Bluebell Wood Children’s Hospice, which cares for babies, children and young people across South Yorkshire, North Derbyshire, North Nottinghamshire and North Lincolnshire have reached an exciting point in their new-look care services. Over the last year the hospice has been developing a new nurse-led approach to meeting the needs of children with life limiting conditions, ensuing that care services offered by Bluebell Wood are responsive to the needs of families, delivered in a safe, effective and child-focused, family-centred way. 

The hospice has employed a team of advanced nurse practitioners and clinical nurse specialists, forming a Symptom Management Team. The team provides care, advice and support to children, their families and the professionals who support them in providing palliative care, predominantly to children who are experiencing new or challenging symptoms associated with their condition. 

Michael Tatterton, Chief Nurse at Bluebell Wood says, "our symptom management team is key to helping us provide care to the poorliest children across south Yorkshire. Our team of highly skilled advanced nurse practitioners and clinical nurse specialists is helping us to care for more children with life-limiting conditions and enables us to provide care where families choose.

"Lots of families want to be cared for at home, but a lack of flexible services often makes this difficult. Our symptom management team means we can support children and their families wherever they choose – at home, at the hospice or in hospital. It marks a real changing point for our care services."

Advanced nurse practitioners are nurses who have undertaken a master’s degree in advanced level practice. They are used increasingly across the UK and internationally to develop capacity and capability of healthcare services, in places such as hospitals, GP surgeries and community settings. Advanced nurse practitioners can assess the needs of children, make a diagnosis, and plan care, usually in partnership with other professionals. They can prescribe medicines needed to treat conditions in the same way doctors do. In palliative care lots of medicines are prescribed in an anticipatory way – this means that medicines can be prescribed for symptoms that are likely to happen in the future, allowing them to be managed quickly and effectively. These symptoms may include, for example, pain, distress, agitation or seizures, depending on the condition a child has.

Bluebell Wood’s Symptom Management Team comprises four advanced nurse practitioners and four clinical nurse specialists. Members of the team have a range of clinical backgrounds including palliative care, oncology (cancer), neonates, and caring for children with complex needs, both in hospital and in the community.   This will allow the hospice to provide responsive symptom management 24 hours a day, seven days a week, 365 days a year.  The Symptom Management Team has enabled Bluebell Wood to play more central roles in the provision of responsive palliative care. This includes perinatal palliative care and facilitating hospital discharges for children who choose care at home, and leading advance care planning.

Zoë McShane, clinical nurse specialist says, "Keeping children and families in the centre of care is vital. As a clinical nurse specialist I support families in making decisions about the care of their baby or child through advance care planning -it is a real privilege. My role has helped me to understand families in a different way; to understand their needs, and how Bluebell Wood can best support them."

Sustainability of our care services is at the heart of our care services strategy. Responsive palliative care cannot provided by one agency alone – teams must work together in order to ensure we can provide care where and when families need. Bluebell Wood take this responsibility very seriously. We work closely with a number of partners across NHS South Yorkshire Integrated Care Board, providing consultation, education and direct care provision.

Claire Bethell, advanced nurse practitioner says, "we’ve been able to work with teams across South Yorkshire, supporting them in the provision of children’s palliative care. The training, advice and support we provide has kept children out of hospital, enabled children to be discharged from hospital more quickly, and helped families to feel in control of their child’s care."

Over the last year, Bluebell Wood has strengthened links with local stakeholders, including NHS hospitals, community teams and commissioners, to understand where the gaps are in meeting the needs of children requiring palliative care. this has helped us to develop a care strategy to meet those needs, ensuring our care services are relevant and responsive to the needs of some of the most vulnerable children and families in our region. 

Heidi Hawkins, CEO says "we’ve done lots of work over the last year to engage with families who use the hospice, local NHS services and commissioners to really understand what people need from Bluebell Wood. Our symptom management team helps us to meet these needs in new and exciting ways, building on the already great work of our hospice and community nursing teams."

Bluebell Wood is working on maximising the use of our care resources. Our Symptom Management Team play an important role in helping us to expand our care offer, enhancing planned care and enabling us to provide unplanned care both in the hospice and at home.

"Bluebell Wood is more than bricks and mortar, and the care we offer is not confined to our hospice building. We’re fully committed to offering care flexibly, based on the needs of children and their families and not limited by hospice-based provision."

Michael Tatterton, Chief Nurse