Health Transitions Dr H Royden , DMO Elaine Mooney , DCO and Julie Hudson SEN manager

1. Health Transitions Dr H Royden, DMO Elaine Mooney , DCO and Julie Hudson SEN manager AIMS To provide information in relation to health and transition To give an overview of some of the health transition arrangements currently on Wirral

2. Designated Medical Officer & Designated Clinical Officer roles res

3. Preparation for adulthood A key component for preparing for adulthood Health services have a duty to ensure this is addressed as part of the transition planning for young people.

4. Young people preparing to make their own decisions: - ‘As young people develop, and increasingly form their own views, they should be involved more and more closely in decisions affecting their own future. After compulsory school age (the end of the academic year in which they turn 16) the right to make requests and decisions under the Children and Families Act 2014 applies to them directly, rather than to their parents. Parents, or other family members, can continue to support young people in making decisions, or act on their behalf, provided that the young person is happy for them to do so, and it is likely that parents will remain closely involved in the great majority of cases.’

5. Mental Capacity Act 2005 ‘The right of young people to make a decision is subject to their capacity to do so as set out in the Act. The underlying principle of the Act is to ensure that those who lack capacity are empowered to make as many decisions for themselves as possible and that any decision made or action taken on their behalf is done so in their best interests. Decisions are done on an individual basis, and may vary according to the nature of the decision ie someone who may lack capacity to make a decision in one area of their life may be able to do so in another.’

6. Health Transitions Three main NHS Health service providers Cheshire & Wirral Partnership Wirral Community Health and Care Trust Wirral University Teaching Hospital Wirral NHS Wirral Clinical Commissioning Group is responsible for planning and purchasing most of the NHS services for the people of Wirral, including the care you receive at hospitals and in community clinics. This is known as commissioning.

7. The “Musts” for Health from the SEND Code Of Practice Beyond Health`s fundamental responsibility to co –operate in strategic planning around preparation for adulthood there are certain Musts in the Code of Practice .

8. Health Must contribute to strategic planning around Joint commissioning Local Offer All of which must include support in preparing for adulthood (see paragraphs 4.52 to 4.56 in Chapter 4, The Local Offer) regardless of whether the Young person has an EHC plan .

9. Health must inform Local Authorities of their services and how to set them out in their Local Offer Wirral`s Local Offer https://localofferwirral.org/

10. Where young people are moving to adult health services, the local authority and health services must co-operate, working in partnership with each other and the young person to ensure that the EHC plan and the care plan for the treatment and management of the young person’s health are aligned.

11. The clinical commissioning group (CCG) must co-operate with the local authority in supporting the transition to adult servicesand must jointly commission (health) services that will help meet the outcomes in the EHC plan.

12. Health Service local response Wirral has a number of operational and strategic level groups set up to help develop transition arrangements in which health and Local Authority are equal partners. There needs to be much development in this area and we are aware that transition arrangements are not all perfect. However  we in health are committed to development of improved transition so that Young Person with SEND can stay as healthy as possible for as long as possible

13. Why is transition difficult?

14. Health • Orthopaedics • Orthotics • Chiropody • Sexual health • Weight management • Podiatry • Haematology • Neurology • Cardiology • General Practitioners • Dermatology • Urology • Respiratory • Endocrinology • Ear ,Nose and throat. • Dental • Attention deficit hyperactivity disorder (ADHD/ADD) • Autism Family nurse practitioners Obstetrics Hospital at home Oxygen service Rheumatology Stoma Tuberculosis Neonatology Oncology Children`s Emergency Dept Children`s assessment Unit Gynaecology Psychological services Palliative care Pain management Complex care Continuing care Nephrology Gastroenterology Genetics +++++++++ Paediatrics (acute/general ) Paediatrics community Audiology Ophthalmology Physiotherapy Occupational Therapy Speech and language therapy Child and adolescent mental health services (CAMHS) Health visiting School nursing Dietetics Continence Epilepsy Diabetes Cystic Fibrosis Asthma Allergy

15. Why is it difficult ? • Community Paediatrics = AKA Neurodevelopmental paediatrics which covers lots of different health needs until the age of 19 (sometimes longer if complex conditions ) • No corresponding adult service to transition to. • Each individual paediatric service a YP may access will have their own transition arrangements, at different ages depending on specialty. It is important to be mindful that all young people have varying needs therefore a holistic approach is required. • Adult services can have different referral criteria compared to paediatric services • Previous good practise guidance on transition has not always been adhered to leading to confusion, frustration, lack of support and lack of service provision for patients and their families. • Limitations on resources and time • It is an evolving process requiring ongoing training for staff and GP’s

16. Case study Jane age 17.5 years current health services - Audiology - Bilateral hearing aids in use - transfer over to adult services via joint clinic with adult service Ophthalmology – has an ophthalmic condition requiring ongoing monitoring - service is seamless covers all ages no transition required Dietetics – coeliac disease management – transfer to adult services at 25 Continence – management of incontinence and product provision transferred to adult Bladder & Bowel management services from 18 following joint clinic . Community Paediatrics - learning disability with ADHD & sleep difficulties (medicated ) – In relation to LD should have commenced a yearly health check from 14 at GP - ADHD – transferred on to adult services at 18 if still medicated Epilepsy - minimal seizures on medication – transferred to adult neurology Liverpool

17. How would using the Ten Steps to transition work?

18. Questions answered health Query- We have had questions around the Health Passport and who provides this ? – Answer – CWP LD teams offer health passports to young people within their care who have LD and recently Autistic Spectrum Disorders. Health Passports are also available for young people who have been subject to CLA (child looked after)

19. Health Facilitation • Involves working with individuals, carer's, families and care agencies to help people with learning disabilities access health services • Includes working with health services to support them in understanding people with learning disabilities and their health needs • Development of tools to improve access to health services e.g. health passport

21. Inpatients Outpatients Unplanned Admissions Planned Admissions

22. The Learning Disabilities Liaison Team provides individualised support and care pathways to enable patients with a learning disability to access acute services. These include: •  Support for People with Learning Disabilities/Autism, their carers and family. • Preparation for admission/appointment   • Support for planned admission • Support for unplanned admission   • Provide support, education and raise awareness to health care professionals

24. Questions answered health Query – What support is out there around mental Health ? Lots of people have an important role to play in promoting positive mental health and supporting children and young people with mental health difficulties – these include children and young people themselves, their families and friends, schools and other community resources as well as CAMHS (a specialist mental health service). (CWP Resource information pack Aug 2017) A resource Information pack about self-help resources, community services, when to refer to CAMHS and what to do if you are concerned about immediate risk is available For an online copy of the resources pack, please visit: http://cwpcamhscentre.mymind.org.uk/wp-content/uploads/2017/07/Wirral-CAMHS-Resource-and-Information-Pack.pdf CAMHS also have a telephone advice line – 0151 488 8453

25. Mental Health support Cheshire and Wirral Partnership (CWP ) 2018

26. Conclusion: Transition is complex! Transition needs to be started early with a holistic approach. Lots of work going on to improve the transition process on the Wirral. Good communication is required – we will continue to work to meet the needs of the YP in our care.