NIHR Birmingham BRC-CRF Joint Equity, Equality, Diversity and Inclusion Strategy 2022-2027

Collective intelligence: Group intelligence emerged from collaboration, cooperation, and information sharing among a diverse group of individuals.

Diversity of thought: Diversity of thought includes various perspectives, opinions, beliefs, and ideas beyond demographics like race and age.

Constructive dissent: Refers to constructive criticism that aims to improve a situation, idea, project, or decision instead of opposing it for the sake of opposition.

ACDG: Academic Career Development Group

ARC: Applied Research Collaborations

BWCH: Birmingham Women’s and Children’s NHS Foundation Trust

BRC: Biomedical Research Centre

CPROR: Centre for Patient Reported Outcomes Research

CRF: Clinical Research Facility

CRN: Clinical Research Network

EEDI: Equity, Equality, Diversity, and Inclusion

FTE: Full-time Equivalent

HEI: Higher Education Institute

HR: Human Resources

ICB: Integrated Care Board

ICS: Integrated Care System

NIHR: National Institute for Health and Care Research

UoB: University of Birmingham

UHB: University Hospitals Birmingham NHS Foundation Trust

RC&EDI: Research Culture & EDI Group

WRES: NHS Workforce Race Equality Standard

WRESI: NHS Workforce Race Equality Standard and Inclusions

WMAHSN: West Midlands Academic Health Science Network

The NIHR/Wellcome Trust Birmingham Clinical Research Facility (CRF) and NIHR Birmingham Biomedical Research Centre (BRC) serve a diverse population of 5.7 million people and employ an expanding workforce. We work together on patient-orientated research to translate scientific discoveries into new treatments.

We connect patients and communities with healthcare professionals and scientists to develop treatments that benefit patients and invigorate the local economy, often through partnerships with industry or patient charity groups.

Our teams are part of the below organisations. There are several other partner organisations, detailed in Appendix 1.

• University Hospitals Birmingham NHS Foundation Trust (UHB)
• Birmingham Women’s and Children’s NHS Foundation Trust (BWCH)
• University of Birmingham (UoB)

The National Institute for Health and Care Research (NIHR) commits to embedding Equity, Equality, Diversity, and Inclusion (EEDI) across its research infrastructure, systems and culture. The Birmingham BRC and CRF will work together to contribute to the NIHR EEDI objectives.

Equity means to ensure fairness and justice by providing what each person needs to succeed. It acknowledges that only some start from the same place. It promotes inclusivity, justice, and equal opportunities for all.

Equality guarantees equal treatment and opportunities for all, regardless of identity or background. Everyone must live a fulfilling life and make meaningful contributions to society. It promotes social justice and helps to build a more harmonious and cohesive society. It allows everyone to contribute to their full potential.

Diversity refers to differences in race, ethnicity, gender, age, religion, culture, and socioeconomic status. It encourages respect and support where everyone’s unique qualities are appreciated.

Inclusion means respecting everyone and providing equal access to resources, opportunities, and support.

Under-served reflects the perspective that the research community needs to provide better services for people in these groups.

Under-represented reflects the recognition that people from minority ethnic groups (and other groups with protected characteristics) are often not included in clinical and health research.

Biomedical Research Centres are collaborations that bring scientists and clinicians from universities and hospitals together to translate scientific breakthroughs into new treatments, diagnostics and technologies for patients.

The NIHR/Wellcome Trust Clinical Research Facility is a dedicated environment for delivering high quality early phase and experimental medicine with specialised clinical, administration and laboratory teams.

We commit to creating an environment that fosters dignity and mutual respect. An environment where everyone can achieve their full potential without hindrance or discrimination. The Equality Act 2010 underpins this commitment. The act outlines nine protected characteristics, which are:

• age
• disability
• sex
• sexual orientation
• gender reassignment
• race
• religion or belief
• marriage or civil partnership
• pregnancy or maternity

The strategy also recognises specific barriers and inequalities some individuals face. These include:

• socioeconomic status
• geographic location
• ability to access health care services
• support of flexible working

Our approach aligns with BRC and CRF’s current policies and the recent updates from UHB, UoB, and our other partners but also allows our research to remain flexible and curious, identifying and incorporating unrecognised characteristics while considering cultural and social changes.

This strategy document outlines our principles and goals for promoting EEDI within BRC and CRF and our unwavering commitment to achieving them. We strive to provide equal research opportunities for all, regardless of their background or circumstances. This approach accurately represents the broader population and reflects our dedication to fairness and equality.

As part of our EEDI strategy, we are implementing initiatives to enhance diversity among study participants. This will enable us to better understand and empathise with underserved communities. Our efforts will also help to improve research accessibility for underrepresented groups and foster a more diverse and inclusive research workforce.

The strategy aims to foster inclusivity, promote active engagement, and collaborate with community organisations catering to underrepresented and diverse groups. These partnerships will enable the delivery of community engagement and provide access to invaluable guidance. Furthermore, the strategy will allocate resources towards cultural intelligence development programmes for our research team, ensuring they can respond to diverse communities’ specific needs and values.

We recognise the need for collaboration with underserved communities. But relying on them alone is not the answer. We aim to make lasting changes by involving diverse stakeholders, including those often overlooked. We are committed to ethical and fair engagement with all communities without relying on stereotypes.

The strategy will continuously evolve during our programme journey. We recognise that to ensure the programme’s success, we must remain open to making necessary adjustments throughout its duration. By adopting a pragmatic and introspective approach, we can establish an inclusive framework that reflects progress and partnerships, promotes EEDI research and empowers us to realise our objectives and vision for a fairer and more inclusive society.

We want the BRC and CRF to demonstrate diversity, inclusion and fairness in all their research efforts. We aim to prioritise patient and public outcomes by upholding impartiality, taking action and building cultural and inclusive understanding. Therefore, we will strive to cultivate an inclusive, diverse culture that amplifies all voices and fosters cooperation and partnership.

A successful delivery from the Birmingham BRC and CRF will include:

• Adopting a collective intelligence approach to experimental medicine. It combines our vision with our capacity and capability to design and deliver research. It will enable us to develop robust evidence that addresses the impact of complex and challenging issues. In this context, it may mean tackling systemic racism, promoting gender equality, or creating inclusive workplaces and communities.
• Enhancing workforce diversity and public participation. The aim is to reflect better the population we serve. This includes promoting diversity of thought and ensuring equity in our workforce and research, leading to better patient outcomes.
• Ensuring a constructive dissent approach, allowing us to hear all voices. We value different perspectives and challenging discussions. This approach will foster creativity and innovation and result in equity in decision-making.
• Providing an environment that instils a sense of safety. Enabling people to feel comfortable being themselves, sharing their opinions, and taking risks. It will stop the fear of criticism, judgement or punishment. It fosters open communication, collaboration, and trust. This can lead to higher levels of creativity, innovation, and productivity. It can also improve problem-solving and decision-making skills.
• Committing resources towards collecting and analysing pertinent data within the BRC and CRF to include diligent monitoring, comprehensive reporting, and thorough analysis of various aspects, such as our workforce, committee composition, and all individuals involved in our research programme.

Our ambition for the future is to create a diverse workforce that embraces different perspectives and worldviews. A place where there is a shared sense of purpose and belonging. A place where diversity and inclusion are integral in all aspects of the organisation, such as:

• behaviours
• structures
• systems
• processes
• research
• patients and public participants

Inclusion and diversity are crucial for the success of our NIHR infrastructure programmes. Without it, risks include limited perspectives, biased outcomes, recruitment challenges, ethical and legal complications, compromised research quality, missed funding opportunities, and damage to reputation. Our well-defined plan for assessing and overseeing EEDI is essential in establishing an inclusive and diverse research environment, leading to improved outcomes and strengthened sustainability.

In Birmingham[1], involving underserved communities in studies is important to ensure we do not have incomplete data sets, and is imperative to developing customised interventions. Furthermore, diverse teams spur innovation and enhance outcomes. Thus, prioritising diverse representation in research is essential for advancing society.

The BRC and CRF aim to establish an inclusive and diverse research environment. They will foster a community and culture that welcomes and supports talented researchers, patients, the public, and contributors from all sectors of society, genders, and life stages. This approach will be incorporated and promoted in all partnerships and relationships.

Key partnerships in these research ecosystems include local organisations. These include charities, community groups, and industry partners. Please see Appendix 1 below. These are alongside NHS and HEI partners. We will work together with these groups to design and deliver inclusive research. We will aim to improve the quality of life and disease status of every patient from every community. The several equality standards we hold will be critical enablers for this approach. Please see Appendix 1 below.

Our BRC and CRF partnerships combine outstanding clinical care and cutting-edge research. It gives us greater reach, diversity and opportunities for co-creation and co-production. It allows collective influence across our regional population.

Our collaborative work uses the “One NIHR” approach. This involves breaking down traditional silos between research areas. It also promotes collaboration across NIHR centres, teams, and partnerships. By working together in this way, we aim to create a more integrated and efficient research system. A system that can better tackle complex health challenges and that produces the most significant outputs from our research.

We will promote the adoption of available EEDI-related methodological tools and identify and use new tools as they become available.

A variety of sources were consulted to support the development of this strategy, including:

• the NIHR Equality, Diversity and Inclusion Strategy
• the University Hospitals Birmingham NHS Foundation Trust WRES Report 2022
• the recent NHS Workforce Race Equality Standard and Inclusion (WRESI)
• the Equality Delivery System 2022 for UHB
• the local Equality, Diversity and Inclusion Policies

It was also developed with input from various stakeholders, including:

• the local Equality, Diversity and Inclusion Team
• CRF Team Leads
• BRC Core Strategic Group
• School of Public Health Research (SPHR)

The Centre for Patient-Reported Outcomes Research (CPROR) also thoroughly audited the NIHR BRC applications (past and present) to support the development of this strategy, including identifying any gaps, or areas of strength.

Our strategy will adapt to the needs of the local community, BRC, CRF, and our partners, as well as the evolving EEDI landscape. Collaborative, consultative processes will ensure everyone is on board and takes ownership.

Our collaboration involves several organisations at different maturity levels regarding inclusion and diversity. We will implement the Deloitte Inclusive and Diversity Maturity Matrix to ensure seamless integration across our BRC and CRF infrastructures. This four-level model tracks the evolution of diversity and inclusion and will be a reliable tool for measuring our progress throughout the program.

With this model’s aid, we can assess our maturity level comprehensively, comparing it against specific actions and improvements aligned with our core metrics.

To ensure we are working towards integration of the maturity matrix, the NIHR BRC and CRF will adopt the following approach to monitor overall objective achievements:

• Implementing robust governance and leadership, ownership and accountability for outcomes across the strategy for BRC and CRF.
• Identifying and implementing a focused set of reporting protocols.
• Establishing feedback mechanisms and providing continuous improvement opportunities.
• Taking an evidence-based approach to data collection on EEDI metrics, including but not limited to gender, race, ethnicity, disability, sexual orientation, and age of employees and stakeholders, to understand improvement on disparities and take relevant action.
• Defining benchmarks against industry standards or similar institutions to identify areas of improvement.

All staff in our NHS Trusts must undertake mandatory EDI training. This includes clinicians and researchers, who complete this as part of their induction. All academic staff must also complete training programmes to support cultural intelligence development. We will ensure that the programme workforce undertakes a minimum requirement of EEDI training, such as implicit bias, inclusion awareness and cultural intelligence.

The training relates to the nine protected characteristics and other social inequalities. These include socioeconomics, healthcare access and geography. It focuses on the impact on staff and research participants from protected characteristic groups. Our programme partners are committed to EEDI development and training all researchers and staff across the BRC and CRF.

We are actively implementing and improving our services as a newly expanded programme. We are currently positioned at the beginning of the programmatic stage and aim to become leader-led in the EEDI Maturity Model within the next three years.

Our infrastructure is funded by the National Institute for Health and Care Research (NIHR). We have analysed the strategic goals of NIHR to identify areas where our goals align.

The NIHR EDI Strategy for 2022-2027 has been highlighted across all aspects of our strategy. We are committed to this goal and have developed our strategy based on the NIHR EDI principles to bring our vision and objectives to life. As we move forward, the NIHR BRC and CRF have the potential to contribute significantly towards advancing EEDI across the NIHR.

Our partnership between the BRC and CRF has identified several strategic initiatives aligning with local and national NIHR infrastructures. Collaborating on these will further enhance our impact. The CRF and BRC also oversee and deliver the NIHR BioResource portfolio. This joint work further solidifies our collaboration.

The BRC and CRF will continue to expand their joint efforts with other institutions, such as:

• NIHR West Midlands Applied Research Collaboration (ARC);
• West Midlands Academic Health Science Network (AHSN).
• UK CRF Network

We are committed to developing regional alliances with:

• NIHR Clinical Research Network West Midlands (CRN WM);
• Genomic Medicine Service Alliance (and the associated Genomic Laboratory Hub);
• the 17 NHS Trusts in our region.

We aim to strengthen our national relationships, established through leadership in many programmes. These include the BRCs in Bristol, Cambridge, Leicester, Nottingham (via Midlands & Wales Advanced Therapies Treatment Centre (MW-ATTC)). We co-lead the NIHR BTRU in Precision Cellular Therapeutics with Oxford. This maintains links with UCL and the Alan Turing Institute. Additionally, we lead the NIHR Non-Alcoholic Fatty Liver Disease (NAFLD) BioResource. Our respected partner institutions include Nottingham, Newcastle, Oxford, and UCL universities.

The strategy will refer to these associated strategies:

• NIHR EDI Strategy
• BRC and CRF joint PPIE Strategy
• BRC Training and Development Strategy

BRC and CRF Executives will establish a clear and effective system to promote EEDI. These management and leadership groups will periodically receive updates regarding delivery against the EEDI strategy and will be required to actively support and model any changes to behaviours, systems or processes. This commitment ensures high governance standards and successful implementation of the strategy. We will continuously refine our approach to remain adaptable and responsive. Our dedication is crucial in achieving our joint EEDI strategic objectives and creating an inclusive and equitable environment.

Research Culture & EDI Group

The role of the Research Culture & EDI Group (RC&EDI) is to:

• • provide regular oversight of the EEDI strategy and the delivery plan;

• • highlight areas evidencing strong EDI advancement;

• • identify areas where this needs improvement;

• • make recommendations for action where appropriate.

The RC&EDI group will develop and implement relevant strategies and policies across the BRC. They will also create task and finish subgroups to support outcomes as required.

The Research Culture and EDI Group (RC&EDI) will report to the Management Committee(s) and the Executive Board/Leadership teams. This ensures that the BRC and CRF commitments are upheld across all areas of the programme infrastructure.

Academic Career Development Group

The Academic Career Development Group aims to create a research culture supporting a skilled, diverse and resilient workforce conducting world-leading clinical research programmes, driving improvements in patient care.

Key objectives include:

• • Developing a shared research culture

• • Recruiting and retaining diverse future research leaders

• • Building complementary skill sets and resources

Our research training culture takes an “Inclusive, Responsible and Responsive” approach. We foster an inclusive environment for staff, patients, community partners and participants. We do this by making sure our culture reflects the alignment of our institutions with:

• • the Equality Act

• • UoB EDI Scheme

• • NHS Equality Delivery System

• • Workforce Race Equality Standard

Inclusivity is embedded at all levels of training and within group membership. This means all individuals, including current leaders, are mentored to succeed (e.g., reverse mentoring).

This group will report to the BRC Executive Board. The chair is the Academic Career Development Lead, and the BRC EDI Lead is the deputy chair. This will ensure that the group’s activities support the organisation’s commitment to EEDI. This promotes equity of opportunity for all individuals in their training programmes.

Partner Organisations

• Birmingham Community Healthcare NHS Trust
• Birmingham Women’s and Children’s NHS Foundation Trust
• Sandwell and West Birmingham Hospitals NHS Trust
• Aston University
• Keele University
• University of Oxford

Community Partners

• Ada Lovelace Institute
• Age UK Birmingham
• Birmingham LGBT
• Black Lives Matter
• BRAP
• Data4BlackLives
• Women in AI

UHB and UoB Frameworks and Policies

• Dignity at Work Process – Prevention of Bullying Harassment – UHB
• Equality, Diversity and Inclusion Scheme – UoB
• Equality and Impact Assessment – UoB
• Fairness and Diversity – UoB
• Fair Employment Policy – Diverse, Equal and Inclusive – UHB
• Flexible Working Procedure – UHB
• Religious and Belief Guidelines – UoB
• Spiritual, Religious and Pastoral care – UHB
• Supporting individuals who are transgender and non-binary – UHB

Equality Standards and Compliance Frameworks

• Athena-SWAN Silver
• Carer Friendly Employer
• Disability Confident Employer
• Equality Diversity System 2023
• Gender Pay Gap
• Public Sector Equality Duty
• Race Equality Charter Bronze
• Stonewall Silver Employer
• Workforce Disability Standard
• Workforce Race Equality Standards
• Workforce Race Equality Standards and Inclusion

[1] https://www.birmingham.gov.uk/downloads/file/23111/blachir_report