Dynamic Support Register
Overview
In line with the national guidance under Transforming Care on Care and Treatment Reviews (CTR), Clinical Commissioning Groups are required to keep a register of individuals with learning disability (LD) and / or autism that were at risk of admission. This risk register was variously labelled as ‘at risk register’, ‘dynamic risk register’, ‘dynamic support register’. For the purpose of this project, we have referred it as ‘Dynamic Support Register’ (DSR).
Care and Treatment Reviews (CTRs): Policy and Guidance
Transforming Care for People with Learning Disabilities – Next Steps (2015)
Our objective for the service innovation project was to:
• Develop a tool that could objectively identify individuals at risk of admission to hospital
• To ensure that such tool could be used by members of a multi-disciplinary team , and was easy to use and easy to incorporate into the electronic records.
• Develop a framework for the use of DSR with agreed mitigating actions, regular reviews and quality standards.
• Ensure that all the individuals that were known to LD services were on the DSR with their RAG rating.
The DSR Workstream
A scoping exercise showed a wide variation, inconsistency, and subjectivity in identifying individuals to be on the DSR and the use of DSR and CTR processes. With a lack of existing objective tools, we set out to develop a tool that would help professionals to proactively identify individuals with potential risks for admission.
The purpose of the DSR tool with its associated risk score was to ensure that there was proactive identification and management of risks thus ensuring that patients received timely and appropriate multi-disciplinary and multi-agency therapeutic and social care input in a person centred way so as to reduce the likelihood of admission.
A risk rating tool for adults with LD has been developed by Cheshire and Wirral Partnership Trust and has been accepted as the rating tool for the North West region. Two lead clinicians from Cheshire and Wirral Partnership Foundation Trust (CWP) have worked with all LD and Autism Provider Trusts across the North West to roll the tool out to bring consistency to risk stratification across the footprint.
Over the last year it has also been recommended by NHSE.
Training on the tool is available through the NHS Learning Hub as well as through the CANDDID website. The tool and training is free of charge and feedback has been positive.
The NHSE Dynamic Support Register (DSR) workstream hosted a National pre-launch event for the new DSR policy guidance. The DSD - CST was discussed within this session and Dr Woodrow (ODN workstream lead) has been asked to support further DSR events and support the development of the new policy guidance. This will be fed back to the NW ODN over the following year. It is known that the policy guidance will recommend RAG rating for understanding level of risk and the DSD-CST is likely to be recommended as a validated tool to support this.
Outcome and Next Steps for 2022/23
Significant work has been completed to raise awareness and to try and embed this in clinical practise. Many community teams have now received training for the tool and are actively using it in practise.
The key tasks and next steps for 2022/23 include:
Understanding people rated as ‘amber’ or ‘red’
A multi-site (multi Trust) qualitative evaluation of intensive support and the needs of those who rate as amber or red has been ongoing over the last 12 months. One site has now completed all interviews and another site is half-way through. The research team hope to complete three linked papers in relation to this.
Evaluation of Admissions
Work on understanding number of admissions and reasons for this is ongoing in all areas. An evaluation of admissions and delayed discharges has been completed in one organisation (follow-up to 2018 paper, Washington, Bull & Woodrow). Factors for delayed discharges remain similar with the main reason being the lack of appropriate community provisions.
- To continue embedding the risk rating tool and DSR process within all areas of the ODN explore
- Extend the risk rating tool to include areas relevant to children and young people/people with ASD without LD (this work compliments the recent bids made by all 3 TCPs to develop robust risk rating and DSR processes for the CYP cohort)
- Explore the mechanism of assessing its effectiveness.