Dynamic support register and care, (education) and treatment reviews

Introduction

A dynamic support register (DSR) and a care, (education), treatment review (C(E)TR) are methods to review and support the needs of people with a learning disability and/or autism.

Guidance from NHS England about C(E)TRs and DSRs aims to support services to:

Understand the needs of people with a learning disability and/or autism
Recognise the early warning signs that might lead to a crisis

This can help services to put extra support in place to avoid and reduce unnecessary hospital admissions.

Go to the NHS England website to read and download the DSR and C(E)TR policy and guide and the easy read and plain English versions.

Read the DSR and C(E)TR code of practice on the NHS England website.

More about the Norfolk DSR and how to get added

More about C(E)RTs in Norfolk and how to request one

Dynamic support register

A dynamic support register (DSR) is a list of people with a learning disability and/or autism who are at risk of going to hospital if they do not get the right support. This includes children, young people and adults.

A DSR uses a rating system to show the different levels of risk. The ratings are:

Red: For people who are at high risk of going into hospital straight away
Amber: For people who are at high risk of going into hospital if they do not get the right care and treatment soon
Green: For people who are having their risks managed well at home
Blue: For people who are already in hospital

Ratings help determine the person's needs and makes sure that they get the right care and treatment, such as:

Going to hospital if appropriate
Extra support at home to avoid unnecessary hospital admissions. For example, having a care, (education) and treatment review (C(E)RT) or a referral to a transforming care navigator.

A DSR also helps make sure that services include the person's needs in:

Commissioning plans
Financial plans
Service delivery
Service development

How someone gets added to a DSR

Professionals can refer someone to go on a DSR
You can refer yourself to go on a DSR

Download the Norfolk and Waveney DSR self-referral form online

What happens to DSR referrals

The Norfolk and Waveney integrated care board (ICB) receive local DSR referrals. They review all referrals with education and social care workers to consider:

The persons level of risk of going to hospital
If the person should go on the DSR

The risk review process happens within four weeks of receiving a referral for the DSR. The ICB will tell the person and/or their parent, carer or referrer the outcome of the review. This will include an update of what will happen next. This is even if the person is not eligible to go on the DSR.

If the ICB decide that the person should go on the DSR, they will:

Organise regular multi-agency review meetings to manage the DSR
Review the risks to the person
Agree appropriate cross-system actions and support

There is a clear escalation structure for people with immediate risks (red and amber ratings). Senior managers across health and local authority services are responsible for the care of these people.

Guidance and resources from NHS England

NHS England have co-produced a set of young people Dynamic Support Register (DSR) and Care Education and Treatment Review (CETR) guides for Autistic young people aged between 16 and 25 years. These leaflets aim to empower young people to better understand the process and benefits of deciding whether to be on a DSR, have a C(E)TR and be actively involved in this process.

Visit NHS England's website to download the leaflets.

You can also:

Care (education) and treatment reviews

A care and treatment review (CTR) is for adults with a learning disability and/or autism.

A care, education and treatment review (CETR) is for children and young people (ages 0-18 years) with a learning disability and/or autism. It is different to a CTR because it includes educational needs.

C(E)TRs are for people who are at risk of going into hospital or who are already in hospital. They are a chance for the person to share what matters to them and their thoughts about their care and treatment.

Key lines of enquiry

Each review will follow the appropriate key lines of enquiry for whether the person is:

A child or an adult
In hospital or not

The key lines of enquiry are sets of questions asked to the person. Asking these questions aims to help understand their needs. This will help determine the right support they need.

Go to the NHS England website to read and download the key lines of enquiry for children, adults, child inpatients and adult inpatients with easy read versions.

How to get a C(E)TR

Norfolk and Waveney integrated care board (ICB) are responsible for arranging C(E)TRs.

A request for someone to have a C(E)TR can come from:

The person themselves
Their family, carer, advocate
The team that supports them in the community or in hospital

The person will only get a C(E)RT if their support needs show that they should have one.

Contact Norfolk and Waveney ICB to request a C(E)TR or more information