The local commissioner, Ann Warrington, has taken part in CTRs that have led to the person being supported in the community, when it was thought they would need to be treated in hospital. “As a commissioner, it’s given me a vehicle to challenge people’s assumptions and be creative. It’s given me the support to do things differently,” she says.
Seeing how CTRs have worked has given the staff at Tameside and Glossop the confidence to not rely on hospital. “It’s brought about a culture change and everyone is now able to see alternatives to ATUs. Because people are starting to see good that’s happening, people are more excited about getting involved. Everyone can see that it’s not about services, it’s about the person,” says Ann.
“When we carry out a CTR it’s a day centred-around that person, where we chuck the barriers to one side and try and figure it out together. Attendance at CTRs is expected, which means we had full attendance from very early on.
“As a CCG, we’ve also saved money because we’re not making as many admissions to hospital.”
Between January 2016 and March 2017 Tameside and Glossop carried out nine pre-admission or community CTRs, and only one person was admitted to hospital.
Two people that Tameside and Glossop have been able to help are Sophie and Michael:
Sophie is 27 with a mild learning disability and borderline personality disorder. All her life she had been cared for by her family, but after both her parents died she was placed in accommodation for people with a learning disability. With few social boundaries, and unused to her new freedoms, Sophie started coming in regular contact with the police for a number of offences and was a risk to herself and others.
Her multi-disciplinary team (MDT) from Tameside and Glossop wanted to admit her to hospital. At her Care and Treatment Review (CTR), the team discussed why they thought she needed to go to hospital and what alternative options were available. Realising that her need was for psychological support therapy and that this did not need to be provided in hospital was the ‘lightbulb moment’. They were able to challenge the assumption that she needed to be admitted and arranged for her to go to a community residential placement with high levels of support and deprivation of liberty safeguards (DoLS) in place to manage some restrictions in care.
Seven weeks into her placement Sophie is described by the commissioner as ‘unrecognisable’. Her appearance is immaculate, her skin is improving and she is responding to boundaries. Her staffing has been reduced from 2:1 support to 1:1 and she is able to get out more. She is happy, relaxed and smiling, and has responded to feeling safe and secure.
On seeing Sophie’s progress, one of the team, who had doubted whether Sophie could live in the community, told the commissioner: “we have to tell people that this works!”
Michael has a mild learning disability and borderline personality disorder. He had been on remand on a charge of arson and an attempt to endanger life. His multidisciplinary team had just three days leading up to his court hearing to see if they could find an alternative to prison.
The CCG led a Care and Treatment Review (CTR) at short notice to see if there was a way that he could be supported to live in the community. The team developed a proposal for a residential placement with restrictions and identified a provider who was ready to take him. This was presented to the judge, who adjourned the hearing to gather more information and at the next hearing decided that Michael did not need to be in prison.
Michael has been in his placement for six weeks and is doing very well; receiving psychological intervention and engaging with staff. He has told his carers that he feels safe.
Contact: Ann Warrington, NHS Tameside and Glossop CCG, firstname.lastname@example.org