Welsh palliative and end of life care services at risk due to broken funding model

Adult hospices in Wales are calling for Welsh Government and health leaders to urgently protect vital end of life and palliative care services, and update the current funding model, which is unsustainable.

The appeal comes as new data from Hospice UK reveals that adult hospice inpatient and community services are now likely to reduce across the country unless things change.

Welsh hospices provide essential care and support to 20,000 adults and children affected by terminal illness every year. However, due to rising costs, workforce pressures and increasing need, many hospices are struggling to maintain the level of inpatient and community services they have delivered in recent years - and are facing a worrying future.

In the past year, Shalom House Hospice in Pembrokeshire has closed and a four-bed inpatient unit at St David’s Hospice in Holyhead has been shut temporarily, due to the combination of increased running costs and funding difficulties.

Now, a new survey of all 14 voluntary hospices in Wales conducted by Hospice UK has found that:

● Nearly 30% of Welsh hospices are reducing the number of inpatient beds or wider services as a result of increasing cost and workforce pressures.

● Over 70% of those with in-patient units agree that cost of living pressures are likely to result in one or more inpatient beds becoming temporarily or permanently unavailable.

● Three-quarters of Welsh hospices agree that cost of living pressures are likely to result in reduced support being available to the wider system, such as hospitals and care homes.

Adult hospices in Wales are under particular pressure, with increasing demand and rising costs putting the care they deliver at risk.

On average, 70 per cent of the care costs of delivering hospice services are funded by charitable donations (approximately £30m), with the remaining 30 per cent provided by Welsh Government and health boards. Local communities treasure their hospices and their generosity is a vital part of hospice funding. But as adult hospices continue to face these unprecedented challenges, this large reliance on kind donations from the public to deliver essential palliative care is not sustainable.

This financial year (2025/26) Welsh Government provided £3m in funding for hospices to help them meet financial pressures. It also committed to developing a commissioning framework and sustainable funding solution for the sector. While this standalone investment and commitment was welcome, hospices need to see action that gives them the financial certainty they need to ensure they can continue to support people closer to home for years to come.

In the short term, Wales’s charitable hospices need Welsh Government and health leaders to plug the funding gap now and into 2026/27, so that providers can continue to deliver the care and support that people living with a terminal illness need.

To secure the future of Wales’s hospices, fully addressing the way they are funded needs to be prioritised by the current and next Welsh Government as part of the new commissioning framework. Without a long-term, sustainable solution, hospices could be left with little choice than to close further services.

Matthew Brindley, Policy and Advocacy Manager for Wales at Hospice UK, said: “Hospices are a cornerstone of Wales's health and care system. They provide essential clinical care that ensures people have dignity at the end of their lives.

“Without urgent action, we could be looking at a future where adult service capacity is further reduced, specialist staff are lost and - crucially - people with life-shortening conditions and their families have less access to the compassionate and high-quality care they need.

“We greatly appreciate the support Welsh Government has provided to hospices in recent years, and are committed to working with them to get hospice and palliative care services on a more sustainable footing - but that work to safeguard services and prevent any further closures has to start today.

“Hospice services are not optional. Financial support in the coming weeks and months is going to be essential if we want to make sure that hospices can be there for everyone who needs them.”

Liz Booyse, Chair of Hospices Cymru and Chief Executive of City Hospice, said: “Welsh hospices are grateful for the support they receive from the people of Wales through charitable donations and fundraising, and of course, the funding from Welsh Government. The level of recognition of the important work we do for people and families, and how these are intrinsic community services, is incredible.

“But we are now in a situation where the everyday costs of running our vital services have risen to a point where many charitable hospices cannot continue to provide the same level of service going forward with its current funding.

“Everyone in Wales should have access to the same high-quality, compassionate end of life care that they need. That’s why the essential, specialist care provided by hospices should have the option of being fully funded by the current and next Welsh Government and made a guaranteed part of healthcare provision in Wales.

“The demand for palliative care is estimated to increase by 25% in the next 25 years. We have a chance to make sure people will be able to access this help for a long time to come and further improve to help people with more complex illnesses - but we have to act now. Everyone needs to accept that the current funding model for our hospices is not working and not sustainable.”

Rachel Jones, Marie Curie Cymru Associate Director of Strategic Partnerships and Services said: “Hospice services are an essential part of our palliative and end of life care system which is under immense pressure. Too many people are spending their final days isolated, in pain and struggling to make ends meet.

“Almost a fifth of hospital beds in Wales are occupied by people in their last 12 months of life, despite many people expressing their wish to die at or close to home, while one in 14 people at end of life have an emergency admission to hospital. We know that hospices and hospice care services in the community help people to avoid such admissions during an already distressing time and provide carers with the support they so desperately need when caring for someone close to them. More people should be able to access those services.

“Truly transforming end of life care means making sure people can access the care they need, in the right place at the right time. Placing hospices on a sustainable financial footing is a critical part of this transformation, which must also be accompanied by action to truly integrate palliative and end of life care into our health and social care system.

“With demand for palliative care likely to increase in the coming years it’s imperative that Welsh Government and health leaders urgently take the action needed to ensure our palliative and end of life care system is fit for purpose.”