Assuring Transformation (AT)

Measures describe a question asked to a participant during a survey or an item of information requested from a manager when they fill out a data return. For example, ‘Who do you live with?’ is a measure and the possible responses might be, mother, father, brother, sister etc.

Question/Data item wording	Response scale wording	Need OR provision OR receipt	Description of measure	Start Year	Age of interest	Age to	Informant	Multiple rater	Reporting term	Sweep title	Standard instrument	Dataset
Date the patient was diagnosed as autistic (mandatory if post-admission)	DD-MM-CCYY	Need;	Autism diagnosis date	2023	0-120	120	Data manager	No	Current	Data specification - August 2023 onwards	No	AT
Record Closed: Discharge destination/Reason for Record Closure	Patient discharged to Independent Living Patient discharged to Supported Housing Patient discharged to family home Patient discharged to care home without nursing Patient discharged to care home with nursing Patient discharged to Residential School or College Patient transferred to acute hospital for physical health care Patient transferred to other mental health or Learning Disability bed (any transfer with a change of ward type, security, site or provider) Patient transferred to prison Patient discharged to local authority foster care Patient discharged to hospice Patient discharged to temporary place of residence when usually resident elsewhere (includes hotel) Patient no longer in scope of transforming care: diagnosis for Learning Disability removed Patient no longer in scope of transforming care: diagnosis for autism removed Patient no longer in scope of transforming care: other, e.g. hospital reclassified as no longer a hospital Patient died Other	Need;	Reason record close including social care discharge	2023	0-120	120	Data manager	No	Current	Data specification - August 2023 onwards	No	AT
Other reason that a patient is not able to be discharged or transferred despite being clinically ready for discharge or suitable for transfer.	Awaiting care coordinator allocation Awaiting allocation of community psychiatrist Awaiting allocation of social worker Lack of agreed health care funding Lack of agreed social care funding Awaiting further non-acute (including community and mental health) NHS care (including intermediate care, rehabilitation services, step down service etc.) Awaiting availability of placement in prison or Immigration Removal Centre Awaiting availability of placement in care home without nursing Awaiting availability of placement in care home with nursing Awaiting commencement of care package in own home Awaiting provision of community equipment and/or adaptations in own home Patient or Family choice (any reason) Disputes about responsible commissioner (including where this relates to funding issues) Disputes about proposed pathway between clinical teams and/or care panels Awaiting availability of private rented accommodation Awaiting availability of social rented housing via council housing waiting list Lack of suitable housing option – awaiting discharge to an identified supported living vacancy. Lack of suitable housing option – awaiting discharge to a supported living vacancy, not yet identified. Lack of suitable housing option – awaiting adaptation of an existing independent property (already purchased or rented; not part of an existing supported living scheme). Lack of suitable housing option – awaiting sourcing of a suitable independent property through either: purchase / new build / identification of suitable general needs rental property’. Awaiting availability of residential children’s home Awaiting availability of secure children’s home (welfare or non-welfare) Awaiting availability of placement in Youth Offender Institution Child or young person awaiting family or foster placement Awaiting Ministry of Justice agreement/permission of proposed placement Awaiting outcome of legal requirements (mental capacity/mental health legislation) Awaiting Court of Protection proceedings Awaiting Deprivation of Liberty Safeguards (DOLS) Application Delay due to consideration of specific court judgements Awaiting residential special school or college placement or availability Lack of local education support Public safety concern unrelated to clinical treatment need (care team) Public safety concern unrelated to clinical treatment need (MoJ) Highly bespoke housing and/or care arrangements not available in the community No lawful support available in the community (not including social care, see code 34) Lack of social care support including social care funded placement Delays to NHS-led assessments Hospital staff shortages Delays to assessments from external partners Lack of health care service provision No reason and/or other reason given	Need;	Discharge delays - including social care related reasons	2023	0-120	120	Data manager	No	Current	Data specification - August 2023 onwards	No	AT
The secondary reason that a patient is not able to be discharged or transferred despite being clinically ready for discharge or suitable for transfer.	Awaiting care coordinator allocation Awaiting allocation of community psychiatrist Awaiting allocation of social worker Lack of agreed health care funding Lack of agreed social care funding Awaiting further non-acute (including community and mental health) NHS care (including intermediate care, rehabilitation services, step down service etc.) Awaiting availability of placement in prison or Immigration Removal Centre Awaiting availability of placement in care home without nursing Awaiting availability of placement in care home with nursing Awaiting commencement of care package in own home Awaiting provision of community equipment and/or adaptations in own home Patient or Family choice (any reason) Disputes about responsible commissioner (including where this relates to funding issues) Disputes about proposed pathway between clinical teams and/or care panels Awaiting availability of private rented accommodation Awaiting availability of social rented housing via council housing waiting list Lack of suitable housing option – awaiting discharge to an identified supported living vacancy. Lack of suitable housing option – awaiting discharge to a supported living vacancy, not yet identified. Lack of suitable housing option – awaiting adaptation of an existing independent property (already purchased or rented; not part of an existing supported living scheme). Lack of suitable housing option – awaiting sourcing of a suitable independent property through either: purchase / new build / identification of suitable general needs rental property’. Awaiting availability of residential children’s home Awaiting availability of secure children’s home (welfare or non-welfare) Awaiting availability of placement in Youth Offender Institution Child or young person awaiting family or foster placement Awaiting Ministry of Justice agreement/permission of proposed placement Awaiting outcome of legal requirements (mental capacity/mental health legislation) Awaiting Court of Protection proceedings Awaiting Deprivation of Liberty Safeguards (DOLS) Application Delay due to consideration of specific court judgements Awaiting residential special school or college placement or availability Lack of local education support Public safety concern unrelated to clinical treatment need (care team) Public safety concern unrelated to clinical treatment need (MoJ) Highly bespoke housing and/or care arrangements not available in the community No lawful support available in the community (not including social care, see code 34) Lack of social care support including social care funded placement Delays to NHS-led assessments Hospital staff shortages Delays to assessments from external partners Lack of health care service provision No reason and/or other reason given	Need;	Discharge delays - including social care related reasons	2023	0-120	120	Data manager	No	Current	Data specification - August 2023 onwards	No	AT
The primary reason that a patient is not able to be discharged or transferred despite being clinically ready for discharge or suitable for transfer.	Awaiting care coordinator allocation Awaiting allocation of community psychiatrist Awaiting allocation of social worker Lack of agreed health care funding Lack of agreed social care funding Awaiting further non-acute (including community and mental health) NHS care (including intermediate care, rehabilitation services, step down service etc.) Awaiting availability of placement in prison or Immigration Removal Centre Awaiting availability of placement in care home without nursing Awaiting availability of placement in care home with nursing Awaiting commencement of care package in own home Awaiting provision of community equipment and/or adaptations in own home Patient or Family choice (any reason) Disputes about responsible commissioner (including where this relates to funding issues) Disputes about proposed pathway between clinical teams and/or care panels Awaiting availability of private rented accommodation Awaiting availability of social rented housing via council housing waiting list Lack of suitable housing option – awaiting discharge to an identified supported living vacancy. Lack of suitable housing option – awaiting discharge to a supported living vacancy, not yet identified. Lack of suitable housing option – awaiting adaptation of an existing independent property (already purchased or rented; not part of an existing supported living scheme). Lack of suitable housing option – awaiting sourcing of a suitable independent property through either: purchase / new build / identification of suitable general needs rental property’. Awaiting availability of residential children’s home Awaiting availability of secure children’s home (welfare or non-welfare) Awaiting availability of placement in Youth Offender Institution Child or young person awaiting family or foster placement Awaiting Ministry of Justice agreement/permission of proposed placement Awaiting outcome of legal requirements (mental capacity/mental health legislation) Awaiting Court of Protection proceedings Awaiting Deprivation of Liberty Safeguards (DOLS) Application Delay due to consideration of specific court judgements Awaiting residential special school or college placement or availability Lack of local education support Public safety concern unrelated to clinical treatment need (care team) Public safety concern unrelated to clinical treatment need (MoJ) Highly bespoke housing and/or care arrangements not available in the community No lawful support available in the community (not including social care, see code 34) Lack of social care support including social care funded placement Delays to NHS-led assessments Hospital staff shortages Delays to assessments from external partners Lack of health care service provision No reason and/or other reason given	Need;	Discharge delays - including social care related reasons	2023	0-120	120	Data manager	No	Current	Data specification - August 2023 onwards	No	AT
Is the relevant ICS aware of the planned transfer / discharge of this patient to the area?	Yes No Don’t know	Receipt;	Integrated care system awareness of discharge	2023	0-120	120	Data manager	No	Current	Data specification - August 2023 onwards	No	AT
Where the patient is being placed out of the originating Local Authority, is the receiving Local Authority aware of the planned transfer / discharge of this patient to their area?	Yes No Don’t know	Receipt;	Local authority awareness of discharge	2023	0-120	120	Data manager	No	Current	Data specification - August 2023 onwards	No	AT
Is the originating Local Authority aware of the planned transfer / discharge of this patient to the area?	Yes No Don’t know	Receipt;	Local authority awareness of discharge	2023	0-120	120	Data manager	No	Current	Data specification - August 2023 onwards	No	AT
Part 1: Where is the patient’s planned transfer to? Part 2: Full postcode of the proposed community setting	Part 1: Independent Living Supported Housing Family home Residential Care Residential School or College Acute hospitals for physical health care Prison No transfer planned Other Adult Mental Health/Learning Disability Bed Acute adult mental health care Acute older adult mental health care (organic and functional) Adult Psychiatric Intensive Care Unit (acute mental health care) Adult Eating Disorders Mother and baby Acute Mental Health Unit for Adults with a Learning Disability and/or Autism Adult Low secure Adult Medium secure Adult High secure Adult Neuro-psychiatry / Acquired Brain Injury Adult Personality disorder Adult mental health services for the Deaf Adult Mental Health Rehabilitation (Mainstream Service) Adult Mental Health Rehabilitation for Adults with a Learning Disability and/or Autism (Specialist Service) Children and Young people Mental Health/Learning Disability Bed General Child and young person – Child (including High Dependency) General Child and young person – young person (including High Dependency) Eating Disorders Child and young person Child and Young Person Low Secure Mental Illness Child and Young Person Medium Secure Mental Illness Child Mental Health Admitted Patient Services for the Deaf Child and Young Person Low Secure Learning Disabilities Child and Young Person Medium Secure Learning Disabilities Severe Obsessive Compulsive Disorder and Body Dysmorphic Disorder – Young person Child and Young Person Psychiatric Intensive Care Unit Child and Young Person Learning Disabilities Child and Young Person Autism Part 2: Enter postcode	Receipt;	Discharge destination including social care services	2023	0-120	120	Data manager	No	Current	Data specification - August 2023 onwards	No	AT
Point 12 .Discharge	Confirmed that the patient has discharged to Community Confirm that the patient has Transferred between Integrated Care Board (ICB) commissioned services, or Stepped down from a secure setting to ICB commissioned services Confirm that the patient has Transferred between secure services, or /Stepped up to secure services	Receipt;	Use of Integrated Care Board (ICB) commissioned services	2023	0-120	120	Data manager	No	Current	Data specification - August 2023 onwards	No	AT
Was the patient admitted for respite only?	Yes No	Receipt;	Use of acute services for respite care	2023	0-120	120	Data manager	No	Current	Data specification - August 2023 onwards	No	AT
Does the person make use of any other advocates?	Non-statutory / citizen advocate: family member Non-statutory / citizen advocate: Social Care Advocate Non-statutory / citizen advocate: friend, independent person or other	Receipt;	Use of social care advocates	2023	0-120	120	Data manager	No	Current	Data specification - August 2023 onwards	No	AT
Date the patient was diagnosed with a learning disability (mandatory if post-admission)	DD-MM-CCYY	Need;	Learning disability diagnosis date	2023	0-120	120	Data manager	No	Current	Data specification - August 2023 onwards	No	AT
Additional diagnoses since admission	Autism Learning Disability Eating Disorder Personality Disorder Physical illness Mental Disorder Attention deficit hyperactivity disorder (ADHD) Dementia Other Not Different Not Known	Need;	Diagnoses suggesting social care need - since admission	2023	0-120	120	Data manager	No	Current	Data specification - August 2023 onwards	No	AT
Diagnoses on admission	Autism Learning Disability Eating Disorder Personality Disorder Physical illness Mental Disorder Attention deficit hyperactivity disorder (ADHD)” Dementia Other Not Known None	Need;	Diagnoses suggesting social care need - admission	2023	0-120	120	Data manager	No	Current	Data specification - August 2023 onwards	No	AT
Which of the following categories best describes the patient?	Learning disability Learning disability and autism Autism	Need;	Learning disability and/or autism	2023	0-120	120	Data manager	No	Current	Data specification - August 2023 onwards	No	AT
Does the patient have someone who supports them to manage their affairs?	Appointee (for DWP benefits) Someone with parental responsibility (for a child) Local authority (for a Looked After Child (LAC) at point of admission) Attorney under the Mental Capacity Act Attorney under last or enduring power of attorney Deputy appointed by the Court of Protection No Don’t Know	Need;	Power of attorney etc.	2023	0-120	120	Data manager	No	Current	Data specification - August 2023 onwards	No	AT
Source of Admission Code	Usual place of residence Temporary place of residence when usually resident elsewhere Penal establishment NHS other hospital provider – high security psychiatric accommodation in an NHS hospital NHS other hospital provider – ward for general patients / A&E NHS other hospital provider – ward for maternity patients or neonates NHS other hospital provider – Ward for patients who are mentally ill or have learning disabilities Care home with nursing Care home without nursing Local Authority foster care Independent sector healthcare provider run hospital Hospice Not yet known	Provision;	Source of admission	2023	0-120	120	Data manager	No	Current	Data specification - August 2023 onwards	No	AT
Source of Admission Code	19 Usual place of residence 29 Temporary place of residence when usually resident elsewhere 39 Penal establishment 49 NHS other hospital provider – high security psychiatric accommodation in an NHS hospital 51 NHS other hospital provider – ward for general patients / A&E 53 NHS other hospital provider – Ward for patients who are mentally ill or have learning disabilities 54 NHS run care home 65 Local Authority residential accommodation 66 Local Authority foster care 85 Non–NHS run care home 87 Non–NHS run hospital 88 Non–NHS run hospice	Receipt;	Source of admission to NHS services	2021	0-120	120	NHS Comissioner	Yes	Past month	Apr-21	No	AT
Q42 Details of a patient’s care plan If Q42 is coded 6, what are the reasons for the patient’s planned transfer of care not having an agreed date? If Q42 is code 6, Q48a-s must be answered. Q48b Lack of agreed social care funding Q48d Awaiting residential home placement or availability Q48e Awaiting nursing home placement or availability Q48f Awaiting care package in own home Q48g Awaiting community equipment and adaptations Q48j Lack of social care support Q48I Awaiting residential special school or college placement or availability Q48p No lawful community care package available (non– clinical reason including impact of MM/PJ judgements)	Response scale for Q42: 2 Currently receiving active treatment plan, discharge plan not in place 3 Currently receiving active treatment and working towards discharge or with discharge plan in place 6 Delayed transfer of care: no community option or onward placement available or deliverable 7 Unable to discharge due to legal restrictions (e.g. MM judgement) Response scale for Q49’s social care related measures: Y Yes N No	Receipt;	Details of care plan and reasons NHS discharge being delayed	2021	0-120	120	NHS Comissioner	Yes	Past month	Apr-21	No	AT
Q44: Where is the patient’s planned transfer to?	1 Independent Living 2 Supported Housing 3 Family home 4 Residential Care 5 Residential School or College 50 Acute hospitals for physical health care 51 Prison 14 No transfer planned 16 Other Adult Mental Health/Learning Disability Bed 110 Acute adult mental health care 111 Acute older adult mental health care (organic and functional) 112 Psychiatric Intensive Care Unit (acute mental health care) 113 Eating Disorders 114 Mother and baby 115 Learning Disabilities 116 Low secure/locked rehabilitation 117 High dependency rehabilitation 118 Long term rehabilitation/ Continuing Care 119 Low secure 120 Medium secure 121 High secure Children and Young people Mental Health/Learning Disability Bed 123 General Child and Adolescent Mental Health (CAMHS) inpatient – Child (including High Dependency) 124 General Child and Adolescent Mental Health (CAMHS) inpatient – Adolescent (including High Dependency) 125 Eating Disorders inpatient – Adolescent (above 12) 126 Eating Disorders inpatient – Child (12 years and under) 127 Low Secure Mental Illness 128 Medium Secure Mental Illness 129 Child Mental Health inpatient services for the Deaf 130 Learning Disabilities / Autistic Spectrum Disorder inpatient 131 Low Secure Learning Disabilities 132 Medium Secure Learning Disabilities 133 Severe Obsessive Compulsive Disorder and Body Dysmorphic Disorder – Adolescent 134 Psychiatric Intensive Care Unit 122 Neuro-psychiatry / Acquired Brain Injury 140 Adult Personality Disorder 141 Adult Deaf	Receipt;	Transfer destination upon NHS discharge	2021	0-120	120	NHS Comissioner	Yes	Past month	Apr-21	No	AT
Q36: Does the young person have an Education Health and Care plan (EHC plan)?	Y Yes N No Z Not applicable	Receipt;	Receipt of EHC plan	2021	0-120	120	NHS Comissioner	Yes	Past month	Apr-21	No	AT
Q35 Does the patient have a named locality care coordinator/care manager?	Y Yes N No	Receipt;	Use of care coordiantor	2021	0-120	120	NHS Comissioner	Yes	Past month	Apr-21	No	AT
Q34: Was the patient admitted for respite only?	Y Yes N No	Receipt;	Respite as reasons of admission to NHS services	2021	0-120	120	NHS Comissioner	Yes	Past month	Apr-21	No	AT
Does the patient have someone who supports them to manage their affairs?	2 Appointee (for DWP benefits) 11 Someone with parental responsibility (for a child) 12 Local authority (for a Looked After Child (LAC) at point of admission) 13 Attorney under the Mental Capacity Act 14 Attorney under last or enduring power of attorney 15 Deputy appointed by the Court of Protection 8 No 9 Don’t know	Receipt;	Support in managing affairs	2021	0-120	120	NHS Comissioner	Yes	Past month	Apr-21	No	AT

England

Aims

Assuring Transformation collects data to monitor the progress in moving people with learning disabilities from inpatient to community settings. Data is collected about people with a learning disability, autism or both who are getting care in hospitals for their mental health or because they have had behaviour that can be challenging. Data is collected via the NHS Digital Clinical Audit Platform (CAP) on an ongoing basis. Submitters are expected to keep data held in this system up to date and reflect changes as and when they occur. This information tells policy makers: how many people are in hospital; how long they have been in hospital for; when their care and treatment is checked; what kind of hospital they are in.

Institution

NHS Digital

Geographic coverage - Nations

England;

Start date

2013

Minimum age at recruitment

Sample Size

2,650

Sample

Study design

Rolling data collection

Sample details

Assuring Transformation is a rolling data collection, consisting of a Clinical Audit Platform collecting live data. There is no deadline for the submission of data for the collection. Commissioners are required to update records as soon as they are informed of changes to the patient's care plan. Commissioners are expected to keep data up to date for all patients they commission. For reporting purposes, a cut of the data is taken at midnight on the last day of every month (this is not dependant on working days), this data is used by NHS Digital to produce monthly and quarterly reports. An additional cut is taken at midnight every Sunday. The data is used to produce weekly management information dashboards which are shared with NHS England and the regions.

Sex

All

Sample Characteristics

People with a learning disability

Sample size at most recent sweep

Varied

Individual data available (e.g. upon special request)?

Yes

Data Access Level

Mixed - open source and restricted access (on application)

Data Access

webarchive.nationalarchives.gov.uk/ukgwa/20170505130704/

https://webarchive.nationalarchives.gov.uk/ukgwa/20170505130704/

www.england.nhs.uk/learning-disabilities/atd/

https://www.england.nhs.uk/learning-disabilities/atd/

Regional variable present?

No

Local Authority variable present?

No

Complementary Data

N/A

Genetic Data Collected

Linked Data

HDR UK Innovation Gateway

Website

digital.nhs.uk/data-and-information/data-collections-and-data-sets/data-collections/assuring-transformation

Notes

Related Measures

Ethnicity and race, Housing, Mental health measures, Social support,

Study Code

Reference paper(s)

https://nhs-digital.citizenspace.com/standards-assurance/assuring-transformation-data-collection-v4/

Funders

Department of Health and Social Care

NHS Digital

Catalogue of Social Care Data

UNITING SOCIAL CARE DATA