Advancing Equity and Inclusion Strategy

Reduce inequalities in health and employment by using data and intelligence to assess impact, guide activity and monitor performance.

• Improve the quality of our equality data and develop equality data dashboards which will include metrics that will guide activity and monitor performance through the business planning process.
• Work in partnership with the Greater Manchester Integrated Care System (GM – ICS) and identify how we use data and intelligence to advance equality and drive improvement through the application of the NHS Equality Delivery System V3 2022 (EDS 2022).
• Develop systems and processes that will improve the way we use data and intelligence to conduct health equality impact assessments of our polices, our services and our environments.

 

The immediate action we will take includes: 

• A review of our Board Assurance Framework and ensure performance metrics are disaggregated by ethnicity and indices of multiple deprivation (NHSE, 2022; NHSE, 2023).  December 2023 
• Outline an 'Equality Data Quality Improvement Plan' making year of year improvements with an overall ambition to have 95% accurate data on all protected characteristics across both our services and workforce (NHS Digital 2022, NHSE, 2023). October 2023
• Develop guidance on using the internal clinical audit process to interrogate local Data Quality Maturity Index (DQMI) information related to data quality of protected characteristics and other vulnerable groups and identify actions to improve the accuracy of our data where it falls below 95%.  To focus on accommodation status, disability, ethnicity, gender identity and sexual orientation.  October 2023
• Outline a proposal to develop a set of equality data dashboards for our workforce which is aligned to the NHS National Dashboard, that will help prioritise action and monitor progress through local business plans. (NHSE, 2023) ​​​December 2023
• Development of a set of Mental Health Act data dashboards disaggregated by ethnicity, gender and learning disability or autism to support the Draft Mental Health Bill 2022 and monitor and tackle racial inequalities in mental health services and provide stronger safeguards for people with learning disabilities or autism (UK Parliament, 2023). June 2023 
• Development of a set of Restrictive Practice data dashboards disaggregated by ethnicity, gender and learning disability or autism to support the implementation of the Mental Health Units (Use of Force) Act 2018 or ‘Seni’s Law’ that came into force in 2022. Date TBC.
• Development of a set of Core 20 Plus 5 data dashboards disaggregated by ethnicity, gender and learning disability or autism to support the Core20PLUS5 approach to reducing healthcare inequalities. Date TBC.
• A review of our routine outcomes monitoring data for adults, children, young people and perinatal (including inpatient) mental health services and disaggregated the data by ethnicity to highlight any areas for concern and inform future priorities (CQUIN: 2023/24 guidance). October 2023 
• ​​​​​​​Implement the NHS Equality Delivery System 2022 in partnership with the Greater Manchester Integrated Care Board (GM – ICB) and the GMCA Equalities Panels with a focus on CYP Services, and Interpretation Services for 2023/24 (NHSE, 2022 Core 20 Plus 5). February 2024
• A review of our 'Annual Equality Information Report' and structure future reports around the three domains outlined in the Equality Delivery System (2022), focusing on inclusive leadership, tackling physical and mental health inequalities in service delivery, and inequalities in our workforce, ensuring it supports action on tackling health inequalities through the Core 20 Plus 5 approach, Advancing Mental Health Equalities Strategy and the NHS Equality, Diversity, and Inclusion Improvement Plan October 2023
• A review of our Workplace Race Equality (WRES); Workplace Disability Equality (WDES); Our Gender Pay Gap Reporting and develop an action plan which includes recommendations on future reporting and monitoring on intersections between disability, gender, race and sexual orientation (NHS, 2023).  October 2023
• To develop guidance on using the internal clinical audit process to interrogate local data on annual health checks for people accessing our services who experience racial inequalities which are living with severe mental illness and where this fall below 60% identify actions to engage with community partners, experts by experience and experts by profession to increase uptake (Core20PLUS5 (adults) – an approach to reducing healthcare inequalities). March 2024

Reduce health inequalities by working with community partners, and experts by experience and profession to co-produce inclusive integrated services that improve outcomes.

• Increase access to community mental health services for people who experience inequalities by co-producing inclusive culturally appropriate integrated care pathways through the Mental Health Community Transformation Programme.
• Reduce racial inequalities in the use of the Mental Health Act by working with community partners, experts by experience and experts by profession to co-produce culturally appropriate services.
• Reduce inequalities in the use of force including physical, chemical restraint, or the isolation of a patient, by integrating knowledge about identity and cultural competence into trauma informed approaches to care.

The immediate action we will take includes:

• Host an event 'Advancing Race Equity through the Community Mental Health Transformation Programme (CMHTP)' to bring providers funded through the GM Integrated Care Board Culturally Appropriate Mental Health Services Fund (GM ICB CASF) together with providers of community mental health services at GMMH and co-produce a partnership agreement that enables community led organisations to work alongside and in partnership with mainstream providers in an integrated inclusive way. December 2023. 
• To develop guidance on using the internal clinical audit process to interrogate local data on detentions, length of staff and use of community treatment orders under the MHA, broken down by ethnicity and gender and implement policies to reduce inequalities including supporting the use of culturally appropriate advocacy services (such as the service delivered by Gaddum), a recommendation of the Mental Health Act review (Mental Health Bill UK Parliament,2022). October 2023. 
• In partnership with the Greater Manchester Integrated Care Board (GM – ICB) and our VCSE partners support the co-delivery and evaluation of the GM Integrated Care Board Culturally Appropriate Mental Health Services Fund (GM ICB CASF) through the Community Mental Health Transformation Programme (CMHTP). Publish GM Integrated Care Board (ICB) Culturally Appropriate Mental Health Services Fund (CASF) Year 1 2022/23 August 2023
• In collaboration with the Greater Manchester NIHR Applied Research Collaboration (GM-ARC) deliver the 'Evaluating the Implementation of the Patient Carers Race Equity Framework (PCREF) in Greater Manchester:  Delivering the GM Integrated Care Board Culturally Appropriate Mental Health Services Fund (GM-ICB-CASF)' as part of the Mental Health Implementation Networks (MHIN) Improving access to mental health services for minority ethnic communities (project 1). March 2024 
• Co-create an anti-racism action plan which will support the implementation of the NHS Patient Carers Race Equality Framework (which includes competencies related to Workforce Race Equality Standard (WRES). October 2023.
• Develop a Race Equality Audit Tool to support the local implementation of the Patient and Carers Race Equity Framework (PCREF)  Based on the three domains outlined in the Equality Delivery System (2022), the tool will identify the criteria that will allow us to assess performance on reducing health inequalities, advancing equity in mental health services and in our workforce. October 2023.
• In partnership with Greater Manchester Integrated Care Board (GM – ICB) and the GMCA Equalities Panels implement the Advancing Mental Health Equality (AMHE) Resource through our participation in Advancing Mental Health Equality Collaborative: Wave 2 - Phase 1 Local Design July 2023 Phase 2 Test Changes October 2024  Phase 3 Sustain October 2025. 
• Develop guidance on using the internal clinical audit process to interrogate local data on use of force including physical, chemical restraint, or the isolation of a patient by ethnicity and where disparities are evident identify actions to reduce restrictive practices including engaging in culturally competent trauma informed training and development (Commissioning for Quality and Innovation (CQUIN): 2023/24 guidance). September 2023

 

Reduce workforce inequalities by working collaboratively to create a culture of conscious inclusion where diversity is valued and nurtured.

• Increase the percentage of staff who feel we are compassionate and inclusive by creating cultures of psychological safety where civility and respect is modelled through collective leadership
• Elevate the impact of our staff networks providing them with the support and resources required to support them to contribute to and inform decision making processes demonstrating measurable change.
• Increase the percentage of staff from Black Asian and other Minority Ethnic backgrounds in bands 6 and above, in clinical and non-clinical roles, by nurturing a diverse talent pool through the co-production of positive action initiatives across the employee lifecycle.

 

The immediate action we will take includes:

• All board and executive team will identify and be accountable for at least one equality related objective as part of their annual appraisal process (NW Anti-Racism Framework, 2021).  In developing these objectives consideration will be given to our core values as an organisation and they will be linked to the cycle of board activities framework (NHS Race Observatory, 2021).
• Deliver the Trusts new leadership approach: Role Model- Coach- Care and deliver a 12-month pilot Inclusive Leadership Training Programme which focuses on anti-discriminatory practice and the importance of being an active bystander as an inclusive and compassionate leader. A minimum of 12 sessions 15 x 12 Participants – 180 Leaders August 2024 
• In partnership with our staff network groups review the 'Developing your NHS Staff Networks Toolkit' and co-create a proposal which sets out the actions and resources our network need to contribute to and inform decision making processes demonstrating measurable change.  October 2023
• Consider the Royal College of Nursing’s Cultural Ambassador Programme and co-produce a proposal with our staff network groups on how best to establish a capacity-based programme that aims to improve outcomes for staff who experience inequalities related to recruitment, disciplinary and grievances processes.  September 2023
• Co-create an anti-racism action plan which will support the implementation of the NHS Patient Carers Race Equality Framework (which includes competencies related to Workforce Race Equality Standard (WRES). October 2023.
• Develop a Race Equality Audit Tool to support the local implementation of the Patient and Carers Race Equity Framework (PCREF)  Based on the three domains outlined in the Equality Delivery System (2022), the tool will identify the criteria that will allow us to assess performance on reducing health inequalities, advancing equity in mental health services and in our workforce. October 2023.

Increase people’s sense of belonging by creating inclusive and accessible environments where people feel respected and safe.

• Increase the percentage of staff who feel we offer a safe and healthy place to work by implementing initiatives which address unacceptable behaviours such as bullying, harassment, discrimination, hate and violence.
•  Increase the number of people who feel able to report unacceptable behaviours by developing effective report and support systems and processes for those who experience or witness them.
• Ensure we provide digitally inclusive accessible information by working with people and communities that experience inequalities to co-design systems, processes and resources that improve their experience.

 

What immediate actions will we take? 

Deliver an Inclusive Cultures Programme which will include: 

• Delivery of an EDI Champions Training Programmes during 2022/2023 - 2023/24, which will explore anti-discriminatory practice; anti-racism, anti-homophobia, anti-transphobia, and anti-disablism over the course of 12 months.   Purpose to build capability in the organisation to raise awareness around these issues.  3 cohorts 12 x 3 = 36 participants (x1 2022/23) x2 2023/24) - A minimum of 100 awareness sessions delivered across the Trust. Cohort 1 December 2023 Cohorts 2 and 3 September 2024.
• Delivery of an Active Bystander Training Programme which encourage people to speak up and safely take action when they witness bullying harassment, discrimination and hate based abuse and violence.  A minimum of 12 sessions 15 x 12 = a total of 180 Participants.  August 2024 
• Delivery of a 12-month quality improvement project at Park House, to test trauma informed active bystander responses to behaviours, including racism from patients.  Measure as part of the project we will outline a measurement strategy. August 2024 
• Delivery of a Trust wide zero tolerance campaign that is underpinned by a set of renewed policies and procedures , improved recording and reporting processes including anonymous functionality and increased support To 1) x 4 policies (bullying and harassment; discrimination; hate crime; safety at work) reviewed and new drafts agreed October 2023 2)  Co-create an accessible Speak Up and Get Support systems July 2023 - March 2024 3) Deliver a 12-month zero tolerance communication campaign delivered October 2023 - 24 
• To include metrics aligned to NHS People Promise We are Compassionate and Inclusive to help benchmark and measure staff experiences using the NHS Quarterly Pulse Surveys based on the metrics outlines in the NHS Survey. July 2023 

The Board of Directors is responsible for ensuring that the Trust meets both its statutory and regulatory duties and obligations.  The Equality Act (2010) must be implemented with consideration to the Health and Social Care Act, 2012; the Mental Health Act 1983; the Mental Health Units (Use of Force) Act 2018; and the  Mental Capacity Act 2005(as amended, 2019).   The Chief Executive is responsible for providing assurance ‘that controls measures are in place’ to ensure action to advance equalities and prevent discrimination is taken through the NHS Foundation Trust Annual Report (NHSE&I, 2022).

As nominated Health Inequalities Executive Lead the Deputy Chief Executive is accountable for the Health Inequalities Action Plan (NHS Standard Contract Team, NHS England, 2022). Our Advancing Equalities Action Plan 2023 sets out the immediate activity we will undertake to support this, and this has been supported by investment in an Equality Diversity and Inclusion Team. 

All Directorates and Care Groups within the Trust are responsible for advancing equalities in their areas. Through the annual business planning process, they are required to identify and take action on their own specific priorities linked to the equality objectives outlined in our Advancing Equity and Inclusion Strategy 2022-25.  It is advised that all Business Plans 2023/24 have at least 3 EDI Priorities 1) reducing health inequalities 2) advancing equity in mental health services 3) promoting inclusion in the workforce.

 

Quality Improvement

Our strategic approach to advancing equity and inclusion will use quality improvement methodologies to co-produce and test ideas that promote equity and reduce inequalities in our services and promote inclusion across our workforce. Our theory of change will help guide their activity based on their individual local priorities. By adopting a quality improvement approach we are making a firm commitment ‘to understanding and reducing variation and inequalities and ensuring that everybody has access to high-quality care and outcomes’ (The Health Foundation, 2021).   To support this, we have become a partner of the Advancing Mental Health Equality Collaborative: Wave 2 a 3 Year programme that will help us to implement the Advancing Mental Health Equality (AMHE) Resource.