The Act introduces statutory care and treatment plans with respect to all patients formally detained under the 1983 Act, excluding those under short term sections (e.g. section 5(2) which allows detention for 72 hours only), by inserting new section 1230ZA to the 1983 Act. This applies to England only, as there is similar provision already in place in Wales. The main purpose of the new statutory plan is to ensure that all relevant patients have a clear and personalised strategy in place describing what is needed to progress them towards recovery and their timely discharge from the 1983 Act.
	Subsection (1) requires that the appropriate practitioner, as defined in section 34 of the 1983 Act, prepares a care and treatment plan, in respect of all eligible patients. Subsection (2) identifies the groups of patients to which the requirement to prepare a care and treatment plan applies, including: those liable to be detained in England excluding under certain provisions, patients who are subject to guardianship where the relevant local authority is England, and patients being under a CTO, with a responsible hospital in England. This excludes patients detained under "short-term" sections of the 1983 Act (sections 4, 5 subsection (2) or (4)) detention in a place of safety under emergency powers in sections 135 or 136 , or where there is a direction for Part 3 patients under section 35 subsection (4), 36 subsection (3), 37 subsection (4), 38 subsection (4) or 45A subsection (5) of the 1983 Act, as these patients are not detained long enough to obtain a benefit from a plan.
	Subsection (3) defines the care and treatment plan as a document containing a plan for meeting the patient’s needs, arising from or related to their mental disorder, made in accordance with regulations made by the Secretary of State. The scope of the plan is to include meeting the patient’s needs in relation to their care, treatment, leave, and eventual discharge, as well as wider relevant issues such as those relating to the patient’s life in the community, for example, their employment and accommodation where this helps meet their needs that arise from or relate to their mental disorder. In addition, the plan may also contain other information, for example, how the patient’s communication needs will be met. By setting out in regulations what these plans are to contain, the aim is to create a consistent framework that clinicians must follow when preparing a care and treatment plan, thereby helping to ensure that patient’s plans are sufficiently comprehensive, while also making them comparable, so they can be more easily quality assured.
	The plan is also intended to provide evidence about important clinical decisions, such as the reasons behind the individual’s detention, as well as evidence of how the patient and those close to them have been included in care and treatment decisions. This is to ensure greater transparency and scrutiny around clinical decision making, such that detention and the use of restrictive practice (e.g. compulsory treatment and seclusion) is only used when there is a robust justification. The Independent Review of the 1983 Act described the new statutory care and treatment plan as the ‘cornerstone’ of the reforms, delivering on all four of the guiding principles: choice and autonomy; least restriction; therapeutic benefit; and the person as an individual.
	Pursuant to subsection (4), the regulations may include ‘information’ about those with whom the patient has a relationship, or other connection, or those to whom the plan is relevant, if this information is for purposes related to meeting the patient’s needs, or for the purposes of reviewing or revising the plan or is information contained in a report produced under new section 125A or 125B (as introduced by section 4). For example, if the patient has a learning disability, the plan could include how adjustments will be made to communicate information to the patient appropriately e.g. details of someone who will do this, or information relating to the family members the patient wishes to be involved in their care and any updates to their plan (see subsection 4). For patients detained under Part 3 of the 1983 Act, this may also include other information related to the victim(s) of the crime the patient has been accused or convicted of, and any criminal justice involvement such as Multi Agency Public Protection Arrangements to protect members of the public.
	Subsection (5) introduces requirements around when the plan should be reviewed, such as if the appropriate practitioner is notified that the patient’s case is to be considered at a Tribunal hearing, following a care, education and treatment review meeting (relevant for patients with a learning disability or autistic patients – see section 4 of the Act which inserts new sections 125A to 125G of the 1983 Act, or when certain people, including the patient or their Nominated Person - see section 23 of the Act, make a reasonable request). By setting out clear trigger points, the aim is that the appropriate practitioner keeps the plan up to date and ensures that it reflects the circumstances of the patient’s case.
	Subsection (6) requires that when the practitioner prepares or reviews the plan that, where practicable and appropriate, they do so in consultation with the patient, and others, such as family members engaged in the welfare of the individual, the patient’s nominated person, and their independent mental health advocate. The intention is that the plan is prepared in direct collaboration with the patient, or where they are not well enough to engage, those close to them, so that the plan is built around the patient’s wishes, preferences, and individual needs, as far as possible, thereby reflecting the principle of choice and autonomy.
	Subsection (7) gives the Secretary of State the power to make regulations regarding the circumstances under which a patient’s plan should be revised and specifying where a plan is to be prepared, reviewed or revised, when that is to be done.
	Subsection (8) gives the Secretary of State the power to make regulations regarding the disclosure of information contained in the patient’s plan, or information held for the purposes of meeting the requirements associated with the plan. For example, this might include the sharing of information regarding the patient or those who the patient wishes to be involved and consulted on their care, between inpatient and community services, to help facilitate the safe and effective discharge of the patient.
	Subsection (9) specifies that the provisions made in regulations under section 130ZA may be specific to certain groups of patients, or different cases, or transitional, consequential, incidental or supplemental provision. For example, provisions may be made specifically in relation to restricted patients, who are subject to controls by the Secretary of State for Justice, which do not apply to civil patients.
	Section 21 also inserts new section 130ZB into the 1983 Act, which sets out how patients’ plans will be monitored, to ensure that everyone has a care and treatment plan and that these are made in accordance with the legislation to help ensure they are sufficiently comprehensive and up to date. Subsections (1) and (2) impose requirements on the managers of a hospital (within the meaning of section 145) or a registered establishment in England, or a local social services authority, whichever is relevant, to make arrangements to ensure that plans are prepared in accordance with the relevant duties imposed by section 130ZA. If the responsible authority considers that a patient’s plan should be reviewed, they should also make arrangements for the appropriate practitioner in charge of the plan to be requested to review it (subsection (3)).
	Any processing of personal data is subject to the main data protection legislation, (see section 183A of the Data Protection Act 2018 (the "DPA 2018")).
Treatment Section 21: Care and treatment plans