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CARE & TREATMENT REVIEWS

Review Protocol & Report Template May 2015

Care and treatment reviews (CTRs) were introduced in October 2014 in order to facilitate planning for discharge of people with

learning disabilities and/or autism who remained in hospital care but without an identified plan for discharge.

Following successful outcomes for many patients and positive feedback on the process, these reviews have been extended to

other parts of the patient pathway, to prevent unnecessary admissions and for those in NHS funded inpatient beds including

Child and Adolescent Mental Health Services, and secure hospitals.

CTRS are not intended to replace or undermine the Care Programme Approach, but to enhance the process of person centred

planning and support at various points along the patient pathway.

The aims of CTR are to:

Support the individual and their family to be partners in the care and treatment process.

Support professionals to work together with the person and family to find alternatives to admission or support discharge

from hospital

Ask why the person needs to be in hospital and, if there are care and treatment needs, why these cannot be carried out

in the community?

If the resources are not in place to support someone’s discharge, then to make clear recommendations about what

needs to be done to get to the point of a safe discharge.

The spirit in which the CTR is carried out is as important as the process and the documentation. It is the responsibility of all

involved to ensure that a CTR is conducted in an atmosphere of:

Openness

Honesty

Transparency2

Flexibility

Person-centredness

Mutual respect

Wherever possible the CTR report should include direct quotes from the person with learning disabilities and their family in

order to maintain a strong personalised focus.

This document represents the core framework for care and treatment reviews. We have prepared addenda for children and for

people in secure hospital settings who may be under a restricted section of the Mental Health Act.

The questions in these addenda should be regarded as an enhancement and/or an aid to focusing the emphasis of the

questions in the core framework to match the particular and personal characteristics of the individual whose care is being

reviewed. For each group of key questions in the core framework, there are enhancing questions for that section in the

relevant addendum.

.

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Local Patient identifier: ………………….. Healthcare Provider: ………….. Location of Review: ……………….. Date of Review: …………………

Originating CCG Area: …………………… CCG Commissioner Representative: ……………………………..

LA Commissioner Representative: ………………………. Specialist Commissioner Representative: ……………………………. Expert Reviewer- Clinical: ..........

Expert Reviewer- Expert by Experience: …………………… Advocate: ……………………… Others: ……………………………………………

Mental Health Act/ Mental Capacity Act Status: …………… MoJ Restriction Order: ……………. Details: ……………………………..

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Guidance for reviewers on structuring information gathering The review team should structure their questioning and information gathering around the following themes in order to draw their conclusions on safety, current care & future planning:

Who is the person including: family, schooling, time in 'care', family or care breakdown stories, forensic history etc. ( A brief pen picture/timeline to be established at the beginning of the day)

Formulation and Diagnosis(es): including physical health, annual health check. Do any of these diagnoses necessitate care as an inpatient?

What is the treatment plan that follows from the formulation and diagnoses? Include drugs, therapy, diet and care that keeps them safe and well. Is there an evidence base for these treatments and are they effective & leading to discharge?

Can the treatments and care be given in a community setting? What is the person's view of their needs? What are their hopes and fears? What is the family's view of the person's needs? What are their hopes and fears? What does the commissioner and provider think the person needs? What are their

concerns? What does the Clinician and clinical team responsible for their care think the person

needs? What are their concerns?

The checklist below will help in the drawing together of information to support the above themes. It is not intended to be used as a rigid set of questions but as a guiding framework for discussions and help in drawing up the findings and recommendations.

RATINGS:

Discharge from hospital, or support to remain in the community, is being prevented or made more difficult by these issues

Discharge from hospital, or support to remain in the community, is largely unaffected by these issues

Discharge from hospital, or support to remain in the community, is being supported by these issues

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Question No

Do I need to be in Hospital?Response Reviewers notes

1Is there a current formulation / diagnosis in place which clearly supports the need for inpatient care?

2Is there a comprehensive treatment plan in place?

3 If yes to the above, do these treatments have to be delivered in hospital?

4Are there clear time frames and targets for my treatment?

5Am I meaningfully included and supported to contribute to my care and treatment?

6Is the treatment I am currently receiving able to be continued in the community (or non-hospital setting)?

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Have people thought about whether being in hospital will make my problems worse and making it more difficult for me to return to the community?

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Have people thought about whether I have suffered trauma before admission or during my hospital stay? If so am I having treatment for this trauma?

RELEVANT QUOTES FROM

INDIVIDUAL / FAMILY

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Question No

Working with me to manage my risks

Response Reviewers notes

9Is there a clear and detailed assessment in place of risk to myself and to others?

10Have people got an understanding of my risks now rather than what people have said about me in the past?

11Does the risk management plan clearly identify both immediate and longer-term risks?

12Has the risk assessment involved me/community staff/commissioners/ my family?

13Is there evidence of positive risk-taking – can management of any risks take place in the community?

14Are there any risks to me returning to, or staying in, my chosen home / family setting?

15 Have people used physical interventions to control my behaviour in the last month?

16 If yes to the above question, has this involved using face-down restraint?

17 Have I been the subject of any safeguarding procedures in the past 12 months?


INDIVIDUAL / FAMILY

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Question No

Communication - My Behaviour and My Needs


18 Is there a clear and active plan of Positive Behaviour Support in place?

19 If yes to the above question, is this reflected in practice/understood by all?

20 Will I be supported by providers who can give high quality Positive Behaviour Support?

21Do I have an accessible behavioural / care plan that I help to review and which helps to understand any behaviour problems?

22Are service providers who support me now or in future confident that they can do this reliably within the community?

23Do I have a communication passport that supports me in living in the community?

24Is there evidence available to illustrate the progress my carers and I have been making with any behavioural challenges?


INDIVIDUAL / FAMILY

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Question No

Least Restrictive Options for a Better Life


25 Have alternative models of service provision and support been actively reviewed and considered?

26Have providers / commissioners with a credible track record of experience been involved in planning my future support?

27Do I have a person-centred plan in place which people regularly use to help understand my likes, hopes and dreams?

28 If yes to the above question, is this being used to design a service specification for my support?

29Does my current care team believe that I can be supported safely and with a good quality of life in the community?

30Are there any other significant people or organisations involved in my life whose opinion needs to be listened to?


INDIVIDUAL / FAMILY

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Question No

The Voice of My Family and Carers


31 Have people made sure that they have clear views of my family/carers about where I live now and in the future?

32 Do my family/carers feel that they have been listened to and have they been helped to be involved in my care and in my future plans?

33 Do my family want me to return to live closer to home?

34Are the family (or will they be) involved in the development of any tenders and procurement process for the son/daughters future care package?

35Are there any disagreements between my family / carers and professionals about my current and future care and treatment plans?

36If there are disagreements, have professionals actively worked hard to try to reach agreements and / or to understand their views? Have they had access to Patient Advice and Liaison Services / Carers Link or Complaints processes?

RELEVANT QUOTES FROM INDIVIDUAL / FAMILY

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Question No

My Involvement, My Rights & Freedoms

Response

37 Are my carers and professionals involved my care protecting and supporting my human rights?

38Do I have support from an independent advocate? (Independent Mental Capacity Advocate (IMCA), Independent Mental Health Advocate (IMHA), Non-instructed advocate)

39Have people thought about whether the Mental Health Act or Mental Capacity Act could be used to help support me safely in the community? (e.g. Community Treatment Orders, Guardianship, Section 17 leave)

40Have people assessed my capacity to make decisions about my care and treatment?

41If people think that I don’t have capacity, has there been a proper process of deciding what would be in my best interests?

42 Do the deprivation of liberty safeguards apply to me?


INDIVIDUAL / FAMILY

TOTAL SCORE (+SCORES FROM ADDENDA IF APPLICABLE)

3 + 1 8 + 4 18 + 15

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Key measurable Outcomes Care and Treatment Review

Local Patient identifier:

tick

Location: Low Secure √Assessment & TreatmentStep downLocked rehabForensic rehabOther

Outcome from CTR (NB shaded boxes to be used for a pre-admission review)

Tick

Hospital admission supported for a specific time period and purposeHospital admission not necessaryReady for discharge, discharge plan in place & discharge date in next 3 monthsReady for discharge, discharge plan in place & discharge date in next 6 months

Ready for discharge- no discharge plan: reasons for this

No Person Centred Plan on which to base individual service specificationLack of agreement on

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future planNo identified care coordinator in communityLack of suitable housingNo suitable care providerLack of agreement on fundingAppropriate Clinical skills not available in community to support packageResponsible commissioner issuesTreatment formulation unclear & absence of outcomesPerson subject to MOJ, discharge could be facilitated but need endorsement from MOJLegal barrier ( eg Court of Protection)Other- please specify

Not ready for discharge- needs to be in a hospital bed for care & treatment.

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ADDENDUM FOR INDIVIDUALS IN SECURE PLACEMENTS AND THOSE SUBJECT TO RESTRICTION ORDERS

NB. Please use this alongside the core CTR template

What section of the Mental Health Act is the individual detained under?.....................Are they subject to MoJ retrictions?...........................

Names and roles of other key individuals involved (not listed in core framework) e.g. Specialist Commissioner, NHS Gatekeeper, Victim Liaison Officer……………………………..

Question No

Do I need to be in Hospital?Response Reviewers notes

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If I am transferred from prison (on a long tariff) is it clear why I should continue to remain in hospital rather than return to prison? (offender pathway rather than hospital pathway)

44Does any of my planned care and treatment have to take place in a SECURE hospital?

45Am I taking part in any time-limited psychological therapies (e.g. Modified sex offender treatment programme, CBT)

46If I have to remain in hospital for care and treatment could this take place in a less secure setting?

47If I have been in a secure hospital for a lengthy time, is this affecting my wellbeing and ability to move on from an institutionalised way of life?


INDIVIDUAL / FAMILY

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Question No

Working with me to manage my risks


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Do my risk assessments and management plans take into account well enough any restrictions that are in place? (details of restriction orders)

49Do my risk assessment and management plans take into account well enough how to manage any risks to victims ?

50Do my risk assessment take into account well enough any involvement of the Ministry of Justice or the Probation service?

51Could my risk assessment and management plan be delivered in a setting of lesser security – or non-secure?


INDIVIDUAL / FAMILY

Question No

Communication - My Behaviour and My Needs


Has a My Shared Pathway been completed with me?

If I am in a mainstream secure provider, do my care plans address specific identified

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behaviours within My Shared Pathway?

52Does My Shared Pathway identify my communication needs and how these could be supported in an alternative setting?

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Are providers with clear capacity for delivering effective management of my identified needs being considered as part of my discharge planning?

54Is there clear, documented evidence of progress in reduction of my risks ?

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Do I have an accessible behavioural plan/ care plan which I help to review and which helps me to understand and manage my own risky behaviours better?


INDIVIDUAL / FAMILY

Question No

Least Restrictive Options for a Better Life


56Has the relevant NHS gatekeeper reviewed my case within the last 12 months ?

57If I am transferred from prison is someone from the National Offender Management Service involved ?.

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Have my Care Coordinator and Secure Commissioner been updated on my case /invited to CPA meetings / peer reviews in last 6-12 months

59Does anyone involved in my care and treatment think that I should be moved (returned) to a custodial placement?

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Are there any other significant stakeholders whose views have not been heard? e.g. Victim Liaison Officer, Ministry of Justice, MAPPA, Local Commissioner, NHS Gatekeeper


INDIVIDUAL / FAMILY

Question No

The Voice of My Family and Carers Response Reviewers notes

61Have my family ‘s / carer’s views been taken into account in My Shared Pathway or any other Care Pathways?

RELEVANT QUOTES FROM INDIVIDUAL / FAMILY

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Question No

My Involvement, My Rights & Freedoms


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Are the limitations of a secure placement and / or legal restrictions having an unacceptable impact on my human rights? How are these being addressed?

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Is this the least restrictive placement that could care for me and manage my risks effectively and safely? If not, what are the challenges to achieving this?


INDIVIDUAL / FAMILY

SCORE

CARE AND TREATMENT REVIEW FINDINGS & RECOMMENDATIONS

( to be complete by the lead commissioner with contributions from the review panel)Submit to …………………. For data collection purposes ( please ensure no name, originating postcode or DOB is on the form )

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Copy to individual, and others involved in care and treatment as appropriate.

Area Findings Recommendations Who responsible? By when?Safety(NB- please note if CTR led to alert in relation to safety via CQC or safeguarding board)Current Care

Future planning

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Documents

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