11 Dec 2003

Speech by Nigel Williams, Northern Ireland Commissioner for Children and Young People at the Winter Graduation of School of Nursing, Queen’s University

Vice-Chancellor, Graduates, Distinguished Guests, Ladies and Gentlemen.

The most important word today is “Congratulations!” I want to be the first to congratulate all the students who are graduating as nurses. You have worked hard, studied hard, and no doubt found some time to play hard as well, and now you have achieved your initial goal.

I want also to say “well done” to the teaching staff in the School of Nursing under Professor Orr’s leadership. The students graduating today could not have got where they are – ready to start on a career in nursing – without your instruction, encouragement and example. I was privileged to meet a number of the teaching staff, students graduating today and some final year students last week when I visited the school to prepare for today. I was very impressed by what I saw and heard.

That leaves one very important group, that we too often forget – the parents and families of those graduating. As a parent of two recent graduates, with another daughter still at university and a fourth hoping to go next year, I know only too well the challenges and sacrifices involved. I think that it is only right that we recognise today the families’ contribution to the students’ success. Perhaps all those graduating would like to stand and clap their families who have helped get them to this point.

It is just over two months since I started my job as the Northern Ireland Commissioner for Children and Young People. What is it all about? Well the legislation that set up my office requires me to “safeguard and promote the rights and best interests of children and young people”. In simple language I am a watchdog for children, trying to make sure that all the different government departments and public bodies really are taking account of children’s rights and needs.

There are three main ways I will be doing that – through responding to individual complaints; through researching and investigating general issues affecting children and young people, and recommending changes; and through encouraging the participation of children and young people in decisions that affect them.

Now at the moment, I am still recruiting my staff and preparing for the tasks ahead. But I have already received a lot of concerns and views from individuals and organisations about what my priorities should be. I hope to appoint next week a research team to undertake a major project on what areas of children’s rights and services are weak in Northern Ireland compared with the international standard of the UN Convention on the Rights of the Child. My legislation requires me to take that treaty into account in my work, and it sets out in simple language the main rights of children.

I would like to highlight one issue today which will affect all of you in your nursing careers. That is the issue of health services for adolescents. It is particularly pertinent that I should raise this issue as it was two of the nurses on the Shortened Children’s Programme who were doing a research project who first drew it to my attention in early October. But since then the issue has kept cropping up in a number of ways.

For example, I visited the Royal Children’s Hospital to see the fantastic work that they do with children with brain injuries. It is a wonderful facility with a dedicated multi-disciplinary team, where the paediatric nurses are fundamental to the success of the health care provided. But the hospital’s rules mean that they should only admit children up to the age of 13. Those who are 14 or older should be treated in the intensive care wards in the main hospital.

Now with the best will in the world, it is difficult for an adult ward to cope with the varied needs – especially the social needs – of a very sick adolescent. That is particularly so as the teenager begins to recover and realises their situation and the mix of people with whom they are sharing a ward.

But this cut off of 13 can produce other problems. Just a couple of weeks ago we had the unseemly squabble played out in the media of where a 17 year old with epilepsy might receive dental treatment. It was major treatment requiring anaesthetic, and thus needed to be in a hospital context. The School of Dentistry here at the University referred the family to the Children’s Hospital, who under their rules had to say “No” and the School then said “No” as they could not get an adult intensive care bed. As a result this young girl suffered with appalling toothache for over six weeks, until the media scrum resulted in an offer of help from the Erne Hospital in Enniskillen.

One aspect of health care where this gap in provision for adolescents is particularly marked is in mental health. Teenagers with eating disorders or with serious psychiatric problems have very few dedicated facilities in Northern Ireland. As a result if they need to be admitted to hospital they will end up on general wards, with adults some quite elderly with a range of problems. Is this the best way to help set such young people on the path to recovery? Are we not risking them being further damaged by exposure to this environment? I know that this is an issue which the current government review of mental health services is examining.

Similar issues arise in community health provision. Adolescents are often the forgotten group – even though so many of the important patterns of healthy living are established during this time of our lives: our diet, exercise or lack of it, issues of sexual health and risk taking behaviour like smoking, alcohol and drugs.

I do not want to give the impression that no thought is given to the needs of adolescents, or that there is no provision at all. I have heard for example of the special unit for adolescents at the Ulster Hospital, and the psychiatric unit for teenagers here in South Belfast. I admire the work of a number of voluntary agencies in this field working on issues like sexual health, risk taking behaviour and mental health. But the message I am receiving is that the situation is patchy, there are real gaps, and that our teenagers are suffering as a result.

I think many professionals recognise this and would like to find better ways of dealing with the situation. I was heartened by the discussion I had with the group of students and teachers in the Nursing School last week – examples were given of where they had intervened to help teenagers who were suffering in adult wards.

I think the nursing school could play an important role here in helping prepare nurses for the challenge of treating teenagers. And all of you graduates have a real opportunity to reach out to this age group. Most of you have only recently left your teenage years behind so you have a natural understanding of some of the pressures they are under.

Can I urge you to look out for them, whatever your specialty, and get alongside them, listen to their views and support them whatever health issues they are facing. Don’t underestimate the value of a smile, a conversation, or a question about problems they may be facing. You could be a crucial link in helping them to recovery, especially in the vital area of their own self-esteem.

What then can I do about this as Commissioner for Children and Young People? Well, first I feel I need to hear a lot more about the particular issues that teenagers are facing in the area of health care. Most importantly I want to hear from young people themselves, from their families and from professionals within the different parts of the health service. I want to hear about what is good, what is bad, and what is ugly about current provision.

If you like, I want to have a conversation with everyone in Northern Ireland on this issue. I suppose I had better call it a “little conversation” as somebody else I understand is having a “big conversation” at present. Or perhaps we could call it a “wee chat” about how teenagers are doing when they have health problems.

I would encourage you all to share your own experiences with me – write to me – the easiest way is through my web site at . I will then be able to build up a better picture of what the issues are. Then later next year I can decide whether I need a more detailed investigation of some kind, and what message I should be giving to the government.

I hope that with the combined efforts of us all we can improve health care provision for adolescents. That may mean adjusting some of our existing facilities or building new ones, it may mean better training and more targeted programmes. Or perhaps as one student nurse put it to me “We need to give adolescents more choice – some will want to continue to use paediatric services for longer; some may be happy with adult provision; and others may need a more dedicated service”.

My mind is open on these issues – however, my mind is certainly made up that we need to do better for young people with health care problems, and I want to play a part in that.

I hope you savour the moment of your graduation today, enjoy the photographs and the fuss – it is a special day and you deserve it. But as you move on in your professional life, perhaps you will remember just one thing I have said today – that our teenagers deserve better of us, and we need to listen more to them, even when they are struggling to communicate with us.