Patient and Carers Race Equity Framework (PCREF)

The Patient and Carers Race Equity Framework (PCREF), a recommendation of the Mental Health Act Review is part of the NHS Advancing Mental Health Equalities Strategy.  This anti-racism framework intends to support NHS trusts to improve access, experience, and outcomes for people from communities that experience racial inequalities.  This includes the provision of a psychologically safe work environment that is diverse and representative of the communities it serves. 

As part of our commitment to becoming an anti-racist organisation we have been working with NHS England and NHS Improvement supporting the development of the Patient and Carer Race Equity Framework (PCREF). In testing our approach, we have chosen to implement the framework through our Advancing Equity and Inclusion Strategy 2022-25.   This is to ensure we provide visible senior leadership on advancing racial equity in relation to reducing health inequalities, advancing equity in mental health services, and promoting inclusion in our workforce.

 

Leadership and Governance

Organisations need to commit to the principle that anti-racism work matters and ensure leaders see it as a priority for them as well ( NW Anti-Racism Framework, 2021 )

As Deputy Chief Executive Andrew Maloney has responsibility leading on tackling health inequalities including our commitment to becoming an anti-racist organisation.  Our Advancing Equity and Inclusion Strategy 2022-25 has been supported by investment in an Equality Diversity and Inclusion Team.  The Team have been working alongside our Equality Diversity and Inclusion Research Unit (EDI-RU) to support the implementation of the Patient and Carer Race Equity Framework (PCREF). 

To further support this we will establish an Anti-Racism Steering Group and continue to work in partnership with our Black Asian and Minority Ethnic Staff Network and members of our ethnically diverse community to co-produce our anti-racism action plan.  This plan will set out the actions required to roll out the Patient Carers Race Equity Framework (PCREF) across the organisation and help us drive forward improvements. 

 

What immediate actions will we take?

  • A review of our Board Assurance Framework and ensure performance metrics are disaggregated by ethnicity and indices of multiple deprivation (NHSE, 2022; NHSE, 2023).  December 2023 
  • All board and executive team will identify and be accountable for at least one equality related objective as part of their annual appraisal process (NW Anti-Racism Framework, 2021).  In developing these objectives consideration will be given to our core values as an organisation and they will be linked to the cycle of board activities framework (NHS Race Observatory, 2021).
  • Deliver the Trusts new leadership approach: Role Model- Coach- Care and deliver a 12-month pilot Inclusive Leadership Training Programme which focuses on anti-discriminatory practice including ant-racism and the importance of being an active bystander as an inclusive and compassionate leader. A minimum of 12 sessions 15 x 12 Participants – 180 Leaders August 2024 
  • Outline an 'Equality Data Quality Improvement Plan' making year of year improvements with an overall ambition to have 95% accurate data on all protected characteristics including race across both our services and workforce (NHS Digital 2022, NHSE, 2023). October 2023
  • Develop guidance on using the internal clinical audit process to interrogate local Data Quality Maturity Index (DQMI) information related to data quality of protected characteristics and other vulnerable groups and identify actions to improve the accuracy of our data where it falls below 95%.  To focus on accommodation status, disability, ethnicity, gender identity and sexual orientation.  October 2023
  • Development of a set of Mental Health Act data dashboards disaggregated by ethnicity, gender and learning disability or autism to support the Draft Mental Health Bill 2022 and monitor and tackle racial inequalities in mental health services and provide stronger safeguards for people with learning disabilities or autism (UK Parliament, 2023). June 2023 ​​​​​​
  • Development of a set of Restrictive Practice data dashboards disaggregated by ethnicity, gender and learning disability or autism to support the implementation of the Mental Health Units (Use of Force) Act 2018 or ‘Seni’s Law’ that came into force in 2022.  Date TBC.
  • A review of our routine outcomes monitoring data for adults, children, young people and perinatal (including inpatient) mental health services and disaggregated the data by ethnicity to highlight any areas for concern and inform future priorities (CQUIN: 2023/24 guidance). October 2023 
  • Implement the NHS Equality Delivery System 2022 in partnership with the Greater Manchester Integrated Care Board (GM – ICB) and the GMCA Equalities Panels with a focus on CYP Services, and Interpretation Services for 2023/24 (NHSE, 2022 Core 20 Plus 5). February 2024

 

Organisational Competencies

Organisations need to engage with racialised and ethnic minority communities to identify and agree core organisational competencies requiring further development ( PCREF, 2022 ).

In exploring the Patient and Carer Race Equity Framework (PCREF) competency themes originally outlined by NHS England we have engaged with community led organisations to try to better understand the barriers and enablers to accessing mental health services for people and communities that experience racial inequalities. 

We have been working with colleagues in the GM Integrated Care Board (ICB) to support the evaluation of the GM-ICB Culturally Appropriate Mental Health Services Fund (CASF). To support and sustain innovation in how culturally appropriate services can be delivered in partnership with community led organisations as part of the wider adult Community Mental Health Transformation Programme (CMHTP), the GM Integrated Care Board (ICB) Culturally Appropriate Mental Health Services Fund (CASF) was established.

The development and delivery of the Fund was led by the System Lead for VCSE Integration (Mental Health) a secondment from Mind funded by the GM Integrated Care Board (GM ICB) and supported by the Head of Equality Diversity and Inclusion at GMMH.

Three objectives were outlined, which included:

  • Partnership Model.  To develop a partnership model that enables community led organisations to work alongside and in partnership with mainstream providers in an integrated inclusive way.
  • Culturally Appropriate Inclusive Integrated Mental Health Services.  To support innovation in how culturally appropriate integrated mental health services can be delivered in partnership with community-led organization's as part of the wider Community Transformation Programme.
  • Reducing racial inequalities in mental health services in Greater Manchester. To reduce racial inequalities in mental health services with respect to access, experience, and outcomes across Greater Manchester.  

A total of 31 services were commissioned across three workstreams including i) core ii) innovation and iii) wellbeing services.  These services aimed to support a range of racialised communities including African and Caribbean, Bangladeshi, Pakistani and Indian, Chinese, Afghan, Persian, Dari, and Middle Eastern, Roma, Orthodox Jewish along with services specially supporting Refugee and Asylum Seekers were funded for an initial 12-month period.

To help us evidence impact we established a small evaluation team consisting of the Director of the Equality Diversity and Inclusion Research Unit at GMMH, the Head of Equality Diversity and Inclusion, GMMH; and Senior Research Assistant, EDI Research Unit, GMMH.   The team outlined an evaluation framework, which was kept purposefully simple weighing the pressure on services against the need to demonstrate effect.  The evaluation was broken down into 3 phases 1) October 2022 2) March 2023 3) July 2023.  In total 29 of the 31 services engaged in the evaluation. 

The GM ICB Culturally appropriate Services Fund Year 1 and its evaluation has yet to be completed.   However, it’s clear from the interims reports that the fund has enabled providers to offer a range of interventions to a variety of ethnically diverse populations. 

 

Partnerships

To support the evaluation a Culturally Appropriate Services Evaluation Network was established. Service providers noted that the Network encouraged ‘collaborations with other services’ funded and facilitated information sharing about reporting requirements ‘increasing standards for collating data and impacts for our service users supporting learning for future projects’.  15 of the services funded reported working collaboratively with statutory services taking referrals from and making referrals into services, signposting and supporting people to navigate the system.  The importance of consistent contact and structured approaches to communication was highlighted as facilitating successful partnerships and improved referral pathways.

 

Next Steps

  • Host an event 'Advancing Race Equity through the Community Mental Health Transformation Programme (CMHTP)' to bring providers funded through the GM Integrated Care Board Culturally Appropriate Mental Health Services Fund (GM ICB CASF) together with providers of community mental health services at GMMH and co-produce a partnership agreement that enables community led organisations to work alongside and in partnership with mainstream providers in an integrated inclusive way. December 2023. 

 

Culturally Appropriate Inclusive Integrated Mental Health Services

By the end of Phase 1 27 services had been established in line with the original specification, 2 had been established following some agreed amendments.  By the end of Phase 2 (3rd March 2023) 1625 service users had engaged in services across the 3 workstreams and 1173 had 2+ contacts.  Between 1st August 2022 to 3rd March 2023 the GM ICB Culturally Appropriate Services Fund facilitated 7444 contacts with people from ethnically diverse communities across the Greater Manchester.

In providing culturally specific services providers highlighted the importance of meeting basic cultural needs often missing from mainstream services such as appropriate food options, faith accommodations, spiritual counselling, and productive conversations on faith and spirituality. On a practical level ethnically diverse and multilingual staff with an understanding of the sometimes-intricate nuances of communities supported effective therapeutic relationships. For many, services were seen as ‘cultural hubs’ or ‘social cafes’ where people could seek support on a variety of issues including finances, access into physical health services as well as mental health services. 

 

Reducing racial inequalities in mental health services in Greater Manchester.

Monitoring on access has been aligned to 5% year on year increase in the number of adults and older adults supported by community mental health services, paying attention to the 2 + contacts measures outlined by NHS England (NHS Planning Guidance, 2023/24).  This has allowed us to clearly demonstrate how these services and the GM ICB Culturally Appropriate Services Fund are contributing to the wider strategic goals on the Community Mental Health Transformation Programme (CMHTP).  This has supported our case and has enabled us to secure funding for Year 2 (2023/24) and Year 3 (2024/25).  

Monitoring on experience 11 of the services funded report that they have co-produced service user experience questionnaires using a variety of methods including holding group discussions and 1-2-1 interviews with people with lived experience, and in one case utilising a suggestions box.  Service providers reported that overall, 60% (974) of service users supported by the fund completed a questionnaire and all of those that did respond agreed that the services provided were culturally appropriate for their needs.  Feedback has been that service users’ reported improved access to support in safe spaces ‘I feel safe coming here’ which enabled them to better able to manage crisis points. Being able to access services which provided support not labelled as ‘mental health’ helped reduce stigma and increase confidence in accessing services. In cases of early intervention carers felt supported and informed ‘I know now where and how to get the help I need for my son’. 

 

Next Steps

 

Using a capacity-based approach and being directed by the community led organisations meant that the services established met the needs of the intended target population.  The purpose of the fund has not been to dictate to communities what is needed rather its aims to build on what is known in communities and act in a facilitative capacity.  In this way we have been able to co-produce what good looks like with respect to several of our core Patient and Carer Race Equality ‘Organisational Competencies’ including i) Inclusive Co-production ii) Culturally Appropriate Services and iii) Inclusive Partnerships.

As a patient

As a service user, relative or carer using our services, sometimes you may need to turn to someone for help, advice, and support. 

Find resources for carers and service users  Contact the Trust