Policy – National Network of Parent Carer Forums C.I.C

NHS England has published the new Dynamic Support Register (DSR) and Care (education) and Treatment Review C(E)TR policy

February 2023

At the end of January, NHSE published its new DSR and CETR policy.

You can find a link to it here: PR1486-Dynamic-support-register-and-Care-Education-and-Treatment-Review-policy-and-guide.pdf (england.nhs.uk)

There is also an easy read version here: Easy-read-version-of-the-Dynamic-support-register-and-Care-Education-and-Treatment-Review-policy-and-guide-Jan.pdf (england.nhs.uk)

The policy will be rolled out in April 2023.

Some definitions:

A Dynamic Support Register (DSR) is the tool used in a local area to identify individual children, young people and adults with a learning disability, autism or both who are at risk or may become at risk of admission to a mental health inpatient setting without specific and timely Dynamic Support

Note: the term “At Risk of Admission Register” was originally used, this term continues to be used in some areas. Similarly, the Dynamic Support Register is also known in some local areas as a Dynamic Support Database (DSD)

A C(E)TR is a meeting bringing together those responsible for commissioning and providing services (including nurses, social workers, local authority representatives, such as from housing and education, and health and social care commissioners) together with independent clinical opinion and those with lived experience of learning disabilities and/or autism, which includes people with a learning disability and/or autistic people and their family carers.

The aim of a C(E)TR is to check that a person who is either at risk of being admitted or who has already been admitted to a hospital setting is receiving appropriate care that meets their individual needs and that, where possible, challenges are overcome to support discharge to or continued care in the community.

The policy outlines the new process for the implementation of DSRs and C(E)TRs. The NNPCF did not have direct input into the development of the policy but we were involved in broader conversations about the issues with DSRs and CETRs in the current system, the experiences of children and young people and their families and some of the changes that we wanted to see in the new policy.

We are working with NHSE to ensure that parent carer forums are engaged in the implementation of the new policies:

NHSE will be hosting a webinar for parent carer forums to explain the new policy, what has changed and the role that parent carer forums can play in its roll out. This webinar will be held on 14 March please follow this link to sign up https://us06web.zoom.us/meeting/register/tZEud-CgrzgoH9y7_fOCdMb0HNSu7AxXToRc
In addition, NHSE are holding a briefing session for people with lived experience. This is not targeted at parent carer forums but at individual families who have had experience of the DSR / CETR process. This is open to anyone and a link to sign up for it can be found here: https://teams.microsoft.com/registration/slTDN7CF9UeyIge0jXdO4w,QEJVWbS9TUK5AFArxhPZ0g,XHWJVzje40-WI0Cvo7uh4g,RqoXUlop0EmnTOfUib1-EA,Opgv9tfH2U6JeIA35LisMg,4twvijWsJ0W_YL66zI7fvg?mode=read&tenantId=37c354b2-85b0-47f5-b222-07b48d774ee3
We are working with NHSE to convene a focus group to ensure that the face to face section of the Key Lines of Enquiry (KLOE) template which is used in C(E)TR meetings to support the consistent recording of findings and generate the C(E)TR report, is accessible and easily understood by families moving forward. We are looking for input from families that have experienced a CETR. Our participation lead Jacqui Watt is organising this to find out more or participate please contact Jacqui at participation@nnpcf.org.uk
If you have any comments on the policy you can feed them back to NHSE at england.ctrdsr@nhs.net

Dynamic support register and Care (Education) and Treatment Review

NHS England has a new policy to help people with learning difficulties and autism get the right support for their mental health at home instead of in hospital which will be implemented from 1st May 2023.

Dynamic support registers DSRs – Local areas must create a list of people with learning difficulties and or autism who are at risk of needing mental health hospital care, to try an ensure they receive appropriate care and reduce the need for an admission for hospital. This list is called the dynamic support register (DSRs). The DSR should be organised in such a way that adults, children, and young people can be identified when their health and care needs are increasing or complex, and may require a multi-agency response, monitoring and prioritisation for extra support.

Forums may wish to read the core standards for dynamic support registers, which also includes minimum requirements on standards and datasets. There is also a section on carer contingency planning for unpaid carers which may be of interest to forum members.

Care (Education) and Treatment reviews C(E)TRs – A C(E)TR is a person-cantered review to ensure the care (education) and treatment and support needs of the individual person and their family are met, and that barriers to progress and/or discharge are challenged and overcome. All autistic children and young people and those with a learning disability are required to have a community C(E)TR if they have been admitted to or are considered to be at risk of admission to a mental health hospital.

There is an increased focus on advocacy for the child or young person, physical health, quality of life, as well as looking at participation in meaningful activity.

Forums can find out more about DSRs and C(E)TRs in the Dynamic Support Register and Care (Education) and Treatment Review Policy and Guidance document. Easy read and plain English versions are also available.

The NNPCF are working with NHSE to ensure that parent carer forums are engaged in the implementation of the new policies including a webinar for PCFs to explain the changes on 8th March. Details of how to sign up will be released shortly.

Mental health issues affecting a pupil’s attendance: guidance for schools

The government has recently published guidance for schools where mental health issues affect pupil’s attendance as well as giving some examples of effective practice.

Integrated Care Systems – Public Accounts Committee Report

The Public Accounts Committee have published its response to its inquiry into Integrated Care Systems.

SEND and Alternative provision Green Paper

The NNPCF is awaiting the release of the SEND improvement plan which is the Department of Education’s response to the SEND and AP green paper consultation paper, which we believe is due to come out before March.

The DofE will be coming to our conference on 28 February to lead an interactive co-production session on the next steps of the AP and SEND improvement plan. We would really like to encourage forums to come to our conference to be part of these vital discussions.

Details of the NNPCF conference can be found on our website.

Children’s Social Care Review

The government recently published its response to the Independent Review into Children’s Social Care. The response can be read in the Stable Homes, Built on Love: Implementation, Strategy and Consultation paper.

There is little detail or content in this paper about the SEND social care system – the Department for Education has indicated that the SEND and Alternative Provision Improvement plan which they intend to publish shortly will aim to align the two systems. However, some of the key themes that the NNPCF raised are explicitly picked up in the strategy, namely:

The call for a more joined us system across education health and care
The need for earlier intervention

But some of the more specific things that we asked for in the independent review are not picked up:

A call for a “support not safeguarding” for the majority of SEND families
The quality of social care input into EHCPs and a recognition that too often this is non-existent.
A huge variation in consistency and standards across the country

In March, the NPPCF will be engaging with forums to help formulate our response to the strategy; in particular our response to question of the consultation “What more can be done by government, local authorities and service providers to make sure that disabled children and young people can access the right type of help and support? “

Details of how to be involved with this will be included in our March consultation briefing. The NNPCF response as well as further details for forums are available to read on our website.

Census Data on Carers

The Office of National Statistics has published data on Unpaid Care in the UK. Their data includes anyone aged 5+ who indicated they provided unpaid care in the 2021 census. They found regional variability in number of hours of unpaid care given: the local authority with the highest proportion of unpaid carers was found to be St. Helens; whereas the North East was found to be the region with the largest proportion of unpaid carers.

More updates are due on the health, disability, and unpaid care series over the next year.

Children’s and Young People’s Mental Health Trailblazer programme

The National Institute for Health and Care Research (NHIR) has published the final report from the early evaluation of Children and Young People’s Mental Health Trailblazer programme. The trailblazer programme, led by the Department of Health and Social Care, Department of Education and NHS England, was launched in 2018. The programme saw the creation of mental health support teams and training education mental health practitioners working directly in schools.

The report can be downloaded here and NIHR have published an infographic with a summary of the key findings.

Reports on location

The Child of the North All Party Parliamentary Group has issued a report highlighting areas where children and families in the north may have a different lived experience of parenting a children or young person with a disability.

The Coastal Communities Alliance have published their report highlighting challenges for disabled people in employment in these regions as well as higher levels of disability and long-term sickness.

February Policy Briefing

NHS England has a new policy to help people with learning difficulties and autism get the right support for their mental health at home instead of in hospital which will be implemented from…

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