Changes to the Care Programme Approach (CPA)
The Care Programme Approach can be difficult to understand because of how it involves several different care providers such as social services and different parts of the NHS. It has also changed quite significantly over the years, but for people who qualify it should mean their care needs are met.
When the Care Programme Approach was introduced, many people were confused because there were already two other care systems running alongside it - social services’ care management and after-care provided to people who had been detained under the ‘treatment’ sections of the Mental Health Act (Section 117 Aftercare).
This meant that when professionals talked about assessment, it was sometimes unclear to users and carers which care system they were talking about.
CPA has changed over the years. One of the biggest changes was in 1999, when it was combined with the other two care systems.
Also at this time, the four CPA levels which were then in place were reduced to two levels – enhanced and standard.
How has CPA changed?
In March 2008 the DH published ‘Refocusing the Care Programme Approach’ which provided guidance to the Mental Health Trusts on the ‘new CPA’.
The main change which affected many service users was that everyone who received it at the standard level was no longer entitled to it.
Only those on enhanced level now receive the ‘new CPA’. This change was opposed by almost all of the users, carers and organisations.
The Department of Health says that all users should still expect the values and principles of CPA from the care that is provided to them.
As well as summarising current good practice, the guidance also encourages the use of direct payments, individual budgets and advance statements.
When did the changes take place?
The introduction of ‘new CPA’ coincided with changes to the mental health legislation which were introduced in October 2008 and included ‘supervised community treatment’ (SCT).
What replaces standard CPA?
In practice, local decisions determine what alternatives to standard CPA are provided. The DH guidance states that:
- Losing CPA does not mean that patients should lose touch with the secondary mental health services.
- The written care plan should be replaced by a ‘clear understanding’ of how, when and where care & treatment will be carried out.
- Although there will be no care co-ordinator there should now be a lead professional identified and care be ‘self-directed’ by the service user, with support.
- There should be both a clinical assessment and a social services assessment using the FACS criteria.
What does the guidance say about carers?
It contains some important information about the way that carers should be treated, as the Department of Health is aware of some of the current problems and attitudes towards them.
You can find further information on the current system of CPA in Care Programme Approach (CPA) Factsheet.
