WHAT IS “YOU’RE WELCOME”?

You’re Welcome (YW) is a Department of Health (DH) initiative to improve the quality of adolescent healthcare.1 It is endorsed and supported by a number of key professional bodies.2 3 The first edition of YW was produced in 2005, revised and piloted in 2007; a national support programme began in September 2008. The latest version with a self-assessment toolkit is available on the DH website.4 YW addresses the need for services to be friendly to young people (YP) who are under the age of 20, providing holistic care and “joined up working” at a local service level.

Evidence-based criteria lay out key principles applicable to all health services, both in the community and in acute hospital settings. Criteria include the acceptability, accessibility, quality and choice of services for YP. These have the potential to contribute to the national indicator set and vital signs for local priorities in PCTs,5 which include achieving the target for teenage pregnancy under-18 conception6 and ensuring good-quality services and best practice.

WHAT DOES “YOU’RE WELCOME” MEAN FOR SEXUAL-HEALTH SERVICES?

The concept of setting standards for YP sexual-health services is not new. Genitourinary medicine (GUM) services recognise that YP with or at risk of sexually transmitted infections (STIs) often have other high-risk behaviours and vulnerability factors when compared with their non-infected peers and, additionally, have specific requirements from service providers.

The first standards document was published by the Adolescent Special Interest Group (ASIG) of BASHH in 2002.7 Other “stakeholders” have developed standards3 in response to a variety of initiatives including the National Strategy for Sexual Health and HIV,8 and the Teenage Pregnancy Report from the Social Exclusion Unit9 on the provision of “YP friendly” services.

Currently, GUM services provide sexual-health services for YP, using a variety of models of care. Safeguarding children and young people is high on the political agenda, and there is now greater scrutiny of care given to this patient group. GUM services may already be assessed on their service provision to YP through Healthcare Commissions reviews on trusts providing services for children in hospital10 and compliance with DH core standards, such as child protection through annual health checks.11 Participation in YW prepares services well for Healthcare Commission assessments and reviews, increasing their compliance with these quality standards.

Fortunately, GUM is “ahead of the pack” when compared with other NHS and independent sector service providers for YP, as current BASHH “best practice” guidance7 is in line with You’re Welcome (YW) quality criteria. Although gaining YW status is not presently mandatory, there are many opportunities for GUM services and Sexual Health Commissioners to improve patient care and service provision for YP (see box 1). As more services engage, signposting of YP to endorsed services will occur more readily.

IMPLEMENTATION OF THE YW QUALITY CRITERIA

Health and local authorities are being asked to put into place a 3-year implementation plan for embedding “YW” into commissioning, performance and quality assurance frameworks. The implementation plan will also include setting targets on the range and number of settings expected to achieve YW year on year as identified by DH and local priorities.

Identified project coordinators will be key to driving forward YW locally and will initially work alongside the regional moderation panel. In London this is the Government Office of London (GOL). Regional moderation panels will not exist from 2010, as service accreditation becomes local. The assessment process involves completion of a toolkit, evidence of YP involvement, outcomes and audit materials. In London, funding is in place to support the young assessors programme through Local Authority participation programmes.12 Young assessors on moderation panel and “mystery shoppers” will be an important part of user involvement in the quality assurance framework.

WHAT DOES IT INVOLVE?

The YW toolkit assessment, currently paper-based, has 10 criteria. To make the scoring system and collaborative input from multidisciplinary team members easier, an interactive online version is being developed. Each element of the toolkit is scored as “starting out (1),” “getting there (2)” or “achieves YW status (3).” The good practice examples given for each criterion give tips and ideas on how individual services can work towards achieving the YW status. Local project coordinators have a role in supporting and creatively exploring how local services can work together to attain YW status. The process will be easier as more YW best practice resources become available nationally and locally.

For sexual-health services seeing YP, elements 1 to 9 should be completed. “Achieves YW status” must be demonstrated in key areas such as access, confidentiality and consent, environment and monitoring, evaluation and involvement of YP to be considered for the YW award. Submission of the assessment toolkit to the local project coordinator and audit visit then follow. The moderation panel review the evidence and make recommendations. The YW status to services is then awarded according to the overall rating score achieved and production of evidence such as feedback from YP. Quality assurance is undertaken on a minimum of 20% of services, which often includes “mystery shoppers.” The YW accreditation lasts 3 years; however, patient complaints may trigger reassessment within this period.

Three GU services were in the first wave of services to receive the YW award from the DH, announced at the end of March 2009, by the Minster of State for Public Health, Dawn Primorolo.

CONCLUSIONS

GUM services must embrace the challenge of demonstrating compliance with YW. The assessment is a lengthy multidisciplinary process requiring preparation but offers many unique opportunities such as methodical service provision review, better partnership working, securing service level agreements (SLAs) and involving YP in service development.