Weekly political news round up – 13th June 2014

June 13, 2014 in News by Whitehouse

Around the sector

The Department for Education has published the final draft of the SEN Code of Practice, which will need to be approved by Parliament before it comes into effect in September. Very few changes were made to the previous draft in April, the most notable being that all mainstream schools are recommend to have a governor with the specific responsibility of holding the school to account on its SEN provision. It is likely that the debate on the Code will happen in early July.

The Department for Education has published details relating to the reception baseline assessment. Baseline testing was introduced as part of the government’s new accountability and assessment framework which measures the progress of primary school pupils with new performance descriptors, and will be introduced from 2016. Unlike with the Early Years Foundation Stage profile, children will only be assessed on academic ability.

Care Quality Commission publishes report into the transition from children to adult health services

The Care Quality Commission (CQC) has published a report, From the Pond into the Sea, analysing the transition that young people face when they move from children’s health services to adult health services. The report found that the transition process is variable and that previous good practice guidance has not always been implemented, leaving confusion at the lack of information, support and services available. The findings come following interviews by the CQC with 180 young people, or parents of young people, between the ages of 14 and 25 with complex health needs.

Findings          

In terms of the transition process, the report found that the information and preparation provided by children’s services to young people and parents about the changes they face when transitioning was inconsistent and poor. It found that there was a general lack of understanding of the transition process by both young patients and by some of the professionals delivering car, with some professionals unaware of guidance and protocols for transition. One key complaint there was no lead professional to support young people during their transition, meaning that was that parents and young people often had to tell their story repeatedly to numerous professionals.

General information on different funding arrangements was found to be unclear, with some parents and young people unaware of money they could receive following the move to adult services. Disagreements over responsibility for funding meant that young people were left without equipment services, respite and other requirements during their transition. When funding was assessed, some found that the assessment was being made by professionals with no former knowledge or connection with the young people and their family.

Those interviewed revealed that there were often no transition plans at all, and where they did exist, they were of variable quality. When planning did happen, it often started late, which sometimes resulted in delayed decisions and gaps in case. Poor coordination between children’s and adult health services was a factor.

The report found that only 54% of young people preparing for transition and their families felt that they had been involved as much of they wanted to be. It found that services often relied too much on parents and families, with parents telling the CQC that they felt abandoned by health and social care services. With regards to carers, the carers believed was a limited assessment of their needs, and only a limited understanding of what was important to them during the transition time.

Adult and children’s healthcare professionals who were interviewed believed that they were competent to meet the specific needs that they were trained for, which the young people and parents agreed with. However, professionals did not feel equipped to manage the transition process as they lacked knowledge about age-specific needs in relation to their complex needs. Moreover, parents did not have a great deal of confidence in adult services and young people often believed that the care provided for them in this setting was not appropriate for them.

Outside of health settings, the report found that the provision of services to meet other needs, including social care, life skills, and educational needs, was often not well co-ordinated and relied on the parents and carers of young people to take the lead. Services themselves were often found to be developed without the involvement of young people and their families.

In general, the transfer to adult services was considered to be a negative experience. It was found that there was no evaluation or quality checking of the outcome of the transition planning for individual young people and their parents.

Recommendations

The report subsequently made four overarching recommendations, which were that:

  1. Commissioners must listen to and learn from young people and their families.
    1. Local authorities and CCGs, when planning for new legislation relevant to the transition arrangements for young people from children’s health services, must check the implementation of best practice guidance and be clear about the responsibilities in each area.
    2. Local authorities and CCGs must ensure they agree a clear process to ensure taken about funding and funding responsibility are taken in a timely and coordinated manner.
    3. Commissioners and local authorities should ensure that they have accurate and up-to-date local data to ensure that complex health needs are known and planned for.
    4. Joint Strategic Needs Assessment should include the needs of young people transitioning to ensure there is data on who will require input from multiple health services.
  1. Existing good practice guidance must be followed to ensure young people are properly supported through transition.
  1. GPs should be more involved, at an earlier stage, in planning for transition.
    1. A new enhanced service for general practice will be introduced in 2014/15 for people with complex health and care needs at high risk of unplanned admission to hospital. This will be under the supervision of a named, accountable GP.
    2. All information about the health care of a child or young person should be shared with their GP.
  1. Adolescence/young adulthood should be recognised as an important developmental phase across the health service – with NHS England and Health Education England taking a leadership role.
    1. Services should be tailored to the needs of this specific group, and provided by staff trained in the specific needs of young people.

Next steps

As the report received the support of NHS England, Health Education England, the Department of Health and the Royal College of General Practitioners, these organisations will set out their expectations for how these improvements and recommendations will be delivered.

Debate on the transition between children and adult health services

In an oral questions session, Shadow Health Spokesperson Lord Hunt of Kings Heath asked Health Minister Earl Howe what action the Government was taking to ensure continuity in the standards of care for teenagers with long-term health conditions transferring to children’s services to adult services, as recommended in the Care Quality Commission report From the Pond into the Sea (summarised above).

Earl Howe responded that as part of the Government’s pledge in 2013 to improve health outcomes for children and young people, plans had been developed to co-ordinate care around young people with complex needs in order deliver the best experience of transition to adult services. He said that the partners to the pledge – including NHS England and Health Education England – were working to deliver this. He added that the mandate to NHS also called for improvements to the transition between children’s and adult services.

He added that plans were underway by NHS England to develop service specifications across the range of commissioning models: specialised commissioning, CCG secondary and primary care commissioning, adolescent mental health and special educational needs, and learning disability. He said that these will translate examples of best practice and published outcomes into specifications for commissioning to hold providers to account for the delivery of robust transition services with measurable quality standards attached to them.

 

In terms of stakeholder engagement in the development of these specifications, Earl Howe praised the Children and Young People’s Health Outcomes Forum for highlighting the need for new outcome indicators to measure transition, and the work it has done in asking the National Network of Parent Carer Forums to develop a narrative of what good integrated care looks like.

Earl Howe said that the Government was addressing “the full range” of complex needs in children and young people. He added that Health Education England (HEE) will be working with the Royal College of General Practitioners (RCP) and the Royal College of Paediatrics and Child Health to develop a training course that will allow GPs to develop a specialist interest in the care of young people with long-term conditions. The course is scheduled to be implemented in 2015, and will include an emphasis on the transition from childhood.