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Transforming Mental Health Services: The Impact of the Patient and Carer Race Equality Framework

In November 2023, the Patient and Carer Race Equality Framework (PCREF) was introduced, marking a significant step in addressing racial disparities in mental health services. We explore the PCREF's impact and what it means for mental health providers.

Evidence of racial inequalities within mental health services in England is stark. And through our work on the NHS England commissioned Mental Health Act Quality Improvement Programme, we’ve had honest and reflective conversations with clinicians who recognise the impact of (often unintentional) power & privilege, assumptions and under-represented populations on their inpatient wards, which can perpetuate inequalities for patients from ethnically diverse backgrounds.

Transforming Mental Health Services: The Impact of the Patient and Carer Race Equality Framework

Image published by NHS England 

In November 2023, we welcomed the national launch of the Patient and Carer Race Equality Framework (PCREF), a statutory race equity and accountability framework for mental health service providers in England. Here we share some of our insights on how providers will need to respond. 

What is the Patient and Carer Race Equality Framework (PCREF) and why has it been launched now? 

In 2018 the Independent Review of the Mental Health Act found the Act needed significant reform. A key recommendation of the Review was the development of the PCREF, a framework to improve racialised communities’ trust and confidence in mental health services.  

The framework has been tested throughout 2022/23 by four PCREF pilot trusts and six self-selecting early adopter sites and has been coproduced with experts by experience, communities, patients and carers. It aims to support NHS Trusts and secure facilities to improve the access, experiences and outcomes of racialised communities, by providing practical steps to deliver culturally responsive care.  It has also been developed with other providers in mind, including those within the independent sector, voluntary sector organisations, social care services and police forces across England.  

The PCREF is a core element of NHSE’s Advancing Mental Health Equalities Strategy, and forms part of a journey towards services which are, in the words of Dr Jacqui Dyer (Chair of the PCREF steering group), ‘anti-racism, anti-oppressive, anti-discriminatory and are rights based’.   

What difference will patients, their families and carers notice? 

‘Making decisions with communities not for them’ - Erk Gunce, Expert by Experience within the NHS England mental health team.  

This anti-racism framework aims to bring ‘ground-breaking change’ to the mental health sector, centring individuals and communities in the design and implementation of services that they use. Service-users, their families and carers from racialised communities should notice increased engagement, including opportunities to co-develop and review local PCREF plans and have their voices heard at board level. We’re beginning to hear about “lived experience mentoring” initiatives where people with lived experience of mental ill-health provide mentoring to Trust executives – and we’re fascinated to track how this develops.   

The plan calls on Trusts to improve patient and carer feedback mechanisms: with the use of patient experience data to drive lesson-sharing and improvement, and the implementation of real-time and transparent feedback mechanisms. This will result in services which are better tailored to the needs of the community, where patients and their families have their voices heard, and where improvements can be made quickly. 

What will mental health providers need to do differently?  

The PCREF framework was launched nationally on 3rd November 2023, and its adoption by providers will become mandatory by the end of 2024/25. By the end of March 2024, Trusts will need to develop a localised PCREF plan will then be evaluated against PCREF requirements as part of CQC inspections.  

Specifically, trusts will be required to: 

  • Review their governance structures and board-level accountability
  • With particular focus on elevating the voices of the community representatives and ensuring better representation of racialised people at trust board-level
  • Review business planning for 2024/25 to agree resources to rollout the framework
  • Plan for how the PCREF will be embedded at a: service / operational level across older adults, adults and children and young people. And at an ICB level - with local population planning for racialised communities, community assets planning and using the information available to coproduce plans to reduce inequity in access, experience and outcomes
  • Put in place strategies, monitoring and reporting and strengthen data collection and flow requirements underpinning the PCREF 
  • This includes improving data collection around ethnicity and other demographic  
  • Regularly review and monitor the impact of PCREF-related initiatives 

How can Trusts successfully roll out the PCREF?  

Common to all transformational work, we think that Trusts need to have in place two key elements to successfully roll out the PCREF, and ensure a centrally-supported, locally-owned approach

  1. Strong strategic leadership: setting up the strategic agenda, governance and generate buy-in across executive and clinical leadership groups. 
  2. Locally-led schemes to deliver improvements: mobilising delivery programmes and providing capability-building to implement the framework across mental health service design and quality improvement initiatives. 

Lived experience involvement is critical here – at both a strategic level and a delivery level. This means recruiting and involving lived experience practitioners from the outset, and supporting them to work effectively alongside clinicians and managers in a way that is both complementary and challenging.  

The PCREF is an exciting opportunity to improve experiences and outcomes for people from racialised communities, reduce inequalities in mental health delivery and embed the voices of service users and what matters to them. 

And at The PSC we have extensive experience in tackling health inequalities. We’ve also supported providers to gather protected characteristics data, set up appropriate governance structures and develop service-level roadmaps. 

The PSC Transformation team 

The PSC exists to make public services brilliant. Our collaborative tried and tested approach to transforming services is focused on creating meaningful and lasting change. We work together to analyse and diagnose your situation, devise a programme of support, then make it happen. In doing so we empower your people to deliver, unlocking ongoing results. If you would like to talk to our Transformation team about how we might help your organisation harness the potential of the PCREF, please contact Harris Lorie:  


Jessica Solomon  

Harris Lorie 

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