Review of palliative care funding
Announced by the coalition government in July 2010, the review was chaired in a personal capacity by Sir Thomas Hughes-Hallett, the then Chief Executive of Marie Curie Cancer Care.
Examining funding for hospice and palliative care services across England, the review included both adult and children’s services.
Terms of reference
The terms of reference of the review were:
- To review the current funding mechanisms for dedicated palliative care for adults and children.
- To consider and quantify the impact of changes in funding mechanisms, based on an NHS tariff to meet NHS responsibilities, regardless of the choice of provider, on a per patient basis.
- To make recommendations on a funding mechanism which:
- Is fair to all sectors, including the voluntary sector.
- Encourages the development of community-based palliative care services.
- Supports the exercise of choice by care users of provider and of location of palliative care provision.
Listening to hospice views
A priority of phase one of the review was to offer a definition of dedicated palliative care services, together with some indicative costs. We invited hospices to share their views on how to define dedicated palliative care and we submitted our findings to the review team.
In September 2010, we issued a consultation document to our members as the first step in building a consensus on how hospices should be funded by the NHS. An overriding message from the consultation was the importance of the new system being as straightforward as possible.
Through the consultation, and direct engagement with hospices in a series of regional events, we developed a framework for our negotiations for the new funding model.
The framework included the following key points:
- The starting point for the new funding model must be patient need, not a service based approach.
- A tariff or set of tariffs for components of care to meet patient needs seems the most logical way forward. However, these tariffs must not operate in the same way as the current Payment by Results system, which is focused on activities and inputs.
- Over time, we support moves to introduce elements of outcomes into the funding system, but recognise that this will be a longer term evolution.
- In the meantime, we support an unlocking mechanism for emerging tariffs that is based in some way on quality (there may be learning from the CQUIN payment system that could be helpful here, although payments would need to be prospective rather than retrospective).
- There will be a need for flexibility in the funding system, and specific elements of services, such as education and training, may need to be funded in a different way.
The review team submitted its final report to the government in July 2011.
In autumn 2013 we partnered with Together for Short Lives and NHS England to host workshops across England. The discussions held during these events continue to form the basis of our ongoing work to secure a new funding system for hospice and palliative care.
In February 2014, NHS England established a new steering group to advise on the next phase of the work to develop the palliative care funding system. Hospice UK is represented on that steering group.