Zoe's Place Baby Hospice

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that children’s care, support and treatment reflected these needs and any protected equality characteristics to ensure they were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

Families and carers were involved in assessments of their and their children’s needs. Staff took account of people’s communication, personal and health needs. Care provided to children was based on the latest evidence and good practice.

At the last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good.

This service scored 83 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service made sure children’s care and treatment was effective by assessing and reviewing their health, wellbeing and communication needs with their parents and carers.

Children’s needs were comprehensively assessed and included consideration of their physical, sensory, social and communication needs. The assessment informed the care plans. Each child had a detailed care needs assessment completed in conjunction with their parents or carers before they became a patient. This was to ensure the child met the providers eligibility criteria and that the hospice had the resources to meet the child’s care needs. Eligibility for care was based on the type of condition the child presented with. The condition had to be life limiting or life-threatening.

Families, carers, and professionals working with children were fully involved in the assessment of children’s needs and reviews of their care. For example, consultant paediatricians, physiotherapists, and speech and language teams were asked to contribute to the assessment and the development of care plans.

The first assessment lasted around 2 hours and was an opportunity for staff to find out about the health, developmental and social needs of the child, as well as their likes and dislikes. The assessment was used to develop care plans for each child to reflect their specific care needs. The care plans were reviewed every 6 months or sooner if needed. Staff kept clear and comprehensive care records to support reviews and evidence of appropriate action taken in response to changes noted.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. Staff did this in line with legislation and current evidence-based good practice and standards.

We saw staff providing evidence-based care for children and exploring ways to improve care. Staff worked in conjunction with therapists, doctors and other nursing staff to ensure babies and children received evidence based care as reflected in their care plans. All care plans, including advanced care planning was developed in line with national guidance written to support children with life limiting conditions. For example, the National Institute for Health and Care Excellence (NICE) guidance (NICE NG 61 End of life care for infants, children and young people with life-limiting conditions: planning and management 2019) and the guidance produced by the Association of Paediatric Palliative Medicine (APPM).

Staff used a range of tools to assess and review children’s health and care needs. The tools were standardised, so staff understood how to use them. The type of tools used to record and monitor people’s health depended on the clinical presentation of the child and their individual care needs. For example, blood glucose monitoring was performed for children with diabetes, and staff used hydration and nutrition intake charts to help monitor children’s nutritional needs. Staff used tools to measure pain, for example, the ‘face, legs, activity, cry, consolability’ (FLACC). The FLACC was used for nonverbal or preverbal children who were unable to self-report their level of pain.

Children’s nutritional and hydration needs were met in line with current standards and evidence-based guidance. Children relying on nasogastric or percutaneous endoscopic gastrostomy tubes for feeding had comprehensive enteral feeding plans. Nursing staff received training to ensure proper nutrition delivery and to minimise the risk of complications.

Staff followed up-to-date policies to plan and deliver high quality care according to best practice and national guidance. Policies and procedures were stored on the organisation’s intranet and were available to all staff. The organisation had a clinical Governance committee which reviewed policies to ensure they incorporated up to date clinical practice, and introduced new policies when they were required. For example, in January 2025 the rapid transfer for end of life policy was up dated, and a new policy regarding the use of nebulizers was introduced. All staff were advised when a policy been revised or a new policy had been introduced.

The service worked well across teams and services to support people. Staff made sure people only needed to tell their story once by sharing their information about their assessment of children and families’ needs when they moved between different services.

The service used a model of care that prioritised partnership, collaboration, and a person-centred approach to ensure continuity of care and support for children with life-limiting conditions and those receiving end of life care. This was achieved through close collaboration with community teams such as physiotherapists, occupational therapists, and the speech and language team, as well as specialist palliative care teams. This model also included the engagement of families in decision-making and care planning.

Staff emphasised the importance of multidisciplinary involvement for continuity of care. They consistently attended all multidisciplinary team (MDT) meetings for the children they cared for, regardless of the meeting's location (hospice, other venues, or virtual). As well as medical MDTs staff also attended meeting convened by schools and nurseries. To ensure children were protected from abuse staff attended meeting held by social care teams. These included ‘Child in Need’ meetings, ‘Looked After Child Reviews’, and child protection conferences and core group meetings.

All relevant staff at the service could access the information they need to understand children’s needs and appropriately assess, plan and deliver their care and treatment. We saw good documentation regarding information shared at MDT meetings was consistently maintained in the children's patient records. This ensured effective information sharing and communication among team members.

Plans for transition, referral and discharge considered children’s individual needs, circumstances, ongoing care arrangements and expected outcomes. For example, when children graduated from the care of the hospice aged between 5 and 7 they transitioned to care provided by external services. Staff worked with the new service to fully handover details of the care they had been providing and supported the new service to receive the child.

The service supported children to maximise their independence, choice and control. The service supported families to live healthier, less stressful lives.

Healthcare professionals provide treatments at the hospice for babies and children during their stay. They also provided training for staff in the therapies and techniques they used so staff were able to provide the care and treatment that supported babies and children to live healthier lives.

Staff supported children to develop their motor skills, cognition, and social skills through play. They designed play experiences tailored to children’s learning needs and developmental stage. The service had a range of resources designed to meet children’s needs. These included a light sensory room, a soft play room, an outdoor play area, and a well-equipped indoor play area. Parents and carers told us they thought the resources available helped maximise their child’s independence. For example, one person said, “They have helped [child’s name] developmentally. They have given her the opportunities to get outside, and to get out of her chair when she’s indoors. They do loads of floor work with her. It’s really helping her become more independent.” Another parent described how, “staff have been exploring [child’s name] developmental needs and are encouraging him to sign” which, they said, significantly improved his ability to communicate.

Long-term caregiving can be physically and emotionally exhausting. Respite care offered temporary relief from the duties of caregiving, allowing parents and carers to take a break and focus on their own well-being. Parents told us their and their family’s health and wellbeing was enhanced when some of their child’s care was provided by the hospice. Respite care gave them a break from their caring duties, a chance to devote time to their other children, and an opportunity to participate in activities they might not have chance to while caring for their child. Parent’s said respite care gave them a chance to “miss” their child and to “look forward to seeing them again”. One parent describing how respite helped them, they said, “It means 24 to 48 hour's of normality and that's massive for us. When we pick her up we're better parents because we've had a break from intense and stressful parenting”.

The service routinely monitored children’s care and treatment to continuously improve it. Staff ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

There was a robust approach to monitoring the effectiveness of children’s care, and treatment and action was taken to continuously improve it. Outcomes were measured through a series of audits. The audits focused on the care babies and children received. For example, audits for postural care, feeding and medicines. Feeding and medicines audits checked to see if babies and children were fed and given medicines at the correct time and in the correct quantities. The postural care audit involved checking that children were positioned correctly while sitting or lying in line with to guidelines established by physiotherapy teams and were spending adequate time using equipment designed to improve their posture. Care plans were audited to check if they had been updated within the last 6 months. All of the audits we reviewed were above the organisations acceptable compliance standard of 92%.

If an audit result demonstrated less than 90% compliance action would be taken to improve compliance. This might mean staff received additional training or additional resources to help them complete tasks, or that staff met to have a structured conversation about how things could be done differently to improve outcomes. Audit results were benchmarked against other services within the organisation but not with external services.

The service sought and considered feedback from families, carers, professionals, and other stakeholders as appropriate when monitoring individual outcomes. For example, the service also collected the feedback of parents and carers to measure outcomes. The feedback was consistently positive however, staff told us there had been a reduction in the amount of feedback received. To ensure the expectations of people were being met staff were planning to relaunch a monthly feedback survey in the hope of increasing the amount of feedback they received.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

We saw parent’s consent to care and treatment recorded in babies and children's records. We also saw parents were given information about how information was shared with other agencies involved in their child’s care.

Most of the babies and children who received care at the service could not communicate their explicit consent for participating in activities. The care and treatment provided by staff and the activities children were involved in mimicked what was provided at home by parents or carers. However, if staff witnessed tears or other behaviours not normally seen during a child’s routine care, depending on how urgent or important the treatment was, staff would pause the activity and try again when the child was calm. If the child continued to be upset, staff would have a telephone conversation with their parents or carers. Staff would then follow the advice or instructions given by parents or carers. If there was an important treatment the play lead might become involved to help distract the child so treatment could go ahead.