Background/context Calanzani et al. (2013) highlighted the changing nature of cancer and the impact that this will have on the NHS and hospice services. Cancer incidence and mortality are set to rise, along with an increased prevalence of people living with chronic disease and dementia. Calanzani et al. (2013) concluded that the demand for end of life care will rise and its nature will become more complex. In order to meet the changing needs of the population and increased demand for the service, the Palliative Care Clinical Nurse Specialist (PCNS) and Hospice at Home (H at H) teams have had to re-evaluate why and how care was delivered, whilst continuing to ensure a patient focused service and the maintenance of high standards of quality care.

Aims The aims were to evaluate the roles of the PCNS and H at H support workers, and to analyse service processes around how care is delivered.

Method A detailed in depth analysis was conducted using Macmillan Cancer Support's workforce profiling resource as a framework. Workforce profiling, functional mapping and skill levels workshops were held, all facilitated by external workforce experts.

Outcomes Defined interventions were established for PCNS and H at H support workers based on core and specific functions. Analysis confirmed that the PCNS role should encompass the dimensions of clinical excellence, innovation, management and leadership. Analysis has informed service development to meet the needs of the local population.

Application to hospice practice Workforce analysis and evaluation is a complex process. The evaluation approach has provided clarity of roles and supported re-evaluation of both the PCNS and H at H support worker job descriptions and person specifications. The evaluation has provided evidence for the recommendations for service developments which have been implemented by the organisation and supported by the Clinical Commissioning Group.