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Commitment and collaboration

Organisations that are explicit, clear and engaged with their EDI strategy have a greater chance of succeeding and have a better reputation among service users. Commitment also brings a sense of accountability, which is critical to the overall success of any strategy. This section outlines practical steps you can take to represent and execute your commitment to EDI. Whether your organisation is only a few people, or a larger entity, declaring the organisation’s intention to consider EDI in all it does can be powerful.

Appoint a board member as EDI lead

Ensuring a named person on your ICB is taking responsibility for EDI is a strong signal that your ICB is committed to addressing health and workforce inequalities in the ICS. Having a named EDI lead on your ICB is not intended to detract from EDI being the collective responsibility of the ICB, but rather it can provide clarity, continuity and accountability to ensure someone is focused on EDI. Similarly, include EDI as a standing agenda item for your ICB meetings.

Continue learning about EDI best practice and grow the evidence base by discussing EDI initiatives with other ICBs, and looking to other sectors for adaptable EDI interventions

EDI best practice, legislation and advice evolves quickly. Continual learning about EDI and how it applies within your sector will help your organisation to be an EDI leader with a positive culture and working environment. Consult and share your emerging findings with your organisation’s board members and any Employee Resource Groups (ERGs) as well as collaborating with them in relation to updates and expertise. You can learn more about EDI in the Health sector in London.

There are specific reports available which will help give you a solid grounding in the concerns facing your particular sub-sector at present. Please check the resources available.

ICBs should lead the way in collaborating with other ICBs to share best practice and cascade EDI knowledge through their ICSs. One way to do this is to join the NHS Employers ICB Peer Anchor Network, where ICB representatives share good practice on approaches to employment issues.

Collect data on the diversity of your workforce and support and encourage organisations in your ICS to do so too

Data is fundamental to any successful EDI initiative, as it helps to identify where particular interventions will successfully improve EDI outcomes. By having a deeper understanding of the diversity and lived experiences of your workforce, you can begin to identify any existing biases, gaps or challenges and plan to improve them.

Although data collection is mandatory for many NHS organisations, you can go above and beyond mandated data collection by looking at your data through an intersectional lens.

Research compiled by Nuffield Trust has shown, for example, that only 68% of disabled ethnic minority staff reported that adequate adjustments had been made for them, compared with 75% of disabled white staff. On the other hand, BMJ research found that minority ethnic groups are sometimes categorised together in data collection efforts, which can mask challenges faced by particular ethnic groups. Understanding your current data, and establishing the gaps within it, will allow you to collect the data required to support more nuanced and targeted actions.

Analysing data from grievance and disciplinary, salary band, progression, recruitment, sickness and leavers data, can reveal trends within particular departments, teams or locations. This makes it easier to identify challenges, barriers and opportunities to support underrepresented groups.

ONS have released guidance on how best to group ethnicity data at a high level. Using these groupings is one way to structure data to aid comparisons and benchmarking, whether to other NHS organisations, trusts, ICBs, or to show year-on-year progression to your own historic data.

The importance of reliable and triangulated data, that includes lived experience, is emphasised throughout the high-impact actions that form NHS England’s first EDI improvement plan. It has committed to the same high impact actions that have been directed at trusts and ICBs.  The plan emphasises that the actions have been chosen to address “the widely-known intersectional impacts of discrimination and bias”.  Find out more on information and resources.

When we spoke with sector employers, data-sharing was cited as an issue in most trusts, and accessing information regarding EDI or recruitment is still a work in progress. Collecting data about who is in your workforce and their pay is fundamental to embedding EDI in your organisation, particularly in order to identify any disparities that can be remedied. Do not limit salary analyses to gender; search for pay discrepancies by ethnicity, disability and other characteristics, or within departments and teams. You can go further again by looking at pay gap data intersectionality. For example, cross referencing information on gender pay gaps with information on ethnicity and disability pay gaps. The intersection of gender and age with regard to NHS pay gaps, for example, is also an area that is only just beginning to be researched.

INvolve ethnicity pay reporting shows commitment to transparency, and why it is important to have  conversations about race in the workplace.

Mend the Gap is a comprehensive, independent review into gender pay gaps in medicine in England.

ICBs have additional duties in this regard as they are required to comply with the duties under the public sector equality duty (PsEd).  They are required to publish information on how they are complying with the PsED and equality objectives, including how they are prioritising the needs of people with different protected characteristics. ICBs are uniquely placed to assist the organisations in their ICS to collate the data that will be helpful to them and to share anonymised data from peers as benchmarking.  By providing a consistent template for data collection, ICBs will gain access to a more usable and comprehensive dataset.

Embed workforce EDI, with a focus on the Priority Groups, as a key strategic priority for your ICB

An EDI policy is a written agreement for your organisation which addresses how you will promote equity and create a safe and inclusive atmosphere for your employees and service users. Equal Measures has created an adaptable EDI policy template you can use. You can also take a look at this example from the Health and Care Professions Council.

To create your EDI policy:

  1. Before embarking on creating an EDI policy it is crucial to first set a specific vision on what your EDI policy is and its impact on your company and its customers. 
  2. Review existing resources, such as this one from High Speed Training, which includes guidance and a free template.
  3. Outline the behaviours expected from the workforce and ensure they align with the organisational and EDI values.
  4. Clearly state that any form of discrimination, victimisation, harassment or bullying is unacceptable, in the form of a zero tolerance approach and statement. Set out procedures for dealing with complaints and reporting. Take a look at this resource from Acas.
  5. Be clear about how to access support within your organisation as well as any helpful external resources. Also be clear about how to go about reporting discrimination within your organisation specifically.

GPs in particular are always squeezed for time and wear many hats in the organisations they work in. Setting aside time regularly to consider EDI will help to create a regular habit. Even 30 minutes a fortnight or a month will help you to become more intentional about how you build EDI into your work.

Where you can, allocate a specific pot of money for EDI. This pot of money could be used to:

  • Upskill people in your team on EDI. For example, staff  training on  inclusive and safer recruitment practices for anyone who makes hiring decisions in your organisation;
  • Attend networking conferences led by diverse health organisations. If you are too busy, send a representative of your practice as part of a mentoring programme;
  • Update your website to include your EDI vision statement, strategy or commitment.

An effective EDI strategy should detail how the organisation seeks to improve its EDI outcomes over a defined period of time, typically with specific and measurable actions.

  1. Set a clear EDI vision that articulates what EDI means for your organisation. Be specific about the type of culture you want your organisation to embody;
  2. Engage key stakeholders (senior management, board members, employees and trade union representatives) to create your EDI strategy - EDI strategies work best when they have the buy-in of senior leadership, and any Employee Resource Groups (ERGs). You can find more information on ERGs in the ‘Building an Inclusive Culture’ section. 
  3. Collect and analyse both quantitative and qualitative data (i.e. surveys, focus groups and interviews) to assess your current workplace demographics, staff experiences and identify any opportunities for improvement specific to your organisation. This will help set appropriate EDI goals and provide a baseline to benchmark improvements against;
  4. Set an EDI budget. It is important that your organisation has the resources to deliver on any commitments built into the EDI strategy. This budget must be proportionate to the opportunities for improvement identified across your organisation as well as your EDI ambitions;
  5. Identify the internal / external resources needed to deliver against your EDI strategy and upskill your teams on EDI best practice. Consider creating an EDI team or an EDI Committee to help engage employees across the organisation and work with senior management;
  6. Put your plan into action and communicate progress regularly. Be transparent with your employees about areas where improvement is needed, and how you will go about this. Be sure to regularly consult and share your findings with your organisation’s board members and ERGs;
  7. Senior leadership should visibly lead EDI and revisit the strategy on a regular basis in order to monitor and deliver progress.  Agreed goals should be regularly measured and assessed against results, and any necessary changes put in place.  The acronym SMART (Specific, Measurable, Achievable, Relevant and Time-Bound) can be useful in setting goals.

You may wish to appoint an external provider to help you create or review your EDI strategy, particularly where time and subject matter expertise are limited in your organisation. If you have the budget, you might also appoint an EDI expert to carry out a broader programme of work. The decision depends on finances, time needed to hire and train a new team member, how comprehensive your EDI plans and ambitions are, and also whether your existing leadership team has the confidence and skills to carry out this work in-house.

A good example of an EDI strategy was released by Portsmouth Hospital University. This strategy is both comprehensive and goes beyond regulatory compliance toward thoroughly embedding EDI. It includes measurable goals and specific roles and responsibilities, which is essential to accountable and sustainable EDI practice.

Joint EDI Strategy -  In 2022, Barnet, Enfield, and Haringey Mental Health NHS Trust and Camden and Islington NHS Foundation Trust launched a joint EDI strategy. The aim was to create a just, fair and inclusive culture.

The five focus areas were: improve service user access and experience; better health outcomes; representative and supported workforce; inclusive leadership; and culture change by mainstreaming EDI.

Further actions include encouraging a healthy work-life balance, developing collective leadership at all levels, and realising individual development opportunities through collaboration.

ICB example - North Central London (NCL) ICB was one of three Boards that were singled out and highlighted as having exemplary strategy plans for working with the public.  Its strategy plan emphasised how it dovetailed with NCL ICB’s Equality and Diversity Strategy and established committee accountability for this aspect of the strategy. 

A flexible work schedule is a great way to make your organisation more attractive to potential candidates, particularly if they have caring responsibilities. Reasonable adjustments ensure your organisation is inclusive to all, by meeting their specific needs. They typically will involve adapting working methods, procedures, or the physical work environment to mitigate against any potential disadvantage.

Flexible working can improve employee well-being and morale, reduce sick leave, protect against burnout and ill-health, and increase productivity and career longevity. It is also a crucial way to support parents and carers, and help retain neurodiverse and disabled employees. Employers may wish to consider offering flexibility across the workforce more broadly where appropriate.

It is helpful to note that employers have a legal duty to deal with requests for flexible working in a reasonable, unbiased, and transparent manner, and offer an appeal process should the request not be met with approval.

Senior leadership support for your organisation’s EDI ambitions is critical as they have influence over organisational priorities and can ensure the EDI vision is effectively communicated. Equally important are middle leaders and managers who are crucial to the promotion and embedding of EDI actions and principles.  Spending time ensuring they understand the organisation’s vision, values and expectations on EDI is central to how the strategy is received and implemented.

A maturity matrix is a useful tool to assess your organisation on EDI, review progress, and consider next steps. This can then be shared internally and externally; inviting feedback from both internal and external stakeholders can provide further opportunities for honest reflection and building on key successes.  You can see an example of a maturity matrix.

Regular internal communication on your organisation’s commitment to EDI is essential to keeping employees engaged with your strategy. Making your EDI commitment public ensures accountability of senior leadership, encouraging stakeholder buy-in. Communication around your EDI strategy should also invite views and feedback from both internal and external stakeholders. Where feedback isn’t positive, it is important to be honest about any challenges, admit mistakes, and understand EDI as an ongoing process of improvement.

Many organisations communicate their commitment to EDI by signing a pledge. This can be helpful in raising industry standards and encouraging open dialogue across organisations.

Below are some best practice examples of organisations sharing their EDI Strategies on their website:

Collaborate with other healthcare organisations and trade unions on EDI guidance

If you are an ICB, consider the ways in which you can take a more active role in sharing information with smaller healthcare organisations. This provides an opportunity to showcase your leadership on relevant EDI topics, and further promote EDI within the sector.

For Priority Group individuals not currently working in the sector, seeing a whole industry committed to positive change may help alter perceptions that the industry is not for them. Engaging with other healthcare organisations can help organisations access advice and support, whilst also sharing lessons learnt and best practice. It provides an opportunity for the industry to evolve into a sector committed to inclusion.

Trade unions are also a helpful source of guidance on equality issues in the workplace. If your employees are members of a union, their representatives will be important stakeholders in consulting on and developing your EDI strategy. Whether your employees are members or not, the TUC, the BMA and many others have a range of helpful resources on EDI issues.

Here are some of the ways that your organisation can start to think about engaging and collaborating:

  1. Encourage and support employees to speak on external industry panels and publicise these events explicitly via all appropriate channels;
  2. Attend networking events for Priority Groups within the industry and highlight role models , encouraging leaders and managers to attend events;
  3. Share health sector EDI best practice with other organisations, as well as obtaining guidance on how best to facilitate a robust EDI strategy and culture. Share collaborations publicly to bolster accountability
  4. Consider cross sector mentoring and reverse mentoring; 
  5. Take part in research within the sector to improve data disclosure, data gathering, and data analysis in relation to EDI.

Incorporate an EDI shadow board with representatives from the Priority Groups

An EDI shadow board can be an enormously rewarding and an engaging way to signal your organisation's commitment to real change, and to address systemic power imbalances between your senior leadership and those from underrepresented and minority demographics in your organisation. Shadow boards serve to bridge the gap between junior and senior members, creating a direct line of communication for strategy-building and future-proofing the organisation. The inspiring leaders network has put together a shadow board programme, helping to develop aspiring board members and senior management within the health and social sectors.

ICBs have an opportunity to lead by example, by setting up or providing adequate guidance on EDI shadow boards with modules and videos describing their benefits, including developing strategic thinking, and offering personal development support.

A shadow board is a group of non-executive employees that works together with senior executives on strategic initiatives. They serve to bridge the gap between junior and senior members, creating a direct line of communication for strategy building and future-proofing the organisation. Shadow boards can enable people from underrepresented groups to influence the decision-making and strategic direction of the employer.

Creating a shadow board has helped a number of NHS organisations including the Hertfordshire Community NHS Trust improve their EDI strategy and interventions.