What is the ETOC service?
Enhanced Therapeutic and Observational Care (ETOC) sometimes referred to as enhanced care, enhanced therapeutic observations, 1:1 care or specialising is a person-centred clinical intervention designed to support patients who require additional observation and engagement beyond standard nursing care. It aims to keep patients safe, promote recovery, preserve dignity, and reduce restrictive practice wherever possible. (NHS England)
In our hospital, the ETOC Team provides dedicated enhanced therapeutic support for patients with complex needs, including those with cognitive, psychological or behavioural challenges, increased risk of harm, or who are experiencing acute distress.
Why ETOC was introduced
Healthcare needs are evolving, with more patients presenting with complex mental, physical and cognitive needs that require close observation and therapeutic engagement. Traditional models of enhanced observation were often reactive and inconsistent, with wide variation in practice and frequent reliance on temporary staffing. (NHS England)
In 2024, NHS England launched the national ETOC programme to support trusts in adopting a clinically led, patient-centred, therapeutic approach to enhanced care, shifting away from passive oversight towards meaningful engagement and tailored support.
The programme was developed to:
- Improve patient safety, experience, and outcomes by focusing on therapeutic engagement rather than just supervision.
- Ensure staff are trained, supported, and equipped with the skills to deliver high-quality enhanced care.
- Reduce length of stay and variance in care provision across wards.
- Promote consistent governance, workforce planning, and local clinical ownership of ETOC services.
This new model supports proactive, individualised care plans that help patients feel safer, more understood, and more engaged in their recovery journey.
Our ETOC Team
The Enhanced Therapeutic and Observational Care Team is led by Jennifer Chapple (ETOC Lead), responsible for driving excellence in therapeutic care delivery, policy implementation, and service development across the hospital.
Core Team Members
- ETOC Lead: Jennifer Chapple (Registered Mental Health Nurse)
- Enhanced Care Advisor
- Healthcare Support Workers
- Registered Mental Health Nurses
This multi-disciplinary team works collaboratively with ward staff, the multi-disciplinary teams, mental health specialists, and families to ensure safe, compassionate, and personalised care.
What the ETOC Team does
Clinical assessment and care planning
- Carries out risk assessments and care planning for patients requiring enhanced support.
- Uses therapeutic engagement techniques, such as active listening, de-escalation, and meaningful interaction.
- Reviews and adapts care plans regularly to support step-down from enhanced care as safely as possible and using least restrictive practice.
Safety and observation
- Provides direct observation and support, tailored to individual patient needs.
- Monitors behaviour, risk factors, and therapeutic progress, reporting observations to the multidisciplinary team.
- Expert advice to support patient safety and a positive therapeutic experience
Principles of ETOC practice
Our service is built on a foundation of:
- Person-centred care respecting patient dignity, preferences and individual needs.
- Therapeutic engagement over passive observation focusing on meaningful activity, connection and rehabilitation.
- Least-restrictive approach tailoring observation levels to what is clinically justified and safe.
- Collaborative care planning, involving patients, families, and multidisciplinary teams.
Patient and family experience
ETOC is designed not just to keep patients safe, but to enhance their hospital experience through proactive communication, personalised care strategies and supportive therapeutic engagement contributing to better outcomes and smoother care transitions.
Please see Friends and family feedback form and patient information leaflet.
Contact the ETOC Team
If you have questions about the ETOC service, please email:
