NELFT PCREF Logo - Patient and Carers Race Equality Framework (PCREF)

Patient and Carer Race Equality Framework (PCREF)

The Patient and Carer Race Equality Framework (PCREF) was a recommendation following the national Mental Health Act Review in 2018 and NELFT is one of 7 trusts in the country who are early implementers of the framework. In our Trust, PCREF exists to eliminate the unacceptable racial disparity in the Access, Experience and Outcomes of Black, Asian, and minority ethnic communities and significantly improve their trust and confidence in our mental health services.

What is PCREF?

PCREF, (Patient and Carer Race Equality Framework) has been developed as a framework by NHS England and NHS Improvement, to address mental health inequalities amongst different racial groups.

The Patient and Carer Race Equality Framework (PCREF) was a recommendation following the national Mental Health Act Review in 2018. PCREF is the NHSE accountability framework to eliminate the unacceptable racial disparity in the Access, Experience and Outcomes (AEO) of Black, Asian and Minority Ethnic communities and to significantly improve their trust and confidence in mental health services.

The PCREF Framework presents in three parts:

PCREF Part 1 Leadership and Governance [Statutory and Regulatory obligations]:

Covers the laws and regulations of all Trusts under key pieces of legislation or national policy.

1.Trusts will be given advice on how to demonstrate their obedience to these obligations using a self-assessment tool and pointers on how to become fully compliant.

2. We are working with different government agencies to specify these core obligations.

PCREF Part 2 Organisational Competencies [Cultural & Practice change]:

Covers the organisational competencies Trusts will be asked to improve. Areas of focus will be explored in consultation with ethnic minority communities and staff and Trusts will be asked to identify actions to strengthen those competencies and implement them.

PCREF Part 3 Feedback Mechanism [Patient and Carer experience and co-production]:

Covers the way by which patient/carer feedback will be sought and acted upon, using the principles of transparency and timelines. Trusts will be expected to improve the collection of patient experience data and put in place a system/approach which allows these experiences to be learned from.

This should provide a well-rounded view of how patients are getting on, how they feel about the service and whether the actions the Trust are currently undertaking are demonstrating an impact. Once the measures are agreed, how the measures will be reported back to communities and learned from will be agreed and tested.


The priority areas our trust has chosen to focus on is the black male experience whilst in talking therapies and acute wards, the south Asian women experience in accessing talking therapies and the abuse and identification of carers.

We have chosen these priority areas due to trust data showing that these groups have the worst access, experiences and outcomes in our mental health services. We also aim to change the experience of carers as they are an important part of this framework so we will be launching a carers strategy in 2023/24. We will also be continually collaborating with local communities, voluntary organisations and faith organisations .

There are three component parts to the NHS England PCREF that we are considering how we measure, these are also our priorities:

  1. Statutory and Regulatory Obligations
  2. Organisational Competencies
  3. Patient and Carer Feedback and Assessment tool

NHS England’s National Organisational Competencies are 10 core competencies a culturally responsive mental health service should demonstrate. Six of the ten organisational competencies (below) were highlighted as the most important competencies from the community. They are: 

  • Cultural Awareness
  • Co-production
  • Partnership Working
  • Staff Knowledge and Awareness
  • Co-Learning
  • Workforce
  • Leadership and Governance
  • Use of Data
  • Digital Inclusion
  • Information and Advice

Our events

A special thank you to everyone who attended our PCREF events over the last year. These events were touching and informative and have been a great starting point in helping us develop this framework. Below are some of the key themes we gathered from each event.

Users of service event: From the feedback the Importance of religion and faith was apparent and spiritual care was just as important than medical care for some. Users of service expressed how they would want Managers and carers to have spiritual and cultural awareness training. Transparency for patients was also a key theme for example wanting to see their care plan, having access to more information about their diagnosis/treatment etc. Another important theme was that patients just wanted Safe spaces to express how they truly feel without backlash and to be seen and heard as a person and not just a patient.

Carers event: The key themes in the carers event were loss of identity, the sense that carers want to feel like themselves again and many emphasised the fact that they wanted to take some time out of their day to just do what they want to do. Guilt was also a theme, throughout feedback, they expressed that they rarely get to do the things they want and when they do they feel as if they shouldn’t be doing it. Another recurring theme is mental health this was mentioned throughout most answers whether it was for highlighting their struggles with MH or for making mental health awareness courses more accessible for carers. In terms of what can be helpful- the most common idea mentioned was therapy and mental health awareness courses. Also, someone checking in on them by phone and managers allowing time off work for mental health.

Staff event: Throughout the feedback some of the key themes that came up across the priority areas was more representation and diversity in staffing at all levels, raising awareness of mental health and eradicating the stigma surrounding it and working closer with local communities, organisations, and religious groups to build partnerships. Also, with regards to carers including their voices in the assessments and offering respite care and better processes for escalating concerns. Lastly, in order to improve data collection was offering payment and recognising that it is a job and educating users of service/carers on the importance of data.

Lastly, we want you to know how important this framework is to NELFT with the help of our PCREF delivery group, users of service, carers, staff, voluntary and faith organisations we hope to eradicate race inequalities in access, experience, and outcomes for our Black, Asian and minority ethnic patients and carers.

Trust commitment- Our pledges

Executive pledges

Event images
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Meet the team

Below is our PCREF delivery group who are passionate about implementing this framework in NELFT.

Wellington Makala Debbie Smith Julie Jaye Charles CBE

Wellington Makala

Debbie Smith

Julie Jaye Charles CBE

Executive Chief Nursing Officer/Executive Director AHP & Psychological professions Director of Nursing/Patient Experience

Board advisor & Lead on Advocacy and Co-production 

Harjit Bansal Asia Zaman
Harjit Bansal Asia Zaman
Head of Equality, Diversity & Inclusion Project Manager



Lee Chester, Associate director of Nursing/Patient experience

Tracy Fletcher, Head of Patient Experience

Kalpna Patel, Involvement representative

Tarek Seeraullee, Carers lead

Anna Tsirmpa, External communications and engagement manager

Stephen Reid, Knowledge specialist

James Hurst, Knowledge specialist

Mkieva Bray, EDI administrator