At present, hospitals in Scotland provide children’s wards, which are mainly occupied by young people up to ages ranging between 13 and 16, depending on hospital or NHS Board policy. Over that age, young people are routinely admitted to adult wards for hospital stays, with the exception of young people with particular medical conditions where they continue treatment within children’s wards or in specialised centres or hospitals which can extend up to 18 depending on circumstances. With the exception of a unit catering for 16-25 year olds provided by the Teenage Cancer Trust at Beatson West of Scotland Cancer Centre (http://www.beatson.scot.nhs.uk/content/default.asp?page=s22_2), there are no adolescent wards in Scotland.
In support of her Members Motion, Rachael outlined her concerns with the present system creating barriers to young people’s recovery in hospitals. She called for “a young person’s ward or rooms within hospital settings for 16 to 21 year old young people to provide better support and help them recover both physically and mentally in a more youth friendly environment.”
Young people have many particular needs that are distinct from children or adults. With no-one of the same age group to talk to, it can be a lonely and isolating experience at a time when young people’s social lives are particularly important to them. With an absence of age-appropriate leisure facilities or things to do, it can be a long and boring experience, and being of a distinctly different age to the other patients it can be difficult for young people to be appropriately involved in their treatment or respected as independent young people by staff.
Consultation was conducted with young people who had been treated in adolescent wards in England compared with those in children or adult wards. Those treated in an adult ward raised a number of concerns relating to not feeling secure, having limited access to appropriate leisure facilities, not being treated with respect or being involved in their care, as well as being concerned about confidentiality. (Health Care Commission Patient Survey Report – Young Patients, cited in ‘Better Health, Better Care’ report). One particular problem appeared to be the age gap between young people in the adult ward and the other patients, who were all more than 30 years older than the lone young person in the ward. Young people in children’s wards had particular issues with not being involved in their care, and were less likely to rate the care they received as excellent.
There have been calls from some of those practicing adolescent medicine for specific young people’s wards for a long time, with the Platt Report as far back as 1959 suggesting that “the requirements of adolescents differed from those of adults and children and ideally adolescents need their own accommodation” (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1120118/), which has been cited and re-examined by academics periodically in the decades that have followed.
Findings from a survey of young patients in England in 2007, where adolescent wards and oncology units are a feature in a number of hospitals, found that “dedicated adolescent inpatient wards improve aspects of quality of care for young people compared with child or adult wards, particularly for older adolescents.” (http://pediatrics.aappublications.org/content/120/4/749.abstract)
The Scottish Government’s ‘Better Health, Better Care: Hospital Services for Young People in Scotland’ report in 2009 admitted that “with specific regard to hospital admissions, Scotland has historically been at variance with England, North America, Australia and many parts of Europe in setting relatively low upper age limits for its children's hospital services. As a result many patients aged 13 years and over have routinely been admitted to adult units within which the ethos and emphasis is inevitably orientated towards a much older patient population.” (http://www.scotland.gov.uk/Publications/2009/05/07130749/4) The report proposed that the age limit for children’s hospital was raised from 13 to 16, but stopped short of recommending specific adolescent wards, or specific provision for 16-21 year olds.
That report, which was issued as guidance, acknowledged that “the specific and different attributes of adolescence need to be adequately understood and appropriately addressed by all staff, whether hospital or community based, who have any substantive responsibilities for delivering care to this patient group. Young people consulted about the National Delivery Plan strongly supported the need for staff to learn more about working with their age group.” The Government committed to require all NHS Boards to ensure that all staff routinely dealing with young people have had appropriate training by 2013.