who can refer?

Referrals come from a variety of sources, including professionals across statutory services and from the voluntary sector. Families can also self refer.

We need to ensure that services we offer are suitable for the children and families that are referred.  As part of the referral process, we contact the professionals involved in the child’s care, including their GP and consultants to determine their level of need.


our eligibility criteria

Due to the nature of the life shortening conditions that children suffer with, our criteria are flexible, and we always look at children and families on an individual basis.

Our core criteria are that the child should:

  • Live within our geographical boundary, West Yorkshire
  • Be under the age of 19 years at time of referral;
  • Fall within one of the ACT categories below.

We are happy to discuss any potential referral child with you – please contact or a member of the Care Team on 01484 411042.


the ACT/RCPCH categories

In an effort to map the palliative care needs of children, the Association of Children’s Palliative Care (ACT) and the Royal College of Paediatrics and Child Health (RCPCH) (1997) categorised palliative care needs into four broad groups, as illustrated below.

It is important to recognise these groups and the relationship each presents between curative and palliative care as it can assist in the commissioning and delivery of services, depending on the needs of the children, young people and families.


children falling into group 4

Forget Me Not Children’s Hospice strive to offer equitable acceptance criteria and services to all life shortened young people living within their geographical catchment area.

With this aim in mind, these specific guidelines have been developed to assist the referrers in ensuring appropriate referrals are made within Category 4.


definition of group 4 conditions

Irreversible, but non-progressive conditions, causing severe disability leading to susceptibility to health complications that are likely to cause premature death. These include acquired neurodisability such as cerebral palsy, birth injury and those who suffer an insult following illnesses such as meningitis, encephalitis or head injury 

Children/young people being referred under this category need to fulfil at least 3 of the following criteria:

  • Total body involvement with poor head control.
  • Severe scoliosis that compromises respiratory function.
  • On going need for interventions to maintain respirations e.g. ventilatory support, O2 therapy.
  • Regular apnoeic episodes.
  • Poorly controlled seizures despite optimum treatment.
  • Frequent unplanned hospital admissions, please state number of admissions, reason and length of stays.
  • Underlying complex nutritional condition which requires accurate assessment, without which would be life shortening 

Click here to download a Referral Form


Forget Me Not Children’s Hospice actively encourages referrals, and will happily discuss potential referrals.

We review all children and families on an individual basis.

Would you like more information on how our referral panel makes its decisions?

Click here to download our decision making framework.


would you like more information?

More information can be sought in a number of ways


Our Care Team will be happy to answer any questions you may have about children’s palliative care service at Russell House, or our hospice at home care service.

The Team can be contacted on 01484 411042 during normal office hours.

Out of hours referrals can be made 24 hours a day by paging on the on call specialist nurse on 07663 700 244


You can email your questions or comments to:


other useful websites

More information can be found on the following websites:

Together for Short Lives, (Act & CHUK)

Royal College of Paediatrics and Child Health

Contact a Family

the child bereavement trust

winston’s wish


Freephone Helpline and Advocacy Service

Are you a parent, carer or professional who looks after or knows a child or young person with a life shortening condition? If you have questions or are finding it hard to cope, please contact the Together for Families Helpline free on 0808 8088 100 or click here for more information.