Assuring Transformation (AT) glossary

People with a learning disability often have poorer physical and mental health than other people.  An annual health check can improve people’s health by spotting problems earlier. Anyone aged 14 or over who is on their doctor's learning disability register can have a free annual health check once a year.

An appointee is a person or organisation appointed by the Department for Work and Pensions (DWP) to be responsible for making and maintaining any benefit claims on behalf of a person who cannot do so because they either lack capacity or their physical disability prevents them from being able to do so. It is only applicable where the person is receiving state benefits only and has little savings (less than £5,000).

Care (Education) and Treatment Reviews (C(E)TRs) are for people with a learning disability and autistic people living in the community who are at risk of going into mental health inpatient care and for those already in a mental hospital.

C(E)TRs bring extra check and challenge and check to people’s care plans They are carried out by an independent panel of people. This includes an expert by experience, who is a person with a learning disability or autism or a family carer with lived experience of services. The panel also includes a clinical expert who is qualified to work in healthcare and the commissioner who pays for the person’s care. The commissioner has the responsibility for ensuring that all the right things happen before, during and after a C(E)TR.

Reviews for adults are called Care and Treatment Reviews (CTRs).

Reviews for children and young people are called Care, Education and Treatment Reviews (CETRs).

A local care co-ordinator is responsible for co-ordinating and managing a person’s care, in partnership with the individual, their family and carers. A care-co-ordinator is usually, but not exclusively, allocated as part of the care programme approach (CPA). The local care coordinator is likely to be a member of the local Community Learning Disability Team (CLDT), for example a social worker or community learning disability nurse. They will participate in regular reviews to determine whether or not a person’s needs are being met, or have changed and support their transfer from an in-patient to a community setting

The Care Programme Approach (CPA) is a package of care that might be used to plan care for people with a mental health condition. The person will have a written care plan that sets out the support they will get and they will have a CPA care co-ordinator (usually a nurse, social worker or occupational therapist) to manage and review the person’s care plan.

This person might be a neighbour, a friend, a relative, a volunteer from an advocacy organisation or a paid advocate. A family member is only considered to be independent if the person has expressly chosen them as an independent advocate.

The Mental Capacity Act (2005) provides the legal framework for acting and making decisions on behalf of individuals who lack the mental capacity to make particular decisions for themselves. The Act introduces several new roles, bodies and powers, all of which support the Act’s provisions. One of the new services created by the Act is the Independent Mental Capacity Advocacy (IMCA) Service, which introduces the new role of the Independent Mental Capacity Advocate (IMCA). The Mental Health Act (2007) created the role of the independent mental health advocate (IMHA).

The organisation who is responsible for paying for the care and treatment of the patient whilst they are in hospital.

A Commissioner Oversight Visit is a visit to the person in a mental health, learning disability and autism inpatient setting by the commissioner who has commissioned the care. It is a visit to check the quality of care that the person is receiving. For children and young people, the commissioner visit takes place at least every six weeks, for adults at least every eight weeks and is carried out in line with NHSE Commissioner Oversight Visit Guidance

These were introduced in November 2008 when new sections 17A-G were inserted into the Mental Health Act (1983) by the Mental Health Act (2007). In the Code of Practice it is called Supervised Community Treatment; in the Act those subject to CTOs are called community patients.

The Purpose of a Community Treatment Order (CTO), also known as Supervised Community Treatment (SCT) within the Mental Health Act Code of Practice (1983, revised 2008), is to allow suitably identified people to receive care within the community rather than be detained in hospital. It is intended to provide a framework for the management of a person’s care in the community and support them to maintain stable mental health whilst also promoting recovery. People eligible for a CTO/SCT should have been detained for treatment in hospital under Sec. 3 of the Mental Health Act (1983). A CTO/SCT is an option for people who meet the following criteria:

The person is suffering from a mental disorder of a nature or degree which makes it appropriate for them to receive medical treatment,

• it is necessary for the person’s health or safety or for the protection of others that the person receives treatment
• such treatment can be provided without the person continuing to be detained in hospital
• appropriate medical treatment is available to the person

The decision as to whether a CTO/SCT is the right option for any person lies with the Responsible Clinician and requires the approval of an Approved Mental Health Professional (AMHP). The person and their family/nearest relative should also be consulted and involved at the earliest stages and throughout. A CTO/SCT may only be used if it would not be possible to achieve the desired objectives of a person’s care without it.

There is a requirement for clinical commissioning groups (CCGs) to develop and maintain registers to identify people with a learning disability, autism or both who display, or are at risk of developing, behaviour that challenges or mental health conditions who are most likely to be at risk of admission.

People who are at risk of admission should be offered a community care and treatment review to see whether they are safe, in the right place, and to understand their plans for the future. By understanding people’s needs and recognising early signs that might lead to a crisis it means that extra support can be put in place quickly, so the person doesn’t end up going into hospital unnecessarily.

Learn more about Dynamic risk registers.

Learn more about  Dynamic registers and dynamic systems Information about the NHS England Dynamic Support Database (DSD) and clinical support tool. 

An education, health and care (EHC) plan is for children and young people aged up to 25 who need more support than is available through special educational needs support. EHC plans identify educational, health and social needs and set out the additional support to meet those needs. An Education, Health and Care Plan (EHC) is the document which replaces Statements of Need and Learning Difficulties Assessments for Children or Young People with Special Educational Needs.

Formal review means that a review has been undertaken and a formal record of the review has been made and shared with the person, their family, care and/or advocate, other key providers and commissioners. A formal review or assessment includes a Care Programme Approach (CPA) review meeting, a treatment planning meeting or a Care (Education) and Treatment Review (CTR) meeting.

The World Health Organization (WHO) International Classification of Diseases (ICD) is the global standard which categorises and reports diseases in order to compile health information related to deaths, illness or injury; the current version is at 10th revision.

Learn more about ICD-10 codes. In particular, section V and the F codes relating to mental and behavioural disorders.

Note that the term "mental retardation" is is outdated and is not acceptable to be used in clinical practice but is synonymous with intellectual disability. Future revision of ICD-11 is expected to come into effect on 1 January 2022.

An Independent Mental Capacity Advocate (IMCA) assists people who lack mental capacity to express their views. 

An Independent Mental Health Advocate is a specialist mental health advocate, who helps patients understand the legal provisions to which they are subject under the Mental Health Act. 

A named key worker is someone in a designated Keyworker role, for children and young people under 25 with a learning disability or autism, delivering the defined functions and from the Key working service in the young person’s originating area. This excludes the young person’s social worker, advocate, care co-ordinator, teacher or family members

The Local Area Emergency Protocol (LAEP) is raised when a person with a learning disability or autistic person has been, or is likely to be, recommended for inpatient admission with little or no notice meaning a community C(E)TR has not taken place. (Previously named Blue Light.)

Ministry of Justice (MOJ) is the government department in charge of the criminal justice system including prisons and courts. 

A supreme court judgement that there was no power within the Mental Health Act for a tribunal to set conditions of discharge for restricted patients that would amount to deprivation of liberty. Also judged that any deprivation of liberty arising from the discharge accommodation care and support must be authorised through an appropriate legal process, (not including personal consent by the person).

Read the NHSE briefing note.  

A multi-disciplinary team is made up of professional stakeholders from all agencies involved in the person's care, treatment (and education for under 25 year olds). For example, this might include forensic support, crisis services, specialist learning disability or autism or mental health community provision. MDT is a term used in both inpatient and community settings.

An Out of Area Placement is a placement outside of the patient's STP (Sustainability and Transformation Partnership) also known as Integrated Care System.

A Supreme Court judgement that there was no power within the Mental Health Act for a Mental Health tribunal to vary conditions within a Community Treatment Order (CTO). Also that any CTO conditions could not amount to a deprivation of liberty and any deprivation of liberty arising from the accommodation care and support must be authorised through an appropriate legal process. 

The organisation who is providing the inpatient bed for the treatment of the patient.

The QPM is a quality assurance assessment for providers of independent advocacy in England, Wales and Northern Ireland. It is based on the principles contained in the Advocacy Charter and the Advocacy Code of Practice, enabling providers to demonstrate how they are meeting the different standards. The QPM is only awarded to organisations who can demonstrate that they provide excellent services in line with QPM standards and the advocacy charter.

This register (as required by the commitment in ‘Transforming Care: A national response to Winterbourne View Hospital’ and the ‘Concordat’) should have been established by the former Primary Care Trusts in January 2013 and handed over to Clinical Commissioning Groups on 31 March 2013.

General (non-secure): non secure accommodation or accommodation that only has normal levels of security such as general wards.

Low secure: low secure wards/units deliver comprehensive, multidisciplinary, treatment and care by qualified staff for patients who demonstrate disturbed behaviour in the context of a serious mental disorder and who require the provision of security.

Medium secure: medium secure wards/units deliver comprehensive, multidisciplinary treatment and care by qualified staff for patients who demonstrate disturbed behaviour in the context of a serious mental disorder and who may present a serious risk to others.

High secure: high secure wards/hospitals provide comprehensive, multidisciplinary treatment and care by qualified staff for patients who demonstrate disturbed behaviour in the context of a serious mental disorder and have been assessed as presenting a grave and immediate danger to others. The hospital must be part of an NHS trust approved by the Secretary of State to provide high security psychiatric services.

Psychiatric intensive care unit (PICU), challenging behaviour services, and secure rehabilitation service

Any behaviour where the intent is to deliberately cause harm to one’s one body for example:

• cutting, scratching, scraping or picking skin
• swallowing inedible objects
• taking an overdose of prescription or non-prescription drugs
• swallowing hazardous materials or substances 
• burning or scalding 
• hair-pulling
• banging or hitting the head or other parts of the body
• scouring or scrubbing the body excessively

The actual hospital or facility where the patient is being treated.