Next week sees the end of a consultation on a Common Assessment Framework (CAF) for Adults. The government plans to make it easier for health and social services to share information with each other on patients and has been calling for submissions on its drafted plans.
CAF for Adults stems from the government's Putting People First initiative, which aims to to recast all public services around individuals, instead of individuals having to fit in with the services on offer. CAF for Adults implements that concept in health and social services. But is it a good idea?
Lynda Rowbotham, contract manager in housing and support at mental health charity Mencap, certainly thinks so. "There has always been a gap between health services and social care, and it has always been a difficult gap to navigate," she says, arguing that it has been difficult to avoid falling through the net, especially for individuals who find it difficult to articulate what they need.
"It is improving but it's often quite difficult for people with a learning disability, where what professionals see is their learning disability, and not what these people came to talk to them about," she adds.
Ideally, CAF would change all that. Instead of having to explain their situation afresh to each new health and social care worker that they meet, the framework would create a CAF record that would let all relevant workers see their information. As an example of why things should be more joined up, Rowbotham points to the Health Ombudsman's report, issued in March, that shows how six people died following inadequate procedures on the part of health trusts.
Poor show of form
Not everyone thinks that CAF is a good idea, however. Ross Anderson, professor of security engineering at the University of Cambridge's Computer laboratory, argues that 'patient-centric' is little more than Whitehall bureaucratese, and draws on his experience with the children's version of CAF, which he says fails for the same bureaucratic reasons.
Before the original eCAF was created, GPs or teachers with concerns about a child could simply call a local social worker and deliver information verbally. eCAF imposed a more stringent, structured form that Anderson says could take up to two hours to fill out.
"The government made the system electronic, and compelled those filling out the CAF forms to fill out every single bloody record," he says. "As a result, some people will spend two hours filling out a CAF form to cover their arses, and others will say 'I have to see 35 more patients in six minute intervals and then rush off to pick up the kids. CAF form? Get stuffed.' "
A Department of Health spokesperson warned that we shouldn't infer too much about CAF for Adults from the existing children's version. "The Common Assessment Framework is different from the children's electronic version, in that it is not an assessment tool and does not require the collection of additional information that is not already collected as part of existing assessment processes," she said. "CAF should reduce the data collected by prepopulating forms with information that has already been provided where appropriate."
Nevertheless, the consultation document calls for CAF for Adults to "link appropriately and share information with" eCAF. In fact, it seeks to have a broader scope than that, enabling information about patients to be shared across community support agencies, particularly housing, "and to the voluntary and independent sector".
This creates some concerns in the context of Clause 152 of the Coroners and Justice bill. That clause, withdrawn from the legislation pending further perusal in early March, would have made it easier to share data between different Whitehall departments. The British Computer Society criticised the clause in February for going against the principle of informed consent under the Data Protection Act.
Perhaps most telling is that those working at the coalface also seem suspicious of CAF. "I am not clear of the need for a CAF if services work closely together anyway," said Clare Gerada, a GP in Lambeth in London. "The drive is towards integrated services , where you have link or liaison works, joint meetings, and shared care that goes beyond the simple exchange of a letter.
"I think the document makes assumptions about the CAF that are unrealistic – certainly from where I come from in primary care," Dr Gerada continues. "It focuses on assessment rather than treatment, and assumes that that the process itself will lead to better care. It won't. It will lead to a tick box burden on most health, and I think social, care professionals."
The consultation period ends on 17 April, and the Department of Health is already calling for "demonstrator sites" to pilot test the initiative. As part of the government's overall strategy to modernise public services, it's perhaps no wonder that strong voices are being raised on both sides.
