Assuring Transformation support

NHS commissioning organisations are responsible for ensuring that the data collection is completed. NHS specialist commissioning teams/hubs and provider collaboratives should report for individuals who are receiving in-patient care in a secure mental health service (low/medium/high) or for children and young people who are inpatients in child and adolescent mental health tier 4 (in-patient). The collection may also be completed on behalf of an NHS commissioner by a Commissioning Support Unit (CSU), or other commissioners that have a pooled budget arrangement.

It is a statutory duty to participate in this data collection. NHS England has Data Alliance Partnership Board (DAPB) approval and the resulting data is intended to help improve care and outcomes for people with a learning disability and autistic people. The collection also has formal directions from the Secretary of State mandating the collection: (Health and Social Care Act 2012) in the general guidance section. The Information Standard Notice for this data collection was published on 31 August 2023 (Amd 18/2022).

A patient should be considered in scope for Assuring Transformation and recorded in the AT data set where they meet the following requirements

• an NHS commissioner in England is responsible for commissioning their care, and
• the person is receiving treatment / care in a facility that provides assessment and / or treatment for mental disorders, and is registered by the Care Quality Commission as a hospital, operated by either an NHS or independent sector provider and
• the person has an inpatient bed normally designated for the treatment or care of people with a learning disability or a bed designated for mental illness treatment or care and
• the person should have a diagnosis or be ‘clinically understood’ to have a learning disability and/or autism (including Asperger’s syndrome)

Patients can be of:

• any age
• any level of security (general/low/medium/high)
• any status under the Mental Health Act (informal or detained)

Whether or not a person is recorded as having a primary diagnosis of a learning disability and/or autism is not relevant. If the patient has a diagnosis of a learning disability or autism they are in-scope of Assuring Transformation.

Record level returns should only reflect patients in hospital or individuals on leave if a bed is held vacant for them.

The following patients are out of scope of AT:

• people in accommodation not registered with the Care Quality Commission as hospital beds
• people in beds for physical healthcare
• people who do not have a diagnosis/are not clinically understood to have either a learning disability or autism

Data should be recorded for each individual person who meets these requirements.

If commissioners have not commissioned inpatient care for people who meet the above definition in the relevant period they will still be required to submit a ‘nil’ return.

NHS England has approval from the Secretary of State for Health for receipt of all of the data within this collection. In addition, there are S251 agreements in place for the flow of this information from providers to CCGs and specialised commissioners (CAG 8-02 (a-c)/2014)

One commissioning organisation will need to take responsibility for the submission or assign a ‘lead’ commissioner and this should be established through discussion between the commissioners involved. Either organisation can make the submission. The submitter will need to obtain a Single Sign-on and Data Depot registration to do this. If necessary, we can send a registration invitation email, please contact us at [email protected].

You will receive a registration email entitled Registration Form from the NHS England. This will guide you through the registration process. Support with registration can be obtained by contacting us on 0300 303 5678 [email protected].

If you think you should be submitting data to this collection, but I have not received a registration email. Please contact us at [email protected] and then if necessary we can send you a registration email.

The Clinical Audit Platform (CAP) is an online data entry system that allows you to upload data securely.

If you have a Single Sign On (SSO) account with NHS England then you can use your username and password to sign into CAP, which can be found at https://clinicalaudit.hscic.gov.uk/.

If you do not have a single sign-on account, then you can still register by clicking the Sign in button and then the Register link and following the online instructions. You may already have a single sign-on account with NHS England, if you have completed each step of the registration process or submitted data to NHS England previously.

If you need any help with this process, then contact us at [email protected]. 

For multiple organisations

1. Log into CAP

2. Your email address will have been associated with all the commissioning organisations you have registered to submit data for which will give you access to all the patient records commissioned by all the commissioning organisation you have been associated with.

3. Amend all the patient records where a change has occurred within the reporting period/month by using the ‘File submission dashboard’ and uploading an amended csv file or by manually using the Add / Search for a patient record option.

4. Complete these steps every time you need to amend a patient record throughout the reporting period/month.

5. At the end of the month, select the submission confirmation option from the AT Home screen. This will confirm all the current patient records on the system for all reporting commissioning organisations as correct and will therefore confirm a null submission for the commissioning organisations who did not have any patient records updated.

6. Changes to patient records can still be made after the submission confirmation has been selected.

If there have been no changes over the month then you will be required to declare that all the data currently present on CAP is correct and up to date by selecting the submission confirmation option on the CAP home page. 

Commissioning organisation

If you are completing the Assuring Transformation returns for ICB-commissioned patients, then the originating commissioning organisation is expected to be the commissioning organisation that is reporting on that patient in CAP.

This should relate to the patient’s current GP. Specialist commissioning hubs will need to cross reference this information with the patient’s record on the Secure Mental Health database. They should only report on patients whose originating commissioning organisation is within their area. Provider collaboratives should only report on patients whose originating commissioning organisation falls within their provider collaborative footprint.

Postcode of usual address

The postcode should be the patient's home address. Where the patient does not have a home or if their home will be the address they will live at when they are discharged but they are not registered for discharge, then the postcode should be the one used in question 14c (postcode of hospital site). 

Current or original admissions

Question 12 refers to the admission to the first hospital in the current continuous stay in hospital. 

Unplanned 

An urgent need for admission with very short notice. The need for admission has not been recognised in the individual’s care plan. For example, the admission route may be through Accident and Emergency, a crisis team intervention or via a Section 136.

Planned

Where there has been time in advance to plan and structure an admission, or because it is deemed an appropriate part of crisis management and has been written into crisis or care plans in advance. An example of this may be where there have been a number of multidisciplinary meetings held to discuss the individual’s behaviour, or outpatient appointments that identify the possible need for admission to hospital for assessment and treatment.

Recording respite care

Respite care patients need to be included. Patients should not be admitted for respite care for social reasons or for medical care that should be delivered in the community or other inpatient settings. 

Commissioning specialist learning disability services from a local NHS trust, including an assessment and treatment unit

When commissioning specialist learning disability services from a local NHS trust including an assessment and treatment unit you will need to request those patient details from the provider trust to ensure you can record all the data required for the AT record. 

Ministry of Justice order

People who have been recalled subject to a Ministry of Justice order should still be included in the AT return and the referral codes will identify the source of the referral. An individual patient’s record will show the transfer between provider organisations, so any movement / transfers / recalls will be indicated in their record.

Formal reviews and assessments

A formal review or assessment includes a Care Programme Approach (CPA) review meeting, a treatment planning meeting, a multi-disciplinary team meeting, a Care (Education) and Treatment Review (C(E)TR) meeting.

Information about the Care and Treatment Review policy is available. Information about the Care, (Education) and Treatment Review policy is available. 

A Care Programme Approach (CPA) review is a formal review which is used for people either who have been sectioned under the Mental Health Act (which means they are automatically reviewed under this approach) or it is a review used for people who haven’t been sectioned but have significant mental health needs, or complex needs which require a high level of support. This also means that the person will have a care co-ordinator who will have regular contact with the person and who will organise CPA reviews. Under this approach a review usually takes place every 6 months, although there is no mandated frequency, simply a requirement that a review is undertaken on a regular basis.

Usually a CPA review will last about an hour and is led by the Responsible Clinician (RC) who oversees the person’s care, the exception to this is in specialised commissioning where they structure a CPA using ‘my shared pathway’ and the person chairs their own CPA review. This membership of the review is usually the multi-disciplinary team (MDT) who work with the person so are likely to be for instance physiotherapists, occupational therapists and nursing staff, and the person is invited to attend the meeting which is usually organised by the provider.

With a C(E)TR, whilst the focus is still very much on the person it is not chaired by the RC, it is instead organised and chaired by the commissioner who is responsible either for placing the person in patient care, or who is the responsible commissioner covering the geographical locality where the person lives, and will often be funding part or all of their care package. At a C(E)TR there is also the addition of external experts – clinical expert and expert by experience – who bring additional external challenge to the review. Unlike the CPA process a C(E)TR does not focus on using reports drafted by the MDT to shape the review. Instead, there is an opportunity to access all records relevant to the person and their review to fully understand the person and their needs and identify blockages to moving on with their life. It also lasts for up to a day to ensure that full consideration can be given to the person’s needs and allow for time to be spent with the person as well as their carer’s and family.

Formal reviews and care (education) and treatment reviews

A C(E)TR is itself a formal review meeting and the date of the most recent C(E)TR (Q29) could be the same as the date of the most recent formal review or assessment (Q38). However, if the patient has had another review meeting (such as a CPA review) since their latest C(E)TR then the date of this review meeting should be reported in Q38. Ward round would not fall within this remit, as whilst it is a review it is not a formal overarching review with the depth of either CPA or C(E)TR.

The frequency of C(E)TRs is dependent on the age of the patient and what type of hospital setting they are a patient in. Further information about CTRs and C(E)TRs are available. 

Details of patient's care plans (Q42)

The patient’s care plan refers to their care plan in accordance with their Care Programme Approach (CPA) review. Care (Education) and Treatment Reviews should inform the CPA review, but the outcome of the patient’s most recent C(E)TR can differ from the patient’s care plan (for example if a CPA review makes a decision someone is ready for discharge and the most recent CTR had an outcome of ‘Not ready for discharge - still needs to be in hospital bed for care and treatment’).

It is important that all the information relating to a patient is kept up to date in Assuring Transformation. If the details of a patient’s care plan (Q42a) differs from, or appears to contradict, the entry under Q30 (Outcome of most recent CTR), check that Q29 (Date of most recent CTR), Q30 (Outcome of most recent CTR) and Q38 (Date of most recent formal review) are up to date.

Further care (education) and treatment reviews guidance is available. 

You should be able to extract the number of incidents that have occurred from the risk management department via your clinical record system, so a case note audit should not be necessary.

If the data that you receive from the provider for your patients does not include all the data required for the AT record, then you will have to request the additional information from the provider.

When a patient is being trialled within a medium secure setting whilst retaining a bed in a high secure unit at a different facility, the commissioner responsible for the person’s care will make the submission.

Coding

Coding for a patient’s stay within a PICU unit In Q19a, Psychiatric Intensive Care Units should be coded 4.

Recording a step down from low secure to locked rehabilitation units should be coded as 0 under Q19a.

If the patient has transferred from A&E and is homeless there is a designated code if the full postcode of admission in Q7b is not known. Please enter ZZ99 3WZ until you can find out the postcode. If the patient is homeless then please use the postcode of the current hospital site of treatment as in Q14c.

Checking the records entered onto CAP

To get a copy of the records you have successfully entered use the reporting function in CAP.  Add in the dates you need your extract to include and click export. The system will then produce a CSV file for you.  The date range is based on the hospital admission date. 

There are 2 reports available in the CAP. 

Current patient

A current patient is any patient that is currently in hospital and consequently will have an open episode against them. If a patient doesn't have an open episode they won’t be in this report.

Full patient history

The full patient history is the same view as the current patient export, but with ALL episodes, not just open ones. This report has an extra column which is the period the episode is assigned to.

Recording estimated discharge dates

Planned discharge dates should be recorded in Assuring Transformation for every patient with an agreed discharge date. Whilst estimated discharge dates should not be entered; if a prospective date has been agreed, then this should be entered. As a minimum we would expect every patient that has a C(E)TR outcome (Q30) recorded as one of the following to have a date completed in Q47b.

6 - Ready for discharge, discharge plan in place and discharge date in next 1 months

7 - Ready for discharge, discharge plan in place and discharge date in next 2-3 months

2 - Ready for discharge, discharge plan in place and discharge date in next 4-6 months. 

10 - Ready for discharge, discharge plan in place and discharge date in next 6-12 months. 

Agreed dates for the planned discharge or transfer

If there is an agreed date of planned discharge enter ‘’D’ to Q47a.

If there is an agreed date of planned transfer enter ‘T’ to Q47a. The date can be an agreed prospective date based on the discharge/transfer plan. The date of planned discharge or transfer should be entered in Q47b. If the planned discharge or transfer date is subsequently changed, the revised date should be updated in Q47b.

If a patient is transferring to another ward or site, it is important that the Date of closure of record (Q49) from the patient’s most recent episode of care and the start date (Q11a) for the new ward/site are the same. If the start date is after the discharge date (even by one day), the transfer will be treated as a readmission.

Recording CAMHS if a patient moves to an adult mental health service

The scope of the Assuring Transformation collection includes patients of all age groups so may include CAMHS patients. The CAP system can track transfers across commissioning regions and should follow a patient in transition from CAMHS to Adult Mental Health Services. However, if you have any specific concerns about recording this patient group then please contact us at [email protected].

Amending a patient who has been recorded as being commissioned by the wrong commissioner

It will be necessary to have a dialogue with previous inputters so that a discharge and readmission date can be agreed, and the record amended to reflect the true situation as far as possible. In this example the patient’s record would need to be closed (discharged) by the ‘old’ Commissioner identified in error and admitted by the ‘new’ Commissioner. You would also need to email high level details to the [email protected] mailbox.

If a patient is on AT but should not have been included or where added by mistake

If you are sure the patient has been added in error and they have never met the eligibility criteria, then their record(s) must be deleted. If they have records on their record tree that have been added by another commissioner, then you will not be able to delete the records they updated. If you feel the whole patient should be deleted from CAP, then you will need to speak to the other commissioner to ratify your opinion and they can delete their own records.

How should I record a patient I am responsible for has been diagnosed as having no learning disability or autism

If a patient was clinically understood to have a learning disability or autism at any point then they are eligible to be included in the AT data in CAP, therefore their records should not be deleted.

If they receive a diagnosis of no learning disability or autism, then the date of this diagnosis needs to be entered into Q49 (Date of record closure) and Q50 (Record Closed: Discharge destination/reason for record closure) should record the reason for the record closure under one of the following codes: 

• 9 Patient no longer in scope of transforming care: diagnosis for Learning Disability removed
• 10 Patient no longer in scope of transforming care: diagnosis for autism removed

How is a patient's transition planned

Regarding Q44, areas may differ slightly in the way they plan for a person’s transition. However, when such a transfer is being made to another in-patient rather than community setting this can be within an existing service or to a form of lesser/higher security with a new provider. In this situation the Mental Health Act status of the individual, the ‘risk’ and ‘relapse’ part of their CPA plan along with any person-centred plans/documentation should form the basis of the transition arrangements. 

Regarding Q46, while recognising areas will differ in the way they process referrals in the first instance and upon transfer of an individual, the NHS Commissioner should liaise directly with the individual’s local authority learning disability service to instigate a referral for allocation of appropriate professional. In the case where an individual is eligible for Section 117 aftercare entitlements, the nominated learning disability lead officers within the Integrated Care Board (ICB) and Local Social Services Authority (LSSA) should collaborate to agree the respective funding arrangements and key responsibilities.

NHS Number

The NHS number is a mandatory field. If your patient does not have an NHS number, you should use the tracking service.

The system links the commissioning organisation that has been given to an NHS number and only this commissioning organisation can edit the record. If you try to enter an NHS number that is not linked to your ICB, you will be presented with an error message stating that the record was ‘Created against submitting org XXX and cannot be edited.’ (XXX will be the three-character code of the other organisation).

If you feel that the NHS number is correct for a patient in your care, contact the organisation named in the error message to resolve the issue. You may have to go through an NHS tracing procedure. 

Editing records for the last month

At the end of each month the system will take a cut of the data. If you come to edit the data the month after, the previous month’s data will become read only whilst the changes will be reflected in the record for the current month. The amendments or changes made in the current month will be picked up in the cut at the end of the following month.