Select Committee on Health Written Evidence


NCSC Recommendations to the Department of Health (1 May 2003) regarding amendments to the regulation of Children and Adults Hospice provision


  Regulation 36 of the Private and Voluntary Healthcare Regulations states that "where a child is treated in an independent hospital he is treated in accommodation which is separate from accommodation in which adult patients are treated."

  This absolute legal requirement for total separation between accommodation of those under 18 and those over 18 has been raised by children's hospice providers as a problem for many hospices that wish to continue much needed provision for young people beyond the age of 18, and for individual young people whose care and support from their hospice may be disrupted on reaching the age of 18 if the Regulation is strictly applied.

  The problem is particularly acute for young people with conditions such as muscular dystrophy, whose care in a children's hospice is increasingly needed to continue beyond the age of 18 and for whom there is rarely a similar and suitable local respite, palliative and terminal care facility.

  A more flexible solution to the need to separate children's and adult services in establishments that span the age of 18 has been already been adopted in the Care Homes Regulations, where the requirement is that the provision for care, treatment and supervision of children is "so far as it is practicable to do so" made separately from other service users, but with the specific proviso in the Regulations that this shall not prevent provision jointly for children and other service users whose age does not significantly differ from those children.

  The intention of change in relation to children's hospices is to enable those already supported by a hospice under the age of 18 to continue that support after they reach 18, not to enable new admissions of adults to children's hospices.

  The Commission proposes that the Private and Voluntary Healthcare Regulations relating to Children's Hospices should be amended to require the following:

    (i)  That a children's hospice may accommodate and provide treatment for young adults over the age of 18 who have already received accommodation and treatment at the hospice under the age of 18, where this is appropriate to meeting their welfare and clinical needs, safety, rights and wishes, taking into account the welfare and clinical needs, safety, rights and wishes of children with whom the young adult will be accommodated and treated in the hospice, and taking into account the availability of any suitable local palliative care provision for young adults.

    (ii)  That the process for assessing the welfare and clinical needs, safety, rights and wishes of both the young adult concerned and of children with whom they will be accommodated and treated, should be included in the hospice's Statement of Purpose and Patients' Guide, and a record kept of each such assessment.

    (iii)  That the hospice should provide separation of provision for patients over 18 if this is or becomes necessary for the welfare, treatment, or safety of any child or young adult concerned, either through separation of accommodation, separation of times of accommodation and treatment, additional or separate staff supervision or support, or by other appropriate and effective means.

  To avoid change in the status of the hospice, the definition of a children's hospice should include the proviso that it is "wholly or mainly for children", following the precedent of the definition of a children's home. The age range for a children's hospice should continue to enable admission of babies and very young children, irrespective of any accommodation and treatment of over 18s.

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Prepared 26 July 2004