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Transforming care

Transforming care aims to improve the lives of people with learning disabilities, autism or mental health conditions.

The three key aims of the programme are to:

  • improve quality of care
  • improve quality of life
  • increase community care to reduce unnecessary hospital admissions and length of stays

For more information on transforming care, visit NHS England. You can also view a guide for family survival by visiting Bringing Us Together.

Care, Education and Treatment Reviews (CETRs)

CETRs are for children and young people under 18 who are at risk of being admitted to, or are already patients in a specialist learning disability or mental health hospital.

After 18, young people become part of the adults’ policy and process, called CTRs.

The Care and Treatment Review (CTR) policy was updated by NHS England in 2017 to include a section for children, introducing CETRs to recognise the importance of education in a child’s life.

CETRs explore alternatives to hospital admission. If a young person is admitted to hospital, professionals will continue to work with the family to manage their discharge and community support package.

There are three types of CETR:

  • Community CETR - when the child or young person is living in the community (including residential placements) and is at risk of being admitted to hospital. The CETR will look for alternative services or options to keep them in the community.
  • Post-admission CETR – If a child or young person is admitted to hospital in an emergency, a CETR will take place within two weeks
  • Inpatient CETR - when a child or young person is in a specialist learning disability or mental health hospital, CETRs take place every three months to find solutions to barriers keeping them from being discharged. Timelines, actions and responsibilities are agreed using the CETR.

Principles of the CETR Panel:

  • Person-centred and family-centred
  • Evidence-based
  • Rights-led
  • Seeing the whole person
  • Open, independent and challenging
  • Nothing about us, without us
  • Action-focussed
  • Living life in the community

The CETR includes:

  • the child or young person (if they choose to attend)
  • family members (if the young person wants them there)
  • the responsible commissioner (usually the local CCG if a community CETR, or NHS England if a post-admission or Inpatient CETR)
  • a responsible Clinician or Senior Nurse
  • other professionals and services who may be helpful as appropriate

The process uses ‘Key Lines of Enquiry’ (KLOE) which includes a summary and feedback for the child or young person regarding safety, current care (and whether it needs to be in hospital), and the plan for their future.

Hospital discharge and post-admission

The CETR doesn’t decide whether the child or young person is discharged, but makes sure there are plans in place to get the right support once they are.

Requesting a CETR

Anyone can request a CETR with the child or young person’s consent. If this is not possible due to their age or they are assessed as lacking capacity, consent can be given by their parent, guardian or carer.

To request a CETR, you need to speak to your social worker, SEN keyworker or the health professional leading on the care. They will discuss the request with you and escalate.

Admission avoidance register

The admission avoidance register is for children and young people at risk of being admitted to a specialist learning disability or mental health hospital.

The register allows professionals to review young people’s care needs, making sure there is a plan and support in place to prevent unnecessary admission hospital, to help them continue to live at home.

It will also help prevent a child’s needs escalating, ensuring there are services available in the local community.

A child or young person can only be included on the register if they, or their parent, guardian or carer give consent. You can request a form from your social worker, teacher or health professional leading on your child’s care.

Some of the children and young people who are on the register will already be known to these services.

Positive Behaviour Support Service (PBS)

The PBS model is being used in Enfield by the Joint Service for Disabled Children (JSDC), local special schools and health colleagues as a strategic approach to supporting children, young people and their families. We have many staff trained as PBS coaches, with more training to come for staff and parents.

To find out more about PBS, visit the British Institute of Learning Disabilities (BILD) YouTube channel.

Behaviour support services (including the secondary pupil referral unit) work in partnership with schools, parents and the council to support the inclusion of all children and young people, and support remove barriers to learning.

They assist children and young people experiencing social emotional behavioural difficulties (SEBD) and social emotional mental health difficulties (SEMH) to access successful learning opportunities. The team may also:

  • offer preventative interventions to support pupils at risk of exclusion
  • provide a support and training services in the primary sector and secondary sector
  • refer to the Enfield secondary tuition centre who work with learners in Key Stage three and four to ensure that young people receive a curriculum that enables them to reach their full potential


When considering whether to exclude pupils, Headteachers will look at all the evidence and decide whether the pupil did what they are accused of doing. A Headteacher can exclude for incidents that take place going to and from school, even if a pupil is involved in an incident outside school hours and still wearing school uniform.

For more information, visit the school’s website to view their behaviour policy.

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