Personalised Care and Support Plan
Allows the sharing of care plans between patients, carers and all involved health and care professionals.
Contents
- Documentation
About this standard
- Publisher
- NHS England
- Reference code
- DAPB4022 Amd 38/2021
- Publication date
- 22 December 2021
- Publication version
- 1.0.0
- Status
- Active
Show definitions of statuses
Active. Active standards are stable, maintained and have been approved, assured or endorsed for use by qualified bodies.
Deprecated Deprecated standards are available for use and are maintained, but are being phased out, so new functionality will not be added.
Retired standards Retired standards are not being maintained or supported and should not be used.
- Standard type
- Information standards
Show definitions of standard types
Collections. A Collection is a systematic gathering of a specified selection of data or information for a particular stated purpose from existing records held within health and care systems and electronic devices.
Extractions. An extraction is a type of collection that is pulled from an operational system by the data controller and transmitted to the receiver without additional processing or transcription by the sender.
Information standards. Information standards are agreed ways of doing something, written down as a set of precise criteria so they can be used as rules, guidelines, or definitions.
Technical Standards and specifications. Technical standards and specifications specify how to make information available technically including how the data is structured and transported.
- Contact point
england.standards.assurance@nhs.net
Using this standard
The Professional Record Standards Body (PRSB) were commissioned by NHS England to develop the following set of resources. These have been migrated into the NHS Standards Directory and will be managed by NHS England from 01 January 2026.
- Associated medias
- Applies to
- All service providers in the following health and care settings MUST conform to this information standard:
- Community services
- Mental health services
- Elective admissions
- Outpatient clinics
- Non-elective admissions
- General Practice
- Impacts on
- Implementation of this information standard impacts all health IT systems suppliers providing systems to the above providers; suppliers should work with their customers to determine necessary changes.
- Effective from
- 22 December 2021
Topics and care settings
- Topic
- Care records
- Demographics
- Information governance
- Key care information
- Patient communication
- Referrals
- Tests and diagnostics
- Care setting
- Ambulance (Urgent and Emergency Care)
- Care home
- Community health
- Dentistry
- GP / Primary care
- Hospital
- Mental health
- Pharmacy
- Social care
- Urgent and Emergency Care
Dependencies and related standards
- Related standards
Review Information
- Scope
- NHS Services; Adult Social Care
- Sponsor
Alison Ainsworth, Deputy Director, Adult Social Care Technology and Data, NHSX
- Senior Responsible Officer
Nilesh Bharakhada, Clinical Director, PRSB
- Business Lead
- Tom Hobbs, Analyst/Project Manager, PRSB
- Contributor
- Professional Record Standards Body (PRSB)
- Approval date
- 6 December 2021
- Post Implementation review Date
- 31 March 2024
- Technical Committee
Data Alliance Partnership Board (DAPB)
Legal basis
- Link to Information Standards Notice (ISN)
- View the information standards notice
Information Standards Notices (ISNs) are published to announce new or changes to information standards published under section 250 of the Health and Social Care Act 2012
- Legal authority
Section 250 of the Health and Social Care Act 2012
This information standard is published under section 250 of the Health and Social Care Act 2012
- Licence information
NHS England permits the copying and re-use of Information Standards, in whole or in part, for commercial and non-commercial purposes but, to protect the integrity of the Information Standards, you are not permitted to adapt, amend or decompile the Information Standards for any purpose without our prior consent.
- Licence
Crown Copyright https://digital.nhs.uk/about-nhs-digital/terms-and-conditions
More information
More people than ever are living with long-term physical and mental health conditions in the UK. As a result, there has been a national drive towards developing long-term care plans collaboratively between professionals and people.
Personalised care planning standards will help people manage their own care, with the support of a wide range of services including GPs, hospitals, occupational therapy and social care. This standard will help them and the health and care professionals who support them to get the right information when they need it.
About this standardThe standard supports personalised care and support planning so that individuals have a single shared personalised care and support plan to which all health and care professionals can contribute. The aim is to avoid what currently happens too often, where separate care plans are created by different professionals or teams of professionals and they are not widely visible, don’t join up, and don’t promote a holistic approach to meeting a person’s care needs.
The plan should be developed with the person themselves and/or with their carer where appropriate, based on the person’s strengths and holistic needs.
The benefits:- Improves continuity of care by ensuring people have a single care plan that shares key information to help them to get the right care and support when they need it.
- Helps people contribute and feel actively engaged in their own care.
- Provides a single, holistic picture of their needs, goals and actions, enabling them and their family/carers and health and care professionals to provide appropriate support to improve a person’s health and wellbeing.
The standard is UK wide for use across the whole of health and social care and for anyone requiring a care and support plan, including children, with any health and/or care needs.
How it worksA personalised care plan should be produced from a conversation between the person (and/or their carer) and a care professional, focusing on what’s important to the person and their holistic needs and goals.
The standard supports the personalised approach to care and support planning with a single shared care and support plan for all the professionals and people involved in a person’s care, including the person themselves and/or their carers.
It starts with their ‘About Me’ information, then focuses on their strengths and needs, together with their goals, hopes, and aims. It should demonstrate how the person’s aims and goals will be met and who is responsible for delivery of the activities to achieve them. These are the person’s holistic needs (e.g. to recover their mobility or manage anxiety) which may require support from different parts of health and social care.
Additional support plans may be linked to the care and support plan and should be available for others to view. Their format will vary according to the type of plan and can be structured and coded, and some may include diagrams or images. They can be used for detailed plans to support particular conditions such as a dietician’s plan, wound management plan or behaviour support plan, or to set out care plans, for example to support activities of daily living.
Contingency plans, also known as anticipatory, escalation, or crisis plans provide details of how predictable risks associated with health and wellbeing are managed if they get worse’. They are plans of what to do should a person’s health or circumstances get worse and who to contact.
Page last updated: 18 December 2025