Care (education) and treatment reviews

Care (education) and treatment reviews (C(E)TRs) are part of NHS England’s commitment to transforming services for people of all ages with a learning disability and autistic people. C(E)TRs are for people who have been admitted to a mental health hospital or for people who are at risk of admission.  They are undertaken by commissioners to ensure that people are only admitted to hospital when absolutely necessary and for the minimum amount of time possible. Care and Treatment Reviews (CTRs) are for adults and care (education) and treatment reviews (CETRs) are for children and young people.

Since 2015, thousands of C(E)TRs have been carried out. They are helping to reduce the number of people going into these hospitals. For example, of the 552 community CTRs recorded between April 2016 and January 2017, the outcome was a decision not to admit in almost three out of four (403) reviews. For example, of the 1904 community CTRs recorded between April 2016 and May 2018, the outcome was a decision not to admit in more than three out of four reviews. And of over 350 children and young people who have had a community CETR since 2016, 79% resulted in a recommendation not to admit the child to hospital.

C(E)TRs also seek to improve the quality of care people receive in hospital by asking key questions and making recommendations that lead to improvements in safety, care and treatment. They aim to reduce the amount of time people spend in hospital and bring people together to help to sort out any problems which can keep people in hospital longer than necessary. They do this by helping to improve current and future care planning, including plans for leaving hospital.

C(E)TRs are carried out by an independent panel of people. This includes an expert by experience, who is an autistic person or a person with a learning disability or a family carer with lived experience of services. The panel also includes a clinical expert who is qualified to work in healthcare and the commissioner who pays for the person’s care.

There are lots of tools and downloads for everyone on these C(E)TR pages. In September 2018 we added a new booklet for health and social care providers, to support people at every stage of their C(E)TR. There is more about this on our page for commissioners, CTR panels and people providing care, and there is a page of resources for panels that carry out CETRs for children and young people. There are also booklets and a planner written specially for people having a CTR or CETR. Parents at Bringing Us Together have also written a guide for family carers which offers further help and advice about CTRs.

Pathways report

In 2017 NHS England asked Pathways Associates to look at how well our new care and treatment review policy was working for people with a learning disability, autism or both. Their report is called ‘Effectiveness of the new care and treatment review policy’.

Pathways work shows what a positive difference a care and treatment review can make to a person’s life and we welcome the recommendations made in the report. We are  using these recommendations in our work to help improve care and treatment reviews.

Updates to the care and treatment review policy

The policy for C(E)TRs was last updated in March 2017. The care (education) and treatment review (C[E]TR) policy for adults, children and young people is currently being reviewed and rewritten. The updated policy is due to be published in Summer 2022. Supporting materials, including the C(E)TR code and toolkit and the Key Lines of Enquiry (KLOE) template are being refreshed in accordance with the new policy and will also be published later in the year. You can view the existing C(E)TR policy  on our CTR policy page.  We also have a range of tools to help you plan your C(E)TR and for commissioners, clinicians and experts by experience.