Refocusing the Care Programme Approach

1 Refocusing the care Programme Approach Policy and Positive Practice GuidanceMarch 2008 Crown copyright 2008 First published March 2008 Produced by COI for the Department of HealthThe text of this document may be reproduced withoutformal permission or charge for personal or in-house PurposeBest Practice GuidanceGateway Reference 9148 TitleRefocusing the care Programme ApproachAuthorDepartment of HealthPublication Date19 Mar 2008 Target AudiencePCT CEs, NHS Trust CEs, care Trust CEs, Foundation Trust CEs,Medical Directors, Directors of Nursing, Local Authority CEs, Directors of Adult SSs, GPsCirculation ListDescriptionFollowing the national consultation, Reviewing the care Programme Approach (CPA), and having considered the issues identified, this guidance updatespolicy and sets out positive practice guidance for trusts and commissioners toreview local practice to refocus CPA within mental health RefReviewing the care Programme Approach 2006 Superseded DocsN/AAction RequiredN/ATimingN/AContact DetailsJanet DaviesDepartment of HealthWellington House133 Waterloo RoadLondon, SE1 Recipient s UseDH INFORMATION READER BOXP olicyEstatesHR/WorkforceCommissioningMan agementIM & TPlanning / PerformanceFinanceClinicalSocial care /Partnership WorkingRefocusing the care Programme Approach Policy and Positive Practice GuidanceMarch 2008 ContentsPageForeword1 Executive summary2 Section 1: Introduction3 Section 2: Personalised Mental Health Care6 Section 3.

2 Refocusing The care Programme Approach11 Section 4: Assessment and care Planning18 Section 5: Whole Systems Approach27 Section 6: Supporting the Workforce33 Section 7: Measuring and Improving Quality39 Annex A: CPA and Other Assessment And Planning Frameworks43 Annex B: CPA and Child and Adolescent Mental Health Services47 Annex C: CPA and Older Adults50 Annex D: Glossary531 Foreword by Louis ApplebyOur NHS, Our Futureinterim report sets outthe vision for the NHS to deliver services whichare fair, personalised, effective and safe. Inmany ways mental health services can claim tolead the way in delivering such an approachacross health and social care . Since the publication of the Mental HealthNational Service Framework in 1999 mentalhealth policies have increasingly focused onpersonalisation through an emphasis onmeeting the wider needs of those with mentalillness, addressing equalities, tackling theproblems of social inclusion, and promotingpositive risk management.

3 The setting of PublicService Agreement (PSA) indicators to improvehousing and employment opportunities forpeople with severe mental illness will provide awelcome additional lever. The care Programme Approach (CPA) is at thecentre of this personalisation focus, supportingindividuals with severe mental illness to ensurethat their needs and choices remain central inwhat are often complex systems of care . Itprovides an excellent framework, the principlesof which are supported by all. But it is clear from the recent review that thereneeds to be more consistency in applying thesesound values and principles across the is much good practice, but more needs to be done so that individuals directly feel the impact of policy advances in their dailyinteractions with services, and can recogniseand realise the tangible benefits and outcomesfrom receiving them.

4 This document Refocusing The care ProgrammeApproachupdates guidance and highlightsgood practice. It emphasises the need for afocus on delivering person-centred mental healthcare and also repeats that crisis, contingencyand risk management are an integral part ofassessment and planning processes. I urge everyone working in mental healthservices to critically examine current policies andpractice against this guidance so that progresscan continue to be made. Louis ApplebyNational Director for Mental HealthRefocusing the care Programme Approach : Policy and Positive Practice GuidanceExecutive summaryThe care Programme Approach has beenreviewed to ensure that national policy is moreconsistently and clearly applied and unnecessarybureaucracy removed. All individuals receiving treatment, care andsupport from secondary mental health servicesare entitled to receive high quality care based onan individual assessment of the range of theirneeds and choices.

5 The needs and involvementof people receiving services (service users) andtheir carers should be central to service underpinning set of values and principles of person-centred care which apply to all isessential, and is described. Individuals with a wide range of needs from anumber of services, or who are at most risk,should receive a higher level of care co-ordination support. From October 2008 thesystem of co-ordination and support for thisgroup onlywill be called the care ProgrammeApproach (CPA). The revised characteristics ofthis group is set out and trusts should reviewpolicies against this. Assessments and care plans should address therange of service users needs. Risk managementand crisis and contingency planning is integral to the process. A number of critical issues arehighlighted, including assessing the needs ofparents; dual diagnosis; physical health; housing;employment; personality disorder; history ofviolence and abuse; carers; and medication.

6 Whole systems approaches should support and organisations should work togetherto: adopt integrated care pathway approachesto service delivery; improve information sharing;establish local protocols for joint workingbetween different planning systems andprovider agencies. The role of commissioners iskey in ensuring a range of services to meetservice users needs and choices. Joint planningacross agencies through Local StrategicPartnerships and Local Area Agreements arealso ensure that services are person-centred andvalues and evidence based an appropriatelytrained and committed workforce is needed. For individuals requiring the support of CPA therole of the care co-ordinator is vital. Nationalcompetences for the care co-ordinator areoutlined and the development of nationaltraining for care co-ordination, risk and safetyhas been commissioned.

7 Guidance is given onmeasuring and improving capacity quality of assessment and care planningshould be focused on improving outcomes forservice users and their families across their lifedomains. Attention to local audit; performancemanagement; national regulation; and issues of equalities is needed to ensure equitableoutcomes for consultation document Reviewing the CareProgramme Approach 2006set out the reasonsand aims of the current review of the CareProgramme Approach (CPA). It made clear thatthe ultimate aim was to ensure that there is arenewed focus on delivering a service with theindividual using the services at its heart inwhich national policy is more consistently andclearly applied and where bureaucracy does notget in the way of the relationship between theservice user and practitioner.

8 A clear response from everyone contributing tothe review of CPA was support for the principlesunderpinning a system of care assessment,planning and review in secondary mental healthservices. These principles are set out in the MentalHealth National Service Framework (MHNSF)(Standard Four)1and Effective care Co-ordinationin Mental Health Services: Modernising the CareProgramme Approach : A Policy Booklet2. Morerecent documents about mental health andwider have echoed these principles. The National Service Framework for MentalHealth 5 Years On3recognised that serviceswere becoming increasingly responsive to theneeds and wishes of services users, yet urgedthat continued effort needed to be made. Othermajor Department of Health (DH) publicationsemphasise, at their core, the need for services toempower individuals to achieve greaterindependence and improve their lives throughmore personalised care , more choice, and theiractive engagement in service development4, 5, 6, 7.

9 However, the review also found that, althoughmuch positive practice exists, there still remainvariations around the country in applying thesesound principles. In particular improvements still need to be made in service user and carer engagement and involvement, and inconsistency in the identification and support ofindividuals most in need of engagement whoare at risk. This document Refocusing the care ProgrammeApproach: Policy and Positive Practice Guidanceaims to build on the strong foundation of theMHNSF1 Effective care Co-ordination in MentalHealth Services3, and other DH policy guidanceand to reinforce them by: 3 Section 1: Introduction1 Department of Health, National Service Framework for Mental Health: modern standards and service models. 1999. 2 Department of Health, Effective care co-ordination in mental health services: modernising the care Programme Approach A policy booklet.

10 1999. 3 Department of Health, National Service Framework for Mental Health, Five Years On. 20044 Department of Health, The NHS Improvement Plan: putting people at the heart of public services. 2004 5 Department of Health, Independence, Well-being and Choice: Our Vision for the Future of Social care for Adults. 20056 Department of Health, Our Health, our care , our say: a new direction for community services. 20067 CSIP, Our Choices in Mental Health: a framework for improving choice for people who use mental health services and theircarers. 2006>setting out an underpinning statement ofvalues and principles that all in secondarymental health services should aim for; >highlighting positive practice around serviceuser and carer involvement and engagement;>providing a clearer definition of individualsand groups who may need a higher level ofengagement and co-ordination support;>focusing on areas of assessment and careplanning that should be strengthened;>presenting an overview of the systems thatcan support multi-agency delivery to meet therange of an individual s needs; >strengthening workforce capabilities bydescribing the core competences needed by a care co-ordinator and commissioningnational training for CPA and risk and safetymanagement.