A hospital passport is a short document that travels with a care home resident into hospital and tells staff who do not know them what they need to know: how the person communicates, what they take, what they are allergic to, how they show pain, what frightens them, what helps, and what reasonable adjustments they need. It was developed for people with a learning disability, whose deaths in hospital from avoidable causes have been documented for two decades, and it now belongs on the file of every resident who cannot easily give their own history under pressure.
This guide is for registered managers, deputies and owners of learning-disability, mental-health, nursing and residential homes. It covers what a hospital passport should contain, in what format, who owns it, how it relates to the care plan, what happens when the ambulance is called, and how to keep it current so that the version that goes out of the door is the right one.
The short answer
A hospital passport should be no more than four to six pages, organised so that the things that could kill the person come first: allergies, swallowing, epilepsy, diabetes, anticoagulants, DNACPR or ReSPECT status, capacity and consent, and how the person shows pain. Then the things that make a stay tolerable: communication, anxiety triggers, routines, food, mobility, continence and who to call. Then likes and dislikes. It is written in the person's voice where possible, carries a photo and a date, and is reviewed whenever medicines, health or wishes change and at least at every care plan review. One named person owns it, it is held with the care record so there is one version, and it leaves the building with the resident every time, together with a medicines list and a member of staff who knows them.
What is a hospital passport?
A hospital passport is a summary, written for a busy ward or emergency department, of the information that will keep a person safe and comfortable when they are away from the people who know them. It is not the care plan. The care plan is long, detailed and written for the home's staff. The passport is short, prioritised and written for a nurse who has thirty seconds to read it before deciding whether the person's silence means they are fine or that they are in pain.
The format most widely used in England is the traffic light layout: a red section for things staff must know, amber for things that are important, green for likes and dislikes. Most acute hospitals have a learning disability liaison nurse who will recognise it, and many trusts publish their own template. The exact layout matters less than the content and the currency.
Some services call it a health passport, an all about me document or a communication passport. Communication passports have a narrower purpose, describing how a person communicates, and are often part of the hospital passport rather than a replacement for it.
Where hospital passports came from
The hospital passport grew out of a series of reports into the deaths of people with a learning disability in NHS care. Mencap's Death by Indifference in 2007 described six deaths where basic needs, pain and illness were missed because staff did not understand the person or did not listen to those who did. The independent inquiry that followed, Healthcare for All in 2008, recommended reasonable adjustments and better information sharing. The Confidential Inquiry into premature deaths of people with learning disabilities in 2013 found that people with a learning disability were dying younger, and that delays in diagnosis and treatment, problems with care coordination and failure to recognise deterioration were common factors.
The LeDeR programme, Learning from lives and deaths of people with a learning disability and autistic people, has reviewed deaths across England since 2017 and continues to find the same themes. The hospital passport is one of the practical responses: a way to carry the person's needs into a setting that does not know them.
Managers should tell staff this history. A passport that is understood as a life-saving document gets kept up to date. One understood as paperwork does not.
Why hospital passports matter: reasonable adjustments and diagnostic overshadowing
Two things go wrong when a person with a learning disability, autism, dementia or serious mental illness goes into hospital. The first is that reasonable adjustments are not made: the person is left in a noisy bay, given information they cannot understand, examined without explanation, and offered food they cannot eat or will not recognise. The Equality Act 2010 requires the hospital to make adjustments, but the hospital has to know what adjustments the person needs. The passport tells them.
The second is diagnostic overshadowing: symptoms of physical illness are attributed to the person's disability or condition. A man with a learning disability who is agitated and refusing food is assumed to be behaving, when he has a bowel obstruction. A woman with dementia who is more confused is assumed to be declining, when she has a urinary tract infection. The passport counters this by saying what the person is normally like, so that a change can be seen as a change.
Our guide to equality, diversity and inclusion in care homes covers reasonable adjustments in more depth. The passport is the adjustment that carries the others.
Who needs a hospital passport
Every person with a learning disability or autism should have one; the sector expectation is clear and inspectors in learning disability services will ask. Beyond that, the honest answer is every resident who could not give an accurate history to a stranger under stress. That includes people with dementia, people with serious mental illness, people who do not use speech, people whose first language is not English, and frail older people who may be able to speak but not to remember their medicines or their allergies when they are frightened and in pain.
In practice, the simplest policy is that every resident has one. It removes the question of who qualifies and it means the process of keeping them current is the same for everyone. A home with a mixed population will find that the passport for a fully capacitous, articulate resident is short and still useful: allergies, medicines, DNACPR status, next of kin and what she wants staff to know.
At a glance: the traffic light structure
| Section | Purpose | Content | Example |
|---|---|---|---|
| Red: must know | Things that could cause harm if missed | Allergies, swallowing and diet texture, epilepsy and rescue medication, diabetes, anticoagulants, DNACPR or ReSPECT, capacity and consent, pain signs, risks such as absconding or self-harm | Level 4 pureed diet, thickened fluids to level 2; chokes on normal textures |
| Amber: important | Things that make the stay safe and bearable | Communication method, anxiety triggers and what helps, routines, mobility and transfers, continence, personal care, sleep, medicines list, contacts | Understands short sentences; uses Makaton for yes, no, drink, toilet; becomes distressed by uniforms |
| Green: likes and dislikes | Things that keep the person themselves | Food, drink, music, television, people, topics, things to avoid | Likes tea with two sugars and talking about Arsenal; hates the curtains being drawn |
Identity, photo and contacts
The first page carries the person's full name and the name they use, date of birth, NHS number, a recent photo, the home's name, address and phone number, the name and number of the key worker and the manager, next of kin and their relationship, anyone with lasting power of attorney and for what, the GP, and any specialist teams involved: community learning disability team, community mental health team, epilepsy nurse, dietitian, speech and language therapist.
The photo matters more than it seems. It confirms identity in a setting where wristbands go missing, and it makes the person a person to the reader. The NHS number matters because the hospital's own record may hold a reasonable adjustment flag, and matching the person to it depends on the number.
Say who to call, at any hour, for questions about the person. A ward nurse who can ring the home at 3am and speak to someone who knows the resident will do so. One who cannot will guess.
Communication
Communication in health and social care fails first in hospital, and the communication section is the one that ward staff use most. It should say how the person communicates, whether by speech, signs, symbols, objects, gestures, sounds or behaviour, and how the person understands: short sentences, one instruction at a time, pictures, a familiar voice, time to process.
It should say how the person says yes and no, how they ask for a drink or the toilet, and how they show they are frightened, in pain or unhappy. Where the person uses Makaton or a symbol system, include the signs or symbols that matter most. Where the person needs an interpreter, say which language and that a professional interpreter is required, not a relative.
Include what not to do: do not stand over him, do not touch her without saying what you are doing first, do not use the word injection. These are the lines a ward nurse will remember.
Health conditions and medicines
List every diagnosis in plain words, with the ones that matter most first. Then the current medicines list with dose, time and route, including PRN medicines and what they are for, and the date the list was checked. The medicines list is the part of the passport most likely to be wrong, because medicines change and paper passports are not updated. A home using an electronic MAR should print or export the current list at the moment of transfer rather than relying on the passport's copy.
Include specifics that a hospital will not know: how the person takes tablets, whether they need them crushed or in yoghurt, whether covert administration has been agreed under a best interests decision and for what, whether they refuse certain medicines and how staff handle that. Include rescue medication for epilepsy with the protocol, insulin regimes, anticoagulants and the reason, and anything that must not be stopped abruptly.
Include recent significant events: falls, admissions, infections, weight loss, and the date of the last annual health check for a person with a learning disability.
Allergies, swallowing and other red risks
Allergies and intolerances, with the reaction, go at the top of the red section. Swallowing follows: the IDDSI level for food and drink, whether the person needs supervision or a particular position, and what happens if they are given the wrong texture. A resident with dysphagia given a normal ward meal is a choking death waiting to happen, and it has happened. Our guide to choking risk and IDDSI levels covers the assessment.
Other red risks include epilepsy and seizure presentation, diabetes and hypoglycaemia signs, risk of pressure damage and the repositioning plan, falls risk and mobility limits, absconding or wandering, self-harm or suicide risk and the safety plan, aggression triggers and de-escalation, and infection risks such as MRSA status.
Write each as a fact and an instruction. Not: has epilepsy. Instead: has tonic-clonic seizures, usually lasting under two minutes; rescue medication is buccal midazolam 10mg after five minutes as per protocol attached; call the home if unsure.
Capacity, consent and end of life wishes
The passport should say whether the person has capacity to consent to treatment in general, and where capacity is decision-specific, what that means in practice. It should say who has lasting power of attorney for health and welfare, if anyone, and how to reach them. It should say whether there is a DNACPR decision or a ReSPECT form, where the original is, and that a copy is attached. It should say whether there is an advance decision to refuse treatment or an advance statement of wishes, and summarise it.
Where the person lacks capacity, the passport should say who should be involved in best interests decisions and that the home expects to be consulted. It should note any DoLS authorisation and its conditions, because a hospital admission may require its own authorisation.
For residents with an end of life care plan, the passport should summarise the person's wishes about place of care and treatment, so that an admission that is against their wishes is questioned before it happens rather than regretted afterwards. Respect and dignity in care at end of life depend on the hospital knowing what the person wanted.
Pain and distress
Many residents cannot say they are in pain. The passport should describe how this person shows pain: a particular sound, rubbing a part of the body, refusing food, withdrawing, rocking, hitting out, sleeping more or less. It should describe what the person is like when well, so that a change is visible, and it should say which pain assessment tool the home uses for the person, if any, and what a normal score looks like.
Distress is separate from pain and often looks similar. The passport should say what frightens the person, what calms them, whether a familiar person or object helps, whether the person needs to be told what is happening before it happens, and whether a quiet side room is needed. It should be explicit that a change in behaviour should be investigated as a possible physical cause, not attributed to the person's condition.
Eating, drinking, mobility and personal care
Beyond the swallowing risks in the red section, the passport should say how the person eats and drinks: what support they need, how long they take, what they will and will not eat, whether they need adapted cutlery or a particular cup, and whether a food and fluid chart is in place. Hospital meals arrive and are taken away; a person who needs support to eat and does not get it will not eat.
Mobility and transfers: whether the person walks, with what aid, how far, whether they need a hoist and which sling, and the falls risk. Continence: what the person uses, how often they need support, and the words they use. Personal care: what they can do, what they need help with, any cultural or religious requirements, and the sex of the worker if it matters. Sleep: routine, position, what helps.
These are the amber items that make the difference between a person coming back in the same condition and coming back dehydrated, incontinent and with a pressure sore.
Likes, dislikes and what keeps the person themselves
The green section is the one staff are tempted to skip and the one that most changes how the person is treated. It says what the person enjoys: tea with two sugars, the radio, talking about their grandchildren, being called by their nickname. It says what upsets them: being rushed, being called dear, having the curtains closed, the television on a particular channel. It gives a nurse something to say and something to do that will reach the person.
Write it in the person's voice where possible. I like it when you tell me your name before you touch me. I do not like the lights on at night. A passport that sounds like the person does more than one that sounds like a form.
Format, length and the person's voice
Four to six pages is the target. Longer passports are not read. The red section should fit on one page. Use short sentences, plain words, and instructions rather than descriptions. Use a large clear font, headings and space. Include a photo. Date it and give it a version number.
Where the person can contribute, write the passport with them, in easy read if that is their format, and give them their own copy. Where the person cannot contribute, write it with the people who know them best and check it with them. The passport should reflect the person-centred care planning the home already does, in a condensed form.
Attach what is needed: the current medicines list, the DNACPR or ReSPECT form, the epilepsy protocol, the PBS plan summary, the dysphagia assessment. The passport itself points to them.
Who owns the hospital passport
One named person owns each passport, usually the key worker, with the senior or manager accountable for the system. Ownership means keeping it current, checking it at every care plan review, updating it after every medicines or health change, and making sure the copy that goes out is the current one.
Where the passport is held in the care record system as a tab on the person's profile, ownership is easier because there is one version and the audit trail shows who last changed it and when. Kiwi holds a hospital passport tab on every profile for this reason, drawing the medicines list and key sections from the care plan so that they cannot drift apart. Where the passport is a separate document, the owner has to be disciplined about versions, and the manager should audit that discipline.
The hospital does not own the passport and will not update it. What comes back with the resident is the home's responsibility to check and to reconcile.
Keeping the passport current
The passport goes out of date the moment a medicine changes. These events should trigger an update.
- Any change to medicines, including PRN and dose changes
- A new diagnosis or a change in a condition
- A change in swallowing, diet texture or fluid consistency
- A change in mobility, transfers or falls risk
- A new or changed DNACPR, ReSPECT form, advance decision or advance statement
- A change in capacity, a new DoLS authorisation or a change in LPA
- A change in communication method or in how the person shows pain or distress
- A change of key worker, GP or specialist team
- A change in next of kin or contact details
- Every hospital admission, on return, with what was learned
- Every care plan review, as a standing check
Set a maximum interval as well: if nothing has triggered an update in three months, the owner reads it through against the care plan and confirms it is still right, and records that. Our guide to care plan reviews covers how to build this into the review cycle.
What happens when the ambulance is called
- The senior on duty confirms the passport is current: date checked, medicines list matches the MAR, attachments present. If it is not current, it is corrected before it leaves, even if that takes five minutes.
- The current medicines list is printed or exported and attached, with the time of the last dose of each medicine.
- The DNACPR or ReSPECT form, if any, goes with the person, original or copy as the local protocol requires.
- A member of staff who knows the person goes with them, or follows, and stays until the ward has read the passport and understood the red section.
- The staff member hands the passport to the triage nurse or ward nurse in person and says the three most important things out loud.
- The home calls the hospital learning disability liaison nurse, where the person has a learning disability or autism, and asks for the reasonable adjustment flag to be checked.
- Next of kin and any attorney are told, and the local authority if required.
- The transfer, including who went, what was handed over and to whom, is recorded in the daily log.
The passport and the care plan: one source of truth
The most common failure is that the passport and the care plan disagree. The care plan has been reviewed and updated; the passport is a document from two years ago in the back of the file. The person goes into hospital with the wrong diet texture, the wrong medicines and a DNACPR status that has since changed.
The fix is structural. The passport should be generated from, or held within, the care record so that the key sections are the same data. Where that is not possible, the care plan review procedure must include a step that updates the passport, and the manager's audit must sample passports against plans. A care record system with the passport as part of the profile makes the first option available to any home.
Whatever the system, the test is simple: pick three residents, put their care plan and their passport side by side, and check medicines, diet, DNACPR, capacity and communication. If any disagree, the system has failed and the audit has found it before the hospital did.
Passports in mental health and nursing services
In mental health services, the passport should include the person's mental health history in brief, current medication and the risks of stopping it, Mental Health Act status including section 117 aftercare and leave conditions, risk to self and others and the safety plan, early warning signs of relapse, what helps in a crisis, and who the care coordinator is. A person with a serious mental illness admitted to a general hospital is at particular risk of having physical symptoms dismissed.
In nursing homes, the passport draws on the nursing assessment: pressure risk and the repositioning plan, wound care, catheter and stoma care, PEG feeding regime, oxygen, diabetes management, anticoagulation, and the advance care plan. Nursing staff should own these passports and the medicines list should be reconciled by a nurse at transfer.
In both settings, the communication and distress sections remain as important as the clinical ones. A nursing home resident with dementia needs the ward to know how she shows pain as much as it needs to know her INR.
Learning from every admission
Every admission is a test of the passport. When the person returns, the key worker and senior should ask: did the passport go? Was it read? Did the ward act on it? What went wrong that the passport could have prevented? What did the hospital learn about the person that the home did not know? The answers go into the passport and the care plan, and into the home's learning log.
Where the hospital did not read or act on the passport, the home should say so, through the liaison nurse, the patient advice and liaison service or a formal complaint. Hospitals improve when care homes tell them what happened. Where the home's own passport was wrong or missing, that is an incident, recorded and reviewed like any other.
Debriefs should also include the resident where possible. How was it for you? What would have made it better? Their answers belong in the green section.
Working with the hospital
Most acute trusts in England have a learning disability liaison nurse or team, and many have dementia and mental health liaison services. The home should know who they are, how to reach them, and what template they prefer. A relationship built before the admission is worth a great deal at 2am.
NHS England has introduced a reasonable adjustment digital flag on the NHS record, which can carry key adjustments so that hospital staff see them before the person arrives. The home should ask the GP or liaison team whether the flag is in place for each resident with a learning disability or autism, and what it says. The passport and the flag should agree.
Discharge is the other half. The home should insist on a discharge summary, a reconciled medicines list and a handover call before the person returns, and should review the care plan on the day of return.
Auditing hospital passports
- Every resident has a passport, dated within the last three months or since the last change
- Medicines list matches the current MAR
- Diet texture and fluid consistency match the current speech and language assessment
- DNACPR or ReSPECT status matches the care plan and the form is attached
- Capacity, LPA and DoLS information is current
- Communication, pain and distress sections are specific to the person, not generic
- Photo is recent and identity details are complete
- Contacts are current, including out-of-hours contact for the home
- The named owner is recorded and knows they own it
- The last admission led to a debrief and an update
Sample a third of passports each quarter and record the findings, actions and completion in the audit schedule. Where the passport is held in the care record, the compliance view can show passport review dates alongside care plan reviews.
Common mistakes
- Passports written once at admission and never updated, so medicines and DNACPR status are wrong.
- Ten-page passports that describe everything and prioritise nothing, so the red risks are on page seven.
- Generic communication sections that say communicates verbally when the person does not.
- Passports that stay in the file while the resident goes in the ambulance.
- No staff member accompanying, so the passport is handed over by a paramedic who has not read it.
- The passport and the care plan held separately and never reconciled.
- No debrief after admission, so the same failure repeats.
- Assuming only residents with a learning disability need one.
What good looks like on inspection day
The inspector asks a support worker what happens if a resident has to go to hospital. The worker describes the passport, where it is, that the senior checks it against the MAR before it leaves, that someone goes with the person and stays until the ward has read it, and that the liaison nurse is called. The inspector picks a resident with a learning disability and finds a passport dated within the last month, with a photo, a red section that fits on a page, a medicines list that matches the MAR to the dose, the ReSPECT form attached, a communication section with the person's actual Makaton signs, and a green section in the person's own voice.
The inspector reads the last admission in the daily log and finds the transfer recorded with who went and what was handed over, a debrief on return, an update to the passport with what the ward learned, and a care plan review the same day. The audit schedule shows passports sampled quarterly with findings and actions. The care plan and the passport agree on every item the inspector checks.
What the inspector is seeing is a home that treats the passport as part of the person's care, kept current because it will be needed, not because it will be inspected. A daily log that records the transfer and the return and a care record where the passport lives with the plan are what make that routine.
Final conclusion
A hospital passport is a few pages that carry a person's safety into a building full of strangers. It should say what could kill them first, what will keep them comfortable second and what keeps them themselves third, in the person's voice, with a photo and a date. It should live with the care plan so that it cannot drift, have one owner, be updated on every change and checked at every review, and leave the building with the resident and a member of staff who knows them every single time. Homes that do this find that admissions go better, that residents come back in the state they left, and that the hospital starts to see the person the home sees.
Frequently asked
What is a hospital passport?
A hospital passport is a short document, usually four to six pages, that goes with a care home resident into hospital and tells staff who do not know them what they need to know: allergies, medicines, swallowing, capacity and DNACPR status, how the person communicates and shows pain, what frightens them and what helps, and their likes and dislikes. It was developed for people with a learning disability and is now used much more widely.
What should a hospital passport include?
A red section of things that could cause harm if missed, such as allergies, diet texture, epilepsy, diabetes, anticoagulants, DNACPR or ReSPECT status and capacity. An amber section covering communication, pain and distress signs, anxiety triggers, routines, mobility, continence, personal care, the medicines list and contacts. A green section of likes and dislikes in the person's own voice, plus a photo, date and version.
Who needs a hospital passport in a care home?
Everyone with a learning disability or autism should have one, and inspectors in those services will expect it. In practice, every resident who could not give an accurate history to a stranger under stress needs one, including people with dementia, serious mental illness, no speech or limited English. The simplest policy is that every resident has one.
How often should a hospital passport be updated?
Whenever medicines, health, swallowing, mobility, capacity, DNACPR status, communication or contacts change, after every hospital admission, and at every care plan review. Set a maximum interval of three months for a full read-through even if nothing has triggered an update. The medicines list should be reconciled with the MAR at the moment of transfer.
Who owns the hospital passport?
One named person, usually the key worker, with the senior or manager accountable for the system. The owner keeps it current, checks it at every review and makes sure the copy that leaves the building is the right one. The hospital does not update it; what comes back is the home's responsibility to reconcile.
What is diagnostic overshadowing and how does a hospital passport help?
Diagnostic overshadowing is when symptoms of physical illness are wrongly attributed to a person's learning disability, dementia or mental illness, so that a bowel obstruction is seen as behaviour or an infection as decline. The passport describes what the person is normally like and how they show pain, so that a change is recognised as a change and investigated.
Should a member of staff go to hospital with the resident?
Yes, wherever possible, or follow as soon as possible. The staff member hands the passport to the nurse in person, says the most important things out loud and stays until the ward has understood the red section. For a person with a learning disability or autism, the home should also contact the hospital learning disability liaison nurse.
Sources
- Mencap: Death by Indifference (2007)
- Healthcare for All: report of the independent inquiry into access to healthcare for people with learning disabilities (2008)
- Confidential Inquiry into premature deaths of people with learning disabilities (2013)
- NHS England: Learning from lives and deaths, people with a learning disability and autistic people (LeDeR)
- Equality Act 2010
- NHS England: Reasonable Adjustment Digital Flag
- Mental Capacity Act 2005
- NHS England: Accessible Information Standard
