Quality standard

Quality statement 6: Missed initial appointments after transfer to adults' services

Quality statement 6: Missed initial appointments after transfer to adults' services

Quality statement

Young people who have moved from children's to adults' services but do not attend their initial meetings or appointments are contacted by adults' services and given further opportunities to engage. [2016, updated 2023]

Rationale

Adults' services need to engage with young people following transfer so that they continue to receive the care and support they need. If young people stop attending meetings or appointments or engaging with services during transition it can affect their future health, mental health and social care needs.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

a) Evidence of local arrangements to monitor and assure transitions from children's to adults' services.

Data source: Data can be collected from information recorded by health and care practitioners and provider organisations, such as local policy and audit, data sharing platforms and patient or client surveys.

b) Evidence of local processes in adults' services for follow-up arrangements for young people who have moved from children's to adults' services but do not attend their initial meetings or appointments.

Data source: Data can be collected from information recorded by health and care practitioners and provider organisations, for example from service protocols.

Process

Proportion of young people who have moved from children's to adults' services but did not attend their initial meetings or appointments who were contacted by adults' services and given further opportunities to engage.

Numerator – the number in the denominator who were contacted by adults' services and given further opportunities to engage.

Denominator – the number of young people who have moved from children's to adults' services but did not attend their initial meetings or appointments.

Data source: Data can be collected from information recorded locally by health and care practitioners and provider organisations, for example from patient or client records. For measurement purposes, this could be defined as any one of the first 3 meetings or appointments or any meeting or appointment within the first 12 months in each adults' service but can be adapted to fit local service characteristics.

Outcome

a) Proportion of young people who transferred from children's to adults' services who are discharged from each adults' service without attending a meeting or appointment.

Numerator – the number in the denominator who are discharged from each adults' service without attending a meeting or appointment.

Denominator – the number of young people who transferred from children's to adults' services.

Data source: Data can be collected from information recorded by health and care practitioners and provider organisations, for example from patient or client records.

b) Proportion of young people attending adults' services after transfer from children's services who continue to engage with services.

Numerator – the number in the denominator who continue to engage with services.

Denominator – the number of young people attending adults' services after transfer from children's services.

Data source: Data can be collected from information recorded locally by health and care practitioners and provider organisations, for example from patient or client records. For measurement purposes, this could be defined as engagement at 1 or 2 years after transfer or engagement at a specific age (such as 25 years) but can be adapted to fit local service characteristics.

What the quality statement means for different audiences

Service providers (adult health, mental health and social care services) ensure that systems are in place, so they know who is transferring from children's services, and that a young person is contacted and given further opportunities to engage promptly if they do not attend (or were not brought to) any one of their initial meetings or appointments in adults' services. Providers ensure that young people who do not attend their initial meetings or appointments and do not respond to follow-up are not discharged from the service but are referred back to the named worker or children's service.

Health and social care practitioners from adults' services (such as hospital consultants, social workers, mental health workers, GPs) ensure that they work with children's services to identify young people who have moved to adults' services but did not attend (or were not brought to) any one of their initial meetings or appointments. They ensure that the young people are contacted and given further opportunities to engage as quickly as possible. If a young person does not respond practitioners should not discharge them from the service but should refer them back to the named worker or children's service.

Commissioners ensure that they commission adults' services that contact young people who have moved to their services but do not attend (or were not brought to) any one of the initial meetings or appointments and quickly give them further opportunities to engage (for example, other appointments). Commissioners ensure that the adults' services they commission do not discharge young people if they do not attend their initial meetings or appointments but refer them back to the named worker or children's service.

Young people who have moved from children's to adults' services but do not attend (or were not brought to) their initial meetings or appointments are contacted by someone from adults' services as soon as possible. They will check if the young person's care and support plan is still right and whether they need any other help to get back in touch with the service.

Families and carers of young people who have moved from children's to adults' services but do not attend (or were not brought to) their initial meetings or appointments are contacted by someone from adults' services as soon as possible to try to help the young person keep in touch with adults' services.

Definitions of terms used in this quality statement

Further opportunities to engage

If a young person does not attend meetings and appointments in adults' services, the adults' service should try to contact them and their family or carers and follow up with the young person, then involve other relevant practitioners (including children's services and their GP) if necessary. They should try to understand the reasons for not attending and identify any changes that could be made to encourage attendance in future. If there is still no contact then the relevant provider should refer back to the named worker or the children's service with clear guidance on re-referral, if applicable. The named worker should review the person‑centred care and support plan with the young person to identify how to help them use the service. If the young person does not want to engage in adults' services, they should be offered alternative ways to meet their support needs by the named worker. [NICE's guideline on transition from children's to adults' services for young people using health or social care services, recommendations 1.4.1 to 1.4.3 and expert opinion].

Equality and diversity considerations

Health and social care practitioners should consider any specific needs relating to disability, leaving care or where someone lives when working with young people who have not attended their initial meetings or appointments in adults' services. They should consider if reasonable adjustments can be put in place that will encourage future attendance.

Service managers should ensure a range of support is available, and used, to help young people communicate effectively when adults' services engage with them. This could include having a written record of how a young person prefers to communicate, such as a communication passport or 1-page profile, and different ways to help the young person communicate, such as communication boards, digital communication tools and advocacy. [NICE's guideline on transition from children's to adults' services for young people using health or social care services, recommendations 1.2.11 and 1.2.12]. For people with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's Accessible Information Standard or the equivalent standards for the devolved nations.