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Care and Treatment Reviews – What makes a good CTR?

Last modified: February 28, 2019
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What makes a good CTR?                                  

The updated policy and guidance published in March 2017 brings lots of changes designed to improve the effectiveness of CTRs. It introduces a clear commitment to autism and includes a new Policy Annex on CETRs.

The new guidance builds on the existing four key questions:

  • Is the person safe?
  • Are they getting good care now?
  • What are their care plans for the future?
  • Can care and treatment be provided in the community?

The new KLOE sets (outlined on pages 11 and 12) are supported by a new acronym, PERSONAL, which explains the principles of a good CTR.

PERSONAL stands for:

  • Person-centred and family-centred
  • Evidence-based
  • Rights-led
  • Seeing the whole person
  • Open, independent and challenging
  • Nothing about us without us
  • Action-focused
  • Living life in the community

SMART outcomes

To make the CTR activity more accountable and effective, the CTR frameworks will expect that recommendations will be made in the context of SMART outcomes:

Specific:  What exactly should happen and the name of the person responsible for ensuring that it is carried out

Measurable:  How will people know if the recommendation has been implemented satisfactorily?

Action-focused:  Recommendations should be in the form of clear tasts to be carried out by named persons.

Realistic:  Recommendations have to be possible to achieve and not merely aspirational or outside the remit of capabilities of the individuals named.

Time-framed:  there should be a specific stated date by which the recommendation is to have been implemented or reviewed.

My CTR

Two brilliant new booklets will help your loved ones understand and organise their CTR. These are:

  • My Care and Treatment Review: All you need to know about your CTR; and
  • My CTR Planner (Includes consent form, planner, report and feedback forms).

These are well worth using. Both can be downloaded from this page: https://www.england.nhs.uk/learning-disabilities/ctr/my-ctr/

Key lines of enquiry

The Key Lines of Enquiry (KLOE) for CTRs and CETRs are slightly different to reflect the differing needs of Adults (CTR) and children and young people (CETR). The CETR, being specifically aimed at children and young people, includes a greater emphasis on the need for engagement by local authorities and education services:

11 KLOEs for an adult CTR

  1. Key areas of concern
  2. Does the person need to be in hospital?
  3. Is the person receiving the right care and treatment?
  4. Is care person-centred?
  5. Are the person’s health needs known and met?
  6. Is there the right use of medication?
  7. Are there clear, safe and positive approached to risk?
  8. Are any autism needs being met?
  9. Is there active planning for the future and discharge?
  10. Are families and/or carers involved?
  11. Are the person’s rights upheld?

12 KLOEs for a child or young person CETR

  1. Key areas of concern
  2. Does the child or young person need to be in hospital?
  3. Is the child or young person receiving the right care, education and treatment?
  4. Is the child or young person being involved in their care, education and treatment?
  5. Are the child or young person’s health needs known and met?
  6. Is there the right use of medication?
  7. Are there clear, safe and positive approached to risk?
  8. Are any autism needs being met?
  9. Is there active planning for the future, including discharge from hospital?
  10. Are parent(s)/carers, family members and other carers involved?
  11. Are any specific issues for children or young people being addressed?
  12. Are the child or young person’s rights upheld?

The panel should look for proof or evidence of the care being delivered. This might be forthcoming from the person’s care notes or from what people say. The chairperson needs to show how or why the panel decides on something.

CTR document checklist

Before attending the CTR meeting, the independent experts are unlikely to know anything about the person, their background or the care being provided. They will, therefore, expect an information pack to be prepared and shared at the start of the meeting to enable them to learn about the person quickly and comprehensively.

These are the documents that should be prepared for the CTR panel and put into a pack. The CTR panel will not take any of these documents away with them nor will they make copies of them to take away. The CTR chairperson will be responsible for ensuring that all written and verbal information provided will be kept private and confidential within the CTR.

For a CTR in a hospital, the responsibility for producing the pack is with the provider.

For a community CTR, the commissioner is responsible.

CTR documents will typically include:

  • Risk assessments
  • Mental Health Act papers
  • The most recent Mental Health Act Tribunal report
  • Social circumstances report
  • The community service specification
  • The last four weeks of progress notes
  • Safeguarding reports from the last year
  • Incident forms where restraint was used, either since admission or last CTR
  • Health action plan
  • Person-centred Care plan
  • Positive Behaviour Support Plan and other care plans
  • Communication Passport
  • Hospital Passport
  • Medication Chart
  • Mental Capacity Assessments
  • Ministry of Justice documents, where appropriate
  • Activity Planner, and
  • Discharge Plan (if in hospital)

For a CETR, the local authority can provide:

  • Child in Need Plan
  • Child in Care or Looked after Child Plan
  • Other relevant education or social care assessments or plans (e.g. EHC Plan), and
  • Any relevant youth justice assessment or plan

Further information

CTR document checklists can be found on page 33 on the link below:

https://www.england.nhs.uk/wp-content/uploads/2017/03/ctr-code-toolkit.pdf 

CETR document checklists can be found on page 38 on the link below:

https://www.england.nhs.uk/wp-content/uploads/2017/03/children-young-people-cetr-code-toolkit.pdf    

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