With an increasing number of younger adults with a young family being referred to our adult hospice service, there was a noticeable gap in the provision of appropriate support for these children. As a provider of palliative care services for both adults and children, there were opportunities to offer holistic, integrated care designed to meet the individual needs of all our patients.The staffing includes a Play Therapist and a team of Nursery Nurses who had predominantly worked within the children's service in the home setting. However, their skills and expertise were accessible to the whole service, including children of adult patients. A programme was introduced to promote awareness among the adult teams of utilising these staff further. In the first 6 months, the Play Therapist has provided specialist interventions with 14 children of adult patients (not including bereavement support). The Nursery Nurses have so far delivered childcare support with 7 children of 4 patients. These childcare sessions have proved invaluable to the families receiving them; for example, helping at home when the patient has been feeling ill after chemotherapy, or looking after the children to allow other relatives to visit the patient in the Hospice Inpatient Unit. They have also developed therapeutic relationships with the children and enabled a sense of normality and routine at a time when there is a great deal of disruption, including trips out or assistance in accessing regular clubs or groups.Specialist palliative care has always encompassed support for the whole family, not just the patient. The additional support for children has proved beneficial to the families cared for, and the evaluations so far have been extremely positive. There are plans to develop and extend this service in order to meet the holistic needs of this group of adult patients.

Clinics at the hospice have been largely medically-led with patients attending on an ad-hoc basis with eligibility restricted to existing patients. This project aimed to set up weekly nurse-led clinics with access to all patients; thus allowing patients to access our service at an earlier stage and enabling a more seamless transition to our Specialist Homecare Team when their condition deteriorates.The clinic was established by an Advanced Nurse Practitioner with appropriate training using Hatchett's (2008) guidelines and aimed to offer a less threatening option to access palliative care in a clinic environment instead of a home visit. The clinic sees patients at initial referral and for ongoing support and fulfils both the DH (2010) suggestion to offer more choice to patients and widen intake to non-cancer patients as well as advancing nursing practice.Evaluation was facilitated using a questionnaire completed by patients attending. Data was evaluated and comments collated in themes for analysis by the researcher.This clinic was evaluated highly by patients with 100% saying appointment length was appropriate and 67% stating that their symptoms were fully assessed. 100% of attendees felt satisfied about being seen by a nurse rather than another healthcare professional.After 1 year referrals for assessment have steadily increased with one fifth from outside agencies. Presently the service has a caseload of clinic-only patients which is a step towards increasing choice and shows greater access to existing hospice services.The findings confirm that the clinic is an effective use of time and skills and is well received by patients. It offers another dimension of service for patients and this data reinforces the need to extend and develop this service.