Dynamic Support Register

The DSR is for everyone with a learning disability and/or autism (whatever their age), who are most at risk of hospital admission or placement breakdown. Inappropriate hospital admissions can be related to placement breakdown therefore it is important to ensure the right level of support is identified.

Appropriate referrals will be for people who when faced with difficult challenges in their lives can or are presenting as a risk to themselves or others that could lead to an admission to specialist/inpatient services.

For a referral to be accepted a person must either have capacity to give informed consent or where capacity is lacking at the time of referral, a best interest decision has been made. Where appropriate, a person with parental responsibility can consent to inclusion of a child or young person (please see the “Information for those under 18 years of age” section for more information).

The DSR team will be proactive in responding to requests for information to help a person understand, retain, and weigh up information about this decision.

Prior to the DSR different agencies, services and teams held their own information about people who they were trying to support. By developing a single register with input from all those involved in supporting an individual, it will be easier to make sure people get the right support at the right time in the community and help to avoid inappropriate hospital admission wherever possible.

People who are included on the register will be proactively reviewed to identify as early as possible whether any additional support is needed.

Information from these reviews will also be used to identify key themes, trends, and service gaps. This information will not use person identifiable data, but it will help to plan and develop future services.

The information held on the DSR will be the minimum required to facilitate high quality communication of needs and actions, including:

• Name
• Date of birth
• Place of residency
• NHS number
• Key professional involvement, their names and contact details
• Current issues that relate to risk of admission and the risk of escalation
• What has been tried that could mitigate risk (including positive strategies to improve a person’s quality of life, increasing life opportunities and self-esteem)
• What could be useful to further reduce risks
• Action plan moving forwards including recommendations for current and potential future service involvement

We rate the risk of each person on the DSR being admitted into a specialist hospital using the risk stratification parameters outlined in the NHS England Dynamic Support and C(E)TR policy (page 21).

Currently the key agencies and services who will collaborate and communicate through the DSR are:

• • NHS Suffolk and North East Essex ICB

• • Norfolk and Suffolk  NHS Foundation Trust

• • Suffolk County Council

If you have a North East Essex GP you will need to send an e-mail to Essex.DSR@essex.gov.uk  to get information about the DSR in your area.

For a referral to be accepted it is essential that the person has capacity to give informed consent, a best interest decision has been made on behalf of a person who lacks capacity or where appropriate a person with parental responsibility has consented to inclusion on behalf of a child or young person. It is therefore important that all relevant information about the DSR is made available to the person themselves, people with parental responsibility and agencies when referral decisions are being made.

Information about the DSR is available in various formats to ensure that it is provided in a way that maximises a person’s ability to understand, retain and weigh up information about this decision to be able to give informed consent. Consent, once given, can be withdrawn at any time.

If a person is assessed as not having the capacity to give informed consent (and no one holds parental responsibility, or a court of protection appointed personal welfare deputyship), a best interest decision can be made under the Mental Capacity Act for inclusion on the DSR.

It is important to know that not consenting to join the register will not affect the person’s current support. Although the benefit of inclusion on the DSR will be the multi-agency collaboration and communication, scrutiny of the current support provided and the potential to access other appropriate agencies as part of the DSR process.