The Patient and Carer Race Equality Framework (PCREF) was a recommendation following the national Mental Health Act Review in 2018. In our Trust, PCREF exists to eliminate the unacceptable racial disparity in the access, experience and outcomes that Black communities face and to significantly improve their trust and confidence in mental health services.
PCREF is an ambitious and transformative programme where partnership working is at its heart. Our PCREF approach focuses on the four London boroughs that our Trust operates in – Lambeth, Southwark, Croydon, and Lewisham. We welcome local, Black-led community members and partners, Black patients who have used or are using Trust services, Carers and Trust staff at all levels to learn from and get involved with our PCREF approach.
These pages will give you more detail on how our PCREF approach at South London and Maudsley NHS Trust has developed since 2020.
What is the Patient and Carer Race Equality Framework?
The Patient and Carer Race Equality Framework was a key recommendation following the national Mental Health Act Review in 2018. PCREF is NHS England’s accountability framework to tackle and eliminate the unacceptable racial inequalities in access, experience and outcomes faced by Black, Asian, and Multi-Ethnic communities and to significantly improve their trust and confidence in mental health services.
The PCREF is split into three core components:
- Part 1: Leadership and Governance – Meeting Statutory and Legal requirements
- Part 2: National Organisational Competencies
- Part 3: The Patient and Carers Feedback Mechanism
At South London and Maudsley (in common with most mental health trusts), we are able to look at our service data and clearly see which groups have the best and worst access, experience and outcomes (AEO). Our Trust data shows that patients from Black African, Black Caribbean, Black Mixed and Black Other census categories have the worst AEO with us and in this first iteration of PCREF, we are focusing on these groups. We will talk of ‘Black communities’ in our materials which refers to all four census categories listed above.
From Spring 2023, PCREF will be rolled out by NHS England across all mental health trusts and will form part of the Care Quality Commission (CQC) assessments. The Trust is one of the pilot sites for PCREF, and this means, once developed, PCREF will begin to be rolled out by NHS England across all mental health trusts and will form part of the Care Quality Commission (CQC) assessments. The Trust is an NHS England Pilot site for PCREF – we have been developing our work on all three components. As part of this we will test and learn from co-produced projects to transform services locally and inform what the national roll-out to all mental health providers will look like.
This ambitious programme is only possible through true partnership working, with Black Thrive Lambeth and Croydon BME Forum as community Host Organisations and South London and Maudsley NHS Foundation Trust.
Find out more about our host organisations:
Collaboration and Partnership
Our PCREF approach is an ambitious programme with partnership working at the heart. We acknowledge from the outset the expertise that local, Black-led organisation bring as partners and are delivering the programme in partnership with Black Thrive Lambeth and Croydon BME Forum.
Everything we do involves counting to three. This means we have a Black service user / carer rep, Black community rep and Trust staff rep involved in decision making and keeping views and perspectives in balance.
The PCREF programme is led by Dr Jacqui Dyer from the Community and Zoë Reed from the Trust as the Joint Strategic Leads. PCREF is a core part of the Trust’s strategic approach and the change within the Trust is led by the Chair, Sir Norman Lamb and Chief Executive, David Bradley.
Get in contact to join:
- The PCREF Community Action Group
- The PCREF Black Service Users and their Carers group
- The PCREF Staff Network
Our Trust data shows that patients from Black African, Black Caribbean, Black Mixed and Black Other census categories have the worst access, experience, and outcomes in our mental health services. In this first iteration of PCREF, we are focusing on these groups.
Our PCREF programme is focused on the three core components also known as our priorities:
- Part 1: Leadership and Governance – these are national expectations on all NHS Mental Health Trusts to fulfil their statutory and legal requirements. Our PCREF approach will demonstrate compliance against six requirements, through several areas that will be monitored and reviewed by ethnicity by the Trust Board.
- Part 2: National Organisational Competencies (NOCs) – these are ten core competencies a culturally responsible mental health service should demonstrate. At our Trust, Part 2 is broken down into three key areas:
- NOCs Change Ideas: Our Trust chose six competencies to explore and developed ‘change ideas’ to address local issues.
- Local OCs – Anti-Racism Action Plan: The Trust made a commitment in it’s Strategy to be leading anti-racism in Mental Health care by 2026. A Joint PCREF Partnership/Trust Strategy Group has been set up to develop this plan and the steps on this journey.
- Evaluation of Change Ideas and Anti-Racism Plan: This will be a quarterly review of the patient and service outcomes and adoption and engagement of PCREF through a racialised lens, using the Proctor Framework.
- Part 3: The Patient and Carers Feedback Mechanism – this component seeks to embed patient and carer voices at the heart of the planning, implementation and learning cycle.
If you would like more information on what the PCREF Partnership Programme is doing to address these, please contact us.
The PCREF Partnership Teams in each of the four London boroughs the Trust operates in – Croydon, Lambeth, Southwark, and Lewisham – have been working on the National Organisational Competencies (NOCs) from NHS England. They initially co-created definitions for their NOCs that relates to our PCREF approach and began designing ‘Change Idea’ projects that will have a measurable impact on the access, experience, and outcomes of Black patients in the Trust's care.
These Change Ideas are practical projects where we can test and learn if improvements are being made. They will fit in to the PCREF metrics, a set of six indicators which will support the Trust to reach equity in specific areas.
The six chosen NOCs based on local priorities are:
- Cultural awareness
- Staff knowledge and awareness
- Partnership working
The six agreed PCREF Metrics for the Trust are:
- Equity in service user by ethnicity
- Equity in diagnosis of psychotic spectrum disorders by ethnicity
- Equity in use of medication for Black people with a diagnosis of psychotic spectrum disorders by ethnicity
- Equity in the use of detention by ethnicity
- Equity in the use of seclusion and restraint by ethnicity
- We will develop culturally appropriate and accessible measures of recovery
Further information on this is available through the PCREF membership newsletter. Please get in touch for more information.
'Aiming High; Changing Lives' is our Trust's five-year strategy. It sets out the organisation’s focus from October 2021 – October 2026 and we are pleased to see PCREF embedded within it. This is an important strategic step for PCREF becoming ‘business as usual’ in the way our Trust operates.
Read more about the strategy: Aiming High; Changing Lives - Our Strategy 2021-2026
You are welcome to attend regular six-monthly engagement events, which will update on the progress of the Trust Strategy.
Join the PCREF membership and be informed of upcoming dates to join these events and receive important PCREF updates.