A Hospital at Home service for children was begun in April 1991 in a rural health authority in England. After 18 months a mainly qualitative evaluation has shown that the children and parents concerned have been very satisfied with the service and would choose the same type of care again. General practitioners and health visitors felt it was to the benefit of the whole family for the child to be at home while ill. They acknowledge a high standard of care received by the children but were critical of poor liaison between hospital and community and the loose arrangements for medical responsibility. These areas of strength and weakness are known to have been experienced in other districts establishing paediatric home care. Here, proposals have been made to improve the weaker aspects of the service as a direct response to the evaluation. These are now being put into practice, with one new appointee already in post. It is suggested that the proposals are applicable to other districts planning similar services and could help them to avoid the same pitfalls and establish a more credible service with good community integration from the start.