1. CPA Standards and update (CPA Level 1) April 2015

2. Why do we have standards?

3. What do you know about CPA and Core Care Standards?

4. CPA standards are based on the following: Assessment Care Planning Review Care Co-ordination Discharge/transfer Service User and Carer Involvement Began: 1991 Last Updated: 2008 From: NHS and Community Care Act 1990 CPA may apply to: –Any patient accessing specialist secondary mental health services, of any age, who has serious and complex mental health characteristics Care Programme Approach

5. Who needs CPA? The decision about CPA is: Only made after someone has been accepted by mental health services Ideally made in a multi-disciplinary forum/review Based on professional judgement Particular groups who need CPA: key groups would usually be included: who have parenting responsibilities; significant caring responsibilities; with a dual diagnosis (substance misuse); with a history of violence or self harm; or who are in unsettled accommodation Inpatients automatically included. People with a learning disability should be included if they are also accessing specialist mental health services, or have been admitted under the MH Act Any one guideline may be significant enough to indicate the need for CPA

6. Guidelines for needing CPA Complexity: –Severe mental disorder with high degree of clinical complexity –Multiple service provision from different agencies –Disadvantage or difficulty as a result of: parenting responsibilities; physical health problems/disability; unsettled accommodation; employment issues; significant impairment of function when mentally ill; ethnicity, sexuality or gender issues Safety: –Current or potential risks –Current or history of severe distress/instability or disengagement –Non-physical co-morbidity e.g. substance misuse, learning disability –Currently/recently detained under MH Act, or accepted by crisis/home treatment team –Significant reliance on carer/s, or has own caring responsibilities Link: Glossary on CCS website

7. Standards for CPA Service users needing CPA can expect: The support of a CPA Care Co-ordinator (trained, probably part of job description, significant part of caseload), who keeps in contact if they are in hospital or prison Comprehensive multi-disciplinary multi-agency assessment A comprehensive formal written care plan including management of risk, and direct payments where appropriate Formal multi-disciplinary, multi-agency review at least once a year, but probably more often Carers identified and informed of their right to their own assessment Increased advocacy support

8. Mental Health Service Users not needing CPA Service users with: more straightforward needs, lower risk, and contact with only one agency (or no problems with access to other agencies/support) will no longer need CPA, but can still expect: An identified lead professional That care will be self-directed, with support A full assessment of need including risk A care plan in the form of a statement of care agreed with them, which will be recorded in a letter On-going review as required, including annually the need for inclusion in CPA Their Carers identified and informed of their rights to their own assessment NB After assessment no further formal CPA paperwork needs to be completed – good record keeping standards apply

9. So why Core Care Standards? In 2011 we looked at why CPA wasn't as effective as it should be? Staff said –What are the standards and where are they? –Why don’t they apply to all our service users? –We don’t just provide mental health services – what about children, substance misuse and learning disability services? –How do we find out the latest information? Service users and carers said –What are the standards? –What should we expect and what are our rights? –How do we find out the latest information? Partners said: –How do your services work? –What are your policies and standards? –How do we find out the latest information?

10. CPA standards are based on the following: Assessment Care Planning Review Care Co-ordination Discharge/transfer Service User and Carer Involvement Link: ‘Care Standards handbook’ ‘Core Care Standards’ booklet Core Care Standards cover the following: Assessment Care Planning Review Co-ordination Discharge/transfer Families and Carers Involvement and Choice Keeping yourself and others safe Core Care Standards and CPA

11. Core Care Standards We will find out with you what your needs are You will have a clear care plan We will check that things are working for you Your care will be co-ordinated We will make sure your transfer or discharge works well We will work with Families and Carers You will be involved as much as you want and are able to be We will help you and others be as safe as we can

12. Core Care Principles We will provide good quality services We will treat you with dignity and respect We will respect your rights, and make sure you can access our services We will try to help people be as well as they can be We will communicate well with everyone We will employ staff who know what they’re doing We will provide care and support in a place that’s safe You will be at the centre of your care and support You can tell us what you think about services We will safeguard children and vulnerable adults We will keep information safe and share it when needed, and you will have the right information at the right time We will work together with other organisations

13. Service User involvement Core Standard: You will be involved as much as you want and are able to be Fully involved in planning and reviewing care (if able to) Given accessible information and choice Offered a copy of their care plan Can involve carers, advocates, friends Treated with dignity, and diversity taken into account Links: Infolink Resource Booklet Care Plan folder Capacity

14. Families and Carers Core Standard: We will work with Families and Carers Identify and welcome carers and families, giving them information about care, assessment, services etc Involve them as fully as possible, giving them a chance to speak to someone separately, and understanding confidentiality and information sharing Signpost or refer for help and assessment if needed to ThinkCarer/Derbyshire Carers Assoc. Know who your local Carers Champion or lead is Offer support plan if needed Triangle of Care Links: Carers Handbook & Information folder Infolink Families and Carers Sharing information with families and carers Who Cares? quarterly carers newsletter Carers Contact Card Carers Emergency Card

15. Assessment Core Standard: We will find out with you what your needs are Each person who is referred to specialist mental health services will have a systematic assessment of their needs carried out by a qualified mental health worker (following triage if appropriate) Include contributions from all Consider safety safeguarding caring responsibilities informal carers physical health the need for CPA Ensure physical health assessment is completed

16. Care Planning Standard: You will have a clear care plan Based on the current assessment of their needs Using principles of recovery and wellbeing Written in plain language Details how and by whom the needs will be met Service user involved in designing the plan and understands it Includes responsibilities, outcomes, unmet needs, crisis and contingency arrangements Copies to all including service user, in an accessible format Should include (where relevant): medication management, self-directed care, service users and carers involvement, support for parenting, safeguarding etc. Links: Care Plan Folder ‘Writing Good Care Plans Booklet’ My Recovery Plan

17. Review Standard: We will check that things are working for you All service users will have their care plan reviewed systematically and regularly, at least every year, in a way that ensures that all those involved can contribute effectively, and in a way that reflects their needs. Review within a month of discharge from hospital Anyone can request a review, service user must be involved, can bring advocate Date of next one set at this one Remember - A review is a process, not necessarily a single meeting N.B. Medication should be reconciled every 12 months Anyone with identified accommodation needs should have a home visit at least once a year. Review Guidance

18. Care Co-ordination Standard: Your care will be co-ordinated All mental health service users will have a care co-ordinator or lead professional who will be responsible for co-ordinating their care Qualified health or social care professional employed by health or social care, ‘best placed’, whose role continues if in hospital (or in prison) Service users will: know how to contact them have a choice of care co-ordinator which takes account of any cultural or religious needs, or gender preferences due to damaging experiences of abuse or violence. Be involved in the care process Named Deputy Care Co-ordinator identified Link: Responsibilities of the Care Co-ordinator or lead professional

19. Discharge/Transfer Standard: We will make sure your transfer or discharge works well Co-ordinated and planned Written plan (detailing any follow-up and review) copied to the service user (and carer where relevant) Jointly agreed and signed plan if entitlement under s.117 of the Mental Health Act Enhanced care package if recent risk of suicide Review before any discharge/transfer Follow-up within 7 (or 2) days for those on CPA discharged or on leave from hospital Keep a record of which documents are transferred to whom

20. Keeping yourself and others safe Standard: We will help you and others be as safe as you can be Trust standards and processes for safety and risk assessment, currently FACE Types of safety issues would include: self harm; self-neglect; suicide; violence; bullying, domestic violence, substance misuse, vulnerability to abuse or neglect, sexual exploitation, moving and handling, infection control, physical health, and falls. Therapeutic or positive risk-taking can also be used to help people to develop new skills and opportunities. Care plans should include: management of risk and focus on safety crisis and contingency plans a plan for follow up if there is disengagement from the service and a problem has been identified sharing information with relevant people NICE guidance: on depression in adults recommends that the quality of interpersonal relationships and living conditions, and social isolation, should be considered on common mental health disorders also emphasises the importance of considering living conditions and social isolation

21. Core Care Standards www.corecarestandards.co.uk

22. Website www.corecarestandards.co.uk Standards Principles News Help What’s on Services Infolink Keeping well PbR Twitter Glossary Language and Accessibility

23. So what does that look like? Everyone who uses our services has: an assessment of their needs involvement in putting their care plan together and the chance to have someone to support them a copy of a written care plan safe and effective care that focuses on wellbeing and recovery, and recognises physical health needs as well as mental health needs involvement in a review of their care at least once a year the needs of their carers and family recognised safe and effective transitions and discharge

24. What do you know about CPA and Core Care Standards - the answers

25. For more information please contact: Wendy Slater/Lynn Dunham Core Care Standards and CPA wendy.slater@derbyshcft.nhs.uk wendy.slater@derbyshcft.nhs.uk lynn.dunham@derbyshft.nhs.uk 01246-515974