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The Patient and Carer Race Equality Framework (PCREF) is a recommendation following the 2018 independent review of the Mental Health Act. As NHS England's pioneering anti-racism framework, PCREF empowers Trusts to enhance services for diverse ethnic, racial, and cultural backgrounds. (NHSE easy read version available here).
Starting our PCREF journey in 2021 alongside three other Pilot Trusts, ELFT engaged with community organisations, service users, and carers to gather insights during the pilot phase. Sharing our findings with NHS England, we launched PCREF locally in November 2023, ahead of it becoming mandated across NHS Mental Health trusts and integrated into CQC inspections.
At ELFT, we are strategically implementing PCREF across our mental health directorates and services. Our PCREF approach addresses race, ethnicity, and intersectionality, encompassing the Equality Act's nine protected characteristics, lifestyles, neurodiversity, and special educational needs. Applicable to all mental health pathways, we recognize the disparities faced by minority communities and prioritize coproduction and implementation through partnerships with local statutory services and community organisations.
The PCREF’s approach focuses on race and ethnicity, but it also considers the intersectionality of patients and carers. This includes the Equality Act’s nine protected characteristics, lifestyles, neurodiversity and special educational needs.
The PCREF applies to all mental health pathways for older adults (65 plus), adults (18-64), children and young people (0-25). Our Trust data shows that patients from Black, Asian and other ethnically minoritised communities have the worst Access, Experience and Outcomes in our mental health services.
At ELFT, the PCREF is a partnership with local statutory services, such as the police, local authorities and the community and voluntary sector. By collaborating widely, the PCREF will bring together Trust staff, service users, and their carers. Our aim is to ensure diverse and minoritised communities are coproducing and implementing the PCREF into standard practice.
Implementing the PCREF is mandatory, and the framework will form part of CQC inspections. Each Directorate will work towards the PCREF goals by responding to the needs of their individual populations, taking decisions on a local level about required actions. A robust leadership and accountability structure will be developed with stakeholders to facilitate Trust-wide adherence to and delivery of the PCREF.
ELFT is dedicated to ensuring a robust leadership and governance structure to effectively implement PCREF Part 1. This involves addressing 12 key legislative and regulatory requirements that have significant implications for racially and ethnically diverse communities.
The Trust have established a PCREF Steering Group which is co-chaired by a Clinical Director and a Service User Representative from our Trust wide service user forum the EDI Working Together Group.
The role of PCREF steering group is to provide strategic direction for PCREF, which includes steering and overseeing the development and delivery of the PCREF framework for implementation in our mental health services focusing on equity of access, experience, and outcomes.
If you are a service user and would like to get involved, please contact: elft.join.edi-team@nhs.net
If you are a VCSE, or other type of organisation and you would like to get involved in this work, please contact the EDI Team.
The session will cover six national competencies, as well as ELFT’s two regional competencies. These are as follows:
National Competencies:
Local Competencies:
Recognising and understanding the needs of the diverse cultural backgrounds of the communities a Trust serves. This encompasses awareness of and sensitivity to socioeconomic issues faced by local populations, to ensure services are more inclusive.
Recognising and understanding the racialised experiences of the communities a trust serves and overcoming biases and prejudices by acting upon them.
This means that mental health services work more closely with racialised and ethnically and culturally diverse communities, leaders and other organisations beyond the NHS, such as religious groups, ethnic led VCSE organisations, social care and others to support wellness in the round.
Ensuring ethnically and culturally diverse patients and carers are treated as equal partners in decision making on their care and treatment plans, and actively involved in the design, development and review of care pathways. When describing a service, project or piece of work as coproduced, this must mean power-sharing from design to delivery.
This is a two-way process that strengthens collaborative knowledge sharing beyond co-production principles and focuses on how trusts can raise awareness of early intervention support amongst racialised and ethnically and culturally diverse communities and learn more about community concerns and barriers in return.
A culturally competent and diverse workforce that has a positive impact on patient and carers from racialised and ethnic minority communities; and creates a safe space where the workforce champions inclusive leadership, shares learning, intentionally embeds anti-racist approaches, and tracks progress.
Trauma-informed care is an approach acknowledging that mental health issues often stem from trauma and adversity. Trauma-informed practice aims to increase practitioners’ awareness of how trauma can negatively impact on individuals and communities, and their ability to feel safe or develop trusting relationships with health and care services and their staff.
This means understanding the unique needs of people with multiple marginalised identities, such as Black LGBTQIA+ people or disabled people of faith.
A patient and carer feedback mechanism will establish clear and effective processes that ensure feedback is received, reported, and acted on. This will include the development of a racialised question for patients and carers. This is being actioned by an NHSE task and finish group, and groups within ELFT, including the Carers Strategy Group.
