are at a point where we need to be living these values as part of the recovery plan. So, perhaps just
to throw it out there, they might be something you can do to look at amalgamating two that look very similar to your point, and whether or not we couldn’t move forward quicker. The other couple of things, I would agree with the point, we had
a stakeholder at our dinner last night who asked us to be more curious, a major stakeholder, the Board have raised curiosity, I think it is one that we do need to think about. And the other point is when we do come back, I am
very interested in how are we going to marry our internal values with the external values, the external things we are expecting from our providers, to make sure that we are holding ourselves to account in
Ian Dilks - 1:17:15
the same way we are holding them to account? Shall
I go first, if I may? So ultimately, Sacha would tell me from a
Kate Terroni - 1:17:24
governance perspective, the values are the decision of the Board. I think this is a really important opportunity, though. So, when we did the values 10 years ago, Chris and some colleagues
around the table would say that it was an extensive engagement session and everyone can see their fingerprints on the final values. So, we have gone at this with that kind of level of sensitivity because our values really matter to our people. So, I think
it’s really important that the final values are what our people have said that they should be, but that this is a chance to steer. So, I guess we have got two suggestions so far. One is where is curiosity, so it wouldn’t be purist, but
what would it look like if that was put back in the pot to be voted on? It may be something we kind of [unintelligible] could be working out together, and then the second suggestion from Charmion is, is there a way of capturing those final
four into two that we just lock in. I suppose for me, my preference would be that we do give our colleagues the opportunity to vote on the final four because this is an opportunity for really good engagement, by and through to the end feels
really important. But I would want to assure Board that just because we haven’t locked in what the final four or five values might be, we still have our current four values and they are not looking like they are massively changing at the moment. If
we do agree, these are our top three, so I don’t think this would cause any delay in terms of our expectations that right here, right now, we should all still be demonstrating integrity and caring and the other values, but I am happy to hear
Ian Dilks - 1:18:55
how the rest of the conversation plays out. Any other comments? Mark.
Mr Mark Chambers - 1:19:02
OK thanks. I enormously welcome this process, I think I was one of the initiators of it, so thank you for delivering it, and thank you for delivering it in the in the way
it should be done, with engagement throughout the organisation and the evidence trail so that when this is replayed back to the organisation, people can recognise their contribution and see how they have helped shape it. It is absolutely how it should be done. I am
also, I think there should be something around that space around listening, learning, curiosity, a little bit of humility in the organisation, because these are things that we have not been great at. The value shouldn’t just reflect the things that we are great at every
day. There should actually be some element of stretch and aspiration in there and I think that is something we need to be better at. And I think it does matter if about the headline words, I do see that some of those themes underpin some
of the underpinning behaviours up across these words, but you want these words to have special organisational meaning and resonance in the organisation. So if somebody says, look, I’ve got a problem with how we are collaborating here, I’ve got a problem with integrity. I have
worked in other organisations where that is like dropping a plate, and people stop and realise that something has gone wrong and have a discussion about it. So, you know, I do feel uncomfortable about that, but, you know the process has been done properly, I
think the bigger challenge for us in relation to this and the one that we need to look at here is, you know, in reality, these four words did not have any special resonance in this room. They are not words that we mention regularly, they
don’t feature in our Board papers, they are not things that we have ever challenged each other on and, you know, if we remind ourselves of some of the underpins to this this work, only 27% of our colleagues believe that values and behaviours of the
Executive leaders were consistent with the organisation’s value. So, we have got a pretty poor score, and that was one of our worst scores in the survey on this. So, I think we need to ask ourselves, what are we going to do that is different,
particularly when the words are not wildly different from the words that we have had before. They may be well-embedded in the organisation, but the reality is, they are not well-embedded around this table, so I think we need to reflect on how we are going
to be different. Could I just pick up there that the words might not
Presenter 1 - 1:22:10
Ian Dilks - 1:22:11
Presenter 1 - 1:22:12
have changed wholly, but the behavioural statements underneath have and the we statements have. And I think that regardless of that word and whether it has lived or not, there is some
really clear information about what our colleagues have said will bring best value to life and what their expectation would be around that. Now those are still in draft at the moment, but I think that gives us an opportunity to really re-embed our values, even
if the words have not changed. And it gives us an opportunity to talk
Mr Mark Chambers - 1:22:41
about that, about those more here, because, you know, that will focus
Ian Dilks - 1:22:50
us on what is going to be different. I see a few hands going up. Chris, very brief then please. Sorry,
Chris Day - 1:23:02
I think the exercise is very important because it has truly reflected where people are today, because there is an important point about this, this is literally what people feel today and in a sense what we would like them to feel is important, but this
is what they feel today. I think there are two important statements from this. This is as much about the behaviours that underpin these values as it is about the words, in fact it is more about the behaviours that underpin these values than it is
about the words, but it starts with us. So it is important that…, this conversation today is important about locking in three and having a conversation about four. I tend to agree, there are elements of those four that I would want to see in our
work, and in my work and in the work of my colleagues. I think the challenge of this is, we can certainly lock in the conversation around the three and discussed the other four. The way this comes to life is for us and for the
people that we lead and for everybody else in the organisation, what changes, what changes in the way that we work as a result of the behaviours that sit behind these values. I think that is the conversation we should have a Board, I think that
is a conversation we should have as we begin to talk about the other
Ian Dilks - 1:24:13
four. I’ve got just a couple of comments. I mean, I totally agree with you, Chris, and I think elements of comments on there. I mean I think, the posit is do
we approve of the first three? While they are a mile ahead, they are remarkably similar to what we have now with some improvements. But as Shelley, as you said in the Operations Conference, for example, when you arrived – it was the same for me
- somebody mentioned a word, but it was never brought to life. So, I do think before we go nap on all of this, we just need to do a bit more thinking on what differences would it make, and is that aligned with some of
the priorities that that we have got? So Kate spent some time outlining what we need to see changing. Is this stuff going to help that, or is it going to hinder? An I would like that, I think, to something I think it was Mark
Chambers said that, you know, we have done this for a very difficult period of time. It was interesting a lot of the debates I took part in, people got to two or three very quickly, but then they struggled a little bit with the rest
and I’m not sure they gave quite the same input on four, five, six, seven, eight or whatever. I think if before we kind of agree what four is, if four is the number, we really do need to go through that process and build in
just a little bit of aspiration and say, in addition to what we have got now and clearly - I think it’s obvious caring is going in there or something like that - but we need to make sure that the values that we say not
just we have, but we aspire to, and we need to have in order to deliver the changes. I think there’s got to be a degree of cross-trek there, What does that mean? Well, I do agree with the comments made on words like openness. I
do agree on the curiosity type point, what I would end as well - sorry, I would add – and it is touched on, but only very briefly, is this whole concept to improvement. I mean it is in the legislation, but we hear the new
government coming in and others, we have got to see a role for how we can help the system improve. It seems to me that has got to be baked into our value somehow. That doesn’t mean a value has to be an improvement, maybe it
if you get the value right, it is in the explanation underneath as to what does that mean in practice. But again, I just think it would be…, if we ended up with four values that didn’t reflect the things that are needed to deliver the
recovery plan that we have talked about or were not going to meet the expectations put on for what looks like being a long-term government, I think we would have missed the tricks. Let’ not disagree with anything, but I just think it would be useful
to do a little bit more thinking and road testing really along the lines I think the two Marks said, probably Chris as well, but just adding a few penn’orth, so that that that would be my observation. If I then take the request for approval,
I think, can I take it in two elements? So, one is to say, do we approve the first three and then the other is what do we do for something else? So let me bifurcate that, on the first three, allowing for the fact that
we have said work needs to be done to bring it alive and everything else, is the Board comfortable to agree with those three? I think that is probably the easier bit. For the rest, are we comfortable to say, yes, go ahead and do a
poll as it is, or is there a wider agreement about the sort of observations that the Marks were making, and I was trying to make and said actually, can we just do a little bit more thinking about what this might mean and make sure
that our end set of values, we are going to have something that delivers what we need? It is an open question. I’ve given my view, but there may be others. Kate, I mean, do you want to respond? So, we have
Kate Terroni - 1:28:00
got the kind of
purist approach, which is our data tells us these are the final four to vote on, but, as I say ultimately it is Board’s decision. My preference is whatever we do, we go back out to ask our people what the final four or five should
be, but I think it is up for Board to decide to say there is the top four, but actually we want to put curiosity in the pot, and it might be interesting to go back to say how much further down the list was curiosity,
colleagues. But, I think it is just being, frankly it wouldn’t be completely pure if we were to throw him one that didn’t statistically come to the top of the pile, but that is Board’s prerogative. And then, ultimately, it would be back to our people
to say, what do you think for Board to make the final decision but
Ian Dilks - 1:28:43
Jackie. Yes. I agree with that. That was going to be my suggestion because I think to Charmion’s point, I think inclusivity is really, really important, and I think we need to
Jackie Jackson - 1:28:54
reserve the right just to come back in September with the final data, have another conversation, but I think we need to reserve the right to say inclusivity, if it was really serious about a lot of the discussion today, we need to think about whether
we pin that to the mast as well, and that would be my reflection to colleagues just to think about that as well. What inclusivity means to you, means to your colleagues, means to service users? And I think that would be a real shame, I
think, if we missed out on that. So, I think we need to just keep that
Ian Dilks - 1:29:36
in view, would be my idea. So we have agreed the first three, I’m not suggesting the Board decides [unintelligible] around the room, totally wrong, and I hope no one
thought that is what I meant. I think we are agreeing we need to go back and see what our people think. But all we are saying is, with the benefit of experience and hindsight, perhaps on other Boards, and looking at joining up the dots
of what we see and hear, but an awful lot of other things, it would be helpful when we go back to people to say, actually when you are deciding on this, have you thought about… I think we would be making a major mistake as
Board on behalf of the organisation, if we signed off with a set of values that, with the benefit of hindsight, allowed politicians, service users or whatever to say what a [unintelligible] of values and you didn’t want to learn, or you didn’t want to do
something that that, you know, we would be opening ourselves to criticism. So, I think it is just wisdom round the table, a little bit more thought, and asking people to reflect on some of these things before we, you know, we go back to the
next stage of the consultation. So I thought everyone was nodding and that was agreed, but Joyce, did you want to comment. Yes. I might be
Joyce Frederick - 1:30:47
the only one that sees the irony of using statistics to try and manage sentiment, because these are values, sorry,
it is just the pure irony of calculating something when we are trying to think of values. So, I think we could agree the first three, but I would like to go out with options, so because it is statistical and we have got, you know,
what has hit the top, you could ask people if we merged caring and respect because they are so similar in terms of sentiment and what people wanted. I had two workshop discussions because I happen to fall into two areas and those things just overlapped
so much, it was not a clear [unintelligible],as in it is this one or this one. So, I wonder if we could just go out with, if we did that merge or we voted straight, give people options when we go back out, because I do
think that if people don’t feel that they own them, they are not going to be values. They won’t live them, they won’t breathe them, they won’t be behaviours, but if we just think a little bit more about the sentiment behind it because it does
feel ironic to me that we have used a statistical method on a
Ian Dilks - 1:31:45
sentimental issue. Can we find a way of thinking about that in the context of the consultation? So I don’t think you are disagreeing with the Board agreement, but it is, you know,
this is complex. We have got to get it right. I think it is helpful to be quite clear that, however, those first three are going to be understood and locked in, and there is no reason why we can’t be making sure we are doing
more to live those values now. However, let’s get it right. Sorry,
Network Rep. - 1:32:14
Diane, you wanted to comment. I am just conscious that part of this discussion has, obviously is to do with Board, but this does come from a consultation with staff and so, as a
representative of staff on Board today, I am just very conscious, if we then go back or you then go back and say, we thought this, in the current climate, it could be taken as Board imposing something on staff when staff were led to believe
that they were having more of a say in it. So, I am just conscious that we need to be very careful about, you need to be very careful about how you get that message out there, so that staff don’t feel, oh, well we were
consulted, but it has been imposed again. I mean, I will see if Kate
Ian Dilks - 1:33:11
or others want to add, but I think it is a very fair question. I know somebody had said, you know well we did a consultation, what’s wrong with the Board, doesn’t
it look odd? I mean, in any governance structure, the Board, ultimately, is responsible for the values of the organisation, only if saying they are put in place. So, it is totally wrong for the Board to say, you know what, this is what we think
the values should be. We have got to understand what people want, but at the end of the day, if we are accountable for them, we have to have had a chance to consider them and road test them. I mean the comment I made a
moment ago, we would be doing - it’s not my personal view, particularly - but it would be doing a disservice to the organisation if we got in a position where the Secretary of State or providers or whatever said, if that is it and you
haven’t even thought about something, then what are you doing? And it is not a fair defence of the Board to say, well, we never thought about it, we just collated on a word map, what somebody said. So we are not imposing anything, we are
just saying, with the benefit of a bit of experience and looking at other things, can we just ask you to rethink in the light of some of these other observations what something might be? That is not imposing anything, it is giving an opportunity for
further consultation, but with a bit of grease in the mill. Shelley, you wanted to comment. Yes, so I think there is two things. Joyce, I
Presenter 1 - 1:34:35
wanted to come back to your point in saying the analysing of the data was about us taking out bias.
So, the reason we chose to go that route was so that we weren’t sat in a room, theming with our personal preferences, that we had got some robustness to our colleagues have said this. So, the sentiment in terms of - and I know you
were part of those workshops - in terms of how we, I guess. underwrote it being an analytical process without any of that sentiment was what value, what behaviour will bring that value to life. And because we had that discussion, that is how we protected
that process. In terms of my view from, you know, putting my subject matter expert hat on is that these values should be our North Star for how we go about being who we are and make our decisions in line with our strategic objectives to
meet our purpose. So, if we need a further conversation to map that out, to go, actually our remaining two values at this moment, we can’t work out how they talk to that, that is a good discussion to have. There is a robust data pack
that will show you the underneath - we did not have time for it today - but it it is there and what we are presenting to you is on the back of that, is showing you what values sit under the ones that we have
presented. So, you are talking about curiosity, it will have been mentioned, it might sit under that innovation one and it has been included in that because of the ways. So, I am really comfortable sitting here saying we need a further discussion about those things,
you might need that further in-depth pack to have that discussion and make that time to do that, but equally, I’m really comfortable with the process that we have used to get to our values. I hope that is helpful, and we also need to decide
on an action word or a singular word to express them as well.
Ian Dilks - 1:36:34
Thanks, Shelley. we are quite a long way behind, are people comfortable with we landed on that, or do people need to make extra comments? OK, thank you very much, sorry [unintelligible], could you
make it quick please? I will, I will do. Sorry. I think it is really
Gemma Skipsey - 1:36:53
important that we are taking a view that this is being co-produced as well. So it’s not necessarily Board saying this is how are we going to do this, or it’s not our people saying, you
know it is about bringing up both of those options together as one to get to the right outcome as a collective. I think the opportunity we have got with this as well, is really looking at the We and I statements. So, for me, I
think we can pick whatever four or five words that we want to use, but what is really going to bring those words to life and drive those behaviours are those I and We statements. So, you know, we mentioned curiosity a few times so we
could have that as part of our, you know, I and We statements which is really articulating what we would expect to see in those behaviours to
Ian Dilks - 1:37:47
discharge those values. Thank you very much indeed. I hope that is clear, but if not, we will pick
it up outside. OK, thank you very much. Joyce I really hate doing this to you- we are a bit behind, but not surprising, that took way longer than I expected - you have colleagues coming down to join you for the [unintelligible] research report, would
it cause a problem or inconvenience if we deferred that to a later meeting, or do we need to address it today? I need to check, but there
Joyce Frederick - 1:38:22
is an external colleague joining us as well. Can you check? I really don’t want to be rude
Ian Dilks - 1:38:31
or inconvenience anyone, but equally… What would I do without you Kate? So, what I was saying, while Joyce is checking on that, we will, let’s move on to the LLR Evaluation Report. Hugely important itself, but we are going to have to keep this to
no more than 15 minutes, I’m afraid. So, James and Joyce – we have just asked here to move out - picking it up, are Helen and Jillian going to be joining us for this? Could you have a look? OK. Thanks. Thank you Joyce. James,
after you. Thank you very much for joining us. My apologies, but we are running a little late, so I said we could keep this to - despite the importance of the subject matter, the papers are pretty thorough, voluminous in fact, so can we keep
this to no more than 15 minutes? Thank you. Yes, certainly, thank you,
James Bullion - 1:39:49
and Helen Rawlings and Jillian Marsden carried out this work. So, this is an important focus for us on how we listen and how we deal with information of concern and the whistleblowing
and the safeguarding. And also this report on the evaluation contains a strong part of our commitment to equalities. I will take the paper as read. We have made some progress on the aims and the recommendations. You can see that, on half of the work
that is coded here, we are making some progress, but we are clearly not in the place where we should be, and it is partly, as the report says, for the reasons that Kate Terroni outlined earlier around the impact of our transformation. So, it does
mean, as you can see in the evaluation, that there is a stack of work we are behind with. I particularly wanted to acknowledge the role of our external panel members in helping us with our work and with the evaluation, Professor Joy Warmington, Arpita Dutt
and Anne Robson bringing their expertise to this work, both in terms of its evaluation and its origin. We clearly, as the report says and as Helen and Jillian can outline, we have clearly got a list of potentially more focused areas that we can look
at on page 101-2. I am very conscious that - Kate previously outlined sort recovery areas or areas of focus over the next year, year and a half - I suppose we are seeking the Board’s approval for these are the areas to focus on, but
Ian Dilks - 1:41:49
also a strong alignment with that work, but we will occasionally need to look through the lens of LLRC. OK, thanks James. So, we are being asked to agree some things but comments, colleagues. Stephen. Thank
Stephen Marston - 1:42:04
you very much. A very comprehensive report, two points if
I could? Much of what we were talking about earlier in this Board meeting about the Recovery Plan, significantly overlaps with the aims stated in LLRC. Where that takes me is to think that, rather than continuing to try to sort of manage and monitor all
of the recommendations in LLRC in a kind of ring-fence box, that is kind of other than main business, I think we should take those core aims into our delivery of the Recovery Plan, because those key pieces about listening to staff, engaging with staff, making
staff feel safe about raising concerns and effective change management that includes staff and takes account of their experience, those are all critical to successful delivery of the Recovery Plan. So personally, where I would go with this, is take out those core aims from LLRC,
say they are the same core aims as for the Recovery Plan, and we track them and monitor them and ensure delivery of them through the delivery plan. Second and more detailed point, it is really good news that you feel the specific recommendations about Freedom
to Speak Up have made good progress. I would have to say I think there is still further that we need to go on Speak Up. I think we have a range of colleagues who feel that they have tried to use the Speak Up mechanism,
and it has not obviously worked well for them, and so in discussion with Charmion on ARAC, with Carolyn Jenkinson and others, we do have work in hand to try to develop how we use Freedom to Speak Up, to make sure that we understand the
themes that are being raised, that there is timely follow-up and response, and that colleagues are clear about the different pathways they can use to raise concerns. So I am not denying the progress that has been made, I am just noting that I think we
still have quite a long way to go to make sure the FTSU framework is credible and colleagues have confidence in it. So, just a few things
Presenter 2 - 1:44:55
on that. I think absolutely the aims of LLRC fit very well with the aims of the recovery, and
absolutely you can map the LLRC aims to those three recovery priorities, and I think that that is absolutely essential, because what we have seen up until now is the LLRC has been othered, and actually, by integrating them into everything we are doing is the
right approach and actually is the challenge that we got back from our colleagues and from the independent panel members. So I think that is absolutely right. I think we do need to ensure that reporting does allow for reporting against LLRC, so that we can
actually show that we have delivered against those aims, because I think that our colleagues and our stakeholders would be expecting to see that. But absolutely, we should deliver it in a coherent and unified way. With regards to the Freedom to Speak Up, I would

3.0 Reporting updates

say that I think what it does say in the Evaluation Report is that we have delivered against individual recommendations for Freedom to Speak Up, but we have not had the impact that we want to see. So, what I think again that speaks to is,
rather than looking at the recommendations as transactional, have we delivered, tick-box yes or no, but actually have those recommendations enabled us to deliver what we set out to achieve. I think that the evaluation going forward will absolutely raise a focus on, have we achieved
Ian Dilks - 1:46:39
those aims and are we having the impact we want? So, absolutely. Thanks, Other questions? Ali first, and then… Thank you. Like my
Ali Hasan - 1:46:47
colleagues, I recognise that progress has been made, and I also recognise that we are not where we would have liked to have been at
this current position. I think there is value in focusing on the aims, and to facilitate that to your point earlier, it is so critical that we focus on articulating what the outcomes are, that we would have from achieving these aims, and how we would
be able to confidently measure them with the support of a wide range of stakeholders. I also think it is critical to continue involving the external panel members, as we do so, so that we can ensure that we have concluded, I suppose, the mission of
Ian Dilks - 1:47:27
what LLRC set out to achieve. Thank you. Diane, you wanted to comment.
Network Rep. - 1:47:32
Yes, just a minor comment. We have all been using acronyms, it is a public Board, can we say what LLRC actually stands for, and ARAC, it is an important point. Maybe we
Ian Dilks - 1:47:47
should have something of a put on the screen definitions, but Listening and Responding Review. OK. To be fair, when it was first presented to this Board - actually it wasn’t half of this Board - so I hope those who joined more recently feel they
are up to speed, but I will take the point, the public may not be. The regular listeners will know, we have talked about it many times. James, sorry other colleagues, Belinda. So, the whole purpose of this
Belinda Black - 1:48:21
report was as a result of whistleblowing by
Mr. Kumar. Very disappointed to see that the main area that we haven’t achieved on is in the area of whistleblowing, particularly with regard to protected characteristics, and how that might impact upon people’s experiences of institutional abuse and bias. So, I just wonder if you
could talk a little bit more about that and how you might look at prioritising some of the actions that still remain. Looking to my
Ian Dilks - 1:48:53
James Bullion - 1:48:55
colleagues as to whether they want to contribute to any of that film, feel free to add after me. So, I
think it is… [inaudible] in that area, as the report indicates, it needs to become a stronger area of focus for us. On the protected characteristics and, generally speaking, on the information flow of equality data, we haven’t made sufficient progress in the past year. I
think that, to some degree, reflects the sheer amount of technical change that we have needed to do over this period of time, since we adopted the recommendations in relation to our main systems, and the capacity for the organisation, as it were, to allocate a
resource for that. So, I don’t think there has been a lack of will, or a lack of policy intent, as it were, to not prioritise that, but we clearly have not because we have had to prioritise, in particular, the work around the regulatory platform
and the transformation, and accelerating the implementation of that, so we just haven’t got to where we should have got to in relation to that data, but it is a commitment and again it is one of those areas of commitment that we do need to
Ian Dilks - 1:50:24
track as a Board, and to raise its profile. Thanks James. Mark. I mean
Mr Mark Chambers - 1:50:29
I would support integrating this into the Recovery Plan. I think just sort of extending the timelines for something that ring-fenced is not delivering, it is not going to get us anywhere
and we need to change the approach. The great thing about the Recovery Plan, which we know is the highest priority for the organisation, we know it is going to have milestones, we know it is going to have resources behind it, and we know it
is going to have ownership around this table, so I would strongly support that. Let’s just make 100% sure, though, when we are translating what was a very complex set of deliverables, some which may now no longer be appropriate, when we are translating that through,
we don’t lose anything, so we can go back at the end of the day and
Ian Dilks - 1:51:26
say the things that we committed to 15 months ago we have done. OK.
Jackie Jackson - 1:51:33
Yes. Jackie. Yes, just very quickly, We work closely together with my team regarding the evaluation and where that
fits in Staff Survey, how do you see that being impacted, Jillian, in
Ian Dilks - 1:51:51
terms of timescales, and is that still the right method to track? So,
Presenter 2 - 1:51:54
I think that we are, so the current conversations that we are having with your colleagues around timescales for the
Staff Survey are kind of in line with what we would need to do for two years, so, I don’t see that as a problem. I think that the Staff Survey has been so powerful in articulating the fact that the staff don’t feel psychologically safe,
don’t feel able to speak up, and I don’t think there is a better mechanism for getting that broad perspective of our colleagues. Of course we will supplement that with qualitative interviews and focus groups with colleagues to understand the detail, but I think that that
will never capture the kind of breadth of experience. I think it really is important that we have that litmus test to be able to say yes, we have turned a corner here and our colleagues are telling us that they are feeling safe when they
didn’t feel safe before. So, I absolutely think that that is necessary and I think that that is important, that we do that on a two-year trajectory, because we know that if we survey them in the next couple of months, which is what we would
have to do to report at 18 months, we wouldn’t be hearing something different, so we need to give ourselves that time and then really see whether we are starting to turn the corner. Great. Thank you.
Ian Dilks - 1:53:11
OK. Thanks. So, I mean James, you have explained a
huge amount of work, you have explained the position, you are asking for approval on the timeline. I would like to propose that we agree on that, although I have to say I won’t make it a subject too, but a strong emphasis on the point
that Mark Chambers made, if we can be quite clear on that as well. And I just have an ask of you, that we would rather this hadn’t taken so long, but you have explained there are other things going on, that is accepted. But I
would ask that if there are blockers to impediment that we understand them, they get called out, so we are aware of what the issue is. Alright, well look, thank you very much everybody. Can I, we are going to discuss the second Annual Research Report,

COMFORT BREAK

although Joyce, we will be very tight, but we have guests here to present to us, so we must do that, Let’s take a 10-minute break now, so if we can be back by five past three please, sorry five past four.
Ian Dilks - 1:54:13
Thank you. Welcome back
everybody, I hope you enjoyed your very fast tea-break. As you saw, we rejigged the agenda, but we are now going to deal with the report that we deferred. So, welcome, thank you very much indeed for joining us. Joyce I don’t know whether you need
to introduce this. I have explained to our guests that firstly we take the papers as read, and secondly, so we can get to questions, and secondly we are running behind time, so if we could try to make sure we certainly can’t go beyond 15
minutes, if it would be less, that would be great. I am going to curtail some of the committee reports later on, on the agenda, just for the benefit of colleagues, so it is going to be a rush, but I am still aiming to finish
at 5 o’clock, and I know some people do have to go anyway. Thank you Thank you Ian. I don’t need to introduce, I will hand over to Jillian and Hasham, because this is important, really, to demonstrate the
Joyce Frederick - 1:55:17
impact and why evidence supports our decisions, particularly at this crucial time as
we are in recovery and for the longer term as well, so I will hand over to Jillian and Hasham. Yes, thank you. I won’t go through the
Presenter 1 - 1:55:29
impact that is demonstrated through the report, I will take that as read. I did just want to
point out that I think our research programme is more important than ever, now as we enter a period of recovery. So in terms of colleagues having a good day at work, the evaluations that we are doing ensures that we are listening to our colleagues
and that we, therefore, can reflect on what they have told us and respond. We need to be an evidence-based regulator and have decisions based on evidence, if we are going to improve our operational performance. I think we have the right kind of research programme
going forwards to help us with that. I think that showing that we are basing what we do and how we do it on evidence is going to be really critical for improving and building back our credibility and trust with our own colleagues and with
our external stakeholders. I do have Hasham here who is from NHS Confed to talk a little bit just about a project that we did with NHS Confed called Putting money where our mouth is. I think the reason why that is important is because what
we know is that we have a greater impact through the programme when we do it in partnership with others because we not only have our own reach, but we have the reach of those partners to have that impact and also to strengthen the credibility
we have as well. So, Hasham, I don’t know if you want to say anything before we go to questions? Brilliant, thank you very much. I just want
Presenter 2 - 1:57:13
to say thank you for having me today. My name is Hasham, I am a senior policy advisor
on population health at the NHS Confederation. As Jillian said, the detail has been sort of mentioned in the report, but I just wanted to highlight in terms of the project that we did, alongside CQC and some academics at Leeds Beckett University, and a healthcare
consultancy. In terms of what we found, in terms of what systems were doing around health inequalities funding was, again, there was a need expressed that there is a need to do research and build some of the evidence base for how healthcare systems, especially from
an integrated care system perspective, they are working. And with something like the health inequalities agenda, I think it was very important for us to sort of really be member-led and the conflict being a membership organisation, I think it was sort of really important to
demonstrate that we really need to get an understanding of what some of the nascent problems are, and if we do, if we are looking at sort of patient quality and care, health equity, really sort of needs to be at the centre of that. I
think, given that we are sort of dealing with complex situations and systems, both at an organisational level but at a system level, research really sort of brings to fore the sort of idea of kind of really, and again some of the values in the
conversation that was just mentioned before, that curiosity, that ability to innovate, the way leadership or leaders are actually being a bit more pragmatic in terms of trying to deal with the challenges, given some of the financial challenges and operational challenges that exist. With this
piece of work, what we were really able to do, working in partnership with CQC and the academics, was to really highlight some of the issues, but also actually create a toolkit which was kind of co-produced in a way that helps systems to really effectively
kind of understand what they need to do around sort of health inequalities and again, not surprisingly, some of the issues that emerged were around sort of systems really needing to have a really good culture, especially around leadership. So, leadership was like a key driver
to really inform the work that they are doing on health inequalities, as well as kind of robust governance mechanisms and sort of issues, around sort of kind of reporting and transparency. Again, just wanted to reflect back, I think the partnership was really valued by
systems because I think having CQC, on board, as a sort of a partner on this research, I think they really felt the ability to sort of kind of influence and co-produce something that was done alongside us as a membership organisation, but alongside the regulator
as well. I think just to kind of say final words around, I think going forward. I think there is a really great need to sort of look at research with system leaders to really try to surface some of the issues, the underlying issues that
are sort of causing them to sort of face the challenges with health inequalities and equity. If we really are wanting to work with the regulator in a way that is sort of more empowering and learning to systems, I think research is sort of a
great sort of a way of doing that. And in terms of just some impacts that we had. So, the report that was published, it has been sort of mentioned a number of times in the HSJ. We have had endorsements from the NHSE Health Inequalities
Lead, and again, it has been presented at numerous sort of conferences, and there are colleagues here who actually spoke at the NHS conference in June. In terms of kind of usage of the report, we recently did a kind of analysis of how many sort
users there have been on the website to look at the report, and the toolkit, and, again, between March and June there was probably just over 4,000 users that had actually utilised or viewed the report. So, I think just in summary, we really valued the
partnership that we had with CQC conducting this research. I think going forward and we are really open to working more closer with system leaders, and alongside yourself, to really try to understand the issues around sort of challenges within systems. Thank you. Thank you very
Ian Dilks - 2:02:10
much indeed. Questions from colleagues? James. I just wanted to
James Bullion - 2:02:16
acknowledge the quality of the work here in the programme. I attend, a few NIHR meetings and applied research collaboratives in the social care field, and actually CQC’s reputation for research is strong. And in a
couple of examples from Adult Social Care, the work on the Local Authority Assessments has been strengthened by a research-based approach and that has enabled us to change our approach and to convince the DHSE of a change. The current work on dementia, which is a
really good example of, whilst we are fixing the basics, we need to have an eye to what improvement outcomes we want, and it is a good example of, if you don’t have research and evidence, you don’t build your credibility, so I think it’s really
important that we have this programme. It is a modest amount to commit to it and I am really impressed by the partnership too, so thank you.
Ian Dilks - 2:03:15
Thanks James. Ali. Thank you. This is a really great report to read.
Ali Hasan - 2:03:19
It is clear that the investments
that have been made in research have been productive and the work has been industrious, and a large number of outputs with practical relevance have been demonstrated. I’m quite keen to understand when we come to the end of the review period in 2025, how much
further we could potentially go, having had several pieces of research that have been produced and implemented to understand the effect of some of our research in changing outcomes. I know that is normally a challenge with many types of research, but I would be keen
to understand if there are any specific areas or foci where we could go even further in saying, this has been the impact of implementing work based on the research we found. Thank you. Well, I was going to make a very similar comment, there is
Ian Dilks - 2:04:04
a reference said here to strengthen visibility with more frequent reporting to the ET and the Board. The ET is another matter, but I think for the Board, rather than necessarily more frequent, it would just be helpful to identify where and what we are doing
as an organisation has benefitted from. So, it is kind of measuring the outcomes rather than the activity. So, that is not saying, do report totally differently, it is saying, to the extent that we’ve had benefits from this, it would be helpful to highlight them
when we are talking to the relevant topic. Any other questions? Belinda. It is just a quick question, so some of your work, you put
Belinda Black - 2:04:48
down was internal reports, but some of them like Preventing mortality in mental health settings, Rapid review of current practice and
guidance is an internal report. I just wondered why you wouldn’t make that external when it would be so helpful and useful for people in mental health settings. So, just what your thinking is behind that really.
Presenter 1 - 2:05:08
Sorry, so some of the ones listed as internal reports just have not been published, yet, so it’s not that they are not going
to be published, and that is about making sure that…, sometimes there is a kind of an internal focus to how the reports are written, and we produce an external report which is a more useful and brings benefit to systems and to providers in how
it is written. So, it is about making sure that we get the audience right and that we publish in the right way, and we are working with Chris and his colleagues to do that. I don’t know if you want to say anything Chris. Just
Ian Dilks - 2:05:47
to say, well just to agree with you. I think what is really important
Chris Day - 2:05:48
Ian Dilks - 2:05:49
Chris Day - 2:05:49
in this is how much, not just a question of publishing, but how well they are used to drive real, meaningful change in the way services are delivered. So, for each of
these reports, there is a really good question about who is this actually…, who are we trying to target with this? This has an audience internally about making sure we understand, going back to our curiosity point, what are we being curious about, how do we
make sure we understand what good looks like, and then how do we support people in those settings, improve the way they deliver it? And we know, as many other people know, a thick report is not necessarily what people want to wade through, what they
do want is, what is the practical guidance and information that they need. So, we are often working with partners, with providers and people use services to make sure the information is targeted to them, but each one of these will definitely have an external and
Ian Dilks - 2:06:44
an internal perspective. [unintelligible]. Just very quickly, I think again the sentiment that was reflected in the conversation prior to
Presenter 2 - 2:06:49
the break, is actually, I think, what we are really trying to do with the sort of partnership work, because [unintelligible] is trying to really look
at it through the improvement lens. And again, given systems are on the sort of journeys, very different in terms of the variation of outcomes, so I think the health inequalities talk that that sort of emanated was something that systems can take away and sort
of almost tailor to their sort of specific context. I think it is only through that sort of improvement and sort of innovation lens, I think we can make these products more sustainable as opposed to them just being a research report and something that was
done as a sort of moment in time and sort of make them more sustainable. So, I think the improvement lens is a very crucial way of sort of looking at the research side of things.
Ian Dilks - 2:07:44
Thanks. Sorry, Joyce, do you want to add? Yes, first of all I do want to…., this
Joyce Frederick - 2:07:49
is my first year of lead in research for the organisation, so I have been really proud to work with Jillian, Zoe and the Research and Evaluation Team on this report. I also want to say that this is cross sector, so it there is work
from people in Finance, Ops, Reg. Leadership, Data and Insight, who have all contributed to the report. There are a couple of things for me. I do agree with you, Chris, about you target the audience that the research is used, but people also need to
find research, whether it is on our website, in a place where they consistently say that is where you go for it. So, there is something that we need to create where people know where to go and look, even if they didn’t know it was
out there in the first place. I also think that we have to continue the impact of our work, so we are going to look for continuation of the research budget and the funding to do, because this is vital work that actually is influencing, as
you can see from the report, influencing the way people in services use information, but also the way we are using it in our assessments. I want to say that actually, in the past, we have got quite a lot of research history over a number
of years and it has been underused. So I have asked Jillian, for example, to pull together our research history on provider relationships and sector expertise. We are piloting, but there is a lot of research we already have and we are going to make a
drive to actually deploy that and make sure it does inform the decisions that we have made, because we know that in some circumstances we have made decisions that did not align to the evidence base. So we want to make sure that that actually is
the undercurrent through our recovery and all our effective decisions
Ian Dilks - 2:09:25
as well. Thanks Joyce, so I could say that next time we come back to talk about this report, it would be really helpful to pick that point up explicitly and just see how it has been used
in the value as well, as a cross-check that we are not using it, if you are with me, so thanks, Joyce. OK, well look, apologies, it was a little bit rushed, but a really good piece of work. Thank you very much indeed for putting
such a comprehensive report together, and Hasham, many thanks for joining us, sorry to keep you waiting, but thank you very much. If you don’t mind, I am going to move on quickly. Chris we have your report. Could we try and do this in 10
minutes rather than 15, please. Usual rules, we have read it, but it is an important piece of work, so there may be one or two points you want to pull out and then we will go to any questions. Thanks. Thanks Ian. I suppose the
Chris Dzikiti - 2:10:22
starting point, just to give people a bit of context in terms of why we ended up doing the report. So, it was after the conviction of Valdo for the killings of three people that we were asked by the Secretary of State to complete a
Section 48 Review at the end of January this year. There were three elements of that commission, the first was to look at a rapid review of available evidence related to the care of VC, the second bit was to us an assessment of patient safety
and quality of care provided by Nottinghamshire Healthcare Foundation Trust, and then the third element was to assess progress made by Rampton High Secure Services, which is one of the three high secure services in the country in terms of some of the recent CQC inspection
activity. I take it, like Ian said, people have read the report itself, so if I just quickly go to our high level findings in terms of the first two elements of the commission. What do we did was we separated the Commission into two in
order for us to get enough time to look at each element in order for us to bring the evidence that we were asked to sort of look at by the Secretary of State in the previous government, just for people to note that the Commission
was from the Secretary of State from the previous government. On Work Stream 1, we haven’t yet published this report. We are still aiming to publish the report at the end of July or just at the beginning of August. We will confirm the timelines once

4.0 Policy matters and external environment

we have finished some of the internal discussions we are having. On Work Stream 2, the key areas we forecast, or we picked up from that work stream was around access to care for people with mental health needs. The quality of care didn’t always meet
the needs of people in Nottingham. Then there was an issue around safety of services. There was a high demand of services, and also staffing shortages, which meant that they couldn’t meet that demand of the needs of people in Nottingham and people were not always
kept safe, as a result of that high demand. On leadership and governance, leaders were aware of the risks and issues within their trusts, but unfortunately they were not proactive in trying to address those issues. They were sort of reactive to addressing the challenges they
were facing, and there was also an issue around system level working. You know, there were issues around communication between services, and also which meant then there was no consistency in terms of the continuity of care for people in Nottingham. On Work Stream 3, there
were also issues when we looked at Rampton, which is the high secure like I said. Quality of care was a big issue in terms of, some people who were deaf, they didn’t actually get people who could communicate with them, with the skills that were
required to communicate with them. There were issues around inconsistencies in terms of monitoring patients’ physical health which meant the issue around patient safety was a high risk within Rampton, especially after people had been given rapid tranquilisation. Staffing levels were a big issue in terms
of, actually the service did not always have enough staffing to respond to the needs of patients within Rampton. There were also issues around leadership and governance and we know that the Trust had already started taking steps around trying to address some of the issues
on leadership and governance within Rampton. So, at the end of the review, we had recommendations that we gave. There were a set of recommendations we gave which were directed to the Trust itself in terms of some of their inpatient services and some of the
community services. But also we took this opportunity to make some recommendations, because some of the issues we discovered within Rampton, and within Nottingham itself, were issues from our own intelligence. We thought, actually, it is not just on this organisation alone, some of those were
much wider across the country. So we made some recommendations to DHSE. We made some recommendations to NHS England in terms of some of the improvements we wanted to see in terms of mental health services. But we also made some recommendations to us, to CQC,
and you will see in the paper the two main ones in terms of us actually looking at community mental health services because we think, actually, this is the starter of actually looking at some of the quality issues, at some of the patient safety issues
within community mental health services. So, when I take the opportunity between now, in the next coming years to look at the services within community mental health services across England, and also you know the ferocity to improve patient services and patient experience. So, I will
leave it there Ian, unless there are other questions people wants to ask. Thanks very much indeed Chris. Belinda, I knew you would be
Ian Dilks - 2:15:47
first. I have got loads of questions, but in this, I haven’t got time
Chris Dzikiti - 2:15:52
to ask them all, so I am just going
to ask the one I think is the most critical, and I think that is about
Belinda Black - 2:15:58
Rampton Hospital that for years, five or six years, it has been rated as “inadequate” or “requires improvement”. So that clearly means that the patients there are not getting the
right care and treatment and support. I just wonder as regulators, how long can we allow that to continue? Because it has gone on for six years now. We haven’t seen any sort of massive improvement, little improvements up and down, up and down, and I
just wonder what your thoughts are about that in the longer term.
Ian Dilks - 2:16:27
Chris Dzikiti - 2:16:32
Thank you. Thank you Ian. For five years we went into Rampton and has always been “inadequate” and “requires improvement”, but on this occasion, because it is high secure, so every five years each
high secure has to get a licence to operate as a high secure. And we took the opportunity, actually, because there licence was due for renewal last year, and part of our work was because we have seen some concerns within Rampton, we had done some

4.1 Rapid review update: Nottinghamshire Healthcare Foundation Trust (incl Rampton Hospital)

enforcements and we had escalated our enforcements in terms of how we supported Rampton. For example, admissions into Rampton, we restricted those admissions. Every admission to Rampton has to be signed off by CQC was one way to make sure when people come into Rampton, they
are receiving safe care and safe treatment. So, that is why we have restricted those admission. That is one thing we have done. The second area we focused on was, instead of them getting their licence for five years, we recommended actually they get their licence
for 12 months to give us an opportunity to continuously assess them over 12 months, to see whether there are any improvements we are expecting to see, and I think this is the reason why Rampton ended up being part of the Section 48. It was
because of some of the work we were trying to do and what we have tried to do over the last few months, and also going to the end of this financial year, is constantly actually using our Single Assessment Framework in terms of actually going
into Rampton on a monthly basis and looking at different quality statements to try and see if there is any progress. The trust appreciates that approach, which is sort of continuous improvement methodology, and I think this is where we are starting to see actually if
SAF is implemented the right way, you actually deliver what you are trying to deliver with SAF So, for example, by the time we get to end of this financial year, we would have completed at least 40 to 50 assessments within Nottingham, using SAF. So,
you can see actually if you apply it the right way, and engage the system, and engage the providers, SAF does actually work. So the reason we are doing that, we want to make sure we can give some reassurance to the government, and to the
new Secretary of State, in terms of the progress they are making. The only way we can make that progress is continuously going into Rampton. So to answer to your question, we have never been here before, where we have given an organisation, or where we
have recommended for [unintelligible] to get 12 months of licence, and if they don’t get that improvement within 12 months, our recommendation is then for the Secretary of State to look at an alternative provider, and we have never been there before. So, we think this
way actually will help the provider itself, and if I can just give you some reassurance, we have been going into Rampton every month. We are starting to see the progress we were sort of expecting in terms of the safety domain and caring domain. We
are starting to see some changes in terms of improvement, they are maintaining in terms of staffing levels, they are maintaining it. They are also working with other two high secure services for support as well, they are doing some work around culture transformation work, and
we think the progress they are making, they might be able to sustain it. Thanks Chris. Stephen, one last question. Chris, thank you. A
Ian Dilks - 2:19:50
Chris Dzikiti - 2:19:53
really helpful report and great work that you and your team are doing. I wanted to just ask if you could say
a bit more about your first recommendation because, looking in depth at the standard of care in community mental health across the country, it sounds a great thing to do. Do you kind of have in mind something like the maternity service review that we did?
Stephen Marston - 2:20:15
And I am kind of interested. I don’t think the Board would normally get involved in deciding the programming of inspections, so kind of what are you asking specifically of us as a Board? Because it sounds like a fabulous thing to do, but we should
just get on and do it, but what are you actually asking of us? So, I guess I suppose for the Board to take note of what we are planning to
Ian Dilks - 2:20:42
Chris Dzikiti - 2:20:45
do in terms of, we want to use the same methodology we used to own
the maternity way of working and for us, I suppose, it is also for Board to see because, I suppose mental health is one of the priorities for the new government and I think we need to align ourselves as well with those priorities. So, for
us, looking at, you know, the commitment to mental health services. I think actually one element of what we are trying to do is patient experience, and we’re talking more and more of patient experience, and staff experience. So if we look at community mental health
services, we are aligning our priority with some of the priorities that Kate is talking about, about credibility, about improving our operational performance and through this way, that is exactly what we are doing. So, for me, it is for the Board to take note of
actually we have already started doing some work in trying to deliver some of the priorities that Kate spoke about earlier. OK, thanks very
Ian Dilks - 2:21:45
much Chris. Let’s pause it there. Chris many thanks indeed, and I think we have probably said it before, but many thanks
for a great piece of work. Keeping moving on quickly, we have on the agenda two policies, we haven’t much time to spend on them, so I’m going to work on the basis that if people are happy, we will approve them and if they are
not happy, if there is major discussion, we may have to defer that discussion and take it offline. The first one here is, handling and responding to a matter of concern. Tyson, it has got Rebecca and Karen down here, but are they here, are they
going to join us? I think they are going to join us to hear, listen to the discussion, if there is any. All I was going to say is that.. How do they know, how do we make sure we get them in? Sorry, not clear…
As well as introducing Rebecca and Karen, it was to say that I think it is a very clear policy, a very welcome policy and the Board is asked to approve it. Yes. As I said we are very pushed for time, so I am going
to work on the basis for this and the next one that if people are…, we will take a few quick questions, if any. If people on the Board are happy, we will deal with it, if there are major issues, though I might take it
offline or bring it back rather than prolong time today. Can you just, so people had the chance to read, I think it was circulated in advance. Can you just very briefly summarise why this is needed? I don’t mean as a concept I mean why
this update is needed and what is different, and who is the policy owner. I would like to ask when policies come to the Board in the future, it is probably aimed more at the Secretariat this, but can we always be clear who the policy
owner is and the proposed review date. I mean it may be at the moment we are having much faster review dates on a number of things, but I think if we are to approve a policy, we need to know who’s the owner. So, can
you just say please, sorry to rush here, but highlight what has changed, what is important and clarify for us, who the policy owner is? OK thanks, Ian, just to say the purpose of this is actually, of
Presenter 1 - 2:23:59
this policy, of handling information of concern, is
very much part of the Listening, Learning and Responding to Concerns Review, and so it is very much about the roles and responsibilities of our staff about handling information that comes in, and we didn’t have a policy that set that out so that is why
we needed it. I am going to hand over to Karen who is one of our senior specialists for safeguarding in closed cultures to answer the specific questions that you have asked Ian, about the policy and the other pieces. Thank you, so in terms of
Presenter 2 - 2:24:37
the policy owner, then that will be Rebecca, and supported by Lucy Wilkinson who is the Head of Equity and Rights, who is our policy lead for this particular policy. In terms of the review dates, it will be a bi-annual review with, unless otherwise indicated,
and we are expecting that we will need to make updates following piece of improvement work that has just been stepped up. So, as part of the work from the Listening, Learning and Responding to Concerns Review, and through some of the audit work that we
have carried out throughout the transformation. We have identified that we have improved in timeliness around responding to the highest priority of information of concern, in terms of making referrals onto the local authority where there is safeguarding risks that have been identified. But, as a
consequence of that, we have also identified that we are sending some referrals that perhaps need not have been sent so that has led to a quality improvement piece which we are starting with a rapid improvement event in October. Depending on the outcome of that,
or once we have got the outcome of that, that will indicate an initial review ahead of that bi-annual. Thank you very much for that
Ian Dilks - 2:26:08
clarification. I mean, you did say on the cover sheet that it replaced something else, but you are implying that it
is rather more significant than merely a simple update. So, I mean I am going to suggest that, since this is really quite new and given our fundamental idea is we get it right, that, even if the default review is normally over two years, pretty
much, as you have said, I think it would be helpful to at least to consider in 12 months’ time, whether or not, on the basis of experience of implementing something that is relatively new, that we decide whether or not we need to review it
or not. But I think seeing how it is working in practice, in the current environment, and nevertheless discussing would be a sensible thing to do. So, given that, so this is relatively new, we are being asked to approve it for use for a year,
and see how it goes. So, I have amended the approval ever so slightly, just to clarify that. Comments, questions observations from colleagues? Charmion. It is welcome, it is great that we are on the
Charmion Pears - 2:27:17
journey. Just a couple of small things. For me, one, it would
be great to have a section on measurement, how we measure it, we are getting some of the measurements through, but I think it would be useful to talk about how we measure effectiveness and handling information of concern. So perhaps something around your governance paragraph
around that. And I just wondered if there was a reference through, after RGB through to RGC, the Committee that sort comes up, how we look at some of this which wasn’t in there for me, but otherwise support it. Yes, absolutely, through the Reg. Leadership
Presenter 1 - 2:27:48
Ian Dilks - 2:27:49
group meetings, we will be looking at performance data in terms of KPIs routinely, and sharing that and working with our network colleagues around that. And any changes or gaps will be followed up in terms of the end-to-end process that we are going to be
looking at and the quality improvement review that Karen has already referenced. So any changes in the policy or process will then be fed into the RGC. OK. Regulatory Governance Committee.
Presenter 1 - 2:28:18
Ian Dilks - 2:28:19
Presenter 1 - 2:28:23
Ian Dilks - 2:28:23
You were listening. Any other questions or comments? I mean, if not…, Mark. I think what we want to
come to RGC is what is the assurance that we are actually doing this,
Mr Mark Chambers - 2:28:36
rather than the details review, the review of the policy. I think that is the point about ownership as well, to make sure somebody is actually tracking this, measuring it, making sure
it actually happens. Yes. So, currently we are rolling out training in
Ian Dilks - 2:28:54
Presenter 1 - 2:28:54
Ian Dilks - 2:28:55
terms of Level 2 and Level 3 and some of that is online, but Level 3 is face-to-face. The feedback we are getting from staff is really positive in terms of the content and
the learning around that, and obviously we need to keep that under review and will continue to track and trace in terms of people’s learning, and if there is any gaps. So yes, absolutely, that’s absolutely at the front of our minds. So, I think you
have asked for approval, we are giving approval, but default assumption is since it is so new, let’s look at it in a year’s time, and one of the things we would consider then is the evidence the RGC - Regulatory Governance Committee, I don’t think
I need to say it again - the RGC has had as to the effectiveness or otherwise of the new policy. So, alright, thank you very much indeed. Sorry to rush you but people seem to agree, so thank you for that. Health and safety policy
is down under Max Hood. Is Max outside? If you see Max on the way out, would you ask him to come in? Max, hello, thank you for joining us. Apologies for keeping you waiting, actually it is not too long, but we are running late,
so we will have to keep this brief. I have said for other policies, I am working on can apply this that if people are broadly happy to approve, with a couple of questions, we will deal with it, if there are major issues, we haven’t
time to debate today, so we will bring it back. Can you, I have said when policies come here, I want to be clear who the policy owner is and the normal current review period. My understanding in this case is that no other Committees have
seen it, but I know that Charmion personally, based on experience, went through a number of details, she and I had a brief discussion. My understanding was that this was more of an interim update we have incorporated into other things we need to do, but
it is worth another round and look for a number of other things that we ought to consider. I will ask you to explain that, Charmion, in just a moment. So, Max, can you just - points of doubt - who is the policy owner? Can
you just spend a minute or so, no more, summarising what has changed that we should be aware of. I am going to ask Charmion to give her personal views since she has spent more time on it, and then we will see whether we are
happy to approve it or not. Thanks. Thank you. Policy owner is Donna
Presenter 1 - 2:31:22
McTernan who is our Health, Safety and Workplace Manager, and is part of my team. It has been recommended by Charmion that we move this to an annual update for the Health and
Safety Policy, so sort of be bringing it back on an annual basis. The main changes were to reflect structural updates in CQC, focus more on individual responsibilities for everyone across the board, taking out some of the wording like delegating responsibilities to make it clear
that responsibility still sits with people in various roles strengthened language around zero tolerance, work-related stress, and then we have changed the risk table towards the rear of the policy, which sets out the main risks for colleagues who work in CQC. So that, in summary,
are the main changes, and a few other bits and pieces as well, and we plan, subject to agreement, to do some communication around this following agreement just to reinforce with people the importance of the policy, what their roles and responsibilities are, particularly focusing on
some of the prevailing risks at the moment. OK, so just want to make
Ian Dilks - 2:32:40
clear in my words there is no fundamental change to scope or intent, but quite a lot of upgrade, let’s put it that way, to make it fit and relevant to new
structures in the organisation, and to deal with a few specific deficiencies we knew about. So, Charmion, I know you spent quite a bit of time looking at this, can we have the benefit of your views? I know it’s not a recommendation, but what are
your views? So, we spent some time, I think Max has highlighted it is
Presenter 1 - 2:33:08
Charmion Pears - 2:33:10
good practice to review this annually, so we should move to reviewing it annually. We do need to be clear in terms of the roles and responsibilities, including our own as the
board. So, we have talked today about what reporting we should be getting, and looking at [unintelligible] and incidents and how we close those out. I think, like all policies we need to look at tone and how we simplify, so the year is a good
period for us to sort of look at those elements. But really importantly, as Ian alluded to, I think, what’s important with this, as with all policies, is we link it to the mandatory training and make sure we have the right training. We link it
to the reporting through the various committees, so it is the broader governance to support the policy that, I think, needs the work. I think over the course of the next year we will be able to refine that, pull that all together and come back
and then look at what revisions are required to the policy, but to take us forward with that real clarity of accountability, I think it
Ian Dilks - 2:34:10
is a step forward. Thanks. My proposition, having heard that, is that we approve this as an upgrade, it is better
than what we have, so why wouldn’t you do that, but on the understanding that there are still some wider things we need to look at as part of a review which we will schedule in as soon as practicable. Are people happy with that as
an approach? Yes, OK. Thanks very much indeed, Max, appreciate it. So just to move to a few final things. The Audit and Risk Assurance Committee, we have an annual report and an update here scheduled. We probably cannot, it is too time-critical, and our public
can’t give justice to the time. So, I agreed with Charmion that we will postpone that update, and much of it was oral, to the next Board meeting, so I hope that is okay. By that stage actually, they will have had another Audit Risk Assurance
Committee meeting. That said, is there anything you wanted to highlight, would it be worth at least just commenting on the signature and filing of the accounts? Sure. So, our annual report and accounts
Charmion Pears - 2:35:27
for the 2022/23 period had been signed by the CNAG and are
going to be laid either on the 25th or the 30th. So, we have worked through that and when I come back with the update we will be talking more with the Board around improved risk management and control procedures. And obviously we have swapped our
auditors now. So, our previous internal auditors were Price Waterhouse Coopers. we are now with GIA, so we will be able to report on the first set of audit reports that are coming through under the new annual plan. I mentioned earlier, that we will be,
Ian Dilks - 2:36:06
obviously we are now in the cycle of the next year, so that will be coming back fairly shortly. Any questions for Charmion, either on that or anything you feel you need to know about the ARAC that cannot wait until September. OK. Charmion will always
answer questions offline if there is anything you don’t want to raise now. Mark, the Regulatory Governance Committee, we do have a short report in here from you. I mean it is pretty self-explanatory, is there anything you want to, we do actually now have a
couple of minutes, is there anything you would like to highlight to the benefit of colleagues? No, I think there are just two things that
Mr Mark Chambers - 2:36:43
I would have mentioned going through the report, but I think the detail is all in there. You know, first to emphasise how
valuable it was to have a data informed pack, and to have the MI that we have been pushing for, for quite a long time, in the pack and available to the meeting. I think, you know, it was a challenging and robust meeting, but it
was much better-informed than some of the meetings have been in the past so that was great. So, thank you to the team and to, I think, Steph in particular who helped us get to a lot of that, and hopefully that will continue to evolve.
Also, we talked about the great work that has been done in terms of core performance and the great work that has been done in developing pathways to resolution of some of the operational backlogs. I was also going to emphasise how grateful we are to
our Operations colleagues, for all the incredibly hard work that has gone into doing that, so there’s the other thing I was going to
Ian Dilks - 2:37:52
mention. Thanks Mark. Any questions? I would add, not so much to report just observe, I mean the Regulatory Governance Committee is
a unique committee to this organisation, for obvious reasons, I think, but for the benefit of those listening, it is the main mechanism for the Board to look at the evidence of the effectiveness, or otherwise, of our regulatory, the way we discharge our regulatory obligations.
It is always important, but I think it is probably going to have a particularly important role over the next while as we go through the Recovery Plan because changes are going to be made, and we do need to make sure that the changes are
not just evidence-based, as you said, Kate, but then on delivery are what is expected. So, Mark and colleagues, ever more important. Thank you very much indeed for that. We have some minutes here from the previous Board meeting, any comments on those, or can I

6.4 Minutes of the previous Public Board meeting held on 22nd May 2024

take them as approved? we have agreed for the benefit of anyone listening that we will try to get a shift in the balance slightly in the way the minutes are recorded. They do, at the moment, as some colleagues pointed out, tend to be a
little bit more on the reporting, and perhaps less on the subsequent discussions. So, we are going to try and fix that balance, not of the accuracy of the end conclusions, but we will try to alter the balance a bit. And then there are a
couple of matters arising still in here, so one was on LLRC. I would like to suggest that was closed by the discussion earlier, perhaps not in the way put in here, but we had a good discussion of LLRC, and some actions coming out of
that and approved a new way. So, I would like to suggest, if people agree, that is closed. Then the Ofsted point, that is due to come back in September not now, so I think we have got on top of those. So, we do have
some questions from the public which we need to take after the Board meeting, which is why I was keen that we didn’t run on. So, as far as the Board meeting is concerned, is there any other business from any colleagues? No, OK. Well, thank
you very much for a hard afternoon, been a long couple of days, but I appreciate everyone’s input. I will formally close the meeting down at that stage, so the next public Board will be on the 25th of September, estimated start time 2 o’clock, subject
to agendas. I’ve now got…, we, as listeners know, we do take questions from people who listen in and members of the public, and we actually have rather more this time than usual, there are five of them. So I hope the people I am going
to ask know that I am going to be asking about this. Joyce, the first one, I believe, is for you which says how does CQC review its ratings of “outstanding”, “good”, “requires improvement” and “inadequate”, so how do we review them? Thank you Ian, I did
know you were going to ask this question. So in terms of ratings
Joyce Frederick - 2:41:02
review, we keep all our frameworks under review and for engagement and previously consultation, we update frameworks accordingly. Where necessary, we have updated sections of our rating characteristics to keep pace with change
like best practice, or rise in public expectations or recommendations from other agencies. This had previously been on about a five-year cycle, but with the Single Assessment Framework, we have the ability to be more responsive. We do need to produce ratings characteristics for the Single
Assessment Framework. It does take time to do, because we don’t do it alone. We want to make sure that this is co-produced and we are going to be in the process of doing so, as well as information about how we describe our scoring and
how we describe our quality statements. So our new approach, which includes evidence and scoring against quality statements, will have that co-production, will make judgments, and we will do this work with providers and the public. OK. Thanks Joyce. Actually I could interpret that question in a number
Ian Dilks - 2:42:01
of ways, so thank you very much indeed for the response. I hope it answers the question. The second one is also for you, but I think much more straightforward, about how we will contribute to Lord Darzi’s investigation into the NHS. Yes, Lord Darzi is
Joyce Frederick - 2:42:19
doing, on the request of the government, an investigation into NHS performance. The review will offer some valuable insights for government on the challenges facing health and, I suspect, some of the care sector as well. We will be reaching out to Lord Darzi to offer
Ian Dilks - 2:42:39
our support and insights. Thank you. Tyson, move to you, I believe, so how does CQC plan to improve the frequency of its inspections of dental practices, many of which haven’t been inspected for at least 10 years? Thank you for the question. The Oral Health
Tyson Hepple - 2:42:55
Team started assessing dental practices using the Single Assessment Framework in May 2024. Once the team has been using the framework and the regulatory platform for a longer period, so they can measure the business as usual time it takes to complete an assessment, we will
be able to decide whether increasing the 10% model is possible. We will continue to innovate to increase the productivity, nonetheless, for example, we are currently exploring which element of our dental assessment can be put completed off-site. This should reduce the burden on a provider
at the point of inspection, but also improve our efficiency. Thank
Ian Dilks - 2:43:33
you. OK. Thanks, Tyson. Chris Day, a question for you, actually it starts of as a statement, rather than a question, so you may decide how you want to answer this. But the statement begins, CQC is
failing to listen properly to the public and has a tendency to downplay serious concerns raised by the public about NHS Trusts. You may wish to comment on that opening statement, but then the question goes on to say, what is the Board prepared to do
to gain the trust of the public? And is CQC prepared to engage meaningfully with families who raise serious concerns? So it is down to you, there is a limit to how long an answer we can give, but there is an opening contention you may
wish to comment on. I think it is down to you, but I will see if Kate wishes to add, and also how is the Board seeking to respond, so I may add a word. OK, so first of all, I think the best place to
Chris Day - 2:44:27
begin is to say that the voice of people who use services and in fact the voice of staff at the front line of care is critical to our work. Colleagues may know we get, on average about 300 every working day, we get 300 pieces

7.0 Any Other Business

of information coming from people who use services and about 50 or so coming from the front line of staff, and we use that in about 50% of inspections. So, 50% of inspections will include something from people who use services or people at the frontline
of staff. I will give a couple of examples to make that point and I will come back to the point about how we involve families and colleagues at the front line of care. Recent examples of where we have involved people who use services, Gloucester
Hospitals Foundation Trust, where we have recently completed an inspection was entirely prompted by members of the public talking to us about safety concerns they had around different aspects of service. Interestingly, we went into those services, we were able to triangulate what we had seen
from, or heard from people who use services with what colleagues at the front line of care told us, and with both of those, we were able to take action against the organisation. There was a warning notice issued and there is emergent improvement that has
taken place as a result of what we did. Similarly, but more focused on frontline colleagues, Bedford Hospital where we’ve responded to concerns about staffing and culture which again enabled us to - this is about maternity services, in particular - and features in the HSJ
were able to use that to demand improvement, and there is now an improvement team supported by our work going in to look at how they can support the organisation to drive change. I think what is really clear is those things are only possible if
people trust us with their information. Perhaps another example, we have been working for a long time on people’s access to and use of learning disability services, and where we have been working very closely with both people who use services and their families, to try
and first of all understand people’s experience of care, but also try to drive change in that care. I am absolutely certain there is always more we can do in that space, and it is really, really important that people trust us with the information. That
is why I talk about the volume of that information that comes in every single day, because that is what helps us, what guide us in our thinking. As recently as last week we were talking to a group of families who were using the service
in the north-east of England about their experience of that service prior to going into a service. So that is, in a sense, an active piece of work that we are doing at the moment. Just going back to a conversation we had slightly earlier, part
of the role of this is, how do we use that information without necessarily exposing people or exposing families to a feeling that they are putting themselves at risk? Some of the ways in which we have done that more recently have been to take what
family members are saying, triangulate that before we go in so that we can go in without having to expose individual whistleblowers to any form of or recrimination. I would say that we do not always get this right. There are examples of where we have
let individuals down, but our goal and the way in which we want to use that information is to drive improvement in services and, although from my perspective, there is much more we can do to make that difference, I know that the work we do
today is driving change in the way services operate. And indeed, I
Ian Dilks - 2:48:10
think we have seen examples at the Board. Kate, I wasn’t going to add an awful lot, but it just seemed to me that there is a direct link between the answer to the
question and what you said earlier, so I mean, maybe, I am asking for no more than confirmation, if you want to comment. Absolutely, so I talk about my third priority being credibility for us as an
Kate Terroni - 2:48:29
organisation, my second priority being operational performance. So we
need people to continue to talk to us as they are families, people who use services, and we need to demonstrate, continue to demonstrate to the public and the people in the health and social care workforce that we take that information really seriously, and it
does inform where we regulate. Thank you. …which is all part of the
Ian Dilks - 2:48:52
Board consideration. So last, David we will give you a speaking slot, really quite a long question. As CQC has had nearly 14 years to implement Regulation 20, the duty of candour, to
enhance transparency and patient safety, it appears that CQC is failing to address this regulation effectively, as reflected in the very few prosecutions. So why so few prosecutions? While incident guidance has been defined by CQC for other key regulations to assist inspectors, none exists for
the duty of candour, which is a troubling omission on behalf of CQC that should be of concern to the public. Why is this accepted by CQC? There’s about four questions in there, but I’ll leave it to you to address it. Thanks, Ian. So, I
Mr David Scutt - 2:49:40
think there are six points to make in answer. Firstly, CQC was given prosecution powers in April 2015. Practical guidance in relation to the duty of candour regulation, which is Regulation 20, is available to CQC inspectors and other CQC colleagues. Thirdly, duty of candour is
often dealt with as part of wider regulatory enforcement action, for example, we might choose to use a requirement notice or a warning notice, and CQC has taken over 300 regulatory actions since 2014. So CQC prosecutions are reserved always for the most serious cases and
where it is proportionate to take action, and that is taking into account all the facts and circumstances surrounding the alleged breach. CQC has responded to the Department of Health and Social Care’s call for evidence as part of its review into the operation of the
regulation. We agreed the purpose of the regulation was generally well understood by providers, but there were some issues clearly with compliance and the technicalities of the regulation itself. So, we made some recommendations to the review, including whether CQC should be specifically notified by providers
when they consider a notifiable safety incident triggering the duty of candour, such that is in their view which is what the regulation says, has occurred. And perhaps more importantly, for there to be a greater focus on Part 1 of the Regulation, which is the
general duty to be open and transparent about safety incidents because that is the cultural and behavioural expectation at heart of the duty. Ok. Thanks very much indeed, David. Long question, a number of
Ian Dilks - 2:51:24
questions, comprehensive answer, thank you. That was the last question, so once
again, thank colleagues. Thank you for those listening in and we will see you again in two months’ time.