An independent care pathway review of a young person: Published July 2025

NHS England should introduce a framework (perhaps linked to the CETR process where appropriate) which enables early identification of highly complex adolescent patients in order to facilitate the development of bespoke packages of care in a timely and patient centred fashion. The framework should also allow issues to escalated to a sufficiently senior manager to enable problem resolution across health, children’s social care, and education. The framework should include commissioning arrangements to assist with the continuity of care across care providers and geographical areas for these cases where relationships are paramount to recovery. NHS England should ensure that resources are available nationally to help in the most complex of cases, rather than ringfenced for Provider Collaboratives. NHS England should review the learning from this case to inform decisions on refining the role of a complex care coordinator/case manager/specialist intervener. Given that these are long-term placements, continuity of case management may also be boosted by a team approach. These teams would develop in-depth knowledge of complex cases and would enable clinicians to form relationships with commissioners and to familiarise themselves with the different commissioning thresholds and processes; they would also facilitate applications for specialist funding. The team would be a point of contact for patients, families and treating teams, keeping them up to date with progress, and providing a single point of contact for commissioners. It is also important for the degree of complexity to be identified at an early age so that appropriate resources can be directed accordingly. ICBs should ensure that they are engaging with local social care and education partners to enable timely identification of young people with complex presentations.

Best practice guidance should be developed to support staff in navigating approaches to international medical teams or opinions.

NHS England and Specialised Commissioning should establish if a wider introduction of the Autistica guidance in supporting families with autism diagnoses is required across services.

NHS England Specialised Commissioning must share the learning from this case across all regions to ensure a multi-agency systemic approach to complex cases sufficiently early in the patient’s pathway.

Trusts and their commissioners should ensure that inpatient teams have a directory of staff, services, or organisations where staff are trained in sensory integration assessments. The commissioning of such sensory integration assessments should be at the discretion of the treatment team where sensory function is being considered.

Trusts should set out guidance for staff to take when there is a contested diagnosis. This should include best practice in respect of best interest decisions and options for seeking independent views. The guidance should include: • mediation approaches; • legal options; and • when to seek independent advice.

All services should introduce the Autistica guidance in supporting families with autism diagnoses. This should be embedded in protocols for organisations. The application of support to families with a newly diagnosed family member with autism should be the subject of a thematic review.

Trusts must ensure that group and individual reflective practice are essential parts of team development and must be facilitated when dealing with particularly challenging and complex patients.