We are working urgently at a national level to secure the systemic, long-term statutory funding reform the sector needs. That work continues. But hospices are having to cope with these pressures today and every day. And for many that means having to make difficult and painful decisions.
What's in the toolkit
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The toolkit is split into the below sections. Many of the suggestions and prompts within each section will have wider application than simply where we have placed it and, in practice, the various stages merge into each other. The general consideration is that a turnaround situation needs to be approached holistically.
It goes without saying that, where possible, building a level of financial resilience that materially reduces the possibility of needing turnaround, or minimising the impact if it becomes unavoidable, is desirable.
Trustees and leadership teams should engage in certain targeted activities before substantively kicking off a turnaround programme. By preparing thoroughly, you will reduce the potential for the process to go off course, though there will always be events you cannot predict or prepare for.
Starting turnaround well, not least by recognising that there is a problem, is a big part of tackling it. This area will require careful reflection from senior management and trustees. This phase of the work is where you start to define your change plans and to implement substantive changes.
Putting the right structures and processes in place to ensure that the change progresses is key. Your initial plan will almost certainly flex as the work evolves. Having good governance – at both trustee and programme level – will help you maintain focus and consistency. It will also help you ensure that none of your workstreams go rogue.
This area can be the most difficult element of turnaround, not least given the level of emotional investment on the part of all stakeholders. It will often require some difficult but necessary reflection – and action – on the part of those with leadership and governance responsibilities.
What's a turnaround?
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A financial turnaround is the deliberate, timebound process of stabilising a charity whose income can no longer sustain its expenditure, while protecting—as much as possible—the continuity of end-of-life care for local people.
A turnaround is not the same as a restructure or a strategy review. It is a specific kind of intervention; one that requires honesty, openness, discipline, and a willingness to take decisive action to create a sustainable platform from which future strategic choices can be made.
Where turnarounds are approached with clarity, pace but not haste, and strong governance, there is evidence that hospices can stabilise and continue to deliver high-quality care, even in constrained circumstances.
We recognise that entering a turnaround is one of the most difficult periods any hospice will face. It involves complex judgements, difficult trade-offs, and a sustained focus on both financial discipline and compassionate care.
