Children and young people's palliative care is an increasingly recognised specialty for life limiting and life threatening conditions. These children often have a difficult life filled with hospital appointments and strange professionals invading their homes. The siblings of these children may often be forgotten about or neglected, as the focus is on the sick child. The siblings have their own grief and bereavement and very often need support in getting through this.Our children's hospice at home service offers pre and post bereavement support to the whole family, but recognised that more could be done to meet the specific needs of siblings.There was a review of the caseload to identify possible siblings ranging in age from 5 to 19 years. Family's views were sought, and discussion was had at the multidisciplinary team meetings to identify appropriate participants. Following a successful bid to the Department of Health children's palliative care funding, two separate age-appropriate support events for siblings were organised. The older children (11 – 19) did not take up the opportunity for a place, so only one event was held for the younger age group. The day was structured and therapeutic group work formed the basis for the sessions, led by specialist children's palliative care nurses, the play therapist and support staff.It was recognised that the older children regularly attend a youth group which offers them ongoing support. The day was very well evaluated by the children attending, and subsequently their parents. More sibling events will be organised for the future, as the day proved to be an effective way of meeting their needs. Due to the success of the day, there is also a plan to open up future days to the children of our adult palliative care service, who have some similar needs.

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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.

Novel data sources and analyses of statutory data are highlighting challenges and opportunities for the children's palliative care sector. Such services have a growing evidence base for their work which includes some of the most robust demographic data to date (Fraser et al . 2011, 2013). Articulating how to channel the knowledge gained into effective service developments is a key challenge for children's hospices.One example of using data to challenge existing thinking and evolve evidence based services concerns post death care. Child Death Overview Processes [CDOP] facilitate annual reporting of child mortality. Of the child deaths reviewed in 2014, over 80% had ongoing health problems and 70% had a known life-limiting or life-threatening condition (DfE 2014). Children's hospices provide end of life care. Post death care may also be offered, providing an alternative to mortuary or funeral home for the child's body and facilitating immediate bereavement support forextended family. Not all children's hospices provide this service. Of those that do, practice varies with respect to service provision for families whose child has not accessed the hospice in life and who may not fulfil hospice access criteria.Not extending the service to such families may reflect anxiety among children's hospices that their bereavement services will be overwhelmed by numbers of families requiring the service. This paper seeks to address those concerns and contextualise appropriate service development utilising local and national data sources.Local CDOP data are reviewed for a number of children's hospices and compared to bed availability for end of life care and post death care services, alongside a review of the evidence of the impact of provision or not of provision of such services upon family grieving and morbidity.