About The Care Programme Approach (CPA)

Introducing the Care Programme Approach (CPA)

Joint Health And Social Services Circular — HC(90)23/LASSL(90)11

The Care Programme Approach was introduced in England in the joint Health and Social Services Circular HC(90)23/LASSL(90)11 ‘The Care Programme Approach for people with a mental illness, referred to specialist psychiatric services’ published by the Department of Health in 1990, effective from 1 April 1991. It requires Health Authorities, in collaboration with Social Services Departments, to put in place specified arrangements for the care and treatment of mentally ill people in the community.

National Differences

There are some differences to the application of CPA in Scotland, which was effective from 30 April 1997, and in Wales, but the principles are the same.

The CPA Process

The Care Programme Approach has four main elements as defined in ‘Building Bridges: A guide to arrangements for inter–agency working for the care and protection of severely mentally ill people’. DoH(1995) London HMSO: Components of CPA There are four distinct aspects to the CPA:

• Assessment

  Systematic arrangements for assessing the health and social needs of people accepted by the specialist mental health services;

• A Care Plan

  The formation of a care plan which addresses the identified health and social care needs;

• A Key Worker

  The appointment of a Key Worker (now Care Co–ordinator) to keep in close touch with the patient and monitor care; and

• Regular Review

  Regular review, and if need be, agreed changes to the care plan.

The Cornerstone of the CPA

These four principles of assessment, care plan, Care Co–ordination and review are the cornerstones of the Care Programme Approach. Implicit in all of them is involvement of the person using the service, and where appropriate, their carer.

Modernising the CPA

In 1999, the Government undertook a review of the CPA which was considered timely for a number of reasons:

• The introduction of the National Service Framework for Mental Health, published in September 1999
• The lessons learnt through research, reviews and inspections
• The need to listen to professionals views about the CPA Effective Care Coordination in Mental Health Services, Modernising the CPA The review resulted in the publication of ‘Effective Care Coordination in Mental Health Services, Modernising the CPA’, published in October 1999.

Key Changes

This confirmed the Governments commitment to the CPA for working age adults in contact with secondary mental health services and introduced changes to the CPA. The key changes are:

• Integration of the CPA and Care Management — the CPA is care management for people of working age in contact with specialist mental health services.
• Appointment of a Lead Officer — Each health and social services provider is required to jointly identify a Lead Officer to work across both agencies.
• Levels of the CPA — two levels of the CPA must be introduced — Standard and Enhanced.
• Abolition of the Supervision Register — from April 2001, Supervision Registers can be abolished providing the Strategic Health Authority is satisfied that robust CPA arrangements are in place.
• Change of name — Keyworker to be referred to as Care Co–ordinator.
• Reviews of Care Plans — the requirement to review care plans 6 monthly is removed. Review and evaluation should be ongoing. At each review the date of the next meeting must be set.
• Audit — regular audit will be required to take place looking at qualitative implementation of the CPA.
• Risk assessment/risk management — risk assessment is an ongoing part of the CPA. Care plans for people on enhanced CPA are required to have a crisis plan and contingency plan.

The CPA in Wales

The Care Programme Approach in Wales Improving Health in Wales: A Plan for the NHS with its Partners’ sets out a commitment to develop a co–ordinated system of care management in partnership with relevant interests. It also sets out to tackle:

• Inequalities.
• Improve health and service performance, and;
• Develop partnership working In order to provide co–ordination between health and social care, and primary and secondary care, especially for people with complex problems.

The Adult Mental Health Services Strategy (Wales)

The Adult Mental Health Services Strategy along with the National Service Framework, set out the direction and standards for mental health services in Wales Key Action 29 of the NSF gives a commitment that the CPA will be introduced across Wales for all people with a serious mental illness and/or complex enduring needs.

The Mental Health Policy Guidance ‘The Care programme Approach for Mental Health Service Users — A Unified and Fair System for Assessing and Managing Care’ states that although the NSF applies to adults of working age, the CPA principles also apply to those above the age of 65 and adolescents between 1 and 18 years of age who also meet the eligibility criteria for standard or enhanced CPA, as described in the guidance and CPA is therefore recommended.