Promoting staff equality and improving Northamptonshire’s services

Northamptonshire Healthcare NHS Foundation Trust (NHFT) have made significant improvements to their Workforce Race Equality Standard (WRES) indicators. They have done some great work to improve equality within their workforce. This is making a real difference in the working environment and the quality of care they provide.

We spoke to NHFT for our State of Care report. This case study describes some of the actions they are taking and how they are improving their service.

What went well with WRES?

Our 2018 inspection report highlights several areas related to WRES. There was an established, accessible BME network which supported both staff and patients. The trust co-produced its WRES action plan with staff through the network. This plan implemented the reverse mentoring scheme and staff focus groups.

The national director for WRES had recently visited the trust and praised the culture and approach.

In WRES 2019, the trust experienced improvement in six out of nine WRES metrics.

Work with the colleagues to equip them, the best they possibly can do, to kind of develop careers and actually make the decision [not to appoint BME staff] really difficult for managers. I think that’s the message that we’ve been giving to colleagues, is: ‘Let’s get you in a space where actually, it makes it really hard not to appoint you’

Some figures:

• latest staff engagement score = 7.5 out of 10, the 7th best across the country
• 76% of staff would recommend the trust as a place to work, up from 62% from 2015
• BME staff believing the trust provided equal opportunities for career progression: 68% in 2015, 80% in 2019
• BME staff entering formal disciplinary proceedings improved: 4.61 times more likely than white staff in 2015, 2 times in 2019.

In 2015, 25% of BME staff reported experiencing discrimination. By 2019 this was reduced to 11%, and the trust continues to drive forward initiatives to improve this further.

How was WRES implemented?

Enabling factors

Leadership

The trust saw both leadership and engagement as a top priority. The chief executive was heavily involved, setting up a steering group for diversity network leads which is co-chaired by the BME network lead and the chief executive, and oversees all equality strands across the whole workforce. This reassured staff about the trust’s intent.

It’s chaired by our chief executive and co-chaired by our BME network lead. And I think that signalled a real intent to the BME network that actually, we’re going to take this issue really seriously

One equality initiative from the steering group was to run a reverse mentoring scheme. Eight executive board members took part, each mentored by a BME staff member from a lower grade. These relationships focused on race and ethnicity. They provided a safe space to understand differences in experience and the impact on staff. Feedback from reflection sessions revealed that the experience was very powerful.

The Board was fully committed to advancing equality within the trust. They showed oversight and steer. Leaders were expected to uphold four leadership behaviours:

• working together
• taking responsibility
• being authentic
• embracing change.

Equality ran through each of these behaviours. Every six months, board reports are scrutinised against ‘Developing a Diverse Workforce at NHFT’. Board members are also executive sponsors for each of the four staff networks.

Engagement

Initially the BME network did not feel confident in bringing up difficult issues that BME staff felt needed addressing with the senior leadership team. The BME network facilitated listening events to support action planning which, for the most part, the senior leadership team did not take part in so staff felt they could raise issues safely. Selected directors attended to host a question and answer session at the end of each session.

So it [the listening event] allowed people, in a really safe space, to raise issues that they were experiencing without it then being identified by senior managers. All the questions that we answered, all the feedback we took was kind of fed back through a facilitator. And that gave us a unique kind of spot analysis that we could use about where some of our biggest concerns are and it was that overall trust, confidence, belief that our BME staff thought that we were actually going to do something seriously about it and make a difference with it

As engagement and trust with the BME network improved, they co-produced WRES action plans to tackle the real issues. The trust then held an event to embed equality and diversity priorities within the culture called Changing the lens on diversity. This included both external speakers and internal staff.

On 21 March 2017 we held a ‘Changing the lens on diversity’ conference with 132 leaders. The event was co-produced with the Diversity Network Leads and included a presentation on unconscious bias by Professor Binna Kondola OBE and trust colleagues sharing powerful stories across the equality strands

The trust collaborated with external agencies on their WRES work. The national programme directors for WRES and Equality & Inclusion visited to learn more about their approach. The WRES national programme director wrote the foreword to the trust’s Equality Matters booklet. This gives a seal of approval for their work.

Culture

When NHFT first implemented WRES, they developed action plans in isolation with HR. They based initiatives on policies and procedures. Although these were fairly implemented, they did not address the real issues. The focus was on the ‘outcome’ rather than ‘inputs to the process’ or ‘culture’.

Leaders felt the BME network expected solutions to come from management ‘to make the decision’ and the network was not part of the solution. The trust wanted to shift the thinking towards solutions having grass roots involvement. A ‘sea of change’ came about in 2016/17 when the chief executive set up the steering group. As trust and engagement improved, action planning became a trust-wide responsibility.

I think probably one of the most important things we’ve done is recognise that we can learn from each other. So, we’ve moved the responsibility for action planning out from HR into the whole organisation

The trust re-launched its PRIDE values, which explicitly included equality:

• People first
• Respect and compassion
• Improving lives
• Dedication
• Equality

Senior leaders saw equality as a priority and these values were channelled through the organisation. Staff were encouraged to sign up to a Staff Charter. This included a responsibility to:

• act with courtesy, compassion and respect
• listen to others
• behave in ways which do not cause offence
• speak up if things aren’t right.

NHFT produced staff booklets about acting with respect and compassion and valuing equality.

Challenges or barriers

In 2015, CQC rated NHFT as requires improvement, and only 62% of staff recommended the trust as a place to work. Feedback from BME colleagues was also seen as an area for concern. On reflection, the trust noted that the first two WRES action plans were barriers to success as they were developed without the necessary engagement with BME colleagues.

Leadership

A challenge was embedding commitment for improvement beyond the chief executive into the wider senior leadership. Some senior managers failed to grasp the issues colleagues faced or see equality as a priority. Reaching middle management was also seen as a challenge.

Moving towards co-production and better engagement helped the senior leadership team to understand what needed addressing. Board members in the reverse mentoring scheme also gained unique experience about the impact decisions had on BME staff. The mentoring scheme dramatically improved trust between BME colleagues and the board. It also developed strong alliances. Introducing the leadership behaviours behind the trust’s values of PRIDE ensured equality was a priority.

For middle management, external facilitators helped discussions around leadership and equality. These included deputy director and service manager levels, with plans to move to Band 6 and 7 as the next wave. This approach means both senior leadership and grass roots were signed up to improving workforce experience. This helps embed the culture within middle management.

Culture

Initially, BME staff feedback showed a mistrust in senior management to address challenges staff with protected characteristics faced. Some feedback suggested that the trust was out of touch with the views of BME staff and resistant to change. They needed to create an environment in which shared ownership and partnership working would flourish.

The staff listening events and the steering group provided strong foundations to improve engagement and trust. Improvements allowed the real issues to emerge, and collaboratively solutions to be developed.

I think there are always challenges with some of this work [WRES implementation] and new things [challenges] that kind of surface throughout. I think what we have is some real good building blocks. As I’ve mentioned, we have that kind of trust from our BME colleagues that actually, we are taking this issue seriously and it is allowing some of the real issues to emerge

Beyond the organisation

A future challenge was supporting staff on the ground to link the work to local area communities. This aimed to help improve both experience and outcomes for people with protected characteristics. One of the first approaches to address this was the moving ahead project.

What was the impact?

The trust’s approach to improving the working experience for all staff, including BME, had led to many positive outcomes.

Impact on staff

BME staff believing the trust provided equal opportunities for career progression improved from 68% in 2015 to 80% in 2019. The overall figure, regardless of any kind of protected characteristics, for perception about equal career progression opportunities is 91.5%. This is a leading score for their trust type. Another benefit for the trust has been its external reputation. People — including those at a senior level — cited the trust’s culture as one of the reasons they wanted to join the organisation.

They implemented a new ‘Trac’ recruitment system in 2018. This required more robust feedback and evidence of decision not shortlist from managers. The trust used this alongside a culture supporting BME staff in planning and managing their career. A career development workshop, co-produced with the BME network, equipped staff with the skills to plan their career. One of these workshops was attended by 40 BME staff members. One staff member who was interviewed the day after the workshop and secured a job, cited the workshop as making a difference.

WRES implementation also provided improvements around other indicators:

• BME staff entering formal disciplinary proceedings improved from 4.61 times more likely than white staff in 2015 to twice as likely in 2019. The trust plans to implement cultural ambassadors to improve this further.
• In 2015, 25% of BME staff reported experiencing discrimination but by 2019 this had been reduced to 11%.

The trust supported staff to get involved with national projects. In 2018 one staff member attended the WRES experts programme to further support the trust. This improved their understanding of issues and they establish a network to share best practice. Another staff member attended the WRES frontline forum group. They shared their experiences within NHFT and brought in stories from other organisations.

Impact on other areas

Other protected characteristics

The approach to WRES implementation also supported staff with other protected characteristics. The LGBTQ+, disability, and working carer staff network leads were part of the equalities steering group. These leads, along with the BME network lead, gathered feedback from the career development workshop. The trust plans further work with organisations such as Stonewall and Northamptonshire Carers to support staff with protected characteristics.

To prepare for the workforce disability equality standards (WDES) the trust had taken a similar approach as they had done with WRES. They focused on co-production between senior leaders and the Staff Disability Network (including allies). The next steps are to focus on identifying issues staff face and what actions can be put in place to improve these areas.

The trust introduced a diverse network of Freedom to Speak Up Champions. These support all staff including those with protected characteristics. Their role is to act as a check on the trusts’ culture and provide staff with the confidence to speak up.

Patients

NHFT’s ‘moving ahead project’ aimed to address inequalities in mental health for BME communities. This project would not have been possible without engagement with BME staff members to make it feel authentic. With staff and patients supporting the trust, it provided the confidence to access communities to understand barriers and challenges BME people faced.

The project included a BME community day. This featured speakers discussing bias around mental health service access. They brought in partners to collectively understand the challenges and collaboratively make improvements. As staff experiences and engagement improved, this can translate to improved patient experience and outcomes.

So one of the real benefits of WRES is, actually, by focusing on the outcomes of colleagues and the experiences of colleagues, it has helped increase that engagement score. What we know from research is, the more engaged your workforce is, the more that spills over into patient outcomes, the more the colleagues feel as if they’ve been treated fairly, with respect, compassion and dignity and that spills over to then, how they treat patients, which then spills over into patient outcomes

What can others learn from NHFT?

The trust felt there were three areas which were important to the effective implementation of WRES.

1. Co-production

Without support from the BME network, they would not have been able to identify the real issues so could not take meaningful actions. This was also key to building trust between the staff and senior leadership. It gave the network faith that the Board were authentic in their desire to improve workforce experience.

So, learning would definitely be around co-production. It would be around making sure you’ve got that executive buy-in and having our chief executive, sponsoring our BME network and really being out there and saying, ‘Actually, I’m going to make a difference to this,’ has been so critical in our success

2. Leadership

The chief executive’s involvement setting up the equality steering group was seen as a turning point. It was also recognised that ensuring Board interest and involvement was also key. Regularly scrutinising papers about developing a diverse workforce helped demonstrate this. The co-produced action plan, presented by the BME network rather than HR, was a big change in approach. The Trust reaches middle management with the collaborative efforts of senior leaders and the grassroots.

3. Culture

It was important to:

• develop a culture based on collaboration
• treating everyone with compassion and respect
• focus on equality.

These ‘building blocks’ improve workforce experience, and will start to improve patient experience and outcomes.

Finally, NHFT felt an organisation should strive for continuous development to improve equality and diversity within.

I think what’s really important for us is, we’re not comfortable with where we are and we know there’s still more work to do on that and that’s very clear from us as an organisation. Yes, we have made improvements, yes, we have started to improve the experience; but we’re not finished yet. There’s still a lot of work to do to get some equality coming through to the experiences of all colleagues with protected characteristics