Adult Social Care Glossary, v 0.6

When you move from one place of care to another, such as from hospital to your home, supported housing or residential care. Your transfer should be properly planned and coordinated, and health and social care services should work together. Transfers of care may be delayed for various reasons. For example, you may be ready to leave hospital but end up staying there longer than you need to, while you wait for community care services or a place in a care home to be available.

When a person is moved from one place of care to another, such as from hospital to their home, supported housing or residential care. A transfer should be properly planned and coordinated, and health and social care services should work together.

Name Description Data Type
Date of transfer: The date/time of transfer of care to home or another institution. xs:dateTime.
Reason for transfer: The reason for referral/transfer - e.g. diagnosis, treatment, transfer of care due to relocation, investigation, second opinion, management of the patient (e.g. palliative care), provide referrer with advice / guidance. This may include referral because of carers' concerns. xs:string.
Code: Coded value for type of transfer. xs:string.
Description: Freetext description for type of transfer. xs:string.
Comments: Additional information/details about the transfer. xs:string.
Informed of transfer: Care actors to be informed of transfer. Care actor.
Transfer from: The details of the referrer that is making the transfer. This could be the person, GP surgery, department, specialty, sub-specialty, educational institution, mental health team, care home etc. Care actor.
Transfer to: Details of where the referral is to be sent. Care actor.
Subject: Subject of care. Subject of care.

This guidance sets out how NHS bodies (including commissioning bodies, NHS trusts and NHS foundation trusts) and local authorities can plan and deliver hospital discharge and recovery services from acute and community hospital settings that are affordable within existing budgets available to NHS commissioners and local authorities. It applies to NHS bodies and local authorities exercising health and adult social care functions in England and should be used to inform local service planning and delivery.

This guidance applies in relation to adults being discharged from acute hospitals and community rehabilitation units in England, excluding maternity patients.

Discharges from mental health hospitals are not within the scope of this guidance. However mental health trusts are encouraged to embed some of the principles, adapted for mental health care pathways. Separate guidance will be published for those being discharged from mental health settings in due course.

This guidance is applicable from 1 April 2022.