Health Needs – DSRs & CETRs

Dynamic Support Registers and Care, Education and Treatment reviews are used to help children and young people who are at risk of being admitted to a mental health hospital (to help prevent unnecessary admissions) or those already in hospital (to prevent any unnecessary prolonged stays). They apply particularly to those with learning disabilities or autism.

Dynamic Support Register (DSR)

A Dynamic Support Register (DSR) is a list of children, young people and adults with learning disabilities or autism, whose needs show they are at risk of going into hospital. People on the Dynamic Support Register are at risk of going into hospital if they do not get the right care and treatment in the community.

Local health and care organisations need to make it possible for people to ask to go on the DSR and must have policies to enable this. Lots of health and care organisations that already have a DSR, use a colour system to show different levels of risk. This helps health and care workers to decide how much risk there is of someone going into hospital.

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

The DSR is then used to make sure that the right checks are carried out by health and care teams.

Using the colour system means:

  • a Care and Treatment Review or Care (Education) and Treatment Review might take place.
  • health and care teams can make sure they provide the right care and treatment.

For someone to go on the DSR they would have to give their consent.

Care, Education Treatment Reviews (CETRs)

Care, Education Treatment Reviews or CETRs (sometimes written as C(E)TR or Care (Education) Treatment Review) are independent meetings about a child or young person who is at risk of going into hospital or who is already in hospital. The meeting is to look at the care and treatment required for their educational needs as well as their health needs.

Who can ask for a CETR?

Anyone can ask for a CETR, but you will only get a CETR if your support needs show it is right for you.

What are CETR Panels?

CETRs are run by a group of people called a CETR panel. CETR panels include people who are not involved in a child or young persons everyday care. This helps the panel to be independent when they discuss the care and treatment required at the CETR meeting. The panel members listen to those who is involved in a child or young person’s care. They look at the notes and check that the care and plans are working well.

There are three people that must be part of any CETR panel.

A Chairperson who:

  • runs the meeting.
  • makes sure the meeting is run well.
  • makes sure that everything that was agreed at the meeting goes into an action plan.
  • makes sure the agreed actions listed in the action plan go ahead.

An expert by experience who:

  • Is someone who has lived experience.
  • supports the meeting.
  • helps to decide what is in the action plan.

A clinical expert who:

  • independently checks the care and treatment.
  • supports the meeting.
  • helps to decide what is in the action plan.

What happens at the CETR meeting?

As well as the 3 people named above on the panel, other people will be invited to the meeting. These include:

  • the child or young person
  • someone they trust such as a family member, a friend or carer
  • health professionals
  • social care professionals
  • advocates or self-advocates
  • an education professional
  • someone from their community team

The most important thing about a Care (Education) and Treatment Review is that it is about the child or young person. As a parent carer (or as a young person) you should get the chance to talk about:

  • their safety
  • how you feel about the care and treatment you are getting
  • what daily life is like
  • if physical health needs are being me
  • their educational needs and provision
  • putting a plan in place for the future
  • if there is a need to stay in hospital, to carry on getting care and treatment.

The CETR will also:

  • look at any care plans already in place
  • make sure the care plans are right for the individual and are keeping them safe
  • set out a plan that gives the chance for the young person to live as independently as possible.

Who should have a CETR?

A CETR may be held in a hospital or in the community. Hospital staff will make plans to support going home from hospital when well enough.

A CETR in the community looks at the extra support needed at home and in the local area. Getting the right care and treatment at the right time could mean only going into hospital when it is really needed.

Who can ask for a CETR?

Anyone can ask for a CETR but you will only get one if your support needs show you should have one. Sometimes other people might ask for you to have a CETR. Such as:

  • A family member or carer
  • The person who plans and pays for your care
  • An advocate – someone trusted to support you and speak up for you
  • The team who support you while you stay in hospital
  • The team who support you in the community

To have a CETR you will need to give your consent.

What happens after a CETR?

The person who leads the CETR writes a report about what needs to be done to.
The report:

  • checks that you are getting good care and treatment.
  • suggests how you could get better care and treatment.

The report should be written in a way that is easy to understand. If there are any difficult words you can ask someone to go through the report or action plan with you.

The report is sent by the Chairperson to:

  • you and the people who manage your care and treatment.
  • the people who were at the CETR.

What to do if you a have a problem with a CETR?

The first person to speak to about a problem with a CETR is usually the CETR chairperson – this is the person who leads the meeting. Anyone can talk about a problem or worry that you have. Such as:

  • You
  • Your family
  • A health or social care professional

If you have a problem with your CETR speak to someone you trust to support you. Such as:

  • Your named nurse
  • Your advocate
  • A family member

You will be asked if you agree to:

  • go on the DSR
  • have a CETR

This is called consent.

If someone is under 16 years old, their parents or guardian would need to give consent for them to go on the DSR or have a CETR. Note: the child or young person should also be asked if they give their consent too.

If someone does not have the capacity to make their own decisions:

  • a ‘Best Interests’ decision will be taken on their behalf
  • a record will be made about the decision

Local health and care services must make sure that if you do not agree to a CETR:

  • It will not affect the care and treatment you receive
  • You can change your mind at any time
  • You have the right to get support from an advocate to support your decision
  • Other types of reviews of your care can be looked into.

If you give your consent you are agreeing to share your information with people involved in your care and treatment.

Further Information

NHS England

Local Offer – CETRs

Local Offer – DSRs

To find out specific information about the DSR and CETRs in West Sussex Please contact the Children & Young Peoples Joint Commissioning Team:

Hospital Admission Avoidance. NHS England and NHS Improvement have produced a booklet written by parents with children and young people that have special educational needs and/or disabilities, to inform families what can be done before your young person needs to be admitted to a tier 4 mental health hospital. It is especially for a young person who has autism and or a learning disability, who may be experiencing mental health needs or a child or young person on the Dynamic Support Register.

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