Donate Refer

Routine referrals

For children/young people who have a life-limiting or life threatening condition requiring palliative care support.

Eligibility criteria

All of the below must apply

The child/young person must

  • Be under the age of 18 at the time of referral
  • Live in South West England
  • Have a life-limiting or life threatening condition requiring palliative care support
  • Not be expected to live beyond 18 years
  • More information is available directly from CHSW or from the Together for Short Lives website.

Urgent referrals

For children/young people who require imminent end of life care and need a hospice response within 48 hours.

Ante-natal referrals

For children who are yet to be born, but have been diagnosed with a life limiting or life threatening condition in utero.

Referral process

Please follow the steps below 

Step 1

  • Parent/carer to complete Parental Consent Form A (download below)
  • AND
  • Parent/carer or professional to complete Care Referral Form B (download below)

Step 2

  • If a professional has completed Form B, please ask lead paediatrician, via phone or email, to complete Medical Referral Form C (download below) and to submit it by email to the Care Team. NB. Form C should be completed by a doctor.

Step 3

  • If a parent/carer has completed form A and B and the medical Referral Form C has not been received, CHSW will contact lead paediatrician on parents/carers behalf to request completion.

Step 4

  • Send forms A and B (and C, if complete) by email to the Care Team.

Step 5

  •  Once all forms have been received, the child/young person will be discussed in the CHSW weekly referral meeting. Referrals cannot be considered until Forms A, B and C have been received.

Step 6

  • Parent/carer will be informed of the outcome of the referrals meeting and, if accepted, to which hospice the child/young person has been allocated for the coming year. Notifications will also be sent to GP, lead paediatrician and the referrer.

Downloads

Download Parental Consent Form A (PDF)

Download Care Referral Form B (PDF)

Download Medical Referral Form C (PDF)