TOGETHER they care for more than 2,500 sick and dying children and adults in North Staffordshire each year.

Without their services, already stretched NHS services would be put under even further pressure to deliver the £14 million of care and equipment which they annually provide.

But Caudwell Children, the Donna Louise Children's Hospice Trust and the Douglas Macmillan Hospice have all been faced with a challenge.

How do you meet increasing demand for your services as funds – both from the public, and the public sector – become harder to come by?

Figures from the Charity Commission show 69 per cent of charities had seen falling levels of incomes from investments, 31 per cent reported a drop in income from grants and 26 per cent experienced a decrease in fund-raising income.

Against that, almost one-fifth of charities reported an increased demand.

The differing size and scope of each charity means there is no one-size-fits-all solution.

Caudwell Children has a small, focused team which concentrates on raising cash which it spends on equipment and treatment for the 1,100 children it has supported nationwide.

At the other end of the spectrum, the Douglas Macmillan Hospice employs 200 people who handle everything from collections to making 1,700 residents comfortable during their last weeks and months at the Blurton hospice.

The Donna Louise Children's Hospice Trust is the smallest – in terms of funds raised – but plays a crucial role in caring for around 150 seriously-ill children at its hospice in Trentham.

Either way, the crunch has forced some tough decisions to be made.

Both Caudwell Children and the Douglas Macmillan were forced to make redundancies, while staff at the Donna Louise Children's Hospice Trust agreed to take a pay cut.

Nuala O'Kane, pictured right, chief executive at Donna Louise Children's Hospice Trust, which has a team of 56 at its Trentham Lakes hospice, said: "Over 80 per cent of our costs are staffing. We can't operate without people and we must employ qualified healthcare professionals to provide care for children with high-dependency needs.

"At the beginning of 2009 we could see there was a £150,000 shortfall in our budget. We had three options. Make redundancies, cut services, or cut costs."

The hospice board consulted with staff who unanimously agreed to reduce their working week to 35 hours – down from 37.5 – although most continued to work the full number of hours, effectively taking a pay cut.

That followed a decision to condense the opening of its six overnight care beds at the Treetops Hospice into four instead of six days a week.

The move allowed the charity to cut back on running costs such as heating, lighting and catering, while still caring for the same number of children.

Both initiatives have helped save the charity around £100,000, which along with the success of its fund-raising, means it returned a surplus of £93,111 in the nine months to March.

It is a position the organisation has maintained with a series of high-profile events including the Save Our Services campaign, which drew support from Jonathan Wilkes, Nick Hancock, Jo Brand, Rory Delap, Phil Taylor and patron Robbie Williams, and its 10th anniversary ball at Keele Hall in September.

Ms O'Kane said: "Our profile has never been higher and that is due in part to the role of the celebrities who support us.

"All our Celebrity Champions are genuinely committed to our cause and they support us in many different ways, often coming in privately, away from the cameras and spending time with the children and families."

Caudwell Children has continued to grow, although it has had to make radical changes to ride out the recession.

Despite the economic uncertainty, the charity continued its traditional high profile events.

These include the annual Caudwell Ball, which starred Rod Stewart and raised £1.7 million from celebrities including Elizabeth Hurley, Bruce Forsyth, Frank Lampard and Boyzone.

Latest filed accounts with the Charity Commission end before the recession hit the UK, although chief executive Trudi Beswick revealed the squeeze put on the nationwide charity.

In the summer, the charity reported a £1 million shortfall in its £3 million target for national fund-raising. At the same time, demand rose by 55 per cent.

Mrs Beswick, who heads up the organisation from its base at Minton Hollins House in Stoke, said: "Traditionally, our most successful area has been running events, corporate sponsorship and high net worth value individuals. All these sources have dried up or dwindled.

"We're now looking at what other charities are doing and trying it ourselves. We're not doing anything revolutionary, but we're doing things which we've never done before."

This includes efforts to gain regular donations from face-to-face collection on city centre streets, rather than large, single, donations.

This change in focus has led to a cut in the fund-raising team to 14 staff from 22.

She explained most of the posts affected were home-working fund-raisers, who concentrated on high-value donations.

The recession failed to affect any of the charity's work including the £200,000 annual Destination Dreams event where 25 children and their families were flown out to Florida for a week-long holiday.

Mrs Beswick said: "To take children on events such as the trip to Florida is extremely pleasurable, but it can be very hard work. On average, you're working 16-hour days. The first day at the airport was 22 hours, and no sleep.

"It is hard work, but you're doing it for the smile. Or when you get the letter from one of the families which says, 'I really enjoyed the trip, I got a chance to just walk and hold my husband's hand."

Meanwhile, the Douglas Macmillan Hospice has faced pressures to reduce services, although it was forced to make nine non-clinical staff redundant.

Karen Rose, the Dougie Mac's fund-raising director, explained the difficult balance the trust has to strike.

She said: "In terms of priorities, we would not reduce any care service unless there was absolutely no other option.

"We couldn't introduce a pay freeze because the majority of people we employ are clinically trained to the standards of the NHS. We have to pay NHS rates otherwise people would not work for us.

"And you can't cut fund-raising too much because you risk not being able to get the money to provide the services."

She added: "People express surprise when we say we have two palliative care consultants, but we need that skill to be a centre of excellence as we are."

The hospice has redoubled efforts to ensure public events such as the Midnight to Sunrise Walk, which drew in 1,500 women this year, continue to generate vitally-needed funds.

The hospice in October highlighted a £250,000 shortfall in income, a position which has stabilised.

Mrs Rose said: "We are still working our way through the recession. Halfway figures we are still down in income. People have supported us a little more so our shortfall has not got any deeper.

"Our worry is still ahead in 2010. We are not optimistic things will get better."

The position is echoed by the Donna Louise children's Hospice Trust. Ms O'Kane said: "We're not looking to cut back services, but we're not able to increase services dramatically, either.

"We will try to add services, but we won't be able to do that without the support of the public."