Transition for Young People to Adulthood Rachel Gair

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Transition for Young People to Adulthood Rachel Gair NHS Improving Quality Presentation from an event held in London on Wednesday 9 October with the Teenage and Young Adult (TYA) Centre Champions and our Clinical Leads to share learning, good practice examples, the successes, challenges and barriers to implementing: Treatment summaries End of treatment care plans Increased self-management for TYAs after cancer treatment The output from the meeting will be to define what support NHS IQ can provide locally to assist TYA teams in order to make progress with their implementation plans.

Health & Medicine

National Context

Children lose out to demands of adults in NHS, says report
Failure to provide more than 'mediocre services' argues Sir
Ian Kennedy - 2010

Context - Transition
• We know – young people get lost to follow up at
time of transfer to adult services
• We know – as a result there are adverse
consequences for mortality/morbidity
• We know – social/educational/psychological
outcomes are affected
• We know – young people aren’t satisfied with
transition
• We know – brain development can continue up to 25

Two populations
On treatment or still in follow-up for tumour
recurrence (lead clinician- oncologist)
In long term follow-up (no tumour recurrence
follow-up) diverse population ( no designated
lead clinician)
Two transition points
Childhood to TYA service (-25yrs)
TYA to adult service

National Cancer Survivorship Initiative
Achievements from Children and Young People Work Stream
2008-13

Completion of three CYP patient pathways
Including 4 models of care
Recognition of the need for transition

How
• DH policy mandates smooth transition between
childrens and adult services
• A Transition Operational Group was set up at the
request of Dr Cornish ( NCD CYP & Transition)
• NHS England commissioned NHSIQ – March 2014

REMIT of OG
• Operational group with clinical experts ( paeds/adults & GP),
patient safety, patient experience representatives
• Discussion/debate & review of best practice & evidence to
define the critical elements of an effective transition model
• Develop a generic Service Specification as a commissioning
template, onto which all specialised and complex services can
be bolted
• Define generic components of transition along with outcome
measures
• Transition Strategy Group - work with commissioners to
progress this in a practical way so that it can be commissioned
and monitored.

Generic aims of transition are:
• Centred on young people and placed in the context of young
people’s lives and their changing circumstances.
• Age - appropriate and take into account young people’s
maturity, cognitive ability, need in respect of LTC,
social/personal circumstances and psychological status, as
well as inclusion of the whole family.
• A streamlined progression from paediatric to adult services as
part of a planned and structured process embedded in service
delivery.
• A multidisciplinary, multi-agency approach with involvement
from professionals in general practice and elsewhere.

Draft Outcome Measurement
• (1.4) Provision of a database and alert on PAS
to identify 13 – 25 year olds with long term
conditions within organisation and evidence
of commencement of transition
• Evidence of above

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