The aim of Transforming Care is to improve the lives of children, young people and adults with learning disabilities and/or autism who display behaviours that challenge, including those with a mental health condition.

The programme has three key aims:

  1. To improve the quality of care for people with a learning disability and/or autism
  2. To improve the quality of life for people with a learning disability and/or autism
  3. To enhance community capacity, thereby reducing inappropriate hospital admissions and length of stay

More information on Transforming Care can be found on the NHS England website and in the Guide for Families written by Bringing Us Together. 

The Transforming Care Lead for Children and Young People in Barnet is Deian Abankwa (d.abankwa@nhs.net).

Care, Education and Treatment Reviews (CETRs)

The original Care and Treatment Review (CTR) policy was published by NHS England in 2015, as part of the wider Transforming Care work.

This was updated in 2017 to include a section specifically for children, and the introduction of Care, Education and Treatment Reviews (CETRs), recognising the importance of the role of education within a child’s life.

CETRs are specifically for children and young people up to the age of 18 who are facing potential admission to, or are patients in, a specialist learning disability or mental health hospital and who are the commissioning responsibility of NHS England or Islington CCG (i.e. they fund the placement).

After 18, the young person will come under the adults’ policy and process; this is very similar to the children’s process in many respects. These reviews are called CTRs.

Who can request a CETR?

Anyone, including the child or young person, or their family, can request a CETR. However, CETRs cannot take place without the consent of the child or young person, or where this is not possible (either because of their age or they have been assessed as lacking capacity) their parent/guardian or carer.

If you are a young person or a parent/carer and want to request a CETR, you need to speak to your social worker, the health professional leading on your or your child’s care, or your or your child’s SEN Keyworker. They will discuss the request with you, and can escalate the request to the responsible commissioner.

Admission Avoidance Register

The Admission Avoidance Register is a register of children and young people for who there are concerns that they are at risk of being admitted to a specialist learning disability or mental health hospital. This will mainly be for children and young people who have a learning disability or autism or both who display, or are at risk of developing, behaviour that challenges or mental health conditions who were most likely to be at risk of admission.

Potential relevant risk factors include (but are not exclusive):

  • Already in a residential 52 or 38-week placement but providers are raising concern at their ability to be able to meet their ongoing needs
  • Is in a JAP placement which is consider to be unstable
  • Is displaying significant challenging behaviours that providers are raising as being of significant concern
  • Has previously had a CAMHS T4 admission and there remain concerns
  • Is known to the criminal justice system / Youth Offending Service and there are concerns about mental health / challenging behaviour
  • Is presenting significant challenging behaviours at the Integrated Learning Space (ILS) and there is concern about their ability to meet their ongoing needs.

A child or young person can only be included on the register if they (or their parent/guardian or carer) have given their consent. There is a form that needs to be completed and signed, and this can be requested from your social worker, SEN key worker or health professional who leads on your or your child’s care.
Many of the children and young people who are on the Admission Avoidance Register will be known to existing services such as SEN, Disabled Children’s services, or Children Looked After.

If a child or young person is placed on the Admission Avoidance Register, this means that we can ensure that they are receiving support to enable them to stay in the community, and that their needs are less likely to escalate to the point of needing a CETR and are at risk of being admitted to hospital. A child or young person will only require a CETR at the point of which all current community services have been exhausted.

What is a CETR?

The aim of a CETR is to facilitate a process of exploring alternatives to hospital admission. If this is not possible, it will continue whilst the child or young person is an inpatient, through their assessment and treatment, and their discharge.

You can find more information on the "What is a CETR?" page.

Leaving Hospital: discharge and post-admission

The CETR itself will not decide whether the child or young person is discharged. What it should do is ensure that there are clear plans in place for when the child or young person is discharged, and that the right support is in place to make the discharge a success.

NHS England have developed ‘Discharge Steps and Standards’ to support those involved in the CETR process plan for when someone is leaving hospital. This includes ensuring there are follow up meetings, and plans to ‘check-in’ with the family to ensure that things are working well.