Lousia Ovington independent investigation report ... - NHS North East

CHAPTER 4 – THE CARE PROGRAMME APPROACH (CPA)
Chapter 4 – The Care Programme Approach (CPA)
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After consideration of the voluminous documentation available to the panel and after
hearing from many witnesses, the panel’s view is that the effective operation of the
CPA was absolutely fundamental, perhaps the most fundamental factor in the health
care and treatment of Louisa Ovington and for that reason has been dealt with in this
separate chapter, which describes the legislative requirements of the CPA and how
they impacted on the direct care arrangements for Louisa Ovington.
Policy context
In 1990, the Department of Health issued Health Circular (HC (90)23) entitled:
‘The Care Programme Approach (CPA) for people with a mental illness referred to the
specialised psychiatric services’
The CPA was introduced as a response to concerns regarding the quality of care being
provided to those with mental illness who were being cared for under care in the
community arrangements and followed on from a number of serious incidents where
the care appeared to fall short of the standards required.
It was intended to provide a framework for effective mental health care and applied to
all who came into contact with the secondary mental health services.
Its five main elements were:
• Systematic arrangements for assessing the health and social are needs of people
accepted into the specialist mental health services;
• Formulation of care plans which identified the health and social are required for
the patient from a variety of providers;
• A minimum, medium or complex care approach level, depending on need;
• The appointment of a key worker to coordinate care;
• Regular review and, where required, revision of care plans.
However, there was general recognition throughout England, that the application of
CPA was too bureaucratic and that there was a reluctance to engage with the process.