1. 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

2. 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?

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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