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Care and Treatment Reviews (CTRs): Policy and Guidance

Care and Treatment Reviews (CTRs): Policy and Guidance Including Policy and Guidance on Care, education and Treatment Reviews (CETRs) for children and young people March 2017. OFFICIAL. NHS England INFORMATION READER BOX. Directorate Medical Operations and Information Specialised Commissioning Nursing Trans. & Corp. Ops. Commissioning Strategy Finance Publications Gateway Reference: 06658. Document Purpose Policy Document Name Care ( education ) and Treatment Review - Policy and Guidance Author Anne Webster Publication Date 27 March 2017. Target Audience CCG Clinical Leaders, CCG Accountable Officers, Directors of Nursing, Directors of Adult SSs, NHS Trust Board Chairs, NHS England Regional Directors, NHS England Directors of Commissioning Operations, GPs, Directors of Children's Services Additional Circulation All NHS England Employees, Communications Leads List Description This Policy sets out the expectations for implementation of Care ( education ) and Treatment Reviews (CTRs), across England.

Directors of Adult SSs, NHS Trust Board Chairs, NHS England Regional Directors, NHS England Directors of Commissioning Operations, GPs, Directors of Children's Services All NHS England Employees, Communications Leads N/A CTR Policy October 2015 Implementation of this policy Care (Education) and Treatment Review - Policy and Guidance Superseded Docs

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1 Care and Treatment Reviews (CTRs): Policy and Guidance Including Policy and Guidance on Care, education and Treatment Reviews (CETRs) for children and young people March 2017. OFFICIAL. NHS England INFORMATION READER BOX. Directorate Medical Operations and Information Specialised Commissioning Nursing Trans. & Corp. Ops. Commissioning Strategy Finance Publications Gateway Reference: 06658. Document Purpose Policy Document Name Care ( education ) and Treatment Review - Policy and Guidance Author Anne Webster Publication Date 27 March 2017. Target Audience CCG Clinical Leaders, CCG Accountable Officers, Directors of Nursing, Directors of Adult SSs, NHS Trust Board Chairs, NHS England Regional Directors, NHS England Directors of Commissioning Operations, GPs, Directors of Children's Services Additional Circulation All NHS England Employees, Communications Leads List Description This Policy sets out the expectations for implementation of Care ( education ) and Treatment Reviews (CTRs), across England.

2 CTRs were developed to improve the care of people with learning disabilities, autism or both in England with the aim of reducing admissions and unnecessarily lengthy stays in hospitals and reducing health inequalities. Cross Reference N/A. Superseded Docs CTR Policy October 2015. (if applicable). Action Required Implementation of this Policy Timing / Deadlines N/A. (if applicable). Contact Details for Improving Health & Quality team further information Learning Disability Programme NHS England Room 4W23, Quarry House, Leeds LS2 7UE. Document Status This is a controlled document. Whilst this document may be printed, the electronic version posted on the intranet is the controlled copy. Any printed copies of this document are not controlled. As a controlled document, this document should not be saved onto local or network drives but should always be accessed from the intranet. Document number: 1 of 1 Issue/approval date: 27/03/2017 Version number: Status: Approved Next review date: 01/04/2018 Page 2.

3 OFFICIAL. Care ( education ) and Treatment Review Policy and Guidance Version number: First published: October 2015. Updated: (only if this is applicable): March 2017. Prepared by: Anne Webster Transforming Care Programme workstream: Improving Health & Quality Signed off by: Hazel Watson, Head of Mental Health & Learning Disabilities, NHS England, March 2017. The National Health Service Commissioning Board was established on 1 October 2012 as an executive non-departmental public body. Since 1 April 2013, the National Health Service Commissioning Board has used the name NHS England for operational purposes. This information can be made available in alternative formats, such as easy read or large print, and may be available in alternative languages, upon request. Please contact NHS. England's Improving Health & Quality team on Page 3. OFFICIAL. This is a controlled document. Whilst this document may be printed, the electronic version posted on the intranet is the controlled copy.

4 Any printed copies of this document are not controlled. As a controlled document, this document should not be saved onto local or network drives but should always be accessed from the intranet. Equality and Health Inequalities Statement Promoting equality and addressing health inequalities are at the heart of NHS. England's values. Throughout the development of the policies and processes cited in this document, we have: Given due regard to the need to eliminate discrimination, harassment and victimisation, to advance equality of opportunity, and to foster good relations between people who share a relevant protected characteristic (as cited under the Equality Act 2010) and those who do not share it; and Given regard to the need to reduce inequalities between patients in access to, and outcomes from healthcare services and to ensure services are provided in an integrated way where this might reduce health inequalities.

5 Page 4. OFFICIAL. 1 Contents 1 Contents .. 5. 1 Foreword from Gavin Harding MBE .. 8. 2 Policy statement .. 10. 3 Policy aims .. 13. 4 Policy 15. 5 Policy context .. 17. 6 Consent and Information Governance .. 21. 7 CTRs the review process .. 23. 8 The Key Lines of Enquiry responsibilities .. 28. 9 When do CTRs happen? .. 30. 10 CTRs community (re-admission) .. 33. 11 CTRs post-admission .. 35. 12 CTRs inpatient .. 36. 13 Follow up after a CTR, the next mandatory CTR .. 37. 14 Right to request a CTR .. 38. 15 Roles and responsibilities .. 40. 16 Leaving hospital: the discharge process and standards .. 42. 17 First tier tribunals (mental health tribunals) .. 43. 18 Access to specialised services .. 44. 19 Governance .. 45. 20 Disagreements and escalation of concerns .. 46. ANNEX A Care education and Treatment Reviews (CETRs) for children, young people .. 49. 21 Introduction .. 50. 22 CETRs for Children and Young People.

6 51. 23 Ensuring children, young people and their parent carers remain at the centre of the review .. 52. 24 Access to specialised Children and Young People Mental Health Services (CYPMHS) .. 53. 25 Pathway for CETR on request .. 54. 26 Capacity to consent .. 55. 27 Timeline for CETRs .. 56. Page 5. OFFICIAL. 28 Chairing of the CETR .. 57. 29 Who should be invited to a CETR? .. 58. 30 CETRs the review process .. 62. 31 Crossover with other assessment and review processes .. 67. 32 Maintaining contact between children, young people and their families and community .. 69. 33 Advocacy .. 71. 34 Frequency of CETRs .. 72. 35 Joint commissioning arrangements .. 73. 36 Young offenders .. 74. 37 Key Lines of Enquiry .. 75. 38 Identifying children and young people likely to be at risk of admission .. 76. 39 Roles and responsibilities .. 77. 40 Governance .. 80. 41 Disagreements and escalation of concerns.

7 81. 42 APPENDIX 1 CTR Code and Toolkit .. 84. 43 APPENDIX 2 Proactive monitoring and intervention .. 89. 44 APPENDIX 3 Discharge steps and standards .. 92. 45 APPENDIX 4 Local Area Emergency Protocol .. 102. 46 APPENDIX 5 Data to support the monitoring of CTR pathway implementation and effectiveness of outcome .. 107. 47 APPENDIX 6 CTR Review Policy restricted patients .. 108. 48 APPENDIX 7 Use of CTR approach in other settings and/or with other care groups .. 112. Page 6. OFFICIAL. List of Figures Figure 1 - Care & Treatment Review Principles .. 11. Figure 2 - Example of a Key Line of Enquiry (KLOE) .. 28. Figure 3 - CTR Pathway - Adult, non-secure services .. 31. Figure 4 - CTR Pathway - Adult, criminal justice route .. 32. Figure 5 - CTR Pathway - Adult, non-criminal justice route .. 32. Figure 7 - SMART outcomes .. 37. Figure 8 - Pathway for CTR on request .. 38. Figure 10 - Care, education and Treatment Review 51.

8 Figure 11 - Pathway for Care, education and Treatment Review on request .. 54. Figure 12 - CETR Pathway - Children or young people .. 56. Figure 6 - Minimum dataset to develop a local register .. 91. Figure 13 - Local Area Emergency Protocol: steps to follow .. 104. Figure 14 - CTR flow chart, restricted patients .. 108. Page 7. OFFICIAL. 1 Foreword from Gavin Harding MBE. As an ex-patient I wish that Care and Treatment Reviews (CTRs) were invented when I was in an assessment and Treatment unit. People with learning disabilities, autism or both have a right to CTRs if they are in hospital for a mental health problem or behaviour that challenges services. And if they are at risk of going into one. They and their families need to know they can ask for one if they need one, or if they haven't been offered one. People have said to me they feel like CTRs are on their side. And commissioners have said it gives them a lot of insight into the person they commission services for.

9 CTRs are done by an independent panel chaired by the commissioner. They don't just happen in hospital. You can have them in the community in a safe environment where you feel comfortable and I would like to see them in other settings like prison and in social care, because we know how much difference they can make to people's lives. It's just over a year since local areas took over the job of carrying out CTRs. We have asked lots of people about the Policy to work out what needs to change. We got lots of feedback from people with learning disabilities, autism, their families, and providers, experts by experience and professionals across clinical commissioning groups, education and social care, regional and local transforming care teams. Hundreds of people gave their feedback through questionnaires, meetings, focus groups and events. We have used all this feedback to make changes to the Policy that will help CTRs work even better for people who have them.

10 The Policy has changed quite a lot as we have learned so much from the first year. We have also improved our information for people and families, so their voices get better heard. We have also added a section that is all about CTRs for children and young people. An important part of the Policy , and also of Building the Right Support1, is to make sure that there is a way that services know the people who are likely to need additional support so that they don't end up being admitted to hospital unnecessarily. In this Policy we have noted that many people do not like the name at risk registers'. and at the same time we have said that, whatever they are called, it is important to know where to deliver the right support at the right time. I would also like to encourage people to feel empowered enough to begin to have some control over your own care and Treatment . If people can be helped to recognise early symptoms that might lead to a crisis, then they may be able to ask for help from families and friends, providers and social care and community nurses who can take necessary action according to your care plan, if you have one.


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