nhs trust the burdett trust national transition nursing ......leeds teaching hospitals nhs trust...
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The Burdett Trust National Transition Nursing NetworkAn introduction to the team
nThe Leeds
Teaching HospitalsNHS Trust
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In 2015 Leeds Teaching Hospital Trust (LTHT) were successful in securing funding from the Burdett Trust for Nursing to implement a three year project aimed at developing an exemplar Model of Care for the Transition of Young People.
The intention was to work with all clinical services across the Trust to ensure that young people were actively prepared for the transition to adult services.
In 2016 the project was commended by the Care Quality Commission inspection team as an area of good practice, and current evidence indicates that the project has delivered real improvements to patient care and patient experience, with case studies describing improvements in health outcomes, treatment compliance and lives saved as a result.
Work continues at LTHT to ensure all young people have transition plans in place and are well prepared for the transfer to adult service.
Owing to the success of the project, the Chief Executive of the Burdett Trust for Nursing asked the Trust to submit a proactive grant application to support the development of a National Transition Nursing Network, with a view to the team from LTHT leading a roll out and formal evaluation of the quality improvement model for transition improvement across England.
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National Lead Nurse Transition
Regional Nurse Advisor
North
Organisations Supported
Regional Nurse Advisor Midlands
Regional Nurse Advisor London
Regional Nurse Advisor
SouthAlder Hey Children’s
Foundation TrustUniversity Hospitals Birmingham NHS Foundation Trust
Imperial College Healthcare NHS Trust
Somerset NHS Foundation Trust
Acute Service ProvidersChildren’s Hospitals and Adult TrustsPrimary CareLearning Disabilities Healthcare Organisations
The implementation of this project will support and empower nurses to help other nurses, doctors and AHPs to lead multidisciplinary teams to deliver evidence based best practice transition support to young people and their families. This will enable them to work better together, including across organisational boundaries, whilst also learning from others throughout England.
Figure 1. Burdett Trust National Nursing Network
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Mental Health ProvidersCommunity HealthcarePalliative Care Organisations
Key StakeholdersSocial CareSpecial Educational Needs Services (SEND)Education / schools / Colleges / UniversitiesLocal Councils
Clinical Commissioning GroupsPartner OrganisationsCharities
This equates to the development of a national network of expert nurses who will lead the implementation of the quality improvement model for transition across the defined regions of England. Figure 1
The project will have a national Lead Nurse hosted by LTHT who is an expert in the implementation of transition pathways.
The Lead Nurse will then work with four Regional Nurse Advisors (RNAs) placed strategically across England i.e. North, Midlands, London and South.
The RNAs will outreach to identify and support local transition Leads / champions in key organisations within their area.
The implementation of this three year project will give nurses the opportunity to engage in high profile leadership roles at a national, regional and local level.
The team will encourage and support transition leads to provide a co-ordinated and unified approach to transition for young people across all organisational boundaries and encourage partnership working.
The Model for improvement is designed to be flexible so that it meets the needs of young people and their families, and adaptable in order to meet the needs of individual clinical services and wider Trusts / organisations.
The work of the newly formed network will be formally evaluated with the support of a team of researchers at the University of Surrey & Great Ormond Street Hospital for Children NHS Foundation Trust. Ultimately the work of the project will be shared through presentations and publications designed to reach a range of audiences.
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Figure 2. RNA Patches
Four Regions:
North East and YorkshireNorth West
MidlandsEast of England
South EastSouth West
London
North
Midlands
London
South
Figure 3. The Quality Improvement Model of Care for Transition
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Scope and geographical reach of the national project:
The project will utilise a Quality Improvement Model of Care for Transition (Figure 3) developed and tested in Leeds. This is to inform and positively influence the service provision for all young people, aged 11 – 25 years who have a long term condition and are required to transition between services in order to access on-going care and surveillance.
We aim to roll out the model to organisations across the four regions of England, encompassing a range of healthcare settings, primary & community care, palliative care and mental health services.
In addition we aim to ensure that transition pathways incorporate social care in order to reach, for example, those who have complex physical disabilities, learning disabilities, hidden disabilities or autism.
What is transition and why do we need to support the process?
Preparing for the move from children’s to adult services is referred to as healthcare transition. This transition occurs in mid adolescence; adolescence can be defined as the period between childhood and adulthood characterised by the onset of puberty up until the brain fully maturing, which is currently thought to be about mid-twenties.
The transfer from children’s to adult services is a critical time in a young person’s life and like all transitions it presents both risk and opportunity (Northumbria, 2017).
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In addition there is a a substantial body of evidence showing that morbidity and mortality increases for young people following the move from children’s to adult services and Nagra (2015) states that ‘Despite the evidence of risks associated with poorly managed move to adult services and availability of potential solutions, studies continue to show that the move remains ad hoc and an unsatisfactory experience for a significant number of young people’.
Whilst NICE (2016) recommends that ‘health and social care service managersin children’s and adults’ services should work together in an integrated way to ensure a smooth and gradual transition for young people’, research evidence suggests that many staff feel ill equipped and often lack confidence to provide this care.
The Care Quality Commission (2014) emphasise the fact that ‘everyone seems to want to do the right thing but there seems to be a missing link and no one seems to work together’.
Training of staff in the unique needs of adolescents and developmentally appropriate care has to be a large part of the implementation of any change.
Better-tailored approaches to transition are key if we are to bridge the “care-gap” between child and adult services so far described in the literature: interventions that teach life skills and self-management need to be evaluated; strategies that improve collaboration between services and enhance a shared understanding of approaches to care must be described and made known; different models of transitional care need to be examined; and finally, we need to know more from the populations we care for about their experiences. Aldiss et. al, (2016) & Campbell et. al, (2016)
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Through experience in Leeds we have found that the delivery of transition and developmentally appropriate healthcare requires leadership, a whole team approach and collaboration across organisations to meet the needs of young people. Making small changes in clinical practice as well as broader organisational changes contributes to improved long term health outcomes for young people.
We believe that Regional Nurse Advisors as transition experts with knowledge of quality improvement and change management are best placed to:
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Advise and support professionals delivering whole organisation quality improvement work.
Map where transition is currently happening, which will particularly benefit the stand alone children’s hospitals/organisations, helping them to identify professionals in adult specialities, working with them to develop transition pathways. This will aid understanding of these services to help prepare young people for their transition into adult care.
Support organisations to implement national transition guidance and developmentally appropriate healthcare.
Support staff to deliver best practice transition for young people, working in partnership with others across organisational boundaries in order to meet the holistic needs of young people.
NHS Improvement - Improving Healthcare Transition Collaborative
This project has worked and will continue to work along side the NHS Improvement Transition Collaborative led by Angela Horsley, Head of Children, Young People and Transition/ Interim Clinical Director - Maternity and Children.
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Louise Porter - National Lead Nurse Leeds Teaching Hospitals NHS Trust [email protected] is a Paediatric Nurse who has held multiple leadership roles and holds a business management degree. Louise led the original project in Leeds; developing and implementing the QI Model for Transition Improvement and leads this national team.
Josette Niyokindi - RNA North Host Trust: Alder Hey Children’s NHS Foundation Trust [email protected] Josette is a dual registered Paediatric Nurse and Health Visitor with experience of working inpublic health at national and international level, providing nursing leadership and leading QI projects.
Nathan Samuels - RNA Midlands & East Host Trust: University Hospitals Birmingham NHS Foundation Trust [email protected] Nathan is a dual qualified Learning Disabilities and Public Health Nurse with extensive experience in mental health, public health and learning disabilities in both acute and community settings across Birmingham and Northamptonshire.
Nigel Mills - RNA London Host Trust: Imperial College Healthcare NHS [email protected] Nigel is a senior Paediatric Nurse who has worked with young people in settings including dedicated general adolescent and oncology units and in recent years as Transition Lead at a Tertiary Children’s hospital.
Lucy Duncombe - RNA South Host Trust: Somerset NHS Foundation [email protected] Lucy is a senior Paediatric Nurse with a critical care background in acute and community settings, within both the NHS and private sector. In recent years Lucy has led QI projects at national and regional level.
The National Transition Team
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Reference list
Aldiss S, Cass H, Ellis J, Gibson F. 2016. ‘We sometimes hold on to ours’ – professionals’ views on factors and facilitators that delay transition. Frontiers in Pediatrics 4:125 eCollection 2016
Blakemore, S.J. and Mills, K.L. 2014. Is adolescence a sensitive period for sociocultural processing? Annual review of Psychology, 65, pp.187-207.
Campbell F, Biggs K, Aldiss SK, O’Neill PM, Clowes M, McDonagh J, While A, Gibson F. 2016 Transition of care for adolescents from paediatric services to adult health services. Cochrane Database Syst Rev. 2016 Apr 29;4:CD009794. doi: 10.1002/14651858.CD009794.pub2. Review.
Care Quality Commission. 2014. From the pond into the sea: Children’s transition to adult health services. London: CQC.
Nagra, A., McGinnity, P.M., Davis, N. and Salmon, A.P. 2015. Implementing transition: ready steady go. Archives of Disease in Childhood-Education and Practice, 100(6), pp.313-320.
National Institute for Health and Care Excellence (NICE) Transition from children’s to adults’ services December 2016 Quality Standard qs140
Northumbria Healthcare. 2017. NIHR Making Healthcare Work for Young People - A tool kit to support developmentally appropriate healthcare. Northumbrian Healthcare NHS Foundation Trust https://www.northumbria.nhs.uk/wp-content/uploads/2017/04/nhs-making-healthcare-work-web-02.pdf
Wells. F, Manning. J. 2017. Transition of care from children’s to adult services. Nursing Children and Young People. 29, 8, 30-34 October
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