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Care and Treatment Reviews – Surviving

Last modified: February 28, 2019
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Estimated reading time: 6 min

This may feel like a very stressful time, but try to stay calm. This is not an adversarial process; everyone tries to work together to meet the needs of the person concerned. 

If you take part in the meeting, expect to hear a range of opinions and views expressed. You have a right to share your views based on your personal experience, as does your loved one who will be offered their own support to help them have their say.

Community CTR

If this is a community CTR, the aim will be to stop things breaking down and avoid an admission to hospital. Everyone will be trying to stop this happening. The review will make sure that a detailed assessment is carried out and the right community support established as soon as possible to meet the needs of the person.

Inpatient CTR

If this is an inpatient CTR review, it is an important opportunity to evaluate the care being provided to make sure that appropriate steps are taken to treat your loved one effectively and to discharge them as soon as they are well enough to move back into the community.

Remember that two of the three core panel members at a CTR are independent of the care being provided.  They will be able to provide an objective view and challenge the professionals when necessary. 

When you arrive, you will probably need to sign in. Depending on the security arrangements in place, you might also be asked to put your purse, wallet, phone or other personal things in a secure locker. This is so they are kept safe while you are there.

You will then be escorted to a waiting room while the panel get ready. The review starts with a meeting of the panel members to talk about the day, fix meeting times, find out more and ask for notes. As a result, there may be a wait before anything happens. 

As soon as the panel is ready, someone will come and meet you. Before you join the main meeting, you may be asked if you would like to speak to the independent member of the panel who, like you, has lived experience. This panel member is known as an Expert by Experience (E by E). 

Speaking with the E by E is a really good opportunity to share your views and experiences. It will also help the E by E to understand your loved one, and to find out what your views are about the current treatment and the future after discharge. 

The E by E is there to listen to you and make sure that your voice is heard. S/he may also want to speak to your loved one either together with you or separately and will ask you to give your opinions about the following questions: 

Confidentiality

All written and verbal information provided will be kept private and confidential, and will not be shared with anyone outside the meeting.

The review

Before you join the meeting, it is worth reflecting on the current guidance found on pages 12 onwards of the Guide for CTR experts by experience to clarify the purpose of the review and your important part within it:

  • A CTR is an independent review of a person’s care.  It checks that people are safe and getting the right care for them, that they have good care plans for the future and that any problems with their health, safety or care get sorted out.
  • The person has the right to be treated as an equal in their CTR and to have all the support they need to take part.
  • A CTR is not just about a person’s mental health or how they behave. It is about seeing the whole person, their quality of life, likes and dislikes, choices, hopes and fears.
  • The person, and their family carers if taking part, should be fully involved and at the centre of the CTR.
  • The panel will make time available to meet separately with the person and their family carers.

Taking part in the meeting

Try to be positive and stay calm. The meeting is led by the chairperson who will make sure that the meeting is run properly. Everyone will introduce themselves to start with. 

The review team will have spent the first part of the meeting studying the notes and patient records, and finding out as much about your loved one and their care as possible. The CTR is not an inspection of the provider, but the review team will be asking lots of questions and will have a role in constructively, but robustly, challenging inappropriate or ineffective practice, supporting cultural change and a shifting model to community care.

Questioning by the panel members will follow a set of key lines of enquiry (KLOE) to make sure that nothing is missed. Detailed minutes will not be taken, but the Chair will be responsible for logging key findings and recommendations in the assessment/report template that is used to record progress, concerns, barriers, actions and outcomes at the end of the day.

Each person will be asked about their own role in the person’s care and support, and there will be time for everyone to ask questions. You will have an opportunity to have your say too. Follow your gut instincts where behaviour is concerned. You know your loved one best.

The review will be carried out in a consultative and informal manner, with the aim of supporting people to find solutions and unblock barriers to discharge.

The review team will discuss with the care team and the person whether there are more appropriate, effective and safe alternatives to hospital admission, or whether the person could be discharged from inpatient hospital care.

An inpatient CTR may last most of the working day and discussions may involve something like a dozen people. Neither you nor the person being reviewed has to attend for the whole meeting. The chairperson may wish to invite you to join the review soon after the meeting has started to avoid you sitting in the waiting room for too long, but there are no set rules about this as the agenda will vary depending on everyone’s availability.

A Community CTR may also last for most of a working day and the format will be similar to an inpatient review. It will usually be held at the local offices of the commissioner or relevant LD team rather than a hospital.

If it is necessary to call an unplanned urgent Local Area Emergency Protocol review (for example, due to an impending crisis situation), the format, location and duration will depend on the circumstances, and you will be advised accordingly. In this situation not all the survival tips may apply, however consider all that are still helpful.

At the end of the review, the panel will agree and record actions and recommendations on the review template. They will then call back a number of the earlier attendees to share their findings and recommendations, and clarify who will do what by when. 

Once you have left, on the way home (if not driving), make a note of outstanding issues or concerns to raise in the coming days with the commissioner, care coordinator or named nurse.

Meeting Survival Tips
  • Don’t forget to look after your own needs. Eat and drink something before you go.
  • Double check the venue and the start time.
  • Tell people where you are going and when you will be back.
  • Allow time to get there. Aim to arrive about half an hour before it starts.
  • Remember – the panel and staff are there to help you.
  • One of the key aims today is to support people to find solutions and unblock barriers to discharge.
  • Remember the review is not to apportion blame or raise complaints.
  • Switch your phone to silent if you have it with you in the meeting.
  • If you prepared a list of things to ask at the meeting, let the chairperson know first.
  • Don’t be afraid to ask what everyone’s role is at the CTR.
  • Stay calm, listen and make notes or jot down questions on your note pad if you wish.
  • The meeting will last for most of the day.  It is completely up to you how long you stay.
  • Tell them what has helped your family member now and in the past and what you think could help them in the future.
  • If you feel you need a break at any stage let the chairperson know.
  • For an inpatient review, if it isn’t clear, ask if a discharge plan is in place and if so what the challenges and timescale are.
  • Ask the chairperson what the next steps are and to keep you informed. Also ask who to contact if you have anything else you want to ask about.
  • Don’t forget to retrieve your belongings on the way out.

 

Further information

Additional information on the CTR process can be found in the following publications:

My Care and Treatment Review
https://www.england.nhs.uk/wp-content/uploads/2017/03/my-care-treatment-review.pdf

Care and Treatment Reviews (CTRs): Policies and Guidance                  https://www.england.nhs.uk/wp-content/uploads/2017/03/ctr-policy-v2.pdf (please see page 24)

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