1. Addressing ethnic inequalities in health service access, experience and outcomes through the critical mobilisation and application of evidence This project was funded by the National Institute for Health Research Service Delivery and Organisation (NIHR SDO) programme (project number 09/1002/14). Visit the SDO programme website http://www.sdo.nihr.ac.uk/projdetails.php?ref=09-1002-14 for more information. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the SDO programme, NIHR, NHS or the Department of Health.http://www.sdo.nihr.ac.uk/projdetails.php?ref=09-1002-14

2. Project Background & Purpose Need to address ethnic inequalities in health outcomes, healthcare access and experiences highlighted in many NHS & government policies. –Ethnic differentials in access to smoking cessation services, cancer screening, cardiac rehabilitation, coronary angiography –Poorer intermediate outcomes for minority ethnic patients with diabetes –National patient surveys show lower levels of satisfaction for black and minority ethnic patients

3. Project Background & Purpose How can commissioning be a lever towards reduced ethnic inequalities? What role can (research) evidence play? How can this be supported? Aiming for: Nationally relevant findings; transferable tools / interventions Local-level influence; supporting key stakeholders to make progress

4. Approach An 'Integrated Knowledge Translation' model - researchers and research users (PCT co- researchers & Champions) working together over life of the project. A collaboration between NHS Sheffield; NHS Bradford and Airedale, & NHS Leeds; Sheffield Hallam University & University of Leeds

5. NHS Commissioning "the set of linked activities required to assess the healthcare needs of a population, specify the services required to meet those needs within a strategic framework, secure those services, monitor and evaluate the outcomes." Woodin (2006:); strategic purchasing, funding and planning

6. Obstacles – key learning Much NHS commissioning work is transactional rather than transformational Equality Impact Assessments are often “tick box” exercises Real and perceived data gaps

7. Simple 'instrumental' evidence use is rare Most likely where: - evidence is non-controversial; problem/issue uncontested - high degree of certainty in what is the best course of action - requires limited change; little upset to current status quo - clear responsibility for bringing about the change - wider supportive environment for the change Not common characteristics of evidence on (ethnic) inequalities

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

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

11. Examples of our tools Stakeholder analysis Prompt sheet for ethnicity in service specifications

12. Further Information Project website www.eeic.org.uk Contact details lynne.carter@bradford.nhs.uk