Children’s transition to adult services (CTAS)

1. Children’s transition to adult services (CTAS) Carl Marsh 29 October 2014 1

2. Our purpose To carry out a themed review to better understand the experiences of young people with complex physical health needs during the transition to adult services. “From the pond, you are picked up and put in the sea.” 2

3. CTAS programme milestones June-July -information received from CCGs and sample agreed June 2013 - Advisory group established August – December - CCG visits and inspections and focus groups May 2014 - ‘From the pond into the sea’ report published June 2013 - Training and work with inspectors to develop methodology and tools July - Tools piloted December-February - Analysis and report

4. Our approach • We held focus groups in five areas around the country • We visited 19 CCG areas where young people meeting our criteria were identified • We visited young people at 23 services registered with us

5. Our approach • We spoke to 180 young people, and/or their parents, between the ages of 14 and 25 with complex physical health needs • We spoke to more than 500 staff who were providing care, were managers or commissioners • We used case tracking to look at the transition process for 199 young people 5

6. A mum of a 20-year-old with complex health needs told us: • “I could cry, even now, at the frustration of it all. No one health department seemed to talk to the other and the same is true today. I have to go to one place for hearing problems, another for sight... and as for repetition, I have lost count of the number of forms I have had to fill in time and time again... It is like they deliberately try to make it difficult to get anything. I was not told we had any choices in what was going to be given to my daughter. Should we have been?...Why do I have to fight for anything to get done?”

7. The National Network of Parent Carer Forums In August 2013 the NNPCF published its document ‘What Good Integrated Care Looks Like in Transition’. We worked with the NNPCF and included the experience and outcome measures from their report, as a framework on which to report on our findings.

8. Findings • Only 50% of young people and their parents said they had received support from a lead professional during the process leading up to transition to adult services • 80% of the pre-transition case notes reviewed (ages 14 to 18) had no transition plans for health at all • Only 54% of young people preparing for transition and their families felt they had been involved as much as they wanted to be • 35% of young people who had transitioned in the last 18 months and their parents said they had not received all the equipment they needed once they had moved to adult services • Staff that we spoke to from both adult and children’s services had concerns about the support they were able to provide to young people during the planning for transition

9. Where transition planning worked well • We found that examples of good transition planning were often in specialist services, e.g. teams specialising in cystic fibrosis, epilepsy, and cardiac services. These services had some common characteristics: • The staff were consistent, and knew about the conditions and the young person’s history • They provided adolescent clinics (adolescence is ages 10 to 19) • There was good communication with young people, their parents, and each other • They provided good information about what to expect

10. “....our daughter ended up on the adult ICU but they did not want her because in their eyes she wasn’t an adult, paediatric services would not take her because she was over age 16. They were arguing about who would take her for two weeks while we were in the situation of having a young child who was seriously ill. It was just dreadful. It was the worst experience of our lives.”

11. Four key messages: Changes that need to happen to improve the experience of transition for young people and their families: Commissioners must listen to and learn from young people and their families Existing good practice guidance must be followed to ensure young people are properly supported through transition GPs should be more involved, at an earlier stage, in planning for transition Adolescence/young adulthood should be recognised across the health service as an important developmental phase

12. Thanks to the External Advisory Committee Standing Commission on Carers