Care and Treatment Reviews (CTRs) were developed to improve the care of people with learning disabilities, autism, or both in England with the aim of reducing admissions and unnecessarily lengthy stays in hospitals and reducing health inequalities.


CTRs are for people living in the community and in learning disability or mental health hospitals.


CTRs help to improve care for people whose behaviour is seen as challenging and/or for people with a mental health condition.


People and their families who could benefit from and are entitled to them need to know they can ask for one if they need one.


In March 2017, the policy around CTR’s was revised. An easy read version was also provided.


The policy statement describes the purpose of CTRs as:

"CTRs bring together those responsible for commissioning and procuring services (this will include nurses, social workers, education commissioners and other health, education and social care professionals alongside strategic commissioners where appropriate) with independent clinical opinion and the lived experience of people and families from diverse communities with learning disabilities, autism or both.

The aim of the CTR is to bring a person-centred and individualised approach to ensuring that the care and treatment and differing support needs of the person and their families are met, and that barriers to progress are challenged and overcome.

CTRS are being driven by the NHS but involvement of local authorities and education services in the CTR process and its outcomes are necessary for improving care and treatment for people with learning disabilities and their families. The ‘spirit’ in which CTRs are carried out is paramount and is rooted in principles of human rights, person-centeredness and co-production."


Taking that person-centred approach further, the principles of CTR’s are set out as follows:

At its core, the CTR has a set of principles that the CTR panel should always uphold. Panel members each have an equal role in making sure these principles are followed:

P - Person centred and family centred

E - Evidence based

R - Rights led

S - Seeing the whole person

O - Open, independent and challenging

N - Nothing about us without us

A - Action focused

L - Living life in the community


The CTRs were designed to bring an additional challenge and scrutiny to existing review processes and an alternative perspective and ‘second opinion’ which, in part, is achieved by the inclusion of an expert by experience (a person with learning disabilities, autism or both or family carer of someone with a learning disability, autism or both who has relevant experience) and the additional input of an independent clinician.


The outcomes of a Care and Treatment Review (CTR) will feed directly into the Care Programme Approach (CPA) process. CTR in effect inform the CPA. This will lead to a revised CPA plan that will be the responsibility of the CPA care coordinator to complete and share with others including the individual and their family. Subsequent CPA meetings will address whether CTR actions are completed and progress is to be fed back to the chair of the CTR panel at agreed intervals. The person and their family will also be kept updated on progress.


A detailed code and toolkit which sets out how CTR’s are to be used can be found here. NHS England have also provided a video explaining CTRs.


In April 2017, it was reported that the Public Accounts Committee found just 39% of learning disability inpatients received CTRs within six months. One year on, there is limited further information about the number of people who have received CTRs and any delays in the system. At Conroys Solicitors LLP, when assisting a client with a learning disability or autism who is living in the community or who is an inpatient in hospital, we are mindful to ensure the CTR process is explained to them and their family, as well as offering support to access it.

Conroys Solicitors LLP offer advice and assistance in legal matters relating to mental health law. To arrange a free 30 minute consultation with one of our lawyers, please telephone the office on 01872 272 457.