Hospice UK’s Chief Executive, Toby Porter, sets out why change is urgently needed in government funding models for the UK’s hospices at the next general election.

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The current funding model for hospices is failing


On Thursday, the country will decide who will form the next UK government. On the ballot, as at every election, are different approaches to public services, taxation, domestic and foreign affairs.

From the manifestos of the main parties we know that the UK’s local hospice charities enjoy cross-party support. Candidates quickly appreciate how hospices are both cherished parts of local communities and vital parts of local health and care provision.

And yet, despite widespread political and public support, the current funding model for hospices is failing.

A looming funding crisis


Hospice UK has been warning about a looming funding crisis, caused by rapidly rising costs without the NHS funding increases to match. It is inevitable that the first services facing cuts are those serving communities in more deprived parts of the country.

These warnings have been politely heard, and hospices have received significant expressions of support from MPs. In Wales, the Welsh Government took action, recently agreeing a £4 million package of support for increased staffing costs. 

But despite desperate need, we haven’t seen similar action in other areas of the UK. In England we see a back and forth between NHS England and local Integrated Care Boards (ICBs – the bodies that plan and fund services locally) over what funding is available and who can take action. While both blame the other, hospice services are being cut. 

Unacceptable cuts to services


The hospice sector is now facing a stark financial challenge. Only last week, Birmingham Hospice announced 45 redundancies and a reduction by a third of the hospice’s bed capacity on its inpatient wards.

It is unacceptable for the largest adult hospice of England’s second city to find itself cutting clinical staff and closing beds due to lack of funds. I know Birmingham well – for six years between 2016 and 2022, I was privileged to lead its children’s hospice, Acorns. 

People in Birmingham support their hospices in their droves with their money and their time.

This situation is not the fault of the local community. Like all hospices, Birmingham gets a mixture of funding from the state, and funding from local communities. They work tirelessly to make savings and bolster their charitable income.

The state funding model needs to change


The problem is not with the level of charitable giving, but with the model of state funding, which is arbitrary, inconsistent and unfair. 

Funding for hospices varies hugely, both between different regions, and often between different hospices delivering similar services in the same region. This postcode lottery is often based on historical precedent and no discernible strategy or rationale.

This model means that when costs go up, and they have soared in recent years, it’s unsustainable for local charitable giving to make up the shortfall, except in wealthier areas. 

Meanwhile, hospices are running huge deficits. As my colleagues at Birmingham have said, in the charitable sector, deficits can only mean one thing – cuts, and, heaven forbid, closure. I worry, I really worry, that what we are seeing in Birmingham will repeat itself across the country, with, as ever, the most deprived areas hit the hardest. 

Birmingham isn’t the first area where we’ve seen cuts like this. And I fear it won’t be the last. 

There’s no excuse, funding decisions for hospices should be dictated by facts and figures, and hospices can report these to their health boards in the same way as other acute services can.

As an independent provider, they can also explain how much it would cost the NHS and local councils to provide the same services. While hospices aren’t the only provider of end of life care, they provide exceptionally good value and high-quality services which are effectively subsidised by charitable income. 

Hospice funding: the solutions


This situation can’t go on. There are solutions, and at Hospice UK we are working every hour of the day to explore them, to discuss them with government, and to set us on a different path. 

At a local level, improvement must start with better integration of hospices into local planning; fairer, multi-year contracts with local health boards based on activity and complexity, accompanied by commitments to automatically uplift contract values with inflation. 

Ultimately we need central government to provide funding for palliative care and set minimum standards of services that we should expect to see across the country.

The deep, devastating irony here is that the thousands of hospice staff across the UK are desperate to help – to support their patients and families and to support the NHS. To help reduce waiting lists, to relieve the immense pressures in A&Es and hospital wards. 

All that happens when hospices make cuts to their services is that those patients are put back through the NHS system – ultimately, at a greater cost to the public purse.

I simply don’t think that major redundancies of midwives, of dentists or of GPs in a city of a million people would be accepted. But right now, that is what we are having to stomach. 

I sincerely hope it starts to change after polling day on Thursday.

Toby Porter is Chief Executive of Hospice UK

Toby Porter

Chief Executive, Hospice UK