 Okay, and we shall begin. Bona dda pal. Good morning, everyone. Diolch. Croeso, welcome to the third of our monthly anti-racist Wales Action Plan webinar series, evolving together the journey towards anti-racist Wales by 2030. The Minister for Social Justice and Chief Whip Professor Ogg Bonner and the Permanent Secretary launched the first of these webinars in September. Our October webinar focused on education and our focus today, as you will know, is health. The anti-racist Wales Action Plan is a very bold plan with goals and statements running across nearly all areas of government and policy. The vision is for Wales that is truly anti-racist, systemically and culturally. So thank you very much for being part of this and being interested enough and engaged enough to join today. I'm Rajavi Glasbrook Griffiths. I'm a member of the anti-racist Wales Action Plan implementation team and chairing today. We have structured the session to be engaging and informative and have a diverse set of speakers today. We have a policy official and we have an expert professionally within the field, but also somebody with a great deal of lived experience. Something that is absolutely central to our plan and how we're building it. It's on the ground change that we wish to see. We encourage you to actively participate by using the Q&A tab. You can share your name or you can ask questions anonymously. We'll address your questions after both speakers have spoken. If we don't get a chance to address your question, we will provide written feedback following this session that addresses all the questions asked. So please don't feel badly if we don't get around to your question. It's simply a matter of timing. Recording and transcription are both on. We hope that's okay and to ensure that the session runs smoothly. Your microphones are muted and cameras are off. This will help reduce background noise and distractions. I will introduce both speakers together because in many ways there's a lot of joined up connection between what they're both explaining today. So they will follow on from each other. So our first speaker will be Rebecca Gorman. Rebecca Gorman is the Head of Equality Strategy, Transformation and Chief Digital Officer in Welsh Government. She will be discussing progress with implementation of the Anti-Racist Dwells Action Plan for Health and be sharing the key achievements to date. Challenges faced because it's very important I think to discuss the challenges and the barriers we face as we move along to and strategies that are employed to overcome these challenges and move forward. Rebecca then will hand on to Professor Antoni Emanuel. Professor Antoni Emanuel is Neuro Gastroentrologist at UCL. He's also Medical Director of Publishing at the Royal College of Physicians and Editor-in-Chief at Clinical Medicine. He leads on the workforce race equality standard about which he will be speaking today. We are very lucky that Professor Antoni Emanuel is also a very important member of our External Accountability Group and the External Accountability Group work hand in hand at every stage of the development and implementation of our plan. I shall hand over without much ado to Rebecca. Thank you very much, Becky. Efoenwyl Rebeca Gorman reynhaffesi shyradu gyda chi heddiw. Good morning. My name is Rebeca Gorman. I'm happy to speak to you this morning. I'm head of the Quality Strategy for Health and Social Services Group within Welsh Government. I'm going to provide you with an overview of progress with implementation to date with the health components of the Anti-Racist Dwells Action Plan. yw'n cael ei ffordd o'r peth o'r ysgol, oherwydd, yn ymddangos i'ch ddweud yma, pan'r ysgol yw'r ddweud yma, oherwydd, mae'n ymddangos i'r ddweud a'r ffianfaen yma, felly mae'n darparu o'r ddweud yma, ac mae'n ddweud yn gweithio'r ffianfaen yma, ond, yn ysgol yma, mae'n ddweud, mae'n ddweud, mae'n ddweud, ond yma, mae'n ddweud, mae'n ddweud yn ymddangos i ysgol, the Wellbeing in Future Generations Act. This act places a requirement on all public bodies to work towards improving Wales for future generations. The Act has seven goals, one of which is a more equal Wales, and these well-being goals have collectively underpinned our approach to developing and implementing the health components of the anti-racist action plan. To meet our collective duty within the Act, we've sought to take an anti-racist approach to everything we do from involving people with lived experience throughout our policy development and the creation of the health components of the plan to fostering the right culture in the ways that we work with our stakeholders and communities. Can I have the next slide, please? I just wanted to take a moment to reflect now back to the point at which this journey started. You know that the plan was published in 2022 in June and I think it's fair to say that we face a significant challenge in health. Health and social care were a major focus of the responses to that consultation and through that process and ongoing engagement we have heard and sadly continue to hear about the unacceptable experiences of racism, our black Asian and ethnic minority colleagues and people in our communities face both when providing health care and accessing services in Wales. We know there remains an unacceptable variation in how individuals from ethnic minority groups access and engage with health and social care and how this affects people's health outcomes and I think as a department we recognise the fundamental importance of delivering this plan and we remain collectively committed at all levels to its successful implementation. Next slide please. When we consulted on the plan, particularly the health chapter within the plan, we placed lived experience at the centre of our approach and we really took time to work with our partner organisations and stakeholders and staff networks, trade union representatives and community mentors to co-produce the goals and actions that you see within the health chapter and we focus those around the vision and purpose of the plan itself and those areas of desire change. So just to very quickly recap, the next slide is in Welsh if we could for people to access after the session but if we could just slide forward to the English version please. So I think it's move on to thank you. Through the process of engagement we developed five overarching goals for health and they're underpinned by 21 actions and those 21 actions also have within them five key priority actions recognised as being those that would catalyse the most change. Three of those are workforce focused but our national experts group recognised that if we improve the experience of our staff and the culture of the workplace then we will see positive impact on societal health outcomes and access to services. If we can go to the next slide please. Again there's a Welsh version for reference and there's an English version on the follow on slide if we can move on. Thank you. So we're now well into that implementation phase and what we've tried to illustrate with this slide is that since the publication of the plan we've very much focused on embedding the structural systems and governance arrangements that provide those foundational building blocks on which we will be able to leave a change. We've really taken that demand for accountability seriously both for ourselves as government but also for our partners so we're using the existing legislative frameworks to require NHS organisations to evidence their anti-racism approaches both from employment and service delivery and doing this will ensure the workforce reflects the population it serves and that everyone feels welcome and can reach their full potential. We've set high expectations of our NHS Wales boards to lead in embedding anti-racism throughout their organisations with the Minister for Health and Social Services setting explicit objectives for board chairs on anti-racism. Last year in June Judith Padgett who's the director general for health and social services group and the chief exec of the NHS established and now chairs an exec director level implementation and challenge boards within Welsh government for health and social services and that board provides really strong governance and accountability mechanism through which we've been able to accelerate action implementation across health and social services. It meets by monthly to scrutinise progress and and address any of those barriers to delivery. My reflection is that that board really does invite scrutiny and challenge and understands that transparency is essential to successfully drive meaningful cultural change and both in Dudek Ligar who's one of our external accountability group representatives and Professor Anton who is with us today our external accountability group representatives for health and of valued members of that group. We've focused on strong governance and co-production within our national stakeholder groups and sponsored bodies as well and have embedded lived experience into all areas of policy review and programme development. Inclusion especially race isn't achieved through a single intervention it requires multiple actions across the whole system and we're really trying to embrace that in the health sector not just in the context of the immediate requirements of the Arab app but in how we embed and sustain that focus in the long term and in future iterations of this inaugural plan. So the work we've progressed within health to establish these foundational building blocks has been quite extensive we acknowledge that it's essential to get these in place in order to start to drive that change that we want to see. What I wanted to do now was just look at how the plan if we could move on sorry just to the next slide thank you so I just wanted to speak a little bit about some of the specific work we've done aligned to some of the statements of desired change in the plan so if we can move on a slide thank you. So the plan sets out clear measures of success which we've sought to align our progress with implementation around and over the next exercise I've mentioned I just want to share this progress around how we said we would deliver the plan so if we look at ethnic minority people's experience in terms of resilience and success despite racism we've been able to commission an audit of all world's NHS policies through an anti-racist lens and diverse Cymru were successful through an open procurement process in attaining that. Diverse Cymru are also members of our new national programme for palliative and end-of-life care. The ethnic minorities and youth support team east have been supporting with the development of a workforce anti-racism training module and also support the work of Time to Change Wales to ensure we have a culturally appropriate output. We've engaged with a diverse range of stakeholders from across health and social care to be part of our workforce race equality standard strategic steering group which Anton will speak about with you shortly and we've established an ethnic minorities mental health task and finish group to inform the work of the mental health strategy for Wales. Ethnic minority people were involved in the duty of candor consultation and an anti-racist approach has been taken in the establishment of CLICE to ensure recruitment governance and policies are anti-racist and fully representative. Can move to the next slide please. If we're looking at people's experience of racism in everyday life and service delivery and the statements of desire change that sit around this, we've looked at the existing structures to report racism within the NHS through putting things right. This has been scrutinised for its accessibility and effectiveness and has been revised for patients with ethnic minority patients involved in that consultation. The specific needs of ethnic minority communities and vulnerable groups continue to be considered in the new successor of this strategy to work to um sorry I've lost my words together for mental health and talk to me and the mental health strategy for Wales has been developed with direct engagement for ethnic minorities mental health task and finish group that I mentioned previously. We're developing a framework for anti-racism competence with that foundation module that I mentioned on the last slide being mandated for all staff as a core part of that. The NHS Wales anti-violence collaboration has identified a new chair and the obligatory response to violence in healthcare is being reviewed. Policy leads saw an opportunity to include racially aggravated incidents specifically into that new guidance which is not currently included and the anti-violence collaboration have agreed to take this work forward and considered the systems and processes regarding reporting analysis and learning of racist incidents. Next slide please. In terms of visible role models I've already mentioned when we were looking at the building blocks at the start of this presentation that some of the work that's been happening here but we have mandated the requirement to evidence anti-racist leadership and plans through the NHS Wales boards chairs objectives and through the NHS Wales performance framework and we have established that implementation and challenge board which is chaired by Judith Padgett. In addition all NHS Wales boards have appointed executive equality champions and all NHS boards have committed to the aspiring board members program being developed by Academy Wales. We're also currently reviewing the public appointments process to embed an anti-racist approach throughout our public appointments. Next slide please. That review of anti-racist, sorry that review of board processes also links to this statement with regards to racism in the workplace and additionally we're working within Welsh Government at pace around the implementation of the workforce race equality standard which will enable workforce data regarding racial disparities in recruitment, representation, harassment and training to be reported for the first time in Wales and I've previously mentioned linked to this as well some of the work that we're doing with regards to the policy audit that work will provide us with recommendations which have identified systemic issues within our policies and we've engaged Black Asian and Minority Ethnic staff members through that policy audit. The recommendations coming from that work have been shared with our NHS Workforce Partnership who will now look to consider those recommendations and implement actions into the policy review cycle. In addition Welsh Government have recruited an equality diversity and inclusion manager within our maternity and neonatal policy team to provide guidance and empowerment to ethnic minority midwifery workforce and the work of the HIW talent board is underpinned by a strong commitment to recruit diverse candidates. So I hope in the short time we've got available that I've been able to give you an overview of the implementation that we've done to date and shown that we remain very committed to the ambitions of an anti-racist Wales. We absolutely acknowledge there is still more that can be done and that we have faced some challenges with progressing elements of some actions in the plan. I think it's important really to remember that the plan was written at a point in time based on available evidence and consultation responses at that time and that time does never stand still if we can just move on to the next slide piece. As ever we'll work with stakeholders to find a way forward or find alternative approaches to overcome the barriers that we face to the successful implementation of the plan. As we look forward now we're looking at how we measure the impact of the actions that we have implemented. The plan requires us to develop both strategic and operational measures. The race disparity evidence units work is to develop the strategic measures and we're working very closely with that unit to look at our departmental level operational measures for health and they in turn will feed back into the strategic measures process. It will help us to look at whether our actions are meeting the expectation of our goals. I think it's important that we that we really see that our approach must continually evolve as implementation of actions within the plan is concluded. We will have measurable evidence of their impact through which to shape and inform both our immediate policy response now and the next iteration of the anti-racist plan. This will build on the work that we've undertaken to date and drive progress towards anti-racist Wales. So I'm going to pause now and hand over to my colleague Anton who was joined us here in Wales from May to help lead the implementation of the workforce race equality standard. Thanks Becky and thanks Jess for driving the slides. So yes I'm delighted to be able to join and apologies for having absolute poverty in terms of work language so hopefully you'll tolerate my English speaking. Next slide please. The intention is really to be very purposeful. The anti-racist workforce action plan as you'll hopefully all know is as Rajari said a really bold document more than its boldness what's really critical about it is that it encompasses the whole spectrum of life of public life which influences how society functions now in healthcare. We have that kind of unique thing of the outputs of healthcare being something which affects everyone in a very direct way every day. So if we have a rubbish health system we have rubbish health which influences people in the most extreme way so our measures and what we can see is evidenced very quickly and I often say this within our teams you know the outcomes that come from other parts of public life education and housing and all that incredibly important obviously but there's often us of a longer pipeline to delivery and the reason I'm saying all this is to understand that we don't really have a second chance to get this right. It has to be taken as a right that unfortunately we live in a system which is systemically oppressive not just by race by gender by disability by religion by all sorts of ways in which we find to behave badly with each other and that is not just random bad people I think I think it's really important hopefully everyone in this call is experienced and mature enough in their thinking to know that you know the bad experiences we've had aren't due to just one rogue individual it's the system which allows those individuals to use their influence to deliver bad care to individuals which then results in bad services. So that in the context of this slide is the one thing that I'm trying to get at which is that the unequal outcome that we see for our people in terms of the proportionate rate of cardiovascular disease of prostate cancer of time to diagnosis that we see in certain populations is an outcome of that systemic problem and getting a workforce which looks more like a people it treats and which understands the needs of all the people it treats is utterly essential if we are serious about improving health inequalities which has to be the goal and I guess I'm biased as a clinician the most fundamental goal of society is to maintain the health of its citizens so the work we're doing in healthcare is deeply critical it's also for all the reasons I've mentioned but it's also not least because we're the largest employer you know the NHS is the largest employer in Wales it's the largest employer in the UK as a whole you know it's it's an enormously important thing for all that we can be at the vanguard of best practice and if it works for us it should be able to work wider within healthcare and at even larger workforce in social care now what this slide reminds us of is the fact that the ways in which inequality is met but I said are systemic but they are we can break down that systemic thing into the four key themes that the literature and our experience in other parts of the world and in other sectors because we can learn not just from health and social care but from banking from the army from other countries where they've made initiatives to try and improve things and there are four key areas which we sort of fall onto a better question you call our four domains around which inequality is perpetuated not just for race but for everything pretty much gender sexual orientation etc one and probably most importantly if you ask me to where I would aim my silver bullet is the one around leadership and the progression through the ranks in all our jobs so it's very clear that there's a deep inequality in the representation of black and Asian people as they go higher up the ranks towards more managerial and influential positions there are plenty of us working at clinical level at grassroots level but the representation in board room and above is poor and that is a significant reflection of the culture and organisation it's something which we're desperate to improve but by understanding our data and we can get very clear numbers which reflect that as Becky alluded to everything about what we're trying to do is alluded to by lived experience all this means something only when it reflects what happens to our people and so if we jump to domain four there the bullying harassment and discrimination that's one in four very intimately linked one is the numerical representation of people at all levels four is the culture and how people treat each other both from within the organisation but also from the public and what that means and so we can again get metrics from staff survey to really understand what people's experiences of their day-to-day do they feel they belong in the organisation they work in do they feel they want to be cared for in that organisation do they experience day-to-day aggressions and then those middle two number two and three in our progression through are we offered equal opportunities as women as black and Asian people as disabled people as our non-minoritised colleagues do we get denied certain things and so we can again get metrics around that and part of that is also around the metrics specifically in terms of race quality around how well trained are we to understand racial inequality it's something which number one lot of people find very hard to talk about because they feel they're trading on eggshells don't you know go with open almost inquiry it's we're not frightening people it's not frightening talking to women unless you're an adolescent boy boy which i once was it's not frightening talking to black and asian people we're not out to to harm or to be be easily offended um so how do we help people overcome that and some of that is education but not all of it because the dangers I often say is if we educate people but run rubbish processes we just create you know informed but powerless people and that's worthless so education is a tiny part of it but an important part of it um and then the third part which is a really a very destructive thing in all professions but especially we see in health care is the inappropriate rates by which black and asian people get referred up for regulatory and capability discrimination so that we see that there's a wild discrepancy unfortunately for the same offence to be like the likelihood of being referred up to your regulator so these are the four domains which you can see really reflect the kind of key areas and we can get number one they're important but number two with their data we can extract from various sources the service record but also from survey next slide please Jess um so the illusion I made too early on is about um about how important this is to um relate to lived experience what that slider apologies is my fault for not um curating the slide carefully um the slider the right side of the panel should sorry showed the full detail of this which is a case which is one of many that we've met in England when I was doing this work there of a recruitment um lead for an organisation writing um through a colleague she thought saying another application but unfortunately Nigerian um and it unfortunately for her um she pressed reply rather than forward and so this was sent back to the candidate who then made it public and what that reflects is something which is part of the lived experience of individuals and how do we capture that in data and it can get it from surveys but we can also get it from understanding so we can then take a deep dive into this organisation as it happened in Coventry to really say what is happening is this this is a rogue individual of course it isn't it was a part of a general process but this is a lever into that so lived experience is important because it allows the workforce this huge large workforce in Elfan social care to have a voice but it also it's the lever that by which we understand what is really happening in organisation it puts flesh to the numbers we can get percentages we can get ratios we can get likelihoods all those numerical things that I like to put into graphs but it only means something when it mirrors what is happening to our people that ultimately this is about improving people's experience next slide please Jess um so that kind of strapline of facts being more than data but within that and I'll just show you the left hand panel of this rather than the right hand panel so don't when you advance a slide in a second don't just double advance please but Jess we need to understand our workforce is complicated we have an progressively more diverse workforce it outstrips the diversity in our community in as much as healthcare and attracts people in for anything minority background plus governments bring in communities from Cairo from the Philippines from Nigeria to preferentially provide healthcare and so lumping people in is all one big lump saying well you're black in Asia and there you are that's your space as individuals we that's not how we see it we don't live our life like that we live our life as black people as Asian people we can live cheap by jail we do live cheap by jail but understanding the challenges that we face are different equally and incredibly importantly and obviously as this bit of data on the left hand side of the panel shows the experience of white people isn't all the same experience of the white gypsy and traveller community is worse you can see that their line goes further to the right and that indicates worse outcomes and it's especially bad if you're a black gypsy white gypsy and traveller man it's a paler part of each of those double bars is for men and the darker bars women and you can see that that's especially bad for that community so it's really understanding breaking our data down to really understand what it is for different ethnicities and also by gender you can see for black and Asian people the experiences are generally worse for women than men the darker bars are women as I said and this is an important thing because it helps us understand the particular challenges that are in our workforce but it also helps us monitor what outcomes are if we monitor the whole outcome for say um if we do an intervention to target gypsy and traveller people and we measure the outcomes for and where it comes as white people as a whole in an organisation we won't see that change because they'll be dwarfed by the experience of the majority so we need to use disaggregated data to really understand what's happening to our workforce and it mirrors that comment that's making about lived experience so if you double advance please can address thank you and I'm just going to sort of finish this little bit of data stuff by by hopefully not making you feel too cross-eyed with numbers or blinded by colours we will produce our data in a kind of a sheet map way to really help organisations know what to do so this is as um as Radri and Becky alluded to I've been doing this work in England um before I was drawn across to Wales by the genuinely by the opportunity to work with the Enteraces Watch Action Plan that was the single biggest reason for my working in this space in Wales but this is a work as you can see that it provided in England the pink uh who's the main with the organisation this is from but this is the kind of thing we produced for all 225 hospitals in England um it's a slightly easier challenge in Wales we have 13 health boards that makes my life already um a fifth of what it was before um but the point being that we can for each of our indicators this is the kind of the tabular front page so it's like a kind of like a league table that we could present to each organisational executive on each row are the each of the indicators that we would be measuring covering those four domains and then the first column of numbers gives the that hospital that trust as we called it in England that trust's data tells you by number what's happening and then it compares it with the rest of that region um and then it compares with the second column the third column compares it with the nation as a whole that's the value for the country as a whole and then the last colour coded column is the one which then presents that as a heat map of the country so you can see at a glance where your challenges are in an organisation but you can also have that reflects the country in the whole of those two coloured columns so it allows people to really break into what to do and then they can say okay from that we can see that we have a real challenge around bullying and harassment of our colleagues um especially in um low paid roles what are we going to do about that and break into that because that's our real challenge as well it's towards the bottom of that display about five lines up it's red in that first colour column and orange in the in that final right column so it tells him that they have a real challenge around there so I'm just I'm not going to go through this line by line will be pleased to hear but it illustrates how we want to use data in a way to really arm people to know what to do next slide please Jess and beyond that we can go to the next slide if you don't mind please Jess sorry oh no no trouble at all always happy to see Becky for a second just for a second so all is going to show while that's happening is probably the technology oh perfect yes I'm done that lovely this again looks like a baffling so I test that you get new operations isn't it but again it's intended to show how we can use data presentation smartly have just advanced a second please you can see that what we're trying to do press the advance button please Jess um is you will see that if you look at that visually that there are oops sorry this thank you sorry for being difficult um that's perfect you can see that what those red rings cover is the particular indicators that are especially bad so we as a national level this could be so why I showed you just now the previous slide on a particular trust or could say health board in the world complex here's what we would see as a government function on this we'll be able to see here each row is each of our organisations this is again for a region in in in England and each column now these each of those indicators that we got from one to nine in England we've got 12 in Wales because we're more ambitious but if you look at those you can see that the particular areas of red in those columns that have been ringed and so if we're going to take action next slide please um we need to focus on those indicators one two five and nine as you can see that lower part of that panel so we could use that data at a national level or in this case a regional level and say right that tells us exactly we can ignore indicators three four six and seven and eight in that region because they are the priority not that everyone's got no problem with those this is where the particular challenges are and that's the whole point data gives us that leverage to really understand and one of the things I'm really keen to make a point of with this slide but it's a more general point perfect thank you is that people sometimes think you can gain data and of course you can people are very good at you know not measuring things or presenting things in a certain space but that's why we're having this host of indicators it isn't just one thing how many leaders have you got or how many this have you got it's looking at a whole range of these well indicators across four domains so that you have to lift yourself up by everything and what we will see is that every organisation will have one or two particular challenges and that you know just trying to gain the system by sticking in a couple of you know for example you say oh we haven't got enough black and asian directors in a Welsh health service they're easy to do we'll go and raid and find a few high ranking black and asian people and pop them into the space and say well we've ticked that off now we're done we're good our anti-racist action plan is now ticked off because we've got a few more but you know the problem with that is that for those individuals we've been brought in they've often been brought in to become a sought out EDI which was no individual can in their own but number two it's it's literally putting those people in a position which is untenable because you know what's going to happen after them why is the pipeline of talent we're developing and so the whole thing about this is to develop that organisational culture which means something so not just saying we're going to change culture we're going to celebrate black history month we're going to celebrate chinese new year those are all important things but those aren't really culture culture grows to sort of paraphrase mouth from the barrel of a gun the gun being the gun of change the thing that says we disrupt our systems we break that down and then we intentionally make a change so this funny little slide is meant to show you that you know we can do our personal things we can make our commitments to do things we can run our service as well but then within that the the mix and a pink circle is all about how we need to work within teams to really disaggregate our data down to understand where the particular challenges are and recognising that there are a variety of opportunities and challenges there but the really big blob is the black blob here which is where we have to change things at a huge systemic level target that gun of change at all our processes which disrupt things but do it in iterative styles and not try and do everything at once use the way to say here's where our challenge is so it'll be different in Kamal than to up in Betsi it'll be different in you know Paris compared to what's in Newport that's as it should be but we will gradually target our most disadvantaged colleagues and the most disadvantaged indicator whether it's around disciplinary or whether it's around promotion whatever it is target that and then gradually drive up the standards for those who are at the very very bottom of the of the pyramid feeling the greatest weight of the what's above it and by making that better we will flatten the pyramid not by making the top worse next and I think final slide please um so the intention of this is to say look this is my particular personal heroes I feel okay using it as a final statement um you know we have to be prepared to accept that the challenge that is there is the one that's articulated beautifully in the our weapon the address action plan it tells us that we accept that we have a system which is systemically flawed unfortunately it doesn't really matter about the history of it but it is what it is now and that we have our weapon is the thing that puts our glasses on to say we can face this now and it's now now that we're facing it it's the opportunity to change that and what Becky and I have tried to do is to show you the kind of the processes that underpin and that's what Becky was trying to do but underpin us as we then mount this challenge to our processes which is the kind of the gun analogy that I'm not a violent person but I don't know I've found myself starting that analogy two minutes ago I can't get off it now but that's the point it's to say like how do we how do we create the base conditions for us to be able to do this work so that we can then target what we need to target in a meaningful way thank you very much for listening to myself and to us both and I look forward to hearing all the questions you have trying to appreciate. Can I just say Diolch yn fawr o Galon, both for a you know a really good precy of what is an enormous amount of work underway at pace and the complexity of that I think in a really showed through Professor Emanuel in there is no homogeneity here there is such a vast level of work that needs to be done at multiple layers to really ensure that systemic change which is what the focus of the plan is. What really emerged strongly in what both Rebecca and Professor Emanuel said is that the focus remains on accountability accountability depends on implementation and that the ultimate focus is the embedding of anti-racism we want to go beyond and further than anything that's been done before no surface measures this needs to run at every route through every route of every person's life experiencing these services the means are lived experience co-production and representation again both presentations showed the need for representation within our workforce we value what we measure the value of what matters is affected by how we measure it and what we measure and in order to for that to have any value it needs to be meaningful people on the ground need to feel the change it can't be us talking in forums that are nothing to do with lived experience. The graphic that you use Professor Emanuel was deeply powerful it was I don't know if you saw it was in a cloistered bell, ethnic minority people working and life carrying on around them relentless and I think it's so powerful to note that that how often do we within our own settings place the burden of anti-racism within our ethnic minority people rather than seeing it as an issue that affects us all because racism is something that affects us all not just minority ethnic people and that intersectionality was the other point I hope everyone who's here will really take away that race doesn't exist in a vacuum and these things are compounded by gender by socioeconomic status sexuality so for many people many odds are stacked against them and to understand that complexity is incredibly important and I just am so grateful for two excellent presentations there thank you so much I hope everyone else has got as much from it we've got a lot of questions in the chat so we'll try to get through as many as possible the first one it's for both of you actually so perhaps Becky you could go first followed by Professor Emanuel what are the major pinch points or barriers in taking this forward this is enormous amount I mean it's a very big question but yeah that's a huge question so thank you for that I think the pinch points and barriers have been fairly limited with this work I think we've been able to create a narrative and an approach that cuts across all components of health so we're looking at it as a kind of whole system piece so largely people are committed and support with that I think I alluded to probably quite specifically I alluded to some challenges and barriers that we've faced in specific elements of certain actions I think we created the plan at a point in time and a good example of that might be around the we indicated that we wanted to include cultural ambassadors through our consultation work that came out as something that was that would be well received within organisations we have a fantastic group of very committed equality leaders in our NHS organisations across Wales and they fed back on this action I think we struggled and in part due to some of the stuff that Anton was speaking around those kind of regional differences that we need to look at but we've struggled to form a national descriptor for that role I think the requirements of that would differ dependent on local needs and on demographic and so we're really reflecting on that now recognising that time doesn't stand still and some of the actions that we put together at that point in time and felt right maybe need to be reflected and refined further now looking at that kind of whole system piece and that need for allyship across your organisations as well you know this may not be a task for one individual we need to focus it into that space of culture shift and so this is something that we will probably look to revisit and reframe working with our equality leads again to see how we can do that so I think that would probably be for me a reflection is that that time moves on so I think it was our best and most informed space that we were in coming out of the pandemic and shaping the plan in 2022 so there are some elements that we now need to reflect and refine and that's absolutely why we then have a second iteration of the plan planned for next year so If I can just take that very briefly when Becky said most of it is that I think that the opportunity that the pinch points are are less because because of the hour because of the government commission to this is what makes a difference if I hope I'm not being negative to English colleagues on the line plan you know since I live here actually I can say it because it's also my little experience the ambition of the English government in this space of equality not just about race is close to zero and so doing this work in that space is almost impossible so that's the biggest pinch point removed I think where that where there is that I'm not rosy eyed I do recognise as a challenge is I think because we haven't ever exposed a data set in Wales about this there's this hope I think that we will have a little quite as bad in Wales and we're good people in Wales and especially in health care we're especially good people we wouldn't do that the reality is that unfortunately it isn't available by good and bad people it's about good and bad processes and that's what's messed up and so I think there's a slight there's going to be a slight discomfort that we all will people will feel once they see the data sets in there and the other pinch point then around black and Asian people don't have the confidence to say yet say their voice out loud because they think they can be identified and so on so this is that it's where in England the problem was government in ambition but people knowing there's a problem it feels slightly the other way around to this side but we're at the start of the journey that actually flows on really smoothly to several questions which we've got in the chat which I'll try to group together but it's mainly for you Professor Emanuel but Becky please feel free to come in are you able to highlight key lessons learned from your work in England about what to do but also as well as what to do differently here in Wales so successful practice as well as lessons learned that's a really really key set of questions there thanks for under summarising that so it's absolutely and that is another part of what draws so we can see that of the 225 organisations England there were some which made some really good headway and the there are some very particular things they did and I want to use the time we have to describe the particular policies that were taken around overhauling recruitment or improving disciplinary processes but there were those ones and we know that we can do things which are actually impactful rather than if I can be a bit rude again and things which are just sort of first of all in performative like you know training of various sorts and so on in cultural awareness and commitments those don't get anywhere you've got to really argue that process it but the other thing is that beyond those individual things is that it's that ambition where we saw change was where there were leaders who got it for whatever reason and they said we're going to do this then we're going to make this transparent we're going to make this process have a single goal I'm going to hold myself accountable to the executive to my my board to do this or the chair of the organization would hold people to account or pledge that and when that happened we then saw changes and you know when what does zero tolerance lots of people in this audience who have colleagues in health care or family in health care will know that people get abuse all the time and we all this we all say oh we have zero tolerance of racism in all this what does that actually mean are you going to give somebody out of casualty when they abuse you no you're not and so just saying that is another slap in the face of the black and Asian person who says oh yeah okay so they say that so I can't even complain now because I've been told it's zero tolerance but it doesn't so I think is I think about matching towards so what we can use use data intelligently by the ways we've described instead of disciplinating it but then aim jointly as much as the data for every bit of data there's a jigsaw piece which fits which is the evidence of what works what what processes are there once you've got the combination of the data telling you what to do and the evidence of what works and put those two together with somebody who's accountable an executive which is accountable you then get progression so that's the thing is to get our execs to buy into this and give them data where we shall allow them to take action absolutely can I say your and the candor is so refreshing professor Emmanuel because I think it's only through this straight speaking straight talking way of addressing what the actual issues are that we can move forward the next question is definitely for both of you and it's actually it's an enormous issue somebody has written in anonymously how do we overcome the issues of trust by ethnic minority people and I'm imagining in this instance it means as patients and as staff in the complaints processes currently available and that is we know it's an immense consideration saying it's probably a bit harsh from Becky is almost as the ethnic person in this pairing Becky have points of view from other characteristics but also from a more systemic way but for me the issue around specific ethnic minorities is that there's an issue about feeling that you can't voice something for the reasons we just alluded to then secondly you feel that you are identifiable as in that you do this thirdly there's lack of and on and on independence the people who are you're reporting to often the ones who may have wronged you and how do I do so what we and the answer is that that there's no there's no solution around the corner this is something we're going to have to do with times of confidence is built up very very slowly you know lack of confidence occurs in a second you burst the bubble in a moment but you build that bubble up over a longer time and so we need to show that we are serious about translating the ambition of the rwap into practice we need to show that and create a speaking up process which actually has those things where people are anonymised they are empowered they are independent and they are judged by a sort of a jury of their peers it isn't just that I will take the word of the person because they're more senior than you they've had more experience than you so the answer to this is that this is an iterative thing it's going to start from now we're going to begin the speaking up process which allows people to have some confidence in it but confidence is built up slowly and it's going to be done with the right reasons I think Becky will have said in many conversations where this is the experiences it's talked about and people who often in positions of power have never or haven't for a long time experienced something bad and so what we're trying to do is to introduce the in making these big decisions about our processes what is actually happening at the grassroots the thing that you were involved with 20 years ago so if I had on to Becky to make a succinct word on what I've just said the getting this right will take multiple iterations of doing this again and again and again that will mean we're getting it right as a government function but that will then be translated into people slowly accepting that this is actually changing this can happen it has happened properly in countries like Canada and the Canadian education system there's a really terrible culture around Jamaican immigrants and so on and they changed that to 15 years we've set ourselves a much tighter target but that's quick summary sorry Thanks Anton I think Anton's absolutely right there in terms of the actual processes within the system I think if we take that up a level what we're talking to there are the fundamental principles of what we're trying to achieve with the anti-racist plan so it's a whole system piece if we focus in on a complaints procedure a putting things right procedure a speaking up safely process in their own right they will not change and they will not improve however if we look at the the collective ambitions across the whole of the plan and you look at how you're going to improve your leadership's response to complaints that are being raised and improve that educational piece so your organisations are more culturally competent they're more aware of what your allyship means improve the demographic of your workforce so again people recognise themselves and the people who they are sharing their experiences with that's when you'll that's when you leave with the change so I think it's around if you want to improve people's confidence in the system you've got to have wholesale buy-in to improve in the system so and that's got to be maintained for more than just the period of the lifetime of this plan it's got to go on into the into the future of the next plan it's got to go on beyond 2030 it will be you can't take your foot off the gas with with this work it's got to it's got to kind of continue and and remain focused on what we're all all collectively trying to deliver and it isn't it isn't the responsibility of Welsh Government in their entirety it isn't the responsibility of an organisation as an individual it's how we collectively come together around that that narrative to really drive forward forward the change and that's when people become confident so it's a long term we want short response but it's a it's a long term commitment that is needed so no I think it's exactly so anti-racism isn't a product that we deliver by 2030 it's a process and it's a lifelong process I agree it's a systemic process not a product we'll squeeze in one last question I know we're coming to the end of the time but I think this flows on very nicely from the what you've just said Becky about you know collective effort how can individuals or groups support and contribute to these efforts within health care environments but to the general anti-racist purpose in general what can people do I suppose when you know we attend these things often and we come away and we feel well what can I do what can individuals and groups do would you like to go for us Professor Emmanuel no I'll let Becky have the last word I should too so I think yeah I mean so as individuals please share your data please understand that this is a non-invise that this is going to be used in a way which protects you that's absolutely fundamental and I am convinced of that for what it's worth I know we've just sent a staff server hindered and so it's probably a week later and the messages are on there but you know but that thing you can do again if you have health care in health service but also everything else your survey fill your dating on your electronic service record be prepared comfortable to display your gender density it is important number two of reality it will be used the intention of this certainly on the I am convinced that the government's intentions strong this so we will use this data we won't just be saying oh well here's what it is bye bye we'll come back in a year's time in a minute again it is intentional so data number one number two say is that don't walk by things the biggest problem we have is that black and ancient people feel that they are often in that isolated and they aren't because our heart goes out to things but we feel I don't want I don't know how to do it that thing about not knowing how to do something so they're used resources that allow you to think oh how do I have that conversation how do I avoid you know why did somebody take a fence when I asked mentioned touching their pair or whatever is it then being prickly or is it and then so since you do that it then means that you stop being afraid of that thing so I think the things you can do us to educate ourselves I will say genuinely from a raised point of view from ethnic produced so that creators of content who are black and Asian give you something which is genuine so you can source content by black and about how to discuss what they call microaggressions about how you have a conversation how you pledge something how do you be an ally effectively rather just performatively those things are the kind of thing you can do so share your data be prepared to do a tiny bit of reading with you know from useful sources and one things of the rest website we'll have in time as a set of resources about where these are we can't produce everything ourselves but we'll signpost where there's good stuff for people to learn and from like Becky give a more overview on it and I think that was fantastic and on absolutely everything that I would say I think I think from a as a person who looks like me in this space I think it's really important that you educate yourself that you recognise your privilege if you're sitting in this seat you have a you have a unique opportunity to drive change for other people and to improve other people's experiences which will by in turn improve the whole system and improve it for for for far broader demographics than race you know we focus on race now because this is the issue we have other demographics that we need to look at as well and we need to consider those so really reflect self-reflection in terms of how to be an effective ally within your organisations and beyond it is a is a kind of key take home certainly it's something I've taken home from this work and it's something that I would hope other people will as well just from from the the way that the arabap is structured and the way that it it embeds those kind of principles of change that we want to see. Thank you so much both and I completely echo that Becky I don't think we can underestimate the importance of allyship and collective effort and everybody working together. Thank you to both Rebecca Gorman and Professor Anton Emmanuel for your excellent presentations most of all thank you to all for coming in along with today taking part engaging with us you are part of our journey and I hope you really feel that and we really appreciate you joining us and supporting our work in this way as we approach the end thank you to both speakers as I said but thank you also to the implementation team in particular Jess Lauren and Reena behind the scenes moderating all the questions putting everything through organising the event in effect so thank you very much to the team any questions that we haven't been able to answer we will provide written feedback and pass that on to you if you are already signed up you will get an invitation to our next webinar which is in January the date and timer to be arranged but the focus will be on social care if you've not attended today but you think somebody else might be interested please direct them to fill in and apply we have got a long way to go as you can see but look how far we've come I think it's very much the message that I feel and the momentum being gained is what we invest our optimism and drive in so you know Diolch yn fawr to everybody who's joined us today Diolch yn gwrando hwyl fawr see you hopefully in January I think it's allowed to say it today I'm allowed sort of because the 30th I hope everyone has a very lovely Christmas and new year Becky shaking her head all the best Diolch yn fawr okay bye