CQC Board Meeting - March 2025 - Wednesday 26 March 2025, 9:00am

CQC Board Meeting - March 2025
Wednesday, 26th March 2025 at 9:00am

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Speaking:

Start of webcast

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Ian Dilks

1.0 Opening matters

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1.1 Chair’s opening remarks, Apologies and Forward View

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1.2 Declarations of Conflicts of Interest

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1.3 Any urgent business

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1.4 Feedback from the Private Board meeting

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2.0 Strategic Discussions

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2.1 Independent IT Review

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CM032521 Item 2.1 Independent IT Review

Julian Hartley
Esther Provins
Ian Dilks
Stephen Marston
Ian Dilks
Charmion Pears
Ian Dilks
Julian Hartley
Ian Dilks
Esther Provins
Ian Dilks
Mark Chambers
Ian Dilks
Mr David Croisdale-Appleby
Esther Provins
Christine Asbury
Esther Provins
Ian Dilks
Chris Dzikiti
Ian Dilks

2.2 Organisational Priorities Update

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Julian Hartley
Ian Dilks
James Bullion
Ian Dilks
Chris Day
Ian Dilks
Chris Usher
Ian Dilks
Chris Dzikiti
Ian Dilks
Jackie Jackson
Julian Hartley
Ian Dilks
Charmion Pears
Ian Dilks
Julian Hartley
Chris Dzikiti
Ian Dilks
Christine Asbury
Joyce Frederick
Christine Asbury
Joyce Frederick
Ian Dilks
Mr David Croisdale-Appleby
Julian Hartley
Mr David Croisdale-Appleby
Ian Dilks
Chris Day
Ian Dilks

2.3 Anti racism: Setting Board objectives

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Ian Dilks
Joyce Frederick
Ian Dilks
Presenter 1
Ian Dilks
James Bullion
Ian Dilks
Charmion Pears
Ian Dilks
Stephen Marston
Ian Dilks
Mark Chambers
Esther Provins
Ian Dilks
Julian Hartley
Presenter 1
Ian Dilks
Joyce Frederick
Ian Dilks
Julian Hartley
Ian Dilks
Stephen Marston
James Bullion
Ian Dilks
Joyce Frederick
Ian Dilks
Christine Asbury
James Bullion
Christine Asbury
James Bullion
Simon Godefroy
Ian Dilks

3.2 Q3 Performance Report Update

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Chris Usher
Charmion Pears
Ian Dilks
Chris Usher
Mrs Nimali De Silva
Charmion Pears
Chris Usher
Charmion Pears
Chris Usher
James Bullion
Ian Dilks
Stephen Marston
James Bullion
Stephen Marston
Joyce Frederick
Chris Dzikiti
Ian Dilks
James Bullion
Ian Dilks
Joyce Frederick
Ian Dilks
Simon Godefroy

3.3 Hearing From our Networks

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Ian Dilks
Julian Hartley
Ian Dilks
Joyce Frederick
Christine Asbury
Simon Godefroy
Ian Dilks
Mark Chambers
Charmion Pears
Ian Dilks

COMFORT BREAK

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Ian Dilks
Jackie Jackson
James Bullion
Jackie Jackson
Ian Dilks
Jackie Jackson
Joyce Frederick
Ian Dilks
Charmion Pears
Ian Dilks
Aidan Fowler
James Bullion
Aidan Fowler
Jackie Jackson
Ian Dilks
Simon Godefroy
Ian Dilks
Simon Godefroy
James Bullion
Ian Dilks
James Bullion
Suzanne Kirwan
Stephen Marston
James Bullion
Stephen Marston
James Bullion
Stephanie Tarrant
Jackie Jackson
Julian Hartley
Ian Dilks
Jackie Jackson
Mark Chambers
Ian Dilks
Charmion Pears
Ian Dilks
Esther Provins
Ian Dilks
Julian Hartley
Ian Dilks
Mrs Nimali De Silva
Presenter 1
Mrs Nimali De Silva
Presenter 1
Ian Dilks
Mrs Nimali De Silva
Chris Dzikiti
Ian Dilks
Mark Chambers
Ian Dilks

4.0 Policy matters and external environment

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Joyce Frederick
Mrs Nimali De Silva
Julian Hartley
Joyce Frederick
James Bullion
Joyce Frederick
James Bullion
Joyce Frederick
Aidan Fowler
Joyce Frederick
Ian Dilks
Mark Chambers
Ian Dilks
Joyce Frederick
Esther Provins
Ian Dilks
James Bullion
Ian Dilks
Stephen Marston
James Bullion
Julian Hartley
Ian Dilks
Charmion Pears
Ian Dilks

6.0 Any Other Business

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Julian Hartley
Mark Chambers
Ian Dilks
James Bullion
Ian Dilks
James Bullion
Ian Dilks
Chris Usher
Ian Dilks

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Disclaimer: This transcript may contain errors. Please view the webcast to confirm whether the content is accurate.

1.0 Opening matters

1.1 Chair’s opening remarks, Apologies and Forward View

Ian Dilks - 0:00:00

Well, good morning, everybody, and welcome to the public board meeting of the Care Quality

Commission.

It's 9 o'clock on the 26th of March, 2025, for those watching it on catch-up.

Welcome to my colleagues around the table.

I should just do, for the benefit of those listening in, one or two introductions.

Firstly, Simon Godefroy is here to join us from our network,

because you know we always has a network representative.

Simon is from the Disability Equality Network,

and we'll be hearing from him directly later on,

although, as ever, free to chip in if he wishes to

as we go along.

And then two new other faces around the table.

There have been public announcements of both,

but they haven't actually been to meetings before.

To my right here, Aidan Fowler,

from NHS England,

Executive Team Member, and is the Interim Chief Inspector

of health care and working with Julian to work out some of

the regulatory model going forward.

And the lady with nothing to do, as we're going to hear,

Esther Provins joined us very recently as the Chief digital

and data officer.

So welcome to both of you.

And I know you'll be speaking later on.

I have one apology from our board member,

Mark Chakravarti.

Mark is traveling and unable to join in today,

but I should make it clear he has read the papers and sent in

comments, I'm not going to identify his comments as we go

through, but where I've got approval I'll know that.

And if there's other observations, I'll make sure

that they are picked up by somebody in the room.

And then, last but no means least, Chris Day is unable to travel,

so he's joining us by Teams as you can see on the screen.

I think that's all I want to say by way of introductions.

I should - a couple of other formal bits of business,

1.2 Declarations of Conflicts of Interest

Are there any new conflicts of interest that people wish to be clear?

I look around the room.

No, they don't seem to be.

We've published the agenda.

There are no major changes.

I might ask Charmion and just say a couple of words about the ARAQ

as an oral update at the end if we can squeeze that in.

But that will only be a few minutes.

1.3 Any urgent business

Is there anything else people wanted to flag now?

They want to make sure we pick up.

Okay?

1.4 Feedback from the Private Board meeting

The, I think the first thing, and it's probably just down to me, is as regular listeners will

know, we have in the last six months or so given to the public board - an update or a brief

commentary on what is being discussed at the private board that's being held previously.

So we had a private board meeting yesterday, a long discussion as usual.

I'll just highlight four things that we discussed that I think

are relevant to those listening in.

So let me run through them, and I'll ask my colleagues to add if

they think I've missed anything.

The first is that we understand and reviewed the approach to

tackling the priorities and the progress that's being made.

We didn't cover IT, because that's on the agenda today.

You recall that a couple of months ago I said we'd had an

update on how the IT review is going, but we took -

we undertook to make public and publish the report when it was

finished, which is what we're doing this morning,

consistent with our views on transparency.

So we didn't touch IT yesterday, but we looked at other things.

I would say the board is very pleased to see the continuing

focus on the priorities that the board approved last year.

And the way that I think Julian's focus on the leadership

is brought to the organisation has been able to build on the

progress that was being made in the back end of last year.

And indeed, you know, as we'll hear a little bit later on, making progress in all areas,

which is good.

Secondly, we talked about the approach to business planning and budget setting for the

next few days left this year.

But the – this stage was an approach.

It's not the final plans or budgets.

They will come to the board in May, and probably the board will need to find a way, sorry,

the board will need to find a way.

We agreed how to give board input to the development of that before now and May.

Again, I think we should say that the board was pleased to see the approach that's going

to be adopted and the progress that's being made, for example, incorporating things that

have been raised in the past that we'd like to see more detail of in the plan.

So I'm not going to list everything that was agreed,

but for example, more transparency on key assumptions

underpinning the plan in areas such as efficiency

and productivity.

So that there can be a clear linkage between the sort

of commitments we're giving to the public and to our own

colleagues in key areas like the number of assessments,

but into how that's underpinned by the efficiencies that we can

reasonably expect, the changes we're making to support that,

and then the cost of doing it reconciling to the

business plan.

And so we were delighted to hear of the process that's being made.

The other thing, obviously, is a challenge for Julian here is to – and his team – is

to make sure we have that sort of balance of the continuing focus on the short-term

priorities, in particular, probably assessments, but at the same time recognising this is a

plan out a year and the organisation needs to start addressing some other wider issues.

So there's got to be a balance on that plan of not letting up

on the focus on the short term, but recognising it isn't just

about dealing with the problems from the transformation

of the systems problems last year.

And of course, all of that has to be

done in the context of a changing landscape

that we are regulating that probably wasn't foreseen

even a couple of weeks ago.

The third area we've covered was LLRC.

I believe everyone who would listen in

knows what I mean by LLRC.

It is two years since the board first received two reports underpinning the LLC work.

There were something like 84 recommendations there.

That's what I remember.

Apologies if I got that number wrong.

The board has received updates over the last couple of years on progress made.

And I think in short, say it has been disappointing or underwhelming.

What is now being proposed is a reshaping of the approach to dealing with the LLRC recommendations.

recommendations, perhaps a refocus on some of the high

priority items, and perhaps most importantly,

recognising quite a bit of it is culturally related

that links closely into the CQC way.

So it's not a separate program being dealt with out

with the board, but it becomes core and central to what

Julian and his team are trying to do.

At the same time, though, and this is important,

we've given commitments to people, particularly our own

colleagues internally, that these recommendations

were dealt with.

So I want to make it clear, this is not a question of

say we're going to lose the recommendations and

subcieve them somewhere else.

We will still shine the spotlight on completing them,

but the method by which it's being done will be slightly

different going forward with the aim of speeding up progress.

And lastly, we had a session on provider sentiment.

This was a request from the board a little while ago.

Probably other things have intervened slightly,

but we had a good presentation from Chris Day and his

team yesterday on the work that's being done measuring

provider sentiment.

I suppose there were no huge surprises,

which in some ways you might say was disappointing

because it told us in more granular detail

what we thought we knew.

But it was a good piece of work.

And what's been agreed is that this will become a more

regular reporting into the board because how providers see us

is desperately important to us.

And we will take a subset of that,

together with seeking to measure the experience of users

of the system, not just providers,

and have that incorporated into the board reporting

for the next financial year.

So I think those were the main things I just

wanted to report back.

I'll look around the table if any of my colleagues

feel I missed anything or wish to add.

First summary, Julian, from your point of view?

OK, great.

Well, thanks very much for that.

I hope that was helpful to those that weren't at the meeting yesterday.

2.0 Strategic Discussions

So the next item, big item, is the independent IT review.

2.1 Independent IT Review

Julian Hartley - 0:08:41

So Julian, can I just hand over to you for that?

Certainly.

Thank you very much, Ian.

Well, good morning, colleagues.

Important, important item.

And I think we're setting the context for this.

So, if we go back to what would be very familiar to all of us as a board, Penny Dash Review

last year cited serious operational problems, particularly poorly performing IT systems,

and highlighted the time taken for staff to do assessments, inspections, and I think we're

feeling the impact of that in terms of our current operational performance.

Secondly, the feedback we've had from sectors has been unambiguous, particularly in the

CPA report recently about the experience of providers, problems with the provider portal,

registration, reinspection rates, and thirdly, the experience of staff.

So our own staff have been unambiguous about their experience.

The board will recall the piece of work in asking staff what they felt our top three

priorities should be.

And number one by far was technology tools and regulatory approach.

So the issues around the regulatory platform, and when I talk about regulatory platform,

I'm including provider portal, the whole kind of, the whole experience.

And I guess it's worth just bringing it to life.

We've considered these before, but I think worth repeating.

A couple of quotes from staff.

The regulatory platform and the IT systems, this is far and away the number one reason

for low productivity, staff stress, low staff morale and poor staff wellbeing.

The regulatory platform is not fit for purpose and is preventing us from doing our job.

And secondly, we need the regulatory platform and provide a portal fixed or replaced as

a matter of urgency.

This is having a major impact on us delivering our core purpose.

It is also damaging our reputation and credibility as an effective regulator.

So I think if ever there were a need to really understand what was behind all of that and

where we are with that, it was really clear in the context of those pieces of feedback

and previous reviews.

So in response to all of that and with the support of the board, I commissioned Peter

Gill, independent IT expert and former NHS Director of IT to conduct an independent review

of the whole issue of the regulatory platform.

And Peter was asked to consider two key questions.

How and why did we get to the point where the technology is causing such significant

organisational disruption?

and can we continue with the technology as it is?

If so, what needs to be done to make it fit for purpose?

If not, how do we get the right technology

in place as quickly as possible?

Both really key questions.

On the second question, I'm going to,

when we get into that stage, ask Esther

to talk you through the kind of key next steps

in relation to that and where we think we can go to respond to the point about whether

we can fix it and salvage the technology.

I should say that the full report will be available at the end of our meeting, made

public as we committed to, as you said, Ian.

For now, we're going to, I'm going to summarise that

and then we're going to get into some of the core issues.

So, top lines.

Two kind of top lines from Peter's report.

The first being the primary cause

of the IT failure was a failed organisational transformation.

So, the whole approach around the development

of a new regulatory platform to support a new assessment framework and it's clear and

he concludes when organisational transformation fails, IT also fails as it underpins core

processes.

Unclear or unstable processes make designing technology like hitting a moving target and

the IT issues are a visible example of a broader failure.

So, it's clear that in terms of the business cases, the planning, the way that this was

managed and governed, clear lessons to learn and clear failures in terms of what led us

to this point.

And that has manifested itself, obviously, in the challenges I've described.

The regulatory platform and the provider portal, and this is critical in terms of his judgment,

are salvageable.

Now that has to be positive in the sense that significant resources have been expended on

this.

So the importance of being able to recover and rebuild is going to be very important

and is something we're going to have to focus on getting absolutely right.

But it will require substantial development and rebuilding work.

And that's what Esther will speak to.

So thinking about our response to the report, first of all, I want to thank everyone, including

the board around the support for this piece of work.

I want to particularly thank all of our staff who gave time and expertise to this process.

There was a lengthy set of conversations that Peter had with over 100 colleagues, and Peter,

in his report, praises our colleagues for their diligence and determination to move

forward positively and bring CQC back to a fully effective and efficient organisation.

I want to echo those thanks because our colleagues have been through the mill with this, but

many of them are desperate to get us to a better place.

And I think this is why this report is so important at this moment, to give us the opportunity

to think about how we move forward.

The review does lay bare the scale of the problems, both in the way the regulatory platform and

the provider portal function, as well as wider issues across the organisation, including

poor decision making, major failures in governance, fundamental cultural issues.

It also sets out the financial impact and the total spend on the regulatory platform

which includes the regulatory - total spend on the regulatory transformation programme

as a whole which includes the regulatory platform and provider portal.

That is 99 million from inception in July 2019 to date.

Significant investment.

Less than 30 % of the expected deliverables have been signed off as completed.

These are across areas including registration, assessment, enforcement and oversight.

That's impacted a number of areas including staff health, safety and mental wellbeing.

And just as an important aside, when we think about the work that Esther will describe going

forward, health and wellbeing is a central part of what we will need to think about in

terms of our staff and the health and safety of our staff looking ahead.

It's going to be a key issue for us to get right and make sure we're clear about.

It does mean, in terms of the conclusions of the report, we do have an overly complex

assessment system that requires lots of workarounds, has led to registration being kept on the

previous system, and only 5% of the benefits have been realised.

So our transformations had a huge impact on colleagues across the organisation.

Concerns were raised, and many colleagues felt they weren't being listened to.

They felt that they were flagging the issues, but that that wasn't being recognised and

action wasn't being taken as a result.

And that in particular was reported to have had a negative impact on mental and physical

wellbeing.

Also the use of data and the importance of data, and this comes through in the report

very clearly as well, was a key theme.

the way that we should, as CQC, be really strong in terms of how we manage and organise

and use data as the lifeblood of the organisation.

And we've been impeded with that given the challenges here.

And equally, it's clear we've lost credibility with providers we regulate and wider stakeholders.

Practically speaking, the IT failures resulted in a range of impacts, including complicated

processes in the assessment part of the regulatory platform resulting in the need for workarounds,

a poor user experience with registration, meaning we've had to revert to legacy systems,

low use of the provider portal by providers for submitting notifications, and challenges

with data quality, consistency, and extracting data.

Now all those fixes that are needed will take time.

They'll need to be properly planned to make sure we don't have further issues.

And alongside this, we recognise that there will need to be a major recognition of the

scale of cultural issues that we need to tackle.

And Ian, you've already mentioned CQC way.

That is going to be a central part of how we build a better culture in the organisation

and also with those that we regulate.

I would also include in that the importance of speaking up and what you said about the

discussion yesterday about listening and learning, responding to concerns.

We are taking steps to strengthen and improve our freedom to speak up process and that on

that grateful to the engagement and support Stephen, Charmion on that issue.

that is going to be a central issue for us.

So although there's lots and lots of challenges here, but there are some parts of the regulatory

platform actually that are working.

And that's important in terms of giving us confidence about how we can move forward.

Those that are working include richer data capture when using notifications, automation

of some manual customer service processes which saves time, and the ability to connect

different sets of data and better visibility of information.

So in terms of next steps, we've already begun work to get us back to delivering our purpose

and protecting people from poor care.

Those areas of focus that we've set out, the four immediate priorities, the five foundational

improvements have been informed by the feedback from colleagues, from our sectors, engagement

with providers, public, wider stakeholders.

Technology and IT is one of the five foundational improvement areas we're prioritising as we

rebuild the organisation around that, and central to doing that is, as I have said,

the importance of developing our culture.

I've been encouraged and impressed with the level of engagement in that.

The majority of you, I think, in fact all of you have attended one of the events that

we've run where you've heard firsthand from staff their issues and concerns.

And I think we're clear about where we need to go in relation to developing CQC way, which

looks at how our culture needs to change, how we recenter our purpose, values and ways

of working.

Steps, as I said, will be taken to strengthen and improve

freedom to speak up arrangements. So we have a

positive culture where everyone feels they can speak up and the

voices will be heard. We have taken steps to strengthen our

leadership in digital. Obviously with Esther joining

us.

Esther will provide critical leadership and expertise in her role as Chief and digital data officer. And alongside this, because this isalso mentioned in the report, we are rebuilding our sector expertise

and leadership through the appointment of four chief inspectors and a new - obviously

with Aidan joining us for the, for the - secondment period that's already given us greater

strength in terms of chief inspector and as I'll say in my update, we're making progress

on those four chief inspectors and Chris, thank you to you for shouldering much of the

burden and challenge on all of this hitherto, much appreciated.

So, critical to our approach to improving will be ensuring we engage effectively with

colleagues, providers, and the public and wider stakeholders and demonstrate the action

we are taking on what we are hearing.

In terms of what I think we would all recognise in terms of failures of governance, I'll be

recommending to the new chair an independent review of organisational governance to make

sure that we learn the key lessons from what we've been through in relation to this whole

process.

And an action plan specifically to respond to the recommendations from this independent

review will be shared at a future CQC board meeting.

So, I'm going to, in a moment, hand to Esther.

There are 23 recommendations in the report, which can be grouped into kind of five key

themes, broad areas, and they reflect what's needed as part of rebuilding CQC and redeveloping

the regulatory platform and the provider portal.

So, Esther, over to you.

Esther Provins - 0:23:28

Thank you.

Good morning, and thank you, Julian.

I think before taking you through a summary of the recommendations, I'd like to just add my thanks to everyone who has contributed to the review, both our internal colleagues, but also those colleagues in our provider sectors and organisations that we support.

And it's really clear to me, even just a few weeks into this role, that colleagues have

been speaking up but have not felt heard.

And my hope is now that those colleagues do feel heard and now have a strong voice.

And their honesty and transparency in this process is really fundamental to helping us

move forward and resolving the issues that we clearly face.

So the depth and breadth of the recommendations

really mirror Julian's reflection on the findings.

And the recommendations cover not just technical issues,

but also issues that relate to our wider

organisational challenges.

And I'll just try and summarise those 23 recommendations, which

can all be seen in detail in the report

when it's published on our website.

So the 23 recommendations cover governance, they cover subjects around how we approach our

regulatory methods, they cover technical improvements and cultural and change management

themes.

So,

fundamental is the first recommendation that we should use our current platforms to rebuild our IT systems.

So we currently use Microsoft Dynamics 365 and as Julian reflected the findings are that

that is a platform that we can use, that is credible and can support us in doing what

we need to do.

But we do need to undertake a significant rebuild process and the recommendation is

that we should as much as possible use internal CQC expertise to do this but recognising that

we do need external support and assurance and expertise in that process.

In the process of that rebuild, the recommendation is that the whole organisation are involved

in that process and we should proactively nurture that engagement from all of our colleagues,

not just those that use the system on a daily operational basis, but also those that use

and benefit from the data that the system generates.

That engagement process should include all of our staff networks

to make sure that everybody's voices are heard.

And this approach should apply to every aspect of the rebuild process.

And I think that speaks directly to some of the comments that Julian made

around the findings with regards to engagement.

The review recommends that we should take every step to adopt and ensure that best practice

and industry standards are used as part of that process. So standards such as programme

management standards, PRINCE2, Agile, ITIL, the Government Digital Standard will be familiar

to those colleagues who have worked in those areas and we should take every step and support

and proactively mandate the use of those standards and best practice as part of our rebuild process

and in everything to do with the recovery programme.

With regards to data, Julia mentioned the importance of data as an organisation and

the recommendation is that we need to develop a data and reporting strategy that really

prioritises the use of data and signifies its value in the same way as we look at public

money, in the same way as we care for our colleagues who work with us. We need to take

care of the data that we use, we collect and we work with. And so our recommendation is

that we develop a data reporting strategy to do that and make sure that we adopt a data-led

approach from the start rather than it being an afterthought.

Colleagues who work with us will know there's various interim

solutions that we've put into place,

and those have been fairly urgently and swiftly done

to support colleagues in doing their jobs

and to support the challenges that have clearly been felt.

And the recommendation is that we recognise those as part

of a formal rebuild programme.

Those workarounds also have or may have unintended consequences

and the recommendation is that we carefully manage those

as operational work whilst we go through the rebuild process.

Julia mentioned complexity and I think for anyone who has touched our systems

and used them, it's fair to say some of the processes contained within are really complex.

So the recommendation is that we really hold fast to the principle of keeping it simple

and practical, reducing the complexity in our systems but also our processes.

This includes considerations for such things as how can we support providers to use one

way of submitting notifications and can we simplify that process to support providers

and all colleagues that use the system.

And I think lastly, in summary, the report recommends

we have a close look at our regulatory approach

and start with an examination of our single assessment framework methodology.

And I know that's been a subject of conversation for some time now.

So that gives, I think, a whistle-stop tour of the recommendations.

As Julian said, there is 23 of them.

They are clearly detailed in the report that will be published.

In fact, it already may be on our website as we speak at the end of the meeting.

Sorry, thank you, Julian.

But I think the question on top of – probably on the top of everybody's minds is what

are the next steps and when can we resolve these?

And I know that colleagues who have had personal impact from the challenges we face will be

asking that question. I think if you have a look at the approaches to digital transformation,

one of the main principles is do it well and not necessarily do it fast. So we will be

taking our time to do this safely with the engagement and the approaches that we've talked

about today. However, that needs to be balanced with the fact that we know there are significant

pain points for colleagues using our systems that we are experiencing and so we need to

adopt a prioritisation approach to make sure that we do the urgent and most important things

first to reduce the pain and improve the functionality as much as we possibly can.

So next steps obviously are really important. Julian you mentioned an action plan coming

back to board and that is now what we are working on. The time to do this properly is

a really important principle but doing the most important things first and well is a

principle that we will be working with. As you mentioned Julian, health and safety and

the impact on our staff and colleagues is a really key focus area for us and our engagement

with our staff networks and colleagues, both internal and external, will be a really important

part of that as well as supported by our improvements in our freedom to speak up and our listening

to colleagues' voices. And I think for me, one of my reflections is fundamental to our

success is the engagement and involvement of our colleagues in this. And so a really

strong, true approach to co-production is really valuable and we will be working on

using that as part of our planning and development process going forward.

So I think I know there's lots of questions that colleagues will have and lots of questions remain.

However, I think for now that is our approach. We will be bringing back an action plan

and in the meantime, I think we are really happy to answer any questions

that colleagues may have around our approach and obviously the findings, the recommendations

in the report. So I'll hand back to yourself, Julian, and the Chair. Thank you.

Ian Dilks - 0:32:36

Julian? Okay. Thank you very much indeed, Julian and Esther. I mean, there's a lot there

even in the summary, never mind the full report that this week said we'll make public. We've

got about 15 minutes for questions, so I've got some or some comments, but I won't kick off

let me open the floor to colleagues if there's any points they want to raise.

Stephen.

Stephen Marston - 0:33:01

I really welcome Peter Gill's report.

I think it's a very important moment of learning for us and well done to Julian for commissioning

it.

I think it's been a really important exercise.

It certainly helps me as an NED understand better kind of what was going on in the organisation

that led to the problems because we've known for a long time what the problems with the

regulatory platform and the technology are, what Peter's report helps us understand is

why we got into that place.

So I think that's really important learning.

And I hugely welcome what Esther's just said about the way we're now going to follow this

up.

It's really reassuring that Peter and Esther feel this is salvageable, but there's a

lot to do to salvage it, and we'll all be in full support, Esther, as you and the team,

you know, go about trying to put all of this right.

I do agree with Julian that as a board we also need to review the lessons to be learned

from this.

I think the board has recognised for some time that we need a review of governance in

its broadest sense, not just the technology developments but the transformation programme

more broadly.

To look at the internal approaches that Peter has investigated quite closely to programme

management, to business case development, to assurance controls, to reporting to the board

all of this is wrapped up in needing to understand what happened in the

governance space that led to some of the problems that we've seen so that going

forward we've got confidence in our decision-making, in our assurance

processes and our reporting that they're working well right across the

organisation so I hope we can pick that up with with our new chair when he starts.

Could I also just briefly welcome Julian's specific comments about freedom to speak up,

because this is for me a hugely important part of the culture that we need to build

within the CQC way.

I would pay tribute to our FTSU guardian and champions, because they have been doing for

some time brilliant work trying to give colleagues a route through which they can raise concerns.

But if colleagues are to do that confidently, they must be sure that there will be appropriate

follow-up. Not just that they'll be able to state their concerns, but that something will

happen as a result. And as the FTSU board champion, I would have to recognise that's

not currently where colleagues are in terms of their confidence about the FTSU processes.

So it's hugely welcome for me that there will be a particular initiative to look again at

how FTSU can be made to operate effectively so that everybody has confidence that they

can raise concerns, they will be listened to, and there will be follow-up.

Ian Dilks - 0:36:26

Thanks, Stephen. I think the observation is probably an open question.

Charmion Pears - 0:36:32

Thanks for the team and to Peter Gill for a fantastic report. I think as a board member

the way Pete was able to summarise it and Esther you've responded to it and Julian I

think is full credit to the team and very welcome. I guess I have a couple of questions

if I can just outline them and then maybe you can come back. For me when we come back

it's really important that we think about how we're going to prioritise. It's a lot

of recommendations and we know we struggle with that sometimes because we have so much

going on. We're also trying to balance very important colleague priorities which is number

one with health and safety, etcetera, with issues such as our systems needing to be decommissioned

by the end of the year. So when it comes back to the board with an action plan, can we get

that prioritisation really clear so we understand the risks and trade-offs? So that's sort of

request really how are we going to balance operational imperative with other risks. The

second thing for me is the governance around this was not right, we know that. Peter's

report reiterated that but we did find that quite early on last year when I talk about

some of the stuff later on in ARAC we'll talk about what we've done to look at business

cases but I really would like to get some assurance that we - how we're going to go about ensuring we don't fall the same trap with this because Julian, as you say the amount of spend that has been incurred, we don't want to go through a similar process moving forward. So interested in how we become a learning organisation in the short-term because we do need to rectify this quickly. Two other big concerns for me I guess, you'd expect this from me, as the ARAC chair we didn't look at risk adequately throughout the business case process from 2019 right the way through.

actually get the

For example, in Mexico, when the internet first started to fall into place, they did

unlikely to go through a financial crisis.

And on this idea of another financial crisis involved unless there was absolutely no joint

interest with China again directly to the US, and on PC and on the other hand there

was dissertation on whether or not there was any downturn at that time considering

19 right the way through. I applaud using internal colleagues to do this, it's great

to build people's capability etc, but one of the things we don't have internally is

a strong second line assurance. We don't have strong embedded risk management. It may

not be for today because it's a big question, but when we come back how we are going to

look at risk and how the team are going to gain second line assurance that that is adequate

it's going to be really important to me and my colleagues around the ARAQ table and around

the board because we got that very wrong. We lack a second line, we're heavily reliant

on our third line, so that would be something. And then finally, I think most people around

the table would know health and safety as a topic very close to my heart and the findings

in the report are obviously disappointing. I think it's just, would like to say that

We, as Eric called in March for a health and safety audit,

the results of that audit will be coming back to the Eric

at the next meeting.

And that we've asked to look at the process specifically

around how incidents, accidents, and near misses

within the organization are dealt with, escalated,

and managed through the process.

So we'll talk a little later about the audit plan

and the other things that will complement the work

that Julian and Esther have done that's been going on for the last 12 months, but please

have some assurance that it's not acceptable to anybody around the table that colleagues

were in that position. So that's all I wanted to add from my perspective.

Ian Dilks - 0:40:01

Like Sharmi, I mean the last was more an observation, Julian, I don't know, do you want to pick

up ones you want to hand to Esther or go straight to Esther?

Julian Hartley - 0:40:08

Well I'm happy to respond in just initially, Charmian, to your point on the ordering of

priorities, I agree is absolutely crucial, not least because we have workarounds in order

to try and improve our operational performance but at the same time we're trying to fix the

problems we just described while not seeing performance dip as we try to improve it. So

that is going to be a set of challenges and issues to work through with the teams. I know

it's uppermost in Chris's and other exec colleagues' minds at the moment about how we achieve that

operationally. Doing it in the right way and doing it in the order that makes sense, that

is going to be, I completely agree with you, that's going to be vital and we need the clarity

and we're going to have to make choices about what we do when. On the governance, again

agree I think there's quite a lot of evidence in the report about following best practice

and where we didn't and where we should. So best practice exists for project management

and business case development and managing public money and all of those things we know.

So I think we will be using those in the context of how we get the governance right as well

as the broader arrangements and the review of risk agree on that, the need to have that

second line.

And I think through the presentation emphasising the importance of health and safety, it would

be good to see the output of the audit, you mentioned Charmian, to connect to what we

need to do to get this right.

So thank you.

Ian Dilks - 0:41:59

Astrid, you want to go?

Esther Provins - 0:42:01

Yeah, thank you.

And thank you, Charmion.

So completely agree.

And I think for me, the key across the things

that you mentioned, which I'll work through in a second,

is us being clear on how we are approaching those things

and then seeking assurance that we're doing it well

and not just saying that we're going to do something.

And so with regards to your prioritisation comments,

And for me, it's really important that we are all aware and we all are comfortable with

the way that we are prioritising.

And so I think our transparency around that and our sign off around that as a board is

really important.

And our assurance around how that is being implemented and working throughout the organisation

again is a really key point.

So fundamentally agree and I think that's really important that we have that oversight

in that transparency around that process. With regards to avoiding some of the pitfalls

that we've clearly fallen into in the past, it is about best practice and industry standards,

but again, for me it's around us as a board seeking assurance that those are embedded

and working properly and that colleagues are following those. And I think, you know, there

will be some really difficult decisions around when something is operationally very, very

important how we adhere and stick to those industry best standards, best

practice and standards and not react around something that we may then regret

later on. So for me again it's around how do we make sure that those standards are

adhered to while still maintaining our nimbleness as it were in our approach

and that requires a really fine balance and again requires us to understand how that is

operating in the organisation. With regards to risk management, your comments around the

second line, I think it's really important that colleagues are aware what that means

and I think there's probably work we need to do that's probably already in train around

how we support colleagues to understand risk management, but again a really clear area

focus and one that we need to seek assurance around how that's operating in the organisation.

So many of these things will be part of the approach that we bring back to the board in

May and so I welcome the challenge and the prioritisation around those things because

Ian Dilks - 0:44:32

I think they're the right things to focus on.

Thanks Esther. Mark, changes.

issues.

Mark Chambers - 0:44:38

Thank you.

And at the risk of repeating what some of my colleagues have already said, I too really

welcome this piece of work.

I think it's a tremendously helpful foundation for responding to what was looking like an

all-consuming problem, and it's given an incredibly useful framework for a way forward.

And we're all very grateful that you're here, Esther, and we're all wanting to be as supportive

as we can be as we move forward.

To a bit like Stephen, the two areas that I focused on in relation to this are the focus

on freedom to speak up.

That really has to be core to our culture.

We have to have an organization where people don't hesitate.

Colleagues don't hesitate to speak up, but equally are confident that they will be listened

to and that appropriate action will be taken.

And we have been far from good in relation to that.

So I think that's great that there is momentum around that.

On governance, I do think we need to reflect that this has been red -rated for as long as

that's been on our risk register.

When we reflected on the progress that had been made

on enterprise risk management a year and a half ago,

and split governance as a separate risk out,

it's been read since then.

And I think we've seen the different dimensions to that.

We know that the absence of an assurance framework has been a significant hindrance to our effectiveness

as a unitary board.

We know that, as committee chairs, that we know that the lack of clear alignment of executive

governance through to the board committees has been an additional challenge for us.

I really hope, you know, I really strongly welcome

the plans for an independent review of that.

I think an external perspective on that

would be really, really helpful.

But I think it's really important that it doesn't just

tell us more about the problems,

because I think we've got a pretty good idea

of what the problems are, they've just been hard to fix.

And I hope it will help the team develop a clearer

roadmap for the significant improvement that is needed in that area. So I welcome that.

But this is an incredibly important and incredibly useful piece of work. Thank you to everyone

who has contributed to this and thank you to Peter who is not here for a really fantastic

piece of work.

Ian Dilks - 0:47:46

David, I think you were next down here.

Mr David Croisdale-Appleby - 0:47:50

Thank you Ian. It's a question for you, Esther, if I may, and I'm very conscious of what you said, that

you're working up an action plan at the moment, so I fully understand that. From the viewpoint,

however, of the people whom we regulate, are you able to say anything about what is the

first significant change that they might see? Not when, I'm not asking that because that's

possible, but what sort of change from the work you've done so far are they likely to

be able to notice?

Esther Provins - 0:48:27

Thanks David. So I think it's clear that our provider colleagues have had significant

problems with the provider portal, so the interactions that we have with them and the

way in which they contact us using that technology has been really challenging. So I think they

they will see a change in that. I think there is also challenges around the time in which

we are able to publish reports and some of those factors are technology and I think there

will be improvements in those areas as well. So I think the challenges that we are facing

and colleagues have experienced are both technology and other issues but I think that there will

be some significant improvement in the way in which our provider colleagues can contact

and interact with us using our technology.

Thanks very much.

Thanks, Esther.

Christine, over to you.

Christine Asbury - 0:49:28

Thanks very much. Likewise, like my other colleagues, I do welcome this report and just

also to sort of flag up the point that we have been transparent in actually publishing

this report and I think that's really important that we are prepared to share this with our

wider stakeholders. And I welcome, Esther, what you're saying about co-production. I

think that's really important. I think some of the wider work we've done recently, for

example, the CPA report has shown that we're very prepared to collaborate and to hear the

experiences of both internal and external audiences. But I think in the past CQC hasn't always

done co-production very well and just to make the point that we really need to make sure

that it is genuine and authentic when we are doing that co-production. And I am heartened -

I saw an invite go out yesterday for the external strategic advisory group which is specifically

wanting to hear views of external people on where we are going, so I think on transformation

generally, I think. So I do believe that's happening, but just to make sure that we do

keep that focus on genuine co-production with both internal colleagues and external providers

and other stakeholders. And just the last thing is that we've been very transparent

about Peter Gill's report. Can we also be transparent when we have an action plan that

we publish and share that, and that we involve people, which we will do through co-production

of prioritising and making sure that we stay with our users.

Thank you.

Esther?

Esther Provins - 0:51:15

Thank you, Christine.

Really helpful comments and completely welcome those.

I think just to echo the importance of that co-production approach

from my perspective, and that's not just within our internal colleagues in CQC,

but also following on from your question, David,

around what changes would we expect and support or learn that our provider colleagues would

want to see first. And so for me there is a real opportunity now to work with our colleagues

in the sectors that we work with to actually understand what's most important to them and

how can we support the changes and prioritise our changes that will be most useful for our colleagues. And that involves - for example - one of the recommendations

is around a data reporting strategy and there's something for me which is what do our provider

organisations need from us from a data perspective? How can we support that? How can we build

a strategy that gives our colleagues what they need as well as our internal use? And

that feels to me really valuable given the scale and breadth of data that we have access

to and we work with, much of that is useful to others

and how can we really support that growing and the use of that

in the way that we operate.

So completely agree, Christine, and we'd welcome your comments

around authentic co-production because that, for me,

is really important.

It's not just a tick box exercise.

Ian Dilks - 0:52:47

Can I just add a footnote to the point there,

particularly in adult social care sector.

And I know that we keep everything after this,

but I think one of the things that came through

very strongly from the adult social care work

that was done for us, and we heard at the last board meeting

was the importance of recognising the difference

of scale across the organisation, so -

sorry, across the market, so whatever the phrase is,

85% of providers have less than 50 people,

but there are other care providers,

in massive facilities with very sophisticated systems,

and a suggestion that in co-production,

We've perhaps looked a part of the market and not the rest.

And I'm sure that applies in health care as well,

but I think nothing like the same extent.

So I just emphasise that co-production does

have to reflect the feedback we've had about the diversity

of the market.

We're almost out of time.

We don't have to have everybody speaking.

We can go around the table after.

But a couple of comments I want to make.

Before I do, is there anybody else

that just has a burning comment I wish to make?

Chris.

Chris Dzikiti - 0:53:49

Thanks, Ian.

And I just wanted to add, I suppose what Esther was just saying, every week we spend time

talking to providers and I suspect some of my IT colleagues do so as well.

And the big issues around reports, around registration, and like Esther said, I think

if ever we're going to make any improvements, that will make a big difference to providers

or to people whom we serve.

it's around reports and around registration,

and as well as just to say internally,

so in terms of health and well-being for our colleagues.

So I think those recommendations,

I just wanted to say thank you, because they mirror

what is needed.

And I think if we can deliver on those recommendations,

we'll make a positive impact on people working in CQC

and also the providers we regulate.

Ian Dilks - 0:54:39

Thanks.

I mean, if that's it, then just a couple of observations for me

if I could.

And I'll try not to repeat what others have said,

because I'll never go last, the people who made the comments.

But it really gets back to making sure we do learn the lessons

from the past.

So, you know, the board has agreed.

We need to call it a governance review if you want.

I'm probably focused particularly on lessons learned.

So that really will be down to the future board,

including my successor.

So since I won't be part of that discussion,

it does emphasise a couple of things from my perspective.

I mean, this is not a time to debate terms of reference,

but I think there's at least two key things.

One is Peter's report.

Let me step back.

I should have said we had the benefit of listening

to him talk directionally before.

So I guess there were no surprises in this very long report.

So like all my colleagues, you know, welcome it.

And I should thank you for, you know,

we'd be doing some work before we arrived.

But I think having someone independent only kicked off straight

away has been enormously helpful.

And I haven't heard any disagreement anywhere around the table - over

anything is said.

So that's great.

I should have said that earlier.

But coming back to what he's looked at, for the most part,

not entirely, deals with things that happened between 2019

and 2021, you said earlier, kicked off in mid-2019.

And, I mean, the challenge, you know, around this table is

that none of us will hear that.

I don't think there's anybody either on the board

of seniority that was part of that.

Now, you know, the significance of that is, it's very difficult,

sometimes to understand how things happen that weren't right.

So if we didn't follow good standards, how did that happen?

Either in the organisation or over-sight from anywhere else.

So looking forward, we do need to find a way that we'll

consider how it gets its assurance that the right things are being done.

The world's moved on, we have different people now.

So I mean, personally, I feel assured by Peter's work and

hear what you say, Esther, but I think it would be complacent just to say simply

because we've got new faces, it'll all be okay this time around.

So I think a consideration for the board is how does it know,

given the expertise around the table,

that it is not repeating the mistakes.

I'm sure that whatever it is, six, seven years ago,

our predecessors did not knowingly

or willingly not follow best practice.

So how do we not repeat that mistake?

And then the second thing is an area that perhaps wasn't so much

of a focus in Peter's report is the point that I think Mark -

well actually Mark and Charmion touched on,

that this board relies on assurance.

And as late as June last year,

we were being assured through the formal channels

that the systems are working.

That was at odds with what our own people were telling us.

And as others have said,

we should thank people for flagging that up.

So I think the second point current today

is how do we just make sure we get the right assurance.

and probably part of the answer to that is a rather technical term, but I think what

you should said Charm - in the second line, assurance, to make sure that what the board is told actually

reflects reality, what's happening around.

And again, I have huge confidence in the people now in place that things will be different,

that it would be utterly complacent for all of us, I'm sure, to just say, well, simply

because of new faces, it will be different.

So, you know, we've made it – I've made it clear to the Health and Social Care Committee

the other day that governance and risk management were poor.

And I know you have plans, so this is not telling you anything you don't know, but

I just think it is important that the board can have the right assurance on the progress

that is being made.

So just my few pennies I won't have the opportunity contributing to the board discussion

on governance in a later date, but I do think it's right that it should be done.

I would, though, echo the point you made, Mark, that we know a lot of the problems.

There's a lot of red-risk flagging the problem with solutions to it.

So I think it's important that the lessons learned should focus on how do we ensure we

do it right this time rather than getting too hung up about what happened in the past.

And we know a lot of the problems, so I would urge it to be ensure – whilst not saying

we know of everything, by all means take a broader view.

But I do think the focus should be on saying we recognise a lot of the problems now.

The question is what are the solutions to them.

So I would just like to put that on record.

Thank you very much indeed.

I mean, none of this made great reading.

But it's always reassuring to have somebody fully accept

that there are problems and a clear list of things

that we need to do better.

So once again, thank you to our executive colleagues

and welcome aboard.

Esther, you're going to be a busy lady

over the next few months.

We're delighted to have you on board.

2.2 Organisational Priorities Update

If that's okay, let's move on.

Julian, another session from you.

This is the organisational priorities update.

We have touched probably on a number of these things already, to be honest, but I'll hand

it over to you.

Julian Hartley - 0:59:43

Thank you very much, Ian.

I think the most efficient way of dealing with this item is perhaps to draw your attention

to Appendix A with the graphic, with the listed boxes that have down the left-hand side what

we're familiar with in terms of the various reviews which influence the setting of the

four immediate actions.

And what we've done is under each one put a progress update.

So, if we look at stuck assessments, we are down to 135, which is good progress.

Still 135 to clear, but work underway on that.

And incidentally, I will give the opportunity to my exec colleagues who are leading each

of these to offer a comment on those if they want to add anything to what I've said.

enabling new assessments, we've completed 3,527 against a target of 3,500 to 4,000,

but that is a low watermark for CQC and we must do better and the key work going on at

the moment is to think about how, given everything we've just discussed, we're going to improve

that over the course of the coming year.

That will form a key part of our business plan for next year.

We're not there yet in terms of the absolute definition, but we're working hard to get

to a sense of what that trajectory needs to look like and engaging with our colleagues

and teams who are supporting this work.

On the backlog of information of concern, we are down to 286 information of concern

cases from 1,984 based on the 9th of January position.

I'm grateful to everyone's efforts on this, really important issue, one that I know has

been raised previously by board and is a very important issue for us to focus on.

Good to see the progress.

We've got Catherine Halford helping us, former Chief Nurse from the NHS, helping support

this push to look at the end-to-end process and make sure that we get to a better place

on that, Chris may want to add to what I've just said,

and on registration backlog, backlog of applications

reduced to 29.6 from a peak in May of 61.6.

So still work to do to get us to where we want to be,

but I know that James and colleagues that he's working with

are doing all they can to try and improve

that position as well.

And then on the foundational improvements

on the next slide, building the foundations.

We've just had the conversation about systems

and the work we need to do on that and data,

so I won't dwell on that.

On operations and regulatory leadership integration,

I think I'd want to say that it's encouraging

that we're having, I think, productive

and engaging discussions with staff-side colleagues

on this issue, trying to move forward in a positive way,

recognize that it's an important part of our overall plan

to build that sector specialist approach.

And I'm grateful to everyone's involvement in that

and the work that Jackie and the team are doing

with staff side colleagues.

And on the assessment framework,

Joyce and the team are looking hard,

with Aidan now joining us as well,

looking at the way that we can move to a sort of

interim position around refining key quality statements

and making sure that we've got the opportunity

to simplify, clarify, work with our sectors

so that the assessments are in a place

that we want them to be and where they're well received

while we think about the medium to longer term

in relation to our assessment framework.

So that's a brief summary of where we are on the four immediate actions and five foundational

improvements. Perhaps Ian, some of my exec colleagues might want to just add a bit of

detail to the four immediate ones that each of them acts as an SRO for. Thank you.

Ian Dilks - 1:04:14

Thanks Julian. We don't have a lot of detail everyone, but if you'll run around quickly.

James.

James Bullion - 1:04:21

Thank you. Thanks Ian and thank you Julian. In relation to registrations, you can see

we've got a clear timeline and process improvement underway. There are no outstanding registration

applications in 2023 at all now and in 2024 we're rapidly eradicating those from January

to May, so that not only are we working on the percentage that are longer than ten weeks

in the system, we're also trying to bring in the tail so that the absolute length of

time that people are experiencing, which is often relating to a complexity in the process

that is being undertaken in registrations, is reduced as well.

But I wanted to make another point, if I might, about the level of expectations, particularly

among social care providers about our, as it were, performance in the future and Julian

was speaking recently at the Care England annual conference and he will have courtesy

of my encouragement another series of speaking arrangements in the social care sector. There

are high expectations of not just eradicating our problems but really ramping up and I think

Julian you used the words in that conference of a long and difficult road I think which

the chairman of that conference acknowledged. I just want to set expectations going forwards

that we will of course deal with whatever we are dealing with in terms of back performance

but we are working in a hybrid way going forwards and that will necessarily be a little bit

of a drag on expectations. I wanted to make that point. Without depressing the social care

sector, I think it will be more of a challenge than they might have expectations of.

Ian Dilks - 1:06:11

Thanks James. Should we just see if any other executives wish to comment on that?

We'll move to any questions from NEDs.

Chris Day - 1:06:26

Chris Day, you've got your hand up. Yeah, just to give a bit of a note where we are on stuck assessments.

It's been tremendous work going on across the organisation to move us down from the

high figure of 500. We're now at broadly a fifth of that figure. The thing I said to

colleagues before, a lot of this was around both some of the technical reasons why reports

were stuck, but also just making sure we were operationally prioritizing the completion

and the fact of the final stages of the PAC Act process to get those reports out. We're

they realise that their report is in that backlog and I hope over the next few weeks that

that backlog will return to zero. The final part of this project is also to make sure we leave in

place flags so that we don't get into this situation again. So again we're working with

with colleagues from the hub and also colleagues from operations and the technology teams to make

sure that we can see when reports are beginning to go out of the norm for where we'd expect them

go through different phases of the process. So tremendous work done and I think probably

by middle of April we'll have removed those 500 -stroke assessments that we had originally.

Thanks Chris. Others? Chris.

Chris Usher - 1:07:50

Yeah thanks Ian. Just on the cases really, I mean this is coming down at a rapid rate

now. So we reported in the paper at the 10th of March at 286, it's now down to 75 so the

work continues to come down to 96 % reduction.

So I guess two things, the work doesn't stop

because cases don't stop, we need to ensure

that we've got a sustainable process

that we can keep on top of.

And the second bit would be just a huge thank you

to everyone who's been involved in working through

and clearing the backlog.

Lots of colleagues involved and great efforts going in,

so thank you to everyone that's been involved in that.

And we're nearly there in terms of clearing it.

Ian Dilks - 1:08:26

Thanks, and the other Chris.

Chris Dzikiti - 1:08:32

Yeah, I just thought since every Chris has spoken I might as well speak as well.

I think the discussion this morning reflects actually why enabling new assessments is really

important.

I think everything we're doing eventually is leading to enabling new assessments.

And if I just reflect on most of the contacts I get from providers, it's around assessments,

They are waiting for assessments.

They have registered.

They are waiting to be assessed.

They are waiting for a rating and at times impacting on their business.

So that's why this is really important.

But I suppose the positive aspect around enabling new assessments is that the hybrid approach

we are taking in terms of using the regulatory platform for some parts of the assessment

and also going off the system to try and make sure actually we can deliver those assessments.

Anecdotally, the feedback coming through from providers

I've spoken to, especially in other social care,

is actually the positive experience they have had

when we used the hybrid assessments.

Some of the assessments we have done have taken

about five weeks, within five weeks we've been able

to complete an assessment.

When you compare that to previous months,

where it's taking more than a year sometimes

to get a report out, you can see actually

the big impact it's having on people's experiences

of working with the CQC.

And also the feedback coming from staff

in terms of their health and well -being has been positive.

So staff we've used the hybrid approach,

have reported actually they're seeing a big difference

in terms of their well -being,

and actually starting to find joy at work,

which is really encouraging.

So I just wanted to reassure people that,

yes, it's taking a bit of time,

but I think we are taking those steps

to actually having positive impact on new assessments. Thank you, Ian.

Jackie, you want to start?

Jackie Jackson - 1:10:30

Yeah, I just wanted to go on record to thank colleagues, staff groups, our staff side,

our reference group who have worked really transparently, diligently and collaboratively

to get us to the point where you're consulting now on our inspector job revision and the

new inspector job description with a go -live date of the 12th of May. And it's been a real

testament to everybody's commitment as to how that's been carried out. And our trade

unions have been critical partners in that, so thank you to all of them as well.

Julian Hartley - 1:11:13

Ian, if I may complete the set just by saying that it's worth mentioning the CQC way safe

space continues to be open until the 2nd of April.

And we've had great feedback.

So all of that will be gathered, distilled,

and we'll move into the next phase of that.

And board colleagues will see the next kind of iteration

of that over the coming weeks.

So that obviously underpins the foundational improvements

and important to reinforce that and encourage colleagues

who may be watching us meet in public to continue

to offer their thoughts, ideas, and views.

Thank you.

Thanks, Julian.

Ian Dilks - 1:11:53

So this was basically an update.

So thank you very much for that.

And it's pleasing to see progress in all areas.

I know you're not being complacent,

but so much better to have some measurable progress.

We have time for a couple of questions.

Sharmila, I'll come to you first.

Thanks. And just wanted to say well done.

Charmion Pears - 1:12:14

first of all on the MI because it's very, very difficult to get information out so it's

great to see where we are. This is the first time we've had this kind of handle as a board

so it's great but also to everyone involved, certainly as a board member this is really

reassuring to see things moving in the right way so well done on what is an enormous amount

of work. There was just a couple of things from me, I'm sorry I should also say Chris

and Chris that the points around the assurance I think is really important as well that we're

not just fixing a backlog we are trying to gain assurance that this won't repeat itself

so that was also music to ears. One of the things we talked about yesterday Julian was

the concern that had been raised by colleagues with some of us board members around risk

and around how provider risk was being looked at and we had quite a good discussion and

Chris raised some of the things that were being done, because it cuts across, doesn't

it?

It cuts across those immediate priorities.

And I just wondered if the way that we are looking at risk and how we will project that

and how we are projecting out what we do next year can be shared, because I think that would

be important for some colleagues to hear.

And then just finally for other board members to know, we talked about the workarounds that

that are in place and I think Esther's joining Eric and that we're having sort of especially

around some of the IT areas in April.

One of the things we'll be looking at specifically is how we look at the work arounds sound like

they're working really well but how do we make sure that we don't create other risks

like record keeping risks, et cetera.

So just to let colleagues know we'll be doing that in April but if there is a chance, Julie,

in a few minutes to do, I think it would be useful.

Ian Dilks - 1:14:02

Thanks, Sharmini. On your second point, it's been clear that the risk matrix is quite complicated

because every time you move and do something, it creates a new risk and making sure we've

identified that managing it is desperately important. So thank you for setting up the

additional audit and risk assurance. By the way, you just told me not to use the phrase

ARAQ and you've done all of it. Audit and risk assurance, for those that don't know,

that's what I mean by ARAQ. So thank you for doing that. On the first point, Julian, just

more comment. Do you want to respond to that?

Julian Hartley - 1:14:26

Yeah, I know, absolutely. I think it's a vital consideration, Charmian, in the sense that

inevitably we've been and are focused a lot on our own internal issues to sort out. However,

our core purpose around keeping people that use services safe and also spurring improvement

is a vital part of our work, so having more of a sense of what's happening in the regulatory

environment, in all the providers that we regulate.

I think Chris, you articulated it nicely when we spoke about this yesterday.

Do you want to perhaps just reprise that in terms of what we're doing and how we're approaching

that?

Chris Dzikiti - 1:15:14

Thanks, Gillian.

And I think it is important, I think the point you're making,

Gillian, in terms of, yes, we have spent a lot of time

focusing internally in terms of the areas we need to address.

But also, our key purpose, or our purpose, really,

for existence of CQC is supporting people

who use services in either health or social care,

and in terms of how we support those providers to, one,

manage risk or mitigate risk, and also

how they can improve in terms of patient safety.

So what we've decided to do internally is to have a network national risk and performance

meeting every month to try and address some of those risks that are coming through in

terms of what are the risks that our colleagues who are inspectors and assessors are raising

to their D .D .s, to their deputy directors, and what are those risks being escalated to

the network directors.

So the network directors, when they come to this monthly meeting, they are bringing a

collective assessment of risk from their network, and then we agree in terms of how we address

those risks in terms of our approach.

Do we need to go out and carry out an assessment, for example, for a provider, or which providers

collectively do we think we need to support in terms of risk?

But we're not just using our internal risk, we're also using risks that is being reported

from other stakeholders, for example, ICBs, NHS England commissioners, to try and make

Actually, our risk is not just informed by our intelligence, but it's also informed by

other stakeholders.

And thinking about, you know, whistle -blowing as well and feedback coming from people who

use services.

So this is a place where we gather all the intelligence, and then we have an understanding

of what risk is being presented within our networks, and then how we respond to that

risk going forward.

Thanks, Chris.

Ian Dilks - 1:17:05

I saw a couple of questions.

Christi, I will come to you first.

No, David.

Christine Asbury - 1:17:09

Thank you.

Just to say first of all that it's really good to see that the progress is being made.

It may not be happening really, really fast but I hope that it is being felt by providers

and I'm trying not to be the person who always talks about the provider perspective.

However, that is my background and I do still hear a lot from providers.

And I think again I appreciate the transparency that, you know, James you're mentioning about

being realistic about what can be expected by providers,

that it's not going to happen possibly as fast as providers

would wish.

Hearing from Chris as well about where it has gone well

and where people are feeling that it's now beginning to work.

And also that we seem to be really communicating well

with providers at the moment and how important that is,

and that it reinforces our commitment to CQC

to working in partnership with providers

and to ensuring that actually going forward,

we will sustain that partnership.

It was very much evidenced by the work with the CPA.

And I know you went to Julian and talked to Care England,

and I know that was very much welcomed.

So just to say, please, let's keep going with that.

And then just a question, I think, probably for you, Joyce,

which is there was brief mention of refining the quality

statements.

And again, I know there was an offer through CPA to work with us on that, and is that happening,

and will they be involved in that, just to hear how that might be happening.

Joyce?

Joyce Frederick - 1:18:49

Thank you for the question, Christine.

In terms of refining the quality statements, I think what we are doing is thinking about

the regulatory model in its entirety and the assessment framework of which the quality

I think we have to look at the whole thing and there might be refinement both in the

interim, sorry, in the long term because it would have to be done through consultation.

And I've been working with people like Aidan, Chris and others and the new chief inspectors

that come in so that the quality statements are meaningful that we can then lead to ratings

and then providers actually understand what standards are expected of them. So in the

long term, definitely we are reviewing the quality statements. It will be part of the

consultation. In the medium term and the short term, we have to make interim changes, but

we are helping with further guidance around what we expect around the quality statements

so that it will be clearer to providers what the quality statement means, what might be

are key lines of inquiry and might be the prompts that help them understand what do

I do in my sector and my plans. The short answer is yes, but it is for the longer term

and we have to consult on it. So I do think that there was an offer

Christine Asbury - 1:20:08

from

CPA to help with refining and with the guidance. Is that happening?

Joyce Frederick - 1:20:15

So James can talk to how he intends to work with CPA. My comment on that is we have to

work with CPA and others, including people for youth services and public, because we

have to engage, collaborate completely, but we have to engage more widely than single

– not single, they represent a whole group of people, but we have to engage more widely

with lots of people, partners and stakeholders and people in youth services as well.

Ian Dilks - 1:20:47

Chris, I saw your hand up. I'll come back to you if maybe it's an answer, but I've

been promising David. He's had his hand up for ages. David.

Mr David Croisdale-Appleby - 1:20:55

Julian, in the incredibly short time that you've been here you've made lots of changes,

lots of moves forward and we've heard some of those today. My question really is, in

order to focus on what is essential in delivery to our formal mandate and to those we regulate,

I wondered if as yet you had had any time to fully examine what activities we might

stop or we might at least pause because most organisations accrete to themselves nice to

have activities and they never become the priority but in order to streamline the organisation

and add to the focus that you know that Esther's talked about and you've spoken of and some

your team members have spoken of.

You know, any comment that you'd like to make on things that we

might pause or stop?

Julian Hartley - 1:21:56

May I respond, Ian?

Yes, sorry.

So already, I think, David, and to answer your question

directly, we've prioritized the essential things

that we need to deliver.

So we've tried to give the organization a clear focus

around what we're discussing now.

We have already paused the assessments of integrated care systems that were planned.

That was a necessary step given the issues that we needed to sort out.

There has been, I'll refer to it later in an update in the report on where we are externally,

well -publicized changes planned around NHS England,

and indeed integrated care systems,

they ask in terms of their level of headcount reduction.

So we need to be thinking about our role

in relation to where ICBs and ICSs are going.

For the moment, our focus on these priorities,

I think is paramount.

And I think that the question of what else we might stop,

I think that this is part of the conversation

about our wider role, the role of regulation

across health and care more generally.

We're expecting the output of a further review

of the health and care landscape

that may lend further clarity, we await that.

and also we're influencing the work on the 10 -year plan in terms of regulation, which

again is going to be vital because although it's a 10 -year plan, there's a lot of interest

in the first sort of three to five years of that.

So I'm sure there'll be more to say in answer to your question in due course.

Right now we've got a clear focus I think necessarily so and more thinking to do in

relation to those areas I've described.

Well, thank you for that, Julian.

Mr David Croisdale-Appleby - 1:24:09

I mean, that is reassuring, and I take your point about a very rapidly changing and slightly

uncertain context in the climate outside of that.

I suppose what I am saying, however, is the application of Occam's Razor to some of the,

you know, activities of our organization probably could go on somewhat independently of that.

I'm just asking, you know, perhaps you could just reassure me in due course when you've looked at it.

Perhaps that would be a point to pick up when the business plan comes back.

Ian Dilks - 1:24:43

I don't think it needs large documentation, but that sets up what we are doing. It may be helpful to have a response.

Is there anything that we're paring back? So we'll capture that. Chris, can I make this last comment from you, please?

I just, it's just a response to. Yeah, I'm too many points.

it's me. And just to respond to Christine's comment, so James has established a group

from the CPA to work on exactly those issues around what can we describe, what the key

characteristics of outstanding good requires improvement and inadequate, but we need to do

that in all the sectors that we regulate. So our intention is to work with providers from all the

sectors that we regulate alongside people who use services to re -establish and re -calibrate that as

alongside our colleagues as well. So we have something that is meaningful to our colleagues,

that is meaningful to providers, that gives an ability to really understand collectively

when we come out to inspect what we are looking for. I eventually want that to build into a wider

handbook for inspection so we're clear on the people who have clear expectations of us as a

regulator and we've got clear expectations of them. So that work starts now, as I say the CPA

a really important integral part of that, but they are one of a number of groups and

organisations that we will be working with over the coming weeks to establish and support

that interim approach.

Okay, thanks Chris. If we could, let's close the discussion. Thanks very much for the update.

I mean, clearly it is important just to keep a continuing focus on those priorities there

and so that will continue for a little while. If we can move on one last session before

we have a comfort break.

And it's anti -racism.

3.3 Hearing From our Networks

I think we've been joined by one of your colleagues, Joyce.

Yeah, Cara Haynes.

Joyce Frederick - 1:26:39

Cara Haynes is joining us.

Ian Dilks - 1:26:43

Just while Cara's coming in, I'll

hand over to Joyce in a second.

But colleagues will recall that I

think it was in the September board meeting

I think we talked about the anti -racism, a clear commitment from the board that we should

become an anti -racism organization.

Work is continuing.

There will be something more complete coming back to the board in May, but I thought it

would be helpful just to have a very brief update on progress, position things, rather

than just having something coming in in May.

So we don't know where Kiara is.

Is she darling again or are we?

As far as I know she's attending in person.

Okay, welcome.

As we pointed out to me, I was predicting the comfort break too quickly.

Apologies for that.

So we have a couple more items.

Anyway, I did this yesterday as well.

Joyce, so welcome, Carol.

We are running slightly out of time, so if you could make sure we don't overrun on this.

But I was just explaining to her why this was important, so have a brief update today

ahead of a longer discussion in May. So, can I ask you to take this on, please?

Joyce Frederick - 1:28:28

Thank you very much, Ian. And I'm really pleased, actually, to bring this paper to

board. Like you said, we first discussed it in September 2024, and this is an update to

board to note progress, but also to follow up on the commitments that the board has discussed

around the objectives that they may want to see. We will come back in May, but we'll

about some immediate commitments about a position statement we want to have on being an anti -racist

organisation. There are two things I want to say first. First of all, in response to

David's comments about what priorities we lose, this is definitely not one of them.

This is something we keep, it's integral to our role, it's integral to how we approach

the CQC way as well. And secondly, though I lead it, you may think I lead it because

I have a personal stake in being an anti -racist organisation. I do, but I also think this

is absolutely important for us for another two reasons.

First, it is how we regulate.

And when we think about health inequalities,

which are avoidable, the worst care

is done to people who come from ethnic minority groups.

You would want to make sure better care is given to all,

and you make sure that the worst care is improved for those

who are on the receiving end.

We need to regulate, because racism

is the cause of the cause of those health inequalities.

So that's really important in terms of our regulation.

Secondly, it's really important in terms of workforce.

The workforce in health and care services, as well as our own workforce within the Care Quality Commission.

Because if you have anti -racist policy, you make people feel included and belong.

And there is research that shows in healthcare that the impact on health workers who are affected by racism

impacts their mental health and their wellbeing, but it also impacts the care of patients.

and we've seen that in maternity care and we've seen it in mental health care as well,

but I could go through an entire list. So what I want to do is hand over, I do want

to give Keira time to talk about the input, she's really been involved in this work as

well as some team, so I want to give her the time and space. I did say keep it to two minutes

Keira, but if you go over that's absolutely fine, because I want to have a quick quality

and answer session as well, but I do want Keira to have the time to tell us about this

work and about how we see it progressing.

Thank you.

Thanks.

Carol, just trying to just add to what you've said, Joyce, about the

Ian Dilks - 1:30:53

importance of this.

It seems to me, you know, we talk about things like LLRC, which after all, part of that work

and its grounding and concerns about race.

And I think if we're to demonstrate we are listening and responding rather than just

talk about the process, there couldn't be a better example of taking this on, because

I know it's important to our people both internally and elsewhere, which is why I was particularly

bearing in mind this was my last meeting, was keen that we should have this discussion

today. Anyway, Chiara, we have got the papers, don't need to talk us through the detail,

but I take the point from Joyce that we need to give you time to explain. So, over to you.

Presenter 1 - 1:31:28

Okay, this happened last time as well, sorry. I'm still getting used to it. But good morning

board members. Six months ago, or just over six months ago, you prioritised CQC being

transformed into an anti -racist organization to turn the dial on the

recruitment, advancement and well -being of our racialized colleagues here at CQC

but also to use our unique position and it is a unique position to eliminate the

unacceptable inequalities that we see for racialized communities across health

and care. And I am proud that we have been guided by the seven anti -racist

principles from the Race and Health Observatory and we will continue to do

this across all of our phases.

But in terms of phase one, which is naming racism and signaling

our intent, I would like to give a brief update

on where we're at so far.

So we remain committed to producing an anti -racism

position statement that not only builds trust with communities,

but outlines our responsibilities.

We have supported the review of our Freedom

to Speak Up offer, which has led to specific and measurable

anti -racism measures.

We have embedded the RHO principles

into our quality impact assessments, which we hope will directly influence

the four immediate actions and the five foundational improvements. And we are

working closely with the Race Equality Network and our Anti -Racism Theorem Group

to take all the opportunities we can to embed anti -racism into the CQC way. And

of course we remain aligned with the EDI strategy and working on the development

of our learning and support offer to improve the confidence and the

race and racism so that way when they go out and do their jobs,

we're all on the same page.

But now, leaders, what we need from you is your continued

commitment, understanding and action.

And the way we can do this is through adopting evidence -based

collective and individual objectives so we can have

transformational, not just transactional change.

So what do I mean by this?

Under our strategy, this is the public and internal continued

commitment to this approach.

culturally it's modeling these values and behaviors, taking the time for that

deep self reflection on our own behaviors and how they can contribute to

the culture we want to see, to normalizing conversations around racism

so we can support the identification of racism and take the action required.

But also under performance, not only asking for data broken down by ethnicity

but then using that to target action and steer the direction of this

organization and accountability.

We want to be transparent and accessible,

but haven't we thought also about equipping and enabling

community representatives onto our board

and our decision -making processes

so we can really see some change?

These are your objectives, leaders,

and I ask you what is it we're going to do about this.

Thank you.

Ian Dilks - 1:34:23

Thanks so much, Karen.

You left us with a challenge, so anyone wish to respond?

James, I will come to you first. I did see Charlie and Seth, James.

James Bullion - 1:34:38

As the board will know, I come from a social services background mainly, where anti -discriminatory practice and anti -racism is a strong part of social services and indeed social work.

I think I really welcome this, I absolutely commit to it personally and I think in anti -racist

work it is about confronting racism including our own but also organisational change and

then supporting community initiatives. I think this is one of those areas of work where CQC

incorporates this into our regulatory action but we have a community role in addition to

that of promoting this issue and we live in a world where this agenda is actually quite

challenged and getting increasingly challenged. I think just being vocal and in the space

about this is an important part of us influencing other peer organisations and governments and

communities. And I think that there's a lot for us to say in our voice and encouraging

change in the way that practice is done in health and in social care and more broadly

in community settings. So it's deceptively simple at one level but actually keeping a

focus on this and putting resources to this I think is critical for us to do. So thank

you.

Ian Dilks - 1:36:01

Sharmi, do you want to add a comment?

Charmion Pears - 1:36:04

Thanks very much. Great to hear about the work that's been underway and our aspirations

going forward. I think for me, I, like James, am totally committed to this. Personally,

I've got a lot to thank my mentor for on the journey, so that's one personal aspect.

I think as a team, this is a different level of commitment to having an EDI strategy, hold

ourselves out as being an anti -racist organization comes with a different

level of proactive commitment and I think it's really important that we show

how we're demonstrating our delivery against that commitment. So you've

asked sort of about board objectives I mean for me I think it's about us

thinking about how we make time on the board to discuss it and to learn about

ensuring we have the right resources applied internally to deliver what we

need to deliver. And you know there are a number of indicators that we should be

looking at and Nadi is doing a lot of work for May on this and I'm a big

fan of triangulating multiple sources of data because we can get that real depth

of information. So I'm looking forward to seeing the results of that in May and

I wonder it's a bit sort of out there but we do well -led inspections

ourselves EDI is one of the areas we inspect providers on. I wonder if we

shouldn't ask some of our inspectors to give us a slice of a well -led inspection so we

see how we would shape up come May.

So that's the first thing. The second thing is the second part of this was the phase two

is auditing and I just wanted to provide an update from the audit and risk assurance committee

chair. There are a couple of things that are happening and have happened. We have just

recently undertaken an RRC audit which we're working through with the team the results

of and we've discussed that today. On next year's plan we have agreed with GIA, Government

Internal Audit Agency, that they will do an audit of, they're calling it grievances, but

it is grievances and disciplinaries. They have been provided with the what is and what

is data and they will be looking to ensure consistency across all colleagues, which I

think is really important. Also speaking with some of Chris Usher's team who are responsible

for looking at policies, one of the things we want to do is to add into our policy headers,

which sort of look at all the things we need to look at when we accept a policy or it goes

to the board for approval, what have we specifically done in relation to this commitment. So I

think there's a few things that we're trying to do there to support it, but really, really

the work.

There's quite a lot of comments there, there's a few other hands up, but Cara, do you want

to respond to the points that Sharmi does make?

It's just great to hear that you are committed and that through the audits and through, and

specifically on the policy section as well, about having how we embed and the debiasing,

because I think that's important as well.

I think having it in the background is one thing, but having it firmly within our processes,

especially while we kind of get the culture alongside it is just really

important so yeah I appreciate your commitment.

Thanks. There's a few hands going up and then I come to Stephen,

Ian Dilks - 1:39:40

Chris, one of the Chris's saw your hand go up, let me have a brief comment and then Mark and then Estran I think probably will call it stumps.

That's four of you. Stephen.

Stephen Marston - 1:39:49

Firstly congratulations and thank you. I think the way you came into the room, big

group of people and projected really constructively and bravely was admirable.

I think you did a really terrific job on that, well done. I would like to make the

link through to freedom to speak up because I think that's an important route

for colleagues who feel they are experiencing racism or abuse or

harassment and we were talking earlier that actually we're not yet in a place

where the organization and our colleagues all feel confident about

using Speak Up to raise concerns.

But for me, that would be one way of, if you like,

kind of mainstreaming into some of our core practices

and frameworks this really important part of the agenda.

So I hope we can do something about sort

of building the profile of freedom

to speak up as a way of raising concerns

about racism and harassment.

Second one, like Charmian, I've had the benefit

of the reverse mentoring program and a wonderful reverse mentor, thank you Millie, who has

just been brilliant.

But the reason that for me is so important is that it kind of gives me an understanding

of just what it's like, the experience on a day to day basis.

because so often our sort of anti -racism programs can focus on the big processes, recruitment,

promotions, discipline, but understanding the day -to -day experience is I think hugely

important for the board in addition to thinking well are all of our processes working well.

So I think that is a really powerful part of the anti -racism program to keep going with

the reverse mentoring so that we all have a really deep understanding of what is it

really like for colleagues in this organization on a day -to -day basis, and that I hope we

can continue with that program.

Ian Dilks - 1:41:53

Thanks, Stephen. I was going to make a similar point on reverse mentoring. I won't profess

to be a star pupil, but it has nevertheless been incredibly useful. And when we come to

re -look, I think it would be worth seeing whether to either re -energize that program

We'll do a light touch version if you like for board directors.

Chris Day, you did have a hand up.

Let me come to you quickly and then Mark Chambers.

Sure. I just wanted to make a point that if we are to be an effective regulator and deliver

our purpose, we need to build the trust of all the communities that we serve.

And it's important. This is an important part of building that trust.

I commit myself to this work.

I still have the words of the maternity court ringing in my ears.

we remain concerned about inherent inequalities in access to maternity

service experience by women from different backgrounds and

the safety risks that presents. We need to call it out in our own

organisation if we are to tackle it in others.

Great thanks. Mark, Travis. Thank you and I strongly welcome this work as well. One

of the things that I worry about about the organisation that

Mark Chambers - 1:43:02

we've not been strong on, we've not been strong on consequence management for behaviors.

And if we're really going to have accountability for people living the behaviors that we want

to see in the organization, we've got to make sure that that is underpinned with a structure

of consequence management.

So can we make sure that we kind of, I think that, you know,

that's a theme that we have across a whole array of fronts,

but I think it would be really helpful as this moves forward

to get feedback as we move forward of actually

where we're seeing this not happening,

or we're not seeing this happening fast enough

and deeply enough.

You know, are the consequence management tools in place

to help us deliver that.

If people have got ideas and suggestions for how that could be improved, let's listen

to them because I think we need to do a better job on that front.

Thank you.

Thanks, Mark.

Esther.

Yeah, briefly, thank you.

Esther Provins - 1:44:10

And I think your challenge to us both as individuals and as a board is absolutely the right one,

so thank you.

I think I was reflecting as you were speaking that unless people have personally faced discrimination

it's really hard to understand and so your comments around reverse mentoring and the

priorities around learning and education and support to other colleagues in the organisation

it feels really important.

And I just wanted to make the link with the CQC way.

It feels like to me the secrecy way has been mentioned many times this morning and its

importance of resetting the way that we work and the culture that we have as an organisation

feels really, really important and so this being a key part of that I think is a really

helpful approach and I'm left with the reflection of a personal call to action from your comments

as individuals and as a board and also the comment that the standards we walk by are

the standards we accept. So those are my reflections on your words, so thank you.

Ian Dilks - 1:45:23

Julian Hartley - 1:45:28

Thanks so much, Tessa. Is there anybody else who wants to make a comment?

giving us the challenge and also a bit of inspiration, I feel. Personal commitment,

continue to prioritise this and actually Joyce knows because she was in the audience, taking

myself out of my comfort zone by going on panels like the one we did at the Nuffield

Summit, Joyce, to talk about anti -racism and what we do in health and care. What I was

I'm interested though quickly is of the seven steps, where do you think we are in relation

to working through those because you mentioned about naming step one, there's another six.

How do you think we're doing and what do you think we need to do next?

Presenter 1 - 1:46:30

Honestly, I don't think these principles are meant to be done sequentially.

I think the challenge is doing them all all the time which I know can seem daunting

But I think the way they're broken down actually when you take some time to absorb it

we can do them at the same time and it we I

Think viewing the the different sub work streams. I've been supporting, you know, I think it would be wrong to say

Oh, this one is for naming racism or this one we break down ethnicity and we use data across everything

We need to take that collective approach.

And I think in terms of honestly where we're at,

I think our ability to use data to inform and target action,

both lived experience data, but also

our numerical data, our quantitative data,

we're lacking.

Internally, their needs work, but essentially

externally as well.

I hear comments a lot about even out for our NCSC colleagues,

the information that we're getting internally, we're unable to capture that in a way where

we can then use it to drive action and that is fundamentally going to hold us back.

We're not going to be able to benchmark our progress and fundamentally we're not going

to be able to see where those areas of key support are.

So that's something that critically is on my mind.

Great, thank you.

Thanks, Joyce.

Ian Dilks - 1:47:48

Last call, Linda.

Thank you.

Joyce Frederick - 1:47:51

I think that was a really good response, carefully worded response, because I would say quite

directly then, we're at step one and not even achieving that yet. But that's the subject

of this paper, to one, understand our progress and then secondly, commit to step one, which

is about we will publish a strategic policy position statement as an organisation. So

that's what I want to get and we both want to get on board today.

Ian Dilks - 1:48:20

Thanks Joyce. I mean I was really keen that we made some progress and got prompted ahead

of May, just a couple of comments.

I did spend some time with the team the other day and made,

we discussed two things.

One is a link of this to the CQC way.

It seems to me that you've already said this yesterday,

it's just been an integral part, it should be able to the CQC way,

end of.

And the second thing is we did talk about the business plan.

I've already given a brief update of the discussion we had

yesterday, but one of the points we did make is we would like to

be as a plan, recognize this as a priority for CQC.

So we and I talked about it and we discussed about it in the

the board yesterday.

Reverse mentoring or a light version or something I think has a part to play, and I would encourage

people to look at it.

I would just say that you talk about the board, we have to recognize it's quite fluid at the

moment.

We are recruiting new chief inspectors, who I would have thought would be pretty pivotal

to this anyway.

We're also recruiting a number of new non -executive directors.

The job adverts are out there and interviews are taking place in the next week or so.

So there will be four, five, six or more new people, in Tutee of course, to have my own

successor.

So there's a practical issue we can work through, but I would encourage you, through Julian,

to have an early meeting with my successor and just see, particularly given those changes

to the board, get him on board and take that forward.

Otherwise, thank you very much indeed.

I would encourage you to keep prompting us.

Thank you.

Julian, we have two sessions coming up, both reasonably long, but both of which contain

material I think to varying degrees, quite a bit we've already covered.

So can I suggest that for the first one, the report from the executive team, we've all

read the paper so I don't know if there's anything you want to highlight or add to,

but I won't just go straight to any questions, but it was a pretty comprehensive paper.

And then the similarly really on the performance report update, if we could, the paper's

there, take it largely as read.

Obviously, that covers much more of the business as usual stuff rather than simply the priorities,

but nevertheless, the priorities are by definition such an important part.

We've discussed a number of things.

So I think we'll perhaps find a way of moving through both of those rather more quickly.

I think a lot of time goes back on track.

So report from the executive team.

Anything you want to add?

One thing I would like to add, which is sort of breaking news post these papers being written,

Julian Hartley - 1:51:07

which is the appointment of our Chief Inspector of Mental Health, Dr. Aaron Chopra.

Aaron is, until very recently, has been the Medical Director of the Mental Health Wellbeing

Commission in Scotland with particular responsibility of Mental Health Act.

He has worked as a psychiatrist in England, New Zealand and Scotland, recipient of the

Royal College of Psychiatrists President's Award, highly regarded in his field and performed

very strongly through the whole process and delighted that we have made that appointment.

And while I'm saying that, I also want to thank Chris again,

because Chris has taken on and really made,

done a lot of important things

in relation to mental health over this period.

And I know, Chris, we've spoken about it,

that you'll support Aaron in his work,

but I wanted to put on record my thanks to you

for your work on mental health,

because I think it's given it a really strong priority for us and I think

important that we've got mental health as one of the four chief inspector

appointments so thank you. I think perhaps also Ian if I may just to say it's

been a big time of change across health and care over the last couple of

weeks. We have been involved in and present at some of the key meetings in

in relation to NHS England, DHSC, meetings of Chairs,

Chief Execs of NHS organisations around some of the changes.

I was able to give Chairs and Chief Execs assembled

in London last week an update on where we are

in relation to our key issues and priorities,

which was helpful, and also make sure that

we're building the relationships with the new team,

the transition team, under the leadership of Sir Jim Mackey.

Thank you.

Okay.

Ian Dilks - 1:53:19

Can I just, Chris, a little bit of an embarrassment, but just add the thanks to the board.

I mean, give a bit of context, and it's probably, I'd say, six months, more like eight or nine

months ago that we felt that having greater focus on mental health in the light of what

we were doing, including indeed your own work up in Nottingham, really ought to have a greater

priority.

Obviously, there was a time of change when we didn't have a permanent chief executive,

But it was great that Julian embraced the idea.

The department was very supportive.

That all moved very quickly to the idea.

But it was one thing having an idea of it,

but we'd never done it before.

So you drew the short straw in trying to run with that.

And I think the fact that we moved so quickly,

it speaks a lot for your willingness to pick it up.

So just that, not just Julian, but thanks on the whole board

for setting it up and running.

And it'll make Aaron's job easier.

So thank you.

Any questions for Julian on the written report? Stephen.

Stephen Marston - 1:54:18

I just wanted to pick up a bit about local authority assessments. Firstly, because I

do think James and his team deserve enormous credit for in a sort of quiet, calm, professional

way, despite everything else going on across the organisation, they've delivered a completely

new assessment programme against a new assessment framework, and I think that's really, really

impressive. I would like just to understand, and now how are we going to evaluate how well

has this worked, particularly picking up from a bit of yesterday's discussion. Are we getting

some structured survey evidence back from local authorities? Where is this added value?

value, where not, where might it add more value on their own journeys about improvement

and will that come back to the board or just be interested in sort of the evaluation frame

for something that I think has been a really impressive achievement?

James Bullion - 1:55:23

Thank you Stephen and I'll pass and let's hope some of them are watching the board meeting

to hear that praise of their work. They have done a tremendously good job. It's not insignificant

that they're not using a regulatory platform for this work actually, it's all done on Microsoft

Office products, as it were. We are in that phase now of the final six or seven months

of the two year baselining period, so we are at that stage where lessons from both our

own process and its effectiveness are being drawn together, and also we're in discussions

with DHSE about the outcome of the baselining and whether the themes that are emerging,

and I know at the previous board meetings we've discussed some of those themes like

waiting for access to care, support for family carers, safeguarding concerns, so those and

commissioning of care services by local authorities and its impact on providers.

So there are strong themes emerging from the small number of reports that we've published,

I think 27 so far.

The remaining 120 or so will get published between now and April of 2026.

And a pattern is emerging.

And that pattern we will discuss with the department about whether they would see further

work post -baselining for us to do.

So revisiting authorities or doing themed work or whether they would – or whether

an improvement to gender, as it were, would be part of our future role.

So that's still to be discussed with the Department.

We've got a process now of doing that over the next six months.

This work, as you remember, is determined by priorities of the Secretary of State.

So in order to go beyond baselining, we will need sign -off of an approach, funding for

approach and political priorities put into there. All of that will come back to the board.

We are talking to the Department about a sort of end of process report, independent voice

report. Again, that will lead agreement, but that's our intention to do that.

Just anecdotally, talking to my ex -peers, DASs around the country, the anticipatory

work of this work has been enormous. Local authorities everywhere have been increasing

their co -production work, talking to providers, trying to get rid of their backlogs, and it's

really had a dramatically positive impact. And it's a good example of regulation working

effectively, actually. And it shows what CQC can do when we are focused, when the job is

I'm sure we will be right across the service doing similar work.

Thank you.

Thanks, James.

I won't repeat what Steve has said, but I was going to write some of the point just

that.

Ian Dilks - 1:58:25

I also – because many people in the audience, I got copied in on all the reports that we

issue, and they are a simple but very intelligible read, so I'd be commended on that.

I would also say – I mean, you have far more contacts with local authorities than

I do, but I have some, and I also hear that anticipatory impact.

I mean, when we look at how we can achieve improvement, one of the things we know is

that if we're about to go in, that can have an impact.

Maybe that's lost – it's lost a little bit in some of the people who regulate, but

in this area, there is no doubt that it has encouraged people to improve. Joyce, I think

you wanted comments. I'll let you come in first. I know Christine had a question. While

you've got the mic, and since this is an ET update, you also mentioned in passing yesterday

in Ward that we've been shortlisted for. Do you just want to mention that as well?

Joyce Frederick - 1:59:18

I was actually going to respond to Stephen's comment about evaluation, but I will say just

in response to James. The local authority assessment work is led ably by Mary Crij and

they use the assessment framework but it's off platform but it works and they have expert

inspectors who know the context, who know the services, many of whom have worked in

local authorities and so understand the services in which they are evaluating and that model

works so that there are things that we need to get right in our broader reg model and

assessment framework and that is having that expertise and using the assessment framework

in the right way with the ability to make it work with the technology that we have.

But in answer to your evaluation question, whatever we do in terms of introducing a new

regulatory model or assessment framework or anything around how we regulate, we need to

evaluate.

So the local authority assessments were when they were piloted, there was an evaluation

which fed into improving the methodology.

There has been, it's in the paper, a recent research update from IFF who have evaluated

the impact on early assessments and that's also been fit in to improve how we do local

authority assessments and we will also evaluate the impact when all, is it 152 James, or is

it 154, 153, when all 153 assessments are done or close to when they're all done, there

will be an evaluation of the impact as well. And you're alluding to the Institute of Regulation

conference tomorrow of which there will be announcements on the awards for regulation

and we will look closely to see whether we are mentioned in that tomorrow.

Okay, thank you. Christie.

Ian Dilks - 2:01:06

Christine Asbury - 2:01:10

Thanks. I actually have two things I wanted to raise. The first one is around the local

authority assessments, just picking up what else has been said. And in your summary in

this report, you didn't mention commissioning practices as an emerging theme and some of

the challenges that are faced by providers in relation to that. But you have just verbally

stated that, James. So I assume it will be flagged up as one of the themes in future.

The main thing I wanted to raise was around the independent care treatment reviews, because

looking at these stats it seems that 25 % of the reviews have resulted in a change to the

treatment that people are receiving which means that 75 % have not. And I was quite shocked

by that. I think I had, these people are probably experiencing the worst experience of care

that anybody could and yet actually those reviews don't seem to have changed very much

I just wondered either now or as we move forward whether we could understand more about why

there hasn't been more change there and whether we can, through the work we're doing, whether

we can have any impact on that.

Certainly, and Simon will have a perspective on this actually as an expert that may want

to say something.

James Bullion - 2:02:34

I mean, you're right about the number, the 25 percents versus the 11 of the 44.

These are complex care situations for these individuals, so to some degree there is some

inherent difficulty in whether you can reduce the segregation and the seclusion.

Nonetheless, I was going to make a point on this, that for those 11 people their quality

of life has fantastically improved for the positive.

There is a mirror of this work, this is the National Independent Care and Treatment Reviews,

there's a mirror in every ICB of care and treatment reviews going on, partnership with

local authorities and if anything this work demonstrates to that local work, which to

some degree might be less complex perhaps, that it is possible even within the difficulties

and challenges that you might have of access to local services, care services and health

services, it is possible to make an improvement in the quality of life. But you're right,

Christine, in having the ambition of sort of 100 per cent, you're right about that.

I completely accept that as wanting that to be our ambition. But I think we've probably

demonstrated in this process, again, conversation with the Department about whether it should

continue after December when we've dealt with the initial cohort here. But we're probably

demonstrating impact both in terms of the individual lives but also this is a process

necessarily integrated between all the players, as it were, that can help support people's

lives. It's worth doing. But I completely accept your challenge that it should be 100

percent, but it is really difficult to get that, as Simon will no doubt know.

So is the conclusion that there's 33 people whose treatment didn't change were getting

the right treatment through segregation or is it that actually the resources and expertise

Christine Asbury - 2:04:40

isn't there to enable them to leave segregation?

James Bullion - 2:04:44

I think inevitably it's a mixture of that but I think what you're demonstrating is probably

there might be appetite around the board for a more in -depth discussion because it's absolutely

life affirming and fascinating conversation to be had around the impact of this for this

population of people.

Simon, did you want to add?

Yes, for those of you who don't know, I'm a mental health act reviewer in my day job

Simon Godefroy - 2:05:11

and I chair independent care and treatment reviews. I've chaired 11 of the 44 we've done,

so I'm fairly confident.

None of mine, one came out of long -term segregation

three days before I did the review.

I would like to think we, poking with sticks,

does help focus people's minds on improving outcomes.

And it's a really complex situation.

We're now at the stage where we're following up with the people and with their relatives

and I've had some of those conversations, I had a conversation the day before yesterday

with a relative and there were ten recommendations and nine of them the relative was able to

tell me very clearly why improvements have been made to the person's quality of care.

The person is not out of LTS and the plan is to move them into the community which mum

is very worried about because that's gone badly wrong.

So I think it's a really complex systemic issue.

I think there's a big impact on social care and ICBs working together to provide the placements

in the community because these people end up in hospital mainly because care in the

community hasn't worked. They've either gone into crisis which has been generated by poor

quality care or they've gone into crisis because of life circumstances and the care hasn't

been there to support them when their distress is calling harm to others and they've ended

up in hospital and they get stuck. And they get stuck for years. I'm the longest person

I reviewed, been in hospital 37 years, most of that time in segregation, mainly self -imposed.

I have to say I know him from my review work.

So big systemic issues.

I welcome your suggestion that the board should look at this in more detail.

I'm more happy to work with the team on that because as you can see I'm as passionate about

this as I am about disability issues.

So I will shut up at that point.

And thanks for your shining the light on that,

because obviously it's a very important piece of work,

as James said.

OK, thanks, Simon.

Ian Dilks - 2:07:47

And we'll capture that, see whether there's

an appetite to have a closer look.

I think there is.

Thank you very much for that.

If I could close that report down.

Thank you very much indeed.

Let's move on to the Q3 performance reward update.

As I said, this is kind of a business as usual.

3.2 Q3 Performance Report Update

having already tested the priorities, and the information is a little bit out of date

for reasons I think the paper explains.

Chris, are you handling this alone or?

Every time I try and get rid of performance, it always keeps coming back to me, so I will

– I was hoping to just take any questions, if I'm honest, given that, as you said,

we've covered a lot of this in the earlier priorities update, and a lot of it is to be

I'm happy to do any updates, but I prefer we probably take questions, I think.

Chris Usher - 2:08:36

Okay, questions for Chris.

Charmaine.

Thanks, Chris.

I just – one comment I think I should make that the risk register that's in this pack

isn't reflective of where we're sitting with the risk register at the moment.

Charmion Pears - 2:08:52

So I think probably we just need to note that because the team have done a lot of work to

risk ahead and this is the old kind of cut of that and we talked a lot about risk yesterday.

I just had a couple Chris, the FOI requests, we've talked about what we've found but what

is the specific issue here?

Ian Dilks - 2:09:18

Actually I was going to, obviously the same question but can we just understand, are we

getting lots more in or are we just finding it difficult with resources to cope with the

ones that we're getting?

Chris Usher - 2:09:25

I think it is a case of increased volume.

I think it is increased volume.

Mrs Nimali De Silva - 2:09:39

I think there may be some resource issues in the team, but I think also the complexity

of some of the requests has required more work in terms of review and application of

exemptions as well.

So I think it is a combination of a few different factors.

Charmion Pears - 2:09:54

So we'll see the trajectory improving going forward or what's the plan I guess?

I think we need to do more work to understand those complexity points and align that with

the resource issue.

Chris Usher - 2:10:07

So I'm not sure we'll necessarily see an immediate improvement but that's what we need to take

away and look at.

Okay great and my other one because we've talked about as you said Ian most of this

within the priorities round is MNSI.

We're not hitting our targets there

in terms of investigations being complete within six months.

And I just wondered what the plan was there,

because we haven't spoken much about it.

Charmion Pears - 2:10:28

I don't know if that's one for today,

or maybe one to come back on, because it has consistently

been under target.

It would be maybe perhaps one to come back.

We did raise it when the report came,

and I think there was going to be some looking

at the target, perhaps.

But if maybe next time someone could come back on that,

I couldn't comment on that.

Chris Usher - 2:10:50

I don't know if James or Julian would like to.

MNSI.

I mean, we regularly, previously had an update from Sandy Lewis who came to the board periodically

James Bullion - 2:11:02

to give us the context for this performance.

It has been, I think it's been a consistent challenge for the team in terms of the throughput,

the numbers of investigations recommended to be undertaken. So I think I don't have

the specific answer, but I think it's worth reconsidering that periodic update from MNSI

at the board.

Okay.

Thank you.

Just coming back to FOI, actually, I suppose I'll add a personal perspective, because

Ian Dilks - 2:11:33

some of these do come across my desk either because I'm asked to sign off on them or

they get sent to me as the chair because they get my email rather than going through the

I think that's a good point.

I would make a couple of observations.

The first is that it is sad how many of these are phrased in a

way that's

prefaced on the basis that we individually are working with

others are conspiring to withhold information.

I suspect that's a comment on views on government generally

rather than just us.

but for the benefit of anyone who might be listening,

so I'm absolutely sure you are committed to transparency.

And I hope the sort of discussions we've had on things

like the IT discussion earlier on,

we do commit to being transparent.

Wherever we can, we will.

In addition, second point, though, is in addition

to the complexity that Marlee mentioned is we've got

to be honest, our record keeping is not great,

and that may come up later on.

And sometimes what somebody might think is a very simple task actually is not.

And if we have to go back over years on multiple systems, it can be extraordinarily difficult

or indeed expensive to reply to what might appear to be a very simple request.

So I think it's just worth, I'll make that observation to colleagues, because I probably

see more of it than most of my fellow board colleagues, but also, as I said to the benefit

of everyone listening, we do try very hard, but it can be quite difficult and complex

and potentially costly on occasions.

Stephen.

Stephen Marston - 2:13:01

Really helpful report as always.

Two I wanted to pick up.

The first is the one about colleague sentiment

in the culture and people block.

Because that one seems to have got stuck

and we agreed some time ago in the board

that it's really important that we keep tracking

up -to -date, regular evidence on staff sentiment. I can only assume this one is actually going

back to the Comprehensive Staff Survey, not the Pulse Survey, but we really, really need

to bring back in to this performance reporting dashboard up -to -date, regular, reliable evidence

of staff sentiment because it is so important that we as a board understand how our colleagues

feeling. The other one I wanted to pick up because I thought it was kind of interesting

was the one about number of assessments. Where is it? It was here somewhere. Sorry, number

of quality statement average per assessment because this one has doubled within a year.

We're now doing double the number of quality statements per inspection that we were doing

a year ago.

Is that deliberate or has that kind of just happened as teams have got used to working

with the assessment framework?

Do we know which indicators they're choosing and why?

And do we think at some point we need to start trying to shape this?

Penny Dash did recommend we put more focus on the effectiveness of outcomes and I don't

know whether this increase in the quality statements is getting us to that greater focus

on the effectiveness of outcomes. What's going on in this indicator?

James Bullion - 2:15:18

Who would like to? James?

I think it's an interesting point. We're tracking this for information at one level.

I think when you look at social care, the average actually is 17, so obviously social

care volume is probably driving some of the number.

well and just really me knowing everyone has decided how we're going to implement

it on difficult paper but I just want toOUTBreaking our Bauer involvement goal and as I've

and rating as needed. But I think it probably merits a whole further discussion as to the

quality statements themselves, with Joyce's review I guess strategically is looking at

in any case as part of the enablers to change. So I'm confident, I'm pretty confident

in my point of view, Chris and Zeke, that staff are picking the right statements and

doing that. It's one for observation rather than it's not a performance. The performances

is are you doing the right piece of regulatory work for what you're trying to achieve rather

than which statements have you used, as it were, I think.

Stephen Marston - 2:17:02

If I may, Chair, I think this might be worth sort of exploring a bit further. Firstly,

it surely does have consequences for the work that Suzanne and Chris are doing on what is

a productivity ambition going to look like because the more quality statements we have

per inspection, presumably, the longer they will take. So this is one of several dimensions

in trying to get our heads around what is an appropriate ambition for volume of assessments

given that our assessments are becoming more intensive. The other one is kind of you may

be right that our colleagues are choosing absolutely all of the right indicators for

all of the best reasons, or they may be choosing the ones they feel comfortable with. And I

simply don't know. But, you know, again, I've got in my head something that felt quite important

as a recommendation from Penny Dash, and she's not the only one who was raising this. Are

things because the quality indicators are our mechanism for focusing or not on the right

things. So I think it's kind of worth some evaluation. Why are our teams choosing these

particular indicators and should that be something we have a view on?

Joyce, do you want to comment on it? I don't know whether Julia wishes to, but I'll come

to you first, Joyce.

Joyce Frederick - 2:18:36

So I would agree with Stephen that we should actually do some analysis on what indicators

that we choose in and why.

And I do agree with James, as in they're probably

doing it's an observant thing that you look at in terms

of what quality statements they choose,

as in they are doing it in response

to the professional judgment on risk.

So both apply.

They're not mutually exclusive.

And it's very important for us to understand

what we're looking at.

The issue of if you do more, it takes longer, actually is,

we're not finding that.

The hybrid approach that we are doing in operations

looks at all 33.

and it's a lot quicker. So there's something about, Alessa might want to add, the technology

has been a hindrance. The process of collecting evidence and using that evidence and answering

the questions in the quality statements actually doesn't multiply the more that you use. It's

about being smarter in what you do, what you collect and how you do it to answer those

processes. So it doesn't automatically take longer if you do more. The issue that Penny

has raised in terms of what do we look at in terms of effectiveness and outcomes, that's

not a question of the what, that is a question of the how. So even if we had five, ten, fifteen

quality statements, you would still need to adopt different quality indicators so that

we can start looking at outcomes. The regulations themselves are like systems and processes.

They answer the question of have you done this and then more a compliance check. What

Penny is saying is that our regulation has to move beyond just pure regulations and moving

into this theory of what is the effectiveness of care, what do we know about outcomes of

care and people's experiences and that means we have to develop better quality indicators

around our quality statements. Does that help to explain it? There's a sort of layer and

layering about you've got one step of regulations, then you've got your quality statements, but

then you need to say are we asking those right questions, those acute questions that say

what are people's experiences and what are people's outcomes as well and we have to do

that work, we really have to move from where we are as a regulator and really start focusing

on safety effectiveness and outcomes and people's experiences.

Chris.

Chris Dzikiti - 2:20:55

No, no, thanks, Ian.

What I was just going to add to what Joseph said is, so for the hybrid approach, we have

been encouraging people to do all the college statements because one we wanted a comprehensive

assessment of those services and also to enable us to do the ratings and also to help us to

do the evaluation as well so we understand exactly what we're doing when we evaluate.

So you will see maybe that the average has gone up because we are actually encouraging

people to do the full college statements and it's not taking longer like Josh said. Actually

it's much quicker than what you would expect.

Chris, you wanted to comment and then I had a question.

Then perhaps we'll close it.

I was always going to repeat exactly what Chris has just said.

So the feedback I've had from talking to the team that are doing this work is that

it's actually working better to try and

complete a comprehensive assessment that changes the rating.

Actually, as Joyce and Chris have both said,

it doesn't add more time,

it actually makes a more, it actually makes a better rating and a better report for people

who use services. So I wouldn't think, we don't think this is as functionally linking in more time.

I think this is us settling into a better rhythm of how we assess organizations and provide an

update for the public that is meaningful. Thanks Chris. Can I just ask a question about

Ian Dilks - 2:22:20

how we're prioritizing where we're doing inspections? I mean it's, we've debated over

my time on the board, whether we've got that balance of philosophy right, which is

still something I think needs to be picked up in the future.

But sitting here today, we know we're not doing enough assessments.

We're trying to increase it.

We talked about ensuring that's not doing more of the expensive quality, so we need

to keep the quality up.

But we've got a metric out in the public that is the average age of ratings, which

is going up because of the current level.

But we also recognize that we have tendered over the years

to focus on areas that we think are highest risk

because that best serves our mandate of keeping people safe.

But there's obviously a tension, at least a potential tension.

So I just wonder in this transitional phase,

while we're not doing enough in terms of volume,

how we're approaching the assessment

and getting the right balance between trying

to get average age of ratings down if we can,

whilst at the same time making we are looking

at the errors of highest risk.

I don't know who would be best placed

to answer that question.

James, looks like you're going to.

Can I have a go first, and then Joyce

James Bullion - 2:23:36

can give the correct answer after I've had a go.

After I've had a go, and I'm mainly speaking

from a social care perspective.

But it's worth, isn't it, remembering that the board,

And I think it was, was it March last year in 24, when we were ambitious for 16 ,000 assessments,

we had said at that point that we wanted to shift the ratio from a largely risk -based

approach to a, from a 70 -30 risk versus a frequency to the other way round, 70 % frequency

and 30 % risk.

and we were anticipating the mechanism working properly and we quickly found because of the

issues around the technology that we in fact reversed the 16 ,000 to 5 ,000 in the summer.

We published, I can't remember when exactly it was, but Chris Day was instrumental in

us making the public statement of bringing that number down from an unrealistic number

to a more realistic number and in fact the frequency statement that we'd made at that

which was 70, 30 with 4 % aimed at trying to get, look for outstanding 4 % of our resources,

quickly became unrealistic. I don't think we have published an updated version of that

ambition for this coming year. But we have in the work that Chris is leading on assessment

sort of upscaling, and I'm speaking again about the social care part, there is now a

plan developed that will be a mixture of trying to deal with the 3 .9 years is the frequency

sort of average, to try and bring that down by targeting particular situations where either

we know that a provider is, that we have information and evidence that a provider is sort of ready

for a change, for example, from RI to good, or where we know that we've got a particular

approach that we might take for example in social care for home care where we've got

a potential model about doing more frequent home care inspections and those kind of as

it were non risk based but functional based approaches might then change that frequency

but I don't think we've made a statement Joyce of frequency for 25, 26 which would change

the risk profile that we had adopted last time, which was 70%.

I may wish to comment, Joyce, but perhaps I would suggest that having talked previously

about a business plan and the number of assessments on links and everything else, that something

should be addressed there as to if we are still not going to be able

Ian Dilks - 2:26:23

to get up to the

number we'd really like to bring all ages down, how we're going to address the prioritisation

issue. But Joyce, if people are happy with that, let's capture that as an action. Anything

you want to add?

to change you're not wrong and there's nothing too much that I want to add to what James has said.

I would say that if we're saying what our priorities now we are risk -based, we have been

since Covid and we are risk -based now but what we want to do as an organisation is to become more

risk informed and more predictive because the last thing a regulator wants to do is to arrive too

late and point out problems that people already know so we have to become more risk informed and

and we have to have more predictive data and analysis that helps us as well as looking

at outstanding and innovative care so that we can spread adoption and good practice across

different services.

So we have to make that shift.

As Julian has pointed out, we're not there yet and we've got things to do in terms of

the way we work and absolutely have to enable more assessments.

But that shift has to happen and it has to happen probably at greater speeds than we

are doing now and we need to think about over the next year.

The section 46 statement, which is about how frequently we go out and in what period we

go out, we do, we have a statutory duty to declare that and I'll be working with the

Mali policy legal colleagues and reg leadership to say when can we make that statement.

I think we have to make it really soon.

We are in a place where we're not actually clear ourselves what we can do and how we

can do it, but we can talk about an interim position so that we provide as a clear about

our intentions around priorities and the frequency by which we may want to look at services.

OK, thanks. We're allowed to say perhaps you need to think about that.

Joyce Frederick - 2:28:10

If it's OK, unless

Ian Dilks - 2:28:12

there's any more questions, let's move on from that. Simon, over to you. We allowed

some time from hearing from our networks. It's down to you this time. So I have no idea

what you're going to say. This has been rehearsed, but I'll leave it up to you. But we have sort

20 minutes or so allotted, so we'll leave you to make remarks and then be useful I think

Simon Godefroy - 2:28:34

to leave some time for questions as well if we could. So over to you.

I forgot. Ian feels better now. Thanks for welcoming me to the board and this opportunity.

I really enjoyed yesterday and today. I'm one of the co -chairs of the Disability Equality

I'm also an inclusive mentor.

It's now called inclusive mentoring, not reverse mentoring,

so I correct my colleagues.

And that's been a really positive experience,

so it was good to hear about that in the session on racism.

I think I have got some comments,

and I'm happy to take some questions.

I think, and I don't think, Julian,

this is your first call, but I do want to say,

how you have come to the accommodation

from the Equality Network point of view.

I think you mentioned then within your second sentence

in your opening call, so that made me very happy.

But just the way you've engaged

with all the Equality Networks

and obviously the staff forum have been very welcome,

set a very positive tone.

I think Kate said that when she took over as interim

and chief exec put some stuff in about

all kinds of calls and accessibility.

We were flagging some issues with that

and James took that on.

So you were carrying on what other people had started

but you've taken that forward and that's been

set a really warm and positive tone.

So and we've heard a lot over the last couple of days

about engagement with staff on lots of issues.

I'll touch on some of them but there's a real tone

from a quantitative network point of view that staff are being engaged with and listened to

and that's coming across so that is really good. One of my hobby horses that Jackie will know is

accessibility, so I can't not mention this. I think we've made huge progress, I mean I thank

Jackie for some of the work she's been doing on that. We've got workplace passports in place and

well embedded and I think our third iteration of the workplace adjustment library. Um, and

I think that's made a huge difference in people, everybody trying to get a workplace passport

in place, whether they have a protected characteristic or not, because they may acquire that, they

may get caring responsibilities or something. So that's been a really good thing, um, to

Also, a really niche issue that Jackie and I have worked on is about support officers.

There's three of us in the organisation who have support officers funded by Access to

Work. Traditionally the CQC starts where they had to be freelance or agency. That didn't

didn't work, and Jackie and Hannah really tried to move that forward, and now we have

these support offices employed directly by CQC, but funded by Access to Work, and I'll

let Jackie know, Access to Work are paying the bills for my support officer, so she'll

be very relieved about that.

3.3 Hearing From our Networks

And that made a huge change.

A very small group of us that need that support,

most of us have support for a half hour working week

and that made a huge difference for me

and especially chairing ICTRs,

because we have now a note taking involved.

So thanks for Jackie for that.

And there's been a lot of work about accessibility

and involving the networks in changes to the organization.

I do have a challenge for you, though.

I think accessibility is still something of an afterthought.

And I want to make a challenge as we talk about rebuilding CQC.

It's about building it in from the foundations up.

I think you've probably heard of universal design in terms

of the standards for buildings, like this building, for example, wheelchair accessible,

Braille signs, all sorts of things. And I would want us to look at how we would universally

design CQC to be accessible so that when you ask people if you've got any reasonable adjustment,

people say no, because you're going to do it anyway. Or there's very few of those and

we're still asking people and asking people to repeat.

And if I go to something, I usually

have to spend half an hour looking at accessibility.

And we know how many disabled colleagues.

Half an hour times x is an awful lot of time

that we're not spending doing the job,

because people are talking about accessibility.

So in terms of productivity, Chris, that's a hint for you.

To help with that.

So that's one of the challenges I want to put to you.

The CQC way confidence went down really well.

There was a very positive feeling in the room

and lots of people picked that up

and reported it back to us as network chairs.

I think people are looking for actions

and people do realize it's gonna take time

and that's a challenge from internal comms point of view

They don't want to make the same mistakes you made last time, but they want to see things

happen and I think obviously Peter Gill's report will be instrumental in that.

There were some challenges in terms of accessibility that they would generally address, but it

varied venues.

I was at Bristol, worked really well.

Some people in Manchester found it a too bigger venue with some sound issues.

Other people found venues cramped and they couldn't get the space if they were neurodivergent

and wanted to get out.

So still, but generally, those things went down really well.

The platform, the IT platform, in terms of main comments, was a bit of an issue for people

who use screen readers.

Maybe there's some pluralism in capturing feedback might have helped there.

I do want to speak about the Peter Gill report, although I haven't read it, I didn't have

a chance to speak earlier because it was a lot of discussion. I think the network's really

welcome to have Peter Gill engage with them over this. They definitely felt very listened

to and the high profile to health and safety and staff wellbeing in the report and in the

recommendations is really welcome. I think the anxiety is about how will you engage with

the Quality and networks and staff forum on rebuilding the system and I think we will

look with anticipation at your action plan on actually on how you're going to do that.

and obviously my comment yesterday about accessibility in terms of building it in rather than trying

to fix it after you build the system is something that I think is important.

There have been a couple of recent incidents about leaks of personal information to outside

media, which some of you might be aware about impacting on two members of staff in particular.

This was personal information that staff shared internally as part of Black History Month

and our Wellbeing Week and it wasn't designed outside CQC because it was very personal and

And there was a lot of negative feedback on social media with the agenda, what did the

CQC do in spending money on this when it can't do its day job right.

And I think from a quality network's point of view, this is quite a difficult time in

the international scene.

DEI is a really bad word across the pond.

and a lot of people being completely wiped out. And this makes people who are non -white,

male or heterosexual feel very nervous and very anxious. So life outside CQC is challenging

for some people who represent minority communities, in case of women not minority communities.

um and I think it's really important that the board and CQC and leaders

really carry on doing what you're doing in terms of really signing up to being

an anti -racist organisation that we've heard, supporting our LGBT plus colleagues

as you did Julian was it with last week or the week before with um Historyman

those high profile things are really important because it really reassures

start that this is being taken seriously, so I welcome your continued commitment and

support of that. I do want to talk about recruitment. We've had a recent meeting about recruitment

following our report. I think, to be fair, the equality thing that works, we're a little

In terms of

It really seemed to go with the status quo

Competent -based interviewing which people from with protected characteristics have found really challenging

And it's about how well you are doing content

Competent -based interviewing rather than your ability to do the actual

job

I think that's a really keen

move

to look at how we're doing recruitment. I know that's an ongoing piece of work.

And looking at how we assess people

for jobs, how we support our staff

to move on within the organisation, I think is really important.

And how do we

make sure that

people are successful in moving on and getting promotion

and that sort of thing. And I know from my own experience the idea of going outside of

CQC to get another role with all the support I've had in place is not something I want

to do, especially if you've got a support officer because that's quite difficult. So

I do think it's about that and I think the other part of that is that people who meet

benchmark but haven't got the highest score are put on a ice, people call it, waiting

for opportunity but then they don't get off of them because the recruiting managers don't

look at their list and go out to campaign again and spend money on another campaign

when they might have people already recruited who might be able to do the role or do the

role of development and we may save money on a recruitment campaign but also support

people to develop so I think there's some work to be done on that. Um and I think there

are the career conversations happening but how do they help people move forward apart

from, like my manager said, keep applying for grade A roles, well I have four times.

So I think there's more to do on supporting people to progress.

My last comment, being fairly brief for me, is about accessibility of board papers. I

and speaking and apply CQC style about easy read, use of English and that sort of thing.

I still don't know what a second level, whatever that is. So I think most of the time I manage

to get my head around it but there's still some so I think it's really important that

we do that using plain English. I've had to really work really hard at that in writing

ICTR reports because of trying to explain what is going on and not use assumptions and

stuff. So that will be my final plea and I think I'll draw it to a close at that point.

Simon, thank you very much indeed. I mean, as with some of your predecessors, it's really

Really appreciate that.

It's great to know the sort of positive,

but you've also put down some challenges.

Ian Dilks - 2:42:01

We haven't got time, and I think it's appropriate

to ask the management to respond to individual stuff,

but we've captured that we'll take them away.

We've got time probably for a couple of questions.

I mean, Julie, I don't know

if you have any high -level observation you wish to make,

and then perhaps time for a couple

of questions if people have any.

Julian Hartley - 2:42:16

Yeah, thanks.

Simon, that was great kind of set

reflections really, really helpful. I'm struck by the sort of what feels like a very vibrant

and engaged group of equality networks in this organisation, which is a real positive.

And it's quite exciting actually for me to be able to engage and have a sense of how

how we can frame a culture which is one that is all inclusive and indeed you reference

the societal headwinds at the moment, feels psychologically safe, feels a place where

people can express themselves, can be themselves, can realise their potential, all of those

things can make such a difference to people's lives, I think that as we want to do with

the sectors that we regulate.

So I think the sum of the parts with the Equality Networks is great.

It feels very positive.

I think there's always good challenge as well to keep us thinking and keep us grounded

and focused on what we can do and change.

And I just say encourage to continue the dialogue and the conversation and some of the specifics

you mentioned, recruitment, issues around accessibility, board papers, I like the idea

of the universal approach, building it in.

That's yeah, that's made me think a lot about how we approach some of the work we're planning

to do.

But no, really appreciate it.

And again, thank you for your reflections on the IT review as well, because I think

we hope to make sure we've got a sense of doing justice to what colleagues said to Peter,

so that we can then move on to the plan that Esther will lead, but in consultation and

engagement with you and your colleagues in the networks.

Ian Dilks - 2:44:26

Any time for a couple of questions or comments if people wish to make them.

Anybody? Christine.

Thanks. Thank you, Simon, for that. It was very helpful.

And I think the slots, we've had about four or five of these slots now with different people from different equality networks,

Joyce Frederick - 2:44:45

and they have all given us real insight.

Christine Asbury - 2:44:51

and you've taken us through a whole range of different issues as Julian said both positive

and negative about how it is, that that's an insight that we as non -execs particularly

wouldn't get otherwise so thank you for that. I just wanted to ask you, it's not sort of

directly related to your equality network experience that you're bringing here but you've

said to a couple of us that coming to yesterday's board and today's board has given you a real

insight that you didn't have before into how the board functions and the role and profile

of non -exec members. And I just wondered, I suspect that we as non -execs particularly

appear quite remote and inaccessible to the majority of our colleagues, whether that's

part of their network or not. And I just wondered if you've got any thoughts on how we can become

more accessible and more available and learn more and take on board more of your issues.

Yes, I think, I mean this has been a learning experience to see,

Simon Godefroy - 2:45:54

sometimes grilling, from

the non -execs, the executive and the board members, I think that has been good and that's

really good to see. I mean I think yeah as a frontline member staff we don't really hear

about what the non -execs do and we're used to grilling non -execs if we're frontline staff

in NHS trust but not how they were within the organisation. I know there's a piece of

work still to be done on executive sponsors of the network because at the moment we don't

and have executive sponsors.

That totally understandable,

because of the fluid state of the board.

Our executive sponsor was Edward Prita Sasso,

he was fabulous, he was a really good support to me,

individually, and I started a network,

so I would welcome moving back to executive sponsors

at the right point in the evolution of this board.

But I just wondered if there's a role for Ned in that.

I'm looking at your workload.

I don't know how you would fit it in, but I'm sorry.

I think there is something about whether Ned could be involved

in the quality networks in some way

if there was capacity to do that.

Because I think that would be a way of keeping plugged in.

But obviously, that's a board decision.

You asked me what I thought.

So that's my response.

Ian Dilks - 2:47:29

I mean, it just, simply like that again, leave Julian to think about it, but it was something

we were looking at and planning to do probably about a year ago, and it just got overtaken

by events.

The other observation I make, Christine, is this is the second body in the health and

care system that I've chaired, and even though in the last case we didn't have anything like

the same open forum in public board meetings.

People would come if they wanted, but nobody did.

So on the one hand, we did less.

But I have to say, all the NEDs are much more accessible.

And the single difference was office -based as opposed

to home -based.

So when we come into the office, if we

could walk around the building and meet people,

then that would be much easier.

And it is much more difficult. And I

don't have a solution to that.

And it pervades other things as well.

Anyway, Mark, so a question for you.

And I would just emphasize the importance

and agree with the importance of executive sponsors because I think when we had a higher

Mark Chambers - 2:48:32

level of direct engagement with the network chairs in the past, one of the problems was

that executive level issues, frankly, were just being escalated to us and that wasn't

kind of the right pathway.

So I think we had a proposed model for how it might work with potentially when the chairs

get together, that seemed to be the network chest collectively got together, that seemed

to be a right forum with the executive sponsors there for us potentially to have a role.

But you know, we can't be sort of quasi executive sponsors because I think it just sets expectations

out of whack.

The issues are escalated to us that we're not in a position to actually influence or

deliver on.

So as the work progresses with executive sponsors, as the team crystallises, I think that would

be really helpful to build in some non -exec involvement because we'd love to be involved.

It just wasn't working with the model that we had before.

Thanks very much, Mark.

Charlotte, her last question.

Charmion Pears - 2:49:46

I just wanted to say thank you as well.

I know it's really hard when you come in the first time.

I remember my first public board and it's quite daunting, but you've done a really great job of giving us some insight today.

So thank you for that.

And can I just take the second to explain the second line of assurance?

So if you think about risk, we have a risk, say a risk of health and safety to our people,

and then we have controls or mitigating actions that are in place to stop that risk occurring.

What we need to do is have what are called three lines of assurance that make sure that that control is working effectively.

The first line sits with the management, so the people who are looking after the people in your team, that's your first line.

Your second line, to take health and safety, would be your health and safety function, your people function, and the things you do independently but internally.

So we're talking about what functions we have internally that oversee others that are independent to that function.

And then your third line are independent auditors like GIA.

So you need all three lines of assurance to be working effectively.

So what we were saying this morning is we've got a good third line with our new auditor,

but we need to get the other two lines working strongly, particularly that second one, so

we can work at arm's length but internally.

OK.

Thank you.

That's where they are.

Thanks, Sharmi.

Ian Dilks - 2:51:01

And I hope the hundreds of people listening found that helpful.

Let's pause at this stage.

Looking at the end, I'm not quite sure why we ended up with a break in a very long morning

after about three hours, but I only spotted that this morning.

COMFORT BREAK

And you can't change it at the last minute because people are coming in and out.

Let's take a break.

If we can try and be back at 12 or soon after, that would be really helpful.

I did say there's one other thing I want to slot in,

but we'll make sure we finish by 1 .30.

Okay?

Ian Dilks - 2:51:28

Well, welcome back, everybody.

Thanks to my colleagues for drinking their coffee.

so quickly here. Just before we move back to the formal agenda, just say that we did

spend a considerable amount of time on the IT report this morning. It is going to be

made public. I think it is right, and Chris, I'm looking at you in terms of communications,

if we could just make it clear to the outside world that the board did as expected, consider

the report, they welcomed it. We accepted all of the findings and we endorsed the proposed

actions that we heard from the management and added some points we would like to see

taken account of in the future planning. I think that's quite important since we did

that just to make the point that the board has accepted and endorsed it. We weren't

the formal agenda, so if we could, as I said earlier,

please try and make sure we do keep exactly the time,

if that's okay.

So, Jackie, I think it's to you, we have a quarterly people

and culture report.

We have read it, but I'm sure there's points we want

to highlight, and then we'll go straight to questions.

Yeah, just a few updates from me.

Now, I've looked at this through the lens of our priorities

and colleagues' support.

Jackie Jackson - 2:52:58

So, first.

The first one is around our operational recruitment. Our headcount for inspector assessor is 1003

and the current recruitment campaigns should get us to that figure of

James Bullion - 2:53:27

1003. We will continue

Jackie Jackson - 2:53:32

on with the recruitment by way of a pipeline but what that will do will

support colleagues already in teams by increasing capacity and also help for

the forward planning of performance. That will be underpinned by a review with

ops colleagues of induction and ongoing support and training. We've also

implemented and are using new job advert boards that are looking specifically at geographic,

geographical opportunities and ADI to support our ADI strategy. So like I say that has been

really quite positive and it's been a long time since we've been in touch and distance

of getting to our headcount. In addition to that, the work that we're undertaking at the

moment of consultation on the new inspection job description should also see an increase

in inspectors for those colleagues who are assessors at the moment but want to move across

and are willing to move across into Inspector. So the combination of that should positively

improve and contribute towards performance and planning and the filling of teams so that

actually we've got that teamwork and we've got that team building and colleagues can

work together on that.

Linked to that, equally as important for existing colleagues is our focus on supporting our

absence, recognising the challenges that colleagues have experienced over several months, it will

undoubtedly impact mental and physical wellbeing and really working with line managers on how

we support colleagues back into the business. Regular reviews, reasonable adjustments, workplace

sports, working with our staff networks and ADI colleagues in terms of best

practice. So again, you know, a dual fold in terms of absolutely the right thing

to do from a colleague perspective but also giving colleagues, you know, that

purpose, clarity, belonging, engagement and actually hope for the future will

impact both mental and physical health so we absolutely need to keep the momentum going

on that and with that the real focus on wellbeing that we can sustain that support, be innovative

in the support and be proactive in what we are supporting colleagues with as we go through

our priorities. So happy to take any questions, but they were the three linked activities

that we are certainly working on from the people pack at the moment.

Ian Dilks - 2:56:51

Okay, Jackie, thanks for the paper and the update. Questions or comments? I'll come

Jackie Jackson - 2:56:58

to your first choice, but then to Sharlene. It's just a comment which Jackie is aware

Joyce Frederick - 2:57:06

of in the paper and the slides it talks about having a target number for race and disability

colleagues. We don't have a target in the sense that we will be the equivalent of the

target population. That's the threshold at which we want to go above. I don't care if

we have 100 % people from different backgrounds or different disabilities but it's not a target

as in we will match it and then we will go no further. So it just

Ian Dilks - 2:57:28

needs to be corrected

in forthcoming papers.

Okay, thanks very much, we'll do that.

Sharmi and then James.

Charmion Pears - 2:57:35

Thanks Jackie for a really useful paper, a couple from me.

One not a question for today but if we could reflect on it for the update in May.

We talk about our minority ethnic colleagues within the pack but there's a couple of

areas where things are off kilter.

So one is the vouchers, so it was great to see that the,

that was sort of in line with our colleague proportions

in terms of the other protected characteristics

that it wasn't in terms of race.

So if we can understand that one,

but also while we are seeing increases

in the proportion of our colleagues

that come from minority ethnic groups,

we're seeing a decrease in positions of influence.

So if we can have a chat about that in the round as well

and what Nadia is pulling together,

that would be fantastic.

In terms of sickness and wellbeing, it's really great to hear you talk about that because

it's an issue, as you know, we've been worried about for some time and I think Julian reflected

on this earlier in terms of psychological safety and the importance of it.

One of the things that struck me is that the sickness relating to stress is high, but also

colleagues with protected characteristics are higher in every instance, which points

to a psychological safety issue.

So I think that's something we should have a look at as well if we can please.

And then the final point, and I have raised this before and it's just one of those ones that maybe you can shed some light on for me.

We have a stat that shows that 324 of our colleagues, so 10 % of our workforce, is that right, about 10%, are absent one month in every six.

But our long -term sickness is only 4%.

So we've got colleagues that aren't on long -term sick that are taking the equivalent of one

and six months off.

So I think we need to understand that because that would double our long -term sick or we've

got people who are off for long periods of time not on long -term sick.

I don't understand the 10 % number relative to the 4 % and it could all just be tied into

the round.

So if we can, I think that sickness piece would be useful.

Thank you.

Ian Dilks - 2:59:48

So we'll capture the first point.

James, you want to add?

Aidan Fowler - 2:59:56

I just want to place on record some thanks actually to the people teams for the recruitment

work that's been underway.

James Bullion - 3:00:02

I think it's really impressive to have got ourselves a position where we are within sight

of getting to the right level of establishment, particularly in the operations.

And I know that my colleagues in reg leadership and others have been sort of leaning into

that process of helping to short list.

So it's taken an enormous effort, I know, outside of the people team and as alongside

the people team.

But without that real focus they've given, we wouldn't be in with a chance to now turn

the performance of the organisation.

Aidan Fowler - 3:00:29

Thanks, Jim.

Jackie Jackson - 3:00:31

Ian Dilks - 3:00:32

Simon, did you want to add?

Simon Godefroy - 3:00:34

Yeah, just to slightly take Sharmia's point further about stress -related sickness and

people, disabled colleagues and colleagues with protected categories having a higher

level of stress, sickness, to make the point that stress, that's only indicating people

who are absent because of stress.

Stress affects people's physical health and if you've got a long -term health condition,

So they may be absent because of their physical health

condition, but it may be related with stress,

but not recorded as that.

So I think that's probably an under recording

of the impact of stress.

So I think that means it's really important that we get

to the bottom of stress related sickness,

Ian Dilks - 3:01:19

because not all stress related sickness is reported as such,

Simon Godefroy - 3:01:25

because it exacerbates people long term health conditions.

So that's the point I wanted to make.

James Bullion - 3:01:29

Yeah, thanks Simon, for sure. Absolutely right, so we should capture

Ian Dilks - 3:01:32

that. Any other questions?

Stephen?

James Bullion - 3:01:36

Suzanne Kirwan - 3:01:38

It's a really helpful report so far as it goes. All of these are

Stephen Marston - 3:01:43

important and valuable

data and indicators. But the paper calls itself a people and culture assurance report. And

if I ask what as a board member would I like to be assured about in the people and culture

domain, it would go some way beyond this. I'd quite like to be assured about management

practices. What do we know about whether all of our people are getting appraisals and do

they find them valuable? I'd like to know quite a lot more about productivity. What

do we know? Suzanne, I think, is developing a data set on productivity. I'd certainly

like to know about staff engagement and staff sentiment and how it relates to culture. So

I just wonder whether there's a bit of a stand back to say,

what ought the board to be being assured about,

and do we have indicators that would give us some insight

in getting that assurance?

Because this is really helpful,

but it's kind of only part of the picture

about how well are we deploying our staff resource,

James Bullion - 3:02:50

Stephen Marston - 3:02:51

and how well motivated and engaged are our staff

James Bullion - 3:02:53

in the organization.

I might ask Julianne to respond as well.

Stephanie Tarrant - 3:02:59

I would agree with that, Stephen, and I think even without your comments, this pack has

Jackie Jackson - 3:03:06

been our first step into it because there was nothing but not much over a year ago,

so it was all a bit of finger in the air.

So I think we've had this running for a few months, we've had feedback, and I think probably

in the next few months it's time to review it.

Exactly, exactly that.

And we might say, well actually,

some items will come a bit longer in duration

and we will have a standard agenda

which we can all sign up to.

And also that might make the data more meaningful as well,

looking at the duration

and what's important at the time as well

because it's been pretty stagnant.

But I think it's time to look at it in the round.

Julian Hartley - 3:03:56

I think on appraisal, I was surprised that we don't have an appraisal approach that's

across the whole organization that we can see and track and use positively, both in

terms obviously of objective setting and also personal development plans.

And also, once we have CQC way defined, the way people work, we can track that, we can

use that as part of an appraisal process.

So we did have a discussion about this at our last executive team meeting.

I think we all agreed that that's desirable.

And we asked Jackie and the team to have a look at that and come back with some proposals

on that.

So I do expect to see that improving, taking shape.

and on the sentiment, I'm always a bit wary of asking people too often, but I want to

make sure we've got a tracker of kind of where we are in relation to how colleagues

are feeling because some of the feedback I've had is, can we have more, to quote someone

you'll be familiar with, a little less conversation, a little more action in terms of some of the

just some of the kind of momentum we build.

So I think there's a point about the frequency

and timeliness of that sort of culture,

checkpoint sentiment, survey, staff engagement feedback,

but I think there's some important stakes in the ground

on actual improvements to the processes

that we do and deliver that we want to kind of get into.

So more to come on this.

≫ Thanks, Julian.

Ian Dilks - 3:05:44

If that's okay, Jackie, thank you very much indeed.

There's some points to capture and pick up going forward.

We have another paper from you as well on mandatory learning.

This was a specific request from the board for an update on where

we are.

I know there was one question that Mark was going to ask you, and you may respond to us

without asking about where we are on the bullying and harassment policy.

Jackie Jackson - 3:06:25

So just as a recap, and we've had the conversation around mandatory training a few times over

the last few months, but just as a reminder, the current cycle starts on the 1st of April

and ends on the 31st of March.

So that gives colleagues 12 months in which to complete all the modules of the mandatory

training. This approach we know is problematic. It's difficult to track and if it is left

to the last minute it becomes more of a task than it needs to and we want to assure ourselves

that colleagues are completing the mandatory training that we've set out. So from the 1st

of April this year we will mandate training that has to be concluded in quarters. So quarter

one through to quarter four we will be clear about the topics that have to be completed

in a 12 week period. We will report on that, we will use Christie's team in terms of

comms, regular reporting to line managers and follow up and it will be smaller chunks

to manage. I think that will also support colleagues and managers in the way they approach

this, whether it would be some type of team event, individual protected time, but by doing

it smaller it would be manageable. So that is the proposal which will start on the 1st

of April. And to your point Mark, next week will be the launch of the Bullying and Harassment

Training and that will be in Quarter 1 as mandated to be completed in the first 12 weeks

of the next financial year, along with business continuity.

As an aside, not dissimilar to the People Pack, we are also going to look at the relevance

and whether it's still right for us, the mandatory training we already have, and also what, if

anything, we need to add to it.

Joyce and I have had conversations around old colleagues to undertake some type of mandatory

training on regulation.

So that sort of foundation level and an awareness and I'm sure there will be other topics that

ETA colleagues want to consider.

So in terms of mandatory training I think we're going into next year in a much stronger

position than we've maybe been over the last year to 18 months and I think as well notwithstanding

we know in terms of the priorities that colleagues have had and sometimes when things aren't

reported on or tracked as much they're sometimes lost because there are other priorities that

take preference. So yeah, so that's the proposal for mandatory training.

Okay, thanks Jackie. I'll come to you Mark if you have any follow up on that and then

Siamid.

Mark Chambers - 3:09:38

Thanks, yeah, and it's great to hear that that is happening because I think we've pushed

for that for quite a long time. It's been a very big gap, a very obvious gap, and unfortunately

it's one where we have live issues, so it's not that we haven't done it because we have

no bullying and harassment in our organization, we do. And it's absolutely key to an inclusive

of culture and it's key to psychological safety, so some of the things that we're actually

trying to push very hard on the cultural side.

So hopefully that will help.

I also want to sort of focus on consequence management.

The sanctions for non -completion, anyone who doesn't do it is ineligible for any funded

learning opportunities.

That's not the heaviest sanction I've seen in plenty of other places I've worked.

You wouldn't get a pay rise.

You would. It would be much more significant.

You wouldn't get a bonus.

It would be much more significant real impacts than that.

So I think we need to have another look at that as well.

How can we, what levers do we have and are we using all of them to ensure

that there's proper consequence management?

You know, lead tables for managers showing how their team, you know, those being handed

around at executive teams are pretty powerful.

Being able to do that quarterly is definitely, you know, definitely the right way to do that.

You do a theme by quarter and that's absolutely the way to do it.

But we need to create much more pressure for people to understand that that's important.

And I think if you get that right, also, it stops the risk of everyone deciding that every

– every topic requires mandatory training.

I mean, these are things that should have serious consequences for people if they're

not – if they haven't done it.

These are things that we absolutely need people to do.

It's essential to work here to know and understand the standards we set around bullying

and harassment, the standards we set around IT security and acceptable use.

those are all things that you need to follow

because you're the guardians,

the individual guardians of significant risk.

If it becomes a bit too loose,

it's kind of just here's something

that we think you should know.

I don't have a problem with that being part

of our training suite,

but it should not have the same consequences.

So I think you can keep that,

that you can keep the block, making sure that there are real consequences for not doing

the really important stuff also keeps that list honest, because it's stuff that – where

they – those serious consequences seem proportionate and appropriate for the failure.

Ian Dilks - 3:12:35

Can we capture that as something that needs to be looked at, Mark?

And Sharmi, do you want to speak, and then Esther?

I know it's probably only got time for, but let's take the boat together and then

say if either Jackie or Julia want to have a first -world start to the points race.

But Sharmi, you next.

I just want to start by saying well done to the team and for everyone who's done the training,

Charmion Pears - 3:12:53

because since we looked at this last time, we've seen a really big improvement, so – and

that's not in a time that hasn't been really busy for everyone.

So well done to the team for chasing it, well done to everyone for getting it, because it

is important.

I mean, there's important topics on here, so that's great.

Also, really welcome what you said, Jackie, about looking at what we do in the training.

So just to pick an example, and it's not to undermine where we've got to, but knowledge

and information management, we've got great results, but we've just got an audit back

saying that we're really struggling with our people and Esther's going to deal with this

to manage knowledge and information.

So it's about, as you've said, looking at is the training fit for purpose so that we

know that we're doing it and they can be some quite useful levers when we get these assurances.

Likewise with health and safety it would be really good to, we updated the health and

safety policy last year, the back of it contains a whole lot of risks. Doing a cursory check

to say does our foundation training adequately cover our risks would be an important kind

of cross check. And then finally just to clarify bullying and harassment there was some thinking

at one point in time it would be managers only, can we just get some assurance that

Ian Dilks - 3:14:06

it's going to be everybody. Thank you. Ashley you wanted to comment or question?

Esther Provins - 3:14:10

Yeah thank you and Charming you mentioned a couple of things there that I was going

to refer to but just to say I think you know your comments Jackie around the

content has been reflected is really important because for me there's an

opportunity for us to triangulate this with for example our incidents so how do

we know that our training is effective and what other data do we have that will

give us that wider picture. It's great that we have our kind of stats around completion,

but also the reasons why colleagues do these things. So for example, the knowledge and

information management training is required in order for us, for anyone to be able to

access our systems. So it's mandated and it only happens once. And so the fact that we've

got great, a great kind of completion rate in that, I'm not surprised about at all because

we mandate that people have to do that before we give them access to our systems. However,

is that really representative and effective

in the kind of principles around that,

which this report doesn't go into that in detail,

but I think we've got a really good opportunity now

to think about how do we triangulate this

with what we know around our incidents

and our risk areas, as Charming said,

to give us a wider picture.

Ian Dilks - 3:15:22

I mean, isn't part of that, Esther,

yet another thing that links to the CQC way?

I mean, part of the way it ought to be

to make sure that you are appropriately skilled

and trained to do your job properly. And I absolutely agree Mark, they help with that

sanctions, but CQCA ought to be, we shouldn't need them because people just see it as part

of their job. I mean, that fair Julia?

Julian Hartley - 3:15:43

Yeah, I was going to come in on that point just before then to say good to see the improvement,

Jackie, in the rates, great. Yeah. Good stuff. And I mean I know this is the kind of approach

that having visibility of the data is, creates its own

improvement just by the fact that I know colleagues will be

looking at their own areas and thinking I don't want to be the

one who's in last place.

You know, so there is merit and benefit in sharing the data.

And indeed that goes for things throughout the organization at

team level. My experience is that when teams are clear about the things that they're being

judged on or measured on, they'll respond because they don't want to be in a position

of not being where they need to be. Just one extra point on this, I was really pleased

to do the first corporate introduction last week in Newcastle to new starters. We're reframing

induction process. Part of what I think induction should be about is having a welcome from the

CEO on your first day and being, so I had a good hour with our new colleagues and that

was really, really encouraging. So I think on a range of fronts, good to see they're

sort of starting to make progress but Jackie and the team I know are ambitious to go further

with this so that's good.

particular effort so if we can make sure that there are

this sort of case has change s s

Ian Dilks - 3:17:46

To my fellowivering faculty, thanks,

to you, Dean and everybody else, we can

As Julian said, I mean, there's some ways to go, but at least most of the indicators

are heading in the right direction, so thank you for that.

If we could keep moving on, we have a session on public inquiries update.

We've only allowed 15 minutes for this.

It was a request from the board previously to have an update.

Obviously we're very constrained in what we can say in some cases, so it is – if I say

it's content light, that's not meant anyway an insult.

But we're being joined by Lisa Price and Nimali's team, I hope.

I don't know – Nimali will take the paper as basically rare, but I'll leave it to

you and Lisa to highlight any points you think we ought to be aware of.

Lisa, welcome.

Sorry, we're a bit pushed for time, so we were progressing.

Please take a seat.

When you're trying to speak, you need to press the right -hand button so we can hear

you.

or the camera will focus on you if that's okay.

But, Nawali, leave it to you and Lisa.

So as far as you take the paper, it's rare,

but don't think to highlight those questions.

Thank you, Ian.

Okay, so I'll kick off and then hand on to Lisa.

But very quickly, just to frame this to start off with.

So I think we all know public inquiries are really important,

independent method of investigating complex issues

of deep public concern.

If we think about previous inquiries, they have been a way

of shedding light on injustices of the past,

to provide a means for victims and survivors

to have their voices heard,

and to help rebuild public trust and confidence

following those types of situations.

So in CQC we absolutely recognize

Mrs Nimali De Silva - 3:19:32

the vital importance of public inquiries,

and we are committed to supporting their effective operation.

So currently we are supporting four public inquiries.

Three of those are statutory inquiries

established by the government under the Inquiries Act 2005. That's the Covid Inquiry, the

Thirwell Inquiry, which follows the events from Lucy Lettby's conviction and looks

into the Countess of Chester, the Lampard Inquiry, which is looking at a high number

of deaths of mental health in patients in Essex between 2000 and 2023, and we're also

supporting the Fuller Inquiry, which is a non -statutory inquiry. And the common theme

across all of those, of course, is that CQC's regulatory

activity is being examined as part of the inquiry's

operation, and as a result, as you'd expect, CQC has

core participant status in those inquiries.

And I want to start off just by recognizing the tremendous

amount of effort that has been put in by colleagues

across CQC, so not just in the inquiries team,

which Lisa is part of and I'm responsible for,

but also operations, data and insights, the list goes on.

And those efforts, just to give you a flavor of the types

of work, are very much focused around submitting evidence

to the inquiry in response to inquiry requests,

often to very tight timescales.

They've involved identifying and reviewing large volumes

of material, both electronic and paper,

across multiple systems.

And again, with the timescales of LAMPARD in relation not just

to CQC, but to our predecessors as well.

I won't go into the details of the paper,

but the paper does absolutely recognise some of the challenges that we've encountered

in that respect in locating and reviewing the relevant material for the inquiries and

the paper references the review that's been undertaken of our records and information

management practice with a view to making improvements in that area ahead. I certainly

wouldn't want to preempt what, for example, the Third Will Inquiry will report on and

what recommendations, but I think anticipating is important given that we have had the experience

of being in the farewell hearings, and so that's a piece of work that has been kicked

off ahead of the inquiry reporting.

But also just I think it's important as well just thinking about the conversation earlier

to weave in, Esther, what you were talking about in terms of the wider data strategy

and improvements that are being taken forward as part of the foundational work, because

that too will play a really important role.

In addition, again, a range of CQC colleagues, including Chris S

Gertke, gave evidence at oral hearings in Thirlwell, and Joyce Frederick has met with

the Fuller Inquiry as well.

And we have oral hearings coming up this year in relation to Lampard and COBOL Module 6,

which is impact on the care sector.

And finally, before I hand over to Lisa, the paper flags the financial risk for CQC as

this work has been unfunded to date, but I'm pleased to provide an update to that particular

risk, which is that we now have confirmation of funding for the inquiry's work, which has

come from DHSC, so I think that's a good step forward. Lisa.

Presenter 1 - 3:22:49

Lisa, anything to add?

Mrs Nimali De Silva - 3:22:51

Thanks, Nimali. I just wanted to follow on from what Nimali has

Presenter 1 - 3:22:54

provided in terms of

more of an up -to -date update on the three statutory inquiries following the submission

So, first, inquiry B, the inquiry team just wanted to start by saying thank you to all

the witnesses, including Chris Tzaziki, who provided corporate evidence from half the

CQC.

The inquiry had the closing submissions on 17th and 18th of March.

You may be aware that the chair was asked to consider a request from Council to the

Executive Team for the Council of Chester Hospital to suspend the inquiry.

So that would have been pending the outcome of their appeal to their criminal convictions

and this request to suspend the inquiry was rejected.

We've been provided with an update now that the inquiry will consider maximisation in

the summer of 2025 and that's the process by which core participants are given a period

to respond to any criticisms before the report is published.

And we anticipate the final report will be published in November 2025.

The next inquiry just to provide an update on is the COVID -19 inquiry. So the secrecy

to date provided three statements for the three modules in the inquiry. The secrecy

received a rule 9 request for module 6 of the inquiry and the response has been provided.

So the hearings for module 6 are due to start in June and this will look at the impact of

the pandemic on the care sector. So the final statutory inquiry that I want to provide an

update on is Lampard. CQC has now received a Rule 9 request regarding the role and remits

of CQC and the responses being provided to the inquiry. The inquiry has confirmed that

substantive hearings in April will cover an opening statement from the chair and contextual

background regarding the provision of mental health inpatient care and looking at systemic

issues with the provision of care. CQC's role in the April hearings is to be confirmed.

That concludes my update.

Do we have any questions?

Thanks very much.

I mean, your remarks do flag up.

Well, firstly, we're continually thanking Chris because he had to step in on things here.

Ian Dilks - 3:25:04

But the sheer amount of time and effort and personal commitment that's required

to inform our people, particularly where they're representing CQC,

but weren't involved initially, of which there are quite a lot,

because these things go back donkeys years in many cases and people have moved on.

So we should, I think, bump it off the board,

just to say we do recognize that.

Thank people for the efforts they have made.

Any questions on the paper for either Nimalik or Sara?

Mrs Nimali De Silva - 3:25:28

Chris, you wanted to come in first, I think, and then Mark.

Thanks, Ian.

I just wanted to say a massive thank you to the team,

Chris Dzikiti - 3:25:37

Nimali and the inquiries team.

Because when you're involved in the inquiries,

you see the amount of work which is put into preparing people like us who ended up going

and attending the inquiries, but I just want to say a massive thank you, Nimala and your

team, because they were absolutely amazing preparing for that inquiry and the documents

we had to look at. I think we ended up looking at 62 documents before going to the hearing

and they were summarizing all those documents for me, so I just want to say a massive thank

you. It's a lot of work actually they have to do, so thank you.

Mark.

Ian Dilks - 3:26:14

Mark Chambers - 3:26:17

We're just going to focus on the last paragraph on the last, or the last couple of paragraphs

on the last page. I think one of the challenges that we've had with external recommendations

in its broadest sense is that it's been relatively easy to accept the recommendation. They've

some lessons from it, but how do we translate that

through to concrete actions?

And when we've looked at this at RGC in the past,

we've had a long list of actions that,

sorry, a long list of external recommendations

that we've accepted but not implemented.

So it's great that there is that one list now.

It's on the agenda for the next RGC to have a look at that.

You know, that's an area where I hope as we continue to work on this, we'll get to a position

where we can provide better assurance to the board that the things that we've committed

to do, we've done.

Thanks so much.

Ian Dilks - 3:27:27

I thought you'd comment on that.

And I think there's a, Julian, also a message for your others.

I think in the future when we look at these things and before accepting recommendations,

just make sure we actually can do it, we're aware with all,

we've got the resources, because part of the problem is we've

accepted more than we can possibly take on.

So something's got to give.

Either we don't do it, we have more resources,

and now's not a good time to be asking for more people

to do this stuff.

So I think Mark's point is very well made.

Can I just add, it's an observation,

but it relinks something I really meant to say earlier.

You talked a reference in here to the record keeping,

and then I touched on that earlier,

it's an example, it is a problem for us.

And I think it, just in terms of managing expectations

on Julian, it's worth saying that much of what we've been

doing over the last six and a month is focusing

as priorities of fixing the problems created

by the systems issues.

And that clearly has to remain a priority.

But if you kind of look at the totality of it,

there's then other things that were agreed five

or six years ago that we now think weren't right

and we want to reverse.

Inspector assessor split and some of that,

I think, is on those lines.

So that wasn't a big problem that emerged last year.

It emerged over a period of time.

But we've now determined that something was done not right.

But there are many other things where

we are setting or identifying problems that actually

go back a long way.

So record keeping is not a problem created

by failed transformation.

It's been there ever since CQC was set up.

So I think in terms of Juliet of encouraging applauded,

and the board has made a real effort over the last six

or nine months to get to grips with all these things.

But I think it is just worth recording the fact that there is a long, a large number

of things going back almost to the foundation of CQC that we've now got on the list of

creates.

And they do have implications.

So if our record keeping isn't very good, that creates enormous problems for the organization

to respond and that you've given a great example.

So I think it's worth making that point.

But we absolutely support you, Julian, for witness of any doubt in focusing.

We want you to focus on the priorities, but we do also want you to get a grip of the people

bigger challenges.

Any other questions for Nima or Lee?

Okay, well, thanks very much indeed for joining us.

Keep it brief, but the paper was very clear,

and of course we'll have to keep it under review.

Just in terms of managing time and stroke expectations,

we're only about two or three minutes behind schedule,

so it's very good.

But I do want to shoehorn a couple of things in,

and we have a couple of AOB.

I said we're finished by half one, and we absolutely will, but Julian has got an all

colleague call, so there may be people listening in now, he's letting him speak to them at

1 .30.

So what I'm going to suggest is – or we'll wait till we do – is when we get to the

end of the board meeting, Julian can leave.

We always have another five minutes or so answering questions, but I don't think we

need that for you, Julian.

So it's just a way of making sure I'll meet the 1 .30 commitment, but also you can

I'm going to ask you to join us and get away to join other

colleagues.

Joyce, we have a paper on what's going on in the world.

Fascinating stuff.

We could probably spend a whole strategy day on it but we've

4.0 Policy matters and external environment

allocated you 30 minutes and if you can do it in 25 that would

be great.

And of course there's one major issue not even on the list.

So I presume you're going to take this.

We'll take the paper largely as read, but I'm sure the points you want to highlight

as well as updating for what's not in here.

Okay.

Joyce Frederick - 3:30:57

Thank you very much for the opportunity to go through what's going on in our external

environment.

And you're right, there is a major decision that happened last week or so that is not

on the paper because the paper was submitted before that decision.

I did speak to Julian just prior to this session to say whether he would like to comment on

that just broadly around NHS England and the Department of Health changes.

I don't know whether you want to do that first, Julian.

I'll be quick.

Yeah.

I think we've all heard the announcement.

It's significant.

Mrs Nimali De Silva - 3:31:35

It changes the kind of dynamics of the whole landscape.

Julian Hartley - 3:31:37

And I think ultimately it will have implications obviously for us in relation to our role as

the independent regulator for health and care.

It's going to be important in the context of our work to notice how that transition

is taken forward.

early conversations already with Sir Jim Mackey,

who is leading that transition, his new team in place.

Important that our relationship with NHSE

as it moves into department is good,

already good relationships with colleagues

in the department.

So I think we're reasonably well placed

in terms of our sort of seat at the table

around the plan changes, but watching the impact, obviously, of the really strained

financial challenges faced by the sector, both at provider level and at system level.

In both social care and NHS, this is, when you look at local authority settlements, are

likely so this is going to be a really tough time.

It raises the question that we've looked at before about,

and not for today, Ian, but I think for future consideration

about our role in use of resources assessments

and the partnership that we may have with NHSE

on that issue given the scale of the challenges

that are being faced.

So early days, obviously being worked through,

but I think we're part of the conversation and the planning around how all this will

kind of change and develop, so, and obviously involved in the development of the 10 -year

plan.

Thanks, Joyce.

Thanks very much, Julian.

Joyce Frederick - 3:33:40

Right, so taking the papers read, there were several areas, six areas that I will just

run through and highlight very quickly.

The first is the role of physician associates and anaesthetic anaesthesia associates, which

are healthcare professionals who are trained in a medical model but they are not doctors.

Now we'd be blind if we thought that this isn't a sort of lightning rod debate, really

challenging environment in terms of the culture that's driven around it, in terms of the scope

of these roles and the transparency of these roles to people, patients who maybe think

they are having a doctor and having a doctor's assessment but that's not happening. The debate

is quite fiery I have to say in places and Professor Gillian Leng is undertaking a Leng

review to look at the safety and effectiveness of these roles. We have contributed through

Dr Tim Ballard who is our national professional advisor and it's really important that as

a regulator we talk about our role and our role broadly is about how they ensure that

staff are appropriately deployed and as they're effective in their roles and have effective

supervisory arrangements. So we're neutral on the subject. We want to take the learning

and we want to contribute to the debate. There have been lots of guidance that have been

done by various different bodies and we've issued our own guidance on how we view this

as a regulator in one of our Mythbusters, which is also on our website. So it's a challenging

environment and I think Professor Leng's report will be published shortly, certainly in the

The second area the government announced perhaps a couple of months ago about elective care

reform, and this is really because we, you know, understandably there are very long waiting

lists for NHS care and treatment, and this was about trying to reform the agenda so patients

probably have more power, more power around choice, a different experience if we use digital

technology in a different way, different pathways, because quite a lot of people on the waiting

are actually going to end up having surgery,

but they do need to have diagnosis and assessment

and tests and then be streamlined or triaged

to the appropriate care.

And then making sure that care is delivered in the right place

so having better pathways of care for people

who require surgery.

For us, there may be implications

for our registration, for how we assess,

for how we make sure providers feel empowered

to have that choice.

But also, part of that plan was that we

should have really up -to -date ratings around care.

And we know that some of our ratings are aged,

and we have to have a process by which we can make sure

we've got up -to -date ratings and get back to that position

where we do say this is the quality of care across England.

The third paper, and I may bring James,

you may want to comment on this,

is the Baroness Casey review,

which is looking at the National Care Service

in social care.

It does not report fully until 2028.

It looks at workforce digitalisation and prevention, but there is a shorter -term report in 2026

which is trying to look at some of the immediate priorities and problems.

James, did you want to – because you're doing engagement around this in terms of the

review.

Only to add, Joyce, thank you.

Only to add that we've had an initial roundtable discussion with

James Bullion - 3:36:58

people on the Commission.

Of course, it hasn't started its work yet and it is an independent Commission, but prospects

look good for us giving a conversation. As part of that conversation we've been invited

to consider what regulatory impact we think there could be in some of the initial proposals,

particularly around the workforce issues, the National Care Service, digitalisation

and whether regulation is a lever to bring about reform and change in both short term

and the medium term. Thank you.

Joyce Frederick - 3:37:34

Thank you James. The fourth area is the AI opportunities action plan which the government

announced or published in January. There are two areas for us that we need to think about

as a regulator. First, how we use AI for ourselves so that we become more efficient and effective

as a regulator, so that's the internal use in our data, in our work processes, so that

We are we add value and we use taxpayers money appropriately and secondly how we regulate for AI and

Innovation and growth so the expectations the spread and adoption that we can drive for our regulation in the sectors that we regulate

So across health and social care as well

We are also expected to produce an annual report of our work as part of this new

Opportunities plan so the AI paper that we are bringing and you wanted to come to RGC

but it will need to come to board because it will require board approval because it

covers our regulation and the work that we want to do going forward.

The fifth area is the national insurance and the national living wage increase and the

impact that has particularly in social care and James again you may want to say more.

This particularly and there's work being done by the Nuffville Trust and others which show

this particularly has an impact on social care in terms of staff costs and the cost

it takes to commission that care, particularly in terms of fuel and wages and the sustainability

that some providers are saying about the sector, which may not exist if this was brought forward

for social care providers.

James, you may want to add to this.

James Bullion - 3:39:11

I need to add, Joyce, thank you, that we are monitoring this closely from the position

of market oversight for that particular area where we have oversight and we are talking

regularly to both DHSC and to the Treasury to share our intelligence as to the impact.

There is a question to the board later on, and I've got some more detail then about some

of the percentage indicators that we know about.

Joyce Frederick - 3:39:37

And the last, it's not the last, it's the last in this paper. There have been several

other external factors that influence our work. But the last in this paper, we had Penny

The first one which was focused on us as a regulator and that has a seismic impact on

the way we work and what we do now.

The second report is an independent review of patient safety, also covers quality.

The standpoint really is that we have many organisations involved in patient safety but

we have not made the impact in patient safety in the way that you would expect and Ada you

may want to come in on this.

We do expect, for the reasons that Julian outlined earlier around the changes across

NHS England, the Department of Health, this report is delayed.

It was expected in January, but we do expect it possibly next week, but certainly in spring.

So very shortly there will be something said about what does this regulation look like

across the various regulators.

But Aidan, do you want to add to this?

We've both been on the patient safety across these regulators.

Aidan Fowler - 3:40:43

Yes, I think there are several important points about the report and it's welcome to review

the safety landscape.

Obviously, I have worked in that landscape for the last seven years particularly.

I think it's not right to say we haven't made progress in patient safety and I would

say that wouldn't.

I think there has been progress in patient safety.

Inevitably, I'm going to have a bias on that.

I think some of the references to the amount of cost that's been attributed to patient

safety, some of which is staffing that has much wider impacts on safety alone.

I think sometimes there is a slightly unfortunate narrative in saying we talk too much about

patient safety and not enough about other elements of quality.

I don't think we talk too much about patient safety, but I accept that we need to talk

more about patient experience and clinical effectiveness, the other domains of quality.

So I think that's important.

And I think it is true to say people have found the landscape of safety confusing and

there's been a tendency to add into it each time there is a concern, and therefore considering

the rationalization of that makes sense.

And I think it is welcome, but there's definitely been progress on patient safety, and I would

hate to see us lose that progress in amongst this.

So I think it's important that we recognize some of the impact we have had.

Joyce Frederick - 3:42:02

Thank you, Aidan, and we eagerly await the report.

There are six organizations where they'll look across the landscape and how they probably

could work more effectively together, and that's CQC, us, the National Guardians Office,

Health Watch England, the Health Services Safety Investigation Body, HSIF, the Patient

Safety Commissioner and NHS Resolution and it will talk to the point of what can we do

together or differently to have greater impact, bearing in mind Aidan's words that we've made

some progress. It's about building on this I think.

I'll just finally end on Mark's point actually earlier as in we've had a lot of external

recommendations which we have accepted and perhaps maybe we shouldn't have. We need to

look into that because I don't think there is a huge about, I think it's how we record

Some of those are really long -term cultural recommendations, so they wouldn't actually

have done them by now.

Some of them are things that we need to look at shorter.

This paper points to the fact that actually sometimes they're not recommendations that

you have a choice about accepting or not.

They are things that are going to be expected of regulators.

And I think for us, the choice is about how we do them to make it manageable, rather than

the fact that we say we're not doing them.

Because there's a lot in this paper and a lot of things about how do you change the

and how do we make sure that we are impactful in these areas?

Okay. Thanks, Joyce.

Ian Dilks - 3:43:41

I mean, a couple of quick comments.

I go to questions elsewhere.

On DASH, it will be what it will be,

so no doubt we'll have an update when it's published.

On AI, I mean, there are two elements.

So just to be clear on the impact on the use of AI and things we regulate, we agreed that

initial paper to the RGC, quite agree with you, ultimately comes to the board, but the

RGC, this isn't something we've delegated authority to approve, but we have asked the

RGC as the natural place to review the implications and make recommendations to the board.

But the other thing is about use of artificial intelligence internally, which we touched

on.

I mean, obviously, with everything else going on in recent months, you know, this would

have been for the birds at one level.

But I do think – and I'm also feeding in a comment here from Mark Chakravarti – that,

yeah, I think we'd all be forgiven if the Manchin team were a bit scarred by anything

to do with IT over the last year or so, a couple of years.

But we shouldn't allow that to make us too unambitious, and particularly in areas where

artificial intelligence is well, as a well trodden path

and what we can do elsewhere.

I think we do need to have the ambition.

We've been saying that anyway,

but I think we now have the imperative from outside.

And if we are to be the quality of regulator

that we aspire to be, I don't think we'd be able to say,

and I'm not sure there's a time span,

but 12, 18, 24 months, you know,

we haven't got around to it or we haven't looked.

So I think there is an agenda item there.

Any other questions?

It was just to say on those recommendations, yeah, I mean if we can

Mark Chambers - 3:45:22

start seeing them in terms of, you know, translated into actions with

measurable outcomes, that will be so much easier for us to track. If some

of those are problematic in terms of how they're phrased, then I think we need

to have the courage to redefine them in a way where we're confident that the

action and the outcome that we deliver will address the substance of the recommendation.

Ian Dilks - 3:45:47

Esther wanted to come in, perhaps in response to my comment. You go first then, Esther.

I was going to point to it, Esther, if you have not known because there is work going

Joyce Frederick - 3:45:58

on, AI and data and insights, so I was going to...

Esther Provins - 3:46:00

Thanks, Stuart. Thank you. And just a couple of comments really welcome the approach outlined

and how we support others to do that.

Ian, your comments around what we have on our plate at the

moment are absolutely true.

And quite interestingly, just in the last few hours, the public

accounts committee have released a report about how out of date

technology and poor quality data is even going to impede the use

of AI in the public sector.

So the truth of those words are probably not lost for us given

the conversation today.

However, I think there are real opportunities for us to carefully consider how we do this

well and what we can do quickly to support colleagues.

Colleagues around this table and in the organisation who have been here much longer than I will

know that we have used things like robotics in the past and they have really supported

colleagues to do their jobs well and to support our productivity.

So I think there is some important and priority pieces that we can look at introducing quickly.

However, there will be some time before we can make full use of all the AI capability

that is available to us, not least because of the challenges cited in the news and the

report from the Public Accounts Committee.

Thanks.

Any other – are there any other questions or comments from Joyce?

Ian Dilks - 3:47:28

Okay, look, Joyce, thank you very much indeed for that, but I appreciate it.

This has been bounced off the agenda a couple of times, and every time we bounce it, it

gets a bit longer.

I was also very struck earlier in one of the reports, you were talking about the number

of things that we're inputting to at the moment about change, consultations, or whatever.

So we've already talked about the demands on people in the organization responding to

things like inquiries, who add on consultations,

and that's only going to go up.

It's a not insignificant demand of people's time,

and unfortunately it comes, demands on time of the people

who got these times to spare.

Right. I'm going to slot a couple of things in before we

come to board and committees.

I realized, James reminded me earlier, that we didn't

at any stage talk about where we are on ICS work,

And probably we've got a question later on, which it's probably better we can answer it

by reference to what we've cleared.

So, James, can you update the board and anyone listening on where we are on ICS assessments,

and then Sharmi and I will come to you.

Yes, thank you.

James Bullion - 3:48:36

Yes, so the board will be aware that we've got under the Health and Care Act 2022, we've

got this duty to carry out assessments of ICSs to see whether they are meeting the needs

of their local populations and that we had piloted an approach in 2023 and by the spring

of 2024 we were in discussions with the previous government for signing off the methodology

and an approach. That was then paused as we had not completed with that government the

agreement on our reporting approach and was subsequently paused by the election that followed

And then with the publication of the DASH report, that pause was made formal for other

reasons.

In January of this year, we'd been invited by DHSC to submit a proposal that would look

at a revised approach, including potentially amending our methodology, which we had drawn

up in co -production with NHS colleagues and local government colleagues through the NHS

ConFED and the LGA. It's always been understood that any proposal we make for a piloting approach

in 2526 had to be congruent with our performance improvement as an organisation, but the context

referred to earlier around changes in NHSE and integrated care boards I think have led

to a situation where the Department of now withdrawn their invitation for us to put a

proposal in by the end of this month.

We have reserved a small amount of ICS staff to work on this, so it has an implication

for that group of staff.

We have agreed to stay in contact with the Department for a further conversation probably

in the autumn of this year when the output of the NHS 10 -year plan and indeed the ramifications

of what was referred to earlier around NHS England are clearer. So to be clear with the

board for 25 -26 that means we will cease work on integrated care systems assurance work.

It doesn't mean we won't work on systems and we do have a very strong view that systems

work is a priority for us in that we continue to raise our voice on the impact of system

working on outcomes for people and the operation and outcomes of providers within it, including

local government as well as the NHS. But we will cease our work in this area as a result

of that formality of the pause. And finally, we've asked the Department to write to us,

which they have agreed to do, which will formally cap off the risk that we are not undertaking

in our statutory duty with their agreement, as it were, to not do that. Thank you.

Thanks, James. I think it's pretty clear, but I will emphasise the case, I believe,

Ian Dilks - 3:51:34

that the work of ICS local authorities are unique in all our regular remit that we do

in the ministerial approval, so we can't progress without it. I think you said that,

but I will emphasise it. Any questions for James on that? Stephen.

Stephen Marston - 3:51:49

I think what James has said is really welcome and entirely sensible that we're pausing the

whole thing, because it's not just that ICP budgets have been cut by 50 percent, but there

is clearly still debate going on about the role and purpose of ICPs and ICSs anyway.

Are we part of that debate?

because we can't sensibly frame how would you go about inspecting ICPs, ICSs until we

get national clarity, well what is their role, what do we want them for and then we can try

and work out what does good look like in the discharge of that role. But we don't know

that. Are we part of that discussion?

James Bullion - 3:52:37

I think as Julian indicated earlier on, we've got a seat as it were around the discussion

table about how the system model pans out over the next year.

And in addition to that, as part of the 10 -year plan, there is an oversight and assurance

aspect to that too.

So I'm sure we'll be in that debate.

I think as an independent organization, we – my advice to ourselves is to still point

out the benefit of oversight of systems and the impact of particularly how local government

to the NHS work together on people's health and care outcomes is really a really important

priority.

As we've shown with the local authority work, it's a sister to a potentially ICS work of

the future.

It makes sense for that to be considered in the round as part of the description that

Julian gave earlier.

Julian Hartley - 3:53:27

Julian?

Yeah, just to add to that, I would hope, Stephen, that we'll have, we do have and will have,

particularly with four chief inspectors in place working as a team, quite a bit to say

about what the evidence is telling us about when systems work well together, when you

have social care, primary care, hospital, voluntary sector mental health effectively

working as a system thinking about patient pathways rather than individual institutions.

I think we'll be able to bring quite a bit of insight,

data, some thought leadership to that hopefully,

and that I think is an important part of what we can add

as an independent regulator.

Ian Dilks - 3:54:20

Thanks, Julia.

And then the other thing is we didn't have an update,

I will use ARAQ, the ARAQ on the agenda today,

didn't think it was necessary,

but we spent quite a bit of time earlier

talking about governance, particularly in the context of the Peter Gill IT report.

So I thought it might be helpful, Sharmini, if you just give a very brief update, not

on everything Eric's doing, but just those things related to the governance topic.

Charmion Pears - 3:54:47

Thanks.

So just building on Peter's report and the discussions we had this morning, as Ian said,

we thought we'd take the opportunity to talk about what the Audit and Risk Assurance Committee

So we have done, in terms of the plan for the year and to try and sort of look at how

much assurance we can take in some vital areas.

So for those colleagues who don't know, we define an audit plan at the start of the

year.

It's agreed March time and that runs from April to March.

And in last April we commissioned an audit plan and a number of those audits completed

and are still coming.

but just to give our colleagues a flavor of those to complement the work that the team

have done on the IT work.

So there's been an audit on risk management, given the issues we have as an ARIC with the

reality of the risk register and looking at how we do risk management and how that could

be done better.

There's been one on data governance.

This arose out of obviously the notifications and the issues of the data flows, but also

as some of the data breaches that occurred in sort of the first and second calendar quarter

of last year. We've had an information governance audit done which has been instigated by some

issues as we all know we've had with record keeping, an LLRC audit, a review and audit

into the process around the definition of the values prior to the CQC way. We had asked

and is in the field work now for a governance audit to be done that not only looked at sort

of board governance but the governance of the exec committees and all the way through

which hopefully will complement some of the work Julian was talking about this morning.

Health and safety as I mentioned and the process by which the team look at the benefits realised.

So there's a lot of audits within this year's scope that have been completed and are due

for completion within the course of the next month, month and a half. That then comes back

to the Audit and Risk Assurance Committee and we look at it informing our opinion. I

think it's fair to say that we are expecting like the, from what we've seen and from what

we anticipate, it's not going to be a strong opinion from either the ARIC or the auditors

this year, but the goal for us is to get it on the table and to look at what we need to

to improve across the piece. A couple of other things that colleagues might want to hear

is that in June last year, Chris's team did some work, we called for a review at

Eric of benchmarking of how we look at business cases relative to the Green Book, which is

the government standard for business case work and Nina and Chris's team have done

a lot of work on that to look at where gaps were and what can be done to cover those.

We've had the lead NAO value for money colleague at the Department of Health and Social Care

that covers the health and social care sector at NAO come and talk to the team about value

for money and how value for money should be considered within decision making.

And in relation to freedom to speak up, because that's come up as well, we've now had three

Also, if others want to participate, check out our LAC door.

and around people assurances. It has been a real focus of the audit plan for next year.

So we've just approved that and there's a lot of audits in there. We have tried to change

the balance this year to including more people audits. So some of the audits that are on

there I mentioned earlier, the grievances and disciplinaries. There's one, Julian, you'll

be pleased to know around performance management and how performance management works and there's

on whistleblowing as well. So we are ensuring that of the 16 audits we do, there are a good

balance that cover people aspects as well. So we thought we would just give some update

to some other areas of assurance we're looking for as a board, which hopefully will get everything

on the table. That does put an enormous amount of pressure on the team, but at least we have

everything on the table.

Ian Dilks - 3:59:29

Thanks, Sharmi. I think part of the reason I thought it might be helpful is, you know,

earlier that, you know, the various aspects of governance

need to be looked at.

And that was aimed specifically at learning lessons

for the IT staff.

But I mean, there were a number of related aspects.

And we did say we know a lot of the issues,

so the review's got to be solution focused.

I just emphasize that there was an awful lot of work

going on in the last year.

We have a lot of information.

What we need to do is find a way of finding solutions to that

rather than reinventing the wheel.

So thank you for that, Sharmi.

Right.

I think there's a lot of work to be done.

A couple of what I call administrative things.

Minutes of the previous meeting, they were circulated some weeks

ago, both Shami and Mark Chambers asked for some

amendments to their write -up of their reports and their

committees, which we have done, and I'll reflect on this.

So are people on that basis happy to approve?

Yes?

And then there's a very long action log. I wasn't actually proposing to work through

line by line. There's an awful lot of things I'm proposing that we should regard as closed,

really on virtue of the fact that many of these were actions from last autumn and the

fact that Julian's now arrived is doing some things differently. I think it is overtaken

by events, and I see no point in continuing action that is no longer required.

So I'm not going to go through line by line.

Do you want to – any objections to the items I'm regarding as closed on that basis?

If not, we can hand over a much cleaner list.

There are two red -related items, meaning significantly overdue.

We may be being slightly inconsistent on what the difference between a red if someone else

asked to be deferred or green if I've agreed to a defer.

Also, apologies to Chris Day for that.

But the two red items are the Ofsted response item number one,

which Chris asked to pick up next meeting,

and then a longstanding discussion around out -of -house

inspections, which we asked the RGC to look at,

but I think is still something that's outstanding.

So I regard that as outstanding.

So if there are no comments, I'll take the action log as agreed as well.

Brings in that case to any other business.

I've got a couple of things, but I'll look around the table first of all to see if anyone

else.

6.0 Any Other Business

Julian.

Well, I thought before I go to do the old stuff, I think I recognize Ian.

Julian Hartley - 4:02:09

this is your last board meeting as chair.

And before I hand to Mark, I just wanted to say,

really appreciate the support you've given me personally

and we've worked together for just a few short months,

but nevertheless, support to the changes necessary

and the encouragement you've given me to really pursue that with the team and the way in which

I think we've been able to really, as we've done today, make sure we've been transparent

about the challenges that we face in order to move to a better place.

So I just wanted to note my appreciation of your support and encouragement.

Thank you very much.

And Mark.

Thank you, Julian.

Mark Chambers - 4:03:13

And, you know, your last day in the hot seat, I wanted to make sure that we record the thanks

of the non -executive directors, non -executive members of the board as well.

You know, as we all know, this has been an immensely difficult and at times quite painful

period for CQC and for the board.

And you know, in leading the board, you've shown quite a quite extraordinary commitment

to doing everything you possibly can to get this organization on a pathway to recovery,

and we all owe you a big debt in relation to that.

You know, for those dialing in, you know, know that we do have committees to help support

the operation of the board, but, you know, they may not know, people listening in may

may not know that Ian has also stayed very, very close

to the RGC, the committee I chair,

and to ARAQ, the Charmian chairs,

and has been a standing attendee

and a very active participant at both committees.

We greatly, greatly appreciated his support

and his contributions to our discussions

at a committee level as well.

And of course, you know, have led the REMCO discussions as well, so it's, you know, it

is full on.

And I really don't think there is a widespread understanding of just how pressurized and

demanding the role of chair is.

You know, the sheer volume of formal and informal meetings with colleagues, with key stakeholders,

would have been absolutely relentless.

We see that but we only see half of it. So

You know, we're in awe of the workload that you have taken on in this role

Not on typically I'm afraid, you know, we had a board call

over the summer

where Ian's

holiday in Canada

was interrupted and

And we had Ian's family sitting waiting in the car outside in the car park while we had

what turned out to be quite a lengthy call, much to our embarrassment and shame.

But that was indicative and not untypical.

So I hope that – I think we all hope that whatever you choose to do next, Ian, involves

a better – slightly better balance than this role has offered at times.

But in the meantime, there's the opportunity for you to spend some meaningful, quality

time with your family.

So we wish you great success and all the best for whatever you choose to do next.

But thank you.

Well, thank you very much.

That stole them, my first AOB.

I wasn't aware that was coming, but I appreciate your remarks, Julian, and those comments.

Ian Dilks - 4:06:32

So, as you say, I stepped down on Monday afternoon.

I'm fully expecting before then the department will confirm the appointment of my successor.

The I've made no secret the fact this has not quite panned out the way I expected when

I applied.

And it's been both on the one hand one of the more rewarding jobs I've ever done, but

on the other hand one of those challenging, the last 12 months in particular, both the

nature of things.

You've made a number of nice comments,

but you could have rather, actually, a second holiday I tempted later

on in the year when I was in the meeting, prospective colleagues

for the role that Julian now holds.

And yes, my family are expecting me

to have a little bit more time to spend with them.

So we didn't mention perhaps, and all doing all this

in the Goldfish Bowl, there were dash review.

And then we commissioned Mike Richards to do another review.

And of course the change of government, none of which made

life easier. But I really do appreciate the comments.

It was a very difficult decision.

But I think I will look forward to doing other things.

Don't know what yet.

But I appreciate the support that I have had.

And I wish all of you and also my successor all the best in

taking it forward. So thank you very much indeed for that.

My other AOB will take much less time.

But I'm very conscious of that.

You know, it's the nature of these things that we only look

at the, we focus on the negative.

And unfortunately, the external world only wants to pick

up the things of the negative.

Interestingly, we've had a few examples as we've gone

through today of some things that aren't at all negative.

I mean, even, dare I say, the regulatory platform, you know,

there are things that actually work quite well.

We don't talk about those.

There are other bits of the organization we only hear

of rather frequently.

I made the point in the last meeting,

market oversight does a fantastic job,

and nobody comments on it because it worked partly

to the secret, but also no negatives.

But there are individual bits of the organization as well,

just do well.

And they're very simple examples.

I'm not going to single this out compared to others.

But I discovered quite maximally the other night

that Nimali's team are up for some,

The Attorney General runs some prosecution awards.

The organization has been nominated for Team of the Year.

One of our particular lawyers has been nominated for

Prosecution of the Year.

They'll never get publicity.

It's only one team.

Probably others have done it.

But, you know, I'd just like to recognize the fact we've got

some pockets of excellence all over the place,

and people do well, and we perhaps don't recognize it.

I don't think we'd win any friends in the current

environment if we ran a sort of rah -rah session,

say, I'll be good.

It wouldn't go down well.

But I do think colleagues should recognize,

and anyone listening in should recognize,

there are some very good people doing a very good job

day to day.

And I believe the awards are tonight,

so I should wish you like your short list,

but let's see what comes out of it.

So on that, I'm going to close

Formula the Board meeting.

We will take some questions afterwards,

but this is the end of the board meeting.

So Julian, we will let you go so you can join colleagues.

And then if others could remain with me

just for a few minutes, I will address the questions

that we have had.

I'll touch on it.

Your game's about that, sir.

So one of the questions actually I think

is more or less answered now by the thing I slaughtered

in on ICSs.

But the question was when will integrated care systems

be inspected and reports published?

What we don't know, I suppose, is the answer.

But James, any further comments?

James Bullion - 4:10:16

Well, at the risk of repeating myself from earlier,

after piloting our work in 23 and submitting a proposal

in 2024, we had not reached agreement

with the previous government and had

paused the work when the general election came along.

That was formally paused in October 2024 by the Dash review.

Following the recent Government announcement that NHS England will be brought back into

under the arm of DHSC along with productions planned for ICBs, DHSC have withdrawn a request

they'd made for us in January of this year for a revised piloting proposal in 2526 and

we will cease piloting work in 2526 and review in line with DHSC requirements in future.

The Department of Acknowledge the risk of us not undertaking our statutory duty in this

area and will be writing to us about that.

Okay, thanks James. The second question is also for you. The question that came in was

how does CQC currently view the financial stability of social care services? Now we

Ian Dilks - 4:11:35

presumed from that that it meant adult, specifically adult social care services. I'm not sure

we can comment more widely, but if we add the word adult in, how do we current review

of the financial stability of adult social care services? So I think

James Bullion - 4:11:46

you again, James.

Thank you. Yes. So CQC's market oversight team assessed the financial sustainability

of 67 of the largest and potentially most difficult to replace providers in adult social

care and they together represent around 30 % of the market. From their assessment, the

market oversight assessment of these providers performance in 2024, there are a number of

positive trends that can be identified, an increase in operating margins, an overall

improvement in recruitment and retention of staff alongside some reduction in agency use

as well as a continued rebuild as it were in occupancy levels in homes for older people.

Notwithstanding that though, the increases in national living wage and changes to employees'

national insurance contributions, rates and thresholds which come into effect on 1st April

will increase providers' employment costs by an estimated 9%. Providers are still awaiting

the full details of local authority in NHS 25 -26 funding settlements, but they, the providers,

anticipate that these material cost increases will not fully fund that 9%. And so that may

that in order to remain sustainable they may need to consider some or all of the following

options, which are delayed planned expenditure, reducing costs where it is possible and safe

to do so, increasing fees, particularly for self funders and reviewing any local authority

or NHS contracts profitability and considering whether they can continue the work in some

of those instances.

Ian Dilks - 4:13:52

Thank you very much James, a very comprehensive response there. I hope the person who asked

the question found that helpful. And the third question, this one goes to Krishasra I think.

But a question, and I may add, Chris, but how is CQC planning to reduce its costs?

Chris Usher - 4:14:16

Thanks, Ian. A few things I'd say is one of which we're always working hard to manage

our cost base. I think that's evident with our fee scheme being unchanged since 1920,

2019 -20, which means that any inflation or increases we've had since then, we've had

to manage and absorb them within our ongoing budget.

Currently doing work around our medium -term financial planning, but I think for now at

present our primary focus is around increasing our delivery is what I'd say.

Thanks, Chris.

And I hope this doesn't come as a treat to your question in any way trivially, but as

you said, we actually in real terms reduced the cost significantly over the years, and

And interestingly, it was a thing that – a comment that Mike Richards made when he did

the review for us in the autumn, that we actually had held our fees at a very low level and

actually questioned whether or not we shouldn't have been doing more.

But anyway, he'll be here at this meeting next time so he can comment further if the

question comes back.

On that basis, I think we've answered all questions.

So for those listening in, thank you for joining us.

We hope you found it helpful.

Ian Dilks - 4:15:25

and we'll see you again on May 14th at 9 o 'clock.

Presenter 1

Christine Asbury

James Bullion

Mark Chambers

Mr David Croisdale-Appleby

Chris Day

Mrs Nimali De Silva

Ian Dilks

Chris Dzikiti

Aidan Fowler

Joyce Frederick

Simon Godefroy

Julian Hartley

Jackie Jackson

Suzanne Kirwan

Stephen Marston

Charmion Pears

Esther Provins

Stephanie Tarrant

Chris Usher

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CQC Board Meeting - March 2025 - Wednesday 26 March 2025, 9:00am - Care Quality Commission

CQC Board Meeting - March 2025Wednesday, 26th March 2025 at 9:00am

Agenda

Slides

Transcript

Map

Resources

Twitter

Forums

Speakers

Feedback

Votes

1.0 Opening matters

1.1 Chair’s opening remarks, Apologies and Forward View

Ian Dilks - 0:00:00

1.2 Declarations of Conflicts of Interest

1.3 Any urgent business

1.4 Feedback from the Private Board meeting

2.0 Strategic Discussions

2.1 Independent IT Review

Julian Hartley - 0:08:41

Esther Provins - 0:23:28

Ian Dilks - 0:32:36

Stephen Marston - 0:33:01

Ian Dilks - 0:36:26

Charmion Pears - 0:36:32

Ian Dilks - 0:40:01

Julian Hartley - 0:40:08

Ian Dilks - 0:41:59

Esther Provins - 0:42:01

Ian Dilks - 0:44:32

Mark Chambers - 0:44:38

Ian Dilks - 0:47:46

Mr David Croisdale-Appleby - 0:47:50

Esther Provins - 0:48:27

Christine Asbury - 0:49:28

Esther Provins - 0:51:15

Ian Dilks - 0:52:47

Chris Dzikiti - 0:53:49

Ian Dilks - 0:54:39

2.2 Organisational Priorities Update

Julian Hartley - 0:59:43

Ian Dilks - 1:04:14

James Bullion - 1:04:21

Ian Dilks - 1:06:11

Chris Day - 1:06:26

Chris Usher - 1:07:50

Ian Dilks - 1:08:26

Chris Dzikiti - 1:08:32

Jackie Jackson - 1:10:30

Julian Hartley - 1:11:13

Ian Dilks - 1:11:53

Charmion Pears - 1:12:14

Ian Dilks - 1:14:02

Julian Hartley - 1:14:26

Chris Dzikiti - 1:15:14

Ian Dilks - 1:17:05

Christine Asbury - 1:17:09

Joyce Frederick - 1:18:49

Christine Asbury - 1:20:08

Joyce Frederick - 1:20:15

Ian Dilks - 1:20:47

Mr David Croisdale-Appleby - 1:20:55

Julian Hartley - 1:21:56

Mr David Croisdale-Appleby - 1:24:09

Ian Dilks - 1:24:43

3.3 Hearing From our Networks

Joyce Frederick - 1:26:39

Ian Dilks - 1:26:43

Joyce Frederick - 1:28:28

Ian Dilks - 1:30:53

Presenter 1 - 1:31:28

Ian Dilks - 1:34:23

James Bullion - 1:34:38

Ian Dilks - 1:36:01

Charmion Pears - 1:36:04

Ian Dilks - 1:39:40

Stephen Marston - 1:39:49

Ian Dilks - 1:41:53

Mark Chambers - 1:43:02

CQC Board Meeting - March 2025
Wednesday, 26th March 2025 at 9:00am