IMPLEMENTING THE CARE PROGRAMME APPROACH

RESULTS OF A JOINT SURVEY BY THE SOCIAL WORK SERVICES INSPECTORATE  AND THE ACCOUNTS COMMISSION

Background

The CPA was introduced in 1992 to ensure that people with severe and enduring mental illness including dementia, who also have complex social care needs are provided with co-ordinated care and supervision. Scottish Office Circular SWSG16/96 gave revised guidance to local authorities, health boards and Trusts on how their responsibilities to implement the CPA should be taken forward. We stated our intention to subsequently review progress in the implementation of the CPA at a local level by means of a joint survey. Questionnaires were sent to all 32 local authorities and 15 health boards. The survey was conducted jointly with the Accounts Commission and this report is derived from the information provided by the 26 areas which responded. (These are listed in the annex together with a statistical analysis of responses to key questions.)

Seven responses were from coterminous health board and local authority areas, 16 were from individual local authority areas and 3 were from health board areas. Three of the local authorities (all Forth Valley Health Board area) and 11 health boards are acting as lead agencies. Three island authorities have joint health board/local authority arrangements. One NHS Trust has lead responsibility in its area.

Main Findings and action required

• Implementation of the CPA in Scotland has been gradual. Approximately half of the areas responding to the survey only implemented it in 1996/1997.

• The CPA is being used less for people with dementia than for people with other mental illnesses.

• Most areas had developed the necessary structures to implement the CPA but there is still one area where it is not yet operating.

• Just over 1,000 people were on the CPA at 1 July 1997, 700 of whom were in just four areas. Up to that date, 1,344 people had received the CPA since its introduction in 1992.

• The numbers of people who were on the CPA per 100,000 population varied between 0.8 and 100. In some areas, these figures were estimates.

• All areas should fully implement the CPA.

• People with dementia who have complex social care needs should be offered this service alongside people with other severe and enduring mental illnesses who have such complex needs.

• All the areas had established multi-agency groups responsible for planning and coordinating the CPA.

• All areas had produced operational guidance and agreed eligibility criteria, although four had not included people with dementia in their criteria.

• Seven areas did not have a procedure to resolve interprofessional disputes about individual suitability for the CPA.

• CPA arrangements and assessment and care management processes were not compatible in all areas (17 out of 26).

• Only half the areas had developed shared assessment tools and fifteen had agreed common formats for care plans.

• Most areas (24) had defined the roles and responsibilities of key workers in writing.

• Social workers, community psychiatric nurses, mental health nurses, occupational therapists and psychiatrists were eligible to undertake the key worker role in most areas.

• Most (22) areas had a jointly agreed policy for the CPA between health, social work, housing and other relevant groups.

• Only 17 areas had set out the roles and responsibilities of each agency involved in implementing the CPA.

• All agencies should clarify and agree their respective roles and responsibilities to develop, manage and administer the CPA.

• All areas should develop and agree common formats for assessments and written care plans.

• All areas should agree mechanisms for resolving interprofessional disputes about who is suitable for the CPA and the person’s care needs.

3. Clarifying agency responsibilities for care provision, monitoring and follow-up

• Not all areas had set up the necessary systems for the monitoring and follow-up of people with complex health and social care needs.

• When a person refused the CPA, most areas offered care management or reassessed the person’s needs to consider compulsory measures of care.

• Two areas had no written policy for following up people who failed to maintain contact with services and methods used by other areas were very variable.

• The majority (21) of areas either contacted or sent relevant information as the means of arranging continuing care for people on the CPA who moved elsewhere. Procedures were unclear in some areas.

• Less than a third of areas included information about expected standards of care in their operational guidance about the CPA.

• All areas should have a jointly agreed system for monitoring and follow-up of people with complex health and social care needs.

• All areas should have jointly agreed written policy and procedures for following up people who fail to maintain contact with services.

• All areas should have arrangements to ensure that people who move are provided with continuous care.

• Operational guidance should include jointly developed health and social care standards to ensure quality and consistency of care provided to people on the CPA.

• Standards should include outcome measures.