Care & Treatment Reviews – All About

Last modified: February 28, 2019
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What is a CTR?

A CTR is a meeting to check that a person’s care and treatment is meeting their needs.

A CTR may be held for anyone with learning disabilities, autism or both who may be at risk of admission to a specialist learning disability or mental health hospital, or who is already in a specialist hospital.

There are now two versions of the Care and Treatment Review.

One is for adults and is still known as a Care and Treatment Review (CTR). The other is for children and young people and is called a Care, Education and Treatment Review (CETR). Each has its own code and toolkit.

NB: Throughout this guide, information about CTRs will also apply to CETRs unless otherwise stated.

The following people may be invited to attend reviews:

• The person;

• Their advocate if one has been appointed;

• A family member(*); and

• Those responsible for providing the individual’s care.

The review is led by the responsible commissioner with support from two independent expert advisers whose role is to bring an additional challenge and an alternative perspective. The review team makes recommendations to improve the individual’s care with follow-up checks to ensure this is happening. A CTR may last a full working day or take place between 9am and 5pm.

(*) if the patient is 16 or older consent is required

When is a CTR held?

A CTR can be held before or during care in one of four ways:

Community Pre-admission. This review seeks to establish whether the person needs to be admitted to hospital or whether their care and treatment needs could be met safely and effectively in the community instead.

Local Area Emergency Protocol. This is used when a review is unplanned, urgent or if someone is in ‘crisis’. Its duration is variable and it can be via face-to-face meeting or secure teleconference.

Post-admission. This takes place within four weeks of admission unless it is for a child when the meeting is held within two weeks of admission.

Inpatient. These reviews should be held at regular intervals to identify the reasons for an extended hospital stay and any barriers to progression and discharge. The meeting should include a review to find out whether the correct and most effective treatment is being provided

How often can you have a CTR?

For children and young people, a CETR should take place every three months.

For adults, a CTR should take place every six months if the person is in an assessment and treatment unit or another type of nonsecure hospital.

If the person is in a secure hospital the CTR should take place every twelve months.

If there are good reasons for having a CTR more often, everyone involved can agree when they should happen.

You also have the right to request a CTR at any time. There is more about this here

What happens in a CTR?

Before the meeting takes place, the commissioner/chairperson will make sure that the appropriate consent has been obtained from the person under review. If the person does not have capacity to give consent, a best interests decision to continue the review should be made under the Mental Capacity Act.

On the day of the CTR meeting, the first task will be for the chairperson to finalise the agenda so that everyone invited will have an opportunity to take part in person. Some people may join in via teleconference if they are unable to travel to the meeting.

Before anyone else joins the meeting, the review team will study the patient’s clinical and support documentation to learn as much about them and their care programme as possible.

Early on in the process, one or both of the independent experts will wish to meet the person and their parent, guardian or other unpaid carer if available. It is very important to hear their views about the care and treatment being provided and to make sure that their voices are heard during the review. The person, their advocate (if one has been appointed) and a family member(*) also have the right to join the meeting.

(*) if the patient is 16 or older consent is required

The chairperson will then invite one or more of the professionals involved in providing or managing the care programme into the meeting room, together or in succession, to provide a summary of care and to answer questions from the panel.

The review team will seek to answer the following 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?

Under each of these four main headings is a list of other important questions known as Key Lines of Enquiry (KLOE) which help guide and structure the review process.

Once all attendees have been interviewed, the chairperson and the independent experts will discuss what they have heard and together write up a detailed report based upon a standard CTR template.

Each KLOE section of the report contains a list of prompt questions about the quality of care being provided. Notes, comments and concerns are entered alongside each question and a red, amber, or green (RAG) score given for each section. Any actions raised should state a named individual responsible for the action and the expected completion date of that action. Use of the standard template makes sure that the final report is consistent, to a high standard and that all actions are completed in a timely manner.

Finally, the chairperson may provide a verbal summary of the CTR outcomes to senior hospital staff before concluding the meeting.

The person and their family should also be offered verbal feedback at the end of the CTR.

The final report will be sent by the chairperson to the person, their advocate (if one has been appointed), a family member (*) and the care team within two weeks of the CTR.

(*) if the patient is 16 or older consent is required

If you have any questions arising from the report, you should contact either the care manager or the commissioner responsible.

 

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