1. INTRODUCTION

 This policy relates to the Care Programme Approach (CPA) within Health & Social Care North & South Lanarkshire.  It is applicable to General Adult, Older Adult, Forensic, Learning Disabilities and CAMH services.

The CPA is a systematic approach to assessing, planning and managing the care needs of patients with a diagnosed mental disorder and complex needs that utilise resources from multi-agency/professional groups.

Various legislation and reports from Governing Bodies have influenced the development and application of the CPA in Scotland, with key papers including:

• Scottish Office Circular SWSG 16/9 (1996)
• Department of Health (DoH) (2008)
• Mental Welfare Commission for Scotland (2009; 2010; 2010a)
• NHS Lanarkshire – (2012; 2012a)
• NHS Lanarkshire – (2013; 2013a; 2013b)

2. AIM, PURPOSE AND OUTCOMES

 By adopting the principles of this policy and the CPA process, collaboration and communication within and between agencies and professionals in Health, Social Services and Housing will be enhanced.

 Aim of Policy

• Guidance on CPA processes within Health and Social Care North & South Lanarkshire
• Provide a framework for a standard of working across Health and Social Care North & South Lanarkshire

Purpose and Outcomes

• Ensuring a consistent and integrated approach across Health and Social

Care North & South Lanarkshire in the application of CPA

• Ensuring decisions regarding assessing and planning care, and risk management are made according to best practice, legislation and needs of the service user
• To make CPA care planning transparent and open to examination

3. SCOPE

3.1  Who is the Policy intended to Benefit or Affect?

 This Policy applies to all health and social care professionals working within Health and Social Care North & South Lanarkshire and their client group.

3.2  Who are the Stakeholders?

• Patients and their carer who are under the care of Mental Health and Learning Disability services in ensuring that patients needs being addressed in a co-ordinated manner
• NHSL healthcare staff and partner agencies in providing guidance on an alternative means of agreeing and communicating the care plan to standard processes for those patients with complex need
• NHSL Management in compliance in a system of work

3.2  Who are the Stakeholders?

• Patients and their carer who are under the care of Mental Health and Learning Disability services in ensuring that patients needs being addressed in a co-ordinated manner
• NHSL healthcare staff and partner agencies in providing guidance on an alternative means of agreeing and communicating the care plan to standard processes for those patients with complex need
• NHSL Management in compliance in a system of work

4.   PRINCIPAL CONTENT

4.1  CPA Inclusion Criteria

When considering utilising the CPA process for an individual, the following are recommended as inclusion criteria for CPA within Health and Social Care North & South  Lanarkshire:

Inclusion Criteria:

Presence of a mental disorder as defined by the Mental Health (Scotland) Act 2015.  The  disorder will be usually severe with a high degree of clinical complexity AND

Complexity of care requiring input from 2 or more psychiatric specialities, or one psychiatric specialty and  other agency involvement including NHS physical healthcare, housing, employment, criminal justice, voluntary sector etc AND

The presence of high and significant risk to health, safety and welfare of the individual or others as a result of:-

1. An assessed high risk of non compliance with treatment/care plan and/or
2. Ineffective communications and dialogue between care agencies or providers.

 The level of risk would usually include areas of significant uncontained risk such as poor compliance, poor  engagement with services, substance misuse, presence of vulnerable dependants etc AND       

The degree of care coordination likely to benefit the person would not be achievable without the support of the CPA process.

4.2 CPA Pathway (Appendix 1)

A CPA Pathway was devised and developed as an aide to illustrate the stages in the application of the CPA process to those applying the framework.

5. ROLES AND RESPONSIBILITIES

The Executive Lead for Health & Social Care Partnership

Other designed responsibilities are as follows:

Clinical Directors/Service Managers

• Oversees progress and advises on aspects of the implementation of the CPA process across NHSL
• Disseminates information    regarding       CPA    to         their    respective Boards/responsible directorate

• Lead Consultant Psychiatrist nominated by Health and Social Care North & South Lanarkshire

• Chair of the CPA Steering Group
• Report to relevant Boards re: the use of CPA
• Review of Policy and related documents

CPA Administrator

• Provision of administrative and secretarial support to the CPA Steering Group
• Minute taking of all Steering Group meetings
• Management of information systems

CPA Steering Group    

• Promote the use of CPA in Health and Social Care North & South Lanarkshire
• Review, monitor and update related CPA policy/ procedures and protocols
• Respond to future training needs
• Advisory group to Health and Social Care North & South Lanarkshire and partner agencies in the application of The CPA Process

5. RESOURCE IMPLICATIONS

 Ongoing consideration by the steering group of:

Funding of permanent substantive CPA Administrator support

• Impact on workload for Locality Administration support will be considered by the Steering Group
• Impact on staff roles for documentation completion and meeting attendance
• Future training needs, including the undertaking of e-learning modules

6. COMMUNICATION PLAN

• Progress reports as per appropriate reporting structures/boards
• Future training as and when identified within Health and Social Care North & South Lanarkshire
• Intranet / Health and Social Care North & South Lanarkshire Policy website and Staff Briefing
• CPA Guidance Document / Protocol 2015 – available on FirstPort for NHSL staff

8. QUALITY IMPROVEMENT – Monitoring and Review

• Policy review at regular intervals as necessitated by the introduction of legislation from the Scottish Government/ DoH and other relevant bodies
• Policy cross-reference to other NHSL Policies, i.e. Information Sharing and Information Governance
• The Forensic Clinical Governance Group will be responsible for ensuring regular audit and monitoring, with support as required via the Clinical Quality Team using agreed Audit tool
• Provision of information via the CPA Administrator, re: statistics for local and national reports

9. EQUALITY AND DIVERSITY IMPACT ASSESSMENT

This policy meets NHS Lanarkshire’s EDIA

10. REFERENCES

• Department of Health (DoH) (2008) – ‘Refocusing the Care Programme Approach; Policy and Positive Practice Guidance Health 286218 IP 3K March (CWP)
• Mental Welfare Commission for Scotland (2009) ‘Too Close to See’
• Mental Welfare Commission for Scotland (2010) ‘Loss of Focus’
• Mental Welfare Commission for Scotland (2010a) ‘An investigation into the care and treatment of Mr N’
• NHS Lanarkshire (2012) – CPA Review Group Report by Dr L Findlay December
• NHS Lanarkshire (2012a) – Lanarkshire Mental Health Services. Development of the Care Programme Approach by Dr K Mackay December
• NHS Lanarkshire (2013) – Critical Incident Report (CIR) : Patient X
• NHS Lanarkshire (2013a) – Critical Incident report 2013 No 94098
• NHS Lanarkshire (2013b) – Care Programme Approach Protocol October
• Scottish Office Circular SWSG 16/9 (1996) Community Care: Care Programme Approach for People with Severe and Enduring Mental Illness. 1996

11. OTHER RELEVANT READING/RESOURCES

• Care Programme Approach Association (CPAA) (2008) The CPA and Care Standards Handbook. 3^rd CPAA.
• Department of Health (1990) The Care Programme Approach for People with a Mental Illness Referred to Specialist Psychiatric Services. Department of Health, HC (90)23/LASSL (90)
• Department of Health (1999) Effective care coordination in mental health services: modernising the care programme approach-A policy booklet.
• Department of Health (1999) National Service Framework for Mental Health.   LAC (99)34.
• Scottish Government (2007) Adult Support and Protection (Scotland) Act 2007 Code of Practice.
• CPA Guidance document/protocol.

Care Programme Approach (CPA) Pathway