Patient and Carer Race Equality Framework (PCREF)

It is now widely accepted that people from racialised communities have very different access, experiences and outcomes in the care they receive in NHS mental health services. The stark evidence of these inequalities is led to the national Mental Health Act review in 2018. One of the key initiatives to emerge from that review is the Patient and Carer Race Equality Framework (PCREF), the first-ever national anti-racism framework for the NHS.

It lays out an approach to anti-racism within mental health trusts in England, working hand in hand with affected communities to reduce health inequalities and improve experiences of care. As one of four national pilot sites for PCREF, South London and Maudsley NHS Foundation Trust has been working with NHS England since 2020 to inform and shape its wider implementation, set to begin in 2024.

Co-production is at the heart of PCREF, which uses a ‘triple leadership’ model involving the NHS trust, minority-led voluntary and community sector (VCS) organisations and patients and carers representatives working together as equals. In south London, Black Thrive Lambeth and Croydon BME Forum were the designated VCS organisations, with Maudsley Charity funding Croydon BME Forum’s participation.

Before work on solutions could begin in earnest, the programme supported these stakeholder groups to become ‘fit for partnership’ helping to develop the capacity and confidence of each group, provide access to key information and come to a shared understanding of the issues.

Over the past three years, South London and Maudsley has been embedding PCREF at scale across its mental health services, in an ongoing process that has involved nearly 600 people to date.

In 2022, the Trust launched its first anti- racism vision statement as part of its overall strategy, committing to applying “anti-racism approaches to remove the conditions that hold systemic racism in place.”

It has worked with experts from the Black community to develop an Anti-Racism Action Plan. As a result, mandatory recording of patient ethnicity data has been introduced to consistently identify, monitor and hopefully address unequal outcomes.

Staff initiatives on race inequalities have also been strengthened by being brought under the umbrella of PCREF, ensuring a more systemic approach to the Trust’s journey to becoming an anti-racist employer.

One key output of the PCREF partnership has been the development of a series of innovative ‘Change Ideas’ to embed anti- racist approaches across the Trust. Together, the stakeholders evaluated each of these ideas for its potential to shift the conditions holding unequal treatment in place. A final shortlist of nine Change Ideas were selected to be taken forward across the Trust.

In 2023/24, Maudsley Charity committed a further £991,566 to fund the implementation of these nine ideas. With NHS budgets increasingly stretched, this significant investment ensures that action to advance anti-racism activities can be advanced. These projects will address the disproportionate use of restraint, seclusion, and detention against racialised and ethnically and culturally diverse communities, with a focus on:

• Cultural awareness – staff developing cultural knowledge, informed by the lived experience of service users, to be applied in both inpatient and community settings.
• Co-production – staff and service users co-creating a number of improvements to measure patient outcomes and satisfaction.
• Co-learning – staff and service users working together to jointly examine complaints and incidents using a racialised lens.

The ‘triple leadership’ model that has been so crucial throughout the development and selection of the Change Ideas will continue to inform their implementation and evaluation. Progress is likely to be both gradual and incremental. Keeping the community involved and managing expectations will be essential to shift the historic power imbalance between decision- makers in the Trust and the people it serves.

The PCREF team has framed real, systemic change is a collective responsibility. Over the next three years, Maudsley Charity is committed to supporting the Trust to engage with difficult questions and meet challenges set by its communities, helping it become the best service it can be.