Jean A. Davies Clinical Nurse Manager Children and Young People

1. Growing up and Moving on:Developing a pathway for young people who are cared for in adult settings Jean A. Davies Clinical Nurse Manager Children and Young People

2. Why develop a care pathway? • Care pathways reflect rights, safeguards, health and wellbeing • Standards and legislation: UNCRC, CYP Act, EACH, Trieste: duty of care on service providers to ensure that best practice standards are met (Royal College of Nursing) • Collaboration, sharing ideas and joint working addresses universal issues the ‘wicked problems’ relating to care https://www.rcn.org.uk/professional-development/publications/pub-004496

3. Young people in adult settings: is this a ‘Wicked Problem’? • ‘Wicked problems’ in health services first described 10 years ago and deemed can only be managed not solved • Do we still have a problem now that Children’s hospitals admit children up to 16 years? • Wicked problems require adaptive solutions that are tailored to work in the local setting : Young people aged 16 to 18 years • Wicked problems need to be implemented by local stakeholders and champions https://curandi.org/concepts/healthcares-wicked-problems-can-only-be-managed-not-solved

4. What does the UNCRC say? • Definition of the child (Article 1) The UNCRC defines the child as a person under 18 years of age • Best interests of the child (Article 3) • Respect for the views of the child (Article 12) • Best healthcare possible (Article 24) https://www.unicef.org/crc/files/Guiding_Principles.pdf

5. What do Children’s Charters say? • Children shall be cared for by staff whose training and skills enable them to respond to the physical, emotional and developmental needs of children and families. European Association for Children in Hospital (EACH) Article 8 Right to an age-appropriate health service https://www.each-for-sick-children.org/images/stories/2016/Charter_AUG2016_oSz.pdf

6. What do Children’s Charters say? European Association Charter for Children in Hospital (EACH) Article 6 • Children shall be cared for together with children who have the same developmental needs and shall not be admitted to adult wards • Clearly separate facilities should be available for the treatment of children and adults emergency rooms, outpatient , surgery https://www.each-for-sick-children.org/images/stories/2016/Charter_AUG2016_oSz.pdf

7. Charter for the rights of the dying child • Listened to, properly informed about illness, consideration of wishes, age and ability to understand • Cared for in setting appropriate for age, needs and wishes, family close and involved • Access to child-specific palliative care services http://www.fondazionemaruzza.org/en/charter-of-the-rights-of-the-dying-child-the-trieste-charter/

8. Assessing the risks:young people in adult settings • How do you carry out a risk assessment? • Step 1: Identify the hazards. In order to identify hazards you need to understand the difference between a 'hazard' and 'risk'. ... • Step 2: Decide who might be harmed and how. ... • Step 3: Evaluate the risks and decide on control measures. ... • Step 4: Record your findings. ... • Step 5: Review your assessment and update as and when necessary http://www.nrls.npsa.nhs.uk/resources/patient-safety-topics/risk-assessment-management/

9. Developing the care pathway • Attention to the patient experience • The right people • In the right place • Doing the right thing • In the right time • With the right outcomes • ‘Variance tracking tool’ (real time audit) • Formal links to paediatrics http://www.wales.nhs.uk/sitesplus/documents/829/integratedcarepathways.pdf

10. What happened next? • Improvement in the facilities and standard of care of 14 to 16 year old boys on the Urology Ward, NHS Ayrshire & Arran • Discussion with Children’s Health Scotland about other service providers who admit young people to adult service provision • Meetings to discuss use of Risk Assessment in other settings • Adaptation of the pathway for use in other settings, epilepsy centre, hospice care, outpatient departments, ophthalmology and orthopaedics https://www.childrenshealthscotland.org/

11. Summary • Identification of a ‘wicked problem’ • Review of standards, legislation and children’s charters • Risk assessment, preventative factors and controls • Development of care pathway • Support from Children’s Health Scotland to adapt for use in other settings caring for young people • Views of young people on services

12. Thank you for listening