FAQs

The frequently asked questions below (FAQs) cover the key areas for Care and Treatment Reviews (CTRs):

  1. What is a CTR?
  2. Who is involved in a CTR?
  3. When do they happen?
  4. How do you identify who needs a CTR?
  5. Who can request a DTR
  6. How do CCGs identify people ‘at risk’ of admission to a specialist hospital?
  7. How does the new approach differ from what has been done before?
  8. Aren’t individuals’ care plans already reviewed?
  9. What support is available for CTRs?
  10. Can the individual receiving care ask for a CTR?
  11. How do you check that any changes have been made?
  12. How have CTRs been developed?
  13. How are CTRs being implemented?
  14. What’s different from what has been done before?
  15. Are you preventing people from getting routine hospital care?
  16. How is NHS England checking that CTRs have been implemented?
  17. How do you measure their impact on patient outcomes?
  18. What are the timescales for embedding CTRs across England?
  19. How does this fit with the wider Transforming Care programme?

1. What is a CTR?

A CTR is one or more meetings to check that a person’s care and treatment is meeting their needs, and are carried out for people who are at risk of admission to a specialist learning disability or mental health hospital, or are already in a specialist hospital.

The review focuses on four areas: is the person safe; are they getting good care; what are their care plans for the future and can care be provided in the community. The review is led by a commissioner, with support for two independent expert advisors. The review team makes recommendations to improve the individual’s care, with follow-up checks to ensure this is happening.

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2. Who is involved in a CTR?

The CTR brings together the commissioner, an independent clinician and an ‘expert by experience’ (an individual or family member with experience of learning disability), the person receiving the care, and their family member. The people involved in providing the individual’s current care are also involved in the review. The meeting ensures that care plans are meeting the individuals’ needs and that there is a plan in place for the future.

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3. When do they happen?

CTRs are carried out for people who are in a specialist learning disability or mental health hospital, to check that their care meets their needs and whether they could be cared for in the community. They are also done when someone is at risk of admission to a specialist hospital, to check whether there is a better alternative in the community or, when someone does need hospital care, to ensure that there is a care plan in place from the start, with a focus on transferring the individual back to a community setting as soon as their treatment is completed. The individual, their family, commissioner, advocate or clinical/community team, can all ask for a CTR if they are concerned about the individual’s care and treatment.

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4. How do you identify who needs a CTR?

Clinical Commissioning Groups (CCGs) and specialist commissioning teams in NHS England, will continue to carry out CTRs for people who are already in a specialist learning disability or mental health hospital setting to check whether their care plans meet their needs – this work is already underway. CCGs are also now using CTRs for people who are at risk of being admitted to a specialist hospital, to see if this can be prevented, and for those who do need hospital care, , to ensure the focus is on discharge from the outset.

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5. Who can request a CTR

The individual, their family, advocate or commissioner can all request a CTR, if they are concerned about an individual’s care or care plan. They should contact their care-co-ordinator in the first instance, to try and resolve any issues before progressing to a CTR.

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6. How do CCGs identify people ‘at risk’ of admission to a specialist hospital?

CCGs are expected to develop an ‘At Risk of Admission Register’ that identifies individuals with a learning disability/ and or autism that are at risk of admission to a specialist learning disability or mental health hospital, to see if this can be prevented with additional support.

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7. How does the new approach differ from what has been done before?

CTRs are already used to review the care for people who are already in a specialist learning disability or mental health hospital to check that their care meets their needs, and whether there is a better alternative in a community setting. The new policy means that CTRs now cover the whole care pathway to prevent admissions and for those that need specialist hospital care, CTRs ensure there is a care plan in place from the start.

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8. Aren’t individuals’ care plans already reviewed?

Yes. The CTR provides an external challenge to ensure that people are getting the care that best meets their needs and in the right place – wherever possible this should be in the community, close to home. It aims to prevent unnecessary admissions to specialist hospital or lengthy hospital stays. If someone does need care in a specialist learning disability or mental health hospital, the CTR ensures that there is a care plan with clear outcomes and a focus on discharge, from the start.

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9. What support is available for CTRs?

NHS England has developed a new policy and guidance for CCGs that outlines what a CTR should involve, when it should be used and the required standards for reviews, to ensure a consistent approach across England. We have also produced a range of tools and templates to support CCGs in implementing the process locally.

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10. Can the individual receiving care ask for a CTR?

Yes. All the people who are involved in the CTR process can request a CTR if they are concerned that the service or care doesn’t meet the individual’s needs. This includes the individual receiving care, their family member, their carer or advocate, or commissioner. Individuals should contact their care coordinator initially to request a CTR, who will work with them to try and resolve any concerns, before progressing to a CTR if they still have concerns.

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11. How do you check that any changes have been made?

At the end of a CTR there are agreed actions, including who is responsible for carrying these out and by when, with checks to ensure they have been done. Any follow-up following a CTR will usually be done through the individual’s usual Care Programme Approach meetings.

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12. How have CTRs been developed?

The current policy and approach has been developed based on over 1,400 CTRs that have been carried out so far, and with input of the people involved, including individuals with learning disabilities and/ or autism and their families. This includes experience from the first reviews for individuals at Winterbourne View, led by NHS England’s Improving Lives Team. and feedback from partners across local authorities, education, service providers and specialised commissioning.

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13. How are CTRs being implemented?

Clinical Commissioning Groups and NHS England’s specialised commissioning teams are now leading the CTR process in their areas.

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14. What’s different from what has been done before?

CCGs have already been doing CTRs for people who are in a specialist learning disability or mental health hospital. We are simply extending CTRs to people who are at risk of being admitted to a specialist hospital, and for individuals that do need to be admitted, to ensure that the focus is on transferring people back to a community setting from the start. This should prevent unnecessary admissions and lengthy hospital stays.

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15. Are you preventing people from getting routine hospital care?

No. People with learning disabilities and/or autism will continue to use hospitals for routine health checks – such as cancer screening – or emergency care. The CTR focuses on people who are receiving care in a specialist learning disability or mental health hospital, to see if they could be better cared for in the community, or people who are at risk of admission to a specialist hospital. CTRs aim to prevent unnecessary and lengthy hospital stays.

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16. How is NHS England checking that CTRs have been implemented?

Data that is collected by NHS England’s regional teams will track CTRs and we are developing the Assuring Transformation data – that provides broad oversight of where people are cared for – so it also tracks whether individuals are getting CTRs. This should be in place by the end of 2015.

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17. How do you measure their impact on patient outcomes?

The Assuring Transformation data measures the impact of CTRs, including whether individuals have had a CTR, and have a care plan. This tells us what happens to people following a CTR, for example, was an unnecessary admission avoided, or after a CTR, was an individual discharged from inpatient services, as expected.

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18. What are the timescales for embedding CTRs across England?

We have been working with commissioners to help them embed the new process over the summer. CTRs are now fully embedded locally, using the new guidance and tools.

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19. How does this fit with the wider Transforming Care programme?

The Transforming Care programme is focusing on providing the best care now for people with learning disabilities and /or autism, whilst we re-design future services to ensure that people are getting the right care, in the right place that meets their needs. The CTRs cover both areas, ensuring that people are getting the best care now and will continue as services are being re-designed, to prevent unnecessary admissions to specialist hospitals and lengthy hospital stays.

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