Specialist Paediatric Palliative Care Clinical Advisory Service (CAS) 

• children at end-of-life who are known to NHS paediatric services or CHAS  
• children with serious, life-limiting illness who are symptomatically unstable or deteriorating
• for professionals providing care to the above populations across NHS, CHAS and other hospices

• To increase access to specialist paediatric palliative medicine advice across Scotland, for professionals 
• To offer 24/7 access to specialist paediatric palliative medicine advice to enable and empower regional paediatric teams to deliver care locally in the child/families preferred place of care
• To support access to holistic palliative care and wider family support services to family members
• To improve patient safety through enhanced partnership working, standardisation of practice, decision-making and clear robust standard operating procedures
• To provide clear governance structures for the specialist paediatric palliative medicine workforce, enhance peer support and peer review

• senior Clinicians working in Paediatric Palliative Care
• accessible 24/7 across Scotland 
• delivered by an expert and multi-professional workforce of skilled and knowledgeable professionals 
• empowering and enabling professionals through partnership working with existing clinical teams and services supporting a child  
• enhances the ability to facilitate a child or family’s preferred place of care/death 
• underpinned by a clear governance framework, closely aligned to NHS and independent healthcare principles
• urgent advice can be received outside of the Tuesday MDT. The medical team can be contacted via clinicaladvisoryservice@chas.org.uk or by phoning 0131 659 9134

The Clinical Advisory Service will:

• increase access to specialist advice for clinicians and professionals across Scotland who are supporting children with life-limiting illness who are unstable and deteriorating  
• enable local teams to deliver care, with specialist advice where required, which can assist children to remain in their preferred setting with symptoms well controlled 
• reduce unnecessary hospital admissions 
• provide effective partnership working across agencies, improve systemic resilience, and streamline care in all settings

Weekly MDT

The weekly MDT provides a ‘one-stop’ for professionals to access specialist holistic palliative care expertise.   

The MDT will be consultant-led, with wide representation from across the MDT including Medical, Nursing, Pharmacy, Family Support and Spiritual Care. Referrals can be made by the lead consultant who has overall responsibility for the care of the child or young person.

Following acceptance, professionals will be invited to attend the MDT and present the clinical details of the case to allow MDT discussion and recommendations.  

Where recommendations will require ongoing input from a member(s) of the MDT this will be agreed during MDT discussion. MDT recommendations and agreed actions will be documented and shared with the referring professional.  

The MDT will meet weekly to consider referrals and, if accepted, will provide advice to the referring clinician on care options. 

This may involve discharge, ongoing support from partner agencies with MDT support, activation of out of hours clinical advice, or signposting to other agencies. A process is in place for urgent referrals. 

• all antenatal referrals of a patient with a serious health condition
• children / young people up to their 16th birthday
• young people aged 17-18 who continue to access paediatric services
• young people up to 21 in the care of CHAS and resident in a children’s hospice 

A child should have a serious health condition plus an additional requirement for specialist palliative care input. For example, any one of the following: 

• any child considered to be at end-of-life (including facilitating rapid discharge for end-of-life care)
• any child or young person with a clear ceiling of treatment in place
• symptom management that requires specialist palliative care input

The service will accept referrals from a child’s lead professional or from any other professional provided the lead professional agrees with the referral.  

Referrals can be made electronically, via clinicaladvisoryservice@chas.org.uk or by phoning 0131 659 9134.

Referrals can be made for MDT case discussion or to support end-of-life care planning +/- clinical advisory service.

Routine/non-urgent referrals will be discussed by the core clinical team, and if accepted the referrer will be invited to the next MDT to present the case. 

Urgent referrals will be discussed with the consultant on-call (or another member of the medical team) and where necessary advice given prior to presentation at MDT.  

• Head of Medicine Optimisation and Governance (CHAS)
• Spiritual Care and Bereavement Lead (CHAS)  
• Family Support Team Lead (CHAS) 
• Nursing service managers from CHAS 
• Paediatric sub-speciality trainees in PPM (SPIN or GRID)
• CAS Administrators  

Where a clinician refers a child to the CAS, there is no transfer of clinical responsibility. The CAS provides peer advice to other clinicians. It does not provide direct care to a child or family member. It provides an opportunity for a multidisciplinary table-top review of a child’s care and offers specialist advice to those who are leading on that child’s care