Setting the conditions: a shared responsibility

If reflection is optional, the people who are already under the greatest pressure are least likely to have time for it.

Build protected time into the calendar. This could include supervision away from direct line management, regular reflective sessions and INSET training with structured follow-up. One-off awareness days are not enough.

For senior leaders, one question: what protected thinking time do frontline staff actually have?

“If they need me, they can come to me” is not protected time. It is line management.

The conditions around the work affect whether the work is possible.

Large class sizes, high caseloads, short-term funding and unstable budgets are not background issues. They shape whether staff have the time, capacity and support to build relationships and respond well to young people.

The toolkit’s recommendations that need proper resources cannot become wishes that are quietly dropped when funding is tight. They are asks of the system.

The risk is that this toolkit becomes a box-ticking exercise rather than a change in culture.

Accountability means being clear about:

• Who is responsible for change.
• Who checks whether change is happening.
• What evidence shows that it is working.
• What happens when it is not working.

No organisation judges itself alone here. Community members, people who use services and staff all have a real role in deciding whether change is happening.

Not every change has to wait for permission from senior leaders.

Workers and allies inside organisations can find each other, meet regularly and build change from within. Connections with organisations such as Black Thrive can provide support, challenge and a link to a wider movement.

But do not leave people creating change to carry it alone. Without protected time, peer support and senior backing, changemakers can burn out and progress can disappear when they leave.

Recognise and support this work. Do not simply tolerate it.

The conditions for good practice need funding, not just good intentions.

This toolkit sets out clear asks for funders and NHS South East London Integrated Care Board in Chapter 15.

When writing a bid, funding a service or sitting on a board, use Chapter 15 alongside this chapter. Fund the conditions needed for good practice. Do not expect staff and communities to deliver change without them.

PCREF is NHS England’s anti-racism and accountability approach for mental health services. It aims to improve access, experience and outcomes for racialised communities, while improving trust in services.

It is useful here because it offers a practical answer to a key question: who decides whether this work is working? The answer is not the organisation alone.

PCREF uses Triple Leadership. This brings together:

• Community representatives.
• People who use services and carers.
• Staff representatives.

These groups share responsibility for decisions, challenge and accountability. South London and Maudsley NHS Foundation Trust was a PCREF pilot site and has used this approach to bring Black communities, Black service users and carers, and staff into decision-making together.

What to borrow from PCREF. You do not need to reproduce PCREF in full to learn from it. Borrow these principles:

• Share decision-making with community members, people with lived experience and staff.
• Set outcomes on racial equality that can be measured.
• Use data alongside people’s lived experience.
• Make feedback visible and show what changed because of it.
• Do not rely only on policy statements or internal assurance.

PCREF, NHS England ↗