Transitions
TRANSITION FROM VRANCH HOUSE TO ADULT SERVICES
Adult Therapy Services Information
At 18-19 years old, your young person will be discharged from paediatric services and will be eligible for adult services. There are some differences about access depending upon whether the young person receives Health funding or Social Care or Education funding, but this leaflet contains useful general information and contact numbers.
DOCTORS
Who will my young person’s doctor be from 18 years old?
At 18 years old the paediatrician will no longer be involved. However, the GP will remain the same. From 14 years old the GP is legally required to see children with complex health needs for at least once a year check ups. It is recommended that you attend these check ups so that the GP is familiar with the complexities of your child and they are better equipped when they are responsible for situations, like reviews of medication or any health changes, when the child turns 18 years old. The GP becomes responsible for referrals to neurologists or other specialists.
Some young people may be able to be seen by Pathway Clinic and Dr Sarah Jackson who can become their transition doctor until they are 25 years old. If you would like your child to be considered for this, the names to email are below. If your child has epilepsy, they will have open access to the epilepsy nursing team.
Pathways clinics are also run on site at Ellen Tinkham College and InFocus / Jigsaw, for YP who attend there.
Pathway
Transferring young people with complex needs from a
Consultant Paediatrician to a Consultant Adult Physician
Who is the consultant/s likely to be involved in orthopaedic follow up?
If the child is known to Bristol Children’s Hospital teams, some young people have stayed on at Bristol and transferred to adult services. If your child is under the local paediatric orthopaedic team in Exeter, they will be transferred to the adult orthopaedics team, or you can ask your GP to action a referral to the local adult orthopaedics team.
PHYSIOTHERAPY
When my child turns 18 years old (or 19 years old when a pupil leaves Vranch House School), how do they access physiotherapy?
Is physiotherapy provision through episodes of care, or continuous input?
Your child’s Vranch House Physiotherapist will inform the Adult Learning Disabilities Physiotherapy Service of names and numbers of any school leavers aged 18-19 years at the start of your child’s last academic year with us. They will also send a physiotherapy referral report within the last three to four months your child attends Vranch House School. If it is possible to arrange, we will aim to hold a joint handover session in your child’s last summer term or summer holidays.
The Adult Learning Disability Physiotherapy Service’s provision is through episodes of care, to include advice and exercise programme updates, which can vary in length of time dependent on presenting complexity of clinical needs, via GP or self-referral from the young person’s parent/carer.
The Adult Learning Disability Physiotherapy Team can be contacted directly:
dpn-tr.ExeterLDTeam@nhs.net Tel: 01392 208373 at Franklyn House.
However, if it is a specialist service that is needed, e.g. musculoskeletal outpatients, that may have to be accessed via the GP to refer to the mainstream adult community or outpatient physiotherapy service.
If physiotherapy is accessed through episodes of care, is there a criteria for triage re urgent/non urgent referrals and how long is the waiting list for urgent/non urgent referrals?
There are timelines within which urgent referrals need to be triaged but we could not find out exact times. Any referral is triaged on priority based on clinical need to determine if the clinical need is urgent or routine.
RESPIRATORY PHYSIOTHERAPY
The Adult Learning Disability Physiotherapy Team are able to advise parents and carers regarding manual chest physiotherapy techniques and positioning for preventative and community respiratory management. If your child requires more specialist respiratory assessment, review and support, the GP/community nursing team can refer your child for respiratory assessment or for a review of your child’s existing respiratory management and protocol if they are already known to the respiratory service. They will also provide respiratory equipment and carer training should there be a need to use respiratory treatment adjuncts, techniques and equipment such as inhalers, nebulisers, suctioning, positive pressure masks (PEPs), assistive cough techniques etc.
EQUIPMENT
If physiotherapy and occupational therapy are delivered through episodes of care, what measures are in place for monitoring equipment?
Any concerns about community equipment in your home (e.g. specialist chairs, standing frames, sleep systems, toilet seats/frames, bathing aids, hoisting equipment etc) need to go through Millbrook Tel: 0330 124 4491.
WHEELCHAIRS
Contact Exeter Mobility Centre (EMC) about wheelchair assessment, reviews and repairs Tel: 01392 547400. Invacare no longer exists; please ask for Exeter Mobility Centre Repairs when given the option.
HYDROTHERAPY
What is the hydrotherapy provision/criteria?
There are hydrotherapy pools available for a physiotherapist to refer to which operate from the RD&E or Axminster if a block of hydrotherapy is clinically indicated. The hydrotherapy referrals are usually for a block for up to a maximum of 8 sessions.
There are also hydrotherapy pools available for families/carers to book in Newton Abbot (Hydro Hub Tel: 01626 325807) and Axminster (Flamingo Pool Tel: 01297 35800).
What group/individual therapies are available to access? What is their criteria/frequency of sessions?
There are currently no group therapy sessions run by the Adult Learning Disabilities Physiotherapy Service. Young people are seen for physiotherapy on an individual basis. Your physiotherapist will be able to signpost you to other organisations that may be appropriate to access e.g. Riding for the Disabled.
ORTHOTICS
Do parents/carers need to take the lead on recognising the need and booking orthotics clinic review appointments?
Yes, you will need to request a review appointment by contacting Exeter Mobility Centre (EMC) Tel: 01392 547400 e.g. if the orthotics shows signs of wear and tear, causing redness and marking on the skin that does not fade within 30 minutes after taking the orthotics off, or if the orthotics is causing blisters or skin damage. You should also contact EMC should there be any physical changes to your child, such as increased muscle tone causing difficulty getting the orthotics on or reduced tolerance in using the orthotics. Should you require an orthotics referral, please ask your GP to action a referral.
OCCUPATIONAL THERAPY
Your child’s GP can refer your child to occupational therapy for an episode of care in response to any relevant changes or concerns. You can ring Care Direct Tel: 0345 155 1007 (Monday to Thursday 9am to 5pm, Friday 9am to 4:30pm and Saturday 9am to 5pm), which is a one stop shop support for queries e.g. social services, equipment etc. In the future, there will also be an LD SPA number that is operational to facilitate self referrals.
Self Assessment Portal (millbrook.store) - provides advice about staying safe and independent at home.
Home - Independent Living Centre - based in Newton Abbot. Offers 1:1 appointments re: equipment advice.
What the Adult OT service can provide:
If your child is over 18 years old and has a long-term health condition resulting in disability and need help with practical tasks, they may be able to help with things like:
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accessibility entering and leaving your home
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washing, bathing and toileting
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using living and sleeping areas
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using food preparation and cooking areas
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reducing risks in your home related to your child’s condition
They provide advice and assessment by telephone or may come and see you in your own environment. They aim to maximise your child’s wellbeing and independence and ease the physical burden on parents and carers with the provision of moving and handling equipment.
Types of support they can provide, subject to eligibility criteria, are:
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equipment
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minor adaptations
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advice, equipment and risk assessment if you need help with your mobility
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advice if you are providing physical assistance for someone you are caring for
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referral to district councils for major adaptations
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referral and signposting to other agencies, such as the Reaching for Independence Team.
SPEECH AND LANGUAGE THERAPY
How can my child access Speech and Language Therapy (SALT) when they turn 18 years old?
Speech and Language Therapy can be referred to through the GP. You can ring CARE DIRECT. In the future there will also be an LD SPA number that is operational (see above).
For concerns with regards to acute changes regarding ability to swallow, the dysphagia SALT team triage dysphagia assessment referrals within 48-72 hours.
What happens if there is a problem with their eyegaze or grid pad?
If support is needed for high-tech AAC devices ring AAC West: Tel: 0117 414 5850. If the young person has a device provided by AAC West there are yearly appointments made by AAC West.
If there is a problem with the software or you need help editing then you can ring the Smartbox helpline on Tel: 01684 578868, they can then access the device remotely and edit the grid or fix any problems.
If you have any further questions please do not hesitate to contact:
Zoe Gilbert: Secondary School Coordinator; zoe.gilbert@vranchhouse.org
Lucy Wills: Physiotherapist; lucywills1@nhs.net
Kim Warne: Occupational Therapist; k.warne@nhs.net
Vranch House is an Independent Charity registered with the Charity Commissioners under Number 1002700 and a Company Limited by Guarantee (Registered Number 2599511). Our Principal Office is at Vranch House School, Pinhoe Road, Exeter, EX4 8AD, Tel 01392 468333, Fax 01392 463818. See us at www.vranchhouse.org
Created by Zoe Gilbert: Secondary School Coordinator
Lucy Wills: Physiotherapist
Kim Warne: Occupational Therapist
To be reviewed February 2025.
Transitions TIMELINE
PFA is Preparing for Adulthood. The team is changing and are now managing all transitions into adult social care and are now called the Transitions Adult Social Care Service (TASC).
www.devon.cc/asctransitions
Year 9 – From age 14 young people are entitled to an annual check up with their GP. This is important as they will no longer be able to access their paediatrician after they turn 18 and all health needs will be vis the GP. It is also important to check with the GP that the young person is on the Learning Disability Register in order for them to access all learning disability services a an adult.
Year 10 – refer in to the service via the online form if you haven’t already done so. The team will signpost to our website as above and are available for any questions. The children’s transition team may begin work with you regarding information about mental capacity and decision making.
Age 16 – The team will make contact with the family and introduce adult social care. Your named person from the TASC team will then keep your young person on their caseload, and will contact you again when your young person is 17.
Age 16 – The mental capacity act comes into effect and decision making for significant decisions such as care, accommodation, medical or financial decisions. A mental capacity assessment will be carried out to see if the young person has capacity if a significant decision is required. Capacity is always assumed unless there are reasons to doubt it. Currently the disabled childrens service will do this assessment and consider deprivation of liberty safeguards.
Deprivation of Liberty Safeguards (DoLS) is to protect your young person from any restrictions on their lives that are over and above what is needed to keep them safe and well. It also protects you as their carers. It is not a judgement on you and it is not about reducing restrictions if they are needed. It is carried out by the Disabled Childrens Service. If a community DoLS is needed an application will be made to the court of protection for it to be granted. It is reviewed regularly.
Age 17 – The Reaching for Independence team (RFI) can be offered to help with working on short term independence goals. This is a free in house service that can be accessed at any point during adulthood and can be used more than once.
Age 17 – Your allocated worker form the TASC team will contact you again
A more in depth assessment will be carried out, this is the Care Act Assessment.
Age 17 – if your young person may be eligible for part or full funding from health (Continuing Health Care) this process will be started. A screener will be completed with you and if accepted a bigger meeting will take place to discuss your young person’s health needs.
Age 17 – Parents/carers can now be referred to the Devon Carers service to look at support for them in their caring role. This is optional but can offer good support.
Age 17 – Your young persons care plan will be in place and all funding will be agreed ready to start on their 18th birthday. If this doesn’t happen for any reason the children’s package will continue whilst things are finished off so there is no break in provision.
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Continuing Health Care funding (CHC) This process is followed where a young person has significant health needs. A checklist is completed and sent to the health board (ICB) who will review it and if it passes threshold a meeting called a Decision Support Tool meeting (DST) will be arranged. Parents/carers, adult social care, health and any other professionals involved will be invited.Your worker will be able to explain the process to you.
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If your young person is agreed to need full health funding then social care will withdraw and the health team will allocate a caseco-ordinator to put in place plans for care provision.
Age 18 – Deputyship can be applied for relating to care and support needs and also financial needs. This can only be done if the person lacks capacity to manage these decision and lacks capacity to give power of attorney to someone. You will need to see your own legal advice about this.
Financial assessments – adult social care is not free and once your young person has left education they may be assessed for a financial contribution towards their care. This is based on their own income and is means tested. If your young person is fully or partly health funded the health funding is free to them.
Once the transition is completed the young person will have their needs reviewed annually by their local community health and social care team. If things change in the interim an earlier review can be requested via Care Direct 0345 155 1007.
Mental capacity assessments will be carried out throughout an adult’s life when needed to check again in case capacity has been gained. These assessments are decision specific so your young person may have capacity for some choices and not others. The assessments are carried out by the relevant professional depending on the decision to be made, e.g. health professional or social care professional.
Direct payments – if you have had a direct payment from the children’s service and this is being continued there will be a new adult account set up and a new card.
If you have any questions please contact the TASC team.
01392 381291
Adultsc.adultsocialcaretransitions-mailbox@devon.gov.uk