The Patient and Carer Race Equality Framework (PCREF) was a key recommendation following the national Mental Health Act Review in 2018. PCREF is NHS England’s first ever anti-racism and accountability framework to tackle and eliminate the unacceptable racial inequalities in access, experience and outcomes faced by racialised and ethnically and culturally diverse communities and to significantly improve their trust and confidence in mental health services.

Our PCREF programme is focused on the three core components also known as three priorities:

  • Part 1: Leadership and governance
  • Part 2: Organisational competencies
  • Part 3: Patient and carer feedback mechanisms

SHSC has four strategic aims; deliver outstanding care, great place to work, reducing inequalities and effective use of resources. Delivering the patient and carer race equality framework is a key strategic objective under reducing inequalities. The delivery of PCREF is also a key quality objective for 2025/2026. 

Since the initiation of PCREF in 2022 there has been an ongoing commitment from executive level to develop this work. The below action plan lays out the achievements to date and our objectives over the next three years for each of the three core components of PCREF.

Part 1: Leadership and governance

This refers to Legislative and Regulatory Obligations (Leadership and Governance) that applies to all NHS trusts. SHSC as a mental health provider will need to ensure these core pieces of legislation are complied with across their organisation in relation to PCREF. The Trust’s Board will be leading on establishing and monitoring plans of action which fulfil our statutory and legal requirements.

Our commitments, we will:

  1. Improve our governance structures, to include better representation of racialised community partners and representatives at all levels of PCREF delivery. We will ensure community partners are involved in all levels of decision making and lead on some of our key PCREF objectives this year.
  2. Improve data collection around ethnicity and other demographics. We will use this ethnicity data to co-produce plans to improve access to services and outcomes for racialised groups
  3. As identified in our quality objectives; Establish a PCREF stakeholder delivery group comprised of community leaders from racialised communities who will have shared oversight on the development and implementation of PCREF, including from the VCSE sector.
  4. Continue to have racial inequality as a key measurement in reducing restrictive practice.

Progress made in 2024/2025

  • SHSC have an Executive PCREF Lead at Trust Board level accountable for delivery and oversight of PCREF; the Executive Director of Nursing, Quality and profession is the nominated executive lead
  • Local evaluation of PCREF has been completed led by University of Sheffield
  • Creation of health inequalities dashboard which includes measures which we have a statutory obligation to provide; including use of restrictive practice by ethnicity, safety incidents and near misses for people from racialised communities and complaints broken down by ethnicity
  • Partnered with NHSE’s ‘Advancing Mental Health Equalities Taskforce’ as a PCREF early implementer site
  • Continued to grow the scope and impact of the ‘Being There’ project. Through collaboration with Pakistan Muslim Centre (PMC) the ‘Being There’ project focuses on providing informal cultural advocacy recognising the diverse needs of our service users and the need for independent involvement to gain experience feedback from all service users
  • We are part of the Culture of Care Programme from NHS England's Quality Transformation Programme aiming to improve the culture of care in our inpatient mental health wards. Cultural advocacy workers are involved in this work and anti-racism is a key component
  • Introduction of the Head of population health inequalities role which has had huge contribution and impact on work regarding data recording and a clear plan to address our recording of data in relation to ethnicity

Our key objectives 2025/26

  • Implementation of the PCREF stakeholder delivery group comprised of community leaders from racialised communities
  • Further development of the PCREF action plan in collaboration with stakeholder delivery group
  • Report progress on PCREF through agreed channels (Lived experience and co-production assurance group (LECAG), Quality assurance Committee, Trust Board)
  • Consolidating governance process for PCREF implementation including role of stakeholder delivery group
  • Develop principles for anti-racist working in clinical areas through the development of the PCREF implementation toolkit (including pro active equality impact assessments) delivered in collaboration with the delivery group, staff and service users
  • Further work on restrictive practice in community settings with a lens on anti-racism, ethnicity and human rights
  • Further development of the PCREF dashboard, including statutory requirements but also those agreed as a priority, led and advised by community partners
  • Continue to work with population health inequalities on improving reporting data in relation to ethnicity across the organisation.
  • Work with services to improve feedback and service user experience considering race equity within this including experiences of patients, carers, their families
  • Continue to work as an organisation on culture of care standards and implementation of these
  • Ensure the feedback and themes from the cultural advocacy workers feed into organisational improvements and are acted upon
  • Introduction of community development workers recruited through VCSE services to support pathways to care and support as well as access community assets that support recovery

Our key objectives 2026/27

  • Review the role and effectiveness of the PCREF stakeholder delivery group, ensuring that any feedback from community leaders is reviewed and implemented
  • Ensure that findings from the University of Sheffield evaluation of PCREF (local evaluation) is reviewed and any amendments made to reflect any changes, ensuring community and VCSE partners are leading on this.
  • Review provision for those most marginalised can complete health equity data in various methods, this includes use of interpreters and translation
  • Working in collaboration with key partners across Sheffield including social care to share data and findings around health inequalities
  • Work with wider NHS mental health trust to share best practice and learning in the further development of the dashboard

PCREF Part 2: Organisational competencies

Through a co-production process, six organisational competencies have been identified by NHS England through working with racialised communities, patients and carers. Trusts and mental health providers should work with their communities and patients and carers to assess how they fair against the six organisational competencies

These competencies are: Cultural awareness; Staff knowledge and awareness; Partnership working; Coproduction; Workforce and Colearning.

Our commitments, we will:

  • Embed Advance choice directives across the organisation with a lens on cultural advocacy respecting and considering unique identities and cultural and spiritual needs of service users
  • Through coproduced training and resources ensure our staff are equipped to address racial inequalities in clinical practice
  • Ensure staff from racialised, ethnically and culturally diverse backgrounds are provided with a safe and supportive environment and learning opportunities, through the ethnically diverse staff network group and using tools such as the staff survey and NHS Workforce Race Equality Standard (WRES)
  • Have clear communication internally, externally and directly to our community partners about the development and implementation of PCREF and PCREF action plan
  • Ensure staff from all teams and services are aware of the PCREF implementation plan and their role in the delivery

Progress in 2024/5

  • SHSC is the first Trust in the UK to have made embedding human rights into day-to-day practice a core strategic priority. In practice, this means that human rights go beyond legal compliance, serving as a catalyst for cultural change within the Trust and its principal ethical practice framework​
  • ​Human rights has become a well-established and influential part of the Trust's discourse. The integration of human rights into the RESPECT training has been particularly significant in SHSC - by August 2025, approximately 1,500 staff members will have completed between 90 minutes and three hours of training across all groups and professions
  • ​The 'Human Rights and Practice Leads' training is a comprehensive three-day course that is conducted twice a year for approximately 20 staff members whose role is to lead on human rights. All members of the PCREF team have successfully completed this essential training.
  • Across the year several cultural awareness training sessions (circa 10 sessions) have been delivered to teams by the cultural advocacy workers with further sessions planned
  • Organisationally we continue to develop links with VCSE. An engagement officer employed by the trust continues to work into Aspiring Communities Together (ACT) to focus on supporting members of the community to access care for the Yemeni community and addressing barriers to care
  • Funding has been received by Sheffield Charities and two Somali peer support workers are now working into SHSC to support understanding, development, training and access to care
  • We have invested in external contracts with a focus on colearning and co-producing how we develop staff and services. This includes the continuation of the ‘being there’ project with PMC and work with SACMHA
  • An Equality officer from SACMHA works within the restrictive practice team ensuring training, development and awareness on the impact of restrictive practice to service users from a racialised background is understood by staff
  • Locally there continues to be a focus on the reciprocal mentoring programme and the Inclusion, Diversity and Equality Group
  • Forest Close inpatient rehabilitation unit for adults have their own catering budget to support service users to cook their own halal meals
  • Over the last 6 months, 174 service users were supported by the cultural advocacy link workers and over 40 family members were liaised with. Of particular note is the impact of working with family and supporting with feedback to the MDT, specific examples of this were received from the PMC report highlighting the need for cultural advocacy for family member
  • achieving a consistent reduction in the use of seclusion and physical restraint across inpatient services (number of incidents and use of seclusion)
  • Further rollout of the RESPECT training programme
  • Embedding of Safewards interventions to improve inpatient safety

Objectives 2025/26

  • Develop a communication plan to ensure PCREF is embedded across the Trust, this will form part of the communications and engagement strategy
  • Development of the action plan, in collaboration with community partners and regularly reviewed through the PCREF stakeholder delivery group
  • Review in collaboration with EDI, the human rights officer and considering responses from WRES, the trust policies and frameworks on addressing racism. Involvement of partners and the ethnically diverse staff network group within this
  • Improve and develop training off in particular for managers and leaders on addressing anti-racism
  • Review the use of advance choice documents across the Trust for documented treatment preferences. Coproduce tools and improvements in their use with racialised, ethnically and culturally diverse communities
  • Continue to develop further partnership working opportunities
  • Focus on the provision and access to Interpreters across services
  • Continue the South Yorkshire ICS reciprocal mentoring programme led by the CEO
  • Continue to build relationships wider with other trusts and as early adopters continue to share best practice. Continue to work with other early adopter sites to share learning
  • Communication through Regularly update intranet pages with best practise examples

Objectives 2026/27

  • Improve opportunities for ethnically diverse staff with a focus on training and career development
  • Further develop cultural advocacy roles from wider communities
  • Implement improvements in the use of advance choice documents which have been co-produced with the stakeholder delivery group, service users and communities
  • Work with system partners, Sheffield City Council and Head of population health inequalities to ensure that work around prevention and early access to treatment consider ethnicity and racial disparities
  • Work across South Yorkshire and wider to share achievements and share learning through community events with a focus on involvement of members of the local community

PCREF Part 3: Patient and carers feedback mechanisms

PCREF Part 3 - seeks to embed patient and carer voice at the heart of the planning, implementation and learning cycles.

Our commitment, we will:

  • Ensure we close the feedback loop and that service users, carers and communities can see and understand how their feedback has influenced and changed practice
  • Achieve two star Triangle of Care rating by the end of 2025/26 as per SHSC quality objectives
  • Communicate in various methods our progress on PCREF and addressing health inequalities. Ensuring transparency and working with partners to find solutions and make improvements
  • Ensure we have a clear process for co-production of actions relating to PCREF with a focus on reaching out to the most underserved communities in Sheffield

Progress made 2024/25

  • PMC Qualitative and Qualitative feedback on patient experience which continues to increase. The feedback is given in themes which highlights areas which are required for improvement then acted on; this includes access to religious materials and culturally appropriate meals
  • Implementation of first star of Triangle of Care and work on the second star. The triangle of care ensures the voices of carers including those marginalised by race are included and inform service improvement
  • Engagement officer input to wards and to community service to gather qualitative feedback
  • Growth of lived experience colleagues in a range of opportunities and fixed roles across the organisation
  • Safe2Share work recommenced with a new project lead in November 2024, capturing live feedback on wards
  • Feedback shared with Lived Experience and Coproduction Assurance Group
  • Provided relevant data to national bodies according to our statutory responsibilities
  • Coproduction and extensive engagement taken place with community organisations through community mental health transformation, trust strategy refresh and Feedback February

Objectives 2025/26

  • Membership of a task and finish group to develop a Triangle of Care (TOC) self-assessment audit tool in relation to the PCREF in collaboration with the Carers Trust and Avon and Wiltshire Mental Health Partnership NHS Trust
  • Implementation of trust wide feedback improvement plan with a focus on improving feedback across the organisation and from partners, with a focus on health inequalities in feedback responses
  • Developing clear outcome measures for the work strands of PCREF and continually reviewing these
  • Review the University of Sheffield local evaluation and ensure changes are implemented based on their recommendations
  • Start to work with wider organisations and strengthen partnerships with the most marginalised and underrepresented communities in Sheffield to be able to build our understanding of community and service user needs.
  • Improve feedback mechanisms to ensure we are responding feedback received
  • Improve external and internal communication on PCREF and the action/delivery plan
  • Through the stakeholder delivery group encourage and ensure further coproduction and involvement in transformation projects

Objectives 2026/27

  • Integrate outcome measures across services and trust in relation to PCREF, that have been coproduced and reviewed
  • Further recruitment of lived experience colleagues in roles across the trust through recruitment in SHSC and through partnerships
  • The feedback dashboard will be well established, teams and services will be able to use this effectively to improve service delivery and with cultural and racial considerations
  • Every year we will publish our action plan and progress made and communicate this widely
  • Have more creative involvement of communities ensuring we have informal and formal ways to seek feedback
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