Background and context Within the UK, there is a general consensus that hospices should be extending their reach to care for more people, providing equity for those with a broader range of conditions. However, it is acknowledged that we are caring for people with increasingly complex needs and in reality there is a greater demand on beds. When viewed alongside nursing recruitment issues in hospices nationally, there is a need to review services to ensure we meet needs effectively and remain relevant.

What we are doing As a result of the changing context for palliative and end-of-life care, we have conducted a strategic review of our in-patient services. We plan to implement a new model of working, piloting two distinct wards each with a different nursing structure. One [specialist palliative care] ward will look after patients who have a high level of complex needs; this necessitates greater input from the multi-professional team, most notably the medical staff. The other will be a nurse-led [general palliative care] ward caring for a wider spectrum of patients who require less complex interventions. As well as caring for a greater number of patients, the model will also enable us to reach out to more people through education and training, offering clinical placements to our colleagues from non-specialist settings.

Evaluation The new way of working will be evaluated using an adapted action research approach at three-monthly intervals over a nine-month period with a final evaluation at 12 months.

Implications for practice It is anticipated that the new model of working will provide greater flexibility in the ways we can deploy our beds and resource, allowing us to care for more patients and ‘reach more people’ by sharing our knowledge, thereby improving the quality of care being delivered in other settings.