The Ready Steady Go (RSG) programme was successfully introduced at University Hospital Southampton NHS Trust. RSG is a suite of resources designed to deliver high-quality transition for young people (YP) across all subspecialties.
▸ Addresses the full range of issues for good transition and facilitates discussion in greater depth where required by the YP, carer or healthcare professional
▸ Is simple to understand and use. It has been widely and enthusiastically adopted and has led to a cultural change in healthcare practice where implemented.
▸ Improves clinical practice and clinical outcomes.
▸ Empowers YP to manage their healthcare confidently and successfully in both paediatric and adult services.
Ready Steady Go was developed in reference to the NICE guidance NG43. ‘Ready Steady Go’ provides a tool that enables the delivery on all the over-arching principles in the NICE guidance.
‘Ready Steady Go’ and it’s follow on programme- ‘Hello to adult services’ - also provides a tool for Health and social care service managers in children's and adults' services to work together in an integrated way to ensure a smooth and gradual transition for young people (for young people with education health and care plans [see the gov.uk guide]- this is currently being explored.
‘Ready Steady Go’ and ‘Hello to adult services’ helps deliver on all the transition planning recommendations in the NICE guidance. The programme also provides a structure to ensure that the patients and carers are appropriately supported before and partially after transfer to adult services as recommended in the NICE guidance.
Example
Aims and objectives
Our aim was to develop and implement an effective generic transition programme- called ‘Ready Steady Go’.
Our objective was to deliver high quality transition thereby improving patient and young people’s experience and ability to manage their healthcare independently- in a cost effective manner.
Reasons for implementing your project
There is good evidence that morbidity and mortality increase for YP following the move from paediatric to adult services (see 1-5 in supporting material). In response to this evidence there have been a number of reports and guidelines seeking to reduce the risks associated with moving to adult services. Central to this work is the concept of transition - a gradual process of empowerment which equips young people with the skills necessary to manage their own healthcare in paediatric and adult services. Effective transition has been shown to improve long-term outcomes and to improve YP experience (see 6-9 in the references) .
At our local trust, through an audit, we found that there was no effective transition for young people with a long term condition moving to adult services. Aware of the evidence and taking into account the principles of transition, we convened a multi-disciplinary group made up of healthcare professionals, young people, carers and patient groups to develop and implement Ready Steady Go (RSG).
It is a generic programme for young people with a long-term condition aged 11+ years. It can be used across all subspecialties. RSG is a structured, but where necessary adaptable, transition programme. A key principle throughout RSG is ‘empowering’ the YP to take control of their lives and equipping them with the necessary skills and knowledge to manage their own healthcare.
How did you implement the project
Ready Steady Go is being implemented within a large NHS teaching hospital in the UK, with secondary and tertiary paediatric services, where it is now established as part of routine care. The programme is promoted through standard approaches such as staff briefings and workshops and the use of posters in clinic.
More uniquely, four weeks a year “11+ clinic weeks” are held. All clinics during these weeks are intended for YP aged 11+ years. These targeted weeks allow the physical environment to be made ‘YP friendly’ and encourages the YP to start taking the first steps towards independence of care as they watch other YP/peers go through the same process. Seeing other YP and carers go through the programme also helps carers understand that letting the YP become more responsible for their care is expected and to be encouraged.
In addition, the ’11+ clinic weeks’ focus health professionals on transition and encourages them to adopt the Ready Steady Go Programme as part of their regular clinical practice so that effective transition becomes part of their routine throughout the year.
Initially there was reluctance to support the implementation of YP clinic weeks due to concerns about an increase in the administrative burden to cohort YP. This was overcome once the healthcare teams and hospital management appreciated that the majority of appointments are follow-up reviews so to cohort these YP should not increase administration time or require an increase in resources.
The appointments for YP have started to come in-step with the 11+ clinic weeks and over 80% of the patients attending clinic during these weeks are 11 years of age or older. There is no expectation, or need, to achieve figures of 100% as urgent clinical reviews of younger patients are still sometimes required.
The only costs were in printing the documentation.
We shared all resources with hospital Trusts, the strategic clinical networks, patient organisation and patient charities across the UK- this included transition policies, RSG tools and implementation guides. These are freely available at www.uhs.nhs.uk/readysteadygo. Also offered support for all using the programme.
Key findings
Patient satisfaction improved, outcomes improved as evidenced in the service evaluation of ‘Ready Steady Go’ in diabetes (see 6 in supporting materials).
The programme enables reduced costs to the NHS with better disease control and fewer disease related hospital admissions. Further evaluation research would be required in order to establish the nature of these resource savings.
Outcomes improved in our teenage diabetes group who went through 'Go' from the RSG programme compared to those who had no structured transition to adult services. Only older teenagers (17-19yrs) were assessed as there was a need to transfer them to adult services.
It was noted that HbA1C's were already heading in the wrong direction, 2 years prior to transfer. On the structured RSG programme, using 'Go’ this reduced diabetes related hospital admission by more than 50% compared to no transition- just using ‘Go’ (% in improvement greater as they start earlier on RSG).
More patients attended their adult appointment using 'Go' from RSG compared to no structured transition (78% cf 54%). We anticipate this improving further.
Starting RSG earlier at 11yrs old with the 'Getting Ready' questionnaire it is anticipated that the HbA1C's will also improve for these young people.
Ready Steady Go has gained interest from other local organisations both across the UK and internationally. At South West Clinical Network (SCN), at least 12 of 14 Trusts have adopted the programme. The RSG has also been widely adopted in the Thames Valley and Wessex region. Adoption has also extended northwards into the UK where parts of Greater Manchester SCN and Yorkshire and Humber are also using the programme. It is also being used in parts of Scotland and Wales. Provider organisations in countries including Portugal, Switzerland, Sweden, Amsterdam and Denmark have expressed a positive intention to translate and adapt the programme for use in their local settings. Contacts with these have been established and maintained through international networks and forums.
Where countries overseas have expressed an interest in the programme, they have asked to translate the contents with a plan for local adoption. The results of this adoption have not been formally evaluated yet although an update from these sites will be sought in the near future and this example updated when possible.
Key learning points
Setting up a transition steering group:
Start with an enthusiastic bunch and develop it to include members of the MDT, parents, young people, executive leads from the trust board, adult physicians, admin etc.... waiting for perfection leads to delay. Keep it simple and do not over-complicate it.
Transition champions are needed to convey:
- RSG provides a structured frame work to ensure all issues addressed – you will already be doing some of it in clinic
- You can start the programme yourself – with or without an official transition team/clinic
- All members of the MDT are involved in transition- not just transition nurses
- You do not need to identify an adult team prior to starting transition
- Don't ask if the YP or carer wants to start on the programme→ expectation is that everyone will
- Start programme early and go slowly. Remember small bite size pieces. Check progress and knowledge retention.
- There are many models for running a successful transition programme. See what works for you.
- In YP with learning disabilities RSG has to be introduced sensitively. Parents are told they will work through the programme as the YP's voice/advocate. Some topics are especially difficult for HCPs and carers- sex, pregnancy and the future. We recommend the forms are completed with a HCP expanding on the questions so applicable for the YP and carer. Remember ‘parity of esteem’ for all patients with a LTC.
- Complex cases. Start RSG early. Address the issues you can and signpost or seek help/advice early for those that are outside of your area of expertise.