CQC Board Meeting - February 2025 - Wednesday 5 February 2025, 9:00am - Care Quality Commission

CQC Board Meeting - February 2025
Wednesday, 5th February 2025 at 9:00am 

Agenda

Slides

Transcript

Map

Resources

Forums

Speakers

Votes

 
Share this agenda point
  1. Ian Dilks
Share this agenda point
Share this agenda point
Share this agenda point
  1. Charmion Pears
  2. Ian Dilks
  3. Stephen Marston
  4. Ian Dilks
Share this agenda point
Share this agenda point
Share this agenda point
Share this agenda point
  1. Julian Hartley
  2. Chris Day
  3. Ian Dilks
  4. Chris Dzikiti
  5. James Bullion
  6. Chris Usher
  7. Ian Dilks
  8. Stephen Marston
  9. Ian Dilks
  10. Chris Dzikiti
  11. Ian Dilks
  12. Julian Hartley
  13. Ian Dilks
  14. Charmion Pears
  15. Julian Hartley
  16. Ian Dilks
  17. Christine Asbury
  18. Ian Dilks
  19. Mark Chakravarty
  20. Ian Dilks
  21. Chris Day
  22. Ian Dilks
  23. Mark Chambers
  24. Ian Dilks
  25. Mr David Croisdale-Appleby
  26. Julian Hartley
  27. Ian Dilks
  28. Joyce Frederick
  29. Ian Dilks
  30. Mr David Croisdale-Appleby
  31. Ian Dilks
Share this agenda point
  1. Julian Hartley
  2. Chris Dzikiti
  3. Julian Hartley
  4. James Bullion
  5. Julian Hartley
  6. Joyce Frederick
  7. James Bullion
  8. Julian Hartley
  9. Ian Dilks
  10. Chris Day
  11. Ian Dilks
  12. Mr David Croisdale-Appleby
  13. Julian Hartley
  14. James Bullion
  15. Christine Asbury
  16. James Bullion
  17. Ian Dilks
  18. Charmion Pears
  19. Julian Hartley
  20. Ian Dilks
Share this agenda point
  1. Ian Dilks
Share this agenda point
  1. Network Rep
  2. Ian Dilks
  3. Julian Hartley
  4. Network Rep
  5. Ian Dilks
  6. Chris Usher
  7. Ian Dilks
  8. Charmion Pears
  9. Ian Dilks
  10. Joyce Frederick
  11. Ian Dilks
  12. Joyce Frederick
  13. Ian Dilks
  14. Mark Chambers
  15. Ian Dilks
Share this agenda point
  1. Mr David Croisdale-Appleby
  2. Louise Ansari
  3. Ian Dilks
  4. James Bullion
  5. Ian Dilks
  6. Chris Day
  7. Ian Dilks
  8. Joyce Frederick
  9. Ian Dilks
  10. Julian Hartley
  11. Ian Dilks
  12. Louise Ansari
  13. Ian Dilks
  14. Charmion Pears
  15. Louise Ansari
  16. Ian Dilks
Share this agenda point
Share this agenda point
Share this agenda point
  1. Mark Chambers
  2. Ian Dilks
Share this agenda point
Share this agenda point
  1. Chris Dzikiti
  2. Ian Dilks
  3. Chris Dzikiti
  4. Ian Dilks
  5. Webcast Finished

1.0 Opening matters

Ian Dilks - 0:00:00
Well, good morning, everybody in the room, and welcome to those listening in or listening
to this on iPlayer (online) later on.
Welcome to the public board agenda of the CQC.
This is 9 o'clock on the 5th of February.
We have a number of things on the agenda, but probably spend – the most significant
piece will be on looking at our priorities, so we'll move reasonably soon to a session
by Julian and his executive team.
I should welcome Julian.
This is your first board meeting.
(Julian) Thank you.
Delighted, really delighted to have you.
And as we'll hear as we go on, you've
only been here a couple of months,
but a lot's happened already.

1.1 Chair’s opening remarks & Apologies

We don't have any apologies, but Mark Chakravarti,
one of our non-executives, is joining on the screen.
So for those of you watching on your own screen,
and we'll see him look slightly differently.
I'd just like to welcome Zee, who's
we always have a representative of our equality networks,
as you know.
Zee represents the race equality network.
And we've introduced a new slot later on the agenda for Zee
just to give us a few views on behalf of the networks
about working for CQC.
We have done this in the past, but not in the public meeting.
So there is no script.
We don't know what Zee is going to say, but Zee, we look forward to hearing from you later
on.
This is the last – sorry, the first meeting we've had for many years without Belinda
Black being here.
I did mention on the last call that Belinda stood down on the 31st of January, so we've
only just missed her.
But she was kind enough to review some of the papers that the board's been considering
and give her input ahead of the meeting.
I mention this in part because, in addition to thanking Belinda again, as I did last time,
it does mean we are now at least two non-executives short on the board.
Dr Ali Hassan obviously had to stand down because of a conflict late last summer.
So just for the avoidance of doubt, the Department is running a campaign at the moment to recruit
two new non-executives.
Details are on their website.
but we've also put a link on the CQC website should anyone wish to see what we are, or

1.2 Declarations of Conflicts of Interest

the Department rather is seeking to recruit. Are there any declarations of interest to
note? I think a couple perhaps to mention.
Charmion Pears - 0:02:35
I've got one if I can please, Ian. My husband has taken on a role as non-exec and senior
independent director for Post Office market services, the insurance arm's length to the Post Office
And I don't see there's any conflicts at all with CQC and what we're doing today.
Ian Dilks - 0:02:54
(Ian Dilks) Okay, thanks, Charmion.
We'll make a note, but we know the interest but don't see any conflict there at all.
Stephen Marston - 0:03:04
And just to remind the Board of Interest I declared a while ago, I've joined the Board
in common for three mental health and community NHS trusts
in Central, North and West London.
So discussions about mental health of particular interest.
Ian Dilks - 0:03:23
Thanks, Stephen.
So keep that under review, but should there become a conflict,
we'll deal with it.
But that hasn't been.

1.3 Any urgent business

We have an agenda in front of us.
Is there any urgent business that people
want to add before we start the agenda?
Looking around.
No?
OK.

1.4 Feedback from the Private Board meeting

I thought it would be helpful,
this is something we started two or three meetings ago.
as anyone listening know, we do our board meetings in two parts
as a private and a public.
We held a private board meeting yesterday,
and I thought it would be helpful just to give feedback
on one or two things.
We, in fact, spent much of the time on two topics,
which was the single assessment framework and IT and some of the
challenges we faced there.
If I cover that in that order, so on the single assessment framework, we were joined in the
meeting by Vic Rayner.
Now, Vic, as I think everyone knows, has led the work that we in CQC commissioned from
her and the Care Provider Alliance.
But we're also joined by Professor Mike Richards, who of course carried out some work for us
in relation primarily to the NHS on a similar theme a little while ago, and his report
was published last year.
I would say we had a - actually it was quite long -
but a good and early conversation about the
findings from the CPA's work.
We were very grateful, I have to say, to Vic,
and everyone we know that's contributed to that.
A number of the CPA members have been heavily involved.
So we're very grateful for the work they've done to
help us understand, or better understand,
and here they've used quite a range of adult social
care providers.
And Vic reminded us again, I think we knew the facts,
but it's helpful to be reminded, that the range of size
of providers which introduces challenges
assemble what we do.
So a statistic that always sticks in my mind,
something like 85 % have less than 50 employees,
and some have very much less than that
and probably the ways of interacting with them
is somewhat different to a big multinational group.
The final report from her work is
going to be published shortly, so I won't say anything now.
But I would emphasise that is consistent with our approach
to transparency.
Apologies.
It was clear, I think, from that discussion,
firstly, that her findings are pretty closely aligned
with where relevant, with what Mike Richards told us before.
But also, I think, pleasingly for us,
it was aligned with the work already underway
under Julian's leadership to rebuild confidence in our what
we do and trust in CQC as a body.
I would say that in our discussions,
and I should make this clear, the board is mindful that
ultimately our prime responsibility is to users of
the system, and that is the lens that we look at what's already
taking place and the changes we'll need to make
in the future.
But we also hope that, based on the very good work that Vic and
the CPA have done, we can not just use this as a one-off,
but see it as a platform and a mechanism for closer cooperation
in the future
and we look forward to seeing how that can be done.
At the end of the meeting, though, just to be clear,
the board approved two things.
One was the publication of the report,
which I've already mentioned.
And the other is the approach that Julian and team are
proposing to approach and see how to respond to the various
recommendations that are going to come forward.
On IT, similar structured discussion.
We were joined by a man called Pete Gill,
who we've mentioned before, who is an independent expert that
Julian brought in on his arrival to report on findings.
We where also joined by Esther Provence,
who is joining CQC shortly in a senior IT role,
then it will be her responsibility to take forward a lot of what needs to be done.
So it was helpful to have her in the discussion, although she hasn't actually joined us yet.
Again, I thought it was a good discussion.
Peter talked us through some of his findings, but also the implications for the options
that are now going to be available to us.
Peter is going to summarise his findings in a report, which again, consistent with our
approach to transparency, we will publish.
I don't have an exact timeline for that, but we would hope it will be later on or certainly
before the end of this month.
The concluding on the way forward is going to be a challenge, and we are mindful of the
need not just to correct some of the problems that we have and we've been very open about,
Julian and I spoke very openly about them at the Health and Social's Committee, for those that listened
two weeks ago now.
But we are mindful of the need to balance
the need to progress and fix things as quickly as possible,
whilst maintaining the interim or work around solutions that
we've been putting in place to support our colleagues and the
work that they do and help us meet the targets that we are
seeking to address.
And some of that, of course, will be the subject of the
session that we're about to come to.
Again, in terms of board approvals,
we approve two things.
One is in principle approval of the report. I say in principle because it's not been
finalised yet, but we think the principle is that it should be published. But also the
approach that was outlined to take forward how it is that we approach the recommendations
is likely to come up with to fix the system problems we've got.
So I hope my colleagues would think that is a fair representation of our discussions.
I'll look around the table.
Okay.
Thank you very much indeed, and I hope to those listening in that that's helpful just
to understand where the board spent a lot of its time yesterday.

2.0 Strategic Discussions

2.1 Organisational priorities

So we now have a session on organisational priorities.
There are papers in the deck for those that have had a look at them.
But Julian, can I hand it over to you to lead this for us, please?
Julian Hartley - 0:09:46
Thank you very much, Ian.
And good morning, everyone.
Very good to see you all, very good to be here, and good morning to those watching and
listening online.
Can I say first of all what a privilege and honor it is to be Chief Executive of CQC?
I have been here for two months and I have been overwhelmed with the support and very encouraged by our colleagues and indeed,
meeting many, many colleagues across all of the sectors that we regulate and represent.
I'm in no doubt that we have a huge challenge ahead of us in terms of our work, and there's
an enormous amount to do to ensure that we deliver our core purpose, our main objective,
to protect and promote the health, safety, and welfare of people using health and care
services, and of course encourage the improvement of those services.
So in taking up the role and thinking about the scale of the
challenges that we've got, it was really clear to me that we
have to address some of the fundamental issues that are
impacting on that core purpose and our ability to deliver that
as effectively as we can.
And we don't start here with a clean sheet in the sense that we
already have vital information that has been done in relation to feedback and indeed reports
that have been written about our performance and about where we stand.
So if I draw your attention - perhaps best described in the graphic attached to the papers - you
can see that on that graphic, and it's this piece here where we list out the key issues.
Down the left-hand side, you can see the context within which we're operating and the response
that we've had to make to those.
So first of all I'm sure our colleagues are very familiar, of course, with the work that
Penny Dash did in terms of the review of our operational effectiveness.
That set out a clear series of recommendations for us to address in relation to our operational
performance.
And it's worth saying, actually, because in there,
Penny did highlight the importance of sector
expertise that we are right now out for our four chief
inspector roles, which we'll be recruiting to in terms of
primary and community, mental health and to follow
in due course adult social care and hospitals.
So that will give us a really clear focus on those sectors and indeed those four chief
inspectors working as a team to make sure that we're joining up all of the key issues
for people who use services.
Penny's report highlighted a range of issues in relation to our operational performance
and I'll talk about how we're responding to some of those.
But we've also had the work from Professor Sir Mike Richards
that highlighted the impact of and the issues associated
with the single assessment framework and its implementation.
And also he made some observations about the way
we should be working and how we ensure
that we've got that sector expertise also.
Ian, you've mentioned the work of the Care Provider Alliance
and that's a very, very important part of this also
and I'm very grateful to colleagues across the CPA, and indeed many of those organisations that
have had the opportunity to meet over the last couple of months. To hear directly the
feedback
and I spent some time with Vic Rayner and colleagues from those organisations that represent
care providers and heard directly some of the deep concerns they have about our work
and their experience of that
and as you indicated in your introduction, we'll be getting - we heard about those findings
and we'll be working on that
and already we're building into our work some of those conversations and feedback that we've
already heard.
And then I think thirdly, in terms of the context, it's very important to think about
our own staff because I mentioned at the start the importance of our people here in CQC,
3,000 valued colleagues, all trying to do their very best
to deliver our core purpose.
And before I started in role
I wrote to all 3,000 staff
and asked them what they thought
the top three priorities should be
and the feedback was absolutely clear.
the top priority by some distance was all about the impact of the implementation of
the regulatory platform and indeed concerns about the implementation of the assessment
framework. And I've said this before, but I think it's worth repeating as we meet as
board in public, that the feedback on that was troubling and obviously concerning and
quotes like "the regulatory platform and the IT systems, this is far in away the number
one reason for low productivity, staff stress, low morale and poor staff wellbeing. The regulatory
platform is not fit for purpose and is preventing us from doing our job". So I think it's clear
for us as a board that all of those reports, Penny Dash, Mike Richards, Rick Rayner, and
indeed our own staff are aligned in terms of describing the problems that we of course
are aware of. So what that means is we have to respond to I think some immediate and urgent
issues in relation to that because the implementation of regulatory platform, assessment framework
and so on are impeding our ability to deliver what we know
our providers and people at youth services want.
So in terms of our response, we have set out four immediate priorities.
We're describing these as immediate actions because these are the things
that we have to get onto urgently to address the major concerns
that are being raised by all of those groups
and indeed that we know as a board that we need to do.
And just taking each of those in turn,
with what we're calling unblocking stuck assessments,
and just to explain that, these are assessments that are at
different stages of development but are effectively still in -
can't be progressed in our regulatory platform or published
because of some of the problems and glitches with the system.
And that's incredibly frustrating for providers
and colleagues.
And I know, because I've spoken to many colleagues in care
providers, in the NHS, who are waiting for their reports
and have been waiting months.
And of course, it's vital as the regulator
that we're able to offer timely, relevant, high quality
information about services.
So we're focused on making sure that we're
able to clear the backlog of those assessments
and I've asked Chris Day to lead on that.
And Ian, when I finish my summary, each of my colleagues,
I'm sure, will want to come in to give an update on where we
are with each of those areas.
Secondly, the point that we've made consistently in terms of
being at just over 2,500 assessments so far this year,
that is a sort of new low in terms of our overall activity
and it's absolutely clear that we have to improve that.
We have to be able to increase the number of assessments
that we're doing.
That helps us with our feedback,
and of course it's vital for our providers
of health and care services.
So we've got to try to find the way
to enable new assessments,
and much work is happening on that.
We need to make sure that we find ways of working around some of the problems that the
regulatory platform has presented us with.
You mentioned earlier, Ian, the work that Peter Gill has done to look at our – why
we are where we are, but also the way forward.
But in the meantime, as we pull together the way forward on our regulatory platform, we've
got to use some workarounds to get those assessments out.
And I've asked Chris Zakhiti to lead on that, and Chris will perhaps say a bit more about
that.
And I know all of our operational teams are, and indeed the whole organisation's really
clear about the importance of that.
The third area is about making sure that the backlog of information of concern cases with
no action or risk review, which are over 10 days old, is addressed.
That's an issue I know the board have been concerned about.
and I think early on raised with me,
so and it's also clear that that's an area
where we need to make sure we're mitigating
and managing risk out there
and understanding exactly where we are with those.
And that was a key area of interest
from the Health Select Committee
when you and I met with them
and we're obviously following up
to brief them in terms of where we are.
And I've asked Chris Usher to lead on that
and Chris will say a bit more about that,
but we have bought specialist expertise in to help us address that issue.
And fourthly, registration.
I've spent time with our registration colleagues, they're doing great work,
but we have - and understandably because of the problems with the platform -
challenges there in terms of the backlog of registration applications,
which is causing a lot of frustration from people in the sector
who are wanting to get registered, all the delays that are happening.
And we have moved back to CRM off the regulatory platform
to enable us to work through that.
And I've asked James to lead on that,
and James will say a bit more about the work
we're doing on registration and where we are with that
to make progress.
So I think it's fair to say that all those four -
as an executive team - we have been clear from,
well, pretty early on in terms of starting the organisation,
and these are the things that we've got to get onto
in short order.
The challenge of course with these four
is making sure that - and I'm sure colleagues
in providers will be interested in the timelines
and the volumes and so on.
I would emphasise the complexity and challenge
with some of this, but the absolute commitment
for us to get there.
So we're working on the detailed data
to give us a sense of real confidence
about what we can do by when. Recognising that people will want to hear that as soon
as possible, but it is vital we get this right in terms of the quality of data that we use
and give confidence to our stakeholders and indeed as a board that we're clear that we
can commit and deliver on the improvements that we set out.
So those are four things that we need to do very,
very quickly and work through with some urgency
and alacrity. But they are not the only things
we have to do because of course we've got to think
about the organisation in terms of not just addressing
the symptoms of distress but the underlying root causes
and that takes me to what we're describing
as the foundational improvements. Each of those addresses, again, many of the concerns
that have been raised by the reports and the feedback that we've had from all of our stakeholders,
all of our provider representatives, and indeed our staff.
The first of those is about the – our culture.
And I think it's worth just emphasising that we,
as the regulator for health and care,
we know the evidence tells us that a positive,
engaging culture in any health and care organisation
is vital for the delivery of safe, effective care.
The sense of shared purpose,
the ability of staff to feel psychologically safe,
to speak up, and so on.
All of these things are vital ingredients
in any health and care organisation
of delivering safe, effective care for people that use services.
So we as the regulator need to hold the mirror up to ourselves in terms of our culture and
our approach.
And it's really clear from the feedback I've had from staff that we've got work to do on
our culture.
And I know as a board, you've previously seen the results of our staff survey and the issues
that are highlighted in that,
the very, very poor levels of engagement,
of sense of leaders sharing the same values as staff.
You know, there's a number of things
that are flashing red on that.
So it's vital that we start, and have started,
work on improving our culture internally,
but also the way that we're experienced
by all of our sectors.
And I'm pleased that this week we start our program of in-person countrywide events, both
with staff but also with our sectors to bring together people in person to really focus
on the fundamentals of our shared purpose, the way we work, the way that we inspect,
the approach we take, and we'll be engaging with a major piece of work around that. And that will
give us, over the coming weeks, a really strong sense of our shared purpose, our values, behaviors,
and approach, and crucially, I think, align with the feedback that we've had from the range of
sectors to make sure that all of the commentary about how we're experienced out there is addressed
and we get to a better place.
I did want, actually, given it is, you know, culture is about engagement and inclusivity
as well, it is Race Equality Week and Zee is over there
and it's great this week, Zee, that we've got the five-day Race Equality Challenge
and of course today's challenge on inclusive language.
I was having a look at that this morning,
but the importance of being open, curious,
willing to seek different perspectives,
people being valued and heard,
that is absolutely lining up, I think,
with what we need to do across the whole organisation.
So it's important that we use - and I think it's great, Ian,
that we've got network representatives
around the board table, but certainly,
having spoken to our staff and having spent a lot of time
in the organisation, there is a real appetite
and willingness to want to improve our culture
and approach and get to a better place on that.
So that really is an important part of this work.
Secondly, the importance of getting our structures right
in terms of operations and regulatory leadership.
And this is all about making sure we're aligning around,
and bringing in four chief inspectors, the sector expertise, the sense that we're - we
address all of those points that Penny Dash raised about the importance of specialist
expertise, the importance of credible inspections, the sense of confidence that providers have
in the work that we do. That will require - and is - this is happening in terms of lots
of conversations about how we get that right and how we make sure that colleagues across
the organisation feel that they've got the right focus, they're in the right sort of
place to deliver the work that they want to do.
Thirdly, the importance of the assessment approach. Now, we've seen a lot about the
single assessment framework and the implementation of that, and the way that we go at that, the
way that we take stock of where we are on that with the 34 quality statements, how we
refine those, how we look at what's appropriate for each sector.
And Joyce is doing a lot of work on that already and taking on board the feedback of that and
will be looking at how we can give our providers clarity around what's expected and make sure
that that assessment approach is in the right place.
We talked about systems, including the regulatory platform.
The independent review will give us a direction of travel on that.
It will give us a kind of route map to improve and hopefully give us a sense of how we transition
from some of the temporary workarounds to a more sustainable approach over the medium
to longer term.
And finally, organisational data ratings and register.
It's so important that the data and intelligence we gather -
because we get lots of it every day from people that use services -
we need to be able to respond to that, use that in the context of how we deliver our work,
as well as obviously improving and increasing the number of inspections,
making sure that the data that comes in is used in an intelligent way
and is joined up with the work that we're doing across the organisation.
So, four immediate priorities, five foundational improvements,
lots to do here, but the good news is we've got, I think,
a really strong sense of clarity, cohesion from within the organisation
about the importance of those, and the fact that these are directly derived
from the feedback that we've had from colleagues out there in the sectors.
and I'm sure that over the coming days as we meet both with staff and also with
our colleagues in those sectors will amplify and expand on this and get
really clear about the building the new approach and culture in a nutshell
the CQC way. So what I wanted to do Ian if I may was just perhaps give my
executive colleagues an opportunity to comment on each of those four immediate
priorities because of course those I'm sure uppermost in our mind about how we
chart progress and where we need to be on each of those and given the importance
of those to people out there in - in the health and care sector - vital that we
make progress on that so maybe if we could start with with you Chris on the
Chris Day - 0:29:30
unblocking the assessments.
Thanks, Julian and colleagues.
So stuck assessments is very much what it says on the tin.
This is where reports have taken longer
to get through our processes than we would have expected.
A working group of colleagues from across the organisation
has been involved in trying to understand
why this is happening
and there's a really, really strong support
from colleagues in operations, colleagues in technology
and colleagues in regulatory leadership.
Although some reports are stuck for what
might be described as a technological reason,
the vast majority aren't.
And it's where colleagues need support from themselves
or from the leaders in order to complete an assessment.
So just to say, what stuck report isn't necessarily
is all about the technology.
In fact, it's much more about people's ability
to use the system that we have and to use it well.
So we are working through a number of stuck assessments
that we described at the Health Select Committee
in early January.
The contribution of this group is crucial
to getting progress in this space,
and I'm really, really grateful to all the colleagues
for their time to get to a place where we've not only
identified the range of reports that are stuck,
but also the reasons behind them
and there's a systematic process now underway
to make sure we can clear that backlog,
which I know is exactly what providers want
and expect from an organisation like CQC.
So we are seeing positive progress.
We'll update providers, colleagues, and the board,
obviously, on how that progress has been made
alongside the other four priority actions in due course,
but there is strong progress,
and I think there's some learning here
for how we provide the right support for colleagues
as we introduce changes to the system moving forward.
Ian Dilks - 0:31:27
Should we go around all four and then take questions afterwards?
I think that's probably best.
Okay.
Chris Dzikiti - 0:31:39
So on assessments, this is about increasing
our operational performance.
So we've got two elements for that.
So we've got what we are calling the hybrid approach.
And we started testing this in adult social care
and the focus is how do we best use the regulator platform,
using it in some elements, and then
using outside of the platform.
So that's why we are calling it a hybrid.
We've done some testing,
initial indication is we are seeing some improvements
in the way we use hybrid approach.
We spoke to 30 providers, and these are registered managers or nominated individuals within providers
to just ask them about their experience of hybrid.
Their feedback has been positive in the sense that, one, it reduces the amount of time we
do the assessment so they don't have to wait for a very, very long time for a report.
The quickest, I think, assessment we did as part of that process was three weeks -
within three weeks we were able to start an assessment,
do the report, and obviously issue a report to a provider.
Obviously, the one thing to note is
there were no enforcements, obviously,
so it was quite straightforward, but it was three weeks.
When you compare with some of the STAC reports
that Chris is talking about, that's a huge difference,
and providers are finding that really, really helpful.
So we are now working on how best do we scale
the hybrid approach across the services
we are able to use that for, especially in adult social care, and also working with providers
and getting feedback from providers, and also getting feedback from our colleagues who work
in CQC, the inspectors because they feel much, much happier to use that system.
You know, they feel less stressed, less worried about the process, because it's quite straightforward
for them to end up writing a report.
The other area we are working on is the location assessment plans, or LAP, as other people
might call it. This is about secondary and specialistic care, especially in hospitals.
How do we do assessments in those places? What we've done in the last month is working
to find an IT solution, because we can do the assessments, but how best can we publish
the report? So we are using a system called i365, which we have been working on. We have
finished doing some work on that i365 end of January. We are now in the process of starting
to test that system in terms of publication of reports,
and we are hoping to finish our user acceptance testing
by the 21st of February, and then hoping to go live
with that i365 beginning of March.
So I feel we are heading towards somewhere
in terms of improving our operational performance,
and the initial feedback - like I said -
from both staff and providers has been positive.
So I'm hoping by the time we come back to you in March,
I can bring some numbers in terms of actually where we are at, as we would have at least evaluated
the approach by that time.
James Bullion - 0:34:55
Yeah, thank you, Julian.
So on registrations, it's about 10,500 registrations in our system.
Our target is to make sure that no completed registration is older than – the current
trajectory should get us by the summer, but I – as you said earlier, Julian, we don't
want to make promises that we're not sure about.
We need to make sure that we've got the right people and the right systems in place
to sustain any progress.
And so therefore, underlying this work is a technical solution to finally get ourselves
and providers in the right way of applying quickly and responding quickly. This is a
partnership with our health and care providers. So we do get a lot of applications that are
incomplete, actually, and that causes us a problem - causes us more work - and for the
providers it ends up in a rejection. So there is something here about making sure that our
information on our website and our communications with providers is really clear so they know
what a good application looks like and that staff express frustration to myself and others
about that's a continuing problem actually - quality of application.
So we've got to deal with that with providers, we've got to make our systems stronger and
then we've got to give the staff the support in terms of the numbers.
But it's going in the right direction but it's a constant flow, that 10,500
It's not new people registering, it's changes in registration.
So we'll always have lots of work to do in this space.
Thank you.
Chris Usher - 0:36:39
Yeah, so information, concern and notifications.
Just a bit of background.
So providers must notify us of certain changes, events, incidents that affect their service
or people who use their services.
These are notifications.
We get on average about just under 600,000 a year
as context and cases - so information of concern
is feedback received directly from staff,
information about people's experiences,
and information from partner organisations
we get just under 200,000 of them a year.
Both of those have backlogs that we're working through,
and we're tracking everything that is over 10 days old
in relation to those.
The tricky bit of this is, it's not necessarily
that we haven't acted on them, it's
we can't evidence easily out of the system
what action has been taken.
So that could be just as simple as we filled in the free text
notes of what's happened but we haven't then enabled -
or the business flow hasn't been correctly filled to enable
the process to be closed through.
So what we need colleagues to do is go back
through those cases, review, close them off in the right way and assure that we have
taken action in the right way. So you can imagine it's quite a manual process.
In terms of what we've been doing, we've set up a weekly sit-rep or situation report
meeting to review overall cases, the oldest cases. We've brought colleagues together
in a central team to work through the backlog. We're also looking at how we can do sprints
within operations where the main focus is on case notifications. We've gone through
all of the oldest cases. We've validated actions that are needed and what needs to happen to
close off the oldest cases. And we've also, alongside all of that, been looking at the
end-to-end process. The end-to-end process - and I've been taking through this in a few
sessions - it has workarounds, it has risk in there, and it has things that we need to
to ensure that end-to-end process works slicker.
So we've been doing that at the same time
to get the heart of the systemic issues.
We've had support from Katherine Halford,
who's Chief Nurse at Barking, Hevering,
and Redbridge NHS Trust,
who's been given some expert oversight.
And we've also been starting to look at
'what have we learnt?' as we're going through
these case notifications, what action have we taken,
but again, all of that is a manual process.
In terms of targets, we are working through this
with an aim to reduce the backlog.
We've not yet set togs, but we see progress being made.
Through January alone we brought the overall volume
of cases down by 41%, and that ranges across
what we call P1, P2, P3 in terms of the severity
of the cases, overall 41%.
Notifications trailing slightly behind at 15%,
but it is heading in the right direction,
so I'm confident we're gonna bring this down.
Also really wanna thank colleagues who have been working
on this and really appreciate the efforts to get those cases and notifications down.
So it's heading in the right direction, more to do, but the end -to end-to-end process also
needs a review alongside that.
Ian Dilks - 0:40:01
Are you happy to go to questions now, Julian?
Christie?
No, sorry.
Any questions or comments from a colleague?
Stephen, I think you're first.
Thank you.
You go first.
Stephen Marston - 0:40:18
Firstly, and most importantly, a huge thank you to Julian and the whole team for the clarity
and speed with which this has been done.
I think the organisation and many of our partners have been sort of waiting for some time now
to get this clarity about, so what are our priorities?
What are we going to act on now?
And this is hugely valuable and very helpful.
So thank you for the clarity with which we've now got these
priorities sorted out.
Couple of sort of reflections if I may?
The first is on the enabling new assessments.
Because if I've understood it, I think what we've now
developed is what's, we call it the hybrid model
or the interim model.
And I think it's been described as a minimum viable product.
So helping colleagues understand kind of this is great,
I've now got something that I can go out and I can use
and it will be quicker, it will be easier, it will be more efficient,
I can get my reports done faster, but it's not the steady state.
So kind of what's the interaction between now getting on and using this now
and if I can see ways of improving it, where do I feed those in
to say that as we build the steady state product,
where do I take that?
The second reflection is the CQC way, positioned rightly,
is completely foundational to all of this,
and it is, because we must get the culture, the ways
of working, the behaviors right.
Everything else will depend on that.
But it feels a bit kind of different in kind
from all of the others, the four and the other four.
The others, it's kind of easier to see at a glance,
well, what's in scope of that task?
CQC way is kind of bigger.
I think it includes our purpose, our goals,
our operation methods, our behaviors and values.
So I suppose it would be really great
if in the colleague conferences this week and next - we can help colleagues sort of get
their heads around what's in scope here, how do I contribute to that discussion about the
CQC way because it's just a bit different in kind, it's so foundational that it may
be a bit harder for colleagues to get, you know, exactly what is this, so let's use the
conferences to try and sort of flesh that out. Thank you.
Ian Dilks - 0:42:56
Do you want to take them in that order Chris, for your first comment?
Probably Julian, you should pick up the CQC one.
Chris Dzikiti - 0:43:02
No, no, no.
Thanks, thanks, thanks, Stephen.
That's really helpful.
And you're right.
You know, this is about what we are doing now with the hybrid, but we need to think
about the future, you know, the medium and the long term.
And I think the discussions we were having yesterday with Peter, for example and with Esther now joining us, is to think about actually
what do we do in terms of the platform itself. The issues we have heard with assessment app
on the platform, what do we do with that?
Because I think that's where we need to get to, because what we're doing with the hybrid
is for now.
And we'll learn from the hybrid as well in terms of we've got evaluation end of this
month to just understand actually what is it we have done in the hybrid, because there's
learning there.
What do we need to take forward as we improve the assessment app?
So those are the conversations I suppose we need to have with IT colleagues and the board,
with Esther and Anthony to think about actually what do we do, because we definitely need
an IT solution in order for us to continue doing what we are doing.
Ian Dilks - 0:44:05
Thanks Chris.
Julian, do you want to add anything?
Julian Hartley - 0:44:11
Yes, thank you very much Ian.
Stephen, that's a great question.
You're absolutely right.
and in a sense, the way this is presented obviously
in terms of this is one of the foundational improvements,
but in truth, our cultural way of working
will run through everything that we do.
I think the important thing to say is
we're an organisation that cares about evidence,
and there's clear evidence, particularly the work
of Professor Michael West and others,
that demonstrates that in order to be
a really effective health and care organisation,
the importance of engagement of staff
and the right culture, behaviour, sense of shared purpose,
and the sense that if you're a frontline inspector,
you feel absolutely connected to the overall mission, goals, purpose of the organisation.
That is a vital part of what we're aiming to build here,
and it's very, very clear that where we are right now is not in that place.
and you particularly, Stephen, I know,
because we've spoken about this in terms of the ability
for staff to speak up, in terms of the sense
of psychological safety, in terms of how we feel
as an organisation, and also crucially -
because it's not just about internal -
it's about how we're experienced externally as well,
in terms of when our inspectors go out and so on,
and the interactions and the relationships and so on,
and all the feedback that we've had
from all of those different sectors.
So I guess this is a broad piece of work around building our culture.
And I think it's vital that we as a board, obviously, as I know we are - are really focused on supporting this.
I know that there's been work, because I've watched the previous board meetings around values and so on,
But for those to be genuinely owned and co-produced requires, I think, this major effort to fully
engage and get to the root of some of the causes of distress that we've heard about.
And so in that process, I do expect there to be both the sort of unpacking of the challenges
and issues, but then the sense of coming together about let's coalesce around a clear core purpose,
a clear set of goals, a clear vision for the organisation, and a clear sort of set of behaviours
and values that we all share, and indeed that we are communicating externally, so we have
a clear sense of expectations and reciprocity between those that we're regulating as well.
So it is a big and ambitious program, but I think it's absolutely necessary in the context of where we find ourselves.
So I would say to all board members, and I'm grateful to many of you who I know are coming to the events, to see first hand and experience that,
that we get to a place by the spring where we have that and then we've got our true north that we can really focus on
and that hopefully we will have shared and co-produced
with those that the sectors that we regulate as well.
So I hope that answers the question.
It's probably not represented fully in the way
that the graphic demonstrates,
but this is probably the most foundational
of the foundational improvements.
Ian Dilks - 0:47:41
Okay, thanks.
Christine, there was someone down here.
Charmian first, thank you, Christine.
Charmion Pears - 0:47:48
Thanks. I really welcome this - as you know, Julian, I think the simplicity of how we've
sort of focused on things and the prioritisation is brilliant. And just to echo what Chris
said at the outset, having been lucky enough, like my colleagues, to have met some of the
colleagues who are working on these things, I think we really do need to give them credit
for the work that's going on and the passion they're putting into it.
Just a couple of points from me, Julian
and the first is, and I know you are looking at this,
but the importance of measurement of these.
But when we get the measurements and the timings right
for that to make sure we're not just taking
a one-dimensional approach.
So Joyce and I were talking yesterday
about the importance of measures not just being,
for example, in terms of volume
but in terms of quality of output.
So not just how many new assessments we're getting,
but are they assessments in the right area?
are we risk assessing those in the right kind of way?
and what is the quality of some of our outcomes.
So it's sort of a two-dimensional measure
on sort of the volume, but also the quality or the outcome.
The second thing for me is, I guess,
just wanting to be clear that what sort of sits behind this
is two lenses that we, as an organisation,
probably haven't got fully right in the past.
One is a risk management lens,
because with each of these things comes risk in resolving it.
So we've talked about hybrid workarounds, we've talked around going off the regulatory platform,
back onto the CRM system, so we just need to be really clear of that overlay for each of these boxes,
what the risk is and how we're managing it so we don't repeat mistakes of the past.
And the second thing for me is the value for money lens, and I think we talked about this as a board before,
when we've looked at this to say, you know, we obviously need to do some, you know, really
important things with our systems, but how we do it in a way that really considers value
for money I think will be essential going forward.
Julian Hartley - 0:49:53
Thanks very much, Charmaine. I think very important issues that you flagged. I think
first of all, on the quality, absolutely, it's vital.
And we've had feedback from colleagues across the sectors
on the quality of a number of our reports and inspections,
and vital that those are high quality based
on all the relevant up-to-date data conducted
by experienced and colleagues with expertise - of whom we have
many in the organisation. But they obviously have been hampered by the challenges that
we've had with all of the technology, the regulatory platform and so on. So that point
about quality as well as quantity is something I know, Chris, that you're having conversations
with the team about and making sure that it's not just a rush to get more and more done.
We've got to make sure that the quality and the value to our providers that we regulate
and ultimately for people that use services who will read our reports and make judgments
are really clear and high quality.
And also they incorporate some of the data that we're receiving.
So that connection between the assessment reports but also the data that comes in on
on a daily basis so that there's a sense of having more real time, up to date, intelligence
is vital.
Your point about metrics on the immediate actions, absolutely.
And we've brought in additional expertise to look at how we make sure the performance
reporting and the data is reliable, because of the well-documented challenges about the
difficulties we've had with implementation of regulatory platform and the problems that's
created, making sure that we've got reliable, trusted data is a key priority in order to
inform accurate metrics that we can rely on
and that we can give confidence to our sectors on.
That is absolutely urgent work to make sure
that each of the colleagues you've heard from
has the confidence in the reporting.
And that is an iterative process.
We're getting there, but we're not absolutely there.
And I want to make sure that as CQC,
we can stand behind our commitments to people
in terms of what we're gonna deliver by when,
which will entail getting really trusted data metrics
from the team and the additional expertise
and capacity we brought in will help us with that.
And then on risk, yeah, I think the way that we as a board
and indeed through Arak that you chair Charmion,
I mean, it's crucial that we give some attention to how we're looking at risk in the context
of what we set out to achieve overall and that that risk framework matches the kind
of overall goals of the organisation and we're clear where some of those key risks lie.
I think it's a vital core competence for us to be good at assessing risk, both internally
but also in providers and having that visibility on that.
And I think strengthening our clinical capacity,
particularly around chief inspectors,
will help us with that over the medium term as well.
And yes, on value for money, absolutely critical
that we do this in the right way.
And there's no doubt that learning the lessons
of what has happened around investments and benefits,
that looking ahead, putting together really good
business cases, using best practice in terms of taking things forward is vital for us.
Ian Dilks - 0:54:02
I think Christine was next and I'll come to you Mark. Do you mind Mark? I've been just seeing you,
let me get to Christine, I did promise her ages ago we come to her next and I'll come to you.
Christine Asbury - 0:54:16
Thank you. Like others, I really welcome this focus and the clarity of the immediate actions
and the foundation improvements, I think is really important.
And I think the reports that you've given verbally have given us some really helpful
and detailed insight into actually the activity that's going on in the progress.
Wanted to build on what you were saying, Julian, about external partners and also pick up something
that you said at the beginning, Ian, about the focus of our work and our purposes about
the needs of people who use our services, which I absolutely agree with.
but I would just like to point out that usually, not always, but usually, providers are aligned
with that, that the needs of service users are their priority too. And that going forward,
the importance of a strong and positive relationship with providers is essential to the quality
of services that they're going to deliver. So I would just, you know, that's particularly
in relation to the forthcoming CPA report, I would just urge the board and colleagues
to look at our organisational priorities, particularly, I think, as we start to do the
CQC way work through this lens, that let's not assume that there's a conflict in terms
of needs of service users, but let's assume that we're aligned.
Ian Dilks - 0:55:44
I think it's probably more a comment than a question. Mark Tricrovati, sorry I missed
Mark Chakravarty - 0:55:51
your hand earlier. No, thank you very much. Again, let me echo the comments of my colleagues.
I think this is a really, really positive progress in terms of focus, in terms of prioritisation,
in terms of critically action to start moving things forwards. And again, I would just sort
reiterate that this has been a really critical first step in starting to the journey on rebuilding
trust with our own staff, with our stakeholders, and ultimately again with patients and carers.
So thank you for everyone who's helped us take those steps forward. Again, I'd also just underline
as part of that trust, it is about making sure that we're really clear on what expectations are
and I do see that we are not yet in a stable state, particularly around how we move towards
assessments because of the hybrid approach requiring systems that are not long term suitable
for the job.
We know that there are systems that we are having to use in the hybrid approach that
will be decommissioned by the providers over time.
So we have to make sure that we do transition to something that has long term stability.
So, I think the clarity of that and not miscommunicating that we are at an end state, but we are in
a transition state towards a clearer end state, it's really important to maintaining that
trust.
And then I had the same question about two points.
One was it was on backlogs and also on stock reports.
Great to hear the progress that we're making around addressing those.
The question that I had is, are we already seeing any data or do we have any data on
are we preventing new ones occurring, both in terms of backlogs and stuck reports? Is the inflow
starting to subside or do we not yet have that data? It would be good just to hear.
It's really critical to clear them out, but it's probably even more important to make sure that we
Ian Dilks - 0:57:56
stop them occurring in the first place. Julian, do you want to answer that or?
Chris Day - 0:57:59
Shall I go in terms of stuck reports?
Mark, taking on board what you said about the fact that the hybrid approach isn't a
final state for where we want to be, the benefit of it is that as colleagues move over to it,
we have not yet seen a report that is from a hybrid approach that is stuck in the system.
As I say, the vast majority is not stuck for a technical reason.
It's stuck because the college needs support with understanding how to complete a report
or indeed managing the FACA process.
So there have been very few that have come in to,
as it were, stuck reports,
and those that have have been from the system
that predated the hybrid approach.
So there's been no reports that have come in
as a result of the hybrid approach.
As I say, the vast majority aren't technical anyway,
they're more about colleagues engagement
with the system as is.
But no reports of the hybrid approach
causing either a different problem
more a further problem, and in fact the opposite of that.
Ian Dilks - 0:59:00
Thanks. Other questions? Mark, then David.
Mark Chambers - 0:59:06
It's perhaps more an observation, but, you know, building on Mark's point that we have
a lot of workarounds in the organisation by necessity at the moment, we have a lot of
interim and temporary solutions that we're having to put in place simply to keep the
wheels turning. We understand that and this has to be a time
for pragmatism as well as prioritisation. But I think one of the things that feels different
and very positive for me, this is not the first time we've had operational backlogs.
I have been on the board, we have been through this cycle before.
Perhaps without the same visibility as to actually the risk profile of what those backlogs
mean.
But what feels different this time is actually we're trying to fix the root cause where we
can.
We're actually, you know, we're stepping back and looking at the end-to-end process.
We're trying to look across departments and look across siloed activities to say how is
this working end-to-end.
The fact that that is proving very difficult, I think, indicates, you know, some of the
problems, that actually stuff is being done in teams and not against a bigger picture.
But I really commend that work.
We as a speaking for my committee, we kind of understand that that's not a quick fix.
If you want to do this robustly and effectively, you have actually got to fix the root cause.
It does feel to me on a lot of these operational issues if we're finally trying to get to a
understanding of what a robust fix would look like, and that gives me a lot of confidence.
Ian Dilks - 1:00:50
Thanks, Mark.
David?
Mr David Croisdale-Appleby - 1:00:54
Thank you very much, Ian.
Can I just reiterate Ian's welcome to you, Julian.
Delighted to see you here, and, you know, we really appreciate the strategic focus that
already in the couple of months you've brought to the organisation.
I just have two points I'd like to make, if I may?
The first one is in terms of the fundamental work that you've done on assigning priorities,
the foundational and the immediate.
I wondered whether there were any activities that you'd come across that we do, as most
organisations do, that actually we could well halt or pause in the interests of further
focus on those things that really matter.
That's my first question.
The second one is going back to a point
that we mentioned on values.
One of our values, I think, is curiosity.
And I just wondered, in trying to look
for a definition and an understanding of what
good looks like for CQC, in terms of regulation - yes,
but also in terms of some of the other values
of an organisation, what goods look like.
Are we open to evidence from regulation in other sectors
and indeed in other countries?
Because I think in terms of building
an organisation of great quality,
we need to have inputs from those sources.
Those are my two questions.
Julian Hartley - 1:02:34
Thank you.
Thank you, David.
So, on your first question, in terms of the focus to support the delivery of the priorities,
we have paused our work on assessing integrated care systems.
I've met with the team we've got.
We've got some great people in there who are currently supporting work on these priorities.
So we've made sure that we're kind of training the firepower of our colleagues to work on
this.
We will obviously, and we are in discussion with the department about how and when we
pick that up.
It was a conversation that the Health Select Committee were interested in.
And obviously given that we've got a 10-year plan being developed, the importance of integration,
our work on integrated care systems will be important.
Right now - we're pausing it to answer -
give you an example - in order to deliver against these,
but that's not to say we won't be picking that up
once we build greater progress, confidence, and so on.
In terms of what good looks like in curiosity,
that's a great question, and that's certainly
something we'd want to encourage,
and that was the word actually I referred to earlier
in terms of the inclusive language point
from the today's challenge, Zee, but I think that's vital
and I think that curiosity does extend more broadly.
We do have a - I was in conversation with colleagues
from King's Fund recently about our research -
the research into how other systems sectors regulate,
what we can learn from that, how we make sure
that as the regulator of health and care in England, we're learning globally, we're learning
from other types of regulator in other sectors. I've spent time speaking to chief executives
of other regulators in this country, so I absolutely agree with you about the point
about taking the learning and best practice around regulation and what is working elsewhere,
both in other sectors and indeed in other countries on health and care and
we'll have some research capability to help support that approach. Joyce might
want to say a little bit more about that but I also while I've got the mic just
wanted to make sure I thought because I wanted to come back to what you said
Christine because I thought that was a really important point and sometimes I
think there's a false dichotomy between this idea of, you know, providers and
people that use services. There is, the vast majority we know of
providers absolutely are driven to deliver for people that use services. I
worked in a number of care homes in West Yorkshire when I was younger. I've seen
firsthand the kind of importance of that sector and what it does for people. But also of course, we deal with failures, we deal with - and
there's been some recent media scrutiny on that and our role to ensure that we are really,
really focused on having that really good sense of feedback and understanding of what's
happening out there.
So that relies on really good relationships, as you say, with the provider sector, but
also a clear-eyed view of how we make sure we're protecting people that use services.
I don't think those two things are in opposition.
I think they go together.
And also, we've got to remember our core purpose of supporting improvement.
And we can support improvement in health and care services by having that positive relationship with providers
and working to highlight good practice, put a focus on what's working.
So I thought it was an important point.
Okay, sorry, thanks.
Ian Dilks - 1:06:31
Thanks for all the comments. Joyce, do you want to just add to what was said?
Joyce Frederick - 1:06:36
Yeah, thank you, David. I think that's a really important question about thinking about what good looks like in regulation and in terms of assessing quality and safety and outcomes in health and social care.
And we do a lot of work on that in terms of our own research program and working with other regulators so that we get what good looks like.
I would say, because you've talked about that, Julian, about our research program and the evaluation that we do with the King's Fund and others.
And Julian, you may not have started yet, but as a regular meeting with all the regulators
nationally - UK nationally in this country.
We also work within policy and strategy with other regulated bodies and also host international
meetings with people from other countries who want to learn about regulation.
CQC is also part of the European regulators where we meet together and talk about what
good looks like.
and we are part of Erasmus, which is a program where we
teach regulatory skills, which we recognise as being
absolutely important.
And finally, we are also members of the Institute of
Regulation, which do master classes in regulation itself
in terms of what good looks like.
And they are hosting their annual conference this year,
and I'm a member of the award panel where I will be part of
judging what good regulation looks like.
There are lots of connections and interconnections that we
are using and leveraging to make sure what we build within CQC is not just local, but
also nationally, internationally, based on good practice.
I won't say best practice, but good practice is what we know is best, but what can actually
be implemented.
I will also say, David, there is a lot more we can do, because there's constantly a cycle
of change these things, and actually they'll leverage improvement.
But we are doing a lot of work in that area.
Ian Dilks - 1:08:28
Thanks
Mr David Croisdale-Appleby - 1:08:29
Could I just come back on that? Thank you, Joyce, and thank you, Julian.
One of the things I'd like to suggest is although CQC is obviously a regulator of organisations,
we also have a number of regulators of individuals, professional individuals, and it would be -
I think there's - I found that there's a lot to be learned from looking across to the other
side of that particular fence, not just directly to import something, but rather to understand
some of the methodologies but on some of the underlying principles of how you get good
and how you get excellent from that. So I just make that suggestion, Joyce, to you and
Julian, if I may.
Ian Dilks - 1:09:15
Okay. Thanks, David. We should probably conclude, unless there are any other pressing questions,
Just a couple of observations from me, and then we'll conclude.
The – Chris, I was interested in the way you presented your figures, but giving some
context to the backlogs, and I think it is something worth saying, and to a degree commending
that the management here, that when we talk of very crude metrics like the percentage
that are over 10 days old, there are often very good reasons why things are beyond a
certain age.
It doesn't mean that it's wrong, just made more information.
And I think it would be unhelpful and appear defensive of us if we started saying that
upfront and giving excuses.
But I think it is worth bearing in mind that when we've got these very crude measures,
I wouldn't say it's absolute worst case, but it probably on balance tends to make things
sound a little bit worse than they are.
And what would be nice is when we – let's stick with the objectives we've got, but
I think in due course, hopefully as the systems improve, we can have rather more sophisticated
measures.
So we actually get a handle on what is overdue for reasons beyond our control and what is
overdue here.
Certainly when Julian and I appeared for the Health and Social Care Committee, I think
we said basically it was 800,000 if you add together notifications, information, et cetera.
Those are huge volumes that a lot of people have to be employed to deal with.
And, of course, it's the overall cost of regulation that providers don't necessarily
see, but ultimately is what they bear – what they tend to see as the inspection.
But there is an awful lot on this that's going on there.
So I think it is worth flagging that's a sophistication we need to introduce.
But for the moment, I think the organisation is right not to start getting defensive about
the scale of the way we present the challenges.
Julian, I – we weren't asked to approve anything as such, but I think it's important
we had this discussion.
And I think it's pretty clear from discussions here and other feedback that really we do
unilaterally, sorry universally, beg your pardon, welcome what we've seen.
I mean in a sense it's good that we haven't unearthed any kind of new major problems over
the last few months.
The problems are to some extent we knew what were there, but this has given a better definition
and most importantly picking up phrases my colleagues have used in a much greater focus,
clarity of purpose and prioritisation.
And I think our colleagues in the organisation need that.
We could have come up with a list of 200 things to do,
but given the challenges, I think it's essential that we
group around a number of things.
And the four priorities that you've articulated are very
much the things that we were talking around around
this table last month.
What you presented us with is a little bit of a greater
understanding of what the problems are,
but more to the point, some focus and clarity on how we're going to deal with them. And
I think that's the difference that we've just seen.
We have heard some observations about the need to develop metrics for progress to better
monitor the risks as we move from things that weren't working to workarounds to something
that's more sustainable. And there's clearly a big role there for the Ordered Risk Committee
to oversee what it is that management are doing. But we know you've got that as a priority.
I suppose any other observation I'd make, and again there's a risk of another four of
this seeming defensive, but we've focused on, rightly, on what is wrong and what has
undermined our reputation and trust in CQC.
But I think it is important to make absolutely clear, firstly, that even within the areas
we've been talking about, there's a lot of great people doing great work, and somehow
we don't surface that.
I know you've talked about it, Julian, but I just want to emphasize it from all of my
all colleagues, we've been here longer, and we also see the very
good work, and in many cases that's been undermined by the
problems with systems.
But also there are many bits of CQC that we're not actually
talking about in this session.
So, you know, I've just mentioned a couple of Health
Watch England, we'll be talking about later on, our market
oversight function.
You know, these work very well, and, you know, people in those
areas have to be part of an organisation that is subject to
criticism in – albeit the major part of our organisation isn't working. But again,
I think it is probably just helpful from a board perspective to say we do recognise there
are parts of the organisation that do work very well and don't get published.
So really, just to say to summarise, sort of for approval per se, but we really do utterly
endorse everything you're doing. We're grateful for the approach you put forward,
and I think specifically within the CQC where we recognise that something that has to be
– we don't just support you, it has to be owned by the board. So I hope colleagues
would see that as a fair summary. So thank you very much indeed.

3.0 Reporting updates

We're not letting you off the hook there. We go straight on to a more routine reporting
update. We have a longer paper on this in the pack, so usual practice. We take papers
as read, but perhaps if I could ask you to highlight anything specific, either personally
or through your colleagues and then we'll go to questions.
Julian Hartley - 1:14:28
Indeed, thank you very much, Ian.
And to that point about important work that we are doing
and there's, you know, in addition
to what we've just gone through,
there are some key topic areas
where we're doing very important work.
And I want to start - and I will go
I'm going to turn to my colleagues to speak about some of these important issues in the
paper, but I did want to start, and Chris, I'll come to you in a moment on this, but
with, particularly given today's publication by NHS England of the report into Nottingham
and Valdo Calacane, that we, our adult community mental health program, we publicly committed
to look in depth at the standard of care in adult community mental health and crisis services
across the country given that we continue to see issues with quality and with patient
and public safety post the section 48 review into the care and treatment of Aldo Calacane.
It's one of the reasons why we need a chief inspector of mental health as well as the
others because mental health services are such an important issue right now for across -
across the country and I know from my previous role just how under pressure
many services are and the importance to deliver for the public and people
that use services. So we intend to achieve this commitment by
carrying out an inspection program and thematic review of all mental health
trusts across England commencing with a six-month pilot in quarter four of this
year, we've got a clear program of activity set out which we hope to complete in a two-year period.
Our inspections will provide an updated rating of quality in those trusts and
in addition, we're aiming to identify
both high-performing and struggling services to make sure we identify risks as well as good practice, which we then want to
share. And I know Chris that this is very important in your work and
doing a huge amount on this.
So I thought you might want to say a bit about this,
and indeed to pick up any of the other key updates
under the heading of Chief Inspector updates,
given there's a lot happening and it's vital work,
but perhaps just hand to you on that.
Chris Dzikiti - 1:16:56
No, thank you, Julian.
And you're absolutely right in terms of, you know,
the work that we are doing
on community mental health services.
What's really important to mention is,
when we're thinking about the work as part of our response
to the recommendations from the section 48 we did,
we were actually here in Stratford with providers.
We had medical directors, chief nurses,
leaders in the provider sector who came
and we had a discussion about the community mental health
services and listening to some of the challenges
they're experiencing because we were quite keen for them
to shape some of the work we were doing
because we wanted to make sure it was corporate,
produced in terms of the work we were doing.
And it was a great day actually to see actually,
you know, the amount of people turned up to talk about
commitment to our services.
So we know it is a priority for people who lead services.
It is also a priority for people who use services to think about
how best people are being supported in commitment to our
services.
So that's why we are doing that piece of work as you've
just described.
And as part of that, the other thing we're thinking about
is how best do we bring colleagues from providers
to come and support the work we do here in CQC.
So we decided to launch a program around clinical fellows
by bringing people with expertise from NHS
to come and join us here.
So we started a pilot with two clinical fellows.
We've got two senior mental health nurses
from two of our NHS providers.
So they combined sort of mental health history of practicing
of more than 40 years, and they're part of this program
we are doing in commitment to mental health services.
And what we've seen is they're bringing their expertise
to help us actually think about some of the work
we are doing.
But what's even more important for them is they're also
seeing some of the work we are doing in CQC
and some of the changes we are doing,
and they're able to comment in terms of actually
how it can be received within the provider sector.
So that has been really encouraging.
So, having those clinical fellows has been helpful and always happy to come and talk
about the evaluation once we've completed the 12-month pilot for that.
And then on, just to mention a few other areas, on primary and community care, just to highlight,
obviously, the demand for primary and community care in terms of - especially the past few
months - in terms of influenza, in terms of other respiratory sort of conditions we have
seen.
And we know GPs have tried to increase the capacity of staff, but we are still seeing
demand outweighing provision of services
because of this winter pressures.
On urgent and emergency care, we're really keen
to start our work on system pathway pressure work
because sometimes people might think actually
when winter pressures, people are really busy,
we shouldn't be going to services
because we're putting more pressure on services.
But what has been interesting is actually going out
and doing some inspections or assessments
in emergency department is actually people
welcoming us to come and see the experience, one of what staff are going through and also
what patients are going through.
And we have seen, actually, firsthand how much pressure services are when it comes to
emergency services.
So we continue doing that work and we'll be more than happy, again, in the near future
to bring back some updates in terms of how that work is going.
So I'll leave it there and pass on, I think, to James because there's a bit around dementia
and adult social care.
But thank you.
Julian Hartley - 1:20:28
Thanks, Chris. And Ian, I think it's important, obviously, as you mentioned, obviously, we've
seen the paper, but some important issues obviously out there that in terms of the external
environment we're talking about. Thanks very much, Chris. That's really helpful.
I thought, James, it would be helpful to talk about our dementia strategy, but also a particular
kind of moment is the pressure on adult social care, the adult social care market and the
challenges and also local authority assessments.
James Bullion - 1:21:00
Thank you, Julian, and yes, thanks.
As the paper says on our dementia strategy, this was one of the areas where we have paused
but simmered the work, actually.
And this update is a lead in to the publication in April of that dementia strategy, which
I think will come back here on its way out to publication.
But I just wanted to give a sense that dementia remains a key concern about which we get feedback
in terms of people's experience of both health services and care services.
Our ultimate goal as a regulator, I think, is to produce some guidance, in effect statutory
guidance to which we could then measure in inspections that we're doing or the local authority inspections that we do, or indeed if we begin
ICS work down the line in those assessments to measure the quality of what good dementia
care looks like.
So that's the ultimate aim, is to use the partnership that we've created with dementia based
organisations and with clinicians and with social care practitioners to state what's
good and what the gap is between what people's experiences and what needs to be good.
And it's important for people's lived experience, but I did note - and I noted a recent meeting
of executive leaders of external organisations - concern about the relative prioritisation
of dementia across the NHS.
The recent operational guidelines took away the target for some outcomes around dementia.
And not commenting on that, it's quite right that the NHS needs to prioritise what goals
it does set and what targets it does use.
But it puts more perhaps onus on us as a regulator and advocates to think about how you give
a voice to people's experience.
So that's what's behind the dementia work.
And we had a really good engagement in parliament with MPs and the minister indeed for social
care gave a keynote about the importance of this. I think - it's work that we need to pause
while we do the priorities but simmer so that we can bring it back to life at some point
during this year.
On the markets for social care, last time at the board we had expressed some concerns
about the messages we were receiving from social care providers about the potential
impact of rising costs on social care provision and on the stability of the market. And the
evidence is that those concerns have not gone away, in fact they've been heightened and
we are getting lots of messages from our engagement with providers both in our market oversight
function formally but also wider than that in the social care leaders that we're meeting
with. We are alongside the providers in expressing their concern, as it were. We won't get in
the way of the decisions that need to be made in local councils. They will be setting their
budgets in February. Many of them face a dilemma of how to fund those additional costs versus
other pressures that they have. From our point of view as a regulator, despite those pressures,
Our concern is about the quality of people's social care, about the continuity of that
care, and in particular whether we might see some providers unable to continue to provide
care and therefore, to use the jargon - hand back - as it were, the contract to local authorities.
And we will monitor that situation alongside others who need to monitor it, particularly
in local government themselves.
and we are, as a regulator there, to play our part, as it were, to host and make sure
that we give a voice to those concerns and to pull together social care providers where
they've got a concern particularly about their sustainability that is hard to replace, as
it were, given our regulatory responsibility for that.
And then finally, on the local government assessments, I think the paper gives the current
numbers. We are in 88 of the 152 councils. You can see in the paper what we've got scheduled
in terms of site visits. We are near the top of the bell curve. We're in 10 councils a
month at the moment. We had a slow start. We need a managed end to that. So now is the
time when our staff are working really flat out. There are some risks and constraints
around that and we are making sure that we draw in expertise from social care to maintain
the teams and their capacity to deliver.
Some themes will emerge which I think in our state of care arrangements we'll be able to
make some commentary about what people's experience is, particularly around waiting times, around
safeguarding, around the experience of family carers as well.
And I wanted to say as well I'm enormously grateful for the Director of Adult Social
Services and community leaders for sort of coming route one back into CQC about what
they think of this process and that will be both concerns and praise about what we're
doing and its impact.
We know it is having an impact in anticipatory and in proper performance management terms.
But we are getting lots of feedback.
Even though we've published just 20 reports,
it feels like a really engaged process with local government
and with people who draw on social care.
So I just wanted to mark we're probably at the halfway point
in this two-year baselining period,
and it's, in my view, working very well with really good quality work
by our inspectors.
Thank you.
Julian Hartley - 1:27:10
Thanks, James, really helpful. And Joyce, I know we've already mentioned the research
on our regulatory model, but wondered if there were any other points under the policy heading
you wanted to draw out for us, given quite a lot of work happening in policy right now.
Joyce Frederick - 1:27:31
Yes, thank you, Julian. Can I just mention beforehand, with both what Chris and James
have said, I mean the key issues, we, you know, services are under pressure and feeling
tremendous challenges at the moment and you've talked really eloquently about our role to
work with providers to improve care within those circumstances.
But also our key role is actually being the voice of people who use services and call
out where people are not getting the standards of care where they need it.
And we have to really be far more eloquent in terms of what we do as a regulator and
and build confidence.
I know where we are now,
and we've talked about that this morning,
but we do have to build confidence.
And there are three areas where providers
and people who use services want us to really get in and out.
And that's, first of all, you know, show the benchmarks,
show the maturity of organisations.
How far are they in achieving what they need to achieve?
Secondly, provide those insights.
What do we do well?
What can we demonstrate that we do well?
How can we help serve our public and people who use our services?
And thirdly, show us where we need to improve.
Not just show it or blame or league table,
but also think about how do we as a regulator help people
and share good practice and have those improvement conversations
so that people can be supported to improve.
So there's some key roles that we will be working through,
which are really important now as we build confidence
as a regulator, because strong regulation is really important
in supporting really good health and care,
particularly in the work that we do in England.
In terms of the policy, you did mention the research.
I think it's absolutely important that, and it's not something we should deprioritise,
if we are going to do a new assessment framework and a new way of working
or any tools in terms of regulation, we have to evaluate that work
because we have to be evidence-based and we have to show that we are driving improvement
or there's no point in doing it at all.
So part of our changes or part of those foundational changes that you've made,
There is evaluation across almost all of those things because of the need to be evidence-based
and ultimately drive improvement.
We discussed and have launched our intention and our policy to be an anti-racist organisation.
We are working with the NHS, Race and Health Observatory to be able to do that both internally
within our organisation, and I'm sure Zee will say more about the work of our REDD Network,
but also externally in our regulation in terms of what we
see in health and care in terms of inequalities,
in terms of people using services,
but also the care of the workforce.
Because your point about engaging the workforce is - if
there are anti-racist issues within how people look after
their workforce and there's not equality,
diversity, and inclusion, that will impact on the care that
people receive and also the care and the humanity in which we
treat staff who work in those services.
So we're looking at that in terms of our anti-racist policy.
Finally, the government launched
the AI opportunities action plan,
and that has implications for us as a regulator to one,
think about how we use AI internally for our productivity
and our growth, and secondly, to decide and work out
through our regulation how we support innovation in AI
across health and social care services. The last thing that I have noted under policy is the
Baroness Casey Commission but I will hand over to James because I know you've had some meetings
with the department and you can speak in terms of an up-to-date view on the Casey Commission.
James Bullion - 1:31:15
Thank you Joyce, yes and we welcome didn't we at the beginning of the year the announcement
about the Commission and the work around social care reform more broadly. Of course, the terms
of reference of that Commission are still being worked upon, so those aren't finalised.
We would want to play a part as a regulator in trying to help shape both what might be
expectations in the short term over the next year for what changes or what improvements
in the social care reform space should take place, as well as recognising that broader
question around how society pays for social care is going to be a matter of both evidence
and politics and will take longer and that's the matter of the 2028. And I acknowledge
the comments and observations made externally around time scales and the sense of urgency
out there in social care for what can be done immediately on reform. So, for example, areas
of the Care Act that might need strengthening or areas of innovation around the workforce
and the tasks that they undertake or the fair wage process that's also underway. I think
we as a regulator have got a lot of evidence that we've collected both through market oversight,
through the local authority work and through the concerns that we receive about, as it
were, what needs fixing. And that includes, in this respect with the Casey Commission, the
point of interface between health and social care and integration. And I know that in particular,
that will be included in the scope of both the Commission. It's also in the scope of
the NHS 10-year plan, and there's something about ensuring that both those processes talk
to one another. One is further down the line than the other, so there's a need to make
sure that as that Commission begins that it speaks in dialogue to what has already been
found in the consultation, the very broad consultation in the health 10-year plan engagement.
We've been formally asked to assist and engage with the Commission, so it's important
that we draw up through our executive and through the board what our formal responses
will be, and there will be time for us to do that and follow a proper process for that.
But as I say, it's likely to be in the area of what current innovations can be made around
around technology, around the tasks that social care staff undertake, around the workforce
conditions, and around the role of regulation as a lever that encourages change. And then
secondly, more broadly, in our findings around the Care Act and what needs strengthening
or changing or enhancing around the formal duties that others might have as we have a
perspective on that. And I think the final thing I would say is that of course we are
an independent regulator with our own perspective, but we're also working in partnership with
partners in a grouping called the Time to Act Reform Board, which includes CQC, Skills
for Care, ADAS, and the Care Providers Alliance, and Social Care Future, where we are, as it
were working out what we have in common to give a single voice in social care.
One of the challenges for social care is the distributed nature of it.
There is no social care England in a way that there is in the NHS, and therefore bringing
those voices together for common advocacy is one of the perennial challenges.
Thank you, Julian.
Julian Hartley - 1:35:15
Thanks.
Thanks very much, James.
And conscious of timing, and so I was going to ask Chris just to cover off any key points
around consultations and then any questions the board will have on the
Ian Dilks - 1:35:28
report.
OK. We'll only have about five minutes for questions. So, Chris, if you pick that up. David,
Chris Day - 1:35:35
I know has a question - I'll come to you in a moment. To try and draw out three, obviously, our
consultations are our ability to inform government and parliament. So there's a joint commission
from Human Rights on – into the mental health bill. And I think from our perspective, we're keen
to use some of what we know from our own work in our own assessment of the current Mental
Health Act to check and to challenge how the bill is progressing and we're having further
conversations with MPs around particular topics such as second opinion doctor service. In
addition to that, we're doing some work with the Health and Social Care Select Committee
on an inquiry into mental health community services, which is an area that Chris mentioned
in this earlier report where we have genuine concerns about capacity of those services
as well as the quality of some of them.
Another area of consultation is around leadership and DHSC have launched a consultation seeking
views on the oversight of NHS managers and leaders in the NHS.
And again, there's information from state of care which will go into to inform that.
Just 30 seconds on wider engagement.
We've been really pleased at the support we've had
from providers and from people who use services groups
on our work around the foundational improvements
and also our four immediate actions.
I just want to thank colleagues who've engaged
with that process and who are coming to our events
this week and next week.
They've been really, really focused on trying to support
the improvement in the organisation
And in particular, how we might co-produce issues from what good looks like for different
services, how we offer a good, consistent view of regulation, not just of individual
organisations but of local systems.
And I'm really grateful for their continued support for us in our work.
Ian Dilks - 1:37:30
Thanks, Chris.
We're probably ending in about five or seven minutes, but I've got David and then Christine.
David.
Mr David Croisdale-Appleby - 1:37:37
Thanks very much, Ian.
And I'll address this to you, Julian.
You might want to bring in colleagues to this.
It's about the dementia strategy that we're developing.
As you probably know, I've been chair of Dementia UK for 10 years or more.
It is concerning to me, first of all, the tsunami in dementia, which is huge, which
means that quite a lot of people are receiving institutional care in, for example, residential
homes when they should be in nursing homes, et cetera, and that's because of capacity,
availability of skills, et cetera, et cetera.
But I think it's very important that in terms of our inspection teams, we don't just assume
that knowledge about mental health, for example, is sufficient to allow you to be a perceptive
of investigator of the quality of delivery of dementia,
because it's a very different sort of area.
And there's quite a bit of criticism within the sector -
that being the dementia care sector -
about the level of skills of some of our colleagues
looking at that.
So I suppose what I'm asking as we're developing this,
please come to me and to others who might have
an insight onto this that could be useful to you.
But I think it's important that we don't fall into that trap of saying, well, you know,
if we can inspect community mental health facilities, we can do the same for dementia.
I don't think we can.
So I'm really just making the point and asking for some reassurance that you'll come back
before we publish this in April.
Julian Hartley - 1:39:26
Absolutely, David, and I completely agree with the point and indeed over my career in
working in the NHS I've seen how dementia has had an increasing and challenging impact
in terms of people with dementia in a whole range of settings across health and care.
So vital that we've got our inspectors that understand and appreciate what they involve.
Great that we've got your expertise around the board table on this.
And I'm sure that when we come to the point of looking at the work that James has outlined,
we'll want to engage you and indeed the whole board on these questions to make sure that
we get this right.
I've already spoken with some of our teams in the organisation on dementia.
We have got, I think, some really good expertise.
We want to build and strengthen and take forward that kind of overall approach.
James, I don't know if you want to add to what I've said.
James Bullion - 1:40:23
I mean, it is great to have your insight, David, on this, only to confirm that in the
strategy itself, training and development is a core part of it, including training for
our staff as well as promoting the minimum, as it were, standard that we would expect
from providers. So it's at the core of it, David.
Christine Asbury - 1:40:43
Thank you. I was going to say something about the dementia strategy, but I think that's
been covered, but what I would say is that another NHS priority that's been stood down
is that of people with learning disability, and it's equally important that in our inspection
work we are looking very carefully at the health needs of those people. But I did have
a couple of questions, I think mainly for Chris and James. On the urgent and emergency
care work, are we going to be looking at how social care has or hasn't been commissioned?
Because it seems to me that that is an important issue
in relation to the problems there.
And then on LA assessment, I think about a year ago, James,
I asked you about how we're looking at commissioning practice.
So I'd just appreciate an update on how much focus there is on that,
and particularly things around fair cost of care,
around communicating or deciding on inflation increases,
because I've heard that in some cases the 2024-25 the current financial year, inflation
increase still hasn't been announced, let alone once for the forthcoming financial year.
So it seems to me that some of those things are important. I'd like to know how much we
focus on those. And all of those things seem to me very important to have information on
and to feed into the Casey Commission as it happens.
Yes, thank you, Christina. In relation to that point about the local authority assessment,
so commissioning is part of our information gathering and our methodology of looking at
that question. In relation to that Care Act duty that councils have to have a well -functioning
local care market. So we have gathered information and where it's an issue, we put, we pointed
out in the published reports that we publish around individual councils, but you're right,
James Bullion - 1:42:45
it is emerging as a theme and whether we will do any thematic work will be subject to further
discussions with the department around that. But certainly we have fed that back to in
our quarterly meetings with the HSE that it is emerging as an issue of inconsistency and
of differing practice. And then to link it to the Casey Commission and the gathering of
information around that is featuring, I know that it's featuring there as a potential
Care Act examination question about whether the duties are specific enough.
And I do reiterate what you say about the need for local authorities to be realistic
with their care providers and to pay them sufficiently that will enable them to have
a functioning care market. So that's not us getting into, in the way
of Councillor decisions, it's their responsibility to make those decisions, but as a regulator
we can say the Care Act that we are overseeing says that you must have a properly functioning
care market and it can't be properly functioning if you've got lots of people handing back
a contract or they can't pay the right price. So I don't want to get into individual council
and their circumstances in relation to any feedback from the board's discussion, but
policy-wise, that's right, I thoroughly agree with you, they've got to be realistic.
Ian Dilks - 1:44:10
Thanks James. Charmion, I think you had a question, if you could, let's make that the last one.
Charmion Pears - 1:44:15
Thanks, I just had a question in relation to our commitment to have an anti-racist policy within the organisation.
And I guess I want to try and understand as a board how we think we have understood whether we're moving the dial on that
and the commitment we're going to make.
So I guess I was just going to ask or suggest that maybe midway through the year we pull
on some of the work that's going on to give us a view, because it's one thing to commit
to the policy, but if we don't know that it's actually having any impact for our people,
then it's not doing much.
So I think sort of May time we should have the results of a couple of audits, the LLRC
audit and one we want to do on EDI in the first quarter. We should have the speak up
annual report through, we should have the people survey response through and I guess
Ian when we are looking at the forward plan, Julian I think it would be really useful to
give Nadia a decent amount of time to come and talk to us about that, just to really
understand are we shifting the dial. And you know I am part of the mentoring programme
which I'm incredibly grateful for.
And one of the things I was talking about with my mentor was,
it's one thing being in a colleague group
and feeling psychologically safe,
but you should feel psychologically safe
wherever you are in this organisation,
whether you're within a colleague-led group or you're not.
And I think we have to take a pulse on that
and give it some decent time to hold ourselves to account.
Julian Hartley - 1:45:46
Just very quickly, if I may, Ian, really important point.
I'm sure we, yes, Charmion, I think it's right that we do
ensure that there's embedding and penetration of this across the organisation. And having
met with our Race Equality Network already, with Zee and colleagues, I know that we've got
a great group of colleagues here, and we'll hear from you after the break, Zee, on some
of this, and also what Joyce said earlier. I think there's – I've got a sense that
we've got an opportunity to really align the anti-racist work and the work of the network
with the co-creation of CQC way. It's built into our culture. It's part of who we are,
how we work. So I think that will help with that sort of sense that this is real and being
felt throughout the organisation. But of course we also want to pay attention specifically
to the policy work that we set out and making sure that we are keeping faith with that.
Ian Dilks - 1:46:50
Thanks very much everybody. Julian and your team, thank you for the comments there. Let's
take a break now. We are about five minutes behind schedule but let's take a break.
Could we start again at five past eleven?

COMFORT BREAK

Ian Dilks - 1:47:20
Thank you.
What was I saying?
It would be me that forgot.
Okay.
For those that didn't hear, welcome back, everybody.
Thank you for pointing out I wasn't using the microphone.

3.2 Hearing from our networks

So the next item on the agenda is to hear from Zee.
So, Zee, I mentioned right at the top of the call that you are chair of the Racial Equality
Network, but I'll leave you, won't say any more, leave you to introduce yourself.
Be interested in what you have to say.
We've allowed about 15 minutes in total, so if you could allow a little bit of time for
any comments or questions, that would be great.
But over to you.
Network Rep - 1:48:02
Good morning, colleagues, and good morning, everyone, on the call.
Good to be here.
I'm representing the various networks in our organisation.
I'm Zeshe Repinda, and I'm the co-chair of the Race Equality
Network.
We've got five equality networks for the benefit of those
who don't know what we have.
We've got the LGBTQ+, the Carers Network, the Disability
Equality Network, and the Gender Equality Network.
I got them.
Okay, so it's a privilege to be here because I think there are synergies to be benefited
from having us work with our board and our SLT.
I think we bring a different stance and an opportunity to feel and to hear how we live
our daily lives and how the actions or lack of the board and our SLT impacts our members.
So I would start by celebrating the work that all the Equality Networks have done. We have
been involved in a number of Equality Impact Assessments in various forms, so there is a lot going on in the organisation. So the carers network; they've been
involved in that carer's policy -
they've had input, the race equality in the carers,
we did support the strategy people where the polices
were non-working.
We had the menopause policy that was also supported
by our members in the gender equality network.
So we've got quite a number of events.
Why do I mention these events of what we are doing?
We do feedback from our lived experiences into the work that CQC does.
And I think we bring a flavor of things that some of you may not see.
We do have a board that's not so diverse, but we are your eyes and ears.
We tell you how we see things.
So I'll give you an example of the work that the Race Equality Network has done.
Towards our drive to being an anti anti-racist organisation, we get invite from various teams
like the Equality Rights Team Strategy to feed into the designing of the working towards
the anti anti-racist organisation.
It is a big ask that we do not take lightly.
When a person or not is a co-chair, I have got my day job, my substantive role is an ops
manager, but I feel that and I know for a fact I put more work into the race equality
network more than my role, so I tend to start my core job late in the afternoon because
of what we are doing.
People do ask me, so I do it, concentrate on your day job, but I always say change begins
with us. And I cannot, and other colleagues in the network say, let's leave it. So the
work we have done on anti-racism, you see it filtered through into how we work. What
I love about the work we are doing is when you look at the bullying, discrimination,
and harassment issues that are raised with colleagues, without a reset via the CQC way
that Julian here trying to bring to us.
The work of anti-racism when anti-racist organisation
will come to note, it's a time to self-reflect
and working with the networks, we give you the views
of what it is that we see happening in the organisation.
We have contributed to what the EDI strategy.
We've got those lived experiences,
but not just lived experiences.
We have colleagues in various roles so they are able to bring the various perspectives
to this which I think makes CQC a better organisation.
So with all this work that we are doing as networks, I would really want to see the board
and SLT engage more with us.
So, on a daily basis, I get emails, oh, Zee, we are starting this project.
Can you attend?
There is only one Zee.
But I do go to, I think, the majority of the meetings.
I can't say no because I think this is important work that if we miss an opportunity to contribute
to, we'll continue to be disadvantaged.
Then, they ask that we can go back to our members, whether in RAINN, LGBTQ, Carers
Network, but these are colleagues with their day jobs, and we've got the organisation not
fully appreciating that this is important work equally like our day jobs, so colleagues
struggle to get time away from their day jobs.
I think that is work in progress.
I just also wanted to celebrate some work we are doing, again,
touching on the anti-racism work.
I went to a conference and we did a day, we didn't know,
I met Chris Day at the Race Health Observatory workshop,
and it was a good exercise.
It feeds into what we are doing as an anti-racist organisation.
My ask and challenge to all of the board members and SLT, I do send invites like this race
equality week challenge.
We don't get to see that much engagement from you, the them and us.
How do you know how we feel?
In RAINN we've got the 'chill and chat'.
I think LGBTQ, I think they've got a coffee session.
We don't see you.
You're not visible.
So when we come to Stratford, I'm waiting by the pillar to try
and catch some of you to tell you how our members are feeling.
If we are going to be going forward with the CQC way,
increase your visibility.
Come and hear from us, not just sending these multiple surveys.
I move on to my next point because I know we only got a
short time.
So, I know there is some work that is going to be done around restructuring networks.
I know from all our network coaches we are saying we want to remain independent of execs
and SLT.
We want our autonomy.
We do not want to be an extension of management because we see things differently.
We've got a common goal but different, you know - all roads leads to Rome.
But so we hope that with the proposed restructuring we maintain our autonomy.
There's also an issue that I wanted to highlight in terms of the budgets towards the networks.
Last year we worked without knowing how much we have.
When we go out to assess providers, I was out at a Trust.
We do ask how much do the networks, what support, what resources do you have?
And someone asked me, and how much do you have?
Because I did say, I may quote here, I couldn't say.
Last year we worked without knowing how much we have.
This year we've been asked to give figures and again without knowing how much you value
our work without a budget, some of the work we do, we do not think that we are getting
that really credit we do have.
And I would say some of the events we did last year, some of the leads in the race equality
network, we funded them with our own funds. So I'm challenging the organisation to set
up a reasonable amount of funds for our work. We grapple with the bargaining to get good
quality speakers who come, like for the Black History Month or for the KRS network. Those
people don't come cheap, and we also want to value their time and without a meaningful
budget we are hindered in celebrating and gaining what we want.
I will now move on to another area that's of great importance to all our network members.
Without the right people in the right places, all the efforts to move to drive operational
performance your CQC way will not succeed.
How does that impact our members?
The issue of recruitment, Julian, is something that you really, really need to look at that.
When I joined 2015, we had issues around recruitment.
The theme is still the same.
The Roger Klein report of yesteryear talks about recruitment issues.
We've got issues that have been highlighted in the LLRC.
They are still there. We now have a recruitment review report that has just come out from
external providers who were commissioned to look into these issues.
As Charmion said,
do we do audits of
this project that are done? Do we track where we are? And for our members in different degrees
we are affected by the way the recruitment is done.
In our view, recruitment is not fair,
it's discriminatory, and it's very upsetting
that we are called to arms to drive improvement,
but when they are glaring disparities
on how recruitment is done.
So I can talk outside the meeting
because there's only a limited amount of time I can talk,
But it is a burning issue.
So with all the networks, we have raised these issues.
And we really want to adopt those changes in our ways of working.
And we want to see a fairer recruitment.
Without going into too much detail, for example, we've got colleagues who have come to us to
highlight they've been in interim positions for months.
We are literally in an interview perpetual mode because we are wanting to be your best
all the time.
We do need to have those issues looked at.
So from the networks we are here, we want to work with our leadership.
We are raring to go with the CQC way, but we also require your support on those issues
that are close to our hearts.
Thank you.
Any questions?
Thanks very much indeed, Zee. I mean, there's a lot in there, and I doubt we've got
time to respond to the detail of a lot of it. But I mean, there's points around kind
Ian Dilks - 1:59:54
of board access and just updating whatever, which, you know, noted and we'll think about.
I mean, I think inviting you and giving complete freedom to talk today is at least part of
that. But I can assure you and anyone listening,
certainly personally, and I think I speak for the board, we've increasingly found
how valuable the networks can be. I know in previous discussions - not necessarily in this
sort of session, but where the networks have volunteered their knowledge and expertise
to the development of our assessment methodologies and the way we work with people. And it may
well be that we could do more and systematise that, make use of internal expertise.
I'd also just remind colleagues and, again, anyone listening that when we were searching
for a new chief executive for reasons of confidentiality, we couldn't introduce prospective candidates.
But we did ask the networks, and they did an excellent job of – we had a facilitated
discussion to gather on behalf of the organisation what they would like to see in a new chief
executive.
And that was captured and it was shared with the candidates.
And part of the evaluation process was how that responded.
And I know I chaired that panel and others around.
I'm sure they'd agree with me that the responses – the fact we could give it out
on the responses was insightful.
Should we say leave it at that?
But there are also questions, some structural or budget things.
Julian, I don't want to put you on the spot, but I don't know if you have an initial response
to that.
Julian Hartley - 2:01:30
Thanks, Ian.
Thank you, Zee.
(Zee) You're welcome.
It's really good to hear from you, and I appreciate the fact that, well, first of all, just to
pick up what Ian said, I remember paying close attention to those qualities and characteristics
that the Equality Network put forward as part of the CEO recruitment.
It was one of the things I was keen to make sure I attempted to live up to in terms of
what you have all asked of your CEO.
Having met with the five Equality Networks, and I've been really impressed with the sort
of the commitment, the how much colleagues care
about our future collectively and the role
that the networks play in that.
And also having spoken to you a few times now
at different events, I've got a really, really strong sense
of how positive the energy is around culture change,
around engaging stuff and so on.
So I have no doubt that the work that you and the other
equality networks do is going to be critical for us over the
coming weeks as we build and improve our culture,
but also over the longer term.
So you mentioned some particular HR issues on recruitment.
Made a note of that.
I think that's important.
I've already been struck by some of the issues that I know Jackie
and the team are working on, particularly in relation to
things like induction and supporting colleagues coming in.
But obviously we want to make sure that our commitment
to anti-racism runs through all of our approaches
around HR inclusion, diversity.
There's, I think there's a good challenge from you
about engagement and visibility of senior leaders
and what we do to make sure that we're supporting
the work of the networks and that we're, you know,
actively involved and engaged.
And I was, as you heard earlier, interested in the challenge for Race Equality Week and
the five kind of challenges on a daily basis.
I know Chris talked about the yesterdays and I spoke earlier about today's, but I think
that was a really good kind of practical way of getting engagement from a large number
of colleagues across the organisation.
My experience is that organisations that have healthy positive networks like this always
help support an improved positive culture.
So I'd want to support the work.
I mean, I can't give you an immediate response around budgets and so on.
That's something we can talk about, Chris, but I mean, we've got to support the work
that the networks do.
we want to make sure that you continue to be influential
and help support the work that we're doing.
And I hear absolutely that sort of sense
of being independent, but part of,
and making sure we respect the kind of role
that you play as networks.
So plenty to do, I know.
But I hope you've got a sense already
of my personal commitment to the work that you and the other networks
Network Rep - 2:05:01
are doing.
Thank you very much. Thank you.
Ian Dilks - 2:05:05
We're pretty much out of time, so I'm afraid we haven't much time to debate this,
but I'll take a couple of questions. Chris, did you want to comment first? And then Charmion?
Chris Usher - 2:05:15
I was just going to say Jackie's had to step out. I don't think Jackie's been well.
I think she would come back on quite a few points.
some specifics, I'm happy to pick up conversation on budget.
I wasn't close to that - aware of that - but we can pick up.
I think you've touched on a bit that for me
plays to a conversation we're having in people committee
about the risks that we have,
and also thinking about the four plus five
and the priorities, and some things
that might sit alongside that,
but not necessarily front and center of the four plus five,
thinking about the employee life cycle.
So how we attract colleagues, how we recruit colleagues,
how we induct colleagues, how we train colleagues,
how we part way with colleagues.
That plays to a number of issues you talked about there in terms of recruitment but also
the fixed-term contract situation that we have with a number of colleagues.
So I think there's definitely areas there that we need to get into - understand.
Ian Dilks - 2:06:02
I know Jackie's doing a lot of work around recruitment.
So just acknowledging the issues and the challenges, and I think there are things being worked
on but we need to do that with the networks.
And then I love the challenge you've given everyone about the visibility, and we need
rise to that challenge I think and absolutely take that on board so that's really good.
Okay, thanks.
Time for one question.
Charmion.
Charmion Pears - 2:06:25
Thanks, very insightful, Zee.
Thank you.
Just a couple of things from me.
I guess one is about how we are holding ourselves out to be data and insight led and it is definitely
our aspiration and we look at that a lot from an external perspective and what we're going
to do with the data to be better regulators.
I guess one of the things that I think we need to do more of internally with the sources
of information we have is triangulate those data sets.
So for example, the report that Zee is talking about in relation to recruitment, it's a form
of assurance.
It's a third line, effectively.
Are things working the way that we think they are within the organisation?
So I'd like to see that kind of thing come to AHRIC.
It should be coming as one of our third lines to AHRIC, so we're getting visibility of that.
and I think when we do look at - are we moving the dial,
we should be pulling all those sources together to create a really clear picture,
because we talked in our earlier board about some of the themes coming out of Speak Up,
and some of the concerns around bullying and harassment,
and how all these things linked together I think are really, really important.
The other point I'd just like to say is just a bit of personal experience around the table.
Myself, Mark and Chris were involved in recruiting for our ARAC recently,
and we were lucky enough to have Nadia Raymond work with us on that to look at the way we
were approaching it, to look at the questions, and I think I can say, as my colleagues would,
that the result we got in terms of being able to ask questions that just showed such diversity
and thought within the answers was well worth it.
So I'm an advocate, and if anyone wants to talk through what we learnt around the table
out of that process, I would be very happy to do so, but it was certainly insightful
for me.
Ian Dilks - 2:08:10
Thanks, Charmion.
So that's two of us already talked to the benefits of the networks and inputting processes
that we're going through.
Joyce, were you wanting to speak?
Joyce Frederick - 2:08:22
I thought we went out of time.
Ian Dilks - 2:08:26
We'll have to keep this brief, I'm sorry, but yes.
And Mark, if Mark has a comment, Joyce, go first.
Joyce Frederick - 2:08:32
I'll keep it very brief, so thank you very much.
The bit I wanted to highlight, and I do have an action actually at the end of the programme
in the board's role in being an anti-racist organisation, which I'll come back to the
board in March, but the bit I wanted to highlight was the discrimination bit.
We talk about HR policies and procedures, and we talk about bullying and harassment,
but discrimination is the lived experience of colleagues day to day in this organisation,
whether it's microaggressions or whether it's pure discrimination, where they might be sidelined
for not being a role or not even being asked to do things that are within their competence
or being denigrated in terms of – and it can be very, very subtle.
So I think those are the issues that we need to think about as well as the broad HR policies.
I did have the advantage of speaking to Roger Klein last week because he has talked quite
a lot about evidence-based policies and procedures that work if we want to fundamentally change
and be an anti-racist organisation. So part of my action is to come back to board and
talk about those evidence-based policies and actually probably at some point invite Roger
Klein to come to the board as well, or others who may give us that perspective on our role
and then the evidence-based policies that we need to introduce in the organisation.
Ian Dilks - 2:09:49
Thanks Joyce, and for reminding me of the - or Brian - he asked about the paper you're bringing
back to the board in March. Mark, sorry, I didn't mean to cut you off, but we'll make
this the last question.
Mark Chambers - 2:09:59
No, no, it's fine. And it's just an offer, really. There are very different – we all
have very different networks around this table, and many of us from different sectors have
a different footprint. Very happy to try and help source speakers, guests, anyone who could
help your and the other networks, and I'm sure we'd all be happy to do that.
Ian Dilks - 2:10:26
Thanks for the offer, Mark.
Let's suppose I'm sure we can spend the rest of the day on it, but thank you very
much indeed for your time.
And I've not going to kind of re-summarise the old comments, but clearly there were
questions or challenges for the organisation around, you know - personally the role in access,
visibility of leadership, and secondly some structural and budget issues.
So we will capture those and we'll find a way
of responding publicly.

3.3 Health Watch England (HWE) Update

If that's okay, let's move on.
So my apologies, hopefully we have Louise.
Yes, so Louise, I can see you on the screen.
So Louise Ansari, Chief Executive Healthwatch England,
unable to be with us physically,
but is joining us on the screen.
We have a report in the deck.
So I think you know Louise from being here before.
We take papers as read.
There's no need to talk us through the detail.
But what I would like is perhaps David,
just to say a few words of introductions,
the chair of Healthwatch England.
And then Louise, if you'd like to highlight
any particular points.
Either you want to make sure we have taken notice of,
or you want us to focus on,
and then we'll go to questions.
But David first.
Mr David Croisdale-Appleby - 2:11:33
Fine, thanks very much.
Very briefly, a little bit of context,
mainly for the audience who aren't here today
but are listening.
Health Watch was spawned out of the Mid Staff's inquiry led by Sir Robert Francis who then
became the first chair of Healthwatch
It's in two parts.
It's Healthwatch England and it's a network of 153 local health-watchers which are independent
organisations and they are highly present in both integrated care systems and local
authorities.
What is vital to us is that the perception that we have out there amongst patients and
the public about our independence, that independence of the patient and public voice, and we have
to ensure methodological thoroughness of our own research.
That's really important to us.
Perhaps I should point out that we do not adopt a Pareto curve kind of approach in seeking
the views of disadvantaged and isolated communities.
Because sometimes it can take many, many months to gain the trust of such isolated communities
before we're in a position to seek their experiences and their views.
My own role really is about building the board of Healthwatch England.
And, Ian, you mentioned Belinda, who's just stood down from CQC board, and she's a continuing
member of the board of Healthwatch England.
And my other role has been particularly visiting the 153 organisations which form the network.
Louise Ansari - 2:13:26
And again, I'll just reiterate that point also about assuring the methodological thoroughness.
and we have a number of research experts in the organisation,
and we set our standards by those of NICE, those of NIHR, etc.
So that's my brief introduction, and I'd like to hand over with your permission now to Louise.
Louise, over to you.
Thank you very much, David, and thank you, Ian.
Good morning, everybody. Thanks so much for having me online.
you all spared my germs this morning so that is good. I'm going to say a few words by way
of introduction to the paper, I know you've read it. So it is a long time actually since we've
reported to the board, I think it was last summer and there's been a huge amount of work since then,
obviously since the general election a huge amount of change in approach to health - if not social care
And some of the work we've done is detailed in my report, but I'm happy to answer questions
about all of the time since I last reported. I'll be delighted that Julian was appointed
as Chief Executive. We've worked with him before and had common cause on a number of
areas. And I know that Julian really understands the importance of lived experience and really
values very highly user experience of services and how to feed in effectively that evidence,
not just to risk-based inspection, but also to service improvement.
So the other bit of context really that's very important at the moment is the Dash second
review, which I mentioned in the report. And we've been working with Penny Dash and her
team over the last few months to try and work obviously to the terms of reference that she
has which are very broad and about patient safety even though we're not primarily a patient
safety organisation. But we have been talking to her about the sustainability of Healthwatch
and the future of a particularly local Healthwatch where funding has reduced in real terms by
at least 50% since they were set up about 12 years ago.
And indeed our funding is reduced year on year
because we've had pretty much flat cash.
And as people will know,
we are now only 36 people at Healthwatch England.
And as Joyce mentioned earlier,
the point that CQC's job is also to reflect
people's experience of easing services
and calling out poor performance.
And as legally a committee of the CQC,
that is our raison d'être, you know,
that's what we do day in day out to, as David mentioned, high standards of evidence. So
we don't know exactly what's going to be in Penny's report, but we hope it will mean a
significant strengthening of the Healthwatch movement. And if that is the case, if for
example we become the commissioners of local Healthwatch and we are given a stronger role
in undertaking things like surveys, then we will be co-creating hopefully with CQC what
that transition looks like, what it means in terms of us being a part of the CQC if
we remain in the CQC, which I expect we will. And I know that there is a programme at the
moment of looking at the 25-26 business plan for the CQC. I've attended one of those meetings.
I'm assured there is a kind of placeholder for that transformation.
Obviously we're operating here in the context of CQC having really having to focus on significant
priorities for reform on registration on inspection, but I would underline our importance and the
importance of patient and service user voice in health and social care as a really critical
part of that work going forward. So I haven't, and I won't reference any of the detail in the
report on the very wide range of policy areas that we've been working on and the support that
we've given the network but happy to have a conversation and answer any questions. Thank you
Ian Dilks - 2:17:47
chair. Okay thank you very much Louise. So any questions or
James Bullion - 2:17:52
observations? James. Thank you Ian
and thanks Louise and David for that introduction.
First of all, I wanted to say I attended the NHS Partners Council
where Louise was giving feedback really ably and excellent feedback
on the role that she's playing in that process for the 10-year plan.
And the reason for making the point is that the culture that comes from Healthwatch
which is around the whole person, the psychosocial models of health and care
and the importance of all of that in the way that we vision both the future of the health
service and the future of social care reform is really critical it seems to me. That fellow
culture that both CQC and Healthwatch have around that rights-based approach. And then
the second point I wanted to acknowledge was that in the work that we're doing in place
in the local authority work and previously with the ICS, the importance of Healthwatch
locally and bringing that voice of people that we can use as evidence, but also, you
know, helping us connect with other community groups, I think is really, really crucial.
It's a small thing, but actually, if it isn't there, you really notice the gap. And we do,
I think, struggle in some places to make connections with community groups. And I bet you there's
a correlation between a strong Healthwatch and a strong engagement locally as well. So
I wanted to acknowledge that. Thank you, Ian.
Ian Dilks - 2:19:26
Thanks, James. Others? Chris.
Chris Day - 2:19:30
Just to build on that, really, two things from my perspective. One, I wanted to thank
Louise and her team for their ongoing involvement in our Share for Better Care campaign. It
It really does drive from different communities better engagement with how people are experiencing
services and I know the effort that colleagues both in Healthwatch England and also the
health-watchers around the country go to supporting our information gathering to make sure that
we hear from the voice of people who use services and to Chris' point of earlier that we use
it in our assessment of services.
So I just wanted to thank her and the team for that.
And next week sees a launch of the ICS
and it calls it improvement framework.
And again, Healthwatch have been an important partner
in that work to look at how ICSs can better understand
the voice of people who operate in their area.
I know there've been other partners involved
in that national voices, et cetera.
but I just wanted to thank Louise and her team for their involvement in that work.
Because I think talking to the ICSs that have been involved so far,
it's a very practical framework that I think will drive a better understanding of
where different communities start from and indeed how we track improvement over time.
So thanks very much for that Louise.
Ian Dilks - 2:20:59
Thanks Chris.
Can I go Joyce first and then you Julia? Joyce.
Joyce Frederick - 2:21:05
And just briefly, I actually wanted to congratulate Louise and David on Healthwatch annual report.
I thought it was an excellent annual report and we should all read it.
It was evidence-based, it was people's lived experience, it was impactful because of that,
and it gives accounts of the key areas that we should focus on and any organisation involved
in health and social care could focus on based on what people have said.
and it's just well structured and to the point.
So I wanted to say thank you very much
for that annual report.
Ian Dilks - 2:21:38
I was going to mention if I had a question,
but I'll come back, Julian, you next.
Julian Hartley - 2:21:42
Thanks Ian, and thank you very much, David, Louise.
I think I've said this before,
but I think it bears repeating that in my previous roles,
I've always found the work of the local Healthwatch
particularly important in the context of getting the feedback from, certainly in the case of
my work in Leeds, both patients waiting in our emergency department, for example, where
Healthwatch did a really important survey of people's experience and indeed - much more
broadly, the big Leeds chat, which was all about getting feedback from across the whole
of the city, many, many members of the public, patients, residents - big exercise where health
leaders came and participated in those conversations.
And Healthwatch I think, played a key role in bringing to life all of that feedback that
was then actively used to shape and influence the delivery of services.
I think, Louise, you mentioned the work that Penny Dash is doing, and I'm sure in the kind
of next iteration when those recommendations emerge.
I think the importance of that integrated care perspective
locally, the importance of how services
are joined up for people.
One of the things I learned that came out very, very clearly
from those examples I've given was how people talk about
some of the gaps between different services
and where there needs to be greater
strengthened integration. That's certainly something I'm sure that we'll
see as part of the importance of the role of Healthwatch locally but I think
as ever the the critical value of having a really strong feedback loops to inform
our work and the work of health and care services is vital and of course Louise
the work that previously we've done together to influence and try and support change in
response to concerns and issues raised by patients, public, people that use services.
So good to have this.
I'm delighted to be here in this role working with you, David, Louise, and look forward as
As we chart what may be some changes around roles, functions, we will wait to see what's
recommended but whatever the outcome, we'll want to work and continue to have that strong
relationship.
Ian Dilks - 2:24:21
Thanks, Julian.
Please, to jump in a couple of questions from me.
I was going to mention the annual report, so I agree with what Joyce said, so we'll
repeat that.
But I just wondered if you'd had any particular response to it
that is worth sharing.
And then my second question is, I mean,
we often say that CQC has a unique position because it's
the only organisation that looks right
across health and social care.
So it's a very privileged position,
and it enables us to comment on kind of the join up
nature or lack of it sometimes beyond any work we
may do on ICSs.
and we certainly did that very much in our state of care report - not the recent one but
the one the year before that. But of course, having said that, one area we don't actually
regulate is pharmacy. So - and you did touch on your report on the pharmacy first initiative,
but you are the only bit of CQC that actually looks at that bit of the whole spectrum. We don't in CQC so i'd be just interested in any
observations you may have about that initiative. So two questions.
Louise Ansari - 2:25:33
Thank you Ian, and thank you everybody else for your positive comments - really appreciate
that. So I'll wrap those questions together I think because obviously in our annual report
and we talk about the work we've done on pharmacy, we'll be doing more work on pharmacy eminently.
What we obviously try and do is take on some of the major concerns that people have got.
They raise them with the network, they raise them with us directly.
We go out, particularly with the health equity lens and kind of seek views on what's happening in terms of people's experience.
And we also exist to support change.
So on Pharmacy First, we've got a history of working with the team in the department and in NHS England to say,
yes you know we've talked to people they think it'd be great if they could get more services
via the pharmacy so let's work with you on pharmacy first. We're now doing a piece of work
saying is it working basically especially in the context of things like medication shortages and
permanent and temporary closures of pharmacies but also whether or not people are responding to the common condition advice and so on and whether or not they are able to access that.
So that's a kind of feature of our work,
which is we will support improvement,
but we'll try and get an ongoing dialogue
with the policy teams based on people's real experience.
So it's not all kind of ivory tower policy stuff,
is then is it actually working on the ground?
And local Healthwatch are key to that.
And we often find that, you know,
there are big gaps in terms of provision,
and those are often to do with often quite prosaic things
like physical access to buildings
or temporary closures of chemists and so on. So we will keep feeding that back and then in the
annual report you know we've done that obviously on dentistry we're trying to keep that feedback
loop going on access to GP services on support whilst people are waiting. I think what we're
finding with this new government is that there is a real - I mean I think the previous government and
certainly at the NHS really did listen to what we're saying and what people are saying.
We've seen in the elected recovery plan for example a commitment to improve customer service
as well as bringing waiting times down. We're seeing commitments to bringing waiting times down
in emergency departments and we will keep talking about people's experience in pharmacy, in getting
GP appointments in emergency departments and in corridor care and so on. We are seeing
that loop of policy improvement and commitments by the government and NHS England. What tends
to happen is that when that then gets down to practice, we just see a huge amount of
variation around the country in all healthcare settings. Not even started talking about social care
yet but so the real issue for us is how can we reduce that variation whereby
some systems and some providers are working really well through primary
acute secondary community care and some really aren't and that sticks as a
really big issue and I'm sure obviously CQC colleagues understand that really
deeply so we will keep feeding that back. The annual report is one route,
So our kind of main formal annual route.
But we have ongoing dialogue with colleagues
in the department in NHS England,
and obviously at an ICB level
and at provider level with local Healthwatch.
I hope that does answer your question.
I mean, I suppose the work on regulation
of different elements of primary care,
I'm not sure if that's going to come through
in terms of the regulation of ICBs effectively,
then how well they're regulating primary care which is now their commissioning responsibility,
but that would be an interesting discussion to have offline.
Ian Dilks - 2:29:41
Okay thanks Louise, I mean I won't put too much on this pharmacy thing but I mean in our state of
care report we pride ourselves on what we do being evidence-based, it's not opinion, it's
evidence-based, but obviously this is an area where if we don't regulate it we have no evidence,
so I don't think we should change the golden rule of going on opinion not evidence,
All of that said, given the fact that Healthwatch is inside CQC, I think it would be a workpoint
noting for next year that if there is a migration of the provision of types of healthcare outside
the regulatory net, or at least the bit we regulate, then it would be worthwhile reflecting
on the implications of that we should be mentioning.
But that's the point forward.
Is there anything else that people want to ask?
Charmion.
Charmion Pears - 2:30:27
Thanks.
I think everyone around the table knows that Healthwatch have their own ARAC and their
own board, but we were lucky enough to have our sort of annual overview from the team,
which was well received by the ARAC.
We provide obviously a different level of sort of a higher level of scrutiny than their
own ARAC.
But one thing I just wanted to sort of ask Louise is we were lucky enough sort of through
that process and the surrounding discussion to learn about your staff or your colleagues'
survey results which you've been quite modest in not mentioning in the in the report so I wondered
if you could just perhaps share those and just perhaps any reflections you have for us because
we're obviously interested in being a learning organisation and they were pretty fantastic
results if there's any kind of key learnings you could share with us
Louise Ansari - 2:31:14
as a board. Thank you,
I mean, yes, that's very kind. So obviously we carry out stuff. So if you've got quite a small
staff group, we have excellent results. They're normally in the kind of - you know, we have -
we have 95, if not more percent staff actually filling in the survey. And then we get in the sort
of high eighties and nineties of people being very happy to work for Healthwatch. We have
zero people reporting bullying, harassment and discrimination in our
workforce. We have in the 90 percents people understanding our work and their
objectives. I've been proud of what we do. We have in the 90 percents people saying
they would recommend Healthwatch as a good place to work. Where people are
slightly less happy. It's to do with areas like IT provision and pay, which obviously
we are part of the CQC, so that's part of something we need to have ongoing discussions
and I do have very positive discussions with Chris Usher and colleagues on things like our
SLA on IT. And on our culture, people believe that we will do what we say as a leadership
team as a committee. I think we've done a huge amount of work on our culture in the
last two years. We've co-created a new set of values, we've co-created a whole set of
behaviours that people need to demonstrate to show that those values are running through
their working life and we do workshops around them, we keep them alive. Yeah, people are
really happy and proud to work at Healthwatch.
And we've shared that work and been working
with the Healthwatch network on that as well.
A lot of that is about their impact.
And I, you know, in some ways I think it's slightly easier
for a small organisation, you know.
I know personally all of our 36 people very well
and, you know, they're all fantastic people.
They're really brilliant at their jobs
and I think they perform extremely well.
So any support or any help I can give, I'm going to come along next week to one of the CQC
WAY events to listen to how that's going and help support it if I can. So yeah, any support that we
can give to the CQC and any learning from the work we've done on our culture and our staff happiness,
Ian Dilks - 2:33:52
very happy to do that. Thanks very much Louise. Looking around the table, I don't think there
any other questions, Louise.
Thank you very much indeed for the paper and your comments
and coming along today.
Appreciate it and credited for a number of the positive things
you've said, so well done indeed.
And also thanks to David.
OK, thanks, Louise.
We'll see you again in the future.
Bye bye.

4.0 Policy matters and external environment

5.0 Board and Committee matters

5.1 Regulatory Governance Committee (RGC) summary from the meeting on 15 January 2025

Right, a few other matters just to conclude with.
We have an oral update on the recent meeting of the regulatory governance committee.
Mark, I don't know if I can hand over to you.
Mark Chambers - 2:34:34
Thank you.
Yeah, we met on the 15th of January.
For those who aren't aware of what this committee is about, we look at the design, delivery,
and effectiveness of our regulatory model for really a year or so.
I think our focus has been on issues around delivery.
The – I think we've been – we've had two phases of that, and I'm glad we're
into the second phase.
You know, the first phase was a sort of journey of discovery as we sought clarity and transparency
and understanding of exactly where we were with that and we're very grateful to Chris, Steph
and others who helped us get the MI that we really needed to focus on that.
And our concerns have been around the significant operational backlogs in registrations information
of concern and the higher risk notifications in particular.
Although they are a very small proportion of what we deal with, there are some kind
of obvious risks around us not being able to evidence, as Chris said, evidence the fact
that we've dealt with notifications of death, abuse,
serious injury promptly and effectively.
And it's an ongoing journey to understand exactly the sources
of assurance in relation to that.
I think sort of stepping back and seeing that process across
the organisation as an end-to-end process will help us
enormously in relation to that.
But the big transformation that we have seen over the last couple of months and we are
enormously grateful for - I'm grateful to you Julian for your personal leadership of this
for having listened and acted on the feedback from the committee.
These are now acknowledged high priorities for the organisation, communicated internally
and externally, and I think that's great.
And we, you know, we now have individual sponsorship around the exec table.
That's a significant step forward for us.
It's hard, you know, the - we haven't seen the progress that we hope to see on registrations
despite a really significant deployment of additional resources against that problem.
Chris explained why the notifications issue is hard to answer what seem like obvious questions
about understanding the risk that's in there.
But the - you know - it's great that we are not, that these issues are now getting the
focus and leadership attention that we need, and it does feel like a significant step forward.
We would like to be more assured.
We would like to see more progress.
But we understand the challenges and we really appreciate the focus that this is now getting.
We did have a discussion about design which having been completely dominated by challenges
around delivery it was nice to step back and look at the other parts of what we're supposed
to be doing as a committee.
I think that we know that there are a lot of views out there as to things that we might
change.
It's really important that we are aligned, that the executive and board governance is
fully aligned in relation to this.
It's really important when we're looking at changes we might make to our regulatory model
that were properly informed, the changes any decisions we're making at a committee or board
level that we are properly informed by a good level of understanding, provider sentiment
patient voice and other relevant stakeholder views in relation to that.
A disappointing note in the meeting, we have one of the things that we want to have as
part of our tool kit is better capabilities to do out of our inspections.
I think progress in increasing our capabilities in that space has not progressed as fast as
we would like.
It's an area that we will continue to push for as a committee but we understand there
are many, many priorities at the moment.
So, I don't want that to, you know, deflect us from the general message that, you know,
we now think that the right things are front and center for the leadership team and that
is great.
There are very many external recommendations that have been made in relation to CQC and
over the years we've accepted quite a lot of them.
And I think we have perhaps struggled to prioritise and deliver on all of those.
That's an area that we'll come back and look at at the next committee.
I think it is really important that we are clear on what are the most significant recommendations
that we think are going to most directly contribute to our effectiveness as a regulator and we
prioritise and deliver on those and make sure that the acceptance of the recommendations
is translated into concrete actions, but that's something that we'll revisit at the next
committee.
But, you know, overall, I think it was, you know, I think it's an encouraging position
for us in relation to the things that have been of most concern for the committee for
a long time, and it feels as if we have turned a corner.
So I'm pleased with that.

5.2 Minutes of the previous Public Board meeting held on 27 November 2024

Ian Dilks - 2:41:42
Thank you very much indeed Mark. Any questions or comments?
Okay, Mark your speakers on.
We have some board minutes in here for approval. So there were circulated to board members a few weeks ago.
There were some comments from Mark Chambers who wanted changes to the RGC. I think it turned out that
the version that was updated on the website and anyone listening in may have read was
slightly out of date. Anyway, that has been corrected. This version
incorporates the comments that Mark gave. So as far as I'm aware, there are further
comments. Can we take these as agreed, approved? Thank you very much indeed.
Last item on the agenda is the actions log. And I would like to quickly look at this one.
I'm going to go through it very quickly.
I mean, there's an overarching point
that awful lot of things here are down for,
particularly March or maybe May.
And I think one of the drivers for that is,

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

as management have rightly been prioritising
and posting other things,
and the board time has been spent
spending more substantive time on big issues
as indeed we did today
with our now on the organisational priorities.
A lot of things have been kicked forward.
Realistically, we don't currently have time to deal with everything that is shown here.
So we've agreed I'll sit down with Julian and the team afterwards and we'll go through
everything that's shown for March and May in a bit more detail and work out what the
options are. I'm not going to run through them all, they're pretty obvious. So on that
basis, I'm not going to go through everything, but there are two or three I wanted to pick
up. Item 5, which was key points on the recovery,
it says here further information provided at the meeting.
I'm going to suggest that although there's probably less in terms of numbers than maybe
in position when we did this, that I think that was pretty well covered in James' comments
earlier on. We will have more metrics earlier in due course,
But with your agreement I will regard that one as closed.
The item 7, the publication of future reports, I mean the critical ones I mentioned in my
opening remarks, so in terms of the work commission, so we have said we will be publishing the
the work of adult social care shortly, very shortly, and the IT one, we hope, by the end
of the month. So I think those are the two key ones. I think there's more general point,
Julian, about just how we ensure that the way we respond to things is cycled into board
meetings, but I'd regard that as a future way of working. So again, I'd like to regard
that one as closed, if we could.
Item 8, this is to do with out of hours, which you touched on a moment ago, Mark.
I mean, it doesn't seem to me that it has actually been dealt with in the way envisaged.
So sitting at the moment, I would say that's not closed at all, that's red.
But it may not be as top priority as something else.
So as a statement of fact, it's not being done.
But I'll work with Julian and see how we can prioritise that as appropriate.
The corporate performance report, it was down today but we didn't address it today, so I
don't regard that as done.
So that remains, I would say that is read.
The – and I think – oh, yeah, sorry, there is another page.
The – but most of those end of March meetings, I wasn't going to comment further on any
of those if that's okay.
Any other observations?
I work with Julian to find a way of working out how we're going to most effectively use
board time.
It may mean some more board time.
I know that's difficult to schedule in the public arena, but we'll see what we can do.
So I think that concludes most of the meeting.
We will have some questions I'll come to in a moment, but are there any other comments

6.0 Any Other Business

people want to raise?
Any other business?
Look around the table.
Okay.
With that case, I will formally close this meeting.
So thank you very much to colleagues.
As you know, or people listening in, we do allow the public to address questions to us.
Indeed, we're keen to have them.
So we have three.
The first one I'm going to take and then two, Chris Dzikiti
I hope you know this.
So I'll take them one by one.
So the first question was, what process is in place for the
appointment of CQC non-executive directors?
Now, I did touch on this in my earlier remarks,
but let me just fill that out a little bit.
So to be clear, all are non-executive directors,
and that includes the chair.
Slightly different process, but the comments I will make reply
to the chair and all others.
They are ministerial appointments.
There is a process run by the appointments team, the Department of Health and Social
Care.
So they would advertise, they would shortlist, they would run panels and they would make
recommendations to ministers.
But I do stress, at the end of the day, it's ministerial choice.
So this board has little direct impact to that.
It's very different for what anybody may be familiar with in the private sector.
Although, obviously, as a board, we have made suggestions to the department as to the
skills that we think would be appropriate for any new appointments.
Specifically in terms of NEDs, we are looking for several at the moment, as I mentioned
earlier.
The process is live, so to repeat the comment I made earlier, details are available on the
Cabinet Office website, because they oversee all public body appointments, but we've also
enclosed details on the CQC website, and they're available there.
But that is being run by the Department of Health and Social Care, not by CQC.
So I think that was all I can say.
I hope that covers the question.
Second question was how do inspections of dental practices check that patients can choose
a hospital for their oral surgery in compliance with the NHS constitution?
Chris Dzikiti - 2:48:14
Thank you, Chair.
So for dental practices, as part of our assessment,
we ask questions about practices, referral processes
in place as part of us assessing the effective key question
under the quality statement around delivering
evidence-based care and treatment.
So all referrals in dental practice tend to go
to a central hub who deal with allocation based
on location of the person who's wanting
the treatment to be done.
Anecdotally, we are aware that different NHS regions
operate different systems.
This is because some areas,
particularly those that are bordering
between several NHS trusts,
can add a preference to the person
to where they want to be treated.
We check the referral process is in place,
and also making sure that people are given
that opportunity to choose where they need to be
as part of our assessments.
Ian Dilks - 2:49:11
Thank you very much, Chris. And last question, how do inspectors monitor the use of Martha's
Law in hospital inspections?
Chris Dzikiti - 2:49:21
Thank you, Chair. And I think just a bit of context on that, because some people might
not know what is Martha's Rule. So, Martha's Rule is a patient safety initiative implemented
in England, which started in April 2024.
The rule was named after Martha Mills, a 13 year-old girl who tragically died in 2021 due to septic
shock after her condition deteriorated in hospital.
Her family's concerns were not adequately addressed.
So Martha's rule's aim is to empower patients and their families, ensuring their concerns
are heard and acted upon when someone is deteriorating in hospital.
So as part of CQC, we issued a joint statement with NMC and GMC in April 2024 on our support
for the implementation of Martha's Rule.
So during our assessments of NHS trust, we look at how well they are managing deterioration
of patients.
We will specifically look at how deteriorating patients are identified, how they are assessed,
and how the risk is then mitigated by hospitals.
So that's what we are doing at the moment.
We know there are about 143 trusts
who have signed up the Martha's Rule,
so we tend to work with those.
And those trusts we have signed up,
we look at what else are they doing to mitigate the risk
and what plans are in place
to implement Martha's Rule in the future.
Ian Dilks - 2:50:51
Thanks very much, Chris.
I mean, for a very comprehensive answer,
it is something I find, you know,
I get asked about quite a bit,
But thank you also for a really important distinction.
It is Martha's rule, not Martha's law.
I read the question.
OK, on that basis, I will conclude everything.
So thank you for those who are watching in.
Thank you very much indeed for joining us.