Life-limiting conditions, which shorten or threaten to shorten life, are becoming increasingly
prevalent among young people in England, attributed partly to longer survival.
There are concerns about the transition from paediatric to adult healthcare.. Specialist
paediatricians oversee childhood healthcare, with needed allied services provided continuously.
A General Practitioner (GP) often coordinates adult healthcare; GPs may lack knowledge of the
young person or condition. There can be provision gaps in allied services. Sometimes no
equivalent adult service. These issues may lead to an increase in unplanned hospital care.
Previous research is limited to a few more prevalent conditions and has used small, potentially
unrepresentative, samples or used age to assign transition status, risking misclassification.
I aimed to determine whether there is an association between transition from paediatric to adult
healthcare and increased unplanned hospital care for young people with life-limiting conditions,
to understand the nature of the population, including changing medical complexity and to explore
the role of primary care. I used secondary data analyses of routinely collected healthcare data in
England and a systematic review. My research was the first to analyse healthcare use across the
transition using national data with transition point estimated for each individual, using a newly-
developed method.
I found the population of young people with life-limiting conditions transitioning to adult
healthcare is growing in size and medical complexity, with more comorbidities and consultants of
more different specialities involved. Evidence from previous studies was mixed and conflicting on
changes in healthcare use at transition and there was a lack of UK studies. My research found
unplanned hospital care increases for young people with life-limiting conditions after the
transition and regular contact with the same GP is associated with reduced use of unplanned
hospital care. The role of the GP should be considered in reforms to improve transition
