84. The Care Programme Approach (CPA)29 is one means by which this process can be formalised. It has the strength of being supported as a matter of Government policy, and by local agreements involving Health Boards, Trusts, and Local Authorities.
85. It is focused on those with complex needs assessed as being at some risk to themselves or others, where care is being provided by a number of agencies. It is about identifying needs, assigning individuals or organisations to meet those needs in an agreed and co-ordinated way, and regularly reviewing progress with the people who receive the services and with those who care for them. That process of review should be attended by the individual and his or her carer and a written record should be kept, which is available to all present or involved with the consent of the person receiving the service. An Accounts Commission/Social Work Services Group review (1998)22 showed a 100-fold variation in the number of people across Scotland subject to CPA, which suggested a degree of professional reticence and organisational sluggishness until then. Out of a total of just over 1,000 people on CPA in Scotland 700 were from 4 (out of 32) social work areas.
86. Some detractors argue that the CPA process is too bureaucratic, that somehow it is an excuse for lack of resources, that it is "too stressful" for service users to be involved, that there is a "lack of control" over confidential information and that there is no evidence base for its use. The counter view is that CPA is not an intervention or treatment but a process to support joined up treatment - a quality issue in fact. Organisations and staff ignoring the CPA increase risk and individuals receiving care and those around them are also put at unnecessary risk.
87. Further arguments in favour are that CPA formalises communication and does not leave the transmission of information to chance. It need not be bureaucratic, and the process can complement other service activities. It requires all to be explicit about their roles and gives clarity to the service user or carer as to what they can expect. Effective use of the process will maximise the best use of available resources. It avoids duplication and minimises risk. The benefits of properly co-ordinating care by a number of staff and agencies, joint communication and informed involvement of both service user and carer should not be underestimated.
88. Similar principles should apply in the management of individuals and the risks which they may present by community care assessment and care management processes when the severity of the presenting problems do not justify use of the CPA.