Patient and Carer Race Equality Framework

The Patient and Carer Race Equality Framework (PCREF) was a key recommendation following the national Mental Health Act Review in 2018. PCREF is NHS England’s first ever anti-racism and accountability framework to tackle and eliminate the unacceptable racial inequalities in access, experience and outcomes faced by racialised and ethnically and culturally diverse communities and to significantly improve their trust and confidence in mental health services.

The PCREF is split into three core components:

• Part 1: Legislative and regulatory obligations (Leadership and Governance)
• 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 the relative levels of access, experience and outcomes (AEO) across the recorded ethnicities. Our Trust data shows that people from Black African, Black Caribbean, Black Mixed and Black Other census categories are likely to have the poorest AEO with us and therefore in this first iteration of PCREF, we have been focusing on these groups. We will talk of ‘Black communities’ in our materials which refers to all four census categories listed above.

In November 2023, the PCREF was launched nationally across England and will become mandatory in all mental health services from April 2024. PCREF will also form part of the Care Quality Commission

(CQC) assessments. Our Trust was one of the pilot sites developing the framework together with the other NHS Trusts and the NHS England staff and governance structures. To find out more, please see NHSE Patient and Carer Race Equality Framework.pdf [pdf] 24MB.

This ambitious programme is only possible through true partnership working by drawing upon local experiences. From the outset, we have partnered with two Black-led community organisations, which we refer to as Host Organisations and local Independent Advisory Groups (IAGs) made up of service users, carers and community members to deliver the programme.

• Lambeth Black Thrive hosts the Lambeth and Southwark IAG
• Croydon BME Forum hosts the Croydon and Lewisham IAGs

Everything we do involves counting to three. This means we have a Black service user / carer representative, a Black community representative and a Trust staff representative involved in decision making processes and to ensure we keep 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 organisation is led by the Chair, Sir Norman Lamb and Chief Executive, David Bradley.

Find out more about our host organisations:

Visit Black Thrive Lambeth  Visit Croydon BME Forum

Contact PCREF

Our Trust data shows that patients from Black African, Black Caribbean, Black Mixed and Black Other census categories are likely to have the poorest access, experience, and outcomes in our mental health services. In this first iteration of PCREF, we have been focusing on these groups.

Our PCREF programme is focused on the three core components also known as our priorities:

• Part 1: Leadership and Governance – Legislative and Regulatory Obligations (Leadership and Governance) – Our Trust’s Board will be leading on establishing and monitoring plans of action which fulfil our statutory and legal requirements. 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 the team.

 

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:

1. Cultural awareness
2. Staff knowledge and awareness
3. Partnership working
4. Co-production
5. Workforce
6. Co-learning

The six agreed PCREF Metrics for the Trust are:

1. Equity in service user by ethnicity
2. Equity in diagnosis of psychotic spectrum disorders by ethnicity
3. Equity in use of medication for Black people with a diagnosis of psychotic spectrum disorders by ethnicity
4. Equity in the use of detention by ethnicity
5. Equity in the use of seclusion and restraint by ethnicity
6. 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.

South London and Maudsley Trust is driving racial equity via PCREF, embedding leadership, metrics and lived experience to lead bold, system-level transformation.

Read the 2025/26 South London and Maudsley NHS Foundation Action Plan here