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

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
  • Early year worker - Together for Children
  • City Hospitals Sunderland
  • Newcastle Hospitals
  • 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

Learning Disabilities Service
Health Transition Team
Monkwearmouth Hospital
Newcastle Road
Sunderland
SR5 1NB

Main office telephone: 0191 566 5672, 9am to 5pm
When we are closed: call 0303 123 1145

 

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

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 www.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 www.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 one's care.

We 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.

North of Tyne
Telephone: 0800 032 0202
Email: pals@nhct.nhs.uk
Post: FREEPOST PALS

South of Tyne
Telephone: 0800 328 4397
Text: 07825 061 035
Email: pals@cntw.nhs.uk
Post: Patient Advice and Liaison Service, Garden Lodge, Hopewood Park, Ryhope, Sunderland, SR2 0NB

9.00am – 4.30pm, 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 on 0191 246 7288

Published by the Patient Information Centre
2026 Copyright: Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust

Ref: PIC/455/0126 January 2026 V12
Review date 2029

Website: www.cntw.nhs.uk