We have tried to limit the number of acronyms throughout this document but below we have listed the few key ones used throughout.

BRC – Biomedical Research Centre

CRF – Clinical Research Facility

EDI – Equality, Diversity and Inclusion

EM – Experimental Medicine

GDPR – General Data Protection Regulation

NIHR – National Institute for Health and Care Research

PPIE – Patient and Public Involvement and Engagement

STH – Sheffield Teaching Hospitals NHS Foundation Trust

UoS – University of Sheffield

The NIHR Sheffield BRC and CRF are committed to promoting and embedding EDI through all aspects of our work.

Diversity in all its forms delivers greater impact in our research and enhances the experience of our patients, communities, and workforce. By working collaboratively with our partners we will create a thriving inclusive research environment that provides widened access and public confidence in health and care research; an environment that attracts and supports a diverse range of world leading staff, fostering equal opportunity for everyone to achieve their potential.

Through embedding these principles we will foster the development of a culture of Impact, Excellence, Inclusion, Collaboration, and Effectiveness.

The NIHR Sheffield CRF offer purpose built, dedicated research facilities within STH for the conduct of high-quality clinical research. We have the capacity to care for participants on a day and overnight basis. We recruit patients and healthy volunteers into clinical trials across a broad range of health conditions. We are experts in delivering early-phase studies where new treatments are being tested to make sure they are safe and effective. The services we provide can lead to important developments and advancements in health and social care and transform the lives of patients, so it is essential that EDI is at the core of all our work.

NIHR Sheffield BRC and CRF are committed to the promotion of an inclusive research environment to facilitate wider participation and involvement from diverse groups.

'Despite our previous endeavours, such as the highly successful CognoSpeakTM project (see appendix 5 for detail) and a newly designed dementia friendly reception area (see appendix 6 for detail), we recognise additional work is required to initiate more inclusive recruitment strategies and identification of research priorities to further represent the patient community we serve.'

We therefore have identified three key areas important to widening participation in our overarching objectives:

1. Community engagement and improved public understanding of research.

2. Recruitment to studies, with a focus on increasing the participation of under-represented groups in Experimental Medicine (EM) studies.

3. Involvement of patients and the community across all stages of the research pathway.

Below we have expanded on each of these goals and how we aim to achieve them.

Community engagement and improved public understanding of research

Working directly with our patient community and EDI contributors in an open, honest and consistent manner allows for the development of trust and understanding between researchers and diverse groups. Only by improving engagement and public understanding can we ensure that diverse groups feel comfortable contributing to and participating in research.

The BRC and CRF will:

• Continue to develop existing and new relationships with primary care groups, community groups and charities in the local and wider regional area to create a network of contacts to provide valuable insight and collaboration in our research programmes.

• Develop and maintain trust with ethnic minority community groups. We will identify key researchers linked to community groups. Ensuring approaches are made through linked researchers will reduce the risk of over burdening organisations with too many requests and provide scrutiny of research requests to community groups.

• Capitalise upon our existing partnerships to advertise, promote and disseminate research to encourage engagement and understanding in groups who are less likely to access research traditionally.

• Develop a community outreach engagement programme to promote inclusion of under-served groups and increase representation in clinical research with the support of the EDI Senior Research Fellow, PPIE Officer and research nurses.

• Promote inclusive communications and the wider dissemination of research outside of traditional scientific publications to encourage engagement from diverse health and care professionals, patients and the public.

• Add new EDI pages to the BRC and CRF websites to display activity and news related to EDI and review accessibility of the websites with PPI members.

• Create and share a calendar of relevant awareness days and events to promote and engage in.

• Create an evaluation form for EDI events and training, using the findings to put in place improvement and track progress.

Recruitment to studies, with a focus on increasing the participation of under-represented groups in EM studies

To deliver this objective, we first need to recognise the current EDI landscape of recruitment to our clinical research studies and the populations within Sheffield as a whole. This knowledge will enable us to better understand barriers to inclusion and identify populations or areas which need targeted strategies to improve engagement and participation.

To begin this, we will work together to:

• Implement a newly created ‘Diversity Monitoring Data Form’ into all BRC funded work, and other BRC/CRF supported studies where possible. A development plan, and an outline of the information we hope to collect is described in Appendix 2.

• Work with STH, GPs and community groups on a mapping exercise to highlight our locally served area, thus improving our understanding of which groups are under-served by research in Sheffield. We will also review which protected characteristics are already collected at a local level, helping us determine which it is appropriate and proportionate to collect as part of our Diversity Monitoring Data Form as mentioned above.

• Improve researcher and participant awareness and promote completion of the Participant in Research Experience Survey (PRES) and other feedback forms as part of the research pathway to allow participants to voice their opinions and give ideas for improvements.

• Work with researchers to encourage the development and implementation of new, innovative ways for the public to be involved in studies. This could include improved remote consenting and monitoring systems, or research visits taking place at home or in the community rather than in healthcare settings.

Other activities that the BRC will undertake:

Another aspect of delivering this objective is the optimisation of the design of clinical trials to ensure they are as low-burden, inclusive and efficient as possible. Some examples are:

• Encouraging researchers to identify ways to make research participation more inclusive at grant and early project design stage through on-going, high-quality engagement with PPIE and EDI groups and champions.

• Ensure funding is included for activities which will improve inclusivity within grant applications where possible. For example, including costs for translation of documents into multiple languages.

Other activities that the CRF will undertake:

•  Adapt the CRF feasibility form to collect information on studies that have a focus on underserved groups.

• Publish results of the data collected on the CRF website, including findings, recommendations, and progress.

Involvement of patients and the community across all stages of the research pathway

Embedding involvement from the public and community groups at all stages will help us to improve the relevance, appropriateness, and value of the research we conduct. Focusing on EDI groups and under-served communities will ensure their unique perspectives are considered and trials are conducted in an inclusive and sensitive manner.

The BRC will promote involvement at all stages through:

• Prioritising co-design of study documentation with community members and groups to ensure appropriateness and inclusivity.

• Encouraging BRC researchers to co-develop research priorities and projects with minority groups to ensure that research is of interest and value to the wider public.

• Including community group members and research champions as co-applicants in grants where appropriate to facilitate and reimburse involvement and time in research projects.

• Encourage collaboration with diverse groups when evaluating research findings, analysing results, and disseminating findings.

The CRF will promote involvement at all stages through:

• Reviewing and acting on participant feedback.

• Develop text and graphics to make participant experience results accessible and display these resources online and within the department.

• As part of the NIHR Local Clinical Research Network Yorkshire and Humber pilot project – develop an accessible, plain English template to describe research output.

The BRC and CRF are proactively working to instil a diverse and inclusive environment where clinical research can thrive and provide equitable benefits to people from all communities. In doing so, we place great value on continual diversification of the workforces including staff, researchers, and trainees. By further improving diversity, the outputs generated have the potential to achieve greater reach and impact to those currently underrepresented.

Through the implementation of this strategy, we envisage growth in the BRC and CRF EDI maturity. Therefore, it is key to understand the current landscape to enable measurable growth, development and areas potentially requiring more targeted intervention.

To do this, we will:

• Continue to systematically collect, analyse and review diversity data relating to our staff through an optional form with clear commitment as to how these data will be used to strengthen our workforce. We will also review which protected characteristics it is appropriate and proportionate to collect data for.

• Work in conjunction with the UoS and STH Human Resource Departments to utilise existing diversity data where possible. Where required, data sharing and governance procedures will be implemented to ensure and uphold confidentiality and General Data Protection Regulation (GDPR) practices.

• A data management plan will be developed, implemented, and shared with the BRC and CRF workforce. The collection of this sensitive data will be managed with the greatest respect and integrity. Confidentiality and GDPR principles will be strictly adhered to.

The BRC will:

• Utilise the workforce diversity data in conjunction with BRC output data. We will aim to evaluate whether the BRC support provided could be more equitable looking at data such as successful grant applications, clinical fellowships, lead authors on publications etc. in relation to staff characteristics. This may help to identify areas requiring targeted intervention to improve the equitability of the BRC support provided.

The CRF will:

• Publish results of the data collected on the CRF website, including findings, recommendations and progress.

Implementation of Methods

In the short-term, significant effort will be taken to gain a comprehensive understanding of the current landscape with respect to equality, diversity and inclusion within our workforce. Once these baseline statistics have been collected and analysed, we will endeavour to implement various strategies to build a more diverse workforce. It is important to note that the BRC and CRF teams will ensure continual optimisation of current methods and innovation of new methods to achieve this. Therefore, the list below is not an exhaustive list of strategic workstreams.

The BRC and CRF will:

• Establish EDI Champions: Each theme within the BRC will identify an EDI Champion who will be responsible for oversight of EDI within the theme workforce and EDI workstreams. They will meet with one another regularly to ensure synergy across themes and take learnings from one another. They will report to the BRC Executive committee on a regular basis, helping create accountability within each theme in addition to the BRC as a whole. The CRF will establish Equality Champions to support education around EDI at each CRF site.

• Wider dissemination of opportunities: Since BRC and CRF staff are recruited through the STH or UoS Human Resources processes, our influence on these standardised processes will be minimal. In addition to this, STH and UoS have organisational EDI strategies to which the recruitment processes adhere. We have identified that the initial dissemination phase of recruitment opportunities will be where we can have the most impact. Therefore, our focus will be widening the dissemination of job opportunities through creative methods to broaden their initial reach, by utilising our community relations for example. Analysis of collected diversity data will be used to create a workforce diversity baseline, which we can compare with that of the wider Trust to identify target areas for circulation of job opportunities.

• Continual synergy with partners: The BRC and CRF EDI strategy is strongly aligned with the NIHR, STH and UoS EDI strategies. As the respective partners execute EDI workstreams, we will ensure that the continual implementation of various workstreams are aligned. For example, the STH Reciprocal Mentoring Programme which enables people in senior positions (e.g., Directors/Matrons/Managers etc.) to learn from and understand issues from the perspective of people in less senior roles from under-represented groups. At the same time, people from under-represented groups are exposed to new ideas, experiences, and networking opportunities. We will seek to integrate our Equality Champions into relevant existing staff networks and provide staff with opportunities to take part in local EDI discussions as part of primary care and community groups.

• Training and development: We will encourage our workforce to participate in all training courses shared. This will support the transition of cultural maturity from cultural awareness to cultural competency and finally to cultural safety; and an understanding and practice which encompasses both the individual differences, and the systemic processes are supported. We will actively seek appropriate training and share learnings and examples of good practice to continually improve the knowledge and practice surrounding EDI within the BRC and CRF workforce and gather feedback from staff on their training needs in relation to EDI. We also want to ensure staff from diverse backgrounds are accessing opportunities. We will develop tools to capture staff participation in relevant leadership and management development programmes to establish a baseline. We can then use this baseline to set targets for access to leadership training for staff from diverse backgrounds (e.g., the reverse mentorship scheme, and career fairs for internationally educated staff).

We will strive to deliver an impactful and expanded network of effective research collaborations. By forging strong relationships with our partners (Sheffield infrastructures, NIHR, charitable funders, and industry) we will bring together technologies and research approaches to benefit our local, regional, and national communities, helping to raise research awareness across our health and technology themes.

We will champion EDI principles and develop EDI planning across all research activities, including but not limited to:

• Grant applications

• Study designs

• Showcasing impact cases via an array of platforms

• Participating in national and local networks related to EDI

•  Share best practice and incorporate into local EDI activity

• Gather evidence based on the work of the NIHR-INCLUDE project to:

  • • Gain understanding of local barriers to including underserved groups in research

    • Understand what actions we can take to overcome these barriers

    • Begin to develop the tools, training, and resources we need to deliver these actions

To ensure the BRC and CRF delivers an evidence-based strategy for implementation of EDI principles we will adopt an open and reflective approach. This will be iterative and will incorporate regular reviews of progress throughout our governance structure and partner organisations. This approach will enable our infrastructure to measure the progress and impact of our key EDI themes (Widening Participation, Research Capacity, and Improving Impact through Collaboration).

This EDI strategy will be published on the BRC and CRF websites along with other key resources and information about the EDI work taking place. This improves transparency with the community and will provide accessible methods for interested individuals to learn more and get in touch.

These key themes will allow the BRC and CRF to harness a vibrant, forward-thinking energy within our activities, and ensure that an inclusive and diverse environment is promoted and embraced.

We retain an acute awareness that the more we collaborate and instil positive EDI approaches the more effective our strategy will be. Key to advancing this will be the relationships across our partnership and raising awareness across our health and technology themes.

To devise our goals and action plan we have opted to measure our maturity level using the Veza Global maturity model. We feel this will provide a useful tool to measure our progress and reflectively stride forwards in our EDI journey. The diagram below demonstrates where the Sheffield BRC and CRF see our maturity levels currently. We place ourselves at Compliance level (our organisations are meeting legal requirements and has noticed a need to create a company culture) and are working towards Discovery (have identified and are seeking to address a gap in our diversity and inclusion practices). This is because this is our first EDI strategy where we will outline our plans to further understand the current company culture and identify how we can make improvements.

Our partners, UoS and STH, have already outlined their EDI strategies with SMART objectives, demonstrating they are further along the maturity pipeline. Working with these partners will help us to improve and ensure we are increasing our maturity level.

The National Institute for Health and Care Research (NIHR) published their ‘Best Research for Best Health: The Next Chapter (2021)’ outlining the national focus to improve the health and wealth of the nation through research. To effectively achieve this, it will be vital to ensure equality, diversity and inclusion are embedded throughout. To support the success of this the NIHR has launched an EDI strategy 2022-2027 which will collaboratively implement inclusive practice across research, culture and systems. You can access the full NIHR EDI strategy here.

Sheffield Teaching Hospitals NHS FT (STH) published its ‘EDI strategy 2021 - 2025’ to reflect the Trust's commitment to ensuring that services are fully accessible and that they meet the diverse needs of the people that STH serves. Key to delivering an impactful strategy, STH will work towards:

• Ensuring services are accessible to all service users and carers who require care and treatment.

• Identification of health inequalities in our services and have systems in place to tackle these in an open and transparent way.

•  Creating a culture where staff feel valued and recognised for their important and individual contributions.

• An inclusive and diverse workforce that is representative of the community with measurable improvement through effective recruitment, selection and promotion in order to positively attract, retain and support the progression of under-represented groups of staff at all levels.

• Demonstrating compassionate and inclusive leadership.

You can read the full STH NHS FT EDI strategy here.

The University of Sheffield (UoS) published its ‘One University - A vision for our future 2020 - 2025’ which champions key values to success via collaboration and embedding EDI throughout its pillars (Research, Innovation, Education, One University). As part of this, UoS are striving towards objectives, including:

• Increasing the diversity of the staff and student body, and identifying and tackling patterns of inequality, to ensure that all staff and students can achieve their full potential.

• Ensuring that we continue to consider EDI in the development of core policies, processes, procedures and guidance documents.

• Support the creation of an inclusive culture through the provision of appropriate and accessible training and development opportunities for all staff, aligned to their role and responsibilities, and provide training in cultural difference and inclusive behaviours for students.

• Geographically diversify our international activities, including student recruitment and partnerships.

• Facilitating the integration of international staff and students, both academically and socially.

• Giving all students the opportunity to develop skills that make them culturally agile, internationally employable and ready to play a part as global citizens, including expanding study abroad initiatives.

Consistent with NIHR’s Equality, Diversity and Inclusion Strategy 2022-27 and the Equality Act 2010, we aim to explore ways to collect improved diversity data from our participants and staff in a sensitive way and in line with NIHR guidance, Trust requirements and GDPR.

Following this, we plan to implement a diversity data form. We will aim to offer this to all BRC and CRF staff and trainees and implement this in all BRC and CRF funded or supported studies where possible. The data will help inform us on how inclusive the workforce and studies are in Sheffield currently, and where we need to implement targeted strategies for improvement.

We will develop the form in line with the NIHR Standard for Diversity Data (currently in development), which will cover data governance and when and how to ask diversity monitoring questions and our EDI colleagues.

Specific NIHR question guidance we will follow includes:

• Order of responses will be presented alphabetically.

• A ‘Prefer not to say’ option will always be provided as the final response option.

In the form we will clearly outline why we are collecting these data and how the data will be used, to foster increased trust and improve response rates. We will ensure ethical approval is in place for collecting these data in each study and that we have a safe, secure location to store the data once collected. We aim to collect data around socio-economic status and across the 9 protected characteristics outlined by the Equality Act 2010 which include:

• Age

• Disability

• Gender reassignment

• Race

• Religion or Belief

• Sex

• Sexual Orientation

• Marriage and Civil Partnership

• Pregnancy and maternity

We are also aware of the impacts of intersectionality, recognising that multiple social identities overlap to exacerbate the experience of inequities. We hope that by collecting these diversity data, we will be able to better understand our workforce and participants and promote increased diversity beyond the picture established at baseline.

Equality

Ensuring that everyone is given equal access to resources and opportunities to utilise their skills and talents. Taking a systems approach to what we do and how we do it and identifying and removing long standing, structural barriers to success.

Equity

Trying to understand and give people what they need to achieve their potential, promoting principles of fairness, justice, entitlements, and rights.

Diversity

Being reflective of the wider community. Having a diverse community, with people from a broad range of backgrounds represented in all areas and at all levels.

Inclusion

An approach where groups or individuals with different backgrounds are welcomed, culturally and socially accepted, and treated equally. Engaging with each person as an individual. A sense of belonging that is respectful of people for who they are.

Intersectionality

A framework that acknowledges that all people have unique experiences of discrimination and disadvantage exacerbated by the overlap of multiple social identities.

Protected characteristics

Identified in the Equality Act 2010, protected characteristics are a set of nine characteristics which have evidence to show there is still significant discrimination in these areas in employment, provision of goods and access to services.

Equality Act 2010

The Equality Act 2010 brings together a number of existing laws into one place so that it is easier to use. It sets out the personal characteristics that are protected by the law and the behaviours that are unlawful such as discrimination, harassment, or victimisation. Everyone in Britain is protected by the Act.

Equality Delivery System for the NHS

The EDS2 is a system that helps local NHS systems and organisations, in discussion with local partners and local populations, to review and improve their services for the local community and provide better working environments for people with characteristics protected by the Equality Act 2010.

NHS Workforce Race Equality Standard (WRES)

Comprises a set of nine metrics supporting Ethnic Minority staff in relation to recruitment, career development and training and addresses negative outcomes relating to disciplinary process and the disproportionate impact of harassment, bullying and victimisation.

NHS Workforce Disability Equality Standard (WDES)

Comprises a set of metrics that enables a comparison of the experiences of our disabled and non-disabled staff, with the aim of ensuring equitable and positive outcomes, reporting annually.

Previously, the BRC and its researchers have worked closely with ethnic minority groups to develop and deliver research projects.

A strong example of this is our ‘CognoSpeak’ project, led by Dr Dan Blackburn which has had high levels of involvement from the Israac Somali Community Association charity.

This has included employing community research champions to recruit from the community, co-developing recruitment videos and study documents and ultimately developing an enduring relationship with this traditionally under-served group.

The CRF has previous experience of working with diverse groups to enhance and improve facilities for patients.

In supporting the BRC, the CRF saw an increase in the number of research studies involving patients living with Dementia. It was important to the CRF that the facilities were suitable for use by this patient group. We worked closely with the South Yorkshire Dementia Advisory Group (SYDEM RAG), Sheffield Hospitals Charity Trust and colleagues across STH to create a reception area that was dementia-friendly. The SYDEM RAG membership included patients living with dementia and their carers. 

Creating a Dementia Friendly Reception in the NIHR Sheffield CRF

Through welcomed conversations we learned that the environment was important to patients living with dementia and that small changes can go a long way to reducing stress and confusion.  Also, that signage and comfortable seating made a difference to the experience of this patient group.

Work to ensure a contrast between walls, flooring and furniture was undertaken in reception and the patient toilet. In addition, signage was improved, seating was replaced, clocks and artwork were changed.

Work was completed in March 2020.  There are plans for SYDEM RAG feedback to be provided.

Acknowledgements and Thanks

The refurbishment scheme was supported by:

• South Yorkshire Dementia Research Advisory Group

• Alzheimer’s Society: Dementia-Friendly Business Guide

• Arts in Health

• STH Lead Dementia Practitioners

• Funded by Sheffield Hospitals Charity Trust