A collaboration between

1. A collaboration between NHS Sheffield, NHS Bradford & Airedale, NHS Leeds, Sheffield Hallam University & University of Leeds This project was funded by the National Institute for Health Research Service Delivery and Organisation (NIHR SDO) programme (project number 09/1002/14). Visit the SDO programme website http://www.sdo.nihr.ac.uk/projdetails.php?ref=09-1002-14 for more information. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the SDO programme, NIHR, NHS or the Department of Health.

2. Workshop Objectives Drawing on a two-year empirical study of commissioning, this workshop aims to raise awareness of: • wide variety of different sources of evidence/insight/ data/knowledge used in service design & improvement • different ways in which evidence can be used • importance of packaging and delivery • opportunities for using evidence effectively

3. Background • Strong legal and policy framework supporting race equality. • Areas of good practice; but persistent minority ethnic disadvantage in access, experiences and outcomes. • The increasingly evidence-based policy environment disadvantages this agenda. How can the commissioning/service development cycle be a lever towards reduced ethnic inequalities? What role can (research) evidence play? How can this be supported?

4. Commissioning or service development cycle - Cultural/structural factors supporting: - Equalities work - Evidence use

5. Sources of data/information/ evidence?

6. Sources of data/information/ evidence? -Population-level health and wellbeing data by ethnicity -Service-level ethnic monitoring data; including care pathways -Community level consultation -Insight/intelligence of front-line workers - National level surveys; national policy documents - Research studies Obstacles -JSNAs lack detail on ethnicity -Local data on health needs of BME lacking -Ethnic monitoring poor -Community consultation variable -Insight/evidence from VCF contested -Equity Audits rare Enablers - Strategies to make the most of imperfect data -Using data to prompt improved collection -Combining national and local data -Identifying small ££ for dedicated needs assessments; partnering with local researchers -Looking across service areas - common issues

7. Sources of data/information/ evidence?

8. Sources of data/information/ evidence? -NICE guidance -NSFs / national policy documents -Systematic / rigorous reviews by trusted sources -Published research -Case studies - Needs Assessment information - Local information on constellation of existing services, capacity etc. - Expert opinion Obstacles Enablers -National guidance lacks detail on ethnicity -Few 'blue prints'; 'how to' evidence limited -Reluctance to transfer across settings -Little cost effectiveness data -socio-cultural distance between decision-makers and BME communities -Willingness to take risks, pilot & learn - Documentation/sharing good practice (networks) -Entrepreneurialism; persuasive packaging - Creative RoI arguments - Co-production of solutions with communities

9. Sources of data/information/ evidence?

10. Sources of data/information/ evidence? -Routine monitoring data by ethnicity; cross-tabulation by gender; SES etc. -Equity Audit - closer look at service access and outcomes by ethnicity; DNAs, adherence, outcomes etc. - User and carer feedback; qualitative & quantitative -Staff feedback; concerns - Complaints and compliments; SUIs -External evaluation -Use in relation to need --> link back to needs assessment data at population level Obstacles Enablers -Performance indicators not specific wrt ethnicity - No benchmarking for equalities work - Patient/carer satisfaction rarely stratified by ethnicity -Front line staff distant from decision-makers -Some use of KPIs, CQUINs for equalities - Auditing work that takes equity focus - Models of joint provider-commissioner reviews on equalities -Peer reviews -Engagement of community in review work

11. Exercise in pairs PART A: Identify a service area within which there is a concern regarding inequality in access, experience and/or outcomes for minority ethnic people. • Identify the key barriers to making progress on this issue. • Identify what types of information/evidence/insight might help address the obstacles identified. • Think about how you might find/generate this information/evidence. 10 minutes - work quickly to get some ideas down!

12. Types of evidence use Interviewer: So, tell me a bit about how you go about getting the evidence and information you need to improve services Respondent: Well, there's the information you need to work out what needs to be done; and then of course there's the information you need to convince people to let you get on and do it

13. Simple direct application of evidence use (instrumental use) Rare ! Most likely where: - evidence is non-controversial; problem/issue uncontested - high degree of certainty in what is the best course of action - requires limited change - clear responsibility for bringing about the change - wider supportive environment for the change - little upset to current status quo Are these common characteristics of evidence on (ethnic) inequalities?!

14. Other types of evidence use • Conceptual: changes understanding; redefines the problems/issues; relocates the causes; suggests alternative places to look for solutions; challenges taken-for-granted assumptions etc. • Influential: reframes issues to increase their perceived importance, urgency, relevance; empowers actors to take action; gives legitimacy; persuades etc. Useful to identify ways of mobilising evidence/information /insight to increase understanding andprompt action

15. Mobilising evidence for understanding inequalities Describing:What? Patterns/differentials across groups. Explaining: Why? Underlying causes, pathways of effect. Prescribing: How? Interventions that can tackle issues. ►Aim is to inform decision-makers of what actions will bring about positive changes in issues of access, experience or outcome that are currently of concern. ►Tends to be mainly instrumental mode (some conceptual)

16. Mobilising evidence for action on inequalities Describing: What? Highlight the unacceptable; urgent. Explaining: Why? Locate cause within influence/responsibility Prescribing - How? Identify what should be done. Benchmark. ►Aim is to align issues to core priorities, engender commitment, empower and leverage resource. ►Influential and conceptual uses are key to success.

17. A brief case study example (from our forthcoming collection) Ensuring the F.A.S.T. message reaches BME people: 1. Local practitioner experience alerted PH practitioner to potential exclusion of BME groups from campaign. 2. This committed individual leveraged initial resource by combining messages in national policy document with basic local data. 3. Social marketing techniques used to generate insights community level - new qualitative data. 4. Findings taken to funding board in hopes of further resource for development phase ► rejected 5. Careful thinking, repackaging, re-delivery of the message ►funds secured! 6. Development work undertaken with community members. 7. Currently piloting customised communication materials.

18. Return to exercise PART B: Look back at the evidence/information that you identified as being needed. 3. Think about how you would use this evidence? To increase understanding or promptaction? Both? Use evidence instrumentally, conceptually, influentially? 4. Think about the audience(s) for this evidence? Considerations in packaging and delivering information?

19. Sharing and Discussion • Brief sharing of key points, 1 or 2 people • Easy to complete? • Difficulties? • New way of looking at things? • Thoughts to take away?

20. Interested to find out more? We will be developing a number of briefing papers and tools over the next few months, and also holding free workshops. Please contact us if you are interested: Sarah Salway s.salway@shu.ac.uk Lynne Carter lynne.carter@bradford.nhs.uk Thank you