National report into financial sustainability of England's Adult hospices

The National Audit Office (NAO) has published a report into the financial sustainability of the adult hospice sector in England, deeming it of "national importance". The report finds that the Government lacks clarity on the impact of its funding for independent adult hospices as demand rises for palliative and end-of-life care.

Key findings

The Department for Health and Social Care (DHSC) and NHS England (NHSE) do not clearly understand what proportion of palliative and end of life care is delivered by independent adult hospices, and therefore, how much they are reliant on the sector, or what the real impact of government funding is.
Nearly two thirds of adult hospices reported a financial deficit in 2023-24, with combined income from fundraising and government funding in decline.
Demand for hospice care is projected to rise, placing further pressure on adult hospices, some of which are already reducing the services they can provide.
Demand for palliative and end of life care in community settings is increasing, with most people now dying outside of hospital.
Charitable donations, fundraising and retail generate most of the income, with government funding being only 29% of the sectors funding in 2023-24.

Toby Porter, CEO of Hospice UK says: “We welcome this important report, which lays bare the inconsistency and insufficiency in how hospices are funded.

“Palliative and end of life care is not prioritised across England. This report shows how a historic lack of understanding from a national to local level about the care delivered by hospices means they are currently not funded fairly, and it is patients that are paying the price.

“Demand for end of life care is increasing, yet two in five hospices are already being forced to cut services – a direct result of a system that treats palliative and end of life care as the poor relation in the health system.

“We know the Government is committed to finding a long-term solution and we stand ready to work with them. We're calling for full funding of specialist palliative care provided by hospices, proper NHS contracts for hospices, funding to cover the cost of NHS pay rises for hospice staff, and national accountability for equitable access to palliative care.

“These changes would stem the wave of cutbacks to hospice services and ensure that no one misses out on the expert, compassionate care they deserve at the end of life.”

Through the report the NAO have focused on the distribution of hospices across England, trends in funding, spend and delivery of services, and the financial challenges across the sector.

Hospice UK supported the evidence gathering for the NAO investigation. Thanks to member hospices completing our surveys, we were able to share vital information on the charitable hospice sector’s financial and activity data.

The NAO do not make recommendations in the report but throughout imply that standardising commissioning and funding would create more clarity and equity. Improving NHS data collection would assist in building a better view of the sector. The report also recognised the collaboration between hospices and encourages further collaboration.

The report will go to the Public Accounts Committee, whose inquiry is currently open for written submissions of evidence.

The report falls against a backdrop of increasing financial pressure for hospices, with many already forced to make cuts to services, and 2 in 5 hospices planning cuts this year.

What’s more, with support in Parliament, it is likely that an assisted dying service will be introduced in the coming years. While Hospice UK remains neutral on the principle of assisted dying, we are clear that no one should feel they need to choose an assisted death because of a fear of not getting the care they need at end of life. Well-funded hospice care is a critical safeguard if assisted dying is introduced.

Hospice UK continue to campaign for Fair Funding for Hospices, with a four-point plan to secure the future of hospice care.

We’re calling for:

Full funding of specialist palliative care provided by hospice
Proper NHS contracts for hospices
Funding to cover the cost of NHS pay rises for hospice staff
National accountability for equitable provision of palliative care, wherever you live.

These changes would stem the wave of cutbacks to hospice services seen in the past two years.

They would open up significantly more community palliative care capacity to underpin the government’s vision for neighbourhood based care – allowing hospices to better meet the growing needs of our ageing population.

And they would help guarantee, as a critical safeguard in a future assisted dying service, that good quality palliative care was available for all who need it.