DH Policy on transition - Karen Turner NHS Improving Quality held an event in London on 31 July 2013 to progress the children and young people transition to adult services work with a focus on turning the rhetoric into practice entitled “Working to Define a Generic Service Specification for Transition”

1. DH Policy on transition
Karen Turner
31 July 2013
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2. Transition from children’s to adult
services
•Moving from children’s to adult services is often a challenge
•Young people, at the point of transition, often feel that the system is fragmented
and they have to tell their story repeatedly, to different professionals
•There is no adult equivalent of a paediatrician
•Settings are far from age-appropriate (e.g. hospices and in-patient wards)
•Services and professionals do not always take a holistic view of the young person
or take into account all of their needs
•Improving this transition has been a health policy priority for successive
governments
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DH Policy on transition

3. Transition and Integration
• The transition from children’s to adult services does not
currently deliver that person-centred, coordinated care which
should result from integration
• “I can plan my care with people who work together to
understand me and my carer(s), allow me control, and bring
together services to achieve the outcomes important to me.”
[National Voices/NHS England – A Narrative of Person-centred,
Coordinated Care (2013)]
• This should be the experience of children making the transition
to adulthood
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DH Policy on transition

4. Children and Young People’s
Health Outcomes Forum
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Jointly chaired by Christine Lenehan and Professor Ian Lewis.
Launched 26 January 2013
Membership brings together a wide range of expertise,
commitment and knowledge of children and young people’s issues
Tasked with giving independent advice on :
– the health outcomes that matter most for children and
young people;
– how well these are supported by the NHS and Public
Health Outcomes Frameworks;
– how the different parts of the health system will contribute
and work together in the delivery of these outcomes.
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DH Policy on transition

5. •
Forum recommendations :
indicators
relevant to transition bands up to 25 to
All data should be presented in 5 year age
enable effective monitoring of transition
• Inclusion of children and young people within existing patient
experience surveys (e.g. GP Patient Survey)
• Children’s experience of care following transfer from
paediatric services to adult services – ensuring children
continue to receive the care they need etc
• Use of NHS number as a unique identifier to bring together
health, education, and social care data
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DH Policy on transition

6. Transition from children’s to adult
services : levers
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The Mandate asks NHS England to ensure smooth transition between
children’s and adult services. NHS England is legally required to pursue
the objectives in the Mandate. CCGs have a statutory duty to act
consistently with the Mandate
NICE are developing quality standards and guidance in relation to
ensuring quality outcomes in transitions between childhood and adulthood
The Children and Families Bill introduces joint arrangements for
assessing, planning and commissioning services. Education, Health and
Care Plans will set out support services for children and young people
from 0-25, with a new focus on improvement outcomes, including future
employment and independent living
The Care Bill supports transition by giving local authorities powers to
access children, young carers of children under the adult statute, and has
new protections to ensure services under children’s legislation must
continue to be provided after the young person’s 18th birthday, until
assessed for adult care and support
DH Policy on transition

7. Transition – young people with poor
mental health
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There are wide variations in the way transitions from CAMHS to adult
services are handled
The Government’s mental health strategy – “No health without mental
health : a cross-government mental health outcomes strategy for people of
all ages”, published in February 2011, states that care and support for
young people going through transition needs to be age and
developmentally appropriate, involving careful planning to avoid
unnecessary disruptions in care. The strategy also confirms that services
can improve transition, by :
– planning for transition early, listening to young people and improving
their self efficacy;
– providing appropriate and accessible information and advice so that
young people can exercise choice effectively and participate in
decisions about which adult and other services they receive; and
– focusing on outcomes and improving joint commissioning, to promote
flexible services based on developmental needs.
DH Policy on transition

8. DH Policy Research Programme –
research on transition in adolescent health
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Recent research has established what young people want and how good
transition improves outcomes. Such evidence has resulted in a decade of clear
guidance to health services on the importance of providing good transitional care
in England. This guidance has resulted in improved practice in some conditions,
e.g. diabetes and renal transplantation. Despite this, and subsequent initiatives,
such as the Transitions Champions programme, there appears to have been
limited change in the majority of health services in England
Barriers to improved transition lie in both the paediatric and adult healthcare
systems and in the relationships between these two systems. Similar problems
are experienced in most international health systems
The Children and Young People’s Policy research Unit (CPRU), will :
– explore the potential movement of the transition point to 24 years of
age, and likely effects on the quality of improved disease control and
adherence;
– examine the implications for health professional training and practice
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DH Policy on transition

9. NIHR funded research on transition
• A £2m programme to provide evidence to help NHS
Commissioners and Trusts allocate resources to facilitate
successful transfer of young people with complex health
needs from child to adult services
• Led by Professor Allan Colver, Professor of Community
Child Health, Newcastle University
• Aims to identify a small number of key components of
transition arrangements for which there is an evidence base;
and for which there are outcome measures against which
implementation of these components can be judged, using
an audit tool, in NHS environments.
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DH Policy on transition

10. NIHR funded research on transition
• A £2m programme to provide evidence to help NHS
Commissioners and Trusts allocate resources to facilitate
successful transfer of young people with complex health
needs from child to adult services
• Led by Professor Allan Colver, Professor of Community
Child Health, Newcastle University
• Aims to identify a small number of key components of
transition arrangements for which there is an evidence base;
and for which there are outcome measures against which
implementation of these components can be judged, using
an audit tool, in NHS environments.
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DH Policy on transition