Rapid review dynamic support registers (minimum standards) to:

• Make sure you already have the referral criteria in place (as per policy) for entry onto the dynamic support register – for ‘at risk level’ – and identify children and young people at risk of admission. It is important that you continue to follow policy.
• Identify children and young people who are likely to become at risk of admission without immediate intervention.
• Include a specific focus on autistic children and young people who may not be known to services.
• Ensure a two-way information flow between the dynamic support register and care, education and treatment reviews (CETRs) so that those children and young people at risk of admission are offered community CETRs.

Make sure community CETR compliance to agreed standard:

• Local system communication should ensure compliance to a minimum of the agreed compliance standard (90%).
• Admission without a community CETR should be exceptional and in line with the current CETR policy.

To support this work, draw down funding is available on a locally agreed basis to support individual interventions that will potentially lead to an avoidance of admission.

Root cause analysis – to be carried out to understand the circumstances of any admission without a community CETR. This will:

 Explore why a community CETR was not possible.

• Determine whether the child or young person had been identified on the dynamic support register.
• Inform system changes to ensure CETR compliance and better identification through dynamic support registers.

Post-admission CETRs – the following interim changes to be implemented:

• Post-admission CETRs will be by exception where a valid community CETR has not been possible and a root cause analysis will have been completed.
• Post-admission CETRS will take place within five working days not 10 working days as previously stated [interim measure]. It is envisaged that clinical commissioning groups (CCGs) and specialised commissioning will need to work together to organise CETRs within the prescribed timescales, by local agreement.
• Post-admission CETRS will be co-chaired by CCG and specialised commissioners [interim measure]. Attendance by CCG commissioners is already in the policy, the expectation that they will co-chair is the new interim measure.

While these changes will have a significant positive impact on the individual children and young people who may otherwise be admitted to inpatient services during this difficult time, we do not anticipate a negative impact on the system due to the small numbers affected.