To see the full EDI Annual Report with images, please download the PDF version:

Equality, Diversity and Inclusion Annual Report 2023-2024 (3MB pdf)

Foreword by Lisa Ward, Director of People

It is my great pleasure to present the NWAS Equality, Diversity and Inclusion Annual Report for 2023/24.

Over the past year, we have continued to build on our solid EDI foundations in the trust – making recruitment more inclusive, supporting the growth and development of our staff networks, understanding our communities better and promoting a culture of speaking up for our staff.

We have remained committed to ensuring that EDI values and principles are embedded within our organisation, making it a great place to work and a great service for our patients. This report sets out how we have delivered on this commitment, and highlights key programmes of work which have been undertaken over the last year relating to the EDI agenda.

I am proud of the breadth of work we have delivered, particularly in new areas such as improving sexual safety particularly for female and LGBT+ colleagues, working with North West universities to improve representation of BME students on paramedicine courses, and hosting our first ever Iftar event in Ramadan. You can read more about these initiatives and others in this report.

Despite operational challenges which continue to persist, we have proactively sought to ensure that equality and inclusivity remains at the heart of everything we do in NWAS. This is evidenced by the EDI-related accolades we have achieved in 2023/24 including:

• Employers Network for Equality and Inclusion’s Gold Standard for Talent Inclusion and Diversity Evaluation, for the second consecutive year
• Race Equality Matters (REM) Bronze Trailblazer Status
• Revalidation of the Veteran Aware accreditation

I am very grateful to everyone who has supported our EDI ambitions this year. I recognise however that we are not yet where we aspire to be and know that we need to do more. As a trust, we will continue to build on our achievements in 2024/25, to make this an even better place to work and receive care.

Public Sector Equality Duty (PSED)

The Equality Act 2010 says public authorities (such as NHS organisations) must comply with the public sector equality duty. The duty aims to make sure public authorities think about things like discrimination and the needs of people who are disadvantaged or suffer inequality when decisions are made about how services are provided, and how policies are implemented.

As a public authority, under the general duty we must have due regard for, or think about the need to:

• eliminate unlawful discrimination
• advance equality of opportunity between people who share a protected characteristic and those who don’t
• foster or encourage good relations between people who share a protected characteristic and those who don’t

Having due regard means we must consciously consider the need to do the three things set out above.

There are also specific duties under the PSED which we have to comply with:

• publish equality information at least once a year to show how the public authority has complied with the PSED
• prepare and publish equality objectives at least every four years

This annual report meets the requirements relating to the specific duties as it sets out information highlighting how we have undertaken our work in line with the PSED.

The report also references our current three-year EDI objectives (which we refer to as Priorities) – these were agreed in 2021 and are being refreshed for 2024 – 2026.

Our NWAS

At the North West Ambulance Service (NWAS) NHS Trust our vision is to deliver the right care, at the right time, in the right place; every time.

We are the second largest ambulance trust in England serving more than seven million people across approximately 5,400 square miles in the communities of Cumbria, Lancashire, Greater Manchester, Merseyside, Cheshire, and Glossop in Derbyshire. This region is punctuated by several cities and towns; other parts of the footprint are sparsely populated and rural with significant distances to hospitals.

Around 7400 NWAS staff members work in over 300 different roles and are supported by over 1000 volunteers to deliver 999, NHS 111, patient transport and paramedic services.

The trust footprint is split into three main areas – Cheshire and Merseyside; Greater Manchester; Cumbria and Lancashire. Strategic capacity and support services are led centrally from the trust headquarters in Bolton.

The diversity in the region makes the North West a unique place to live, but also presents some challenges. In the North West, 32% of people live in the highest levels of deprivation and have significantly worse health outcomes, healthcare experiences and life expectancy than the general population. Through our work, we are committed to reducing health inequalities and improving access to services.

At NWAS, everyone is connected by a shared purpose; to help people when they need us most.

Our workforce

We regularly review and monitor our workforce numbers and demographics as we continue to make efforts to develop a workforce representative of the communities we serve. This section of the report provides an overview of the diversity within our workforce, and is based on data extracted from the NHS Employee Staff Record system as at 31 March 2024.

NWAS headcount

At the end of March 2024, our total workforce headcount was 7415 – a significant increase from 7074 staff in March 2023.

Age

The largest age cohort in our workforce currently is the 25-34 age-range with 26.1% of staff in this category. This is followed by 24.1% of staff in the 45-54 age-group.

Disability

The number of staff declaring a having a disability/long-term condition has consistently been increasing year on year. 7.8% of staff have declared they have a disability (6.5%, 2023).

Similarly, the proportion of staff who have not declared their disability has reduced from 7.7% in 2023, to 5.9% in 2024 – equating to 437 staff members.

Ethnicity

Representation of Black and Minority Ethnic (BME) staff in the workforce has seen an increase to 6.0%, from 5.1% in 2023.

Declaration for ethnicity is 99%, which means only 1% of staff have not disclosed their ethnicity.

Sexual orientation

The number of staff who identified themselves within the broad category of LGBT+ has increased from the previous year.

The gay and lesbian staff count has increased from 5.2% in 2023 to 5.7% in March 2024. The number of bisexual staff has also increased from 1.5% to 1.8% over the year.

Around 10% of staff have not declared their sexual orientation, however this is a significant improvement from 20% not declaring in 2017.

Gender

Representation of female staff in the workforce has increased to over 4000 / 54.9% (53.7%, 2023). Over 70% of staff in our contact centres are female, as are just over half of all staff in our Patient Transport Service.

In Paramedic Emergency Services, the gender split is nearly even with slightly more males, as is the case in corporate services too.

Note about other genders: at present, NHS workforce systems only record genders as ‘male’ and ‘female’. While the trust does have staff who identify as non-binary/other genders, there are no accurate numbers which are currently collated in this regard. However, findings from the 2023 National Staff Survey showed that around 0.6% of respondents identified as non-binary/prefer to self-describe.

How we made an impact in 2023/24

Over the last year, we have delivered a number of impactful pieces of work related to the EDI agenda – aimed at making a difference to staff and patients, while also picking up some prestigious accolades too!

Reasonable adjustments

At NWAS, we’re dedicated to creating inclusive work environments that help all staff realise their greatest potential. Nevertheless, the results of the NHS staff survey for 2022 revealed that 4 out of 10 NWAS staff with a permanent medical condition or disability did not have any suitable adjustments in place to allow them to perform their jobs. We launched a project to create a guide for managers and employees as a solution to this, and it ultimately developed into a “Procedure for Requesting and Managing Reasonable Adjustments.”

This landmark document was produced with the input of a range of internal stakeholders including operational and corporate staff, Disability Network and trade union representatives. As well as setting out clear processes around reasonable adjustments, this work also introduced an application form to further support and simplify the reasonable adjustments journey for both staff and management.

The procedure was fully signed off in December 2023 and was launched with trust-wide promotion in the New Year.

Hidden Disabilities Sunflower Scheme

We are proud to have joined the Hidden Disabilities Sunflower scheme during National Hidden Disabilities Week in 2023. The Sunflower Scheme aims to raise awareness of and assist individuals with hidden disabilities which are not immediately apparent to others. In addition to promoting the Sunflower lanyard and wristbands, we also rolled out an e-learning package for staff to increase their understanding of hidden disabilities and the scheme.

Equality Impact Assessments (EIAs)

A review of Equality Impact Assessments was undertaken this year in order to improve the way in which we assess the potential impacts of proposals, projects and policies on staff, service users or both. Following this review, the existing EIA pro-forma was refreshed with an additional Stage 1 Screening Tool being introduced to streamline the process.

To help staff familiarise themselves with the new process after the launch, the ED&I Team designed and delivered a training package to teams across the trust, and remains a point of contact for queries and support.

Since the rollout of the refreshed EIA process, the feedback has been extremely positive, and there has been a considerable increase in the number of EIAs being undertaken across all Directorates within the trust.

Religion, Belief and Culture Guide

In the last year, we relaunched the Religion, Belief and Culture Guide (formerly Faith and Culture Guide), with the input of the Religion, Belief and Culture Forum membership.

The work on the refresh the guide was led by our End of Life and Palliative Care Lead, Keiran Potts and allows quick access to information relating to customs and processes in difference communities across our geographic footprint.

The guide is intended to be used by front-line staff to help provide a culturally aware and competent service to our diverse communities.

Improving sexual safety in the workplace

Around 8% of respondents in the 2023 Staff Survey said they experienced unwanted behaviour of a sexual nature from colleagues. For those in PES, female or LGBT+, the figure was more than 1 in 10.

To improve sexual safety in the workplace, we launched a brand-new campaign in 2023/24 – Stop. Speak. Support.- along with our statement setting out the expectations around sexual safety and sexual harm.

We are committed to reviewing our approach to handling complaints related to sexual safety and the way we support those involved – this work is being undertaken by a dedicated working group.

We are working hard to change the acceptance of inappropriate behaviour, and encouraging everyone to challenge this behaviour when they see it.

Race Equality Matters Bronze Trailblazer Status

In recognition of our work to address racial inequality within NWAS, we were awarded the Race Equality Matters (REM) Bronze Trailblazer Status and recognised as a Solutions Trailblazer for the #MyNameIs campaign. The Trailblazer series spotlights forward-thinking organisations that are implementing impactful solutions to drive race equality. Organisations apply to be Trailblazers and their applications are assessed by an independent judging panel.

LGBT+ Pride-wrapped ambulances

We added three new LGBT+ Pride-wrapped operational ambulances to the fleet in summer 2023. The first of these arrived at Blackpool station with the other two vehicles operating in Merseyside and Manchester respectively. As well as being emergency vehicles, these vehicles are also symbols of inclusion and are also used at Pride events across the North West.

ENEI Gold TIDE Award

For the second consecutive year, we were pleased to have achieved the Employers Network for Equality and Inclusion’s (enei) Gold Standard for Talent Inclusion and Diversity Evaluation (TIDE). This was an incredible achievement for the trust, as we were one of only 15 Gold Standard winners out of 171 global entries, from across 26 different sectors.

Our overall score was 95%, and this placed us as the 2nd highest ranked organisation out of all entries globally.

TIDE is a benchmarking tool which enei have developed to assess organisational performance and progress in relation to diversity and inclusion. It measures organisations against eight different areas of diversity and inclusion practice.

EDI priorities 2021 – 2024

Over the last year, we have continued to deliver on our 2021 – 2024 EDI priorities. This section of the report sets out the work which has been undertaken in order to make a positive impact.

Priority 1: We will ensure our current employees and future talent have fair opportunities and access to jobs and career progression, resulting in improved representation of diverse groups at all levels of the organisation, including Board.

This priority is focused around improving the diversity of our overall workforce, while also ensuring that our leadership and management staff cohorts are representative of our communities.

In the last year, a number of pieces of work have been delivered to help improve our recruitment processes, and to ensure they are as inclusive as possible. Our engagement and outreach work into communities across the North West has also grown over the last year, reaching new areas, groups and individuals. 

We are proud to continue to be a Disability Confident Leader Employer and in December 2023, we also achieved revalidation of the Veteran Aware accreditation – recognition of being exemplars of the best care for, and support to, the Armed Forces Community. Logos representing our commitments to inclusive recruitment and being an inclusive employer have continued to be prominently listed on our job adverts and the careers page on the NWAS website.

Operating in a way which supports inclusivity in recruitment is a trust-wide responsibility which requires conscious efforts from individuals and teams across the organisation. In this section we highlight the work of some of these key internal stakeholders such as the HR Hub, positive action and widening access functions.

Inclusive recruitment audit

We commissioned our ED&I partner, enei, to undertake an inclusive recruitment audit in early 2023, which was concluded in the summer. The purpose of the audit was to comprehensively review the trust’s recruitment approach, making recommendations for sustainable and positive change. The audit was commissioned following recognition of the challenges faced in improving our workforce representation. 

The main driver behind the audit was a recognition that our recruitment approaches and processes needed to change in order to attract and retain a diverse workforce.

Since the conclusion of the audit, there has been a period of review and reflection on both the content and the recommendations in the feedback report.

The audit recognised that there is a demonstrable commitment across the organisation for creating a workplace that people want to join, and for NWAS to become an employer of choice.

However, a number of areas for improvement were highlighted which have been summarised into the following key themes, and are being delivered on through various internal programmes of work:

HR Hub

The HR Hub has continued to support inclusive recruitment and selection methods across the trust, and remains a key source of guidance for managers, staff and applicants around equality and inclusion issues relating to the recruitment. The HR Hub team manager is a key member of the trust’s Inclusive Recruitment Group which was established this year following the ENEI audit.

Over the last year, the Hub has led improvements on the Recruitment and Selection Masterclass, with the input of staff side representatives, Race Equality and Disability Networks and past attendees, as well as facilitating a refresh of interview questions. Work has also been undertaken to increase the diversity on assessment and interview panels, but there is a recognition that there is still more to be done in this area.

Outreach and engagement

A core component of our recruitment strategy is to promote the organisation as an ‘employer of choice’ to groups and communities who traditionally may not have perceived the ambulance service to be a viable career choice. To highlight the organisation as an inclusive employer, the Positive Action and Widening Access teams in 2023/24 have continued to proactively engage with a range of diverse communities, reaching out to diverse ethnic groups, young people, and individuals from low socio-economic backgrounds. Guidance is provided to people who need additional support to apply for jobs in the trust.

In the last year, both teams have attended and organised a variety of engagement and support events across the trust footprint to promote NWAS and provided information, advice and guidance on the range of roles available – including operational, corporate and apprenticeship opportunities. The Widening Access Team with the support of NWAS ambassadors (colleagues who volunteer to help promote the trust) was represented at nearly 200 events this year, reaching close to 80,000 individuals. The Positive Action Team supported over 40 external face-to-face events including careers fairs and events organised by community and faith hubs, reaching over 15,000 people.

Positive action

The positive action work has focused in spotlight areas in the North West, identified through data extrapolated from the 2021 Census. These are primarily areas with high rates of representation from ethnic minority communities such as Lancashire (Preston, Blackburn and Burnley areas), Greater Manchester, and Merseyside. Since we started delivering positive action initiatives in NWAS, we have engaged with over 300 community organisations across the North West footprint, with 50 of these relationships being formed in the last year to promote the opportunities in the trust.

With the support of community partners, the Positive Action Team organised 16 bespoke engagement sessions this year for local communities, attracting over 400 individuals from diverse backgrounds. The events included input from the NWAS Community Resuscitation Engagement Team and NWAS ambassadors and we held both in-person and virtually (via MS Teams). They provided valuable insights into roles within the trust, guidance on how to apply, and included basic life-saving skills delivered by the Community Resuscitation Engagement Team.

Partnership working

The Positive Action and Widening Access Teams have both worked with a range of organisations to engage communities and individuals across the North West. In 2023/24, these organisations include:

• Department for Work and Pensions (Job Centres)
• Liverpool City Region Combined Authority
• Other NHS organisations
• Sahara in Preston
• One Manchester
• Kensington Community Centre
• Wirral Deen Multicultural Centre
• Rochdale Borough Council

Online support

Collectively, the Widening Access and Positive Action Teams have arranged and delivered around 40 online support sessions this year via MS Teams and the NWAS website live chat function.

The purpose of these sessions has been to provide initial information, advice and guidance to individuals interested in applying for roles in the organisation. Those who expressed a desire for further support, were contacted directly after the sessions to follow-up and discuss the level of support required.

One to one support

Through positive action and widening access initiatives, prospective applicants benefit from tailored one to one support to guide them through the recruitment process. They are coached through the application stage, and if shortlisted for interview, they can also access bespoke interview preparation support.

In 2023/24, over 70 prospective external applicants were provided with 1:1 support and coaching at the pre-application stage by the Positive Action Team. 50* of these individuals subsequently applied for roles with nine applicants being successful at the interview stage.

The Widening Access Team provided support to more than 60 external applicants, of which 16% identified as BME. The team also supported over 30 internal staff members who were seeking to progress in NWAS – around 10% were from ethnic minority backgrounds. 

Applicant tracking

In order to better understand the recruitment stages at which BME applicants do not progress, we have continued to deliver our tracking initiative through which we monitor the recruitment journey of applicants from ethnic minority backgrounds. Those applicants who are unsuccessful at either shortlisting or interview /assessment stages are contacted with an offer of additional support to help with future applications for the same or different roles in the trust.

This year, over 15 individuals have accessed coaching and support for applications as a result of the tracking interventions, while many more were contacted.

From next year we will we embedding applicant tracking in to all large-scale recruitment campaigns, not just EMT recruitment as has been the case to date.

Careers with Heart

To support the challenging recruitment plan this year, a brand new trust-wide recruitment campaign, ‘Careers with Heart’ was launched in early 2024. The campaign highlighted the range of roles within the trust, with images showcasing the diversity of our workforce on billboards, buses and in train stations. This was the first campaign of this nature and was aimed at attracting a broad and diverse mix of applicants to support filling vacancies during Q4 of 23/24 and during 24/25.

Recruitment of former Armed Forces personnel

Through our partnership with NHS Employers Step Into Health, we have continued to support veterans and service leavers into employment with NWAS. We attended four Armed Forces careers events last year, engaging with over 1000 service leavers and veterans and in June 2023, we organised our own Armed Forces Careers Insight Day at trust HQ in Bolton. This was supported by the Armed Forces Network and teams across the trust to highlight both patient-facing opportunities and support roles.

Over 300 individuals with an Armed Forces background applied for roles in the trust last year, with more than 50 either having received a conditional offer or started in post by the end of March 2024. Over 40 prospective applicants from the Armed Forces community were provided with information, advice and guidance regarding roles within the trust.

Engagement with higher education institutes

Our biggest workforce group in the trust is the paramedic cohort. To become a paramedic, an individual can join the trust as Emergency Medical Technician (EMT) and then progress to undertaking a paramedic degree apprenticeship. Alternatively, college leavers or those wanting a career change can apply to enrol onto the paramedic sciences course at a university provider.

However, university data and our own workforce data shows that there is a significant and disproportionate underrepresentation of BME communities on paramedic science courses.

To address this, over the last year we have been working collaboratively with partners from the five higher education institutes/universities in the North West from which we host students for placement.

This programme of work has been facilitated by a steering group comprising of representatives from all the partners, and workstreams were established to identify and deliver interventions which will help achieve the programme’s objectives. The workstreams have been exploring ways in which the paramedic science degree courses can be made more ‘attractive’ to ethnic minority communities, and importantly how the ‘applicant to student’ journey can be improved to ensure ethnic minority applicants are not at a disadvantage.

The programme is aiming to make an impact for university applications being made in 2024 for the academic year starting in 2025.

Priority 2: We will educate and develop our leaders and staff to improve understanding of racism, discrimination and cultural competence to deliver a step change in the experience of our staff and patients.

This priority seeks to develop the trust’s approach to racism, discrimination, and cultural competence with an overarching aim to deliver a change in the experience of both our staff and patients.

The Learning and Organisational Development (L&OD) Team has continued to support the roll-out of EDI-focused training and development programmes for staff. The team has also been working with the Disability and Race Equality Networks to explore how the trust can support increased access to learning opportunities, particularly for staff with disabilities and those from ethnic minority backgrounds.

Beyond Bias

Since October 2022, Deep Insight (an external training provider), has been delivering ‘Beyond Bias’ as part of the NWAS Making a Difference leadership programme. This module examines how bias, discrimination, and prejudice affect the workplace, was a significant accomplishment.

Nearly 600 leaders and managers completed the training by the end of March 2024, with the overwhelming majority providing exceptional feedback on the how the module challenged them to think differently. Around 800 individuals in total are expected to have participated in the module by the time it concludes in May 2024.

An updated training module developed internally with the input of staff networks will launch in mid-2024, titled Leading with Inclusivity, building on the solid foundations of Beyond Bias. The new iteration focuses on the lived experiences of range of workforce groups by using a facilitative approach.

Board Development

The Board continued to show commitment to EDI agendas through participation in development sessions and engagement with staff networks (executive directors operate as network sponsors). At the most recent ED&I development session in January 2024, the Board received an overview of ED&I work undertaken in the trust over the past year, considered the impacts of what had been achieved and outcomes, and explored the journey of becoming an anti-racist organisation.

The Board remains committed to supporting an inclusive organisational culture with a culturally competent workforce, operating with civility, respect and compassion.

Reverse mentoring

In April 2023, we launched our first reverse mentoring programme – led by Collaborate Out Loud (an external partner) with the support of the Race Equality Network, EDI and L&OD Teams.

In addition to BME staff, colleagues who were part of the Disability, LGBT+ and Women’s Networks were invited to join the programme as reverse mentors.  The programme ensured appropriate support and guidance was provided to mentors and mentees, to enable valuable and meaningful engagement.

10 senior leaders were matched with 10 frontline staff members. Both groups took part in half day workshops to understand their roles and meet informally with their partner over lunch.

Each pair was asked to meet six times over an eight-month period to work together on a topic that the senior leader brought to the table. This could be anything that they wanted to understand, and the reverse mentor through their ‘lived experience’ was able to provide their perspective, ask questions and challenge.

The programme evaluation shows that the initiative increased staff connections, improved cultural awareness of senior leaders, and created a pipeline for both large and small EDI improvement actions. The feedback suggests that despite the need for full equity, EDI is becoming more widely recognised and valued within the organisation. This indicates that recent efforts to combat racism and encourage allyship are beginning to take hold at senior levels.

The programme has been described as ‘empowering’ and ‘enlightening’, with new relationships formed which are likely to last. A second cohort of the programme will be launched in summer 2024.

Reflections from reverse mentees:

• “Racism does exist, and we need spaces like this to understand it in order to change it.”
• “It has felt like a privilege to be a reverse mentor. It felt like we had good rapport. It helped me to build my network further and has put me in a position I would never normally have been in.”

Reflections from a reverse mentor:

• “It’s been good to protect the time and concentrate on this for the meetings. I want to continue to meet after the official programme ends.”

Priority 3: We will improve our use of patient data and patient experience to drive improvements in access and health inequalities, for patients from diverse communities.

This priority reflects the need to enhance our use of data to inform and influence improvement of services for all.

The Sustainability Strategy 2023-2026 sets out our commitment to work as an effective system partner to improve population health across the North West.

To achieve this, alongside improving the input, analysis and utilisation of NWAS data to reduce health inequalities, we have also worked on improving staff capability and capacity, and on developing interventions to support prevention and provide holistic care.

Ethnicity data and Electronic Patient Records

The Clinical Audit Team has been working over the last year to find solutions to improving the ethnicity data collation of patients in the EPR system.

There is a national drive exploring the possibility of accessing this data via the NHS Spine, and this will be closely monitored in 2024/25.

Undiagnosed hypertension

Over the past year we have been working with primary care partners to support identification and management of undiagnosed high blood pressure (hypertension).

We have been exploring if sharing blood pressure readings from patients not conveyed to hospital can identify patients with previously unknown hypertension. We have run two initial pilots in previous years, and are now assessing how we can replicate the process across NWAS coverage.

Social prescribing

A new single pathway for social prescribing referrals was developed this year and piloted in Wigan. We mapped existing social prescribing services in this area, and provided functionality for crews on the road to search and identify appropriate services in the locality. They could then select the service and, with consent from the patient, make direct referral.

In the period November-December 2023, around 40 referrals had been made in Wigan area.

Community and patient engagement

In line with our Patient Engagement Implementation Plan and annual priority mapping exercise, we have continued to actively engage with communities and service users across the North West. Our engagement has been focused on understanding the experience of our diverse communities in accessing our services, as well as considering the impact of health inequalities on various patient groups.

In the last year, we attended community events such as:

• Oldham Volunteers Fair
• Winter Well-being event, Preston
• Preston Asian Cultural Mela
• Diverse City North Manchester
• Burnley East PCN Health and Wellbeing Mela
• Disability Awareness Day, Warrington
• Windrush
• Multicultural Culture Bazaar, Cumbria
• Pride events in Cheshire, Cumbria and Liverpool.

Our engagement data shows that in 2023/24, we heard from significant numbers of younger people, ethnic minority communities and people with disabilities.

Patient and Public Panel

This year has seen the continued growth and development of the PPP, now at 329 members.  2023/24 was the best year to-date for increasing the diversity of the Panel’s membership, rising from 16% to 24% for cultural representation, 31% for youth representation and 20% for representation of patients with disabilities.

Staff networks

Our five staff networks have continued to make a positive impact in the organisation – providing a space for their members to share experiences, while also contributing to key programmes of work. This section showcases the highlights of our staff networks in 2023/24.

Armed Forces Network

The Armed Forces Network maintained its strong form for the second year as a member led network, continuing the rhythm of an event per quarter, as well as advocating for the Armed Forces community across the trust’s footprint.

The first event in our calendar was a network birthday celebration at Bolton Stadium Hotel, where the network was joined by charities representing support for veterans across the North West. Following that, in June 2023, the network took the Reserves Day roadshow to Estuary Point with a successful show-and-tell, raising the profile and awareness of reservists to NWAS colleagues.

During the summer months we marked the anniversary of the Battle of the Atlantic as well as supporting the NWAS/service leavers career roadshow at Ladybridge Hall. Remembrance, the cornerstone of our calendar, was marked by NWAS colleagues in over 30 locations as well as collecting donations in support of the Royal British Legion Poppy Appeal.

The year ahead contains a similar cadence, and the aim to not rest on our laurels, we will look to expand and improve on the events organised. We are looking forward to supporting Reserves Day with an expanded programme of events, as well as progress subjects close to our hearts such as supporting veterans in need in the community and consider ways we can increase our presence within the trust.

Disability Network

The NWAS Disability Network continues to thrive and marked its second anniversary in December 2023 which coincided with Disability History Month.

During this month, the network worked with the Communications Team to share a number of short films featuring members talking about their disability and working at NWAS. The aim of this was to increase visibility of the network and encourage more open conversations about managing disability in the workplace, as well as raise awareness of the prejudices people with disabilities face and what needs to change.

In 2023/24 the network transitioned to hold more face-to-face meetings and events, while continuing with the option to join online for those unable to travel. This hybrid approach to meetings and events has helped maintained engagement by existing members and make it easily accessible for all staff.

The network is pleased to have increased its visibility across more areas of the trust this year, and provided a number of opportunities for all NWAS staff to better understand the experiences of those with disabilities and long-term health conditions. This was undertaken through the reasonable adjustment forums, and also by contributing the development of the Procedure for Requesting and Managing Reasonable Adjustments.

The network also supported the introduction of the Sunflower Scheme at NWAS. The launch event was attended by co-chairs of the network along with the Chair of the Board, Peter White and Network Executive Sponsor, Carolyn Wood.

Members of the network have been invited to participate in interview panels, Trust Strategy ED&I Reference Group, Policy Group, and attend careers events with the Positive Action Team. Representatives of the Disability Network have also worked with the National Ambulance Disability Network.

LGBT+ Network

The LGBT+ Network has continued to grow and thrive during the year. We adopted a hybrid meeting model this year in which allowed for face-to-face meetings rotating across sites, but also facilitated members to participate via Microsoft Teams. This has led to continued increased participation in network meetings.

During LGBT+ History Month in February 2024, we worked with the Communications Team to promote the ‘lived experience’ and real-life stories of several senior NWAS leaders identifying as LGBT+. Network Chair Adam Williams prepared a story about his experiences and on his LGBT+ hero Paul O’Grady, and produced a blog in June too on “what pride month means to me”. We also ran a lived experience story of Sophie Rice for Lesbian Visibility Day.

Supporting Pride events has been a hallmark of network activity with members representing the trust and network at Blackpool, Liverpool, Manchester and other local events.

We supported the fifth National Ambulance LGBT+ Conference, which was held at Manchester Metropolitan University on 15 and 16 June 2023. This was the first two-day event and combined a traditional conference format with a more informal learning day. The title of the 2023 conference was Intersectionality+, and considered how best the ambulance service can meet the needs of people with multiple protected characteristics, as well demystifying the LGBTTQQIAAP acronym.

Race Equality Network

The Race Equality Network continued to focus on supporting staff, improving the culture within the organisation and highlighting health inequalities. This was done through a number of key events, roadshows and work programmes.

The network played a key role in the facilitation of HART taster days for women and BME staff. This helped to promote HART to underrepresented groups at a time when they were actively trying to diversify their workforce. This action had the desired effect with an increase in applications from each group.

We have explored new ways of engagement, including through podcasts, touring sites across our trust footprint and supporting positive action activities – with network Chair Wes Proverbs making his radio debut to promote a positive action careers event in Liverpool in 2023.

We have been fortunate to have the support of the Strategy and Transformation Team to help focus on making an impact through effective work planning.

During Black History Month, we collaborated with the Women’s Network to host a landmark event – spotlighting health inequalities faced by BME women in maternity care. External experts and colleagues from across the trust came together to raise awareness and consider better practices that can improve outcomes for this group. The event received lots of positive feedback and showed how effective collaborative working amongst networks can be.

The REN also played a key role in securing the Race Equality Matters Bronze Trailblazer Status.

Women’s Network

The Women’s Network has grown considerably in membership and scope within the last year, across the workforce within NWAS. In October 2023, we celebrated our first birthday as a formal network.

Our campaign for 2023/24 focused on Fertility, Maternity, Paternity and Parenting (FMPP). We embarked on hosting many roundtables focusing on the campaign – with the participation of parents-to-be, grandparents and parents to celebrate the successes and discuss struggles of parenting. We are looking to keep some of these roundtable events as permanent fixtures to the Network calendar.

The network has been heavily involved in a project to scope out emergency sanitary products for all staff across the trust. The project is currently at the pilot and testing phase, which will then move into a scale-up. We have also been involved in the Sexual Safety Charter which has recently been published by NWAS.

The network has collaborated throughout the year. The Miscarriage Association hosted an online session for staff which was highly educational and emotive, offering support where necessary. To mark Black History Month, the network collaborated with the Race Equality Network (REN) to host an in-person event in Brockholes.

The network has worked on improving policies such as the breastfeeding at work guidance alongside working with HR and the Wellbeing Team on improving the guidance and information relating to abortion, fertility, adoption, baby loss. The Green Room has now been developed with information where staff can go for support/signposting.

Our biggest event was International Women’s Day 2024, held in-person on 8 March 2024 in Manchester. A major challenge has been engaging and reaching PES and contact centre staff, so we were delighted that the theme this year of ‘Inspire Inclusion’ enticed more PES and contact centre staff to join the event.

We had the CEO of the College of Paramedics, Tracey Nicholls as our keynote speaker and ran two panels supported both by the EDI advisor and employee engagement manager.

We look forward to the 2024/25 and seeing what we can achieve as a network. We have lots more planned and looking forward to finding opportunities to improve the lives of staff across the trust.

Religion, Belief and Culture Forum

The Religion, Belief and Culture Forum continued to provide a ‘safe space’ to discuss important and pertinent topics related to these important areas on a quarterly basis. The forum supports our trust priority to improve the cultural competency of our workforce through developing an understanding of our communities

Each session had a specific theme and faith spotlight:

Commemorating Ramadan

Celebrating the diversity of communities and cultures represented in our trust is one of the ways in which we become a truly inclusive organisation. In this spirit, we hosted our first Iftar event during the Islamic month of Ramadan (March 2024), bringing together colleagues from across the organisations. ‘Iftar’ refers to breaking the fast.

Around 100 attendees including staff members from across the trust, student paramedics, volunteers, managers and senior leaders including Board members, as well as representatives from community organisations met at the Bolton Excellency to network, learn from each other and enjoy a delicious dinner.

We also published guidance at the start of the month for staff and managers relating to impact of Ramadan on the workforce, and steps they can take to support their positive wellbeing during the fasting period.

Guidance was also produced for frontline staff in relation to clinical interventions which may or may not invalidate a person’s fast, while they receive care from us.

Chaplaincy

The Chaplain for Staff Wellbeing, Reverend Karen Jobson started in post in September 2023 to work across NWAS to provide confidential listening and support in times of change, challenge, and distress. The role also provides the opportunity to explore issues of faith and spirituality and how they impact both personally and in the workplace.

For many in our workforce, faith and/or spirituality are an important part of their identity – informing values, a sense of purpose, their overall wellbeing and support resilience. When challenges arise, faith or spirituality can be a protective factor in helping our staff to cope.

By offering pastoral care to people of all faiths and none, the chaplain encourages and recognises the importance of faith in the workplace. The chaplain is working to develop cultural competency amongst all our staff to encourage everyone to understand the importance of belief to their colleagues and their patients.

In 2024/25, Karen will be developing a diverse team of volunteer chaplains to increase the spiritual and pastoral care offer throughout the trust. The chaplain will also be exploring ways to further enhance cultural competency through mediums that are accessible to staff in the many different contexts in which they work. The Religion, Belief and Forum will continue to play a role for this purpose alongside more targeted training and awareness raising.

Policy development

All new and existing policies, procedures and guidance are developed in partnership with the membership of Policy Group which comprises of trade union representatives, managers and Staff Networks. Where required, additional consultation on policies and procedures is undertaken with any staff group which may be impacted by the proposals.

All policies and procedures (new or revised) are equality impact assessed, with the trust supporting continuous improvement for best practice, which is also a pre-requisite for any policy to be signed-off by the Executive Leadership Committee. The trust remains committed to support the development of best practice and learning from others in this regard.

Since April 2023, the following key EDI related policies, procedures and guidance have been approved with an EIA completed:

• Breastfeeding at Work Guidance
• Policy on Supporting Neurodiverse Employees
• Procedure for Requesting and Managing Reasonable Adjustments
• Procedure for Managing Disability in Employment

Workforce equalities monitoring reporting

This section provides an overview of the key regulatory and statutory reporting requirements on the trust which include:

• Equality Delivery System (EDS)  
• Workforce Disability Equality Standard   
• Workforce Race Equality Standard        
• Gender Pay Gap

EDS

The Equality Delivery System (EDS) is a system that helps NHS organisations improve the services they provide for their local communities and provide better working environments, free of discrimination, for those who work in the NHS, while meeting the requirements of the Equality Act 2010. 

The refreshed EDS framework which we used for the first time this year, comprises of eleven outcomes spread across three Domains.

Domain 1: Commissioned or provided services

Domain 2: Workforce health and well-being

Domain 3: Inclusive leadership

Domains 2 and 3 were assessed by a diverse internal stakeholder panel in December 2023, and Domain 1 assessed by panel of external stakeholders including PPP members in February 2024.

Across the three domains, we received an overall score of 20 which is at the high end of the ‘developing’ rating. While not directly comparable, this rating is not inconsistent with the overall position of the previous year’s EDS assessment. It does however indicate the fact that more can be done to understand the differential impact on protected characteristic groups, both in the workforce and in the communities we serve.

View the full evidence pack here.

Workforce Disability (WDES) and Race Equality (WRES) Standards

Key headlines from the WDES and WRES data submitted to NHS England in May 2023 are presented below. The full data sets and reports for each of the Standards was published on the NWAS website, along with an action plan.

WDES Indicator 3 (Likelihood of entering the formal performance process): Data in 2023 showed that disabled staff were nearly one-and-a-half times more likely to enter the performance process compared to non-disabled staff.

However, the overall number of staff in the formal performance remains low, and the actual number of disabled staff in the performance process is lower still. Therefore, work is underway to understand the disproportionality.

WDES Indicator 4, part 1 (% of staff experiencing harassment, bullying or abuse from patients/service users, their relatives or other members of the public in the last 12 months): A much greater percentage of disabled colleagues reported these experiences (47.2% compared to 34.1% non-disabled), and this represents the biggest difference in experience between disabled and non-disabled staff since 2018.

WDES Indicator 7 (feeling valued): The percentage of staff who were satisfied with the extent to which the organisation values their work was 76.1%, which is an increase from the year before (72.5%). This was significantly higher than the experience of non-disabled staff (66.4%).

WRES Indicator 2 (relative likelihood of appointment from shortlisting): White applicants were one-and-a-quarter times more likely to be appointed compared to BME applicants. This metric has however improved compared to the previous year and was at the lowest disparity rate since 2020.

WRES Indicator 7 (% of staff believing that trust provides equal opportunities for career progression or promotion): There was an increase for both BME staff (36.8%) and white staff (50.4%) on this indicator, however there was still a stark difference between the perceptions of both workforce groups.

WRES Indicator 9 (% difference in board voting membership and overall workforce): The 9.1% BME representation on the trust Board was almost double compared to the BME representation within the workforce

Overall, both the WDES and WRES data sets presented a mixed picture with some positives and negatives. However, there were still clear areas of differential experience between staff with these protected characteristics, and those without.

Gender Pay Gap

Our Gender Pay Gap data for the period of 1 April 2022 – 31 March 2023 was submitted in December 2023, in line with national guidance.

The data showed that for the first time, over 50% of the upper middle quartile comprised of representation from female staff and this is expected to grow, as there is now greater (and growing) female representation in the trust compared to male staff.

However, the hourly mean (average) pay gap was 10.6% between male and female employees. The hourly median rate of pay reveals 10.5% difference in pay. Both are greater than the previous year (9.8% and 8.7% respectively).

Our Gender Pay Gap action plan focuses on recruitment, career progression and flexible working to enable progression of women within the organisation into the higher pay quartiles.

The trust applies the national NHS terms and conditions of service and uses the national job evaluation system to determine job bandings.  These systems have been equality impact assessed and are jointly reviewed by trade unions and managers in partnership at a national level.  The trust believes these systems provide a non-discriminatory set of conditions which meet the requirements of equal pay for work of equal value.  We remain committed to working to close the gender pay gap through improvements in representation in the upper quartiles of pay.

Looking ahead to 2024/25

Going forward into 202/425, we are excited to continue building on the progress that we have already made. There are a number of focus areas which we will be prioritising for delivery over the coming year.

We will…

• Review and refresh organisational EDI priorities
• Develop a route-map for becoming an anti-racist organisation
• Implement recommendations from the Inclusive Recruitment Audit – improving representation across the workforce at all levels
• Develop leaders as allies to support to the EDI agendas – promoting active bystanders, allyship and reverse mentoring
• Use demographic data to improve learning from patient feedback, complaints and incidents
• Fully embed and further enhance the sexual safety campaign – Stop. Speak. Support

Produced by the: Equality, Diversity and Inclusion Team

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