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Transition. Briony McNelly – Nurse Practitioner The Mark Holland Metabolic Unit Salford Royal NHS Foundation Trust. What is transition?. Learning to let go. Parent’s have been their main care provider all of their lives You knew best throughout their childhood And probably still do
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Transition Briony McNelly – Nurse Practitioner The Mark Holland Metabolic Unit Salford Royal NHS Foundation Trust
Learning to let go • Parent’s have been their main care provider all of their lives • You knew best throughout their childhood • And probably still do • But young people need to learn and develop themselves • A young person can consent to their own care at 16 • This is the law • It is important to prepare the young person for this • Both professionals and families
Parent’s concerns • Who will they be seeing? • What will change? • Where can I park? • Will I be able to speak to their doctor? • They are still my child • Why can’t I make their decisions? • How will their condition change?
Young person’s concerns • Can I drink alcohol? • Does my mum have to be in the room? • I don’t want to be different • Do I have to come to hospital? • Girlfriend/boyfriend issues • I don’t want to miss college due to exams • What medication can I stop? • Is my condition going to stay the same? • Do you have any patients at your centre with my condition? • How do I get to your hospital? • Can my mum stay with me if I am unwell and need to be admitted to hospital? • Do I need to stay on my diet?
Transition Clinic • Manchester children’s hospital - 4 weekly transition clinic • Bradford – 2 monthly clinic • Transition team – Doctor, Clinical Nurse Specialist, LD nurse and dietitian • Rotating doctor • 1:1 consultation with nurse and patient • Same day appointment at SRFT • Transition passport • Ready, steady, go paperwork • Care taken over on the day with or without adult hospital visit
Adult Nurse Role • Transition clinic at Manchester/ Bradford • 1:1 • Care plan to identify needs • Young person clinic at SRFT • Transition document • Home visit • Link person for family – point of contact • Hospital passport • Liaise with local services • Best interest meeting
What are the differences with an adult service? • The focus is on the young person from 16 upwards • Questions directed to you, not parents • It is up to the young person if parents are involved • Attendance is stricter • Adult hospital patient numbers are very large compared to children’s hospital – non attendance is not tolerated • Information given to you
What are the differences with an adult service? • Focus on adult problems - Diabetes, heart problems, cholesterol • G.P. main local contact • Your responsibility • Choose appointment • Decisions about further education • Employment opportunities • Independence • Pregnancy
ReadySteadyGo: Transition Programme • What? • A purposeful, planned process for adolescents with chronic conditions as they move from child-centred to adult orientated health care. • Why? • Reduce morbidity and mortality • Improves vocational success • Who? • Young people >11yrs with chronic condition’s • How? • Ready Steady Go programme
Learning Disability Patients • Where the young person has a learning disability the parent/carer also works through the Ready Steady Go questionnaires with the YP engaging as much as possible. • This prepares the carer’s for the move to adult services; the programme allows all concerns/issues to be carefully addressed and progress monitored prior to transfer.
What is Capacity? Capacity is the ability of an individual to make a decision • Decision making can be affected by a cognitive impairment • An appropriate professional should assess capacity • It is decision and time specific
Assessment of capacity A person is deemed to have capacity if they are able to: Understand Retain Useor weigh up Communicate
What is the Mental Capacity Act? • Mental Capacity Act 2005 – legal Framework within in England and Wales • Aged 16 and over • Legally an adult at 16 with regards to health • Parents can no longer sign the consent form • Provides a safeguard for people lacking capacity • It puts the individuals at the heart of the decision
Best Interest Meeting • Carers and parents are the experts, we need your opinion to make the right decision • Once a plan is in a place, we don’t need to keep discussing it
How does this impact on transition? • Transition process takes place between the age of 14 to 18 years old. • Benefits are transferred into the individuals name at the age of 16. • Social worker assessments for future placements. • Transfer to college/day centre depending on the individuals abilities. • Residential care may end. • The main issue from the age of 16 is that their parents cannot consent for their children. The child has to consent for him/herself. This includes people with learning disabilities!
Salford Royal Service • First appointment • Contact details • Nurse input – Contraception, sexual health, relationships, smoking, alcohol, drugs, consent, care plans, hospital passport As an adult service, our purpose is to provide you with the information you require and give you the options so that you can make an informed choice about your healthcare.
To Summarise • Transition is a gradual process • You are at the centre of it • Aim to develop independence • Support learning • Management of condition
To Summarise • The process is adapted for those with learning disabilities • Families are included in the best interest meeting • YOU are the expert, we need your input • Start your research, know your rights! • If you are concerned talk to your doctor/nurse
Thank you for listening Any questions?
