It was very exciting to see the Quality Improvement Report “Bridging the gap: an integrated paediatric to adult clinical service for young adults with kidney failure” by Paul Harden et al. It strongly reinforces the work currently being undertaken in Southampton Universities Hospitals Trust. The work led by Paul Harden is consistent with other studies that show how effective transition between paediatric and adult care has a major impact on long term outcomes for all patients with a long-term medical condition.

The challenge is to ensure that young people across all medical sub-specialities have effective support to enable them to make the transition to adult care in a manner that is tailored to their own particular needs and strengths. Studies suggest that the earlier the transition process starts – usually around 11 – 12 years of age the better the long-term outcome in morbidity and vocational success. At Southampton we also believe that starting the process of transition well before the patient needs to move enables the medical care to be kept on track rather than trying to recover the situation and then attempt transition.

Faced with the challenge of materially improving the long-term medical and psycho-social outcomes for our young patients at Southampton University NHS Trust Hospitals, we have launched the “Ready, Steady, Go” transition programme for children with a long term medical condition aged 11 years and older. This is a generic programme as many of the problems faced by each sub-speciality group during transition are similar. We ensure the medical, psychosocial and vocational needs of the young person are being addressed by following a structured, but where necessary adaptable, transition plan. A key principle throughout the process is ‘empowering’ the young person to take control of their lives and equipping them with the necessary skills to be able to function independently and confidently in adult services. For those families with severely disabled children we ensure the family are ready to move to adult services and all concerns addressed prior to transfer using this programme.

The transition programme starts with a “Moving to Adults” information leaflet and a questionnaire which, through a series of structured questions, is designed to establish when the patient is likely to be ready to move to adult services and what needs to be done to get “Ready” for the move to adult services. In due course this is followed up by a questionnaire to assess progress and keep them “Steady” and ensure that they have all the skills to “Go” to adult services at a time which has been mutually agreed by the patient, medical professionals and where appropriate parents. The programme can also be used for those young persons aged 16 years or older who first present to adult services with a chronic medical condition.

This structured approach across sub-specialities is being implemented through “Young person clinic weeks” in children’s outpatients 4 times a year. During these weeks we try and see children aged 11 years and older. This enables an environment to be created in outpatients to encourage young people to start to take steps towards independence of care. These targeted weeks allow the physical environment to be made ‘young person friendly’. We have posters, a disc jockey, live music and information regarding psychological support, sex education and careers advice. The feedback from the patients, their families and medical professionals has been excellent.

During these set weeks all sub-specialities are encouraged to focus on transition for those patients with long term medical conditions. We have found that this also encourages medical professionals to adopt the “Ready, Steady, Go” Programme as part of their routine clinical practice.

Initially cohorting patients into these clinics was a significant administrative challenge. With sub-specialties working together to promote excellence of care for all patients the transition appointments for young people have started to come in-step with the young person’s clinic weeks. At steady state there should be no increase in administrative effort and with outpatient facilities continuing to be used no significant increase in costs is anticipated for these clinics. Furthermore, an effective transition process which properly empowers young people is also associated with significant savings in the longer term as their chronic medical conditions are managed better. In short, effective transition helps the patient and helps NHS finances.

It is heartening that this important area of service provision has been highlighted in the July 2012 Children and Young People’s Health Outcomes Forum Report. In Southampton we have already started sharing our “Ready, Steady, Go” transition documentation with many Trusts and sub-specialities across the country. The feedback has been very positive and the programme has been described as an “excellent initiative”.

Dr Arvind Nagra
Consultant Paediatric Nephrologist,
Email: Arvind.Nagra@uhs.nhs.uk

1 Harden PN, Walsh G, Bandler N, et al. Bridging the gap: an integrated paediatric to adult clinical service for young adults with kidney failure. BMJ 2012;344:e3718.
2. Gleeson H, Turner G. Transition to adult services. Arch Dis Child Educ Pract Ed 2012;97:86-92 doi:10.1136/archdischild-2011-300261
3. The Children and Young People’s Health Outcomes Forum Report. http://www.dh.gov.uk/health/2012/07/cyp-report/

Competing interests: None declared