Dynamic Support Register

The purpose of the Dynamic Support Register (DSR) is to identify people who with appropriate, proactive intervention and support can be prevented from unnecessary or inappropriate admission to mental health or specialist hospitals.

The DSR process enables an opportunity for communication where a person's support needs can be reviewed, and issues escalated where appropriate.

For more information visit: NHS England: Dynamic support register and Care (Education) and Treatment Review policy and guide (opens new window).

Who the DSR is for

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 are sometimes related to placement breakdown therefore it is important to ensure the right level support is identified for individuals, noting that this can change over time.

Appropriate referrals to the DSR will be for people who may be facing specific challenges in their lives, 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. This will be recorded as part of the DSR process. Where appropriate, a person with Parental Responsibility can consent to inclusion of a child or young person. Support will be provided by professionals where individuals would like to understand more about what giving consent means, and how information about them is used.

The benefits of the dynamic support register

Prior to the establishment of 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 is 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 agencies and organisations who are involved

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

• NHS BaNES Swindon and Wiltshire Integrated Care Board (BSW ICB)
• Wiltshire Council
• Wiltshire Health and Care Community Team for people with a Learning Disability (CTPLD)
• Avon & Wiltshire Mental Health Partnership NHS Trust - Learning Disabilities Intensive Support Service
• Oxford Health
• Swindon Borough Council
• Bath & North East Somerset Council
• HCRG Care Group

The information the DSR will hold

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
• RAG rating (red, amber, green) based on potential admission risk

Information for professionals

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 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.

Referral for inclusion in the DSR can be made by a professional involved in someone's care, or a self-referral can be made by people with LD/ASC, families, unpaid carers and others.

When a referral is received, it will be assessed against a set of criteria. If the person is eligible for inclusion on the DSR, the notifier or referrer will be contacted.

To download a self-referral form please visit: NHS Bath and North East Somerset, Swindon and Wiltshire ICB: Dynamic Support Register (opens new window)