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

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

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  1. Ian Dilks
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  1. Julian Hartley
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  10. Esther Provins
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  12. Mark Chambers
  13. Ian Dilks
  14. Mr David Croisdale-Appleby
  15. Esther Provins
  16. Christine Asbury
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  18. Ian Dilks
  19. Chris Dzikiti
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  1. Julian Hartley
  2. Ian Dilks
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  5. Chris Day
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  10. Ian Dilks
  11. Jackie Jackson
  12. Julian Hartley
  13. Ian Dilks
  14. Charmion Pears
  15. Ian Dilks
  16. Julian Hartley
  17. Chris Dzikiti
  18. Ian Dilks
  19. Christine Asbury
  20. Joyce Frederick
  21. Christine Asbury
  22. Joyce Frederick
  23. Ian Dilks
  24. Mr David Croisdale-Appleby
  25. Julian Hartley
  26. Mr David Croisdale-Appleby
  27. Ian Dilks
  28. Chris Day
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  1. Ian Dilks
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  9. Ian Dilks
  10. Stephen Marston
  11. Ian Dilks
  12. Mark Chambers
  13. Esther Provins
  14. Ian Dilks
  15. Julian Hartley
  16. Presenter 1
  17. Ian Dilks
  18. Joyce Frederick
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  20. Julian Hartley
  21. Ian Dilks
  22. Stephen Marston
  23. James Bullion
  24. Ian Dilks
  25. Joyce Frederick
  26. Ian Dilks
  27. Christine Asbury
  28. James Bullion
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  30. James Bullion
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  32. Simon Godefroy
  33. Ian Dilks
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  1. Chris Usher
  2. Ian Dilks
  3. Charmion Pears
  4. Ian Dilks
  5. Chris Usher
  6. Mrs Nimali De Silva
  7. Charmion Pears
  8. Chris Usher
  9. Charmion Pears
  10. Ian Dilks
  11. Chris Usher
  12. James Bullion
  13. Ian Dilks
  14. Stephen Marston
  15. Ian Dilks
  16. James Bullion
  17. Stephen Marston
  18. Ian Dilks
  19. Joyce Frederick
  20. Ian Dilks
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  22. Ian Dilks
  23. Chris Day
  24. James Bullion
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  26. Joyce Frederick
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  3. Julian Hartley
  4. Ian Dilks
  5. Christine Asbury
  6. Simon Godefroy
  7. Ian Dilks
  8. Mark Chambers
  9. Ian Dilks
  10. Charmion Pears
  11. Jackie Jackson
  12. Ian Dilks
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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 into 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. 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 ARAC 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 ARAC called in March for a health and safety audit,
the results of that audit will be coming back to the ARAC
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 Charmion, 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, Charmion, 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' 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
Esther, 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 organisation 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 Chris.
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 - 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 stuck assessments that we had originally.
Ian Dilks - 1:07:41
Thanks Chris. Others? Chris.
Chris Usher - 1:07:46
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.
Ian Dilks - 1:10:26
Jackie, you want to start?
Jackie Jackson - 1:10:29
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 - 1:11:52
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.
Charmion, I'll come to you first.
Charmion Pears - 1:12:09
Thanks. And just wanted to say well done.
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 ARAC 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, Charmion. 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
ARAC and you've done all of it. Audit and risk assurance, for those that don't know,
that's what I mean by ARAC, 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, Charmion, 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, Julian.
And I think it is important, I think the point you're making,
Julian, 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.Ds, 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 sure
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.
Ian Dilks - 1:17:03
Thanks, Chris.
I saw a couple of questions.
Christine, I will come to you first.
Then 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 statements
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 characteristics
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 our
key lines of inquiry and might be the prompts that help them understand what do
Christine Asbury - 1:20:02
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 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 who use 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 who use 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?
(Ian) Yes, sorry.
So already, I think, David, and to answer your question
directly, we've prioritised the essential things
that we need to deliver.
So we've tried to give the organisation 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-publicised 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.
Mr David Croisdale-Appleby - 1:24:06
Well, thank you for that, Julian.
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 organisation 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.
Ian Dilks - 1:24:39
Perhaps that would be a point to pick up when the business plan comes back.
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 pairing back? So we'll capture that. Chris, can I make this last comment from you, please?
Chris Day - 1:24:54
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.
Ian Dilks - 1:26:08
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

2.3 Anti racism: Setting Board objectives

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 anti-racism.
I think we've been joined by one of your colleagues, Joyce.
Yeah, Keira Haynes.
Keira Haynes is joining us.
Ian Dilks - 1:26:41
Just while Keira'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 organisation.
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 Keira is.
Is she dialling in or are we?
(Background) 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, Keira.
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?
Thank you very much, Ian. And I'm really pleased, actually, to bring this paper to
Joyce Frederick - 1:28:35
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.
Keira, 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 brief discussion
today. Anyway, Keira, 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 organisation to turn the dial on the
recruitment, advancement and well-being of our racialised 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 racialised 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 normalising 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
organisation 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, Keira.
You left us with a challenge, so anyone wish to respond?
James, I will come to you first. I did see Charmion. 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
Charmion, 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 organisation 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 worries 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 Keira, do you want
to respond to the points that Charmion 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, Chris
Ian Dilks - 1:39:40
- Day, one of the Chris' saw your hand go up, let me have a brief comment and then Mark and then Esther, 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 organisation 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 Charmion, 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 organisation 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-energise 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 - Chambers. 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 organisation, 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 CQC 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, Esther, Is there anybody else who wants to make a comment? Great, thank you. That was great. Very quickly, really really good to have you
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 Keira. Joyce?
Ian Dilks - 1:47:48
Last comment then.
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 Esther,
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 - recognise 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 recognise 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.
Julian Hartley - 1:50:58
Anything you want to add?
One thing I would like to add, which is sort of breaking news post these papers being written,
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.
Ian Dilks - 1:53:17
Okay.
Can I just, Chris, I don't want to embarrass you but just to 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 - 1:54:15
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 - 1:55:20
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 agenda, 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 relatively properly resourced and so on. And professionally led by experts. It's how we should be right across the service.
I'm sure we will be right across the service doing similar work.
Thank you.
Ian Dilks - 1:58:19
Thanks, James.
I won't repeat what Steve has said, but I was going to write some of the point just
that.
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
an award 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 Cridge 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.
Ian Dilks - 2:01:03
Okay, thank you. Christine.
Christine Asbury - 2:01:07
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.
James Bullion - 2:02:26
Certainly, and Simon will have a perspective on this actually as an expert that may want
to say something.
I mean, you're right about the number, the 25% 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%, 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%
Christine Asbury - 2:04:28
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
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.
Ian Dilks - 2:05:02
Simon, did you want to add?
Simon Godefroy - 2:05:05
Yes, for those of you who don't know, I'm a mental health act reviewer in my day job
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 causing harm to others and they've ended
up in hospital and they get stuck. And they get stuck for years. 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,
Ian Dilks - 2:07:45
as James said.
OK, thanks, Simon.
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.

3.2 Q3 Performance Report Update

Thank you very much indeed.
Let's move on to the Q3 performance report update.
As I said, this is kind of a business as usual.
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?
Chris Usher - 2:08:16
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 taken as read.
I'm happy to do any updates, but I prefer we probably take questions, I think.
Ian Dilks - 2:08:36
Okay, questions for Chris.
Charmion.
Charmion Pears - 2:08:40
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.
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 - 2:09:16
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.
Mrs Nimali De Silva - 2:09:35
I think it is increased volume.
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 - 2:09:50
So we'll see the trajectory improving going forward or what's the plan I guess?
Chris Usher - 2:09:59
I think we need to do more work to understand those complexity points and align that with
the resource issue.
So I'm not sure we'll necessarily see an immediate improvement but that's what we need to take
Charmion Pears - 2:10:10
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.
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, that would be beneficial. Do you want to comment Chris otherwise we can come back to it.
Ian Dilks - 2:10:44
Chris Usher - 2:10:48
I couldn't comment on that.
I don't know if James or Julian would like to.
MNSI.
James Bullion - 2:10:54
I mean, we regularly, previously had an update from Sandy Lewis who came to the board periodically
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.
Ian Dilks - 2:11:27
Okay.
Thank you.
Just coming back to FOI, actually, I suppose I'll add a personal perspective, because
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 proper channels.
I would make a couple of observations for the benefit of everyone listening.
The first is that it is sad how many of these are phrased in a
way that's
prefaced on the basis that we either individually or 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 Nimali 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 - 2:13:00
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 are 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?
Ian Dilks - 2:15:16
Who would like to? James?
James Bullion - 2:15:19
I think it's an interesting point. We're tracking this for information at one level.
Joyce will have a policy led answer to this, but from a practitioner point of view
in terms of Social care - in a way i'm not surprised by the increase
from that particular period to now given the journey that the platform has been on, and our assessment capability over that time.
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.
Inspectors are picking statements they need based on the task in hand.
So whether that's a comprehensive - as it where -
assessment based on risk or whether it's something that's more targeted
and just looking at a couple of statements to update.
So that's what's driving it, I think in that sense Stephen, it's not accidental,
it is based on people's judgement as to what's needed for a particular assessment.
And to translate that into inspection
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 - 2:16:58
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?
Ian Dilks - 2:18:32
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.
Ian Dilks - 2:20:46
Chris.
Chris Dzikiti - 2:20:55
No, no, thanks, Ian.
What I was just going to add to what Joyce has said is, so for the hybrid approach, we have
been encouraging people to do all the quality 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 quality statements and it's not taking longer like Joyce said. Actually
it's much quicker than what you would expect.
Ian Dilks - 2:21:33
Chris, you wanted to comment and then I had a question.
Then perhaps we'll close it.
Chris Day - 2:21:37
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 organisations and provide an
update for the public that is meaningful. Thanks Chris. Can I just ask a question about
how we're prioritising 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 at the expense of 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 recognise 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,
why 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.
James Bullion - 2:23:31
Can I have a go first, and then Joyce
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%.
Ian Dilks - 2:26:09
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 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
Joyce Frederick - 2:26:32
an action. Anything
you want to add?
So James, 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 providers are clear about
our intentions around priorities and the frequency by which we may want to look at services.

3.3 Hearing From our Networks

Ian Dilks - 2:28:05
OK, thanks. We're allowed to say perhaps you need to think about that. If it's OK, unless
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 hasn't 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 Network.
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 board, but I do want to say,
how you have come to the recommendation
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
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 see.
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 stance was they had to be freelance or agency. That
didn't work, and Jackie and Hannah really tried to move that forward, and now we have
these support officers 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.
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 taker 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 organisation.
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 realise it's going to 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
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 Equality 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.
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+ colleagues
as you did Julian was it with last week or the week before with History month
those high profile things are really important because it really reassured
staff 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 a report. I think, to be fair, the equality networks where a little bit underwhelmed by it.
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 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.
Ian Dilks - 2:41:43
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.
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 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.
Christine Asbury - 2:44:35
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,
and they have all given us real insight.
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.
Simon Godefroy - 2:45:48
Yes, I think, I mean this has been a learning experience to see, 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 work 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 Esther's predecessor
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 emphasise 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.
Ian Dilks - 2:49:40
It just wasn't working with the model that we had before.
Thanks very much, Mark.
Charmion, last question.
Charmion Pears - 2:49:45
I just wanted to say thank you as well.
I know it's really hard when you come in the first time.
Jackie Jackson - 2:49:49
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.
Ian Dilks - 2:49:59
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, Charmion.
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.
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 13.30.
Okay?

COMFORT BREAK

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 - Day, 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

3.4 Quarterly People and Culture Assurance Report

that just to make the point that the board has accepted and endorsed it. We weren't formally asked to, but I think in the circumstances that's important. Let's move on to
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.
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 1003. We will continue
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 touching 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 roles. 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 - 2:56:50
Okay, Jackie, thanks for the paper and the update. Questions or comments? I'll come
Joyce Frederick - 2:57:00
to your first Joyce, but then to Charmion. It's just a comment which Jackie is aware
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 needs to be corrected
in forthcoming papers.
Ian Dilks - 2:57:30
Okay, thanks very much, we'll do that.
Charmion 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
in 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?
James Bullion - 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.
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.
Jackie Jackson - 3:00:29
Ian Dilks - 3:00:29
Thanks, Jim.
Simon, did you want to add?
Simon Godefroy - 3:00:34
Yeah, just to slightly take Charmion's point further about stress-related sickness and
disabled colleagues and colleagues with protected characteristics 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,
because not all stress related sickness is reported as such,
because it exacerbates people long term health conditions.
So that's the point I wanted to make.
Yeah, thanks Simon, for sure. Absolutely right, so we should capture
Ian Dilks - 3:01:32
that. Any other questions?
Stephen?
Stephen Marston - 3:01:38
It's a really helpful report so far as it goes. All of these are 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,
and how well motivated and engaged are our staff
in the organisation.
Jackie, I see you want to respond. I might ask Julian to respond as well.
Jackie Jackson - 3:02:59
I would agree with that, Stephen, and I think even without your comments, this pack has
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 - 3:03:54
Yes I agree with that Stephen. Couple of things to respond to - I think on appraisal, I was surprised that we don't have an appraisal approach that's
across the whole organisation 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'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.
Ian Dilks - 3:05:42
Thanks, Julian.
If that's okay, Jackie, thank you very much indeed.

3.5 Mandatory Learning Update

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. The paper itself is reasonably self explanitory. If there was anything you wish to add, can you let us know and then we'll go to questions.
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 - 3:06:21
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 Christine'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
IT 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.
Ian Dilks - 3:09:30
Okay, thanks Jackie. I'll come to you Mark if you have any follow up on that and then
Charmion.
Mark Chambers - 3:09:36
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 organisation, 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, league 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 Charmion, 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 response to the points raised.
But Charmion, you next.
Charmion Pears - 3:12:47
I just want to start by saying well done to the team and for everyone who's done the training,
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 - 3:14:04
it's going to be everybody. Thank you. Esther you wanted to comment or question?
Esther Provins - 3:14:08
Yeah thank you and Charmion 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 Charmion said,
to give us a wider picture.
Ian Dilks - 3:15:20
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, it would be helpful to have
sanctions, but CQC way ought to be, we shouldn't need them because people just see it as part
of their job. I mean, that fair Julian?
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 organisation 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 induction 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 - 3:17:25
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.

3.6 Public Inquiries Update: Thirlwall, Lampard and Covid-19

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 read, 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, Namali, leave it to you and Lisa.
So as far as you take the paper, it's read,
but anything to highlight those questions.
Mrs Nimali De Silva - 3:18:56
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 recognise
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 Letby's conviction and looks
into the Counties 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 recognising 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 Thirwell Inquiry will report on and
what recommendations, but I think anticipating is important given that we have had the experience
of being in the Thirwell 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 Dzikiti
gave evidence at oral hearings in Thirwell, 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.
(Ian) Lisa, anything to add?
Presenter 1 - 3:22:50
Thanks, Nimali. I just wanted to follow on from what Nimali has provided in terms of
more of an up-to-date update on the three statutory inquiries following the submission of the papers.
So, first, inquiry B - Thirwell, the inquiry team just wanted to start by saying thank you to all
the witnesses, including Chris Dzikiti who provided corporate evidence on behalf of 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 CQC
to date has provided three statements for the three modules in the inquiry. The CQC
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?
Ian Dilks - 3:24:50
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.
But the sheer amount of time and effort and personal commitment that's required
to inform our people, particularly when 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 recognise that.
Thank people for the efforts they have made.
Any questions on the paper for either Nimali or Sarah?
Chris, you wanted to come in first, I think, and then Mark.
Chris Dzikiti - 3:25:32
Thanks, Ian.
I just wanted to say a massive thank you to the team,
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, Nimali 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 summarising 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.
Ian Dilks - 3:26:12
Mark.
Mark Chambers - 3:26:15
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 made sense and we've said yes, that's a good thing to do.
We've learnt 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.
Ian Dilks - 3:27:25
Thanks so much.
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, or 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 to nine months, is focusing
as priorities on 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 Julian to be encouraged and 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 organisation
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 Nimali or Sarah?
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
13.30.
So what I'm going to suggest is – or make sure 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 13.30 commitment, but also you can
get away to join other
colleagues.

4.0 Policy matters and external environment

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
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.
Julian Hartley - 3:31:23
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.
It changes the kind of dynamics of the whole landscape.
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.

4.1 Key developments across health and social care and implications for CQC

Joyce Frederick - 3:33:37
Thanks very much, Julian.
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 making sure 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 Spring.
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 lists
aren't 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.
James Bullion - 3:36:53
Only to add, Joyce, thank you.
Only to add that we've had an initial roundtable discussion with people on the Commission.
Because 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 want it 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 Nuffield 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 - 3:39:09
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 the Penny Dash report.
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 Aidan 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 - 3:40:41
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 rationalisation 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 recognise some of the impact we have had.
Joyce Frederick - 3:42:02
Thank you, Aidan, and we eagerly await the report.
There are six organisations 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 landscape across health and social care,
how do you make it better for people using services.
And I just think we just have to work out a way
of how do we get that in our priorities, in our long-term strategy.
And how do we make sure that we are impactful in these areas?
Ian Dilks - 3:43:37
Okay. Thanks, Joyce.
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 management 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?
Mark Chambers - 3:45:16
It was just to say on those recommendations, yeah, I mean if we can
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 - 3:45:46
Esther wanted to come in, perhaps in response to my comment. You go first then, Esther.
Joyce Frederick - 3:45:55
I was going to point to it, Esther, if you have not known because there is work going
on, AI and data and insights, so I was going to...
Esther Provins - 3:46:00
Thanks, Thank you. And just a couple of comments really welcome the approach outlined around our careful consideration around how we use AI. Both internally
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.
Ian Dilks - 3:47:18
Thanks.
Any other – are there any other questions or comments from Joyce?
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 organisation responding to
things like inquiries, who add on consultations,
and that's only going to go up.
It's a non 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 realised, 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 Charmion I will come to you.
James Bullion - 3:48:33
Yes, thank you.
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 25/26 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.
Ian Dilks - 3:51:28
Thanks, James. I think it's pretty clear, but I will emphasise the case, I believe,
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% 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 - 3:52:34
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 organisation, 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
(Ian) 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, Julian.
And then the other thing is we didn't have an update,
I will use ARAC, the ARAC 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, Charmion, if you just give a very brief update, not
on everything ARACs 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
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 ARAC 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 ARAC 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' team did some work, we called for a review at
ARAC 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' 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 quarters worth of updates.
When Caroline comes to the ARAC, she comes with the purpose of talking through themes,
it's really important ARAC understands the themes that are arising from our concerns
that are raised but also that's given us some insight, as Julian mentioned earlier,
into what could potentially be done better in terms of a process.
So we'd hoped to support that as an ARAC. And as Stephen mentioned earlier.
Finally, just to come back to your question earlier, Stephen 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, Charmion, 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, Charmion.

5.0 Board and Committee matters

Right.
I think there's a lot of work to be done.

5.1 Minutes of the previous Public Board meeting held on 5th February 2025

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.

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

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.

6.0 Any Other Business

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.
Julian.
Julian Hartley - 4:02:00
Well, I thought before I go to do the old stuff, I think I recognise Ian.
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.
(Ian) Thank you very much.
Mark Chambers - 4:03:10
(Julian) And Mark.
Thank you, Julian.
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 organisation 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 ARAC, that Charmion 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 pressurised 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
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.
Ian Dilks - 4:06:24
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.
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 the most 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 organisation 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 organisation 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 by accident the other night
that Nimali's team are up for some,
The Attorney General runs some prosecution awards.
The organisation has been nominated for Team of the Year.
One of our particular lawyers has been nominated for
Prosecutor 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 recognise the fact we've got
some pockets of excellence all over the place,
and people do well, and we perhaps don't recognise 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 recognise,
and anyone listening in should recognise,
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 - you're short listed,
but let's see what comes out of it.
So on that, I'm going to close
formally 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.
You're going as well Esther, ok.
So one of the questions actually I think
is more or less answered now by the thing I slotted
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 25/26 and so
we will cease piloting work in 25/26 and review in line with DHSC requirements in future.
The Department have acknowledged the risk of us not undertaking our statutory duty in this
area and will be writing to us about that.
Ian Dilks - 4:11:22
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
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 you again, James.
James Bullion - 4:11:48
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 - probably will - adversley impact financial sustainability. So consequently providers are informing us
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 - 4:13:50
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 Chris Usher I think.
But a question, and I may add, Chris, but how is CQC planning to reduce its costs?
Chris Usher - 4:14:13
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.
Ian Dilks - 4:14:45
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.
and we'll see you again on May 14th at 9 o'clock.