NHS England has published its first ever anti-racism framework to improve experiences of care for racialised and ethnically and culturally diverse communities.
The Patient and Carer Race Equality Framework (PCREF) was launched on Monday 30th October 2023 and is specifically aimed at supporting mental health trusts and providers to tackle systemic racism, become actively anti-racist and “shift the dial on race equality.”
It applies to all mental health pathways, including community mental health services, inpatient services, secure care, talking therapies, children and young people and perinatal care. It also applies to the care of adults, older adults and children and young people.
Data shows vital nature of anti-racism framework
The anti-racism framework was developed in response to data that revealed that people from Black and Black British groups are 4-5 times more likely to be detained under the Mental Health Act than their white counterparts. They were also more likely to be restrained in inpatient units and far more likely to encounter mental health services within the criminal justice system.
Data also shows that people from other racialised groups also experience poorer access to mental health care, with increased use of crisis pathways, leading to more negative experiences and outcomes compared to white majority counterparts.
Drawing on the experiences of racialised communities, the PCREF is designed to cater for them in 3 main ways:
- Naming racism
- Identifying how it operates in health and care services
- Working with communities to organise and create meaningful actions from these insights
Fundamentally, the anti-racism framework was developed to improve access, experiences and outcomes for racialised and ethnically and culturally diverse communities, patients and carers.
“Significant progress” on anti-racism in the NHS
The programme partnered with four pilot NHS trusts and six early adopter sites across the country. They trialled embedding the new anti-racism framework in different and innovative ways and, over the last 3 years, have reflected on the needs of their local communities.
Dr Jacqui Dyer, an independent health and social care consultant and the Mental Health Equalities advisor for NHS England who led the creation of the framework, and Dr Habib Naqvi, the Policy Lead for the NHS Workforce Race Equality Standard (WRES), report that these pilot sites are “subsequently making significant progress towards becoming actively anti-racist organisations.”
They say the key to doing this is “elevating the voices of service users, carers, and communities to inform service improvements,” – something which is a vital part of implementing the PCREF.
“Every NHS trust’s journey will look different because no area’s population demographic is the same as another.
“These pilot trusts have shown us what is possible when we listen to local communities and work with them to deliver care that is culturally appropriate trustworthy and meets their needs.”
Anti-racism framework an “invitation to engage” with communities
The NHS Race and Health Observatory’s Systematic Review into ethnic health inequalities recommends that NHS trusts work with partners and stakeholders across public service, the voluntary sector and community organisations in order to demonstrate their commitment to tackling racial inequality in mental health care.
To ensure that ethnic minority patients receive high-quality, safe, compassionate and person centred care, NHS providers must establish relationships with ethnic minority communities. NHS England’s new anti-racism framework is designed as the intervention and enabler to facilitate this.
Doctors Dyer and Naqvi herald it as “a powerful example of embedding genuine anti-racist practice into the day-to-day working of the NHS.”
The hope now is that this can be replicated elsewhere in the system.
The PCREF is intended to provide mental health trusts and providers with an essential tool with which to tackle disparities in mental health care, but it should also serve as an invitation to engage with the diverse communities that providers serve.
NHS services must also now work together, share successes, failures and best practice and “combine their collective expertise for the benefit of all patients and service users.”
Fighting for a fairer system
In the foreword to the new anti-racism framework, Dr Jacqui Dyer spoke of how she has witnessed health and care inequalities firsthand:
“I am driven to fight for a fairer system where people from racialised communities no longer have significantly worse experiences and outcomes.
“I have lost two brothers, who throughout their lifetime grappled with long-term mental health challenges, and sadly died young, Barry at age 53 and Carlton at 41. In 2023, I also lost my aunt, who died whilst in the care of mental health services.
“It has been extremely difficult for me to see how my loved ones were failed by mental health services where they endured racialised experiences. I live every day with the excruciating thought that if culturally appropriate care had been available for them, they may have been alive today.”
The anti-racism framework consists of 3 core components:
- Part 1: Leadership and governance – which includes legislation and regulatory obligations
- Part 2: National organisational competencies – this aligns with the vision in the Independent Review of the Mental Health Act 2018 (MHA)
- Part 3: Patients and carers feedback mechanism – this seeks to embed patient and carer voice at the heart of the planning, implementation and learning cycles
It also outlines guidance for implementing the framework, next steps, examples of what good looks like, a self-assessment checklist and outcome measure tools.
Anti-racism framework helps ‘shift the dial on race equality’
The Centre for Mental Health welcomed the launch of the PCREF and called for its full implementation throughout the NHS.
Their Chief Executive, Andy Bell, commented:
“People from racialised communities in England have far poorer experiences of mental health services: with less access to talking therapies, much higher rates of coercion and poorer outcomes. This is an injustice that has to end.
“The PCREF, created through the leadership of Dr Jacqui Dyer, provides a framework for mental health services to shift the dial on race equality. It sets out the systemic changes that service providers must take to be able to offer anti-racist, anti-oppressive mental health care to everyone.
“The PCREF must be at the heart of the mental health services of the future – starting today. It has the potential to create system change that will benefit everyone. To fulfil that potential, it needs to be implemented in full, with the necessary resources provided and the time to bring about sustainable change to services and systems.”
He also called on the government to develop a reformed and modernised Mental Health Act “to reduce the stark disparities in its current operation.”
Learning and development solutions for health and care
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Their diverse portfolio includes training awards designed for care workers, such as Mental Capacity Act, Mental Health Awareness, Understanding Mental Health, Positive Behaviour Support, Safeguarding Adults, Equality, Diversity and Inclusion, Person Centred Care and Support and many others.
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A Trainer at FRT, says:
“It is essential that all communities and all patients have fair and equal access to high-quality care which is safe, dignified, compassionate and person centred. People from all backgrounds and communities must be supported and provided with the highest level of mental health care when they need it and, crucially, the right type of care to meet their needs.
“We cannot allow disparities in access, treatment and outcomes to continue and hopefully this new anti-racism framework from the NHS will address those and will provide a blueprint for future frameworks and all areas of health and care.”
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