Recent clinical advances in Neonatal and Paediatric Intensive Care have increased the incidence of survival of children with life threatening or life limiting conditions. Over the same period technological advances have produced a range of portable, easy to maintain, reliable and efficient mechanical ventilators. As a result, children who have long-term breathing difficulties needing either temporary or permanent ventilatory assistance have an increased potential for survival and must be offered an integrated care pathway from hospital to home and coordination of Long Term Ventilation (LTV) specialist input across organisational boundaries.Children on long term ventilation are a high cost group with complex and varying underlying medical conditions requiring input from multiple teams, including among others, neonatal intensive care, paediatric intensive care, paediatric respiratory medicine, cardiology, ENT, spinal injury, neuromuscular and neurodisability specialists, as well as access to palliative care.Ventilation can be delivered via a tracheostomy (invasive ventilation) or through a mask or other device that is not directly connected to the airway (non-invasive ventilation). Most tracheostomy ventilated children start their journey in a critical care environment and have already had intensive medical input. Children on complex non-invasive ventilation often have underlying co-morbidities or associated life limiting illness, and these children require coordinationof care across the relevant specialisms within paediatric medicine, as well as a clear pathway of transition to adult services. Most children on long term ventilation progress to a point of medical stability where their clinical needs can be met outside of the hospital environment. However, children on invasive long term ventilation (LTV) or complex non-invasive ventilation can remain in an inappropriate intensive care or hospital environment while awaiting a home care package to be established in the community. Work is taking place nationally to improve discharge processes in order to reduce inappropriate lengths of stay. The scope of this specification covers children who have long term ventilation initiated on a Paediatric or Neonatal Intensive Care Unit, regardless of whether the interface for delivery of that ventilation is mask or tracheostomy