As a clinician with over three decades of experience, I have attempted with variable success to transfer my patients at the right time, with the right support, to adult services.
There is a growing recognition that the distinction made between young people aged 17, 18 or 19 years old is often artificial, and that sometimes, adult services are not always able to provide the same attention to young adult patients as paediatric services, because of the way that services are constructed and commissioned.
The numbers of young people who need additional support from the NHS as they move into adulthood is increasing, and some of this group of young people have complex needs or conditions which require input from a number of services, and/or providers. The numbers of young people aged 16-19 with life-limiting conditions has increased from 18 per 10000 of the population in 2005 to 24 per 10000 in 2010. There are also 40,000 children and young people with challenging behaviour that will need support into adulthood to be part of their community. This is good news – we are getting better at treating and supporting children and young people to develop into adulthood but there is a need for the system, and the workforce, to provide the necessary support to this group of young people.
All clinicians, whether paediatricians like myself, child and adolescent mental health practitioners, adult clinicians or primary care staff working with this age group must recognise the need for a planned and supported transition process for young people with long term health conditions and complex healthcare needs as they move from child centred to adult delivered services and lifestyles. Primary care play a critical role with involvement throughout a child’s early and middle years – both to support young people, and crucially, to act as a point of continuity at the point of transition out of paediatric services.
GPs are one of the few healthcare practitioners who are well versed in managing the shift in dynamics as children grow to adulthood and wish to be seen independently. We need to capitalise and build on that experience for children with more complex needs.
We need to create a model of delivering health services that fosters ambition and independence from an early age and supports the development of knowledge, skills and expertise in adolescence and young adulthood. We also need to make sure that services join up and work across current boundaries for children and young people. At the core of this has to be the delivery of collective connected assessments, single plans and a single set of outcomes that matter to children, young people and their families.
This is the key emphasis of the Children and Families Act and the Care Act which both emphasise that services should be integrated across providers and age ranges. It is only by working together that we can ensure that young people make the as smooth a transition as is possible, into as healthy and fulfilling an adult life as is possible.