Northern England Strategic Clinical Networks

Transition

“A purposeful, planned process that addresses the medical, psychosocial and education/vocational needs of adolescents and young adults with chronic physical and medical conditions as they move from child-centred to adult-oriented health care systems”

Taken from a position paper of the Society for Adolescent Medicine. J Adol Health 1993:14; 570-6

Research and evidence from numerous studies and focus groups on the experience of transition from the young person’s perspective often describes it as ‘falling off a cliff’. Young People want to be listened to and understood, to be taken seriously, to have a well-planned service, to have access to flexible services, to have choice, information and advice and to have continuity of care.

For some other young people and their families with complex health needs it’s the desire to have an identified adult clinician or GP that co-ordinates care and that when healthcare is needed it can be accessed appropriately and swiftly.

Within NHS England there is a National Clinical Director for children, young people and the transition to adulthood.

Nationally the clear objectives for Transition are:

  • To share learning from existing good practice – successes, challenges and barriers to implementing clinically and patient designed Transition models
  • To define the critical elements of an effective Transition plan
  • Using the above, develop a Generic Service Specification as a commissioning template, onto which all specialised and complex services can be added, with separate consideration of CAMHS, and young people with SEN and Learning Disability, and LTC’s
  • Start to consider measurable outcome indicators against which successful Transition plans can be commissioned and monitored
  • Work with CRG’s, SCN’s and AT’s to identify partners, LA & others – provide the “scaffolding” not the detail of “how”

With the Children and Families Bill, The SEND Reform, Personal Health Budgets and the imminent adoption of Education Health and Care plans for ages 0-25 years it is important to recognise the role of transition in all of this.

There will be many teams or specialities within our network region that provides excellent transition experiences for young people – we want to find out about these and share this with others.

If you would like to work on developing a network wide strategy for transition please register your interest by contacting england.nescn@nhs.net

 

Useful Links

Southampton’s Ready Steady Go Programme for Transition

Transition Information Network

Together for Short Lives

STEPP Research Practice Prompts

STEPP Research Briefing

In-Control

Involve North East

 

Useful documents

CQC June 2014 – From the pond into the sea