Health Needs – DSRs & CETRs

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 con

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 children and young person who are at risk of going into hospital or who are already in hospital to looks 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 C(E)TR, but you will only get a C(E)TR if your support needs show it is right for you

What are CETR Panels?

C(E)TRs are run by a group of people called a C(E)TR panel. C(E)TR 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 C(E)TR 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 C(E)TR panel:

A Chairperson:

  • 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:

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

A clinical expert:

  • 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 including:

  • 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 met
  • 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.
  • The plans should give the chance for the young person to live as independently as possible.

Who should have a CETR?

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 C(E)TR 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 C(E)TR 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 C(E)TR 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 C(E)TR is usually the C(E)TR 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 C(E)TR 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 C(E)TR:

  • 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.