Moving Transition Forward in the South West. Jennie Shine BSc RGN RM RN(Child) Quality Improvement Lead SW Strategic Clinical Network for Maternity and Children Westminster Health Forum, March Thames Valley Transition Event 8th December 2014

Definition of Transition: “Paediatric and adult health care professionals need to provide developmentally appropriate health care for adolescents and young adults with long term physical and mental ill health conditions addressing medical, psychological and educational/vocational needs working together with the young person to support continuity of care”

National context: One of major objectives of the National Clinical Director for Children, Young People and Transition. Endorsed by NHS England / included in their Business Plan 2014/2015 & 2016/2017 Mentioned in The Pledge: Better Outcomes for Children & Young People (Transition to adult services - one of 4 new potential indicators) Governance - reports to the NHS England CYP Board Our work is aligned to standards in CQC, NICE, Royal Colleges, Dept of Ed. Transition was identified as a priority by the SW health community.

Purpose of the work: To work at both a national and local level to engage commissioners and key stakeholders in defining working principles and service specifications that constitute “best practice” in relation to transition of CYP patients to adult services; taking into account the literature, evidence and clinical opinion, and making connections with relevant initiatives focusing on transition. Source: A Working Framework /CYP Transition Work Stream

Outcomes: Specialised service specification insert completed & awaiting outcome of Specialised Services Review Working principles developed to inform CCG local commissioning by the end of this year. Connections made with relevant initiatives and stakeholders to spread and implement the work Improved transition structure both within Trusts and specialities but also across organisational boundaries when necessary. Better patient and family experience by meeting their specific needs So ‘how’ is this happening…

SW SCN focus: What is the current situation in acute Trusts and CCGs? Strategic Clinical Network decision to start with acute trusts Using National work to identify key generic standards for transition Hold SW wide events to enable sharing of best practice, peer support and circulation of potential resources to implement change. Ensure that transition is high on the agenda within Trusts to encourage a practice change to cascade through different specialities both in paediatrics and in Adult services. Engage with CCG commissioners to offer standards as guidance to contracting for transition and possible tool for monitoring compliance

Transition Dashboard The key principles that have been taken from the work in developing the National generic spec are presented as a ‘dashboard’. This dashboard was used as a self assessment tool for acute providers to see their current status in delivering the principles. Providers felt this was a real eye-opener but also gave a structure to moving forward. This tool forms the basis of a CQUIN and potentially a monitoring tool for a CQUIN.

Transition Dashboard TRANSITION DASHBOARD Framework to assess Trust readiness to implement possible forthcoming standards of care for young people in transition from paediatric to adult services. Please (Red, Amber, Green) rate your Trust against the questions below and give details of anticipated barriers. In order to share best practice, avoid reinventing the wheel and to offer peer support for this work, please forward any documents you are happy to share to inform this process and help colleagues across the South West and ultimately our Young People. Thank you for your time. STANDARDINDICATORREQUIREMENT READINESS (R/A/G)COMMENTS & ANTICIPATED BARRIERS Provision of young people friendly services Compliance with 'You’re Welcome' Quality Standards and 'Young person Friendly' services for young person appropriate services Has the Trust completed 'You're Welcome' assessment? Link: ns/self-review-tool-for-quality-criteria-for- young-people-friendly-health-services Provision of transition focused services Named executive lead for transition Name: Role: Transition policy covering services for young people (13 -25) developed, implemented and reviewed annually with assurance report to the Board and commissioners Policy exists? Please share. Policy is implemented across the Trust? System in place to review policy annually? System in place for reporting effectiveness to the board?

Collation of dashboard responses: Dashboard Indicator Trust You're Welcome Named executive lead for transition Trust Transition policy Trust Transition Steering Provider database identifying population of 13 – 25 year olds with transition plans DNA rates for 13 – 25 year olds tracked and managed Patient safety incidents Patient –Led Assessments of the Care Environment ( PLACE ) ONLY 1 AREA Patient survey Provider’s training directory identifies relevant training available ONLY 1 AREA Published pathway and guidelines ONLY 1 AREA SOME AREAS ONLY All young people have assessments, action plans, reviews and transfer reports documented ONLY 1 AREA SOME AREAS ONLY ONLY 1 AREA All parent carers of young people have access to support and information ONLY 1 AREA ONLY SOME AREAS SOME AREAS ONLY All young people have the name of the health care professional responsible for their transition co-ordination ONLY 1 AREA SOME AREAS ONLY All young people and their parent carers can identify the person in their team ONLY 1 AREA SOME AREAS ONLY Multi-media information resources SOME AREAS ONLY All young people have access to peer support

Examples of good work in SW UHB have had a CQUIN and managed to identify and flag their transition cohort electronically to enable tracking progress through transition. Southampton’s ReadySteadyGo programme has been heralded as a good way to engage and support CYP and families and is being widely implemented. Torbay have a transition nurse for a year to put in the ground work to implement good transition practice and identify the cohort. Several Trusts have now engaged Trust Exec leadership and Trust Steering groups are forming. Several Trusts developing and implementing generic trust transition policy.

Commissioning for Transition Commissioners invited to all events so far and welcome at our SCN working group meetings. A children’s commissioners forum has been set up to meet 3 x a year. In October’s meeting we discussed putting Transition into the acute contracts for 2015/16. Developed a CQUIN with Glos and Kernow CCGs which has been shared for internal discussion rounds within all CCGs. We would like to see, at very least, some quality markers included in each contract.

Next steps… Work with CCGs to add transition into the acute contracts for 2015/16. Looking to develop a method of progress reporting to record what changes are being made in Trusts. Looking to provide a patient reported measure to record how the changes are affecting Children, Young People and families. Starting to expand the work to include SEND and CAMHS populations, working with the Mental Health SCN. A lot of good practice across SW and the SCN has provided a forum for sharing and peer support – this will be extended to the wider aspects.

Finally… Becky and I are both part of the National Transition SCN forum. The SCN improvement leads working on Transition have a monthly teleconference to share our work. Transition is a National priority and so needs to move forward; the more sharing we can do the better. Few wheels need inventing just sharing! Thank you for listening.