Good afternoon everybody and to those styling and welcome to the public board meeting of the Care Quality Commission on 7th of February 2024, thank you for joining us. I have a number of introductions or welcomes to do firstly I believe everyone on screen can see but can I enter your Shami and
Introductions or welcomes to do, firstly, I believe everyone on screen can see, but can I enter your Shami in pairs over in the corner? who joined us on the first of February so so brand new and will take over has taken over as the Chair Risk assurance
Who joined us on the 1st of February so so brand new and will take over has taken over as the Chair of the Audit and Risk Assurance Committee. we’ve had a number of new non-executive course of the last we’ve had a number of new non executives join us over the
Course of the last few months. and our regulations they have to outnumber the executives but are bringing more people on to the Board has meant that we have been able to appoint some of the executive team to the Board as well so I would like to welcome from our
Places are all familiar with but Tyson apple James Molyneaux and Mark Sutton existing members executive team but now formally joining the boat to welcome are all familiar with but Tyson apple, James Molyneaux and Mark Sutton existing members executive team but now formally joining the boat so welcome colleagues.
We have apologies from one board member Sean Kelley who unfortunately is still ill are cameo administration are for the illness but delighted that prime premature and erroneous works on the team is is whether son I know your shouldering a lot of responsibility and insurance absence so thank you for joining
Erroneous works on the team is is whether son, I know you’re shouldering a lot of responsibility and insurance absence, so thank you for joining us today. the last person will introduce is Alan Sam’s Alan choose the CHA gender Equality Network representative and then it
Might just be helpful if you’d say a few seconds on why you join us thank you very much and yeah thank you for allowing me to join today and here representing all the Equality Network so I’m one of the co-chairs of the gender Equality
Network but it’s also the the raised Disability and carers now x yeah so thank you for allowing Equality Network, so I’m one of the co-chairs of the gender Equality Network but it’s also the the race, disability and carers now ex yeah so thank you for allowing me to be here.
It’s just a really op excellent opportunities ready for Institute to highlights of seldom heard voices were end ahead voices and also it allows me to provide but the nuance perspective or questions based on on things that you know we’re hearing from inequality perspective so nuanced perspective or questions based on on things that
You know we’re hearing from inequality perspective, so thank you very much. flicks Bravo Charlie then it is I find a Christian useful as a sort of conduit to the wider population of our people to the Board so thank you for that and they do colleagues who joined us
Useful as a sort of conduit to the wider population of our people to the board, so thank you for that and indeed your other colleagues who joined us in other meetings. declarations of interests I know there are a couple of things for the record we should note Mark I might start
With you thank you very much just to a new declaration of interest as of January I started as an adviser to archetype which is venture fund based in the US I don’t think it indirect issue there but thank you and Charvy of thank you
I should advise it I am an independent member of the HSE Health and Safety Executive orders and risk committee and if there was ever any items that involve both organisations the HSE and CPC I would bring those this conflict to the attention of the board and secondly my husband is a
Non-executive on a housing organisation and Cornwall where a small part of that business is extra care accommodation regulated by the sea QC again if there was ever to become a topic that was discussed at the Board I would would accuse myself from that conversation OK thanks Charlotte I mean
That the first thing red-handed policy at a mutually ventures rather than conflict thanks, Charlotte, I mean that the first thing mentioned and I policy at a neutrality ventures rather than conflict, but that’s what ever recorded and for the avoidance of doubt Penygarn Road and for the avoidance of doubt, Penygarn Road, your husband
Has, we it was looked at the Department of Health signed it offers a lot of issue on your appointment I was also consulted and I think in the highly unlikely event that we ever this board discuss anything that could come seemingly impact your husband’s rolled out and obviously you would be
Neutral accuse yourself although say it’s unlikely but thank you for a impact your husband’s rolled out and obviously you would be need to recuse yourself although say it’s unlikely but thank you for a declaring it. it’s thoroughly urgent business we haven’t agenda in front
Of us as part or full agenda is there anything else you have people want to put on it before we it’s thoroughly urgent business, we haven’t agenda in front of us and I was quite a full agenda. Is there anything else you have people want to put on it before we stocks
It looks like not the the first item on the agenda is the and Ian as part of your revenue marks you might also pick update from the Executive I would say would allow 20 up a one thing that’s not here which is the work we’ve minutes for that but actually
Recently asked to undertaken nothing but I think that would be of interest both to the board and people listened again so I’m going to allow behalf of Alpha this first session if we try to keep to that apologist if that means we rather
Over at the end I’ll try not to now but just warning in advance that I think we’re those extra points we may just run over slightly at the very end but near of over to yeah thanks for thanks very much Ian and good afternoon
Everybody as he said quite a loss going on at the moment so if I do what I normally do and take this paper and the next paper in in one go and then we can come back with with questions after that so kicking off on regulation 9 A on
Visiting many of you remember particularly during Covid there was a a very important public conversation around the right to visit the right to be a calm to be a CA accompanied by people when you are I I that resident in a
Care home, going to a hospital, or indeed in a in a hospice the LA add in the latter part of last year governments set out a new regulation this Regulation 9 A if relating to visiting visiting it is worth stressing it is care homes is
Hospitals and hospices it is not just not just in social care settings is designed to ensure that people have visitors and can be accommodated by advocates even in the these fairly complex environment but we are whenever there’s a new regulation published we need to publish a 0
Comma we need to be published guidance to accompany that new regulation so we are consulting now on that guidance and that consultation is open until the 20th of February it is worth stressing this is not a consultation on the regulation itself that was carried out by the Department of
Health and social Care last year this is about the guidance component of is the CCSC component so I guess I would appeal to any any members of the public or any providers were listening in if they want to to to comment on our
Guidance than they haven’t told the the 20th February to do so moving on to the next page we are but commencing work on a dementia Strategy we have as part of our purpose the need to regulate providers and to promote improvement is something we we take very seriously and we’ve seen in other
Areas like like maternity services or mental health when we look across the country and look at themes we can make a big difference if we have a thematic approach to to some some sorts of services and that I therefore makes improvement much more structured we feel that given the
Impact of dementia on so many of the people that are being looked after in those that we regulate and indeed sometimes in terms of how it impacts on that are being looked after in those that we regulate, and indeed sometimes in terms of how it impacts on us internally,
The the both in terms of health and social care it’s important to stress this is not again not just a social care issue and that it would be really worthwhile having a a dementia Strategy and we can make sure that the that we can learn lessons from that strategy and then embed them
Into a single assessment framework so that when we are regulating on a regular basis we can link directly back to this dementia Strategy so work is ongoing and and James can talk a little bit more about that if if this dementia Strategy so work is ongoing and and James can
Talk a little bit more about that if, if colleagues would like, moving on to the national maternity programme you will be aware that we carried out a them and maternity programme over the last 18 months or so so we have a a post Covid
View of every maternity service in the country the fieldwork fieldwork was completed over the last 18 months or so, so we have a a post Covid view of every maternity service in the country. The fieldwork was completed in December and we now just writing up those individual provider
Reports the last few are being written up and we’re also going to be doing a summary report from which will spin off a number of other other products and and some of that will be about creating products that that that individual practitioners are using in terms of identifying good
Practice and making sure that we can find ways to in bed that good practice into our own regulation but also encourage all providers to try and try and be as best as good as the best in terms of maternity so we know that it
Is a particularly important area of work and it’s something that over the over the next couple of months you’ll start to see the summary reports coming coming through I want to move on and talk about martha’s rule Martha Mills sadly died in 20 21 after
And a coroner ruled last year that Martha would most likely have survived hot air doctors moved her to an intensive care and listened to the concerns particularly those that were expressed by her her mother about the the case the patient safety commissioner Dr Henrietta Hughes has been
Asked to develop a set of recommendations for for for a martha’s rule in England enabling families to request a clinical review of the care that that they are receiving the scheme is based on practice in are both Australia and and some parts of the UK as well we’ve been passed of of
The work all the way through this and a work is proceeding quite deliberately at pace and our engagements being led by by our colleague George Frederick and the aim is to is to bed the the the martha’s rule the requirements of Martha role again into a single assessment framework so it becomes
Framework, so it becomes an integral part of the way that we regulate moving onto organisational matters we are where we want to we were I’ve I’ve got well I’m pleased to have verbose both prime and Chris in the room today they’ll be talking about
Managing risk in the NHS during winter and a little bit more detail in a second but I think the headline is that we’ve continued to ensure that we work in a proportional way over the winter period balancing the needs of the public with those of of those delivering services under
Very significant pressure I think I think we do need to acknowledge the significant pressure that both health and care system have been under or over this last winter period but also recognising the impact that has on the public and our role as a regulator trying to navigate between those
Two the those those two important per person has on the public and our role as a regulator, trying to navigate between those two, the those those two important PR perspectives this year we for we’ve used the work that we’ve refined over the last couple of years the the there was there was
Very much led by by pram and and colleagues and in the Royal College of emergency Medicine and we’ve we’ve we’ve generate we we we’ve refreshed it but we’ve also again embedded that within our single assessment framework and I think that’s that’s been the new thing this year is that
We’ve been able to make sure that as as part of our regulatory work there is clear regulatory value being derived from that from that work and and prime can talk a little bit more about that in a second exactly one thinks I worked as I will amend we’ve been also working closely with
The the there are other regular NHS groups that manage winter to make sure that we can be the there’s an effective escalation point we understand when things are going PE going going going God grumpy getting particularly badly and in some areas and we can support appropriately
Escalation point. We understand when things are going PE, going going going God grumpy, getting particularly badly and in some areas, and we can support appropriately. moving on to the farewell inquiry we we know that often in terms of the farewell inquiry we’ve received a formal
Request for information and we have been designated as a core participant in relation to the work that we didn’t in regulating the Countess of Chester hospital our first draft a statement has been submitted and will be a and and will be finalised a formally submitted as as a final statement
In the next few days that largely covers the the background to what we do as an organisation or and and statement in the next few days that largely covers the the background to what we do as an organisation or and and and our methodology.
During the the period under review of the inquiry the second part of our submission will be a second statement and that will cover the more detailed detailed issues of exactly why when we went in and who we spoke to and so forth that more detailed specific inspection dimension of
Our inspections of the counties of Chester hospital and we expect hearings to start in the autumn we will obviously be giving evidence at that point in terms of the COVID-19 inquiry we have submitted our application to be a core participant for module 6 which covers the care sector
You’ll recall that we have submitted evidence for earlier modules where we were not a core participant we took advice from the inquiry in and it wasn’t it wasn’t deemed appropriate being a core participant is is a a positive in the sense that enables us to have greater range of access
To material than the average member of the public would have but he does also mean there’s a work and a significant to material than the average member of the public would have. But he does also mean there is a significant amount of work and a significant expectation
The that if we’d get access to the material we have read it analyzed it and again we we we are we are proactively responsive to the information that other people are offering it analysed it, and again, we we, we are. We are proactively responsive to the information that other people are offering
In terms of technology there’s a couple of pieces in the in future regulatory platform through to to making it alive the report around technology significant amount of focus at alive service and that that’s taking up a lot of the time the moment as you would expect
Are of of the both the programme team but also Mark Moxon and and his group I just want to just record an enormous thank you for a number of colleagues who’ve been involved in that the oftentimes we just see this stuff happened seamlessly a very much doesn’t haven’t seamlessly say an
Enormous thank you to to to my technology colleagues for for the great work that have been doing in that area colleagues from the from the the Programme, some of whom will be with us later on we will be launching on new internet shortly whilst there’s
A big technology component to the new internet there’s also a big the there’s also a significant component around refreshed content again Chris and his team have been working incredibly hard to to refresh the around refreshed content again, Chris and his team have been working incredibly hard to to refresh the content of
The internet. the internet in this organisation is a really important tool for inspectors to access quickly guidance and other information and so we want to make sure that it it is as accessible and and as up-to-date as it possibly can be and the ability to search for things quickly is there and hence
The the work that has gone on recently data and inside the data and insight team have been working hard as we’ve been as we’ve gone live with the single assessment framework over the last few weeks they’ve been looking at how the data we’ve been collecting can be can be can be rendered in
A way that’s accessible framework over the last few weeks they’ve been looking at how the data we’ve been collecting can be can be can be rendered in a way that’s accessible to individual managers. individual decision-makers and policymakers to make sure we’re making the best possible use of that of the the data
The that that we are collecting and that those that we and we’re creating new dashboards relatively quickly as one of the the kind of unspoken on on son benefits I think of the system is the ability to take data and very quickly render
That in ways the that it can be used for a range of different purposes which is which is really positive and finally as Ian invites me just talk about where we are in relation to work in in in the Nottinghamshire area around
Mental health trusts you will know in the last few days the the trial of of Mr. Kelly County concluded after he pleaded guilty to 3 Council of manslaughter with diminished responsibility the secretary of State has asked us to carry out a so-called Section 48 Review section 48 of the Health
And Care Act and what that does is it enables the secretary of State to ask us to carry out a piece of thematic work to look at events or themes across the the area that we would normally regulating so we’re doing we’ve been asked by the
Secretary of State to look at at a couple of things one is to look specifically at Mr. Kelly counties care as well as to look at the care that other people with similar conditions have couple of things. One is to look specifically at Mr. Kelly,
Counties care as well as to look at the care that other people with similar health conditions have have received it from the same Trust we’ve also been asked to provide some advert some specific advice around the the the relicensing of the Rampton forensic secure facility ramped
Is one of the three forensic secure mental health hospitals in this country and has some specific specific role to play around around women who’ve been detained but also people people who are Deaf so it has in this country and has some specific specific role to play
Around around women who’ve been detained but also people, people who are deaf so it has some very unique. a very unique role a very unique role in in the country we’ve been asked to do this work at some pace we’ve got colleagues who are on-site doing doing work now and we’re
Expecting to report to the secretary of State in the early part of March for her to make a decision around Rampton 3 Licensing and we’ll be doing case reviews during that period period as well part of March for her to make a decision around ramped and
3 licensing, and we’ll be doing case reviews during that period as well in. thanks are. the huge amount the I’m not going to return to take the items ward by ward of which leaves the colleagues to ask questions but just wondering would it be helpful there was
A lot in here about winter ploughboy would it be helpful just to dive straight to that on the grounds that we’d like to know more so Chris and pro can I hand it to you just to say Don’t repeat the papers that people we’ve read the papers but important
To you just to say Don’t repeat the papers that people who’ve read the papers, but what do you want to highlight because it is an important issue? show justify beginning on that one of beforehand over 2 to Prem as Ian said this is about trying to understand and
Assess risk and what if we know he said very difficult time we’ve also been providing advice and support on assess risk, and what we know he said very difficult time, put first focusing on a system response we know that issues we’ve also been providing advice and support on good
That operate an urgent emergency care don’t all have their practice. origins in urgent emergency care so some of the the support we’ve been providing is around the system context in in different areas I’ll hand over to promote our national professional adviser for urgently and securing a
Second but just to say also our approach hasn’t just been to focus on urgent Care but also focus on building capacity in social care so part of the work we’ve been doing we know that there’s there’s still strong pressure in in in Adult social Care so focusing on building capacity through our
Re-inspection of services particularly prioritising registrations and re-inspection of services that are requires improvement to get to get into good we know that with that good rating they’re more able to to take on further work so I biff I shall handovers premise I think primary can talk through obviously
Able to take on further work. So I biff I shall handovers premise I think primary can talk through obviously premise you know our national pressure advisor but also works are are allayed outstanding trusted Frimley has got some really I think some really interesting insights into the work so far
We will aim to publish a full report on what we found over the winter period to guide our own thinking in terms of system reviews but also to help and support trust as they make those difficult decisions around risk but primary and if you want to say a bit more
Terms of system reviews but also to help and support trust as they make those difficult decisions around risk but primary and if you want to say a bit more about that, thank you Gareth I think what I’ll do is I’ll give you some overview of the current situation and what the CCC response
To the winter pressure and there are few new Single Assessment Framework how actually transform the of objective way of assessing it is I think the first point I want to make is this winter is no different to any other winter in order to understand the problem I think we need
Not only to look at the data but also listened to patients staff and also along with the culture and leadership because they make a big difference I think staff worked very hard the service at the moment in a very difficult circumstances there’s no respite in the NHS winter and also
Is a major spike staff worked very hard the service at the moment in a very difficult circumstances. There’s no respite in the NHS winter and also is a major spike in winter why does is flew Covid in norovirus so that’s piling up the pressure on NHS service so what’s the problem with that
Actually it’s impact on quality and safety of patient care surgeon ambulance call out handover delays crowded emergency departments increased corridor care lack of social care beds these pressures are being crowded emergency departments, increased corridor care, lack of social care beds, these pressures are being compounded by worrying.
Level of staff sickness as well in this winter so these are all causing more problem but I must say despite the changes some trusts have made some improvements better others by doing successful are all causing more problem, but I must say, despite the changes, some trusts have made some improvements better
Than the others by doing successful virtual ward so producing the number of admissions same day emergency care and also other things important thing is collaborative working and also with sharing make a big difference in some places are doing better than the and also other things, important thing is collaborative
Working and also, with sharing make a big difference in some places, are doing better than the other places. I think as we know the only solution to the current problem is a whole system approach that’s the only way to solve the problem the problem actually is a black so like a block in
One part of the system causing serious problem two completely different to the other system particularly there is a gap between the health and social care so that is actually as Chris mentioned it’s a big problem and also the there is the trusts were almost working as series of small islands rather than working
Care so that is actually, as Chris mentioned, it’s a big problem and also the that is the Trust were almost working as series of small islands rather than working together. and also there is we talk about yes there are Holland 20 thousand staff vacancies but there is a lack of teamwork
And most of some of the places complacency and normalisation of certain culture and the situation most of some of the places, complacency and normalisation of certain culture and practice, that’s making the we are committed to work with providers. situation worse. so QC are committed to system wide change to Homogenic
It’s really important and system partners and major stakeholders particularly it’s really important and system partners, and also the major stakeholders, particularly NHS England. to fulfil our role to make sure that social care service provide and also their health provide people with safe effective compassionate high quality care so I think what
We have done this time actually because of the change in our process we are using as Chris already mentioned using the patient first and patient people first documents to support the system to mitigate some of the problems and also as an organisation we want mentioned, using the patient first and patient people first
Documents to support the system to mitigate some of the problems and also as an organisation we want to appreciate. the system in a lot of pressure so we don’t want to increase the pressure by doing some very the system in a lot of pressure, so we don’t want to
Increase the pressure by doing some very intent. inspection to assessment so we are very aware of that so we have frequent conversation with external stakeholders like NHS E regarding our approach inspection to assessment, so we are very aware of that, so we have frequent conversation with external stakeholders
Like NHS E regarding our approach to the problem. we use previous winters call pressure resilient 5 so this time what we have done is we have mapped the pressure Brazilian 5 to single assessment framework and we are going to trial that in different parts of the system to see how
Its work I think I am very confident this new form of Single Assessment Framework will make a better understanding of a problem and more objective and transparent approach single assessment framework will make a better understanding of a problem and more objective and transparent approach.
And also the it’s not this time the inspection is not going to be just emergency department but we want to look at the whole system and how they are approaching the to be just emergency department, what we want to look at the whole system and how they are approaching the risk as well.
There is a good example this approach in East of England recently made a significant improvement and mitigating safety issues there is a good example, this approach in East of England recently made a significant improvement and mitigating safety issues in the system. and also I just wanted to finally before asked for some
Questions in order of the magnitude things right paw right go more than wrong actually so sometimes we spend a lot of time in looking at the wrong things but this important not lose sight of the good things people appreciated time in looking at the wrong things, but this is important
Not to lose sight of the good things people aren’t being appreciative and, there are staff being amazing things often in a very difficult circumstances so I think OK there are difficult situation in the winter but there are pockets of good practice as well I think we need to recognise that as well
I was stopped therefore questions situation in the winter, but there are pockets of good practice as well, I think we need to recognise that as well I was stopped therefore questions. gold during the good practice as well so easy to overlook questions already all of the 300
Gold during the good practice as well, so easy to overlook questions already, all of the 300 subjects we’ve just covered. Christie thank you and more of a more of a sort of common really about the dementia Strategy at the are you ready to
Talk about that yeah so first of all I am very pleased that we are focusing on a dementia Strategy I think it’s very important have also really pleased that it’s cross sector so it’s also health because I my belief is that health lags behind social
Very important to also really pleased that it’s cross sector, so it’s also health because I my belief is that Health lags behind social care. but then I really just wanted to reiterate a couple of points one is the importance of genuine co production which really does involve a wide group of people
Isn’t as points. One is the importance of genuine co production, which really does involve a wide group of people and and isn’t isn’t a sort of after thought and the second is to ensure that we look at innovative practice that is already out there particularly innovative
Providers where there’s a lot to learn particularly from social care and by innovation I don’t natural providers where there’s a lot to learn, particularly from social care and by innovation. I don’t mean technology, I mean actual practice although it says we Oscar the commercial law is gonna also
Thank you about the jokes you although it says we ask him the question I was gonna also thank you about the drugs you want to respond. well thank you and good afternoon and and thanks to Christine for raising the issue is it’s really important
That the dementia Strategy begins with the aim of us improving regulation and starting with the key question is outlined in the paper about what is people’s experience and what’s the experience of carers part of the rationale therefore is to work up the strategy in a way
We can take that into our inspection or our observational frameworks and test as it were provision and healthcare provision against against that ambition. but this process of developing the strategy but this process of developing the strategy and applying that process is also about see QC developing and
Strengthening its own skills level and understanding level both in practice terms for social care and in clinical terms for for health we can only do that actually by bringing in expertise so the very nature of the approach really is to work with national organisations you’ve got
Their expertise and to and to bring it to ourselves and then uniquely apply that to our our regulatory role so I think it’s a really important point the Christine makes that the the co production approach regulatory role. So I think it’s a really important point
That Christine makes that the the co production approach has got to be at the heart of of how we operate in of how we operate it and just just it’s a really important just to state the obvious it’s an incredibly important issue both for older people
And for some younger older people as it were and it’s them now or or after the pandemic has receded it has returned to be the principle cause of death in England and Wales that’s not a death sentence there’s plenty of work that can be
Done with people with dementia plenty of prevention work so it’s a really worthwhile move firstly QC to get into this that can be done with people with dementia plenty of prevention work, so it’s a really worthwhile move. Firstly, QC to get into this improvement agenda
A growing given the increasing prevalence for the issue seems a theological to be commended thank you Mark you had a question that thank you it’s actually to on the broad ranging topics we’ve covered the first one had a question tha, thank you, it’s actually two on the
Broad ranging topics we’ve covered, the first one but still on dementia. again very very welcome the the question is the central question of the way its word I’d wanted confirmation that it will include diagnosis of dementia not just people who have already got the diagnosis because that seems to be a
Very critical part to make sure there’s good care and and if I can be cheeky all the other question which was him on the critical part to make sure there’s good care and and if I can be cheeky all of the other question which was on the him on the emergency care.
Very very helpful mapping of the the PR 5 to the staff it just struck me the one very important line outcomes was blank and I just want to understand whether that’s a didn’t map is or is there something that we’re missing there is
There a gap there is that what should what we would be expecting OK well or James and then I don’t know whether Prebble Chris but I should thank you that’s my second question be at all so we’re doing well James or just to confirm yes the early diagnosis and the and the variable
Experience of that process across England the core of yes, the early diagnosis and the and the variable experience of that process across England. Yes, absolutely at the core of the scalp thank showed grit thank showed grit. just to do to thank to two points on
Just to due to thank to two points on on that. primary care is involved in a co production as well so just to say just to sort of Blink that link those two points back together it starts with the the they’re not just
Involved in a in a production stage so involved right for right from the from from the get-go I think it’s what we’re in terms of the outcomes a lot of this is a is about outcomes at appear elsewhere and noted an emergency care so
We’ll we’re looking at pathways as well and it’s probably not as very not very clear in the document you’ve got there so what we could probably do when we come back with the with the final report will will will show the link between the information we gathered and the wider outcomes because
Part of the following issues here the the the the work we’re doing is around outcomes that happened before people arriving to urgent medical care rather than if letter de adjustments to carry out about the physicality of being in that environment so will will try to cover that of when we
When we part presented the final report back that environment, so will will try to cover that off when we, when we part present the final report back, if that makes sense, yeah I think I think I agree with Chris I think there is a
Good question actually but what we are doing is rather than fixed tapping the outcome the all of the other things a good question actually, but what we are doing is, rather than fixed, tapping the outcome, the all of the other things will. in capture those outcome in this pronounceable rather than
Looking at separately outcome so it will be one of the other three thing will capture the than looking at separately outcome, so it will be one of the other three thing will capture, there was outcome part of it. financial question-mark I I think so but I like the fact
That will get more detail when it comes back to sort of see how it impacts I mean I think we’ve got are always remind ourselves that were were you know outcome sounds very close to impact and that’s what we’re trying to drive so making
Sure that in the approach will be doing the assessments that were actually keep the very close to impact and that’s what we’re trying to drive detail. so making sure that in the approach will be doing the Stephen assessments that were actually keep that always in mind.
And I I understand that it might lie outside of the I wanted to raise 1 about the sole will inquire if were therefore OK to move on to that and it’s really just sort of how do we as an I wanted to raise one about the sole will inquire if were
Therefore OK to move on to that, and it’s really just sort of how do we as an organisation. Take the learning from that whole incident disastrous and and tragic as it was and there is clear that you know we are responding to the Thirlwall inquiry and
Take the learning from that whole incident, disastrous and and tragic as it was, and there is clear that we are responding to the Thirlwall inquiry and that will. hopefully get a full deep understanding of what exactly happened there what went wrong how could it have been avoided
Hopefully get a full, deep understanding of what exactly happened there, what went wrong, how could it have been avoided? and there may be some a sort of different form of learning that that we need in addition to their which is more and there may be some a sort of different form of learning
That that we need, in addition to their which is more about. given developments over the years since the let P given developments over the years since the let P case. do we feel we can now be fully confident that if people had that sort of concern those working in a care setting or
Service users if they have serious concerns would they now be confident with everything that we’ve turned I’ve tried to put in place in raising those concerns would they know how to raise those concerns and would people listen so it’s kind of updating that that whole horrible set of
Circumstances to the present day say with everything now in place Freedom to speak Up guardians the emphasis we put on well led within the single circumstances to the present day say with everything now in place. Freedom to speak Up, guardians, the emphasis we put on well led within the single assessment framework
That the the the welcome we now have to help people raised that the the the welcome we now have to help people raised concerns and worries. could that still happen I think that would be learning for us could that still happen, I think that would be useful learning for us
So that you’re don’t thanks to him and I think that’s a really it’s a really really important question I think there’s a number of there’s a number of strands to to what you’ve just described I think really it’s a really really important question, I think
There’s a number of there’s a number of strands to to what you’ve just described, I think. in terms of Freedom to speak Up as a as a starting point I think I think the notion of of speak Up is now much more
Embedded than it was bear in mind you know the the this relates to events nearly nine years ago so I think people have now seen Freedom to speak Up work well many organisations have got Freedom to speak of guardians that we know we obviously hopes for the Guardian service in fact
I see later on the agenda will we will be hearing from the know we obviously hope to the Guardian service. In fact, I see later on the agenda will we will be hearing from the guardians directly so so in that says I think I think that the architecture is is
Is there the framework is there I still think though as part of our work we are still hearing examples where individuals are not necessarily feeling that they can speak out but I think there’s probably people know how to but whether they choose to for a range of other reasons around
Fearing detriment and so forth is is is I think a it is still as an open question I think I think the the spreading out of speak up as a concept into things like Prophète the professional regulators the professional expectation that
One will speak up as a Dr or nurse him in particular I think he’s more far more embedded than then it won’t than it once well so I think in particular, I think he’s more far more embedded than then it won’t than it once well, so I think I think people know more
If I look at a look on a practical level and within see QC we’ve seen something in the order of about 50 per cent year on year increase in gave feedback on care for members of staff and any died from the public as well because it
That’s a subset of this I think potentially so I think we are better known as an organisation people understand give feedback on care they understand the concepts like Speaker but there is this the this I think they’re continuing question around is the culture in the place of the right
The right thing and is something which within our single assessment framework we are explicitly looking at so again it’s something which which we our single assessment framework we are explicitly looking at. So again, it’s something which which we continue to to test
I don’t think hand on heart I could I could sort of say I am absolutely certain that that people wouldn’t either that the that there would never be a wouldn’t speak absolutely certain that that people wouldn’t even the the that there would never be a situation where someone wouldn’t speak up.
I think in terms of the specifics around maternity we’ve just done the maternity work that I was referencing a few minutes ago and I think again that will give us a sense of of culture within maternity services and whether maternity services as a service type is different to other services I
Suspected may be in some respects but may not be in another respect but I think the other component to this is probably making sure that we’re the Lucy let the case was how long it took the police to the investigate the matter how long the trial took how long the
Jury were out for that would suggest that the case was incredibly complex and and I I sis I I suspect that the the inquiry is gonna struggle to come up with with really short pieces of learning but I do think as we follow the trial
And and and being a core participant will be really helpful because it will enable us to to to to learn as we go during the during the the the inquiry so so I think a number of I think a number of things I I don’t think and I can say a
Definite yes to your question, but it’s the exactly the right questions it is encouraging that things that the organisation was naturally tried to do better and developing appears to be responding in the right way but as you say that what the Committee naturally tried to do better and developing appears to be
Responding in the right way, but, as you say, let’s see what the committee says. would it be right to Strategy would it be alright it’s commended strictly on the dementia Strategy and one for James Reilly around what the dementia Strategy one for James Reilly around what the dementia Strategy means for.
For CCC staff who are carers and whether were considering co-production with carers at sea QC and also just in terms of staff who existing colleagues who developed without 22 co-production with carers at CCC and also just in terms of staff who existing colleagues who developed dementia as without 22 last night,
Thank you yes thanks for the Christian Eleanor and points to a good thank you yes, thanks for the Christian Eleanor, and it points to a good point for. See QC as an employer but actually all employers of large large employers of carer so as as the questioning paper
Says part of are approaching the strategies to consider the lived experience of people with dementia but also their family carers and so a great deal of that our focus will be watched should good look like for those people and some of the research that were undertaking as well to for for
Formally record where best practice and innovation is as part of doing that for us as an employer will learn what good practice looks like and can bring some of that as part of doing that for us as an employer will learn what good practice looks like and can bring some of that into
The organisation. but of course it would make sense to given that we are a large organisation with many family carers inside as to that resources for but, of course it would make sense to, given that we are a large organisation with many family carers inside as to use
That resources for our own internal research so we will be reaching to to to to research, so we will be reaching out to the carers Network to to to to debt, David it’s not just older people but we have an increasing number of people with early onset
It’s not just older people, but we have an increasing number of people with early onset dementia. and that is from really aged 30 onwards which is you know not generally known by by people and these are individuals that also require a great deal of care you might like to
Know that the we we don’t refer people from dementia UK from our nurses to many organisations but the principle one that we certainly we do refer to other Samaritans because so many carers of those with dementia are on the suicide risk list so that offer is there James I I hope it’s
Helpful to you in terms of co production so many carers of those with dementia are on the suicide risk list so that offer is there James, I, I hope it’s helpful to you in terms of co production, etc thank you thank you David I’ve illustrates captured that as election
Takeoff Lloyd Christine we should probably make this the last question whether because we have other people joining us Chris sorry if there was something I’ll come to you but Christine first thank you I just wanted to go back to the the loser, let be.
Thirlwall inquiry and just sort of really to get some reassurance that as an agency that had a at crime that we’ve taken this as an opportunity to learn as we’ve gone along not rather than waiting for what will obviously be a complex thermal inquiry and and probably
Relatively slow as a result of that learning obviously be a complex thermal inquiry and and probably relatively slow as a result of that, but we’ve used the learning opportunities and that, the the analysis of of that will come back to the the the analysis of of that will come back to the Board.
We can certainly do that we absolutely have already done that but we can certainly do future we can certainly do that, we absolutely have already done that, but we can certainly do that and I should point to the future. Chris did you want to say something just it’s it was on the
Point of how we encourage colleagues in organisation E non-state in part by saying we’ve seen a big rise in people using give feedback or care in feedback so direct direct in part by saying we’ve seen a big rise in people using give feedback on care in care settings to give us feedback,
So direct direct frontline, staff we’ve also use different techniques over the past yeah yeah and a half in particular where we’ve brought people out of their normal environment to hear their story so often we have some initial concerns that we’re not here
In everything we need to hear but again when we do a well-led review so we’ve got used to the idea of physically relocating the conversation to a different place so that people feel more able to give their views we’ve also physically relocating the conversation to a different place
So that people feel more able to give their views. We’ve also brought people together as a group so we actually as a group, so we actually brought together. 200 midwives to talk about their anonymously to talk about their experience of care across the country and I think
Both of those techniques are things that we wouldn’t have done a four or five years ago but they are very good at eliciting information that helps us then triangulate what’s actually happening in an organisation and in both instances once helps with the with the overarching report for
Maternity the other one has helped us with to well-read reviews for what would have previously been seen as as very good organisations but it helps to get to the root court so I would like Ian said I think we can say this isn’t that
There’s a perfect answer here but I think there’s some some different techniques that we’re trying to help people feel is that there’s a perfect answer here, but I think there’s some some different techniques that we’re trying to help people feel confident about reaching out
Flicks Chris I think we should probably will want I actually have poor questions on three-year asked one of my colleagues can I just make one as future request I mean it it’s implied that some of the comments but I mean obviously are participating in two significant enquiries neither of
Which were foreseen that we don’t carry lots of staff to do this I know it’s costing us money that we are being funded for and there is also an issue that we are staff to do this. I know it’s costing us money that we are
Being funded for and there is also an issue that we are potentially going to have to run at a cost on some rest systems that we were going to decommission they’re not to hold the data I think it would be helpful though the future ward if we just have some
Siting of what it’s costing the organisation what we’re doing about it and the risks were running as a consequence I mean there is no choice but I think it’d be helpful have that visible maybe that’s what the future thank you very much indeed colleagues I did say I would add that rather
Than its rather than and I thought that there was so much in the it would have been completely wrong to 20 minutes than its rather than, and I thought that there was so much in the it would have been completely wrong to stop it after 20 minutes we
Cater and Chris over to you I think we have a Corporate performance report I think Kate you might want to introduce it usual rules we have read it but Eddie points for the highlight one that will get questions thank you and good afternoon and so this is Corporate performance report for
Quarter 3 I’m gonna chalet hand over to Chris who will talk a bit about a couple of performance highlights and talk about the internal audit actions but first I just wanted to talk a bit about risk so you might have noticed in this
Paper that the risk section is larger than it usually is one that reflects the work we’ve been doing as an organisation to really challenge ourselves about whether we’re judging our risks accurately and particularly on the the kind of question of likelihood so we’ve had discussions
As a SRT 30 groups are senior leadership team we’ve had discussions as an exact team we’ve also benefited from a new risk manager whose calm and and joined our organisation as well so I just want to talk to a couple of risks that
You would have noticed have moved and then I want to talk to the three risks that are still exceeding tolerance if I may say very briefly risk s to around effective governance in place the likelihood of that has reduced as a result of the work we’ve done around establishing sub-committees of
The exact team and really implementing our commitment around one touch decisions decision-making so that has had some successes people and culture Committee about two weeks ago also agreed to that as we would really benefit from having more colleagues doing the job as well so we see that risk coming down
Further in response to getting some more colleagues in the team are working on that as well as three around delivering transformation effectively again that likelihood has reduced because we are now as of yesterday live across the country with our new assessment framework so we were now
Will be as of yesterday working with all providers through providers who are single assessment framework on our new regulatory platform. it’s been a long journey to get to this point and they’re still lots more work to do at us and supporting our providers to work with us differently but a huge success to
Have got here and that risks reflects the fact that we are delivering transformation as we originally hoped to I’m just want to move on down to an P 1 the risk around retaining recruiting are attracting and retaining our work for so this re risk has reduced because actually we
Considered the fact that in the last calendar year in 20 23 we had 30 thousand applicants to wanted to come and work with us as an organisation and these are high calibre at applicants so actually that question about or are we struggling to recruit certainly isn’t the case across the
Board there are still specific challenges around legal technology data and insight that we’re putting plans in place for but we felt on balance we are certainly recruiting a good calibre of colleagues across those other areas are as well as noting those challenges in those recruiting a good calibre of colleagues across those other
Areas are as well as noting those challenges in those couple of groups and then probably the final thing I want to say just going to the exceeding and then probably the final thing I want to say just before going to the exceeding risk is.
1 are operational workforce is not as productive as it needs to be our new single assessment framework is giving us a kind of level of granularity about what our colleagues are doing and where we are with our assessments are providers in a way that we’ve never had it before so now
Any member of the organisation any member of the Exec Team operational managers now have access to a dashboard that shows them wherever it is in the assessment process which quality statements they are assessing against and how far shows them wherever it is in the assessment process which
Quality statements they are assessing against and how far we are away from sharing those results with the public as well so so there’s a there’s just a few highlights about some risks that have moved and are now no longer exceeding tolerance and then I
Just want to talk to the three that are on page 18 of your pack which are the three that are exceeding tolerance the first one is P 1 which is around our colleagues being insufficiently engaged in our cultural change this is a risk that has reduced down since we’ve had a conversation
As aboard about our cultural change plan so we’ve got a plan and over the next couple of months particularly in April and May we are engaging the whole organisation around our values and are associated behaviours so this is a risk that is currently still exceeding tolerance but we
Anticipate in the next three or four months or so that reducing down and coming into tolerance 0 2 0 2 that we don’t make an accurate and timely assessment of the quality of care and risks for people this is a very time specific
Risk and as I say as of yesterday instead of for a for maybe about two months we’ve been working on the two systems depending on where you are in the country yesterday, instead of for a for, maybe about two months, we’ve been working on the two systems depending on where
You are in the country, as we rolled on the single assessment framework across the networks now everywhere in the country is live with our new single assessment framework and our ability to have accurate information that we can share with the public in a timely
Way will increase day on day as that new way of working rolls out so again are whisked at current exceeds tolerance but will be coming back into tolerance we expect by the rolls out. So again I wish the current exceeds tolerance but will be coming back into tolerance we expect by the end
Of the financial year and then finally our last 1 0 5 around Siebel CRM recovery this is are legally legacy system that we are in the process of decommissioning and we anticipate having concluded that by the end of this financial year as well so just aware that we’ve had some discussions particularly in
Our audit risk Committee about a sense that some of these risks aren’t moving or as and where they where they’ve been exceeding toddlers we haven’t had a plan to get them back into place I’m hoping the work that is being done over the
Last month or so show Sir some of those are now back into a place we feel comfortable with and where they’re exceeding tolerance we’ve got a plan now to get them back in into place so that’s what I just want sound risk I’m just gonna
Handover now to talk for Crystal talk about performance and them back in into place, so that’s what I just want sound risk. I’m just gonna handover now to talk for Chris to talk 3 first thing to note is we’ve revise the pack based on about performance and internal audit. France Coote so
Previous feedback, so hopefully. that’s welcome to receive by board are grateful for any feedback after the meeting or ordering or for that matter on the presentation of that to just three errors I was gonna pull out so it was similar to last quarter kind of three probably hot topics safeguarding alerts and
On the presentation of that to just three hours, I was gonna pull out so it was similar to last quarter 23 probably hot topics safeguarding alerts and whistleblowing. we are we are seeing improve trends in this area but our previous dip as any contact centre service went live means
We’re not achieved NAACP eyes we are gap in performance went live, means we’re not achieved, not KPI eyes. We are aiming to close the gap in performance through process review training communication and we now hitting are targeting safeguarding concerns but there’s more to do for example
Safeguarding alerts as you can see in the graph on the right it’s worth noting that we are taking action but this is just pulling out there it’s not timely in safeguarding alerts, as you can see in the graph on the right. It’s worth noting that we are taking action, but
This is just pulling out there. It’s not timely in cases NCSC RAS response times we track for types of call in our call centre let me say we’re just short of target in all except for general enquiries we’ve seen a slight decline from a previous quarter and registration safeguarding and
Mental health lines although in December we did hit the targets for safeguarding challenges faced a largely due to transitional period again with our new regulatory platform but also resourcing challenges in the targets for safeguarding challenges faced a largely due to transitional period again with our new regulatory platform
But also resourcing challenges in the centre. in the last area to pull out would be in the last area, to pull out would be registration. is currently 46 percent of applications were over 10 weeks old this is an increase on the last financial year and the
Previous quarter volume volume of applications continue to to increase we have resourcing challenges both of which have impacted on our backlog and ability to bring it down several initiatives have been put in place as well as a boost to resource it in that service so happy to take
Questions on any of those or any other parts just a couple of its to close on so in terms of our finances the end of September with gotten 8 point 5 million surplus on revenue expenditure that’s a slightly clouded position due to our
Budget profile if you roll it forward to the end of the year forecasts were looking at 5 point 8 million deficit should probably more reflective of our forecast of year forecasts were looking at 5.00.8000000 deficit should probably more reflective of our forecast of our finances this year
That deficit is due to non-recurring pressures such as the closing stages are transformation journey and unfunded work that’s impact in our grant in aid funding such as the COVID-19 inquiry were actively managing both of those to mitigate the overspend on our capital we are 1 point 2
Million overspend for the year to date yeah December that will come down to will focus no 0 point 4 million underspend by the end of the year and that’s following discussions with the Department of Health and social Care on remedial funding for our capital position and then just
One bit of final close on in terms of our internal audit one thing that the that might stand out is that we we have a number of overdue actions in internal audit so we’ve got 302 internal audit actions that we’re tracking just close
To 60 per cent of those who are closed at the time of writing we had 60 that we’re overdue we’ve been hunting needs down one by one you’ll be pleased to know we’ve closed 22 since the time of writing 23 of finalised it just finalising their evidence away and awaiting verification 5
Of asked for an extension with legitimate Les legitimate reasons which leaves 10 that were we’ll chasing down to hopefully will close them all out in due course extension with legitimate Les legitimate reasons, which leaves 10 that were we are chasing down. So hopefully we’ll
Close them all out in due course, and that’s it. For me. duplex Chris Belinda duplex, Chris Belinda. but your but your Michael Mallin. I wonder if he could just elaborate Moran the declining was I wonder if he could just elaborate more on the declining whistleblowing. in performance and what you think that
In performance and what you think, the reasons are behind that. anybody. thank thanks for thank thanks Convener, I think. I think I think the dip earlier on in the year was to do with our changing on onto a new system and I think we
Thought we saw a blip in performance at that point I would like to start into to increase and I think we’re now getting closer to the measure whether we’re striving for thought we saw a blip in performance at that point I’d like to start into to increase and I think we’re now getting
Closer to the measure whether we’re striving for, I think as Chris said there’s an issue of timeliness here about the action taken against them and those who haven’t asked if they are still brand new if notice if they’re being left a about the top priority once but they are they are all
Action is taken against all of the language but as Chris said we continue to engage with with our teams on on what more we can do about that but that we are taking action with just not always doing it within the one day to think his people then not regarding things
Properly in the system rather than actually not being taken there could there could be an element of that year and I think that’s part of the investigation that we’re doing is to have a look at whether whether it’s not being recorded correctly I’ll be fairly confident that our teams are
Taking action because it’s one of their top priorities but of their top priorities, but there may be occasions where they’re not being recorded, but I think the latest uplifting performance is encouraging for exploration any other questions for Kate for exploration and the other questions for Kate or Chris to.
Thanks draft the thank you credits thank you caring for a really helpful report just wanted to pull out kind of a couple of linked to aspects one is I think it is right to note on the organisational transformation just be congratulations and then you’ve achieved go-live right
Across the piece I mean that is a huge huge achievement colleagues right across the organisation have contributed to that has created a huge amount across the piece I mean that is a huge huge achievement. Colleagues right across the organisation have contributed to that has created a huge amount of work.
Great that is really really important aspect of of performance it does then have knock-on consequences through to the risk that you were describing Kate around colleague engagement because we now go into the face of full embedding socialisation everybody owning it feeling understand it filling
Colleague engagement, because we now go into the face of full embedding socialisation, everybody owning it feeling they understand it feeling they can use it. so you know I you you very helpfully described sort of the risk analysis on that and it links very closely to the work
As he said being done on culture the one that isn’t TS them marches there’s also an equivalent need isn’t to sort of secure positive embedding of the whole system with providers and it did make me wonder whether kind of perhaps we needed a little more visibility about how the whole
Transformation programme now it’s in providers and it did make me wonder whether kind of perhaps we needed a little more visibility about how the whole transformation programme now it’s in place and rolled out sits with and works with providers and perhaps I should
Could we should we have a bit more visibility of that bit sits with and works with providers, and perhaps I should could we should we have a bit more visibility of that bit thanks, thank you so much and Stephen and thank you for recognising
The huge amount of effort that has gone into where we are today with go-live across the whole country I think I I wouldn’t be doing it justice if I didn’t I didn’t note the fact that this has been incredibly difficult for people and is still very is still very fresh country went
Fact that this has been incredibly difficult for people and is still very is still very fresh hope we think half of the country went live with this yesterday. and even though because we’ve gone because we rolled out network by network we’ve had the opportunity to address
Issues as they have arisen and those issues have been in kind of 3 groupings ready one has been a technical technology issues where we’ve been able to put fixes in place when we become aware of them some of the the them are being policy issues as we’ve got to grips with implementing
Our fishing around single assessment framework as some of it has been about ways of working so each each time a new Les Network has gone live and there have been less issues but this is still significantly at the significantly different way for our people to work and I think for a
Large number of people despite the training and the fabulous support we have for mob super users’ and many other colleagues this is still a really tough time at the moment so thank you for saying congratulations echo have from our super users’ and many other colleagues, this
Is still a really tough time at the moment. So thank you for saying congregate, congratulate, as I echoey BA, we’re still very much in the thick of it internally and and I’d like to see I don’t know whether Tyson on what might
Want to come in on that but also your point about how we regularly see how this is landing for our providers and I’ll hand over to Chris to comment on on that side of things so it’s a really important point Stephen decision
I’ll hand over to Chris to comment on on that side of things so it’s a really important point Stephen decision just to change of of working waste are working for us it’s also changing the relationship with was use of of working waste are working for us. It’s also changing
The relationship with with providers, and in fact, people use services as well. what I would say is probably probably three things firstly we’d be really grateful not only to colleagues internally but to the organisations that have been part of the early we’d be really grateful, not only to colleagues internally
But to the organisations that have been part of the early adopters Programme. the the the the the tweaks the changes and improvements because they have really helped us understand how the that we want to make to the system in the in in the short system that we’ve implemented and the policy
System works in term it’s fair to say that we’ve we’ve held regular ongoing dialogue with with providers as we do all the time but on this particular topic and we’ve held a number of sessions where we’ve been both providing information and receiving feedback for them on how this is working for them and
That’s influenced some of our guidance that we’ve then issued to providers and how we intend to in 2 2 2. delivered guidance going forward I think the the the the third element for this is what this will mean in terms of what people view in terms of an assessment on the website
And we’ve been having dialogue both with providers and actually with people who use services because obviously this is where it really matters the outcome of this matters so we we we have ongoing dialogue with with providers and people your service about how we intend to improve and I
Think we should we talked to a previous Board about what we want to do in the short term and how he wants to develop in in over the next few months so that it’s a a more real-time view of what we think about the quality through our
Assessment through other information but we have regular dialogue and I think colleagues some colleagues may have joined ESA Wrag which is our external advisory group this week where we talked about transformations one colleagues may have joined ESA Wrag, which is our external advisory group this week where we talked about
Transformations. What is the update topics, a final just end by saying one of the most important bits is that people can hear this and use it to influence what we do next so we produce weekly inside information from both colleagues internally and from the providers
We do next. So we produce weekly insight information from both colleagues internally and from the views of of of providers and another other stakeholders including people who use services and that feeds back into our decision making process and it into the prioritisation process that we spoke about at a previous meeting
Services, and that feeds back into our decision making process, and into the prioritisation process that we spoke about a previous meeting, sorry but partial Roger Rob Da thank you I I wanted to for that also thank Steven for his comments but also to reiterate what what Kate said because of the fact that
We’ve gone live in half of England only FDA is clear clearly a challenging time to thank you we’ve gone live in half of England, only FDA is clear clearly at a challenging time say thank you to my to my teams. as a senior team we continue to step up our engagement so
That we are hearing what people are saying and also respond responding to their concerns and then that will continue and while while I’ve got the floor I also wanted to make a point about registration if I may I talked a bit at the
Last Board about our plan to deal with the demand in registration around recruiting people continuing to look at our processes and maintaining and possibly driving up our high levels productivity but I wanted to remind anyone who might be viewing that we do have a priority system whereby
If you can demonstrate that you will add capacity to your local system we can consider your we will consider your application within 10 working days and that illustrates a system that is used is being Omeath well guided on on Les there are good it was well guided on our website but I
Think it’s worth reminding that in in areas where capacity is desperately needed we can we can flex our our make that work website, but I think it’s worth reminding that in in areas where capacity is desperately needed we can we can flex our our system to make that work. as part of
This parcel 4. there are two Marks and that’s where these last two question were Mark Chambers question there are two marks, and that’s where these last two question were mark Chambers questioner then walk some that well a are obviously going to I’ll answer the
That that was carried out so I can’t give that a some that well, a are obviously going to, I’ll answer the that that was carried out, so I can’t do that, are there Malcolm House, so it just to reiterate what were what Tyson was saying
They are just Hughes thanks to colleagues across the organisation not just technology and data on one site and Transformation colleagues that were incredibly hard to make this change happen but colleagues I respect her own assessment and regulatory colleagues that have worked incredibly hard to and continue to work incredibly hard to
Adopt this what is a significant change operating incredibly hard to and continue to work incredibly hard to adopt this. What is a significant change is a new way of operating. It’s a new regulatory model, it’s a new technology at his new day trillions Hyperlapse
And we we continue to engage with colleagues we continue to take feedback and May continual improvement and that will go on as as long as is necessary but excited for the new wealth that we’re we’re to take feedback and make continual improvement, and that
Will go on as as long as is necessary, but excited for the new wealth that we’re we’re entering into now, well Edinburgh thank you and just back to the risk register it’s great to see this changing because re in its intended
To be a de dynamic Real Time tool for the team to to assess the environment in which we all wish were operating so I’m sorry I s support the changes that you’ve that you’ve made the thing I think it we just got to watch
Having a plan is not the time to change things its execution on the plan and weren’t the very early days in terms of what needs to be done in on on governance and and culture there’s a long term things and I think even or even
In relation to productivity I’m not sure we’ve Les we’ve got the measures now better measures than we’ve ever had before but I’m not sure we’ve laid down what are sort of base level of expectation is to work out where we stand against that on internal audit I think every now and then
Over time you just end up with those difficult audit. responses that proved to people leave the world moves on things have changed and the a solution which look plausible a couple of years ago justice is not either the problems gone away or the solution weren’t work and I think it would
Just gonna have encourage every now and then to clip to go through them as you as you’re going but to clear the deck and then get a very clear FA and refresh the or the the Management action Plan picture clear the deck and then get a very clear FA and refresh the
Or the the Management action Plan picture. Maybe one of those moments thanks Mark Mark Sutton requirement to be on the board the certainly helped Michel Mark walks out and thank you for those observation that I was going to make the same point that we rightly I think congratulate to those who have
Delivered this but that everyone that the organisation was having to go through change though he it would be a life change we’ve recognise it both have to go through change though he it would be a life change we’ve recognise it because people are under stress so.
Certainly if any colleagues listening to the court just say The Board recognised that and will continue to everything we can to ease through that process certainly, if any, colleagues, listening to the court just say The Board recognised that and will continue to everything we can to ease through that process,
Can I just ask one really detailed point and I’d also like other points on the risk register we begin to stage where it’s a live document rather than static so thank you for the progress being made just one really quick question it’s a live document rather than static, so thank you for
The progress being made, just one really quick question on the registration the overdue we we focus on this metric of over 10 days old sorry and until 10 weeks holding sorry and we understand that there’s more coming in so we get a number
Of staff or comes in inevitably it gets denied can I just gave his assurance on the the stuffed just number of staff or comes in inevitably it gets denied can I just gave his assurance on the the tail end that there isn’t stuffed just getting too old.
I mean is if everything is suddenly tethered of weakness that are 10 that’s great but with him I wanted to make sure that there was nothing got six months or 12 I mean is if everything is suddenly tethered of weakness that are 10, that’s great, but with him I wanted to make
Sure there was nothing got six months or 12 months old can you give you that assurance so do we need to look at why go away and look at it I I can’t give you the the reassurance from six-month old because they may be there
May be for a small number of complex and cases in the system what I can say is that we also monitor the average the average age of the work in the system which from my experiences is a sign of a healthy case working system the
Average age of that we’re all of the work in the system the 10 thousand K applications is 7 point 5 weeks and the average age of all of the applications the the thought of for to 46 percent of applications that have over 10 weeks
Old the average ages 12 point 5 weeks what we have been doing recently is that the the older work in the system we’ve been going through them putting that into our priority system so we are dealing with the older work first we could get the 10 week figure down by focusing on the
Work that is in the air and the over the 10 week Mark we’re not doing that we continue to do bringing the tale as it were but I’ll I’ll come back to you on what the oldest cases in the system are but there but then we will be few
Of them thank so that a detailed question but sometimes it does happen if you look at averages and you ignore the VAT but something has gone off the scale that’s great thank you very much I Phillips thank you for your observations of the report Catherine Chris we have a couple of external
Reporting updates now the first is commercial guardians office and then Healthwatch England I’m going to suggest that we take a short term and it break after NGO before we go into h w e so we might let Lewis no sorry we’re going to be joined by Jane tragically Jane is dialling
Take a short term and it break after NGO before we go into h w e, so we might let Louis no, sorry we’re going to be joined by Jane Chidgey Clarke Jane is dialling in, we have a technology problem I’m told that although people
Listening in concede this room and they’ll be able to see Jane we cannot see Jane so Jane if you are listening we can’t actually see you I am with reclining corner so some of to see Jane, we cannot see Jane so, Jane if you are
Listening, we can’t actually see you, I am we have a tiny we’ve read the paper thank you very much indeed but if I computer in the corner, so some of us can see you on that could ask you to pick up any particular highlights you want but it will help
Us to recognise and then we’ll go to questions thank you thank you very much chair and thank you for the invite to join us ever it was May last year was the last time I came to present formally to board and it’s always good to come
And talk about the work of the national guardians office and to hear your questions comments feedback so I will take it as read that you’ve read the report I think things I would really like to highlight and listening to a little listening to a little bit of your earlier conversation
Around the Thirlwall inquiry. I will definitely pick up on that in a moment, but let me just start by just reiterating which I did in May we published a report last year based on the staff survey and I remain concerned at the decreasing confidence that we’ve seen
Again in workforce in the NHS in their in their confidence that they can raise matters of concern and that they will be responded to appropriately and that remains a concern they’ve never more was it more important and when you know we see high-profile cases such as thermal that obviously
Just Rye emphasises that and so the work that you’re doing as a regulator that we’re doing in our office in terms of the support through improvements and speak up culture the work of NHS England and other regulators stays as as important as ever so what I’d like to talk to you about
First is what we’ve been doing work of NHS England and other regulators stays as as important as ever. So what I’d like to talk to you about first is what we’ve been doing since the Lucy let be verdict and you’ll see in the report on
Page three that there’s in various actions that we have taken I was invited to speak with secretary of State we’ve raised various important issues to him into the Department of Health and social Care around adding our voice to the the voice that we need to include increased investment in
Training and support for good leadership implementation of the Cock review and absolutely ensuring that leaders but the high priority on their culture and speaking up culture and responding to work as concerns to help reduce the likelihood of of harm coming from work is not being
Listened to with that important voice in terms of patient safety and worker stated that they bring I also spoke to him about compliance leavers add I feel really concerned about the ongoing challenges of enforcement and assurance on a routine basis regarding speak up culture your work and
Obviously we’ve been very involved with see QC looking at the will lead domain and we’ve really welcomed you inviting us to look at that your work and obviously we’ve been very involved with see QC looking at the well led domain and we’ve really welcomed you inviting us to look at that with you
But as ever with a regulatory system you are not in every organisation all the time and I really welcome the the new regulatory framework the more data-led and obviously we can feed in what we know of that but I’m also very much asking
NHS England will be saying the same when I go to their board that we look at the the contractual compliance mechanisms as well in terms of SpeakUp culture because that’s really gonna be important and I also talked to to sector estate around strengthening the role of and the that
The training and the support for guardians who provide that additional safety route when other routes within organisations aren’t working happy to take any questions around thoughts around conversation organisations aren’t working happy to take any questions around thoughts around thermal, I heard some of your conversation earlier,
What’s really important as this January was the deadline for all NHS organisations to have done a review against the new NHS England Freedom to speak Up policy and our joint for all NHS organisations to have done a review against the new NHS England, Freedom to speak Up policy and our joint guidance.
The sort of the Planning and support tool and boards to be discussing that and I know that will be part of your inspection of well-led what I’m really keen as to ensure that we have some way of seeing if organisations are doing that and taking it seriously obviously there is not an
Option for some organisations do not do this in the in the in-depth organisational development type way that we need to see to get real change and so it’s going to be really important to see how that mandate to do that review is actually monitored and implemented in practice been
Important to see how that mandate to do that review is actually monitored and implemented in practice. I’ve also been talking with national bodies. particularly the NMC GMC and health professionals Council looking at what more we can do to strengthen guidance and to listen up and act up and that’s really important we have
Support for professionals when it comes been undertaking some work with NHS England and you’ve been as an round that table as see QC in terms of escalation routes which the the the the Minister has asked us to look at as a set of patient safety leaders to help reduce the risk of
This happening again and that work is really key going forward we’re not trying to reinvent wheels and invent another regulator but we are absolutely looking to see what more needs to be done to ensure those escalation routes are known by everybody but really importantly that they’re then
Acted upon through the parts my report covers our speak up reviews and I’ll work with partners I don’t intend to talk about that now unless you’ve got any questions for me I did want to just highlight the him ongoing important work of looking at primary medical services and the integrated care
Systems because they are less well developed them trusts in terms of work in their speak up culture and they have the particular challenges in primary medical services so that work is is really important to going forward and I think probably what I’d like to do is remind you that we laid our
Annual report and you will have seen copies of that happy will have seen copies of that happy to take again any questions on that that went to parliament in November last year and I also want to thank the Audit Committee of see QC we
Had a very robust and useful discussion last year with Audit Committee around our risks and particularly around metrics of measurement and impact and as a result of the discussions with you and looking internally ourselves were currently working with some researchers which is
Represented here to look at what pre work can be done to get a successful search bid to look at implementation of the Guardian model it is time now represented here to look at what pre work can be done to get a successful search bid to look at implementation of
The Guardian model, it is time now to look at. and you know what models work well what more needs to be done so we have a more robust evidence base and that work is really important going forward but we need the funding to do that such researches is is you know has financial
Implications so we’re working to to do that with our stakeholders I’m very happy to take any questions comments or feedback on the report and our work since I last saw you our stakeholders. I’m very happy to take any questions, comments or feedback on the report and our work since I
Last saw you thank you thank you very much J questions or comments from colleagues thank you very much, J questions or comments from colleagues. to thank you. I have thereof working with Jane and the the border of NGO which is really helpful and I just wanted to say thank you
To Jane and and the NGO organisation for all of the work they’re done and particularly to draw out the the importance of this with a discussion that we were having about people’s confidence in they’d done, and particularly to draw out the the importance of this with a discussion that we were having
About people’s confidence in speaking up. but as Jane has rightly identified there is some evidence in the wider NHS staff survey that actually quite a lot of people don’t yet have confidence in speaking up so there’s clearly more to to do in that territory the the other point
I just wanted to draw out was people don’t yet have confidence in speaking up, so there’s clearly more to to do in that territory. The the other point I just wanted to draw out was the Jane mentioned the thematic review that NGO did recently on
Ambulance trusts and I think that was an important piece of work because it it doesn’t just sort of look at how do you put a Freedom to speak Up Guardian in individual providers and and and health settings but it looked across the piece that a group of providers
You put a Freedom to speak Up Guardian in individual providers and and and health settings but it looked across the piece that a group of providers ambulance trusts and did find some significant issues about culture and and speaking up everything then depends on follow through and
The action that that that people take which I think is why Jonah’s is rightly putting the focus on it’s one thing to do these review who is it one thing to come up with recommendations about how we could develop a stronger speak up culture it’s a very different matter whether these
Things have been acted on and how recommendations about how we could develop a stronger speak Up culture? It’s a very different matter whether these things have been acted on and how that followed up so we need to put the focus with with NGO and in in the AM
Be on on that question of ensuring robust timely follow up of the recommendations and findings that NGO have thank on, on that question, of ensuring robust, timely, follow up of the recommendations and findings that NGO have, thank you. come back on the come back on that point, please Chair.
It is always well received what I would say in response to cohort I thank you ever so much Stephen and thank that is that the on where we convene a steering group to look at implementation of recommendations following that review the HSE yourself see QC NHS England the Association
Of ambulance Chief execs sit on that and it is really important to keep the focus on this but in the wider context of review recommendations we know over the years there’s been review after review with more and more recommendations that organisations are asked to look at and
There is varying levels of scrutiny of the successive implementation of those such that as a group of patient safety leaders, Rosie pennyworth chief executive haitch SIB is leading a piece of work across many of those those patient safety groups and regulators to look at recommendations and what
Is in the art of the possible to be much smarter about implementation of recommendations databases of who is doing what and that whole assurance peace so that’s ongoing work that we’re really keen to be part of because the last thing we want to do is to use resource to that then
Ongoing work that we’re really keen to be part of, because the last thing we want to do is to use resource to create recommendations that then sit on a shelf, and obviously there is a key role for yourselves in terms of inspections for relevant recommendations implementation to see the evidence of that
Of work inspections for relevant recommendations, implementation to see the evidence of that et cetera, but really important piece of work. Thank you. Stephen both stroke or the other both Joe and the other drought. just echoed the point that’s being made about the importance of the integrated care systems work that we’re
Doing and of course quality and safety and leadership core features importance of the integrated care systems, work that we’re doing and, of course quality and safety and leadership are core features of the work. there and what we’re going to look at and the the two
Pilots we’ve undertaken of course are limited I think as we roll out the work subject to final agreement with with governments as we roll this out I’m sure we’ll see themes emerging that relate to both patient safety issues and the there’s the speak Up culture actually and it’s a good
Opportunity for us to both reinforce the messages from the and the there’s the speak Up culture actually, and it’s a good opportunity for us to both reinforce the messages from the NGO, but also to gather evidence actually for whether the convening power of
That leadership in and ICS is having an impact on the trusts and other NHS organisations that are in local gather evidence actually for whether the convening power of that leadership in an ICS is having an impact on the trusts and other NHS organisations that are in local areas post-stroke bought post-stroke bought.
Incredibly helpful report as always Jane thank you very much I am I I think it’s just worth making sure that we we we don’t get overly focused on just one dimension that ridge that limiting confidence for people speaking up fear and futility are the two main drivers there is plenty
Ridge that limiting confidence for people speaking up, fear and fragility are the two main drivers and there you know there is plenty that can be done. to to you know to to to better evidence that there are outcomes arising from our from people speaking up even from
You know to to to better evidence that there are outcomes arising from our from people speaking up even from some of the worst cases that we we have seen that will help people ultimately understand that things do happen the fear one is is is that’s for sure
Cases that we, we have seen that will help people ultimately understand that things do happen, the fear one is is is hard, that’s for sure. Hawksmoor Chairman may come back to that one Chair just a brief alteration around that thank you Mark that is indeed
In in incredibly important and I think the futility is really Kee you know what’s the point nothing ever changes so that feedback loop seeing those best of organisations that do keep engage with their workers tell them what’s happening and showcase you know you said we did whether
It’s about patient safety whether it’s an them what’s happening and showcase. You know, you said we did whether it’s about patient safety, whether it’s an improvement idea whether it’s it’s something else I think the issue of fear sometimes founded because of the detriment that we see some
Workers who speak up suffer for for for doing that and comes back to that point that I made at the beginning around accountability and we need to see robust implementation of the cop framework we need to see as regulators those conversations being had when there is
Evidence that workers have suffer detriment for doing the right thing making the place a better safer regulators those conversations being had when there is evidence that workers have suffered detriment for doing the right thing, making the place a better safer to work, etc and that will remain a you know
And that will remain a you know a huge priority. thank you thank you, Dr. if there’s no other questions I just finish with a common for me you de reference in the report page 8 I think about ward a few weeks ago so firstly thank you for that I think
Board development sessions and the work you do for trust we all found it very useful and if there’s only provided and just for the record representatives listening I would commend you to contact Jade and organise it are requested in your organisation as
Well I hope you’re in a data the request Jane and you haven’t got the resources and that’s the problem for you to a problem for you to sort out, but thank you very much indeed for adjoining Australian appreciate it. Thank you very much, colleagues, and I
Having said that I would take account Pirbright now I we checked with Lewis she has returned to catch it would be unfair for her to Mr. train so changes joining us we haven’t got that long ago but we’ve still got to quite important topics I suggest we still take iTablet about a
Comfort break after Lewis but Lewis haven’t got that long ago but we’ve still got to quite important topics I suggest we still take a 10 minute comfort break after Louis but Lewis thank you for joining us what I thought I would do is asked David who not that long
Ago you took over as as Chair just to give any observations or reflections as a an incoming chair on the segue into Lewis and Ed Lewis will will turn to you just go straight from one to the other usual rules so we have read your papers but anything you’d like be great
Straight from one to the other usual rules so we have read your papers but anything you’d like to highlight please that’d be great David, thank you in and when I finished my very brief introduction Argonne sit beside Lewis Simon Lewis thank you in, and when I’d finished my very brief
Introduction Argonne sit beside Lewis, I am in the same firing line as Lewis might be for for the benefit of view Sharmeen because you are the only non-executive director who hasn’t met Lewis before just briefly Healthwatch England is a central organisation and there are 152 independent local health watches they
Don’t report into Healthwatch England their independent entities and they were set up in the aftermath of the Mid-Staffs inquiry and the first Chair was the writer of the report on Mid-Staffs Sir Robert Francis entities and they were set up in the aftermath of the
Mid-Staffs inquiry and the first Chair was the writer of the report on Mid-Staffs, Sir Robert Francis Gacy we’re updating everyone today really because Healthwatch England we’re updating everyone today really because, of course, Healthwatch England is constituted as a committee of the sea QC reporting as a
Constituted as a committee of the sea QC, hence were reporting as a committee. what are we were a small independent organisation of around 35 people and the Chief Executive Louisa and Surrey is going to present our work to in a moment but just let me
Remind all of us of our purpose which is to seek and report on the experiences of the the public of patients and of carers across all areas relating to healthcare so without more adieu our introduce Lewis to you and ask the presentation carers across all areas relating to healthcare, so without
More adieu our introduce Lewis to you and ask Lewis to do the presentation, right, thank you. thank you Davidson thank you Chair for the introduction thank you, David, and thank you Chair for the introduction firstly I’d like to says is to recognise the very hard work
That David has put in since he became our chairing June I think he will sort them don’t yet and David has travelled round the country and and a huge number of meetings with local Healthwatch and really got under the skin of are movement and as has been a great support even though just
In the last seven or eight months so thank you David for such an excellent start so I’m not him as he sending them to assume the papers red I’m just going to very briefly pull out a few points and then I’m open to question so one
Of the things that they want says to remind people that we do here a lot of positive comments quality of care in says to remind people that we do hear a lot of positive comments, particularly about the quality of care in every setting unfortunately though we have had throughout the period
Since her last reported which like Jane was in May last year year about the unfortunately, though we have had throughout the period since her last reported which, like Jane was in May last year about the difficulties, many many thousands of people are having accessing care and
Also at the further emergence of a two-tier system where some people are paying for care and older people can’t afford to do that and some people are paying to get care so both this access and two-tier system issue exists faster and many other people
Primarily in primary care and I’ll talk about dentistry a little bit, but also an elective care both of those areas still extremely problematic. we have significant input into the Dental recovery plan which many of you will have seen has been released today
And reported on and we welcome that as a as a really good start and then in terms of access in other areas of primary care we’ve done a great deal of work on the the proposal around Pharmacy First and we’re going to be reporting on
That over the next two weeks we’re going to we’ve already spoken to the health and social care committee in terms of that over the next two weeks we’re going to we’ve already spoken to the health and social care committee in terms of whether or not Primary
Part of me Pharmacy First is going to work to take pressure off GPs and whilst there is a good amount of support from the public there are some areas of concern including access to pharmacy including medicine supply for a range of conditions and including whether or not pharmacies
Pharmacists are being trained quickly enough or indeed if they’ve got the right spaces within their within their farms since they were going to be releasing that and we’re going to see hopefully do another study in a European their farms. Since they were going to be releasing that and
We’re going to see hopefully do another study in a year or so to see whether or not Pharmacy First really will work for Pharmacy First really will work for people as is being talked about on one of three this meeting patient safety following the the Lucy let the case has been
A real priority area for us and we’ve also been working with the see QC regional teams to try and improve the relationship between local Healthwatch and original ce que see teams and find a better way of escalating when the relationship between local Healthwatch and original ce
Que c teams and find a better way of escalating when local Healthwatch have got. concerns about safety in a particular trust or other healthcare setting and then in terms of internally for Healthwatch England which has led me to do so is actually quite small organisations only 30 six of us and we have
Grant-in-aid to around 3 million Healthwatch England, which has led me to do so, is actually quite small organisations, only 30 6 of us and we have granted item around 3 million pounds please note the section of my report on ID and I which flows through every element of our work and the Healthwatch
England staff survey which showed very positive results and we’ve also got a number of organisational development programmes underway including creating a new coaches at for the entire Healthwatch network and committee and staff so very happy to answer any questions on any for the entire Healthwatch network and Committee and staff
So very happy to answer any questions on any element of the report. OK thank you very much OK, thank you very much Lewis. colleagues crossroads or colleagues, crossroads or comments, thank you. you just need to my about the dentistry recovery plan because I know that you’ve had a lot of input into that
You just really taught me about the dentistry recovery plan because I know that you’ve had a lot of input into that. thank you Bilinda yes I mean the the work on dentistry started well before my time as Chief Exec of Healthwatch England and I would say for at least the last four years
Healthwatch local Healthwatch and Healthwatch England have been taking the experience the worsening experience of people back into the system obviously which is our jobs and particularly to the Department of Health and to NHS England and more recently since commissioning has been devolved into particularly to the Department of Health and to NHS England
And more recently since commissioning has been devolved into integrated care boards, and what people have increasingly said to us is has been reported fairly widely there is a lack of NHS provision that was I mean there has been declining provision for decades of of NHS dentistry but certainly since the
Pandemic that plummeted that that provision and it hasn’t got back up to pre pandemic levels decades of of NHS dentistry, but certainly since the pandemic that plummeted that that provision and it hasn’t got back up to pre pandemic levels nowhere near. and that’s created some areas of the country where you
Pretty much can’t get an NHS dentist I’ve met people these are not isolated incidents who’ve pulled the pretty much can’t get an NHS, dentist, I’ve met people, these are not isolated incidents who’ve pulled their own teeth out. it’s really heartbreaking actually of I’ve met people who can’t get NHS dentistry for their
It’s really heartbreaking actually, of I’ve met people who can’t get NHS dentistry for their children. and then we were also finding in terms of the cost of living pressures that people are avoiding dentistry because they can’t afford private dental care and because of the
Cost of NHS dentistry now some people are even avoiding that if they can get an appointment so through a range of methods which you could possibly call campaigning to to a certain extent we’ve been exposing this around the country money into NHS England who have been very receptive to to
We’ve been talking to the what we’ve been telling them and highlighting the experience of people and that has been going on you have to to be tenacious about this kind of change that’s been going on for for a long time. so we were really delighted actually that the department
And NHS England have together work took this recovery plan which we think is genuinely a really could start to fix some of the issues but really deep and radical changes needed to fix the kind of underlying issues around the dental contracts in order to make long term change for
People but as I say we’re really happy particularly on children’s oral health particularly on buses as a as I say, we’re really happy particularly on children’s oral health particularly on things like dental buses as a short term fix. for some of those areas and we ended network will continue
To press on this issue until the swell of of of poor access to Islam and some of you may for some of those areas and we ended network will continue to press on this issue until the swell of of of poor access to Islam, and some of you may have seen,
Victoria Atkins as secretary of state this morning on the breakfast programme really talking in some detail about the new announcements so it’s fairly hot off the press to Victoria Atkins as secretary of state this morning on the breakfast programme really talking in some detail about the
New announcements, so it’s fairly hot off the press to Lewis thank you and the other thank you any other joked. high thanks very much I I wondered sorry interest in what you’ve said in the report around the support to the Healthwatch networks and in the context of the systems work
We’re doing with integrated care systems now at sea QC just your perspective really on how sustainable the networks are how connected you fill their their work is in the development of place and devolution of the permission of the NHS to get on and change and improve at a local or
Local level I I sense from your description in the paper that there’s a mixed the NHS to get on and change and improve at a local or local level. I I sense from your description in the paper that there’s a mixed mixed picture
Thank you James that would allow me to get on my soap box for quite a long time and respect board thank you, James, that would allow me to get on my soapbox for quite a long time and respect with time of the of the board. it’s
The resourcing and the ability for the 152 local Healthwatch to do their job is in an absolutely for next the resourcing and the ability for the 152 local Healthwatch to do their job is in an absolutely dire state for most of them.
The funding in real terms is reduced by around 50 per cent since the creation of Healthwatch in the funding in real terms is reduced by around 50% since the creation of Healthwatch in about 10 years ago, they are responding really well to the to the question of
They are responding really well to the to the creation of integrated care systems. almost all Healthwatch a grouping together on the footprints of ICS is and a number of ICS is actually around 60 70 per cent of our giving sometimes small amounts of funding to local Healthwatch to work together across the
ICS patch many health watchdog and now on the on the in the governance of ICS is sometimes on the ICP committees of the ICS patch many health watchdog and now on the on the in the governance of ICS is sometimes on the ICP sometimes on committees of the of the ECB
And that’s all good on the surface but under underneath that the ability of a local Healthwatch who have for and that’s all good on the surface, but underneath that the ability of a local Healthwatch who, on average, they have for members of staff, their funding varies from about 60 thousand pounds to
Roundabout half a million the variation is absolutely huge on average to get maybe 100 120 thousand obviously they’re commissioned by local authorities that funding is shrunk over average, to get maybe 100 120,000, obviously they’re commissioned by local authorities that for Lingus has shrunk over time
Many of them do a really fantastic job but in terms of actually covering the population being able to listen to everybody’s experience particularly reaching out to communities who suffer the worst health inequalities they’re just not equipped to do that so I said all of this
At the Health and social Care Committee this time and they’re just not equipped to do that, so I said all of this at the Health and social Care Committee this time last year and that committee did ask the Department to look into the resourcing and the
Structure and the commissioning of local Healthwatch which I think needs a significant amount of reform we are as a committee of the sea QC the statutory body set up to listen to patients and we’re not resourced sufficiently to do that and we do make that case David has been very clearly was
Made that we need to continue to make that case and and and make make sure that people understand the value of Healthwatch so that we’re not funded for the sake of it but we can actually show the impact we have for people out there watch, I’m making one tonight.
To Peter Brown temperature they’re increasingly bringing in the integrated care Board chair and chief executive to those meetings such as the importance that they attribute to both listening to and being seen to listen to to the voice of the the patient the evidenced voice of the patient
Which is encouraging the demand is there the need is there voice of the the patient, the evidenced voice of the patient which is encouraging the demand is there the need is there. I don’t see which had worked out for us with I don’t see which had worked at first with titled or Chris.
Chris and just to say to Lewis and her team De thank you because of the work that you’re doing to to help us without I think he’d around state of care particularly focus on identity but also in other areas like our work on systems
Like our work in mental health like outlook on access more generally including to primary care all of the things that we report about his stated account other places a part comes from the work of you and your team I know you’ve got a you know that budget just do it is
Places a part comes from the work of you and your team, I know you’ve got it, you know that Budget just do it as an opportunity just to say thank you for that work thank you for that work and delivery and you know pupils being happy to be to be at
Work we do already have a set of values I don’t think they were kind of potential driven from the from the ground-up so the process that David and I have puts in place is that we’ve held a series of workshops with committee with staff with the local Healthwatch network the local Healthwatch
Network has still in those workshops and through committee with staff, with the local Healthwatch network, the local Healthwatch network has still in those workshops and through really kind of wonderful set of discussions each group in in our organisation is coming up with very similar values so I’ve asked for a set
Of values to be corrected to about sort of 5 values which really encapsulate the work we do and everybody at the moment is coming up with identical values things like candour things like equity collaboration and then once we’ve decided on what those kind of 5 6 values are we will
Go ahead and determine the behaviors that that lie beneath that and then how will hold each other to account all of the staff and all of the volunteers for delivering on those on those values and then we will try and it will have a
Piece of work to keep that alive and keep it meaningful and testing it out and putting it in appraisals and so on so that’s really embedded as as part of who we are as an organisation because it’s the behaviors that are the important thing the values themselves yesterday are
Important but it’s only through the those values important thing. The values themselves yesterday are important, but it’s only through the behaviors that you see those values being evidenced and or as Louisa said it is vital that culture work is not top-down it involves everybody and then everyone feels that
They are committed to it they feel a sense of parentage for it and therefore they they want to live up to that they are committed to it, they feel a sense of parentage for it and therefore they they want to live up to it
Thank you David loss costumes I I just had change it’s probably was will one for you and less reason wants to but I would just be interested in we’ve touched on this a little bit already but just interested in your perception for the work we’re doing with ICS was ICPs of what we
Expect the role of Healthwatch to I think we made a presumption in the work that we’ve done that Healthwatch is a facilitator of voice into the ICS so we expect to see as it were that inaction and are and actually without commented on the specifics of the pilots
The reports of which are published yet I I can anticipate a theme emerging that that might not be the case actually and I think it would probably backs up what Louisa’s saying about the reality of of. sometimes how complex enlarge ICS as are and the difference
Between the ICB and the ICP and those two relationships but I suspect that there will find more to do and some good practice guidance emerging as a result can I just add very briefly that I think the Russell areas of the country whether where the Healthwatch will the groups of
Healthwatch really worked very closely and I’m very kind of embedded in the work of the ICS I think West Yorkshire is a good example but there are others and then there are some areas of the country where actually listening to patient experience through whatever means Healthwatch or you know
Other other means of engagement hasn’t hasn’t taken priority so I think it’s more about variation than than is it is it happening at all just make a few other other means of engagement hasn’t hasn’t taken priority, so I think it’s more about variation than than is
It is it happening at all just make a final comment, that is really about the ICS the Ashby your point that you just referred to when we set up the the RTS sited on the on 0 system in this country one of the things about that
System developed in Spain was it was fundamentally about operating at neighbourhood level secondly 0 system in this country, one of the things about that system developed in Spain was, it was fundamentally about operating at neighbourhood level secondly, it place level, and only thirdly it and only thirdly, at a system level
And one of the things that are Healthwatch local network allows us to do is to operate very much at neighbourhood as well as place level and that’s something that the integrated care systems in the integrated care boards attending to operate quite significantly at system level so
I think we’re a great facilitator in bringing about the right kind of focus for the attending to operate quite significantly at system level, so I think we’re a great facilitator in bringing about the right kind of focus for the integrated care boards. OK thank you very much and James thank you for a
Beautifully crafted response to buy a question we look forward to seeing the variation to the perhaps getting an understanding of why it happens and beautifully crafted response to buy a question we look forward to seeing the variation to the perhaps getting an understanding of why it happens and the consequences.
David thank you for the introduction Lewis thank you for coming you may take your soapbox and I hope you want to see it yours re thank you other colleagues shall I I was we now have a cup psychiatric if I give us which were going
We now have a cup psychiatric and thank you for switchboard like on it. I usually sought without recourse right level was the I usually sought, without recourse to everyone else, to do it right level, was the first to get it wrong, thank you. the we too important things now the
The we two important things now the first is the update on the LLC so James I think you’re gonna have this output Pelham rulings on the our colleagues thank you for joining us you might when we get to you just introduced herself to everyone else given the fact we have some some
New colleagues but James Monaghan the 70 you yes thank you thank you in yes I will be joined by a Helen the new colleagues but James Monaghan the 70 year yes, thank you. Thank you in yeah so we, rejoined by a Helen rulings from the adult social Care part of
Adult social Care part of Rectory leadership Helen’s Helen’s got a and and improvement and it integrated Raul actually into integrated roa actually so it’s a natural leadership for this so this as as the Board will see from the paper this is part of our ongoing reporting back to the Board about the learning
Listening and responding to concerns work the action plan of which came May last year we had an update in September this is another update and the Board will remember that at all our last meeting we were at dating ourselves on the work of the strategic oversight and prioritisation
Committees topic who have taken as it were this piece of work and the broader recommendations monitoring work into such a slightly more cohesive and simpler oversight so we’re at a very crucial time with this piece of work so it’s important obviously for the board to receive an update
On progress during last September mound and Helen or go into the detail of that but we’re also in the run-up to him or a larger consideration at the boards or of the more independent evaluation of the progress we’ve made in this area so we are underway with the preparation for that in in
The background to this and again Helen will be able to or outline and we are underway with the preparation for that in in the background to this and again, Helen will be able to or or outline and the nature of
Of that work or or as well but I’ll hand over to head of further detailed of that work as well, but I’ll hand over to Helen further, detailed thank you please do please do highlight any. thank you Ian so so I’m Helen Rawlings and the Deputy
Director of see QC and I covered James said a portfolio of integrated care inequalities and improvement and as of January this year I’m pleased to have taken on a supporting leadership role for the important recommendations that we all know about and the associated work as a result of the
Listening learning and responding to concerns Review today I’ll keep an update to Board regarding the progress and present a forward view of the work and review in the I’ll keep an update to Board regarding the progress and present a forward view of the work and the outputs for the
Review in the coming months. so we are now around 10 months from the initial review has presented to Board in March March last year and resulted lie we know that recommendations were accepted and the action plan against these recommendations presented in May
Of last year so in September as James said we presented a progress update and today I am pleased to update the further progress has been made against the recommendations from the RHI review out as a progress update and today I’m pleased to update the further progress has been made against the recommendations
From the HRA review out as outlined in the paper. the work continued since September has been led by our senior owners and really important contributions across the whole of CCC many others from the organisation contributing to the work and I think it should be really acknowledge
That the focus on this work has been held with the utmost importance and our staff across the sea QC a really committed to meeting the recommendations and really sharing that strong culture of improvement that we know that can come from this so you’ll also see from the performance
Chart in the paper that there’s still really important work to do and therefore we really mustn’t lose our focus on this and we should ensure that our staff the public and I’ll provide us really see and really importantly feel the change as the result of the review
Our focus on this and we should ensure that our staff, the public and I’ll provide us really see and really importantly feel the change as the result of the review, so in a paper I’ve highlighted some of the work completed so we’ve appointed to new Freedom to speak Up guardians
Since October and I’d also like to highlight some development sessions for the Executive Team and the board around Freedom to speak Up have also been delivered and the board completed the first part of their independently led training and development on recently inclusion with further
Work being undertaken on this in the coming months are are inclusive mentoring scheme is launched for 2024. and are really important further update to our standard operating procedure on how we manage our information of concern this is really important and thorough work which
Has taken place to make sure that all of our staff are really clear and confident to manage any information that comes into us and that when we record this it’s to the highest in really clear and confident to manage any information that
Comes into us and that when we record this it’s done really to the highest expected standard and finally we have updated our approach to human rights and included learning for our staff around how we deliver that and how we’re able to apply and finally, we’ve updated our approach to human rights and
Included learning for our staff around how we deliver that and how we’re able to apply that to our work or across see QC across see QC, so you’ll also see from the paper that the leadership governance and assurance regarding progress against recommendations has been strengthened we’ve made sure that
How we work together to achieve the aims of the review has additional leadership support from myself and they’re also reporting an oversight and how we’re doing is monitored clearly and consistently in the organisation the aim is to ensure that if we face any challenges or barriers to
Achieving the high expectations set out in the review that these can really be addressed quickly and effectively through that process achieving the high expectations set out in the review that these can really be addressed quickly and effectively through that process, I’m finally moving onto our commitment for ongoing
Evaluation so as recommended in the review we’ve got ongoing evaluation work taking taking place we now move as James’s to really important phase to coincide with the one year and then the 18 month period since we accept the recommendations and initial evaluation is planned to report
The middle of this year and then further towards the the recommendations and initial evaluation is planned to report the middle of this year and then further towards the end of this year. we’ve committed to include independent aspects into that evaluation so that includes using an independent research
Agency to conduct some of our qualitative research with staff and partners and also engaged in our Independent Review Panel members so these these individuals were really fundamental in the review and will be fundamental going forward to really check and challenge our progress and help identify where we can complete
Really fundamental in the review and will be fundamental going forward to really check and challenge our progress and help identify where we can complete further work we’ve included questions in our recent people survey to capture feedback from our staff and we’ve included questions in our recent people survey to
Capture feedback from our staff on progress so far. and we really ensuring this evaluation work gets to the centre of what matters to our staff and we’re really ensuring this evaluation. Work gets to the centre of what matters to our staff at sea QC to our stakeholders who worked with health and care
To our stakeholders who worked with us, the public and health and care providers, we really must aspire to embed this change and that this change forms the basis of our ongoing culture and values that ce que city where every interaction that we have we now really really matters thank you very much
Change forms the basis of our ongoing culture and values that ce que city, where every interaction that we have. We now really really matters. Thank you very much Guildford Guildford who? Christians well pupils who have their hands up can I Christians, while pupils with their hands up, can I just ask one.
Part of the detail pot got significant you’ve given us a snapshot part of the detail pot got significant, you’ve, hopefully, given us a snapshot of last September. and a snapshot now I’ll be the good thing is mostly aerosol getting better the glaring exception is speaking up and the
Maybe this is a function of the maths but according to this the progress to date says where the errors of no progress to date or even higher now it’s according to this the progress to date says where the errors of no progress to date or even higher now than there
Were last September, it’s gone up from whatever it was something to 71 per cent which so we seem to be further behind or we’ve revaluated that we are making progress on something so I mean there was are not going to be achieved shot there’s a spider point on their but what
Is the problem in Freedom to speak Up why are we making progress everywhere else apart from that be achieved shot there’s a slider point on their, but what is the problem in Freedom to speak Up? Why we’re making progress everywhere else? Apart from that one area it said at it said Joe.
He needs to do with the secretary NAMA Mark give you chapter and verse unable or a lot of this is doing with secrecy in the events in the right order so that impacts on when we can do what we can do chapter and verse unable, or a lot of this is degree of
Secrecy in the events in the right order, so that impacts on when we can do what we can do over the 18 month period, yeah absolutely absolutely right I’ll know there must have been something that went awry with the mess there I think because we have made significant progress or bringing on
Board through or or or or an organisation wide a recruitment process to new guardians to be able to support see that we’re gonna do now which will involve training the work is going to enable us engagement reporting so there’s that that is going to
Enable us to carry on with and complete those activities that are that we haven’t made any progress on and of course course we had at Bow ball session of their and our 80 session which is, or or another factor in in moving us forward in the in the
In the recommendations around Speaker so another factor in in moving us forward in the in the in the recommendations around Speaker, so I’d be the risk of all development session that Lewis led that I’ve reference earlier and you’ve just picked up an otherwise some actions can be added that which will come
Back to the Board was specific initiatives so God asking precision but presumably that’s quite a big chunk of this red area which we would expect to see back to the Board was specific initiatives, so God asking precision, but presumably that’s quite a big chunk of this
Red area which we would expect to see closure Mark Dunmore. yeah I think it’s a it’s a similar point I I had a problem with this understanding this reporting whether yeah, I think it’s a, it’s a similar point I I had a problem with this understanding this reporting, whether were.
On track for for this on art you can’t actually On track for for this, on art, you can’t actually tell from this, because. if the if things haven’t started it may be because they were dependent on other things and therefore that’s fine
But equally it may be that they ought to start at and lots of other things are dependent on that so it would be helpful but equally it may be that they ought to have started, and lots of other things are dependent on that, so it would be helpful
It will be more helpful to me to see this as a stacks of what on track and what’s not on track rather than the actual tarmac I think the overall timing we need to see separately at a timeline and where are the big deliverables
Dropping off over the course of the of of of the work but that it it may well be that a lot of red shouldn’t be read I accept that better but it is hard to see underlying pattern of of but that it it may well be that a lot of red shouldn’t be
Read, I accept that better but it is hard to see what the underlying pattern of of orderly progression orderly progression against a planet, J I mean just on that and I’m happy to pick up that and do a a slightly more friend friendlier version of this is the
Differences between should have done it by now versus have you done it at all and this is measuring have you done it at all and sometimes that’s because we haven’t but sometimes it’s because it’s not it can’t have been done by now because certain other things haven’t been done so I
I’ll get with Helena version of what should be achieved what have we achieved and I think it represented in a better I think that that would be really helpful because of things that we want to focus on and try and help around this table or the areas where we’re struggling to get
Things going we need to do it now and and there’s there’s a problem for whatever reason and those are the those are the barriers that we need to try and healthy breakthrough yeah I mean just just out to that and that there’s a few hands
Going up but I without making that over the complicated it would be helpful to have an understanding are whether if things are dull how much of that is the natural sequencing you talked about versus not doing it better that the barriers what the barriers are as part of the transparency
But this is something the bulk and due to to help to make sure that we progress this rather will quickly I saw Stevens homes GAPA they’re Nally so I’ll take those two other the if there’s any others will be able rather will quickly. I saw Stevens homes GAPA, they’re
Nally, so I’ll take those two if there’s any others will go to those as well said Helen thank you really helpful report I wanted to follow a kind of where you finished which is that this is giving us a really valuable unhelpful snapshot of kind of progress
Toward tasks and actions following out of the recommendations but ultimately we need to move this into a culture which is a rather more sort of intangible thing to pin down have you taken the right tasks and actions to get to the culture that you really want could you say a bit
More about how this how this is linking in work on on values to the culture that you really want? Could you say a bit more about how this how this is linking in to the wider work on on values and culture? because if that’s our endgame can have we need to see that
This is this is feeding directly into the the on culture because if that’s our endgame can have, we need to see that this is. This is feeding directly into the the wider work on on culture yeah so so the answer to that is yes it absolutely needs to
Move into that back cultural perspective and I think what’s important at this point in the review is that we make sure we move the Frank fragment of fragmentation if you like the recommendations into more of a frame of reference of the overall aims of the review and then link that directly to
The sea QC cultural development work I think this is you know this is my reflection on why the next sort of on getting subjective feedback on how people feel how people are able to deliver their work and the difference that this has made to them and any further challenges that
Come up so is in summary in answer to your question yes it will absolutely be linked to the cultural work and that movement I think to the aims of the review overall is probably a wise decision to make sure that that interface is really well with that work.
But I think you’ll want to cover this will allow me give values question could just conceivable very well to respond but I think you want to cover this, will allow me, give values question could just conceivably be able to respond to that as an ally.
Thanks I’m just to add to everyone’s comments really pleased to see an update on the progression that we’ve had on this work and that this remains an important priority and also very pleased to see that we are definitely going to be bringing back in our independent panel viewers to
Give us assurance that we’ve than what we said that we do in the paper were quite clear on a target end date of some time before the end of the year when it would be presented back to board and notwithstanding the fact that concluding
This programme doesn’t mean the conclusion of the work that needs to be embedded as Stephen said I’d be interested to hear a bit more about any risks challenges with threats that we might say that might potentially result in that timeline for this programmes conclusion
Hear a bit more about any risks, challenges with threats that we might say that might potentially result in that timeline for this programmes, conclusion being pushed back thank you so hello the fewer trial respond to that although perhaps K salt or any other she was swept yeah thank you so I think
Ellie this this is the really important next step for us so I think many of our senior owners for these actions and people who have been delivering the work are really best place to reflects on those many of them have sort of over common identified risks and challenges so far but of course
At this point in time to embed that into the culture of how we work there may well be further barriers that exist around that as we all know we’ve had a move on to on new regulatory platform as well so we have colleagues working
With with new systems and processes as well so that interface is directly with our work around the LA see as well so for me it’s really important that over the next sort of four to six weeks ready to get a very clear and documented overview of those risks and barriers and that
Hopefully will enable both our colleagues but also at board and executive level to to make those decisions around how we can overcome those as an organisation that hopefully will enable both our colleagues but also at board and executive level to to make those decisions around how we can overcome those as an organisation.
So just to get back to to marks point and I suppose with fresh eyes coming in with so just to go back to Mark’s point and Myspace with fresh eyes coming in with James and Helen. I wonder on reflection are eagerness to accept all 84
Recommendations are back in last May and the Royal appetite in the organisation to get on and start delivering was fantastic I wonder whether with hindsight 84 recommendations is a heck of a lot to implement at the same time and actually possibly what might have been more
Constructive would have been to have mapped out what the priorities to get done in the first six months what should we be doing between six and 12 months and what should we do between 12 and 18 months and and thereafter so I think I
Think the challenge as you say with this is it’s hard to tell whether we’re on track or not because we in our original ambition must do all of it straight away so I think that’s a bit of a a bit of a lesson for us to take
Out going forward he came from the RHI the right starting point which as we were eager to get all of this Dan but I think the suggestion James had with which is now with James and Helen looking at this refresh eyes would we expect it
To deliver over the next couple of 3 6 9 months I think that will help Board know whether we side would we expect it to deliver over the next kind of 3 6 9 months? I think that will help Board know whether we’re on track on that side. the the other gushing
The the other groceries. thank you yeah just to note there’s a new new OSC on the internet today about senior leaders undertaking race and inclusion training as part of the great internet today about senior leaders undertaking race and inclusion training as part of the lossy, which was really great great to see.
I guess it just to call for me to encourage a lead us to consider that that training and take it you know taking seriously obviously and are there any other consider that that training and take it, you know take her seriously, obviously, and are there any other wider training or
You know ways that you can develop this officer consider and this more carefully you know ways that you can develop this officer consider and this more carefully really. thank you I shall I was going to ask you if you’re heading alteration surveys were putting up proverbial hand-off yes
Thanks Helen so so a number of us had a training session yesterday which was very impactful and I think we are all still processing the discussion in the the training session just a quick kind of fresh reflection from me it’s a number of activities that we are doing in this area session
So if we think about reverse mentoring if we think about our inclusive leadership programme if we think about independent panel members that the list goes on the challenge we had from our trainer is that you’re doing other activity but actually when you look at your blasts
Set of people results colleagues from black and ethnic minority backgrounds were describing an environment that they would like to see as as different, so it was. It was a very impact for training session I certainly got I think probably a number thinking about
What more what different do we need to do because we’re doing a lot of our activity but as the trainer kind of challenge us back is that translating to you know better experience for that group of colleagues so I think we will
Probably regroup as a as a team to think about what next and this was always as Henan said this was always gonna be the start of a series of training and workshops as we tackle the kind of really key issues that came out of LLC
Which has around our kind of racial competence across all levels of the organisation so we we started on that journey there’s a lot more to do but the kind of where we stand at this moment I think is just to relook and are a kind of
Challenging ourselves about all these things we’ve put in place at the right things what’s missing what do we need a need to differently and then seeing out through the rest in place. Are they the right things, what’s missing, what do we need to need to do differently and then seeing that
Training now roll out through the rest of the organisation. in in kind of months to come as in in kind of months to come as well. if there are no other comments that if there are no other comments that pause that, but
James the hello and thanks very much for that I think you know we are grateful for the kind of re-look on the ramp thus despite my crystal clear progress in some way anyways James the hello and thanks very much for that, I think you
Know we are grateful for the kind of re-look on the ramp that, despite my crystal clear progress in some way anyways, capers interesting you said we agree to everything was is fading that’s not quite November and I think it was always acceptance that you would be take a longer time as some of
This is is slow-build stuff but I agree we didn’t have a sort of maps or maybe it felt like we were trying to do everything won’t go having might call on the progress of the some ways and also learning from other areas it
Probably already a time to if I say draw breath I don’t mean suddenly so everything down of the some ways and also learning from other areas, it probably would be a time to, if I say, draw breath. I don’t mean suddenly so everything down, but I mean just have a
I have sought a better road map as to the timing of we’re going to apply to some of the Suffolk maybe that could come back to the Board in subway but will leave that with you hello thank you very much indeed for adjoining I appreciate
Come back to the Board in subway, but will leave that with you, hello, thank you very much indeed for adjoining is appreciated. one other important one other important point. we put this out and we put this out under the heading of Leslie if the external environment I think we’ll probably
Do more of this in future but we are pretty diligent of discussing entirely things that we can learn from the are affect us directly but there’s an awful lot going under the outside world which is nothing to do with us on the first instance but where people draw parallels or there are
Things that we need to contribute to so I think there’s a few more papers although these lines coming along but the first of this is Ofsted obviously a huge amount of Coventry now we have a paper in here Joyce I think you put that
Together so thank you very much indeed for that it’s quite a long paper we have read it but you want to pick up at the key themes for us and then or go straight questions thank thank you and thank you in I’ll just summarise the key
Points from the paper before I take any questions and you’re right this is about learning from our external environment and areas that impact on how we regulate and following the death of the Headteacher roof Perry there have been free reports and Ofsted and probably not the last
Three that then there may be more there is really quite a bit of learning from the case and the coroner summarise to say that it was the Ofsted inspection that had contributed to her death and while these reports and aimed at us it is appropriate that we reviewed the findings opportunity
These reports and aimed at us it is appropriate that we reviewed the findings and take the opportunity to learn and reflect on our role as a regulator in this space we’ve talked about our role with people at the centre of what we do and the
Fact that our purpose is about ensuring safe effective high quality compassionate care and there is a delicate balance that will be particularly now that some of our providers in the way that we listen and respond to that who are small and probably Amelia Lee in in size take
Regulation in in a very personal way because it is about the service that they live or the paper identifies four areas that we feel in response some of the things we had been doing already before some of these reports but there
Are four areas that that help us rely upon the road in the learning and improvements that we may want to make and the first is our strategy which was published in May 2 thousand and 21 and in that we we’ve talked about how regulation must understand the challenges that providers facing the
Context in which they deliver services and so we committed ready to be a far more collaborative red regulator to update our ratings more frequently to focus on improvement use all our regulatory levers not just inspection so are convenient. Power are the the co production that we do
With others and use our national voice to raise awareness about health and social care services we also introduced are a new single assessment for a framework which already moves towards some of those recommendations in that we don’t have ratings limited ratings are legislative so it’s
A decision made by government but we are doing more of an arcing assessment framework to really get a narrative about people’s experiences of care and think about how we score as well as rate organisations and there was an element of self-evaluation that providers themselves and trusts local
Authorities on our integrated care system work where they evaluate themselves to contribute to the fact to our trusts local authorities on our integrated care system work where they evaluate themselves to contribute to the fact to our findings. we also change the nature of our inspection activity so
It’s moving to approach where it’s far more collaborative where we’re talking to the people who are in services in terms of what they experience but also talking to the staff and leaders and looking at the environment in which care is delivered rather than I suppose traditionally and people
May see us it certainly on the television with a clipboard and A to C Murray and think about compliance but it’s definitely our on site activity will be far more collaborative in that space in terms of relationships who recognise that that is key to trust and trust in the
Regulator and we’re gonna refocus how we should be space in terms of relationships will recognise that that is key to trust and trust in the regulator, and we’re gonna refocus how we have relationships with providers probably the paper focuses on the current report and the
Processes that we need to look at ourselves and it identifies both where we are dissimilar and there are things that we can do in differently really in terms of reporting and the way we allow for factual accuracy checks and the way we deliver reports but there is a lot that we
Can learn from and it’s outlined in the paper how we want to introduce more training and support for providers particularly around wellbeing and areas where there could be distress and people have real concerns about what we do the report also identifies where we might do our quality
Assurance differently and how we produce our reports and the timing of those reports and the fairness since in between women the reports done but when it’s actually published and trying to be transparent about well I provide it has improved during that time so what can we say about
Those improvements we will closely monitor the implementation of our single assessment new framework improvements? We will closely monitor the implementation of our single assessment framework. It’s a new framework, we want to get it right, we have heard from earlier doctors about there’s more we
Can do around the technology and about how the how they share information with us and we’re looking to make sure that those improvements are made and our work is not is not burdensome and we want to evaluate our new single assessment framework so there aren’t any unintended
Consequences and we evaluated to say is is it effective as it having the impact that we want in terms of making sure we identify risks almost certainly but also look for improvements that providers have made so there is a lot that we’re doing in response are stressed that my paper is
Not delivery plan so it’s not you know we are doing these things and there were timescales attached but we have considered the points that we need to learn and the areas that we want to improve so I’ll post there and considered the points that we need to learn and the areas
That we want to improve, so I’ll post there and respond to any questions. so so true. firstly the lately thank you yeah I I mean I welcome this review from a people put into view and from a process point of view and I just think it’s important to note that Ruth
Providers of social care who as you say take it very personally you know sometimes their jobs are on the line but it’s really important to recognise that it’s. a process it is frequently very difficult both I mean I’m obviously we don’t know the impact of of this sort of
Assessment processes yet but the inspection and all the different assessments that are happening or very stressful for pretty much everybody on the least different assessments that are happening are very stressful for pretty much everybody on the front line or at the very least,
It’s our job that’s what we’ve got to do and I recognise that we are trying to do that it’s our job, that’s what we’ve got to do, and I recognise that we are trying to do that in herb it or improved way and in a collaborative way but I
Think it’s just important to keep in mind that this is always going to be difficult for for people who are receiving end of it think it’s just important to keep in mind that this is always going to be difficult for for people who are on the receiving end of it. to
Thank you George are really helpful report and I think it is a really good example of sort of Les learning from other sectors to reflect on how we we do what we do thank you, George, are really helpful report and I think it
Is a really good example of sort of Les learning from other sectors to reflect on how we we do, what we do. I very much welcome what you are saying about building our own training I very much welcome what you were saying about building into our own training.
Just dud thinking about awareness of the the the psychological effects on the people that we’re dealing way so that we get better at spotting you know state of distress I think that that that is a really positive move it what Ofsted have done I think I think we should also be
Training our people similarly think that that that is a really positive move it what Ofsted have done, I think I think we should also be training our people similarly, secondly sort of the issue about consistency in any in any regulator or Inspector which is dependent on very large
Numbers of people supposedly applying a standard methodology and the standard way but actually inconsistency always creeps in so continuing to think about how do we know methodology and a standard way, but actually inconsistency, always creeps in so continuing to think about how do we know that?
Are intended approach is being carried out consistently in in each case because I think part of the learning from Ofsted are intended approach is being carried out consistently and in each case, because I think part of the learning from from Ofsted is that.
It the the effect on the provide a can of too often be dependent on the particular inspection team you get so thinking about consistency and and then the third point I’d I really welcome Joyce what you were saying about the importance of understanding the experience of providers of
Our new single assessment framework but hoping and I’m sure this is the intention that kind of that isn’t just about the technology and is it easy or difficult to upload staff and do you get the right data and so on its more profoundly I think
About the technology and is it easy or difficult to upload staff and do you get the right data and so on, it’s also kind of more profoundly, I think, getting it is the experience that providers with a single assessment is the experience it provides us with a single assessment framework?
Genuinely getting them to believe that if they enter into all of this in the right spirit not a fear and trepidation genuinely getting them to believe that if they enter into all of this in the right spirit, not a fear and trepidation. but believing that they can learn from this themselves and
Can improve from this themselves in in in their own setting that that would be a really valuable and important thing because our ability to promote improvement in providers is very much dependent on whether they own the results of we do with because our ability to promote improvement in providers is
Very much dependent on whether they own the results of what we do with them and for them or go into a state have sort of fear and denial so I I sorry very long winded way of saying I really hope that the way we evaluate the effect to the Single Assessment
Framework on providers will try to get sorry very long-winded way of saying I really hope that the way we evaluate the effect to the Single Assessment Framework on providers will try to get it. that experience of providers does did they believe this is
Genuinely helping them to get better is so I think we’ll be doing something hugely important thanks can I can I respond to that if I may I respond to the first and second points and maybe Tyson might want to talk to consistency you
Absolutely right at the the trade and is going to be important for the psychological effects but it there’s two types of training I describing the paper that are the ones for providers and baby others that work with us but also filed operational to colleagues ASAP
Not just are not not on only one of situations, but some of the things that come. clad in through the doors on a continuous basis which can be particularly stressful for our own operations colleagues who don’t there’s there’s two types of training that’s been
Described here and in the second issue I think you’re absolutely right the the movement of improvements if you like happens when TRO providers trust what we say and have confidence in the judgments that we make and then makes them the improvements themselves so there are two parts of
That first of all it’s really keen to get our judgements right because at the end of the day there are people using services so the judgements are right then we we can get make progress and secondly if regulation is seen as being part of a continuous cycle of improvement rather than
Something that comes to say you’re not doing something right but it’s that continuous cycle they’re only going to get health and social care improving for everyone rather than regulation being seen as something else it is part I I I would say this on the Director of policy and strategy but
Regulation is part of that cycle of Improvement from quality improvement all the way through that policy and strategy, but regulation is part of that cycle of improvement from quality improvement, all the way through to the the support that regulation can put provide to providers and the system and others to make
Provide to providers and the system and others to make improvements themselves why should I think you wanted to cover with a response to them what two of the three marks on here can we after that I think close it down letters don’t the Barnett but title
In Donegal first with the response gag I wanted to pick up on a couple of 11 Stevens coins in everything Chris will pick up on the the provided point on the training I think we’re actually I’ve been working closely with our academy
On what this might look like and I think we’re close to coming up with a proposal which will go to the people and culture Committee soon it’s built around empathy strategies for how to deal with people who demonstrate demonstrating signs of distress but also importantly I think for our own
People self-care and how to do a proper debrief after they’d been involved in what is clearly a very uncomfortable situation I’m hoping that we can start to roll that out rail relatively soon I’m kind of looking at MD may at the moment but but let let see what what the
Discussion with the people and culture Committee comes to on consistency I think one of the one of the advantages of the Single Assessment Framework is that we are we are scoring evidence categories at a fairly granular level so the report will be built up from evidence which is captured
At quite a local level and I also think that we have much better transparency of of data at the moment including how report had been written how people are rating particular evidence categories that we can use our quality assurance mechanisms to try and see if we are if we are behaving in
In a consistent manner so I think that what that will help in that regard as well but that so that you’re right letter really important point yeah so I think you wanted to quit covered as well yeah just just I think this will entices point this incremental up an incremental down I think
Avoids the sort of the big surprise of why things have changed so we should be able to say someone OK actually you’re good but you’re starting to drift so therefore it’s less of a surprise at this point 1 as little technical point which I think is a big Single Assessment Framework
Plus I think an area that I know that Ofsted are also thinking about is having trained their teams in how to recognise distressing providers what do they then do because you know if you’re a large and hospital chief executive you would work with your board and and others to
Seek support in a range of different ways if you’re an owner operation domiciliary care business what would you do are and I think there is probably something for us perhaps in partnership with our with Ofsted and maybe other regulators around connecting with third parties with a
Mental health charities and others to say of we’ve recognised as an issue here we’d like to sort of signpost due to someone else because I think there is a risk for us as a regulators we become a regulator but we also take on a some
Because I think there is a risk for us as a regulators, we become a regulator, but we also de facto take on a some kind of employer vicarious liability which which is not on our role and we should be clear about that but I think our teams I know
Would naturally want to help so we need to give those team search some tools to tangibly help people as well know, would naturally want to help, so we need to give those team searched some tools to tangibly help people as well. Thank you. just I’ve tried to argue that
Just I’ve tried to argue them Mark Chambers. thank you keep it very brief but I won’t I just really welcome this report I think actually you know you you mentioned there that were encouraging people to become a continuous learning environment and organisations this as a
Role model I think of how we’re trying to do that ourselves and I hope it’s one of many that we start to actually think about how can we get learnings from and advance them as for how we can actually apply the learnings from this
And it sounds from Tyson Foods even reassurance that we’ve got a plan within that to say OK what is preventing programme looked like I think it will be important just to revisit this even very briefly just to see you know three months in six months and have we made a difference in the
Way that we operate have we got new support out of this have we actually done that improvement doesn’t need to be to be weighty or heavy or require specific reporting, but just that check in to say, did we make the difference that we hoped it would make
Yeah and I would agree with that or a lie the this is incredibly important I think they they think the report proposed responses are the right ones and it yeah, I’d agree with that or a lie, the this is incredibly important, I think they they think the report proposed
Responses are the right ones and it. you know it’s indicative again that you can and end site yeah, it’s indicative again that you can draw learnings and insight from situations which are distinct from yours and there’s always learnings footfall for everyone so I think the I responses are right
Situations which are distinct from yours and there’s always learnings footfall for everyone, so I think the I think the responses are right I understand we weren’t talking about timelines today but I think I think tracking it in the way the Marks had suggested would be helpful because I think that actually
This is these are subtle and quite difficult interventions this training is not going to be like the sort of training that we’ve that were routinely de delivering and I think for it to be impactful it’s gotta cover or you know just gotta cover RSPCA’s and and others who are involved in in
Inspections as well so it for it to be impactful. It’s gotta cover you just gotta cover RSPCA’s and and others who are involved in in inspections as well, so it won’t be it won’t be straightforward to deliver this but it would be really important and I certainly as my very strong support
That we’re doing this it’s good to say thank you Facebook so be really important, and it’s something, that’s my very strong support that we’re doing this, it’s good to say thank you, OK thanks work, so look Joyce thanks very much for the paper I think we’re though it’s
Been really helpful whether as a model for looking at things but also you know it does two key things that explains on the one hand for those who sometimes look at Ofsted of us and put us together and we’re not we’re very definitely in some ways on the other hand there’s always
Something you can learn and I think that’s being taken on board I think Christine in her comments made a really good point earlier that the existence of this tragic case has changed the landscape in some of the people regulating so some of what we’re doing it’s not we’re not tried to say
That we I’ll I’ll make at this point partly if any of our colleagues I listened alone will not suddenly saying that we’ve been doing it badly which I say we need to respond to the fact that the world are listening alone will not suddenly saying that we’ve
Been doing it badly, which I say we need to respond to the fact that the world has changed. at my albeit very limited experience out so go in inspections as while people are very good at this I’d come across my, albeit very limited, experience out so go and
Inspections, as while people are very good at this, the once I’d come across. but it is stressful it’s extra stress whether it was a cow because you have no notice I’ve been there and see the look of joy on the face of a care in and
Because you have no notice, I’ve been there and seen the look of joy on the face of a care home manager when we walk in and say we’re from Ofsted, it’s also really important for both care homes and independent sector as it came up and down the call I was on
Because this is their livelihood be that the rating losing Oliver losing a rating or drop at the rating counterfeit livelihoods so the stress is absolutely enormous so I think we recognise the changing environment and responding what we do in the future I think can leave you with you to think
About that I’m not sure enormous, so I think we recognise the changing environment and respond to what we do in the future. I think, can leave it with you to think about that. I’m not sure that, and I’m dubious about having a specific tracking mechanism
For everything but one way or another I think it would be really helpful to have a few months time let’s say 6 rather than the its board meeting just to say six-month spirits really helpful to have a few months’ time, let’s say 6,
Rather than the next board meeting, just to say with a bed of the six-month spirit so, putting our people through the programme I mean they will have their own views and they will have better feedback at us on how care home providers in particular are responding
To repair a case of doing so I think it would be quite helpful to have that sort of feedback if we could capture that as an action so thank you very much to repair a case of doing so. I think it would be quite
Helpful to have that sort of feedback if we could capture that as an action, so thank you very much choice we move on to adjust are finally a few covenant slings so Jeremy can I turn to you just were quick Oral update anything from the
We move on to adjust are finally a few covenant slings, so Jeremy, can I turn to you just were quick, Oral update on anything from the last direct meeting. thank you Chair sorry I just want to give some feedback from the last act meeting held in December I think it’s
Worth just pausing slightly and breaking this down into financial year so our accounts for the year ending March 23rd are not yet finalised this was anticipated and it’s caused and come with a number of other organisations about a delay in the order of Local Authority pension schemes
Until that is done and that is likely to be a few months which are partly in corporate and away yet it will be a few months away layout and but having said that the work to finalise our and report on accounts is pretty much there just subject to those final changes
And the Ennio have been doing our audit and so far to date nothing untoward has been identified so we are progressing although this long delay is not helpful for anybody very much so we do have to reflect on how we can adjust the final Arak to make sure that people understand the delay
And why has happened looking now to the current financial year firstly looking at internal audit the good news is our plan is proceeding as desired in the last committee meeting we discussed three reports stakeholder engagement confidentiality and access management and governance and assurance arrangements a number of recommendations were
Raised and all three of those and but owners anything particularly I need to draw attention to the board and individual management responses have been received and have been received and plans are in place to follow up on those actions s the next thing we look at is the progress on the existing
Bank of actions and that’s come up in our private board meeting this morning and there is good progress on that we still have a little bit to do but the the Audit Committee is very much focusing on the ones that are missing the deadlines the ones that require extensions and indeed the
Ones have been hanging around for a long time and actually may now not really be relevant in the way in which they were originally phrased so that’s and continuing Programme progress but we are in a reasonably good shape just worth in which they were originally phrased. So that’s an
Continuing programme progress, but we are in a reasonably good shape. I think it’s just worth noting on a on a balance of transparency that we are changing our internal auditors we have pointed the government Internal Audit Agency to be our internal auditors from April internal auditors, we have pointed the government Internal
Audit Agency to be our internal auditors from April, and indeed at the same time we have given notice to our current internal auditors Price Waterhouse Coopers who’ve been in that role for properly five years now so I should just note thanks to their work and anticipating a a good finalisation
Of the current plan and handover to to do to G I the next stage we look at his risk and risk management and we have updated and looked at all the risks are particularly looking at those that are not progressing back to Green and
The way we would like and that’s a continued continued role for the Audit Committee and we also had a chance to have a look at the new risk management system that’s being developed we should give us a much easier way to manage
Progress show what we’re doing and I think will be a real step forward and that is pretty complete now this needs to half of the data because in think will be a real step forward and that is pretty complete. Now this needs to half of the data putting it there will be other
Then we also looked at triumph transformation particularly important at this time where we are in the programme to give additional assurance to the Board that the relevant controls and processes in place and there’s a specific role for the Audit Committee on give additional assurance to the Board that the relevant
Controls and processes in place, and there’s a specific role for the Audit Committee on approving and monitoring for use of contingent Labour and we discharge that issues to raise for use of contingent labour, and we discharge that again no issues to raise. and there were four things we also looked at there’s a
Bidding busy meeting update from Healthwatch England and the National Guidance Office actually both of the the presentation earlier in this meeting reference back to that we also looked at cyber resilience and our work on that and I think it is worth noting that we’ve genuinely feel that
We’re in a much stronger position in the last year or so as we’ve rolled out the new technology and also adapted to the feel that we’re in a much stronger position in the last year or so as we’ve rolled out the new technology and also adapted to the threats we see so.
Yeah fingers crossed yeah fingers crossed, there has been good progress there which gives us some assurance that were were on top of that always been aware that the risk is changing all the time so not complacent that was in a good place and then finally counter-fraud
Where there is we’re doing some extra work to look at the new government functional standards around that and make sure were aligned were no fraud sentiment are particularly large organisation 7 is proportionate but there is were underway to do that so that was the updated the meeting unless anyone has any questions
Large organisations so we need proportionate, but there is were under way to do that so that was the updated the meeting unless anyone has any questions progress though questions can I just add to be one thing you didn’t mention obviously that’s been Truiseil if you
Have a new newly appointed a chair of the Arak so we have arrangements had had to effect a smooth handover but Javi on behalf of the Board are just like although everyone thinks she’s done a fantastic job very difficult to but Javi on behalf of the board are just like although
That interim period can I just say thank you on everyone’s everyone thinks he’s done a fantastic job very difficult to behalf for the work they have to be to appreciated. ask you to a standard. Mark brief oral update terminology secret yeah very happy to do that thank you Chairman
Mark, brief, oral update terminology secret yeah, very happy to do that, thank you, Chairman. as a reminder of the LDCs sort of broken into two two parts we will look at a a a regular core paper where we look at the changes to the design we look at the delivery and we
Look at the measures that we have indicated we have about the effectiveness of our regulatory model so that’s the first part and then the second part were generally do a a deep dive on a particular topic effectiveness of our regulatory model, so that’s the first
Part and then the second part were generally do a a deep dive on a particular topic that we would not have time to to talk about at board I think the key thing is actually a lot of what came up in the Core paper we have
Covered today so when I will cover that today there more more actually a lot of what came up in the Core paper we have covered today, so when I will cover that today they move more more than any other RJC I’ve experienced the same things came up on board today
But it was a much improved paper so thank you to Executive Team for the RJC I’ve experienced the same things, came up on board today, but it was a much improved paper, so thank you to the executive team for the effort in I’m getting us to a smarter smaller deck that much more
Clearly gave visibility to the issues that are concerning management I think it was a more allowed us more focus meeting as a result I think of all the things and you know the metrics that are in there are are better but continue to to evolve
Meeting as a result, I think of all the things and you know the metrics that are in there are are better, but they will continue to to evolve. As the a single assessment framework and a single assessment framework and our new, methodology for regulation beds in will find the right
Measures that give us the on sites that we need at the at the Committee I think probably have all the methodology for Regulation beds in will find the right measures that give us the and sites that we need at the at the Committee, I think probably of all the things that
We talked about today the anything that would you know but perhaps just one thing I would measure was just as a as a mirror to the update on the All all are we talked about today the anything that would you know, but
Perhaps just one thing I would imagine it was just as a as a mirror to the update on the All all are see. actions that have been quite a lot of recommendations that we every accepted over the years from a variety of sources
So the ones that are or aren’t in the all are see we’re trying to track those or or or Adachi said we every accepted over the years from a variety of sources, the ones that are or aren’t in the all, are see we’re trying to track those or or or add are GCC
Yeah yeah yeah similar story more than half of those are delivered or close to completion but at the next meeting will have a a closer look at the ones that are that the restored to delivered or close to completion, but at the next meeting
Will have a a closer look at the ones that are that the the restored to understanding again is that for good reason or are getting them going is that for good reason, or are we just having difficulty getting them going? the deep dive was you know was on hope
The deep dive was yeah was on whistleblowing which I hope gives those joining the meeting remotely some assurances as to how important it is to us so we’ve got to make sure that people feel a maximum level of confidence in raising issues and concerns directly directly with us I’m you know we we
We were encouraged to see the the the the the the the enhancements and improvements that we’re trying to that concerns directly directly with us. You know we we. We were encouraged to see the the the the the the the enhancements and improvements that we’re trying to drive in that space.
Our next meeting as 17th April our next meeting as 17th April, thank you Kate couple of final thank you Kate couple of final letters. we’ve got the minutes of the last meeting in the PAC there were circulated before what you have in front of you as
What was circulated so can I take those as there were circulated before what you have in front of you as what was circulated, so can I take those as proof thank you very much, and we have in the pack the and we have in the pack the actual log.
Two items are shoulders outstanding but on track but not yet due to we’ve shown us closed while there’s close by virtue of the fact that there must be accepted as Santa we dealt on an ongoing basis so I suggest that’s close so I’m
Happy with that log if therefore the ulcers I think in terms of the formal business then that brings us to any other business so there’s anything else anybody wanted terms of the formal business then that brings us to any other business, so there’s anything else anybody want to
Colleagues for sorry with a few minutes ago but then you raise just put thank you very much indeed Russell but discussions discussions out a few things to follow up that’s the end of the formal business. but as usual we do offer members of the public the
Opportunity to ask questions so we’ve only got three today they’re gonna ask Chris and Tyson to responsible I hope you being forward if not you’ll have to make it up as you go along the first question is one few Chris how will the workers see QC change during the period of election
You go along. The first question is one few Chris. How will the workers see QC change during the period of a UK general election thanks to the question so in accordance with Cabinet Office guidance all bees junior pre-election period are asked to really honed down to discharge their regulatory functions
Only but for us I wrote to functions are inspections of providers and and are asked to really honed down to discharge their regulatory functions only, but for us I wrote to functions, are inspections of providers and and obviously inspections of Local Authority in ICS is what we’ve done in
The past Executive Raisi essays and or or and allays is not publish those documents during the pre-election pavements will carry out the activity so it wouldn’t stop I registry activity it wouldn’t stop as taking enforcement action if we felt that we needed to protect people use services but
We would we would not seek him to to publish those documents and actually is as we were developing our plan for this over that over that short period of time which is the the formal pre-election period we wouldn’t choose to publish a at a at a at a system level a
Which is the the formal pre-election period. We wouldn’t choose to publish a at a at a at a system level but still carry on at a provider level and we’ll we’ll we’ll we’ll do that in instead of CA cooperation with the Cabinet Office the Cabinet Office as
We get closer to an election will set out the actual days of a pre-let experience there aren’t they are determined yet and they are slightly at the behest of the Cabinet Office but will work with that tha dated on guidance when it comes out sorry it’s something you might shift the
Delivery of some things about the core business car as long as usual procedure but the next question was who shift the delivery of some things about the core business carries on as usual procedure, but the next question was who as well Chris interesting one what communications are there were the
Secretary of State concerning serious issues in NHS services so it’s important that we are able to share our concerns with all services but particularly for the NHS with senior partners including the secretary of State so we would regularly share with ha Hunter team there were a
Wider team any serious concerns that we had around NHS services and anything where we were where we were due to take action which would result in had changed the way that service operates but we wouldn’t just show it with with her we’d also share it with colleagues in in in NHS England
Because they may well be responsible for the actions her. We’d also share it with colleagues in in in NHS England because they may well be responsible for the action that follows, follows our action so we would absolutely in due on a regular basis share our concerns say particularly with with
Other colleagues I have responsibility for those services nationally and then will use that to as a as a pre them for anything that we put out to the public wider services nationally and then will use that to as a as a pre
Them for anything that we put out to the public and the wider the wider media. OK thank you Chris and last question is one for you Tyson rather more specific how does the see QC currently engaged with the prison and spectrums to regulate the
Tyson, rather more specific, how does the see QC currently engaged with the prison inspections to regulate their health services? and then thank you for the question we have statutory powers to register monitor and inspect regulated health activities delivered by health providers in the prison
Estate as the quality of healthcare may be impacted by the effective and effectiveness of the wider prison regime we adopt a partnership approach with H M Inspectorate of prisons to deliver the present inspection through a joint inspection framework during these joint inspections we inspect the delivery of healthcare at HMF P expect the
Treatment of prisoners and wider conditions each inspection leads to a joint report should our inspection activity identified breach of healthcare standards then a second a separate report will set out our evidence of breach and any action we are taking there may be situations where we will
Inspect as a single agency if the evaluation of risk determines that a separate on-site inspections is required but in summary we work very closely with the evaluation of risk determines that a separate on-site inspection is required, but in summary, we work very closely with the Inspector of prisons