Health Transition Nursing Team – Learning Disability Service, Sunderland – Information for carers

Transition Nurses work in Sunderland and offer health needs assessments and support to young people with a learning disability and complex healthcare needs to make the transition from child to adult acute health services.

We have a key role in liaising with other health professionals and agencies to ensure that the healthcare received by the young person throughout the transition process is co-ordinated and uninterrupted.

Transition refers to the ages 14 to 25 years, at which time young people with disabilities (learning and/or physical) will have moved seamlessly into adult life with all relevant arrangements in place.

The transition process begins with the Year 9 review at school; we will usually attend and assess the young person.

After assessment we will decide how we can help the young person and their families/ carers through completion of a Health Action Plan, if the young person wants one, and (if appropriate) development of a Health Transition Plan as part of their broader Education Health and Care plan.

• Screening
• Assessment, the level of assessment will depend on complexity of need
• Signposting and/or referral to appropriate agencies
• Co-ordination
• Monitoring and tracking
• Consultation/advisory role
• Support/guidance
• Information giving
• Task centred work with individuals
• Build up a therapeutic relationship with young person and
  their family/carer

Transition Nurses work collaboratively with a range of health professionals and other agencies in order to co-ordinate person centred healthcare as young people move from one service to another.

This can include:

• Schools
• Services for Disabled Children
• Adult Services
• Connexions
• City Hospitals Sunderland
• Acute Services Learning Disability Liaison Nurse

Th Sunderland Action for Health website provides useful information for people with learning disabilities, their carers and health professionals:

• www.sunderlandactionforhealth.co.uk

The Transition Nurses can be contacted at:
Learning Disabilities Service
Health Transition Team
Monkwearmouth Hospital
Newcastle Road
Sunderland
SR5 1NB

Main office telephone: 0191 566 5633 9-5pm

Out of office hours:

Call NHS 111 and select the mental health option.

This service is available 24 hours a day, 7 days a week. You’ll speak to a mental health professional who will listen and help you find the right support.

If you are Deaf or have communication difficulties, you can contact us in a crisis by:

• Texting 07860 064 775
• Using SignVideo
• Contacting 18001 111 using the Relay UK app

The crisis team does not provide an emergency service such as a 999 response.

If you want to make a comment, suggestion, compliment or complaint you can:

• talk to the people directly involved in your care
• ask a member of staff for a feedback form, or complete a form on the Trust website cntw.nhs.uk/contact/complaints/
• telephone the Complaints Department on 0191 245 6672
• email [email protected]

We are always looking at ways to improve services. Your feedback allows us to monitor the quality of our services and act upon issues that you bring to our attention.

You can provide feedback in the following ways:

• the quickest way for you to do this is to complete our short online survey at cntw.nhs.uk/yourvoice
• complete a Your Voice survey, available on wards, reception areas or from staff
• other options for sharing your feedback and experience  cntw.nhs.uk/yourfeedback

Patient Advice and Liaison Service (PALS)

PALS provide confidential advice and support, helping you to sort out any concerns that you may have about any aspect of your or your loved ones care.

PALS act independently when handling patient and family concerns, liaising with staff, managers and, where appropriate, relevant organisations, to negotiate prompt solutions.

If necessary, we can also refer patients and families to specific local or national-based support agencies.

South of Tyne

Tel: 0800 328 4397
Text: 07825 061 035
Email: [email protected]

Post: Patient Advice and Liaison Service
Garden Lodge
Hopewood Park
Ryhope
Sunderland
SR2 0NB

9am – 4.30 pm, Monday to Friday

An answerphone is available at all times for you to leave a message. A member of the PALS team will aim to return your call as soon as possible.

Further information about the content, reference sources or production of this leaflet can be obtained from the Patient Information Centre. If you would like to tell us what you think about this leaflet please get in touch.

This information can be made available in a range of formats on request (Braille, audio, larger print, easy read, BSL or other languages). Please contact the Patient Information Centre by telephone on 0191 246 7288.

Published by the Patient Information Centre
2024 Copyright: Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust

Ref: PIC/455/1224 December 2024 V11

Website: www.cntw.nhs.uk
Telephone: 0191 246 7288

Review date 2026