CQC Board Meeting - November 2024 - Wednesday 27 November 2024, 2:00pm - Care Quality Commission

CQC Board Meeting - November 2024
Wednesday, 27th November 2024 at 2:00pm 

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  1. Ian Dilks
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  1. James Bullion
  2. Ian Dilks
  3. James Bullion
  4. Chris Dzikiti
  5. Chris Dzikiti
  6. Ian Dilks
  7. Chris Dzikiti
  8. Jackie Jackson
  9. Ian Dilks
  10. Charmion Pears
  11. Jackie Jackson
  12. Ian Dilks
  13. James Bullion
  14. Joyce Frederick
  15. Ian Dilks
  16. Mr David Croisdale-Appleby
  17. Joyce Frederick
  18. Mr David Croisdale-Appleby
  19. Ian Dilks
  20. Joyce Frederick
  21. Ian Dilks
  22. Chris Day
  23. Ian Dilks
  24. Belinda Black
  25. Ian Dilks
  26. Joyce Frederick
  27. Ian Dilks
  28. Christine Asbury
  29. Ian Dilks
  30. Mark Chakravarty
  31. Joyce Frederick
  32. Ian Dilks
  33. Charmion Pears
  34. Ian Dilks
  35. James Bullion
  36. Ian Dilks
  37. Charmion Pears
  38. Ian Dilks
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  2. Ian Dilks
  3. Belinda Black
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  5. James Bullion
  6. Belinda Black
  7. Ian Dilks
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  9. Chris Dzikiti
  10. Ian Dilks
  11. Presenter 2
  12. Chris Usher
  13. Ian Dilks
  14. Charmion Pears
  15. Ian Dilks
  16. Mark Chakravarty
  17. Ian Dilks
  18. Presenter 2
  19. Ian Dilks
  20. Mark Chakravarty
  21. Ian Dilks
  22. Chris Usher
  23. Ian Dilks
  24. James Bullion
  25. Ian Dilks
  26. Chris Day
  27. Ian Dilks
  28. Christine Asbury
  29. Ian Dilks
  30. Chris Day
  31. Ian Dilks
  32. Chris Day
  33. Christine Asbury
  34. James Bullion
  35. Ian Dilks
  36. James Bullion
  37. Ian Dilks
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  1. Jackie Jackson
  2. Ian Dilks
  3. Amy Robson
  4. Ian Dilks
  5. Chris Day
  6. Ian Dilks
  7. Charmion Pears
  8. Ian Dilks
  9. Jackie Jackson
  10. Ian Dilks
  11. Mark Chambers
  12. Ian Dilks
  13. Jackie Jackson
  14. Ian Dilks
  15. James Bullion
  16. Mark Chambers
  17. Ian Dilks
  18. Mark Chambers
  19. Ian Dilks
  20. Mark Chakravarty
  21. Ian Dilks
  22. Joyce Frederick
  23. Ian Dilks
  24. Amy Robson
  25. Ian Dilks
  26. Jackie Jackson
  27. Ian Dilks
  28. Amy Robson
  29. Jackie Jackson
  30. Amy Robson
  31. Jackie Jackson
  32. Ian Dilks
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  1. Ian Dilks
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  9. Ian Dilks
  10. Presenter 2
  11. Mark Chakravarty
  12. Ian Dilks
  13. Presenter 2
  14. Ian Dilks
  15. Presenter 2
  16. Chris Day
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  1. Presenter 2
  2. Jackie Jackson
  3. Christine Asbury
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  5. Ian Dilks
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  7. Christine Asbury
  8. Presenter 2
  9. Ian Dilks
  10. Presenter 2
  11. Mr David Croisdale-Appleby
  12. Presenter 2
  13. Ian Dilks
  14. Joyce Frederick
  15. Ian Dilks
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  19. Ian Dilks
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  1. Mark Chambers
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  1. Charmion Pears
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  8. Chris Day
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  14. Chris Day
  15. Ian Dilks
  16. Webcast Finished

1.0 Opening matters

Ian Dilks - 0:00:00
Well, good afternoon everyone and welcome to the public Board meeting of the Care Quality Commission. It is 2 o’clock on the 27th of November for those of you watching it on repeat. I will deal with some administrative matters first, and then we’ll go into
a quite full agenda. I don’t… sorry, I only have one apology who is Stephen Marsden, one of our non-executives. He was able to join us this morning, but is in another part of the country and unable to join us this afternoon, but otherwise we
have a full board attendance. Welcome two people, Howard Mizure, a clinical fellow, is here to observe us, welcome Howard, and Amy Robson, they represent the LGBT+ network and was with us this morning as well, and indeed gave some helpful observations. Are there any conflicts
of interest? There were one or two declared earlier on today, which we have noted, (unintelligible) outside the meeting. so I won’t ask people to repeat those. Are there any others that people want to note? OK, thank you. I should clarify, I say conflicts of

1.1 Chair’s opening remarks, Apologies and Forward View

1.2 Declarations of Conflicts of Interest

interest nothing was a conflict, but they were interests that we noted, but nothing that would represent a conflict. We have a fairly full agenda, but is there anything people wish to add to it? No, OK. I would just note for anyone listening in that

1.3 Any urgent business

2.0 Strategic Discussions

we have got a slight change to Agenda item 4.1. The paper, in truth, probably wasn’t quite ready to come to this Board, so we have withdrawn it, but we have replaced it with a paper that we didn’t have time to discuss in another meeting,
also on another aspect of Ofsted. If any of you are looking for the papers on the website, they should already have been changed over. Apologies for any inconvenience, but we will still have a slight 10-minute session. There is though one point in the paper
that we have withdrawn that I would like to make sure we pick up, so I’m going to ask James or Chris to talk to that later on. A couple of other points from me. I thought it would be appropriate or helpful just to remind
everybody, and put on record, a number of Board changes that have happened, or about to happen, or will be happening at some stage next year. So, and there are potentially quite a number, so on the executive side, Julian is joining us on Monday, but
there is a formality to deal with later on, which I will deal with, but delighted adjoining Julian will be joining us and will become a board member as the Chief Executive. Since we last met, Tyson who remains with the organisation in a slightly different
role, but has now resigned as a Board Director. As mentioned in a few moments, we are hoping at some stage to recruit some new Chief Inspectors and under the framework agreement we operate with the Department of Health and Social Care, we would expect to
appoint them to the Board. Since we haven’t started the campaign yet, we don’t who they will be, but we will probably appoint them to the Board as quickly as we can, so it is possible they will be further changes before our next Board meeting,
which we will need to ratify, but I am not entirely sure about that. On the non-executive side, since the last meeting we have lost Ali Hassan. Ali had a full-time job at another organisation, but also found time to be a non-executive director with us.
He has changed executive jobs and unfortunately his new employer does represent a conflict with the interests of CQC; it is basically associated with a body that we regulate and therefore Ali had to stand down at 31st of October. A sad loss, but we have
thanked him for his contribution over several years. And then Belinda Black is standing down at the 31st of January, so still two months away and many meetings between now and then that she will be participating in, but the timing of our board meetings are
such that the January meeting is actually in the first couple of days of February. So, it does mean that, although it is quite some time away, this will in fact be Belinda’s last full Board meeting. So, Belinda, I would like to put on record
our thanks for everything you have down over the last few years. You are our Mental Health Act-nominated expert as well, so there is a specific issue for (unintelligible) to fulfil, as well as just your common sense and other wider contributions. So, from the point
of view of the Board, we are certainly not saying goodbye to Belinda yet, there is another two months, but I should recognise the fact that by the time of the next Board you will have stood down. I suppose a final point I should mention
– it is much further into the future - but I should say a word about my own position. I, like all NEDs, was appointed on a fixed-term contract, so my contract expires on the 31st of March next year. I indicated to the Department a
little while ago that, for predominantly personal reasons, I don’t wish to be considered for reappointment to this role. It has been a very difficult decision. This is a tremendous organization but, as I said, largely for personal reasons, I don’t have the capacity to take
on another three years after next March. I have indicated that I am really quite flexible on timing, so should my successor not be identified by then, I more than willing to stay on. So, I don’t actually know the date on which I am departing
yet. As I said, that is potentially many months away, but I just thought, mentioning all the other changes, it would be appropriate to say that as well. Then we, as you know, we have private Board meetings as well as public Board meetings; we had
a private Board meeting this morning and, as I am sure listeners expect, we spent a considerable amount of time, roughly half the meeting, on aspects of our recovery. As I did last time, I thought it would be helpful just to pick up a few
high spots for those that were not there and are listening to this. So, let me give a summary of what I thought were the main points, if any of my colleagues feel I have missed something important, I will ask them to add in. There
are really two parts to it a discussion with Vic Rayner, and then a discussion of the presentation from the Executive Team. Vic Rayner, for those that don’t know, has been leading a piece of work looking at the impact of the Single Assessment Framework on
the Adult Social Care sector. And that is complimenting the work of Mike Richards who has already done some work, and indeed there is a report, an interim report, that he provided that we have already published. So, Vic is very much a work in progress
but she’s doing work both herself and working with Mike, but we wanted, given the importance of this work, to have an interim update from Vic on what she is finding so far. She has done a survey involving quite a large number of participants in
the Adult Social Care sector and a lot of what she said is basically playing back to us what she found on that survey. I suppose on a high level, I would say, there was nothing we heard that was a major surprise, and that was
the view also of the Executive. By that I mean none of the topics raised are things we haven’t heard before, but in summary, I would say that the strength of feeling, particularly bearing in mind the number of participants, was very clear from that, and
is something you don’t pick up when you just discuss something with one individual provider. When it is all pulled together, it comes through very much more clearly, as well as some additional insights, obviously in some of the comments. I think there was some question
marks over the co-production work that we have done. I mean we have, as an organisation, tried very hard to co-produce things, but one of the messages from Vic’s work is that the nature of the Adult Social Care sector, with such a large spread of
scale of organisations, from really quite small organisations to multinational groups, means that what is appropriate for working with one group may not read across to another. So, I think there is a lesson to learn for us there when we are working with groups on
co-producing, that we recognise the differences in some way, shape or form. An overarching theme, of course, that we recognise that we need to rebuild trust. I mean that is obvious, but it does also impact the method of communication in the short term. There is
a risk that things we say, which were meant for the best of purposes, could be regarded with some scepticism, and therefore I think we need to be doubly careful in the way that we communicate. We had some discussion, and I think we need to
do some more work, to understand how much - when the findings are given about issues of working with us - how much of that is a consequence of the newer ways of working, in particular the Single Assessment Framework, and how much is a historical
issue I mean it is still an issue to be dealt with, but the solutions are different. Obviously if you change SAF and that’s not the core problem, you’re still left with some issues. So, the Delta, as someone said, for the SAF regime. I think
is important to understand, and we’ve asked Vic and the management team to think more about that. Proportionality came up from providers. Not surprising, I think this is an issue for every regulator, and what the regulator thinks is important, particularly if we are having to
do certain things in accordance with legislation, doesn’t always accord with the views of the Executives who run organisations. So, we recognise we’re not being complacent, we recognise the need to address it, but being realistic, there’s probably always some tension there. The other dimension I
think that we have to take account of is the views of users. I did say this morning, and I repeat it, if I look at the correspondence that comes on my desk, it is notable and entirely understandable that that the view of somebody who
runs a care home with a large number of people, about the impact of one incident could well be different from a close relative of the person who suffered the incident, and that is an additional complexity we need to deal with. So I think, potentially
quite a lot of actions come out of that. Some are already underway and I think, recognise that for some of the points, that have been identified, are already being addressed by the actions we are undertaking. But there are other things we need to think
more about and take account of some of the points that we discussed, that I mentioned a moment ago. And it will be…, we do need to give…, this is work in progress, although she’s still doing more work, but at some stage we will have
to compile what she’s told us, look at what Mike Richards has told us, and then be transparent in communicating to people what we’ve heard – and more relevant for people - what we’re doing about it. I think that’s an important prerequisite to building trust.
So, that was the discussion with Vic and we’re very grateful for Vic, and indeed all the people she works with, for what she was presented to us. The other thing was then, quite a long discussion around the recovery generally, and how that’s going based
on presentations from management. As most people listening, I’m sure, are aware, I mean we are still challenged is a simple way of putting it. We aren’t seeing the progress that we would like in a number of areas, but what I would say, and I
think it’s important for people to understand that, I think the transparency of that to the Board has changed significantly over the last few months. One of the consequences of that is that we recognise that people, and I am thinking particularly of our own staff
here, but it probably applies to providers as well, are not seeing the benefit improvements on what it means for them as individuals. I’m not going to say too much more about that because I think James will probably touch on it in his Chief Executive
update in in a few minutes’ time. One of the ways we need to deal with that, I mean whether or not people see improvement as a combination of (unintelligible) is an improvement, but also do they understand that changes have been made and what should
be happening. I think we recognise there is a need to improve communications. Internally, one of the changes we are looking at or using indeed is to make better use of the existing line management channels. So, instead of a communication from the ET level to
a very large number of people, which is quite difficult to do, but using the existing line management channels. That potentially is slower, but I think it’s more useful because that way people hear directly from their line boss, and if necessary, there can be discussion
to whether or not these changes are the right ones. It does also mean though, that we are able to make more use of input from people in CQC, and there are some examples of whereby (unintelligible) gained better engagement with people on the front line,
we get useful input to things that could be done differently. And probably as an example of that I would cite one of the pilots is now effectively a hybrid pilot, and the way that’s been put together does reflect the input we’ve had from some
of our staff. So, I would like to thank those involved, specifically in this case, but just to offer a word of encouragement to others, if there are things you see are not working, please do raise them and we will seek to address them. I
hope a message that has come through to people is the ability and appetite – or is it the other way round - of the organisation to respond to feedback from our staff has changed. All of that said, I think there is a challenge for
the Executive Team that we are very sensitive to here. that there has been in the past promises for things to be different when they’re not, and nobody wants to overpromise and underdeliver. In many ways it is much better to underpromise and overdeliver, but if
you underpromise too much it means you’re not telling people the things that are happening, what might impact them and it may well be in certain cases, the knee-jerk reaction to not over promising means that we are unnecessarily underpromising which is a difficult balance to
achieve. We recognise that and it has to be looked at. We talked quite a bit about the priorities for the organisation. There was a Board away-day about a month ago, where we looked at this in a lot more detail, and made sure around the
Board table and the executive team that we are aligned on what the real priorities for the organisation are. Given the challenges ahead of us, we have to recognise the fact that not everything can be done at once, so we have to be clear what
the priorities are. There may be a need or an opportunity to be more transparent, about that as well, to people in the organisation. Amy was with us this morning and it is always helpful, increasingly helpful, I found, to have our chairs of networks there
so as to be able to make some useful observations, but in particular suggesting we could make more use of the networks in some of these areas. So, thank you for that Amy. Then, finally, is something we spent quite a bit of time on, is
the backlogs that we have in a number areas, I won’t list them all, but things like information of concern. This has been one of the biggest concerns for the Board and the non-executive members of the Board. We had really a much more insightful analysis,
both of what the problems are, understanding the problems and what it is that we are doing to fix, than we have had before. I won’t go through everything that came out of that, but I will highlight just one or two points. Firstly, as we
clear the backlogs, we are very keen to make sure that we understand the learnings from that, and by understanding the learnings I don’t just mean a technical piece of learning, but getting it back in the hands of frontline users as quickly as we can.
In other words, to say if we did something differently, these backlogs might not be occurring in quite the same way. We do recognise there is a big impact of our systems and technology here, and some changes can’t be made public until we fix the
technology. But there may be work around this that are being looked at, we know. And the second point I would make is we have to recognise the fact that it is a fact of life that there will always be an element of backlog because
of a timing difference between the date on which something is received and we are able to look at it and decide what should be done about it, it needs to be looked at. So, I suppose you could argue that’s not really a backlog, at
what stage something that is a natural time difference becomes a backlog is a point of debate, but we’re trying to get a better understanding of what the total numbers mean in relation to those (unintelligible). If something has been around for too long, that’s clearly
a real concern, and that has to be addressed and the management have initiated a number of steps to try to get through the backlog. We saw some quite useful information about things going into the Hopper and things coming out to the Hopper, but more
needs to be done there. But contrast that with what, historically, has been a fairly steady or often steady level of items that haven’t been processed or dealt with. I mean that is demand-led. Our resources are finite and demand or the number of notifications or
whatever coming in does vary, so you’ve got to accept some fluctuation. But I think as part of next year’s more fundamental business planning we have asked that we look at what, historically, has been the level of timing differences or backlog or whatever you want
to call it, and see whether or not that can be reduced to be more effective, and in particular whether we can make better use of technology. So, I said a summary, but there’s quite a lot we discussed this morning and that there’s only some
high spots, but it was a good discussion that we would thank the management for the openness with which things were presented. I’ll just quickly asked my non-executive colleagues, or indeed any anyone around the Board, whether or not there was anything major you felt I
didn’t cover? OK, well, thank you very much to everyone for listening and I hope it was helpful to understand the time and effort that the Board put into looking at these things. Let’s move on to the more normal business and me covering those two

2.1 Key points on Recovery

areas does mean we are slightly behind schedule, but we will try to make up. James and Chris, we have a report from you on Organisation Regulatory Insights. We will take the papers as read, but there are a few points you might want to highlight

2.2 Report from the Executive Team

and then we will go to questions. Thank you. Thank you. Thank you,
James Bullion - 0:19:38
Ian. I wanted to begin by echoing your point about the amounts of work colleagues are doing to work on the recovery and the improvement within CQC, and to echo your thanks to
the providers that are working with us on our revised way of working. From Monday, the 2nd of December, we are rolling out a hybrid assessment. CQC’s recovery covers all aspects of our work including how we deal with registrations, as you described backlogs, and also
includes how we’ve structured our teams and the expertise within them. But we particularly recognise that on our assessment performance, we do need to radically improve that for the remainder of this year and into next year. So from Monday we will be rolling out our
hybrid approach to assessment, which includes a reduced number of steps and we will put this information in the public domain. For those providers who have been assessed using our current arrangements, that will continue, as it were, for them in the normal way. We won’t
mix and match these two approaches, so we keep consistency and fairness in relation to that. We hope to be reporting to the Board, come February, the impact of that change in terms of the numbers of assessments that we are able to carry out across
social care and health. So look for more information, our own staff, on our internal homepages, but for external colleagues on our website which we will be updating shortly to contain that information. On the Chief Executive’s report, I just want to highlight just a few
matters. First of all I wanted to note the continued work of our local authority assessment teams. We are now into 75 councils, we’ve published 13 reports and the rate of publications and work, as it were, will go up as we enter towards the end
of the first year. I’ve got the opportunity this week of attending in Liverpool the National Conference of the Directors of Adult and Children’s Social Care, and to have a further conversation with them about their experience, but wanted to place on record my thanks to
them, to the LGA and to ADAS, in working with us on improving that process of assurance and assessments, which is growing in confidence internally within our own staff and their expertise, and externally in the reports that we publish. It is not without its challenges,
of course, but that partnership and the collaborative way we’ve approached that has been a central part of rolling that out. Secondly, I wanted to note that every year CQC, we are very cognisant of the impact of winter across health and across social care. This
year, as people will see in the report, we are featuring some work looking at emergency care pathways and carrying out inspections to make sure that, as health services quite rightly focus on the - as it were, sorry to use the language, the throughput of
people through hospitals into the community - and we make sure that the quality of people’s experience and the standards that are applied in those situations are good. So, we were looking at, particularly, systems under pressure over the winter, to look at that work. Thirdly,
I wanted to bring the Board up to speed with the independent Care and Treatment Reviews that we’re undertaking on behalf of NHS England and nationally. A small number of people 93 people in the cohort here, but really, really high levels of support required for
those individuals and their families. We’ve been able to undertake 21 Panel Reviews of those with a further 36 scheduled. So, we are well underway with meeting the target set by us for that piece of work. I would expect to be able to come to
the Board and for CQC to report on the impact of that on people’s quality of life. We will have seen from the media some of the very difficult circumstances that you can find with people with very high levels of learning disability or autism need,
and the difficulty that people have in providing support in those situations, but the absolute necessity of taking a person-centred and safety-first and safeguarded approach to that. I wanted to draw attention, so that good work that CQC is underway with. I will take the rest
of the report as read, but some of my colleagues, Executive colleagues, might wish to comment on either the wellbeing work that is underway within the organisation around supporting our people, and in particular the large degree of engagement work that we’re now doing with the
- it’s not new anymore, is it? - the new government, with the government and its agenda for health Care and communities, and particularly mental health, where my colleague, Chris Dzikiti, he’s taking the lead for us in in responding to the potential for the mental
Ian Dilks - 0:25:11
health changes coming on track. Chris, do you want to add anything on mental health and Jackie, if there is anything on wellbeing, but equally we have a session on people later on, so you may wish to pick it up then? Thanks Ian and thanks
James Bullion - 0:25:23
James. Just a few things to add on the Mental Health Act. So, the government introduced the Mental Health Act Reform Bill on the 6th of November, and the aim of that really is to improve the Mental Health Act, thinking about addressing key concerns are
detention, individual rights for people, care and treatment, safeguards and some issues around racial disparities on the use of the
Chris Dzikiti - 0:25:56
Mental Health Act. There is, there are some implications for us as CQC in terms of an increase in our SOAD work. That’s the Second Opinion
Approved Doctors who review people’s treatment in mental services, mainly in other services where people are given medication. It also increases our work around operational activity on complaints and also thinking about people who are deprived of their liberty under
Chris Dzikiti - 0:26:22
supervised discharge in hospital. Another issue
I just wanted to raise as well is around, we have written to the Minister to highlight some concerns around the delays on the provision of liberty safeguards which is supposed to be replaced by the liberty protection safeguards. There has been a delay on liberty
protection safeguards being introduced. One final thing I just want everyone to note is the work we do with the national preventive mechanism. We don’t normally talk about it a lot actually, but it’s a really important role we play with the other three nations in
the UK, which is about looking at people who are detained in services and their experience, and whether they’re being kept safe or not. We’ve got an annual report which is being published in December. They focus on some of the work we’ve done in CQC
in terms of thinking about the Section 48 work, we’ve done, the work we’ve done on restrictive practice, and also the work we’ve done on patient and carer (unintelligible) quality framework. So, those are some of the areas I suppose I wanted to highlight this afternoon
because they impact on people’s experiences of services in mental
Ian Dilks - 0:27:34
health services. OK. Thanks Chris. Jackie, do you want to comment now or later? Yes, I’ll come in now for a couple of seconds, if that is
Chris Dzikiti - 0:27:40
OK? So I think from a wellbeing perspective, we have
Jackie Jackson - 0:27:44
had quite a few interventions in teams of best practice, taking breaks, talking to colleagues, talking to line managers, about, you know how colleagues are feeling, the challenges that they are facing working with health and safety in terms of the risk assessments, with the usage
of the new system and how we can best support colleagues who are experiencing discomfort with using the system. But I think if we’re truly honest, the bottom line of how we can impact wellbeing is how transparent we are with the Recovery Plan, giving colleagues
the opportunity to contribute to that, understand the direction and also understand that we know what the priorities are. I think there’s still work to be done on that and I think that will be a massive impact on wellbeing. We can’t, you know, overlook that
as part of our recovery plans. I think we can do lots of things to support, but I think they’re around the periphery. I think the root cause is in the Recovery Plan, and delivery and priorities of that.
Ian Dilks - 0:28:54
Thanks Jackie. So, any questions from my
colleagues or comments on what’s been said? Charmion. I just had one
Charmion Pears - 0:29:04
on wellbeing, if I can? Obviously, it’s quite a difficult conversation for a manager to strike up with colleagues working with them. Can we talk a little bit about what we’ve done to support
our managers and what kind of toolkits we’ve given them to enable those conversations. So, we have talked in the past about (unintelligible) have a toolkit, there are things that can be built into conversations that are not always easy to have, and also about how
we’re helping them. Identify risk of significant stress please. So ,
Jackie Jackson - 0:29:35
our intranet we’ve got a dedicated wellbeing results and that has got a wealth of information there, and also in my team we have got a dedicated Deputy Director who is leading on wellbeing, so
we are regularly working with the Wellbeing Coordinators, put up some, you know, new way of thinking, best practice from her experience, being available to talk to colleagues. And also in terms of, from an executive team and my team, how we share that information so
we can identify colleagues who may be at risk who may be needing intervention. Because you’re right, it is a difficult conversation, and what makes it even more difficult is the homeworking element because you can’t see body language, you can’t see people in front of
you, so it is about how we recognise when we hear something, we don’t ignore it, we will follow up on it. So, you know that’s where we are. Is it a perfect fit? It probably isn’t at the minute in terms of trying to understand
what else we can do, but I honestly believe that we’re trying to cover every base from a homeworking perspective to making resources
Ian Dilks - 0:30:58
available, providing support and being vigilant, all of us. A? other comments from people. OK, thank you very much James, Chris and others.
Probably best if we just move on. We have a paper now on…, James, I think probably you are leading as well, along with Joyce, on response to the Penny Dash Report and the report that we commissioned from Mike Richards. Quite a lot of this
is already out there and in the public domain, but I think it would be helpful just now to be quite clear on, for the Board to be clear and approve the responses that we have already made, and we are proposing to make, those pieces
of work, so shall I hand over to you? Yes, just to confirm, given the
James Bullion - 0:31:50
timings of publications of reports, we will very, I think, clear and in the public domain about what our response was. So, we’ve put that out there, but we feel it
important that, formally speaking as it were, the Board gets an opportunity to, as it were, endorse our formal response, and I think Joyce you have led for us in bringing Mike Richards and Vic Rayner’s work together, so I’ll hand to you. Thank you. Thanks
Joyce Frederick - 0:32:20
very much James. I’m just going to go briefly through the key changes that we want to make, and this is really for the Board to note our approval on both reports. So, in October this year we received and welcomed two independent reports on the
effectiveness of our regulation and that was the Penny Dash review which looked at our operational effectiveness, and the report by Professor Sir Mike Richards which looked at our Assessment Framework. So, the Dash Review covered seven recommendations, which are outlined in the paper, around how
we must improve our performance and sector expertise, as well as our assessment framework. There are three further areas, which were not in the interim report, that are in this final report, which is about our local authority assessments and the ongoing improvements that we can
do there. There is a pause to our ICS assessment work, and we will continue to discuss that with the Department as to how that would look and what it might look like in terms of our assessment, particularly considering the Darzi Review and the NHS
10-Year Plan. Then there was a final recommendation about improving our sponsorship arrangements, accountability and efficiency, with the Department as well, who are the sponsors of our independent regulation. The Richards Review, we also highlighted at the same time. There were 30 recommendations, and at the
time we had four high-level recommendations that we agreed, which were about sector expertise with Chief Inspectors, modifying the assessment framework, improving the systems and the tools that our colleagues use, and improving the provider experience of registration. We agreed to those high-level recommendations at the
time, and this paper really is about formally noting to the Board what we are doing in terms of the 30 recommendations that are in Professor Sir Mike Richard’s Report. I’ll say here that we are in broad agreement with that review. There are some recommendations
which we need to consider further because they involve others, they’re not decisions that we solely take and agree as a management action. We have to do involving others in a decision, but also they’re not all within our gift, so we have to do in
collaboration with others. You are absolutely right, Chair, that we have spelt out some of the key changes from both the reviews, but I suppose it’s important just to outline how, and I’ll do so briefly, and then take any questions. So we are in the
process and campaigning to recruit Chief Inspectors. We have talked about three and looking further to possibly recruit four as well. The integration and the importance of sector expertise, we completely acknowledge, and that would mean looking at our Reg. leadership functions and operational functions and
how they might further integrate, bringing that sector expertise, but also relationships with providers in a place, that’s really important to underpin regulation. We know we have to model and recruit resources to get the right grades and skills of people into our operational staff, and
we know we have to improve the tools in terms of the Reg. platform and a portal that providers use which are not the most productive and efficient tools or effective tools at the moment, and we have to improve them if we’re going to do
our regulation appropriately. And within the report, we know we have to improve pay and the job attraction within the constraints because we are outside agenda for change, but within the constraints, within the civil service pay arrangements, we know we will have to work with
the Department to look at that as well as understand what it means for us as an organisation. Some of the key changes to the assessment framework are really about working in partnership and co-production with providers, and being really transparent about our process. That includes,
for example, rating characteristics and producing a regulatory handbook that clearly outlines the processes and the changes that we have made. We recognise that the term Single Assessment Framework is unhelpful. It kind of belies a common approach across all sectors, which was not the intention,
but we will remove the term “Single”, not just because it’s a word or rebranding change, but because we want to make every effort that our assessment, our regulation focuses on that sector expertise and we differentiate based on that sector expertise. Still around the consistency
of which independent regulation demands, we want to make sure that the processes that we do are clear and transparent in terms of the ratings and how we make those judgments about ratings. There are things we are continuing with: the five key questions, the I
statements, the We statements, the quality statements, much of which was developed with providers and people using services who have said this is the standards I would expect from services within those I statements. I also acknowledge that we’ve said we want to do these things,
but we rapidly have to get on and change things, but I think the transparency of that change process is essential and we need to do that quite immediately. Providers need to know what process we are doing at what time, so as to make sure
that our regulation is consistent and we’re not moving any goal posts or changing any thresholds, so we just need to make that absolutely clear. Professor Sir Mike Richards is working with Vic Rayner, which you alluded to, Chair, just earlier, and we do expect Phase
Two of their report, which gives us more information about what good looks like, what our approach looks like, so how do we work with providers and what does the reporting process look like from end to end, from the point at which we might start
an assessment process, speak at the end of an assessment or inspection and then feedback that report and the sort of information we provide to the provider or that area. So, that report will give us much more detail on our regulatory priorities and the assessment
approach, and we look forward to receiving that report in December. There are lots of other things we will do, but the timescale by which we can do them, we have to be really careful and considered about. So, there are some immediate things that we
have done in terms of priorities, and you’ve talked about them, and then the longer-term things, which are in both reports, around looking towards innovation, new models of care, influencing the effectiveness of care and use of resources, using far more outcomes, data, for example, and
being far more robust in our data. We are starting to plan these things and they will build on the work that I’ve just outlined in terms of the priorities for us as an organisation. OK, thank you,
Ian Dilks - 0:38:47
Joyce. So, questions or comments from colleagues. David.
Mr David Croisdale-Appleby - 0:38:59
Thank you Chair. I just had a question, Joyce, if I may? About the term you used, what good looks like which is what we’re looking for. My question really is, what is the bandwidth across which that review was looking to come up with the
proposals about what good looks like? Is it specifically, for example, just to do with health and social care sector, or is it more broad than that? So, currently Mike Richards and Vic Rayner are looking at the health and social care sector in terms of
our regulation. They’re doing a lot of engagement with providers, and engagement with our own internal colleagues as well, but and in looking at the evidence base in terms of what the future of regulation and what regulation looks like. So, it’s well informed, but it
is around health and social care-. And if I may follow up, do they…, within Health and Social Care as both are delegated in the four home nations, are they looking at evidence in the other three home nations in that? Yes, so their review is
about us, in England, but they are going to learn from the other three
Joyce Frederick - 0:40:17
regulators because they do things that we don’t, we do things they don’t, and there is that learning that we do. We also meet with UK regulators, our Chief Exec. Yes, my
Mr David Croisdale-Appleby - 0:40:32
Ian Dilks - 0:40:33
question is specifically about the review, thank you. While other hands are going up, one comment and then one question. Joyce, the comment is really clarification for something that is in here. It says that we are in the process of appointing at least three inspectors. There has been some debate
on whether we should have a new Inspector for Mental Health, I think it has been agreed that we should so, whereas we used to have three Chief inspectors we will now have four. Currently we only have one in the way envisaged in place which
is for Adult Social Care, James, but it says we are in the process of recruiting. For anyone out there that says I haven’t seen the advert, that’s because there isn’t one. To be clear, we are ready to go as soon as we can, but
we do require approval from the Department for some of these things. So, we received approval for the Chief Inspector for Mental Health in the last few days. We are still hoping we will get soon the approval for the Chief Inspector of Hospitals. So we
are ready to go, we have got the adverts drafted, but we do just need that approval. So for anyone listening who is interested in these jobs, please do look out for that and apply. My question is, you say in here that there’s going to
be a handbook co-produced with providers, but one of the things we heard this morning, and I picked up in my highlights, is providers do vary enormously, and suggestion that some of the work we’ve done, including co-production, may be for one group that didn’t necessarily
replicate across. So, how does this work you refer to here map to the findings that Vic Rayner presented, that we need to recognise the fact that the spectrum goes from the very small to the very big? Yes, and
Joyce Frederick - 0:42:27
that’s really helpful. The handbook cannot
go into the specific detail of what good looks like for every single sector. There is about 80, 90 different service types, for example, but what the handbook is going to do is focus on our regulatory approach, which we should do, in co-production with providers.
So, there’s a set way of us doing things in terms of regulation: our framework, our approach, how we use data, how we collect, evidence, what we do on an inspection, what we do in terms of feedback to providers. So, those are the things that
the handbook needs to cover, how we make judgments, for example, and that’s really important that we make that transparent and do that with providers. I think there’s other things that discuss the characteristics, if you like, of what good looks like. So, we want to
develop ratings characteristics, we want to develop far more sector and service specific guidance, and that will give far more information. So if you are in a particular service or a care home, for example, or in a dental practice or in n a general practice,
there will be far more service-specific guidance that you could look to and say, that’s how the rule will approach this for me. We have some of that but we need to update it, but we need to do it with providers. We won’t do it
on our own. And most importantly I think, we need to do all of these things with people using services because ultimately it’s about the expectations of everyone involved in health and social care, not one particular group. We do want our regulation to work. Our
aim is to drive improvement and to work with providers and to work with people to get that improvement in health and care services.
Ian Dilks - 0:44:08
Chris, you wanted to add, and then I will come to you, Belinda. Joyce is entirely right. Just to add to that,
I was lucky enough to be at a co-production event on Monday, which had
Chris Day - 0:44:23
a range of very small, much larger providers by different sectors. We planned it quite well in advance, so those who were part of smaller groups were able to attend. What was
really clear is that all of those, and people who use services, were keen to make sure that we had a model of what we’re looking for that everybody understands, so everybody knows the rules by which we are operating our inspection process. And there’s a
lot of support from small and large providers across the sectors that we regulate to be involved in that. So, just to give a reassurance to the Board that we’re aware of the differences in the different types of providers that we regulate with, we’re allowing
for different types of engagement, so some face-to-face some online, some using our portal, so make sure we can capture the views of people and ultimately present something back that is meaningful to our colleagues, meaningful to providers of different sizes and types, and meaningful to
Ian Dilks - 0:45:18
people who use services. Just ask, I mean that’s good, but it would be useful, I think, just to make sure that, whether you need Vic for the people she represents since she raised it, and also our own people who are getting out having to
apply this, that I can understand that the guidance will largely be fairly generic. But actually what that means in practice, it would be helpful to make sure we’ve got everyone on board as to how that will work in practice. Belinda. And that is some
(unintelligible) work ongoing as I have sat in on a couple of meetings
Belinda Black - 0:45:49
recently where we’ve been discussing that with providers, about what good looks like. But I just wanted to have a rough time frame of when people might expect something in their hands they
Ian Dilks - 0:46:02
Joyce Frederick - 0:46:05
can use. On the handbook? I think we are planning that for, if I say March next year or spring next year, that would be the rough timescale. That being said, Belinda, we want to give people indications of what we’re doing and how we’re doing
it, as we go through the transition and the interim approaches that we have. So, that point I made about being transparent, about what is the context of our regulation here and now, and how will it change, we will need to update people, but I
think it’s spring next year. I can’t give a definite month obviously,
Ian Dilks - 0:46:43
but yes, definitely. Christine. Thank you. Just a point of
Christine Asbury - 0:46:46
clarification, really, we’ve been talking about the work that’s being led by Vic Rayner, and we’ve been talking about (unintelligible) as a shorthand but
actually the work she’s doing is as part of a collaborative project with the Care Providers Alliance and I think it’s just worth making that point. That’s a group which represents the majority of both national and local care providers in the UK, well in England,
and also has even greater credibility to it because it’s being done with all of those agencies. So, although we’re using the shorthand Vic Rayner work, it’s actually Care Providers Alliance. To be fair, had she been here, I’m sure she would have made the same
Ian Dilks - 0:47:25
clarification, but thank you. Any other questions? Mark.
Mark Chakravarty - 0:47:34
Apologies. It is bridging the opening, Chair, about there’s a lot of activity and there is a requirement obviously to underpromise and overdeliver. These are 30 commitments, so again, it’s just seeking the assurance that these are now going to flow fully into the
Recovery Plan, and if there’s anything new that is required, they will go into the Recovery Plan. Within that we will then start to seek clear prioritisation of what is going to get work, because it’s a lot of additional work for a lot of people
and we need to make sure that it’s working in the right direction. So just again, that you’re not envisaging that this is opening up work streams that are outside of the Recovery Plan, apart from the ones that you’ve already pushed a little bit into
the future of, we are also planning to do which will sit into a future
Joyce Frederick - 0:48:34
business plan. I’m glad you mentioned that, Mark, because when we looked across Professor Mike Richard’s review, many of the recommendations we were already doing as part of our Recovery Plan.
We are sequencing because we have got to prioritise, because if we did everything, nothing is a priority, so we are sequencing what’s immediate that we need to do to make our regulation safe and stable, and then what needs to be slightly longer-term, that drives
improvement, is equally as important, but we know we can’t do just now. So, it was helpful that many recommendations were already in our Recovery Plan, but then ceded into our longer-term plans as well.
Ian Dilks - 0:49:15
OK. Thank you Joyce. Look, if there are no other questions, we are being
asked to approve this response. So, as I said in my opening remarks and Joyce said, a lot of this we have seen elsewhere, but pulled together like this, are we happy to approve it? OK, thank you very much indeed. And thanks to the team.
I mean there’s an awful lot out there that we have to respond to, so thanks for the way we pulled together? OK, let’s move on, we have a Corporate Performance Report. Chris, this is down to you, is Sean joining us? Sorry, I beg your
pardon. Can I just ask one question that is not related to the
Charmion Pears - 0:49:52
recommendation approval per se, that is around the timing? So, Penny Dash’s Report had some 6-month and 12-months timings, and just interested in the process by which we’re going to, sort of keep
appraised of the timing, you know, relative to the plan, how are we going to ensure that we are keeping abreast of those timings, James,
Ian Dilks - 0:50:19
and how that’s going to look? I think we’re going to incorporate that into… I think we are going to have
James Bullion - 0:50:23
to do two things, really. One is to incorporate the timings of the outputs of what were committed to into the recovery process more broadly. Then the second, I think there are staging posts for the publication of further reports that we will just incorporated into
Ian Dilks - 0:50:50
reports back through to the Board here. But if I’ve understood the point and the answer, to be helpful next time we get the report to have some transparency of what the future plan is for all of these, which I think is what you’re getting
at, isn’t it, Charmion? Yes. Timing and forecasts and if we are going
Charmion Pears - 0:51:03
to see slippage, knowing earlier than later relative to the
Ian Dilks - 0:51:09
recommendations we’ve just agreed. Here is your opportunity to make (unintelligible) if you like because it will be Julian’s problem from Monday. If

2.4 Corporate Performance Report (Q2 and September 2024)

we could move on, the Corporate Performance Report. Sean, thank you for joining us. Chris and Sean, as you now take the papers as read, but highlight any specific issues or concerns or anything that’s updated since the papers were put together. I don’t often make
this point, but it’s probably is worth saying it now, and I would flag it elsewhere. Timings at Board means often we have to get papers prepared two weeks in advance and the world has moved on a little bit by the time we meet, so
if there’s anything, that has changed, let us know. Good afternoon
Presenter 2 - 0:51:46
everybody. Thank you, Chris, and thank you, Chair. This item covers performance reporting in two areas: the Q2 position on the Board Quarterly Report, which covers people’s experience, quality of care, safety of care and
health inequalities, and the October Balance Scorecard, which covers regulatory effectiveness, business processes, finance and culture and people. In the context of the difficulties we find ourselves in that have given rise to our Recovery Plans, the Board will be well aware that our performance reporting
continues to fall behind where we would otherwise expect it to be. You’ve read the papers, as the Chair has said, and will no doubt have questions for members of the Executive Team. Before you do, I’d like to highlight three areas: Responsiveness in the call
centres is improving across registration and general enquiries; Mental Health and Safeguarding are behind where we would expect, but these are specialist lines and staff redeployed or new to the team will need time to train and become familiar with the work before we can expect
a similar improvement as on the other lines. The volume of assessments in October remained behind where we had aspired for it to be, and in October the year to date position is 1639 assessments that have been completed with an aim to have reached between
5000 and 7000 by the end of this year. Finally, registration timelines are improving: from a high of 61% of registrations being more than 10 weeks old in May, by October this had dropped to 38%. Chair, I will
Ian Dilks - 0:53:10
hand back to you for questions. Anything
to add, Chris? Questions or comments? Belinda. Thanks. I’ve got a
Belinda Black - 0:53:23
couple of questions. So, I know we have moved away from the terminology of inspections to assessments, that’s fine. But how many of those assessments involve an inspection? So, I think it’s important we have
clarity on how many of those assessments involve members of our staff going into services? I also think it’s important that of those physical visits, how many of those visits are done out of hours, and by out-of-hours I mean proper out-of-hours, not just starting the
assessment early and finishing late? I think we really do need that clarity as a Board, and just your views generally on why you think the
Ian Dilks - 0:54:05
James Bullion - 0:54:08
assessments are so far behind. Chair, can I pick up a sort of assessment productivity point because, Belinda, it goes
to this issue, about the interplay between the priorities we set ourselves, the risk-based priorities for regulation, and the performance of our regulatory platform system. As I was saying earlier in the Chief Executive’s update, we plan to roll out the hybrid approach, which we hope
will have a number of reduced steps in it, which will enable us to go out and undertake more assessments. Many of the assessments will be via the means of inspection, but they won’t…, not all assessments will be inspections. And in the trial of the
hybrid approach, I think we undertook around 170 in Adult Social Care during a period of six or so weeks. During that period of time for the trial, we had examples of it taking around 17 odd days from allocation of the work through to publication
of the report, so a much increased productivity from a really poor average in the last six months, well actually the last year. It is that that might give us some confidence that that number that’s in the report, the 1900 assessments, which has now gone
up to 2100 I think, but it gives us some hope that actually that will go up. I was talking to a member of staff, Keshet who was describing to me her absolute pride in being able to get out during that 17 days time, and
the day after, Day, 18, going to another social care provider and starting again with that reduced process. So, I think until we have, as it were, a game changer and more productive system, we won’t see that number rise significantly, but our ambition remains the
target of between 5 and 7, based on better tools for our staff. Because they are absolutely chomping at the bit actually to get better regulation and better productivity out of the system, but many of those will be inspections, but not all of them. There
will be examples where assessment is the methodology. I agree with
Belinda Black - 0:56:32
you, but I think we need to be very clear on… Because assessment is a new, relatively new term that we’ve started using over the past few months. Up until then, we always used the
word inspection, and I’m not suggesting that every assessment needs inspection, but as a Board we need to be crystal clear. You know, we don’t want to have to… we have done thousands of assessments and then we find out that only 200 of those have
involved a physical visit. So I think it is just something we need to be mindful of, and especially in services, where we know there are
Ian Dilks - 0:57:07
more problems, mental health, maternity. Do you want to put your mike
Presenter 2 - 0:57:10
on? I was just going to add and
just say, yes, absolutely agree, you know (unintelligible) in terms of actually assessment and being on-site. But the other thing I was just
Chris Dzikiti - 0:57:21
going to answer is your question around what’s the percentage of site visits or inspections of all the assessments we have done. By
end of Q2 it was 78%, so in terms of what actually being on-site of
Ian Dilks - 0:57:38
Presenter 2 - 0:57:40
those assessments. Chris, you wanted to come in? I was just going to say that at the moment 78% of inspections, sorry assessments, include an inspection against a target of 75%.
I was just going to say it’s in the dashboard, Belinda, on Page 22 of Diligent, it says the assessments with a site visit, so it gives you
Chris Usher - 0:58:00
the volume of assessments and then how many of those were with a site visit, so it is
in there. But your bit on out-of-hours though, I think we need to take that away because I think that needs to, I think that work is kind of
Ian Dilks - 0:58:17
paused at the minute, so we need to look at that. Any other? Charmion. Thanks, and thanks for the
Charmion Pears - 0:58:22
report. Just a few things for me, particularly around prioritisation risks. So, when we look at the dashboard, we had a discussion this morning about sort of sorting it to the highest priority. So, perhaps we can do the same with a dashboard, the things that
we have prioritised in the top right quadrant. We sort of highlight top of the scorecard, I think, would be really beneficial. My other points relate mainly to risk, and obviously we are really delighted, Sean, with the work that the team is doing and with
the idea of a Performance and Risk Committee to really get focused on this. I think it’s fair to say that I would like to just add, because the ARAC Report is out of sync with this, that we have raised some concerns, as an ARAC,
with some of the risks that are missing off the register. I think particularly risks like significant backlogs that may result in risk of harm or record keeping, that may make it difficult for us to discharge our responsibilities, things we are talking about regularly that
are in the top priority quadrant that are risks, don’t feature, And we’ve also raised concerns around some of the scoring, things like benefits realization, the quality of our data that we have in order to assist the risk of services, these kinds of things, I
think the ARAC feel that the risks scoring probably needs review. So, both within the risks that feature and the scoring of those, we have asked the team to look more closely at that before the before the ARAC. Sean has made a suggestion which I
think is really good, so it was asked the question for the Board, which is can we add some categories around our regulatory risk governance and I think it was performance risk, and I just would say for one I would support that. I think one
of the things that it’s really important for us to do, as a Board, is look at aggregate risk, not just the component parts of risks, because, as we aggregate the risk to CQC can be much higher than the individual risks and I think regulatory
risk is one of those. So I would for one, if the Board agree, I would welcome that and support Sean in that recommendation. So, just wanted to note that we do think there is work to do on the risk register. It doesn’t just sit
with Sean and his team and we need to be supportive of helping the team around the table and beyond to really make sure that those risks are the key risks for the business and that we are able to discuss
Ian Dilks - 1:00:54
them appropriately at the Committees.
Thanks Charmion. Sorry, I’ll come to you in a second , Mark, but just before we lose that. Thank you for picking it up, Charmion, I was going to ask. Because we didn’t put it down for approval, but you’re right, there was his comment in
there, subject to Board approval. I’m not sure if it is formally for approval or not, but I mean I was going to come to you, so we’ve already got your comments. So does anyone disagree with the proposal, or can we just make sure we’ve
agreed that? OK, well you have got (unintelligible). Sorry, Mark.
Mark Chakravarty - 1:01:24
Thank you. It is also very, very helpful to see this as a complete dashboard. As we are entering into the phase where the key priority, obviously, is the recovery, the dashboard wasn’t necessarily designed just
to show us recovery. So, you know, we have got as a priority stabilise the regulatory platform or work to make sure that people have got workarounds to get off the platform to do their work, and we’re hearing some very promising anecdotal reports coming through
that those might be helpful. The app discussion that we had this morning. It might be helpful to think through., how would we see that in a scorecard so that we can start to see not just very, very high level indicators of how many assessments,
or how many inspections we’ve done, but actually what is people’s experience with the regulatory platform? Have we got more stability, how are we managing to do workarounds? I can’t suggests the exact metrics, but actually thinking about how do we get a view to whether
we’re tracking in the right direction there, so again helping us as a Board prioritise where we’re focusing energy, resources and support.
Ian Dilks - 1:02:38
Presenter 2 - 1:02:42
Yes, I think that’s a perfectly sensible idea. I think it’s going, we know that the recovery plans are multifaceted. So, we’ve got the
programme, we’ve got the non-programme in the line activities, and we’ve got the work that is being overseen by the Committee, so one of the things I have been thinking about is how do we put all of that together in one place and I think
that’s a really good call. I will it leave with you, just make sure
Ian Dilks - 1:02:59
that get a helpful summary, because some of this is lifting stuff out of recovery plans that perhaps we see elsewhere, but we don’t want to duplicate effort. We also want consistency
between what we’re saying from different sources, but I think it is a
Mark Chakravarty - 1:03:14
helpful… Chair, it’s not about volume of reporting, it is again back to sort of prioritisation. If there are one or two things that we should be keeping an eye on as a
Board from month to month, it’s how do we make sure that we’re doing that at the Recovery Plan level, not just at the results of that level, so that you’ve got a bit of lead and lagging. This seems to be lagging and we need
Ian Dilks - 1:03:37
to get a little bit into the lead indicators. A couple of things for me, there three 3, but you’ve dealt with one Charmion, thank you. On page 20 of the Diligent book we use, this is the safety of care, there’s a measure, and you
say that there’s been an increase in providers who say CQC regulation has led to my service improving the quality and safety of care provided to people. It seems to me that sits slightly oddly with some of the results from the, not Vic Rayner but
Vic Rayner and her supporters, colleagues’ reports this morning. You know, on the one hand we are being told in the survey that people think we should be doing much more, and yet on the ground when we ask our surveys directly, we seem to have
quite a high proportion of people say making a difference. I just wondered if there’s any way of connecting that. My second question will be to Chris, but I’ll ask them both together. Somewhere in here, and the pages seem to have been updated, but there
was reference to the costs of enquiries. So, maybe we will deal with this one first because I think I am just asking for confirmation, I’ve got the understanding right Chris, if I haven’t, it’ll be a longer answer from you. But the challenge we have
got is this year with so many inquiries going on, the costs are considerable. My understanding is that we’ve been told that we are not allowed to use fee income for that, even though that is the overwhelming majority of our income. Our only other source
of income is grant-in-aid. Currently, my understanding is the Department have said they won’t provide additional funding, so the only way we can meet the obligations of the inquiries, and we are told we have to, is either we have underspends elsewhere - so we’ve been
paid to provide another service but for whatever reason we can’t do it - or as a Board we may have to make a conscious decision , should it ever come to that, not to do something that we are supposed to be doing? One of
our regulatory responsibilities. Have I got that understanding right, and if so, can I just make sure that although these are relatively small sums in the scheme of our overall finances, they feel very constrained in how we pay for them. I just want some assurance
from you or James that we are not yet at the stage where the organisation is having not to do work it should be doing, and to make sure that if we ever get to that stage, the Board will be kept informed. So, I’m asking
for confirmation I’ve got the understanding correct and be clear that if there is any inability to carry out another activity, we will be told. You’ve got your understanding correct, and correct in terms of we’re not at the stage of standing anything down. It is
Chris Usher - 1:06:21
a kind of recurring, longstanding issue as our enquiries unfold and more enquiries come on stream, we are in this bind of we can’t use provider fees, which is 90% of our income, and we haven’t got any additional grant-in-aid. The cost of enquiries this year,
and there’s more than one inquiry we are dealing with, they are about 3 million. We are in open dialogue with the Department around that, and around the pressure that brings us. So, in conversations with the Department about, if there’s anything any other budget lines
that could be repurposed. We’re not seeing underspend materialise on any other grant-in-aid activity that we can utilise on this, so it’s an open dialogue, but we’re not at the stage of standing or stopping any other activity, and we obviously would bring that back to
Board for a conversation. OK, so discussions continue, but you will keep us informed. I mean (unintelligible). Enquiries, to some extent I guess, are a fact of life for a body such as ours, what’s different this year is - maybe two things - one is
the sheer number that have come at the same time, and the other is that most of these things are very historical. But in some cases, we are having to go back many, many years, and that is a massive undertaking for us to go back
over eight or ten years of the records, and that’s where chunk of the cost comes. OK, thank you very much. James, sorry, were you wanting to
Ian Dilks - 1:07:41
add? I just want to check echo the points, really. You know, we must
James Bullion - 1:07:44
comply with the law, we
must comply with our own purposes and requirements on us. So, in a sense, if we get to the point where we’re having to, as it were, affect one of those two, then we’ll have got to the wrong point. We have one of our regular
quarterly assurance meetings with the Department this coming Monday actually, so we can express the Board’s concern in that environment. I don’t expect to get an easy answer, if I’m honest actually, based on last years’ experience, but we have a mechanism to escalate the Board’s
Ian Dilks - 1:08:20
concern. So, thank you very much indeed for that, that was my second question. Back to my first, how I square this report about our success in helping people improve what they do with the survey results. I mean, maybe you don’t know, but any thoughts?
Chris Day - 1:08:37
I think there is a dichotomy between what Vic is saying and this. I was at a meeting of the Outstanding Society recently and there are some occasions where we go in to do an inspection and actually help an organisation move from an RI to
a Good or Outstanding position, and I think this probably reflects just that feedback from individuals. But I don’t think there’s…, much of it what we talked about this morning in the private Board, and what we’re talking about here, we recognise there is a long
journey to go on to make our assessments as useful as they can be. But I do think there are individuals, and we probably ought to acknowledge that, there are individuals, inspectors and assessors, who go into organisations and do have a positive impact on those
organisations and do drive a change in understanding and do drive a change in the way they operate and that’s reflected in this score. I don’t think there’s a dichotomy between knowing we need to do more and different. To Joyce’s point earlier about how we
develop and understand inspection characteristics in our work and make sure we’ve got a common framework between ourselves and providers, but there are good inspectors and assessors who are involved in that work, and actually involved in it at registration when they’re helping to guide organisations
around their application to the organisations in the first place. I think it just represents…, there are good performances out there, despite the fact we know we need to make some improvements in the way
Ian Dilks - 1:10:02
we operate more generally. It begs the question, not for now,
but if…, I’m sure you’re right and it is an inherent feature of surveys that the people that speak loudest are those with a bad experience. Certainly, that is what I do when I fill in many of these surveys. It is just human nature, but
maybe there’s a way of seeing if we could make more visible to those who don’t get it right, if we do it right. Christine. Thanks. Just
Christine Asbury - 1:10:26
really picking up the point below the one we are talking about at the moment, which is understand the
volume of assessments, including learning, improvement and innovation, and use the outputs for wider learning. What does that mean and what do those particular numbers mean, and how are we using the outputs for
Ian Dilks - 1:10:46
Chris Day - 1:10:52
wider learning? Chris. Perhaps I can give an example of it. You
will know now recently we have completed a round of maternity inspections, looking at individual organisations around the quality of care they provide. But as part of that, we produced a guide for frontline staff who are providing maternity services which is a sort of a
use the information we gathered from individual inspections to offer practical advice about how they improve their practice, so drawing from the best if you like to offer review. So, that’s an example of how we use that. James talked earlier on about the work we
do, that (unintelligible) is doing in terms of urgent and emergency care. That’s another example of it, where we’re trying to draw from what we know from inspections to guide people back to what they can do differently, what they can do better. So, is those
Ian Dilks - 1:11:37
numbers, 379 for this period and 142 of the previous, that’s those types of inspections, or is it general inspections? So, I think it’s
Christine Asbury - 1:11:47
Chris Day - 1:11:47
all inspections, but I’m thinking where we particularly have a thematic focus on inspections, it tends to generate more of that feedback
on the basis. So, there will be individual inspections. I can think of…, two weeks ago I’ve spoken to colleagues around community mental health where the inspection team has provided information, advice and support. But it tends to happen more frequently where we’re looking thematically at
James Bullion - 1:12:15
an inspection process. I think it also amplifies some of the wisdom
Ian Dilks - 1:12:17
James Bullion - 1:12:18
built into our assessment framework with particular quality statements, so we can look at innovation across the piece by noting the number where we’ve used that particular quality statement, which may indicate what the
number is. I’m not sure, Joyce will probably know better than I, but it may be that is the number of quality statements, number of times
Ian Dilks - 1:12:41
that quality statements has been used. You don’t have to add… Alright, well if there are no more comments, thank you for that. For
the benefit of, again, people listening in, just to be absolutely clear, nobody likes the fact we have got this completely covered in red. So the fact that there aren’t people jumping up and down doesn’t mean we are happy with it, it is just that
what we are getting is, if you look at the quality, and I think, accuracy of the information we get now compared to even twelve months ago is considerably different, so we should thank you for that. It is continually improving and there are discussions elsewhere
as to a lot of this is driven by the problems in the last year, and discussions elsewhere of Recovery Plans, so it’s probably just worth making that point, but thank you very much indeed. Thank you very much and thank you to the team for

2.5 Quarterly People and Culture Assurance Report

putting that together. Thank you Sean. Jackie, can we just move straight on to you, so we have your People and Culture Assurance report. I say it every time and I will say it again. We have read it, but what would you like to highlight? So rolling report on
Jackie Jackson - 1:13:43
the key performance indicators. Apart from the vacancy rate, you will see there are some improvements, some of them albeit small, in terms of moving things forward. There’s still work to be done on workforce representation, but against the backdrop of, you know what we’re working
through, I think we can take some comfort in some of the reported metrics. I want to specifically focus on vacancy rate through the lens of recovery. So, working with operational colleagues, we have really ramped up the recruitment into operations. So we have got 37
inspector roles left and we’ve had 1256 applications with 300 assessments taking place at the moment. Colleagues, a big thank you to colleagues across the organisation who have helped with shortlisting, assessment, review and interviewing because I think, whilst we can look at it from a
resources perspective, but I think we’ve got to broaden the view. Because if we can fill the vacancy rate, the capacity will improve next year and also that team spirit and the impact on colleagues who are already in the business, who have been maybe been
carrying more than their own workload because of vacancies. So, I think, pretty confident that by the end of the year, we will not only have completed the vacancy fulfilment, but also we will have a pipeline for next year when there is maybe some more
clarity around specialisms, chief inspectors and also some of the direction of travel. So, that certainly was a real collaborative effort across the organisation. The other thing I wanted to just bring live was the Sentiment Report. I think that’s been pretty sobering reading, but it’s
something that will need to continue, because we can learn regarding our communications with colleagues, is the Recovery Plan clear, is it understood? And, you know the difficult reality is we probably knew what, certainly, the first survey was going to say, and we just need
to keep on evaluating and critiquing it, and how we can plot colleagues are giving us in the in the sentiment survey amongst other feedback channels, as to how we communicate, and give clarity to the Recovery Plan. Just going back to the point on wellbeing
as well, Charmion, we have got, in the management and leadership programmes, there is a part on wellbeing in there and actively encouraging completion of risk assessments as well. So, we can act upon that. So, you know, wellbeing is on the agenda all the time
in terms of how we can enhance and support that, looking at what we already do and what more can be done. Just to round off with…, continuing the conversation around resourcing. We know that there is work to be done with improvement to the recruitment
and resourcing model, but I have had to prioritise how I can use my resource on the Recovery Plan, certainly over the last three months. However, I have got resource to start and look at how we can improve our resourcing and recruitment approach from January,
February onwards. I know that colleagues and equality networks are really keen to be involved in that. That is something that we will absolutely give one of our first priorities. Because we do have to sequence in how we approach this, because actually, the capacity, capability
strategy and direction of the organisation, underpinned by values-based recruitment need to be known before we can head fully down that track. So, there is some preliminary work we can do with our equality colleagues, our trade unions, to start the conversation, look at the report
that we have had prepared by a recruitment psychologist, and to really understand what the desire and ambition of the organisation is, but there is some fundamental requirements from the organisation before we can fully fulfil that. So, I think that was my two or three
Ian Dilks - 1:19:08
updates, happy to take any questions. We have a session where we kick everything down the road to Julian, but clearly we had a discussion with him the other night, and some of this stuff is the number one priority. Charmion, I will come to you
in just a second, but, Amy, I am just interested whether, either personally, on behalf of the networks, you have any observations or anything to add? Yes, thank you so much Jackie. And thank you
Amy Robson - 1:19:31
specifically for sharing the commitment to involve the equality networks and
the trade unions when it comes to recruitment and moving forward to ensure that that is an equitable process. I really wanted to pull back for a moment to the Sentiment Survey, if we can? I understand it’s a difficult data to digest, but significant and
important data and specifically thinking about poor communication, and then colleagues not feeling that they are informed about programme changes, probably a number of programme changes that directly impact them. I feel like there are a number of nuances there when it comes to the diversity
of our workforce, and the diversity of communication needs that people may have. So, I wonder what the commitment or planning may be moving forward, when it comes to ensuring that there is an engagement with our colleagues that allows for an equitable access to communication
Ian Dilks - 1:20:33
Chris Day - 1:20:40
moving forward. Jackie, or James? Shall I go first, if that is OK? It is a really important point, Amy. One of the most important things for me is probably the person that knows an individual best is their immediate line manager. And one of the things that
we want to do through the communication process is to make sure at each level line managers really understand, not just what’s happening, but why it’s happening and are able to digest it, so they can then talk to and in conversation with their teams have
the right conversation. That might be in a number of different forms, as you say, not everyone respond well to group meetings, they may want individual conversations, they may want to have it in different forms. So for me, I think, hopefully by making sure we’ve
got the right information, then drawing conversations through the line of communications from SLT 30, the wider leadership group, operational managers through to inspectors, and in fact others that sit across the business, we’re giving everybody that leads somebody the opportunity to understand the messages, translate
them into something that is useful for their teams, and to hear feedback from their own team to bring that back into the programme. That will form a regular cycle of communication, and for me there’s something very powerful about giving responsibility and ownership of that
to managers, but then ensuring we can hear back so we can adjust and change the programmes as they move forward. But it’s a really important point you make, and it’s a really important point that we’ve got for the future. I think we’ve relied too
much on central messages that have been cascaded out, either in very large groups or even through e-mail communications. I think we’ve got to get back to tailoring and targeting the information for people
Ian Dilks - 1:22:28
based on the people that know them best. Ian Dilks: Thanks. There’s
a helpful challenge, (unintelligible) response, but some things to think about. Charmion, and then, Mark. I’ll come back to you, Joyce. Charmion, Mark and Joyce. Thanks. I have one for you, James, and a
Charmion Pears - 1:22:42
couple I will start with Jackie, if I can? I was just
interested in some of the data, if we could just understand a bit more please, or just a reflection. So we’re seeing in terms of the exits, we’re seeing a much higher proportion of our and minority ethnic groups than the average. So, just interested in
understanding. We talk about two of the categories being non-disclosed and lack of opportunity. Do we have a feeling for, you know what are the difference between the 8.5 average, and the 11.3 that relates to those two categories versus the others? Then I guess quite
concerning is some of the reasons, it’s really useful and rich data isn’t it, around that dissatisfaction that sits with workload management and people leaving for organisational reasons and wellbeing concerns? So, I think we’re seeing an increasing trend here to some of the things that
(unintelligible) we can do more about. I’m wanting to understand a bit more about what we’re doing to follow up with some of those. So, if we have colleagues leaving for all reasons or wellbeing concerns, are we following up? What could we have done differently?
What was your wellbeing concern? Because that 20.8 is quite high for people to be leaving, one in five leaving, you know, because they don’t feel their wellbeing is looked after. And also workload at 37.3, so that is one thing. James, I guess the other
one for me, you won’t be surprised because I think I’ve raised it at every Board since I’ve been here. I really worry about our mandatory training and we’ve asked a number of times for the pathway to compliance, and I was just wondering how are
we going to see that pathway? These are legislative requirements, regulatory requirements, and it would be really nice for us to have that back, that pathway by Directorate, to compliance around things like health and safety training. You have highlighted the low results in terms of
cyber and database training, and we’ve just had an unsatisfactory audit, so these things are tying in. Health and safety training, people leaving for wellbeing, poor audit results, low training results, and I think, you know, it would be nice to see some commitment to that
pathway.
Ian Dilks - 1:25:07
So, I think it’s Jackie, and then James, but if you could try and keep it brief. Mark, do you want to add
Jackie Jackson - 1:25:13
Ian Dilks - 1:25:15
Mark Chambers - 1:25:17
to that? Yes, to add to that. Fully agree, and for some of the mandatory training, training and awareness is our key control in terms of directing discretionary behaviour around the organisation, so some of these without people doing the training, we have really
quite limited controls in place. So, you know, they are essential. We also have other interventions, I am thinking of the commitments we made earlier in the year to provide some additional training for our colleagues involved in inspections, following up on the learnings and insight
from the Coroner’s Report on Ruth Perry. And, of course, we have another load of training that we’ve got for people, for colleagues around new ways of working across the organisation. So, I think it’s really important that we decide what is absolutely important, that we
deliver on that to consistently high standards, and these numbers are not good enough. But we’ve also got to accept that we may have to clear the way with some optional training, that actually is not mission-critical is not top right corner in terms of priority,
and put some of that off because we need to make sure that the overall training load for people, at a time when everyone is under a lot of pressure, is reasonable and realistic. (unintelligible) two very big
Ian Dilks - 1:26:59
questions, but if I could ask you to
go quickly then…, Jackie, do you want to go first? So, I will just
Jackie Jackson - 1:27:07
come back to the exit interviews first. So, David very kindly helped me think through, so I think a pilot of the exit interviews, which is what you are seeing now. Because
actually we went through a phase last year and beyond where everything, or a big percentage, was not disclosed, wouldn’t say. So, I think we are starting to see that we’re able to drill down and get more data around the reason for leaving. I think
the bit that we are still to crack is getting the information in quickly because once somebody has left, we can’t have those conversations. And whilst we will still follow up when colleagues leave, they’re probably less engaged to elaborate or expand, it is pretty one-dimensional
the conversation. So, I think we have made leaps and bounds with terms of getting specific data. I think what we need to concentrate now on is that follow up and what the path back and forward is with operational management in the conversations we have.
So, I would hope that as we go through next year, that should give a much better picture and actually some dialogue around how we approach it after we get the information. So, I think that was the exit
Ian Dilks - 1:28:45
interview. Just on the mandatory training point,
we are in campaign mode now until the end of December for that. So, there’s a message on the home screen, which keeps popping up, reminding us to do our manager training. We have prioritised the list of 5 compliance courses that we require people to
James Bullion - 1:29:10
do. But like you, Mark, I have to balance, I suppose, the realism of people finding the time to do that with the recovery message that we’re giving them about engaging on work. I know one is a hygiene to the other actually, but I just
wanted to be realistic about expectations for that. I don’t want to send a signal through this meeting, or through my speech, to say it isn’t important because it is. That is why we’ve listed the priorities for people to undertake. And you might, again balancing,
you might expect colleagues to, during the holiday period as it were, use some of that time to catch up on mandatory training. It’s a thing perhaps we shouldn’t encourage, but realistically it is a thing that we all do. But again, we need to balance
the need for downtime for our staff during that holiday period versus compliance. So, I think we are in a tricky place, but as a leadership team we have set ourselves a target for the end of the year for compliance, and we will be able
to come back to the next Board with the outcome of that. The other
Mark Chambers - 1:30:14
dimension to it, of course, is not everyone, you know, some of these training elements are more relevant to some people than others. If people doing it are asking the question, well
how does this apply to my job? Then they probably shouldn’t be being asked to do the training. Everyone is a cyber guardian, not everyone is involved on a daily basis in situations that might give rise to safeguarding risk, so we need to work out
what’s important for everyone. I would also encourage the
Ian Dilks - 1:30:45
Mark Chambers - 1:30:46
old-fashioned trick of making sure that there is league tables visible around the place. There is nothing like being in the bottom quartile for this sort of thing to encourage you, encourage people to make it a
Ian Dilks - 1:31:05
priority in their areas. Can I just…, I mean we won’t have one of these reports for about six months, so can I find a way, well firstly just asking you to make sure that we’ve done the things that we talked about, of prioritisation and
the right people get the right training. But if we are finding a way of giving some visibility to that, I’ll pick up with you offline, as a minimum at the next Board meeting. But I don’t think we need a debate on it, if it’s
being done, it is being done. So, we will circulate it offline if necessary. Can I come to last two comments, then we should move on. I think it was Mark, I was going to go to Mark Chakravarty, and then Joyce. Mine was actually just
Mark Chakravarty - 1:31:45
a quick move back to the Sentiment Survey. So, I think that the two comments we’ve had so far, which is making sure we acknowledge the audience’s diversity and the communication, and also, I think, the leverage of the immediate manager, both are very welcome. The
other bit is just tying the two points that we have here, which is poor communication and unclear programme direction. Those two are very linked, because essentially this is about promises in a situation of uncertainty. There are very specific…, I think we should also think,
particularly as engage the immediate managers more, there are very simple, not difficult training and skills about how you can make acceptable promises in a time of uncertainty, that create confidence rather than vague promises or over commitments that create disengagement and missing expectations. So it
might be worth thinking through how we can actually add that, and it
Ian Dilks - 1:32:52
doesn’t have to be complicated. Joyce I was going to say something
Joyce Frederick - 1:32:54
similar on communicating in a time of ambiguity, that actually you need transparency and you need clarity. It sounds like the
two things are the same, but they are slightly different. Transparency as in how have you made those decisions, who was involved, how does it affect me? And then clarity, as in what do you know will happen and when, but what do you don’t know?
And you almost have to narrate your leadership, walk people through the process in your thinking, because the ambiguity is really difficult for some people to deal with other people conflicts within that as well. But there was two points. I think what you’ve talked about,
Charmion, and Mark, and what this data talks to is that there is an issue of wellbeing, and I think we as an Exec Team, will take that. I think we need to properly look at this in more detail and think about our targeted responses
to wellbeing. Because I think we’ve got people who are on the trauma side of, you know, where they are and what’s happening, other people who are saying, I’m just keeping my head above water and I’m struggling, and there are other people who are probably
in perhaps a better space, but also want to help colleagues who are not. I think there’s a targeted approach that we should be taking across the organisation to understand it, and one of perhaps the key performance indicators we could develop. Because we’ve got indicators,
which are sickness and vacancy, but we haven’t got one that could attract wellbeing. And we need, even if it is a composite of the sentiment and then something else on wellbeing, I think we need to track that to make sure that we really understand
what’s going on with colleagues. The last point, Jackie, it is a minor point, but some people will pick this up. Under our key performance indicators, we have some that say over 10% and then we have some that are exacting. All the ones around ethnic
minorities, disability, and you know, the protected characteristics are exacting to align with the labour market. Actually we don’t want to just align, we want to be better. Our WRES, our workforce - I will just call it WRES and WDES, which is a report we
do on race and disability, always talks to be at least aligned with the labour market, to then be better. Because, as a regulator, we serve communities which are vulnerable and ill-served and have a lot of protected characteristics, so we can’t just be at the
same percentage, we actually need to be over and above that. So, just to match what we do in our national reporting statistics, our Board report needs to say - it’s quite easily done - over and you can even set a higher target as well,
so just to update that. Your last point, Joyce, we are going to be
Ian Dilks - 1:35:29
into business planning season fairly soon, it would be…, this is reporting against the agreed metrics I think it’s a very good point. Probably we should be clear, we set an ambition
along the lines you are describing, build it into next year’s business plan. Unless there are any other burning questions, I would like to move on? Sorry, Amy, last one. Just a brief one from me, thank you so
Amy Robson - 1:35:51
much Joyce. First and foremost absolutely agree
with the sentiment that you just shared. I’ll keep it very brief, Jackie. I want to pivot very slightly to look at reward and recognition, something very important right now for our hardworking, very resilient, colleagues, at the moment. I note and I’m very happy to
see that reward vouchers awarded are currently in an increase, and I am also very happy to see that vouchers among disabled and LGBTQ+ employees seems to be aligned with respective percentages. I was concerned to see that this is not also reflected for people from
an ethnic minority group, and I was just wondering and in line perhaps with some of the things we have just discussed, what planning or what action is in place to try and understand and address that at this
Ian Dilks - 1:36:41
stage? I think this is quite a
difficult one from a people perspective, because it’s very much dependent on line management recognising. I think we’ve all got a responsibility to take here in terms of recognising the purpose of the awards and how we can increase it. You know, we can look at
Jackie Jackson - 1:37:07
some communication. My business partners do prompt on a regular basis, but you know if there are ideas from the networks, would be more than happy to have a conversation about it, because so much of is unseen. You are relying on people recognising and actually
physically saying this is what I want to do with the reward. So, you know anything that you can help with would be greatly appreciated.
Ian Dilks - 1:37:39
Thank you so much Jackie, and yes, I think there is potentially a piece of work there with the Equality Networks,
Amy Robson - 1:37:44
and also empowering our line managers to feel quite confident when it
Jackie Jackson - 1:37:47
comes to recognising and appropriately addressing their colleagues
Amy Robson - 1:37:51
when they’ve gone above and beyond, or just get on with the day job
Jackie Jackson - 1:37:57
Ian Dilks - 1:37:58
really, really well. Yes, I would agree. OK, thank you very much. Let me deal
with one final matter before we take a comfort break. This is mainly, for the record, confirmation of having followed all the good practices, but probably worth saying it, in case anyone has any questions. So in summary, but going back in history, we announced in

2.6 Appointment of the Chief Executive Officer

June a new interim Chief Executive, but said at that stage we would in due course run a process to make that post permanent. We did run that process in September, as I think I’ve reported before, the then interim chose not to apply for the
role. We had a huge amount of interest and a number of really very good candidates. There was a Panel which I chaired, but some of my colleagues here joined me on the Panel, which I think was both very experienced and suitably diverse. We also
had a Director General from the Department as an independent panel member sitting with us. I said it was a good interest right across the piece, but we also ended up with a high quality shortlist, so Julian emerged as the Panel’s recommendation for that. Everything
had to be done in accordance with the approvals that we were given by the Department at the beginning of September, and we have complied with everything all the way along. Julian, we announced his appointment in early October based on the recommendation of the Panel.
We have managed to negotiate with his current employers, NHS providers, and I probably should give a word of thanks to them, actually, that they have agreed to release him quite a bit ahead of his normal terms of notice. So, as everybody knows, he joins
us next Monday, the 2nd of December, and just to complete the formalities you would expect him to become a member of this Board, but that does have to be approved. So, the NEDs, non-executives met last night and we have unanimously approved him, not just
as the new Chief Executive - I’d already signed the offer letter - but as the Chief Executive, a member of this Board, so he joins the Board effective Monday, and we have told him. So, that’s really just a quick run-through to be quite clear,
there’s a lot of process and stuff, but it was all followed very rigorously, I believe. So unless there’s any questions, let’s take a comfort break. We are about 10 minutes behind schedule, so if you could keep this to no more than 10 minutes and

2.6 Appointment of the Chief Executive Officer

Ian Dilks - 1:40:34
come back at 3.50, thank you. Welcome back everybody to the final three-quarters of an hour or so of the CQC public Board meeting,. We’ve just two main matters on the agenda, and then some update reports from Board Committees to follow. We are joined now
by James White, who is the Director of Corporate Provider and Market Oversight. I think people are familiar with what it does, but James will give a very brief introduction. James, I think it’s the second time you have joined us, it is such an important
function of CQC, when people talk about us they often don’t realise we do it. So, I think James Bullion just wanted to give a brief word of introduction, then we will hand to you. People have read the papers, so don’t need to take us
throughout, but if there’s any particular high spots you want to mention, and then we’ll go straight to questions. Thanks. Thanks Ian
James Bullion - 1:41:33
and welcome James to the meeting. I wanted to just say one word by way of context and really with my, as it were,
normal hat of Chief Inspector of Adult Social Care on. I’ve been in a number of environments in the last couple of weeks, for example, yesterday with the National Care Forum, and about 120 or so Chief Executives. I have been at the Local Government Sounding
Board recently and have been in our own engagement meetings with providers, and there is something of a really strongly growing level of concern about the financial position of adult social care providers. Of course, we have a formal oversight role which James will cover in
terms of our role, but broader than our role, I’m concerned as Chief Inspector about the potential for the impact of costs and changes for adult social care providers. It is expressed by the providers, it’s very clearly expressed by the Local Government Sounding Board, of
which we are a member, the gap between, as it were, the allocation or the probable allocation of resources and the probable costs debt, or rather the definite costs in local government around adult social care, in competition with children’s social care, as it were. Then
thirdly, from our own Local Authority Assurance we’re picking up in the commissioning work that we look at, really a bit of a gap between the aspirations of getting the right amount of care for people and the financial constraints or the limitations of the workforce
and the market costs as well. So in three areas, there is grounds to be concerned and I am formally concerned as a Chief Inspector, but wanted to place that as some of the context for James’s presentation on the market. Thank you. OK. Thanks, James.
Then to the other James, I say we take the paper as read, but I
Ian Dilks - 1:43:25
appreciate yours is very short and just a few slides, so by all means if you want to use the slides briefly, but I would like to leave most of the
time for questions. Duly noted. Look just to give you some context
Presenter 2 - 1:43:37
with regards to market oversight, and that period to 30 June 2024, there is 61 provide us with an arrow within Market Oversight at that point in time, which roughly represents one third of
the volume of adult social care within England, so a really critical part of the market. Those 61 providers are split pretty much equally between care homes for older people, home care providers and also specialist providers, and when we speak to specialist providers, they predominantly
look after people with learning disabilities and also autistic people. In terms of just some key trends I’d like to highlight, I suppose the first one is care homes for older people. This has been a really pleasing trend which has really developed since coming out
of COVID. Occupancy levels have built back up slowly and steadily, and as at 30th June 2024, they are now at 86.8%, and where that’s really impactful is, we estimate break-even point in terms of financial performance for care home is around about 85%, so that’s
really pleasing. In terms of home-care providers, one of the trends we’ve seen within a subsector of the providers within market oversight, and that’s roughly 40% of those providers. These providers haven’t grown their businesses by taken over any rivals. What we’ve seen in relation to
their hours of care delivered, we’ve seen that actually contract over the last two years by approximately 5.5%. What those providers are telling us is that it’s mainly down to recent changes in LA commissioning practices whereby LAs sought to have or some LAs sought to
have more providers on their home-care framework, and that’s one of the reasons to give people more choice for care. But, conversely, what that can mean for the market oversight providers is, they may obtain less hours from an LA, and if that is the case
and they are not satisfied with either the level of profitability, or they’ve moved into a loss-making position, they can make the decision to shut a branch. Ultimately, that may mean that the provider is smaller in terms of volume of hours, but equally profitable. The
last sub-sector I will speak to is specialist providers and look, I think it’s fair to say, over the last couple of years they’ve been operating in a difficult business environment. EBITDA margin, which is a proxy for profitability we use. it is at 17.6% as
at 30 June 2024, that’s only 1.3% higher than 2 years previous to that. What providers are telling us is, notwithstanding agency use has more than halved and it is presently at 6% of total staff costs amongst specialist providers, it does remain high and embedded
in certain services in certain parts of the country, and that has a real impact on their profitability. The other important point to make with regards to specialist providers, those providers in market oversight, approximately 98% of their revenue comes from either local authorities or NHS
funding. What that means is in terms of wanting to pass on increased costs to self-funders which other providers have an option to do that, that really isn’t an option for them in terms of the materiality of those self-funders. I will just cover the outlook
for providers before finishing off. Look, in these winter months, traditionally care homes for older people, we’ve seen a retraction in occupancy levels. So we’re doing a lot of work with our providers to understand what is happening with occupancy levels within the winter months, and
that’s due, I suppose, more winter-focused diseases such as flu and norovirus traditionally impact in their occupancy levels, which has a real impact on their profitability. Finally, with all providers within market oversight, we’re working with them to understand what does it mean for them, the
increase in national living wage and employer’s national insurance costs from the 1st of April 2025, because that is fairly substantial. And what those providers are telling us, they looking at taking certain actions, they are thinking around, how can they reduce agency costs further? Can
they obtain efficiencies by better staff rostering? Can they pass on costs to self-funders if they have got that business model? And are there any overheads they can take out of their business? Market oversight providers are telling us say that they are doing a lot
of work on contract-by-contract profitability in terms of their local authority work, to understand what sort of uplift they need from the 1st of April next year. They are also telling us that they are wanting to have conversations early with local authorities to understand what
uplifts they may be having. I suppose my final point is all of the providers in market oversight, and I suppose all providers within adult social care, want to remain financially sustainable in the long-term. What the providers in market oversight are telling us is that
if LA and NHS uplifts are not sufficient to enable them to remain profitable in the long term, they will have to seriously consider contract handback or serving notice on contracts in order to be able to continue to deliver care in the long run. Thank
you. Thanks very much, James. Just before I hand to colleagues, just
Ian Dilks - 1:49:01
to be clear, obviously our primary responsibility in market oversight is to look at the financial condition of 60 odd organisations. Am I right in saying, because obviously I see things that beyond what’s
at the Board here, that our overall assessment, or as of today, or people in that programme, is not dissimilar to last year or so? So, there’s no flashing red on that. On the other hand, both what you and James have said, is going beyond
that. We do see people saying, we know for no good reason, they’re going to be under greater financial strain. They are, they say they would consider things like contract handback, but I think we’re actually seeing some early evidence of that. So, am I right
on both of those broad assessments? Yes, you are. I think, ultimately,
Presenter 2 - 1:49:53
no provider wants to hand back a contract if they can avoid it, because, ultimately, some of these people they may have cared for them for many years, and it is a massive step
for them to have to make. But, look, they certainly understand that if that’s a necessity, it’s something they will have to consider, but no one jumps into it and no one wants to do it without a very good
Ian Dilks - 1:50:19
reason. Thanks so any other? Mark.
Presenter 2 - 1:50:21
Ian Dilks - 1:50:22
Presenter 2 - 1:50:22
Very, very helpful, comprehensive report. I think that the outlook, particularly with the sort of National insurance contributions and the minimum wage, are going to be critical. Are we tapping into other organisations’ research on that, or are we relying on our own sort of primary
research to do the modelling as to what it would look like in the future? Noting that, I think the King’s Fund did something very recently on it, with a breakdown of what that would cost and how that would play out, I wonder if we
Mark Chakravarty - 1:50:56
could take that data and apply it to the subset that we are monitoring in this particular section? Yes, I’ve certainly had conversations with Care England to understand their modelling and if it aligns with our
Ian Dilks - 1:51:04
Presenter 2 - 1:51:04
own. And look, it broadly does, it also broadly aligns
with the Department of Health and Social Care in terms of their modelling. In terms of April 25 onwards, you’ve not only got national living wage increase and national insurance changes, you have your usual inflationary pressures as well with regards to a care home for
older people, consumables, foodstuff. Thankfully, we are operating in a better inflationary environment than what we were in 2023, so that’s less of a stress on these businesses, but I am fairly satisfied with our modelling in relation to the sort of cost pressures providers within
market oversight are facing from April next year. Chris, you wanted to
Ian Dilks - 1:51:52
add, and then Christine. It is a great report, James, and one of the
Presenter 2 - 1:51:53
things we did in the State of Care last year, and we want to do it in State of Care
Chris Day - 1:51:57
next year. This affects organisations differentially across country, so it creates areas of the country which are more susceptible to the chance of contracts being handed back. I think it would be one of the things we are trying to do in State of Care next
year is to look at both the likelihood of that in different areas, but also the implications on people who use services, because these organisations form part of a network that people will use to access care, domiciliary care if they are leaving hospital, potentially long-term
care and residential and nursing care. So, I think it is a really good, a great report, and it’s a great insight into some of the issues. There’s one point that you highlighted around LAs growing the number of organisations that are part of a pool.

3.0 Reporting updates

There’s a real, strong sense of that. It resolves something for a local authority and creates a problem for a provider, and I think there’s something about how the market management and local authorities responsibility for that, how they begin to square that circle. Because there’s
a logical rationale, if you’re a commissioner, you can see why you do that, but the implications of it for the way the market will change in the medium and long term can’t be ignored. And I think that is something we need to think about
in terms of our messaging around State of Care, but great report, so
Ian Dilks - 1:53:11
thank you. Just to pick up a point before I hand over to Christine. You say it is logical, but the risk is that unintended consequences means it has the opposite impact because

3.1 Market Oversight Update

if you get people withdrawing from the market, you end up with less competition, rather than more which I think is obvious. The other thing I thought you were going to mention – it is probably worth saying, really just an observation because, again, we look
at this in more detail – is it does depend on the staff mix, which of course is different between different people in different situations. So there are three pressures. One is the national living wage. One is the percentage increase, but perhaps the unknown and
often for some employers the big issue is the reduction in the threshold. So, we were looking at some things the other day where a company had the majority of its employees were full-time, it had a minority of part-time, and yet the financial consequences of
this were roughly equal because of the reduction of the threshold which starts building into part-time workers. So, I guess it will also have implications for the way that employers wish to structure their workforce, to the extent that others are available. Christine. Several points, really.
Presenter 2 - 1:54:27
First of all, picking up the point about the framework, my perspective on it is slightly different from the one you presented, which is that it’s often not about choice for the service user, it’s actually about managing costs for the Local Authority or the Commissioner.
And they will tend to, in my experience, they will tend to go for the lowest possible price they can, rather than the provider that the
Jackie Jackson - 1:54:51
Christine Asbury - 1:54:53
service user might choose, and that might be something we could pick up in local authority assessments. Then leading on
from that, we know that 85% of adult social care providers are small and medium-sized enterprises which obviously don’t come within our remit in market oversight, but those are most often the providers who are providing socially funded places, i.e. the people who have less choice
because they don’t have their own funding. They are probably going to be most affected by the things we’re talking about around National Living Wage and National Insurance increases. Although it doesn’t come within our sort of reporting remit, it’s something that we need to, as
James and others have highlighted, we need to keep on the agenda because we are potentially going to end up with a lot less socially-funded places available, or socially-funded care available. Then finally, the specialist provider point which really concerns me. I have had sight of
a list of the deficits or surpluses for a number of specialist providers, not all of which will be within the portfolio that you look at, but I would say 70% of them were showing losses from the last financial year, which is before the impact
of April 2025 changes. So, you know, there is a potential real problem coming down the line that we need to be aware of, is going to affect our work and is going to affect social care provision generally. Yes, duly noted. The point around specialist
Presenter 2 - 1:56:39
Ian Dilks - 1:56:40
providers, you know, traditionally there has been a decent percentage
Presenter 2 - 1:56:43
of them have been not-for-profit, charities, and that also applies for market oversight, roughly half of them are not-for-profit. So they have never really been in it to make money, pay a dividend to shareholders, they
seek to make a reasonable profit and reinvest it in the business and hopefully grow their services over the years. Look, I can agree that the margins are not great, it would be the kindest way of describing it. So, we are working with them to
understand what levers they can pull come April in terms of being able to deal without increases in costs. I think the other point to note with small and medium-sized providers which sit outside market oversight, they’ve probably got less options, or they are less mature
businesses than the businesses within market oversight where you may have built up some reserves over the years, you may have some quite understanding financiers, you’ve probably got a more experienced executive team who have been through difficult times before. So, look, we completely agree with
your point around that broader sector, in ASC, just not market oversight. I mean I think the point about some of those specialist providers is that their reserves would have been considerably depleted over the last few years already, and the impact, ultimately, is a logistical
Christine Asbury - 1:58:03
issue that obviously local commissioners and national government need to be aware of. But the impact ultimately, is on continuity of care, and it’s particularly important for that group of people because it is a long-term, as you said, it’s a long-term care provision. Look, with
that point in reserves coming out of COVID, where you know there were
Presenter 2 - 1:58:22
real staffing pressures and agency spiked, yes, we have seen reserves decline over a period of time, so you could probably say most providers going forward into next year are not in a
position they might have been, say two years ago. OK, David. Thank you
Ian Dilks - 1:58:46
Presenter 2 - 1:58:49
Chair. I think there were two points, apart from thank you for the presentation which I do. The first thing that I am noticing at the
Mr David Croisdale-Appleby - 1:58:56
moment is that, you know, the traditional
move by retailers towards the Christmas period of taking staff from the care sector seems to have become much more aggressive in two ways. Firstly, they seem to be not just topping up for Christmas but they’re actually offering considerably more money with a view to
getting people who will then stay with them as retail staff, and of course that’s quite a big impact upon the sector. The second point was that an increasing move for residential homes, many of whom have offered a home for life as one of the,
you know, original promises made, who are extending their capability, or claim capability from, you know, elderly people to frail elderly, to people who would need much more support than that, and particularly in one of the fields I work in, into taking dementia patients when
they don’t really have dementia units, you know specialised nursing units for people with dementia. I just wondered if you, on those two points, you had any particular comment to add in terms of market oversight. Look, we do have a lot of engagement with all
providers around staffing, because ultimately you know 80% of your costs for home care are staff-related, roughly 60 to 65% for care
Presenter 2 - 2:00:39
homes for older people. Ultimately, vacancy levels within adult social care run at roughly three times a broader economy, so there always competing with
retail, leisure, etc. on a war on talent, to a degree. I think the market oversight providers over the last two years have got a lot better at staff retention, their turnover levels are slightly down, they have got a lot better at rostering efficiencies in
order to drive down agency, but again they are large, mature businesses where they have a decent stand-alone HR function. But notwithstanding that ability to improve staffing efficiencies and rosterings. That does come at a cost to the business as well, that does cost them money,
but certainly Skills for Care, the most recent report, the vacancy level has come slightly down, but as I said, when it’s three times the wider economy it’s always going to be a difficult place to play. In terms of, I suppose, higher acuity in terms
of residents in care homes and nursing home, and providers tell us that they are still looking at the average length of stay in a home is still roughly 18 months, but we certainly have received feedback that certain residents coming into the home are probably
higher acuity at first coming into the home than they have been say five years ago. What that means for those care homes is they to make sure that firstly, they’ve got the staffing levels and the staffing mix right to be able to offer you
know, good quality care and also, as part of that, they have got to make sure that they are charging a consummate right based on the acuity level. Because if they’re not, that also creates issues for them around long-term financial sustainability. OK, thanks James. If there are no
Ian Dilks - 2:02:33
other questions, we will close down, James. Thank you very much indeed for that insightful as ever. Joyce I mentioned at the beginning of the meeting that we were moving for this afternoon, a separate paper on Ofsted, as it turns out. So, well, we try
to, on these occasions, just make sure we’re aware of something going on the market and the implications for us. So, the paperwork we’re looking at is to do with Ofsted, and their decision on the use of one-word ratings. It is a fairly short paper,
we have read it and it’s for note, so is there anything you wish to add? I thought the paper was pretty clear, actually, but anything you wish to add, and if not we will just see if there are any questions. Yes, first of all,
I want to introduce Vicky Howes who is here from our Strategy Team and who helped put this paper together. I think, as you know, we’ve put this paper together because of the increasing amount of feedback and
Joyce Frederick - 2:03:25
awareness around the use of one or two-word
ratings, the fact that we use ratings for choice, performance and to describe the quality of care, and the changes that Ofsted made, government made, in September around scrapping the rating, but I’ll hand over to Vicky, if there are other points that you want to
Ian Dilks - 2:03:50
Presenter 2 - 2:03:52
add before questions. Sorry, apologies. There has been a debate for a number of years about the use of one-word ratings on, and whether they adequately sum up the complexity of some of these institutions and whether they mask good and bad performance. As Joyce mentioned,
following the tragic death of Ruth Perry, this debate intensified and Ofsted ceased using one-word ratings in September, and they are now undergoing extensive engagement and consultation to produce a scorecard report. We introduced ratings in 2014, we introduced them on the basis that they improve
accountability, they can drive improvements in performance, they are used to identify and prevent failure, but really importantly they are there to aid choice and public accountability. We know that the calls are continuing for review. We’ve seen it in the Dash report and the Richard’s
report, and we need to do a considered review that takes into account the reasons why ratings were brought in, undergoing extensive engagement, particularly with people who use services as to what they need to make these reports accessible and fair, And also, if we do
decide to change them, we will need to undertake a public consultation. And consultation with the Department. You said we
Ian Dilks - 2:05:13
started in 2014, but none of us were here then and most of us were not certainly on the Board. But my understanding was that it was
ministerial preference, to say the least, and so we would have to take into account the views of the current Secretary of State as to what he thought. So, I think what you are saying is that the pressure is such that we have to look
at it, we have to have a view, but we can’t actually do anything about it until we have views from others. Just one quick query from me, and then see if anyone else has any. I was struck just from discussions with others, including Ofsted,
actually, you know the challenge you get, if you put something in place for one reason and then it gets used for another. So, when you described why this was put in, you didn’t say that it’s important for procurement decisions, which is what it has
become in adult social care for local authorities which is different from a private (unintelligible) saying, do I want to go to Care Home A or B, and in the private medical sector as well, where we know that insurance companies use these ratings for contract
purposes. So, something that was designed for one set of purposes is actually now being used for another, so I think that if we’re looking at it, we probably need to draw a distinction between the different purposes. This is a question, not a statement, but
there’s always the risk that if you design something to do that and it is used for that, that actually, if you were starting again, you wouldn’t design this system to deal with that, so you get my point. So, I think we need to look
at all the uses and consider that, because there is a risk that what we’re doing is being used for a purpose for which it wasn’t designed, which is certainly what I think Ofsted found. So I’ll leave that as a request, but you say work
Presenter 2 - 2:07:10
is ongoing. Any questions or comments from any of my colleagues? You hit us at the end of an afternoon, so thank you very much indeed, but
Ian Dilks - 2:07:15
it was pretty clear. I just want to make one point, that the paper helps to position where we
are as an organisation because we’ve had increasing calls for, can you change it and it’s not an easy change, as Vicky has just described,
Joyce Frederick - 2:07:27
and as you pointed out. It’s a more considerate thing that we have to do rather than a quick win that
we can do as an organisation. So, the positioning, I think, is helpful and doing it in public Board is helpful too. Thanks Joyce. This light seems to be going off at the end of the room, if it carries on, we
Ian Dilks - 2:07:43
will be in darkness.

4.0 Policy matters and external environment

4.1 Response to Ofsted Inquest – Protecting CQC colleague and Provider Welfare - Learning Resources

5.0 Board and Committee matters

5.1 Regulatory Governance Committee (RGC) summary from the meeting on 29 October 2024

Thank you, Vicky. So, Mark over to you for the RGC Report. Thank you. RGC met at the end of October for anyone listening into this who has not heard about this committee before. We look at the design, delivery and effectiveness of our regulatory model.
Our sort of conventional way of working as a committee has been rather overtaken over the last two or three meetings by a focus on the significant operational issues that we’re facing. So, our discussions have been a lot around delivery. I would like to call
out our thanks…, this meeting in particular was…, the discussions were greatly helped by significant improvements in the transparency and clarity of the information that we that we had at the committee, so thank you to everyone, Steph and others, who were involved in that. you
know, amongst the issues we looked at, we looked at productivity which still sits well below expectations. But we also need, within that, to ensure that the sectoral mix is right and, you know, reflects the intentionality of how we’re wanting to go and see the
market. We spent quite a lot of time looking at the backlog of registrations, which still sits there despite a significant investment in resources. A particular concern to the Committee, has been the backlog in higher risk notifications and in processing, evaluating processing information of concern.
The day after we had our committee, we had our prioritisation discussion at Board and these were top right issues for us, and they are issues that have proved to be quite stubbornly unresponsive to the interventions so far. So, we continue to focus on those,
we will talk about them a lot more at our next meeting, but we hope that the level of assurance that we can provide in relation to this, that the interventions against these are proving effective will increase. Another area of concern for us which we
raised before is in relation to the higher risk calls coming into the National Customer Service Centre, the safeguarding and mental health inbound calls. I’m pleased to say that since the meeting, performance in that area is now ahead of the service standards, which is good
to see, so thank you to our colleagues who’ve led that response. But it’s an area where we feel…, these are vital calls, and it’s an area where we want to see, we want to be able to do more in in relation to that, but
it’s a specialist area as Sean was telling us earlier, and it’s hard to make easy, quick interventions in relation to that. But it’s definitely something that we will pick up at the latest in the next round of business planning. We talked about internal and
external sentiment, and we’ve heard a lot of over the course of the day, it’s come up a few times this, the Sentiment Survey, but also the need to make sure that we focus on - there’s lots of anecdotal information - we need to make
sure that we are focused on what are the key measures that we’re going
Mark Chambers - 2:12:08
to be tracking in relation to our external inputs in relation to sentiment, to make sure that the voices we are listening are truly representative of everyone that we regulate. We did
spend some time - again another topic that’s come up today - looking at our responses to some of the key public inquiries, and particularly some of the lessons learned so far. Responding to those has been demanding and resource-intensive, particularly when, as we’ve heard they
relate to reviews of activity which took place many years ago. Having said that, of course, it is absolutely essential that we respond fully comprehensively and transparently in relation to these and provide all the support that is needed for these enquiries. So, the resource will
need to continue to be deployed to deliver against that. In relation to the lessons learned, I think the key thing is we got some valuable insights from the work so far. I think the key thing, as we spent some time earlier today talking about,
is to make sure that those insights are turned into action, and you know we really embed those learnings into improved ways of working, not least it is another set of insights in relation to our recordkeeping. Our next meeting is early January, second week of
January, where we hope to sort of resume normal service a little in reverting to look at some of the areas that we’ve not looked at for a couple of meetings. You know, in particular, where are we on progress with the significant number of recommendations
that have been made to us over the years, which we have accepted, and where are we with the implementation of those. That’s something we looked at a little while ago and we need to look at again. And out-of-hours will definitely be on the list,
which will be a relief to Belinda who’s been a constant champion of that. It will actually be Belinda’s last meeting as a member of the Committee, so I’d also like to add my personal thanks to her for her contribution to the Committee. She has

5.2 Minutes of the previous Public Board meeting held on 25 September 2024

been a very valued committee member. Thank you.
Ian Dilks - 2:15:07
Thanks Mark, and it obviously leaves us with a gap on the Board and knowledge of, on the non-executive side, of mental health. So, we need to address that with the Department. Last couple of things, we have some minutes of the last meeting that were circulated a while ago, I have no comments, Could we take those as approved? Yes? On the action

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

log, just a couple of things I was going to pick up, so it starts on Page 57 of the Diligent book, the first item on Ofsted, it was down for today, but that’s the one we pulled, so I guess that’s outstanding, so we will

6.0 Any Other Business

pick that up next time and colour-code it appropriately. Many of the others are for 25 delivery so are on track, but Item 6. Charmion, are we content that it is now within the internal audit programme? By way of update, we have spoken with…, having
Charmion Pears - 2:16:12
spoken with Nadiya, and some of the team, we have also spoken with GIA, and Julian actually, prior to starting, to look at potentially bringing an audit forward, either into this year or as one of the first audits of next year; specifically looking at some
of the data that was raised at the last Board, so picking up on disciplinary and grievances and ensuring that we are applying equal treatment to colleagues and how they are followed through, how they are raised, how they are dealt with. So, we should have
more information about that to the ARAC in two weeks’ time. Good.
Ian Dilks - 2:16:53
Thanks very much so we will mark that as closed. Right any other business from anybody? Charmion. Sorry, just to say to colleagues
Charmion Pears - 2:17:03
around the table, it is transgender awareness month, and the team
have done a great job down the hall, at putting together a virtual reality display and some videos and a gallery. I did the virtual reality at lunchtime and it’s well worth it. So, they have agreed to stay around, just in case anybody else has
the time to do one or other. The VR took about 25 minutes. but it’s quicker through the gallery, so if anyone can go I’d recommend it.
Ian Dilks - 2:17:34
Good, thank you. Not exactly any other business, but I just like to…, I mean, James, you hand over,
I’m sure with a big sigh of relief, on Sunday night, you hand over to Julian. Seriously, I know for the whole Executive Team, it isn’t just aimed at you, but we know the last few months have been quite difficult. I mean this Julian, if
you want to put it this way, he will be the fourth Chief Executive in about four months, and I know that hasn’t been easy for people. So, I wanted to thank James for the way you - I couldn’t even say volunteered, that’s probably overstating
it - stood into the breach. But also to all of your colleagues, it wasn’t just about you, I think as a collective group have rallied round in very difficult circumstances to keep the show on the road. And as we said a couple of times
recently, despite the fact things don’t get done, because there’s a short of people which we recognise and are sympathetic to, there are so many areas in which we are actually getting better reporting and I think better insights now than we have previously, so I
think we should recognise your contribution, but also your colleagues and the way they have rallied round, so thank you for that. I think that, sorry it does close down the meeting, so we will close that. But, as usual, we have a few questions, there
are three of them in fact, I’ll take them in turn. The first one is down…, I think I should deal with. Interesting question, it says, how is the performance of non-executive director members of the Board appraised? So, I will include myself in that, although
sometimes the documentation treats the Chair separately. So, the answer is that the Department of Health has specific requirements because both the Chair and the NEDs are ministerial-appointed. The appraisal of the non executives, other than myself, is the responsibility…, my responsibility, the responsibility of the
Chair. So, on a formal basis, based upon observations of the Board room, observation in committees because I attend all Committee meetings, even though I may not be a member of things, or virtually all committee members, and bearing in mind what is not visible to
people watching that many of the directors do an awful lot of work outside the Board room, either in extra work in challenging, or being supported from their extra experience, so I do get input from the executive team as well, both collectively how they think
the NEDs are supporting them, or otherwise and, how they are…, you know that sort of additional information they provide. So, I have a number of sources, it may not be quite 360 degree feedback, but it’s very similar. So, I am required to do appraisals,
which I do annually, of course, there may be interim discussions as well as specific issues arise, but the formal bit which I think you’re asking about, is I do that and I then have to submit all of that information to DHSC because it’s all
done in accordance with the format they may require. I’m not going to go into the detail of it, but it’s relatively standard includes setting of objectives, some of which I would do because they are specific to CQC, and some of which are standard objectives
the Department wishes to see all of us undertake, and that includes obvious things like use of public money. So for that’s others. From my point of view, the Department does this themselves, so they are responsible for gathering feedback from the organisation. They send feedback
requests to people around this table and such other people in the Department, including ministers, as they think necessary. I couldn’t tell you who they ask because, although I get a summary of the feedback, it is all anonymous, so I don’t know quite what the
source is. I probably would say, I think a high proportion of it comes from my fellow board members. The Department pull that together and they do an appraisal of me and that is perfectly standard across all of the arms-length bodies, there’s nothing different at
CQC. So that is the answer to that question. Second one is, when a member of the public expresses a concern to the Newcastle office, how can CQC ensure that person is informed of the way in which this is being followed up? It is a
good question. Chris, I’m going to ask you to answer that. Thank you
Chris Dzikiti - 2:22:05
Ian. It is a very, very helpful question, because at the moment, when we receive information of concerns or notifications of cases, what we tend to do is we respond back to inform
the person that will take action by forwarding it, either to an inspector or to other colleagues. What we don’t normally do then is, at the end of that process, going back to the person to say this is how we’ve dealt with the information of
concern. So, it is something we need to look at how best we can do that, considering some cases, some notifications take a very, very long time to get resolved. Some might take months, or even a year, to get resolved. So, we need to work
out a process of how do we go back to the person, because it may be someone raising concerns about their family member in hospital, for example, or someone raising their own experience of care, for example. So I think we need to work out a
process of how do we go back to people, considering some of those will take time to resolve. Although it might be helpful, if you give us a
Ian Dilks - 2:23:09
feel for the sheer volume of things. I mean there are a range of seriousness which I mean
we were touching on how we handle this earlier, for different reasons. But it is a massive volume and I leave you to work out whether it’s even practical to go back in every case. The other option is to whether we could give any themed
reports, although that wouldn’t necessarily give satisfaction you wanted to know when complaining about an individual, for example. But it may be some themed level reporting could do. But in terms of volumes, just for the benefit of the person who asked the question, do you
want to give us a feel for the number? The number of people who either
Chris Dzikiti - 2:23:51
provide information through notifications, or through Give Feedback on
Chris Day - 2:23:56
Care. I mean probably half a million, it is a big number so yeah, it’s a lot of work. But I think
Ian Dilks - 2:24:05
your point, one of the things that we do try and do is to provide
Chris Day - 2:24:09
Ian Dilks - 2:24:11
information to…, a lot of those people come from organisations and groups that represent people who use services and our partners, and we
Chris Day - 2:24:15
do try and provide monthly briefings to them
about how we use that information to guide conversation and we also talk about it thematically when we bring reports like the maternity report to the Board. OK, thanks, And you have got the mike and the
Ian Dilks - 2:24:30
last question is for you anyway. How can members of the public participate
in discussions about changes in CQC systems of working? A really
Chris Day - 2:24:41
important question. People who use services and the wider public are at the heart of why we do what we do as an organisation. As I said before, we have got partnerships with about 2000
organisations that work, either nationally or regionally, but actually on the website, if you’ve got access to the web, you can just click on About Us - How do you get involved, and there is an online community that has thousands of people who help us
with our thinking around everything, from what describes good in different settings to how we go about presenting results on the website, and colleagues use people who use services in all of our thinking around how we present information to the public and how we gather
it in the first instance. So, you can go on to the website, click on About us and How to get involved. It’s there, alongside Give Feedback on Care and access to other groups, it’s a really good way of interacting. There are also, as I
say, there are 2000 groups nationally that we have relationships with. If you’re a member of a local Healthwatch, if you’re a member of Age UK, if you’re a member of any other group that provides support to people, we will probably be linked to you.
But if you want the direct contact, come and join our community, participate in the conversations that we’ve got, there are thousands
Ian Dilks - 2:26:04
of them. I was at an event on Monday which brought together people who use services, our own colleagues and providers together to have
a really interesting conversation about what good looks like in our inspection process. OK, thanks very much Chris. that’s the end of the questions. Thank you for the questions, we do try to answer them diligently. I think that we can close down the recording. Thank
you very much indeed for listening in, for those who are, and thank you to my colleagues for your participation today.