Prioritisation of Care and Treatment

Reviews (CTR) for patients (5 year

plus) who have not yet had a CTR (Project 1)

Completed by Dr
Rebecca CourtneyWalker
And Expert by
Experience Victoria
Farnsworth

The Project
To Undertake Care and Treatment
Reviews (CTR) as identified and
prioritised by NHS England
To produce a CTR report for each
patient
To write a brief summary report of
overarching findings and
recommendations to be reported to
the Expert Advisory Group.

What they did

Completed six Care and Treatment Reviews
Wrote the reports to send to the provider
Each Care and Treatment Review had the same
Expert by Experience present (Victoria Farnsworth)
who was very experienced in this role.
We agreed the summaries given for each patient
and the overall initial findings for each CTR.
We also agreed a summary of overall and
recommendations at the end of all the CTRs based
on the themes we had identified across them.

What they found out

No Health Action
Plans (HAP) or Health
Passports
No Person Centred
Plans (PCP) and a
very poor
understanding of
what one should be
or communication
passports

No Positive
Behaviour Support
(PBS) Plans and there
was an absence of
formal
knowledge/experienc
e in this approach.
No Formulation
processes for any
patient

What they found out

Limited access to
some professions
(Concerns about
staffing levels to
support this
approach were
inadequate).
Limited multi
disciplinary working

limited use of the

My Shared
Pathway (MSP)
document
Timescales for
patients
treatment were
not clear

Things to talk about?

Any questions ?

What was not so

good?

What was good ?

What needs to
happen now ?

Recommendations
Introduction of Health
Action Plans (HAP)
Introduction of either
a Full Person Centred
Planning or My
Shared Pathway and
a coproduced
document about their
hopes, dreams and
aspirations.

Improve psychosocial
interventions
Improved physical
health checks in line
with prescribing
medication
Improvements in
activities programmes
Introduction of
Positive Behaviour
Support

Recommendations
Consideration of
clear admission
and alternative
transition/
discharge routes/
policies for people
Fortnightly
Multidisciplinary
team meetings

Improve
multidisciplinary team
working by using
multidisciplinary
formulation
Daily review in between
of 5mins per patient to
review observation
levels and s17 leave to
ensure these are the
least restrictive possible

Desktop exercise on five year plus inpatients in secure and non-secure

services
project2

Dr Rebecca
CourtneyWalker

The Project
To Undertake a desktop audit of a sample of five
years plus patients in secure and none secure
services.
The random selection of patients was provided by
NHS England and agreed by the relevant
commissioner, looking at CTR and/or CPA
documentation.
Test and understand the application of CTR policy
Length of stay
Discharge planning
Gaps, trends, themes and opportunities

Participants and
Documentation
20%

11%

DOCUMENTS RECEIVED (CPA/other)

DOCUMENTS RECEIVED (CTRs)

REMOVED DUE TO CONSENT ISSUES

17%

52%

REMOVED (NO RESPONSE FROM SC

CONTACT x2)

What they did

Contact was made with the Experts by Experience
representatives to agree key lines of enquiry.
A sample template for each record
(i.e., a record keeping sheet)
Reviewed 28 records received for analysis
(23 CTRs, 5 CPA/other)
8 patients have dropped out of the sample due to
consent issues (one became deceased during the
project)
9 records (5CTR, 4 CPA/other) were not provided
by the commissioner/s (x2)

What they found

CTRs provided the
highest quality data
compared to CPA
Differences in the
standard of
documentation and
versions of CTR were
used
lack of Understanding
of formulation and
processes inconsistent

Inconsistent
understanding of what is
meant by a Positive
Behaviour Support Plan is
and what it should
include.
It was notable that two
providers excelled in this
area
Poor understanding of
what a good Person
Centred Plan should
include.

What they found

Physical health needs

met rather than
coproduced health
action planning

Families are involved in

the care of their loved
ones with learning
disabilities and autism.

However 9
participants did not
involvement of family,

Advocacy was in place

for most people,

What they found out about

communication
Communication Passport/Plan?

Communication Passport/Plan?
1-No, 2- Unclear, 3-Yes

10

12

14

What they found about

lengths of stay
10
9

9
8

8
7
6
5
4
3
Number of People in sample

2
1
0

What they found about reasons

for not being discharged
Other
Legal issues
MOJ permissions
Treatment formulation unclear & absence of outcomes
Responsible commissioner issues
Appropriate Clinical skills not available in community to support package
Lack of agreement on funding
No suitable care provider
Lack of suitable housing
No identified care coordinator in community
Lack of agreement on future plan
No Person Centred Plan on which to base individual service specification
0

Number of People in group 3-ready for discharge but with no discharge plan

Things to talk about?

Any questions ?

What was not so

good?

What was good ?

What needs to
happen now ?

Recommendations CTRs
Future projects to
use CTR
documentation only

Improve the
consistency of CTR
documentation

CTR panel : identify

training needs,
support materials,
recruitment criteria
for panels (SMART
recommendations)

Review of when CTR

are completed and
recommendations
from previous one has
not been met. This
should be reflected in
CTR paperwork

Recommendations- Documentation
Improve Behaviour
Support plans Plan
linking to the personcentred plan
It needs to be made
clear that a PBS plan
is not the same as
a:My Shared Pathway
Risk Management Plan
with behavioural
indicators
PBS trained care
providers
Improved person

Mandatory discharge
planning with service
specification to be
completed within 3
months
Agreement of
essential
tools/assessments
with standard
documents for
providers or agreeing
criteria for essential
tools/assessments.

Recommendations
All individuals in the
sample ready for
discharge need to be
supported to be
discharged
Commissioners need to:
Develop the Local health
and social care provision
Develop of a local
accommodation strategy

Care packages are

appropriately funded to
balance positive risk
taking with safety and
promoting a high quality
of life
Community teams need
to be incentivised to be
more
responsive/proactive in
pulling the patient out
of the hospital

Words and meanings

CTR care and
treatment review
Formulation- a process
used to find out about a
persons behaviour
Positive behaviour
support a way of
working with some one
to support them well
Multidisciplinary team- a
team made up of a
range of professionals

Person centred carefinding out what is

important to the person,
and making sure the care
is around their wishes
and needs
Health Action plan looks at a persons health
needs
My shared pathway- a
document some of the
hospitals use to
document care