National review of healthcare services for young people – findings reveal a mixed picture

HIW has undertaken a review of how healthcare services are meeting the needs of young people, including those who need to transition from child to adult services. This work is part of wider thematic work being undertaken jointly by Inspection Wales (Healthcare Inspectorate Wales, Care Inspectorate Wales, Estyn and Wales Audit Office).

Published at 8am on 29 March 2019, this review brings together the key themes to have emerged from inspections undertaken over the last two years relating to children and young people, including in-patient Child and Adolescent Mental Health Services (CAMHS), treatment for physical health conditions in hospitals and care within children’s hospices.

The review has focussed on:
• Child and adolescent mental health services (CAMHS)
• General healthcare services for young people
• Supporting young people with life-limiting conditions and palliative care
• Transition from child to adult healthcare services.

The review found that overall, young people had predominately good experiences of care within services. We also found staff working hard to provide compassionate, dignified and person-centred care. However, we are concerned about the ability of CAMHS inpatient units in Wales to accommodate people who are high risk. This means that young people are not always able to receive timely care close to where they live and are having to be placed out-of-area. This problem needs to be addressed by Welsh Government.

It is also disappointing to find that many of the challenges young people face when moving between child and adult services are well known but still continue to be seen. More work is needed by health boards and Welsh Government to ensure young people across Wales have smooth and effective transition to support them into adulthood.

Key findings include:

CAMHS
• Staff are working hard to provide compassionate, dignified and person-centred care, with evidence of positive multi-disciplinary team working
• We could not always be assured patients were receiving safe and effective care because we found weaknesses around systems for ensuring safe care, including systems for locating emergency equipment
• We have concerns across Wales over the ability of CAMHS units to accommodate young people who are high risk, due to challenges with staffing, environment and effective management and leadership. We are concerned that this means some young people need to be placed out-of-area.

General healthcare services for young people
• In general, we found children and young people received safe and effective care
• Services needed to make improvements to ensure young people received timely care in emergency departments and for invasive procedures
• Aspects of care documentation were not always completed and a number of staff had not completed training in how to safeguard children at risk.

Supporting young people with life-limiting conditions and palliative care
• Young people received safe and effective care, and we found staff were kind and caring and there was good support available to families
• Care was tailored to the specific needs of young people with children, young people and their families involved in decisions about their care
• Hospice staff were particularly respectful of the wishes of young people and their families for end-of-life care and after death.

Transition from child to adult healthcare services
• We found a varied and inconsistent picture across Wales
• We found examples where transition could be rushed and did not always start early enough
• For young people with complex needs, transition can be fragmented and feel like ‘falling off a cliff edge’
• Differences between child and adult services meant that individuals did not always receive the same level of care and there may not be an equivalent adult service for a young person to transition to.

We expect this review promote improvement, and that the findings and recommendations will be carefully considered by Welsh Government, and health boards.