Care, (Education) and Treatment Reviews: October 2021 policy update

Care, (Education) and Treatment Reviews C(E)TRs were originally designed for  people with a learning disability and autistic people (children, young people, and adults) who might need to go into a specialist mental health or learning disability hospital or are already in a specialist hospital. Increasingly the NHS is conducting C(E)TRs for people with mental health issues including children.


Key messages

  • C(E)TRs were originally designed for  people with a learning disability and autistic people (children, young people, and adults) who might need to go into a specialist mental health or learning disability hospital or are already in a specialist hospital. Increasingly the NHS is conducting C(E)TRs for people with mental health issues including children.
  • The C(E)TR policy was updated in October 2021 to take account of learning from the pandemic and to facilitate the return to face-to-face reviews, whilst allowing a blended virtual and face-to-face approach.
  • Statutory agencies have been reminded of the standards that need to be met for a good review to take place. There is a checklist for review panels which includes advice for virtual meetings.
  • Reviews should provide a degree of independent scrutiny and challenge where necessary to care and treatment plans.
  • The C(E)TR should be offered on time every six months for an adult, or every three months for a child or young person. In secure services for adults they should be offered every 12 months.
  • There are specific standards relating to reviews of people in hospital and children and young people.
  • Children and young people must be offered a C(E)TR before they go to hospital or if this is not possible within a week. The education element needs to be considered if the person is a child or young person.
  • Government is reviewing the C(E)TR policy in full by the end of 2021. This takes account of the relevant recommendations from the review of independently chaired C(E)TRs led by Baroness Sheila Hollins published on 21 July 2021.

Care, (Education) and Treatment Review Policy in more detail

  • As a result of learning from the pandemic there will now be a blended approach to C(E)TRs. This means people can choose to have both virtual and face to face meetings for their C(E)TR. There is commitment to a return to face-to-face reviews whilst taking the best of the learning for the COVID-19 pandemic.
  • The updated policy emphasises that it is always necessary to visit people for their C(E)TR whenever possible and to see the inside of the hospital, meet the person, and talk to staff involved in their care has been emphasised.
  • A quality review needs to involve the person and ideally family (over the age of 16 you have the right to refuse family involvement) and record decisions and take place on time. It is expected that actions are implemented between reviews or within the timescales specified in the plan.
  • The review needs to check the impacts of the pandemic on the person whose care and treatment is being reviewed. Mental health impacts and how risk is being reduced for the person needs to be covered.
  • In the community services must work together so that information about people at risk of going into this type of hospital can show who might need a C(E)TR. They can do this through a Dynamic Support Register, or DSR to people get extra support in the community where needed to avoid admission to hospital.
  • If community support cannot meet the person’s needs, the C(E)TR should look at why.
  • If hospital is needed, the C(E)TR should think about the plan for this, how long the person will be in hospital and how it will help them.
  • Chairs have specific responsibilities to make sure standards are met and people whose care and treatment is being reviewed know what’s happening and have consented to the review and it is well organised and prepared for. Some, but not all, responsibilities can be delegated for the day to commissioners.
  • Care needs to be taken over confidentiality and sharing of personal information. The NHS should set up NHS mail accounts for participants (i.e. clinical experts and experts by experience and supporters if they have one).
  • People whose care and treatment is being reviewed also need support to prepare. Reasonable adjustments should be made where needed.
  • Expert advisors, including experts by experience should be renumerated for their involvement. This includes preparation time.

Advice for councils

  • Reviews should be multi agency involving all relevant agencies as needed including police, probation and multi-agency public protection arrangements where needed. Council staff working with people who have a review should be active members of the review process, so need to be familiar with the changes to this policy. Council staff may be panel members.
  • Councils need to be involved in ensuring that a quality assurance process continues to be applied locally by commissioners (NHS England Specialist Commissioning, CCGs, Provider Collaboratives), and overseen regionally. Quality assurance processes should ensure that actions agreed at a C(E)TR are being followed through or escalated where not.

Useful resources

Relevant legislation