CQC Board Meeting - September 2024 - Wednesday 25 September 2024, 2:25pm - Care Quality Commission

CQC Board Meeting - September 2024
Wednesday, 25th September 2024 at 2:25pm 

Agenda

Slides

Transcript

Map

Resources

Forums

Speakers

Votes

 
Share this agenda point
  1. Ian Dilks
Share this agenda point
Share this agenda point
  1. James Bullion
  2. Chris Dzikiti
  3. Ian Dilks
  4. Charmion Pears
  5. James Bullion
  6. Ian Dilks
  7. Stephen Marston
  8. James Bullion
  9. Chris Day
  10. Mark Chambers
  11. Ian Dilks
Share this agenda point
  1. Shirley Hallam
  2. Christine Asbury
  3. Ian Dilks
  4. James Bullion
  5. Ian Dilks
  6. Claire Oakley
  7. Joyce Frederick
  8. Ian Dilks
  9. Charmion Pears
  10. Mark Chambers
  11. Ian Dilks
  12. Shirley Hallam
  13. Ian Dilks
  14. Chris Usher
  15. Ian Dilks
  16. Stephen Marston
  17. Ian Dilks
  18. Mark Chakravarty
  19. Ian Dilks
  20. Chris Day
  21. Belinda Black
  22. Ian Dilks
  23. Shirley Hallam
  24. Ian Dilks
Share this agenda point
  1. Joyce Frederick
  2. Kira Haynes
  3. Ian Dilks
  4. Ali Hasan
  5. Kira Haynes
  6. Ali Hasan
  7. Joyce Frederick
  8. Charmion Pears
  9. James Bullion
  10. Christine Asbury
  11. Ian Dilks
  12. Ian Dilks
  13. Chris Day
  14. Mark Chambers
  15. Ian Dilks
  16. Joyce Frederick
  17. Kira Haynes
  18. Ian Dilks
Share this agenda point
  1. Presenter
  2. Ian Dilks
  3. Tyson Hepple
  4. Presenter
  5. Joyce Frederick
  6. Ian Dilks
  7. Chris Dzikiti
  8. Charmion Pears
  9. Ian Dilks
  10. Claire Oakley
  11. Ian Dilks
Share this agenda point
  1. Ian Dilks
Share this agenda point
  1. Chris Day
  2. Presenter
  3. Ian Dilks
  4. Stephen Marston
  5. Presenter
  6. Ian Dilks
  7. Chris Dzikiti
  8. Ian Dilks
Share this agenda point
  1. James Bullion
  2. Ian Dilks
  3. Mary Cridge
  4. Ian Dilks
  5. Christine Asbury
  6. Stephen Marston
  7. Mary Cridge
  8. Ian Dilks
Share this agenda point
  1. Presenter
  2. Ian Dilks
  3. Stephen Marston
  4. Presenter
  5. Christine Asbury
  6. Presenter
  7. Charmion Pears
  8. James Bullion
  9. Presenter
  10. Ian Dilks
  11. Joyce Frederick
  12. Ian Dilks
Share this agenda point
Share this agenda point
Share this agenda point
  1. Tyson Hepple
  2. James Bullion
  3. Ian Dilks

1.0 Opening matters

2.1 Report from the Executive Team

Ian Dilks - 0:00:01
Well, good afternoon everybody and welcome to the public will be here with the care quality
Commission and this is 25th of September 2024 at about 2 .30. Many of you would have been
dialing in to watch this live. Unfortunately we've had technical issues with the streaming
so hopefully you got that message from the website when you tried. So actually this is
not live, it is a recording and we'll be posted on the site as soon as we can. Certainly by
first good morning, or three, or most evening are apologies. But as you may know, we are
in a different room today and the personas available are not quite as good as they are
in our own office. Given that, we have a few apologies for what we seem to be hit by a
flu, the number of people not being available at a relatively short notice, and that includes
David Korsalak will be one of our NEDs. Kate Turoney is not able to be with us, is not well,
and Jackie Jackson is on vacation at my HR. James Buggly on my left is deputising Kate
Hudson's one standard as the chief executive today. And Claire Oakley, so the opposite me,
is our usual quality network rep. Well, he's not the usual one, but as usual we have an
and today in this class. So thank you very much for joining us.
There are some other opening remarks I want to make in a moment, just before I do that.
Let's sort out the sort of stuff. Declarations of conflicts of interest. There are any I
did note earlier that Stephen has a couple of other posts taken on that doesn't change
anything from what we reported previously. I think at the moment that's all I need to
say unless there's anything else. Are there any other points that people want to make
sure that we discuss or put on the agenda that are not here? Okay. Before I end up with
James to talk about the executive team, and I know this is a board meeting, but we're
that this is the line that we recorded. We don't think a lot of people are in particular
conduct of the board in relation to important issues like recovery from some of the position
problems we currently have. And that includes our staff who want to know what we're doing.
So I thought I'd just say a few words about the meeting we had earlier this morning. I
think everyone knows that we have a public board, we've also had a private board, we
metrosonic. The meeting was dominated by discussion or some of the challenges we
face at the moment and how we're going to recover the situation as well as
three hours of discussions. I think it's probably worth, I want to emphasize that point,
but it's probably worth saying a few things about what we discussed. The
executive put together a very comprehensive approach and a series of
actions as to what we should consider doing to deal with the challenges that we currently face.
It was a very good discussion. The executive team I think have personally
recognised the seriousness of the challenges. It's the most comprehensive report of that nature we
have ever received and we did give thanks and I repeat those thanks to the team for putting it together.
One of the problems we face is there's a little uncertainty. We're not in a position where you
can divide all the facts and exactly what you're doing, develop a bandwidth with certainty.
We can't do that. There's a lot of unknowns. And therefore, any approach we adopt has to
recognize that. But I think there's been a very logical approach adopted to deciding
how to navigate through that. One of the consequences is the proposal of the use of pilots in certain
cases to test alternative scenarios and see how they work. That has to be sensible. The
last thing we want to do now is to make new jerk reactions, change something
without having properly considered and assessed all the impacts and as a result
making things work. A good outcome, but not making it better. It's impossible to
make it work. So those pilots seems very sensible.
The last thing we want to do now is to make new jerk reactions,
change something without having properly considered
and assessed all of the impacts,
and as a result making things, well, a good outcome,
we're not making it better, it's impossible,
could even make it worse.
So those pilots seems very sensible.
We also had a long meeting with Mike Richards.
I think everybody knows the work that Mike is doing for us.
Loosely labeled around looking at
the single assessment framework,
but he's looked a little bit more.
And he has others working with him
James Bullion - 0:05:10
to make sure we have a good coverage
across other sectors, in particular
across adult social care.
I mean, Mike is still work is going.
We don't have a report.
But we just felt it important that we need to move quickly.
And therefore, we invited him along
to talk to us this morning about his initial findings.
I'm not going to do any detail of that.
In any event, he is still working on it.
But I would summarize or categorize his thoughts
as some things that can probably be changed quickly,
and he's going to recommend should be.
And there seemed to be quite a close alignment between what
he was coming up with there and what
is in the approach that's being put forward
to us by the executive team, which clearly was,
to say, the minimum comforting.
There are other things he may come up
with that I think require a little bit more thought.
That's not to say, well, I don't think we heard anything.
we fundamentally disagreed with or thought we disagree with,
but some things do require a little bit more thought
as to exactly how you might do something or the time scale.
So in due course, when we've got Mike's full report,
one of the challenges for the executive
would be to go through in more detail
and make recommendations to the board as to how we should
respond.
So we gave full support to the approach
that the executive is seeking to adopt, which I think will be of interest to and comfort
to all of our key stakeholders.
We did pick up on a number of things that we want more attention to be given to.
I'm not going to run through them all, but just to give a few examples, I mentioned there
are pilots.
We're very keen to better understand the governance around those pilots so that we are clear how
we go, how we assess the performance,
make as quick a decision as we can,
and are properly thought through how we'd
implement the recommendations.
So alongside that request for governance,
and I think that's particularly true where there may be
an overlap between pilots.
You know, if you go to a pilot and something happens
and you do something else and you look at the consequences,
what was the driver?
So a better governance, but also it's
going to be enhanced or regular reporting to the board.
Our next scheduled board meeting is two months time,
but we don't want to be waiting two months to look at this.
So there'll be enhanced reporting to the wider board.
There are some specifics around ratings
and how they're described that we
would be asking the regulatory governance committee that Mark
Tramger's chairs to look at in more detail in a couple
of weeks' time.
There are one or two areas where we
want to make sure that we're putting
the right amount of effort into identifying and monitoring
risks.
I mean, by definition, if the situation in some cases
are a little uncertain, and we are doing,
we're having to make educated assessments
on what approach to take, there is a possibility
that will increase risk.
So we need to better understand what those are.
And then last, the point I've just touched on
is looking at Mike Richards' findings
when we have them to assess what the impact of that would be.
So I think that's pretty much all I always want
to say about the discussion.
There is one point I would finalise on, though, which I make this comment particularly for
the benefit of our staff.
One common thread, I think, from a lot of our discussions is the recognising the impact
on our people of the stressors over the last few months.
But on the much more positive side, as colleagues who saw me speak at the operations conferences
this summer will know, I did make the comment that when you look at the negative feedback
that we got in the people surveys was,
I wouldn't say it was good in the sense
that I'd much rather have very positive feedback.
The good thing was that the feedback was given
in the way it was because people care.
And that's an important foundation
for all of this to be built on.
And in that context, one of the points
that Mike Richards left with us,
well maybe it was two points I'd say.
One is everybody he spoke to wants a good CQC challenges
for us to deliver it, but there is a strong demand
it adviser or not, alright away.
I didn't want to create the
observation directly to the panel.
I don't think this is a place to go through a great detail.
There will be communications later on what all of this means.
But James, I don't know whether you want to add,
and then I'll ask you to go straight into your report
anyway.
Thank you.
Thanks, Chairman.
And so as you've described, there
are really helpful discussion this morning building
on Kate Tyrone's work and her priorities
around giving our staff the tools, increasing our productivity and our effectiveness, and
then restoring our reputation.
So as you're saying, we will communicate about the detail of this, but I think this
morning's discussion gives us a really clear direction of travel for the organization.
We have put together a series of proposals.
I do want to thank and acknowledge the work within CQC of many staff that have worked
above and beyond to bring together a really detailed approach and to have done really
thorough analysis of the options for us.
As you're describing it, it is rather an adaptive process where we will be implementing change
and then adapting that as we go based on what we find, but in a programmed way, in a risk
managed way and in a way that has a really effective accountability and reporting arrangement
within CQC and to this board.
Last, I won't go through all of the detail now. I think it's helpful to signal to people
that we do feel that we're going to need to change the way we're interacting with our
new computer system, the regulatory platform and take an approach which for assessments
works away from that platform, again in a designed and safe way and making sure that
we manage and respect data properly. But would enable us to speed up and for our staff to
be out there crossing the thresholds and working to increase the number of assessments that
we undertake. We know as well that for our registration service who have worked incredibly
hard to get themselves into a better position, the regulatory platform is holding them up
and so we will be again writing to providers about a changed approach
Chris Dzikiti - 0:12:02
there, going back
to our previous method of registration with people but not losing anybody's work and
making sure that we communicate really effectively around how we will do that.
And then you mentioned Mike Richards review of the SAF and the work that Vic Rayner, Professor
Vic Rayner is undertaking as well for the social care sector. Notwithstanding we will
receive that report and act on it, in the interim we know that from our analysis there
are some changes that we need to make to the way that we are operating, not scoring at
our evidence category level but scoring at our quality statement level, for example,
and not taking into account legacy scores, for example, where we would seek to make quick
changes to those but then amend our approach long term based on the evidence and the findings
of Sir Mike Richards. With regard to our regulatory platform, we are still improving it, we are
investing in it, we are not, as it were, making a final decision about it but we do need to
independently evaluate how that system performs and to give ourselves a long -term direction
around that. And of course we have begun the process of
strengthening the numbers of staff in our operations service and accepting and working
on the very important recommendations from the Penny Dash review about the role of the
making progress there. And finally, we have already begun the work of re -establishing
relationship management with our external providers, both in pilot mode, putting it
back for NHS trusts at the end of this month and commencing work with social care providers
to the same effect. It will take us time to make those changes but it's a really important
symbol that we must reconnect as a mechanism of giving good customer service but also of
managing risk for the organisation. So that detail will be published, we'll be writing
out, giving a lot more detail about how that process will work but I really wanted to send
a signal through our broadcast as it were that we've moved on from accepting accountability
for the position that we are in and we're now into implementing change and making that
change sustainable. In terms of regulatory matters, Chairman, so I recognise the papers
will have gone in rather late for this, so I acknowledge that people may not have questions
yet on what is in there, but I just did want to highlight two matters. One is the publication
Ian Dilks - 0:15:03
of our maternity report and I'll hand over to Chris De Ziegle for a comment on that,
but it's a really important milestone for us as a Commission to have that in the public
to demonstrate that our effectiveness can be really positive and really emphatic through
work such as that. And then secondly the work that we are doing with local authorities on
local authority assessments where again we've published more reports. We are into reflection
mode on that work, wanting to acknowledge that during this baselining period we would
like to work with both local authority colleagues and directors of adult social services to
Charmion Pears - 0:15:46
learn how our process can be strengthened through looking at our processes and looking
at the impacts of our individual judgements on councils and how we have an improvement
agenda there. So I really want to thank local government and ADAS, the Association of Directors,
for their engagement with us on that question. Recognise that. It's always easy to implement,
it's always easy to sort of underestimate the amount of work you need to put into a
process like that and during baselining it's particularly important for us to learn about
ourselves as we go along as well as our regulation of local authorities.
And I want the Chairman then if I might invite Chris Nziki to make any regulatory insight
comments he might want to make.
Thank you.
Thank you, thank you James.
James Bullion - 0:16:36
So a few updates from us around, first one is on independent care, education, treatment
review. As most people know, earlier in the year the government asked us to lead on ICT
errors as part of supporting people with learning disability and autistic people who might find
themselves in long -term segregation. So as part of that work, we met with the oversight
Ian Dilks - 0:17:05
panel earlier this month to talk about some of the terms of reference
Stephen Marston - 0:17:08
and what to expect
from the two -year program to influence market shaping and also thinking about how we prevent
or support people to prevent and making sure that people have got right support at the
right time and reduce the number of people who find themselves in long -term segregation
going forward.
The other area we've been focusing on is also around how we continue to build our credibility
with external providers and organization in response to the DASH review like James was
talking about.
So we've got ongoing meetings with other stakeholders
like NHSE primary care to think about what work we can do going
forward, and also having one -to -one meetings that some
of our directors are having with medical directors
and directors of primary care to bring them on board
and also to explain some of the work we're
doing on the recovery plan.
On the maternity newborn safety investigation program,
From the end of July, we completed a total of 3 ,737 investigation reports with 340 live
investigations ongoing.
The annual report for the Maternity and Newborn Safety investigation for 2324 is planned for
publication later this year and it will reflect on the performance across the war year and
the work undertaken following the move across
to be hosted by CQC in October last year.
James Bullion - 0:18:38
And the final thing I'll mention is, like Jim said,
we published our National Maternity Report,
and which was a hard read,
and I would encourage others to spend time reading it,
and it focused on some of the challenges
that are facing maternity services,
but around environment, around recruitment
and retention of staff, inequalities and racism,
communication with women and families.
But what's really helpful is we also put in some recommendations
and also improvement tools to help services to think about the areas
they need to improve when they're thinking about maintaining services.
So we highlight the challenges, but we also help people to have solutions
when they think about the improvement work they need to work.
and we'll continue working with colleagues in NHS England
to think about the improvements that are required
in maternity services.
I'll leave it there if that's OK, Ian.
OK, thanks, Chris.
James, I'm also conscious that's regulatory.
Chris Day - 0:19:42
You did put something in corporate performance.
It may be that people haven't had,
from this table, a chance to study it,
although a lot of what is in there
I was the driver of some of the discussions we had earlier.
But perhaps I could just ask colleagues if they would like to have any questions for
James or Chris, either on the regulatory staff this specifically spoke to or in the reporting
documents that are also in the pack.
Jonathan.
Thanks.
I was just going to reflect on the fact that looking at the dashboard, it's good to see
that we sort of covered most of the items there, James,
that are in red in terms of the recovery plan
and items that are we picked up at RGC.
I just wondered, we had a good discussion this morning
on mandatory training and looking at how we're going
to look at that over quarters and the kind of training
that will be done and I think it would be useful
if we reflect that in here, because while it's red,
there is some significant progress that's being made
and the way it is being managed may sort of change
the dashboard, so it's just one that's worth reflecting on
post the meeting. Thank you, Chairman. Clearly, the change in the way that we approach spreading
out that training throughout the year and creating a management culture where actually
we don't think this is an addition to your work, this is the core of your work. And so
I think the previous approach we've taken where there's this kind of end of year or
do it at Christmas time type of culture, we're trying to get away from that and treat it
as a management issue and then when people have or haven't done their training, it's
the quality of that management conversation and understanding why that is or isn't happening
that is really important in pushing that improvement in the right direction.
Thanks James. Stephen.
Thank you, Chair, and thank you very much to James for all of the reporting. I mean,
Mark Chambers - 0:21:47
I do think we made some real progress this morning
in getting to the point of being able to agree
this is a valuable, important set of actions.
Now let's kind of try to drive momentum
in building the recovery plan
because I think that's what many of our colleagues
are now looking for.
There's a section in your report
about communications and engagement.
I don't know whether you could say a bit more about sort of how we now communicate through
to our colleagues and to providers, you know, that we were very clear about the actions
we need to take to address the challenges that we face and how that is going to be tracked
over time.
The other question I wanted to raise was something that isn't mentioned in this report, which
is about the Lord Darcy report and what do we think are the consequences for us. He made
some comments about CQC and sort of how can we best contribute as an organisation to the
thinking that's clearly going on about the future plan for the health service in the
light of Lord Darcy's report.
Thank you. Just on the general point about communications internally within CQC, we've
been hosting all colleague calls. We've had at least a couple of thousand of colleagues
on those calls in the last week or so where we've both prepared the communications messages
about the changes we want to make to the way that we're working, but also had a discussion
around the report and indeed the Dr Penny Dash report so that our staff feel aware of
those findings but also supported and that where we have or where we intend to make a
response that we are underway with that. In terms of the communications out about our
proposed changes then I will invite my colleague Chris Day to come in and just explain how
we want to utilise existing arrangements, but we see this as probably the most important
implementation issue for us. We need to get it technically right, but actually people
understanding what we're doing is probably the most important aspect of this. So, Chris,
do you want to?
Yeah, thank you. Thank you for your question, Stephen. One of the things that came across
very clearly in the all -colleague calls that we've had, but also in the conversations we've
Ian Dilks - 0:24:25
had with providers and people who use services is the need for clarity. So what was useful
in this morning's conversation is we got to some, I think some good decisions in terms
of direction of travel. What we need to do is take those and make sure that we can turn
them into actionable plans. So following this meeting tomorrow we've got some work just
to make sure that we've used what we've heard from the board conversation to form those
plans. We've then got two groups that are meeting to help us with the communications
and they'll meet regularly going forward. We've always had an internal reference group

2.2 Culture Change Update – Values, Behaviours & Leadership

and we've augmented it in recent times with particularly those frontline managers, deputy
directors as they're called, who are often at the heart of the communications out to
wider teams. So we're meeting with that group, not just to help share with them the conversation
we've had at the board today but also what that means in terms of each area because not
all areas of the business will need the same information but we want to try and make sure
that deputy directors are involved in the conversations around what we've talked about
this morning means in practice. We want to have those conversations with deputy directors.
Equally we want to have conversations with providers and people who use services. I've
been really fortunate this week I've had a number of conversations with providers and
to provide a group of representatives and I've got a further one tomorrow where there's
a real focus on trying to help us make sure we can communicate well to the provider sector,
to people who use services. So we've got again, alongside the Deputy Redecktress Group
and the WIDA Inter -centre communications group, we've got some trusted provider representative
groups that we're going to have conversations with again on Friday to help land the messages
Shirley Hallam - 0:26:13
externally and then the plan will be from there to be able to communicate well internally
to leaders and then to all colleagues and externally to trained associations and all
providers in the early part of next week. The key thing for me as well is not just that
we do this once but that we can regularly update with where progress is being made and
make sure people feel involved in that conversation. One of the things that we touched on this
morning was the development of assessment characteristics. Both colleagues and providers
feel that is very, very important in order for us to be a successful regulator and both
are very keen to be part of that journey. We need to make sure that we can show progress
in areas like that and so we'll have both a conversation around tone and message but
also in terms of time scale so we're clear to people what to expect and we aim to put
that together and revisit that probably weekly to fortnightly depending on the progress that
we need to make.
Thanks Chris.
Mark.
Thank you.
Just wanted to comment on a couple of things in the performance balanced scorecard, if
if I might, and to emphasize that at RGC we've been having discussions around call handling
and response rates at the NCSC. Our colleagues there are doing a really amazing job under
very difficult circumstances, delivering consistently to the service standards that have been set
set for them, but I think some of the month by month figures
illustrate the challenges of prioritizing high risk calls.
There are inbound calls that are more urgent and more
indicative of risk than others, and we
need to prioritize those.
So we've been talking about that,
but of course it's imperative that in trying
to solve that conundrum, we're ensuring that our staff are properly supported and adequately
resourced to deliver against the standards we do set for them. But that is on the radar
screen for us at RGC and we'll talk about it at our next meeting. But again, thank you
to our frontline staff who are doing a great job there.
the pressure people are under but when people produce
exceptional performance in those circumstances we really
should make sure it is recognised.
James, is there anything you want to add?
No.
Any other questions for performance or regulation?
OK, well, I will go from there.
Thank you very much indeed, James and others, both for your
further information.
summary of this morning and then for that report there. Let's move on to some
of the other standing business then. So we've got an update on the culture
changes. So the agenda says down cutting down is one of those that's
been struck down with flu over the last 24 hours. So we should be joined by
Shelley Hallam from the Academy. I think everyone has met before.
.
Can we just check?
Here we go.
Christine Asbury - 0:30:01
I have explained to you a lot, Darryl.
Thank you very much indeed for joining us.
So important discussion.
We were here before on a previous iteration.
I don't think there's any preamble or anything else
to give, so if we just hand straight over to you to say
where we are, and you know the usual rules.
We take the papers.
The rare people have read them, but even so,
probably helpful if you introduce them.
So this is an update on the values and behaviours in line with our cultural work.
Ian Dilks - 0:30:52
So we've kept an integral and consistent process to date and we're very proud of that.
We're delighted by the input we've had from colleagues, networks, TUs,
James Bullion - 0:31:01
ETM board to date.
It has improved this work.
We're now at a crucial and I would say critical stage for moving this work forward to get
to a conclusion.
So since the last board meeting, we've taken on what was said and merged inclusion and
respect, and we worked with our data and insight colleagues to do that.
So that was validated from the data, and inclusion clearly came out as the fourth value.
So we've continued to consider curiosity, which was the outcome of the input from the
last board meeting, and with that input alongside material around the learning, innovation,
and improvement from the workshops,
we have presented curiosity as a value to our focus groups.
We've run five focus groups to date
and covered inclusion and curiosity
in those focus groups as they were the later
editioned as their values.
Our colleagues have expressed the most variation
in their views on curiosity, so I
think it's safe to say they were curious about curiosity
and it's led to some interesting conversations in itself.
Many of them viewing curiosity as a behavior rather than a value in itself.
Ian Dilks - 0:32:15
And lots of differentiation on how we were viewing the word curiosity and
how we understood the word curiosity, but
Claire Oakley - 0:32:24
also understanding the behaviors around it.
So there's some more work to do around getting the behaviors that sit underneath
if we're gonna go forward with curiosities of value to allow our
colleagues to fully understand what enacting that value would mean.
There's a welcoming of inclusion in the focus groups.
We paused those focus groups and what I would also like to note is that we then went to
ET, presented, and communication in ET was that there was a risk around dropping excellence
as a value at this time.
And from an external perspective, what would that be viewed like, what would that look
like?
Now in our original data set, we had our first three values
that came out clearly.
And in that original data set of the next four values,
excellence came out as number four.
So ET wanted us to consider using that as a sixth value.
Now at the beginning, we've always
said that we would use three to five values.
With the rationale being the fewer values we have,
Joyce Frederick - 0:33:29
it allows us to hold those values in mind,
clearly communicate our identity priorities and guiding principles both internally and externally more easily.
So there is some work to do on understanding whether there is an opportunity to do further work
through exploring one -to -one conversations which we're on with now
around do curiosity and excellence sit together or are we looking at them being two separate values.
Once we've gained some more information and clarity then we'll resume with the focus groups
and continue to shape the behaviours that sit under those values,
because we've got a good set of behaviours sitting under there now.
So I think that's the update.
We will then continue with the work and come back to you
with a recommended set of values hopefully in November.
So any questions?
Thanks, Shelley.
I'll let others go first.
Christine.
Thank you. I think I'm just going to add to your mixed bag of views on curiosity, but
I was a bit disappointed. I'm really pleased that curiosity is there. To me, that feels
a really important value, and I think it embraces excellence and inclusion and a lot of other
things too. But I think at the moment the wording is just a bit
Ian Dilks - 0:34:55
disappointing. It's
Charmion Pears - 0:35:01
not about listening. I don't think the word Excel should be in there because I think it
makes assumptions that we can't necessarily deliver on. But it should be about asking
questions and seeking out creativity and innovation. So I'd like to see it being more proactive
and less responsive, which is how it read to me at the moment.
James, you want to speak?
Well, I want to – should be the other way around, that prompting, Chairman.
So I wanted to just speak on behalf of ET or prompt the ET voice about our feelings
around excellence.
So this is a mixture of really creating expectations in the organisation for improvement and particularly
Mark Chambers - 0:35:50
for performance issues and there is sometimes a danger that the values can be seen as a
kind of soft side of valuing people and for what they do, but not necessarily on behalf
of the people that we serve setting a value that is about delivery for them. That's where
the excellence sentiment comes from and that was the main discussion within the ET. We
felt I think that six was okay in terms of you know the kind of scope of what
people can remember and utilize so we didn't have a problem we weren't as it
were trying to knock something out necessarily but simply add excellence
and you know the kind of quality of the work that we do and the way in which we
do it and the level to which we do it as being part of our values.
I have lots of hands going up. Claire, I will come to you first and then another member
of the exec and then Sharmi and then Mark. Thank you. First of all, I am delighted to
see inclusion there on behalf of the Equality Networks. I think really my reflection on
this is they are really ambitious values and I really like them but I think we have got
are real challenged by how we really live and embed those.
And I presented a story this morning, my own carer's story,
to the board.
And it's the importance of having
a supportive and inclusive line manager
and having those discussions.
So I think for me, and on behalf of the Equality Networks
and the employee voice, I think it's really
about how we take those values off the page
and embed them in our culture.
I just want to come back on that Claire. Absolutely this is the first phase of our cultural work
and to get the right values to then thread through everything else is so essential. So
yeah it is ambitious but it is going to be a North Star to go back to so thank you.
Joyce I come to you first and then ladies. Yeah I also wanted to thank you and everyone
else involved in developing the values that we have on the page and it has gone across
the organization and lots of people have been involved.
I do value that inclusion is included.
I'm in agreement with James and the rest of the exec team
that this is probably not a good time to lose excellence
when we need to think about what we have to deliver
and why it's so important to health and social care.
I am concerned, though, that the plan
is to come back in another couple of months
after we've helped to describe these further, when
my key issue is not the words on the page,
is the fact that we have to live these values culturally
within the organization.
I really would like to start now.
We've just talked about recovery this morning.
Our recovery plan will work if we've got the right culture
and values and behaviors.
I think many of the people in the organization
will recognize these values and want to live these values
and I'd rather help make this a vehicle
to support the change that we need to do
and I'd rather start now.
I think we can iterate and wordsmith
and actually develop them as we go along.
What does it look like? What's the standards we expect to live by and deliver?
And the standards we won't walk past if we see that people aren't living these values.
So I'd rather not have the timetable of two months to come back to board, but let's start living these values.
Let's come back to board with an update as to what are we finding, what's the evidence behind it.
Thank you.
Maybe the others should comment on that in a moment, but Shabian and then Mark.
Thanks, I was really going to come in on Joyce's point and I support Joyce totally.
I think it's wonderful that such a lot of time has gone into working with colleagues
to come up with the values.
I think we do now need to really start living those and looking at how we practically can
make them come to life.
Ian Dilks - 0:39:53
So support what you say Joyce and I think perhaps in November it would be useful to
see, I think some of these things can be done in parallel.
we can be looking at how they can be embedded into appraisal processes, recruitment processes, leadership training.
So I think it would be good to see the combination in November and to see how some of that process has started
rather than getting to November and having the words without the progress.
Mark.
Thank you.
And there's been a huge amount to commend about this process.
There's been the opportunity to engage just about everyone in the organization, which
is absolutely key.
And what is emerging is something where one would hope that everyone can recognize their
contribution and their participation in it.
Having said that, of course, the end result is never exactly what each of us would want.
I think the origins of curiosity, I think, go to something that we've talked about a
lot around this table, and that exact word has been, we've heard from senior stakeholders
as well, unprompted in relation to this.
This organization needs to be more curious.
And I think it reflects the fact that your values should be
ideally a mix of the things that are a reaffirmation of what's
great about the organization, but also some things that are
a little bit aspirational.
And I think curiosity is aspirational for us.
I don't think we are inherently curious enough
as an organization.
We think we look internally a lot.
We don't seek enough external best practice enough.
And all the evidence is that we're not great listeners internally or externally.
Otherwise, that was a big theme of the last two years.
So I would personally, this is exactly where I would have expected to land,
a mixture of some things that are reflective of things that have been strengths and some
things that are new and require unpacking before we really understand them.
As in truth would excellence, you know, excellence is not somebody that is not a behavior, it's
not something you can measure somebody on, it's an output.
So you know, I think however we do this, whatever we land on, we're definitely going to have
to unpack it so that the behaviors required
to underpin it are clear.
I think we also need to do that in,
to really bring these to life, we
need to do it in two dimensions as well.
We need to be clear on the standards and behaviors that
Shirley Hallam - 0:42:55
would be expected of everyone in the organization,
but we also need to unpick the leadership dimension
quite significantly as well.
That was our second weakest employee survey score was leadership
Ian Dilks - 0:43:11
leading the values, living
the values.
So that's got to be unpicked so people can be clear on what we can expect from everyone
and our colleagues, but specifically what we can expect from our managers.
Chris Usher - 0:43:23
I think the other dimension is that we've got to make this, we've got to bring this
a life for not just what it feels like to be here, to work here as an organization,
but also what it feels like for us as a regulator to make sure that there is an external dimension
to that.
You know, the words that are here around inclusion, for example, are quite inwardly focused at
the moment, and I think, well, okay, what does that really mean?
And what does that mean in terms of what it would feel like to be regulated by us?
So I strongly agree that it would be very good for us to land the woods very soon because
the really difficult bit is how you unpack this into the underpinning behaviors that
we can really hold people accountable for displaying.
I think that's a good point.
Just a couple of comments, probably quite similar to Mark,
but just looking at it in a different way.
Let me start by saying I agree with Sharpe and I can't see why
we can't run stuff in parallel. Nobody is saying we're not going
to do anything until November.
I mean, three of the values here are pretty much exactly as they were before, and it should
be the way we're doing things.
We're reaffirming them.
This is nothing new, so we don't have to wait for approval to implement.
We're just saying we're reaffirming the ways that we want to work, so it can be baked in.
Ian Dilks - 0:44:53
But on the other stuff, I'm just reflecting on what I hear when I'm out talking to people,
whether those be users, assistants, or providers.
And I do hear people say, we must start with integrity.
I do hear people talk about the need to be more collaborative.
And I do hear, absolutely, people think
we need a caring motivation.
I've never had anybody say to me, you need to be excellent.
It's just not the way the outside world looks at us.
So I don't know how we'd measure it.
So I wouldn't say no.
And others have to think about it.
But I just throw out the comment that I
I think the outside world expects us to have values of integrity, collaboration and caring
or something very similar.
I'm not sure the outside world expects us to be excellent.
They'd like us to be very good or good.
And we spent three hours this morning debating how we might move from where we are to get
there.
But excellence is a, I think, a slightly curious value.
And I'd wonder how we'd measure it.
I could have a debate about how we'd measure the other three.
Stephen Marston - 0:45:54
I'm not sure how we would measure excellent.
It's incredibly intangible.
So that's one thought.
On the curiosity, whether curiosity is the right word
or not, one can debate.
We're trying to find a young word to look at a concept here.
But we said before, I think it was a comment
I made in the last board meeting,
that the world out there expects us to play
a role in improvement.
It was in our strategy a few years ago.
I think where Street Inc. has been out there commenting about,
we have an important role to play.
I said earlier that we spent an hour with Mike Richards this morning.
Obviously you weren't there, Charlie, but he talks about the critical role
that we have to play in identifying good practice and sharing that,
and how people improve.
So everybody is telling us this is fundamental to the future of CQC.
So I really do struggle if we end up with a set of values,
I'll put this quite strongly, but if we end up with a set of values
that don't recognize something that the Secretary of State
and the PERS, our own advisor,
and I'll say so important to our future,
I think we're gonna be dead in the water.
It just doesn't ring bright.
So whether curiosity is the right word, I don't know.
Now, if what we're hearing is the culture is not to do that,
then we need to think about how we get it there.
But I would posit that in the next year or so,
whatever the starting point,
we simply have to have as a fundamental value
playing a role in the system improving.
And that has to be a value of the organisation.
Thank you. I just want to reflect back in the focus groups there wasn't a pushback
on the idea that we would behave in a curious manner.
It was more about whether it was a value or it was the behaviours that sat underneath.
It was definitely a good discussion that was had around it.
So thank you.
We've probably spent too much time already. Although there's other hands going on.
Chris, I think you were first, and I'll come down here.
Yeah.
What I was going to say is that I was here,
I've been here long enough to remember the last time we
set our values.
Ian Dilks - 0:47:58
I didn't have gray hair then.
And it was a really uplifting process in the organization.
Mark Chakravarty - 0:48:05
Everyone fed in, and there was loads of series
of workshops and things.
And it culminated in the executive team
announcing one by one the values.
And it was generally a big celebration,
everyone got behind them.
And I think when I attended a workshop,
and I fed in the things I thought, it wasn't this list.
And there's things in here that I wouldn't have had,
and they're different things.
And I'll not share them.
But I think there is something about accepting
this is a group exercise, and this
is a series of workshops and focus groups that we've run.
And to Mark's point, not everyone
and we'll end up with what they wanted in that.
But there's something for me that's
really important about if we've gone through that process
and people are fed in, then we need
to ensure that we keep pure to that.
And if you look at the values that came,
the top five values that came back, I think,
were integrity, collaboration, caring, inclusion,
and excellence.
So I think we just need to be careful that we don't
change and amend too much the values that everyone has said, otherwise the danger is
those values will switch people off and people won't be able to live to those values.
So I think that's the only thing we have to be cautious of.
I hear what you say.
I'm just pointing out, I feel quite strongly, if we don't see our role and how as a value
wanting to help the system improve, I think we have a strategic problem.
Ian Dilks - 0:49:40
So either, I'm not sure whether I'm emphasizing, but using different words, something people think about,
or whether I'm making a point that people don't think that way.
Chris Day - 0:49:48
But quite generally, I struggle, given my role, if I have to appear as a Secretary of State or Health Committee or whatever,
if we end up with a set of values that don't incorporate something that everyone else says is the most important thing we should be doing.
So the evidence will show, and it's not up for me
to say what the values are, they've
got to be lived values everyone accepts.
But I just flagged that if we don't have something like this,
I think we have to have a separate debate,
because we've got a problem as an organization.
Stephen, Mark, and Chris.
And probably make those last questions.
On the excellence debate, I was going to agree with James that excellence should be in there
until you made your comments here and suggesting that it shouldn't. The way I come at this
is that kind of we all know and we've known for some time and Penny Dash has confirmed
it, we are not currently a high performing organisation, not a long way. So whatever
particular word we choose we've absolutely got to have a value about
becoming a high -performing organization where that would include high performing
at helping the system improve. Eggson's may or may not be the right word but
there is there is something about a value of being committed, driven, energetic
in driving organizational performance so that we once again become a
a high -performing organisation and I really feel that should be in there.
Second point, I would agree with Joyce very much, that kind of three of these values
are ones that, it's on my lanyard, they've been our values for a long time
and actually colleagues told us in the staff survey and LLRC,
the problem is not those words, it's that you're not living them.
Belinda Black - 0:51:52
And we've really got to move rapidly now to work out, so what will it mean to live them?
So personally, I'd be kind of encouraging the executives supported by HR to sort of
finalise quite rapidly for chosen words and move quickly into what culture do we need
to have that gets everybody behaving in a way that is consistent with this, because
that's been the gap. It's not the words, it's the absence of alignment in the way
we behave in becoming once again a high -performing organization.
Ian Dilks - 0:52:27
Let's take
the comments then and I'll ask Charlie to come back if we keep moving quickly.
Mark, I think you were next. So again, wonderful exercise. I take Chris's point
which is the whole point of bringing in an inclusive view of an organization is
to get that inclusive view.
We're never going to wordsmith this correctly
for any one individual.
So I think we have to be cautious about that.
I'd also double underline the statement
about moving as fast as we can towards behaviors
Shirley Hallam - 0:52:58
that we want to see expressed, but also behaviors that we
won't tolerate anymore.
And it is the two sides of that that I
think are important to drive behavioral change inside
of organizations.
One piece to advocate what I see inside the concept of curiosity
here is also the forward -looking natures of values.
They are meant to make us fit for the future, not just for now.
And one of the things that I think we can all agree with is that the pace of change
in the outside environment, both for ourselves as well as for service users and the people
that we regulate, has never been faster.
So that pace of change requires us also to continue to adapt,
evolve, innovate for the sake of improvement, self -improvement
as well as improvement in health and social care.
And I think regardless of what word heads this,
that last column speaks to that forward -looking requirement
to make sure that we keep up our pace of evolution in lockstep
with the pace of evolution outside.
Otherwise, again, five years down the line,
we'll find ourselves in a place where we are no longer relevant to the conversation.
Well put Mark. Chris and Belinda, I'll put those on the table, ask Shelley to respond
then we'll close it.
Two points, one built on something Mark just said. Just to give my perception on where
providers are, I think they do expect excellence. They don't describe it as excellence, but

2.3 Strategic and Policy Approach Towards an Anti-Racist Approach in CQC

Ian Dilks - 0:54:31
what they describe it as is, as you said, high standards all the time, where the performance
is good. They may not call, they may not use that word, but that's what they expect, and
that's what they've not had, and that's what I think is important that we deliver for them.
So I think there is something very important, intrinsically important about the word excellence,
or a word that denotes the same thing. On the second point, the point that Mark's just
made, when these were developed, and I was with Chris, we both got greyer hair than we
when we started this process.
There was an energy to it.
There was also a lot of work that we
did externally and internally to help coalesce
around those values.
It links very much to our work on purpose.
I describe purpose as 26 words that took six months to write,
because there was a lot of engagement
to make sure that everyone understood it importantly.
I think where we've moved in 10 years, I think 10 years ago,
people wanted us to make sure we had a robust process to inspect organisations.
They look at the end of our purpose, it says we encourage organisations to improve.
People want to know why things aren't changing, what would make them different.
I think this is your point as well.
So I do think whether it's the word curious or whether it's a different word, we are
being asked to do more than just inspect and rate.
We're being asked to say why.
and part of why is curious or another word but it has to be intrinsic to our
role that we don't just rate a service we're not just you know not the traffic
Joyce Frederick - 0:56:00
wards of health and care putting tickets or things walking away and saying you
need to sort that out it is our job to understand why things don't work and to
help providers, ICS's, local authorities understand what they need to do
differently so I'm whatever the word is it's not curious it can be a different
but it has to be something which talks to that, and it has to be something that talks
to our performance.
Thanks.
Belinda.
Just another vote for excellence really.
I think if it came in so high in the wider discussions that I think we really should
have it up there.
And a lot of that for me is about the definition of excellence.
So for me the definition of excellence is about continuous improvement and working to
our standards, working to the best of your ability.
So, you know, I think we really just need to be in there.
And was, you know, in the consultation came out very highly above curiosity.
And we can be very specific in our detail about how we want to define what excellence is.
Yeah, don't go wrong. I'm not saying you shouldn't be in there.
I'm just saying as an observation, it's not a phrase I've ever heard used outside,
lucky and I also question how we measure it.
But if people feel strongly it's there and they can live it and it can be measured,
then absolutely fine if that's what people think.
And as you said, the whole point of this,
the way we did this exercise,
was it's built from the bottom up.
We don't want to make the mistake that you said
apparently we did last time of wheeling them out
one by one from the ET.
Shelley, what sense would you make of those comments
and where do we go from here?
So where I think we go from here,
it's been really positive,
and thank you for the way that you've delivered
that feedback today,
because it's really felt very positive for me sitting here,
is that we've got an opportunity from your comments last time about looking at overlap,
that the seven values that came out top included excellence and innovation, and just the same
as respect and inclusion, they overlap.
I've already spoken to my data and insight colleagues before coming today who confirmed
that.
So we can look at, you know, what does excellence mean if we look at both of those things, potentially
look to that.
In terms of curiosity, I'm hearing that we've got a duty to set a tone for the future,
and I think that's so important in our culture that we go back to
Kira Haynes - 0:58:18
holding onto that.
And against what I came in with in terms of that I was holding tight to five values, I
think there's an opportunity to extend it.
So I think we've got something firm to go away with if that's agreement from you.
we can, from these discussions today, we look at excellence and innovation because our colleagues
had really brought those to the surface in that whole process. We look at where the overlap
is in line with our data and insight colleagues and come out with a value around that. And
we look at curiosity and make sense of it in a better way than we have done so far.
In terms of the now, acting now, to your point about the three values, we're going to start
the focus groups again, really start to move that work forward with the ones that we know
that we've got over the line already.
I think that's fine, if I could just add emphasize firstly Stephen's point. I mean it is about
living them, not doing them, but I see some of them. But then if I did this exercise,
it was not to change anything, but to re -examine and as part of that refresh the whole thing.
So hopefully the process of saying what should they be focuses minds on and actually adding
about living them.
And that, to me, is the real power or benefit of it.
Leave you to move as quickly as you can with the other things.
I suppose I'll just leave you with a cross -check that
do a sense check of how what we think they should be
compares to what they market expectation is.
And if there's a gap, we need to think about it.
And that may be a different discussion.
Maybe that's a future strategic positioning
if we need to shift.
But I think Mark put it very well that a value should also
be about looking to what we want to be as opposed
to how we see ourselves today.
Thank you very much indeed.
Appreciate you coming in.
Joyce, an anti -racist approach in CQC.
So it's Clara coming to join us, is it?
Yeah, unfortunately, she's also.
Lucy Wilkinson is also here with the flu bug every single person has.
So Cara Haynes has come to join us.
Ian Dilks - 1:00:35
You want me to start?
It seems to take people longer to find the doors here than at the other room.
Ali Hasan - 1:00:41
Well, that's the problem when you're going out.
Hi.
Welcome.
So I'll briefly introduce and then I'll hand over to Cara to do the highlights of the report.
So the board, we had a training session on race and racism I think a couple of months
ago, maybe slightly longer, but this came out of our listening and learning in response
to concerns review and the session was also attended by the Race Health Observatory as
well. From that session we've developed this policy on being an anti -racist organisation
and we've developed it with the board discussion but also for engagement with key stakeholders
and across the organisation. We do see this as a really important time to start this policy
Kira Haynes - 1:01:36
and to have this policy for the organisation. Racism and the impact of racism we can see
in society, you just have to look over the last summer that we've had in this country,
the impact it can have, devastating impact that it can have.
It's also impactful within our own organisation and how colleagues want to
be treated, want to be included and want to
belong to the organisation and have that psychological safety.
And we can also see the impact of racism on health inequalities
and people do not get the same outcomes because of structural
systemic and sometimes institutional racism within organisations.
So, we also recognise, as talked earlier, we are in recovery and we've got a recovery
plan. This is not an adage, this is essential to our recovery plan in having the right cultures
and the right inclusion. So, it's an important time to start. So, I'll hand over to Keira.
Ali Hasan - 1:02:26
Lucy, as I explained, is not here and Keira will go through some of the highlights of
the paper.
So, assume we've read the paper.
We don't need to go through the detail,
but there are only 42 other highlights in the demonstrated questions.
Absolutely. Thank you, Joyce.
And good afternoon all.
You need to put your microphone on.
Is that better? Okay, great.
Thank you. Good afternoon all.
Joyce Frederick - 1:02:53
So, what is the strategic and policy approach to anti -racism all about?
Fundamentally, it's a way of thinking and acting
that commits to using all of our levers to address the historical and
contemporary impacts of racism across all of our functions, internally and
externally. It's underpinned by the principles developed by the Race and
Health Observatory and takes an intersectional lens which values the
diverse ways that people experience racism. The strategies developed will be
able to be learnt from and applied to other forms of discrimination to ensure
Charmion Pears - 1:03:29
better outcomes for all. Why do we need this approach? We know that racism permeates at
every level of society, individually, institutionally and structurally. Racism is a key determinant
of health and it stops us in meeting and fulfilling our core purpose as a regulator of high quality
and safe care. The disproportionate detainment of black men under the Mental Health Act,
The disparities in experiences and mortality faced by black and Asian women, and the bullying
and harassment faced by people such as Michelle Cox and our own colleagues is a glaring reminder
of the need to act now and align our internal development, whether that's across the learning
and listening to responding to concerns review, our inclusive mentoring, our response to the
race riots within this coordinated approach. So what's your role within this? Within the
board sessions we developed what your roles are in relation to strategy, accountability,
performance and culture. We ask you to commit to these roles, to live the principles and
to see this as vital work so it is progressed with the pace that it needs. The outcomes
that we expect from this is equitable care for people who use health and care services,
for a better culture and psychologically safe experiences for our own colleagues
and a fairer way of regulating for high quality and safe care. Thank you.
Sorry, thanks very much. Questions or comments? Ali first. Thank you for the
update in the paper. I think this is a positive and important step we're taking
in terms of proudly being an anti -racist organisation and thinking about how we can ensure that
is embedded as a core part how we address inequalities.
What I'd like to understand a bit more is where the early thinking is with relation
to the performance role specifically.
I agree entirely with the sentiment that how we operate as an anti -racist organisation
James Bullion - 1:05:43
requires us to embed anti -racist behaviour so that if we come across things that are
racist or challenging or driving inequalities,
we address them too.
I think what would be really helpful would be to understand,
in the same way this talks about specific quantifiable
anti -racist performance measures,
how we would apply that same performance lens
to understanding what a successful execution
of the strategy might look like two or three years from now.
I completely agree with the need to have performance measures
so we can see how this, the impact this has over a long, sustained period of time.
I think something to raise that is a risk that we are looking to mitigate is the fact
that we currently don't have quality monitoring across many of our functions, which does hinder
us in being able to meaningfully assess the outcomes.
So again, I urge you, as decisions and work comes across your table, to be thinking about
these things to ensure that we can successfully measure outcomes.
And following this, post approval, we would like to develop more measures so that we can
come back to you and say how this is progressing.
Ian Dilks - 1:06:57
Christine Asbury - 1:06:57
Thank you, that's really helpful.
I think what would also be helpful as this continues is, in addition to thinking about
how it's embedded, if there are two or three of the most critical and most impactful measures
that we can look at, either through specific actions or embedding how we operate slightly
differently, that would be helpful to understand as we develop. Again as mentioned earlier,
we are in a very busy phase as an organisation, so to give us the best chance of being successful
in this endeavour I think focus would be really helpful.
I think that's right. I think we already actually have measures internally as an organisation
in our staff survey where we dissect what different groups have said in terms of how
they feel included, how they may be bullied or harassed or what opportunities they have.
So we already have those performance measures.
I think Keira has also given you examples
where we want to influence women's maternity care,
mental health for black men,
and we will choose other examples to say,
if we do this work, are we having any impact
on inequalities that we see?
Charmin.
Thanks for a great overview.
I just had a few reflections, if I can,
in terms of your phases and a few things
we might be able to add.
So in terms of your, under Phase 1, the Freedom to Speak Up piece, we have listened and so
as I chair the ARIC and one of the things that we are introducing is
Ian Dilks - 1:08:21
the Freedom to
Chris Day - 1:08:25
Speak Up reporting and we were really pleased that this time around it came summarised by
protected characteristic.
So while it's anonymous, we are looking at that to understand the key themes and ensure
it is being escalated through the right levels of governance.
Under that phase one I also think a point that's slightly different to sort of measuring outcomes is being able to use the rich set of data we have to really triangulate what's happening.
So we have the freedom to speak up data, we have the colleagues survey data which we look at in the next section, but we also have exit interviews, we have sickness reports, we have turnover.
and I think it's the richness of that data when we get the people reports to the board
on a periodic basis that we should be looking at to say what does the combination of that
tell us and what can we learn from triangulating that data and be really open to sort of really
delving into that. Phase 2 in terms of auditing, again because I chair the ARIC it's important
and probably to note that we are this year getting an audit of LLRC and the outcomes
Mark Chambers - 1:09:32
of that to ensure that we're not only looking at progress but have the things that have
been implemented to have the desired outcomes so that audit is being scoped at the moment
and we shouldn't be far away from getting outcomes and that's a third party audit so
that's done by GIA, the Government Internal Audit Agency, so again we'll be holding ourselves
to account and I think going forward with future years audit plans, I think looking
at some of these things from an independent lens is really important. So it would be great
to work with you as we come into that audit planning approach two or three years out to
look at how we can put some of this into that to get a really clear independent view of
what we are delivering and what we think we are.
Ian Dilks - 1:10:35
support of the wood blowingers through the
then lead us to work in other areas, in the regulatory work
that we do, in our work as an employer,
and in our campaigning work and our voice work.
And the race riots were a really good example
of when that occurred, because we had done the groundwork
for this policy, we were much speedier about responding
to that almost to the day, because we
had this thinking and this approach embedded.
So I think it leads to further positive work.
It is not, however, as easy as saying it.
And I recognise in the organisation there are examples where we are not living up to
the values where we should do in this area.
So we need, as it were, both to adopt it but also to have an internal look all of the time
about where we're not doing so well and learning from that.
Thank you.
Christine, I think you were next and then Chris.
Thank you.
I mean, it sort of builds actually on the last two speakers.
again I very much welcome this policy and it's really about what we as a board
can be doing on a personal level so it sort of links to the last discussion we
had about values. We're not here just to pass policy, what are we doing as
individuals and as a collective as a board to change our behaviors and to
make sure that we are inclusive and that we are responding and I had a very
interesting conversation with my inclusive mentor about how am I going to take back the
learning and the wisdom from those conversations to my role on the board and to share with
the board, which led to a question about, well, how many of the non -exec board members
actually are doing the inclusive program? So I had a look and half of us are and half
Joyce Frederick - 1:12:24
of us aren't. And I appreciate that we are busy people and there's a lot else going on,
but it's sort of actually how much are we going to commit individually to making this
anti -racist policy live? And then how are we, and I don't have the answers, but how
Kira Haynes - 1:12:42
are we as a board going to ensure that we understand both internally and externally
people's experience and that we take that on board when we're making decisions?
questions.
Thanks, Christine. Chris, and then last comment.
I really, the paper's great, it's a great paper. One of the things for me as we move
into phase two is I think there's some things that we are weak on that we need to resolve.
And I think you can audit something you know is not going to work and then say, oh yeah,
that hasn't worked, you want to do something about it, or we can do something about it.

2.4a Workforce Race Equality Standard Report and Action Plan

2.4a Workforce Race Equality Standard Report and Action Plan

Ian Dilks - 1:13:14
And I'm thinking particularly of Give Feedback On Care. It is a primary way in which we understand
understand how people use services. I know you know this, but it's a primary way in which
people who use services tell us about their experience. And I do think we're weak by not
being able to understand the characteristics of people. To be fair, not just race, but
the characteristics as well. So I think as we think about the second phase of our work,
I think where we know we're weak, we should really try and fix that before we audit it.
Because in a sense, auditing something you know isn't going to work is not as useful
as fixing it and then seeing if it has worked.
And I know you know that, so I'm saying that to colleagues as much as I am to back to you,
but it's a great piece of work that's helped them.
Thanks.
Okay, Mark, for your last question.
Just very quickly on triangulation, which I strongly agree with.
Presenter - 1:14:12
You know, these individual measures are not particularly informative until you bring them
together.
That's when the insights come.
You can definitely help us with the number of triangulation points that we have, which
is limited.
We're trying to grow them, but if there are other areas where we can – where data is
available, you know, not – we have anecdotal where we actually have data.
That would be really, really helpful.
And then secondly, I think we in terms of our governance framework need to think about,
well, where does this come together?
Because the danger sometimes with triangulation is it's all, you know, it's all there, but
it's being discussed in different fora and different committees.
And you know, maybe it's something that we need to try and assemble actually in this
forum because this is the only place that it really could come together.
But I think we need to reflect on that.
How could we bring that together?
But thank you.
I mean, thanks, Mark.
I agree probably better summary that I was going
to give a particular point.
I mean, you mentioned there's no asks.
This is discussion.
So you put it on a number of things you want from us.
What we should consider, I mean, I
think you can hopefully take from this strong to violent
support.
It's essential.
It's not a nice to have.
What I think would be useful, though,
for I'm not quite sure who should take it away,
I'll look to Joyce and you in the first instance.
Just to say, well, you've got another thing
on what the board should be doing.
Let's see if we can take that to the next stage
and pick up on Mark's point.
One could have a lot of diffusion of something
like this, but it probably ought to come together
at the board level, I would have thought.
So could I ask you for a future discussion
to say, we agree with all of this.
So exactly what do we need to be doing?
And maybe another way of looking at that
is doing differently from what we're doing at the present time.
The only other thought I just would have from past experience
is that if you're trying to bring about change,
it can be very helpful to circulate heroes,
or maybe villains as well.
But heroes are easier to say if there
are good examples of calling out racism,
that would be useful to know.
I think it's both a good example,
but it also incentivizes if he or she can do it,
then so could I. The poor behavior is rather more difficult to use, but I wouldn't call
that out either. You know, if we believe this is important, then we should be prepared to
back that up with a sanction if we think there's particularly bad behavior. So I think that
needs to be baked into the system.
Thank you.
Is that okay with everyone?
Thank you. I think the paper does highlight the roles the board can play to support this
within the organisation and we'll do work to demonstrate how this policy is being lived
and what difference we're making because of this policy as well.
Thank you, Kira.
Thanks everyone.
Thank you so much.
Thank you so much for your time and I hope the rest of your day goes well.
tocan be offset by a
should see you again.
So we've got two things here for approval.
We take them as read.
They're pretty clear reports, I think.
So I'm not sure we need to debate the content,
but I'm sure there will be comments to raise.
Take the papers as read, so you don't need to talk us
through them.
It would be helpful if you could just clarify,
to avoid spending it out, what the approval requirement is and what happens to these things
afterwards. I have a concern there are some numbers in here that may be wrong just from
looking at it. I meant to send you a note. My apologies I didn't. So when we get to approval
it will be approval subject to me telling you what I think is wrong and you double checking
But apart from that, we'll ask for approval.
But over to you.
Thank you, everyone.
Providing a progress update aligned to our equity,
diversity, and inclusion strategy priorities.
So in terms of inclusion, we have made significant progress
since the summer when we launched our workplace
adjustments policy and library.
There has been over 200 people completing our workplace passports, so we've started
to deliver some real impact in terms of supporting our colleagues to perform at their best so
we can really live our good days at work priority and our value of caring and creating an inclusive
environment in the workplace.
We will continue to build on this momentum.
We are delivering over the course of this month and next manager briefings so we can equip our leaders with the tools
So they can support their teams at scale this will include how they facilitate those conversations
So they can build that trust and safe space with colleagues and demonstrate that we are a valuing
organization that really cares about our staff
In the long term we will be looking at iterating our workplace passport using a technology solution.
We'll be using an accelerator event to do this, so in the long term we can use more real -time data
to inform the way that we work to embed a social model of disability
Ian Dilks - 1:20:12
in our ways of working.
These interventions will be really important for the future so we can achieve our disability
Tyson Hepple - 1:20:19
confidence accreditation as planned in the EDI Strategy Action Plan by next year.
In addition to this activity specifically on disability, we are working very closely
with our Carers Equality Network to improve adjustments more widely because the workplace
this passport is directed to be supportive for all colleagues further to disability.
In terms of our activity on race, we've started with a leadership approach and we've laid
the foundational work with the board race training that you were part of earlier this
year.
We have now advanced to the learning needs analysis phase so we can develop a comprehensive
anti -racist learning offer for our colleagues more widely.
this will be aligned to our organizational anti -racist strategic approach that we are
Presenter - 1:21:10
working closely with our colleagues in policy and strategy.
When the race riots erupted, we took decisive action.
We directly, internally and externally called out racism.
We also worked in partnership with our race equality network to provide tailored well -being
and safety support.
Joyce Frederick - 1:21:32
So this set a precedent for us in terms of our anti -racist ways of working that we hope
to embed as part of our recovery efforts.
Further to this, in terms of eliminating our negative scores with regard to bullying, harassment
and discrimination, in the new year we'll be taking a QI -led approach to evaluate the
process so we can build confidence in the system and proactively address bullying, harassment
and discrimination.
This is part of a three -pronged approach alongside our values and behaviors refresh and our freedom
to speak up policy work so colleagues feel more confident in the system and we can restore
accountability and a zero tolerance approach to bullying, harassment, and discrimination.
In terms of recruit talented colleagues, which is our second priority within the strategy,
strategy. We do expect by the end of the year to have a proposal in terms of refreshing
our recruitment because we've had an external consultant come and review the end -to -end
process. Before that, it is really important that we use the increased operational recruitment
as an opportunity to improve the diversity in who we are attracting and appointing so
we can hope to achieve what we've set out in the EDI strategy in terms of our representation
targets. It's really important that we do this so we can improve our decision -making
and also ensure that we better represent the communities that we serve.
Finally, our last priority on investing in our colleagues. This should be closely aligned
with our work on recruitment and we've started to do this by promoting our career conversations
for grades below executives this month until November so we can align our
internal succession planning alongside recruitment outcomes so we can attract
lots of new talent but also invest within our own talent so we build our
own leaders and this fosters better engagement, well -being and retention
Ian Dilks - 1:23:39
overall for the organization. Within the career conversations that we are doing
we are hoping to identify colleagues as part of the new cohort for our Inclusive Leadership Pathway program.
This year we were nominated by the Institute for Chartered Personnel
Chris Dzikiti - 1:23:56
and Development
for an award for this program as the best diversity and inclusion initiative, so we hope to build on that.
Further to that, in terms of our execs who are from a minority background
and have already had those career conversations,
We are hoping to give them more targeted support so they can be part of business critical roles as and when they arise.
Again, this connects to better decision making at those levels and we hope to embed them as part of EDI objectives for our leaderships within our leadership strategy.
So today we're really looking for your endorsement because this work is really critical for us
to achieve transformational change as part of our EDI strategy.
Thank you.
Okay, thank you, Dada.
Very interesting.
Tyson.
Thank you, Ian, and hi Nadia.
First of all, congratulations on the People's Survey uplift in terms of the reasonable adjustment.
I think that's a great achievement.
On the race report, I'll return to my familiar theme of recruitment, because we do need to
do something about the disproportionality in terms of ethnic minority appointments.
I'm really encouraged by the fact that you're saying that we're going to try and remedy
this and going to use the recruitment into ops in order to do that.
And you can do that by looking at certain parts of the country, you can focus on certain
media or places where people look in order to see jobs that have been advertised.
But are we confident that our processes are fit for purpose when it comes to this?
Or do we really need to give them a good look at in order to make sure that we're screening
out any discrimination that we possibly can?
Charmion Pears - 1:25:42
We are using the external recruitment review to robustly assess how we can improve our
process.
But we have started to make some changes in our job adverts so we can actively encourage
colleagues from an ethnic minority background as well as disabled colleagues as an interim
measure until we put those changes into process for the longer term.
Joyce, move on.
Thank you Nadia.
I think I may have seen ten years of RES and DES, that's the acronyms for the survey that's
done and I have never seen any significant movement in the survey results.
So we've just talked about an anti -racism policy.
the figures here show that we are below in terms of diversity recruitment and
significant below senior leaders who have come from a diverse backgrounds and
it's not just about getting numbers in it's about how do they influence and
we're significantly below there. We also have more discrimination for people from
a diverse background and the same can be seen for disability as well as in
significantly below in terms of recruitment and also in senior positions and more discrimination
Ian Dilks - 1:26:59
in terms of bullying and harassment. These figures haven't moved significantly so I know
we're doing an awful lot to try and change them but I'm not confident that our procedures,
our policies and procedures actually are anti -racist and support disability rights and I think
that unless we are confident and we do that proper cross check, then, and I'm saying this,
I'm not saying that this is our organisation, but you can't say we're not institutionally
racist and you cannot say that we have an institutional bias towards people with a disability
because our figures tell us that we have a problem. I think we need to be a bit more
forensic in our approach and start targeting key areas, particularly around recruitment.
You've laid out an awful lot of good things that we're doing, but until we get the basics
right they will not matter because the people aren't in the
Claire Oakley - 1:27:52
organisation to experience
those good things.
So we've got to get the basics right and I would advocate for a more forensic approach.
Because I don't want to be here for another ten years, I may not be here for another ten
years, but these figures haven't shifted in terms of the dial at all, so we needed
to actually have a bit more action around these.
Thanks Joyce.
The purpose of today is primarily just to approve the documents, but I think it is right
to be clear that there is an action to look at this more forensically and if it hasn't
changed over the years, why not and what do we have to do to shift the dial.
Chris.
Just remembered I need to sit on my mic.
And obviously Nadia thank you so much for the work and it's helpful to see and obviously
in support in terms of where you're trying to get us to.

COMFORT BREAK

Ian Dilks - 1:28:47
But just to add on Joyce's point about things
seem not to be changing over a period of time.
And we are not alone in this area.
But there's something about we might be really busy and active
and doing so many actions and having so many action plans.
But the judgments around the impact of what we are doing.
So we might end up doing a lot of things,
but the impact is very, very minimum.
So we might have to think about actually what are the key,
maybe one or two or three things we really need to focus on
and target on in order for us to get the most impact
on what we are trying to do, that's one.
The second bit I just wanted to highlight
is I suppose the challenge is if you look at certain level,
I suppose grade A's within the organization,

4.1 National maternity inspection end of programme report and supporting improvement resource

Ian Dilks - 1:29:32
and you look at majority of them are sort of colleagues
are from white background.
So when you think about actually how do we improve, for example, our exec roles, for
example, because normally we get people with experience of regulation within those areas.
Chris Day - 1:29:50
So it's always going to be a challenge to get people at exec level because the people
we are sort of recruiting from are all from sort of a wide background.
So there's some work we need to really to be targeted to think about how do we increase
a certain level of colleagues working in the organisation from a diverse background.
But thank you for the paper, really helpful.
Okay, Sharmi, your last comment, if we go.
Yeah, thanks for the paper. Joyce, to pick up your point, because I think I sort of had a similar view again when I read this,
and I wondered in terms of the forensic approach and linking it back to phase two of the past paper we looked at,
whether we should be doing that.
Presenter - 1:30:33
So I looked at what was indicator three, for example,
which looks at the relative likelihood of ethnic minority
colleagues entering a formal disciplinary process.
And you look at the recruitment one.
I don't see any reason why we shouldn't be using our audits,
again, forensically.
And I'm only a sample of one around the table
talking about audits because I chair the committee.
But why wouldn't we put our stall out there
and say next year on our audit plan we want to look at that,
to go through, look at those, get someone
to look independently at all of those processes
and ensure that the process was equal,
that the process followed to put those people
into those disciplinary processes
were followed in the same kind of way,
that the recruitment was done.
So I think as part of putting our stall out there
and doing some of that more forensic analysis,
I think we should commit to things like our audit plan
really containing visible signs that we are going to do it differently.
Could we modify the action we talked about earlier to do just that?
I'm very struck reading this that we are doing an awful lot and we spend a lot of time talking
here and there's a lot of time being spent and there's probably quite a lot of money.
So it's doubly disappointing that we're not shifting the dial.
If we're doing nothing, not shifting the dial, that's bad another way.
But what we're doing is clearly not having the impact that we wanted.
So perhaps if I could ask if – so we're here to approve the reports, but it's what
they tell us, I guess, that's important.
So can we take away – there may be other actions that are precluded in your suggestion
of forensic look, but maybe that would be a particular starting point.
Claire, were you trying to put your hand up?
I really will make this last comment.
Ian Dilks - 1:32:40
Stephen Marston - 1:32:45
.
ly
s
as a document subject to the caveat
that I will drop your line to double check and figure.
I mean, there's some in there that we'd like to be different,
but that's quite different.
This is just factual.
Are we happy to approve these documents?
And these will then become public, yeah?
Yeah, OK.
Well, thanks very much indeed, Nadia.
We approve the reports.
That was easy, but in a way, the more important
bit is what they tell us.
So we've captured a couple of actions there.
Appreciate it.
Thank you very much.
I think we are now to a short comfort break.
So if you could try to keep it to 10 minutes.
It's five past four by my watch.
That won't be the time for those watching this on repeat.
But if we could come back at 4 .15 our time, that'd be great.
Thank you.
Action program.
If we could keep this to no more than 10 minutes.
We're running a little bit late, but thank you for putting it on the agenda.
and Carolyn and Nicola, thank you very much for joining us.
But of course.
I'll let my colleagues talk at the same,
just to say this is an important piece of work for us,
Presenter - 1:34:23
which has its origins back almost in the days of lockdown.
Maternity services were stubbornly poor in the sense
that they didn't improve for a period of time.
And we knew that we needed to do something different
from what we had previously done.
Thanks to my colleagues here today,
but also colleagues that are hopefully looking at this today.
We've managed to produce what I think is a fantastic report,
not just that is honest and truthful,
as Chris was saying earlier, about what we found out there,
but also helps guide people around how to make things better
and how to improve services.
So I'll hand over to my colleagues.
Thank you, Chris. So, taking the report as read,
I think the first things I wanted to draw attention to
is we launched the two projects last week,
but firstly around the end of program report
and also the improvement toolkit.
And through our engagement throughout this program
with frontline staff and with families,
we felt it was really important to have
those two strong elements.
I think it's been very well received out in the sector,
but also it received significant attention last week
in the media.
And I think that was right.
This is calling out some really hard truths.
And I think that did land well out there.
but also the point around the improvement toolkit.
You know, what we can't do is solely focus
on a rhetoric of problems,
because we also did find good care,
and that was really important that we acknowledge that
as part of the improvement toolkit.
So I was really pleased that they were received well.
We are now focusing on the sort of the where next with this,
and that's very much around the follow -up work.
We're also very focused around baby deaths as well.
So we're doing some work at the moment
to explore two tracks.
So firstly there is an option around do we look at the change in regulations, but we're
also looking at actually what other data sets are currently available.
So we're working closely with DNI colleagues around a first attempt at that data set, which
we should have pretty imminently actually, and there are other national solutions which
we are feeding into.
Carolyn, do you want to say any more?
Yeah, I mean I think this program of work was a really good example of how you can bring
Ian Dilks - 1:36:35
a team of inspectors together.
You give them a core purpose, you fire up that passion in them, you give them additional training on that subject
Chris Dzikiti - 1:36:44
and you just get out and you get on and you deliver.
And we've got a team of, as some of you will know because they've contacted you, really passionate people
and now they really want to keep on to drive that improvement forward.
So I think it is a great example of what we can do and we do well.
and we are, we're all proud of what we've done in this space as well.

4.2 Update on CQC’s Dementia strategy work

Ian Dilks - 1:37:08
Absolutely.
Thanks very much.
I had a couple of comments, but I'm sure other colleagues may.
Any questions or comments for you, Stephen?
Firstly, huge congratulations.
I think you and your team have done the most fantastic job and I think it's a great example
of how CQC can add real value in improving the quality of care across a major part of
the system. So I think you've done a fantastic job and your team has just been brilliant.
Two questions then about kind of the follow up. One is I think the improvement toolkit
is really important and valuable innovation. I think it is an innovation in how CQC has
gone about doing the reporting. I think it's a good innovation. How would you also want
us to build it into the future inspection programme? Because particularly for RI and
inadequate, we need to sort of keep going back, helping colleagues in those services
and units to use the toolkit to good effect, to get improvements. How do we build this
into the ongoing programme. Secondly, some of the reporting has come back from providers
saying this is all sensible, it's all good stuff, but we're actually getting a bit overwhelmed
in terms of recommendation for what we should be doing differently and better. How do we
where we should be doing better so that they know what they need to prioritise because
it will really make the greatest difference.
Thank you Stephen. So absolutely and that was very, just if I start
James Bullion - 1:39:04
off with the second
point first of all, the point about recommendations we heard loud and clear throughout that programme
and that's why within the recommendations in this report actually predominantly they
were aimed at other, you know, they were aimed at the system partners, ICBs, Royal Colleges,
you know, other stakeholders within that system that will have a huge influence. So less for
frontline staff to, things that will support frontline staff but not necessarily that's
going to take them away because we recognise there is a plethora of recommendations out
there. I think that really speaks to, again, to the improvement toolkit and the improvement
Ian Dilks - 1:39:40
toolkit very much aims at. There are examples of good care and good practice for frontline
staff but also for managers, for trust leaders, for ICBs and that was very deliberate because
that's what people told us when we met with them earlier in March this
Mary Cridge - 1:39:52
year, that actually
that is what's needed, they need good examples and that absolutely has to be to your first
point, be followed up as part of the follow up inspection activity. And actually it was
really nice, I think it was yesterday I received an email from a colleague in CQC to say actually
it was really good because they were liaising with the Trust to say yes we've got examples
of good care and here's the place where you can go and look at it. And to me that has
to be a live document as we progress through our follow up activity we have to keep that
live and we have to keep it current because it's so, so important to demonstrate what
good can look like.
I think just the point about can we do it for more services in the future, this is the
the beauty of the maternity work was because we focused on a topic, if you like, you know,
and it gave us that real helicopter view of just one area. So it was easier to do it.
But there are opportunities for us to do improvement resources and signposting, you know, most
definitely. But there are lots of ways of inspecting, aren't there? We can inspect
where we all go and inspect different services or we can take more of a thematic approach.
and the pros and cons for both ways of inspecting.
I have to say, probably those are my questions,
so I will have nothing further to add or comment on question.
One more, Chris.
Thanks, Ian.
I just wanted to say thank you to you too.
I mean, there's a team behind you for this report,
but I just wanted to acknowledge your leadership,
and Nicola and Caroline for your leadership for this report,
and thank you so much for persisting and pushing and pushing and we are here now and this will
make a big difference to people who access maternity services so a massive thank you
to you too.
If we haven't spent a long time today, I guess we're very busy rather than anything else,
but just to echo everyone's great piece of work, I love the way that we're trying to
Ian Dilks - 1:41:52
Christine Asbury - 1:41:56
use it to help people improve and then bake it into what we do. Many systems and this
health is no different, maybe it's worse than some others, are full of reports which recommended
things and nothing ever happened. So we can't drive change across the whole system but I
think we can do what we would do. I'll just leave you with a thought and I'm not suggesting
a whole separate report back to the board but it would be interesting to reflect in
in 12 months time, whether we think there's been any
positive outcomes from this.
And as an organization, I think one of the challenges
for us, we've seen this in the Penny Dash reports,
is more focused on outcomes as opposed to activity
or input.
So I think finding a way of saying in 12 months time
what evidence is there that this has had a positive impact.
Hopefully it will have.
I know there are so many things that are going on,
We can't measure our impact in isolation.
But nevertheless, I'll leave the thought.
And if it has, well, lessons learned.
How can that be used in the future?
So I'll leave that thought with you.
But thank you very much indeed to both of you
for what you've done.
Really helpful.
The most important benefit is to the potential mothers,
obviously.
But also being helpful to CQC.
So thank you very much for that.
OK?
Thanks.
If we move swiftly on, there's another piece of work we just want to note at the board.
James, it's the dementia strategy and I think Mary Credge is going to join us hopefully.
We should be being joined by Mary Credge.
Just to give an outline, just to set the context, it's really important that as we focus on recovery,
that we, as it were, take stock of some of the regulatory leadership work that's been
underway and to acknowledge it with external partners that we've been working with and
communicate, as it were, a position to the external world.
Mary Critch, you can see it.
Hello, Mary.
Sorry, so starting without you, but we'll push for time.
So it's us, not you.
Let's go.
Yeah, one more mic.
So, Mary, we've read the papers, so there's no need to talk us through them.
Any particular observations you wish to make would be helpful?
Yes. So the message I wanted to get across was the balance of the importance of this work in its own right
and the relationship to our focus on recovery.
Dementia is a national priority in terms of the numbers of people affected.
It's a truly cross -sector challenge.
It puts great pressure on health and care services.
Alzheimer's Society research has estimated the annual economic cost to the UK as 42 billion,
rising to 90 billion by 2040.
And the huge cost of the service comes in unplanned acute hospital stays.
Stephen Marston - 1:45:08
Very little of that sum is on actual diagnosis and treatment.
We supplied a short video which if you haven't had the chance to look at I commend to you.
It gives insight into the human cost that families are living with.
The papers have set out how this work links to our strategy and to our recovery priorities.
It is the prize that we're playing for is a co -produced,
evidence -based, widely agreed definition
of what good dementia care looks like,
leading to statutory guidance
against which we would register, regulate, and enforce.
And we would pull all our regulatory levers
and this guidance would also influence commissioning
behaviour and future developments. We've taken this work so far, we're now pausing, and before
Mary Cridge - 1:46:09
we put it in the drawer to get it out later, we'd welcome your endorsement of the work
so far and your support to carry on with it when it is sensible to do so.
Thanks very much, Barry. Questions or comments? Christine.
Yes, thank you. I mean, I think this is a very good piece of work. I've obviously been
privileged to be involved in the discussion at the beginning and just more recently about
it. I do see it very much as a starting point, not an end point. And in terms of where we
are with recovery, it is important, as you say, dementia is a massive issue, both on
personal and an economic level.
But I think one of the most important ways in which it helps us with recovery is because
it has been, I would say, collaborated so far with a number of other organizations and
providers and it's helping us with that building trust and credibility.
So that is important and I'm really glad we've done that.
I mean, I'd be very interested to know more about how health is collaborating and how
much good practice we've been able to identify there, because I think I said to you in our
first conversation about this, and Stephen and I had a bit of an exchange about this,
to me it's not that I don't think that there is poor dementia practice within social care,
because I know there is, but I also know that dementia is very much the bread and butter
of a lot of adult social care and therefore I think it is more evolved. Whereas my personal
and professional experience in relation to primary and secondary health has been that
it isn't great, that actually it's very hard to see often that people's dignity is being
protected that there is an understanding of how dementia affects their ability to
access and receive good care in health settings. So that's one of the sort of
things I think is important. I also again have highlighted the issue around

5.1 Freedom to Speak up - Proposed changes

Ian Dilks - 1:48:22
innovation. I don't think innovation and observing and assessing innovation is a
CQC strength in general as yet. I hope it will be in the future. And I think that relates
to dementia too. And as I said, to me there's a real tension between being too prescriptive
and trying to link everything to an evidence base when innovation isn't about evidence,
innovation is about creativity and trying new things. So you won't always have the evidence
base there. There's a tension there and you can see it in the strategy on a page. And
I know you're aware of it, but I just want to sort of put on record that that's something
that we haven't yet resolved within CQC.
It's something that was alluded to by, well, mentioned by, I think by Penny Dash.
And it's very important that we could use this dementia strategy as a way to develop
and evolve how we approach innovation.
So you know, congratulations, it's great.
Lots more work to do when the time is right.
and it will improve how we can help improve practice generally.
Thanks, Christine. Any other comments?
Stephen.
Mary, thank you. It's a really useful report.
I'm not clear what it's recommending to us about the next step and when,
Because you say in the report that we need to develop a better understanding of what
good looks like.
I'm assuming kind of sequentially we've got to do that piece of work before we can
start training our colleagues in how to mainstream this in our inspection and assessment process.
So that piece of work on articulating what good looks like kind of has to come first.
But I think you said we're kind of putting it in the drawer was your language.
So can we go ahead with that or not yet?
Presenter - 1:50:30
What is it you're actually proposing?
Well we wanted to update you on what we've done since the last time that this came to
you.
We have already made great advances in the work about what good looks like.
We've been welcomed with open arms by various universities, key stakeholders, the Alzheimer's
Society, Dementia UK.
We've got a really strong base.
Our own assessment of give feedback on care has pointed us towards access and pathways
as areas to focus.
information from carers, very negative experiences in both a GP practice and receiving a care
in an acute setting.
So we're being very careful not to duplicate what others are already doing well.
I think this is us using our marshalling and convening powers to agree collectively, so
So it wouldn't take much more to get those firm definitions and turn that into statutory
guidance.
But this isn't the moment for that.
We want to divert our attention to supporting recovery.
When inspections do pick up, the prevalence of dementia means that our inspectors will
be encountering that.
Ian Dilks - 1:51:58
Penny Dash has referenced dementia knowledge in her report.
So the reinvigoration of short observational framework training is absolutely key because
that tool is so important in the observation and reporting of people's experience.
Stephen Marston - 1:52:18
So we want, when we are ready to do it, to make CQC a genuinely dementia friendly organisation
so that all our staff, in whatever role they have, are familiar with it as a concept and
most people have encountered it in their personal lives as well as at work.
So we're going to watch and we're putting it down for a little while.
We'll look early next year and see where things are going.
And when we do, the numbers of inspections increases.
That will include dementia services in that work.
Thanks, Mary. I mean, as you say, both of you said it's becoming ever more prevalent.
So we talked earlier about making sure we were adapting as an organization as things
change and this is a classic example where it's going to become more prevalent in many
of the settings and there's a focus on it, so we have to adapt. So this can help us do
our core job, by which I mean assessments and inspections, with due respect to everything
else, then that's got to be good for us and the quality of what we provide. So thank you
very much indeed. If there are no other questions, we'll leave it there. But thank you very much.
Thank you very much.
There's one last main thing on the agenda to deal with which requires approval, which
Presenter - 1:53:41
which is our policy on freedom to speak up.
So Chris, I think this is over to you.
Is Carolyn going to come back in?
I think what Carolyn is coming to you just to say,
I'm encouraged to see, you know,
we have the state in terms of paying with the community
that's just helping us to be able to have our freedom
to speak up.
We're not able to create barriers in terms of
what is speaking up is a role in our computer resolution
of the certain measures.
Christine Asbury - 1:54:12
And this, you know, policy is a huge figure.
If you still ask it, I think it's a very important phase
on the same issue.
The policy isn't widely asked for any proper information.
So Carol, apologies.
We start without using open.
I know one or two people have trains to get, so I want to make sure we're out late.
But I know a huge amount of work has gone into this.
I've seen that from, I have made no real contribution to it, so I claim no credit, but I know a
Presenter - 1:54:50
lot of other people have a huge amount of work into it.
So we've read the paper, you know, did go through the detail, but it'd be interesting
to get your observation and points we should be aware of.
Thanks.
Yeah.
So thank you.
and I'm sure you're all aware that this has been obviously to ARAQ already and you will
see that some purple text in the policy and that's because there have been some changes
since it went to the Audit and Risk Committee. So there's been consultation done with this
policy, with the trade unions, we do need to finish off a bit more work with the equality
impact assessment to go alongside this, but the policy is based on best practice that
comes from NHS England and the National Gardens Office.
So we need to keep hold of that as well as make it
Charmion Pears - 1:55:40
fit to what we want as an organisation.
But hopefully we strengthen the process a bit more.
And we want to do more around the follow -up of freedom
to speak up.
It's not just a case.
People do speak up in our organisation.
People do tell us.
But it's about how we respond and what we do about that and how well they feel listened to.
So hopefully the new policy will help us emphasise that more.
And we're doing a lot more reporting on it now.
Still got a lot more to do, really recognise that,
but we are getting somewhere, we're making progress
and it feels different to what it felt previously and that's really important.
Thanks so much, Carolyn.
I mean, I know this is one of those areas where we've had a number of LEDs, you know,
directly involved, obviously, anyone would know about Chambers, Charmin and Stephen for
no particular order there, have all been heavily involved in discussions given different roles.
The ideas for approval, any observations or questions from colleagues?
Stephen?
Sorry to come in again.
Firstly, a big welcome for this.
Thank you, Carolyn, for putting so much effort with colleagues
into the development of this new policy.
I think it's responded very well to what we asked
James Bullion - 1:57:10
for something that's clearer about what is the process,
what is the follow -up, and how do we signal people
to the right pathways for the particular concern
that they're raising.
So I think that's all a big move forward.
Now that we've got this, there needs to be an extensive at scale messaging to colleagues
across the organisation because I don't think colleagues are
Presenter - 1:57:41
necessarily all aware of SpeakUp,
certainly not in this new form. I'm not sure that colleagues necessarily have full confidence
in Speak Up that it will lead to anything. So there's now that we've got a better policy,
we need to convince people that we've got a better policy, that they can use it with
confidence knowing what's going to happen and what the follow up will
Ian Dilks - 1:58:02
be. So it's that
next piece that I'm interested in, kind of where do we go with this to build awareness
and confidence across the organisation.
Yeah, I absolutely agree with everything you've said. October is national freedom to speak
up month so it's really timely that we can do a lot more publicity around that with staff
and talking about it. We've got more guardians, since April this year we've had two additional
guardians, they're getting out and talking to people a lot more. So we have got more
of a communications plan around what we're doing.
Christine.
Christine.
Thanks.
Really, sort of a question, there's two things we say in here that we talk about making sure
people will be safe and assuring them that they will be safe if they speak up.
And a few pages further on, we tell colleagues that issues they raise will be addressed.
But actually, as a board, both individually and collectively, we know that people haven't
always felt safe most recently and the issues they raised haven't been addressed. So I just
wanted to know how are we going to change that for the future?
It's a good question and I'm not going to pretend that we're going to solve everything
immediately because that would be naive. I think we aim to have a culture where everybody
feels that their opinion is valid and that they are heard.
I think it's really important that we do a lot more work
around going back to people that have come forward
Joyce Frederick - 1:59:43
to see how they're feeling, whether they feel
that they've suffered any detriment from speaking up.
We need to invest a lot more in the back end of freedom
to speak, or not just listening.
It's not just about me listening to people.
Ian Dilks - 1:59:59
It's about the actions.
and we need the whole organisation to commit to that.

6.1 Minutes of the previous Public Board meeting held on 24 July 2024

Can I just comment on that one? I think well done, I think it's fantastic work and I've really enjoyed working with you and the team on it

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

because obviously there's a lot of passion in order to get it right.
So I think obviously colleagues have raised the importance of comms and getting the policy out there, getting it really visible
and there's lots of things we can do with that.
In terms of the structure, if Jackie Jackson was here,
we have had conversations around how to put some of that structure around,
how to ensure we have communication templates really to support that,
that will obviously be tailored to situations,
but also to have logs in terms of concerns raised so that we follow through,
ensure that the concerns have followed up and closed out effectively.
We are getting some great reporting which has come in now from Carolyn to ARAC that

7.0 Any Other Business

looks at on an anonymous basis the types of concerns that have been raised, how it's
been closed out, where the protected characteristics were involved in order to us to really look
at those things. And then obviously in addition to the quarterly
ARAC reporting which we spend time on, it will come to the board once a year so
hopefully some of the structure that HR will put around it over coming months
combined with the communication and then having greater escalation through
governance so we get visibility of the issues and ensuring they are followed
out will provide some of that, that's the goal.
Chris Stewart.
So I think it's really important that we make sure that we
to the
analyze what action we have taken in a systematic way that
Charmian is outlining. The other thing for us as an
executive is about leadership, I think the tone that Kate has set
around this issue and the profile that she's given it has
been really important as part of the change and empowering as it
were, Caroline and others, to really make this effective.
And I think part of Chris's leadership will be about that.
James in to cross talk, could you put people did come forward after Kate had said those things about having a great day at work and encouraging people.
We noticed a significant increase and people told us they came forward because of what Kate had said to them.
Okay, we're being asked to have a couple of observations, but that being asked to approve it, are we happy to approve it?
Yeah, OK, good proof.
I mean, Greg, thanks to you and indeed my colleagues
around the table for that.
It is a mega step forward on where we were.
I'm not sure I'd give it a quartiles,
but it's pretty good now, and it wasn't before.
I just particularly commend two things.
One is the flow chart.
I really love that.
I think, actually, Mark, you may be responsible for that,
Tyson Hepple - 2:03:07
aren't you, as a model, I suppose.
as well. But I think there's benefits in using that sort of approach for other policies,
because where they're complicated, it can be very difficult for people. I mean, most
people don't use most policies most of the time, and you have a limited attention span,
so making life easy to use the right one I think is helpful. So I'd like to see that
used as a model. And then the other thing is not the policy itself, but the cover sheet.
This is a new idea, and I think actually Sharmian did the donkey work on this, but I think it's
really helpful and I'd like to just be clear,
cooking executive colleagues, this is now required.
James Bullion - 2:03:43
No policy comes to the board in future
without one of these.
And Sasha, if you could enforce that please.
The only other point I would make is
you've got a proposed review date of September 2026,
two years away.
Every two years or so would normally sound okay.
I'm not saying change it particularly,
but I don't think we should be wedded to that.
This is new.
I think we should keep on the review,
how we think it's working and not be afraid to change it before then.
We don't need to wait until September 26 if we think we should.
Joyce, sorry.
Just really quickly, and thank you for the policy.
If we're going to have this cover sheet, can we have an addition
that the equality impact assessment has been completed?
All right, Carolyn, thank you very much indeed.
Yeah, thank you, everyone.
Right, a couple of last matters.
We circulated the board papers a while ago.
I think there was a request for a change from somebody, which
Ibrahim has done.
Are we happy to approve the minutes as amended?
OK, great.
The action log, there's not a huge amount there.
Ofsted Learning, given how busy we've been today,
we've deferred that till November.
But in any event, I won't say it's been overtaken by events,
Of course, we've had the new development of Ofsted saying they're proposed to change the
way they do things.
Ian Dilks - 2:05:13
And then the – it says here that RGC committees review response to commitments identified
blah blah blah, and consideration of the November board meeting.
It won't be after that.
I did wonder actually whether it should be at the RGC, but we can sort that out later.
But it will get done.
I had no other business, we have some public questions we'll take after the meeting is
over briefly, but any other business from anybody looking around the table?
Okay, well look, thank you colleagues, it's been a very long day for everyone, so I appreciate
the fact we still get energy in the room at 4 .30, that's fantastic.
I'll close the meeting on that basis, but as usual we agreed to take questions, we have
three. I'm going to take the first and then over to Tyson and James for second and third.
So the first question says, when will CQC invite members of the public to attend its board meetings
in person, as were the case in the past and NHS England board meetings? I mean, the short answer,
I have to say, is we're not currently planning to change the current arrangements. The changes
as I understand it, around about the time of COVID.
I think what we do now by normally making live stream,
although I appreciate it's not a live stream today,
but there is a recording.
But doing that makes it accessible to many more people,
many hundreds of people listening to this.
We get feedback in different ways.
The problem with public meetings is it would require us,
we haven't got the facilities in the office.
We moved to location since pre -COVID.
It would be quite expensive to, as well as disruptive,
to hire facilities elsewhere.
And for the limited number of people we ever used to get,
and the fact that we're not really being requested to today,
it didn't seem that on the basis of value for money,
we could justify the public expense of doing so.
But these things are all kept under review.
So there's such a thing as never.
But subject to the glitch today, I
The live streaming has proved really very successful in engaging with people, far more
so than asking people to trot out to East London to attend a meeting.
The second question, many members of the public expressed concerns to CQC by telephone calls
to the Newcastle.
Why does so few of these calls receive a response from CQC?
Tyson.
Thank you, Ian, and thank you for the question.
All concerns raised with CQC via telephone are either resolved on the call or shared
with inspection colleagues for further review or action.
For priority one and two calls, someone should be contacted to explain what action we are
planning to take or to get some further information.
We do not currently operate a follow -up response to members of the public for lower priority
calls.
Thank you.
Thanks, Tyson.
And last, James, one for you.
How does CQC plan to inspect and rate the performance of integrated care boards?
Thank you, Ian, and thanks for the question.
So it's the Health and Care Act 2022 which gives us the powers, the new powers, to conduct
reviews and assess integrated care systems, and within that we will include an assessment
of the integrated care board with the other relevant parts of the integrated care system
as a whole.
Our assessments have to align with the Secretary of State's objectives and priorities.
there has of course been a change in the Secretary of State since we began the development of
this work, and that's under the legislation as well. We're continuing to work on our approach
to this and we're engaging with government to obtain approval to our approach to this
duty. But in addition, we need to consider the findings, the final findings of the Dr
Penny Dash review, in the interim findings there is a recommendation that we pause this
work and so due to this our integrated care systems assessments currently remain paused.
Point of clarity in the question and the answer. So the assessment of ICBs, which is the question,
is undertaken by NHS England and they are working on a new approach to assessment of
ICB oversight and that was consulted on earlier in this year and secrecy will continue to
work with NHS England to ensure our two approaches complement one another.
But meantime we await further discussions with the government. Okay thank you very much
indeed James, I think that answers all of the questions so thank you for those that
Our next meetings will be on the 27th of November of this year, so we look forward to welcoming
people then.
Thank you.