Facts and figures

What we do

Acorns provides a network of specialist palliative nursing care and support to babies, children and young people aged 0 – 18 years who have life limiting or life threatening conditions.

Eligibility for children is based on the four categories of life limiting or life threatening conditions as established by Together for Short Lives[i]:

• Conditions where curative treatment may fail
• Conditions where premature death is inevitable
• Progressive conditions without curative options
• Irreversible conditions causing severe disability

Please do not use the phrase ‘terminally ill’. ‘Not expected to reach adulthood’ is preferred.

A holistic service meets the needs of both the children and young people and their families, including the bereaved. This includes short break provision; emergency and end of life care; therapeutic and psychosocial support; sibling services; and family support.

Acorns serves the areas of Birmingham, Coventry, Warwickshire, Herefordshire, Worcestershire, Gloucestershire, Sandwell and Dudley, Walsall, Wolverhampton, Shropshire and Staffordshire.

The children and families we support

In the past year[ii], Acorns supported 732 children and 945 families from across the West Midlands and Gloucestershire, including those who have been bereaved.

In the past year[iii], Acorns has supported:

• 268 children and 359 families at Acorns in Birmingham
• 230 children and 271 families at Acorns in the Black Country
• 235 children and 315 families at Acorns for the Three Counties

In the past year[iv], Acorns has supported 1,945 individual family members, including children, brothers and sisters, parents, carers and grandparents. This is an increase of 388 on the previous year.

On average, every month, five of the children Acorns cares for will die.[v]

39% of the children and families at Acorns are from Black, Asian and other minority ethnic backgrounds.

Approx. 3% of the children Acorns cares for have cancer.

Prevalence of life limiting conditions amongst children in our region

The prevalence of life limiting conditions amongst children and young people in our region was calculated in a recent study led by Professor Lorna Fraser at the University of York[vi]. The research showed that:

• There are an estimated 11,079 children aged 0-19 with a life limiting condition in the West Midlands and Gloucestershire. This prevalence is slightly higher in the West Midlands and Gloucestershire than it is in England as a whole[vii].
• The number of children with life limiting conditions in the region has increased significantly over 10 years (56 percent)[viii] and is expected to continue growing[ix].

The data highlights that a significant proportion of childhood deaths continue to be babies under one year old. However, the research also suggests that an increase in numbers of children with palliative care needs is due to improvements in life expectancy. The general trend is towards there being more children living longer, with more complex care needs.

Our facilities and services

Working with the family, Acorns undertakes a comprehensive holistic assessment, from which we are able to determine the outcomes the family needs to achieve for them and their child. Support is then delivered in response to the family’s requirements.

Care is tailored for each individual child which includes all their clinical, emotional, cultural, religious and spiritual needs. Acorns care can be provided in the hospice, a family’s home or elsewhere in the community.

The hospices

Acorns has three children’s hospices:

• Acorns in Birmingham (located in Selly Oak) opened in 1988 (the third children’s hospice in the world at the time)
• Acorns in the Black Country (located in Walsall) opened in 2000
• Acorns for the Three Counties (located in Worcester) opened in 2005

The hospices are purpose-built with specially decorated bedrooms designed to cater for children and young people from birth to 18 years of age. They are designed to be a homely environment to help children enjoy their stay and make the most of every day.

On-site hospice facilities include hydrotherapy pools and spas, multisensory rooms, complementary therapy rooms, and play and activity areas with up-to-date IT equipment and games.

The hospices have landscaped gardens, designed to provide a safe and secure environment for children and families to have fun, reflect and enjoy the outdoors.

Designated areas for older children and teenagers ensure privacy and a managed level of independence.

Separate on-site accommodation for families allows them to stay with their child if they wish.

The hospices have ‘special bedrooms’ in a separate area within the building where children can stay after they have died. The ‘special bedroom’ can be personalised by families and are a place where they can pay final respects and make precious memories before their child’s funeral.

In the past year[x], Acorns accepted 130 children referred to our services.

Each hospice has a Care team comprising:

• Acitivity / Play Workers
• Administrative, Housekeeping and Facilities team
• Consultant Paediatrician in Palliative Medicine
• Family Practitioners
• GP (supported by the Acorns Paediatric Consultant)
• Health Care Assistants (HCAs)
• Hospice Nurses (experienced in palliative care)
• Physiotherapists
• Registered Nurses
• Sibling Workers
• Trained volunteers
• Volunteers Managers
• Young People Workers

Care is provided during a hospice stay (whether this is a planned short break, emergency or end-of-life care) including:

• Personal and nursing care
• Medical support
• Symptom management and pain control
• Physiotherapy, including hydrotherapy
• Complementary therapies
• Play and activities including creative sessions/workshops such as art and craft, music, drama and dance
• Access to IT equipment, toys, books, games, music and films
• Access to outdoor space and gardens

An Outreach team of Nurses and Clinical Support Workers provide support to families within their home. In the past year[xi], Acorns conducted 716[xii] Outreach visits to families across the region.

Acorns Family Services team

On acceptance to Acorns, every family receives an assessment of their needs from the Acorns Family Services team. This will be undertaken by a professional who has a health or social care background.

A Family Practitioner will work with the family to determine the services that will best meet their needs at the current time and agree a plan of care and support that may include: psychosocial support, advocacy, short breaks in the hospice or at home, sibling support and a range of support groups for all members of the family.

End-of-life care and bereavement support will be available whenever is it needed and all families will have access to emergency support via the hospices, 24 hours a day.

In the past year[xii] the Acorns Family Services team provided 15,264 instances of vital
emotional and practical support to family members and siblings, including: one-on-one therapeutic work, bereavement support, group work and advocacy.

Sibling Workers provide support to siblings through focused groups, individual therapeutic based sessions and bespoke programmes, according to assessed need. In the past year[xiii], over 200 siblings were supported at Acorns.

Acorns runs a programme of specialist support groups for:

• Grandparents
• Bereaved parents
• Mums, dads, and carers
• Siblings

These support groups bring together those in similar situations, reducing isolation and helping develop resilience, self-esteem and a sense of identity.

Governance, regulation and representation

Acorns is an independent charity managed by an appointed Chief Executive and a senior management team who are accountable to a board of trustees.

A number of formal groups including parents, carers and young people provide regular feedback and input into how services are delivered and can be improved to better meet needs. These include:

• Young Ambassadors
• Parent Carer Champions

Care services are regulated and audited by the Care Quality Commission (CQC).

Acorns is registered with the Fundraising Regulator (FR) – the regulator for fundraising in the UK.

Acorns is a member of Together for Short Lives– The UK voice for children and young people who are not expected to reach adulthood and their families.

Acorns is a member of Hospice UK – the national charity for hospice care.

Awards and accreditations

Acorns is a UNICEF – Rights Respecting organisation (Silver awards), recognising our commitment to the Rights of the Child.

Acorns is an accredited Thrive at Work organisation (Foundation award), in recognition of our commitment to the health and wellbeing of our people.

Acorns holds an International Diversity Champion mark, for our commitment to recognising diversity and promoting inclusion.

Funding

It costs around £10 million a year to run our care services in the hospices and community, providing care for the child and support for families.

It costs around £27,000 per day to run Acorns care services.[xiv]

It costs around £7,000 a day to run care services within one hospice.[xv]

It costs around £975 to provide a nurse-led 24 hour palliative care break for a child in a hospice.

Acorns relies heavily on donations to fund the majority of our activities. In the past year [xvi], the local community provided around 65% or £6.5 million of the money needed to run our care services.

Income from Integrated Care Boards (ICBs) and other statutory bodies represents a contribution of around 35% towards the total cost of our care services.

Our last set of audited accounts[xvii] show:

• 85p in every £1 we spent went on charitable activities (i.e. care services);
• we raised £4.96 of income for every £1 we spend on non-charitable activities (i.e. fundraising);
• £6.50 out of every £10 we need to run our care services comes from donations and fundraising from the local community; and,
• In the past year[xviii], our network of over 40 shops across the region generated almost £2 million net profit by selling mainly donated goods. This is in addition to the amount raised in donations from the local community.

Acorns participates in two lotteries: TLC in Birmingham and the Hospices Lottery in Worcestershire.

Acorns is part of Childlife, a fundraising partnership between four charities working with children, young people and their families throughout the UK.

Our people

Acorns employs around 360 people in our three hospices, network of shops and head office[xix].

Acorns has around 1,260 active volunteers[xx] who work in all areas of the organisation[xxi]:

• 170 in the hospices (22 in the Black Country, 36 in the Three Counties, 112 in Birmingham)
• Around 150 in fundraising
• Around 940 in our shops

Figures last updated September 2022

[i] Eligibility criteria (as outlined by Together for Short Lives)

Category 1

Life threatening conditions for which curative treatment may be feasible but can fail. Access to palliative care services may be necessary when treatment fails or during an acute crisis, irrespective of the duration of threat to life. On reaching long-term remission or following successful curative treatment there is no longer a need for palliative care services.

Examples: Cancer, irreversible organ failures of heart, liver, kidney.

Category 2

Conditions where premature death is inevitable. There may be long periods of intensive treatment aimed at prolonging life and allowing participation in normal activities.

Examples: Cystic fibrosis, Duchenne muscular dystrophy

Category 3

Progressive conditions without curative treatment options. Treatment is exclusively palliative and may commonly extend over many years.

Examples: Batten disease, mucopolysaccharidoses

Category 4

Irreversible but non-progressive conditions causing severe disability, leading to susceptibility to health complications and likelihood of premature death.

Examples: Severe cerebral palsy, multiple disabilities, such as following brain or spinal cord injury, complex health care needs, high risk of an unpredictable life-threatening event of episode. 

[ii] From 1 April 2021 to 31 March 2022

[iii] From 1 April 2021 to 31 March 2022

[iv] From 1 April 2021 to 31 March 2022

[v] In the year to 31 March 2022, 66 children passed away

[vi] Fraser L. K. et al (2020) Make Every Child Count: Estimating current and future prevalence of children and young people with life-limiting conditions in the United Kingdom

[vii] In 2017/18 there were an estimated 11,079 children aged 0-19 with a life limiting condition in the West Midlands and Gloucestershire. This gives a prevalence per 10,000 of 68.4. This is slightly higher than the prevalence of 66.4 for England as a whole.

[viii] There were an estimated 4,154 more children in area with a life limiting condition in 2017/18 than there were in 2008/9. The equivalence measure for England is 46 percent. 

[ix] It is estimated that by 2030, prevalence in the West Midlands (excluding Gloucestershire) will have increased to between 68.9 and 93.8 per 10,000. This amounts to between 891 and 4,384 more children with life limiting conditions in the region than there was estimated to be in 2017/18.

[x] From 1 April 2021 to 31 March 2022

[xi] From 1 April 2021 to 31 March 2022

[xii] From 1 April 2021 to 31 March 2022

[xiii] From 1 April 2021 to 31 March 2022

[xiv] It costs around £9,000 per day, per hospice to run both in-house and community services. £27,000 per day is the total for the three hospices as a whole.

[xv] It costs on average £7,000 per day, per hospice to run Acorns in-house care and support services.

[xvi] In the year to 31 March 2021

[xvii] Financial figures are based on 2021/22 accounts as reported online at www.acorns.org.uk/publications

[xviii] 1 April 2021 to 31 March 2022

[xix] As of 31 March 2022

[xx] As of 31 March 2022

[xxi] Volunteers may cross over different areas of the organisation.