College welcomes ‘The Inbetweeners’

The Royal College of Physicians of Edinburgh (“ the College”) is welcoming a new report published by NCEPOD: ‘The Inbetweeners’ - A review of the process of transition from child into adult healthcare services. The report makes a number of recommendations and the College hopes it will lead to improvements in how NHS services, clinicians and care providers support children with complex health and care needs as they transition into adult services from paediatric services. The report echoes the recommendations from the College’s own previous Think Transition project in association with the Royal College of Paediatrics and Child Health.

The report is based on the findings of a survey of clinical records, questionnaires to clinical teams and organisations involved in the care of young people from age 13 to 25 with one or more chronic conditions selected to represent a wide range of specialities and services in community, hospital and Primary Care settings. The experiences of a range of young people and parents or carers with lived experience of transition were recorded. The findings are reported with reference to the standards outlined in relevant NICE Guidelines and indicate widespread failures to meet these standards and, importantly, a recurrent picture of overly positive views of services reported by clinical leaders and organisations compared to the content of health records and the reports of service users.

Commenting, Professor Andrew Elder, President of the Royal College of Physicians of Edinburgh, said:

Our College welcomes this report which shines a light on the care of an extremely important and growing group of patients and families. The transition from paediatric to adult services for patients with complex needs requires careful consideration, planning and - most importantly - communication, not just between professionals, patients and families, but also between different professional groups and specialties.

This report highlights the need to improve the process of transition of care but we would also stress that care following transition needs equal attention. It cannot be assumed that all services needed to care for the complex needs of these groups of patients will always be available in each locality. As such, flexibility is required, as is clarity of leadership of care and the development of clear points of contact for patients and their families after care transition has occurred.

Finally, we must ensure that all relevant specialties are included – we would specifically emphasise the need to involve and develop rehabilitation medicine services for this patient group.

Dr Una MacFadyen, College Fellow, current clinical lead for the NSS CEN network and retired consultant general paediatrician, said:

For young people with complex or multiple disorders coordination, effective communication and co-production involving the young person and their care partners and access to a key worker throughout the transition process remain significant requirements.

We applaud the recommendations for the need to incorporate transition care as an essential element in the training of all health professionals as well as in every health and social care organisation, for job plans that recognise the time involved and for the need for ongoing audit of transition services.