Background The Care Quality Commission (CQC) stipulates that all healthcare providers ensure that safe staffing processes are in place (CQC. Regulation 18: Staffing. [Internet]). The National Quality Board (2016) advised the use of a triangulated approach to the annual setting and reviewing of ward establishments/staffing by applying professional judgement to review patient and staff outcomes in conjunction with an appropriate evidence-based decision support tool. The Safer Nursing Care Tool (SNCT) is an evidence based decision support tool validated for use in NHS Trusts to calculate clinical staffing establishments according to patient need. Currently, there is no clearly endorsed tool for use in hospice in-patient units (IPU). However, the principles that underpin the SNCT have been applied and studied in over 80 hospice care units in England (Roberts & Hurst, 2013. Palliat Med. 27:123), which later informed the Hurst Palliative Care Staffing Tool (HPCST) development.

Method A month pilot was conducted using the HPCST in 5 hospice IPUs during April 2021. Work was undertaken with an independent consultant who is also employed by NHSE/I to implement a triangulated approach to setting and reviewing staffing establishments in those IPUs.

Post pilot, two months’ acuity and dependency data were collected in August and October 2021. Additionally, staff and patient surveys were conducted and patient outcome data collated for the same timeframe. The data were analysed, triangulated and inputted into reports. The findings were presented during hospice dissemination meetings. Staff were given time to digest the information and questions were emailed to ward managers to ascertain additional factors impacting on services and gather their professional judgment of the findings.

Conclusion A solid baseline was established and some reassuring findings that the total staffing numbers of Bands 1-8 in the IPU were close to what the tool recommended. The skill mix did, however, require adjustment and it was reassuring that this finding supported the professional judgement of nursing staff at all levels of the organisation.