Reforming care without bureaucracy.

The Care Programme Approach was a valiant attempt to improve the aftercare of people with severe mental illness after discharge from hospital. It was introduced as a response to a scandal, not an advance in knowledge, and has always suffered by being a reaction to events rather than a trailblazer for the future. It may have dragged the worst of care upwards, but at the expense of creating a bureaucratic monstrosity that has hindered good practice by excessive attention to risk, and vastly increased paperwork with intangible benefit. It needs to be simplified to allow practitioners greater scope for collaborative solutions, less minatory oversight and better use of strained resources.Declaration of interestNone.