Partnership for Preparing for Adulthood A positive health transition and commissioning for outcomes 1

2 The transition from childhood to adulthood for many children usually means: leaving school and entering work or higher education leaving the family home becoming more independent getting involved in sexual relationships, cohabiting or marrying becoming a consumer of commodities that indicate adult status What marks out moving into adulthood?

3 Some Policy drivers around improving transition for young people Transition covers all 5 domains in the NHS Outcome Framework. Care Quality Commission’s 4 priorities for transition are: 1.Commissioners and providers involve and learn from YP and their families to understand what they want from their care 2.National guidance must be followed so young people are appropriately supported through transition. 3.GPs should be involved at earlier stage in transition. 4.Services tailored to meet the needs of young people transferring from children’s services & include extra training for health care staff in supporting them.

No change in the meaning of special educational needs Health has a duty to bring C&YP with known or potential SEN to notice of LA New Designated Medical Officer role Duty to cooperate with LA, applies to Clinical Commissioning Groups and NHS England Duty to cooperate in specific circumstances – joint assessments and provision of care specified in education, health and care plan Must cooperate to ensure health services are part of the Local Offer and this, in turn, influences future commissioning What the SEND reforms mean for Health 4

5 For Clinical Commissioning Gro ups What: From September 2014 CCGs must work with LAs to: commission services jointly for 0-25 year old children and young people with disabilities and SEN, including those with Education Health and Care plans; ensure that procedures are in place to agree a plan of action to secure provision which meets a child or young person’s reasonable health need in every case; work with the local authority to contribute to the local offer; ensure that mechanisms are in place to ensure practitioners and clinicians will support the integrated Education Health and Care Assessment within a 20 week maximum; agree personal budgets under section 49.

6 For Practitioners No new money – this is about spending existing money differently, where it works for young people and families Families of children receiving continuing care have greater say over how the money is spent – need to be supported to know about PHBs & use them well Focus on outcomes Requires risk enablement approach Care plan/ education health and care plan is central to the delivery of personal health budgets and Special Educational Needs & Disability reforms Effective care planning is key Personal health budgets – Accelerated development programme

7 Joint Commissioning Joint commissioning is how partners agree how they will work together, to deliver joint outcomes for children and young people with SEND. Listening and responding to the views of children and young people and their parents, and other partners is fundamental to this process. Based on a joint understanding of population need, commissioners will design integrated pathways, which will then be presented publicly as the local offer. Delivery must be monitored to ensure the offer improves over time. Ultimately councillors are held to account to ensure this is done, and CCGs will be monitored against the NHS Mandate by NHS England.

8 Organise and obtain support using appropriate methods Work with families, communities, providers and partners to develop/ support services Monitor progress towards outcomes; Review outcomes; Manage provider performance Develop strategy/ plans Make best use of resources Identify accessible support services Assessment of need Analyse inequalities Review policy, guidance and research Identify resources Joint understanding of need Joint Planning Joint DeliveryJoint Review

9 SEND Reforms and Children’s Continuing Care ● Same principles & drivers ● Information about children’s continuing care, and personal health budgets, should be included as part of the ‘local offer’ (required under Special Educational Needs & Disability reforms) ● Regulations for NHS direct payments fit with Special Educational Needs & Disability requirements, e.g. ‘care plan’ required for a personal health budget can dovetail with as an education health and care plan ● Key difference: ‘PHB’ = NHS money only; PB can include money from education, social care & health Personal health budgets – Accelerated development programme

10. Making it Happen: some questions to help LAs and CCGs deliver cultural change How do we know what children and young people with SEN and Disabilities (and their parents and carers) want and need? How can we work together to deliver what they need? How will we know if services are delivering the expected outcomes? What does the ‘customer journey’ through this provision look like? What opportunities do we have to intervene early? What training is needed to make sure support is person-centred and holistic?

11 The Equality Act 2010 which gives people legal protection from discrimination in the workplace and in wider society. Equal access to good quality care for young people with any disability or long term condition Young people with learning disabilities and other long term conditions may require reasonable adjustments to services in line with the public sector duties in the Equality Act Young people have greater voice once 16 The Mental Capacity Act applies Children’s services can provide for young people over 18 to prevent a gap in support (Para ) Other Legal Requirements

12 Effective communication arrangements in place Use of multimedia with young people for both the delivery of education and for clinical follow-up. E.g. telephone triage, Skype consultations and text messaging, appropriately funded by commissioners. All written communication should be accessible and available in an easy to read format Work out what helps young people to feel safe and confident in the management of their condition Co-production of individual transition plan that is holistic and supports outcomes Important elements in planning

13  Young people with long term conditions should have access to the best clinical care that empowers them to manage their condition and this should extend beyond hospital settings including home and school  Transition clinics should be set up in all Trusts at times and places that work for young people & include paediatric and adult clinicians  All health care professionals who work with young people should have additional training in the specific needs of, and communication with, young people Further Recommendations

14 Holistic outcomes

15 Good Health Aspiration  To be as fit and healthy as I can be Outcome(s)  I will be eating three balanced meals a day by the end of year 12.  By the end of year 13, I will writing a shopping list and going shopping with support buying healthy options.  By the end of year 13, I will be taking exercise at least three times a week (walking, swimming & going to the gym).  By the end of year 12, I will be using my health plan to remind me about my medicines, my diet and exercise.  By the end of year 12, I will be attending regular health checks, with my GP or nurse, to review my health plan.

16 Current relevant work streams NICE guidelines Integrated personal commissioning and personal health budgets Children with Complex Needs Board Regional children, young people and maternity networks

Useful resources Information employment case studies, supported internship factsheet, bimonthly bulletin pdf Transition of Children and Young People to Adult Services Best Practice Pathways Guidance Summary Document South East Coast Strategic Clinical Commissioning networks people/transition/ Information on personal health budgets