Equality, diversity and inclusion policy and practice development in the health care sector
Submitting Institution
University of BradfordUnit of Assessment
Business and Management StudiesSummary Impact Type
SocietalResearch Subject Area(s)
Studies In Human Society: Policy and Administration
Psychology and Cognitive Sciences: Psychology
Summary of the impact
Bradford academics developed a research framework to understand equality,
diversity and inclusion which health organisations used in formulating
policy and practice. This led to more effective engagement in these issues
thereby improving community wellbeing and addressing health inequalities.
The framework informed changes in the commissioning and delivery of local
community health services and in national level human resources rationale.
A service provider redesigned their preventive services, incorporated
novel employment and peer adviser opportunities and achieved higher levels
of engagement and service use within their diverse community. The
framework has been used by a range of organisations including Brap and
Gateway Family Services, to underpin their participation-based,
voice-centred research. Notably McMillan Cancer Support has used the
voice-centred approach, developed by Brap using the Bradford framework, to
develop their policy and practice.
Underpinning research
Bradford's research has generated a body of evidence addressing equality
and diversity issues over 20 years by Dr Myfanwy Trueman (Part-time
Teaching Fellow 1996-1998, Lecturer 1998-2012), Nelarine Cornelius
(Honorary Senior Research Fellow 2006-2008, Professor 2008-current), Tom
Franks (Professor 1997-2013), Dr John Lawler (Senior Lecturer
1999-present) and Dr James Wallace (Senior Lecturer 2004-present).
Lawler's research in public sector management examined how changes in
government policy, organisational climate and leadership practices
influenced community service delivery (1,2,3). The group's work on
well-being and regeneration was the focus of a 2008 Bradford conference,
including the challenges of targeting need in communities, which led to a
special issue of the International Journal of Public Sector Management
edited by Trueman, Cornelius, Franks and Lawler. Cornelius and Wallace
built on the theme of the conference and Sen's "capabilities approach" to
develop a capability framework to promote understanding of equality,
diversity and inclusion practices in non-profit service organisations and
the effectiveness and impact of their service provision to communities
(4,5,6).
Cornelius and Wallace's research was disseminated in four outputs: a
conceptual piece on how community interventions involving multiple
organisations are best configured to enhance the capabilities of
communities and reflect community views (4); an empirical study of the
importance of ethicality structures (including governance and employee
well-being policies) for sustainability of social organisations and impact
of social provision (5); a conceptual piece on UK community development
policies, highlighting how funding institutions need to evaluate hard
evidence on the effectiveness of social organisations in terms of value
created (e.g., community cohesion and social inclusion) (6), and a study
of how organisations can develop capabilities-based corporate social
responsibility (CSR) structures that focus on the social good created and
the ethicality and sustainability of this good. The capabilities
framework developed from this research was a core element in an
ESRC-funded seminar series. Based on the Bradford research, we worked with
the national social research think tank, Brap, to run a seminar (in 2009),
which resulted in on-going collaboration, between the researchers, the NHS
(South Birmingham PCT (SBPCT), now Birmingham South Central), a social
enterprise (Gateway Family Services, GFS) and Brap, focused on city-wide,
community-based well-being and, in particular, community health issues.
These organisations adopted, adapted and applied the capabilities
framework to enhance equality, fairness and quality of life through the
redesign of community health services. Co-production of further research
and an understanding of issues in converting academic ideas into
sustainable action were enhanced by Cornelius' Board and Director roles in
community regeneration organisations, social enterprises and equality
initiatives.
Although Sen's capabilities' thinking has been applied extensively in
development studies, economics and education, there are few examples in
business and management. Two of the articles cited in the case study have
been published in the leading journal in business ethics, Journal of
Business Ethics, after vital developmental scoping work in International
Journal of Public Sector Management. Articles which appeared in
2011-2013 were based on research conducted between 2008 and 2009. The
research (6) discovered that social enterprises have an important
restorative role which is strengthened through their employment of local
people and volunteers because this gives the community a voice. The
research recommends that organisations train staff to be mediators between
the service provision and the client groups to facilitate lifestyle
changes that move them out of the margins of society. Research (4)
highlighted the importance of service deliverers and service commissioners
aligning service delivery and community outcome objectives in order to
enhance capabilities within communities. The research discovered that
where community level concerns were given a clearer voice, the solutions
were more appropriate and effective. Research (5) on ethicality structures
(including governance and employee well-being policies) provided
recommendations on how social organisations can ensure that their internal
organisational structures and ethical norms are configured to enable
successful quality of life and service provision outcomes.
References to the research
1. Holt J, Lawler J. (2005) Children in need teams: service delivery and
organisational climate. Social Work and Social Sciences Review
12(2): 29-47.
2. Lawler J, Harlow E. (2005) Postmodernization: a phase we're going
through? Management in social care. British Journal of Social Work
35(7): 1163-1174.
3. Lawler J. (2007) Leadership in social work: a case of caveat emptor? British
Journal of Social Work 37(1): 123-141.
4. Cornelius N, Wallace J. (2010) Cross-sector partnerships, city
regeneration and social justice. Journal of Business Ethics 94
(Supplement 1): 71-84.
5. Wallace J, Cornelius N. (2010) Community development and social
regeneration: how the third sector addresses the needs of BME communities
in post-industrial cities. Journal of Business Ethics 97(1): 43-54.
6. Cornelius N, Wallace J. (2013) Capabilities, urban unrest and social
enterprise: limits of the actions of third sector organisations. International
Journal of Public Sector Management 26(3): 232-249.
The research framework has been published in journals that are of
international quality and double-blind, peer reviewed. Two of the articles
cited in the case study have been published in the leading journals in
business ethics - the Journal of Business Ethics and the International
Journal of Public Sector Management.
Details of the impact
The research led to changes in policy and practice in healthcare and new
community-based employment opportunities in Birmingham which spread to the
development of organisational policy guidance concerning fairness and
quality of life. Theoretical principles were converted into policy and
practice through organisations developing new, rights-based ideas to
address social inequality. The interface between research and practice has
been a core characteristic of this case, and the understanding of the
importance of the enduring co-production of knowledge is now embedded in
the policy and practice development methods of these organisations.
NHS Birmingham South Central. SBPCT used Bradford's research by
introducing equality and diversity into their human resource policies (a)
and service delivery. They were interested in how best to develop
appropriate measures of effectiveness and outcomes for their commissioning
of community health services for the local population (a). The PCT used
the Bradford research on cross-sector partnerships to enhance their
partnership working in reforms to their patient and public involvement
work (a). The capability framework also influenced a new field research
strategy where a Community worker developed a model of provision which
moved away from a health professional driven approach to a
community-based/informed model of health provision where members of the
public (paraprofessionals) were trained to provide support (a,b).
Paraprofessionals worked with community nurses based in 48 GP surgeries,
with the specific remit of working with those least likely to seek
healthcare but also highly likely to need interventions to improve health
and prevent future ill-health. The chair of the former SBPCT states that
health inequalities did decline and that the capability still influences
contemporary approaches (a).
Gateway Family Services is a social enterprise in Birmingham that
provides health care services to disadvantaged communities, new migrants
and those that are on the margins of society (c,d). Our research (5,6) was
fundamental to changes made at Gateway. Gateway adopted the Bradford
capabilities framework, to inform their governance policy and training of
staff, extending the paraprofessionals model of healthcare
provision into the Health Trainers model. Health Trainers work
within communities to help individuals to evaluate their state of health
(e.g., blood pressure monitoring) and to develop tailored health plans
(e.g. exercise provided in peer groups) which are revised as an
individual's health improves. Gateway works in particular with those
beyond the reach of statutory services, who are often unaware of available
healthcare/welfare options. Cornelius worked with Gateway to train and
develop one of their community workers to include research that built on
the capabilities framework. Individuals who had previously failed to
access the health service, and were on the margins of society, were helped
to access these vital services, and could also train and gain
qualifications as Health Trainers (c). Our research led to the inclusion
of the views of the marginalised within the design of Gateway's service
policy and provision. Gateway now employs 80 people including Health
Trainers and Pregnancy Outreach workers, including staff that had
previously been in severe health and economic difficulties. The
organisation's diversity is demonstrated in the 18 different languages
spoken. Gateway used the Bradford framework to develop an approach to
addressing equality, diversity and inclusion that would allow them to
provide services whilst maintaining the "dignity and voice" of
their client group with a focus on well-being, voice, rights and limited
aspirations (adaptive preferences). Gateway stated: "We used the
research in our redesign of services for local people, in particular our
Health Trainers and Pregnancy Outreach Workers. Employing local people
to offer community health care makes significant savings and offers
realistic solutions to gaps in health provision...We have
improved lifestyle in hard to reach communities and have demonstrated
reductions in smoking and obesity. Not only will these changes lead to
lower use of health services in the future, they increase life skills
and economic prospects" (d).
Brap and MacMillan Cancer. Brap is a national think-tank whose
work focuses on equalities and human rights (e,f,g). Brap incorporated the
capabilities framework in work conducted for MacMillan Cancer
Support (the Cancer Reform Strategy) to provide on-the-ground approaches
to improving equality practice. Research published in references 4 and 6
form the basis of the ideas central to these approaches. The Bradford
framework underpinned the handbook that Brap produced for the Equality and
Human Rights Commission (EHRC) on how to develop human rights based policy
in organisations (e). The handbook emphases capabilities grounded
corporate social responsibility and how client groups benefit from a
sustainable, empowering approach (6). This formed the basis for policy and
practice development for the MacMillan project.
The Cancer Reform Strategy and Human Rights Standard for service
provision (the latter coproduced by staff and patients) developed by Brap
(f) was informed by feedback from focus groups and interviews conducted by
the Gateway community worker in conjunction with Cornelius. "The
Bradford framework underpinned the participation-based, voice-centred
research methods. Cancer patients, their family and staff worked
together to define issues and develop MacMillan's policy and service
level agreements" (g). Brap highlighted the importance of the voice
centred approach developed through this research for effective policy and
practice development at MacMillan (g), highlighting the key role of
community research worker in this process. The community research worker
believed that he had gained a powerful insight into how to develop
equalities based health interventions (b).
The approach developed by MacMillan for service delivery to people with
cancer is based on an established check list of agreements developed using
the capabilities framework, that allow service providers and clients to
judge whether dignity, voice and rights are embedded in the service
transaction. The process has now been developed as a service level
agreement and rolled out nationally for all of MacMillan Cancer's health
and social care providers including 3,700 nurses, 200 care centres and its
volunteer carer network. This has "not only improved the quality of
service provision but ensured that the views of cancer patients are core
to the development of policy and practice at MacMillan" (g).
Sources to corroborate the impact
a. Testimonial #1: former Chair, South Birmingham PCT and Brap board
member, who "Having read and been influenced by Nelarine Cornelius'
work...asked [Cornelius] to work with SBPCT to provide intellectual
input...". The Testimonial explains how the research was embedded in
local health planning and provision.
b. Testimonial #2: Gateway community worker on paraprofessionals project
and MacMillan Cancer Support project. The testimonial corroborates the
explanations in section 4 and states how the community worker developed
community-based research methods to embed voice and community shaping of
service provision, based on the recommendations in references 1 and 5. "I
think more prosaically it has helped me to understand that a passive
approach to equalities, a failure to examine the invasive and shifting
nature of prejudice and discrimination, is stupid."
c. Gateway Family Services http://gatewayfs.org/?s=health+trainers - provides details of the Health Trainers scheme that is mentioned in
section 4 and in source d.
d. Testimonial #3: Chief Executive, Gateway Family Services. The
testimonial explains how "The framework was instrumental in the
redesign of recruitment and selection processes in Gateway, in
developing the methodologies we use and continue to use to collect and
utilise data to inform our service provision." The testimonial also
corroborates that Gateway built on the Bradford framework in the
development of their Health Trainers and Pregnancy Outreach Workers
programmes.
e. Booklet `Why bother with human rights?' published by Brap on behalf of
the Equality and Human Rights Commission (EHRC). In source g, the CEO of
Brap states "We have also combined this [the Bradford research] with
human rights approaches as a means to create a new paradigm about how we
think about equality." This document illustrates how Brap developed
policy guidance on how to incorporate human rights issues into
organisational equality policy informed by the Bradford framework.
f. MacMillan Cancer Support Human Rights Strategy and Standard for Cancer
Care policy document - The CEO of Brap stated in source g that `We
have used this approach to support the concepts we have developed in the
MacMillan Human Rights standard project." This document (pdf
available) illustrates the policy that was developed from `community
voice' based research underpinned by the Bradford research.
g. Testimonial #4: Chief Executive, Brap. The testimonial details how the
Bradford research underpinned the development of the Equality and Human
Rights `Step by Step' guide for the development of organisation human
rights policies.