Case study: Black Country Healthcare NHS Foundation Trust

• Revitalising the existing Cultural Ambassador Programme, run in partnership with the Royal College of Nursing (RCN), through greater investment and recruitment of new ambassadors from across the trust to build confidence in the disciplinary system. Through the programme, cultural ambassadors aim to challenge unconscious bias and discrimination that may occur for ethnic minority staff entering/during formal HR processes acting as a neutral presence in hearings and investigations.  
• Increasing the capacity of the EDI partner by separating workforce and patient EDI into two separate roles within the organisation and introducing two additional posts to provide greater support, advice and guidance to managers and staff. 
• Providing additional anti-racism training for the HR team to improve understanding of practices and processes.  
• Reviewing disciplinary processes and procedures to ensure they meet the aims of a restorative, just and learning culture (RJLC). A RJLC places equal emphasis on accountability and learning when something has not gone as planned, rather than focusing on allocating blame. 
• Increased monitoring of disciplinary data by ethnicity, through the trust EDI committee. 
• Sourcing support from external consultants such as BRAP and drawing on The RACE Equality Code to build the board's understanding of anti-racism, what it looks like in an NHS trust, and how governance, systems and policies could be improved to achieve race equality. 
• Participation of the associate director of HR in the Health Management Academy's anti-racist leadership programme, enabling an increased awareness and understanding of anti-racism and ability to review disciplinary processes through a race lens.  
• Commissioning anti-racism training for the HR team and managers from Show Racism the Red Card. 
• Dedicating an hour of the trust's corporate induction to EDI in addition to mandated online training courses on EDI to underline the importance of staff having a good understanding of anti-racism including for example, microaggressions. 

The work to reduce disparity within the disciplinary processes was undertaken as part of the trust's wider anti-racism journey. The BCHCFT board undertook training with BRAP to support their understanding of racism, anti-racism and what this looks like in practice within an NHS trust. The trust also signed up to The RACE Equality Code to ensure a strong governance structure underpinned their anti-racism action plan.

Following the merger between the two legacy trusts, BCHCFT reviewed the disciplinary procedures and processes of both trusts and applied a RJLC lens. Through this review, the new HR team were able to refine their ways of working, provide clarity about expected behaviours and communicate this more clearly to the workforce. BCHCFT also created a new organisational development (OD) department. The OD department work closely with teams that are facing challenges when addressing systemic issues and to help restore relationships that may have broken down.

The Cultural Ambassador Programme had been initially implemented by Black Country Partnership NHS Foundation Trust in 2017. Run by the RCN, the programme provides four days of intensive training to ensure new (independent) cultural ambassadors can identify and challenge discrimination and cultural bias. Cultural ambassadors are expected to use these skills in their role as a neutral observer within disciplinary processes, formal investigations and grievance hearings involving ethnic minority staff. Cultural ambassadors are drawn from ethnic minority staff members at any 'Agenda for Change' pay band and are expected to help hold HR and management to account through their oversight of disciplinary and grievance processes. It is the responsibility of the HR team to secure funding for the programme and ensure its integration across the trust.

BCHCFT report on the result of disciplinary processes through their EDI committee - who also report on the progress of the anti-racism action plan. This allows the board to keep abreast of progress against both their WRES and anti-racism commitments, as well thematic issues, as they arise. The board also meet for development sessions to discuss results, receive updates on changes, and agree improvement strategies.

Over the years, the trust has seen an improvement in the experience of ethnic minority staff members in the following areas:

• The likelihood of ethnic minority staff entering the formal disciplinary process in comparison to white staff improved from 1.6 times more likely to 1.24 times more likely. 
• Harassment, bullying or abuse from staff within the last 12 months which improved by 5% (WRES metric 5). 
• Discrimination at work from manager/team leader or other colleagues within the last 12 months which improved by 6% (WRES metric 8). 

BCHCFT feel these improvements are indicative of staff viewing the trust as a fairer place to work.  

Following extra support on anti-racism, the board feels it has made good progress on its commitment, understanding and learning and is now more able to provide proactive leadership to tackle race inequality and create a culture where all staff feel supported.  

In 2020, Black County Partnership NHS Foundation Trust's work on training cultural ambassadors and embedding their role into HR processes, led them to win the Health Service Journal's Value Award for People and Organisational Development Initiative of the Year.  In addition, the successful implementation of the programme has led the Black Country integrated care system to train 10 cultural ambassadors to act in non-NHS organisations within their system. The trust is also looking to expand the role of cultural ambassadors to support bank workers at BCHCFT in the same way they do for other staff. 

Through the range of work designed to engage ethnic minority staff, including via the trust's Racial Inclusion and Cultural Heritage staff network, the trust has seen greater appetite among ethnic minority colleagues wanting to engage with workstreams such as the Cultural Ambassador programme. The trust has worked with staff to develop an internal leadership  programme, as well as fund six ethnic minority colleagues to enrol on the Mary Seacole programme. The trust is also investing in 50 staff to become career coaches with ILM qualifications to provide extra support to ethnic minority staff in progressing in their careers.

Ensuring that cultural ambassadors have enough time to fulfil the demands of their new roles alongside their substantive roles is a key challenge.

Maintaining momentum and motivation for the race equality agenda more widely has also been a challenge for BCHCFT. During the pandemic the organisation found staff were galvanised, sharing their lived experiences proactively and engaging in action planning. In contrast, the current perception by some staff is that there is a reduced focus on the race equality agenda due in part to reduced levels of communication. In response to this, the board and HR team have reflected on ways they are communicating about race equality in general, but also ensuring that they are sharing outcomes and changes made as a result of the trust's anti-racism action plan.

The board have recognised they cannot meet the needs of the diverse communities they serve without prioritising a focus on race equality. As a result, the board have communicated across the trust the importance of proactively seeking out and confronting racial disadvantage and discrimination, raising awareness of how it is essential to their ability to be an effective employer and healthcare provider. The board regularly incorporate discussions on race equality into board, executive team and committee meetings and within their development sessions. Board members have both professional performance related objectives on advancing race equality, as well as personal anti-racism objectives to support them in their active white allyship.