Transforming Care Programme

Transforming Care is a national programme, which focuses on improving services for people with:

• learning disabilities
• autism
• severe mental health problems
• behaviour that challenges

The North East Transforming Care Programme covers the North East and North Cumbria.

Aims of programme

The programme aims to:

• make sure individuals are supported within the local community, to avoid unnecessary admissions to specialist learning disability or mental health hospitals
• make sure individuals have the right to the same opportunities as anyone else
• make services in the community better, so children and young people can get their health care at home or near to where they live

It also aims to make sure children and young people:

• have a good quality of life, are treated with respect and feel at home in their local community 
• are kept safe but at the same time be supported to take positive risks 
• have choices and control over their lives 
• make sure support is provided in the least restrictive way 
• get equal health outcomes to the rest of the population
• have the right to the same opportunities as anyone else

Other services

• STOMP / STAMP
  STOMP - stopping over medication of people with a learning disability and / or autism 
  STAMP - supporting treatment and appropriate medication in paediatrics
• Annual Health Checks
  Your child / young person may be eligible for an Annual Health Check.

The Dynamic Support Register (DSR) is a register of people who:

• have learning disabilities and / or autism, and
• are at risk of being admitted to a specialist learning disability or mental health hospital.

It is important that local services are aware of these individuals, so they can make sure they are getting the right support.

Support for people on the DSR includes:

• strengthening support in the community
• helping people to live as independently as possible
• preventing crisis or hospital stays wherever possible   

How the register works

The DSR uses 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.

Green is for people who are having their risks managed well at home.

Blue is for people who are already in hospital.

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.

How the register is managed

An assurance group is responsible for regularly reviewing and monitoring the care and treatment provided to everyone on the register. 

The group is made up of representatives from the health service, education service, and the Council.

It focuses on outcomes for individuals, personalising the support they receive, and looking after their wellbeing.   

The register is managed by the Complex Care facilitator, who works in the Joint Commissioning Unit.

Request to be put on the register

Request a place on the Dynamic Support Register

Sometimes, hospital admissions can be avoided by making sure your child / young person gets the right support at the earliest point.  

To do this, a Multi-Disciplinary Team Meeting may be held.

The meeting will involve someone who is responsible for planning and agreeing services (known as 'commissioning').

Your child / young person may be referred to a Multi-Disciplinary Team Meeting at any time.

This could be because something significant has changed, and different treatment options need to be looked at.  

The Multi-Disciplinary Meeting

The meeting aims to:

• understand the support your child / young person needs
• make sure your child / young person is getting the right care
• look at whether any other support or services can be arranged for your child / young person
• look at the current plan and review your child / young person's progress  
• look at options to meet your child / young person's needs, such as respite or community services. 

You and your child / young person should be asked for your views as part of the meeting.

For more information, contact the Joint Commissioning Unit by emailing transformationJCT@southtyneside.gov.uk  

Northeast and North Cumbria Keyworker Service

Keyworkers are available to children and young people aged 4 to 25 years old, who:

• have a learning disability and / or autism
• are in a mental health inpatient setting
• are at risk of going into an inpatient setting (due to their mental health, autism or learning disability)

Keyworkers will support young people and their family to navigate the system and act as a main point of contact.

Keyworkers must be offered to all children and young people who are rated red or amber on the NHS: Dynamic support register.

For more information, see NHS: North East and North Cumbria (NE and NC) Keyworker Service.

If there is an urgent need to consider admitting your child / young person to hospital, a Care (Education) Treatment Review should be carried out.

Requesting a Care (Education) Treatment Review

A review should only be requested if care in hospital is needed or being considered. 

Request a Care (Education) Treatment Review

You can request a review by completing the following form:

Request a Care and Treatment Review (CTR), or Care (Education) and Treatment Review (CETR)

Who can request a review

Reviews can be requested by: 

• your child / young person
• a family member or carer
• the responsible commissioner 
• someone who is acting on behalf of your child / young person
• a team that supports your child / young person, either from the inpatient services or within the community

The review

Reviews are led by the NHS, but involve the Council and education services.

They bring together:

• those responsible for commissioning (buying) and providing health services for your child / young person
• the views of your child / young person
• the views of family members
• the views of independent clinical health professionals

Review will:

• look at current and future health and care planning for your child / young person
• look at plans for your child / young person to leave hospital 
• make sure your child / young person is getting the right treatment, care, and support  
• help to avoid unnecessary admission to hospital by looking at other ways to meet your child / young person's needs
• reduce the amount of time your child / young person spends in hospital by looking at any barriers that may keep them in hospital for longer than necessary

Listening to your views

Requests are managed by Your Voice Counts, to make sure that your views, and those of your child / young person, are listened to.

Reviews will be centrered around your child / young person and their strengths.

They will look at why care in hospital is being considered, and challenge any assumptions if this is needed.

If your child / young person does need to be admitted to hospital

If your child / young person does need to be admitted to hospital, the Care (Education) Treatment Review will test and challenge the care they receive in hospital.

It will ask key questions and make recommendations to improve the safety, care, and treatment your child / young person receives.

More information

For more information see See NHS: Care and Treatment Reviews.