Thank you to the authors for their survey of Hospice Care in Aotearoa New Zealand.  It includes the question of whether there is a paediatric hospice in Aotearoa New Zealand. Although strictly speaking there is no paediatric-only hospice,[[1]] Rainbow Place is a dedicated paediatric palliative care service, within Hospice Waikato, currently caring for about 40 children in the community.  With a clinical nurse manager, two clinical nurse specialists, three registered nurses (plus one vacancy) and three healthcare assistants, it works with the children’s usual paediatricians, the community services of Te Whatu Ora and True Colours Children’s Health Trust to provide a comprehensive hospice service.  Paediatricians at Waikato Hospital retain their role as the child’s medical lead and have access to the hospice prescribing system. The hospice provides psychosocial input, including counselling and music therapy through the Hospice Waikato team.  Tertiary expertise is accessed from Starship.

Within the hospice inpatient unit, using paediatric trained nurses, the provision of inpatient respite, symptom management and end-of-life care occurs. Over the time of COVID-19, “In-Home” respite started, which has proved very valuable and is therefore continuing.  Such developments are guided by the invaluable services of a parent/consumer advisory group.  It is well supported by the community through fund raising and sponsorship

Paediatric palliative care is different in many ways from adult palliative care,[[2]] as the children are often chronically ill with complex interventions, and the case mix is very different, for example, only 7.5% have malignancy, many have multiple diagnoses—the most common of which is neurological.  

While there is only “a small number” of children on existing hospice programmes, this belies a significant need for paediatric palliative care hidden within our communities.  This was recognised in a report to the Ministry of Health in 2012, which set out a plan for Aotearoa New Zealand[[3]] and was followed by the development of clinical guidelines.[[4]] Although Aotearoa New Zealand may not be populous enough to have paediatric-only hospice services, Rainbow Place demonstrates that it is possible to provide meaningful service for paediatric patients within a community hospice, linked to existing paediatric and community services.