Viewpoint: From child to adult services

Young people with serious health conditions are at risk as they move into adult care, warns Emily Arkell.

In England, it is estimated that more than 40,000 children and young people live with a life-threatening illness. Recent developments in medicine and healthcare mean that treatment for many children with complex health needs has improved. And the good news is the number of these young people who go on to become adults is growing every year.
Young people with complex health needs are particularly vulnerable as they have a high level of dependence on healthcare and there are usually a number of providers involved in its delivery.
The period of transition is a time that is recognised as one of increased risk. Young people move from the ‘safe’ environment of paediatric teams, which generally coordinate all their health service requirements, to a very different adult environment.
It is one where they may need to consult several different health, therapy and adult social care services teams.
Over the last two decades, much guidance has been published about the planning process at this time. These documents agree that a key feature of a successful transition is a skilled multidisciplinary team able to take responsibility for both long-term health needs and disability management.
A wide range of professionals may be involved in supporting a young person at any one time. Paediatricians and general practitioners play a key role but physiotherapists, alongside a range of other medical and allied health professionals, have an important role in managing and ensuring a successful transition. 
Members of the Youth Advisory Panel at the Royal College of Paediatrics and Child Health tell us that there are improvements in planning and management of transition but there needs to be improvement across the board in all disciplines. 
They point to two key priority areas – coordinated care and joint commissioning arrangements – to ensure  that smooth transitions are in place.
Recently published benchmarks developed by London South Bank University contain nine indicators for coordinated child and adult teams to ensure smooth transition, including a keyworker or clinical nurse specialist coordinating care and liaising with the multidisciplinary team. Joint commissioning arrangements are essential to enable proper transition planning between multidisciplinary paediatric and adult services. 
More information here and here.    
Emily Arkell is head of policy at the Royal College of Paediatrics and Child Health

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