Making health services young people friendly
One of the biggest challenges confronting our health service today is how to support and empower young people to access the healthcare. Dr Dick Churchill, GP. Clinical Associate Professor of Primary Care, and Chair of the RCGP Adolescent Health Group looks at some of the reasons why young people are reluctant to seek help and the challenges health professionals face.
You’re Welcome, the Department of Health's quality criteria for making health services "young people friendly" is helping to bridge the gap.
We know that young people often find it difficult to ask for help and advice when it comes to their health, often due to feelings of embarrassment, concerns that their queries won’t be taken seriously, or fears around confidentiality or being judged. However, it may come as a surprise that one of the biggest barriers young people say that they face is simply making an appointment and getting to a surgery or clinic. It’s a process that most adults take for granted, but for young people who are making an appointment for the first time, this can be quite a daunting task.
Yet we also know that by simply raising young people’s trust and confidence and removing some of the practical obstacles and barriers that many of our 11 to 19 year olds face, we can make a real contribution towards empowering young people to access help and advice. As health professionals, I believe it’s vital that we engage with young people and really listen to their concerns in order to ensure that the services we are providing really are ‘young people friendly’.
If we as health professionals can convince young people at an early age that it’s okay to walk through our doors and ask for help, and can build a relationship of mutual trust and respect, then we greatly increase the chances of them continuing to seek health advice throughout their life and help to create healthier communities in the future.
These issues around young people’s perceptions of our health services are also crucial to consider if we are to successfully address some of our biggest public health challenges, such as reducing our numbers of teenage pregnancies or alcohol and substance misuse levels amongst British teenagers, which are both currently amongst the highest within Europe.
However, the issues around improving the accessibility, acceptability and quality of health services for young people aren’t just about addressing the felt needs of young people; many health professionals also express concerns about the delivery of youth health services. These concerns are partly around ethical and legal issues such as the age of consent and whether it’s appropriate to consult and treat patients of certain ages, without consent from a parent or carer. Many GPs and practice nurses also tell us that they feel uncomfortable about being in a position where they ‘find out too much’, and worry that they may not have the specialist knowledge or skills to know how to help if they do.
As these questions around youth health become increasingly common amongst health professionals, the Department of Health has developed the You’re Welcome initiative which aims to address many of these issues head on. With a vision that by 2020 all health services regularly used by 11-19 year olds will meet the 10 criteria themes of You’re Welcome services, which will be set out across all types of health care settings. This includes GP practices, sexual health services, pharmacies, hospitals and school based health services, covering existing good practice and the commissioning and delivery of new services.
Health services and local authorities are now being asked to put into place a three year implementation plan for embedding You’re Welcome into their commissioning, performance and quality assurance frameworks. This year, the first 35 local health services from across were awarded You’re Welcome status for achieving the criteria.
£4.5million is being invested over three years to help the NHS continue to support the national roll-out of You’re Welcome which will ensure that all young people – regardless of background or where they live - are able to access health services which are well tailored to their needs.
For me, I think that building trust between young people and health professionals is probably the most important step in helping young people to access health services, and `You’re Welcome’ offers a set of guidelines and best practice resources, including a simple self-assessment toolkit available to download from the Department of Health website, to enable the sharing of good practice locally and nationally around this issue.
You’re Welcome complements a range of other new initiatives that are designed to strengthen professional competencies and build the confidence of health professionals to dig a little deeper during consultations: the E-Learning for Healthcare ‘Adolescent Health Project’ provides a comprehensive educational tool for NHS professionals working with young people; whilst the newly formed ‘Association for Young People’s Health (AYPH)’ is developing professional networks to promote joint working and training. The RCGP Adolescent Health Group has produced a training about consultation skills with young people and an updated edition of the ‘Confidentiality Toolkit’ for primary care teams. It has also launched an annual award to recognise innovation in providing care for teenage patients in general practice, and will shortly be developing a ‘virtual network’ for GPs with an interest in young people’s health.
All of this is so important, as young people can often present themselves at a clinic or surgery with what may seem to be a fairly trivial matter, but their concerns must be treated seriously, sensitively and with further questioning, as in many cases, this can be a cry for help and not just about their physical health concerns. For example, one young patient I recently saw in surgery visited me with his mother for the treatment of a simple acne problem. However, whilst I was talking to him I noticed signs that he was quite withdrawn and might be struggling with depression. I also sensed that he wouldn’t open up to me with his mother there, so I invited him to come and see me again on his own a few weeks later to see how he was getting on. During this second consultation, when I asked him if everything else was okay, he broke down and told me about how low he was feeling because of some friendship problems he was experiencing at school, and I was able to offer further support. All of the resources mentioned above support health professionals in developing the skills to pick up on these signs and offers advice to staff around the right questions to ask, how to take an interest in young people and encourage them to talk about their feelings.
Young people also need to feel confident in the quality and consistency of the help and advice which we provide. For instance, a young person visiting one health provider about contraception needs to be receiving the same advice as their peer who might go down the road to a different clinic for advice on the same issue. I believe that the guidelines which You’re Welcome provides will be absolutely instrumental in building a high level of credibility and consistency, across a broad spectrum of different health care environments.
Ultimately, I do think that as health professionals we are now more aware of the barriers young people face in accessing health information than ever before, and You’re Welcome will go a long way towards addressing them, through the provision of more holistic, joined-up and young people friendly services. There are a range of doors that open into the health system and I firmly believe that once You’re Welcome is fully rolled out, all of those doors will open into a common framework of care for young people, which gives them excellent, consistent advice from health workers they can trust.
Dr Dick Churchill, GP, Clinical Associate Professor of Primary Care at the University of Nottingham Medical School, and Chair of the RCGP Adolescent Health Group.
