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Developing sustainable community workforce solutions: Enhancing palliative care in hospital

To capture and embed learning from the rapid deployment of a new workforce model to enhance end of life care in a community in-patient setting: Creating a sustainable future.

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  • Proposal
  • 2020

Meet the team


  • Grace Wall: Div/Assoc. Dir. Nursing for Intermediate Tier Services
  • Emma Frain: Modern Matron District Nursing Service, Service lead specialist palliative care/respite team
  • Karen Sage: Prof Applied Clinical Research
  • Peter Weller: Exec.Dir. Nursing & Integrated Governance
  • Tracy Campbell: Dep. Dir. Nursing
  • Lydia Briggs: Lead cancer & research nurse
  • Deborah Davies: Matron Stamford Unit

What is the positive change that has emerged through new collaborations or partnerships during Covid-19 that your project is going to embed?

The 96-bedded NHS community care unit is a setting which, prior to Covid 19, focused on rehabilitation, with little call for end of life care (EoLC) expertise. During the pandemic, the patient population in the unit changed dramatically, with associated need for ELoC quadrupling almost overnight.

A new workforce model enabled delivery of high volume, high quality EoLC for patients and their families. Staff gained enhanced assessment skills and became more knowledgeable and confident in aspects of EoLC such as administering and understanding specialist palliative medications, challenging medication choices and being more comfortable having end of life conversations with patients and families. At organisational level, a new weekly EoLC care MDT meeting resulted in greater appreciation of other team members’ roles and skills. The initiative increased staff morale, helped create a more attractive place to work and is therefore expected to enhance recruitment and retention.

What does your project aim to achieve?

This project aims to capture what has been understood on the ground from patients, carers and nurses as well as at organisational level, a model of  working which improved care under difficult circumstances, and embed the learning from this in a sustainable workforce model as a positive legacy from the pandemic.

To do this, we will

i.  Undertake an impact evaluation of the rapid deployment of a new, collaborative community EoLC delivery model in hospital

ii.  Co-design, with clinicians and other stakeholders, a more sustainable version of the new model

iii.  Pilot and evaluate the co-designed collaborative workforce model in the original setting

The intended beneficiaries of the project are; patients and their families who receive high quality EoLC care in a non-specialist palliative care setting; clinical staff who benefit from knowledge and skills development; and organisations, for whom this model can support business continuity and help recruitment and retention.

How will the project be delivered?

Appreciative Inquiry will guide the study to facilitate deep, meaningful and sustainable cultural and action-orientated change at the core of an organisation. Staff from Tameside and Glossop Integrated Care Trust will be seconded to the project team to engage in 4 key phases: Discover, Dream, Design and Deploy. This process allows staff to identify the core strengths of the new community care delivery model and any necessary adaptations or enhancements that are required to embed this approach as the ‘new normal’ based on concrete operational, context relevant steps towards achieving it.

Within this framework, focus groups underpinned by narrative interviewing will be conducted with community and hospital nurses, to explore how role identity, context and change over time influenced staff responses to the new way of working. These findings will then be used to co-develop a longer-term, sustainable workforce solution with potentially wider applicability.

How is your project going to share learning?

Interactive resources which outline the key principles and worked solutions to the challenges faced in developing and embedding this new community care model, will be developed and made available to Q members and via wider practice and academic networks across Greater Manchester and nationally.

The project site and wider partners, we will have a cohort of engaged and knowledgeable healthcare staff who we can support to champion and share the learning emerging from the project and engage others via their individual and professional networks. These champions will comprise those delivering community and hospital care, senior leaders and patient and public representatives.

We will use social media to share the learning, present at relevant practice and academic conferences and publish in the healthcare professional, policy and management and academic journals. Dissemination resources, tailored to different audiences will include visual formats e.g. infographics; digital artefacts e.g. video vignettes; and text-based formats.

How you can contribute

  • General comments on the concept
  • Information on similar community workforce initiatives
  • Expressions of interest in working with us/testing new in-patient community care workforce models
  • Any other thoughts/comments - gratefully received.

Plan timeline

30 Apr 2021 Project and Advisory Board set up; Ethical/R&D approvals; recruitment
30 Jun 2021 Completed collation and analysis of routinely collected Trust data (WP 1)
31 Aug 2021 Completed exploratory evaluation study with clinicians and senior managers (WP 2)
30 Sep 2021 Completed staff and stakeholder visioning events based on initial findings
30 Nov 2021 New community/EoLC workforce model co-designed; preparation for deployment
28 Feb 2022 Implementation and evaluation of new model. Final report and dissemination.


  1. Hi Gillian,

    Myself and my colleague Emma Adams (Health Transformation Partnership) are supporting the Health Foundation this year by fostering conversations between Q members and encouraging collaboration. We were Exchange applicants last year, so we’re hoping that our experience will help us to help others, as their ideas take shape.

    I'll keep an eye out for other ideas which might have some commonality. In the meantime, I wondered if financial planning for those with receiving palliative care is in scope of your work. There is an idea called: 'Empowering patients with simpler, smarter financial planning for death' which you might find of interest.

    Best of luck with your idea,


    1. Thanks for your comments Peter and John. Financial planning is not what patients and families or staff wanted specific focus on for this project. However, we will keep an eye out for synergy between our projects as financial planning is part of the holistic care approach used by the team.

    2. Thanks Peter,

      Yes we'd be very interested to hear from this project if there was any learning around financial wellbeing, and the difficulties of trying to have sensitive financial conversations with palliative patients who were likely due to Covid unable to see their relatives in person. We'll happily share feedback we're getting on the subject in our market research to support you.

      Our idea here:

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