Equality Diversity & Inclusion Strategy – Annual Report 2023

Being consciously inclusive in everything we do for colleagues and our communities

Introduction

The Equality Diversity and Inclusion (EDI) Strategy was launched 2 years ago, this is the second annual update highlighting the progress we have made against the five strategic aims underpinning our vision which is to be “consciously inclusive in everything we do for colleagues and our communities”. The five strategic aims are:

1. Demonstrating Collective Commitment to EDI.
2. Being Evidence Led and Transparent.
3. Recognising the Importance of Lived Experience ~
4. Being Representative of Our Community.
5. Bringing About Change Through Education and Development.
    

The ambition for this strategy was to be transformational, to take a systemic approach to delivering improvements. We wanted to go deeper than surface level actions, seeking to bring patient and colleague experience together, utilising and capitalising on the opportunity that the two are inextricably linked, finding new ways to understand our data and to reflect on the health equalities in our system and the disparities experienced by colleagues, taking decisive action to bring about change.

After the first year which was focused on setting firm foundations and raising the profile of EDI across the organisation, this year has been about how we consciously start to build EDI into our processes, strategies, education and data gathering mechanisms. There’s lots of work to do, however progress has been made through a purposeful consideration of how we can apply an EDI lens to our areas of work.

The firm foundations set in year one have most definitely enabled an interest, an enhanced visibility and more open conversations in respect of EDI. Delivery this year has been about building upwards from those firm foundations by focusing more deeply on some distinct pieces of work in order to make a more positive (and sustained impact) for example; exploring a more holistic approach to the delivery of workplace adjustments as well as embedding the zero tolerance approach through a multi-faceted approach.

In the last 12 months we have continued to see improvements in some of the data i.e. some movement on our workforce equality standard reporting for race and disability, also with regards to National Staff Survey results. Some areas fluctuate, so our focus will be around how we can elicit a trend of sustained improvement over a longer period of time.

The information in this report represents the action and progress undertaken in compliance with our public sector duties as set out in the Public Sector Equality Duty and the Equality Act (2010), which requires public bodes to have due regard for the need to eliminate unlawful discrimination, harassment and victimisation; to advance equality of opportunity; and to foster good relations between people who share a protected characteristic and those who do not.

Externally, there has been the publication of the NHS equality, diversity and inclusion improvement plan which was published by NHS England in June 2023. The plan details six high impact actions which are:

1. Chief executives, chairs and board members must have specific and measurable EDI objectives to which they will be individually and collectively accountable. 5
2. Embed fair and inclusive recruitment processes and talent management strategies that target under-representation and lack of diversity.
3. Develop and implement an improvement plan to eliminate pay gaps.
4. Develop and implement an improvement plan to address health inequalities within the workforce.
5. Implement a comprehensive induction, onboarding and development programme for internationally recruited staff.
6. Create an environment that eliminates the conditions in which bullying, discrimination, harassment and physical violence at work occur.

The High Impact Actions are being delivered via the EDI strategy action plan, this report will detail our progress with regards to what has already been implemented as well as further detail our future plans to ensure we deliver upon these recommendations and achieve the success metrics defined by NHS England. The following report highlights many of our achievements, provides a breakdown of our data for patients and colleagues and sets out our future focus to continue to progress this vital agenda.

PRINCIPLE 1 – DEMONSTRATING COLLECTIVE COMMITMENT TO EDI

This principle seeks to hardwire EDI into all aspects of the way we provide care and go about our business within our organisation, to ensure we are consciously inclusive. At a strategic level we made a pledge that every strategy published from the EDI strategy’s launch would contain a section on equality, diversity and inclusion in order to support an increased momentum and collective focus for improvement. As well as this we would ensure that adequate consultation and involvement has taken place with minority groups through colleague Ambassador Forums and Patient Involvement Groups.

Over the past year we have undertaken a number of actions which include:

• Continuing to support Divisions to develop their own EDI plans as part of their Divisional People Plan, which contains specific actions to help drive improvements for patients and colleagues with protected characteristics.
• Reviewing all organisational strategies and associated action plans to determine the extent to which they reference EDI including dedicated actions to support the delivery of improvements.
• Creating a guidance document for strategy authors to ensure the EDI and Health Inequality Agendas are considered as a golden thread at the point of strategy development – focused on bringing about improvements for people with protected characteristics. • Revised the approach to Quality Impact Assesments to include equality impact to encourage and promote wider consideration of the impact of changes to minority groups.
• Introducing ‘core objectives’ for all leaders across our organisation, including our Board, which includes an EDI focused objective. All leaders, in discussion with their appraiser, can choose to select the EDI objective listed under the Big Ambition – Great Place to Work titled ‘Undertake a project which helps to improve equality, diversity and inclusion for patients and/or colleagues’. This then enables the individual to further tailor the objective to their area of work in partnership with their appraiser.

FOR PATIENTS AND OUR COMMUNITIES

COLLECTIVELY TAKING ACTION TO BRING ABOUT IMPROVEMENTS FOR PATIENTS FROM MINORITY GROUPS

The Patient Experience and Involvement Strategy is into its second year; centred on engaging with people who use our services by providing opportunities for them to share their views, identify areas for change and shape our services. Our overall ambition continues to be the delivery of excellent care through promoting positive patient experiences, improving outcomes, and reducing harm. The strategy has set the tone to listen more and act on patient experiences, which means really listening to the experience of patients and families when they do not go well, in addition to when they do go well. We have actively sought the views of patient groups who represent those with protected characteristics and recognise the importance of intersectionality when considering their feedback.

The Patient Experience and Involvement Strategy is divided into 3 sections:

1. Insight - improving our understanding of patient experience and involvement by listening and drawing insights from multiple sources of information.
2. Involvement - equip patients, colleagues and partners with the skills and opportunities to improve patient experience throughout the whole system.
3. Improvement - design and support improvement programmes that deliver effective and sustainable change

Some of the progress which has been achieved over the past year is detailed below;

• The recruitment of patient champions is a pivotal enabler for the Patient Experience and Involvement Strategy and this work is now complete, with every clinical department (and a growing number of administrative areas) in the organisation benefitting from at least one patient experience champion who has been trained and belongs to part of a patient experience champions network.
• Thematic reviews have taken place in Maternity and Children’s services leading to a focus on maternity triage, antenatal clinic experiences and the paediatric emergency pathway.
• Patient group review of the Nutrition and Hydration policy using feedback from STAR to shape this.
• Recruitment of a Patient Experience lead for children leading on improving the experience of patients and families with protected characteristics within Children and Young People services.
• The remembrance garden has been renovated next to Charters with a tree recognising those that have donated organs created as a centre piece, providing a calm outdoor space for patients and colleagues.
• Finney House opened as an alternative for patients who do not meet the criteria to reside.
• Cancer forum used to access feedback from patients to help support projects and policies such as Patients Contribution to Case Notes (PCCN).
• Patient Experience lead in place for radiotherapy focusing on improving the experience on attendance to radiotherapy by arranging department visits for future patients.
• Flow Coaching Academy (FCA) big rooms running and routinely use patient stories to open the rooms.
• Renal service opened a new unit in Blackburn, Burnley and Ulverston improving the experience of our renal dialysis patients. Continued improvement in leaflet standards by increasing the languages available, introduction of QR codes and size of font.

Each Division has a nominated representative who attends our EDI Strategy Group meetings; the role of the representatives is to attend the Strategy Group, to coordinate the development of an EDI Annual Plan against the principles set out in the strategy and to ensure there is sustained focus on EDI within the Division through their Divisional Board and 8 Divisional Workforce Committees. The following departments and divisions are represented at the EDI Strategy Group meetings; Medicine, Surgery, Women and Children, DCS, Finance, IT, Education, Nursing Directorate, Estates and Facilities, Workforce, Education and Organisational Development. Several Divisions have continued to include colleague or patient stories as a standing agenda item in these meetings which provides a focus on their experience of care or work with the aim of learning what we can take from their experiences to bring about improvements. The lived experiences of patients with protected characteristics (as well as more general patient and other stakeholder experiences) continue to be routinely used to focus improvement activity as part of each of the Flow Coaching Academy Big Rooms too.

ENGAGING DIVERSE COMMUNITIES, PATIENTS, FAMILIES AND CARERS IN ALL NEW SERVICE DEVELOPMENTS

Across the Divisions, patient and public involvement groups are supporting the co-production of services. Here is a flavour of some of the work which has been co-produced over the last 12 months, illustrating our commitment to engaging our communities and patient groups in line with our EDI strategy aspirations;

• The new ‘Patients as Partners’ role has been launched within the organisation with three Patient Safety Partners now inducted into the organisation, linked to the Always SafetyFirst strategy.
• Work has continued with local health partners such as Galloway's, Healthwatch and NCompass. We have also reached out to Diabetes UK to try to commence a new family forum for the diabetes groups.
• A well-established Carers forum is in place, run in collaboration with Lancashire Carers Service which continues to support our carers, this forum (along with the Cancer Patient forum) has helped change policies within the Trust.
• The Youth Forum have been engaged in developing Patient Contribution to Case Notes (PCCN) in addition to working with teams to improve the waiting areas and develop an environment which is ‘young person friendly’.
• The renovation of the multifaith area and Muslim prayer room at Royal Preston Hospital has provided a calm, respectful, culturally appropriate area for patients and colleagues to pray.
• Launch of trained way finders to support the Blind and visually impaired in the hospital setting.

ENHANCING OUR SERVICES TO WORK AS ONE AROUND THE PATIENT

Several service developments have been introduced to improve the experience of receiving care easier, to ensure we are joined up around our most vulnerable patients and the care we provide happens in the best environment for their needs. Some examples of actions delivered in the last 12 months include:

• Neurology rehabilitation have been working collaboratively with patients and carers to develop a ‘Getting to Know Me’ booklet for patients with neurological conditions. This will 9 be utilised as a nursing tool in respect of how to support and manage patients whilst in hospital, taking into consideration the patient’s likes, dislikes, behavioural triggers and what activities/therapies are required, encompassing holistic patient centred care.
• Elderly Medicine have been working alongside the Dementia Lead Practitioner to enhance overall awareness of supportive approaches in de-escalation and distress; training colleagues to a minimum level of Dementia Champions and having a member of the team allocated to support with activities and the completion of Forget-Me-Not documentation. • Multifaith resources have been created to support the end-of-life CARING campaign to help make it easier to understand and subsequently respond to the spiritual needs of patients at the end of life.
• All wards are promoted to utilise the reasonable adjustments tab within Harris Flex for patients with Dementia, learning disabilities and/or Autism to further improve patient experience and safety within the division.
• The ‘Our Health Day’ has been reestablished which aids to; increase knowledge of specialist teams and interventions, reduce anxieties, increase access to healthcare and reduce health inequalities. Individuals with learning disabilities, as well as their families and carers, were involved in the planning of the day.
• The Kidney Care big room is a multi-professional enhanced supportive clinic that champions shared decision making, ensuring patients have the opportunity to participate in advanced care planning and address their needs before hospitalisation. The clinics aims to improve symptoms over time for patients receiving conservative management and honours the preferred place of care and providing good palliative and end of life care for patients and support for relatives.

FOR COLLEAGUES

The principles contained in this strategy demonstrate a clear commitment to actively ensure EDI is a core part of all organisational business, led from Board and cascaded across all roles and levels in the wider organisation. One of the ways in which this has been demonstrated over the last year is through consideration of how we assess knowledge, skill and experience of equality, diversity and inclusion, particularly in the recruitment of senior colleagues. We have recruited to several executive level posts over the last twelve months including our Chief Executive, our Chief People Officer and our Chair and we know leadership is pivotal in helping us shift the dial relating to equality, diversity and inclusion within the organisation - the move to mandate at least one question in the interview relating to equality, diversity and inclusion as a requirement for all posts from 8a and above, was a positive way of signalling the importance we place on this agenda.

As signalled, in June 2023 NHS England published the NHS equality, diversity and inclusion improvement plan detailing six high impact actions which include the requirement for Chief Executives, Chairs and Board members to have specific and measurable EDI objectives to which they will be individually and collectively accountable. Under each one of these actions are a set of sub-actions which set out activities NHS organisations and ICBs must complete. Specifically in relation to this first high impact action, NHSE also defined the following;

Achievement of which would be evidenced through the annual chair and chief executive appraisals as well as the Board Assurance Framework. The EDI Strategy Group and Ambassador Forum members have been consulted in the process of setting out what they believe the focus for Board objectives should be and the following objectives have been agreed for use:

The draft list of objectives are planned to be used in Executive and Non-Executive Director 2024 appraisals, allowing the appraisee in partnership with their appraiser to select a relevant EDI objective before identifying the SMART actions they will take (appropriate to their portfolio of work) to deliver EDI related performance improvements. The next step will be to publish the Board members objectives to illustrate to all colleagues the focus, attention and dedicated action senior leaders are taking. It is hoped this both creates greater energy for others to also commit to delivering on EDI actions alongside demonstrating to our workforce the importance improving equality, diversity and inclusion is for our colleagues and communities.

COMPASSIONATE APPROACH TO SUPPORTING WORKPLACE ADJUSTMENTS

Over the last year, we have undertaken a significant amount of work and delivered a consistent and sustained narrative around the creation of a compassionate culture to support a more seamless implementation of workplace (reasonable) adjustments for colleagues. Workplace adjustments are changes made to remove (or reduce) any disadvantage related to a colleague’s disability or long-term condition when doing their job, or to remove (or reduce) any disadvantage related to a job applicant’s disability or long-term condition when applying for a job. This has been supported by a number of actions;

Education – we have delivered training to colleagues in our Recruitment team to help them support recruiting managers with workplace adjustments as part of the recruitment and selection process. We have also undertaken a number of educational sessions with line managers; through the Managers Update sessions in addition to presenting at several Workforce Committee meetings. Moving forwards, the session recording and slides will be built into the Core People Management Skills programme as part of the Recruitment through to Induction module.

Simplifying the pathway – we have worked collaborative with colleagues across Finance, Procurement, our Partnership team and the Living with Disability forum chair to understanding the pathway for colleagues to agree and subsequently procure workplace adjustments. As part of this process we have sought to identify and minimise any barriers encountered throughout the process to ensure colleagues received the necessary support as soon as possible to enable them to work effectively within our organisation. A pathway has been developed and will be shared as part of a user guide which is being created and will subsequently be available on our Intranet pages.

Supporting Disability Agreements – the EDI team have provided a number of 1:1 support sessions with individuals and/or line managers to aid them to have effective, supportive conversations which enable a shared understanding of how an individual’s disability or long term condition affects them in the workplace and to agree what workplace adjustments would be beneficial.

RAISING AWARENESS AND LIVING OUR COMMITMENT TO CREATING AN INCLUSIVE WORKPLACE

To ensure EDI remains a prominent part of our organisational narrative across the year, we support the promotion of several key inclusion calendar events. The focus of the inclusion calendar is to identify which events we will actively promote across the year to create interest, raise awareness, share colleague/patient or community member experiences, educate colleagues, bust myths, or break down stereotypes or negative assumptions. Our approach enables us to align the focus of teams to ensure a consistent approach to the events we are promoting, across catering, health and wellbeing, library services, organisational development, communications, and EDI to create greater scale, spread and cascade. Selected events are promoted in the HeaLTH matters newsletter sent to all colleagues via email.

Examples over the last 12 months include;

International Nurses Day

On International Nurses Day we held a hybrid event with the aim to engage with all internationally educated nurses acknowledging their essential role in supporting the delivery of excellent care with compassion to our patients. The event was positively vibrant, with cultural dancing and singing included. Our Recruitment Manager spoke about the dedication and commitment of internationally educated nurses, and our forum chairs affirmed the support we provide for internationally educated colleagues

Black History Month 

We celebrated throughout the month of October with sessions including; an opening event with our Interim Chief Executive who spoke about what Black History Month means to her, an educational session led by the Ethnicity Forum Chairs about Black History Month whilst also promoting awareness of the forum. We learned from two external speakers representing Preston Black History Group and Preston Windrush Generation and Descendants, and we rounded the month off with a closing ceremony attended by carnival dancers, our guest speakers, and our Mayor. 

Disability History Month

The middle of November marked the start of Disability History Month; our aims were to increase forum membership in addition to promoting neurodiversity. A face-to-face event was held which included guest speakers such as the NHS Northwest Dyslexia Network Chair, who shared his story and experiences relating to hidden disabilities, as well as the benefits of becoming an accredited dyslexia workplace assessor. We had attendance from our Chief Nurse who shared her story about having a hidden disability.  
There were a number of other events throughout the year including; LGBTQ+ history month, Windrush Day, Transgender Awareness Day, South Asian Heritage Month, Staff Networks Day, where all three inclusion forums came together to share ideas as well as information about what staff networks or  (inclusion forums) are and more besides. 
The annual Inclusion Event Calendar is planned, on an annual basis, in conjunction with the Inclusion forum leads ensuring a focus on important events which represent minority groups whilst also aiming to shine more of a spotlight on what matters to colleagues. There are so many inclusion days/weeks/months, it would be impossible for us to mark every event corporately, however we actively encourage teams and individuals to celebrate the events which are significant to them, their work colleagues or their patient population such as religious festivals and/or events relating to specific long-term conditions. 

Our Library colleagues continue to support the promotion of inclusion calendar events by undertaking displays across both libraries showcasing authors or literature which supports the topic area. They signpost calendar events through the library newsletter which is circulated to around 2000 colleagues, and they also promote through their social media channels.

To enhance support for colleagues with neurodiverse conditions to be able to engage with library resources more fully Read and Write software has now been installed on PCs, coloured overlays and noise cancelling headphones are also available across both Preston and Chorley libraries.

We also attended a number of community events in 2023, namely, Preston Caribbean Carnival, Preston Health Mela and the Windrush Festival To maintain our promise to raising our profile within the community, and actively engaging with community members, celebrating diversity and illustrate our commitment to being an inclusive employer. These events provided a fabulous opportunity to interact with members of our community, gather feedback in respect of our services, communicate information in respect of the New Hospitals programme and increase the diversity of our membership. 

Due to improvement works taking place in respect of the Harris Library this year, there were restrictions on the spaces available for organisations to participate in the council-organised Pride event. This meant we were sadly unable to attend Preston Pride for the first time in several years; this was a massive disappointment to the LGBTQ+ Inclusion forum members and EDI colleagues yet we will refocus on securing our attendance in 2024.

EMBEDDING A ZERO TOLERANCE APPROACH TO DISCRIMINATION AND RACISM

To continue with our aim to be an antidiscrimination and anti-racist organisation we signed up to the Organisational Sexual Safety Charter in November; this signals our intent to take and enforce a zero-tolerance approach to any unwanted, inappropriate and/or harmful sexual behaviours within the workplace. There are ten core principles and actions set out to help us achieve this. The sexual safety charter is very much in line with our existing Zero Tolerance approach and toolkit, it is supported by our zero tolerance statement in addition to an animation explaining what it is, the principles and points to consider as individuals but also within our teams.

In the latter half of the year we have delivered training sessions to over 100 colleagues to increase awareness and understanding of every colleagues’ responsibility to support a zero tolerance approach. Sessions have been created for both leaders and team colleagues to explore how they can uphold a culture of zero-tolerance and civility in their teams, considering how their own attitudes, actions and/or behaviours can support an effective zero-tolerance approach in their daily work and across their teams. The session also encourages leaders and colleagues to raise their own awareness of appropriate ways to address and challenge negative behaviour from others and guides them where they can seek further support from if needed.

Across 2023, we have also delivered several lightening sessions for c.130 line managers in respect of “Banter – when it’s definitely not a laughing matter” to explore what banter is and when (or why) we might use it to support us in the workplace but also to guard against when it may cross the line towards more negative behaviours. The session revisits cases which have progressed to Employment Tribunals to help provoke discussion around instances where banter crosses the line towards bullying, harassment or discrimination and encourages line managers to consider their role in creating a safe environment for all colleagues alongside a collective commitment to “Call it Out”.

We have made a commitment to embrace becoming an actively anti-racist organisation. This has started with completing an initial review and benchmarking ourselves against each level of the North West Black, Asian and Minority Ethnic Assembly Anti-racist framework (Bronze, Silver, Gold) to understand where our existing gaps are. We have drafted an antiracist statement which will shortly be circulated across the Ethnicity Inclusion forum members for comment and review. Our aim for this year is to attain Bronze level before working towards the achievement of Silver.

OUR FUTURE FOCUS

• Include EDI measures within the STAR quality assurance process.
• Commit to achieving Bronze level of the North West Black, Asian & Minority Ethnic Assembly Anti-racist framework.
• Agree an anti-racist statement which will be published on our website.
• Ensure all new estate developments incorporate a consciously inclusive approach i.e., always consulting with patient groups and ambassador forums to ensure design principles support patients and colleagues with disabilities to navigate around the site with ease and to ensure facilities have gender neutral toilets as standard.
• Continue to use our position within the community as a healthcare provider and as a larger employer to help influence wider community change by actively tackling discrimination and inequality faced by people with protected characteristics when receiving care or working for us.
• To publish Board members objectives in relation to EDI.
• Drive to increase the number of patients from diverse backgrounds responding to national patient surveys.
• Increase the diversity of feedback in national surveys to better reflect the experiences of the community demographic.
• Agree the approach to the measurement and analysis of the 9 protected characteristics as part of all Trust defined audits and clinical reviews, so experience, health outcomes and inequalities can be understood and improved.

PRINCIPLE 2 – BEING EVIDENCE LED AND TRANSPARENT

This second principal is centred around using evidence to help inform our focus and our decision making, enabling us to recognise where the experience of patients and colleagues who belong to protected characteristic/minority groups is not where we would want it to be and empowering us to create focused actions to make the right difference. Equally this principle sets out the importance of using our data to help us reflect, understand and measure the impact we are having through the steps we are taking.

BEING TRANSPARENT WITH OUR WORKFORCE EDI DATA

This second report continued to demonstrate our commitment to deliver against this principle by having a comprehensive annual report which sets out where our focus has been, what we have delivered in the last 12 months and future actions we are going to take. It forms part of our Trust’s public sector statutory duties under the Equality Act 2010 to report on performance and delivery against equality objectives annually alongside the breakdown of protected characteristics detailing the diversity of our workforce.

Our Workforce Diversity Headlines 2023

Headcount

10,348 (8593) (2022 data in brackets)

Ethnic Minorites

26.2% (25%)

Disability

4.9% (4%)

LGBT+

2.4% (2%)

Women

76.2% (76%)

Married

53.3% (53%)

Graph 1 - Age Profile

Image description

The image shows a graph with a title of 'Workforce Age Profile'. The x axis label is "Age Band" and the y axis label is "Head count". 

Graph 2 - Disability Profile

Image description

The image shows a graph with a title of 'Workforce Disability Profile'. The x axis label is "Disability Declaration " and the y axis label is "Head count". 

Graph 3 - Ethnicity Profile

Image description

The image shows a graph with a title of 'Workforce Ethnicity Profile'. The x axis label is "Ethnicty " and the y axis label is "Head count". 

Graph 4 - Religion and Belief Profile

Image description

The image shows a graph with a title of 'Workforce Religion and Belief Profile'. The x axis label is "Religion or Belief" and the y axis label is "Head count". 

Graph 6 - Sexual Orientation Profile

Image description

The image shows a graph with a title of 'Workforce Sexual Orientation Profile'. The x axis label is "Sexual Orientation" and the y axis label is "Head count". 

Appendix 1 and Appendix 2, displays infographics displaying our annual WRES and WDES returns for 2023. The full reports can be found here.

Further actions to support the transparency of our approach with regards to delivering improvements for EDI as defined by the public sector equality duties is to undertake the annual Equality Delivery System (known as EDS2022) self-assessment process via coproduction with colleagues, patients and members of our community from minority groups. The purpose of EDS it to support NHS organisations to improve the services they provide for local communities and provide better work environments whilst meeting the requirements of the Equality Act 2010. The completion of EDS2022 is mandated as part of our NHS Standard Contract. It is reported separately to Board outside of this annual update. The approach to completing EDS 2022 in 2024 is to work on a system level with colleagues across the Lancashire & South Cumbria Integrated Care System (L&SC ICS) whilst consulting, engaging and involving colleagues with protected characteristics via the Inclusion Ambassador Forums, with patients via the Patient Experience group as well as divisional engagement with colleagues supporting the delivery of EDI Actions. To understand our performance against last year’s EDS22 assessment, the report can be found here.

FOR COLLEAGUES

USING DATA AND LIVED EXPERIENCE TO IMPROVE CULTURE

A number of the sub actions detailed under the first of NHSEs High Impact Actions relate to the use of EDI data by the Board, in order to understand lived experience, culture, priorities and progress we are making to reduce inequality. As it stands the Board already receives the following data sets/reports:

• Workforce Race Equality Standard
• Workforce Disability Equality Standard
• Gender Pay Gap - Equality Delivery System (EDS) 2
• NHS Staff Survey results broken down by protected characteristic
• Annual EDI Report

With the exception of this report, all other reports are discussed within Workforce Committee, with escalation (and in some cases approval) by Board to enable the national publication of our data set. In addition to the suite of reports noted above, Workforce Committee also receive the annual strategy update for the Our People Plan strategic aim – to create a positive organisational culture.

Equality impact assessments have been undertaken on all workforce policies which have been reviewed or updated throughout 2023, to understand whether the application of our employee relation policies may lead to an adverse impact for colleagues with protected characteristics, and if so, then undertake actions which mitigate against any adverse impacts. Those policies were;

• Banding/re-banding Policy and Procedure
• European Working Time Directive Policy & Procedure
• Parenting Policy
• Qualifications and registration checks policy and procedure
• Retirement policy

A policy review and approval process has also been developed which sets out the need for an equality impact assessment to be undertaken for all policies in addition to the requirement for Inclusion Ambassador forums to be consulted with when a policy is being developed or reviewed. 2024 will see action taken to roll out additional guidance and training to workforce policy authors to further build on this work and make it more robust.

As a part of our Workforce Disability Equality Standard (WDES) and Workforce Race Equality Standard (WRES) analysis it was found that with regards to the formal capability process, disabled colleagues are more likely to be engaged in this process (being 1.9 times more likely to enter into the formal process), however this has reduced from the previous year (3.28 times more likely) and the number of cases entering a formal capability process overall remains very low (averaging under 10 each year), therefore care must be taken when drawing any conclusions. With regards to the formal disciplinary process, we have seen no movement in the percentage of colleagues from a minority ethnic background (compared to white colleagues) entering the formal stages with the results indicating that ethnic minority colleagues are less likely to enter the process (0.76 times less likely) a figure which has remained static over the last couple of years.

We continue with our commitment to enhance the level of reporting, analysis and assurance we provide around the Workforce Race Equality Standard (WRES), Workforce Disability Equality Standard (WDES) and Gender Pay Gap, all of which we publish externally here. The key findings from the WRES and WDES reports are provided in the Appendix, as the data forms part of our impact measures to assess the improvements delivered through this strategy. The associated strategy action plans contain actions designed to bring about improvements and reduce any adverse impacts experienced by these minority groups.

The National Staff Survey results are reviewed annually to understand if there are any differences in the experience of work for any of our minority groups. Through completing this analysis, we found a number of themes which include:

Bullying, Abuse, Violence and Aggression

• Colleagues who have a disability or long-term condition reported experiencing greater levels of bullying, harassment, violence and abuse from patients, their relatives or members of the public than colleagues without a disability or long-term condition. Similarly, it was found that colleagues with a disability of long-term condition reported experiencing higher levels of bullying or abuse from colleagues and managers. In addition, colleagues with this protected characteristic indicated that they felt less secure in raising concerns and less confident that, as an organisation, we would address them when compared with the Trust average.
• It was found that colleagues from a Chinese background and colleagues who identified as Irish experienced the highest levels of bullying, harassment, violence and abuse from patients, their relatives or members of the public. Colleagues who identified as Chinese also reported the highest levels of harassment, bullying or abuse from managers whereas colleagues from an Arab background noted the highest levels of harassment, bullying or abuse from other colleagues (all when compared to the wider Trust average).
• Colleagues below the age of 30 reported more experiences of bullying, harassment, violence and abuse from patients, their relatives or members of the public. Colleagues 21 between 41-50 reported experiencing greater levels of harassment, bullying or abuse from other colleagues.

The actions which have been taken to bring about improvements in these results are detailed elsewhere in this document and form part of Our People Plan strategic action plan, in summary this has involved the delivery of dedicated zero-tolerance training sessions in addition to a Banter “When it’s not a laughing matter” lightening session and is supported by a bystander intervention toolkit. It is aligned with the actions being delivered through the Freedom to Speak Up Strategy and the Reducing Violence and Aggression Strategy.

Colleague Engagement

• Colleagues aged between 21-30 have the lowest engagement levels (overall score of 6.8), the most engaged groups are those aged 16-20 and 31-40 (score of 7.0), with those aged 66 and over having this greatest levels of engagement with a score of 7.3.
• Colleagues with a disability were found to have lower levels of engagement (6.5) compared to those without a disability (7.1) and in comparison to the organisational average (6.9). Looking at the 2022 results we can see the overall engagement level has slightly increased from a score of 6.4 however the gap has remained the same.
• Colleagues who identified as being Indian or Chinese had the highest engagement scores at 7.6 closely followed by colleagues who are African at 7.4 and Caribbean at 7.3. These scores are higher than the organisation average and also higher than white colleagues (score of 6.8). Colleagues with lower staff engagement levels were those from mixed or multiple ethnic groups (score of 6.0).
• Males and females had similar levels of engagement with males scoring slightly lower (6.8) to females 7.0). Colleagues who identify as non-binary had the lowest staff engagement levels at 4.6 with individuals who prefer to self-describe at 5.9
• Levels of staff engagement were lowest for colleagues who are gay, lesbian, bisexual or other, with a score of 6.2 (all 10 areas had a red RAG rating when compared against the organisation average) in comparison to heterosexual colleagues at 6.9.
• With regards to religion, colleagues who stated they had no religion had the lowest staff engagement scores and had 7/9 areas measure rated as red RAG when compared with the organisation average. Colleagues whose religion is Hindu or Sikh had the highest engagement levels (7.6) followed by colleagues whose religion is Buddhist (7.5).

Staff Satisfaction

• Colleagues between 21-30 years reflected experiencing higher levels of work-related stress and found work more exhausting and tiring than other age groups. With colleagues over the age of 51 years experiencing the greatest levels of satisfaction across the items measured in the National Staff Survey.
• Disabled colleagues report far lower levels of satisfaction across the majority of the questions in the National Staff Survey, including factors relating to their job such as ability to make suggestions to improve the work of their team/department, manage conflicting demands on time, feeling valued for their work. Through to how they feel working in their team; levels of respect and kindness demonstrated from colleagues and line managers and ability to access training and development opportunities.
• Across all the staff satisfaction questions, Pakistani colleagues, colleagues from any other mixed/multiple ethnic background and colleagues from any other white ethnic minority 22 background had the highest number of red RAG rated items compared with other ethnic minority groups and the Trust average.
• Across all the staff satisfaction indicators, colleagues who identify as gay, lesbian or ‘prefer not to say’ had lower levels of satisfaction than heterosexual or bisexual colleagues. Colleagues who identify as ‘Other’ had the greatest number of green RAG rated responses.

This year, we are hoping to be able to obtain our Staff Satisfaction results by protected characteristic group, cut by Division and Band so we can start to explore the experiences of colleagues at a more granular level and understand whether colleague experience varies depending on band/level of seniority, length of service or Division.

As always, we explore ways in which we may bring about improvements in the levels of engagement and staff satisfaction experience for colleagues with protected characteristics, we continue to involve the Inclusion Ambassador Forums to help define the actions which will make a difference.

The actions identified to date include dedicated development opportunities for colleagues with protected characteristics; increased awareness and understanding by team colleagues and line managers as to what inclusion means and how they can help support positive action. Greater analysis of data such as talent management categories, appraisal scores and attendance at leadership development opportunities is also an area for further exploration in 2024.

FOR PATIENTS

Enhancing the routine monitoring of protected characteristics of our patients.

A programme of work is ongoing through the Digital and Health Inequalities EDI Subgroup, focusing in on how we can increase the routine monitoring of the protected characteristics of our patients, to capture information across all 9 protected areas on patient records to enable deeper analysis and understanding of health inequalities. We understand we need to reduce the proportion of patient records which currently have a percentage unknown for a number of protected characteristics.

Through initial benchmarking it was found that we regularly record the following protected characteristics for our patients; age, marriage/civil partnership, pregnancy/maternity, race, religion/belief, disability and sex. Since that time, sexual orientation has been added and disability data is now used to prompt the clinician to discuss and identify whether reasonable adjustments are required to support the patient’s ongoing care.

To increase the accessibility for patients to provide information on their protected characteristics work is underway to create a patient portal, this will enable those patients who are able and willing to self-disclose their personal information, rather than having to verbally state at an outpatient’s reception desk for example deeply personal information.

For those 23 patients such as the elderly or with disabilities we will ensure suitable alternatives are in place to support patients who wish to share this information so we can capture it on their behalf.

As part of being wholly inclusive and diverse we need to ensure we gather as much patient voice from those who are ‘hard to reach’, so a real focus on those with protected characteristics alongside those in deprivation using the Core20PLUS5 as a guiding strategy. The requirement to understand experience by protected characteristic and deprivation is not yet available easily and will form a large part of the focus on data for year 2 of the strategy.

HEALTH INEQUALITIES – Core20PLUS5

The Trust are in the early stages of defining an LTH Health Inequality delivery plan to tackle health inequalities in our locality. The NHSE Core20PLUS5 framework is a national approach to inform action to reduce healthcare inequalities at both national and system level based on the theory of social determinants of health. The Trust’s delivery plan is structured around the ICB health inequalities programme and will link closely with the Preston and Chorley health and wellbeing partnership Boards, of which we are a member.

There are several projects underway to target specific groups of the population to reduce health inequalities including, but not limited to:

• Institute for Health Improvement (IHI) Accelerator Collaborative (NHS England) – Focus on early cancer diagnosis for one population in Preston. ‘Inch wide, mile deep’ methodology to undertake deep dive root cause, focused engagement with patients cocreating interventions around access and awareness.
• Outpatient Did Not Attend (DNA)/Was Not Brought (WNB) (NHS England) - review of DNAs through a health inequality lens. Targeted review of patients from high areas of deprivation and in the top 5 clinical domains to find root cause of DNA as well as ways in which the Trust can support patients to attend their appointments. Initial focus on paediatrics.
• Muslim Girls School Health awareness and education programme – Utilising existing and developing relationships with Imams and Alimas to create awareness of cervical cancer, HPV vaccine, breast health and maternal health.
• Long wait harm review - Utilising waiting list data focused on Severe Mental Illness (SMI) and Learning Disability (LD), a harm review process has been designed to enable specialties to understand which patients on the waiting list have a SMI or LD leading to a proactive review of these patients.
• Peer Support in Emergency Department – Recognising the adverse experiences that may occur when a patient uses drugs and/or alcohol regularly; the ED team are working with Red Rose Recovery to pilot a peer support worker in the ED that will specifically focus on providing peer support, establishing when health checks were last undertaken and signposting to health and social care services.
• Continuity of Carer – The Continuity of Care teams currently provide care to all women who have diabetes, mental health, learning disability, declared domestic abuse, drug and alcohol abuse and teenage pregnancy. The next stage will be to expand this to focus on Black Asian and Minority Ethnic groups.
• CURE smoking and alcohol screening and brief interventions – As part of the big plan, smoking and alcohol screening and interventions are monitored, ensuring teachable moments are acted upon during a hospital inpatient episode.
• Special care dentistry – the service has developed generic resources (films and easy read information) and bespoke welcome meetings with patients who have a learning disability or autism to improve access to services. These continue to be well received by patients and families and lead to successful dental extractions alleviating patients of the pain they experience.
• Audiology – the audiology team have developed easy read and access pathways for patients with learning disabilities to reduce the fear and anxiety associated with using the audiology services. The pre-appointment calls enable the service to understand if longer appointment times and adjustments are required to ensure patients are able to access the services.
• Annual Our Health Day – held in June, this year’s day focused on emergency, elective and outpatient pathways with the learning disability and autism community to reduce fear and anxiety in accessing healthcare.
• Prisoner access to healthcare services – work has commenced with the prison service to understand how health inequalities relating to prisoner access can be reduced

The Macmillan Cancer team have undertaken a project working with ethnic minority community members, as data showed 97% of people that access their services are White British. Members of the Macmillan team visited the Sahara Centre in Preston, which is a voluntary organisation working predominantly for the benefit of the black and minority ethnic (BME) community members, to engage with their members and seek to understand any potential barriers. A few reasons have already been highlighted including the absence of translators at the appointment or not having the correct information. This work links in with a wider community project which has been established, working with Lancashire BME Network, focused on ethnic minority community members accessing Macmillan Care, the project is called MPACE (Macmillan Preston Area Cancer Engagement).

The organisations Library and Knowledge Management Service have delivered interactive sessions titled “Health Literacy Awareness: A Pathway to reducing Health Inequalities” which promises to help attendees recognise the impact of low health literacy, recognise the connections between health literacy and health inequalities in patient outcomes, recognise how patient experience is impacted by the understanding of health information and learn techniques and tools to support better health communication, and therefore, better health outcomes.

OUR FUTURE FOCUS

• Take an intersectional approach to evaluation and reporting, enabling us to identify unwarranted variations in experience for both patients and our workforce.
• Improve our methods of understanding barriers to social mobility and career progression of colleagues from all social class backgrounds by seeking to measure the socio-economic background of our workforce and benchmark our position and progress against the Social Mobility Employer Index.
• Have a clear measurement strategy for all patient facing engagement and involvement groups so we are able to understand impact and improvements delivered through this approach, as well as demonstrating to patients how we have taken forward actions to address their views and experiences.
• Each service will develop the ability to view outcome measures through the lens of protective characteristic data so we have the capability to understand our performance, incident and feedback data through the lens of protected characteristics and take action to reduce systemic inequalities.
• Through understanding the system and Integrated Care Partnership ‘system’ data, approaches to prioritising services will consider health inequalities that affect outcomes for our communities.
• To design and deliver equality impact assessment training, to enable those who produce patient and colleague facing policies, processes and standard operating procedures to competently complete impact assessments and improve the documented evidence of mitigations taken where impacts are recognised and confirm these are sufficient with colleague and community groups.
• To undertake equality impact assessments for appraisal and talent ratings, turnover, sickness absence, training evaluation and education metrics.
• To deliver a campaign which encourages colleagues to update their personal data sets to enable more accurate reporting of protected characteristics

PRINCIPLE 3 – RECOGNISING THE IMPORTANCE OF LIVED EXPERIENCE

This principle emphasises the importance of understanding, valuing, and responding to the lived experience of our communities and colleagues. To provide excellent services and a great place to work we recognise that we need to engage with all groups but ensure the voices of minority groups in particular are engaged to co-produce and co-design as equal partners the shape of our services and type of organisation colleagues wish to work within. To implement Principle 3 the following actions have been taken forward to ensure we consciously recognise the lived experience or patients, our communities and colleagues:

FOR PATIENTS

The new ‘Patients as Partners’ role has launched , linked to the Always Safety First strategy. This role builds on the concept of patient leadership, working to disrupt the ‘them and us’ relationship dynamic in healthcare and develops the capability for shared working by fostering a different relationship with our patients and our community members.

To learn from the lived experience of our patients in making improvements from our services we have sought to engage relevant patient groups in the design of services, to share their stories so we can reflect, learn and make impactful changes. As already mentioned in an earlier section of this report, patient stories continue to be a golden thread throughout a number of board, divisional, patient and committee meetings as a means of conveying the importance associated with understanding the lived experiences of our patient and carers, appreciating impact, learning and striving to embed best practice across their areas.

To further understand the needs of patients who present to hospital with self-harm the Medicine division has actively engaged with patients a part of their individualised care plans, to recognise how the hospital can be made to feel a calmer and safer place. Matrons are also reviewing any incidents of self-harm which take place within the division to ensure that comprehensive plans are in place to support and protect vulnerable patients.

Within Elderly Medicine, day room activities are being re-established and encouraged on Rookwood A and Ward 17, promoting use of activities for patients with dementia by music therapy, games and group sessions where families and carers are encouraged to attend. Relatives are also encouraged to bring items from home to make patients feel secure with recognisable possessions.

Neuro Rehabilitation have arranged for Headway (a charity which supports individuals who have been affected by a brain injury) to come onto the unit to meet with patients and families and offer support and guidance.

The expectation of wards and departments within the Medicine Division, is that a Learning Disability and Autism champion is identified. The champion is expected to attend bespoke training sessions, often co-delivered by people with lived experience and then to cascade information locally, at departmental level. The aim for the next quarter is for all wards and departments to have a champion, in keeping with the Learning Disability Plan 2023-26.

A number of ward areas are demonstrating a proactive approach to EDI through adopting bespoke bed boards called ‘About Me’ boards which communicate individual preferences, needs and personal care. For those on rehabilitation pathways, therapy boards have also been developed which details the patient’s goals and achievements.

The Ear Nose and Throat Team invited a local primary school, which caters for deaf children, into clinic to visit and engage with patients and staff as a means of raising awareness. The team also promote the laryngectomy choir to patients and have updated their colleague display boards with information relating to dementia awareness and learning disabilities awareness.

We continue to look at ways in which we can make accessibility a priority across all our procedures, policies, documentation, web sites, internal/external communication and ways of working (e.g. by achieving the NHS England Accessible Information Standard), through utilising audio leaflets, providing different colour paper copies, and using different font sizes to support visually impaired and/or neuro diverse communities.

FOR COLLEAGUES

INCLUSION AMBASSADOR FORUMS

As noted in last year’s report, we have three Inclusion Ambassador forums which have been established since 2019; Ethnicity, Living with Disability and LGBTQ+. The Inclusion Ambassador Forums are each chaired by a member of the community group, with support from the EDI team and with sponsorship from members of our Board and Executive Team. In addition to the inclusion forums, we have three support groups which are also aligned to the health and wellbeing agenda; a Menopause Group, a Carers Group and, within the last quarter we have also developed an Endometriosis Awareness group.

Membership and attendance across the forums has been variable again this year in spite of strengthened promotion, clarity of purpose and governance. Forum chairs have worked incredibly hard to increase their visibility, foster greater awareness amongst colleagues and secure more engagement, both internally (through events, corporate communications, emails and MS Teams channels) and externally, through social media channels, community events and cross system working.

There has been a notable increase in the number of colleagues reaching out (particularly to the ethnicity forum Co-Chairs) which illustrates a growing sense of trust among colleagues. Open discussions are encouraged around problems, challenges and any instances of discrimination colleagues feel they are encountering within the Trust. While this reflects positively on the forum's approachability, it also highlights enduring challenges within the organisation which we will collectively work to address.

Several of the forum chairs have been strong advocates for Inclusive Recruitment practices, particularly across the number of Board and Executive posts recruited for over the past few months; forum chairs were part of the assessment processes in respect of the Chief Executive and the Chief People Officer roles in addition to Non-Executive Director posts. In support of this, each of the forums have Chairs who have undertaken the Equality Diversity Representatives training which supports them to participate in panels as a champion promoting inclusive recruitment practices.

Every forum has made a concerted effort to broaden their networks – both internally by working on more of an intersectional basis, whilst also strengthening relationships externally across the ICS. This enables cross sharing, a deeper understanding of each other’s workstreams and demonstrates their collective commitment to inclusion and the wider EDI agenda. All forums have welcomed presentations from the New Hospitals Programme teams and have engaged colleagues in discussions to ensure the provision of inclusive facilities as part of any new build.

The LGBTQ+ Inclusion forum has been working as part of the Lancashire & South Cumbria ICS LGBTQ+ group, they’ve also helped to set up Blackpool Hospital’s LGBTQ+ staff network and they’ve reached out to other network chairs.

UTILISTING THE LIVED EXPERIENCE OF COLLEAGUES TO SHAPE HOW WE DO THINGS

As part of the EDI Strategy we continue to co-produce our workforce and organisational development policies with the Inclusion Ambassador Forums, by sharing details of proposed policy changes for discussion, circulating drafted policies for feedback, seeking views on completed equality impact assessments and understanding the impact of how our policies are applied on their lived experience.

We continue to seek the views of our Inclusion Ambassador Forums in reflecting on the findings from WRES, WDES, and our annual National Staff Survey results to identify if this reflects their experience of working with us, what would make the difference and bring about improvements. Their feedback has helped to shape the direction we take and what areas are given priority.

INVITING COLLEAGUES TO SHARE THEIR EXPERIENCES

The library, the EDI team and the Inclusion Ambassador forums are continuing to encourage staff to sign up as ‘books’ for our Living Library. The principle behind the Living Library is that the ‘books’ are colleagues with lived experience who generally belong to a minority group and the ‘readers’ of the books are colleagues who are interested in learning more about other people’s lived experiences, maybe also their challenges, and it enables more of a shared understanding of how others experience life, or our working environment. It also helps to challenge negative stereotypes or generalisations and busts myths, encouraging colleagues to consider how they may be able to utilise their learning to support others.

As mentioned, we hold regular events which are scheduled as part of the EDI Inclusion calendar, to support colleagues with protected characteristics – on these occasions members of our Inclusion Ambassador Forums to come together and share their experience around different topics, examples include International Nurses Day, Discrimination aligned to Black History Month, Transitioning in the Workplace as part of Trans Awareness Day or Workplace Adjustments aligned to Disability History Month.

INTERNATIONALLY EDUCATED COLLEAGUES (IEN)

International Recruitment is where a healthcare professional moves to the UK from all over the world to practice. We have recruited over 650 internationally educated nurses to join our workforce and are actively recruiting for other healthcare professionals including Midwives, Occupational Therapists, Speech and Language Therapists and other AHP's.

Internationally Educated Nursing colleagues have been supported over the last year by our Pastoral Support Officer. An evaluation has been undertaken to gauge the experience of IEN colleagues with the majority reporting a positive experience in respect of recruitment and onboarding (4.36/5).

Once in receipt of their NMC pin, 87% of IEN colleagues noted they felt supported in their ward environment, to work independently which is an important aspect to aid retention. There are some inconsistencies with a small percentage of colleagues reporting they do not feel supported or highlighting they have experienced unfair treatment – this is an area which needs further action. To foster more positive relationships between line managers, team colleagues and IEC, a Cultural Awareness training session has been developed which aims to bridge some of the gaps. This training session was piloted with Band 7s across Surgery and received very positive evaluation feedback, this will be rolled out further across the organisation.

To further support IEC in building on their communication skills, we now also offer an English Communication Course with Runshaw College. The course not only supports development of communications skills but also leadership and team-working skills too.

A new Ward Managers guide has also been created, which is available via the new International Recruitment intranet page. The guide provides information for Ward Managers and Senior Colleagues on how to monitor the progress of Internationally Educated Colleagues as well as FAQ’s.

The new International Recruitment Intranet page also has all of our resources available for colleagues to access to help them in supporting our Internationally Educated Colleagues on the wards. There are a range of resources including important Home Office Visa updates, English Language resources and Pastoral Support Resources. This also helps to manage expectations after they have received their NMC pins including the consideration of patient safety, completing and signing off competencies etc.

Our focus for next year is to support career progression and career aspirations of our internationally educated colleagues through concentrating on talent management, career development pathways, progression and effective appraisal conversations. From the evaluation feedback provided, 75.3% of this group of colleagues reported they have had an appraisal with their line manager and discussed career development and progression as part of that conversation however, 24.7% have reported that they have not.

RESPONDING TO HEALTH AND WELLBEING BEING NEEDS OF MINORITY GROUPS

As already noted, over the last year we have undertaken a significant amount of work and delivered a consistent and sustained narrative around the creation of a compassionate culture to support a more seamless implementation of workplace (reasonable) adjustments for colleagues. Workplace adjustments are changes made to remove (or reduce) any disadvantage related to a colleague’s disability or long-term condition when doing their job, or to remove (or reduce) any disadvantage related to a job applicant’s disability or long-term condition when applying for a job.

As measured through the annual Workforce Disability Equality Standard, we found that 75.1% of colleagues who have a disability or a long-term condition said the organisation has made reasonable adjustments to enable them to carry out their work. This is above the national average for this measure (71.8%) and marks an increase from 72.6% in the previous year.

A new Endometriosis Awareness group has been formed, with a view to enabling the organisation to become an Endometriosis Friendly Employer. As an organisation who has a 76.2% female workforce, this is an area colleagues have signposted would be beneficial for us to consider from a health and wellbeing perspective. Even though the group is still relatively new plans are underway to launch a communications campaign in conjunction with Endometriosis Awareness month in March 2024. We are also exploring how we can develop interventions to assist in raising awareness of the condition across the organisation whilst busting any myths, as well as how we can educate line managers too, ensuring a compassionate and supportive line management approach is adopted.

Alongside this there have been a number of health and wellbeing campaigns designed to help address health inequalities in the workforce, support colleagues with protected characteristics to feel well at work as well as provide guidance to colleagues who may have financial challenges or being experiencing deprivation. These have included:

• 204 blood pressure checks were completed in support of national campaigns such as South Asian Heritage Awareness month and Diabetes Awareness month, with 22% of participating colleagues referred to their GP due to high blood pressure readings. This has supported individuals to access early intervention for a potentially serious health concern they may not have previously been aware of.
• Delivered 106 health check appointments for colleagues at higher risk of serious illness from Covid-19, including BMI calculation, cholesterol testing, lifestyle advice etc.
• Mini Health Checks and Complementary Therapy Appointments were offered to Estates colleagues during Men's Health Week as a way to support males to access wellbeing support and engage them in the health and wellbeing offer when historically this group from this area of the Trust have been harder to reach in this regard.
• Health and Wellbeing team collaborated with Chaplaincy and EDI team to support colleague wellbeing during Ramadhan.
• Worked with Vivup salary sacrifice and employee assistance provider to incorporate ethnic minority group uptake within utilisation reporting.
• To provide financial support to colleagues the Health and Wellbeing Team have engaged with HSBC regarding potential future support available for colleagues as part of their community engagement offer, advertised to colleagues how to access advice from Utilities Warehouse Household utility bills free assessment for potential cost savings and promoted how to access the Household Support Fund available within Preston and Chorley.

OUR FUTURE FOCUS

• To improve the experience of work for our temporary workforce with protected characteristics to reflect that of our substantive colleagues.
• Further evidence targeted health promotion interventions in protected characteristic groups to improve outcomes related to obesity, alcohol and tobacco.
• Review the effectiveness of Supporting Disability in the Workplace Agreement with every colleague who has a disability or long-term condition.
• To review Core People Management Skills Programme in partnership with the Inclusion Ambassador Forums to shape content in which to build the competence and confidence of line managers to have conversations with colleagues about their protected characteristics such as during a return-to-work conversation, as part of appraisal, when considering a range of factors which could be impacting on an individual’s performance.
• For every structural estate change, or new building development we will commit to engaging with individuals with protected characteristics, specifically those patients who are living with the condition in the design and layout of our physical estate from conception stage to build sign off.
• Work with diverse groups of patients, their families, carers and service users to shape wayfinding and signage to make it easier to navigate when in hospital and transferring care between hospital and community services. This should include accessible interventions for those with additional needs.
• Ensure all new software and equipment goes through a procurement, EIA or accessibility check before it is piloted or purchased.
• All pathway and service redesign will involve the patient voice, providing opportunity for codesign and consultation.
• Explore the use of social prescribing to promote health and wellbeing in community groups.
• Undertake a “Sharing not declaring your disability” campaign to increase disclosure rates.

PRINCIPLE 4 - BEING REPRESENTATIVE OF OUR COMMUNITY

This principle focuses inward and sets out our ambitions to increasing the diversity of our workforce so it is proportionally representative of our communities. Within the EDI Strategy we have set out ambitious goals which includes increasing the representation of colleagues with protected characteristics, publicly demonstrating our support to recruiting individuals with protected characteristics or who are from more disadvantaged backgrounds or from deprived areas through to supporting colleagues with protected characteristics to reach their full potential and climb the career ladder should they wish.

INCREASING REPRESENTATION OF COLLEAGUES WITH PROTECTED CHARACTERISTICS

Through the series of annual reports we produce as part of our NHS Contract, we understand our current position with regards to representation for a number of protected characteristics, specifically:

• We have seen some increases in the percentage of disabled colleagues across our workforce, with 4.7% of our non-clinical workforce and 4.8% of our clinical workforce who identify as disabled. It is positive to note an increase in representation in our clinical colleagues at bands 2, 3, 4, 6, 7 and VSM, as well as an increase in representation across our non-clinical colleagues at bands 2, 4, 5, 8a, 8b, 8c and VSM. Despite these increases we know we still have a significant disparity between the number of colleagues who have shared their disability on our Employee Staff Record system i.e., as at 31 March 23, 481 colleagues recorded they had a disability or long-term condition yet we understand from our National Staff Survey data that 996 colleagues who completed the staff survey recorded they had a disability or long term condition. Given the proportion of people who take part in the survey is typically 50% of total workforce, we could be looking at many more than this.
• Through the annual Workforce Race Equality Standard report we found in the last 12 months that across the majority of the agenda for change bands for clinical and non-clinical colleagues we had seen an increase in the representation of ethnic minority colleagues within our workforce. There was a slight decrease in representation of clinical ethnic minority colleagues at bands 8b, 8c and 8d as well as a decrease for non-clinical ethnic minority colleagues at band 8c.
• The greatest representation of ethnic minority colleagues in non-clinical roles are in bands 2 and below (below band 1 tend to be apprentices) and in band 8c (16.7% of band 8c colleagues are from and ethnic minority background). Across all bands with the exception of apprentices and bands 1 and 2, ethnic minority colleagues are underrepresented when compared against the Trust wide ethnic minority workforce.
• From a clinical workforce perspective, the highest percentage of ethnic minority colleagues can be found in band 5 roles, this could in part be due to extensive international recruitment in the last couple of years. With the exception of band 5 clinical roles, again ethnic minority colleagues are underrepresented in all other bands when compared against the Trust wider ethnic minority workforce.
• The majority of our workforce (53.2%) is aged over 40 years. The workforce is fairly evenly distributed across age groups with most groups making up around 10-13% of the workforce. 33 The groups that are lower in representation are the under 25s and over 60s meaning those colleagues are in the minority groups.
• The predominant gender is female at 76%, which is typical for NHS organisations.

Within both WRES and WDES reports we measure the likelihood of disabled candidates and ethnic minority candidates being shortlisted. There has been an improvement in the last 12 months in relation to the likelihood of disabled candidates being appointed from shortlisting (moving from 1.21 to 1.13), showing a levelling of experience between disabled candidates compared against the experience of non-disabled candidates. However, for ethnic minority candidates the race disparity ratio for this indicator has deteriorated from the previous year moving to 1.34 (from 1.28). This means that white candidates are 1.34 times more likely to be appointed from shortlisting than candidates from an ethnic minority background. The disparity ratio is above the range of 0.8 – 1.2, which means there is likely to be an adverse impact experienced by ethnic minority candidates, therefore further action needs to be taken.

DEMONSTRATING OUR COMMITMENT TO CREATING A DIVERSE WORKPLACE

Over the past twelve months we have continued to provide a series of focused pastoral support sessions to assist our internationally educated nurses. Sessions have focused on providing guidance and support in areas such as; cost of living advice, family visas, education support and connecting cultures. There has been a great uptake within the community and attendance at events with over 180 members in the WhatsApp community group. A focus over the next 12 months will be in respect of career development sessions or clinics to enhance knowledge in respect of career development opportunities and encourage retention of colleagues.

In November we celebrated the graduation of colleagues from the Inclusive Leadership at Lancs programme. The programme had been co-designed with colleagues specifically to support our talented ethnic minority clinical and non-clinical aspiring leaders of the future who occupy band 5-8a posts, as data shows there is likely to be some social, organisational and psychological barriers which restrict ethnic minority talent from progressing up the career ladder. The programme contained several elements including a RADA model in respect of personal impact, talent management, management development and continuous improvement - it was designed to help bridge the gap between where colleagues currently were and where they wanted (or needed) to be, in order to progress into a more senior role. 38 colleagues started the programme and 26 colleagues successfully completed 2 or more elements. Early evaluation data indicates that 8 colleagues have subsequently been promoted internally which equates to approximately 27%. Further evaluation is set to take place with programme participants to look at what the next steps might be.

Our Leadership Development team have engaged with each of the Inclusion forums in order to promote the leadership, management and talent management development opportunities we have in existence here at the Trust and to encourage colleagues to apply. 34 A proportionate number of places have started to be ringfenced across accredited leadership development programmes as part of a positive action approach.

To lay down the right foundations we have committed to several pledges, charters and covenants. The purpose of undertaking these actions has been to assess our own current position against the standards set by external bodies, to reflect on what more we should be doing, to show our commitment to our current workforce and externally to our future workforce alongside patients and the communities we serve.

In the last 12 months we have:

Maintained Disability Confident Employer at Level 2 which signals that we think differently about employing disabled people in our organisation; we recognise that disabled individuals are a hugely diverse group of people with amazing skills and experience, in addition to qualities our organisation needs.

We continue to believe in the five steps set out in the Dying to Work Charter, which was led by our Staff Side colleagues.

In January 2023 we signed up to participate in the Care Leavers Covenant which is a national inclusion programme supporting care leavers aged 16- 25 to live independently. The Covenant is a promise made by our organisation that we will support Care Leavers through providing opportunities to enter the world of work, through offering access to our PreEmployment Programme and our Reboot programme. The goals of the Covenant are to better prepare Care Leavers to live independently; to improve access to Employment, Education and Training; to support care leavers to experience stability in their lives and feel safe and secure; give improved access to health and emotional support and help them to achieve financial stability.

In response to our Working Smarter Pledge to ensure flexible and agile working is firmly embedded within our organisation, it has been great to see our staff survey results in response to the question “Satisfied with opportunities for flexible working patterns” increase year on year, with our latest figures (60.2%) reflecting the highest result in the last 5 years as well as being above the national average score.

The idea behind the Working Smarter pledge is to reaffirm the importance of encouraging and supporting agile and flexible working, which can positively support elements such as colleague wellbeing and compassion towards others. It’s a marked shift in focus from “presenteeism” and can act as a supportive mechanism for colleagues with a disability or longterm condition if their role enables them to work productively from home, as well as for other colleagues who need greater flexibility due to demands in their home life such as caring responsibilities.

The renovation of the multifaith area and Muslim prayer room at Preston has provided a calm, respectful, culturally appropriate area for patients and colleagues to pray. Prayer facilities at Chorley will be the next area of focus.

DEVELOPING A TALENT POOL AND SUPPORTING CAREER PROGRESSION

Our WRES and WDES data, submitted in July 2023, tells us that:

• 52.4% of colleagues with a disability and 61.4% of colleagues without a disability believe our organisation provides equal opportunity for career progression or promotion. The disparity ratio falls just between 0.8 – 1.2 indicting for this metric there is no adverse impact for colleagues with a LTC or illness.
• 48.5% of ethnic minority colleagues and 62% of white colleagues believe our organisation provides equal opportunities for career progression and promotion. This is an improvement on results from the previous year, however the disparity ratio falls outside the 0.8-1.2 guidelines, indicating a potentially adverse impact for ethnic minority colleagues and warrants further discussion and action.
• Colleagues from ethnic minority groups are just as likely (1.02) to be able to access non mandatory and continuous professional development than their white counterparts. This is a significant improvement on the previous year and we need to ensure this parity is maintained as far as is possible.
• 0% of the Board's voting membership had an ethnic minority background, compared with an overall workforce of 26.2%. This indicates we had no representation of ethnic minority members on the board of directors and therefore we were not proportionately representative of our workforce.
• With 10.5% of the Board's voting membership identifying as having a disability, this is greater than the NHS average of 3.7% as well as an increase from our position of 7.14% in the previous year. Further actions are required to understand if there are a proportion of Board members who have not disclosed their disability or long-term illness/condition, as well as taking supportive actions which continue to increase the diversity of Board membership.

To bring about improvements and ensure colleagues with protected characteristics have greater opportunity to access development, are supported in their talent and career aspirations, as well as trying to create greater diversity in colleagues who obtain more senior, executive and non-executive director level posts, we have continued to undertake several programmes of work which include:

Leadership to the Disabled NHS Directors Network

Kate Smyth, one of our Non-Executive Directors, co-founded the Disabled NHS Directors Network in October 2020 alongside Peter Reading, Chief Executive of Yorkshire Ambulance Service. The network is open to Executive and Non-Executive Directors with disabilities on the Boards of NHS Trusts, CCGS, ICSs, NHS Arms-Length Bodies and Community Interest Companies and Public Sector Mutuals providing NHS services. It was created to strengthen 36 the collective impact and voice of disabled leaders and, through them, of disabled staff within the NHS and to provide a peer support network for disabled NHS directors. Some examples of the work Kate has undertaken so far are;

Worked closely with the national WDES team on aspects such as WDES strategy and funding support Undertaken a number of presentations at conferences i.e. NHS Confederation, NHS Providers, NHS Employers Disability Summit Produced content to raise awareness and support Disability History Month – nationally (NHS England, NHS Employers, NHS Providers) and locally (trust boards) presentations, Undertaken mentoring for recently recruited disabled NEDs and aspiring NEDs (funded by NHSE/I)

ENCOURAGING SOCIAL MOBILITY AND WIDNENING ACCESS

The Widening participation team continues to provide career inspiration and opportunities for employment to our local community, through provision of programmes and events designed to support those who are at a disadvantage and aspire to a career in the NHS.

In the last 12 months, 11 individuals have completed the Pre-Employment Programme the purpose of which is to help long-term unemployed individuals to gain employment with us, 19 candidates took part in the two week Reboot Programme, with 7 obtaining employment in our organisation. We offer a 3 day Ready, Steady, Apply course which is designed to support candidate who are already employed but struggle with the application process, 27 candidates completed the programme and 14 of which secured employment with us.

Preston Widening Access Programme has been delivered annually since 2014, providing disadvantaged students in our local area with the knowledge and experience necessary to pursue medicine at the University of Manchester. This year, we welcomed 19 students to the January 2023 cohort, of which 18 successfully completed the programme and applied for the course: we're awaiting confirmation of interviews.

The Work Familiarisation Programme is designed to provide students with learning difficulties and disabilities an insight into the world of work. Following completion of the programme, students can participate in work experience for two hours a week over six weeks in an area they found interesting. In 2023, 16 students completed this programme and will proceed to complete work experience in early 2024.

ENSURING OUR COLLEAGES AND COMMUNITY MEMBERS SEE THEMSELVES REFLECTED IN THE CONTENT WE PROMOTE

We continue to ensure that all images, videos, leaflets, training resources, written publications and animations use images which reflect the full diversity of the communities we serve and the colleagues we employ. We consciously ensure images reflect our diversity across protected characteristic groups, professions and areas of the organisation.

Over the last year, Multifaith resources have been created to support the end-of-life CARING campaign to help make it easier to understand and respond to the spiritual needs of our patients at the end of life.

OUR FUTURE FOCUS

• Review our recruitment and selection processes from end to end, this includes having as standard diverse recruitment panels and the presence of an equality representative who has the authority to stop selection processes if deemed unfair.
• Take further steps to increase the representation of minority colleagues to ensure the diversity makeup across all minority and socioeconomic groups is broadly representative of the communities we serve at all levels of our organisation.
• Develop a talent pool database of individuals across the organisation who are identified as Rising Stars and agree the positive action we will take to fill promotion opportunities with colleagues from underrepresented groups.
• Continue to prioritise and promote the widening access work and programmes in the organisation in order to further enable social mobility through our attraction, recruitment, retention efforts.
• Understand disparities in performance management in colleagues with protected characteristics, specifically in relation to formal performance management processes, appraisal ratings, talent management ratings and ability to access training and development opportunities beyond mandatory training.
• Ensure wider engagement from our diverse communities across all services and divisions, in co-production, listening to feedback and taking actions based on feedback.

PRINCIPLE 5 – BRINGING ABOUT CHANGE THROUGH EDUCATION AND DEVELOPMENT

Education and raising awareness is an essential part of the strategy, as it helps to inform, change mindsets and create a force for change. This section details how we are using training, education and development to support colleagues with protected characteristics, through to detailing how we are using education and awareness to raise the wider workforce understanding of their role in supporting us to deliver the aims of this strategy. Some of the progress under this aim, has already been reported under other aims including; the Inclusive Leadership in Lancs Programme, the Bystander Toolkit and Zero Tolerance implementation.

IMPROVED EXPERIENCE FOR COLLEAGUES WITH PROTECTED CHARACTERISTICS

As already covered within this report, we have embarked on rolling out an organisation wide programme affirming Our Zero Tolerance Approach to all colleagues. The programme is intended to ensure all colleagues understand their personal responsibility to uphold a Zero Tolerance approach to abuse within our organisation through looking at our organisational approach and by exploring leadership and colleague responsibilities to take action.

Over the past quarter we have developed additional EDI training sessions to help us respond to organisational needs; Banter – When it’s Definitely not a laughing matter and Cultural Awareness which explores culture, stereotypes, cultural differences in communication all of which positively support a multicultural workplace, generate discussion and increase knowledge or awareness. These are in addition to other masterclasses already developed including; Unconscious Bias, Microaggressions and Inclusive Language.

This year also saw the launch of a mandatory Learning Disability, Autism and Neurodiversity online learning module, developed to help colleagues understand the different aspects of learning disability, autism and neurodiversity. It aims to give people an insight into various conditions along with some guidance about how adjustments could be facilitated.

We believe culture is everyone’s responsibility and throughout 2023, we have been supporting all colleagues to explore how they can put the principles of The Best Version of Us into practise in their day-to-day roles. Each month we have focused on one aspect of the framework and we have released a weekly communication via the HeaLTH Matters Newsletter which includes ideas, resources, activities, and events that colleagues can access and use personally and within their teams. At the end of each month, we have shared a newsletter for leaders which has additional guidance, case studies and engagement activities to support the delivery of cultural improvement within our teams.

A number of the communications have had an inclusion theme, such as “Two Ears and One Mouth – Listening for Inclusion”. The topic of “Be Yourself Always…Recognising and celebrating diversity and differences by valuing each and every 39 person” contained four separate newsletters which focused on Our Approach, Allyship, Increasing Awareness and Supporting Difference, Our Role as Leaders and Learning & Development opportunities.

An action from last year was to implement a Bystander Intervention Kit which includes values based and civility resources to help colleagues to tackle uncivil behaviours, discrimination, bullying and harassment – this has been achieved.

INCLUSIVE, ACCESSIBLE BLENDED LEARNING AND LIBRARY SERVICES

In the last 12 months we have taken the steps to enhance accessibility in respect of our online learning content; all new videos and animations have captions to support learners with impaired hearing. In addition, all mandatory Core Skills Framework courses have an MS Word version available to support colleagues who would find a printable document a more accessible form of learning. There is an option to translate the Core Skills Framework content into other languages too.

LEADERSHIP AND MANAGEMENT SKILLS

We have undertaken a significant amount of education and communication in support of Workplace Adjustments; supporting managers and leaders to understand their responsibilities and requirements in line with legislation, our Supporting Disability in the Workplace policy and our Trust Values. A member of the EDI team has been identified who can support Workplace Adjustment requests or queries and we have detailed a pathway for colleagues and line managers to follow if they require (or require support with) Workplace Adjustments.

As promised in last year’s report, we have finalised the review of current EDI training available to all colleagues to ensure everyone understands their personal responsibility to promote equality, work in line with inclusive practices, challenge inappropriate behaviours and remove any unfair barriers. This includes raising awareness of expected behaviour, terminology, relevant good practices and where to access further guidance and support. In support of this we undertook a Training Needs Analysis across the organisation as a means of understanding how colleagues were educating themselves around inclusion matters and where they felt they required additional support. Responses were very low however the information gathered from those colleagues who did respond has been used to formulate an initial training plan for the coming year.

COLLABORATIVE WORKING WITH EDI COLLEAGUES ACROSS THE INTEGRATED CARE SYSTEM (ICS)

EDI Colleagues from across Lancashire & South Cumbria ICS have assembled to explore ways in which we can work more collaboratively for collective benefit, particularly as a means of gaining some pace and traction in respect of particular programmes of work.

At present, seven projects have been identified for us to move forwards, which are;

• Cultural Awareness • Reasonable Adjustments • Inclusive Recruitment • Delivering on Anti-Racism • Staff Network Chair Development • Reciprocal Mentoring • EDS2022

An initial scoping exercise has been started in respect of each of the projects which will progress throughout 2024.

OUR FUTURE FOCUS

• Deliver Equality Impact Assessment Training for all colleagues and teams who draft policies, guidelines, patient information and colleague communication.
• To ring fence a proportionally representative percentage of apprenticeships, accredited (e.g. Institute of Leadership and Management Level 2, Consultant Leadership Development etc.) non-accredited (e.g. Continuous Improvement Programmes, Core People Management Skills, Senior Leadership Development etc.) taught programmes for colleagues with protected characteristics.
• To foster a restorative, just and learning culture by integrating learning from concerns and complaints made by patients, families, carers and colleagues into the organisations learning to improve processes.
• Embed a talent management strategy which targets under-representation and lack of diversity, which specifically addresses the issues around attracting and retaining younger talent, as well as equity of career progression opportunities for colleagues with protected characteristics, particularly for internationally recruited colleagues.
• Develop and deliver a comprehensive induction, onboarding and development programme for internationally educated colleagues which encompasses both professional and pastoral support.
• Deliver Equality Diversity Representatives training to colleagues to support recruitment, performance, disciplinary and grievance processes.
• Analyse data from appraisal in relation to the number of colleagues who have a completed Supporting Disability in the Workplace agreement, as well as conducting an assessment to determine the effectiveness of the agreements with colleagues who have an identified longterm condition or disability.
• Work with EDI colleagues across Lancashire & South Cumbria to progress the seven agreed collaborative projects.

FINANCIAL IMPLICATIONS

• Costs associated with missed appointments from patients who may have lower health literacy skills, from a poorer demographic background, or minority group.
• Increased treatment costs for patients with health inequalities.
• There is no celling for the maximum amount which could be awarded from a potential employment tribunal with a discrimination claim.
• The associated costs for colleague turnover, this includes impact on team morale which can impact on levels of productivity, impact on reputation, time to hire and needing to use temporary worker colleagues, as well as time spent recruiting and upskilling.

LEGAL IMPLICATIONS

As a public sector body, we are governed by the Public Sector Equality Duty which came into force in 2011 alongside the Equality Act 2010. As part of this we are obliged to meet the objectives set out which include:

a. eliminate discrimination, harassment, victimisation and any other conduct that is prohibited by or under the Equality Act 2010; .

b. advance equality of opportunity between persons who share a relevant protected characteristic and persons who do not share it;

c. foster good relations between persons who share a relevant protected characteristic and persons who do not share it

To ensure transparency, and to assist in the performance of this duty, the Equality Act 2010 (Specific Duties) Regulations 2011 require public authorities to publish:

• equality objectives, at least every four years,
• information to demonstrate their compliance with the public sector equality duty.

This annual report and the EDI Strategy supports the transparency with regards to the objectives we are taking to improve diversity and inclusion alongside our data profile. In conjunction with this report, the Workforce Race Equality Standard, Workforce Disability Equality Standard and the Gender Pay Gap report support further transparency with regards to our data and experience of colleagues from certain protected characteristics.

RISKS

• Ability to analyse our patient data by all 9 protected characteristics is limited due to system limitations, this makes it more challenging to understand any health inequalities that may exist, alongside measure any impact through actions taken in delivering the strategic aims.
• Negative impact on the experience of work for colleagues with protected characteristics leading to challenges with retention.
• Increased discrimination claims.
• Reduction in overall levels of colleague engagement and satisfaction as measured by the National Staff Survey and the National Quarterly Pulse Survey.
• Reduced reputation as an inclusive employer.
• A workforce that is not representative of the communities we serve, across all levels and professional groups.
• A workforce which is not consciously inclusive, or who possess the skills, knowledge, confidence and competence to tackle discrimination and deliver inclusive working practices within an increasingly more diverse workforce.
• Inability to progress social value work through increasing the diversity of our workforce which in turn supports our communities to thrive.
• Increased health inequality gap(s).
• Services are designed which do not meet the unique needs of our local populations. • Inability to achieve CQC standards around equality, diversity and inclusion of the services we offer.
• Inability to deliver on the NHS People Plan and the NHS People Promise Element - We Are Compassionate and Inclusive.
• Failure to deliver the NHSE High Impact Actions.
• Not keeping up with developments in diversity and inclusion from a patient, community and workforce perspective.

IMPACT ON STAKEHOLDERS

The stakeholders are patients, their families, the wider community, our current and future workforce. All these groups could be negatively impacted if we fail to deliver on all aspects of the EDI strategy.

RECOMMENDATIONS

It is recommended that Board approve the paper for external publication.