Alexander Devine Children's Hospice Service

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

At our last assessment we rated this key question as good. At this assessment the rating has remained good. Staff consistently made a real and lasting difference to children and their families. They showed exceptional dedication in understanding and responding to each child’s individual needs, delivering care with kindness, warmth and genuine passion. We saw a deeply caring culture, with staff fully committed to upholding dignity, respect and understanding in every interaction. Strong, trusting relationships were built with children, and their families and staff did everything within their power to help fulfil children’s and families wishes, creating meaningful moments at the most important times.

This service scored 75 (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 treated children and families with kindness, empathy and compassion and respected people’s privacy and dignity. Staff consistently demonstrated caring and respectful relationships with children and families. Families described feeling valued and supported. One family stated, “We are so thankful for the team and so grateful for them.” Another shared, “Everyone is very friendly and we are seen and respected as a family.”

Staff showed kindness through communication and emotional support. They took time to understand families’ needs and responded with empathy, particularly during challenging circumstances. Families felt listened to and reassured, especially during distressing events. One parent told us about the clinical nurse specialist’s support during an interaction with another service. They said, “I felt heard and seen, they were knights in shining armour.”

The service supported positive relationships and emotional wellbeing by staff supporting children through meaningful interactions and activities. Staff supported children with complex conditions in a sensitive and person‑centred way, ensuring comfort and privacy. For example, we observed staff offering compassionate care and child centred attention when a child was unwell during a garden-based Easter Egg hunt. This meant the child could continue the activity with their friends. Families felt confident that care was delivered respectfully, one parent said, “We get a break, with peace of mind as everything is being done to look after our child safely.” Another family told us that they were able to use the service’s flat whilst their child received respite care. They said this kindness helped them to rest, whilst their child was cared for and go home refreshed.

The service recognised the wider impact of caring for a child with complex needs and provided emotional and practical support to parents and siblings. Families valued this holistic approach and said, “It is a family wrap around service”. We also observed a member of staff hugging a recently bereaved parent. Kindness and compassion extended to staff as we also observed compassion towards a member of staff who was distressed.

Care was highly personalised and holistic, with staff demonstrating a clear understanding of each child’s unique needs. Care plans were detailed and individualised. For example, a parent said the service knew how to cover all aspects of their child’s care.

Families actively collaborated in shaping their child’s care, ensuring it reflected what mattered most to them. This supported shared decision‑making and recognising them as experts in their child’s care.

Staff adapted care to individual preferences and routines, enabling children to engage in enjoyable and meaningful activities. Families described the positive impact of this approach, and a parent said, “They work hard to do stuff that the children enjoy.” We observed the service’s preparation to distribute individual seasonal gifts for children and their siblings. These gifts reflected children’s spiritual beliefs and culture.

The service also recognised the importance of individuality within the context of the whole family. Support extended to flexible and tailored approaches to meet family needs. This developed strong relationships and the personalised nature of support provided. One family described, “It’s part of our family.” Another parent described the personalised emotional support offered to a member of their family in response to their situation. This support in turn enabled their whole family to be involved in care planning.

Care environments and activities were adapted to meet individual needs, ensuring inclusion for children with complex conditions. Staff demonstrated flexibility in how care was delivered, responding to each child’s abilities and preferences to maximise engagement and comfort. For example, we observed nurses adapting an indoor craft activity to enable a child to participate more independently which maximised their enjoyment.

Care, physiotherapy, music therapy and play therapy were adapted to meet individual children’s needs. For example, families said how music therapy helped their children relax and feel comfortable in the swimming pool so they could complete the physiotherapy exercises.

We observed 1:1 ratio during activities, with each child supported by a nurse. The care team knew each child well. This meant they were comfortable in their nurse’s company. For example, 2 nurses facilitated the children they were supporting to engage in the activity together. This meant that even though they were participating in a group activity, each child’s activity was tailored to their individual interests and friendships.

Children were supported to exercise choice in how they spent their time and engaged in activities. Staff created opportunities for children to participate in meaningful experiences tailored to their interests and abilities. Families described how care was adapted to support enjoyment and independence, with feedback that “They work hard to do stuff that the children enjoy.” This demonstrated a commitment to enabling children to make choices and experience positive outcomes.

The service also supported independence through flexible and responsive care delivery. This enabled families to retain control over routines and decisions, particularly during periods of increased need. Respite care was given at the hospice, home and in hospital. This enabled families to have a break and children to engage in activities in their preferred setting.

Support extended to the wider family, recognising the importance of maintaining independence and wellbeing for parents and siblings. The service provided opportunities for rest, recovery and emotional support, enabling families to maintain a sense of control in challenging situations. One family described the service as “part of our family.” This highlighted the supportive and enabling environment created by staff.

Staff demonstrated awareness of the importance of promoting independence within safe boundaries. Risk assessments and care planning balanced safety with opportunities for participation, ensuring children could engage in activities while minimising risk. For example, children with long term ventilation support were able to swim in the swimming pool because of the clear risk assessment and staff planning.

People’s immediate needs were recognised and responded to promptly. During activities, staff demonstrated attentiveness to changes in children’s physical condition, comfort and emotional state, and responded without delay. This was particularly evident for children with complex needs, where medical, nursing and therapy staff showed detailed knowledge of individual behaviour, and communication by facial expression and physiological cues. We saw staff recognising and quickly responding to a child’s immediate health needs whilst in the garden so they could continue the activity with their friends. We also observed medical staff compassionately responding to a parent’s distress when the parent had just arrived at the service.

Staff responded promptly and escalated children’s immediate needs such as pain, distress, respiratory difficulty, feeding intolerance or seizure activity, with staff seeking senior or medical input when required. Care plans supported staff to recognise early signs of discomfort and to intervene quickly. A parent said the service knew how to cover all aspects of their child’s care. The care was closely monitored for children who received complex care, including long‑term ventilation or symptom management, and care was adjusted in response to changes. For example, children receiving long term ventilation swam in the hydrotherapy pool because of safe and reasonably adjusted practice

Staff recognised signs of children’s anxiety and distress and responded with reassurance, comfort and familiar routines. Children were supported to access calming activities, such as sensory input, music therapy or quiet spaces, when distress was identified. Staff told us that in these instances, care and activities were paused until the child was ready to start the activity again.

Staff provided reassurance, explanation and emotional support when families were worried or distressed. Families said that staff were accessible and responsive, including through direct contact such as telephone or messaging when children were cared for in the community. Parents felt listened to and supported when they reached out. For example, one parent said, “we get family support, and my partner had counselling because they were stressed.”

Staff worked flexibly to meet urgent needs, including adjusting rotas, delaying non‑urgent tasks and stepping into additional roles when required. Clear escalation pathways supported timely responses and prevented delays. Staff confidence and competence enabled immediate decision‑making within their scope of practice, with clear processes for escalation when needed.

The service recognised the emotional demands of supporting children with life‑limiting conditions and their families. Leaders and managers recognised the importance of staff wellbeing to delivering kind and compassionate care. Staff said, “We have an emotionally demanding job, and our manager looks after us.” Counselling and psychological support were provided by the services counsellor, supervision, one‑to‑one meetings and the employee assistance programme were available to all staff. Staff were encouraged to access emotional support when it was needed. These opportunities enabled staff to reflect, raise concerns and seek support.

Supervision was flexed to respond to increased emotional need. This helped staff process experiences and return to care delivery with confidence and compassion. One staff member said, “After a really hard situation, we are checked in on. We’re not just expected to carry on as normal.”

In supervision sessions, staff discussed workload, emotional impact, professional development and wellbeing. Senior nurses also received additional clinical supervision, supporting reflective practice and emotional resilience.

Reasonable adjustments were in place for staff when needed. This included adjustments to training to enable a member of staff to successfully complete it.

Staff also described pressures related to workload, staffing capacity and emotional intensity. One staff member said, “People do their best, but when it’s busy it can feel a lot emotionally.” Leaders were aware of these pressures and had introduced wellbeing check‑ins and flexible approaches.

Staff spoke positively about their colleagues and described teamwork as compassionate and respectful. Informal peer support was common, particularly following difficult or emotional situations. Operational leaders were described as visible and accessible. However, some staff described missing opportunities for collective reflection across the wider multidisciplinary workforce due to time pressures.