CPA, the Care Act and s117 Moving towards integrated care and support planning in mental health services Mark Trewin – MHA Review working group; chair, s117 Topic Group; MH Social Care advisor for DHSC & NHSE

Care Planning in context Care Planning is undergoing major change: Community MH Review is redesigning CMH services and CPA to meet the needs of the Five Year Forward View Green Paper for Social Care – integrated Care Planning MHA Review is looking at s117 aftercare and Care Plans Development of NHS personal health budgets, integrated with Social care individual budgets How do we link all of this into a co-ordinated strategy?

CPA is not the only show in town Other care planning systems: Care Act support planning S117 aftercare plans Transforming care plans CAMHS and Transition Plans Personal Health Budgets CHC and DSTs

What is going wrong with CPA? Recent research shows service users do not value their care plan as much as consistent, friendly contact. The Care Act is often separate and many LAs are assuming it cannot co-exist with CPA The introduction of clustering and national targets for CPA reviews has changed the culture within the NHS Complex database systems have changed the relationship of CPA with people, professionals and organisations

MHA Review: Phase 2 Topic Groups Understanding why rates of detention under the MHA have increased Community Treatment Orders Discharge, care planning and aftercare Addressing rising detention rates Asian and other ethnic minorities Maximising Patient Autonomy Children & young people Patient autonomy - Detention criteria Learning disabilities / autism Mental Capacity Act interface Patient Dignity and Safety Police role Advocacy Criminal justice system and ‘Part 3’ of the Act Tribunal, hospital managers, renewals Principles underpinning the act Family / carer involvement

Discharge, care planning and aftercare Section 117 aftercare We have committed to consider further: The need to clarify what aftercare means within the modern health and social care system, so that it supports independence and recovery The case for reforming eligibility of aftercare to improve equity of access Resolving some of the complex arrangements across health and social care, especially regarding funding and ordinary residence The need to modernise section 117 aftercare in relation to the provisions of the Care Act The need to plan for discharge from admission

Discharge, care planning and aftercare Care planning and support in the community We have committed to consider further: The opportunity to bring the requirements of the CPA, the Care Act, the Children Act, NHS Continuing Health Care (as well as other legal provisions) and section 117 care planning together in a coordinated way Opportunities for greater collaboration between bodies involved in care plans, which may include new statutory duties How to incorporate opportunities identified in our consideration of advance planning to any proposed reforms

S117 – Some Issues/ areas to explore Clarify what aftercare means - supporting independence & recovery, stability and equality of services. Consider reforming eligibility for aftercare to improve equity of access. Resolving some of the complex arrangements across health and social care – especially regarding funding and ordinary residence. Equality of aftercare and of support in OOA placements Relationship of aftercare to CHC, Care Act, PHB, benefits Ordinary residence and a simplified approach to funding No Recourse to Public Funds Prescription charges

Care Planning – Issues to explore Back to basics – what is the point of a care plan Real co production with a personalised care plan How can we develop one Care Plan to deliver and co-ordinate all of the support needed across agencies but with the person at the centre? Moving from risk management to risk enablement Capacity and care planning Advanced statements

Care Planning – Issues to explore The Use of Joint or multi agency crisis plans Care planning as a tool to access services more easily Linking CPA, the Care Act, Children’s legislation, NHS CHC and S117 together. Does Care planning need to be redesigned for BAME communities? Care Planning for people leaving secure hospital or prison

A new vision for Care Planning Good practice examples: EQUIP; ELFT; Herts etc Based on equality and access to services rather than risk and diagnosis Based on conversations and co production Strength based and ambitious Focussed on realistic goals set by the person Creative – using a the community resources available Time limited