The evidence is clear: the way hospices are funded is not fit for purpose

Hospice UK CEO Toby Porter discusses how, in the past few weeks, two major parliamentary reports have delivered the same stark warning: the way we fund and support hospice and palliative care is no longer working. 

Reports from both the Public Accounts Committee and the Health and Social Care Committee find the current system is failing to meet rising demand, with national health and social care bodies and leaders not responding to the financial crisis in the hospice sector with sufficient urgency. The reports also pointed out a perceived over-reliance on local ICBs to meet the challenge of funding hospices fairly and adequately, particularly given the inconsistent and patchy approach to their current commissioning and of palliative and end of life care services, including those delivered by hospice charities.  

Both reports highlight how the country’s de facto outsourcing too much of our specialist end of life and palliative care services to charitable funding has created an unsustainable model, and one that inevitably drives stark regional inequalities in access to care. 

The message is clear: national and local accountability needs to be accepted to identify and provide the increased statutory funding hospices need to deliver their services. The statutory sector must acknowledge that four years of rapidly rising and compounding care delivery costs have exposed the limits of the current funding model. Costs are now such that for many hospices it is just not possible to carry on raising much more money direct from the local community than they receive from the NHS.  

Both committees call for stronger national oversight and reform, including using the Modern Service Framework to define services, clarify the role of hospices, and set fair, sustainable funding levels, alongside a fully costed plan and targeted support for hospices at risk of cutting services. Over 10% of hospices have already had to make made significant cuts to services over the last two years. More worryingly still, our Hospice UK data shows that nearly 60% of hospices in England have made or are considering cuts to frontline services, as financial pressures across the sector continue to intensify. 

380 beds are shut as hospices can’t afford to staff them. Specialist community visits in people’s homes are decreasing when they should be going up. Hospices are shrinking right when they should be expanding to meet rising demand. This not only pushes more pressure onto an already overloaded NHS, it directly undermines ambitions to shift more care into the community. The Public Accounts Committee report has rightly called for a clear explanation from NHS England on how this will be delivered, but without properly funded hospices, that shift simply will not be possible, and more people will miss out on the care they urgently need at the end of their lives. 

Both reports shows that the current approach is not working and make important points about responsibility. It is not realistic to expect Integrated Care Boards to resolve these challenges on their own, especially while they are managing wider changes and their own financial pressures. 

The Government knows hospices are struggling. The additional capital funding they provided was as important as it was welcome. It has led to some wonderful improvements that will enhance patient experience as well as some important digital and IT investments. But capital funding cannot be used to meet the day-to-day running costs that are pushing hospices to the brink. It does not pay for nurses’ salaries, fuel for community teams travelling to patients’ homes, or rising energy bills. As operational costs continue to climb, particularly with pressures like fuel and utilities, hospices are facing a growing gap between what they can fund and what patients need, bringing many closer to a financial cliff edge. 

There is an opportunity to improve the situation for hospices through the proposed Modern Service Framework (MSF). But as the Health and Social Care Committee mentions, it is not yet clear how the outputs from this exercise will address the immediate financial challenges many hospices are facing. There is a very real worry it will come too late to make enough of a difference for many hospices who are weighing up service reductions right now.  

The MSF requires clear and detailed plans and a sustained investment to deliver it. 

The Health and Social Care Committee’s report includes recommendations to ensure accountability from Integrated Care Boards and the Department of Health and Social Care and suggests arrangements for this must be set out in MSF interim report due in Spring. But with many hospices already being forced to make cuts, there is a real risk the MSF will be too little, too late to address the immediate pressures facing the sector. 

So, what needs to happen next? 

We need fair funding for hospices, and we can’t wait. 

We need full funding of the specialist palliative care hospices provide, whether in inpatient units, people’s homes, outpatient clinics or hospitals, the vital services hospices provide should be fully funded by local NHS commissioners. 

We need proper NHS contracts for hospices. These should be fair, multi-year agreements based on national cost models, with regular reviews and flexibility to respond to rising demand. They must also include continued ringfenced funding for children’s hospices, recognising the scale and reach of their services. 

We also need funding to cover NHS pay rises for hospice staff, so hospices are not forced to absorb these costs from already stretched charitable income. 

And we need national accountability to ensure equitable access to palliative care, so where you live does not determine the care you receive. 

Alongside this, there must be a focus on hospices already under significant financial pressure. Nearly 60% of hospices are planning to make cuts and this number cannot keep growing. Where services are at risk, hospices should be able to receive support to protect them to they can continue delivering their vital services to their local communities. 

Good palliative and end of life care should not depend on geography or patchwork local funding. Both reports have been clear about the scale of the issue. The next step is making sure this leads to real, lasting change for hospices and the patients they care for.