Minutes of the Public Board Meeting 151 Buckingham Palace Road, London, SW1W 9SZ 20 June 2017 at 11.00am Peter Wyman (PW) David Behan (DB) Louis Appleby (LA) Paul Corrigan (PC) Robert Francis (RF) Jora Gill (JG) Jane Mordue (JM) Paul Rew (PR) Steve Field (SF) Mike Richards (MR) Andrea Sutcliffe (AS) Chair Chief Executive Chair, Healthwatch England and Chief Inspector of General Practice Chief Inspector of Hospitals Chief Inspector of Adult Social Care In attendance Rebecca Lloyd Jones (RLJ) Eileen Milner (EM) Kate Harrison (KH) Pete Sinden (PS) Max Hood (MH) Lesley Salkeld (LS) Katherine Arthur-Botchway(KAB) Legal Advisor to the Board Executive Director of Customer & Corporate Services Director of Finance, Commercial & Infrastructure Chief Digital Officer (item 4) Head of Workplace, Facilities and Safety (item 5) Health, Safety and Workplace Manager (item 5) Corporate Governance Manager (minutes) ITEM 1 WELCOME, APOLOGIES & DECLARATIONS OF INTEREST 1. PW welcomed Board members and other attendees. Apologies for absence were received from Michael Mire and Malte Gerhold. There were no interests declared. PW congratulated David Hogarth on receiving a British Empire Medal in the Queen s Birthday Honours list. ITEM 2 MINUTES OF THE MEETING HELD ON 25 MAY 2017 (REF: CM/06/17/02) 2. The minutes of the meeting held on 25 May 2017 were accepted without amendment. ITEM 3 MATTERS ARISING AND ACTION LOG (REF: CM/06/17/03) 3. The action log was noted. 1
ITEM 4 CHIEF EXECUTIVE S REPORT (REF: CM/06/17/04) 4. DB presented the Chief Executive s report for noting. The following matters were highlighted: Performance Report: April 2017 The new format of the report was noted. DB reported that performance on registration continued to improve and there had also been an increase in the volume of applications received in the month. Work continued to improve the timeliness of publication of inspection reports. 5. LA welcomed the new format of the performance report but commented that it was important to be able to understand the number of places that are Inadequate or not improving (and not just the percentages). It would also be helpful to see the breakdown of re-inspections for those locations in breach of fundamental standards for four quarters or more, by sector. DB agreed it would be useful to see this data, and would ensure these changes were made. 6. SF set out for the Board a breakdown of PMS locations in breach for more than one year and their current status to illustrate the availability of detailed data on action being taken. 7. NCSC: PW asked EM to provide further explanation of detail on the increase in the volume of applications and NCSC performance. EM reported that the modernisation programme was progressing to plan. As expected, there are some areas of performance that have yet to meet their KPI, due to staff undergoing training in the new ways of working and embedding that in the new teams. The modernisation programme has had an impact on the timeliness of registration applications and the processing of safeguarding concerns. However, teams are working hard to improve, and there was a robust plan in place to recover performance in Quarter 1. It was expected that by the end of July, targets will be back on track. In respect of the increased applications, EM stated that this was currently being explored to understand the trends and possible reasons for the increase and this data would be reported back to the Board. Action: EM to report back to the July Board meeting on progress and the trends relating to the increased volume of applications. 8. Whistleblowing: RF welcomed the figures on whistleblowing, which would be useful information to the public, and encouraged tracking of the information that was received and what action was taken as a result of that information. Competition and Markets Authority (CMA) study 9. DB reported on the UK-wide CMA market study into care homes for people over the age of 65, looking into how well the market is working for consumers. The CMA had engaged with CQC on this piece of work and published its interim report, setting out high level findings, on 14 June 2017, with the final report intended for publication in December 2017. AS added that the study was focussed on the consumer point of view, and had so far identified that the market for adult social care does not always work in the best interest of customers. The CMA had engaged with CQC (including CQC s market oversight team) from both a policy and inspection perspective for this work, and CQC would 2
3 Agenda item: 2 continue to engage with the CMA over the next six months as they continue to develop the market study. Action: A report would be brought back to the Board for discussion as the work progresses. 10. Another area of work that would be pursued with the CMA is complaints handling in the care home environment. AS added that complaints could be taken up with the Local Government and Social Care Ombudsman if satisfactory redress was not found with the local provider. ASC: Dispatches programme 11. AS reported on the Channel 4 Dispatches programme highlighting the standard of care provided in two Bupa homes: Crawfords Walk and Perry Locks, after evidence of poor care was gathered by an undercover reporter filming in the homes. AS advised the Board that: CQC had had prior knowledge of these homes, having inspected and rated them last year (Crawfords Walk as inadequate) and undertaken a follow-up inspection in March of this year; and was already taking enforcement action to require improvements in the home. Both services have since been re-inspected. It had been made clear to Bupa that failure to meet the conditions imposed on them in respect of Crawfords Walk would result in further action being taken, which could include prosecution. Bupa has a responsibility to manage their homes and it was apparent that this obligation is not being met in all of their homes. Bupa has reassured CQC that it has taken appropriate action against individual staff members at Crawfords Walk. However, the culture of the homes needs to be addressed and this starts with the priorities and expectations of the corporate team at Bupa. AS also stated that in relation to poor services across the country, 3% of services (which is over 600 services) are rated as Inadequate - a third of these either cease to operate or de-register; and those that continue to operate, three-quarters do improve. 5,000 services are rated requires improvement and in each of these services, the providers know what their failings are; what they are expected to do to comply; and also know the consequences of not complying. Where services are rated requires improvement, about half do improve. CQC is increasing enforcement action against failing providers; and a consultation process has recently started seeking changes to the scope of registration. If the proposals were implemented, it would enable action to be taken against a corporate provider and not just the individual service. CQC would continue to pursue with the DH the changes needed to the Regulations in order to remove the current restrictions placed on CQC, which prevent the publication of enforcement action until the end of any appeal process. 12. In the wake of the Grenfell Tower tragedy, the Board discussed the safety of residents in care homes (as well as local authority accommodation blocks), and the importance of having in place good fire safety regulations and evacuation arrangements for residents who are frail or have mobility issues. It appeared that fire safety was a matter of selfassessment for some providers; so when inspecting providers and looking at the issue of fire safety, CQC was reliant on self-assessments.
13. AS confirmed that CQC does look at fire safety during inspections as part of the key lines of enquiry on Safety, and made its own observations (as well as looking at the paperwork supplied by the provider). This would include, for example, looking at fire exits in a home, and at whether care plans contained sufficient information about evacuation arrangements for frail residents or those with mobility issues. Any recommended changes would be followed up on re-inspection and CQC also reported any concerns to the fire authorities to enable them to take action. It was noted that in ASC an environment checklist had been created to assist inspectors when carrying out inspections. 14. AS added that following the Grenfell Tower fire, DB had commissioned a piece of work across the three inspection directorates to look at what is currently being done on fire safety; at what we report; what more can be done; and what partnerships need to be strengthened. It was proposed to strengthen joint working with fire authorities. 15. Hospitals: Convicted Surgeon MR advised the Board that CQC had been aware of the issues with the surgeon. CQC would be working closely with insurers in the future to ensure areas of concern are brought to CQC s attention. The Board asked whether there had been any warning signs in the system from relatives or members of staff. MR stated that there was a wider question of whether in the future there might be a freedom to speak up guardian role to encourage staff in the private sector to raise their concerns. It should also be considered whether there are better ways to ensure the voice of staff who have concerns is heard. Action: MR to report back to the Board on progress with this work. Digital Strategy update 16. PS updated the Board on progress with the first three identified projects. JG welcomed the progress that was being made, but commented that it would be helpful to draw out the large-scale benefits to enable the Board to focus in future discussions on the outcomes to be achieved. PS advised that the benefits would be highlighted in the next update. The Board asked about running an agile project and managing the governance of the project with an external provider; and the potential impact of the gaps in capability referred to in the report. PS advised that in shaping the first project, there had been the right level of business involvement from the start and this would be managed by Liz Owen, Head of Surveys and Qualitative Intelligence, to drive the benefits to the end user. It was noted that the external provider is based in-house and has a remit that includes knowledge transfer to ensure the rest of the team is able to work in agile ways. There are some gaps in capability in terms of roles; and gaps in overall data management and some external assistance would be brought in to meet these requirements. PS assured the Board that these would shortly be going to the Investment Committee for approval. Performance Assessment Regulations 17. The Board noted that CQC had been working with the DH on making changes to the performance assessment regulations to enable CQC to rate services that we cannot presently rate, e.g. cosmetic surgery and termination of pregnancy providers. The consultation would take place over the summer, if the Regulations are intended to come into force in the autumn. 4
Publications 18. It was noted that CQC would be reviewing its guidance published three years ago on the use of hidden cameras or other equipment to monitor someone's care". Appointments 19. It was reported that Professor Ted Baker had been appointed as CQC s new Chief Inspector of Hospitals (to succeed Professor Sir Mike Richards when he retires) at the end of July, following an extensive external recruitment process. The Board extended congratulations to Ted Baker. Decision: The Board noted the Chief Executive s report. ITEM 5 HEALTH AND SAFETY BRIEFING TO BOARD MEMBERS (REF: CM/06/17/05) 20. Max Hood (MH) and Lesley Salkeld (LS) joined the meeting to brief the Board on its health and safety duties and responsibilities. MH outlined the changes and improvements resulting from the internal review of health and safety (H&S). These included: A new H&S staffing structure in place An updated H&S policy Development of a H&S strategy Implementation of a H&S action plan following an internal audit recommendation A revived H&S Committee that was working well. 21. LS outlined the two elements of CQC s risk profile: strategic ensuring H&S governance is robust and up to date; and operational proper management of key risks, e.g. lone working (risk of violence against staff); homeworking, driving at work. LS reported on the importance of staff reporting all accidents at work, even if no injury had occurred and advised of the relaunching of the accident and incident reporting policy. It was noted that under-reporting of accidents/ incidents in the workplace is an area for improvement. 22. The Board noted that it had a role to play in providing strong and active leadership and a commitment to ensuring H&S compliance within the organisation through all levels of management. It was also noted that the Health and Safety Committee reports annually to the Executive Team on the position. 23. In discussion, the Board asked about the psychological safety of staff and whether illness from work-related stress is monitored in the workplace. MH advised that the H&S Committee s remit also includes health and well-being and managers are trained to manage staff suffering from stress. LS confirmed that physical health is also covered through workstation safety and ensuring staff are aware of the correct use and handling of equipment. 5
24. The Board expressed concern about violence against staff by external third parties, e.g. on inspections and the importance of reporting any such incidents to the Board, via the H&S Committee. PR stated that the Audit Committee recommends bringing safety matters to the Board as oversight, in addition to that already provided by the H&S Committee. Action: MH to bring new H&S strategy to Board; and any recorded incidents of violence against staff to be reported to the Board. ITEM 6 AUDIT AND CORPORATE GOVERNANCE COMMITTEE (REF: CM/06/17/06) a. Annual report to Board 25. PR presented the annual report of the Audit and Corporate Governance Committee (ACGC) on the Committee s work in 2016/17. PR advised the Board that the ACGC is assured that the organisation has maintained progress and improved its risk management and control and is also operating more efficiently. The Board noted that in the coming year, the ACGC would be monitoring the implementation of the new strategy; the progress of the digital project work and the next phase of inspection regimes. b. Summary report of meeting held on 23 May 26. PR presented the summary report of the ACGC meeting which was held on 23 May 2017 to scrutinise the Annual report and accounts 2016/17. 27. The Board commended the good work by the Committee. Decision: The Board noted the reports. ITEM 7 REGULATORY GOVERNANCE COMMITTEE (REF: CM/06/17/07) 28. The Board noted the annual report of the Regulatory Governance Committee (RGC) on its work in 2016/17. PW stated that it was Michael Mire s (MM) last meeting and thanks were extended to MM for his work on the Board and as Chair of RGC. It was noted that MM would continue to be involved with the work of CQC and the Board. Decision: The Board noted the report. ITEM 8 ANY OTHER BUSINESS (REF: CM/06/17/08) 29. Time allowed for questions/ comments from members of the public. David Hogarth commented that he was pleased to hear that CQC is reviewing its guidance on the use of video cameras in care homes and hoped it would encourage increased use of these technologies. Mr Hogarth referred to research work he had carried out in April looking at where a rating of inadequate or requires improvement had been given in the caring domain and how far kindness and compassion is taken into account as part of the KLOEs. Mr Hogarth s research showed that out of seventy cases, only nine related to kindness and compassion. Mr Hogarth considered that the use of surveillance, whether cameras or acoustic, or CCTV would help to pick up any incidents of poor care and would enable more rigorous pursuit of providers. Mr Hogarth stated that this might be an area that could be included in the ASC end of programme report as work for the next year. 6
30. In response, DB stated that technology has advanced in three years and it was right to review the CQC guidance at this time. DB would consider all the points raised and the end of programme report would be available to Mr Hogarth when it is published in a few weeks time. Action: The consultation document seeking views on proposed changes for adult social care, primary medical services, complex providers and local systems to be sent to Mr Hogarth. 31. Helen Rochester (HR) introduced herself as a former nurse with twenty years experience, and referred to the April Board meeting and the legal definition of whistle blower that had been provided to the Board. HR outlined her personal experiences as a whistle blower and how she had raised concerns with CQC about poor care on two separate occasions in the last four years. In both instances, HR explained that she had received a standard response letter from CQC, and reported that on both occasions, the CQC inspector had apparently disclosed her identity as a whistle blower to her employer. HR expressed disappointment that this had happened on two occasions, and asked what assurances CQC could give that this would not happen again and that she would be protected as a whistle blower. 32. PW thanked Ms Rochester for giving advance notice of the question. PW explained that because she had made a formal complaint, which was under investigation, it was not appropriate to make any comment at this time. PW offered to meet with HR once the investigation is complete. PW assured HR that CQC takes the need to protect the confidentiality of whistle blowers seriously. 33. DB advised HR that once the investigation is complete, he would personally see the letter of response before it is sent to her. There would also be a discussion at Executive team as to whether CQC practice on whistleblowing is consistent with its policy on whistleblowing. Action: DB to review response letter to HR once investigation complete. Executive team to discuss CQC s policy and practice on whistleblowing. 34. PW thanked all for attending and brought the Public session to a close. CLOSE 35. The meeting closed at 12:25pm. 7