Category: Case study

Our organisation 

Hillside Clubhouse is a charity supporting people with mental health needs on their employment journey. This support varies depending on where the individual is on their journey, and how the individual was referred. At early stages, Hillside delivers a recovery project from its clubhouse, to help individuals who self-refer to gain skills and confidence. Hillside also offers more tailored and bespoke information and guidance around employment support. Specific employment services are co-located within NHS clinical teams to support those who are referred through the clinical route. This includes employment advisors within NHS talking therapies, and Individual Placement Support (IPS).

Why REMI?

Within IPS, all participating services need to develop a Race Equity Action Plan. Hillside felt that the whole organisation needed to support this effort, which led to the development of an organisation-wide Race Equity Strategy. While the Strategy established clear ambitions, it was high-level without detailed actions that would help set priorities, track progress or hold different parts of the organisation accountable. The Race Equity Maturity Index (REMI) was selected to address this gap.

The REMI lead at Hillside is the Director of IPS and Employment Services. He emphasised that race equity is a crucial priority for the organisation. A diverse and anti-racist organisation ensures that service users feel represented and cared for. REMI therefore aligned closely with Hillside’s existing priorities and strategic direction.  

REMI provided practical steps and priorities which could be taken towards achieving the ambitions outlined in the Race Equity Strategy. It also gave a classification of progress which Hillside can work against. REMI gave the organisation a shared vocabulary and set of terminologies to describe race equity and actions taken, therefore allowing it to identify what progress was already being made.

How REMI fits with what we already do

Prior to adopting REMI, Hillside did not use a consistent tool to support progress on race equity. REMI complemented the Race Equity Strategy by translating strategic commitments into concrete actions and by embedding accountability within existing plans. Specifically, the IPS framework requires each participating service to develop a Race Equity Action Plan, and so REMI supports with fulfilling IPS requirements through identifying pathways and ensuring accountability. 

What we’ve done so far

Implementation has primarily focused on using REMI to generate talking points during quarterly race equity working groups and setting aims for the organisation as part of their Race Equity Strategy. 

Hillside have used REMI to understand where they are on their race equity journey. As the REMI is a staged tool, they have identified that whilst they fulfil some aspects of the later stages of REMI, they need to work to complete each indicator and action of the first few stages to ensure that their anti-racism work is as impactful as possible. 

Staff engagement has been positive, with the REMI lead translating REMI to Hillside’s organisational context. He emphasised that the close ties between the existing Race Equity Strategy and REMI were crucial to establishing staff buy-in. In addition, conversations with representatives from the London Anti-Racism Collaboration for Health were important to ensure that he understood the use and value of REMI. 

Value and learning

REMI has given Hillside a shared vocabulary to articulate progress towards race equity. It has provided insight into practical actions which the organisation could take to achieve the ambitions outlined in its own Race Equity Strategy. Crucially, it built accountability into that Strategy and the associated Race Equity Plans. 

The REMI lead wants to use REMI to conduct a biannual review of Hillside’s progress towards race equity. Hillside plan to implement Race Equity Action Plans for each service within their organisation to ensure specific focus and accountability. Ultimately, Hillside want to use REMI as part of the effort to ensure that their organisation is an anti-racist organisation, which will deliver better outcomes for staff and service users.  

Key takeaway for other organisations

REMI gives a clear and consistent assessment of an organisation’s race equity policies and can build evaluation into existing or developing strategies.

The REMI lead at Hillside advised other organisations which begin using REMI to take their time and not rush. They should use REMI to promote deep conversations among staff, and to encourage a rich understanding of the tool and of the actions which they can take. Organisations should not aim for perfection, but for progress, and should share the tool as widely as possible.  

Our organisation

NHS North West London Integrated Care Board (ICB) is responsible for healthcare across eight London Boroughs: Brent, Ealing, Harrow, Hammersmith and Fulham, Hounslow, Westminster and the Royal Borough of Kensington and Chelsea. In the region, there is a collective population of 2.1 million residents, although the actual number of residents served by NHS North West London is even greater, mainly due to virtual GP registrations.

Why REMI?

NHS NW London’s motivation to use REMI was encouraged by its Race Steering Group. REMI stood out from other tools that measure racism and system readiness for anti-racism as it offered a structured opportunity to showcase and strengthen our existing work. The self-assessment tool was also a key factor. It provides clear guidance on what good progress looks like, offers practical support for improvement and functions as an interactive resource.

Although REMI has not been formally adopted across NHS North West London and Integrated Care System (ICS), NHS NW London has used it to facilitate meaningful discussions within their Race Steering Group about the use of REMI in conjecture with the
GLA and local councils.

Moreover, senior leaders at NHS NW London were active members of the Race Steering Group and the approach that REMI outlines has helped the facilitation of discussions around race across the system.

The REMI framework aligned closely with existing priorities within the Health Equity Programme. This programme focuses on understanding the interconnections between three core pillars: health inequalities, population health management and the wider determinants of health, making REMI a natural fit. While ICBs are navigating a period of change, the commitment to anti-racism and the principles of REMI will continue across the system.

How REMI fits with what we already do

The Health Equity Programme for NHS NW London has used the Core20PLUS5 framework to identify areas of need, drawing particularly on the “PLUS” element to highlight the impact of structural racism and its barrier to effective health outcomes. NHS North West London has therefore recognised race as a plus priority group, aligned to the demographics. NHS NW London has begun using REMI as a basis for self-assessment. REMI has complemented their work on race equity rather than duplicating existing frameworks. The ICB also emphasised the need for a tool that can be applied to both staff and the local population, given that many BME staff come from the communities served in North West London.

What we’ve done so far

The Health Inequalities Team within the Health Equity Programme who support the NW London Race Steering Group have been using the step-by-step REMI guidelines for reference when planning agendas and shaping their work.

The Population Health Management (PHM) Team, through the Local Integrated Needs Assessment, has highlighted the value of disaggregating data by race, and has already highlighted evidence showing significant health inequalities affecting Black and Minority Ethnic (BME) groups, particularly in mental health, maternal mortality and long-term conditions. The Health Equity Team is keen to advance this approach further, particularly in strengthening the depth and quality of their data collection.

Key discussions include the wider context, such as developments within the Greater London Authority (GLA), and how these may influence NHS NW London’s strategy for tackling racism within healthcare. Ongoing conversations are focused on determining where REMI would have the greatest impact.

Value and learning

REMI is a call to action. It goes beyond identifying issues or analysing data; it prompts the next stage of meaningful action. It is designed not only to highlight problems but to support organisations in taking practical steps toward improvement.

The value of REMI lies in its non-judgemental approach to different stages of race equity. It provides a structured way of embedding system accountability as part of the wider strategic prioritisation.

In the short term, the focus for NHS NW London is on sustaining and enhancing the cultural change. In particular the merger with the North Central London ICB brings for further scaling and collaborative learning. The North Central London ICB shares their commitment to tackling racism and promoting equity and inclusion, and there is recognition that this is an area where both organisations can learn from each other in taking forward the agenda post-merger. In the longer term, the transition needs to be built into the five-year planning process. The organisation is now looking at strengthening trust with communities, where
REMI is particularly well suited. REMI incorporates key levers of race equity including community engagement and policy and decision making processes, the staged indicators and actions of REMI align with the ambition to strengthen trust within communities.

Key takeaways for other organisations

REMI needs to be fully embedded within strategic planning and future commissioning opportunities. Large organisations should be expected to adopt an explicitly anti-racist approach and integrate this into their frameworks. There must also be open conversations about system-wide commitment and senior leaders need to feel confident and aligned. To be effective, REMI also requires clear enforcement mechanisms to ensure organisations are genuinely held to account. REMI should be reflected across all core documentation and embedded across every portfolio, including planning, commissioning, nursing, and quality.

In the summer of 2020, the Health Innovation Network South London (an NHS organisation in south London supporting change and innovation across the health and care sector) committed to becoming an anti-racist organisation.

Originally catalysed by discussions within the organisation about race following the murder of George Floyd, the aims of their anti-racism programme were to:

• Create a psychologically safe environment, increasing staff confidence in having conversations about race and racial inequality;
• Increase staff confidence in knowing how to speak up and address concerns related to racial inequality and discrimination.

Between 2020 and 2023, the programme worked with staff to co-design, plan and facilitate a range of staff engagement activities, as well as developing practical tools and guides to help with the implementation of anti-racism. Some of the key activities during the programme included:

• Establishing team anti-racism champions;
• Listening events and focus groups for staff to understand current challenges;
• Organisation-wide and team workshops to inform organisational policy;
• Training sessions for staff;
• Hosting of a south London roundtable on anti-racism.

Many of the tools originally developed during the programme are collected in their Anti-Racism Toolkit and Anti-Racism microsite.

In summer 2023, the Health Innovation Network South London commissioned an independent evaluation of the programme. This evaluation found that:

• The programme led to a lasting change in how staff thought about discrimination and racism;
• There appeared to be a positive impact in terms of racially equitable recruitment and an increase in staff from Black, Asian and minoritised ethnic groups;
• The programme had led to greater confidence discussing race and racism in staff;

The evaluation also explored the impact and experience of the programme on Black, Asian and minoritised ethnic staff at the organisation, noting that the feelings triggered by the work were complex and not universally positive.

Want to find out more about this work? Contact the Health Innovation Network South London.