Why young adults and adolescents need better healthcare

Furthermore, in the absence of a review of the current health status of YAA and of barriers to appropriate transitional services for YAA, this document hopes to promote the prioritisation of changes that will improve health and social care outcomes for all YAA.

Suggestions for improvements in clinical practice

Through conducting an overview of the main health issues faced by YAA and by summarising the challenges to good YAA healthcare, we have produced suggestions for improving clinical practice, which are designed to overcome the barriers and promote the opportunities identified in this report. Each suggestion is targeted at a health-related organisation, public body or healthcare professionals, in order to direct implementation.

• Improving standards and systems
  • A national audit of patient care against the ‘You’re Welcome’ criteria should be commissioned in the 16–25-year age group, to allow a baseline against which improvements can be measured (Healthcare Quality Improvement Partnership (HQIP)).
  • Standards of care for YAA in adult services should use the ‘You’re Welcome’ criteria as a template (Department of Health, working with the National Institute for Health and Care Excellence (NICE)).Local needs assessments of the healthcare needs of YAA should be conducted and used to inform the finance and contracting of services for YAA (clinical commissioning groups (CCGs)).
  • It should be compulsory to include and publish an evaluation of transition in the overall rating of both paediatric and adult services (Care Quality Commission (CQC)).
• Service design
  • Alternative models of care (such as telephone or online review and community-based clinics) should be encouraged. Tariff and other financial and non-financial incentives should be reviewed so that NHS providers are encouraged to use new technology and to engage YAA through new media (Monitor and NHS England).
  • Decisions about service reconfiguration should always be clinically led and include arrangements for YAA (NHS providers).
  • Where possible, YAA clinics and services should be developed in tertiary, secondary and integrated care settings. Where this is not feasible, locality-wide healthcare services should develop tiered models of care, for example employing coordinators who are able to advocate on behalf of YAA and to signpost and facilitate access to other services, including primary care.
    • 2.3.1 All healthcare professionals who are likely to come into contact with YAA should be aware of the range of services, such as sexual and mental health services, to which YAA can be referred if required.
  • Standard operating procedure should apply in all services to ensure that there is a common, defined procedure for treating YAA who are admitted to hospital and to avoid the possibility that YAA fall ‘between the cracks’ of paediatric and adult services (NHS providers).
  • If clinicians are serving a population that includes a significant proportion of YAA, their job plans should be adjusted to allow adequate time to meet the needs of this group. Clinical pathway design should allow time for information provision and coaching (trust medical directors).
  • Age-group aggregations that result in clear visibility of YAA service use, satisfaction and outcomes should be adopted nationally by all health service organisations.
  • YAA, and their families and carers,* should have access to all information relevant to their healthcare and treatment (NHS providers, clinicians).
  • Services for YAA should be flexible in terms of accessibility and operation, in order to accommodate the different needs and capabilities of YAA (NHS providers).
  • Evaluation should be integral to service redesign and should allow sufficient time for the accrual of improvement in health and user satisfaction outcomes (NHS providers).
• Education and training
  • Training for physicians should include the care of YAA. Curricula and educational programmes should include appropriate content regarding the care of YAA around:
    • effective communication between physicians and YAA
    • the developmental and psychosocial needs of YAA (physical, mental and sexualreproductive health needs)
    • appropriate palliative care for YAA
    • guidance for YAA to enable them to navigate the NHS, including how to involve youngpeople, families and carers in decision-making and healthcare plans. (General Medical Council, Health Education England, Joint Royal Colleges of Physicians Training Board and professional bodies).
  • Specialties should ensure that aspects of YAA disease that are particular to that specialty are included in curricula and competency frameworks, and are assessed.
  • All professional bodies should consider how to support the training of healthcare professionals in this area.
  • YAA should be involved in the training of physicians.