Background and aims Increasing interventions for children with complex problems are leading to moral dilemmas for both professionals and families. We reviewed support to a children’s hospital from a bespoke Clinical Ethics Committee (CEC): 20 voluntary members, 1 part-time administrator. (Funded GOSH Children’s Charity) Membership: ethics/law, lay/parents, nurses, paediatricians, anaesthetists, surgeons, social care, psychologists, patient advocacy and managers.

Aim Describe activity and case review change from full CEC <6 weeks wait to Rapid Responses (RR) -1–5 days.

Methods Retrospective CEC database and minutes review March 2013–14 and same 2009–10.

Results Cases: 2013–14: 14 cases - 1 full CEC and 13 RR, 3 included external hospitals - 1 via videoconference. Parents attended 12. Themes: withdrawal life-sustaining therapy: 3; limitation life-sustaining therapy e.g. ECMO: 5; innovative therapies: 4; capacity/consent: 1, complex dilemma 1. 2009–10: 7 cases - 5 cases CEC, 2 RR. Parents 2. Themes: LLST 3, innovative 2, WLST 2. 3 meetings general ethical aspects of therapy – enzyme replacement provision, arteriolysis/thrombolysis for limb salvage and mitochondrial ethical pathway.

Education: 1PhD, 2 BSc and 8 SSC medical students - leading to 8 presented abstracts and 2 publications. Lecture series for hospital/other staff. Paediatric Ethics Meeting ‘Making Tomorrows People’; 2 CEC education ‘away days.’ (Judiciary and academic philosophers).

Media: Participation national (BBC) TV and radio ethics programmes and print media.

Conclusions Ethics support to a variety of specialist teams and families is increasing. Support now provided for other hospitals with local reviews or videoconference support. Increasingly prevalent urgent ethics issues have lead to RR being preferred.