Making the NHS user-friendly for the young

Originally published in The Herald, 6/10/2009

A poster campaign to be launched tomorrow aims to reassure young people that NHS consultations are confidential.

Health professionals are also a key target – for, in addition to getting the message to young people, NHS Health Scotland wants to ensure that doctors, nurses and other staff are working to make services fully accessible to adolescents.

The We Keep it Zipped campaign includes materials to be displayed in doctors’ surgeries about confidentiality, which is a barrier to many 12-18 year olds who might otherwise seek health advice or treatment.

It is part of an ongoing initiative, Walk The Talk, which aims to embed youth-friendly practice within the mainstream NHS service.

However, some clinics are not on message with the campaign’s goals, meaning that NHS workers are also in the sights of the campaign.

Nuala Healy, health improvement programme manager for young people with NHS Health Scotland, says the campaign had revealed that some doctors’ surgeries had signs on the walls warning under-16s that they will not be seen unless accompanied by their parents.

This is contrary to NHS Scotland policy and, since 1991, doctors can see under-16s independently – if they judge they have the capacity to understand what is being discussed.

The Walk the Talk campaign aims to eliminate this and other barriers to treatment for young people, Healy says: “We don’t want young people picking up our message and then seeing a poster like that. There is some confusion in the NHS about seeing an under-16 without a parent, but the internal message is very strong. That is why GPs, nurses and pharmacists are a key audience for this campaign.”

NHS Health Scotland research has revealed that young people under-use its services, as a result of a number of barriers including fears over confidentiality, poor communication and unhelpful opening hours. It might appear this could be explained by their having fewer health problems, but Healy says that is not the case.

“Research with young people would contradict the idea that they don’t want health services,” she says. “They do want reliable and confidential health services, but don’t necessarily feel they can get that from the NHS.

“However, we know they under-use services. For example, you will find that they are registered with a GP, but will only go to them for chronic conditions and won’t use the consultation to talk about health concerns they have. The NHS needs to do more to engage proactively with them.

“We know that some feel that, if they discuss their private health concerns with a GP or other health worker, then it will be shared, for example, with parents. That is a fear they have, but it is not the case. This is about health professionals reassuring them at the start of the health conversation.”

Meanwhile, there are important reasons why the NHS should be reaching out to teenagers, she adds: “We know that adolescence is a critical time for establishing future health behaviour. One-third of premature adult deaths result from behaviour and conditions which start in adolescence.”

Such behaviour include the use of drink and drugs, smoking and sexual health, she explained, as well as mental health problems which may have their origins in adolescence.

“Adolescence is a critical time for establishing future health behaviour.”

The new campaign materials, to be launched in Inverness tomorrow, aim to challenge the confidentiality fears of young people. The posters, which feature a green rabbit with a zip for a mouth, clarify the presumption of confidentiality, and explain the circumstances when it might be breached. This is usually only if there is a substantial risk a young person might come to harm. Even then, Healy adds, such a disclosure would be discussed first with the young person concerned.

The new campaign materials have tested well with young people and health professionals, NHS Health Scotland says. Young people involved in the project commented that it would encourage them to talk to their GP if they had a problem.

The campaign is supported by the General Medical Council, Royal College of General Practitioners, Royal College of Nursing Scotland and the Practice Managers’ Association.

It comes just a few weeks after Scotland hosted a summit for the World Health Organisation on the issue of youth-friendly health services and institutions. The prestigious meeting came about as a result of international interest in the Walk the Talk campaign.