1. Bradford District Care Foundation NHS Trust
BAME Improvement Project
HS Consultancy, May 2017

2. IMPLEMENTATION Process
Proposal for project to improve the access, experience and recovery rates of people from Black Asian and Minority (BAME) Groups in District My Wellbeing College.
Bradford District Care Foundation Trust, as part of its commitment to provide fair and equitable services for all sections of the population has decided to consider inequities faced by BAME populations in My Wellbeing College (District) and to seek to reduce of remove these inequalities. This project supports the work of the Equality Delivery System (EDS2) and has co-efficiencies with the Workforce Race Equality Standard and work on Safe Conversations taking place in the Trust.
Aim
To develop of model of improvement that is replicable (with relevant adaptations) across teams and services in the Trust.
In discussion with the My Wellbeing College service, and the District Team in particular, a project is being designed to improve the access, experience and recovery rates of people from Black Asian and Minority Groups. The values and principles underpinning this work are that the project will:-
-be based on a detailed understanding of team service utilisation data;
-involve and be shaped by people who have or who are using the service, including as stakeholders;
-involve and developed with clinicians in the District Team;
-be informed by research evidence about what works;
-seek improvements at all stages in the service user pathway in relation the My Wellbeing College.
©HS Consultancy 2017

3. Implementation stages
Decision to scope
Project management
Data analysis
Decision on actions
Implementation of project objectives
Reviews of inputs, outputs and outcomes
©HS Consultancy 2017

4. Decision to scope
Project management
Data analysis
Decision on actions
Implementation of project objectives
Reviews of inputs, outputs and outcomes
Bradford District Care Foundation Trust, as part of its commitment to provide fair and equitable services for all sections of the population has decided to consider inequities faced by BAME populations in My Wellbeing College (District) and to seek to reduce of remove these inequalities. This intended as an approach to establish ‘proof of concept’ and then for this to be replicated across the Trust. Hári Sewell of HS Consultancy ( has been invited to work with the service to support improvement.
In discussion with the My Wellbeing College service and the District Team in particular a project is being designed to improve the access, experience and recovery rates of people from Black Asian and Minority Groups. The values and principles underpinning this work are that the project will:- 
be based on a detailed understanding of team service utilisation data;
involve and be shaped by people who have or who are using the service;
involve and developed with clinicians in the District Team;
be informed by research evidence about what works;
seek improvements at all stages in the service user pathway in relation the My Wellbeing College.
No rigid solution or model is being imposed on the service but rather, the service and District Team in particular, is invited to participate in the scoping of a potential project within an agreed framework as set out in this document. A first meeting to do this was held on 24th April Initial scoping commenced at this meeting.
©HS Consultancy 2017

5. Decision to scope
Project management
Data analysis
Decision on actions
Implementation of project objectives
Reviews of inputs, outputs and outcomes
Initial scope
Project will focus on District Team but will draw learning from across the service.
Attention will be given to service user access, experience of using the service and recovery rates (including looking at drop out rates).
The duration of the project will cover the phases of the project (as identified in the chevrons above) and the timetable will be established when the project plan is agreed at the stage of deciding on actions.
Implementation of the project will require modest involvement of members of the project team (see following page) and is likely to involve the entire team in activities such as development sessions (training and consultation and review sessions with Hári)
©HS Consultancy 2017

6. There should be a workstream for each element of the project. Namely:-
Decision to scope
Project management
Data analysis
Decision on actions
Implementation of project objectives
Reviews of inputs, outputs and outcomes
Once a decision has been made to scope the potential improvement work, a scoping project group needs to be formed. Most organisations will be familiar with implementing projects, using a clear methodology. This scoping project will require a senior manager sponsor, a project lead, a project group and the engagement of support functions such as the information team. Project Management methodology needs to be applied.
There should be a workstream for each element of the project. Namely:-
-Service user, care and community engagement
-Data and information
-Workforce skills and knowledge development
-Research, positive practice and innovation
These do not need to be major formalised working groups but rather a lead organising a workstream, with clear accountability back to a single person who is overseeing the programme. An individual may have responsibility for more than one component. The main point is that accountabilities much be clear.
From the outset, arrangements should be in place to evaluate the process and impact of any change. This should be a rigorous exercise so that learning from success and failures can be understood.
©HS Consultancy 2012

7. A project structure may look like this:-
Decision to scope
Project management
Data analysis
Decision on actions
Implementation of project objectives
Reviews of inputs, outputs and outcomes
A project structure may look like this:-
Grainne Eloi Project Sponsor
Richard Carrol Project Lead
Data Lead
Engagement Lead
Workforce Development Lead
Research Lead
Hári Sewell Project Manager
Hári Sewell will be a resource to all leads and will do much of the leg-work such a logistics and drafting.
ACTION: Leads to be identified from District Team and the Trust
©HS Consultancy 2012

8. Decision to scope
Project management
Data analysis
Decision on actions
Implementation of project objectives
Reviews of inputs, outputs and outcomes
DATA Information and data to be considered includes: -City of Bradford ethnicity data (coterminus with team boundaries) – working age and 65+ age bands -Referrals to the team, by ethnicity -Admissions to the team, by ethnicity -Treatments completed, by ethnicity -Incomplete treatments, by ethnicity -Team clinical workforce, by ethnicity and grade
©HS Consultancy 2012

9. Decision to scope
Project management
Data analysis
Decision on actions
Implementation of project objectives
Reviews of inputs, outputs and outcomes
INFORMATION
In addition to the data the following information needs to be gleaned and analysed:-
Views of people from BAME service user and community groups about their priorities for action
Staff perspectives on barriers to equitable access, experience and outcome for BAME service users, and priorities for action
Up to date research findings about ethnic disparities, methods for achieving improvements in clinical practice
Feedback from frontline managers and staff about gaps in knowledge and skills and how they would like those gaps closed. Specific attention will be paid to the skills of managers to lead this agenda.
©HS Consultancy 2012

10. At this stage the project will set out plans in relation to:-
Decision to scope
Project management
Data analysis
Decision on actions
Implementation of project objectives
Reviews of inputs, outputs and outcomes
The previous stages of the project will lead to a set of proposals. An early question will be:-
“Based on where we are now, what targets are we setting (with numerical values and end dates and key milestones) and what do we need to do to achieve these?”
At this stage the project will set out plans in relation to:-
-BAME service user, carer, community and stakeholder engagement in shaping services
-Changes in referral patterns, experience and outcomes by people from BAME backgrounds
-Knowledge and skill development of the workforce, including specific attention to the knowledge and skills of managers required to steer agreed change.
At this stage an implementation project plan will be developed. Hári Sewell will develop this based on inputs from leads.
©HS Consultancy 2012

11. Project Management methodology needs to be applied.
Decision to scope
Project management
Data analysis
Decision on actions
Implementation of project objectives
Reviews of inputs, outputs and outcomes
Project Management methodology needs to be applied.
Regular project meetings will be set up at the start of the project to enable progress to be mapped and any exceptional action agreed. These will be chaired by Richard Carroll.
Data
Staff within the team/ Trust with responsibility for data will submit this to the project data lead. A meeting will be convened to review the key messages from the data and information. This will help the setting of priorities for the action plan, alongside information from the Engagement Workstream
Engagement
BAME service users (or recent service users) of the team and carers who may be prepared to contribute by giving feedback will be identified and worked with according to the Trust engagement policy. Consideration will be give to whether a specific survey to BAME service users and carers should be conducted.
Discussions will be held with BAME community organisations, either individually or through a consultation session. This will provide information about barriers, perception and concerns as well as provide ideas for reaching and encouraging service uptake from BAME people.
The engagement activity will aim to gain input specifically in relation to this project and also will aim to establish ongoing relationships to support to work of the team.
Staff from the team who are not part of the project group will be asked to submit their views about challenges, obstacles and potential ways to support progress. Main referring agencies will also be consulted.
©HS Consultancy 2012

12. Workforce development
Decision to scope
Project management
Data analysis
Decision on actions
Implementation of project objectives
Reviews of inputs, outputs and outcomes
Workforce development
Staff knowledge and skills required to work cross culturally in the My Wellbeing College setting will be assessed via a brief, bespoke knowledge and skills audit (self assessment).
The findings will be fed back to the team and will inform a development programme. A ‘Frequently Asked Questions’ and briefing session will also be held with managers, including discussion about challenges that have emerged in management practice, relevant to this project, with a view to equipping them to be more competent based on their lived experience.
This work will be integrated with the trust initiatives o safe conversations.
Research
Staff from the team and the wider My Wellbeing College will be asked to send details of research the have / are aware of in relation to improving referral, experience and outcome of BAME people in IAPT or therapy services.
This request will also extend to seeking examples of positive practice in relation to improving outcomes for people from BAME backgrounds.
The Health Promotion Library will be asked to run a search within parameters agreed by the Research Workstream. The focus will be on what works to most effectively improve assess, experience and outcome from talking treatments and therapeutic group work. The Research Workstream, with Hári, will review and distil the findings.
©HS Consultancy 2012

13. A clear specification for an evaluation process will be drawn up.
Decision to scope
Project management
Data analysis
Decision on actions
Implementation of project objectives
Reviews of inputs, outputs and outcomes
A clear specification for an evaluation process will be drawn up.
Locally developed, senior management approved indicators of success will be agreed at the start of the project
An evaluation may capture information on:-
Measures of effort (e.g. how much time is spent, whether agreed processes are followed). These are also known as inputs.
Output measures (e.g. Measures of the impact of effort. This may include an increase in the number of BAME people referred or an increase in the number who complete agreed treatment in the My Wellbeing College (District Team).
Outcome measures (these are challenging to collect for a large number of people as it relates to the extent to which people are ‘better’ – largely defined by themselves). Further, there are usually so many influences on improved outcomes so claiming a causal link between actions in the project plan and any improved outcomes will need to be well substantiated.
The progress from input to output to outcomes requires time for the changes in the lives of BAME service users to be detectable. The shaping of the evaluation will need to be informed by the reality of practice and will draw on the work of the Engagement Workstream, which will capture staff views. The trust senior management team will wish to see evidence of improved outcomes.
Inputs
outputs
outcomes
©HS Consultancy 2012

14. Project role descriptions – Engagement Lead
The role of the engagement lead is to be the conduit to service users and carers who may participate in the project in two ways:
Reference group and consultative forum (face to face / phone / written comms)
Cohort to be surveyed by questionnaire
Tasks of the Engagement Lead include:-
Be point of contact for Hári regarding how to contact service users, carers and community members who may be involved.
Provide contact details or facilitate the processes of Hári communicating with service users, carers and community members who may contribute to this project.
Assist with navigating the Trust’s policies and systems for involvement such as safeguarding, payments and other relevant policies.
Arrange for safe storage of electronic and physical information relating to engagement within this project.
Attend project group meetings and contribute to the project.

15. Project role descriptions – Data Leads
The role of the Data Leads are to understand the data needs of the project and to agree what is available and additional information that can be feasibly gathered and to assist with collating data and information reports that are fit for purpose in terms of supporting the data needs of this project. Data will be required on clinical activity (access, experience and outcome by ethnicity) and workfrce (team composition, grade and other workforce data specified in this brief plus other information agreed with the project group.
Tasks of the Data Leads include:-
Be point of contact for Hári regarding clinical / workforce data.
Assisting with clarifying essential data needs of the project aligned with what is available and what can feasibly be collected.
Inform the project decisions about additional data to be gathered and the robustness of any proposed methodology.
Provided expert analysis and interpretation of data, by liaising with the service and workforce leads.
Attend project group meetings and contribute to the project.

16. Project role descriptions – Workforce Lead
The role of the Workforce Leads is to work with the project to determine how best to identify knowledge and skills gaps and to assist Hári to design the most efficient and specific interventions to support development. Additionally this Lead will integrate the work of this project with other relevant initiatives such as management and leadership development and the Trust’s initiative on safe conversations.
Tasks of the Workforce Lead include:-
Contribute recommendations about workforce and organisational development interventions that flow from the findings of the project.
Review the proposals from Hári about potential interventions and act as critical friend
Provide advice and intelligence on the feasibility of interventions and provide guidance on how to set up and deliver those agreed by the project group. This will relate to those delivered by (or with) Hári as part of this project as well as ongoing work in the Trust.
Attend project group meetings and contribute to the project.

17. Project role descriptions – Research Lead
The role of the research Leads is to assist Hári to with terms for desk top review of current and emerging research on improvement in IAPT / My Wellbeing Colleges, with specific reference to BAME groups.
Tasks of the Research Lead include:-
Contribute citations of papers that are relevant to BAME improvement in access, experience and outcomes in therapy/IAPT/ My Wellbeing College
Contribute to search terms that Hári will use in the literature search to be undertaken directly and through the Health Promotion Library.
Review the findings from the literature review and identify any gaps and further suggestions.
Attend project group meetings and contribute to the project.

18. Developed by: Hári Sewell HS Consultancy 2017 Contact 07737 281123 hari.sewell@hsconsultancy.org.uk