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Section 5 Age Appropriate Care
173. The last fifty years have seen an increasing recognition of the need for health service planning and provision to take account of the specific needs of adolescent patients. These issues are by no means confined to young people using specialist services, but they are of particular importance for this group given that they are often frequent users of services including, in particular, hospital facilities.
174. Building a Health Service Fit for the Future (2005) recommended that ' NHS Scotland should adopt the guiding principle that the age for admitting children and young people to acute care in paediatric facilities is up to their 16 th birthday', and that 'for young people between the ages of 16 and 18 there should be discussions with their clinician(s) regarding where care is best delivered'.
175. To progress these recommendations, and the wider requirement to develop services that properly address the particular needs of young people, a working group was set up to bring forward proposals for inclusion in the National Delivery Plan. A summary of their findings is given here with the full report available on the websiteNSG.
176. How these issues will manifest themselves and be addressed will vary significantly across Scotland, but there is a fundamental need for NHS Boards and others who plan and commission services, to ensure that much more explicit attention is given to the specific needs of young people including those with serious and chronic conditions.
Training
177. Many staff have received little training in the physical, emotional, psycho-social and legal issues for adolescents. As a result, they often lack confidence in dealing with young people. A training needs analysis is required of the generic skills involved in adolescent care. After that, the appropriate training must be made available for all relevant staff within the NHS in Scotland.
178. The change in the age limit for children's services will expose some clinical staff to conditions and clinical scenarios which are not commonly encountered in their present practice. Individual NHS Boards and hospitals will need to assess and address any particular training needs relevant to their own staff groups.
Facilities
179. The Scottish Office report At Home in Hospital (1993), is one of several over recent decades to recognise that good practice in the hospital care of adolescents includes the provision of discreet accommodation which supports 'privacy, flexibility of regime and independence', and incorporates space for social, recreational and educational activities.
180. In practice the current provision of adolescent facilities in Scottish hospitals remains extremely limited and is often confined to the selective use of single rooms, or small bed bays as required.
181. The consistent preference of young people, wherever clinically possible, is to be accommodated with their own peer group. Evidence from other centres internationally suggests that the development of wards which can accommodate young people with a range of medical and surgical conditions, is entirely feasible and is not contrary to the continued delivery of high quality clinical care.
182. Circumstances and opportunities will vary from a specialist children's hospital to a rural general hospital but there is a need, across the country, for NHS Boards to review current activity patterns and to identify appropriate arrangements for the in-patient care of young people that address their particular needs. Further guidance on this issue is contained in the Age Appropriate Care Working Group Report, which can be accessed on the websiteNSG .
Staffing
183. The particular psycho-social and emotional needs of young people dictate a need for access to an additional range of skills and services. These include clinical psychology, youth and social work, play therapists and specialists and chaplains skilled in addressing the spiritual needs of young people sometimes facing challenging situations. It is important to recognise the contribution of such disciplines as an integral part of adolescent care that requires to be identified and resourced.
Education
184. The Standards in Scotland Schools Act (2000), and related guidance indicate that teaching should 'normally begin after five working days following admission (to hospital), provided the child's state of health makes this desirable'. If a prolonged stay can be anticipated in advance, then teaching should proceed immediately. An effective collaboration is needed between hospitals which admit young people (including those in the adult sector), and their local educational services, with prompt and consistent referral procedures. Hospitals must also provide the privacy, space, time and equipment needed to minimise potential educational loss.
Transition
185. At some stage, young people with long-term conditions will transfer to adult-orientated services. It has increasingly been recognised that the successful transfer of care should be handled in a well planned and co-ordinated process with which the young person and their family are fully engaged.
186. Currently the transition to adult services often takes place at a stage where the young person is still adapting to the developmental changes of adolescence. The proposed change in age limits for hospital services for children offers the option of greater flexibility regarding the age of transition, although there will always be a need to address these matters at an individual level in ways that are sensitive to a young person's clinical needs, maturity and choice.
187. Another significant issue is the fact that medical advances are increasingly supporting the survival into adulthood of children and young people with life-limiting conditions. Such conditions were previously minimally reflected in adult practice, which leaves a service gap. This raises significant challenges in respect of service configuration and staff training, but innovative and achievable solutions must be identified and provided.
Recommendations
NHS Boards should identify opportunities to provide dedicated hospital facilities to suit their local volume and pattern of adolescent use, or alternatively develop other means of meeting the needs of this group.
Based on a training needs analysis by NHS Education for Scotland (2008), all staff dealing with adolescent patients should receive generic training in the care of young people by 2012.
A working group should be established to scope the extent to which the current range of adult services does not fully address the pattern of long-term conditions experienced by young people.
Services dealing with long term conditions in young people should have in place arrangements that ensure well-structured transition from children's to adult services, in a manner appropriate to the individual's clinical needs and maturity.
Clinical leads for adolescent services should be identified at hospital and regional level.
Are there any aspects of age appropriate care provision not sufficiently covered within either the text or recommendations?
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