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Case Study – St Nicholas Hospice Care

Hospice redesigns its support workforce to help patients access End of Life Care (EoLC) in the home and community

St Nicholas Hospice Care in Bury St Edmunds worked with Help the Hospices (now Hospice UK) and Skills for Health to create a new structure for its support workforce.

Demand for hospice care has been increasing as more people are living longer and with complex conditions. The strategic goal for St Nicholas Hospice Care was to meet the needs of this growing and changing demand by adapting how we work.

“We believe the support workforce is a critically important resource; with leadership from registered professionals and following contemporary development opportunities they are able to help more people facing progressive ill-health, death, dying, and bereavement.”

Pippa Wilding, Head of Education at St Nicholas Hospice Care

St Nicholas Hospice Care’s team of professional staff, support workers, and trained volunteers providing care and support cover the communities of West Suffolk and Thetford to patients and their families in the community, in outreach services, and in the hospice.

In common with the rest of the hospice sector, St Nicholas only had care staff at Level 2 who undertake a wide range of duties from direct patient care to porterage and assisting with personal laundry.

To be an efficient and effective charity the hospice needs to make the most of its staffing resources. It has a plan to develop its workforce to ensure it has people with the right skills to deliver services in the right place at the right time.

“It is vital to look at how we can do things differently to make living with dying better for more people in our community. We want our specialist professionals to concentrate on doing expert work, we can achieve this if we up-skill our healthcare assistants.

All staff will work flexibly across different locations – in the community, our outreach centres, or in the in-patient ward. These new generalist support roles will enable us to do that.”

Pippa Wilding, Head of Education at St Nicholas Hospice Care

The hospice commenced its plan to develop the Level 2 Nursing Assistant role into Hospice and Senior Hospice Care Assistant roles at Levels 3 and 4. The aim is for the Level 2 staff to undertake learning and development. After gaining experience at Level 3 and following successful further formal End of Life Care (EoLC) training the hospice developed a Level 4 Senior Care Assistant role. In parallel, the hospice is up-skilling clinical volunteers to support clinical staff.

The Level 3 Hospice Care Assistants’ duties include supporting families/carers/care home staff to continue to look after patients, to undertake first and subsequent assessments and discharges, to assist with physiotherapy and occupational therapy, and to lead and line manage care volunteers. The ethos of the working model is to promote Independent Living whenever possible. The Level 4 Hospice Senior Care Assistant role works more independently, for instance, undertaking community-based assessments, assessing, and ordering equipment.

Level 3 and 4 roles will work as part of the wider Hospice team, with the role, enabling individuals to learn and practice a broad range of skills throughout the hospice and in the community. Two experienced care assistants are undertaking a local, part-time, Foundation Degree specialising in EoLC.

St Nicholas Hospice Care attended a Skills for Health and Help the Hospices workshop for hospices who were interested in role design and/or developing a new role. The hospice identified the chance to increase the skills of its Level 2 assistants and making better use of its volunteers.

It worked with Skills for Health to identify the nationally recognised competencies required for the Level 3 and 4 roles, along with job descriptions, and to identify the training required.

“By working with Skills for Health, the health care assistants’ role template is not only a nationally recognised design, but it also offers staff the opportunities for development and career progression.”

Pippa Wilding, Head of Education at St Nicholas Hospice Care


  • Existing support staff to become more skilled, working at Level 3 and 4, training volunteers, supporting a whole organisation workforce approach, and making the best use of staffing resources
  • Support staff can benefit and get greater job satisfaction from development opportunities and career progression
  • Clinical care volunteers also have additional training
  • Patients are better supported to be cared for in their homes
  • New roles are transferable across the hospice sector
  • Registered staff and also newly upskilled and trained support staff are able to support more people either directly or indirectly through coaching other care staff e.g. care home, domiciliary care, agency staff

As the Sector Skills Council for the UK health sector, we support the NHS, independent healthcare providers, and voluntary organisations. Our purpose is to help develop solutions that can deliver a skilled and flexible workforce to improve health and healthcare.